A 3-year-old boy is found to be in cardiopulmonary arrest. As you begin one-rescuer You selected B; This is correct!
CPR, your partner prepares the AED. The appropriate compression to ventilation ratio for
this child is: Reason:A universal compression to ventilation ratio of 30:2 is used for all one-rescuer CPR (adult, child,
and infant), with the exception of the newborn. A compression to ventilation ratio of 3:1 is used for
• A:3:1 newborns (one- and two-rescuer). Two-rescuer infant and child CPR is performed at a compression to
• B:30:2 ventilation ratio of 15:2. In this scenario, you are performing one-rescuer CPR as your partner prepares
• C:5:1 the AED; therefore, you should give 30 compressions and 2 breaths. However, when you and your
• D:15:2 partner resume CPR, give 15 compressions and 2 breaths.
You selected B; This is correct!
A 3-year-old child has a sudden onset of respiratory distress. The mother
denies any recent illnesses or fever. You should suspect: Reason:You should suspect a foreign body airway obstruction in any child who presents with an acute onset of
respiratory distress in the absence of fever. Croup, epiglottitis, and lower airway infections (ie, bronchiolitis, bronchitis)
• A:lower respiratory infection. commonly present with a fever. If the child is experiencing a mild airway obstruction, in which he or she is moving
• B:foreign body airway obstruction. adequate air, has a normal level of consciousness, and pink skin, do not attempt to relieve the airway obstruction; doing
so may result in a severe airway obstruction. Offer oxygen and transport the child to the hospital without delay. If signs
• C:croup. of a severe airway obstruction are present (ie, ineffective cough, decreased level of consciousness, cyanosis), you
should perform abdominal thrusts until the object is expelled or the child becomes unresponsive. If the child becomes
• D:epiglottitis. unresponsive, perform chest compressions.
You selected C; This is correct!
A 3-year-old female presents with respiratory distress. She is conscious, crying, and
clinging to her mother. She has mild intercostal retractions and an oxygen saturation of Reason:Do not assume that a child will simply allow you to administer oxygen to him or her as you would to an adult.
The child in this scenario, who is in respiratory distress and is mildly hypoxemic (SpO2 of 93%), should receive
93%. The MOST effective way of delivering oxygen to her involves: supplemental oxygen; however, it should be given in a nonthreatening manner. Agitating a sick or injured child causes
• A:ventilations with a flow-restricted, oxygen-powered device. an increase in oxygen consumption and demand, which may cause the child's condition to deteriorate. In this scenario,
ask the child's mother to hold an oxygen mask near the child's face (blow-by oxygen). Closely monitor her condition and
• B:gently restraining her and assisting her ventilations. be prepared to assist her ventilations with a bag-mask device if she deteriorates. An oxygen flow rate of 6 to 8 L/min is
• C:asking the mom to hold an oxygen mask near her face. too low for a nonrebreathing mask; a flow-rate of 12 to 15 L/min should be used. Do NOT use a flow-restricted, oxygen-
powered ventilation device (FROPVD) on any child; doing so may cause severe gastric distention and lung injury. Allow
• D:a nonrebreathing mask with the flow rate at 6 to 8 L/min. the child to assume a position of comfort and transport.
A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, You selected C; This is correct!
has a patent airway, and has adequate breathing. You should: Reason:Once you determine that a poisoning has occurred, and have identified the poison, you should contact the
• A:administer 1 g/kg of activated charcoal. poison control center at once: (800) 222-1222. Give the patient high-flow oxygen or assist his or her ventilations if
necessary. Induction of vomiting with syrup of ipecac is no longer recommended because of the risk of aspiration.
• B:give 15 mL of ipecac and contact medical control. Activated charcoal is contraindicated in patients who have ingested a corrosive substance (eg, drain cleaner) or a
petroleum product (eg, gasoline, motor oil). A head-to-toe exam is not practical in this situation, at least initially. Follow
• C:contact poison control and give him oxygen. the directions given to you by the poison control center, transport the child without delay, and monitor his condition en
• D:give oxygen and perform a head-to-toe exam. route.
A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular
The correct answer is B;
breathing and is bleeding from her mouth and nose. You should:
• A:suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist
Reason:In any semi- or unconscious patient with a head injury, you should manually stabilize the head and open the
her ventilations.
airway with the jaw-thrust maneuver. If there are any secretions in the mouth, suction the oropharynx. If possible, insert
• B:open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and
a simple airway adjunct. The patient in this scenario is semiconscious and likely has an intact gag reflex; therefore, you
assist her ventilations.
should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal airway in
• C:open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via
patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After
nonrebreathing mask.
ensuring a patent airway, you should turn your attention to the patient's breathing. Slow, irregular breathing will not
• D:manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and
provide adequate minute volume and should be treated with ventilatory assistance.
suction her oropharynx.
The correct answer is D;
The 5-minute Apgar assessment of a newborn reveals a heart rate of 130 beats/min, cyanosis - to the
hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists Reason: The Apgar score, which is obtained at 1 and 5 minutes after birth (and every 5 minutes thereafter), assigns
-
attempts to straighten its legs. These findings equate to an Apgar score of: numbers (0, 1, or 2) to the following five areas: Appearance, Pulse, Grimace, Activity, and Respirations. A score of 1 is
assigned for appearance if the newborn's body is pink, but its hands and feet remain blue. If its heart rate is greater than
• A:8
A l G 100 beats/min, it receives a score of 2 for the pulse. If it cries and tries to move its foot away when soles of its feet are
:L2 R
• B:10
: : 2
flicked, it is assigned a score of 2 for grimace/irritability. If it resists attempts to straighten its hips and knees, a score of
• C:7 2 is assigned for activity/muscle tone. If its respirations are rapid, a score of 2 is assigned. Based on these parameters,
• D:9 P 2 ? A the newborn in this scenario would receive an Apgar score of 9. Refer to your EMT textbook for a complete review of
the Apgar score.
A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and The correct answer is D;
approach the child, you see him lying supine approximately 15 feet from the car. Based on the child's age Reason:Children are smaller than adults; therefore, when they are injured by the same mechanism of injury as an adult,
and mechanism of injury, which of the following should you suspect to be his PRIMARY injury? the location of their injuries may differ from those of an adult. For example, when an adult is struck by a vehicle, the
• A:Head injury primary injury typically occurs at or below the knees, depending on the height of the bumper at the time of impact.
• B:Upper thorax injury Because the child is shorter, initial impact typically occurs at or near the pelvis. Secondary injury occurs when child's
Ry
PENLEY
chest collides with the vehicle's grille. Tertiary injury occurs when the child strikes the side of his or her head on the
• C:Lower leg injury .
pavement after being propelled away from the vehicle. In some cases, the child is pulled underneath the vehicle and is
• D:Pelvic injury
→ dragged.
A 6-year-old boy complains of pain to the right lower quadrant of his You selected D; This is correct!
abdomen. Assessment of this child's abdomen should include:
Reason: When assessing the abdomen of any patient, you should determine the location of the pain and palpate that
• A:palpating the right lower quadrant first. area last. Begin by palpating the abdomen furthest away from the area of pain; in this case, the left upper quadrant is
• B:auscultating bowel sounds for 2 minutes. furthest away from the right lower quadrant. Palpating the painful area first will interfere with the rest of your
assessment because the patient will be in significant pain and will likely not remain still during the remainder of the
• C:avoiding palpation of the abdomen. assessment. This is especially true in children. Auscultation of bowel sounds is generally not performed in the
€ prehospital setting; little, if any, information will be gained from doing so.
• D:palpating the left upper quadrant first.
D
A 7-year-old child has an altered mental status,
-
high fever, and a generalized rash. You The correct answer is D;
perform your assessment and administer supplemental
-
oxygen. En route to the hospital,
Reason:High fever and an alerted mental status indicate sepsis (severe infection). A generalized rash should alert you to
you should be MOST alert for: the possibility of meningitis—a condition caused by infection and inflammation of the meninges that protect the brain
• A:respiratory distress. and spinal cord. Children with meningitis are at risk for seizures (convulsions), usually due to increased intracranial
pressure (ICP) and/or high fever; therefore, you must continually monitor the child's condition en route to the hospital
• B:combativeness. and be prepared to treat seizures if they occur. Remember that seizure deaths are caused by cerebral hypoxia. You
• C:hypotension. should also be alert for vomiting, which can jeopardize the airway. Hypotension can occur in patients with sepsis and
should also be of concern; however, seizures directly compromise adequate ventilation and oxygenation.
• D:convulsions.
A 9-year-old girl was struck by a car while she was crossing the street. Your assessment
You selected D; This is correct!
reveals a large contusion over the left upper quadrant of her abdomen and signs of
shock. Which of the following organs has MOST likely been injured? Reason:Abdominal trauma commonly occurs in children as the result of motor vehicle versus pedestrian
• A:Kidney accidents. The contusions over the left upper quadrant and the signs of shock suggest significant injury to
• B:Liver the spleen. The liver lies in the right upper quadrant, and the pancreas and kidneys lie in the
retroperitoneal space. Although the exact injury cannot be determined in the field, you must treat the
• C:Pancreas
patient for shock and provide rapid transport.
• D:Spleen
,A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago.
You selected D; This is correct!
Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How
much activated charcoal should you administer? Reason: First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to
convert pounds to kilograms: Formula 1: weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% =
• A:54 g weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as
• B:60 g follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows:
125 (weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest
• C:51 g tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient.
• D:57 g
A 19-year-old female has a closed, swollen deformity to her left forearm. You are unable to palpate a radial pulse and The correct answer is D;
the skin distal to the injury is cold and pale. Several attempts to contact medical control have failed and you are
approximately 45 miles away from the closest hospital. You should: Reason:
• A:apply an air splint to her forearm, keep her arm below the level of her heart, place an icepack over the injury, and Cold, pale skin and an absent distal pulse indicates that blood flow distal to the injury is compromised. You should notify
transport. medical control, who will likely direct you to attempt to restore distal circulation. However, if you are unable to contact
• B:begin transport at once, gently manipulate her arm en route until distal circulation is restored, and apply an air medical control and your transport time will be lengthy, you should make ONE attempt to restore distal circulation by
splint. applying gentle manual traction in line with the long axis of the limb. Be careful, as excessive manipulation can worsen
• C:splint her entire arm with rigid board splints, elevate the limb above the level of her heart, and transport the vascular problem. If you are unsuccessful after one attempt, splint the limb in the most comfortable position for the
immediately. patient and transport at once. If distal circulation is restored, splint the limb in whatever position allows the strongest
• D:make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the distal pulse. You should elevate the limb above the level of the heart to help minimize swelling. An icepack may also
limb. help reduce pain and swelling.
A 19-year-old male was assaulted and has trauma to multiple body systems. After The correct answer is C;
performing your primary assessment and treating any immediate life-threatening injuries, Reason:
you should: After treating all life-threatening conditions found in the primary assessment, you should perform a rapid head-to-toe
assessment (rapid body scan) to look for and treat other life threats. In many cases, patients with trauma to multiple
• A:obtain a full set of baseline vital signs. body systems have other life-threatening injuries that are not readily apparent during the primary assessment. You
• B:transport at once and intercept with ALS. should obtain baseline vital signs as soon as possible; however, this should not delay or interrupt your primary or rapid
head-to-toe assessments. After performing the primary and rapid head-to-toe assessments, fully immobilize the
• C:perform a rapid head-to-toe assessment. patient's spine and transport to an appropriate hospital. Consider an advanced life support (ALS) intercept, as long as it
• D:fully immobilize his spine and transport. does not cause a significant delay in transport.
The correct answer is C;
A 21-year-old male was bitten on the left forearm by a dog. He is conscious and alert and denies any
other injuries. An animal control officer is at the scene and has contained the dog. Your assessment of Reason:
An avulsion is an injury that separates various layers of soft tissue, usually between the subcutaneous layer and fascia,
the patient's arm reveals a large avulsion with a peeled back flap of skin. Distal circulation is adequate so that they become completely detached or hang as a flap. The patient's injury is isolated and not life-threatening;
and the patient is able to feel and move his fingers. In addition to bleeding control, you should: therefore, a rapid head-to-toe assessment is not indicated. Unless your protocols specify otherwise, oxygen is usually
• A:perform a rapid head-to-toe assessment. not necessary for patients with isolated, non-life-threatening soft tissue injuries. If the avulsed tissue is hanging from a
• B:irrigate the wound for at least 15 minutes. small piece of skin, circulation through the flap may be at risk. If you can, replace the avulsed flap to its original
position, as long as it is not visibly contaminated with dirt and/or other foreign materials, and then cover the wound with
• C:replace the avulsed flap to its original position. a dry sterile dressing. Unless the wound is grossly contaminated with dirt or debris, irrigation is usually deferred until
• D:apply oxygen via a nonrebreathing mask. the patient is evaluated by a physician. Furthermore, flushing an open wound may force dirt or other debris into the
wound, increasing the risk of infection.
A 21-year-old man partially amputated his right arm when the chainsaw he was using to The correct answer is B;
trim trees slipped. You can feel a weak radial pulse and his arm is cool to the touch. Dark
Reason:
red blood is flowing heavily from the wound. You should: When caring for a partially amputated extremity, control bleeding with bulky compression (pressure) dressings and
• A:control the bleeding, manipulate the arm to improve circulation, and apply a splint. splint the extremity to prevent further injury. If direct pressure does not immediately control the bleeding, however, a
proximal tourniquet should be applied without delay. Never pack dressings into a wound; this may cause further
• B:apply bulky compression dressings to the wound and splint the extremity. damage and increases the risk of infection. Although your patient's radial pulse is weak, it is present and indicates blood
• C:carefully pack sterile dressings into the wound and fully splint the extremity. flow distal to the injury. Do not manipulate his arm; doing so may lacerate or compress an artery and compromise distal
circulation.
• D:apply a tourniquet proximal to the injury and tighten it until the bleeding stops.
The correct answer is C;
A 22-year-old female fell on her knee and is in severe pain. Her knee is flexed and severely deformed. Reason:
Her leg is cold to the touch and you are unable to palpate a distal pulse. You should: A dislocated knee occurs when the proximal end of the tibia completely displaces from its juncture with the distal femur.
In some cases, the popliteal artery behind the knee may be compressed, resulting in compromised distal blood flow.
• A:carefully straighten her leg until you restore a distal pulse and then apply padded board splints. Signs of this include absent distal pulses and a pale extremity that is cool or cold. Manually stabilize the knee and
• B:apply gentle longitudinal traction as you straighten her leg and then apply a traction splint. assess for distal pulses. If distal pulses are absent, contact medical control immediately for further stabilization
• C:manually stabilize her injury and contact medical control for further stabilization instructions. instructions. Medical control may instruct you to make ONE attempt to realign the knee to reduce compression of the
• D:place a pillow behind her knee and stabilize the injury by applying padded board splints. popliteal artery and restore distal circulation. If you are unable to restore distal circulation or medical control advises
you not to manipulate the injury, splint the knee in the position it was found and transport promptly. Traction splints are
contraindicated in any injury to or near the knee
A 22-year-old female woman was shot by her husband. Law enforcement is at the scene You selected D; This is correct!
and has the husband in custody. The patient is conscious, but extremely restless, and is Reason:
pale and diaphoretic. As your partner administers high-flow oxygen, you should: The primary assessment of any patient includes ensuring a patent airway, assessing breathing adequacy, administering
high-flow oxygen or assisting ventilations, assessing circulation, and controlling all active bleeding. You and your
• A:keep her warm by applying blankets. partner must work as a team; as your partner administers high-flow oxygen, you should be looking for her gunshot
• B:take her BP to detect hypotension. wound(s) and ensuring that all bleeding is controlled. After the primary assessment and management, begin treating her
for shock (eg, applying a blanket, elevating her lower extremities [if local protocol permits]) and perform a rapid head-
• C:compare her carotid and radial pulses. to-toe assessment to search for other injuries that may not have been obvious during the primary assessment. Assess
• D:look for and control any bleeding. the patient's vital signs after all life-threatening injuries or conditions have been identified and corrected.
The correct answer is C;
A 22-year-old man was stabbed in the chest with a large knife. The patient is pulseless
and apneic, and the knife is impaled in the center of his chest. Treatment should include: Reason:
• A:stabilizing the knife, starting CPR, and providing rapid transport. There are two indications for removing an impaled object: when the object is causing airway compromise
• B:removing the knife, applying an occlusive dressing, and providing rapid transport. and when the object interferes with your ability to perform CPR. A knife impaled in the center of the
chest, which is where chest compressions are performed, in a patient who is in cardiac arrest must be
• C:removing the knife, starting CPR, and providing rapid transport.
carefully removed. Quickly cover the wound to control any bleeding (an occlusive dressing covered by a
• D:stabilizing the knife, applying an occlusive dressing, and providing rapid transport. sterile dressing is preferred) and begin CPR immediately.
You selected D; This is correct!
A 23-year-old unrestrained female struck the steering wheel with her chest when her passenger car collided with a
tree at a high rate of speed. Your assessment reveals that she is conscious, but has signs of shock and an irregular Reason:
pulse. The MOST appropriate treatment for this patient includes: The cause of this patient's shock may be a myocardial contusion, or bruising of the heart muscle. Blunt trauma to the
• A:high-flow oxygen, summoning a paramedic unit to the scene to assess her cardiac rhythm, a cervical collar, and chest can injure the heart, making it unable to maintain adequate blood pressure. In a myocardial contusion, the pulse
transport as soon as possible. is often irregular, but dangerous rhythms (eg, V-Fib, V-Tach) are relatively uncommon. There is no special diagnostic
• B:insertion of an oral airway, assisted ventilations with a bag-mask device, full spinal precautions, and rapid transport. test at this time, and there is no prehospital treatment for the condition. Therefore, waiting at the scene for a paramedic
• C:applying an AED in case she develops cardiac arrest, high-flow oxygen, full spinal precautions, and rapid transport. unit would only waste time. Apply high-flow oxygen, assist ventilations if the patient is breathing inadequately (eg, slow
• D:high-flow oxygen or assisted ventilations as needed, full spinal precautions, blankets to keep her warm, and rapid or fast respirations, shallow breathing [reduced tidal volume]), treat the patient for shock (eg, cover her with blankets,
transport. elevate her lower extremities [if local protocol permits]), and transport rapidly. Because of the mechanism of injury, full
spinal precautions should be taken. The patient is conscious and likely has an intact gag reflex; therefore, an oral
airway is contraindicated. The AED is only applied to patients who are in cardiac arrest
A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She tells you You selected C; This is correct!
Reason:The patient's symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the
that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and
result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are
alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 spread through the tick's saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme
breaths/min. Her symptoms are MOST likely the result of: disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The
• A:Rocky Mountain spotted fever. rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks,
painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many
• B:tetanus.
patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs within 7
• C:Lyme disease. to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis,
• D:a localized allergic reaction. and possibly cardiopulmonary failure.
,A 28-year-old woman has severe lower quadrant abdominal pain. When You selected D; This is correct!
assessing her abdomen, you should: Reason:Assessment of a patient's abdomen includes asking where the pain is located and then palpating
• A:encourage the patient to lie supine with her legs fully extended. that area last. Palpating the painful area first may interfere with the rest of your assessment because of
the significant pain the patient will be in. Bowel sounds are of little value in the field and generally are not
• B:ask her where the pain is located and palpate that area first. included in the abdominal assessment. Patients with severe abdominal pain typically prefer to lie on their
• C:auscultate for bowel sounds for approximately 2 to 5 minutes. side with their knees drawn up into their chest (fetal position). Moving them from this position will
• D:ask her where the pain is located and palpate that area last aggravate their pain.
The correct answer is A;
A 29-year-old woman, who is 38 weeks pregnant, presents with heavy vaginal bleeding, a blood Reason:Of the conditions listed, placenta previa would be the least likely to present with abdominal pain, although some
pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies patients may have pain or cramping. Placenta previa is a condition in which the placenta develops over and covers
abdominal cramping or pain. Her signs and symptoms are MOST consistent with a/an: some or all of the cervix. As the cervix dilates, the vasculature that attaches the placenta to the uterine wall tears,
resulting in vaginal bleeding that is often severe enough to cause shock. By contrast, abruptio placenta is a condition in
• A:placenta previa.
which the placenta prematurely separates from the uterine wall; it is characterized by tearing abdominal pain, heavy
• B:abruptio placenta. vaginal bleeding, and shock. Placenta previa and abruptio placenta occur during the later stages of pregnancy. A
• C:ruptured ectopic pregnancy. ruptured ovarian cyst typically causes lower abdominal pain, often unilateral. Ectopic pregnancy, a condition in which
• D:ruptured ovarian cyst. the egg implants and grows outside the uterus (usually in a fallopian tube), is a first trimester condition; it is typically
discovered between 8 and 10 weeks of pregnancy. If the ectopic pregnancy ruptures, the patient often presents with a
sudden stabbing pain in the lower abdomen and shock due to intraabdominal hemorrhage.
A 30-year-old man sustained partial-thickness burns to the anterior chest and both
The correct answer is C;
anterior arms. Based on the Rule of Nines, what percentage of his body surface area has
been burned? Reason:
• A:36% According to the adult Rule of Nines, the anterior trunk (chest and abdomen) accounts for 18% of the
• B:9% total body surface area (TBSA) and each entire arm accounts for 9%. Therefore, the anterior chest, which
is one half of the trunk, would account for 9% of the TBSA, and both anterior arms (4.5% each) would
• C:18%
account for 9% TBSA, for a total of 18% TBSA burned.
• D:27%
A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is You selected D; This is correct!
confused, combative, and has slurred speech. With the assistance of law enforcement personnel, you Reason:An adult with decision-making capacity (ie, a mentally competent adult) has the legal right to refuse medical
and your partner physically restrain him in order to provide care and transport. In this situation, a court of treatment, even if that treatment involves lifesaving care. In psychiatric cases, however, a court of law would likely
law would MOST likely: consider your actions in providing lifesaving care to be appropriate, particularly if you have a reasonable belief that
• A:conclude that you should have had a court order to restrain. the patient would harm him- or herself or others without your intervention. In addition, a patient who is in any way
impaired, whether by mental illness, medical condition, or intoxication, may not be considered competent to refuse
• B:determine that the patient had decision-making capacity.
treatment and transport. If you are unsure of a patient's decision-making capacity, err on the side of treatment and
• C:agree that you and your partner are guilty of assault and battery. transport. Few would argue that it would be easier to defend why you treated a patient than to justify or defend why you
• D:consider your actions in providing care to be appropriate. abandoned a patient.
A 30-year-old woman crashed her car into a tree at a high rate of speed. She is conscious and alert and has stable You selected C; This is correct!
vital signs. She has some small lacerations and abrasions to her arms and face, but no obviously life-threatening
injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. You Reason:The consequences of refusal should be explained to any patient who refuses EMS treatment and/or transport.
should: After establishing that the patient can legally refuse treatment and transport (eg, he or she is of legal age AND has
• A:advise her that she is probably too emotionally upset to be able to refuse EMS treatment and transport. decision-making capacity), you must advise her that because of the significant mechanism of injury, the potential for
• B:obtain a signed refusal from the patient and ask a law enforcement officer to transport her to the hospital. critical injury or death exists, even though she may feel fine now. Once this is explained, and the patient understands
• C:advise the patient that she should be transported to the hospital because of the seriousness of the crash. and is willing to accept the possible consequences, obtain a signed refusal and ask an impartial person (eg, police
• D:ask a law enforcement officer to administer a breathalyzer test to determine if she has been drinking alcohol. officer) to witness the signed refusal.
A 30-year-old woman has an open deformity to her left leg and is in severe pain. She is The correct answer is B;
conscious and alert, has a patent airway, and is breathing adequately. Your primary
Reason:
concern should be: Initial care for any open injury involves controlling external bleeding. Further care involves manually stabilizing the
• A:administering high-flow oxygen. injury site; applying a sterile dressing to keep gross contaminants from entering the wound; assessing distal perfusion
(eg, a pulse), motor, and sensory functions; and stabilizing the injury with an appropriate splint. The patient in this
• B:controlling any external bleeding. scenario is conscious, alert, has a patent airway, and is breathing adequately. Depending on other assessment findings,
• C:assessing pulses distal to the injury. oxygen may be indicated. Your primary concern, however, should be to ensure that all external bleeding has been
controlled.
• D:covering the wound to prevent infection.
You selected B; This is correct!
A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and
difficulty breathing. When he breathes, you hear audible stridor. What does this indicate?
Reason:This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is
• A:Narrowing of the two mainstem bronchi
a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues
• B:Swelling of the upper airway structures
of the upper airway. If not promptly treated, the patient's airway may close completely,
• C:Narrowing of the bronchioles in the lungs
resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing,
• D:Swelling of the lower airway structures
a whistling sound that may be heard during inhalation, exhalation, or both.
You selected C; This is correct!
A 33-year-old factory worker was pinned between two pieces of machinery. When you arrive at the
Reason:
scene, you find him lying supine on the ground complaining of severe pain to his pelvis. He is restless, Based on the mechanism of injury and the presence of signs of shock (eg, restlessness, tachycardia, diaphoresis), you
diaphoretic, and tachycardic. After performing a rapid head-to-toe assessment, you should: should suspect that the patient has a fractured pelvis and is bleeding internally. Therefore, after completing your
• A:perform a detailed secondary exam. primary assessment and initiating shock treatment (eg, high-flow oxygen, applying blankets), you should perform a
• B:palpate his pelvis to assess for crepitus. rapid head-to-toe assessment to assess for other injuries and then prepare for immediate transport. Spinal precautions
should be considered. Do not log roll the patient; doing so compresses the pelvis and may cause further injury. You
• C:prepare for immediate transport. should also avoid palpating his pelvis; this will only cause further pain and may cause further injury. Palpation of the
• D:carefully log roll him to check his back. pelvis is performed to assess its stability, not to elicit crepitus. A detailed secondary exam of a critically injured patient
at the scene is not appropriate; it takes too long to perform and should be done en route to the hospital if time permits.
A 33-year-old female presents with acute respiratory distress. She is conscious but anxious, and tells you that she has a You selected B; This is correct!
history of asthma. She took two puffs of her albuterol inhaler prior to your arrival, but states that it did not help. Her
oxygen saturation reads 89% and you hear diffuse wheezing while auscultating her lungs. You should: Reason:
• A:give her 100% humidified oxygen to dilate her bronchioles, monitor her oxygen saturation, and transport her to an Despite two albuterol treatments, the patient is still experiencing respiratory distress. Furthermore, the presence of
appropriate medical facility. wheezing indicates continued bronchospasm. After administering high-flow oxygen via a nonrebreathing mask, you
• B:administer high-flow oxygen, contact medical control to request permission to assist her with another albuterol should contact medical control and request permission to assist the patient with a third albuterol treatment. Drugs such
treatment, and prepare for transport. as albuterol (Proventil, Ventolin) and metaproterenol (Alupent) stimulate beta-2 receptors in the lungs, resulting in
• C:ventilate her with a bag-mask device until her oxygen saturation is at least 94% and rapidly transport her to the bronchodilation. Up to three bronchodilator treatments are typically given in the prehospital setting. In most EMS
closest appropriate medical facility. systems, EMTs are not allowed to assist patients with their medication without medical control authorization. After
• D:assist her with a third albuterol treatment, contact medical control for further advice, give her high-flow oxygen, assisting the patient with a third albuterol treatment, reassess her breath sounds and oxygen saturation and transport
and transport her to the hospital. her promptly.
You selected B; This is correct!
A 33-year-old male struck a parked car with his motorcycle and was ejected from the motorcycle. He was not wearing Reason:
a helmet. He is unresponsive, has a depressed area to his forehead, bilaterally deformed femurs, and widespread The patient's abrasions (road rash) and capillary bleeding are the least of his problems. Capillary bleeding, blood that
abrasions with capillary bleeding. Which of the following statements regarding this patient is false? oozes from the capillary beds, is the least severe type of external bleeding and will not kill your patient. Wasting time at
• A:You should suspect that the patient has a skull fracture and increased intracranial pressure. the scene to cover his abrasions, however, will delay definitive care at a trauma center; this may kill him! The patient
• B:You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock. likely has a depressed skull fracture, and the fact that he is unresponsive indicates a traumatic brain injury with
• C:Internal hemorrhage cannot be controlled in the field and requires prompt surgical intervention. increased intracranial pressure. When a motorcyclist is ejected from his or her motorcycle, the femurs typically strike
• D:Femur fractures are a common injury when a motorcyclist is ejected from his or her motorcycle. the handlebars, resulting in unilateral or bilateral fractures. You cannot control internal hemorrhage in the field,
regardless of your level of training. Internal bleeding requires surgical intervention; therefore, you must transport the
patient without delay.
, A 34-year-old female complains of persistent fever, fatigue, and night sweats. During your You selected A; This is correct!
assessment, you note that she has purple blotches on her arms and legs. She MOST likely
Reason:Signs of human immunodeficiency virus (HIV) infection include persistent fever, weight loss, fatigue, a cough,
has: and night sweats. The presence of purple skin blotches (malignant lesions called Kaposi's sarcoma) is consistent with
• A:HIV/AIDS. acquired immune deficiency syndrome (AIDS), also known as late stage HIV infection. Patients with tuberculosis (TB)
also present with fever, fatigue, weight loss, a cough, and night sweats; however, skin lesions are not common. Hepatitis
• B:chickenpox. is characterized by right upper quadrant abdominal pain, fever, nausea and vomiting, and a yellow tint to the skin and
• C:tuberculosis. sclera ( jaundice). Chickenpox is unlikely; the associated rash is characterized by pustules that crust over, not purple
blotches.
• D:viral hepatitis.
A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect You selected C; This is correct!
her airway and ensure adequate ventilation, you should transport her: Reason:Initial care for any patient who is seizing—pregnant or otherwise—involves ensuring a patent airway, adequate
• A:in a semisitting position. ventilation, and administering high-flow oxygen. If the patient is breathing inadequately, ventilation assistance is
indicated. Suction any secretions from the patient's mouth. The pregnant patient should be placed on her left side
• B:in the prone position (lateral recumbent position); this will prevent supine hypotensive syndrome—a condition in which the pregnant uterus
• C:on her left side. compresses the inferior vena cava and reduces cardiac output. A lateral recumbent position will also facilitate the
draininge of oral secretions, thus minimizing the risk of aspiration.
• D:in the supine position.
You selected D; This is correct!
A 36-year-old male, who is a known diabetic, presents with severe weakness, diaphoresis, and tachycardia. He is
Reason:The patient's signs and symptoms indicate hypoglycemia. When you are in doubt as to a patient's
conscious, but confused. His blood pressure is 110/58 mm Hg, pulse is 120 beats/min and weak, and respirations are 24
breaths/min. The glucometer reads error after several attempts to assess his blood glucose level. In addition to high- blood glucose level, you should err on the side of caution and give sugar; this is what medical control will
flow oxygen, medical control will MOST likely order you to: likely order you to do. The patient, although confused, is conscious and will likely be able to swallow.
• A:transport only and closely monitor him. Insulin is not administered to patients in the field, even if hyperglycemia is documented; EMTs and
• B:assist the patient in taking his insulin.
paramedics are usually not familiar with all of the different types of insulin and their respective doses,
• C:give him a salt-containing solution to drink.
• D:give at least one tube of oral glucose. and profound hypoglycemia, potentially resulting in death, can occur if too much insulin is given. After
giving oral glucose, reassess the patient's mental status and vital signs.
A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper You selected D; This is correct!
extremities. Using the adult Rule of Nines, what percentage of his total body surface area
has been burned? Reason:
• A:18% Using the adult Rule of Nines, the head accounts for 9% of the total body surface area
• B:45% (TBSA), the anterior chest for 9% (the entire anterior trunk [chest and abdomen] accounts
• C:36% for 18%), and the anterior upper extremities for 4.5% each (each entire upper extremity is 9%
• D:27% of the TBSA). On the basis of this, the patient has sustained 27% TBSA burns
You selected C; This is correct!
A 40-year-old man was hit in the nose during a fight. He has bruising under
Reason:
his left eye and a nosebleed. After taking standard precautions, you should: During a nosebleed (epistaxis), much of the blood may pass down the throat into the stomach as the patient swallows;
• A:place a chemical icepack over his nose. this is especially true if the patient is lying supine. Blood is a gastric irritant; a person who swallows a large amount of
blood may become nauseated and vomit, which increases the risk of aspiration. Therefore, your first action should be to
• B:apply direct pressure by pinching his nostrils together. ensure that the patient is sitting up and leaning forward. This will prevent blood from draining down the back of the
throat. Next, apply direct pressure by pinching the fleshy part of the nostrils together; you or the patient may do this.
• C:ensure that he is sitting up and leaning forward. Placing a chemical icepack over the nose may further help control the bleeding by constricting the nasal vasculature.
• D:determine if he has any visual disturbances. After controlling the nosebleed, continue your assessment, which includes assessing for facial deformities and visual
disturbances.
A 40-year-old woman presents with widespread hives that she noticed about 45 minutes after taking You selected C; This is correct!
penicillin. She is conscious and alert and denies difficulty breathing. Her breath sounds are clear to Reason:The patient is experiencing an allergic reaction, but she is not in anaphylactic shock. Urticaria (hives) is
auscultation bilaterally, her vital signs are stable, and her oxygen saturation is 94%. She tells you she is common to all allergic reactions, regardless of severity; however, wheezing and hypotension, which she does not
allergic to wasps and has an epinephrine auto-injector. You should: have, are specific to anaphylaxis. Although she carries an epinephrine auto-injector for her allergy to wasps, she was
• A:assist her in administering epinephrine via her auto-injector. not stung by a wasp. Furthermore, the absence of wheezing and hypotension negates epinephrine administration. Give
supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and transport her to the
• B:give high-flow oxygen and administer 100 mg of Benadryl. hospital. Because it can take up to an hour for signs of a severe allergic reaction to manifest, the patient should not
• C:give supplemental oxygen and transport her to the hospital. drive herself. Diphenhydramine (Benadryl), an antihistamine, is an appropriate drug based on her presentation;
• D:advise her that she can probably drive herself to the hospital. however, it is not typically carried on a BLS unit. Furthermore, the correct dose is 25 to 50 mg.
A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but You selected C; This is correct!
confused. His wife tells you that he does not have any medical problems and does not take any
medications. You should be MOST suspicious for: Reason:Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs
and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental
• A:acute stroke. status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and
• B:influenza. potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuberculosis
• C:meningitis. (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke
• D:tuberculosis. may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a
fever.
(
A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of You selected A; This is correct!
speed. You find him in a prone position approximately 50 feet from his car. He is not
Reason:
moving and does not appear to be breathing. You should: When a trauma patient is found in a prone (face-down) position, especially if he or she is unresponsive, your first action
• A:manually stabilize his head. should be to manually stabilize his or her head; this action is based on the assumption that he or she has a spinal injury.
Next, log roll the patient to a supine position (while continuing to manually stabilize the head), open the airway with the
• B:administer high-flow oxygen. jaw-thrust maneuver, clear the airway with suction if needed, and assess for breathing. It would be extremely difficult to
• C:use the jaw-thrust maneuver. adequately open the patient's airway while he or she is in a prone position. Depending on the patient's breathing effort,
administer high-flow oxygen or ventilate using a bag-mask device.
• D:assess his breathing effort.
A 44-year-old male experienced burns to his anterior trunk and both arms. He is conscious The correct answer is D;
and alert, but is in extreme pain. Assessment of the burns reveals reddening and blisters. Reason:
This patient has ________________ burns that cover _____ of his total body surface area. Partial-thickness (second-degree) burns damage the epidermis and part of the dermis, and are characterized by
blistering and severe pain. Areas of superficial (first-degree) burns, which cause reddening of the skin, commonly
• A:first-degree, 27% surround a partial-thickness burn. The anterior trunk (chest and abdomen) accounts for 18% of the total body surface
• B:full-thickness, 18% area (TBSA) and each entire arm accounts for 9%. Therefore, this patient has partial-thickness burns that cover 36% of
his TBSA. Full-thickness (third-degree) burns are characterized by charred or white, leathery skin. Because the entire
• C:second-degree, 45% dermis, including the nerves, is destroyed, full-thickness burns are usually painless. The surrounding areas of partial-
• D:partial-thickness, 36% thickness burns, however, are very painful.
You selected B; This is correct!
A 44-year-old woman was bitten on the ankle by an unidentified snake while working in her garden. She is conscious
Reason:Given the fact that the snake was not identified, you should assume that it was poisonous. Furthermore, the
and alert, has stable vital signs, and denies shortness of breath. Her only complaint is a burning sensation at the wound
presence of puncture wounds, burning, redness, and swelling are suggestive of envenomation. Therefore, you should
site. Your assessment reveals two small puncture wounds, redness, and swelling. You should:
provide emergency care and transport the patient to the hospital. Treatment for a snake bite involves keeping the
• A:conclude that envenomation likely did not occur, provide reassurance, and allow a friend to take her to the hospital.
patient calm, administering oxygen, splinting the affected extremity to decrease movement (helps slow the spread of
• B:give supplemental oxygen, splint her leg to decrease movement, and keep her leg below the level of her heart.
venom), keeping the extremity below the level of the heart, and transporting the patient to the hospital. Do NOT apply
• C:elevate her leg, cover the wound with a dry sterile dressing, and apply an ice pack to reduce pain and swelling.
ice to a snake bite; it may constrict the blood vessels and force venom further into the bloodstream. The use of a
• D:administer high-flow oxygen, apply a constricting band proximal to the bite, and use ice to prevent venom spread.
proximal constricting band is controversial; if one is used, it should be loose, not tight. En route to the hospital, monitor
the patient's vital signs and mental status, and be alert for vomiting.
CPR, your partner prepares the AED. The appropriate compression to ventilation ratio for
this child is: Reason:A universal compression to ventilation ratio of 30:2 is used for all one-rescuer CPR (adult, child,
and infant), with the exception of the newborn. A compression to ventilation ratio of 3:1 is used for
• A:3:1 newborns (one- and two-rescuer). Two-rescuer infant and child CPR is performed at a compression to
• B:30:2 ventilation ratio of 15:2. In this scenario, you are performing one-rescuer CPR as your partner prepares
• C:5:1 the AED; therefore, you should give 30 compressions and 2 breaths. However, when you and your
• D:15:2 partner resume CPR, give 15 compressions and 2 breaths.
You selected B; This is correct!
A 3-year-old child has a sudden onset of respiratory distress. The mother
denies any recent illnesses or fever. You should suspect: Reason:You should suspect a foreign body airway obstruction in any child who presents with an acute onset of
respiratory distress in the absence of fever. Croup, epiglottitis, and lower airway infections (ie, bronchiolitis, bronchitis)
• A:lower respiratory infection. commonly present with a fever. If the child is experiencing a mild airway obstruction, in which he or she is moving
• B:foreign body airway obstruction. adequate air, has a normal level of consciousness, and pink skin, do not attempt to relieve the airway obstruction; doing
so may result in a severe airway obstruction. Offer oxygen and transport the child to the hospital without delay. If signs
• C:croup. of a severe airway obstruction are present (ie, ineffective cough, decreased level of consciousness, cyanosis), you
should perform abdominal thrusts until the object is expelled or the child becomes unresponsive. If the child becomes
• D:epiglottitis. unresponsive, perform chest compressions.
You selected C; This is correct!
A 3-year-old female presents with respiratory distress. She is conscious, crying, and
clinging to her mother. She has mild intercostal retractions and an oxygen saturation of Reason:Do not assume that a child will simply allow you to administer oxygen to him or her as you would to an adult.
The child in this scenario, who is in respiratory distress and is mildly hypoxemic (SpO2 of 93%), should receive
93%. The MOST effective way of delivering oxygen to her involves: supplemental oxygen; however, it should be given in a nonthreatening manner. Agitating a sick or injured child causes
• A:ventilations with a flow-restricted, oxygen-powered device. an increase in oxygen consumption and demand, which may cause the child's condition to deteriorate. In this scenario,
ask the child's mother to hold an oxygen mask near the child's face (blow-by oxygen). Closely monitor her condition and
• B:gently restraining her and assisting her ventilations. be prepared to assist her ventilations with a bag-mask device if she deteriorates. An oxygen flow rate of 6 to 8 L/min is
• C:asking the mom to hold an oxygen mask near her face. too low for a nonrebreathing mask; a flow-rate of 12 to 15 L/min should be used. Do NOT use a flow-restricted, oxygen-
powered ventilation device (FROPVD) on any child; doing so may cause severe gastric distention and lung injury. Allow
• D:a nonrebreathing mask with the flow rate at 6 to 8 L/min. the child to assume a position of comfort and transport.
A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, You selected C; This is correct!
has a patent airway, and has adequate breathing. You should: Reason:Once you determine that a poisoning has occurred, and have identified the poison, you should contact the
• A:administer 1 g/kg of activated charcoal. poison control center at once: (800) 222-1222. Give the patient high-flow oxygen or assist his or her ventilations if
necessary. Induction of vomiting with syrup of ipecac is no longer recommended because of the risk of aspiration.
• B:give 15 mL of ipecac and contact medical control. Activated charcoal is contraindicated in patients who have ingested a corrosive substance (eg, drain cleaner) or a
petroleum product (eg, gasoline, motor oil). A head-to-toe exam is not practical in this situation, at least initially. Follow
• C:contact poison control and give him oxygen. the directions given to you by the poison control center, transport the child without delay, and monitor his condition en
• D:give oxygen and perform a head-to-toe exam. route.
A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular
The correct answer is B;
breathing and is bleeding from her mouth and nose. You should:
• A:suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist
Reason:In any semi- or unconscious patient with a head injury, you should manually stabilize the head and open the
her ventilations.
airway with the jaw-thrust maneuver. If there are any secretions in the mouth, suction the oropharynx. If possible, insert
• B:open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and
a simple airway adjunct. The patient in this scenario is semiconscious and likely has an intact gag reflex; therefore, you
assist her ventilations.
should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal airway in
• C:open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via
patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After
nonrebreathing mask.
ensuring a patent airway, you should turn your attention to the patient's breathing. Slow, irregular breathing will not
• D:manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and
provide adequate minute volume and should be treated with ventilatory assistance.
suction her oropharynx.
The correct answer is D;
The 5-minute Apgar assessment of a newborn reveals a heart rate of 130 beats/min, cyanosis - to the
hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists Reason: The Apgar score, which is obtained at 1 and 5 minutes after birth (and every 5 minutes thereafter), assigns
-
attempts to straighten its legs. These findings equate to an Apgar score of: numbers (0, 1, or 2) to the following five areas: Appearance, Pulse, Grimace, Activity, and Respirations. A score of 1 is
assigned for appearance if the newborn's body is pink, but its hands and feet remain blue. If its heart rate is greater than
• A:8
A l G 100 beats/min, it receives a score of 2 for the pulse. If it cries and tries to move its foot away when soles of its feet are
:L2 R
• B:10
: : 2
flicked, it is assigned a score of 2 for grimace/irritability. If it resists attempts to straighten its hips and knees, a score of
• C:7 2 is assigned for activity/muscle tone. If its respirations are rapid, a score of 2 is assigned. Based on these parameters,
• D:9 P 2 ? A the newborn in this scenario would receive an Apgar score of 9. Refer to your EMT textbook for a complete review of
the Apgar score.
A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and The correct answer is D;
approach the child, you see him lying supine approximately 15 feet from the car. Based on the child's age Reason:Children are smaller than adults; therefore, when they are injured by the same mechanism of injury as an adult,
and mechanism of injury, which of the following should you suspect to be his PRIMARY injury? the location of their injuries may differ from those of an adult. For example, when an adult is struck by a vehicle, the
• A:Head injury primary injury typically occurs at or below the knees, depending on the height of the bumper at the time of impact.
• B:Upper thorax injury Because the child is shorter, initial impact typically occurs at or near the pelvis. Secondary injury occurs when child's
Ry
PENLEY
chest collides with the vehicle's grille. Tertiary injury occurs when the child strikes the side of his or her head on the
• C:Lower leg injury .
pavement after being propelled away from the vehicle. In some cases, the child is pulled underneath the vehicle and is
• D:Pelvic injury
→ dragged.
A 6-year-old boy complains of pain to the right lower quadrant of his You selected D; This is correct!
abdomen. Assessment of this child's abdomen should include:
Reason: When assessing the abdomen of any patient, you should determine the location of the pain and palpate that
• A:palpating the right lower quadrant first. area last. Begin by palpating the abdomen furthest away from the area of pain; in this case, the left upper quadrant is
• B:auscultating bowel sounds for 2 minutes. furthest away from the right lower quadrant. Palpating the painful area first will interfere with the rest of your
assessment because the patient will be in significant pain and will likely not remain still during the remainder of the
• C:avoiding palpation of the abdomen. assessment. This is especially true in children. Auscultation of bowel sounds is generally not performed in the
€ prehospital setting; little, if any, information will be gained from doing so.
• D:palpating the left upper quadrant first.
D
A 7-year-old child has an altered mental status,
-
high fever, and a generalized rash. You The correct answer is D;
perform your assessment and administer supplemental
-
oxygen. En route to the hospital,
Reason:High fever and an alerted mental status indicate sepsis (severe infection). A generalized rash should alert you to
you should be MOST alert for: the possibility of meningitis—a condition caused by infection and inflammation of the meninges that protect the brain
• A:respiratory distress. and spinal cord. Children with meningitis are at risk for seizures (convulsions), usually due to increased intracranial
pressure (ICP) and/or high fever; therefore, you must continually monitor the child's condition en route to the hospital
• B:combativeness. and be prepared to treat seizures if they occur. Remember that seizure deaths are caused by cerebral hypoxia. You
• C:hypotension. should also be alert for vomiting, which can jeopardize the airway. Hypotension can occur in patients with sepsis and
should also be of concern; however, seizures directly compromise adequate ventilation and oxygenation.
• D:convulsions.
A 9-year-old girl was struck by a car while she was crossing the street. Your assessment
You selected D; This is correct!
reveals a large contusion over the left upper quadrant of her abdomen and signs of
shock. Which of the following organs has MOST likely been injured? Reason:Abdominal trauma commonly occurs in children as the result of motor vehicle versus pedestrian
• A:Kidney accidents. The contusions over the left upper quadrant and the signs of shock suggest significant injury to
• B:Liver the spleen. The liver lies in the right upper quadrant, and the pancreas and kidneys lie in the
retroperitoneal space. Although the exact injury cannot be determined in the field, you must treat the
• C:Pancreas
patient for shock and provide rapid transport.
• D:Spleen
,A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago.
You selected D; This is correct!
Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How
much activated charcoal should you administer? Reason: First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to
convert pounds to kilograms: Formula 1: weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% =
• A:54 g weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as
• B:60 g follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows:
125 (weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest
• C:51 g tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient.
• D:57 g
A 19-year-old female has a closed, swollen deformity to her left forearm. You are unable to palpate a radial pulse and The correct answer is D;
the skin distal to the injury is cold and pale. Several attempts to contact medical control have failed and you are
approximately 45 miles away from the closest hospital. You should: Reason:
• A:apply an air splint to her forearm, keep her arm below the level of her heart, place an icepack over the injury, and Cold, pale skin and an absent distal pulse indicates that blood flow distal to the injury is compromised. You should notify
transport. medical control, who will likely direct you to attempt to restore distal circulation. However, if you are unable to contact
• B:begin transport at once, gently manipulate her arm en route until distal circulation is restored, and apply an air medical control and your transport time will be lengthy, you should make ONE attempt to restore distal circulation by
splint. applying gentle manual traction in line with the long axis of the limb. Be careful, as excessive manipulation can worsen
• C:splint her entire arm with rigid board splints, elevate the limb above the level of her heart, and transport the vascular problem. If you are unsuccessful after one attempt, splint the limb in the most comfortable position for the
immediately. patient and transport at once. If distal circulation is restored, splint the limb in whatever position allows the strongest
• D:make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the distal pulse. You should elevate the limb above the level of the heart to help minimize swelling. An icepack may also
limb. help reduce pain and swelling.
A 19-year-old male was assaulted and has trauma to multiple body systems. After The correct answer is C;
performing your primary assessment and treating any immediate life-threatening injuries, Reason:
you should: After treating all life-threatening conditions found in the primary assessment, you should perform a rapid head-to-toe
assessment (rapid body scan) to look for and treat other life threats. In many cases, patients with trauma to multiple
• A:obtain a full set of baseline vital signs. body systems have other life-threatening injuries that are not readily apparent during the primary assessment. You
• B:transport at once and intercept with ALS. should obtain baseline vital signs as soon as possible; however, this should not delay or interrupt your primary or rapid
head-to-toe assessments. After performing the primary and rapid head-to-toe assessments, fully immobilize the
• C:perform a rapid head-to-toe assessment. patient's spine and transport to an appropriate hospital. Consider an advanced life support (ALS) intercept, as long as it
• D:fully immobilize his spine and transport. does not cause a significant delay in transport.
The correct answer is C;
A 21-year-old male was bitten on the left forearm by a dog. He is conscious and alert and denies any
other injuries. An animal control officer is at the scene and has contained the dog. Your assessment of Reason:
An avulsion is an injury that separates various layers of soft tissue, usually between the subcutaneous layer and fascia,
the patient's arm reveals a large avulsion with a peeled back flap of skin. Distal circulation is adequate so that they become completely detached or hang as a flap. The patient's injury is isolated and not life-threatening;
and the patient is able to feel and move his fingers. In addition to bleeding control, you should: therefore, a rapid head-to-toe assessment is not indicated. Unless your protocols specify otherwise, oxygen is usually
• A:perform a rapid head-to-toe assessment. not necessary for patients with isolated, non-life-threatening soft tissue injuries. If the avulsed tissue is hanging from a
• B:irrigate the wound for at least 15 minutes. small piece of skin, circulation through the flap may be at risk. If you can, replace the avulsed flap to its original
position, as long as it is not visibly contaminated with dirt and/or other foreign materials, and then cover the wound with
• C:replace the avulsed flap to its original position. a dry sterile dressing. Unless the wound is grossly contaminated with dirt or debris, irrigation is usually deferred until
• D:apply oxygen via a nonrebreathing mask. the patient is evaluated by a physician. Furthermore, flushing an open wound may force dirt or other debris into the
wound, increasing the risk of infection.
A 21-year-old man partially amputated his right arm when the chainsaw he was using to The correct answer is B;
trim trees slipped. You can feel a weak radial pulse and his arm is cool to the touch. Dark
Reason:
red blood is flowing heavily from the wound. You should: When caring for a partially amputated extremity, control bleeding with bulky compression (pressure) dressings and
• A:control the bleeding, manipulate the arm to improve circulation, and apply a splint. splint the extremity to prevent further injury. If direct pressure does not immediately control the bleeding, however, a
proximal tourniquet should be applied without delay. Never pack dressings into a wound; this may cause further
• B:apply bulky compression dressings to the wound and splint the extremity. damage and increases the risk of infection. Although your patient's radial pulse is weak, it is present and indicates blood
• C:carefully pack sterile dressings into the wound and fully splint the extremity. flow distal to the injury. Do not manipulate his arm; doing so may lacerate or compress an artery and compromise distal
circulation.
• D:apply a tourniquet proximal to the injury and tighten it until the bleeding stops.
The correct answer is C;
A 22-year-old female fell on her knee and is in severe pain. Her knee is flexed and severely deformed. Reason:
Her leg is cold to the touch and you are unable to palpate a distal pulse. You should: A dislocated knee occurs when the proximal end of the tibia completely displaces from its juncture with the distal femur.
In some cases, the popliteal artery behind the knee may be compressed, resulting in compromised distal blood flow.
• A:carefully straighten her leg until you restore a distal pulse and then apply padded board splints. Signs of this include absent distal pulses and a pale extremity that is cool or cold. Manually stabilize the knee and
• B:apply gentle longitudinal traction as you straighten her leg and then apply a traction splint. assess for distal pulses. If distal pulses are absent, contact medical control immediately for further stabilization
• C:manually stabilize her injury and contact medical control for further stabilization instructions. instructions. Medical control may instruct you to make ONE attempt to realign the knee to reduce compression of the
• D:place a pillow behind her knee and stabilize the injury by applying padded board splints. popliteal artery and restore distal circulation. If you are unable to restore distal circulation or medical control advises
you not to manipulate the injury, splint the knee in the position it was found and transport promptly. Traction splints are
contraindicated in any injury to or near the knee
A 22-year-old female woman was shot by her husband. Law enforcement is at the scene You selected D; This is correct!
and has the husband in custody. The patient is conscious, but extremely restless, and is Reason:
pale and diaphoretic. As your partner administers high-flow oxygen, you should: The primary assessment of any patient includes ensuring a patent airway, assessing breathing adequacy, administering
high-flow oxygen or assisting ventilations, assessing circulation, and controlling all active bleeding. You and your
• A:keep her warm by applying blankets. partner must work as a team; as your partner administers high-flow oxygen, you should be looking for her gunshot
• B:take her BP to detect hypotension. wound(s) and ensuring that all bleeding is controlled. After the primary assessment and management, begin treating her
for shock (eg, applying a blanket, elevating her lower extremities [if local protocol permits]) and perform a rapid head-
• C:compare her carotid and radial pulses. to-toe assessment to search for other injuries that may not have been obvious during the primary assessment. Assess
• D:look for and control any bleeding. the patient's vital signs after all life-threatening injuries or conditions have been identified and corrected.
The correct answer is C;
A 22-year-old man was stabbed in the chest with a large knife. The patient is pulseless
and apneic, and the knife is impaled in the center of his chest. Treatment should include: Reason:
• A:stabilizing the knife, starting CPR, and providing rapid transport. There are two indications for removing an impaled object: when the object is causing airway compromise
• B:removing the knife, applying an occlusive dressing, and providing rapid transport. and when the object interferes with your ability to perform CPR. A knife impaled in the center of the
chest, which is where chest compressions are performed, in a patient who is in cardiac arrest must be
• C:removing the knife, starting CPR, and providing rapid transport.
carefully removed. Quickly cover the wound to control any bleeding (an occlusive dressing covered by a
• D:stabilizing the knife, applying an occlusive dressing, and providing rapid transport. sterile dressing is preferred) and begin CPR immediately.
You selected D; This is correct!
A 23-year-old unrestrained female struck the steering wheel with her chest when her passenger car collided with a
tree at a high rate of speed. Your assessment reveals that she is conscious, but has signs of shock and an irregular Reason:
pulse. The MOST appropriate treatment for this patient includes: The cause of this patient's shock may be a myocardial contusion, or bruising of the heart muscle. Blunt trauma to the
• A:high-flow oxygen, summoning a paramedic unit to the scene to assess her cardiac rhythm, a cervical collar, and chest can injure the heart, making it unable to maintain adequate blood pressure. In a myocardial contusion, the pulse
transport as soon as possible. is often irregular, but dangerous rhythms (eg, V-Fib, V-Tach) are relatively uncommon. There is no special diagnostic
• B:insertion of an oral airway, assisted ventilations with a bag-mask device, full spinal precautions, and rapid transport. test at this time, and there is no prehospital treatment for the condition. Therefore, waiting at the scene for a paramedic
• C:applying an AED in case she develops cardiac arrest, high-flow oxygen, full spinal precautions, and rapid transport. unit would only waste time. Apply high-flow oxygen, assist ventilations if the patient is breathing inadequately (eg, slow
• D:high-flow oxygen or assisted ventilations as needed, full spinal precautions, blankets to keep her warm, and rapid or fast respirations, shallow breathing [reduced tidal volume]), treat the patient for shock (eg, cover her with blankets,
transport. elevate her lower extremities [if local protocol permits]), and transport rapidly. Because of the mechanism of injury, full
spinal precautions should be taken. The patient is conscious and likely has an intact gag reflex; therefore, an oral
airway is contraindicated. The AED is only applied to patients who are in cardiac arrest
A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She tells you You selected C; This is correct!
Reason:The patient's symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the
that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and
result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are
alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 spread through the tick's saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme
breaths/min. Her symptoms are MOST likely the result of: disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The
• A:Rocky Mountain spotted fever. rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks,
painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many
• B:tetanus.
patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs within 7
• C:Lyme disease. to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis,
• D:a localized allergic reaction. and possibly cardiopulmonary failure.
,A 28-year-old woman has severe lower quadrant abdominal pain. When You selected D; This is correct!
assessing her abdomen, you should: Reason:Assessment of a patient's abdomen includes asking where the pain is located and then palpating
• A:encourage the patient to lie supine with her legs fully extended. that area last. Palpating the painful area first may interfere with the rest of your assessment because of
the significant pain the patient will be in. Bowel sounds are of little value in the field and generally are not
• B:ask her where the pain is located and palpate that area first. included in the abdominal assessment. Patients with severe abdominal pain typically prefer to lie on their
• C:auscultate for bowel sounds for approximately 2 to 5 minutes. side with their knees drawn up into their chest (fetal position). Moving them from this position will
• D:ask her where the pain is located and palpate that area last aggravate their pain.
The correct answer is A;
A 29-year-old woman, who is 38 weeks pregnant, presents with heavy vaginal bleeding, a blood Reason:Of the conditions listed, placenta previa would be the least likely to present with abdominal pain, although some
pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies patients may have pain or cramping. Placenta previa is a condition in which the placenta develops over and covers
abdominal cramping or pain. Her signs and symptoms are MOST consistent with a/an: some or all of the cervix. As the cervix dilates, the vasculature that attaches the placenta to the uterine wall tears,
resulting in vaginal bleeding that is often severe enough to cause shock. By contrast, abruptio placenta is a condition in
• A:placenta previa.
which the placenta prematurely separates from the uterine wall; it is characterized by tearing abdominal pain, heavy
• B:abruptio placenta. vaginal bleeding, and shock. Placenta previa and abruptio placenta occur during the later stages of pregnancy. A
• C:ruptured ectopic pregnancy. ruptured ovarian cyst typically causes lower abdominal pain, often unilateral. Ectopic pregnancy, a condition in which
• D:ruptured ovarian cyst. the egg implants and grows outside the uterus (usually in a fallopian tube), is a first trimester condition; it is typically
discovered between 8 and 10 weeks of pregnancy. If the ectopic pregnancy ruptures, the patient often presents with a
sudden stabbing pain in the lower abdomen and shock due to intraabdominal hemorrhage.
A 30-year-old man sustained partial-thickness burns to the anterior chest and both
The correct answer is C;
anterior arms. Based on the Rule of Nines, what percentage of his body surface area has
been burned? Reason:
• A:36% According to the adult Rule of Nines, the anterior trunk (chest and abdomen) accounts for 18% of the
• B:9% total body surface area (TBSA) and each entire arm accounts for 9%. Therefore, the anterior chest, which
is one half of the trunk, would account for 9% of the TBSA, and both anterior arms (4.5% each) would
• C:18%
account for 9% TBSA, for a total of 18% TBSA burned.
• D:27%
A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is You selected D; This is correct!
confused, combative, and has slurred speech. With the assistance of law enforcement personnel, you Reason:An adult with decision-making capacity (ie, a mentally competent adult) has the legal right to refuse medical
and your partner physically restrain him in order to provide care and transport. In this situation, a court of treatment, even if that treatment involves lifesaving care. In psychiatric cases, however, a court of law would likely
law would MOST likely: consider your actions in providing lifesaving care to be appropriate, particularly if you have a reasonable belief that
• A:conclude that you should have had a court order to restrain. the patient would harm him- or herself or others without your intervention. In addition, a patient who is in any way
impaired, whether by mental illness, medical condition, or intoxication, may not be considered competent to refuse
• B:determine that the patient had decision-making capacity.
treatment and transport. If you are unsure of a patient's decision-making capacity, err on the side of treatment and
• C:agree that you and your partner are guilty of assault and battery. transport. Few would argue that it would be easier to defend why you treated a patient than to justify or defend why you
• D:consider your actions in providing care to be appropriate. abandoned a patient.
A 30-year-old woman crashed her car into a tree at a high rate of speed. She is conscious and alert and has stable You selected C; This is correct!
vital signs. She has some small lacerations and abrasions to her arms and face, but no obviously life-threatening
injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. You Reason:The consequences of refusal should be explained to any patient who refuses EMS treatment and/or transport.
should: After establishing that the patient can legally refuse treatment and transport (eg, he or she is of legal age AND has
• A:advise her that she is probably too emotionally upset to be able to refuse EMS treatment and transport. decision-making capacity), you must advise her that because of the significant mechanism of injury, the potential for
• B:obtain a signed refusal from the patient and ask a law enforcement officer to transport her to the hospital. critical injury or death exists, even though she may feel fine now. Once this is explained, and the patient understands
• C:advise the patient that she should be transported to the hospital because of the seriousness of the crash. and is willing to accept the possible consequences, obtain a signed refusal and ask an impartial person (eg, police
• D:ask a law enforcement officer to administer a breathalyzer test to determine if she has been drinking alcohol. officer) to witness the signed refusal.
A 30-year-old woman has an open deformity to her left leg and is in severe pain. She is The correct answer is B;
conscious and alert, has a patent airway, and is breathing adequately. Your primary
Reason:
concern should be: Initial care for any open injury involves controlling external bleeding. Further care involves manually stabilizing the
• A:administering high-flow oxygen. injury site; applying a sterile dressing to keep gross contaminants from entering the wound; assessing distal perfusion
(eg, a pulse), motor, and sensory functions; and stabilizing the injury with an appropriate splint. The patient in this
• B:controlling any external bleeding. scenario is conscious, alert, has a patent airway, and is breathing adequately. Depending on other assessment findings,
• C:assessing pulses distal to the injury. oxygen may be indicated. Your primary concern, however, should be to ensure that all external bleeding has been
controlled.
• D:covering the wound to prevent infection.
You selected B; This is correct!
A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and
difficulty breathing. When he breathes, you hear audible stridor. What does this indicate?
Reason:This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is
• A:Narrowing of the two mainstem bronchi
a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues
• B:Swelling of the upper airway structures
of the upper airway. If not promptly treated, the patient's airway may close completely,
• C:Narrowing of the bronchioles in the lungs
resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing,
• D:Swelling of the lower airway structures
a whistling sound that may be heard during inhalation, exhalation, or both.
You selected C; This is correct!
A 33-year-old factory worker was pinned between two pieces of machinery. When you arrive at the
Reason:
scene, you find him lying supine on the ground complaining of severe pain to his pelvis. He is restless, Based on the mechanism of injury and the presence of signs of shock (eg, restlessness, tachycardia, diaphoresis), you
diaphoretic, and tachycardic. After performing a rapid head-to-toe assessment, you should: should suspect that the patient has a fractured pelvis and is bleeding internally. Therefore, after completing your
• A:perform a detailed secondary exam. primary assessment and initiating shock treatment (eg, high-flow oxygen, applying blankets), you should perform a
• B:palpate his pelvis to assess for crepitus. rapid head-to-toe assessment to assess for other injuries and then prepare for immediate transport. Spinal precautions
should be considered. Do not log roll the patient; doing so compresses the pelvis and may cause further injury. You
• C:prepare for immediate transport. should also avoid palpating his pelvis; this will only cause further pain and may cause further injury. Palpation of the
• D:carefully log roll him to check his back. pelvis is performed to assess its stability, not to elicit crepitus. A detailed secondary exam of a critically injured patient
at the scene is not appropriate; it takes too long to perform and should be done en route to the hospital if time permits.
A 33-year-old female presents with acute respiratory distress. She is conscious but anxious, and tells you that she has a You selected B; This is correct!
history of asthma. She took two puffs of her albuterol inhaler prior to your arrival, but states that it did not help. Her
oxygen saturation reads 89% and you hear diffuse wheezing while auscultating her lungs. You should: Reason:
• A:give her 100% humidified oxygen to dilate her bronchioles, monitor her oxygen saturation, and transport her to an Despite two albuterol treatments, the patient is still experiencing respiratory distress. Furthermore, the presence of
appropriate medical facility. wheezing indicates continued bronchospasm. After administering high-flow oxygen via a nonrebreathing mask, you
• B:administer high-flow oxygen, contact medical control to request permission to assist her with another albuterol should contact medical control and request permission to assist the patient with a third albuterol treatment. Drugs such
treatment, and prepare for transport. as albuterol (Proventil, Ventolin) and metaproterenol (Alupent) stimulate beta-2 receptors in the lungs, resulting in
• C:ventilate her with a bag-mask device until her oxygen saturation is at least 94% and rapidly transport her to the bronchodilation. Up to three bronchodilator treatments are typically given in the prehospital setting. In most EMS
closest appropriate medical facility. systems, EMTs are not allowed to assist patients with their medication without medical control authorization. After
• D:assist her with a third albuterol treatment, contact medical control for further advice, give her high-flow oxygen, assisting the patient with a third albuterol treatment, reassess her breath sounds and oxygen saturation and transport
and transport her to the hospital. her promptly.
You selected B; This is correct!
A 33-year-old male struck a parked car with his motorcycle and was ejected from the motorcycle. He was not wearing Reason:
a helmet. He is unresponsive, has a depressed area to his forehead, bilaterally deformed femurs, and widespread The patient's abrasions (road rash) and capillary bleeding are the least of his problems. Capillary bleeding, blood that
abrasions with capillary bleeding. Which of the following statements regarding this patient is false? oozes from the capillary beds, is the least severe type of external bleeding and will not kill your patient. Wasting time at
• A:You should suspect that the patient has a skull fracture and increased intracranial pressure. the scene to cover his abrasions, however, will delay definitive care at a trauma center; this may kill him! The patient
• B:You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock. likely has a depressed skull fracture, and the fact that he is unresponsive indicates a traumatic brain injury with
• C:Internal hemorrhage cannot be controlled in the field and requires prompt surgical intervention. increased intracranial pressure. When a motorcyclist is ejected from his or her motorcycle, the femurs typically strike
• D:Femur fractures are a common injury when a motorcyclist is ejected from his or her motorcycle. the handlebars, resulting in unilateral or bilateral fractures. You cannot control internal hemorrhage in the field,
regardless of your level of training. Internal bleeding requires surgical intervention; therefore, you must transport the
patient without delay.
, A 34-year-old female complains of persistent fever, fatigue, and night sweats. During your You selected A; This is correct!
assessment, you note that she has purple blotches on her arms and legs. She MOST likely
Reason:Signs of human immunodeficiency virus (HIV) infection include persistent fever, weight loss, fatigue, a cough,
has: and night sweats. The presence of purple skin blotches (malignant lesions called Kaposi's sarcoma) is consistent with
• A:HIV/AIDS. acquired immune deficiency syndrome (AIDS), also known as late stage HIV infection. Patients with tuberculosis (TB)
also present with fever, fatigue, weight loss, a cough, and night sweats; however, skin lesions are not common. Hepatitis
• B:chickenpox. is characterized by right upper quadrant abdominal pain, fever, nausea and vomiting, and a yellow tint to the skin and
• C:tuberculosis. sclera ( jaundice). Chickenpox is unlikely; the associated rash is characterized by pustules that crust over, not purple
blotches.
• D:viral hepatitis.
A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect You selected C; This is correct!
her airway and ensure adequate ventilation, you should transport her: Reason:Initial care for any patient who is seizing—pregnant or otherwise—involves ensuring a patent airway, adequate
• A:in a semisitting position. ventilation, and administering high-flow oxygen. If the patient is breathing inadequately, ventilation assistance is
indicated. Suction any secretions from the patient's mouth. The pregnant patient should be placed on her left side
• B:in the prone position (lateral recumbent position); this will prevent supine hypotensive syndrome—a condition in which the pregnant uterus
• C:on her left side. compresses the inferior vena cava and reduces cardiac output. A lateral recumbent position will also facilitate the
draininge of oral secretions, thus minimizing the risk of aspiration.
• D:in the supine position.
You selected D; This is correct!
A 36-year-old male, who is a known diabetic, presents with severe weakness, diaphoresis, and tachycardia. He is
Reason:The patient's signs and symptoms indicate hypoglycemia. When you are in doubt as to a patient's
conscious, but confused. His blood pressure is 110/58 mm Hg, pulse is 120 beats/min and weak, and respirations are 24
breaths/min. The glucometer reads error after several attempts to assess his blood glucose level. In addition to high- blood glucose level, you should err on the side of caution and give sugar; this is what medical control will
flow oxygen, medical control will MOST likely order you to: likely order you to do. The patient, although confused, is conscious and will likely be able to swallow.
• A:transport only and closely monitor him. Insulin is not administered to patients in the field, even if hyperglycemia is documented; EMTs and
• B:assist the patient in taking his insulin.
paramedics are usually not familiar with all of the different types of insulin and their respective doses,
• C:give him a salt-containing solution to drink.
• D:give at least one tube of oral glucose. and profound hypoglycemia, potentially resulting in death, can occur if too much insulin is given. After
giving oral glucose, reassess the patient's mental status and vital signs.
A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper You selected D; This is correct!
extremities. Using the adult Rule of Nines, what percentage of his total body surface area
has been burned? Reason:
• A:18% Using the adult Rule of Nines, the head accounts for 9% of the total body surface area
• B:45% (TBSA), the anterior chest for 9% (the entire anterior trunk [chest and abdomen] accounts
• C:36% for 18%), and the anterior upper extremities for 4.5% each (each entire upper extremity is 9%
• D:27% of the TBSA). On the basis of this, the patient has sustained 27% TBSA burns
You selected C; This is correct!
A 40-year-old man was hit in the nose during a fight. He has bruising under
Reason:
his left eye and a nosebleed. After taking standard precautions, you should: During a nosebleed (epistaxis), much of the blood may pass down the throat into the stomach as the patient swallows;
• A:place a chemical icepack over his nose. this is especially true if the patient is lying supine. Blood is a gastric irritant; a person who swallows a large amount of
blood may become nauseated and vomit, which increases the risk of aspiration. Therefore, your first action should be to
• B:apply direct pressure by pinching his nostrils together. ensure that the patient is sitting up and leaning forward. This will prevent blood from draining down the back of the
throat. Next, apply direct pressure by pinching the fleshy part of the nostrils together; you or the patient may do this.
• C:ensure that he is sitting up and leaning forward. Placing a chemical icepack over the nose may further help control the bleeding by constricting the nasal vasculature.
• D:determine if he has any visual disturbances. After controlling the nosebleed, continue your assessment, which includes assessing for facial deformities and visual
disturbances.
A 40-year-old woman presents with widespread hives that she noticed about 45 minutes after taking You selected C; This is correct!
penicillin. She is conscious and alert and denies difficulty breathing. Her breath sounds are clear to Reason:The patient is experiencing an allergic reaction, but she is not in anaphylactic shock. Urticaria (hives) is
auscultation bilaterally, her vital signs are stable, and her oxygen saturation is 94%. She tells you she is common to all allergic reactions, regardless of severity; however, wheezing and hypotension, which she does not
allergic to wasps and has an epinephrine auto-injector. You should: have, are specific to anaphylaxis. Although she carries an epinephrine auto-injector for her allergy to wasps, she was
• A:assist her in administering epinephrine via her auto-injector. not stung by a wasp. Furthermore, the absence of wheezing and hypotension negates epinephrine administration. Give
supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and transport her to the
• B:give high-flow oxygen and administer 100 mg of Benadryl. hospital. Because it can take up to an hour for signs of a severe allergic reaction to manifest, the patient should not
• C:give supplemental oxygen and transport her to the hospital. drive herself. Diphenhydramine (Benadryl), an antihistamine, is an appropriate drug based on her presentation;
• D:advise her that she can probably drive herself to the hospital. however, it is not typically carried on a BLS unit. Furthermore, the correct dose is 25 to 50 mg.
A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but You selected C; This is correct!
confused. His wife tells you that he does not have any medical problems and does not take any
medications. You should be MOST suspicious for: Reason:Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs
and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental
• A:acute stroke. status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and
• B:influenza. potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuberculosis
• C:meningitis. (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke
• D:tuberculosis. may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a
fever.
(
A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of You selected A; This is correct!
speed. You find him in a prone position approximately 50 feet from his car. He is not
Reason:
moving and does not appear to be breathing. You should: When a trauma patient is found in a prone (face-down) position, especially if he or she is unresponsive, your first action
• A:manually stabilize his head. should be to manually stabilize his or her head; this action is based on the assumption that he or she has a spinal injury.
Next, log roll the patient to a supine position (while continuing to manually stabilize the head), open the airway with the
• B:administer high-flow oxygen. jaw-thrust maneuver, clear the airway with suction if needed, and assess for breathing. It would be extremely difficult to
• C:use the jaw-thrust maneuver. adequately open the patient's airway while he or she is in a prone position. Depending on the patient's breathing effort,
administer high-flow oxygen or ventilate using a bag-mask device.
• D:assess his breathing effort.
A 44-year-old male experienced burns to his anterior trunk and both arms. He is conscious The correct answer is D;
and alert, but is in extreme pain. Assessment of the burns reveals reddening and blisters. Reason:
This patient has ________________ burns that cover _____ of his total body surface area. Partial-thickness (second-degree) burns damage the epidermis and part of the dermis, and are characterized by
blistering and severe pain. Areas of superficial (first-degree) burns, which cause reddening of the skin, commonly
• A:first-degree, 27% surround a partial-thickness burn. The anterior trunk (chest and abdomen) accounts for 18% of the total body surface
• B:full-thickness, 18% area (TBSA) and each entire arm accounts for 9%. Therefore, this patient has partial-thickness burns that cover 36% of
his TBSA. Full-thickness (third-degree) burns are characterized by charred or white, leathery skin. Because the entire
• C:second-degree, 45% dermis, including the nerves, is destroyed, full-thickness burns are usually painless. The surrounding areas of partial-
• D:partial-thickness, 36% thickness burns, however, are very painful.
You selected B; This is correct!
A 44-year-old woman was bitten on the ankle by an unidentified snake while working in her garden. She is conscious
Reason:Given the fact that the snake was not identified, you should assume that it was poisonous. Furthermore, the
and alert, has stable vital signs, and denies shortness of breath. Her only complaint is a burning sensation at the wound
presence of puncture wounds, burning, redness, and swelling are suggestive of envenomation. Therefore, you should
site. Your assessment reveals two small puncture wounds, redness, and swelling. You should:
provide emergency care and transport the patient to the hospital. Treatment for a snake bite involves keeping the
• A:conclude that envenomation likely did not occur, provide reassurance, and allow a friend to take her to the hospital.
patient calm, administering oxygen, splinting the affected extremity to decrease movement (helps slow the spread of
• B:give supplemental oxygen, splint her leg to decrease movement, and keep her leg below the level of her heart.
venom), keeping the extremity below the level of the heart, and transporting the patient to the hospital. Do NOT apply
• C:elevate her leg, cover the wound with a dry sterile dressing, and apply an ice pack to reduce pain and swelling.
ice to a snake bite; it may constrict the blood vessels and force venom further into the bloodstream. The use of a
• D:administer high-flow oxygen, apply a constricting band proximal to the bite, and use ice to prevent venom spread.
proximal constricting band is controversial; if one is used, it should be loose, not tight. En route to the hospital, monitor
the patient's vital signs and mental status, and be alert for vomiting.
