Emergency Care (EMT), 13th Edition Test Bank

Emergency Care, 13e (Limmer et al.) Chapter 2 The Well-being of the EMT 1) Which of the following descriptions BEST defines the term pathogen? A) An immunity developed after an exposure B) A study of the origins of infection and disease C) A medication with a harmful effect D) An organism that causes infection and disease Answer: D Explanation: A) INCORRECT. Immunity following an exposure is known as an “acquired immunity.” B) INCORRECT. Pathology is the study of the origins of infections and disease. C) INCORRECT. A medication with a harmful side effect is not called a pathogen. D) CORRECT. Pathogens are organisms that cause infection, such as viruses and bacteria. Page Ref: 27 Objective: 2.1 2) What is a common term used to describe the items needed for Standard Precautions or body substance isolation precautions? A) Harm-reduction strategy B) Exposure-control plan C) Personal protective equipment D) Infection-control plan Answer: C Explanation: A) INCORRECT. The term harm-reduction strategy does not describe the items needed for body substance isolation precautions. B) INCORRECT. Although an exposure-control plan may include directives for Standard Precautions, the term itself does not refer to the items required. C) CORRECT. Personal protective equipment such as gloves, goggles, and gowns help to protect care providers from exposure to body substances. D) INCORRECT. An infection-control plan will usually call for body substance isolation precautions, but it is not a term used to describe the items needed. Page Ref: 27-28 Objective: 2.1 1 Copyright © 2016 Pearson Education, Inc. 3) All of the following are ways that an EMT can increase both physical and mental well-being, except: A) drinking caffeine instead of alcohol. B) following a regular walking regimen. C) spending more time relaxing with friends and family. D) eating more carbohydrates. Answer: A Explanation: A) CORRECT. Both caffeine and alcohol can increase stress and anxiety, as well as disturb sleep patterns. B) INCORRECT. When performed safely and properly, exercise helps to “burn off” stress, and it can also better prepare the EMT for the physical aspects of the job. C) INCORRECT. Devoting time to relaxing with friends and family can have a positive effect on a person’s mental well-being. D) INCORRECT. Healthful eating habits, such as avoiding fatty foods and increasing carbohydrate intake, is physically and mentally beneficial. Page Ref: 27-28 Objective: 2.2 4) What would be the primary reason for an EMT to change gloves between contact with different patients? A) To protect the EMT from becoming infected B) To minimize the amount of time the EMT’s hands are spent in gloves C) To ensure soiled gloves are changed as soon as possible D) To prevent spreading infection to the next patient Answer: D Explanation: A) INCORRECT. Wearing gloves is what protects EMTs from exposure to infection, not changing them between patients. B) INCORRECT. There is no need to minimize the amount of time an EMT wears gloves while providing patient care. C) INCORRECT. Disposing of soiled gloves is important, but it is not the primary reason to change them between patients. D) CORRECT. Be sure to change gloves between contact with different patients to prevent the spread of infection. Page Ref: 29-31 Objective: 2.3 2 Copyright © 2016 Pearson Education, Inc. 5) An EMT should consider wearing protective eyewear when caring for which of these patients? A) A patient with a difficult-to-visualize scalp laceration B) A trauma patient who is covered in dirt, rocks, and other foreign debris C) A patient who is actively coughing D) A patient who was sprayed with mace by police during arrest Answer: C Explanation: A) INCORRECT. A scalp laceration that is difficult to see does not specifically require the EMT to have protective eyewear. B) INCORRECT. Dirt and foreign debris on a patient does not generally pose an exposure threat to responders. C) CORRECT. Eye protection prevents splashing, spattering, or spraying fluids (such as from a cough) from entering the body through the mucous membranes of the eyes. D) INCORRECT. Mace is not a pathogen that can infect an EMT through exposure to the eyes. Page Ref: 31 Objective: 2.3 6) During which of these situations would the EMT be least likely to experience a body substance exposure? A) Bandaging a laceration B) Childbirth C) Splinting a sprained ankle D) Glucometry Answer: C Explanation: A) INCORRECT. Exposure to blood is likely when caring for lacerations. B) INCORRECT. Emergency responders can easily be exposed to blood and numerous types of body fluids when assisting at childbirth. C) CORRECT. Splinting a sprained ankle will generally not expose an EMT to blood or body fluids. D) INCORRECT. Glucometry involves obtaining blood samples for testing. Page Ref: 27-29 Objective: 2.3 3 Copyright © 2016 Pearson Education, Inc. 7) Due to the high risk of an unstable work environment, EMTs responding to a motor vehicle crash may consider using ________ in addition to standard PPE. A) N-95 masks B) heavy-duty gloves C) face shields D) Level B hazmat suits Answer: B Explanation: A) INCORRECT. N-95 masks will provide no additional protective benefit to providers responding to an unstable environment. B) CORRECT. As an EMT works in rescue operations, such as following a car crash, he will need personal protective equipment that includes turnout gear (coat, pants, and boots), protective eyewear, helmet, and heavy-duty gloves. C) INCORRECT. Although face shields will protect against some fluid exposure, they would generally not be beneficial as protection at a vehicle crash scene. D) INCORRECT. Level B hazmat suits are not only unnecessary during a standard vehicle crash response, they would also provide very little extra protection from metal and broken glass. Page Ref: 49 Objective: 2.3 8) You are called to an assault on a homeless male. Dried blood from the trauma is visible around the patient’s mouth and nose. During assessment, you note the patient has a productive cough. The patient says, “Don’t worry, I’m not contagious. I’ve had this cough for a year.” Describe the best approach regarding respiratory isolation. A) Isolate the patient with a nonrebreather mask. B) Mask yourself and the patient. C) Mask yourself only. D) Use gloves for PPE, as that’s all that’s needed. Answer: B Explanation: A) INCORRECT. A nonrebreather mask would not be appropriate for this type of patient. You should use an N-95 of HEPA respirator. B) CORRECT. Best practice would be to mask yourself and the patient using an N-95 or HEPA respirator. C) INCORRECT. It is a good idea to mask yourself in this situation; however, the patient should also be masked. D) INCORRECT. Since this patient could spatter fluid or blood, a mask should be worn in addition to gloves. Page Ref: 35 Objective: 2.3 4 Copyright © 2016 Pearson Education, Inc. 9) Which of the following is true regarding proper hand cleaning? A) Soap and water should be used following any patient contact if the EMT does not wear gloves. B) If the EMT’s hands are visibly dirty, an alcohol-based hand cleaner is not sufficient. C) In cases where soap and water and alcohol-based hand cleaners are not immediately available, bleach wipes should be used. D) Following patient contact, the EMT should soak his hands in warm soapy water for at least 30 seconds and then shake them vigorously. Answer: B Explanation: A) INCORRECT. Proper hand cleaning is critical even when gloves are used, and in most situations an alcohol-based hand cleaner is appropriate. B) CORRECT. Alcohol-based hand cleaners are considered effective except when hands are visibly soiled or when anthrax is present. C) INCORRECT. Either soap and water or alcohol-based hand cleaners should always be used following patient contact; bleach wipes are not safe for skin. D) INCORRECT. When soap and water are available following patient contact, vigorous hand washing is recommended; soaking and shaking is not effective. Page Ref: 31 Objective: 2.4 10) What mode of transmission most accurately describes the route of spreading hepatitis A? A) Respiratory droplet B) Unprotected sex C) Fecal-oral D) Bloodborne Answer: C Explanation: A) INCORRECT. Hepatitis A is not normally transmitted through respiratory secretions. B) INCORRECT. Although most types of hepatitis can be spread through unprotected sex, hepatitis A is not usually transmitted this way. C) CORRECT. Hepatitis A is acquired primarily through contact with food or water contaminated by feces. D) INCORRECT. Hepatitis A is not a bloodborne pathogen. Page Ref: 33 Objective: 2.5 5 Copyright © 2016 Pearson Education, Inc. 11) Which of the following pathogens can live in dried blood for days and should be a major concern for EMS providers even while cleaning contaminated equipment? A) Tuberculosis B) Hepatitis B C) Hepatitis A D) AIDS Answer: B Explanation: A) INCORRECT. Tuberculosis cannot live for extended periods in dried blood. B) CORRECT. Hepatitis B has been found to live for many days in dried blood spills, posing a risk of transmission long after many other viruses would have died. C) INCORRECT. Hepatitis A does not live for long periods in dried blood. D) INCORRECT. The virus that causes AIDS does not live long outside of the body. Page Ref: 33 Objective: 2.5 12) Healthcare employers are required by law to provide a hepatitis B ________ available to employees free of charge. A) prophylaxis B) vaccine C) cure D) immunity Answer: B Explanation: A) INCORRECT. Although a prophylaxis is a measure taken to prevent a disease, the law governing healthcare providers is more specific regarding hepatitis B. B) CORRECT. Employers must make the hepatitis B vaccination series available free of charge and at a reasonable time and place. C) INCORRECT. There is no cure for hepatitis B. D) INCORRECT. The law does not require healthcare employers to provide immunity from hepatitis B. Page Ref: 36 Objective: 2.5 6 Copyright © 2016 Pearson Education, Inc. 13) Which of the following is an accurate statement regarding tuberculosis (TB)? A) The incubation period of TB is from 1 to 7 days. B) TB is not spread through surface contamination. C) The TB pathogen only affects lung tissue. D) A tuberculin skin test can detect TB exposure. Answer: D Explanation: A) INCORRECT. The incubation period for tuberculosis is between 2 and 12 weeks. B) INCORRECT. Tuberculosis is highly contagious and can be spread through any contact with infected fluids, whether airborne or on surfaces. C) INCORRECT. The tuberculosis infection can sometimes settle in the lungs, but may also be found in other areas of the body. D) CORRECT. Although there is no immunization against tuberculosis used in the United States, a tuberculin skin test (TST) can detect exposure. Page Ref: 34 Objective: 2.5 14) Which of the following statements about HIV/AIDS is true? A) HIV positive needlesticks have a 30 percent infection rate. B) The HIV virus lives longer outside the body than hepatitis B. C) HIV positive needlesticks have less than a 0.05 percent infection rate. D) Drugs are not available that slow HIV from progressing into AIDS. Answer: C Explanation: A) INCORRECT. Hepatitis B, not HIV, have positive needlesticks result in a 30 percent infection rate. B) INCORRECT. Whereas the hepatitis B virus can survive for days in dried blood, HIV does not survive well outside of the human body. C) CORRECT. According to the U.S. Occupational Safety and Health Administration (OSHA), less than half of 1 percent of HIV positive needlesticks result in infection. D) INCORRECT. Although there is currently no cure, there are drugs available that slow HIV from progressing into AIDS. Page Ref: 34 Objective: 2.5 7 Copyright © 2016 Pearson Education, Inc. 15) Which one of these groups is at greatest risk of contracting and transmitting tuberculosis? A) Current and former smokers B) Immunosuppressed patients C) Uranium mine workers D) Healthcare practitioners Answer: B Explanation: A) INCORRECT. Smoking does not create the greatest risk for contracting tuberculosis. B) CORRECT. Those at greatest risk of contracting and transmitting TB are people who have suppressed immune systems. C) INCORRECT. Although inherently dangerous, exposure to uranium does not increase a person’s risk of contracting tuberculosis. D) INCORRECT. Healthcare practitioners who are healthy and take proper body substance isolation precautions are not at the greatest risk for contracting or transmitting TB. Page Ref: 34 Objective: 2.5 16) You are treating a patient who has a productive cough and who reports weight loss, loss of appetite, weakness, night sweats, and fever. Which of the following diseases is most likely the cause of these signs and symptoms? A) Hepatitis B B) Pneumonia C) AIDS D) Tuberculosis Answer: D Explanation: A) INCORRECT. Abdominal and/or joint pain, dark urine, fever, weakness, and jaundice are common signs and symptoms of hepatitis B. B) INCORRECT. A person suffering from pneumonia may present with a cough, fever, chills and difficulty breathing. C) INCORRECT. Although rapid weight loss and night sweats or fevers are common among patients with AIDS, a productive cough is not generally related. D) CORRECT. Patients who have TB may have the following signs and symptoms: productive cough (coughing up mucus or other fluid) and/or coughing up blood, weight loss and loss of appetite, lethargy and weakness, night sweats, and fever. Page Ref: 39 Objective: 2.5 8 Copyright © 2016 Pearson Education, Inc. 17) The CDC recommends using an alcohol-based hand sanitizer in all except which of the following situation(s)? A) The patient has a bloodborne communicable disease. B) The patient has a respiratory illness. C) The provider is not vaccinated against hepatitis B. D) The provider’s hands come into contact with fecal matter. Answer: D Explanation: A) INCORRECT. Alcohol-based hand sanitizers are recommended after contact with patients who have bloodborne diseases. B) INCORRECT. After caring for a patient with a respiratory illness, an alcohol-based hand cleaner would be an effective way for the provider to sanitize her hands. C) INCORRECT. If soap and water are not immediately available, the CDC recommends using an alcohol-based hand sanitizer after treating a hepatitis B patient. D) CORRECT. The CDC considers alcohol-based hand sanitizers to be effective except for when hands are visibly soiled or when anthrax is present. Page Ref: 31 Objective: 2.6 18) What is the name of the federal act that mandates a procedure by which emergency healthcare providers can find out if they have been exposed to potentially life-threatening diseases while on the job? A) Communicable Disease Notification Act B) EMS Personnel Health Protection Act of 1991 C) Occupational Exposure to Bloodborne Pathogens Act D) Ryan White CARE Act Answer: D Explanation: A) INCORRECT. The Communicable Disease Notification Act is not a federal mandate. B) INCORRECT. The federal government did not mandate exposure notifications through an EMS Personnel Health Protection Act in 1991. C) INCORRECT. The Occupational Exposure to Bloodborne Pathogens Act does not exist as a federal regulation. D) CORRECT. The Ryan White CARE Act and the Ryan White HIV/AIDS Treatment Extension Act of 2009 establish procedures by which emergency response workers may find out if they have been exposed to life-threatening infectious diseases. Page Ref: 37-39 Objective: 2.7 9 Copyright © 2016 Pearson Education, Inc. 19) You respond to a laceration call. When you arrive on-scene, you walk into the house and find a person suffering from a severe wrist laceration from a broken window. Without thinking, you immediately grab the wrist and apply direct pressure to the wound. You then realize that, in your hurry to save a life, you forgot to put on your gloves. You look down to see your hand is covered in blood. When practical, you immediately wash your hands thoroughly. What is your next best action? A) Report the exposure incident because it is the law and you could be fined a large sum of money for failing to report the exposure. B) Report the exposure so you can protect yourself from any accidental infection. C) Report the exposure. Failure to report the exposure may result in you not receiving financial compensation for a potential line-of-duty injury. D) If your hands had no open wounds, it is not required to report the exposure as there is no risk of infection, and you could get in trouble at work for failure to follow policy. Answer: B Explanation: A) INCORRECT. There is no law mandating that employees have to self-report any exposures. B) CORRECT. Immediate reporting of any bloodborne pathogen exposure is critical to minimize any potential infection risk to the EMT. C) INCORRECT. Although reporting the exposure may be helpful from a financial perspective should the EMT become infected, this is not the best reason for disclosing the exposure. D) INCORRECT. Fear of discipline is never an acceptable reason for failing to report an exposure, and just because the EMT has no open wounds it does not mean that there is no risk. Page Ref: 37 Objective: 2.7 20) What are the minimum Standard Precautions an EMT should take when transporting a patient infected with Middle East Respiratory Syndrome (MERS)? A) Gloves, N-95 mask, and goggles B) Gloves C) Gloves and N-95 mask D) Gloves, N-95 mask, goggles, and gown Answer: D Explanation: A) INCORRECT. Gloves, N-95 mask, and goggles are not sufficient Standard Precautions when transporting a MERS patient. B) INCORRECT. Gloves alone will not properly protect the EMT when caring for a MERS patient. C) INCORRECT. Gloves and an N-95 mask will only protect the provider’s hands and respiratory system, leaving other routes open to infection from MERS exposure. D) CORRECT. Protection against MERS and other respiratory infections in a patient-care setting includes frequent hand washing and the use of gloves, gowns, eye protection, and an N-95 respirator. Page Ref: 35 Objective: 2.8 10 Copyright © 2016 Pearson Education, Inc. 21) When covering a patient’s mouth and nose with a mask of any kind, which of the following is the primary risk? A) Causing or exasperating respiratory illnesses B) Interfering with patient communication C) Upsetting the patient because of the social stigma D) Obstructing the ability to visualize and protect the airway Answer: D Explanation: A) INCORRECT. The masks used by medical care providers will not cause or exasperate respiratory illnesses. B) INCORRECT. Although certain types of masks can interfere with verbal communication, it is not a primary risk. C) INCORRECT. Upsetting a patient because of the appearance of a medically necessary mask is not generally a risk. D) CORRECT. When covering a patient’s mouth and nose with a mask of any kind, use caution. The mask reduces the ability to visualize and protect the airway. Page Ref: 32 Objective: 2.8 22) When the potential exists for exposure to exhaled air of a person with suspected or confirmed TB, a(n) ________ mask should be worn by the EMT. A) surgical B) B-50 C) nonrebreather D) N-95 Answer: D Explanation: A) INCORRECT. A surgical mask does not provide enough protection when exposed to tuberculosis. B) INCORRECT. A B-50 mask is not used in the EMS setting. C) INCORRECT. An EMT would never wear a nonrebreather mask when caring for a patient. D) CORRECT. EMTs are required to wear an N-95 or HEPA respirator when treating or transporting a patient suspected of having TB. Page Ref: 32 Objective: 2.8 11 Copyright © 2016 Pearson Education, Inc. 23) The tuberculin skin test (TST), formerly known as the purified protein derivative (PPD) test, is used to: A) determine if a person has infected others with TB. B) detect a person’s exposure to tuberculosis. C) inoculate healthcare workers against TB infections. D) prevent tuberculosis from spreading following an exposure. Answer: B Explanation: A) INCORRECT. The TST does not determine if a person is infected with TB, nor if they have infected others. B) CORRECT. The tuberculin skin test will show if a person has been exposed to TB. C) INCORRECT. There is no immunization against tuberculosis used in the United States. D) INCORRECT. A tuberculin skin test will not prevent the spread of TB. Page Ref: 40 Objective: 2.9 24) Which of the following terms is best defined as “a state of physical and/or psychological arousal to a stimulus?” A) Homeostasis B) Distress C) Stress D) Eustress Answer: C Explanation: A) INCORRECT. The body’s tendency to seek and maintain a certain equilibrium is called homeostasis. B) INCORRECT. Distress is a negative form of stress that can cause immediate and long-term problems with health and well-being. C) CORRECT. Doctors and psychologists generally define stress as a state of physical and/or psychological arousal to a stimulus. D) INCORRECT. Eustress is a positive form of stress that helps people work under pressure and respond effectively. Page Ref: 44-45 Objective: 2.10 12 Copyright © 2016 Pearson Education, Inc. 25) Which of the following is the form of stress that can cause immediate and long-term problems with an EMT’s health and well-being? A) Megastress B) Hyperstress C) Distress D) Eustress Answer: C Explanation: A) INCORRECT. Megastress is not a recognized form of stress. B) INCORRECT. The term hyperstress usually refers to a long-term mental or psychological strain that causes a person to feel overwhelmed. C) CORRECT. Distress can cause immediate and long-term problems with a person’s health and well-being. D) INCORRECT. Eustress is a positive form of stress that helps people to work under pressure and respond effectively. Page Ref: 44 Objective: 2.10 26) What action does an organ undergo to best describe the term hypertrophy? A) Absence B) Wasting C) Changing D) Enlargement Answer: D Explanation: A) INCORRECT. Hypertrophy does not indicate the absence of an organ. B) INCORRECT. An organ that is wasting is not considered to be hypertrophying. C) INCORRECT. Although a hypertrophied organ is one that has changed, that is not the best description of the term. D) CORRECT. The term hypertrophy means enlargement and is seen in the third stage of the body’s response to stress. Page Ref: 41 Objective: 2.11 13 Copyright © 2016 Pearson Education, Inc. 27) Which of the following parts of the nervous system is responsible for the “fight or flight” response experienced in response to a stressor? A) Parasympathetic nervous system B) Central nervous system C) Peripheral nervous system D) Sympathetic nervous system Answer: D Explanation: A) INCORRECT. The parasympathetic nervous system is responsible for more passive tasks like stimulating saliva production. B) INCORRECT. The central nervous system consists of the brain and spinal cord and does not directly react to stress. C) INCORRECT. The peripheral nervous system does not create the “fight-or-flight” response. D) CORRECT. When exposed to stressors, the sympathetic nervous system increases its activity in what is known as the “fight-or-flight” syndrome. Page Ref: 41 Objective: 2.11 28) Which hormone helps the body control stress, regulate metabolism, and influence an immune response? A) Immunoglobulin B) Serotonin C) Epinephrine D) Cortisol Answer: D Explanation: A) INCORRECT. Immunoglobulin is a protein that neutralizes bacteria and viruses in the body. B) INCORRECT. Serotonin influences a person’s sleep, appetite, and moods. C) INCORRECT. Epinephrine, also known as adrenaline, does not assist in stress control or regulate metabolism. D) CORRECT. Cortisol is the hormone that influences metabolism and immune response, and is critical to the body’s ability to adapt to and cope with stress. Page Ref: 41 Objective: 2.11 14 Copyright © 2016 Pearson Education, Inc. 29) An EMT is confronted by an armed gunman who is threatening to kill the EMT and his partner. An elevation in the EMT’s heart rate and blood pressure occurs in which stage of the body’s response to stress? A) Resistance stage B) Exhaustion stage C) Alarm reaction stage D) Response stage Answer: C Explanation: A) INCORRECT. The body systems return to normal during the resistance stage of stress. B) INCORRECT. The exhaustion stage includes adrenal gland enlargement and bleeding gastric ulcers. C) CORRECT. During the alarm reaction stage of stress, pupil dilation, heart rate increases, and bronchial passage dilation are all common. D) INCORRECT. There is no clinically recognized “response stage” to stress. Page Ref: 41 Objective: 2.11 30) The “Stress Triad,” or the body’s response to a stressful stimulation, is known as general ________ syndrome. A) incident B) resistance C) reaction D) adaptation Answer: D Explanation: A) INCORRECT. A general incident syndrome is not related to the “Stress Triad.” B) INCORRECT. The body’s response to stress is not called the general resistance syndrome. C) INCORRECT. The “Stress Triad” does not include a general reaction syndrome. D) CORRECT. The “Stress Triad” is also known as general adaptation syndrome. Page Ref: 41 Objective: 2.11 31) According to Dr. Hans Selye, the third stage of the “Stress Triad” is known as the ________ stage. A) resistance B) cumulative C) exhaustion D) alarm Answer: C Explanation: A) INCORRECT. Resistance is the second stage of Dr. Selye’s “Stress Triad.” B) INCORRECT. The “Stress Triad” doesn’t include a cumulative stage. C) CORRECT. Exhaustion is the third stage of the “Stress Triad.” D) INCORRECT. The alarm stage is first in Dr. Selye’s “Stress Triad.” Page Ref: 41 Objective: 2.11 15 Copyright © 2016 Pearson Education, Inc. 32) Which of the following is a physiologic effect of the “Stress Triad” as described by the physician Hans Selye? A) Bleeding gastric ulcers B) Hypertrophy of the lymph nodes C) Atrophy of the adrenal glands D) Amnesia for stressful events Answer: A Explanation: A) CORRECT. During the third stage of the “Stress Triad,” Dr. Selye describes enlargement (hypertrophy) of the adrenal glands; wasting (atrophy) of lymph nodes; and bleeding gastric ulcers. B) INCORRECT. The “Stress Triad” can result in atrophy of the lymph nodes. C) INCORRECT. The adrenal glands will actually become enlarged (hypertrophy) during the third stage of the “Stress Triad.” D) INCORRECT. Amnesia is not an effect of the “Stress Triad.” Page Ref: 41 Objective: 2.11 33) The term burnout is also known as a(n) ________ stress reaction. A) delayed B) post-traumatic C) acute D) cumulative Answer: D Explanation: A) INCORRECT. A delayed stress reaction doesn’t result in burnout. B) INCORRECT. Burnout is not a sign or symptom of a post-traumatic stress reaction. C) INCORRECT. An acute stress reaction occurs during or just after a critical incident, whereas burnout takes longer to develop. D) CORRECT. A cumulative stress reaction (also known as burnout) occurs as a result of prolonged recurring stressors. Page Ref: 42 Objective: 2.12 34) Post-traumatic stress disorder may be described as a(n): A) acute stress reaction. B) cumulative stress reaction. C) severe stress reaction. D) delayed stress reaction. Answer: D Explanation: A) INCORRECT. Acute stress reactions occur immediately, whereas PTSD does not. B) INCORRECT. Unlike a cumulative stress reaction, which is caused by a series of events over time, PTSD can be caused by one significant event. C) INCORRECT. Posttraumatic stress disorder is not generally called a severe stress reaction. D) CORRECT. A delayed stress reaction, also known as posttraumatic stress disorder (PTSD), has signs and symptoms that may not become evident until days, months, or even years later. Page Ref: 42 Objective: 2.12 16 Copyright © 2016 Pearson Education, Inc. 35) What are some signs and symptoms that a coworker may be experiencing delayed stress reaction (PTSD)? A) Suspicion of friends, family, coworkers, or patients B) Excessive sleeping, loss of appetite, and distractibility C) Headaches, stomach ailments, and a chronic cough D) Flashbacks, nightmares, and feelings of detachment Answer: D Explanation: A) INCORRECT. Suspicion is generally not a symptom of PTSD. B) INCORRECT. A coworker with these signs and symptoms may be suffering from depression, but not PTSD specifically. C) INCORRECT. PTSD does not commonly cause physical ailments. D) CORRECT. Signs and symptoms of PTSD may include flashbacks, nightmares, feelings of detachment, irritability, sleep difficulties, or problems with concentration or interpersonal relationships. Page Ref: 42 Objective: 2.12 36) A(n) ________ is a situation that may lead to an acute stress reaction. A) routine call B) abuse of alcohol C) ongoing night shift D) injury of a coworker Answer: D Explanation: A) INCORRECT. A routine call will not lead to an acute stress reaction. B) INCORRECT. Substance abuse will generally lead to cumulative issues. C) INCORRECT. An ongoing night shift may lead to cumulative stress problems. D) CORRECT. An acute stress reaction occurs simultaneously with or shortly after a critical incident, such as a disaster or injury of a coworker. Page Ref: 41-42 Objective: 2.12 37) One’s “cognitive ability” refers to his or her ability to do which of the following? A) Control his or her emotions B) Use fine motor skills C) Adapt to stress D) Think and solve problems Answer: D Explanation: A) INCORRECT. Control of one’s emotions is not related to “cognitive ability.” B) INCORRECT. Cognitive ability does not refer to physical action or skills. C) INCORRECT. Stress adaptation is unrelated to “cognitive ability.” D) CORRECT. Thinking and problem-solving is referred to as “cognitive ability.” Page Ref: 41 Objective: 2.12 17 Copyright © 2016 Pearson Education, Inc. 38) Which of the following terms refers to a positive form of stress that helps people work when under pressure and respond effectively? A) Prostress B) Distress C) Unstress D) Eustress Answer: D Explanation: A) INCORRECT. Prostress is not a term used to describe a positive form of stress. B) INCORRECT. Distress is a negative form of stress that can create immediate and lasting negative effects. C) INCORRECT. The word unstress is related to grammar and word pronunciation and does not apply to stress reactions. D) CORRECT. Eustress is a positive form of stress that helps people to work under pressure and respond effectively. Page Ref: 44 Objective: 2.12 39) Which of the following behaviors would be considered a common sign of stress rather than an acute psychological problem? A) Failure to use PPE appropriately on a regular basis B) Irritability with friends, family, coworkers, or patients C) Flashbacks, nightmares, and feelings of detachment D) Increased speeding and reckless driving Answer: B Explanation: A) INCORRECT. Failure to use PPE appropriately is not a sign of stress, it is just unprofessional. B) CORRECT. Common signs and symptoms of stress include irritability with family, friends, and coworkers; inability to concentrate; loss of interest in sexual activity; anxiety; and loss of interest in work. C) INCORRECT. Flashbacks, nightmares, and feelings of detachment are signs and symptoms of posttraumatic stress disorder (PTSD). D) INCORRECT. Reckless driving and speeding are not common signs of stress. Page Ref: 44 Objective: 2.12 18 Copyright © 2016 Pearson Education, Inc. 40) For the last few days, your regular EMT partner has been having trouble sleeping, has been on edge, and has trouble concentrating on his job during EMS calls. Luckily, your call volume has been low with no serious calls since the infant cardiac arrest you both worked last month. You ask him if anything is bothering him and he states he is fine in every way. He states that he has been going to the bars lately to relax and invites you to come along for some drinks after work. Choose the best answer for this situation. A) Your partner is suffering from acute stress reaction and you should recommend to him that he seek professional counseling. B) Your partner is suffering from post-traumatic stress disorder and you should go to the bar with him to provide moral support and talk with him. C) Your partner is suffering from a delayed stress reaction and you should recommend that he seek professional counseling. D) Your partner is suffering from a cumulative stress reaction. This is a natural response and he should be fine in a few days. Answer: C Explanation: A) INCORRECT. The EMT is suffering from a delayed stress reaction because the incident occurred over a month prior. B) INCORRECT. Drug and alcohol abuse is a common coping mechanism for a delayed stress mechanism, so any form of moral support that involves alcohol should be avoided. C) CORRECT. EMTs suffering from any type of stress reaction where they are having difficulty coping should seek professional counseling. D) INCORRECT. The EMT’s stress response is most-likely from the infant cardiac arrest call, meaning that it is not cumulative, and he should be encouraged to seek professional help. Page Ref: 42 Objective: 2.12 41) What is a positive, healthy way to help deal with stress? A) Caffeine to “get up and go” B) Regular physical exercise C) Adding workload to a busy regular schedule D) Drinking alcohol to “unwind” Answer: B Explanation: A) INCORRECT. Using caffeine or any other stimulant to deal with stress is unhealthy. B) CORRECT. Developing a more healthful lifestyle through diet and exercise is a positive way to deal with stress. C) INCORRECT. Relaxing more, rather than adding work, is a positive way to cope with stress. D) INCORRECT. Drug and alcohol abuse is a negative (although common) coping mechanism for stress. Page Ref: 44 Objective: 2.13 19 Copyright © 2016 Pearson Education, Inc. 42) An EMT involved in an especially difficult call, such as one in which a coworker was killed, should be urged to: A) discuss the experience freely with coworkers. B) begin a course of psychiatric medications. C) seek help from a trained mental health professional. D) conceal the problem because care may not be covered financially. Answer: C Explanation: A) INCORRECT. Openly discussing a difficult call with coworkers may increase the stress levels of all involved and the responses received may not always be helpful. B) INCORRECT. Psychiatric medications are generally not the first step in dealing with a stressful situation. C) CORRECT. Medical professionals and EMS leaders agree that the best course of action for an EMT who is experiencing significant stress from a serious call or experience is to seek help from a mental health professional who is experienced in treating these issues. D) INCORRECT. Concealing the stress caused by a traumatic incident can be very damaging and result in long-term problems. Page Ref: 43 Objective: 2.13 43) Since EMS personnel are often exposed to both acute and chronic stressors, ________ management may be helpful to cope with on-the-job experiences. A) critical incident stress B) crisis intervention C) stress prevention D) chronic stress Answer: A Explanation: A) CORRECT. Critical incident stress management (CISM) is a comprehensive system that includes education and resources to both prevent stress and to deal with on-the-job stress appropriately when it does occur. B) INCORRECT. Crisis intervention is generally only focused on acute incidents. C) INCORRECT. The stresses encountered while working in EMS cannot usually be prevented, so programs should be focused on appropriately dealing with the stresses encountered. D) INCORRECT. EMS professionals are potentially exposed to both acute and chronic stress; both of which must be managed. Page Ref: 44-45 Objective: 2.14 20 Copyright © 2016 Pearson Education, Inc. 44) Critical Incident Stress Debriefings (CISDs): A) are always recommended. B) are now less common than they once were. C) must be held from 2 to 4 hours following an incident to be effective. D) have been replaced with “defusings.” Answer: B Explanation: A) INCORRECT. Critical Incident Stress Debriefings are no longer standard in the EMS industry. B) CORRECT. The CISD model is now used less frequently and is not recommended by many in EMS and mental health professions. C) INCORRECT. If they are to be effective at all, CISDs should occur within 24 to 72 hours following the incident. D) INCORRECT. Critical Incident Stress Debriefings and defusing sessions are two different types of stress management events; one does not replace the other. Page Ref: 45 Objective: 2.14 45) While transporting a patient to the hospital who has a history of terminal brain cancer, the patient says, “I know I’m going to die, but first I want to see my grandson graduate from high school.” What stage of death and dying describes this patient’s current condition? A) Bargaining B) Denial C) Anger D) Depression Answer: A Explanation: A) CORRECT. In the mind of the patient, bargaining may seem to postpone death and will commonly include phrases like, “At least let me…” or “But first I want….” B) INCORRECT. Patients in the denial stage do not believe that they are going to die. C) INCORRECT. This patient is not exhibiting the behavior of someone in the anger stage. D) INCORRECT. The depression stage is usually marked by the patient being sad about the things that she was never able to do. Page Ref: 45 Objective: 2.15 21 Copyright © 2016 Pearson Education, Inc. 46) When responding to the scene of a patient who was discovered to be unresponsive, not breathing, and without a pulse, family members state that the patient has been suffering from cancer for several years. One of his sons is cursing at you and your partner, saying that you are not moving fast enough. Which stage of grief is the patient’s son experiencing in response to his father’s death? A) Denial B) Depression C) Anger D) Acceptance Answer: C Explanation: A) INCORRECT. The denial stage is usually accompanied by a belief that nothing is wrong. B) INCORRECT. A hallmark of the depression stage is sadness and despair. C) CORRECT. The anger stage of grief is commonly vented on family members and EMS personnel. D) INCORRECT. A person who has reached acceptance of the situation would not be cursing or ordering emergency providers to move quicker. Page Ref: 45 Objective: 2.15 47) A family member who keeps pleading with a deceased loved one to “wake up” is experiencing which reaction to death and dying? A) Anger B) Rejection C) Projection D) Denial Answer: D Explanation: A) INCORRECT. An anger reaction would usually be directed at other family members or the EMS providers for allowing the death to occur. B) INCORRECT. Rejection is not a term used to describe one of the stages of grief. C) INCORRECT. There is not a reaction to death and dying called projection. D) CORRECT. This family member is obviously in denial about the death of the loved one. Page Ref: 45 Objective: 2.15 22 Copyright © 2016 Pearson Education, Inc. 48) You have just worked a cardiac arrest call on a 48-year-old father of three. Despite your best efforts, the patient died in the emergency department. As you are getting your ambulance in service, the patient’s wife rushes out of the emergency department. She finds you and begins screaming at you that her husband’s death is your fault. She blames you for not getting on the scene fast enough, taking too long at the house, and not shocking her husband back to life like she has seen on television. What response should you have to her anger? A) Recognize that she is in the denial stage of grief and interrupt her hysterical behavior pattern by getting her attention and helping her calm down. B) Reassure her that you did everything you could and that everything will be okay. C) Correct her misconceptions and remind her that television shows are fiction, so she will not sue you in the future. D) Listen empathetically to all of her complaints and let her know she can contact you for any additional assistance. Answer: D Explanation: A) INCORRECT. The patient is in the anger stage of grief, not the denial stage. Her anger is part of the normal grieving process and should not be taken personally. B) INCORRECT. EMTs should not offer false reassurance by telling the patient that everything will be okay. C) INCORRECT. Correcting her misconceptions will not help the situation and may make it worse. D) CORRECT. Listening empathetically to her concerns and offering to help her as realistically as possible are the best actions to take when confronted by a person in the anger stage of grief. Page Ref: 45-46 Objective: 2.16 49) You observe a coworker telling a terminal cancer patient and her family, “Everything will be okay.” Making false reassurances is considered: A) naive and uncompassionate. B) caring and supportive. C) professional and discreet. D) ambiguous and uncertain. Answer: A Explanation: A) CORRECT. Offering false reassurance will only be irritating or convey the impression that you do not really understand. B) INCORRECT. It is neither caring nor supportive to assure a good outcome in this situation. C) INCORRECT. The coworker making false reassurances is certainly not being professional and discretion doesn’t apply. D) INCORRECT. False reassurances (such as the statement in the situation described) are usually direct and certain. Page Ref: 45 Objective: 2.16 23 Copyright © 2016 Pearson Education, Inc. 50) Which of the following behaviors would demonstrate that an EMT understands reactions to death and dying? A) Being tolerant of angry reactions by patients and family members B) Giving a dying patient hope that a cure can be found before the patient dies C) Providing spiritual guidance to patients who express anger at God D) Being firm with grieving family members and telling them they need to accept what has happened Answer: A Explanation: A) CORRECT. There may be feelings of helpless rage about death or the prospect of death. An EMT should know that the anger is not personal and to be tolerant of the reactions in these situations. B) INCORRECT. Offering false reassurances do not help in situations involving dying patients, and clearly shows a lack of understanding by the EMT. C) INCORRECT. It is inappropriate for an EMT to try to correct, debate or convince a patient who is dying. D) INCORRECT. The EMT should just be patient and comforting; telling people how they should be feeling in a tragic situation is not beneficial. Page Ref: 45-46 Objective: 2.16 51) Which three “Rs” are essential for the EMT to practice when reacting to danger? A) Retreat, radio, reevaluate B) Remember, respect, respond C) Ricochet, recover, re-entry D) Realize, react, reassess Answer: A Explanation: A) CORRECT. The three Rs of reacting to danger are retreat, radio, and reevaluate. B) INCORRECT. The concept behind the three Rs is to get out of danger, request assistance, and determine the next course of action. C) INCORRECT. Ricochet, recover, and re-entry are not the three Rs of reacting to danger. D) INCORRECT. The three Rs of reacting to danger are not realizing, reacting, and reassessing. Page Ref: 49 Objective: 2.17 24 Copyright © 2016 Pearson Education, Inc. 52) What is the EMT’s highest priority at the scene of a hazardous materials incident? A) Personal safety B) Identification of hazardous materials C) Patient care D) Safety of bystanders Answer: A Explanation: A) CORRECT. Your most important roles at the scene of a hazardous material incident are recognizing that a hazard exists, taking initial actions for your personal safety and the safety of others, and notifying an appropriately trained hazardous material response team. B) INCORRECT. There are several priorities that are more important than specifically identifying the hazardous materials involved in an incident. C) INCORRECT. Although important, patient care is not the highest priority at a hazardous materials incident. D) INCORRECT. The safety of bystanders is not the EMT’s highest priority in this situation. Page Ref: 46-47 Objective: 2.18 53) What reference provides important information regarding hazardous materials, emergency care, and procedures in case of accidental fire or release; supplies definitions of placard colors and identification numbers; and should be standard issue on-board all ambulances and rescue units? A) Accidental Exposure and Contamination Guide B) Emergency Response Guidebook C) Emergency Preparedness and Response Plan D) Safety Data Sheets Answer: B Explanation: A) INCORRECT. An Accidental Exposure and Contamination Guide does not provide information on all common hazardous materials, including placard identification, nor is it standard issue on all ambulances. B) CORRECT. The Emergency Response Guidebook provides important information about the properties and labeling of dangerous substance as well as information on safe distances, emergency care, and suggested procedures in the event of spills or fire. C) INCORRECT. An emergency preparedness and response plan is not a comprehensive hazardous materials reference. D) INCORRECT. Safety Data Sheets are not carried on ambulances and rescue units. Page Ref: 46 Objective: 2.18 25 Copyright © 2016 Pearson Education, Inc. 54) You are dispatched to the staging area of a terrorist-related chemical exposure. The incident commander asks you to stand by while hazmat personnel bring patients to the cold zone. As an EMT on-board an ambulance, what statement BEST describes your role? A) Triage patients to be decontaminated. B) Transport decontaminated patients. C) Coordinate hazmat response. D) Transport patients to be decontaminated. Answer: B Explanation: A) INCORRECT. Patients being brought to the cold zone would have already been triaged and decontaminated. B) CORRECT. As an EMT, you should not be treating or transporting patients until after they have undergone decontamination. C) INCORRECT. The hazmat response in this scenario has already been coordinated. D) INCORRECT. EMTs should not be transporting patients until after decontamination. Page Ref: 46-47 Objective: 2.18 55) You are first on the scene of a vehicle collision where a vehicle has gone off a bridge and is partially submerged. You are told that a person is still trapped in the vehicle. Your partner starts to take off his shoes and prepares to go in to save the victim. You stop your partner and tell him it is too dangerous. He tells you he is prepared to die to save a life. What is the best response to him? A) He is not only putting his life at risk, but also placing the lives of the professional rescuers unnecessarily at risk. B) His family will not receive any benefits if he is not trained in rescue and dies while attempting a rescue. C) The patient’s family may sue him if he is not successful in rescuing him. D) He will force additional fire units to come to his aid unnecessarily and waste taxpayer money. Answer: A Explanation: A) CORRECT. The life of the EMT and those who may be forced to rescue him take the highest priority. B) INCORRECT. The financial benefits the EMT’s family may or may not receive are not of importance. C) INCORRECT. There is no guarantee as to whether the victim’s family may or may not sue the EMT regardless of what he does. D) INCORRECT. The fire units will be put out of service unnecessarily at a waste of money, but the life safety of the EMT and the professional rescuers is the first priority. Page Ref: 47-48 Objective: 2.18 26 Copyright © 2016 Pearson Education, Inc. 56) You are dispatched to a female with altered mental status. Once inside the home, you find a female who appears to have been beaten unconscious. A man, who smells of alcohol, says that she is his wife and that he does not know what happened: “I just found her this way!” The husband is behaving suspiciously, appears paranoid, and is pacing erratically around the room. What would be the safest course of action? A) Continue to question the man and begin treating the patient. B) Evacuate the patient and begin treatment. C) Leave the house and call for law enforcement. D) Have your partner call for help while you stay with the patient. Answer: C Explanation: A) INCORRECT. This is a dangerous situation for the responders to be in and staying in it is not a safe choice. B) INCORRECT. Trying to move the unconscious patient from this potentially dangerous situation puts the EMTs at risk. C) CORRECT. The three Rs of reacting to the danger in this situation require the EMTs to leave, call for assistance, and plan how to proceed. D) INCORRECT. The safety of both EMTs should be the priority and leaving one in the dangerous situation is unacceptable. Page Ref: 49 Objective: 2.18 57) You are on the scene of an “unknown medical” call. The patient is a 26-year-old, 250-pound male patient who suddenly becomes violently angry. Everything you say to the patient only makes him angrier. Offended by your questions, he screams that he is going to “cut your tongue out” and hurries into the kitchen. What should you do? A) Radio for police and then calmly walk out of the house, being sure to take all of your medical equipment. B) Tackle the patient before he can get a kitchen knife to stab you. C) Radio for police and relay to dispatch important scene information until they arrive. D) Leave immediately to a safe area and then call for police assistance. Answer: D Explanation: A) INCORRECT. Whenever a patient becomes violent or threatens violence, the EMT should immediately leave the scene and call for police and not do anything that will slow down or impede his escape, such as taking the time to collect heavy medical equipment. B) INCORRECT. The EMT should not try to fight the patient, as he is not trained in law enforcement techniques and the EMT can be seriously injured or killed. C) INCORRECT. The EMT should never stay on-scene in an attempt to calm down the violent patient or provide pertinent scene information to the police. This is a very dangerous situation and can result in serious injury or death. D) CORRECT. The EMT should leave immediately, call for assistance, and not re-enter the scene until it has been made safe by law enforcement. Page Ref: 48-49 Objective: 2.19 27 Copyright © 2016 Pearson Education, Inc. 58) You are dispatched to a “man down” with no further information. As your unit arrives onscene, you see a crowd of bystanders looking at a man lying in an alleyway. The bystanders begin screaming to you, “Help him, he’s been shot! He’s bleeding real bad!” What would be the best course of action? A) Move bystanders aside since the patient will die without treatment. B) Tell law enforcement investigators to meet your unit at the ER. C) Dispatch law enforcement and wait until the scene is secure. D) Load and go, because you’re already on-scene. Answer: C Explanation: A) INCORRECT. The EMT’s first priority–even before patient care–is to be certain that the scene is safe. B) INCORRECT. This patient should not even be approached for care or transport until the EMTs are certain that the scene is safe. C) CORRECT. This is an uncontrolled and potentially dangerous situation. The EMTs should not attempt to enter or care for the patient until their own safety is assured. D) INCORRECT. This unsecured scene is potentially too dangerous for the EMT’s to enter and get the patient. Page Ref: 49 Objective: 2.19 59) You are approaching the scene of a motor vehicle crash. Which of the following would be the first way to safeguard your well-being as an EMT? A) Take personal protective equipment (PPE) precautions. B) Request additional resources. C) Ensure scene safety. D) Utilize DOT-approved reflective safety clothing. Answer: C Explanation: A) INCORRECT. Utilizing appropriate PPE is important for personal well-being, but it’s not the first way to ensure safety. B) INCORRECT. Although requesting additional resources may be necessary based on the situation, it would not be the first way to safeguard your well-being. C) CORRECT. The first way to safeguard your well-being as an EMT arriving at a vehicle crash is make sure that the scene is safe before entering it. D) INCORRECT. DOT-approved reflective clothing can help to keep an EMT safer while on scene, but it wouldn’t be the first way to ensure personal well-being. Page Ref: 46 Objective: 2.19 28 Copyright © 2016 Pearson Education, Inc. 60) Which of the following pathogens is transmitted through contact with open wounds or sores? A) Pertussis B) Staphylococcus C) Rubella D) Meningitis Answer: B Explanation: A) INCORRECT. Pertussis (whooping cough) is not passed through open wounds or sores. B) CORRECT. Staphylococcus is transmitted through direct contact with infected wounds or sores, or with contaminated objects. C) INCORRECT. Rubella is normally transmitted through airborne droplets. D) INCORRECT. Meningitis is passed by contact with oral or nasal secretions. Page Ref: 34 Objective: 2.20 61) What is a simple step EMTs can perform to help prevent the spread of flu in the prehospital environment? A) Place a surgical mask on suspected flu patients. B) Transport all patients with coughs to negative pressure rooms. C) Notify the CDC and local health department of flu cases. D) Encourage patients to get their H1N1 antivirals early in the flu season. Answer: A Explanation: A) CORRECT. When a patient is suspected of having an infection spread by droplets (such as flu or measles), a surgical-type mask may be placed on the patient if he is alert and cooperative. B) INCORRECT. Transporting patients to negative pressure rooms is not a simple step. C) INCORRECT. Although it is beneficial for the CDC and other various health departments to track flu outbreaks, it does not prevent flu from spreading. D) INCORRECT. Promoting flu shots in the community is important, but it is not a simple step that an EMT can perform to prevent the spread of flu in the prehospital setting. Page Ref: 35 Objective: 2.20 29 Copyright © 2016 Pearson Education, Inc. 62) Which of the following provides the greatest personal safety for an EMT working at a motor vehicle collision? A) Nonslip footwear B) Reflective outer clothing C) Portable radio D) Flashlight Answer: B Explanation: A) INCORRECT. Proper footwear is important when working in EMS, but nonslip shoes would not provide the greatest benefit on the scene of a vehicle crash. B) CORRECT. Being highly visible to passing motorists is critical to an EMT’s safety while working on or near a roadway; reflective outer clothing is essential. C) INCORRECT. Simply having a portable radio does not make an EMT safer at a crash scene. D) INCORRECT. A flashlight can be effective at night to expose potential hazards and provide some visibility to the EMT’s location for passing drivers, but if the collision occurs during the day it will not do much good. Page Ref: 48 Objective: 2.21 30 Copyright © 2016 Pearson Education, Inc.