Paramedic Medical Scenarios 2025 Exam Questions with 100% Correct Answers

Paramedic Medical Scenarios 2025 Exam Questions with 100% Correct Answers When treating an adult patient with a blood pressure of 60/40 mm Hg, confusion, a heart rate of 40 beats/min, and sinus bradycardia on the cardiac monitor, you should administer supplemental oxygen, establish vascular access, and then: A) administer 0.5 mg of atropine sulfate and consider transcutaneous cardiac pacing. B) begin a dopamine infusion to increase blood pressure and improve cerebral perfusion. C) administer sequential crystalloid fluid boluses until his BP is greater than 100 mm Hg. D) acquire a 12-lead ECG, which may reveal signs of acute myocardial ischemia or injury. - Answer-A) administer 0.5 mg of atropine sulfate and consider transcutaneous cardiac pacing. A patient who presents with or develops symptomatic bradycardia needs to be treated in a manner that will increase the heart rate, thus improving cardiac output, blood pressure, and mental status. Altered mental status, hypotension, chest pain or pressure, and shortness of breath are indications for treatment of the bradycardic patient. After ensuring adequate oxygenation and ventilation, establish vascular access and give 0.5 mg of atropine; this may be repeated every 3 to 5 minutes to a maximum dose of 3 mg. If the patient is severely compromised or does not respond to atropine, begin transcutaneous cardiac pacing (TCP) without delay. If the patient is in a second-degree type II or third-degree AV block, TCP is the first-line treatment. Atropine and TCP-refractory bradycardia may require a sympathomimetic infusion, such as epinephrine or dopamine. The body's normal physiologic response to hypovolemia is tachycardia, not bradycardia. Therefore, fluid boluses are not the initial treatment for the hypotensive, bradycardic patient. In fact, they may cause further harm to the patient. With a slow heart rate and decreased cardiac output, a sudden increase in preload may result in acute pulmonary edema. After stabilizing the patient's heart rate and improving perfusion, obtain a 12-lead ECG to assess for signs of acute myocardial ischemia or injury. You are attempting to resuscitate a 50-year-old man in cardiac arrest. The patient has a history of congestive heart failure, hypertension, and cirrhosis of the liver. The cardiac monitor reveals a slow, wide complex rhythm. CPR is ongoing and the patient has been intubated. In addition to looking for potentially reversible causes of the patient's condition, further treatment should include: A) hyperventilation for presumed acidosis and 1 mg of epinephrine 1:10,000 every 3 to 5 minutes. B) one breath every 3 to 5 seconds, a 2-liter normal saline bolus, a vasopressor, and a dopamine infusion. C) ventilations at a rate of 10 breaths/min and 1 mg of epinephrine 1:10,000 every 3 to 5 minutes. D) one breath every 5 to 6 seconds, 300 mg of amiodarone, and transcutaneous cardiac pacing. - Answer-C) ventilations at a rate of 10 breaths/min and 1 mg of epinephrine 1:10,000 every 3 to 5 minutes. Pulseless electrical activity (PEA) refers to the presence of an organized cardiac rhythm (except V-Tach), despite the absence of a pulse; it can result from a variety of conditions, such as hypovolemia, overdose, hypothermia, and trauma, among others. Treatment for PEA includes high-quality CPR with minimal interruptions, 1 mg of epinephrine 1:10,000 every 3 to 5 minutes, advanced airway management, and treating potentially reversible causes. After an advanced airway device is in place, perform asynchronous CPR; the compressor delivers 100 to 120 compressions/min and the ventilator provides 10 breaths/min (one breath every 6 seconds). Do not hyperventilate the patient; doing so may impair venous return to the heart and decrease cardiac output. A ventilation rate of 12 to 20 breaths/min is appropriate for infants and children who are apneic, but have a pulse. An apneic adult with a pulse should be ventilated at a rate of 10 to 12 breaths/min. Dopamine is not indicated for patients in cardiac arrest, and current evidence does not support the use of transcutaneous cardiac pacing (TCP) in patients with PEA or asystole. Amiodarone is indicated for refractory V-Fib or pulseless V-Tach; it is not indicated for PEA. Which of the following is an absolute contraindication for fibrinolytic therapy? A) Subdural hematoma 3 years ago B) BP of 170/100 mm Hg on presentation C) Current use of anticoagulant medication D) Ischemic stroke within the last 12 months - Answer-A) Subdural hematoma 3 years ago According to current emergency cardiac care (ECC) guidelines, absolute contraindications for fibrinolytic therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural, intracerebral hematoma); known structural cerebrovascular lesion (ie, arteriovenous malformation); known malignant intracranial tumor (primary or metastatic); ischemic stroke within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours; suspected aortic dissection; active bleeding or bleeding disorders (except menses); and significant closed head trauma or facial trauma within the past 3 months. Relative contraindications (eg, the physician may deem fibrinolytic therapy appropriate under certain circumstances) include, a history of chronic, severe, poorly-controlled hypertension; severe uncontrolled hypertension on presentation (SBP > 180 mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago; dementia; traumatic or prolonged (> 10 minutes) CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding; noncompressible vascular punctures; pregnancy; prior exposure (> 5 days ago) or prior allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of anticoagulants (ie, Coumadin). A patient experiencing a right ventricular infarction would be expected to present with: A) hypertension and tachycardia B) ST elevation in leads II, III, and aVF. C) greater than 2-mm ST depression in lead V1. D) severe pulmonary edema and hemoptysis. - Answer-B) ST elevation in leads II, III, and aVF. A right ventricular infarction (RVI) should be suspected when a patient presents with ECG changes indicative of an inferior wall injury pattern (equal to or greater than 1-mm ST elevation in leads II, III, and aVF; reciprocal ST depression and T wave inversion in leads I and aVL) AND has equal to or greater than 1-mm ST elevation in lead V4R when a right-sided 12-lead ECG is obtained. Patients experiencing an RVI are preload dependent and often present with hypotension; therefore, vasodilators (eg, nitroglycerin, morphine) should be avoided. Instead, IV fluid boluses should be given to maintain adequate perfusion. Other signs of an RVI include jugular venous distention and peripheral edema. Pulmonary edema and coughing up blood (hemoptysis) are indicative of left ventricular failure. A 35-year-old female experienced a syncopal episode shortly after complaining of palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival, she is conscious and alert, denies any injuries, and states that she feels fine. She further denies any significant medical history. Her vital signs are stable and the cardiac monitor reveals a sinus rhythm with frequent premature atrial complexes. On the basis of this information, which of the following would be the MOST likely cause of her syncopal episode? A) sudden increase in cardiac output B) Paroxysmal supraventricular tachycardia C) A brief episode of ventricular tachycardia D) Aberrant conduction through the ventricles - Answer-B) Paroxysmal supraventricular tachycardia Syncope (fainting) of cardiac origin is caused by a sudden decrease in cerebral perfusion secondary to a decrease in cardiac output. This is usually the result of an acute bradydysrhythmia or tachydysrhythmia. In this particular patient, the presence of frequent premature atrial complexes (PACs), which indicates atrial irritability, suggests paroxysmal supraventricular tachycardia (PSVT) as the underlying dysrhythmia that caused her syncopal episode. In PSVT, the heart is beating so fast that ventricular filling and cardiac output decrease, which results in a transient decrease in cerebral perfusion. Not all patients with PSVT experience syncope. Many experience an acute onset of palpitations and/or lightheadedness that spontaneously resolves. You have inserted an oral airway in an apneic patient and are ventilating him with a bag-valve-mask device when he suddenly vomits. After removing the oral airway, you should: A) suction his oropharynx. B) apply cricoid pressure. C) turn him onto his side. D) insert a Combitube. - Answer-C) turn him onto his side. Keeping in mind that mortality increases significantly if aspiration occurs, you must immediately remove the oral airway and turn the patient onto his side - which will facilitate drainage of vomitus from his mouth - and then suction his oropharynx. Do not suction the unprotected airway of a patient while he or she is supine; this only increases the likelihood of aspiration. Posterior cricoid pressure (Sellick maneuver) is no longer a recommended technique as it has been shown to impair ventilation and does not prevent gastric distention and regurgitation as was once thought. A Combitube or other airway device designed to enter the esophagus should not be inserted if the patient is actively vomiting. A 72-year-old male presents with an acute onset of confusion, slurred speech, and decreased movement of his right arm. The patient's wife tells you that this began about 20 minutes ago, and that he was fine before that. He has type II diabetes, hypertension, and atrial fibrillation. Given this patient's clinical presentation and past medical history, you should be MOST suspicious that he has: A) acute hypoglycemia. B) an occluded cerebral artery. C) an acute epidural hemorrhage. D) a space-occupying intracranial lesion. - Answer-B) an occluded cerebral artery.