Emc103 (Chapter 37: Patients with Special Challenges (pre q))

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Which of the following statements regarding patients with intellectual disabilities is correct?

 

Most patients with intellectual disabilities have normal cognitive function but abnormal physical features.

 

Speaking with the patient's family is the least effective way to determine how much the patient understands.

 

An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality.

 

Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

Patients with intellectual disabilities are susceptible to the same disease processes as other patients

Autism is defined as a:

 

congenital condition caused by factors such as malnutrition or birth complications.

 

mental disability caused by insufficient cognitive development of the brain.

 

psychiatric condition related to an imbalance of serotonin in the brain.

 

pervasive developmental disorder characterized by impairment of social interaction.

pervasive developmental disorder characterized by impairment of social interaction

Patients with autism:

 

have extreme difficulty with complex tasks that require many steps.

 

prefer to maintain eye contact with whomever is talking with them.

 

often speak with speech patterns that alternate in tone and speed.

 

use and understand nonverbal means of communicating messages.

have extreme difficulty with complex tasks that require many steps

The rate of autism in the US population is about 1 in:

 

40.

 

27.

 

100.

 

5.

40

Down syndrome is a genetic defect that occurs as the result of:

 

a sperm that contains 24 chromosomes.

 

a triplication of chromosome 21.

 

a separation of chromosome 21.

 

an extra pair of chromosomes.

a triplication of chromosome 21.

Characteristic anatomic features of Down syndrome include:

 

bulging eyes and a large face.

 

a round head with a flat occiput.

 

a proportionately small tongue.

 

long hands with wide fingers

a round head with a flat occiput.

As many as 40% of patients with Down syndrome have:

 

a heart condition.

 

unilateral paralysis.

 

intracranial bleeding.

 

diabetes mellitus.

a heart condition

You respond to a residence for a 9-year-old female with Down syndrome who is sick. When you arrive at the scene and assess the patient, you determine that she is unresponsive and has gurgling respirations. You should:

 

open her airway with the jaw-thrust maneuver and assess the rate and depth of her breathing.

 

insert an oropharyngeal airway and begin assisting her ventilations with a bag-valve mask.

 

immediately apply high-flow oxygen via a nonrebreathing mask and then assess her pulse rate.

 

open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct.

open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct

When interacting with an intellectually disabled patient, the best approach is to:

 

speak primarily with the patient's family to establish the degree of disability.

 

approach the patient as a team to reassure him or her that you are there to help.

 

ask your team members to wait until you can establish a rapport with the patient.

 

position yourself slightly above the patient's level to reduce his or her anxiety.

ask your team members to wait until you can establish a rapport with the patient

When assessing or providing care to a patient with an intellectual disability, you should:

 

move swiftly and deliberately to quickly accomplish the task.

 

be observant for signs of fear or reluctance from the patient.

 

frequently reassure him or her that everything will be okay.

 

explain procedures while in the process of performing them.

be observant for signs of fear or reluctance from the patient

An important aspect in the assessment of a patient who experienced a previous brain injury involves:

 

recalling that most patients with a brain injury have other organ dysfunction.

 

speaking with the patient and family to establish what is considered normal for the patient.

 

contacting the patient's physician to determine the extent of the brain injury.

 

presuming that he or she has cognitive impairment until proven otherwise.

speaking with the patient and family to establish what is considered normal for the patient.

A service dog is easily identified by its:

 

size.

 

color.

 

harness.

 

breed.

harness

When caring for a patient who is visually impaired, it is important to:

 

tell him or her what is happening, identify noises, and describe the situation and surroundings.

 

leave items such as canes and walkers at the residence if the patient will be carried on a gurney.

 

stand to the side of the patient when speaking if his or her peripheral vision is impaired.

 

allow a service dog to remain with the patient at all times, even if the patient is critically ill.

tell him or her what is happening, identify noises, and describe the situation and surroundings

EMTs are dispatched for a fall. The patient, a 16-year-old female with Down syndrome, is experiencing difficulty walking and says that her fingers "feel like needles." The EMTs should suspect:

 

a cervical spine injury.

 

hydrocephalus.

 

a seizure.

 

an intracranial hemorrhage.

a cervical spine injury

In contrast to conductive hearing loss, sensorineural hearing loss is caused by:

 

nerve damage.

 

earwax accumulation.

 

eardrum perforation.

 

barotrauma.

nerve damage

Which of the following would be the most practical method of communicating with a hearing-impaired patient until his or her hearing aids can be located?

 

Using a high-pitched voice while speaking directly into the ear

 

Using a piece of paper and writing utensil to ask questions

 

Contacting dispatch and requesting a sign language interpreter

 

Attempting to use body language to determine the problem

Using a piece of paper and writing utensil to ask questions

General techniques for communicating with hearing-impaired patients include:

 

removing any hearing aids and using pen and paper to ask questions.

 

positioning yourself approximately 18″ directly in front of the patient.

 

exaggerating your lip movements to ensure the patient understands.

 

speaking directly into the patient's ear with an increased voice pitch.

positioning yourself approximately 18″ directly in front of the patient

Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to:

 

speak in a monotone voice.

 

lower the pitch of your voice.

 

try basic sign language first.

 

increase the pitch of your voice.

lower the pitch of your voice

By placing one hand on your head and the other hand over your abdomen, you are asking a hearing-impaired patient if he or she:

 

is sick.

 

needs help.

 

is nauseated.

 

is hurt.

is sick

Which of the following statements regarding hearing aids is correct?

 

In-the-canal hearing aids fit in the outer part of the ear.

 

Over time, hearing aids can restore normal hearing.

 

A whistling sound indicates correct hearing aid placement.

 

Hearing aids cannot restore hearing to normal levels.

Hearing aids cannot restore hearing to normal levels

A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should:

 

remove his hearing aids, turn up the volume, and replace them in his ears.

 

try repositioning the hearing aid or remove it and turn down the volume.

 

recognize that the batteries in his hearing aids are probably depleted.

 

remove both of his hearing aids and use pencil and paper to communicate.

try repositioning the hearing aid or remove it and turn down the volume

Cerebral palsy is characterized by poorly controlled ________ movement.

 

neck

 

extremity

 

body

 

eye

body

Cerebral palsy is a condition that results from damage or injury to the:

 

spinal cord.

 

brain.

 

voluntary muscles.

 

peripheral nervous system.

brain

Which of the following statements regarding cerebral palsy is correct?

 

Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy.

 

A key clinical feature of cerebral palsy is paralysis of the respiratory muscles, which confines the patient to a ventilator.

 

Approximately 25% of patients with cerebral palsy possess some varying degrees of developmental delay.

 

Most cases of cerebral palsy develop within the first 10 years of life and are typically caused by meningitis.

Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy

Which of the following conditions would most likely be encountered in a patient with cerebral palsy?

 

Type 2 diabetes

 

Brain tumors

 

Seizure disorder

 

Paralysis

Seizure disorder

When caring for patients with cerebral palsy, it is important to remember that:

 

they cannot walk and are totally dependent upon you.

 

hearing aids are usually ineffective for patients with hearing loss.

 

their limbs are often underdeveloped and prone to injury.

 

most patients can walk but have an unsteady gait.

their limbs are often underdeveloped and prone to injury

Spina bifida is defined as:

 

a birth defect caused by incomplete closure of the spinal column.

 

chronic pressure on the brain caused by excess cerebrospinal fluid.

 

a birth defect in which the child is born without spinal vertebrae.

 

congenital inflammation of the spinal cord, usually in the neck.

a birth defect caused by incomplete closure of the spinal column

A tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a:

 

shunt.

 

cerebral bypass.

 

CS tube.

 

G-tube.

shunt

Which of the following does not usually contribute to or cause obesity?

 

High caloric intake

 

Low metabolic rate

 

Rapid metabolism

 

Genetic predisposition

Rapid metabolism

An obese person is ________ over ideal weight.

 

15% or more

 

30% or more

 

50% or more

 

10% or more

30% or more

When caring for a morbidly obese patient, you should:

 

establish his or her chief complaint and then communicate your plan to help.

 

leave him or her in a supine position, as this often facilitates breathing.

 

ask the patient if he or she knows what led to his or her obesity problem.

 

call for ALS backup because obese patients are at high risk for heart attack.

establish his or her chief complaint and then communicate your plan to help

You are assessing a 440-lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98 mm Hg, and his heart rate is 120 beats/min. Your most immediate action should be to:

 

avoid placing him in a supine position if possible and administer oxygen.

 

notify the receiving facility and advise them of the patient's weight and status.

 

ask a member of your team to locate the best route to move him to the ambulance.

 

perform a secondary assessment, focusing on his respiratory system and back.

avoid placing him in a supine position if possible and administer oxygen

Because a tracheostomy tube bypasses the nose and mouth:

 

the risk of a local infection is significantly high.

 

severe swelling of the trachea and bronchi can occur.

 

secretions can build up in and around the tube.

 

bleeding or air leakage might occur around the tube.

secretions can build up in and around the tube

According to the "E" in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube?

 

Attempt to pass a suction catheter into the tube.

 

Look for blood or other secretions in the tube.

 

Check the mechanical ventilator for malfunction.

 

Listen to breath sounds to assess for a pneumothorax.

Check the mechanical ventilator for malfunction

General care for a patient with a tracheostomy tube includes all of the following, except:

 

maintaining the patient in a position of comfort when possible.

 

removing the tube if the area around it appears infected.

 

ensuring adequate oxygenation and ventilation at all times.

 

suctioning the tube as needed to clear a thick mucous plug.

removing the tube if the area around it appears infected.

If suctioning of the tracheostomy tube is necessary, the EMT should:

 

insert the suction catheter to a depth of no more than 15 cm and set the suction unit to 140 mm Hg.

 

instill 20 mL of saline into the tracheostomy tube and suction for no longer than 20 seconds.

 

attach a bag-valve mask to the tracheostomy tube and hyperventilate the patient for 2 minutes.

 

attempt to use the patient's suction device first because it is probably already sized correctly.

attempt to use the patient's suction device first because it is probably already sized correctly

A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning, and the child has increasing respiratory distress. You should:

 

reset the ventilator by unplugging it for 30 to 60 seconds.

 

place a call to the home health agency treating this patient.

 

disconnect the ventilator and apply a tracheostomy collar.

 

attempt to troubleshoot the mechanical ventilator problem.

disconnect the ventilator and apply a tracheostomy collar

You receive a call to a residence for an apneic 2-month-old male. When you arrive at the scene, the infant's mother tells you that her son was born prematurely and that his apnea monitor has alarmed four times in the past 30 minutes. Your assessment of the infant reveals that he is conscious and active. His skin is pink and dry, and he is breathing at an adequate rate and with adequate tidal depth. His oxygen saturation reads 98% on room air. You should:

 

transport the infant to the hospital and bring the apnea monitor with you.

 

advise the mother to observe her son and call 9-1-1 again if necessary.

 

request an ALS ambulance to transport the infant to the hospital.

 

administer high-flow oxygen and observe for a drop in oxygen saturation.

transport the infant to the hospital and bring the apnea monitor with you

In contrast to an automated implanted cardioverter/defibrillator, an internal cardiac pacemaker:

 

is implanted under the skin in the left upper abdominal quadrant.

 

will only activate if it detects rhythms such as ventricular fibrillation.

 

delivers a shock to the heart if the rate becomes exceedingly fast.

 

regulates the patient's heart rate if it falls below a preset value.

regulates the patient's heart rate if it falls below a preset value

Under what circumstances is a left ventricular assist device used?

 

To ensure that the ventricles contract at an adequate and consistent rate

 

As a bridge to heart transplantation while a donor heart is being located

 

To permanently replace the function of one or both of the ventricles

 

To reduce ventricular pumping force in patients with aortic aneurysms

As a bridge to heart transplantation while a donor heart is being located

The tip of a central venous catheter rests in the:

 

left atrium.

 

vena cava.

 

right ventricle.

 

pulmonary vein.

vena cava

Common complications associated with central venous catheters include all of the following, except:

 

bleeding around the line.

 

a local infection.

 

rupture of a central vein.

 

clotting of the line.

rupture of a central vein.

Which of the following statements regarding gastrostomy (gastric) tubes is correct?

 

Gastrostomy tubes are placed directly into the small intestine.

 

Gastrostomy tubes are used for patients who cannot digest food.

 

Most gastrostomy tubes are temporary and are not sutured in place.

 

Patients with a gastrostomy tube might still be at risk for aspiration.

Patients with a gastrostomy tube might still be at risk for aspiration

For which of the following conditions would you most likely encounter a ventricular peritoneum shunt?

 

Subdural hematoma

 

Hydrocephalus

 

Epidural hematoma

 

Cerebral palsy

Hydrocephalus

The purpose of a ventricular peritoneum shunt is to:

 

divert excess cerebrospinal fluid to the ventricles of the brain.

 

prevent excess cerebrospinal fluid from accumulating in the brain.

 

remove fluid from the abdomen of patients with right-sided heart failure.

 

monitor pressure within the skull in patients with a head injury.

prevent excess cerebrospinal fluid from accumulating in the brain

Vagus nerve stimulators may be an alternative treatment to medication for patients with:

 

inherently slow heart rates.

 

chronic seizure disorders.

 

certain psychiatric conditions.

 

chronic muscle pain and fatigue.

chronic seizure disorders

A surgical procedure that creates an opening between the intestine and the surface of the body that allows for elimination of waste products is called a(n):

 

intestinal shunt.

 

gastric stoma.

 

colostomy.

 

gastrostomy.

colostomy

Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct?

 

Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

 

Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition.

 

In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient's illness.

 

In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver.

Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition

EMS personnel would most likely be called to the residence of a patient receiving home health care when the home care provider:

 

has recognized a change in the patient's health status.

 

has a question that is specific to the patient's condition.

 

must confirm that a specific intervention is required.

 

needs simple assistance in providing patient care.

has recognized a change in the patient's health status.

According to the Emergency Medical Treatment and Active Labor Act (EMTALA):

 

a healthcare facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical.

 

all healthcare facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured.

 

a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.

 

all healthcare facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

all healthcare facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

EMTs are dispatched for a patient in cardiac arrest. When they arrive, they find that the patient is pulseless, apneic, and wearing an external defibrillator vest. In this situation, the EMTs should:

 

perform CPR and leave the vest in place.

 

apply the AED pads over the vests' pads.

 

quickly remove the vest and perform CPR.

 

wait 5 minutes prior to using the AED.

perform CPR and leave the vest in place

EMTs are dispatched for a patient whose central venous catheter is malfunctioning. When they arrive and assess the patient, they find bleeding from the tubing attached to the line. The EMTs should:

 

request an ALS ambulance to clamp the tubing.

 

gently manipulate the catheter to reduce the bleeding.

 

apply direct pressure to the tubing and transport.

 

carefully remove the catheter and transport.

apply direct pressure to the tubing and transport