Deck 40: Patients With Special Challenges

Question 1

Which one of the following best describes an oxygen concentrator?

A) Portable oxygen device that extracts oxygen from the air
B) Nasal cannula connected to a small cylinder of oxygen
C) Small portable device that administers high-concentration oxygen
D) Small oxygen tank that holds concentrated liquid oxygen

Answer 1

A

Question 2

A central intravenous catheter is typically placed for what reason?

A) Repeated administration of medications
B) High risk for cardiac arrest
C) Administration of transvenous oxygen
D) Easy access for hemodialysis

Answer 2

A

Question 3

While assessing a patient on a home mechanical ventilator, the low pressure alarm sounds. Your immediate action would be to:

A) start positive pressure ventilation with high-concentration oxygen.
B) increase the rate of ventilation on the ventilator.
C) check the ventilator tubing for kinking or obstruction.
D) check the connection between the tubing and tracheostomy.

Answer 3

D

Question 4

The high pressure alarm is sounding on a home ventilator. As your partner prepares the bag-valve mask, you quickly determine that no problem exists with the machine itself. As positive pressure ventilation is initiated, you note high resistance to the ventilations and have a difficult time adequately squeezing the bag. Your next action would be to:

A) reapply the ventilator and transport.
B) continue care and transport.
C) check the patient's breath sounds.
D) suction the tracheostomy tube.

Question 5

The fundamental reason a patient uses BiPAP when sleeping is to:

A) provide high-concentration oxygen.
B) keep the small airways open.
C) lower the amount of exhaled CO₂.
D) decrease the incidence of lower airway infection.

Question 6

When assessing a 32-year-old male with a history of mental retardation, you note the protrusion of a clamped tube from her back in the area of her right kidney. The best method of determining what the tube is and why it is in place would be to:

A) contact medical direction.
B) ask family members.
C) contact the home health nursing agency.
D) ask the patient.

Question 7

You are by the side of a 2-month-old baby who was born prematurely and is on an apnea monitor. While in your care, the apnea alarm emits a loud alarm. Quick assessment of the baby reveals no respiratory activity. Your immediate action would be to:

A) Place the baby on the cot and transport.
B) Start positive pressure ventilation.
C) Administer high-concentration oxygen.
D) Check the apnea monitor.

Question 8

A confused patient with a tracheostomy tube is breathing shallowly at 8 times per minute. He is nonverbal because of the tracheostomy and has an SpO₂ at 81% on room air. Your immediate action would be to:

A) attach a bag-valve device to the trachea and start ventilation.
B) place a trach mask over the tube and administer high-concentration oxygen.
C) deflate the cuff on the trach tube and begin positive pressure ventilation.
D) use the bag-valve device with a pediatric mask and ventilate by sealing it over the tube.

Question 9

When assessing a 65-year-old male patient, you note a tube-like device inserted into the lower portion of his trachea. You recognize that the device has most likely been placed to:

A) to permit the exchange of O₂ and CO₂.
B) to allow the patient to be fed a liquid diet.
C) to allow the patient to talk.
D) to allow easy suctioning of the lower airway.

Question 10

Assessment of a patient complaining of the sudden onset of chest pain reveals a central intravenous catheter to his right upper chest. Which one of the following signs related to the catheter should be of greatest concern to the EMT?

A) The skin is red around the insertion site.
B) The line is unclamped and without a cap.
C) There appears to be fluid in the catheter.
D) The catheter tubing is kinked.

Question 11

Which one of the following statements about abuse is true?

A) It is typically found in those who have lower incomes.
B) It tends to occur more often to those with mental health problems.
C) It most often occurs to those who are unable to report it.
D) It is found in all socioeconomic levels.

Question 12

A patient has accidentally removed his peripherally inserted central venous catheter (PICC). Which of the following would be appropriate in the care of this patient?

A) Place an occlusive dressing over the insertion site to prevent air entry.
B) Apply a tourniquet just above the site to decrease air entry into the body.
C) Place a splint on the extremity and wrap site with a pressure dressing.
D) Apply a bulky dressing to the insertion site to control any bleeding.

Question 13

Which one of the following statements about peritoneal dialysis is true?

A) It is more effective than hemodialysis.
B) A catheter is inserted into the abdomen.
C) It is only effective in acute renal failure.
D) A constant low-grade fever is normal and common.

Question 14

You have been called to a residence for a 63-year-old female with a history of COPD who is short of breath. The patient is moderately dyspneic with the following vital signs: pulse 124, respirations 20, blood pressure 162/56, and SpO₂ at 86%. She is using an oxygen concentrator set at 5 lpm. What is your best course of action?

A) Attach a nonrebreather to the oxygen concentrator and increase the liter flow to 12.
B) Continue oxygen administration with the concentrator and transport the patient.
C) Remove the oxygen concentrator and administer high-concentration oxygen to the patient.
D) Administer medical oxygen from your cylinder at the same rate as the concentrator.

Question 15

The wife of a patient, with terminal lung cancer and a Do Not Resuscitate (DNR) order, has called 911 because her husband's pulse oximeter reading fell below 85% and alarmed. He is currently receiving home oxygen through a nasal cannula. Assessment reveals him to be alert and oriented and slightly tachypneic with no abnormal lung sounds. At this time, your next action would be to:

A) start positive pressure ventilation.
B) check the SpO₂ using your pulse oximeter.
C) administer oxygen through a new nasal cannula.
D) place him on the stretcher for transport to the hospital.

Question 16

A 49-year-old male has summoned EMS because of a problem with his tracheostomy tube. At the patient's side, you note the tracheostomy tube to be protruding abnormally from the stoma in his neck. Your first action in caring for this patient would be to:

A) gently attempt to reinsert the tracheostomy tube.
B) quickly establish a baseline SpO₂ level.
C) establish how the tracheostomy tube became dislodged.
D) evaluate the patient's airway and breathing.

Question 17

When suctioning a 46-year-old male with a tracheostomy tube, which of the following is appropriate?

A) Suction from above, using the mouth or nose.
B) Suction no more than 5 seconds using a hard-tipped suction.
C) Introduce 20 mL of sterile water into the tracheostomy tube prior to suctioning.
D) Insert the suction cannula until resistance is met.

Question 18

To find an implanted port on a patient, the EMT should:

A) examine the patient's arm.
B) check the lower abdomen.
C) palpate the anterior chest.
D) look at the lateral neck.

Question 19

Family has called you after the apnea alarm for their 1-month-old baby sounded. They state that the settings seem too high and the alarm goes off frequently. They would like the home health nurse to readjust the settings, so this scenario can be avoided in the future. They do not want the patient transported to the hospital and are prepared to sign a refusal. Assessment reveals no life threats to the airway, breathing, or circulation. Given the situation, you would:

A) have a refusal witnessed and signed.
B) adjust the monitor settings and have a refusal signed.
C) contact medical direction.
D) contact the home health nurse.

Question 20

At a long-term care facility, a nurse informs you that the patient you will be transporting has a peripherally inserted central catheter (PICC) in place. To find this catheter, you should look at the patient's:

A) abdomen.
B) anterior chest.
C) hand.
D) antecubital fossa.

Question 21

An intraventricular shunt benefits a patient by:

A) providing a route to eliminate urine from the bladder.
B) draining fluid from around the heart.
C) allowing medication to be given to the patient.
D) draining cerebrospinal fluid from the brain.

Question 22

A patient has a dialysis AV graft in his right forearm. Which one of the following is true?

A) A blood pressure cannot be taken in the right arm.
B) The blood pressure cuff must be placed above the AV graft.
C) The blood pressure can only be palpated in the right arm.
D) A blood pressure can be obtained by placing the cuff below the graft.

Question 23

A 92-year-old female informs you that she suffers from diabetic retinopathy. Subsequently, you recognize that this condition has occurred in relation to:

A) pressure-related damage to the optic nerve.
B) the lack of glucose to the eye tissue.
C) damage to blood vessels in the eye.
D) development of a film over the interior of the eye.

Question 24

The EMT should recognize a Texas catheter when he observes a:

A) catheter inserted into the patient's penis.
B) catheter protruding from the patient's pelvic region.
C) condom-like device over the patient's penis.
D) collection bag attached to the patient's abdomen.

Question 25

A mentally retarded male is biting himself and has a bleeding bite to his right hand. As you apply direct pressure to the hand, the patient continually pulls his arm away and screams. At this time, you would?

A) Place him on a stretcher and provide rapid transport.
B) Ask the patient's mother to hold direct pressure to the bite.
C) Advise dispatch that advanced life support is needed.
D) Move him to the stretcher for a nonemergency transport.

Question 26

You have been called to a nursing home for a 39-year-old male with shortness of breath. On scene you discover that the patient unsuccessfully attempted suicide several years ago by shooting himself in the head. The patient is belligerent and swearing at you as you assess him. Of the following questions, which one should you ask the nurse first?

A) "Has he ever had shortness of breath before?"
B) "Does he have a Do Not Resuscitate order?"
C) "Has he been given any medications for this?"
D) "Is this his normal mental status?"

Question 27

A patient who received peritoneal dialysis has called 911 for generalized weakness. Which one of the following should be of most concern in this patient?

A) Heart rate of 112
B) Temperature of 101∘F
C) Blood glucose of 146
D) Complaint of thirst

Question 28

A patient who is completely reliant on his gastric tube has accidentally pulled it from his body. As such, which one of the following is true?

A) He cannot eliminate urine from his body.
B) He is bleeding internally.
C) He is unable to receive his oral medications.
D) He is incapable of digestion.

Question 29

You are caring for a conscious 81-year-old male complaining of weakness. The patient is hearing impaired and is wearing a hearing aid in his right ear. As you attempt to get a history, he shakes his head, claiming that he cannot hear you. Which of the following should you do immediately?

A) Ensure that the device is on.
B) Raise your voice and speak slowly.
C) Write the questions on a piece of paper.
D) Ask family members for a medical history.

Question 30

An 87-year-old female has called 911 for generalized weakness. When assessing her pupils, you note the right eye to be cloudy, making the assessment difficult. Based on this, the EMT should be suspicious of:

A) diabetic retinopathy.
B) cataracts.
C) glaucoma.
D) previous stroke.

Question 31

A skilled nursing facility has called you for a patient who has a problem with his intraventricular shunt. The patient is a 21-year-old man who was born with hydrocephalus and had the shunt placed shortly after. When assessing the patient, which sign would raise your suspicion that the shunt is occluded?

A) Blood pressure of 210/126 mmHg
B) Temperature of 101.4∘F
C) Heart rate of 140 beats per minute
D) Complaint of nausea

Question 32

You have been called to a residence for a patient who is sick and not feeling well. The patient has multiple medical problems and is bed confined, with care provided by family members. The patient has a gastric tube and indwelling urinary catheter. What assessment finding should raise your suspicion that the patient has a urinary tract infection?

A) Complaint of abdominal pressure
B) Cloudy urine in the bag of the urinary catheter
C) Complaint of nausea and vomiting
D) No urine noted in the urinary collection bag

Question 33

You are preparing a patient with an indwelling urinary catheter for transport. Pertaining to the catheter, which action must the EMT take?

A) Place the catheter bag below the patient's bladder.
B) Leave the urine in the bag for the hospital to analyze.
C) Deflate the catheter balloon prior to transport.
D) Remove the collection bag and clamp the tubing.

Question 34

While assessing a patient with altered mental status, you note a catheter-like device projecting from the center of the patient's pelvic area. This is most likely a(n):

A) ostomy.
B) indwelling urinary catheter.
C) intraventricular shunt.
D) suprapubic catheter.

Question 35

A patient has an intraventricular shunt. As such, you recognize that there is a problem with what system in the body?

A) Genitourinary
B) Central nervous
C) Digestive
D) Cardiovascular

Question 36

You have been called for a male patient who began complaining of chest pain while receiving hemodialysis. Assessment shows no threats to the airway, breathing, or circulation. His vital signs and blood sugar are normal. Of the following questions, which should you ask first?

A) "Was the dialysis session completed?"
B) "Has he ever has peritoneal dialysis?"
C) "How many sessions does he have each week?"
D) "When did you eat or drink last?"

Question 37

When assessing a patient at an extended care facility, you note the presence of an ostomy bag. As such, you realize that the patient has impaired function of:

A) urinary elimination.
B) fluid balance.
C) kidney activity.
D) fecal elimination.

Question 38

On scene you are presented with a 21-year-old female with multiple disfigurements from birth defects. She is nonverbal and according to her home health nurse, has a fever, which requires transport to the emergency department. Your partner is familiar with her since he transported her last week for the same condition. When obtaining the patient's past medical history, which source should be tried first?

A) Nurse
B) Mother
C) Patient
D) Partner

Question 39

A 77-year-old male who is blind and has a guide dog called 911 for chest pain. On scene you note no immediate life threats and now must move him to the stretcher, located in another room. Which one of the following is most appropriate, given his impairment of sight?

A) Guide and direct him by taking his arm.
B) Allow the guide dog to guide him to the stretcher.
C) Carry him to the stretcher.
D) Assist him to the stretcher with one EMT at either side of him.

Question 40

When assessing a dialysis patient and his AV graft, which one of the following is of most concern?

A) Feeling of a vibration through the graft
B) Palpable pulse in the graft
C) Red and hot skin at the graft site
D) Strong radial pulse distal to the graft

Question 41

A patient with a past history of quadriplegia from a 4-wheeler accident would most likely be unable to:

A) speak.
B) hold utensils.
C) see peripherally.
D) turn his head.

Question 42

A patient who requires home medical oxygen complains of generalized weakness. Assessment indicates a patent airway and adequate respirations. His radial pulse is strong and regular and skin warm and dry. Vital signs are pulse 92, respirations 18, blood pressure 156/88, and SpO₂ 95%. The patient is currently on 2 lpm of oxygen through a portable tank that is bedside. Which of the following is appropriate in the care of this patient?

A) Continue oxygen administration at 2 lpm via nasal cannula.
B) Place the patient on high-concentration oxygen with a nonrebreather.
C) Discontinue oxygen therapy since the SpO₂ is >94%.
D) Administer 4 to 6 lpm oxygen via a simple face mask.

Question 43

The father of a 45-year-old male with mental retardation summoned EMS because his son was not acting right. The patient is awake, but is nonverbal, which is not typical per the father. Your assessment reveals no abnormalities, and vital signs are normal. When calling the chief complaint into the hospital you would state that the patient:

A) "has an unknown chief complaint at this time."
B) "is awake and nonverbal."
C) "is not acting himself per his father."
D) "appears to be sick and not feeling well."

Question 44

On scene, you are by the side of a 3-week-old male who was born prematurely and has an apnea monitor on. His mother states that she was awakened by the alarm and when she went to check on the baby, he was awake and crying. Assessment reveals him to be resting quietly in his mother's arms. The airway is patent and respirations adequate. Vital signs are pulse 136, respirations 28, and SpO₂ 99% on room air. Since the local emergency department is busy and overcrowded, it would be appropriate to:

A) watch the baby for 15 additional minutes and get a refusal if he remains stable.
B) provide high-concentration oxygen and immediate transport to the hospital.
C) recognize a monitor malfunction and help make arrangements for a new one.
D) further assess the baby and treat any problems found prior to transport.

Question 45

After assessing a 67-year-old male, your partner informs you that it appears that the patient had a stroke and has dysarthria. In relation to the dysarthria, you would anticipate the patient being unable to:

A) speak.
B) pronounce words correctly.
C) move one side of his body.
D) speak without stuttering.

Question 46

On scene, you must lead a patient's visually impaired wife from the house to the ambulance. This is best accomplished by:

A) verbally instructing her past obstacles.
B) physically carrying her to the ambulance.
C) placing her hand on the stretcher for guidance.
D) placing her hand on your shoulder.

Question 47

Which of the following would be true regarding a 42-year-old female with traumatic paraplegia?

A) She cannot move her arms.
B) She requires a walker for ambulation.
C) She is ventilator dependent.
D) She would require a wheelchair.

Question 48

At a nursing home, a patient is on a ventilator. The settings are rate 10, tidal volume 550, and oxygen concentration 50%. Which of following is true?

A) A volume of 5,500 mL is delivered every minute.
B) The SpO₂ is being maintained at 50%.
C) A breathing rate of 20 breaths every 3 minutes is being maintained.
D) The delivered rate is incorrect and low.

Question 49

Which of the following correctly identifies a stoma?

A) The inner portion of the tracheostomy tube
B) The strap that secures a tracheostomy tube
C) The opening in the neck for a tracheostomy tube
D) The proper name for a tracheostomy tube

Question 50

You are responding to a patient with a tracheostomy tube who is weak and has a fever. In this situation, you can assume:

A) the patient cannot speak.
B) the tracheostomy tube is below the larynx.
C) the patient is ventilator dependent.
D) the tracheostomy tube is permanent.

Question 51

A patient with quadriplegia most likely suffered an injury to his:

A) brain.
B) thoracic spine.
C) arms and legs.
D) cervical spine.

Question 52

You are assessing a patient with COPD who uses an oxygen concentrator. As such, you recognize:

A) the patient cannot leave home with the concentrator.
B) the patient has a tracheostomy tube with oxygen attachement.
C) the patient requires less than 6 lpm of oxygen.
D) the oxygen device humidifies the O₂ prior to delivery.

Question 53

The EMT would recognize a sensory impairment when he encounters which of the following?

A) 49-year-old male who is hearing impaired in one ear
B) 76-year-old female with headaches caused by hypertension
C) 22-year-old female who was born without a left hand
D) 43-year-old male who had a stroke and is paralyzed on his right side

Question 54

A ventilator-dependent patient is being ventilated with a bag-valve mask as he is transported to the hospital. Which of the following is the best indication that the patient is being adequately ventilated?

A) Normal skin color
B) Noticeable chest rise and fall
C) Rate of 12 breaths per minute
D) SpO₂ reading of 98%

Question 55

A 66-year-old male has summoned your assistance because he is short of breath and his home pulse oximeter is reading 89%, despite 3 lpm of home medical oxygen. Assessment reveals an intact airway and adequate breathing. His radial pulse is normal and skin hot and dry. Vital signs are: pulse 84, respirations 18, and blood pressure 166/86 mmHg. Breath sounds are clear bilaterally. His pulse oximeter is fluctuating between 88% and 90%. In this situation you would first:

A) check his SpO₂ with your pulse oximeter.
B) place him on 15 lpm of oxygen with a nonrebreather.
C) request advanced life support assistance.
D) increase oxygen flow to 6 lpm through the nasal cannula.

Question 56

You have been called to a residence for an unknown medical problem. As you enter the house, what scene clue would most likely suggest the use of home medical oxygen?

A) Coughing and wheezing heard from a bedroom
B) Wife telling you that her husband cannot breathe
C) Metered-dose inhaler of albuterol on the table
D) No smoking sign located on the front door

Question 57

A patient on a ventilator presents as cyanotic and listless. Alarms are sounding. Your immediate action would be to:

A) determine if the vent is a negative or positive pressure type.
B) establish what type of alarm is sounding.
C) disconnect the ventilator and start positive pressure ventilation.
D) stop the ventilator and obtain breath sounds.

Question 58

You are positioning an obese patient weighing 360 pounds on a stretcher for transport to the hospital. Given that the patient is complaining of a headache, which one of the following is appropriate?

A) Place the patient flat, but lying on his right or left side.
B) Allow the patient to assume a position of comfort.
C) Place the patient supine, with towel rolls between his shoulders.
D) Have the patient sit in the back of the ambulance.

Question 59

Which of the following medical problems commonly leads to vision problems?

A) Seizure
B) Chronic obstructive pulmonary disease
C) Diabetes
D) Coronary artery disease

Question 60

A 17-year-old male with cerebral palsy and severe mental retardation fell down five stairs and is crying. To best determine if the patient is in pain, the EMT should:

A) ask the father to ask the patient.
B) thoroughly assess the patient for injury.
C) defer this task to the emergency department.
D) call for advanced life support assistance.

Question 61

A terminally ill female with ovarian cancer is receiving palliative care when she:

A) has a morphine pump implanted in her abdomen.
B) is to receive surgery to remove her ovaries.
C) is undergoing rigorous chemo and radiation therapy.
D) completes and signs a Do Not Resuscitate order.

Question 62

Poor position of an obese patient on the stretcher would most likely result in:

A) hypotension.
B) skin breakdown.
C) respiratory distress.
D) back pain.

Question 63

The family of a patient in hospice care for the final stage of lung cancer has summoned 911 because their father is short of breath. The patient is responsive to verbal stimuli and has an open airway with adequate respiration of 18 to 20 per minute. His skin is cool and diaphoretic with diminished breath sounds bilaterally. Your partner reports a heart rate of 112, blood pressure 96/44 mmHg, and an SpO₂ of 82%. He has a valid DNR, but family is scared and wants him transported to the ED for evaluation. Your next action would be to:

A) monitor during transport but avoid providing physical care.
B) place an oral airway and start positive pressure ventilation.
C) provide high-concentration oxygen, monitor vitals, and transport to the ED.
D) administer oxygen at 2 lpm and provide emotional support during transport.

Question 64

A patient with hypertension and diabetes weighs 190 pounds. His ideal weight is 150 pounds. Consequently, he would best be described as:

A) bariatric.
B) obese.
C) hypertensive obese.
D) morbidly obese.

Question 65

The friend of an impoverished 50-year-old male called 911 because his friend had chest pain. On scene, the patient informs you that he does have a cardiac history and has not seen his cardiologist in over a year since he lost his job. Additionally, he does not want treatment or transport since he knows that both are expensive and will be unable to pay for it. In this situation your best response would be:

A) "In this situation, it is your right to refuse and I respect that."
B) "You may be eligible for free or reduced-cost medical care."
C) "I will make sure that you do not get a bill for this."
D) "You can refuse, but at least follow up with your cardiologist."

Question 66

Hospice care indicates that a patient is:

A) terminally ill and foregoing any additional care.
B) terminally ill and receiving measures to increase comfort.
C) terminally ill and but receiving care to reverse the disease process.
D) terminally ill but without a Do Not Resuscitate order.