Chapter 37: Patients with Special Challenges

Which of the following is a developmental disorder characterized by impairment of social interaction?
A. Down syndrome
B. Autism
C. Cerebral palsy
D. Spina bifida

Which of the following is a developmental disorder characterized by impairment of social interaction?
A. Down syndrome
B. Autism
C. Cerebral palsy
D. Spina bifida

B. Autism

Known risk factors for Down syndrome include:
A. smoking.
B. traumatic brain injury at birth.
C. increased maternal age.
D. lack of vitamin B.

C. increased maternal age.

The Emergency Medical Treatment and Active Labor Act (EMTALA) states that:
A. patients should only be treated if they can pay for care.
B. all patients must be treated regardless of their ability to pay for care.
C. only those with serious injuries can be treated without payment for care.
D. only certain facilities can treat patients who cannot pay for care.

B. all patients must be treated regardless of their ability to pay for care.

Which of the following may be difficult to perform on a patient with Down syndrome?
A. CPR
B. Pulse oximetry
C. Splinting
D. Intubation

D. Intubation

Most patients with this disease also have hydrocephalus.
A. Paralysis
B. Down syndrome
C. Spina bifida
D. Cerebral palsy

C. Spina bifida

What does the DOPE mnemonic help you to recognize?
A. Causes of airway obstruction
B. Risk factors for patients using technology assistance
C. Questions to ask patients with pacemakers
D. A vagal nerve stimulator

A. Causes of airway obstruction

What device is placed directly into the stomach to feed patients?
A. Colostomy
B. Ileostomy
C. Gastrostomy tube
D. Central venous catheter

C. Gastrostomy tube

What do vagal nerve stimulators do?
A. Keep seizures from occurring
B. Keep the airway clear from secretions
C. Act as an alternative treatment to medicine
D. Both A and C

D. Both A and C

An important part of the assessment process for a patient with special needs is to:
A. interact with the caregiver.
B. interact with the patient.
C. talk to the manufacturer of the equipment being used.
D, transport immediately.

A. interact with the caregiver.

What improves a patient's quality of life shortly before death?
A. Home care
B. Hospice care
C. Comfort care
D. Health care

C. Comfort care

When caring for a patient who is visually impaired, it is important to:
A. allow a service dog to remain with the patient at all times, even if the patient is critically ill.
B. stand to the side of the patient when speaking if his or her peripheral vision is impaired.
C. leave items such as canes and walkers at the residence if the patient will be carried on a gurney.
D. tell him or her what is happening, identify noises, and describe the situation and surroundings.

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

Under what circumstances is a left ventricular assist device used?
A. To permanently replace the function of one or both of the ventricles
B. As a bridge to heart transplantation while a donor heart is being located
C. To reduce ventricular pumping force in patients with aortic aneurysms
D. To ensure that the ventricles contract at an adequate and consistent rate

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

Down syndrome is a genetic defect that occurs as the result of:
A. an extra pair of chromosomes.
B. a separation of chromosome 21.
C. a triplication of chromosome 21.
D. a sperm that contains 24 chromosomes.

C. a triplication of chromosome 21.

Down syndrome patients are at an increased risk for medical complications. Which of the following is NOT one of those potential complications?
A. Respiratory complications
B. Cardiovascular complications
C. Gastrointestinal complications
D. Endocrine complications

A. Respiratory complications

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:
A. recognize that the batteries in his hearing aids are probably depleted.
B. remove his hearing aids, turn up the volume, and replace them in his ears.
C. try repositioning the hearing aid or remove it and turn down the volume.
D. remove both of his hearing aids and use pencil and paper to communicate.

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

Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct?
A. In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver.
B. Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition.
C. 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.
D. Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

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

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):
A. colostomy.
B. gastrostomy.
C. gastric stoma.
D. intestinal shunt.

A. colostomy.

A person is said to be obese when he or she is ________ over his or her ideal weight.Select one:
A. 10% or more
B. 20% or more
C. 30% or more
D. 40% or more

C. 30% or more

Which of the following statements regarding patients with intellectual disabilities is correct?
A. Speaking with the patient's family is the least effective way to determine how much the patient understands.
B. Patients with intellectual disabilities are susceptible to the same disease processes as other patients.
C. An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality.
D. Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.

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

The purpose of a ventricular peritoneum shunt is to:
A. divert excess cerebrospinal fluid to the ventricles of the brain.
B. monitor pressure within the skull in patients with a head injury.
C. remove fluid from the abdomen of patients with right-sided heart failure.
D. prevent excess cerebrospinal fluid from accumulating in the brain.

D. prevent excess cerebrospinal fluid from accumulating in the brain.

Cerebral palsy is characterized by poorly controlled ________ movement.
A. eye
B. neck
C. body
D. extremity

C. body

Which of the following statements regarding autism is correct?
A. Autism affects females four times greater than males.
B. The majority of patients with autism do not speak at all.
C. Most cases of autism are diagnosed by 3 years of age.
D. Impairment of motor activity is a classic sign of autism.

C. Most cases of autism are diagnosed by 3 years of age.

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?
A. Attempting to use body language to determine the problem
B. Using a piece of paper and writing utensil to ask questions
C. Using a high-pitched voice while speaking directly into the ear
D. Contacting dispatch and requesting a sign language interpreter

B. Using a piece of paper and writing utensil to ask questions

Spina bifida is defined as:
A. congenital inflammation of the spinal cord, usually in the neck.
B. a birth defect caused by incomplete closure of the spinal column.
C. a birth defect in which the child is born without spinal vertebrae.
D. chronic pressure on the brain caused by excess cerebrospinal fluid.

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

A ventricular atrium shunt drains excess fluid from the ventricles of the brain into the:
A. right atrium of the heart.
B. left atrium of the heart.
C. right ventricle of the heart.
D. left ventricle of the heart.

A. right atrium of the heart.

Which of the following conditions would MOST likely be encountered in a patient with cerebral palsy?
A. Paralysis
B. Brain tumors
C. Type 2 diabetes
D. Seizure disorder

D. Seizure disorder

Which of the following statements is NOT true regarding the care of a patient with cerebral palsy?Select one:
A. Do not assume these patients are mentally disabled.
B. Limbs are often underdeveloped and are prone to injury.
C. Walkers or wheelchairs should not be taken in the ambulance.
D. Be prepared to care for a seizure if one occurs.

C. Walkers or wheelchairs should not be taken in the ambulance.

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?
A. Look for blood or other secretions in the tube.
B. Attempt to pass a suction catheter into the tube.
C. Check the mechanical ventilator for malfunction.
D. Listen to breath sounds to assess for a pneumothorax.

C. Check the mechanical ventilator for malfunction.

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:
A. avoid placing him in a supine position if possible and administer oxygen.
B. notify the receiving facility and advise them of the patient's weight and status.
C. perform a secondary assessment, focusing on his respiratory system and back.
D. ask a member of your team to locate the best route to move him to the ambulance.

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

Which of the following statements is NOT true regarding patients with autism?
A. They fail to use or understand nonverbal communication.
B. They will talk with normal tone and speech patterns.
C. They may have extreme difficulty with complex tasks that require many steps.
D. They have difficulty making eye-to-eye contact.

B. They will talk with normal tone and speech patterns.

Because a tracheostomy tube bypasses the nose and mouth:
A. secretions can build up in and around the tube.
B. the risk of a local infection is significantly high.
C. bleeding or air leakage may occur around the tube.
D. severe swelling of the trachea and bronchi can occur.

A. secretions can build up in and around the tube.

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:
A. attempt to troubleshoot the mechanical ventilator problem.
B. disconnect the ventilator and apply a tracheostomy collar.
C. place a call to the home health agency treating this patient.
D. reset the ventilator by unplugging it for 30 to 60 seconds.

B. disconnect the ventilator and apply a tracheostomy collar.

When caring for a patient with a previous head injury, you should:
A. speak in a loud, commanding tone.
B. expect the patient to be able to walk.
C. watch the patient for signs of anxiety.
D. never consider restraining the patient.

C. watch the patient for signs of anxiety.

A tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a:
A. G-tube.
B. CS tube.
C. shunt.
D. cerebral bypass.

C. shunt.

Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to:Select one:
A. increase the pitch of your voice.
B. try basic sign language first.
C. lower the pitch of your voice.
D. speak in a monotone voice.

C. 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
A. is sick.
B. is hurt.
C. is nauseated.
D. needs help.

A. is sick.

Cerebral palsy is a condition that results from damage or injury to the:
A. brain.
B. peripheral nervous system.
C. spinal cord.
D. voluntary muscles.

A. brain.

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. an intracranial hemorrhage.
B. a seizure.
C. a cervical spine injury.
D. hydrocephalus.

C. a cervical spine injury.

General care for a patient with a tracheostomy tube includes all of the following, EXCEPT:
A. maintaining the patient in a position of comfort when possible.
B. removing the tube if the area around it appears to be infected.
C. suctioning the tube as needed to clear a thick mucous plug.
D. ensuring adequate oxygenation and ventilation at all times.

B. removing the tube if the area around it appears to be infected.

General techniques for communicating with hearing-impaired patients include:Select one:
A. speaking directly into the patient's ear with an increased voice pitch.
B. positioning yourself approximately 18 inches directly in front of the patient.
C. removing any hearing aids and using pen and paper to ask questions.
D. exaggerating your lip movements to ensure the patient understands.

B. positioning yourself approximately 18 inches directly in front of the patient.

When assessing or providing care to a patient with an intellectual disability, you should:
A. frequently reassure him or her that everything will be okay.
B. move swiftly and deliberately to quickly accomplish the task.
C. explain procedures while in the process of performing them.
D. be observant for signs of fear or reluctance from the patient.

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

When caring for patients with cerebral palsy, it is important to remember that:
A. most patients have the ability to walk, but have an unsteady gait.
B. hearing aids are usually ineffective for patients with hearing loss.
C. they are unable to walk and are totally dependent upon you.
D. their limbs are often underdeveloped and are prone to injury.

D. their limbs are often underdeveloped and are prone to injury.

When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to:
A. avoid any kind of lip movement while he or she is signing with the patient.
B. voice what he or she is signing while communicating with the patient.
C. report exactly what the patient signs and not to add any commentary.
D. document the answers to the questions that the patient has responded to.

C. report exactly what the patient signs and not to add any commentary.

When interacting with an intellectually disabled patient, the best approach is to:
A. approach the patient as a team to reassure him or her that you are there to help.
B. speak primarily with the patient's family to establish the degree of disability.
C. ask your team members to wait until you can establish a rapport with the patient.
D. position yourself slightly above the patient's level to reduce his or her anxiety.

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

Common complications associated with central venous catheters include all of the following, EXCEPT:
A. clotting of the line.
B. bleeding around the line.
C. a local infection.
D. rupture of a central vein.

D. rupture of a central vein.

Autism is defined as a:
A. psychiatric condition related to an imbalance of serotonin in the brain.
B. mental disability caused by insufficient cognitive development of the brain.
C. congenital condition caused by factors such as malnutrition or birth complications.
D. pervasive developmental disorder characterized by impairment of social interaction.

D. pervasive developmental disorder characterized by impairment of social interaction.

Common associated conditions in patients with spina bifida include all of the following, EXCEPT:
A. hydrocephalus.
B. spastic limb movement.
C. extreme latex allergy.
D. loss of bladder control.

B. spastic limb movement.

Characteristic anatomic features of Down syndrome include:
A. a proportionately small tongue.
B. a round head with a flat occiput.
C. bulging eyes & a large face.
D. long hands with wide fingers.

B. a round head with a flat occiput.

An important aspect in the assessment of a pt who experienced a previous brain injury involves:
A. presuming that he or she has cognitive impairment until proven otherwise.
B. contacting the pt's physician to determine the extent of the brain injury.
C. recalling that most pts with a brain injury have other organ dysfunction.
D. speaking with the pt & family to establish what is considered normal for the pt.

D. speaking with the pt & family to establish what is considered normal for the pt.

In contrast to conductive hearing loss, sensorineural hearing loss is caused by:
A. barotrauma
B. nerve damage
C. earwax accumulation
D. eardrum perforation

B. nerve damage

Which of the following statements regarding hearing aids is correct?
A. over time, hearing aids can restore normal hearing.
B. in-the-canal hearing aids fit in the outer part of the ear.
C. hearing aids cannot restore hearing to normal levels.
D. a whistling sound indicates correct hearing aid placement.

C. hearing aids cannot restore hearing to normal levels.

Which of the following statements regarding cerebral palsy is correct?
A. condition such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy.
B. most cases of cerebral palsy develop with the first 10 years of life and are typically caused by meningitis.
C. a key clinical feature of cerebral palsy is paralysis of the respiratory muscles, which confines the pt to a ventilator.

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

In contrast to an automated implanted cardioverter/defibrillator, an internal cardiac pacemaker:
A. regulates the pt's heart rate if it falls below a preset value
B. delivers a shock to the heart if the rate becomes exceedingly fast.
C. is implanted under the skin in the left upper abdominal quadrant.
D. will only activate if it detects rhythms such as ventricular fibrillation

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

The tip of a central venous catheter rests in the:
A. vena cava
B. left atrium
C. right ventricle
D. pulmonary vein

A. vena cava

Which of the following statements regarding gastrostomy (gastric) tubes is correct?
A. gastrostomy tubes are placed directly into the small intestine.
B. most gastrostomy tubes are temporary & are not sutured in place
C. Pt's with gastrostomy tube may still be at risk for aspiration.

C. Pt's with gastrostomy tube may still be at risk for aspiration.

Vagal nerve stimulator may be an alternative treatment to medication for pt's with:
A. chronic seizure disorders
B. inherently slow heart rates
C. certain psychiatric conditions
D. chronic muscle pain & fatigue

A. chronic seizure disorders

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:
A. carefully remove the catheter and transport.
B. apply direct pressure to the tubing and transport.
C. request an ALS ambulance to clamp the tubing.
D. gently manipulate the catheter to reduce the bleeding.

B. apply direct pressure to the tubing and transport.

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:
A. request an ALS ambulance to transport the infant to the hospital.
B. advise the mother to observe her son and call 9-1-1 again if necessary.
C. administer high-flow oxygen and observe for a drop in oxygen saturation.
D. transport the infant to the hospital and bring the apnea monitor with you.

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