NREMT Practice Test Bank - Multiple Choice 2023

Reason: Nitroglycerin (NTG) is a vasodilator drug. It dilates not only the coronary arteries, but also other arteries in the body. In some patients, NTG may cause a drop in blood pressure, especially if they are taking other medications that cause vasodilation (eg, erectile dysfunction drugs [Viagra, Levitra, Cialis]). In response to a drop in blood pressure, the nervous system attempts to compensate by increasing the heart rate (tachycardia). Common side effects of NTG include a headache, a burning sensation under the tongue, or a bitter taste in the mouth. Always assess the patient's vital signs, before and after administering nitroglycerin. The process of loading oxygen molecules onto hemoglobin molecules in the bloodstream is called: • A:respiration. • B:oxygenation. • C:ventilation. • D:diffusion. - You selected B; This is correct! Reason: Oxygenation is the process of loading oxygen molecules onto hemoglobin molecules in the blood. Adequate oxygenation is required for internal (cellular) respiration to take place. Diffusion is the process in which gases (oxygen and carbon dioxide) move from an area of higher concentration to an area of lower concentration. Ventilation is the act of moving air into and out of the lungs. Negative-pressure ventilation is the act of normal, unassisted breathing, and occurs when the diaphragm and intercostal muscles contract, which creates a vacuum and draws air into the lungs. Positive-pressure ventilation is the act of forcing air into the lungs, such as when you are providing rescue breathing to an apneic patient or assisting the ventilations of a patient who is breathing inadequately. Respiration is the exchange of gases between the body and its environment. Pulmonary (external) respiration occurs when gases are exchanged in the lungs and cellular (internal) respiration occurs when gases are exchanged at the cellular level. Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction? • A:75-year-old male with hypertension • B:55-year-old obese female • C:66-year-old male with angina • D:72-year-old female with diabetes - You selected D; This is correct! Reason: Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfort to indigestion. Some patients, however, do not experience any pain. In particular, elderly women with diabetes may present with vague, unusual, or atypical symptoms of AMI; their only presenting complaint may be fatigue or syncope. Do not rule out a cardiac problem just because a patient is not experiencing chest pain, pressure, or discomfort; this is especially true in elderly females with diabetes. Which of the following is MOST indicative of a primary cardiac problem? • A:Tachypnea • B:Sudden fainting • C:Irregular pulse • D:Tachycardia - You selected C; This is correct! Reason: An irregular pulse signifies an abnormality within the electrical conduction system of the heart. Tachycardia, sudden fainting (syncope), and tachypnea (rapid breathing) can indicate many things other than cardiac problems, such as shock, heat-related problems, and diabetic complications. You should always consider the possibility of a cardiac problem in a patient with an irregular pulse. A 56-year-old man was the unrestrained driver of a small passenger car that rolled over twice after he rounded a corner too fast. He is unresponsive; has rapid, shallow respirations; and has a rapid, weak pulse. His left arm is completely amputated just below the elbow. As you and your partner are treating the patient, other responders are trying to find the amputated arm. Which of the following statements regarding this scenario is correct? • A:Your priority should be to recover the man's arm because a vascular surgeon may be able to successfully reattach it. • B:Quickly move the patient to the ambulance, continue treatment, and wait for the other responders to recover his arm. • C:You should transport the patient immediately, even if the other responders recover his arm before you depart the scene. • D:If the patient's arm has not been recovered by the time you are ready to transport, you should transport without delay. - You selected D; This is correct! Reason: Life takes priority over limb. The patient is in shock, which may be complicated by a head injury; therefore, he requires rapid transport to a trauma center. Although efforts should be made to recover an amputated body part, this must not delay transport of a critically injured patient. If the arm has not been recovered by the time you are ready to transport, you must transport without delay. If his arm is located after you depart the scene, it can be transported separately. If his arm is recovered before you depart the scene, however, you should take it with you; surgeons may be able to successfully reattach it. Care for the amputated part in accordance with your local protocols. When assessing a patient who complains of chest pain, which of the following questions would you ask to assess the "R" in OPQRST? • A:Is there anything that makes the pain worse? • B:Is the pain in one place or does it move around? • C:Did the pain begin suddenly or gradually? • D:What were you doing when the pain began? - You selected B; This is correct! Reason: The "R" in OPQRST stands for radiation or referred pain. An appropriate way to determine whether the pain radiates or not is to ask the patient if the pain remains in one place or if it moves around. When determining if the patient has referred pain, ask him or her if he or she hurts somewhere other than his or her chest. If you use the term "radiating pain," chances are the patient will not understand what you are asking. You are assessing a young male who was stabbed in the right lower chest. He is semiconscious and has labored breathing, collapsed jugular veins, and absent breath sounds on the right side of his chest. This patient MOST likely has a: • A:liver laceration. • B:hemothorax. • C:pneumothorax. • D:ruptured spleen. - You selected B; This is correct! Reason: You should suspect a hemothorax if a patient with chest trauma presents with shock, especially if the injury was caused by penetrating trauma. Hemothorax occurs when blood collects in the pleural space and compresses the lung, resulting in shock and respiratory compromise. Other signs include collapsed jugular veins (due to low blood volume), labored breathing, and decreased or absent breath sounds on the side of the injury. A pneumothorax (air in the pleural space) is also associated with difficulty breathing and unilaterally decreased or absent breath sounds; however, the jugular veins are usually not collapsed. If excessive air accumulates within the pleural space, however, pressure will shift across the mediastinum and affect the uninjured lung (tension pneumothorax); if this occurs, the jugular veins may become engorged (distended). Splenic injury is unlikely; the patient's injury is on the right side and the spleen is on the left. A liver laceration can cause severe shock; however, it is not associated with unilaterally decreased breath sounds or labored breathing. A reduction in tidal volume would MOST likely result from: • A:increased minute volume. • B:unequal chest expansion. • C:flaring of the nostrils. • D:accessory muscle use. - You selected B; This is correct! Reason: Unequal (asymmetrical) or minimal expansion of the chest results in a decrease in the amount of air inhaled per breath (tidal volume). Accessory muscle use and nasal flaring are signs of increased work of breathing, which represents an attempt to maintain adequate tidal volume (and therefore, minute volume). An increase in tidal volume, respiratory rate, or both, would result in an increase in minute volume. It should be noted, however, that a markedly fast respiratory rate would cause a natural decrease in tidal volume. For example, a patient breathing at a rate of 40 breaths/min would likely only inhale air into the anatomic dead space before promptly exhaling it. Medications such as albuterol (Ventolin) relieve respiratory distress by: • A:contracting the smaller airways in the lungs. • B:dilating the large mainstem bronchi of the airway. • C:constricting the bronchioles in the lungs. • D:relaxing the smooth muscle of the bronchioles. - You selected D; This is correct! Reason: Medications such as albuterol (Ventolin) and metaproterenol (Alupent) are in a class of drugs called bronchodilators. They relax the smooth muscle found within the bronchioles in the lungs, which causes them to dilate. This effect opens the air passages and improves the patient's ability to breathe. During your assessment of a patient with a gunshot wound to the chest, you note that his skin is pale. This finding is the result of: • A:decreased blood flow to the skin. • B:a significantly elevated heart rate. • C:a critically low blood pressure. • D:peripheral dilation of the vasculature. - You selected A; This is correct! Reason: When the body attempts to compensate for shock, peripheral vasoconstriction shunts blood away from the skin to the more vital organs in the body such as the brain, heart, lungs, and kidneys. When there is minimal or no peripheral blood flow, the skin assumes a pale appearance. By contrast, when peripheral circulation increases (ie, vasodilation), the skin assumes a red (flushed) appearance. Pallor does not necessarily indicate hypotension. Tachycardia is a compensatory response of the nervous system in an attempt to increase cardiac output and maintain blood pressure When ventilating an apneic patient, you note decreased ventilatory compliance. This means that: • A:the lungs are difficult to ventilate. • B:the upper airway is blocked. • C:you meet no resistance when ventilating. • D:fluid is occupying the alveoli. - You selected A; This is correct!