OEC 6th Edition Chapter 11

When assessing a patient with a possible stroke, the OEC technician should first work on:

A) identifying risk factors for stroke.

B) determining if there is a family history of stroke.

C) recognizing the signs of a stroke.

D) determining the type of stroke.

C) recognizing the signs of a stroke.

Glucose

is an energy source for brain cells and other cells in the body.

The signs and symptoms of a transient ischemic attack (TIA):

A) are temporary and resolve within 24 hours.

B) can persist for a few days before they resolve.

C) are mild but permanent.

D) are severe and permanent.

A) are temporary and resolve within 24 hours.

Which of the following statements concerning the causation of seizures is correct?

A) A seizure occurs when the heart beats irregularly, causing a decreased amount of oxygen-rich blood to reach the brain.

B) All seizures are caused by epilepsy, a term that describes a problem somewhere in the body.

C) A seizure condition is a muscle problem that causes the arms and legs to jerk.

D) A seizure occurs when there is an electrical disturbance in the brain.

D) A seizure occurs when there is an electrical disturbance in the brain.

You are called to the lodge to assess a 3-year-old boy. The parents state that their son was playing with his brother and "blanked out" and "stared off into space" for several seconds. They deny any convulsing-like movement. Based on this description, you would suspect what type of seizure?

A) A febrile seizure

B) A simple partial seizure

C) A grand mal seizure

D) An absence (petit mal) seizure

D) An absence (petit mal) seizure

You have been called to the lodge for a behavioral emergency. When you arrive, you find a male in his forties sitting up against a wall. He is confused and incontinent. Bystanders state that he suddenly fell to the ground and was grunting and shaking. From this description, what should you suspect first that the man has had?

A) A generalized seizure

B) A diabetic reaction

C) An absence seizure

D) A syncopal episode

A) A generalized seizure

Some patients experience a premonition indicating a seizure is about to happen known as a(n):

A) syncopal stage.

B) aura.

C) colonic phase.

D) postictal state.

B) aura.

Which of the following statements indicates that the speaker understands the danger posed by status epilepticus?

A) "Status epilepticus is an extremely dangerous condition because the patient can go into shock from blood loss."

B) "Patients who do not have a history of seizures are at greater risk for status epilepticus."

C) "The longer the seizure continues, the greater the likelihood of permanent brain damage."

D) "Status epilepticus indicates that the patient's medications have reached toxic levels in the body."

C) "The longer the seizure continues, the greater the likelihood of permanent brain damage."

The primary problem in Type II diabetes is that:

A) sugars cannot be easily digested in the stomach and small intestine.

B) cells exhibit resistance to insulin preventing glucose from entering the cells.

C) insufficient insulin is produced.

D) too much insulin is produced.

B) cells exhibit resistance to insulin preventing glucose from entering the cells.

Which of the following actions may result in hypoglycemia in a diabetes patient?

A) Failure to take insulin or an oral diabetes medication

B) Lack of exercise

C) Missing a meal when the patient has taken their insulin

D) Overeating

C) Missing a meal when the patient has taken their insulin

Hyperglycemia:

A) has a more gradual onset than hypoglycemia.

B) is preceded by an aura, such as hallucinations or detecting unusual odors.

C) has a more rapid onset than hypoglycemia.

D) is more easily treated in prehospital environments than is hypoglycemia.

A) has a more gradual onset than hypoglycemia.

Which of the following events best describes an ischemic stroke?

A) An artery in the brain has ruptured.

B) Blood has collected throughout the brain tissue.

C) A heart attack has occurred at the same time as a stroke.

D) A blood clot has obstructed a blood vessel in the brain

D) A blood clot has obstructed a blood vessel in the brain.

Which of the following statements indicates that the speaker understands hemorrhagic strokes?

A) "They occur when clots form in blood vessels in the brain."

B) "They occur when a blood vessel in the brain ruptures."

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

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

B) "They occur when a blood vessel in the brain ruptures."

Which of the following questions is critical for establishing a window of treatment for a patient who is weak and dizzy and may have suffered a stroke?

A) "Does your father have a history of heart problems or stroke?"

B) "What time did the weakness and dizziness start?"

C) "What medications do you take?"

D) "Do you have any pain in your arms or legs?"

B) "What time did the weakness and dizziness start?"

After a delayed response, you arrive in the lodge and find a 62-year-old female is still seizing. Which one of the following should you do first?

A) Assess her airway and breathing.

B) Determine if she has a seizure history.

C) Ascertain the duration of the seizure.

D) Move her to the aid room for further assessment and then transport her to the hospital.

A) Assess her airway and breathing.

When performing a secondary assessment on a confused patient, which of the following signs is most suggestive of a seizure?

A) Right sided facial droop

B) A bitten tongue

C) Pinpoint pupils

D) A slow heart rate

B) A bitten tongue

You have assessed a patient and found a patent airway, adequate breathing, and a strong radial pulse. The patient is having no difficulty speaking and no facial droop but exhibits a slight left arm drift. You should interpret these findings as:

A) not suggestive of a stroke.

B) suggestive of a stroke only if the patient's blood pressure is also elevated.

C) suggestive of a stroke only if the patient's pupils are not equal.

D) suggestive that a stroke may be occurring.

D) suggestive that a stroke may be occurring.

Which of the following statements shows that the speaker has an accurate 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 just weak."

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

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

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, you would tell the patient:

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 don't go away, call 911."

D) "You really need to be evaluated in the hospital. You could be having a stroke."

D) "You really need to be evaluated in the hospital. You could be having a stroke."

Which of the following instructions to a possible stroke patient describes the proper procedure for assessing an arm drift?

A) "Hold your arms up over your head for 20 seconds."

B) "Grab my fingers with both of your hands and squeeze as hard as you can."

C) "Raise your hands above your head and close your eyes."

D) "Hold your arms straight out in front of you with your palms facing up with your eyes closed."

D) "Hold your arms straight out in front of you with your palms facing up with your eyes closed."

Which letter in FAST-ED involves the eyes?

A) F

B) S

C) E

D) D

C) E

Your assessment reveals a drooling 48-year-old male to have gurgling speech and left arm paralysis. Which of the following would be your priority?

A) Suction the patient's airway.

B) Protect the patient's left arm.

C) Determine the patient's risk factors for stroke.

D) Monitor the patient's blood pressure

A) Suction the patient's airway.

You have been called for a seizure emergency. You find an adult female actively seizing with a bystander attempting to place a spoon between her teeth. The bystander tells you that he is trying to keep the person from biting her tongue. Which one of the following would be an appropriate response?

A) Tell the bystander to continue trying to get the spoon in place.

B) Ask the bystander to discontinue his efforts and then turn the patient onto her side to facilitate the drainage of oral secretions.

C) Instruct the bystander to restrain the patient while you put the spoon in place.

D) Tell the bystander that a padded tongue blade works better.

B) Ask the bystander to discontinue his efforts and then turn the patient onto her side to facilitate the drainage of oral secretions.

A young boy tells you that his twin brother suffers from seizures and asks what he can do if he sees his brother convulsing. You should give him which one of the following instructions?

A) "Move any moveable objects and furniture away from him."

B) "Hold him firmly against the floor until he stops seizing or until the EMTs arrive."

C) "Insert a spoon into his mouth to keep him from swallowing his tongue."

D) "Call EMS only if the seizure lasts more than 10 minutes or he loses control of his bladder." "When he quits seizing, give him sugar so his blood sugar is OK."

A) "Move any moveable objects and furniture away from him."

As a general rule, a seizing patient should be transported in what position?

A) Supine

B) Sitting upright

C) On their side

D) Supine with legs elevated

C) On their side

Focal seizures

Originates in one side of brain but may quickly spread to other side. Simple focal seizure can be involuntary motion of muscle group or facial twitching, may be patient complaining of blurred vision or seeing spots, abnormal metallic tastes or smells. Complex focal seizure, loss of responsiveness may be repetitive actions like lip smacking or head twisting

Generalized seizure

Affects both side of brain equally, decreased responsiveness, mildest form is absence seizure or petit mal, signs are vacant stare or rolling of eyes, may be less than 15 seconds. Most common type is Grand Mal Seizure with muscle tensing

Normal body blood glucose level

80-140 mg/dL, blood sugar rises after meals, pancreas secretes more insulin to signal the cells to absorb more glucose and lower blood sugar. Once blood sugar levels falls, insulin secretion falls as well

Body with diabetes 

Either insufficient insulin produced by pancreas (type 1) or body is resistant to insulin (type 2)

Hypoglycemia

When circulating blood sugar levels are too low. Blood sugar levels can fall from taking too much insulin, not eating enough food, or physical exercise increasing metabolic demands

Signs of hypoglycemia

Signs are change in responsiveness, confusion, slurred speech, unilateral weakness, diaphoresis (sweating)

Hyperglycemia

When circulating blood sugar levels are too high. Could be when diabetic doesn’t take their medication, is accompanied by polyuria (increased urination) and polydipsia (increased thirst).

Signs of hyperglycemia

These patients may have nausea, vomiting, abdominal pain, slower onset than hypoglycemia 

Stroke

Lack of blood flow to the brain 

Ischemic stroke

When a blood vessel supplying blood to the brain is obstructed or blocked. Typically caused by blockage like blood clot which is in a brain artery or embolus, blood clot elsehwere in body

Hemorrhagic stroke

Occurs when a blood vessel in the brain suddenly ruptures. Reduces the amount of oxygen and nutrients available to the brain plus creates hematoma putting pressure on brain. Most common cause is an aneurysm or bulge in a vessel bursting open. People with hypertension and high blood pressure at risk of this type of stroke.

Managing diabetes issue

Administer oral glucose, hyperglycemia will cause brain damage so better be safe, never put in mouth of unresponsive patient

Signs and symptoms of stroke with FAST-ED scale

Face drooping, arm weakness, speech difficulty, time to call 911 if see these symptoms, eyedeviation, denial

Stroke management

Definitive care must be provided in hospital setting, improve survival with high flow oxygen, record time last known well

Transient ischemic attack

Temporary interruption of blood flow to area of brain causing reversible neurologic deficit, no permanent brain injury results, can be inidcator of future stroke