Chapter 2 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

D) An organism that causes infection and disease. Pathogens are organisms that cause infection, such as viruses and bacteria.

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

C) Personal protective equipment. Personal protective equipment such as gloves, goggles, and gowns help to protect care providers from exposure to body substances.

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.

A) drinking caffeine instead of alcohol. Both caffeine and alcohol can increase stress and anxiety, as well as disturb sleep patterns.

4) What is the primary reason for an EMT to change gloves between contacts 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

D) To prevent spreading infection to the next patient. Gloves should be changed between patients to prevent transmitting infection from one patient to another.

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

C) A patient who is actively coughing. Eye protection prevents splashing, spattering, or spraying fluids from entering the body through the mucous membranes of the eyes.

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) Obtaining blood samples

C) Splinting a sprained ankle. Splinting a sprained ankle will generally not expose an EMT to blood or body fluids.

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

B) heavy-duty gloves. Crash scenes often involve sharp metal and glass, so heavy-duty gloves provide extra protection in addition to standard PPE.

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.

B) Mask yourself and the patient. Best practice is to protect yourself and also mask the patient when possible using an N-95 or HEPA respirator.

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.

B) If the EMT's hands are visibly dirty, an alcohol-based hand cleaner is not sufficient. Alcohol-based hand cleaners are effective except when hands are visibly soiled or anthrax is present.

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

C) Fecal-oral. Hepatitis A is acquired primarily through contact with food or water contaminated by feces.

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

B) Hepatitis B. Hepatitis B can live for many days in dried blood spills, creating an ongoing risk of infection.

12) Healthcare employers are required by law to make a hepatitis B ________ available to employees free of charge.

A) prophylactic

B) vaccine

C) cure

D) fact sheet

B) vaccine. Employers must provide the hepatitis B vaccination series free of charge at a reasonable time and place.

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.

D) A tuberculin skin test can detect TB exposure. A tuberculin skin test (TST) can identify exposure even though there is no standard immunization in the US.

14) 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

B) Immunosuppressed patients. People with suppressed immune systems are at greatest risk for contracting and transmitting TB.

15) 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

D) Tuberculosis. TB commonly causes productive cough, weight loss, weakness, night sweats, and fever.

16) 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.

D) The provider's hands come into contact with fecal matter. Alcohol-based sanitizer is not sufficient when hands are visibly soiled.

17) 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

D) Ryan White CARE Act. This act establishes procedures for emergency responders to be notified of potential exposure to life-threatening infectious diseases.

18) 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 exposur

B) Report the exposure so you can protect yourself from any accidental infection. Reporting exposure is critical to reduce risk and ensure appropriate follow-up.

19) 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

D) Gloves, N-95 mask, goggles, and gown. Proper precautions include gloves, gown, eye protection, and an N-95 respirator.

20) 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 exacerbating 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

D) Obstructing the ability to visualize and protect the airway. Masks reduce the ability to monitor and manage the airway.

21) 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

D) N-95. EMTs should wear an N-95 or HEPA respirator when treating or transporting suspected TB patients.

22) 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.

B) detect a person's exposure to tuberculosis. The test is used to determine whether a person has been exposed to TB.

23) 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

C) Stress. Stress is defined as physical and/or psychological arousal in response to a stimulus.

24) 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) Hypertropy

C) Distress

D) Eustress

C) Distress. Distress is negative stress that can cause both short-term and long-term health problems.

25) 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

D) Sympathetic nervous system. The sympathetic nervous system increases activity during stress as part of the fight-or-flight response.

26) Which hormone helps the body control stress, regulate metabolism, and influence an immune response?

A) Immunoglobulin

B) Serotonin

C) Epinephrine

D) Cortisol

D) Cortisol. Cortisol regulates metabolism, influences immune response, and helps the body cope with stress.

27) 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

C) Alarm reaction stage. During the alarm reaction stage, the body responds with increased heart rate, blood pressure, and pupil dilation.

28) The body's three-stage response to a stressful stimulation is known as general ________ syndrome.

A) incident

B) resistance

C) reaction

D) adaptation

D) adaptation. The three-stage stress response is called general adaptation syndrome.

29) According to Dr. Hans Selye, the third stage of the body's response to stress is known as the ________ stage.

A) resistance

B) cumulative

C) exhaustion

D) alarm

C) exhaustion. Exhaustion is the third stage after prolonged stress.

30) 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

A) Bleeding gastric ulcers. Selye described adrenal hypertrophy, lymph node atrophy, and bleeding gastric ulcers.

31) The term burnout is also known as a(n) ________ stress reaction.

A) delayed

B) post-traumatic

C) acute

D) cumulative

D) cumulative. Burnout results from prolonged recurring stressors and is considered cumulative stress reaction.

32) Posttraumatic stress disorder may be described as a(n):

A) acute stress reaction.

B) cumulative stress reaction.

C) severe stress reaction.

D) delayed stress reaction.

D) delayed stress reaction. PTSD is a delayed stress reaction that may develop days, months, or years later.

33) What are some signs and symptoms that a coworker may be experiencing a 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

D) Flashbacks, nightmares, and feelings of detachment. PTSD often includes flashbacks, nightmares, detachment, irritability, and concentration issues.

34) 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

D) injury of a coworker. Acute stress reactions occur during or shortly after critical incidents like disasters or injury of a coworker.

35) 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

D) Think and solve problems. Cognitive ability refers to thinking and problem-solving.

36) 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

D) Eustress. Eustress is positive stress that improves performance under pressure.

37) 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, and coworkers

C) Flashbacks, nightmares, and feelings of detachment

D) Increased speeding and reckless driving

B) Irritability with friends, family, and coworkers. Irritability is a common stress symptom, unlike flashbacks which suggest PTSD.

38) For the last few days, your regular EMT partner has been having trouble sleeping, has been on edge, and has had 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 posttraumatic 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)

C) Your partner is suffering from a delayed stress reaction and you should recommend that he seek professional counseling. His symptoms started weeks after the incident, suggesting delayed stress reaction, and alcohol is not a healthy coping method.

39) 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"

B) Regular physical exercise. Exercise and healthy lifestyle changes are positive ways to cope with stress.

40) 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 friends or loved ones.

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.

C) seek help from a trained mental health professional. A mental health professional trained in these issues is the best resource for significant stress.

41) Because 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

A) critical incident stress. Critical incident stress management (CISM) provides education and resources to prevent and manage EMS stress.

42) 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."

B) are now less common than they once were. CISDs are used less often and are not recommended by many EMS and mental health professionals.

43) 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

A) Bargaining. Bargaining often includes statements like "But first I want..." as the patient hopes to delay death.

44) 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

C) Anger. The anger stage of grief is commonly directed toward family members and EMS providers.

45) 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

D) Denial. Pleading for the person to wake up shows denial that the death has occurred.

46) 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 t

D) Listen empathetically to all of her complaints and let her know she can contact you for any additional assistance. The EMT should not take the anger personally and should respond with empathy and realistic support.

47) 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.

A) naive and uncompassionate. False reassurance can be irritating and suggests the EMT does not understand the seriousness of the situation.

48) 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

A) Being tolerant of angry reactions by patients and family members. Anger is a normal grief response and should not be taken personally by the EMT.

49) Which three "Rs" are essential for the EMT to practice when reacting to danger?

A) Respond, radio, reevaluate

B) Remember, respect, respond

C) Ricochet, recover, re-entry

D) Realize, react, reassess

A) Respond, radio, reevaluate. The three Rs involve leaving danger, requesting help, and reassessing the scene.

50) What is not the priority of an EMT at the scene of a hazardous materials incident?

A) Personal safety

B) Identification of hazardous materials

C) Patient care

D) Safety of bystanders

B) Identification of hazardous materials. EMTs should focus on recognizing hazards and calling hazmat experts rather than trying to identify materials themselves.

51) 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

B) Emergency Response Guidebook. The Emergency Response Guidebook provides information on dangerous materials, safe distances, emergency care, and procedures.

52) 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.

B) Transport decontaminated patients. EMTs should not treat or transport until patients have been properly decontaminated.

53) 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.

A) He is not only putting his life at risk, but also placing the lives of the professional rescuers unnecessarily at risk. Rescuer safety is always the top priority.

54) 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.

C) Leave the house and call for law enforcement. The EMTs should remove themselves from danger and not re-enter until the scene is secured.

55) 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.

D) Leave immediately to a safe area and then call for police assistance. EMTs should leave immediately and not delay escape by gathering equipment.

56) You are dispatched to a "man down" with no further information. As your unit arrives on-scene, 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 because 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.

C) Dispatch law enforcement and wait until the scene is secure. EMT safety comes first, and the scene must be secured before providing care.

57) 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.

C) Ensure scene safety. Scene safety must be confirmed before entering, even before PPE use.

58) 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

B) Reflective outer clothing. High visibility to passing motorists is essential, making reflective outer clothing the greatest safety factor.