Prehospital Emergency Care, Chapter 18 Altered Mental Status, Stroke, and Headache

1) Which of these conditions would the EMT recognize as most likely indicating a neurologic deficit?

A) Hypoglycemia

B) Paralysis

C) Constricted pupils

D) Headache

Answer: B

2) Which of these conditions places the patient at the greatest risk for an acute neurologic deficit?

A) Acute myocardial infarction (AMI)

B) Transient ischemic attack (TIA)

C) Chronic obstructive pulmonary disease (COPD)

D) New onset of type 2 diabetes (NIDDM)

Answer: B

3) When assessing a patient with a possible stroke, what is the priority?

A) Identifying risk factors for stroke

B) Determining a family history of stroke

C) Recognizing the signs of a stroke

D) Determining the type of stroke

Answer: C

4) While you are teaching a public awareness class about stroke, a participant asks you if all patients with stroke are paralyzed on one side of their bodies. Your reply should be:

A) "Yes. Both the arm and the leg must be paralyzed for the health professional to recognize a stroke."

B) "No. Some patients suffering stroke will show no signs or symptoms, but all still must be evaluated."

C) "Yes. To be diagnosed with a stroke, the arm and/or the leg must be very weak and paralyzed."

D) "No. Some stroke patients may have only slight weakness to one side of their bodies."

Answer: D

5) When assessing a patient with a suspected stroke, the order of the exam would be:

A) Primary assessment, then secondary assessment including a stroke scale.

B) Level of consciousness, facial droop, arm drift, airway, and then secondary assessment.

C) Abnormal speech, facial droop, arm drift, primary assessment, and then secondary assessment.

D) Secondary assessment, primary assessment, stroke exam, and then SAMPLE history.

Answer: A

6) When using a stroke scale to assess a patient for abnormal speech, the EMT should:

A) Observe verbal ability during assessment.

B) Ask the patient to repeat a specific but common phrase.

C) Question family members about the patient's ability to talk.

D) Write questions on note cards for the patient to read.

Answer: B

7) When assessing a patient for a facial droop while completing a stroke scale such as the Cincinnati Prehospital Stroke Scale, the Emergency Medical Technician should:

A) Palpate the face one side at a time.

B) Gently lift and then let go of the skin over the cheeks.

C) Ask the patient to show you his teeth or smile.

D) Observe the patient's ability to turn his head to the right and then to the left.

Answer: C

8) Which one of these instructions to a patient with possible stroke indicates proper assessment for an arm drift?

A) "Hold out your arms and count to 10 while keeping your eyes open."

B) "Grab my fingers and squeeze with both hands as hard as you can for 5 seconds, and I mean squeeze hard."

C) "Raise your hands above your head and close your eyes while counting backward from 20."

D) "Close your eyes and hold your arms straight out for 10 seconds."

Answer: D

9) Which bit of information would it be critical that the EMT determine from the family of an elderly female who cannot speak and is suspected of having a stroke?

A) "Does your mother have a history of heart problems?"

B) "The last time she was known to be well was when?"

C) "Which medications is your mother taking?"

D) "Does your mother have any pain in her arms or legs?"

Answer: B

10) You have determined that an alert elderly male patient has garbled speech and weakness to the right arm and leg. His vital signs and SpO2 level are within normal limits. The family informs you that he has a history of heart problems and diabetes. Given this scenario, what should you do immediately?

A) Administer oral glucose or sugar water

B) Attach the automated external defibrillator

C) Check the patient's blood glucose level

D) Administer oxygen via a nasal cannula at 2 lpm

Answer: C

11) With the Cincinnati Prehospital Stroke Scale, which of these patient parameters is assessed?

A) Blood glucose level

B) Facial droop

C) Time of symptom onset

D) Age of the patient

Answer: B

12) When attempting to distinguish a spinal injury from a stroke, the EMT should remember that:

A) Spinal injuries often result in weakness to one side of the body.

B) Stroke typically results in weakness or paralysis to one side of the body.

C) Stroke does not cause paralysis, while spinal injuries typically do.

D) Stroke usually causes weakness to all extremities; spinal injuries do not.

Answer: B

13) Assessment of a 63-year-old female patient reveals a patent airway, adequate breathing, and strong radial pulse. She has no difficulty speaking and no facial droop, but exhibits a slight left arm drift and has a headache. The EMT should interpret these specific findings as:

A) Not suggestive of a stroke.

B) Minimally suggestive that a stroke may be occurring.

C) Moderately suggestive that a stroke may be occurring.

D) Highly suggestive that a stroke may be occurring.

Answer: D

14) You are called for a 69-year-old male patient with altered mental status. Assessment reveals that he is confused and has left-sided weakness. During transport, you note that the patient is now completely oriented and the weakness has resolved. Which condition would you suspect this patient has?

A) Stroke

B) Low blood sugar

C) Transient ischemic attack

D) Syncope

Answer: C

15) A 49-year-old male patient is unable to speak. You would document this finding as:

A) Apnea.

B) Dysarthria.

C) Dysplegia.

D) Aphasia.

Answer: D

16) Which of these statements made by your new EMT partner demonstrates an understanding of assessment findings related to stroke?

A) "For a stroke to be suspected, both arms must be equally weak."

B) "If one arm is weak, a stroke should be suspected."

C) "A stroke should be suspected only when one arm is paralyzed, not weak."

D) "If one arm is weak, stroke should be suspected only if the blood pressure is also elevated.

Answer: B

17) When a patient smiles, the left side of the face shows significantly less movement than the right side of the face. The EMT would describe this finding as:

A) Left-side facial droop.

B) Right-side facial droop.

C) Left-side facial paralysis.

D) Right-side facial paralysis.

Answer: A

18) Which of these patients would be most eligible to receive a fibrinolytic medication for stroke if no other contraindications are found?

A) A 37-year-old female diagnosed in the emergency department with a hemorrhagic stroke 2 hours after its onset

B) A 48-year-old male whose symptoms started while watching the 6:00 P.M. news, at which time he dialed 911

C) An 81-year-old male who awoke with stroke symptoms after an 8-hour sleep

D) A 62-year-old female whose stroke symptoms started at 8:00 A.M. and disappeared half an hour later

Answer: B

19) For the patient with stroke to be eligible for a fibrinolytic agent, the therapy must be given within:

A) 3 hours of EMS arrival at the scene.

B) 4.5 hours after the diagnosis of stroke is officially made.

C) 3.5 hours of the onset of stroke symptoms.

D) 4 hours of the first signs and/or symptoms started.

Answer: B

20) For the patient with stroke to be eligible for a fibrinolytic agent, the patient must be brought to the hospital emergency department within how many hours of the onset of stroke symptoms?

A) 2.5

B) 3

C) 6

D) 4.5

Answer: D

21) You have been called for a 63-year-old woman with slurred speech and right-arm weakness. On arrival, the patient informs you that the slurred speech and weakness have resolved. Since your assessment reveals no deficits, the patient insists on signing a refusal of treatment form. Which of these statements should you make prior to having her sign the form?

A) "It would be best to start taking one baby aspirin every day; this will decrease the chance of this happening again."

B) "Sometimes seizures present this way; call your doctor in the morning to schedule an appointment."

C) "If this happens again, wait 10 minutes to see if you are okay. If the symptoms persist, call 911."

D) "You really need to be evaluated in the hospital. You are at significant risk for a future stroke, which may be debilitating or even fatal."

Answer: D

22) Assessment reveals a drooling 48-year-old male patient to have gurgling speech and left-arm paralysis. The EMT's immediate priority treatment is to:

A) Suction the airway.

B) Protect the left arm.

C) Determine risk factors for stroke.

D) Determine the time of onset.

Answer: A

23) A patient who is responsive only to painful stimuli has a patent airway, inadequate respirations at 28 breaths/min and irregular, and a strong radial pulse with skin that is warm and dry. The patient is not moving his right arm or leg and is incontinent of urine. What is the priority for the EMT at this time?

A) Insert an oropharyngeal airway

B) Administer oxygen by nonrebreather mask

C) Administer positive pressure ventilation

D) Check the blood glucose level

Answer: C

24) A 73-year-old female patient is responsive to painful stimuli and cannot move her arm or leg on one side of her body. You suspect she is having a stroke. What is the best transport position for this patient?

A) Supine with head elevated 30 degrees

B) Left lateral recumbent position

C) Supine with left arm and leg flexed

D) Prone with left arm and leg flexed

Answer: B

25) An alert and oriented 69-year-old male patient has slight right-arm weakness but exhibits no deficits to the right leg. The EMT should consider this patient to be a:

A) Nonpriority transport since no paralysis exists.

B) Priority only if the patient also has a low blood glucose level.

C) Nonpriority since he is alert and oriented.

D) Priority for transport to a hospital with a stroke center.

Answer: D

26) When transporting an alert but nonverbal patient with stroke and a blood pressure of 210/110 mmHg, the EMT should:

A) Dim the lights and remain out of the patient's sight to avoid unnecessary stimulation.

B) Touch the patient only when absolutely necessary, such as when obtaining vital signs.

C) Make an effort to explain everything that is happening or being done while trying to help the patient feel at ease.

D) Remain in the patient's sight but avoid talking or stimulating the patient.

Answer: C

27) Patients with an altered mental status due to a stroke may not be able to control their own airways because of:

A) Enlargement and swelling of the epiglottis.

B) Paralysis or weakness of the throat muscles.

C) Hypersensitivity of the gag reflex.

D) Increased oral secretions.

Answer: B

28) Which of these is a good description of an ischemic stroke?

A) Rupture of an artery within the brain

B) Blood accumulation within the brain tissue

C) Simultaneous occurrence of stroke and heart attack

D) Obstructive blood clot inside a blood vessel within the brain

Answer: D

29) The EMT demonstrates she understands hemorrhagic stroke when she states:

A) "It occurs when clots form in blood vessels within the brain."

B) "It occurs when a blood vessel ruptures and bleeds within the brain."

C) "Its signs and symptoms generally resolve within 24 hours."

D) "It can sometimes be treated by clot-destroying medications."

Answer: B

30) A patient with stroke cannot move his left arm or leg. Based on this presentation, the EMT should strongly suspect that the stroke has occurred in which part of the central nervous system?

A) Left side of the brain

B) Left side of the spinal cord

C) Right side of the brain

D) Right and left sides of the brain

Answer: C

31) A patient has an altered mental status accompanied by loss of motor function on one side of the body. The EMT must suspect which condition as the cause of this presentation?

A) Seizure

B) Hypoglycemia

C) Stroke

D) Syncope

Answer: C

32) When assessing a patient with stroke-like signs and symptoms, it is critical that the EMT also suspect and rule out which condition?

A) Narcotic overdose

B) Syncope

C) Hypoglycemia

D) Shock

Answer: C

33) Which one of these describes the typical signs and symptoms of a transient ischemic attack (TIA)?

A) Temporary, with many TIAs lasting less than 5 minutes

B) Persistent, with most TIAs lasting more than 1 hour but less than 24 hours

C) Mild, but permanent neurological deficits

D) Severe and debilitating neurological deficits

Answer: A

34) You have gathered and written down all of the medications, including narcotic pain medications, that a confused 46-year-old male patient currently takes. The patient is placed on the stretcher for transport. At this time, how would you handle the medications?

A) Return them to their original places

B) Give them to a family member

C) Turn them over to the police

D) Transport them with the patient

Answer: D

35) You have been called to the house of a young adult male patient who is unresponsive. The man lives by himself, so no family is present. In trying to determine the origin of the patient's altered mental status, which of these would most likely provide the best information, assuming it is available to you?

A) Contact with medical direction

B) Examination of patient medications (prescribed and recreational)

C) Interpretation of physical assessment findings

D) Observation of the living conditions in the house

Answer: B

36) Which of these statements shows that the EMT has an accurate understanding of altered mental status?

A) "It describes any change away from a normal state of mental function."

B) "It applies only when the patient is not responsive to verbal or painful stimuli."

C) "It should be suspected only when the patient is on medications that can cause confusion."

D) "It is any mental state experienced by a person with diabetes or other serious chronic disease."

Answer: A

37) When performing a secondary assessment on an elderly male patient who is confused and combative, which of these assessment findings should be of most concern to the EMT?

A) Respirations of 20 breaths/min

B) Pulse of 164

C) Bruising to the back of the hand

D) Pulse oximeter reading of 94% on room air

Answer: B

38) What does the first "I" in the AEIOU-TIPPSS mnemonic stand for?

A) Influenza

B) Infection

C) Insulin

D) Ischemia

Answer: C

39) Assessment of a 56-year-old male patient reveals him to be responsive to verbal stimuli with garbled speech. Which of these statements made by the patient's wife suggests that the patient's problem may be toxic-metabolic?

A) "He has bad kidneys."

B) "He had a stroke two years ago."

C) "He fell and hit his head yesterday."

D) "He was diagnosed last year with Alzheimer disease."

Answer: A

40) You have been called for a patient who suddenly became confused. Which of these assessment findings should concern you most?

A) Blood pressure of 110/72 mmHg

B) Pupils fully dilated and sluggishly reactive to light

C) Heart rate of 180 beats/min but regular

D) Blood glucose level of 72 mg/dL

Answer: C

41) A middle-aged male patient collapsed while shopping and now responds to verbal stimuli with confused speech. The primary assessment indicates no immediate life-threatening conditions. His pulse is 96, respirations 16 breaths/min, blood pressure 158/88 mmHg, SpO2 98% on room air, and blood glucose level 79 mg/dL. The patient is carrying a vial of nitroglycerin in his jacket pocket. What should you do next after determining the patient priority status?

A) Administer oral glucose

B) Provide oxygen via nasal cannula at 2 lpm

C) Administer sublingual nitroglycerin

D) Perform a secondary assessment

Answer: D

42) You are obtaining the past medical history from the family of an elderly patient with an altered mental status who suffered sudden onset of right-side weakness. Which of these statements made by the patient's family member should you recognize as increasing the patient's risk of stroke?

A) "She takes an aspirin every morning."

B) "Her blood pressure runs low."

C) "She has a history of migraines."

D) "She has an irregular heartbeat."

Answer: D

43) An 82-year-old male patient presents with right-hand weakness and garbled speech. Which question should the EMT ask first to the patient or a reliable family member who is present?

A) "Is he allergic to anything?"

B) "Does he take any blood thinners?"

C) "Does he have a history of high blood pressure?"

D) "What time did these signs start?"

Answer: D

44) You have just arrived by the side of a 46-year-old male patient who receives dialysis for endstage renal failure. He is positioned in his living room recliner, unresponsive with snoring respirations, and appears to have ineffective ventilations. What is your priority intervention at this time?

A) Provide mechanical ventilations

B) Manually open the airway

C) Find out when he last received dialysis

D) Inquire when the symptoms started

Answer: B

45) A 78-year-old male patient was found lying on his bathroom floor. Emergency Medical Responders (EMRs) report that the patient is unresponsive, with unequal pupils, and vital signs are as follows: pulse, 78; respirations, 20 breaths/min with sonorous airway sounds; blood pressure, 210/106 mmHg; SpO2, 99%. The EMRs have applied oxygen by nonrebreather mask, and also report that the patient has a hematoma on the back of his head. What should you do first?

A) Replace the nonrebreather mask with a nasal cannula

B) Quickly apply a cervical collar

C) Ensure an open airway with a jaw-thrust maneuver

D) Lift the patient onto the stretcher for transport

Answer: C

46) Which of these questions would the EMT ask when performing the Los Angeles Prehospital Stroke Screen?

A) "Do you take blood thinners?"

B) "Are your hand grips weak?"

C) "Do you smoke cigarettes?"

D) "Have you ever had a seizure?"

Answer: D

47) You have been called to a long-term care facility for a 77-year-old female patient who was found unresponsive in her wheelchair by staff. The nurse reports that the patient complained of a headache earlier in the day and was given 600 mg of Motrin. Your assessment shows the patient to be unresponsive with a patent airway, slow and irregular respirations, and a weak radial pulse. Her lips are cyanotic, and your partner reports these vital signs: pulse, 44; respirations, 6 breaths/min; and blood pressure, 228/116 mmHg. Which action should be your next priority?

A) Start positive pressure ventilation

B) Check the patient's blood glucose level

C) Attach the pulse oximeter to get a SpO2 reading

D) Perform a prehospital stroke screen

Answer: A

48) You are treating an unresponsive patient. Which piece of information given to you by the patient's family is most important in relation to a possible stroke?

A) "He forgot to take his blood thinner last night."

B) "We think that he had too much to drink last night."

C) "We noticed him acting oddly about 7:00 P.M."

D) "He took some ibuprofen last night for a fever and cough."

Answer: C

49) A 56-year-old patient is in bed and unable to speak. Family members state that he had a stroke in the past and has been bedridden since then, but has always been able to talk, until a few hours ago when his speech became garbled. They also state that the last stroke left him paralyzed on his left side. Your assessment reveals that the patient is unable to speak, but has an open airway, adequate respirations, and a strong radial pulse. Additionally, you note that he is unable to move his right arm. Vital signs are within normal limits. What would be an appropriate step in the care on this patient?

A) Rapid transport to a stroke center

B) Suction the mouth and then place an NPA

C) Administer positive pressure ventilation

D) Insert an oropharyngeal airway

Answer: A

50) A male patient suddenly found himself unable to talk and with profound weakness to his right arm and leg. Currently he is responsive to verbal stimuli and has these vital signs: pulse, 88; respirations 14 breaths/min and adequate; and blood pressure, 210/80 mmHg. You notice his mental status is starting to worsen. When transporting this patient to the hospital, in which position should you place him?

A) Secured to a long board

B) Left lateral recumbent

C) Prone with head elevated

D) Supine with feet elevated

Answer: B

51) The EMT shows that he is performing the Los Angeles Prehospital Stroke Screen (LAPSS) correctly when he asks which of these questions?

A) "May I assess your pupils?"

B) "How old are you?"

C) "Did you lose control of your bladder?"

D) "Do you know where you are right now?"

Answer: B

52) The EMT shows that he recognizes the benefit of using the Cincinnati Prehospital Stroke Scale or Los Angeles Prehospital Stroke Screen when he makes which of these statements?

A) "The screening allows the EMT to identify the patient at risk for stroke."

B) "The screening allows the EMT to differentiate the type of stroke a patient is having."

C) "The screen is very predictive in determining whether the patient will die from stroke."

D) "The screening helps to identify stroke, even when it is not the patient's chief complaint."

Answer: D

53) Which of these statements made by the EMT indicates a correct understanding of caring for someone with a headache?

A) "Unless the patient has some sort of past medical history, a headache is not a true emergency."

B) "If a patient calls 911 for a headache, it is most likely a life-threatening condition."

C) "Assessment is essential in determining if a patient's headache represents a life-threatening condition."

D) "In general, a headache is considered serious only if the pain is felt throughout the entire head."

Answer: C

54) A 41-year-old female patient has called 911 for a headache. Which of these assessment findings should make the EMT suspicious that the patient has a migraine headache?

A) Bright light increases the patient's discomfort.

B) The pain was preceded by an aura.

C) Her blood pressure is 192/124 mmHg.

D) She rates the pain as an 8/10.

Answer: B

55) Which of these statements made by a patient suggests that he is suffering from a tension headache?

A) "The pain starts at the top of my head and spreads down my back."

B) "I get so nauseated with the pain."

C) "The light really seems to bother my eyes when I get these headaches."

D) "The pain seems to get worse as the day goes on."

Answer: D

56) A patient with a headache informs you that his physician has diagnosed him with cluster headaches. He states that his current pain feels just like the last cluster headache that he suffered. The primary assessment reveals no life threats. His vital signs are pulse, 104; respirations, 16 breaths/min; blood pressure, 124/68 mmHg; and SpO2, 98%. You note no neurologic deficits. Based on this information, what is indicated in the treatment of this patient?

A) Massage the patient's neck and obtain a refusal for transport if the pain is alleviated

B) Administer supplemental oxygen at 15 liters per minute

C) Place the patient on the wheeled cot and allow him to assume a position of comfort

D) Immediately transport the patient to the hospital for possible stroke

Answer: C

57) A 30-year-old patient with a history of headaches has called 911 for a suspected migraine headache. She says the headache follows her usual pattern of headaches, the pain is a 10/10, and she is nauseated. Her vital signs are pulse, 108; respirations, 18 breaths/min; and blood pressure, 154/90 mmHg. Which of these treatments is indicated in the care of this patient?

A) 81 to 162 mg aspirin by mouth

B) Providing a darkened environment during transport

C) Emergent transport with lights and sirens

D) Requesting orders for sublingual nitroglycerin

Answer: B

58) For altered mental status to occur, which body system must be affected?

A) Cardiovascular

B) Respiratory

C) Central nervous

D) Endocrine

Answer: C

59) A male patient has altered mental status secondary to a brain tumor. The EMT would classify the brain tumor as which type of cause?

A) Central

B) Structural

C) Metabolic

D) Internal

Answer: B

60) A male patient is confused for no apparent reason. There are no life threats to his airway, breathing, or circulation, and his vital signs are pulse, 88; respirations, 16 breaths/min and adequate; blood pressure, 144/68 mmHg; and SpO2, 93% on room air. When addressing the patient's oxygenation status, which of these treatments would be appropriate?

A) Oxygen at 6 lpm via nasal cannula

B) Oxygen at 15 lpm via a nonrebreather mask

C) Positive pressure ventilation with room air

D) Oxygen at 2 lpm via nasal cannula

Answer: D

61) An elderly male patient with a history of chronic obstructive pulmonary disease, hypertension, and diabetes presents as lethargic and confused. His airway is patent, and breathing is adequate. His skin is hot and his radial pulse is strong, regular, and bounding. Vital signs are pulse, 112; respirations, 20 breaths/min; blood pressure, 108/64 mmHg; SpO2, 94%; and temperature, 102.8°F. Also noted is swelling and erythema to his right lower leg. Given these assessment findings, the Emergency Medical Technician should suspect which condition is responsible for the patient's altered presentation?

A) Infection

B) Peripheral edema

C) Hypoxia

D) Tachycardia

Answer: A

62) On scene, a confused 68-year-old female patient with possible stroke has a SpO2 of 91% on room air. Regarding oxygen therapy and the adjunct by which to provide it, which of these represents the most desirable target SpO2 reading for the amount of oxygen delivered?

A) SpO2 98% with 12 lpm O2 via nonrebreather mask

B) SpO2 95% with 2 lpm O2 via nasal cannula

C) SpO2 100% with 15 lpm O2 via nonrebreather mask

D) SpO2 100% with 6 lpm O2 via nasal cannula

Answer: B

63) Which of these statements indicates that the EMT understands the appropriate use of supplemental oxygen when caring for a patient with stroke?

A) "In the short time that we provide care to a patient with stroke, the benefits of highconcentration oxygen outweigh the risks."

B) "If positive pressure ventilation is required, it should be given with room air and not supplemental oxygen."

C) "Since stroke decreases oxygen delivery to the brain, high-concentration oxygen should always be geared toward achieving an SpO2 as near to 100% as possible."

D) "Oxygen should be administered at a minimal amount, just enough to get the SpO2 at or greater than 94%.

Answer: D

64) The Miami Emergency Neurologic Deficit exam for a stroke does not include which assessment parameter?

A) Mental status

B) Blood glucose level assessment

C) Cranial nerve function

D) Motor and sensory function of the limbs

Answer: B

65) A patient is alert and oriented, with a blood pressure of 228/110 mmHg, a heart rate of 82 beats/min, respirations of 20 breaths/min and adequate, and a pulse oximeter reading of 96% on room air. The patient complains of a bad headache that started suddenly. The patient has equal grips and good lower leg function. The blood glucose is 68 mg/dL, and pupils are reactive, although the patient has trouble maintaining a horizontal gaze when asked to do so. He has a history of seizures, hypertension, and atrial fibrillation. Given these assessment findings, which one meets a criterion for the MEND stroke screening tool that suggests the patient may be experiencing a stroke?

A) Sudden onset of a bad headache

B) Hypertensive blood pressure

C) History of seizures and atrial fibrillation

D) Horizontal gaze abnormality

Answer: D

66) During a continuing education program, the lecturer is talking about the Rapid Arterial Occlusion Evaluation (RACE) scale as a newer tool the Emergency Medical Technician can use to help determine whether a neurologic problem is present. Which neurologic problem does the RACE scale address?

A) Structural versus metabolic cause of unresponsiveness

B) Large-vessel occlusion stroke

C) Seizures that are due to an organic cause versus metabolic cause

D) Stroke stemming from a smaller blood vessel above the circle of Willis

Answer: B

67) When the Emergency Medical Technician evaluates a patient with the Rapid Arterial Occlusion Evaluation stroke scale, the score is 4 points. This score would infer:

A) The patient has likely experienced a stroke.

B) The patient has not likely experienced a stroke.

C) The stroke scale was incorrectly performed, as the minimum score is at least 5 points.

D) A stroke has likely not occurred if the corresponding Glasgow Coma Scale score is 12 points or higher.

Answer: A

68) Rapid recognition of stroke signs and symptoms by the public is part of which assessment system?

A) AHA's Stroke Chain of Survival

B) S.T.R.O.K.E. assessment

C) RACE exam

D) AEIOU-TIPPSS

Answer: A

69) Which past medical condition identified during the SAMPLE history could be a metabolic cause of an altered mental status in an elderly male patient?

A) Brain abscess

B) Brain tumor

C) Hemorrhagic stroke

D) Kidney failure

Answer: D

70) Your partner is using the AEIOU-TIPPSS mnemonic to assess for common causes of altered mental status in a geriatric patient. During this process, your partner forgets what the "T" stands for. You would remind him that it means:

A) Trauma.

B) Tumor.

C) Tachycardia.

D) Toxicology.

Answer: A

71) To better fulfill the AHA's Stroke Chain of Survival goals, which assessment mnemonic was developed to better prepare the public and Emergency Medical Services to recognize stroke?

A) F.A.S.T

B) RACE

C) S.T.R.O.K.E.

D) AEIOU-TIPPSS

Answer: A

72) What is the pathophysiology underlying a transient ischemic attack (TIA) and its typically rapid resolution?

A) Vasodilation of the cerebral blood vessel that was constricted tightly enough to stop blood flow.

B) Agents in the bloodstream bust apart the cerebral clot that is causing the signs and symptoms.

C) Blood flow from nearby vascular beds start to perfuse those regions cut off by the TIA ministroke.

D) Neurons from the areas surrounding the TIA's origin start to assume the functions of the brain region affected by the TIA.

Answer: B

73) You have been called to a local daycare facility for a sick child. At the scene, panicked daycare workers inform you that the 4-year-old child was lethargic all morning and wanted to sleep. After resting for several minutes, she began to "shake all over." This lasted for approximately 30 seconds. Your assessment reveals the patient to be responsive to painful stimuli and breathing adequately. Her airway is open and her radial pulse is strong and bounding. Her skin is hot and moist to the touch, with no signs of cyanosis. You are told that the patient has no medical history. En route to the hospital, the patient's mental status improves. Based on this presentation and information, you assume that the seizure occurred secondary to:

A) Hypoxia.

B) Fever.

C) Hypoglycemia.

D) Altered mental status.

Answer: B

74) You are determining the Pediatric Glasgow Coma Scale (GCS) score for a 28-month-old female who was stung by a bee while playing in the backyard, the mother is unsure if she is allergic to stings. You note that the patient is alert. When asked, she tells you that she was stung on the bottom of her foot as she raises it up to show you. At this point in time her GCS score would be:

A) 14.

B) 15.

C) 19.

D) 10.

Answer: B

75) BRUE evaluations are typically performed on infants who:

A) Are at risk for unresolved events.

B) Had a medical episode that concerned their caregiver.

C) Had an event that the EMT is unable to resolve.

D) Have congenital carotid circulatory problems.

Answer: B

76) The EMT is correctly assessing a child's BRUE when he:

A) Obtains a thorough history.

B) Immediately starts the child on blow-by oxygen.

C) Expedites transport to the ED.

D) Allows the caretaker to hold the child during transport.

Answer: A