NREMT Paramedic 1.4.12 Exam Questions

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21.

All of the following arrhythmias cause a decrease in cardiac output except:

  • Premature atrial complexes

  • Multifocal atrial tachycardia

  • Supraventricular tachycardia

  • Atrial fibrillation

Correct answer: Premature atrial complexes

Premature atrial complexes are benign in the abscesses of side effects. The other rhythms increase the heart rate to dangerous levels, which can cause a decrease in cardiac output.

22.

If the medical command physician orders you to deliver a 200-mL normal saline bolus to a patient showing the signs and symptoms of cardiogenic shock with profound hypotension, which of the following must be monitored closely due to this intervention?

  • Lung sounds for increased congestion/rales

  • Distal pulses to asses peripheral perfusion

  • Increase/decrease in level of consciousness

  • Blood glucose levels

Correct answer: Lung sounds for increased congestion/rales

A patient experiencing suspected cardiogenic shock with hypotension can receive a small fluid bolus (up to 200 mL is common) in an attempt to raise the blood pressure. This is acceptable as long as your patient is not showing additional signs and symptoms indicating the possibility of pulmonary edema such as rales/rhonchi, or JVD in a semi-fowlers position. 

The presence of distal pulses and increases/decreases in the level of consciousness are part of the continued overall examination and are a good indicator of increasing blood pressure; however, it is not the most important element of continued assessment during an infusion/bolus involving cardiogenic shock. Lung sounds must be monitored closely for the onset/presence of pulmonary edema. This is highly possible due to the heart's inability to continue functioning as an effective forward pump.

A patient's blood glucose level may be part of the continued assessment of a cardiogenic shock patient especially if the patient has a decreased level of consciousness. Blood glucose level evaluation in cardiogenic shock would be a secondary assessment finding that would not be as important to monitor closely as the patient's respiratory status for the onset of pulmonary edema and blood pressure.

23.

Electrical waves are sent from the SA node to the AV node, where conduction slows down. The reason for this pause in conduction is:

  • To allow time for the atria to contract completely before ventricular contraction

  • To begin ventricular contraction before the atria finish contracting

  • To send the conduction to the bundle of His more quickly

  • To increase the heart rate

Correct answer: To allow time for the atria to contract completely before ventricular contraction 

The AV node's role is to slow down the electrical conduction before it reaches the bundle of His, causing a pause in conduction for a fraction of a second. This allows the atria to contract completely, and also allows the ventricles to be completely filled with blood before ventricular contraction.

24.

What measure of time on the EKG does the PR segment measure?

  • The end of atrial depolarization to the start of ventricular depolarization

  • The start of atrial depolarization to the start of ventricular depolarization 

  • The cardiac cycle

  • The end of ventricular depolarization to the start of ventricular repolarization

Correct answer: The end of atrial depolarization to the start of ventricular depolarization

The PR segment is the straight line that connects the PR interval to the QRS complex. Therefore, it only measures the time between the end of atrial depolarization to the start of ventricular depolarization.

The PR interval, because it includes the P wave, measures the time between the start of atrial depolarization to the start of ventricular depolarization. The cardiac cycle is measured by the EKG event as a whole, rather than one specific wave. The ST segment measures the end of ventricular depolarization to the start of ventricular repolarization.

25.

Scene

You are on scene, and the ambulance is having trouble getting close due to the crowd and will need several minutes to reach your location. Which of the following would be the most appropriate action in this scenario?

  • Move the patient to a sheltered area near your location

  • Walk with the patient through the open grandstand area to meet the ambulance

  • Stay with the patient until the ambulance can get closer

  • Walk with the patient to the first aid booth, so he can be released from care

Correct answer: Move the patient to a sheltered area near your location

The paramedic should avoid objects that project up from the ground to prevent injury from subsequent lighting strikes. The patient is alert and does not require immediate life-saving interventions, so moving this patient to the sheltered area until the ambulance arrives is the appropriate choice. You should not release this patient until you can perform a secondary assessment. He may have injuries that are not yet apparent and should be evaluated further.

26.

Which of the following may a paramedic be held responsible for if he knowingly makes false statements about a co-worker that ruin her good reputation at her current workplace?

  • Defamation

  • Libel

  • Slander

  • Negligence

Correct answer: Defamation

Defamation of character occurs when a person intentionally makes a false statement, through written or verbal communication, which injures a person's good name or reputation.

Libel occurs when a person makes an untrue statement about another person in writing, or through media, with malicious intent. 

Slander refers to making false verbal statements about another person with malicious intent. 

Negligence is professional action or inaction on the part of the healthcare practitioner that does not meet the standard of ordinary care.

27.

The major difference between sinus rhythm and sinus tachycardia is:

  • The rate

  • The rhythm

  • The number of P waves

  • The shape of the P waves

Correct answer: The rate

Sinus tachycardia occurs when the sinus node fires at the heart rate faster than normal. Therefore, the only difference between the two rhythms is the rate.

28.

ECG rhythms that are conducted by a pacemaker other than the sinus node are known as:

  • Ectopic rhythms

  • Normal rhythms

  • Irregular rhythms

  • Sinus rhythms

Correct answer: Ectopic rhythms 

Ectopic rhythms are all rhythms that are conducted by a pacemaker other than the sinus node.

29.

Post-Scene

Based on the information given in the scenario, which of the following treatments should be initiated during the 9-minute transport to the cardiac center if he develops hypotension and becomes lethargic?

  • Dobutamine (Dobutrex) infusion at 5 mcg/min

  • Oxygen via NRB mask at 15 LPM

  • Start CPAP at 5 cm/H2O

  • Administer 0.3mg nitroglycerin sublingually

Correct answer: Dobutamine (Dobutrex) infusion at 5 mcg/min

This patient is exhibiting signs of decompensated cardiogenic shock. The most appropriate treatment for this patient during transport is to start a Dobutamine (Dobutrex) infusion and monitor the patient closely.

Administration of sublingual nitroglycerin or CPAP is contraindicated and may worsen this patient's condition. There is no indication this patient needs more oxygen via NRB mask.

30.

What represents atrial enlargement on an EKG strip?

  • Prolonged P wave

  • Short P wave

  • Prolonged QRS complex

  • Prolonged T wave

Correct answer: Prolonged P wave

The P wave represents atrial depolarization and is irregular with atrial abnormalities. A prolonged P wave usually shows atrial enlargement.

31.

Which of the following statements is true regarding sinus tachycardia?

  • There can be several non-cardiac causes

  • It is an irregular rhythm

  • The rate is 120-180 beats per minute

  • Treatment focuses on slowing the rate

Correct answer: There can be several non-cardiac causes

Sinus tachycardia is a sinus rhythm of 101-160 beats per minute. Numerous non-cardiac causes of sinus tachycardia include anxiety, pulmonary embolism, and thyrotoxicosis, a medical emergency in which an overproduction of thyroid hormones results in increased heart rate, blood pressure, and temperature. 

Treatment for sinus tachycardia focuses on identifying and treating the underlying cause, not slowing the rate.

32.

Thermal EKG paper requires special care. Which of the following is not recommended when handling thermal paper?

  • The EKG paper should be placed in a well-lit room to avoid discoloration

  • Avoid contact with fluids containing alcohol, such as cleaning equipment

  • The paper should be stored in a cool, dry place

  • The paper should be stored in a room with a humidity between 40% and 65%

Correct answer: The EKG paper should be placed in a well-lit room to avoid discoloration

Instructions on handling thermal paper include the following:

  1. Keep the paper in a cool dark place, free from fluorescent lighting to avoid discoloration
  2. Ensure it is stored in a room with an acceptable humidity (between 40% and 60%)
  3. Avoid contact with cleaning fluids, alcohol, and solvent fluid

33.

What is the next best course of action after seeing this rhythm?

  • Immediate CPR including defibrillation

  • Immediate CPR including cardioversion

  • No immediate action at this time

  • Check leads for malfunction

Correct answer: Immediate CPR including defibrillation

This rhythm is ventricular fibrillation, a lethal rhythm. There is no cardiac output and, therefore, requires immediate CPR to be performed on the patient. Defibrillation is the immediate course of treatment.

34.

En-Route

Which of the following information should EMS crews monitor and document for HAZMAT crew member entry readiness?

Select the 4 answer options which are correct.

  • Blood pressure

  • Respiratory rate

  • Body weight

  • ECG

  • Blood glucose level

  • End-tidal CO2 level

Before entering the hot zone, you or other EMS crew members must assess rescuers and document the following information on an incident flow sheet:

  • blood pressure
  • pulse
  • respiratory rate
  • temperature
  • body weight
  • ECG
  • mental/neurologic status

All hazmat team members should undergo regular annual physical examinations with baseline vital signs placed on file. If you observe anything abnormal, do not allow the hazmat team member to attempt a rescue.

Blood glucose and end-tidal CO2 (EtCO2) levels are not entry-level readiness parameters that are evaluated.

35.

En Route 

Given the details in this scenario, what specific Personal Protective Equipment (PPE) precautions would be recommended?

  • Droplet precautions: gloves, gown, mask and eye protection

  • Respiratory precautions: N95 or similar respirator 

  • Standard universal precautions

  • Full respiratory precautions: N95 or similar respirator with gloves, gown, and face shield

Correct answer: Droplet precautions: gloves, gown, mask and eye protection

Suspected meningitis infections require droplet precautions more than just standard universal precautions. There is no need for respiratory protection with N95 or a respirator.

36.

You are assessing a patient with an altered mental status and a diabetic history. Which of the following would most likely indicate the patient is suffering from diabetic ketoacidosis?

  • Dry skin, dry mucous membranes, hypotension, shallow rapid respirations, and family members report that the patient spoke of increased thirst and frequent urination for several days before calling 9-1-1

  • Cool, moist skin, wet mucous membranes, normal pulses and blood pressure, shallow respirations, and family members report increasing hunger and then nausea in the patient before calling 9-1-1

  • Dry, doughy-looking skin that is cool to the touch, unresponsiveness, bradycardic pulse, normal blood pressure, slow, shallow respirations, and family members report that the patient spoke of increasing intolerance to cold for several days before calling 9-1-1

  • Red hot skin, wet mucous membranes, weak tachycardic pulses, hypotension, shallow rapid respirations, and family members report that the patient spoke of a loss of appetite for several days before calling 9-1-1

Correct answer: Dry skin, dry mucous membranes, hypotension, shallow rapid respirations, and family members report that the patient spoke of increased thirst and frequent urination for several days before calling 9-1-1

Patients with diabetic ketoacidosis normally present with dry skin and dry mucous membranes. They may also be found to be approaching or already hypotensive with rapid, labored breathing. They also often complain of thirst and polyuria for several days in some cases. This often causes ketoacidosis patients to present with dehydration.

Ketoacidosis patients do not present with cool, moist skin and wet mucosa membranes. The patients often complain of thirst and excessive urination (polyuria); hunger is not typical. 

Patients with ketoacidosis do not usually present with doughy skin, bradycardia, or an increased intolerance to cold temperatures. 

Patients experiencing ketoacidosis do not present with red, hot skin. They are more likely to present with cool, dry skin and mucosa.

37.

Negligence is divided into three categories. Which of the following is not one of the categories?

  • Tort 

  • Nonfeasance

  • Malfeasance

  • Misfeasance

Correct answer: Tort

A tort is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability. Negligence is a form of tort. 

Negligence is commonly divided into three categories: 1. Malfeasance, 2. Misfeasance, and 3. Nonfeasance.

Malfeasance occurs if you perform an act that you were never authorized to do, such as a medical intervention outside your scope of practice. 

Misfeasance occurs if you perform an act that you are legally allowed to perform, but it is performed in the wrong manner. 

Nonfeasance occurs if you fail to perform an act that you are required or expected to perform.

38.

A 67-year-old patient has regained a pulse after a witnessed cardiac arrest. She remains unresponsive, with hypotension. Which of the following medications can be used in the management of this patient?

Select the three correct answer options.

  • Norepinephrine (Levophed) 

  • Epinephrine (Adrenaline) 

  • Dopamine (Intropin) 

  • Hydralazine (Apresoline)

The AHA guidelines recommend one of the following medications for treating hypotension in a post-cardiac arrest patient: 

  • Norepinephrine: 0.1 to 0.5 mcg/kg per minute (in a 70 kg adult: 7 to 35 mcg per minute) IV infusion adjusted to achieve a minimum SBP of >90 mm Hg or a mean arterial pressure of >65 mm Hg
  • Epinephrine: 2 to 10 mcg per minute IV infusion adjusted to achieve a minimum SBP of >90 mm Hg or a mean arterial pressure of >65 mm Hg 
  • Dopamine: 5 to 20 mcg/kg per minute IV infusion adjusted to achieve a minimum SBP of >90 mm Hg or a mean arterial pressure of >65 mm Hg 

Follow local protocols. Hydralazine (Apresoline) is used to treat hypertension and lowers the SBP. It is not indicated in post-cardiac arrest with hypotension. 

39.

Which of the following steps are correct for suctioning a stoma? 

Select the 2 answer options which are correct.

  • Apply suction while withdrawing the catheter

  • Use an appropriately sized soft suction catheter 

  • Inject 10 mL of sterile saline through the stoma and into the trachea

  • Use a rigid suction catheter such as the Yankauer 

To suction a stoma, inject a small amount (no more than 3 mL) of sterile saline through the stoma and into the trachea. Next, insert an appropriately sized soft suction catheter without applying suction until resistance is met. Then, apply suction while withdrawing the catheter.

Do not use a rigid suction catheter to suction a stoma. These are for suctioning the mouth and nose only. 10 mL of saline is too much for suctioning and may cause aspiration. 

40.

Cardiovascular drugs are classified according to their action on the heart. Which of the following cardiovascular medication types are administered to increase the strength and/or force of the cardiac contraction?

  • Positive inotropic agents such as digoxin (Lanoxin)

  • Negative chronotropic agents such as verapamil (Isoptin)

  • Negative dromotropic agents such as adenosine (Adenocard)

  • Positive dromotropic agents such as phenytoin (Dilantin)

Correct answer: Positive inotropic agents such as digoxin (Lanoxin)

Inotropic agents given to strengthen or increase the force of cardiac contraction are known as positive inotropic agents. These agents are seen in medications such as digoxin, dobutamine, and epinephrine. A drug given to decrease or weaken the force of the myocardial contraction is a negative inotropic agent. These agents are seen in medications such as propranolol (Inderal).

Chronotropic agents affect heart rate. If a cardiac medication is given to accelerate the heart rate, it is said to have a positive chronotropic effect. These agents are seen in medications such as isoproterenol (Isuprel). A drug that decreases heart rate, such as verapamil (Isoptin), is said to have a negative chronotropic effect. Chronotropic agents do not affect the force or strength of the myocardial contraction. Dromotropic drugs affect the conduction velocity through the conduction fibers of the myocardium. If a cardiac medication accelerates the heart rate by increasing conduction, it is said to have a positive dromotropic effect on the heart. Positive dromotropic agents are seen in medications such as phenytoin (Dilantin). Medications given to decrease the conduction velocity are known as negative dromotropic drugs. These agents are seen in medications such as adenosine (Adenocard). Dromotropic agents do not affect the force or strength of the myocardial contraction.