Test Bank For Prehospital Emergency Care, 11TH Edition Mistovich et al ()

A 67-year-old male patient who lives in an extremely "bad" neighborhood is experiencing chest pain. There are vacant homes throughout the area, including the homes to either side of his residence. Additionally, parked/abandoned cars have forced you to park three houses away, making it necessary to walk and carry supplies to the residence. Which action is most appropriate as you approach and/or gain access to the patient's house? A) Stand in front of the door while knocking to make your presence known B) Walk single file with your partner behind you carrying the medical bag C) Walk on the sidewalk instead of the grass to ensure steadier footing D) Hold a lit flashlight in front of you to illuminate shrubbery and trash cans Answer: B Diff: 2 Page Ref: 322 Objective: 12-3 3 9) On scene, frantic family members direct you into the basement where their 67-year-old mother has shot herself in the chest with a small handgun. She is unresponsive and breathing 6 times per minute. The gun remains in her hand by her side. Which action should you take immediately? A) Pick up the gun by the edge of the grip and carefully remove it, and advise the police of your action B) Do not touch the patient or gun until the police arrive on scene C) Leave the gun in the patient's hand and start providing emergency care D) Determine whether the gun contains ammunition and remove it if it is loaded Answer: A Diff: 2 Page Ref: 323 Objective: 12-6 10) It is nighttime and you have been dispatched for a vehicle on the shoulder of the interstate with a driver slumped over the steering wheel. When pulling up onto the scene, how should you best position the ambulance? A) In front of the car with the white strobe lights activated B) Behind the car with your high-beams on C) Next to the car to block one lane of traffic D) Behind the car with the ambulance wheels turned toward the guard rail Answer: B Diff: 2 Page Ref: 324 Objective: 12-4 11) You are providing care to a patient with altered mental status amid a large crowd gathered for a concert. Which characteristic of the crowd should concern you the most in relation to personal safety? A) An angry mood developing within the crowd B) A growing number of people making up the crowd C) The arrival of news vans to "cover" the story D) The presence of alcohol and possibly drugs in the crowd Answer: A Diff: 2 Page Ref: 325-326 Objective: 12-6 12) An intoxicated patient is complaining of a severe headache and a large bruise to the left side of his face after accidentally being struck with a baseball bat during a family picnic softball game. In this situation, being struck with the baseball bat is called the: A) Nature of illness B) Chief complaint C) Mechanism of injury D) Differential diagnosis Answer: C Diff: 2 Page Ref: 326-327 Objective: 12-7 4 13) Dispatch has sent you to the scene of a fight at a local sporting event. Since the EMS system is busy and there are very few ambulances available, dispatch has instructed you to call for additional units after arrival on scene. On scene, you find that the police are present and what appear to be 10 to 12 people are seated or lying on the ground, many with blood on their faces and clothing. When would you call for additional ambulances? A) Once all patients have been triaged B) After assessing and treating life-threatening injuries C) Once the exact number of patients has been determined D) Before getting out of the ambulance Answer: D Diff: 2 Page Ref: 329 Objective: 12-5 14) When would an EMT enter the scene of a crime to provide care to the patient? A) When an additional crew arrives on scene B) When all hazards have been addressed C) When the police return their guns to their holsters D) When the dispatcher informs the crew to enter Answer: B Diff: 2 Page Ref: 322 Objective: 12-4 15) If a scene becomes unsafe after you have entered, you should first: A) Attempt to neutralize the threat B) Call for assistance on the radio C) Remove yourself from the scene D) Notify the EMS supervisor Answer: C Diff: 2 Page Ref: 318 Objective: 12-3 16) A 67-year-old male patient, who has a history of diabetes and previous heart attack, fell down three stairs. His chief complaint is pain and deformity to his right wrist. The EMT would initially classify this patient as a: A) Medical patient B) Trauma patient C) Medical and trauma patient D) Special needs patient Answer: B Diff: 1 Page Ref: 326 Objective: 12-7 5 17) You and your partner are first on the scene of a bleacher collapse at a local raceway. As you exit the ambulance, you note several patients seated throughout the debris from the collapsed structure. In this situation, which action would you perform first? A) Determine the severity of injuries B) Wait for additional units to arrive C) Determine the number of patients D) Notify the local hospitals of a mass-casualty incident Answer: C Diff: 2 Page Ref: 315, 329 Objective: 12-8 18) Which of these emergency responders have articles of personal protective equipment in place? A) An EMT with gloves, gown, and eye protection B) An Emergency Medical Responder with leather gloves and steel-toed boots C) A firefighter with a self-contained breathing apparatus unit on D) All the responders have personal protective equipment in place. Answer: D Diff: 1 Page Ref: 316 Objective: 12-1 19) At the scene of a motor vehicle collision involving two vehicles on a narrow two-lane road, which actions would be most appropriate to ensure rescuer and patient safety? A) Place flares in each direction from the collision scene B) Remove reflective clothing to avoid distracting passing vehicles C) Turn your reflective back to oncoming traffic so those drivers are aware of your presence D) Treat the patients between the vehicles so all rescuers can see each other Answer: A Diff: 1 Page Ref: 319 Objective: 12-6 20) A young male patient was playing hockey on an ice-covered pond and became injured; he remains on the ice. As you arrive on scene, a park ranger informs you that the ice is 12 inches thick and poses no danger of collapse. In this situation, which action would be most appropriate to help keep you safe while accessing and extricating the patient? A) Have a teammate assist the injured player to your location B) Apply salt to the ice to provide traction C) Place tarps on the ice to walk over to the injured player D) Take small slow steps while walking on the ice Answer: C Diff: 1 Page Ref: 320 Objective: 12-6 6 21) You have been called to a residence of a woman who fell down the stairs. On scene, you find the patient on the couch with a large laceration to her forehead. As you begin assessing and treating her, she states that she did not fall down the stairs, but rather was assaulted by her exboyfriend after inviting him into her home. He has since left the residence prior to your arrival. In this situation, which statement would be most appropriate? A) "What is the name of your ex-boyfriend?" B) "Aside from your head, do you hurt anywhere else?" C) "I am not going to bandage your head so we can preserve evidence." D) "Why did you invite your ex-boyfriend over to your house?" Answer: B Diff: 1 Page Ref: 326 Objective: 12-7 22) You have been called to a bar full of intoxicated patrons for a 46-year-old man who fell off his stool, injuring his left arm. As you assess his arm, the patient screams in pain. Several of the patrons get angry and yell for you to give him something for pain. Someone in the back throws a bottle in your direction. What should you do next? A) Leave the scene and return only when police have made it safe to do so B) Ignore the yelling and continue to care for the patient as you would anyone else with a similar injury C) Inform the patrons that you are a medical professional and will care for the patient as you have been educated to do so D) Contact medical command for permission to give aspirin as a pain medication Answer: A Diff: 2 Page Ref: 324 Objective: 12-6 23) When deciding whether to transport a patient to the hospital using lights and sirens to the hospital, which information carries the most weight in your decision? A) Mechanism of injury B) Index of suspicion C) Past medical history D) Assessment findings Answer: D Diff: 1 Page Ref: 327 Objective: 12-7 24) To best determine the type and extent of injuries sustained by a patient who has fallen, the EMT should consider which of these pieces of information? A) The reason that the patient fell B) The distance fallen and the type of surface landed on C) The patient's past medical history D) Vital signs obtained during the assessment Answer: B Diff: 2 Page Ref: 327 Objective: 12-7 7 25) You have been directed to a car that struck another vehicle at a moderate rate of speed. You note deformity and starring of the windshield on the driver's side. What should you do to determine whether the deformity to the windshield was caused by the driver hitting his head or by the air bags? A) Determine if a seat belt was used B) Ask the front-seat passenger C) Determine if the air bags deployed D) Assess the patient's head Answer: D Diff: 1 Page Ref: 327-328 Objective: 12-7 26) You arrive on the scene at an extended care facility where you see the facility employees removing the residents via wheelchairs and hospital beds. As you exit the ambulance, an employee walks up to you and identifies herself as the night-shift charge nurse. She states that the facility had a furnace malfunction and the carbon monoxide alarms are sounding. There are probably 30 residents already in the parking lot a safe distance away, and there are reportedly 15 more inside who are unresponsive. Given the number of patient overall, the EMT should: A) Alert dispatch of the need for additional resources B) Put on a TB mask and gain entry into the facility to remove the unresponsive patients C) Send his partner into the facility with another employee to start rendering care where the patients are lying D) Continue to supervise the actions of the facility employees until all the residents are removed from the facility Answer: A Diff: 2 Page Ref: 329 Objective: 12-8 1 Prehospital Emergency Care, 11e (Mistovich et al.) Chapter 13 Patient Assessment 1) When assessing a sick or injured patient, which of these indicates the appropriate order in which this assessment should occur? A) Primary assessment; reassessment, secondary assessment B) Scene size-up, secondary assessment, primary assessment C) Scene size-up, primary assessment, secondary assessment D) Scene size-up, history, secondary assessment, primary assessment Answer: C Diff: 1 Page Ref: 335 Objective: 13-1 2) You have been dispatched to a residence for an 89-year-old female patient with a nonspecific complaint. When assessing this patient, what should you do first to develop an initial impression regarding emergency? A) Obtain the patient's vital signs and current medications B) Gather a medical history including allergy information C) Contact medical direction for advice D) Determine whether the complaint is medical or trauma related Answer: D Diff: 1 Page Ref: 335 Objective: 13-2 3) Which of these statements made by the EMT indicates that he has appropriately initiated the first phase of patient assessment? A) "I have placed an oral airway in the patient." B) "The scene appears to be free of hazards." C) "Blood pressure is 124/80 mmHg." D) "Can you tell me why you called the ambulance?" Answer: B Diff: 2 Page Ref: 335 Objective: 13-3 4) You arrive at the scene of a fall, where a 42-year-old woman fell backward off a stepladder while cleaning her kitchen windows. She is seated on the floor and complains of pain to her ankle. She tells you, "If I had just gone to work today instead of using vacation time, this would have never happened!" Based on information thus far, what can you conclude? A) The patient is alert with an open airway B) Her pulse rate is within normal limits C) She does not require rapid transport D) She does not have any other injuries Answer: A Diff: 2 Page Ref: 336 Objective: 13-9 2 5) You have been dispatched to an apartment for an elderly male complaining of shortness of breath. When do you start the process of forming a general impression about this patient? A) As you and your partner approach him B) After completing the primary assessment C) As soon as you obtain his chief complaint D) Following the completion of vital signs Answer: A Diff: 1 Page Ref: 336 Objective: 13-4 6) The EMT shows she understands the importance and reason for forming a general impression when she states: A) "The general impression permits a rapid diagnosis of the patient's problem." B) "Forming a general impression allows me to fully assess the emergency situation." C) "The general impression enables me to rule out any life-threatening conditions." D) "Forming a general impression provides me with a rough idea of the patient's overall status." Answer: D Diff: 2 Page Ref: 336 Objective: 13-3 7) You have been called for an adult patient who suffered a seizure. He is sitting on the floor, and looks at you as you enter the room. When questioned, he knows his name but cannot remember the date, what happened, or where he is. This patient's mental status can best be described as: A) Alert but confused B) Lethargic and agitated C) Obtunded and altered D) Agitated and verbally disoriented Answer: A Diff: 2 Page Ref: 342 Objective: 13-8 8) An Emergency Medical Responder informs you that a 59-year-old female patient is responsive to verbal stimuli. What would be the most accurate representation of this status? A) She is able to answer all questions appropriately when asked B) She cannot be awakened when her name is called C) Her eyes are closed, but she will open them if asked D) She is awake, but having difficulty telling you her name and where she is Answer: C Diff: 2 Page Ref: 342 Objective: 13-8 3 9) A 36-year-old patient who has overdosed on an unknown drug presents in a seemingly unresponsive state as you walk into the room. Given this, what should you do first? A) Check the patient's vital signs B) Assess the patient's mental status C) Determine whether a radial pulse is present D) Ask bystanders which drug was taken Answer: B Diff: 2 Page Ref: 342 Objective: 13-8 10) Which of these patients would be classified as unresponsive? A) A 39-year-old-female who is confused B) A 52-year-old male who cannot answer your questions C) A 70-year-old female who has experienced a stroke D) A 46-year-old-male who does not respond when his fingers are pinched Answer: D Diff: 2 Page Ref: 344 Objective: 13-8 11) You are assessing a 4-year-old patient whose panicked mother states that she cannot wake him. The child is breathing but his eyes are closed. To best determine the child's mental status, you should first: A) Apply pressure to the child's nail beds B) Say loudly, "Open your eyes!" C) Ask the mother how long the child has been asleep D) Identify the child as unresponsive Answer: B Diff: 2 Page Ref: 342 Objective: 13-8 12) An EMT is assessing a 9-month-old infant who is "not acting right" per his mother. Assessment reveals the child to be extremely irritable, crying weakly, and resistant to being touched by the EMT. Which description best describes this infant's mental status? A) Alert B) Lethargic C) Verbal D) Obtunded Answer: A Diff: 2 Page Ref: 342 Objective: 13-8 4 13) You are by the side of a patient who complains of shortness of breath and has a history of heart problems, including congestive heart failure (CHF). When assessing the airway, which of these observations best indicates that it is still patent? A) The patient easily tells you that she is having chest pain B) The patient is sitting in an upright position because she cannot lie flat C) The patient can speak only in extremely short sentences D) The patient is lethargic and confused to person, place, and time Answer: A Diff: 1 Page Ref: 345 Objective: 3-9 14) As you arrive by the side of a 64-year-old unresponsive female patient, you hear snoring respirations. Your immediate action would be to: A) Suction the mouth and airway B) Determine the chief complaint C) Administer supplemental oxygen D) Perform a manual jaw-thrust maneuver Answer: D Diff: 2 Page Ref: 345 Objective: 13-9 15) On scene, you find a 91-year-old female patient who fell down two steps after suddenly complaining of a severe headache. She is unresponsive with gurgling respirations. Which instruction should you immediately give your partner after manual spinal motion restriction is applied? A) "Please perform the head-tilt, chin-lift maneuver to open the airway." B) "Check her breathing and let me know the rate." C) "Let's move her to the stretcher and get moving to the hospital." D) "Get the suction out and clear out her airway." Answer: D Diff: 1 Page Ref: 345 Objective: 13-9 16) A 26-year-old male patient has been ejected from a car after it rolled several times in the median of the interstate. As you perform the primary assessment, you find him prone and unresponsive. Your immediate action is to: A) Assess his breathing B) Apply a cervical collar C) Logroll him into supine position D) Place an oral airway Answer: C Diff: 3 Page Ref: 342 Objective: 13-6 5 17) A conscious and alert 64-year-old female patient complains of chest pain and mild shortness of breath. She appears to have no difficulty speaking and states that the pain suddenly started about 2 hours ago. Her daughter on scene advises you there is a history of blood clots in the lungs of her family, and she is scared and would like her mother to be evaluated. Which of these steps should you take first? A) Consider administering oxygen to the patient B) Determine the adequacy of the patient's breathing C) Place the patient on the stretcher for transport D) Perform a secondary assessment on the patient Answer: B Diff: 2 Page Ref: 340 Objective: 13-5 18) You are an assistant instructor for an Emergency Medical Responder course. One of the students asks you how the head-tilt, chin-lift airway maneuver works to open the airway. Your response is: A) "It opens the airway by lifting the tongue from the back of the throat." B) "It creates an open airway by separating the lips, allowing air to enter." C) "It stimulates the patient to begin taking deeper breaths, thereby moving air into the lungs." D) "It opens the airway by relaxing and expanding the size of the throat." Answer: A Diff: 3 Page Ref: 345 Objective: 13-9 19) To stabilize the cervical spine of a trauma patient while simultaneously opening the airway, how should you position her head? A) Tilted slightly forward B) Tilted slightly back C) Neutral and in-line D) In the position found Answer: C Diff: 1 Page Ref: 341 Objective: 13-6 20) During the primary assessment, how should you best determine the adequacy of a patient's breathing? A) Determine the patient's mental status B) Compare the respirations and pulse rate C) Calculate the number of breaths per minute D) Examine the rise and fall of the chest Answer: D Diff: 2 Page Ref: 349 Objective: 13-10 6 21) Which of these patients would the EMT identify as having the most adequate breathing, free from any respiratory distress? A) A 61-year-old confused female breathing at a rate of 8 breaths/min B) A 34-year-old male with abdominal pain who is alert and oriented with good chest rise and fall C) A 19-year-old male breathing 16 times per minute with slight wheezing in the lungs D) A 67-year-old female breathing 26 times per minute with good chest rise and fall Answer: B Diff: 2 Page Ref: 348-349 Objective: 13-9 22) The EMT would recognize which of these patients as having a normal breathing rate? A) An 8-year-old male breathing 24 times per minute B) A 44-year-old male breathing 6 times per minute C) A 6-month-old infant breathing 58 times per minute D) A 22-year-old female breathing 26 times per minute Answer: A Diff: 1 Page Ref: 347 Objective: 13-9 23) Which finding individually would most likely indicate that a patient is breathing inadequately? A) An SpO2 of less than 94% B) A respiratory rate of 20 breaths/min in an adult C) Numbness and tingling of the fingers and toes D) Shortness of breath during exercise Answer: A Diff: 2 Page Ref: 348 Objective: 13-11 24) You have been called to the side of a 37-year-old female patient whose chief complaint is confusion, anxiety, and chest tightness. Assessment shows her airway to be patent, respirations are 46 breaths/min, heart rate is 134 beat/min, blood pressure is 128/54 mmHg, and SpO2 is 93%. In regard to the respiratory rate, you would recognize: A) It will result in too much air being placed in the lungs B) It is not a concern because the patient is still getting oxygen C) It does not allow the lungs enough time to adequately fill D) It will cause damage to the lungs if not corrected Answer: C Diff: 3 Page Ref: 347 Objective: 13-10 7 25) To best evaluate the adequacy of breathing in an unresponsive adult, the EMT should: A) Assess the skin color B) Check the pupils C) Observe the chest rise D) Look for cyanosis Answer: C Diff: 1 Page Ref: 349 Objective: 13-10 26) The patient's family states that their 16-year-old daughter has a history of asthma and has been complaining of shortness of breath for the past two days. She has been taking her metereddose inhaler with some relief, but this morning, they found her lethargic and struggling to breathe. Your assessment reveals the patient to be responsive to verbal stimuli with an open airway and shallow respirations of 44 breaths/min. You hear minimal wheezing in both lungs. What is your immediate action in caring for this patient? A) Insert an oral airway B) Apply a nonrebreather mask C) Position her on her side D) Start positive pressure ventilation Answer: D Diff: 3 Page Ref: 348-349 Objective: 13-10 27) You are by the side of a 64-year-old male patient who collapsed at home. After assessing his level of consciousness, airway, and breathing, you determine that he is unresponsive with an open airway, but not breathing. The patient still has a weak carotid pulse. Which instruction should you immediately give to your partner? A) "Let's attempt placement of an OPA or NPA and start ventilations." B) "Please check the patient's blood pressure and apply the pulse oximeter." C) "Go ahead and apply the automated external defibrillator." D) "We will need to start cardiopulmonary resuscitation." Answer: A Diff: 2 Page Ref: 349 Objective: 13-9 8 28) You arrive on the scene of a motor vehicle collision and are presented with a patient who complains of chest pain after striking his chest on the steering wheel. On-scene Emergency Medical Responders are maintaining cervical spine motion restriction manually. The patient is alert and oriented and has a patent airway. His respirations are 24 breaths/min with good chest rise and fall, and his skin is warm and dry. He describes some shortness of breath, his heart rate is 96 beats/min, and his SpO2 is 92% on room air. At this time you should: A) Apply a cervical collar B) Provide oxygen via nasal cannula at 2-4 liters per minute C) Obtain a blood pressure and medical history D) Start positive pressure ventilation Answer: B Diff: 2 Page Ref: 349 Objective: 13-11 29) Which characteristic regarding breathing rates must the EMT remember when assessing the respirations of a pediatric patient? A) Respirations in a pediatric patient are similar to those of an adult B) Respirations in a pediatric patient are typically slower than those of an adult C) Respirations in a pediatric patient are not significant in the assessment of breathing adequacy D) Respirations in a pediatric patient are usually faster than those of an adult Answer: D Diff: 1 Page Ref: 347 Objective: 13-10 30) A 28-year-old female patient has fallen 20 feet from the roof a house. She is lying supine and does not appear to be conscious or breathing. On arrival at her side, what should the EMT do first? A) Open her airway using a head-tilt, chin-lift maneuver B) Apply manual in-line spinal motion restriction C) Start positive pressure ventilation after placing an OPA or NPA D) Open her airway and assess her circulation Answer: B Diff: 2 Page Ref: 338-339 Objective: 13-1 31) You have just determined that a 92-year-old female patient found in bed is unresponsive, but still has a carotid pulse. Your next action would be to: A) Open the airway manually B) Check for a radial pulse C) Determine the past medical history D) Immediate transport Answer: A Diff: 1 Page Ref: 336 Objective: 13-7 9 32) Near the end of a workday, a construction worker fell 10 feet from scaffolding, landing on his head and left shoulder. He is found to be spontaneously alert, but confused. His airway is open and his breathing is adequate. Coworkers state that he was unresponsive for a period of 2 minutes following the fall and is on medications for depression and heart problems. Based on this information, the EMT should initially classify him as which kind of patient? A) Trauma B) Trauma and behavioral C) Medical and trauma D) Medical, trauma, and behavioral Answer: A Diff: 1 Page Ref: 336 Objective: 13-3 33) Forming a general impression is essential in the assessment of any patient because it: A) Indicates whether a primary assessment is required B) Helps to determine the clinical status of a patient C) Determines the stability or instability of a patient D) Reveals the injuries the patient has suffered Answer: B Diff: 2 Page Ref: 336 Objective: 13-4 34) Which of these patients should receive oxygen via an oxygenation adjunct such as an NRB or nasal cannula? A) A 39-year-old male with a sprained ankle who is breathing 16 times per minute B) An 18-year-old female who overdosed on a drug and is unresponsive and breathing 4 times per minute C) A 42-year-old female who is confused, weak, and dizzy, and adequately breathing 14 times per minute D) A 61-year-old male who is unresponsive, with a foreign body airway obstruction that cannot be removed with abdominal thrusts Answer: C Diff: 2 Page Ref: 349 Objective: 13-10 35) When assessing an adult trauma patient's circulation status during the primary assessment, the EMT's assessment should include: A) Carotid pulse, capillary refill, blood pressure, and skin color B) Radial and/or carotid pulse, skin characteristics, and presence of external bleeding C) Skin color, pulse rate, blood pressure, and skin temperature D) Pulse rate, blood pressure, capillary refill, and skin condition Answer: B Diff: 1 Page Ref: 350; Table 13-6 Objective: 13-12 10 36) You cannot locate a radial pulse on a 54-year-old male patient who is alert, confused, and breathing adequately. What should you do immediately? A) Start cardiopulmonary resuscitation B) Attach the automated external defibrillator (AED) C) Start positive pressure ventilation D) Check for the carotid pulse Answer: D Diff: 2 Page Ref: 350