NREMT Practice Exam Questions and Answers 2022/2023

NREMT Practice Exam Questions and Answers 2022/2023 NREMT Practice Exam Questions and Answers 2022/2023 Which of the following indicates that a patient is in decompensated shock? A: Restlessness and anxiety B: Diaphoresis and pallor C: Tachycardia and tachypnea D: Falling blood pressure - ANSWER D | Reason: During shock, the compensatory mechanisms of the body attempt to maintain the blood pressure. This is accomplished by increases in heart rate, shunting of blood from the skin to more vital organs, and increasing the respiratory rate to increase the oxygen content of the blood. Once these compensatory mechanisms fail, the blood pressure will fall (hypotension). Hypotension signifies a state of decompensated shock. You must not rely on the patient's blood pressure as an indicator of overall perfusion. Restlessness, anxiety, tachycardia, tachypnea, and cool clammy skin (diaphoresis) are earlier signs of shock and do not necessarily indicate a decompensated state. Which of the following is MOST indicative of a primary cardiac problem? A: Irregular pulse B: Tachypnea C: Sudden fainting D: Tachycardia - ANSWER A | Reason: An irregular pulse signifies an abnormality within the electrical conduction system of the heart. Tachycardia, sudden fainting (syncope), and tachypnea (rapid breathing) can indicate many things other than cardiac problems, such as shock, heat-related problems, and diabetic complications. You should always consider the possibility of a cardiac problem in a patient with an irregular pulse. A 50-year-old man presents with crushing chest pain of sudden onset. He is diaphoretic, apprehensive, and tachypneic. You should: A: obtain baseline vital signs. B: apply supplemental oxygen. C: ask him if he takes nitroglycerin. D: perform a complete physical exam. - ANSWER B: | Reason All of the interventions and assessments listed in this question should be performed on a patient who presents with chest pain, pressure, or discomfort. However, supplemental oxygen is indicated for any patient with a potential cardiac problem and should be given as soon as possible; this is especially true when the patient has potential respiratory involvement as well (ie, dyspnea, tachypnea). Administer oxygen in a concentration sufficient to maintain an oxygen saturation of 94% or greater. Aspirin (up to 325 mg) should also be administered as soon as possible, unless the patient is allergic to it. After applying oxygen and administering aspirin, you should perform a physical exam and obtain baseline vital signs. You would inquire about any prescription medications the patient is taking (eg, NTG) during the SAMPLE history. Immediately following a generalized motor seizure, most patients are: - ANSWER D: | Reason -After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Freshly oxygenated blood returns to the heart via the ? A:vena cavae. B:aorta. C:pulmonary artery. D:pulmonary vein. - ANSWER D: - Reason | The pulmonary vein is the only vein that carries oxygen-rich blood. It carries blood from the lungs back to the left atrium. All other veins in the human body, including the vena cavae, carry deoxygenated blood back to the heart. The aorta is the largest artery in the body and branches immediately from the left ventricle, carrying freshly oxygenated blood to the rest of the body. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs for reoxygenation. A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of speed. You find him in a prone position approximately 50 feet from his car. He is not moving and does not appear to be breathing. You should: A:manually stabilize his head. B:administer high-flow oxygen. C:assess his breathing effort. D:use the jaw-thrust maneuver. - ANSWER A: | Reason - When a trauma patient is found in a prone ( face down ) position, especially if he or she is unresponsive, your first action 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 supinr position ( while continuing to manually stabilize the head) , open the air way with the jaw thrust maneuver , clear the airway with suction if needed, and access for breathing, it would be extremely difficult to adequately open the patients airway while he or she is in a prone position. Depending on the patients breathing effort, administer high flow of oxygenor ventilate using a bag mask device The safest emergency vehicle operator is one who: A:has a positive attitude. B:drives with lights and siren. C:drives with due regard. D:is physically fit. - ANSWER C : - One of the most important attributes of a safe emergency vehicle operator is the ability to drive with due regard for others. This means that the operator must be aware of others around him or her and to keep their safety in mind. The EMT should never assume that all drivers will see or hear the ambulance. A positive attitude about one's ability to safely operate an emergency vehicle is also an important attribute. Although sometimes indicated for the patient's condition, the use of lights and siren increase the risk of an ambulance crash. You are dispatched to the scene of a motorcycle crash. Upon arrival, you find the patient lying facedown approximately 25 feet from his bike. He is not wearing a helmet and is moaning. You should: A:apply a cervical collar. B:evaluate the status of his airway. C:stabilize his head manually. D:log roll him to a supine position. - ANSWER You selected C; This is correct! Reason: The mechanism of injury for this patient was significant. In his present position (prone), you cannot effectively assess his airway. Therefore, your first action should be to manually stabilize his head. Then, you must log roll him into a supine position, keeping his head in an in-line position. If possible, log roll him directly onto a long backboard. After the patient is supine, assess the status of his airway, assess his breathing adequacy, administer high-flow oxygen or begin assisted ventilations if needed, and continue with your primary assessment. Apply a cervical collar as soon as possible, but assess his posterior neck first. Internal or external bleeding would be especially severe in a patient: A:who is hypotensive. B:with hemophilia. C:with heart disease. D:who takes aspirin. - ANSWER You selected B; This is correct! Reason: Hemophilia is a condition in which the patient lacks one or more of the blood's clotting factors. There are several forms of hemophilia, most of which are hereditary and some of which are severe. Sometimes bleeding occurs spontaneously in patients with hemophilia. Because the patient's blood does not clot, all injuries, no matter how minor they appear, are potentially serious. Aspirin does not destroy the blood's clotting factors; it decreases the ability of platelets to stick together. Although this may cause prolonged bleeding time, the patient with hemophilia, who lacks key clotting factors, will bleed more severely. Many patients with heart disease take aspirin daily to prevent clot formation in a coronary artery. When blood pressure is low (hypotension), the driving force of the blood through the blood vessels is reduced; as a result, bleeding tends to be less severe relative to patients with high blood pressure. Unfortunately, however, hypotension indicates decompensated shock. When you arrive at a residence for a man who is "not acting right," you enter the house and find him sitting on his couch. Which of the following findings would be MOST indicative of an altered mental status? A:Odor of alcohol. B:Slurred speech. C:Tired appearance. D:Eyes are closed. - ANSWER You selected B; This is correct! Reason: Often, an altered mental status can be difficult to assess, especially if you do not know how the patient normally acts. However, there are key findings that should increase your index of suspicion. An abnormal speech pattern, such as slurring or incoherent words, can be the result of a diabetic problem, alcohol intoxication, or drug ingestion. All of these can cause an altered mental status. The odor of alcohol suggests intoxication as a potential cause of his problem, but cannot be quantified. Just because the patient's eyes or closed or he has a tired appearance does not necessarily indicate that he has an altered mental status. A 50-year-old woman with a history of epilepsy is actively seizing. Care for this patient should focus primarily on: A:protecting her from injury and ensuring adequate ventilation. B:administering high-flow oxygen and requesting an ALS ambulance. C:frequently suctioning her airway and carefully restraining her. D:placing a bite block in between her molars and giving her oxygen. - ANSWER The correct answer is A; Reason: Seizure deaths are most frequently the result of hypoxia. When a person is actively seizing, he or she is not breathing adequately. Your primary focus when treating a seizure patient is to protect him or her from injury and to ensure adequate ventilation and oxygenation. Many seizing patients require assisted ventilation. Suction the oropharynx only if the patient has secretions in his or her mouth. Do NOT insert anything into the mouth of a seizing patient; doing so may cause an airway obstruction or damage the soft tissues of the mouth, resulting in bleeding. Do not attempt to restrain an actively seizing patient; doing so may result in musculoskeletal injuries. Request an ALS ambulance per your local protocols A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal should you administer? A: 51g B: 60g C: 57g D: 54g - ANSWER A: 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% = weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as 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 tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient. When caring for a patient with an acute behavioral crisis, your primary concern should be: A:gathering all of the patient's medications. B:ensuring you and your partner's safety. C:providing safe transport to the hospital. D:obtaining a complete past medical history. - ANSWER You selected B; This is correct! Reason: When caring for a patient with a behavioral or emotional crisis, your primary concern should be for your own personal safety as well as your partner's safety. Your ultimate goal is to transport the patient to the hospital safely. Gather as much medical history information as possible, but keep in mind that many patients experiencing an emotional or behavioral crisis will not readily provide this information. It is important to remember that patients with emotional or behavioral crises may appear calm initially; however, there is always the potential for them to turn violent. Following an apparent febrile seizure, a 4-year-old boy is alert and crying. His skin is hot and moist. Appropriate treatment this child includes: A:rapidly cooling the child in cold water. B:keeping the child warm and providing transport. C:offering oxygen and providing transport. D:allowing the parents to tranport - ANSWER You selected C; This is correct! Reason: Most children with febrile seizures do not have any permanent aftereffects. The most appropriate treatment is to offer the child oxygen (usually via the blow-by technique), allow a parent to accompany the child in the back of the ambulance, and transport to the hospital. Although most seizures in children result from a simple infection (ie, ear infection) that causes an abrupt rise in body temperature, other illnesses such as meningitis and encephalitis can cause seizures as well and are far more serious. For this reason, any child with fever and seizures should be evaluated in the emergency department. Rapid cooling of the child should be avoided as this will likely cause shivering, which could abruptly increase the child's temperature and cause another seizure. Children with a fever should be kept cool during transport (ie, removing clothing), but not to the point where they shiver. When you begin to assess a woman in labor, she states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be MOST appropriate to ask next? A:Has your bag of waters broken yet? B:At how many weeks gestation are you? C:How many other children do you have? D:Have you had regular prenatal care? - ANSWER The correct answer is B; Reason: When assessing a patient in labor, the first question you should ask is how far along in the pregnancy she is. If she is at less than 37 weeks gestation (37 to 42 weeks is term), you should prepare for possible resuscitation of the newborn if delivery occurs in the field. Other questions, such as asking if her amniotic sac (bag of waters) has ruptured and whether or not she has received prenatal care, also can help you anticipate and prepare for potential complications. You should also inquire as to how many times the patient has been pregnant, regardless of whether she carried the baby to term (gravida), and the number of times she has carried a baby beyond 28 weeks, regardless of whether it was born dead or alive (para). Management for a women who presents with a prolapsed umbilical cord includes all of the following, EXCEPT: A:lifting the baby's head off of the umbilical cord. B:relieving pressure off of the cord by gently pulling on it. C:placing the mother in a position that elevates her hips. D:ensuring that the cord stays moist during transport. - ANSWER You selected B; This is correct! Reason: Management of a prolapsed umbilical cord includes administering high-flow oxygen to the mother; placing the mother in a position that elevates her hips (eg, knee-chest position); carefully inserting your gloved fingers into the vagina to lift the baby's head off of the cord; ensuring that the cord stays moist by covering it with moist, sterile dressings; and transporting rapidly. Never make any attempt to pull on the umbilical cord for any reason; doing so may damage the cord, resulting in severe hemorrhage. A 6-year-old boy presents with a high fever, a headache, and a stiff neck. He is conscious, but is not acting as a normal 6-year-old boy should. His mother told you that he vomited once before your arrival. You should be MOST concerned with: A:the risk of permanent neurological damage. B:the potential for a febrile seizure. C:treating him for severe dehydration. D:performing a secondary assessment at the scene. - ANSWER The correct answer is A; Reason: The child's symptoms (eg, high fever, headache, stiff neck [nuchal rigidity]) are consistent with meningitis, inflammation and infection of the protective coverings of the brain and spinal cord (meninges). Meningitis can be viral, bacterial, or fungal in nature. One form of meningitis, Neisseria meningitidis (N. meningitidis), deserves special attention. N. meningitidis is a bacterium that causes a rapid onset of symptoms, and can cause shock, permanent neurological damage, or death; this should be your primary concern. Administer oxygen as tolerated and transport without delay. If the child experiences a seizure, it will likely be the result of increased intracranial pressure secondary to meningitis, not his fever. Nonetheless, you should monitor him carefully and be prepared to treat any seizure activity. The child may be dehydrated; however, there is little you can do for this at the scene; again, transport without delay. A secondary assessment should be performed, if time permits; however, this should be performed en route to the hospital. Which of the following statements regarding crowning is correct? A:It is safe to transport the patient during crowning if the hospital is close. B:Crowning represents the end of the second stage of labor. C:Crowning always occurs immediately after the amniotic sac has ruptured. D:Gentle pressure should be applied to the baby's head during crowning. - ANSWER You selected D; This is correct! Reason: Crowning occurs when the baby's head is visible at the vaginal opening; it is an obvious sign of delivery in progress. When crowning is observed, you should apply gentle pressure to the infant's head to prevent an explosive delivery. Care must be taken to avoid putting pressure on the fontanelles (the soft spots on the infant's head). Crowning represents the end of the first stage of labor and the beginning of the second stage; it does not always occur immediately after the amniotic sac has ruptured. If the infant's head is born and the amniotic sac is still intact, you need to pinch the thin membrane with your fingers, which will usually cause the sac to easily rupture, and then suction the infant's mouth and nose. Upon arriving at a scene in which a tanker truck overturned and is spilling an unknown liquid on the ground, you should: A:quickly identify the material. B:park upwind from the scene. C:turn off your warning lights. D:stay downhill from the scene. - ANSWER The correct answer is B; Reason: At the scene of a potential or actual hazardous materials incident, you should park the ambulance in an area that is both upwind and uphill from the incident. However, you must be prepared to quickly relocate if the wind direction changes. Staying uphill is important because many hazardous materials collect in low-lying areas, such as valleys. After ensuring that you are in a safe place, attempt to identify the chemical involved by reading the placard on the tanker (with binoculars) and referencing the placard number in the emergency response guidebook (ERG). You are called to a local park for a 7-year-old boy with respiratory distress. During your assessment, you find that the patient is wheezing and has widespread hives and facial edema. What should you suspect has occurred? A:Heat illness B:Poison oak exposure C:Acute asthma attack D:Allergic reaction - ANSWER You selected D; This is correct! Reason: Wheezing, hives, and edema are hallmark findings of an allergic reaction. In this case, the patient is having a severe reaction. Although wheezing occurs in patients with asthma, hives and facial edema do not. Wheezing is not associated with head-related illnesses. Exposure to poison oak or poison ivy causes a local reaction, such as redness and itching or burning; it is not commonly associated with systemic symptoms. Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. Management of this situation should include: A:applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord. B:positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport. C:giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur. D:positioning the mother with her hips elevated, administering high-flow oxygen, and providing transport. - ANSWER You selected D; This is correct! Reason: Limb presentations represent a dire emergency for the newborn and do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the birth canal and remove pressure from the umbilical cord. Administer high-flow oxygen to the mother, cover the protruding limb with a sterile sheet (or any clean sheet, if a sterile sheet is not available), and transport immediately. Do NOT pull on the protruding limb as this may cause injury to the newborn. You are called to treat a 55-year-old man who is experiencing difficulty breathing. After making contact with your patient, he extends his arm out to allow you to take his blood pressure. This is an example of: A:implied consent. B:informed consent. C:actual consent. D:formal consent. - ANSWER You selected C; This is correct! Reason: Actual consent, also referred to as expressed consent, is when the patient asks for your help outright. This may also include nonverbal gestures, such as extending the arm to you to allow you to take the blood pressure. Informed consent involves explaining your proposed treatment to the patient, including the potential benefits and risks of the treatment. Implied consent involves treating an unresponsive patient or minor child (when the parents are not present) based on the assumption that the patient (or the parents of a minor) would consent to emergency treatment. You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should: A:recognize that the patient's injuries disqualify him as an organ donor. B:provide rapid transport only because the patient likely will not survive. C:request authorization from medical control not to initiate care. D:manage the patient aggressively and provide rapid transport. You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should: A:recognize that the patient's injuries disqualify him as an organ donor. B:provide rapid transport only because the patient likely will not survive. C:request authorization from medical control not to initiate care. D:manage the patient aggressively and provide rapid transport. - ANSWER You selected D; This is correct! Reason: It is unlikely that the patient will survive his injury; however, he is still breathing, albeit very poorly, and has a weak carotid pulse. Therefore, you should begin immediate and aggressive treatment and transport him promptly, just as you would for any other critically injured patient. It would clearly be inappropriate to request authorization to provide no care at all. If it is determined by a physician that he will not survive his injury, his organs can potentially be harvested and save several lives. Your actions at the scene of a critically injured patient who was shot during a robbery should include: A:performing a primary assessment only. B:providing care when the police authorize you to. C:starting immediate care as you would with any other patient. D:caring for the patient while manipulating the scene minimally. - ANSWER The correct answer is D; Reason: After ensuring your own safety, your priority while functioning at a crime scene is to provide care to the patient. However, you should make a reasonable effort to avoid manipulating the scene in order to preserve potential evidence. If furniture or other objects do not need to be moved to gain access to the patient and provide adequate working space, they should be left in place. Conversely, if any obstacles impede your care of the patient, they must be moved as needed. Seeking law enforcement approval before treating a critically injured patient would clearly waste valuable time. While you are inside a crashed vehicle assessing a patient who is entrapped, the rescue team should be: A:awaiting specific instructions from you as to how to proceed with the extrication process. B:preparing for a simple extrication process since you were obviously able to access the patient. C:actively extricating the patient using whichever extrication method they deem necessary. D:assessing exactly how the patient is trapped and determining the safest way to extricate. - ANSWER The correct answer is D; Reason: Your ability to access the patient, with or without difficulty, does not indicate the extent of entrapment or method of extrication necessary. The EMT's job is to assess and treat the patient; the rescue team's job is to determine the degree of entrapment and decide how to extricate. As you are assessing the patient, providing any care that you can within the confines of the vehicle, the rescue team should be assessing the vehicle and the degree of patient entrapment; this will enable them to determine the safest, most effective extrication approach. It is critical for the EMT in the vehicle and the rescue team outside the vehicle to constantly communicate. Once the patient has been assessed and provided any immediate life-saving care, and the rescue team has determined the best extrication approach, extrication can begin. After clearing the airway of a newborn who is not in distress, it is MOST important for you to: A:apply blow-by oxygen. B:obtain an APGAR score. C:clamp and cut the cord. D:keep the newborn warm. - ANSWER Answer : D Reason: After ensuring a patent airway (ie, suctioning and positioning), it is extremely important to keep the newborn warm. Newborns cannot maintain body temperature very well and hypothermia can develop very quickly. Blow-by oxygen should be given if the newborn is breathing adequately, but has cyanosis to the face, neck, or trunk (central cyanosis). The umbilical cord should not be clamped and cut until the cord has stopped pulsating and the newborn is breathing adequately. The Apgar score, which is performed at 1 and 5 minutes after birth (and every 5 minutes thereafter), is not used to determine the need for or extent of resuscitation; respiratory effort, heart rate, skin color, and oxygen saturation (SpO2) are used to determine this. How should you treat an unresponsive, uninjured patient with respirations of 16 breaths/min and good chest expansion? A:Suctioning as needed and artificial ventilations B:Jaw-thrust maneuver and frequent suctioning C:Oropharyngeal suctioning and assisted ventilations D:Airway adjunct and oxygen via nonrebreathing mask - ANSWER Answer : D You selected D; This is correct! Reason: After opening the airway of an unresponsive patient, an airway adjunct (oral or nasal airway) should be inserted to keep the tongue from occluding the posterior pharynx. Oral and nasal airways are used in conjunction with manual head positioning to help maintain a patent airway. Unresponsive patients who are breathing adequately (good rate, adequate depth [tidal volume]) should receive high-flow oxygen via nonrebreathing mask. The patient must be monitored closely for signs of inadequate breathing, which will require ventilatory assistance with a bag-mask device. Suction the oropharynx only if blood or other secretions are in the patient's mouth. Freshly oxygenated blood returns to the heart via the: A:aorta. B:pulmonary artery. C:vena cavae. D:pulmonary vein. - ANSWER Answer : D The pulmonary vein is the only vein that carries oxygen-rich blood. It carries blood from the lungs back to the left atrium. All other veins in the human body, including the vena cavae, carry deoxygenated blood back to the heart. The aorta is the largest artery in the body and branches immediately from the left ventricle, carrying freshly oxygenated blood to the rest of the body. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs for reoxygenation. Which of the following patients would be the LEAST likely to present with classic signs and symptoms of acute myocardial infarction? A:59 year-old male with alcoholism and angina pectoris. B:72-year-old female with diabetes and hypertension. C:55-year-old female with COPD and frequent infections. D:64-year-old male with renal disease and depression. - ANSWER The correct answer is B; Reason: Chest pain, pressure, or discomfort (usually lasting greater than 15 minutes) is present in the majority of patients experiencing acute myocardial infarction (AMI). Other common signs and symptoms include shortness of breath, nausea, and diaphoresis. However, elderly female patients—especially those with diabetes—are more likely to present with atypical or unusual signs and symptoms than any other patient population. Diabetic neuropathy—a degenerative nerve condition associated with diabetes—results in decreased sensitivity to pain; therefore, the patient may present without any pain or discomfort. Sometimes, the only presenting signs and symptoms of AMI are generalized weakness, fatigue, or fainting. Which of the following statements regarding the head tilt-chin lift maneuver is correct? A:It can only be used in conjunction with an oropharyngeal airway. B:It is the technique of choice for patients with potential spinal injury. C:It should be used on all unresponsive patients that you encounter. D:It should be used in conjunction with an appropriate airway adjunct. - ANSWER You selected D; This is correct! Reason: In an unresponsive patient without a suspected spinal injury, the head tilt-chin lift maneuver is the recommended method for opening the airway. To aid in maintaining a patent airway, an appropriate airway adjunct (ie, oral or nasal airway) should be used in conjunction with the head tilt-chin lift maneuver. When inserted properly, the oral or nasal airway will keep the tongue off of the posterior pharynx. You must remember that even once an airway adjunct has been placed, proper positioning of the head must be maintained until the airway is secured more definitively (ie, endotracheal intubation). If you suspect that the unresponsive patient has a spinal injury, the jaw-thrust maneuver should be used; however, if the jaw-thrust maneuver does not adequately open the patient's airway, the head tilt-chin lift maneuver should be used. During the rapid head-to-toe assessment of a patient with multiple injuries, you expose the chest and find an open wound with blood bubbling from it. You should: A:apply high-flow supplemental oxygen. B:place a porous dressing over the wound. C:stop your assessment and transport. D:prevent air from entering the wound. - ANSWER The correct answer is D; Reason: A sucking chest wound (open pneumothorax) is a life-threatening condition that must be corrected immediately upon discovery. You must take immediate action to prevent air from entering the wound or the patient's condition may continue to deteriorate. Cover a sucking chest wound with an occlusive (non-porous) dressing and secure it on three sides. This will prevent air from entering the pleural space during inhalation. It is important to note, however, that when you cover the wound, you have converted it from an open pneumothorax to a closed pneumothorax. Therefore, you must closely monitor the patient; if signs of a tension pneumothorax develop (ie, worsened respiratory distress, cyanosis, signs of shock), lift the unsecured corner of the dressing to allow air to escape from the pleural space. In which of the following situations should the jaw-thrust maneuver be used? A:In any patient who is in cardiac arrest B:When the mechanism of injury is unclear C:In a patient who is in need of frequent suctioning D:In a patient with apnea with no signs of trauma - ANSWER You selected B; This is correct! Reason: The jaw-thrust maneuver should be used to open the airway any time the mechanism of injury suggests trauma or when the mechanism of injury is unclear (ie, in a patient who became unresponsive without witnesses). When performed correctly, the jaw-thrust maneuver maintains a patent airway without manipulating the spine. It should be noted, however, that if the jaw-thrust maneuver does not adequately open the patient's airway, the head tilt-chin lift maneuver should be used. Which of the following clinical findings is MOST consistent with a chronic respiratory disease? A:Altered mental status B:Use of accessory muscles C:An irregular pulse D:A barrel-shaped chest - ANSWER The correct answer is D; Reason: In certain lung diseases (eg, emphysema, asthma), air is gradually and continuously trapped in the lungs in increasing amounts; this increases the anterior-posterior (front to back) diameter of the chest, causing the chest to assume a barrel shape. A barrel-shaped chest indicates a chronic respiratory disease. Accessory muscle use and an altered mental status in a patient with respiratory distress should be assumed to be acute findings. An irregular pulse could be the result of a primary cardiac problem, or a cardiac problem secondary to chronic hypoxemia in patients with various respiratory diseases. Proper body mechanics when lifting and moving a patient include: A:maintaining a slight curvature of your back. B:using the muscles of your lower back to lift. C:keeping the weight as close to you as possible. D:twisting at the waist when moving around a corner. - ANSWER You selected C; This is correct! Reason: General guidelines for safe lifting and moving include keeping the weight as close to your body as possible; keeping your back in a straight, locked-in position; using the muscles of your thighs to lift; and avoiding twisting when moving a patient around a corner. Back injuries are the most common injury sustained by the EMT and can be easily avoided if proper lifting and moving techniques are observed. Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. In addition to administering high-flow oxygen, treatment should include: A:treating for shock and uterine massage during transport. B:uterine massage and transport. C:internal vaginal pads and treating for shock during transport. D:placing her on her left side and transport. - ANSWER You selected A; This is correct! Reason: Blood loss of up to 500 mL within the first 24 hours after delivery is considered normal and usually is well tolerated by the mother. However, any bleeding, regardless of the severity, with accompanying signs of shock, must be treated accordingly. In this case, you should apply high-flow oxygen, treat the patient for shock by elevating her legs (if allowed by local protocol) and providing warmth, and provide rapid transport to the hospital while massaging the uterine fundus en route. Placing the mother on her left side is appropriate before she delivers and prevents supine hypotensive syndrome. Dressings should never be packed into the vagina; placing pads into the vagina increases the risk for maternal infection. When applying a vest-style spinal immobilization device to a patient with traumatic neck pain, you should: A:ask the patient to fully exhale as you secure the torso. B:immobilize the head prior to securing the torso straps. C:gently flex the head forward as you position the device. D:secure the torso section prior to immobilizing the head. - ANSWER The correct answer is D; Reason: When you apply a vest-style immobilization device such as a KED, you must immobilize the patient's head after the torso is adequately secured. If you immobilize the head first, the cervical spine may be unnecessarily manipulated as you secure the torso. Prior to securing the torso straps, you should ask the patient to inhale as much as possible so that when the straps are secured, enough space is allowed for the patient to breathe adequately. After full immobilization, the patient's spine should be completely in-line, from the head to the pelvis. During the entire immobilization procedure, the patient's head must be maintained in a neutral in-line position. When ventilating an unresponsive apneic adult with a bag-mask device, you should ensure that: A:ventilations occur at a rate of 20 breaths/min. B:an airway adjunct has been inserted. C:the pop-off relief valve is manually occluded. D:you are positioned alongside the patient. - ANSWER You selected B; This is correct! Reason: When ventilating an unresponsive apneic patient with a bag-mask device, you should ensure that an oral or nasal airway adjunct is inserted, which will keep the tongue off of the posterior pharynx. When ventilating a patient with a bag-mask device, it is best for you to be positioned at the patient's head to allow for better control of the head. Ventilations in the apneic adult with a pulse (ie, not in cardiac arrest) should be provided at a rate of 10 to 12 breaths/min (one breath every 5 to 6 seconds). Generally, only pediatric sized bag-mask devices have pop-off relief valves, which should NOT be occluded, because they help prevent overinflation of the patient's lungs. You are assessing a 70-year-old male who complains of pain in both of his legs. He is conscious and alert, has a blood pressure of 160/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 14 breaths/min and unlabored. Further assessment reveals edema to both of his feet and legs and jugular venous distention. This patient's primary problem is MOST likely: A:left heart failure. B:chronic hypertension. C:right heart failure. D:pulmonary edema. - ANSWER The correct answer is C; Reason: If the right side of the heart is damaged, fluid collects in the body (edema), often showing in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. Another feature of right heart failure is jugular venous distention, which is an indication of blood backing up into the systemic circulation. Left heart failure typically presents with shortness of breath due to fluid in the lungs (pulmonary edema), which indicates blood backing up from the left side of the heart into the lungs. In severe pulmonary edema, the patient may cough up pink, frothy sputum. Right heart failure and/or left heart failure are also referred to as congestive heart failure (CHF). Chronic hypertension cannot be established on the basis of a single blood pressure reading. A 65-year-old man has generalized weakness and chest pressure. He has a bottle of prescribed nitroglycerin, but states that he has not taken any of his medication. As your partner prepares to administer oxygen, you should: A:assist the patient with his nitroglycerin with medical control approval. B:apply the AED and prepare the patient for immediate transport. C:perform a secondary assessment and obtain baseline vital signs. D:administer up to 325 mg of aspirin if the patient is not allergic to it. - ANSWER The correct answer is D; Reason: Aspirin has clearly been shown to reduce mortality and morbitiy associated with acute coronary syndrome (ACS) and should be given as early as possible; the dose is 160 to 325 mg. Even though this patient has chest pain and prescribed nitroglycerin, you must first complete a secondary assessment and obtain baseline vital signs. Medical control will need this information—specifically the patient's blood pressure—in order to determine whether you should assist the patient with his nitroglycerin. The AED is not indicated for this patient because he is not in cardiac arrest. Which of the following patients is the BEST candidate for the administration of nitroglycerin? A:A man with chest pain, expired nitroglycerin spray, and a blood pressure of 110/80 mm Hg B:A woman who has taken three doses of prescribed nitroglycerin without relief of chest pain C:An elderly man with crushing substernal chest pain and a blood pressure of 80/60 mm Hg D:A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg - ANSWER You selected D; This is correct! Reason: Nitroglycerin should be administered to patients who have the prescribed, unexpired drug with them and a systolic blood pressure of greater than 100 mm Hg. No more than three (3) nitroglycerin tablets or sprays should be administered to a patient in the prehospital setting. An expired medication should never be administered to any patient, even if the medication is otherwise indicated for his or her condition. An unresponsive patient with multi-systems trauma has slow, shallow breathing; weak radial pulses; and severe bleeding from a lower extremity wound. You should direct your partner to: A:assist the patient's ventilations while you control the bleeding. B:apply oxygen via nonrebreathing mask while you control the bleeding. C:radio for a paramedic ambulance to respond to the scene. D:prepare the long spine board and straps for rapid spinal immobilization. - ANSWER You selected A; This is correct! Reason: The goal of the primary assessment is to rapidly identify and correct all life-threatening injuries or conditions. In the case of this patient, as your partner maintains in-line cervical spine control, he or she should assist the patient's ventilations. An unresponsive patient with slow, shallow breathing is not breathing adequately and should be treated with ventilatory assistance, not a nonrebreathing mask. As your partner is managing the patient's airway and providing ventilatory assistance, you should apply direct pressure (or a tourniquet, if needed) to the extremity wound to control the bleeding. It is important for you and your partner to work together so that all life-threats can be corrected as soon as possible. Most EMS systems work with two-person crews and do not have the luxury of a third EMT. If the police or fire department is on the scene, you can ask them to gather equipment for you. The request for an ALS ambulance is based on factors such as the patient's condition and transport time to the closest appropriate hospital. The MOST obvious way to reduce heat loss from radiation and convection is to: A:move to a warmer environment. B:increase metabolism by shivering. C:wear a thick wind-proof jacket. D:move away from a cold object. You selected A; This is correct! - ANSWER You selected A; This is correct! Reason: In a cold environment, the body has two ways of staying warm: generating heat (thermogenesis) and reducing heat loss. Radiation is the transfer of heat by radiant energy. The body can lose heat by radiation, such as when a person stands in a cold room. Convection occurs when heat is transferred to circulating air, as when cool air moves across the body's surface. A person standing in windy cold weather, wearing lightweight clothing, is losing heat to the environment mostly by convection. The quickest and most obvious way to decrease heat loss from radiation and convection is to move out of the cold environment and seek shelter from wind. Shivering increases the body's metabolism and is a mechanism for generating heat, not reducing heat loss. Layers of clothing trap air and provide excellent insulation; thus, layered clothing decreases heat loss better than a single, thick jacket. Conduction is the direct transfer of heat from a part of the body to a colder object by direct contact, as when a warm hand touches cold metal or ice. The most obvious way to decrease heat loss by conduction is to remove your hand from the cold object. You are called to a local nightclub for an injured patient. Law enforcement personnel have secured the scene. Upon arrival, you see a young man who is lying on the ground screaming in pain; bright red blood is spurting from an apparent stab wound to his groin area. You should: A:control the bleeding. B:prevent hypothermia. C:ensure an open airway. D:apply 100% oxygen. - ANSWER You selected A; This is correct! Reason: This patient's airway is obviously patent; he is screaming in pain. Blood spurting from the groin area indicates arterial bleeding from the femoral artery. If this bleeding is not controlled immediately, the patient will die. Oxygen and other shock treatment (ie, keeping him warm) should be initiated after this life-threatening bleeding is controlled. If you take the time to set up and administer oxygen prior to managing the bleeding, the patient will die. Base your treatment priorities on what will kill the patient first. When caring for a patient with an acute behavioral crisis, your primary concern should be: A:ensuring you and your partner's safety. B:obtaining a complete past medical history. C:gathering all of the patient's medications. D:providing safe transport to the hospital. - ANSWER You selected A; This is correct! Reason: When caring for a patient with a behavioral or emotional crisis, your primary concern should be for your own personal safety as well as your partner's safety. Your ultimate goal is to transport the patient to the hospital safely. Gather as much medical history information as possible, but keep in mind that many patients experiencing an emotional or behavioral crisis will not readily provide this information. It is important to remember that patients with emotional or behavioral crises may appear calm initially; however, there is always the potential for them to turn violent. Following penetrating trauma to the abdomen, a 50-year-old woman has a large laceration with a loop of protruding bowel. How should you manage this injury? A:Carefully replace the bowel and apply an occlusive dressing. B:Apply a moist, sterile dressing covered by a dry, sterile dressing. C:Apply a dry, sterile dressing covered by an occlusive dressing. D:Apply a tight pressure dressing to control any external bleeding. - ANSWER The correct answer is B; Reason: Management of an open abdominal wound with an eviscerated bowel includes controlling any external bleeding, covering the exposed bowel with a moist, sterile dressing, and covering that with a dry, sterile dressing. Applying a dry dressing directly to the exposed bowel will cause the bowel to dry. You must never replace the exposed bowel into the abdominal cavity or apply pressure to the wound. Doing so significantly increases the patient's risk for infection as well as further trauma. A 44-year-old woman was bitten on the ankle by an unidentified snake while working in her garden. She is conscious and alert, has stable vital signs, and denies shortness of breath. Her only complaint is a burning sensation at the wound site. Your assessment reveals two small puncture wounds, redness, and swelling. You should: A:elevate her leg, cover the wound with a dry sterile dressing, and apply an ice pack to reduce pain and swelling. B:give supplemental oxygen, splint her leg to decrease movement, and keep her leg below the level of her heart. C:conclude that envenomation likely did not occur, provide reassurance, and allow a friend to take her to the hospital. D:administer high-flow oxygen, apply a constricting band proximal to the bite, and use ice to prevent venom spread. - ANSWER The correct answer is B; Reason: Given the fact that the snake was not identified, you should assume that it was poisonous. Furthermore, the presence of puncture wounds, burning, redness, and swelling are suggestive of envenomation. Therefore, you should provide emergency care and transport the patient to the hospital. Treatment for a snake bite involves keeping the patient calm, administering oxygen, splinting the affected extremity to decrease movement (helps slow the spread of venom), keeping the extremity below the level of the heart, and transporting the patient to the hospital. Do NOT apply ice to a snake bite; it may constrict the blood vessels and force venom further into the bloodstream. The use of a 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. A 56-year-old diabetic man is found unresponsive by his wife. She tells you that he ate breakfast this morning, but is unsure if he took his insulin. His respirations are rapid and shallow, his skin is cool and profusely diaphoretic, and his pulse is rapid and weak. Which of the following statements regarding this patient is correct? A:The fact that he ate breakfast makes hypoglycemia highly unlikely. B:He needs glucose as soon as possible because he is likely hypoglycemic. C:You should request an ALS unit so they can give the patient his insulin. D:He probably did not take his insulin and has a high blood glucose level. - ANSWER The correct answer is B; Reason: Based on the patient's presentation, you should suspect that he is in insulin shock (hypoglycemic crisis) and requires glucose as soon as possible. Cool, clammy (diaphoretic) skin; rapid, shallow respirations; and a rapid, weak pulse are classic signs of insulin shock. Diabetic coma (hyperglycemic ketoacidosis) typically presents with deep, rapid respirations (Kussmaul respirations); warm, dry skin; and tachycardia. If a diabetic patient has an altered mental status or is unresponsive, you should assume that he or she is hypoglycemic unless there is a specific information to the contrary (ie, failure to take prescribed insulin, hypoglycemia ruled out by glucometer). Even if the patient is in diabetic coma and needs insulin, it is rarely given in the field by ALS personnel. The EMT can quickly rule hypoglycemia in or out by assessing the patient's blood glucose level with a glucometer. A 36-year-old male, who is a known diabetic, presents with severe weakness, diaphoresis, and tachycardia. He is 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-flow oxygen, medical control will MOST likely order you to: A:assist the patient in taking his insulin. B:transport only and closely monitor him. C:give at least one tube of oral glucose. D:give him a salt-containing solution to drink. - ANSWER The correct answer is C; Reason: The patient's signs and symptoms indicate hypoglycemia. When you are in doubt as to a patient's blood glucose level, you should err on the side of caution and give sugar; this is what medical control will likely order you to do. The patient, although confused, is conscious and will likely be able to swallow. Insulin is not administered to patients in the field, even if hyperglycemia is documented; EMTs and paramedics are usually not familiar with all of the different types of insulin and their respective doses, 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. Which of the following statements regarding two-rescuer child CPR is correct? A:The chest should not be allowed to fully recoil in between compressions as this may impair venous return B:A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations C:The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered D:Compress the chest with one or two hands to a depth that is equal to one third the diameter of the chest - ANSWER You selected D; This is correct! Reason: When performing two-rescuer CPR on a child (1 year of age to the onset of puberty [12 to 14 years of age]), the chest should be compressed with one or two hands (depending on the size of the child), and a compression to ventilation ratio of 15:2 should be delivered. It is important to compress the chest to an adequate depth—one third the anterior-posterior diameter of the chest (about 1 1/2" in the child). The chest should be allowed to fully recoil in between compressions in order to maximize venous return to the heart. If an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) is not in place, two rescuers should deliver "cycles" of CPR; the compressor should pause briefly so the ventilator can deliver two breaths. A compression to ventilation ratio of 30:2 is used for one-rescuer child CPR. After an advanced airway device has been inserted, "cycles" of CPR should not be performed; compressions should be continuous at a rate of at least 100/min and ventilations should be delivered at a rate of 8 to 10 breaths/min (one breath every 6 to 8 seconds). Immediately upon delivery of a newborn's head, you should: A:dry the face. B:cover the eyes. C:suction the mouth. D:suction the nose. - ANSWER As soon as the newborn's head has delivered, you should first suction the mouth, then the nose. As the infant is forced through the birth canal, the thoracic cavity is squeezed, which causes the infant to expel amniotic fluid from the lungs. If this fluid is not thoroughly suctioned, it can be aspirated, resulting in inadequate ventilation and hypoxia. Immediately before or after suctioning the infant's airway, you should check for the presence of a nuchal cord (umbilical cord wrapped around the neck). General guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion include: A:separating the child from the parent to ensure a reliable examination. B:examining the child in the parent's arms. C:palpating the painful area of the abdomen first. D:placing the child supine and palpating the abdomen. - ANSWER The correct answer is B; Reason: If the child's condition is stable, the parent should be allowed to hold the child during the examination. This will minimize anxiety in the child and will make the assessment easier for you. In general, you should avoid separating the child and parents unless the child's condition warrants it. When assessing the abdomen of any patient, you should palpate the most painful area last. A 70-year-old man with a history of emphysema and congestive heart failure is in cardiac arrest. His wife tells you that he collapsed about 5 minutes before your arrival. Your partner begins one-rescuer CPR as you prepare the AED. As you are applying the AED pads, the man's wife tells you that she wants you to let him die in peace. You should: A:comply with her request and cease all resuscitative efforts. B:cease resuscitation only if the AED does not indicate a shock. C:continue performing CPR and ask her if he has a living will. D:perform rescue breathing only and contact medical control. - ANSWER You selected C; This is correct! Reason: When faced with a situation in which a family member does not wish for you to attempt resuscitation of a loved one, you should inquire about the presence of a living will or out-of-hospital do not attempt resuscitation (OOH-DNAR) order. If a valid living will or OOH-DNAR order is produced, it is generally acceptable to cease resuscitative efforts; consult medical control as needed. If a valid living will or OOH-DNAR order is not available, the most prudent action would be to continue CPR and contact medical control. Even in the absence of such documentation, medical control may advise you to cease resuscitation based on the wishes of the family and the patient's medical history. When in doubt, err on the side of the patient and attempt resuscitation. Few would argue that it is preferable to defend why resuscitation was attempted as opposed to why it was not. You receive a call at 3:00 a.m. for a patient who is slumped over the steering wheel of his car, which is parked on the shoulder of the road. Your unit and a police officer arrive at the scene at the same time. You should: A:stay in your unit until the police officer checks the patient. B:park the ambulance 25 feet in front of the patient's vehicle. C:approach the vehicle from the front to ensure maximum visibility. D:shine a spotlight in the side view mirror of the patient's vehicle. - ANSWER You selected A; This is correct! Reason: Unfortunately, it is not uncommon for people to fake illness or injury with the intent of harming responding personnel. In this situation, you should utilize the safety resource at the scene: the police officer. You and your partner should stay in the unit until the police officer checks the patient to ensure it is safe for you to approach. Remember, the safety of you and your partner comes first! As soon as you begin transport of a patient to the hospital, you should: A:notify the receiving facility. B:advise dispatch of your status. C:conduct a detailed examination. D:contact medical control. - ANSWER The correct answer is B; Reason: Immediately upon departing the scene with a patient, you should first inform the dispatcher that you are en route to the hospital. Never leave the dispatcher in the dark, for it is the dispatcher's job to know what units are available to answer emergency calls. Notifying the receiving facility, contacting medical control, and performing a detailed assessment of your patient all can occur while you are en route to the hospital. You are called to treat a 55-year-old man who is experiencing difficulty breathing. After making contact with your patient, he extends his arm out to allow you to take his blood pressure. This is an example of: A:informed consent. B:formal consent. C:actual consent. D:implied consent. - ANSWER You selected C; This is correct! Reason: Actual consent, also referred to as expressed consent, is when the patient asks for your help outright. This may also include nonverbal gestures, such as extending the arm to you to allow you to take the blood pressure. Informed consent involves explaining your proposed treatment to the patient, including the potential benefits and risks of the treatment. Implied consent involves treating an unresponsive patient or minor child (when the parents are not present) based on the assumption that the patient (or the parents of a minor) would consent to emergency treatment. Immediately following a generalized seizure involving tonic-clonic activity, most patients: A:experience prolonged apnea and require positive-pressure ventilations. B:have a slow heart rate because of cardiac depression during the seizure. C:are unresponsive but gradually regain consciousness. D:return to a normal level of consciousness but cannot recall the event. - ANSWER The correct answer is C; Reason: Most generalized (grand mal) seizures last 3 to 5 minutes and are followed by a lengthy (5 to 30 minutes) period called the postictal phase, in which the patient is unresponsive at first but gradually regains consciousness. During the seizure itself, the nervous system releases excess adrenaline (epinephrine); therefore, tachycardia, even after the seizure has stopped, is common. Apnea is common during a seizure; however, breathing usually resumes after the seizure has stopped. Many patients are tachypneic following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Unlike grand mal seizures, petit mal seizures (also called absence seizures) can last for just a fraction of a minute, after which the patient fully recovers immediately with only a brief lapse of memory of the event. Which of the following structures is responsible for regulating body temperature? A:Cerebrum B:Medulla oblongata C:Hypothalamus D:Cerebellum - ANSWER The correct answer is C; Reason: The hypothalamus, which is located within the brainstem, regulates body temperature by acting as the body's thermostat. During a heat-related emergency, the hypothalamus can "reset" the body's normal temperature to a much higher temperature in response to the environment and the body's inability to eliminate heat. A patient overdosed on several drugs and is unresponsive with shallow breathing and facial cyanosis. As you continue your assessment, the patient suddenly vomits. You should: A:insert an oropharyngeal airway. B:suction his oropharynx at once. C:begin assisting his ventilations. D:turn the patient onto his side. - ANSWER You selected D; This is correct! Reason: The patient's airway must be clear of foreign bodies or secretions before it can be assessed or managed. If the patient begins to vomit, he must first be rolled onto his side to allow for drainage of the vomitus. Use suction to remove secretions after you have positioned him on his side. After the airway is clear, you should insert an appropriate airway adjunct (oral or nasal airway) and ensure adequate ventilation and oxygenation. In this patient, this involves assisting his ventilations with a bag-mask device. Which of the following patients obviously needs positive-pressure ventilation assistance? A:Responsive to pain only; respiratory rate of 8 breaths/min and shallow B:Combative; respiratory rate of 24 breaths/min and deep C:Restless; respiratory rate of 12 breaths/min with adequate tidal volume D:Semiconscious; respiratory rate of 14 breaths/min and good chest rise - ANSWER You selected A; This is correct! Reason: Any patient with a decreased level of consciousness should be assessed for inadequate breathing (eg, fast or slow respiratory rate, reduced tidal volume [shallow breathing]). Of the patients listed, the patient who is responsive to pain only and has shallow respirations of 8 breaths/min clearly needs positive-pressure ventilation assistance. Slow, shallow respirations will not produce the minute volume needed to support adequate oxygenation of the blood. You receive a call for a 49-year-old woman who passed out. The patient's husband tells you that they were watching TV when the incident occurred. No trauma was involved. The patient is semiconscious and has cyanosis to her lips. After opening her airway with the head tilt-chin lift maneuver, you should: A:assess her respiratory effort. B:insert a nasopharyngeal airway. C:begin ventilation assistance. D:insert an oropharyngeal airway. - ANSWER The correct answer is B; Reason: In the absence of trauma, open the patient's airway with the head tilt-chin lift maneuver. To help maintain airway patency, a nasopharyngeal airway should be inserted. Your patient is semiconscious, not unconscious, so she will likely gag if you attempt to insert an oropharyngeal airway; this may result in aspiration if she vomits. Remember, you must first open the patient's airway and, if needed, suction any secretions from the mouth. Next, insert an airway adjunct and assess respiratory effort. The method of oxygenation you provide depends on the adequacy of the patient's breathing. Priority treatment for a large avulsion includes: A:assessing distal circulation. B:controlling any bleeding. C:cleaning the wound. D:immobilizing the injured area. - ANSWER You selected B; This is correct! Reason: Immediate treatment for any soft-tissue injury begins with controlling any external bleeding. Once the bleeding is controlled, distal circulation, motor, and sensory functions should be assessed, the wound dressed and bandaged, and then distal circulation, motor, and sensory functions reassessed. The injured area can be immobilized as well to prevent further injury and to help reduce bleeding. Generally, open wounds are not cleaned in the field unless they are grossly contaminated with large debris. Which of the following questions would be the MOST effective in determining if a patient's chest pain radiates away from his or her chest? A:Is there anything that makes the pain better or worse? B:Do you also have pain in your arm, jaw, or back? C:Is there any other part of your body where you have pain? D:Does the pain stay in your chest or move anywhere else? - ANSWER You selected D; This is correct! Reason: When assessing a patient with any type of pain, you should avoid asking leading questions; instead, ask open-ended questions whenever possible. For example, instead of asking the patient if his or her pa