NREMT PRACTICE EXAM WITH WELL
ELABORATED DETAILED ANSWERS
(TEST BANK) GRADED A
A 22-year-old female fell on her knee and is in severe pain. Her knee
... [Show More] is flexed and
severely deformed. Her leg is cold to the touch and you are unable to palpate a
distal pulse. You should:
• A:carefully straighten her leg until you restore a distal pulse and then apply
padded board splints.
• B:apply gentle longitudinal traction as you straighten her leg and then apply a
traction splint.
• C:manually stabilize her injury and contact medical control for further
stabilization instructions.
• D:place a pillow behind her knee and stabilize the injury by applying padded
board splints. - ANSWER-The correct answer is C;
Reason:
A dislocated knee occurs when the proximal end of the tibia completely displaces
from its juncture with the distal femur. In some cases, the popliteal artery behind
the knee may be compressed, resulting in compromised distal blood flow. Signs of
this include absent distal pulses and a pale extremity that is cool or cold. Manually
stabilize the knee and assess for distal pulses. If distal pulses are absent, contact
medical control immediately for further stabilization instructions. Medical control
may instruct you to make ONE attempt to realign the knee to reduce compression
of the popliteal artery and restore distal circulation. If you are unable to restore
distal circulation or medical control advises you not to manipulate the injury,
splint the knee in the position it was found and transport promptly. Traction
splints are contraindicated in any injury to or near the knee
Which of the following is a common side effect of nitroglycerin?
• A:Nausea
• B:Headache
• C:Hypertension
• D:Anxiety - ANSWER-You selected B; This is correct!
Reason:
Because nitroglycerin (NTG) causes vasodilation, including the vessels within the
brain, cerebral blood flow increases following the administration of NTG. This
often causes a pounding headache for the patient. As uncomfortable as it is for
the patient, headaches are a common and expected side effect of the drug. The
vasodilatory effects of nitroglycerin could result in hypotension; therefore, the
patient's blood pressure should be carefully monitored. Nausea and anxiety are
common symptoms of acute coronary syndrome; they are not common side
effects of nitroglycerin.
While assessing a patient with chest pain, you note that his pulse is irregular. This
indicates:
• A:acute myocardial infarction or angina pectoris.
• B:high blood pressure that is increasing cardiac workload.
• C:a dysfunction in the left side of the patient's heart
• D:abnormalities in the heart's electrical conduction system. - ANSWER-You
selected D; This is correct!
Reason:
An irregular pulse indicates abnormalities in the electrical conduction system of
the heart. The electrical conduction system, beginning with the sinoatrial node as
the primary pacemaker, is responsible for initiating the electrical impulses that
stimulate the myocardium to contract. An irregular pulse could indicate
potentially lethal arrhythmias that could result in cardiac arrest. You should
document an irregular pulse and report this important finding to the emergency
department.
Which of the following statements regarding the automated external defibrillator
(AED) is correct?
• A:AEDs can safely be used in infants and children less than 8 years of age
• B:AEDs will analyze the patient's rhythm while CPR is in progress
• C:The AED should be applied to patients at risk for cardiac arrest
• D:The AED should not be used in patients with an implanted defibrillator -
ANSWER-You selected A; This is correct!
Reason:
According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), the
AED can safely be used in infants and children less than 8 years of age. Although a
manual defibrillator is preferred in infants, an AED can be used. When using the
AED in infants and children, you should use pediatric pads and a dose-attenuating
system (energy reducer); however, if these features are not available, adult AED
pads should be used. The AED should only be applied to patients in cardiac arrest;
if a patient is at risk for cardiac arrest, have the AED ready but not applied. The
AED will not analyze the cardiac rhythm if the patient is moving (ie, CPR is in
progress). AEDs can be used in patients with an automated implanted
cardioverter/defibrillator (AICD) or implanted pacemaker; ensure that the pads
are at least 1" away from the implanted device.
Which of the following is an abnormal finding when using the Cincinnati stroke
scale to assess a patient who presents with signs of a stroke?
• A:One arm drifts down compared with the other side.
• B:Both arms drift slowly and equally down to the patient's side.
• C:The patient's face is symmetrical when he or she smiles.
• D:One of the pupils is dilated and does not react to light. - ANSWER-The correct
answer is A;
Reason:
The Cincinnati Stroke Scale is used to assess patients suspected of experiencing a
stroke. It consists of three tests: speech, facial droop, and arm drift. Abnormality
in any one of these areas indicates a high probability of stroke. To test arm drift,
ask the patient to hold both arms in front of his or her body, palms facing upward,
with eyes closed and without moving. Over the next 10 seconds, observe the
patient's arms. If one arm drifts down toward the ground, you know that side is
weak; this is an abnormal finding. To test for facial droop, have the patient smile,
showing his or her teeth. The face should be symmetrical (both sides of the face
should move equally). If only one side of the face moves well, you know that
something is wrong with the part of the brain that controls the facial muscles. You
should assess the pupils of a patient with a suspected stroke; however, this is not
a component of the Cincinnati Stroke Scale.
Shortly after assisting a 60-year-old woman with her second nitroglycerin
treatment, she tells you that she is lightheaded and feels like she is going to faint.
Her symptoms are MOST likely due to:
• A:low blood pressure.
• B:an irregular heartbeat.
• C:a drop in her blood sugar.
• D:nervousness and anxiety. - ANSWER-You selected A; This is correct!
Reason:
Nitroglycerin (NTG) is a vasodilator; as such, it may cause a drop in blood
pressure (hypotension) in some patients. Signs and symptoms of hypotension
include dizziness, lightheadedness, and fainting (syncope), among others. For this
reason, you should always assess a patient's blood pressure before and after
administering nitroglycerin. If the patient's systolic BP is less than 100 mm Hg,
NTG should not be given. The patient is probably nervous and anxious, and may
even have an irregular heartbeat; however, hypotension is a more likely cause of
her symptoms. NTG does not affect a patient's blood sugar level.
A 60-year-old man is in cardiac arrest. You begin CPR while your partner applies
the AED. What should you do if you receive a no shock message?
• A:Ensure that the AED electrodes are properly applied.
• B:Reanalyze his cardiac rhythm after 30 seconds of CPR.
• C:Assess for a carotid pulse for up to 10 seconds.
• D:Resume CPR, starting with chest compressions. - ANSWER-You selected D;
This is correct!
Reason:
If the AED gives a no shock advised message, you should immediately resume CPR,
starting with chest compressions. After 2 minutes of CPR, reanalyze the patient's
cardiac rhythm and follow the AED voice prompts. You should not assess for a
pulse if the AED gives a no shock message; this will only cause an unnecessary
delay in performing chest compressions. Rarely, if ever, does CPR alone restore a
normal cardiac rhythm and pulse. If the AED electrodes are improperly applied, it
will not analyze the patient's cardiac rhythm; instead, you will receive a "check
patient" or "check electrodes" message. Continue CPR, rhythm analysis every 2
minutes, and defibrillation (if indicated) until ALS personnel arrive or the patient
starts to move.
Shallow respirations are an indication of:
• A:increased minute volume.
• B:increased carbon dioxide removal.
• C:increased oxygen intake.
• D:decreased tidal volume. - ANSWER-You selected D; This is correct!
Reason:
Shallow respirations are an indication of decreased tidal volume. Tidal volume is
the amount of air (in milliliters [mL]) breathed into or out of the lungs in a single
breath. Adequate tidal volume is needed to bring in adequate amounts of oxygen
and eliminate adequate amounts of carbon dioxide. Patients with shallow
breathing often need some form of positive-pressure ventilation assistance (eg,
bag-mask or pocket face mask device), especially if they have a decreased mental
status. Minute volume is the volume of air that is moved through the lungs per
minute; it is a product of tidal volume multiplied by the respiratory rate. If tidal
volume is reduced, minute volume will be reduced as well unless there is a
compensatory increase in the respiratory rate [Show Less]