ANSWERS AT BOTTOM
You are called to the scene of a 19-year-old man who struck a tree while riding his sled
down a steep hill. You find him lying on the hillside. The initial assessment reveals he is
a
wake and talking, has shallow breathing at a rate of 20 breaths a minute, a weak pulse
at a rate of 104 breats per minute, blood pressure
of 100/80, and warm, moist skin. When
you assess the patient's
posterior neck you note defomity of the cervical vertebra. The
detailed
assessment reveals bruising along the right side of his forehead
and chest, and
deformity of his right collarbone. The patient
tells you he feels tingling in both his
arms and legs and cannot
move either. He then asks you to help him.
1. The type of consent that allows you to treat this patient is
referred to as _________ consent.
a. expressed
b. informed
c. witnessed
d. implied
2. Treatment of this patient includes:
1. applying a cervical collar
2. placing him into a semi-sitting position on the cot
3. administering 15 liters of oxygen via non/rebreather mask
4. inserting an oropharyngeal airway
5. applying a sling and swath
select the correct answer.
a. 3 and 5
b. 1 only
c. 2 and 4
d. 1,3 and 4
3. The trendelenburg postion refers to a patient who is:
a. sitting
b. lying flat on his back with legs elevated
c. lying on his stomach
d. on his side
You are called to the home of a 68-year-old woman who fainted
after she took two of her "heart pills." Your assessment reveals
she is awake and complaining of a thrombbing headache, is breathing
at a rate of 16 times a minut, has a weak pulse at a rate of 120
beats per minute, a blood pressure of 100/70, and warm, flushed
skin. Her reason for taking the "heart pills" was that she was experiencing
chest pain. She reports that the chest pain has since subsided.
4. This patient is experiencing:
a. acute myocardial infarction
b. cardiogenic shock
c. side effects of nitroglycerin
d. pulmonary embolism
5. The correct location for delivering chest compressions in the
adult patient in cardiac arrest is the:
a. mid sternum
b. lower half of the sternum
c. upper half of the sternum
d. xiphoid process
6 Match the following medications with the correct does for the pediatric patient.
a. adensoine
b. atropine
c. bretylium
d. diazepam
e. epinephrine (1:10,000)
f. lidocaine
1. 1 mg/kg
2. 0.1-0.2 mg/kg
3. .01mg/kg, .1 ml/kg
4. .4 mg/kg
7. Morphine sulfate is contraindicated in:
1. head injury
2. volume depletion
3. acute myocardial infarction
4. undiagnosed abdominal pain
5. patients receiving digitalis
Select the correct answer.
a. 2 only
b. 2,3 and 5
c. 1,2 and 4
d. 1,3,4 and 5
8. Dobutamine:
a. has little chronotropic activity
b. decreases myocardial contractility
c. is used in the treatment of bradycardia refractory to atropine
d. may lead to respiratory depression
9. With junctional excape rhythm the:
1. heart rate is 40 to 60 breats per minute
2. atrial and ventricular rhythms are irregular
3. P waves are normal and upright in leads II, III and aVF
4. P-R intervals are less than or equal to .12 seconds
5. QRS complexes are typically wide and bizarre in appearance
Select the correct answer.
a. 4 only
b. 2 and 3
c. 1 and 4
d. 1,3 and 5
10. In second-degree AV block, type II the:
a. ventricular rate is typically slow
b. P waves are inverted
c. P-R intervals vary from beat to beat
d. ventricular rate is greater than the atrial rate
11. A narrow of a passageway is referred to as:
a. anuria
b. nocturia
c. pyelitis
d. stricture
12. Match the following abbreviations with the correct meaning.
a. aspirin
b. fluid
c. of each
d. right ear
e. dyspnea on exertion
f. discontinue
1. aa
2. D/C
3. OD
4. ASA
5. fl
You are called to a local hotel where a 63-year-old, 150 pound male
patient was found unresponsive in the exercise room. You arrive
to find two security gruards performing CPR. Your assessment reveals
the patient is unconscious, apneic and pulseless. You can feel a
pulse with a rescuer performing chest compressions. You attach the
quicklook paddles to reveal what appears to be a "flat line" rhythm.
13. This patient is most likely experiencing:
a. asystole
b. pulseless electrical activity
c. ventricular fibrillation
d. complete heart block
14. You place an endotracheal tube and are preparing to establish an IV life line.
The following should be used:
1. normal saline
2. 20-22 gauge, catheter-over-needle
3. veins of the antecubital fossa
4. macrodrip administration set
Select the correct answer.
a. 3 only
b. 1 and 3
c. 3 and 4
d. 2,3 and 4
15. The IV is in place and the patient's condition remains the same.
You should now administer:
a. epinephrine, 1.0 mg, IV push
b. defibrillation, 360 J
c. lidocaine, 90 mg, IV push
d. trascuaneous pacing
16. The patient's condition remains the same. The next treatment
that should be provided is:
a. lidocaine, 90mg, IV push
b. Defibillation, 360 J
c. bretylium, 450 mg, IV push
d. atropine, 1 mg, IV push
17. a quick check of hte ECG monitor reveals ventricular fibrillation.
the next treatment that should be provided is :
a. defibrillation, 200 j, then 300 j, then 360 j
b. epinephrine, 1.0 mg, IV push
c. lidocaine, 90 mg, IV push
d. atropine, 1mg, IV push
With the last treatment, the patient's rhythm converts to sinus
tachycardia, you are able to palpate a carotid pulse and find that
the patient has a blood pressure of 110/84. he is still apneic and
unconscious. you note that the IV is infiltrating. you discontinue
the IV line and cannulate a new site in the opposite arm.
18. The next thing you should do is:
a. defibrillate the patient at 360 j
b. adminster epinephrine, 1.0 mg, IV push
c. administer lidocaine, 70 mg, IV push
d. adminster bretylium, 400 mg, IV push
19. the next treatment that should be provided is:
a. oxygen, 15 LPM via non rebreather
b. and IV infusion of dopamine at 2 mg/kg/minute
c. an IV infusion of lidocaine at 2 to 4 mg per minute
d. atropine, 1 mg, IV pup˜
ANSWERS
1. a: The type of consent that allows you to treat this patient
is referred to as expressed consent.
2. b: Treatment of htis patient includes: assisting his breathing
with a bag-valve-mask device supplied with 15 lieters of oxygen
and a reservoir, applying a cervical collar, securing him to a full
backboard and immobilizing his right arm to his body. The patient
should be promptly transported to an appropriate hospital (preferable a trauma center).
3. b: The trendelenburg postion refers to a patient who is: lying
flat on his back with legs elevated.
4. c: a patient who present with syncope, hypotension and/or throbbing
headache after taking her "heart pills" is mostlikely experiencing: side effects of nitroglycerin.
5.b: The correct location for delivering chest compressions in the
adult cardiac arrest victime is the: lower half of the sternum.
6. Medications with the correct does for the pediatric patient:
a. adenosine: .1-.2 mg/kg; b. atropine:.02 mg/kg; c. bretylium:
5 mg/kg; d. diazepam:.4 mg/kg; e. epinephrine (1:10,000): .01 mg/kg,
.1 ml/kg, .1 ml/kg; f. lidocaine: 1 mg/kg.
7. c: morphone sulfate is contraindication in: head injury, volume
depletion and undiagnosed abdominal pain.
8. a: Dobutamine: has little chronotropic activity, increases myocardial
contractility and is sused in the short-term management of congestive heart failure
9. c: with junction escape rhythm the: heart rate is 40 to 60 beats
per minute, P-R intervals are less than or equal to .12 seconds,
atrial and ventricular rhythms are regular, P waves (if visible)
are inverted in leads II, III and VF, and QRS complexes are typically
narrow and normal in appearance.
10. a: in second-degree AV heart block the: ventricular rate is
typically slow, atrial rate is greater than the ventricular rate,
P waves are normal in size and shape, QRS complexes are usually .10 seconds or greater.
11. d a narrow of a passageway is referred to as: stricture. Other
terms include: anuria: absense of urine formation; nocturia: excessive
urination during the night; pyelitis: inflammation of the renal pelvis
12. Abbreviations wth the correct meaning: a. aspring: ASA; b. fluid:
fl; c. or each: aa; d. right ear: OD; e. dyspnea on exertion: DOE; f. discontinue: D/C.
13. a. This patient is most likely expericing: asystole.
14. b. normal saline (or lactated ringers's solution), the veins
of the antecubiatal fossa, and a 16-18 gauge catheter-over-needle
should be used when starting an IV in a patient experiencing cardiac arrest.
15. a the iv is in place and the patient's condition remains the
same. you should now administer: epinephrine, 1.0mg, IV push
16. d: the patient is now in ventricular fibrllatio. the next treatment
that should be provided is defibrillation, 200 j, then 300 j, then 360 j.
18. c: the patient remains in ventricular fibrillation. the next
thing you hsould do is : adminsterlidocaine, 70 mg, IV push
19. c: the next treatment that should be provided the patient whose
rhythm converted to sinus tachycardia with a pulse is: a 2 to 4
mg per minute IV infusion of lidocaine.
