Chapter 40

Chapter 40
Multiple Choice
1. Advanced airway management techniques should performed ONLY after:

A. the patient is assessed as being apneic.
B. the patient has been delivered to the hospital.
C. basic airway techniques have been completed.
D. the upper airway has been thoroughly suctioned.
Answer: C
Question Type: General Knowledge
Page: 1464
2. After opening a patient’s airway, you should:

A. insert an airway adjunct.
B. ensure the airway is clear.
C. assess for breathing effort.
D. administer oxygen as needed.
Answer: B
Page: 1465
3. Endotracheal intubation is MOST accurately defined as:

A. inserting a tube through the mouth and in between the vocal cords.
B. inserting a tube into the trachea to maintain the airway and ventilate.
C. inserting a suction catheter into the trachea to remove thick secretions.
D. blindly inserting a tube through the nose and into the tracheal opening.
Answer: B
Page: 1465
4. Endotracheal intubation is indicated for patients:

A. prior to defibrillation if ventricular fibrillation is present.
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B. who are unconscious and cannot protect their own airway.
C. in need of assisted ventilation due to reduced tidal volume.
D. who are extremely combative and have an intact gag reflex.
Answer: B
Page: 1465
5. If a patient is being adequately ventilated with a bag-mask device attached to high-

flow oxygen:
A. intubation should be performed after 5 minutes.
B. endotracheal intubation may not be necessary.
C. the patient should be intubated via the nasal route.
D. it can safely take up to 60 seconds to perform intubation.
Answer: B
Page: 1465
6. Visualized orotracheal intubation requires all of the following equipment, EXCEPT a:

A. stylet.
B. laryngoscope.
C. 10-mL syringe.
D. local anesthetic.
Answer: D
Page: 1465
7. Prior to performing orotracheal intubation in a cardiac arrest patient, it is MOST

important to:
A. ensure that the stomach is not distended.
B. perform CPR for at least 5 to 10 minutes.
C. hyperventilate the patient for 20 to 30 seconds.
D. adequately preoxygenate with a bag-mask device.
Answer: D
Page: 1466
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8. Although you should carry a variety of endotracheal (ET) tube sizes, a _____ ET tube
will adequately fit most adults.
A. 6.0-mm
B. 7.5-mm
C. 8.5-mm
D. 9.0-mm
Answer: B
Page: 1467
9. Regardless of the size of the ET tube that you will use to intubate your patient, you
should:
A. have one tube smaller and one tube larger.
B. have several ET tubes of identical size.
C. only use a stylet for tubes larger than 7.0 mm.
D. always have a 9.0-mm tube in case it is needed.
Answer: A
Page: 1467
10. When determining the proper size ET tube to use in an infant or small child, you
should:
A. double the child’s age in years and add two.
B. use a length-based resuscitation tape measure.
C. select the smallest possible tube with a cuff.
D. use a tube that is the size of the child’s thumb.
Answer: B
Page: 1467
11. When an ET tube is placed in an adult patient, the tube-to-teeth mark is usually
around:
A. 15 cm.
B. 20 cm.
C. 22 cm.
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D. 25 cm.
Answer: C
Page: 1468
12. When inserting the stylet inside an ET tube, you should:

A. bend the ET tube in the shape of a “U.”
B. recede the stylet 3″ from the tube’s distal tip.
C. apply petroleum jelly to the tube’s distal tip.
D. avoid inserting the stylet past Murphy’s eye.
Answer: D
Page: 1468
13. The distal cuff on an ET tube should be inflated with no more than ______ of air after
it is placed into the trachea.
A. 10 mL
B. 15 mL
C. 20 mL
D. 25 mL
Answer: A
Page: 1468
14. Prior to attempting endotracheal intubation, the EMT should:

A. obtain authorization from medical control.
B. ventilate the patient for at least 30 seconds.
C. contact a paramedic and obtain permission.
D. suction the patient’s airway for 30 seconds.
Answer: A
Page: 1470
15. A single intubation attempt in the adult patient should not exceed:
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A. 20 seconds.
B. 30 seconds.
C. 40 seconds.
D. 45 seconds.
Answer: B
Page: 1470
16. Intubating a patient who is in cardiac arrest should occur after:

A. the stomach has been adequately decompressed with a gastric tube.
B. the patient has been assessed to determine if defibrillation is indicated.
C. adequate chest compressions have been performed for at least 5 minutes.
D. two attempts to insert a multilumen airway device have been unsuccessful.
Answer: B
Page: 1471
17. After successfully intubating a 56-year-old man who is in cardiac arrest, you should:
A. perform asynchronous CPR.
B. defibrillate him with the AED.
C. ventilate at a rate of 20 breaths/min.
D. occlude the esophagus with a Combitube.
Answer: A
Question Type: Critical Thinking
Page: 1471
18. The appropriate method of inserting a laryngoscope blade into the patient’s mouth to
visualize the vocal cords is to:
A. insert the blade in the left side of the mouth, sweep the tongue to the left, and pry.
B. insert the blade in the right side of the mouth, sweep the tongue to the left, and pry.
C. insert the blade in the right side of the mouth, sweep the tongue to the left, and lift.
D. use the tongue-jaw lift maneuver, insert the blade in the center of the mouth, and lift.
Answer: C
Page: 1471
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19. During visualized orotracheal intubation, the straight blade:
A. directly lifts the epiglottis and exposes the vocal cords.
B. indirectly lifts the epiglottis by fitting into the vallecula.
C. is contraindicated in infants and children younger than 5 years.
D. has a broad flange and provides better tongue displacement.
Answer: A
Page: 1471
20. To avoid obscuring your view of the vocal cords during intubation, you should:
A. not pass the ET tube down the center of the laryngoscope blade.
B. gently pry against the patient’s teeth to achieve adequate leverage.
C. direct your assistant to apply firm pressure to the thyroid cartilage.
D. ensure that the straight blade is in the vallecular space before lifting.
Answer: A
Page: 1471
21. You respond to a construction site where a steel girder collapsed on a 22-year-old
male’s chest. Coworkers removed the girder prior to your arrival. Your assessment
reveals that he is unconscious and apneic, but has a pulse. You should:
A. open his airway with the jaw-thrust maneuver, maintain his head in a neutral in-line
position, and insert a Combitube.
B. apply a cervical collar, maintain an open airway with the jaw-thrust maneuver, and
insert a multilumen airway device.
C. ensure that his spine is fully immobilized, maintain his airway with an oropharyngeal
airway, and perform endotracheal intubation.
D. maintain stabilization of his head, open his airway with the jaw-thrust maneuver,
ventilate with a bag-mask device, and prepare to intubate him.
Answer: D
Page: 1471
22. Immediately after you place an ET tube in the trachea, you should remove the stylet
and then:
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A. attach the bag-mask device and ventilate.
B. listen for breath sounds to confirm placement.
C. secure the ET tube with the appropriate device.
D. inflate the distal cuff and detach the syringe.
Answer: D
Page: 1472–1473
23. Confirmation techniques and devices used to determine correct ET tube placement
include all of the following, EXCEPT:
A. rise and fall of the abdomen.
B. esophageal detector devices.
C. auscultation of breath sounds.
D. end-tidal carbon dioxide detectors.
Answer: A
Page: 1473–1474
24. Which of the following is the MOST reliable indicator of successful endotracheal
intubation?
A. the presence of bilaterally clear and equal breath sounds
B. visualization of the tube passing between the vocal cords
C. when the paper in the end-tidal CO2 detector turns yellow
D. the presence of mist or vapor in the tube during exhalation
Answer: B
Page: 1474
25. After intubating a 44-year-old unconscious, apneic male, you place him on the
ambulance stretcher and prepare to load him into the ambulance. After he is placed
into the ambulance, you should:
A. continue ventilations with an automatic ventilator.
B. reassess the patient’s vital signs and attach an AED.
C. reconfirm that the ET tube is still correctly positioned.
D. hyperventilate the patient for approximately 30 seconds.
Answer: C
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Page: 1474
26. Complications associated with endotracheal intubation include all of the following,
EXCEPT:
A. left main stem bronchus intubation.
B. hypoxia due to prolonged attempts.
C. a marked decrease in the heart rate.
D. trauma to the soft tissues in the mouth.
Answer: A
Page: 1475–1476
27. You have inserted an ET tube but are unable to hear breath sounds on the left side of
the chest. You should:
A. treat the patient for a pneumothorax and transport immediately.
B. extubate the patient and preoxygenate for at least 2 to 3 minutes.
C. advance the tube as you are auscultating the patient’s breath sounds.
D. withdraw the tube approximately 1″ and reassess breath sounds.
Answer: D
Page: 1475
28. You have attempted to intubate a 66-year-old male twice without success. Medical
control is unable to be contacted. Your MOST appropriate action should be to:
A. have your partner attempt to successfully intubate the patient.
B. insert an oral airway, ventilate with a bag-mask device, and transport.
C. preoxygenate with a bag-mask device and insert a multilumen airway.
D. continue intubation attempts until medical control has been contacted.
Answer: B
Page: 1475
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29. After performing endotracheal intubation on an elderly male in cardiac arrest, you
think you hear breath sounds, but also hear gurgling over the epigastrium. You
should:
A. withdraw the ET tube approximately 1″ and then reauscultate over the epigastrium.
B. attach an end-tidal CO2 detector to the ET tube and observe for the appropriate color
change.
C. remove the ET tube at once, ventilate with a bag-mask device for 2 to 3 minutes, and
reattempt intubation.
D. secure the tube with the proper device, continue ventilations, and confirm placement
with an esophageal bulb.
Answer: C
Page: 1475
30. A 50-year-old female is found semiconscious by her son. Your assessment reveals
that her respirations are slow and shallow and there is vomitus draining from her
mouth. When you attempt to suction her oropharynx, she begins to gag. You should:
A. ensure that her airway is clear, attempt to insert a nasopharyngeal airway, and assist
her ventilations with a bag-mask device.
B. abort the suction attempt at once, preoxygenate her with a bag-mask device, and
prepare to perform endotracheal intubation.
C. continue to suction her airway until the secretions are clear, insert an oropharyngeal
airway, and ventilate with a bag-mask device.
D. remove the suction catheter immediately, insert a nasopharyngeal airway, and
administer oxygen via a nonrebreathing mask.
Answer: A
Page: 1475
31. You are transporting an intubated 24-year-old female when her level of consciousness
improves and she becomes combative. You should anticipate that your paramedic
partner will:
A. extubate her to prevent laryngospasm.
B. give her a sedative drug per local protocol.
C. have suction available and remove the ET tube.
D. carefully restrain her and continue ventilations.
Answer: B
Page: 1476
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32. Which of the following statements regarding multilumen airway devices is correct?
A. They are contraindicated in patients who have experienced a severe spinal injury.
B. Ventilations can be provided whether the device is in the trachea or the esophagus.
C. Insertion of a multilumen airway device requires visualization of the upper airway.
D. Multilumen airway device insertion does not require medical control authorization.
Answer: B
Page: 1476
33. A major benefit when using a multilumen airway device is that:

A. it can be used on patients of any age and size.
B. it can be visualized as it enters the esophagus.
C. the airway is better protected than with an ET tube.
D. maintenance of a mask-to-face seal is not required.
Answer: D
Page: 1476
34. You should NOT attempt to insert a Combitube in a patient who:

A. has ingested a caustic substance.
B. is in full cardiopulmonary arrest.
C. is unconscious without a gag reflex.
D. has experienced a severe spinal injury.
Answer: A
Page: 1476
35. If it is necessary to remove a multilumen airway in the field, you should:

A. hyperventilate the patient prior to removing the device.
B. place the patient in a sitting position with his neck flexed.
C. turn the patient onto his or her side and have suction ready.
D. intubate the patient’s trachea after removal of the device.
Answer: C
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Page: 1477
36. Which of the following statements regarding the King LT airway is correct?
A. The King LT is a multilumen airway that is inserted into the esophagus using a
laryngoscope and a curved or straight blade.
B. Ventilation through a King LT is provided through an opening at the distal end of the
tube that is blindly inserted into the trachea.
C. When the King LT is properly placed in the esophagus, one cuff is designed to seal
the esophagus and the other cuff is designed to seal the oropharynx.
D. Because the King LT is placed into the esophagus, the end-tidal CO2 detector will not
adequately confirm proper placement and should not be used.
Answer: C
Page: 1477
37. A disadvantage of the King LT airway is that it:

A. cannot be used in patients who are shorter than 5′.
B. does not completely protect the airway from aspiration.
C. is contraindicated in patients who are in cardiac arrest.
D. most often enters the trachea because it is blindly inserted.
Answer: B
Page: 1477
38. The laryngeal mask airway (LMA) helps protect the airway and allows for adequate
ventilation by:
A. entering the trachea, just below the vocal cords, after it is blindly inserted.
B. entering the esophagus and isolating the trachea by the inflation of two cuffs.
C. molding and sealing itself around the laryngeal opening by inflation of the mask.
D. depressing the tongue and propelling it forward, resulting in an unobstructed airway.
Answer: C
Page: 1477
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39. In the prehospital setting, gastric tubes are used primarily to:
A. remove gastric toxins.
B. administer medications.
C. provide gastric nutrition.
D. decompress the stomach.
Answer: D
Page: 1477
40. Proper confirmation of correct gastric tube placement includes:

A. attaching an end-tidal carbon dioxide detector to the end of the tube.
B. injecting air into the tube and auscultating the stomach for gurgling.
C. instilling 25 mL of saline down the tube and connecting the tube to suction.
D. applying manual pressure to the stomach and observing the tube for contents.
Answer: B
Page: 1478
41. For which of the following patients would the use of a continuous positive airway
pressure (CPAP) device be of MOST benefit?
A. 50-year-old woman who is unable to follow verbal commands and is in severe
respiratory distress due to asthma
B. 58-year-old man with mild shortness of breath after being diagnosed by his physician
with left lower lobe pneumonia
C. 60-year-old woman with emphysema, moderate shortness of breath, and a systolic
blood pressure of 78 mm Hg
D. 62-year-old man with severe respiratory distress, a history of congestive heart failure,
and audible rhonchi in the lungs
Answer: D
Page: 1478
42. The MOST important step in assembling intravenous (IV) equipment is to:
A. follow the orders of your ALS partner.
B. strictly adhere to standard precautions.
C. choose the appropriate administration set.
D. select the most appropriately sized IV catheter.
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Answer: B
Page: 1479
43. Common IV solutions used in the prehospital setting include all of the following,
EXCEPT:
A. 5% albumin solution.
B. normal saline solution.
C. lactated Ringer’s solution.
D. 5% dextrose in water (D5W).
Answer: A
Page: 1479–1480
44. D5W is MOST commonly used for:

A. rapidly increasing the patient’s BP.
B. replacing the body’s lost salt and water.
C. treating patients in hypovolemic shock.
D. mixing and administering medications.
Answer: D
Page: 1480
45. Once an IV solution is removed from its protective wrap, it must be used within:
A. 12 hours.
B. 18 hours.
C. 24 hours.
D. 36 hours.
Answer: C
Page: 1480
46. Which of the following statements regarding the IV administration set is correct?
A. It moves fluid from the IV bag into the patient’s vascular system.
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B. Microdrip administration sets are used for rapid fluid replacement.
C. The administration set remains sterile up to 24 hours after it is opened.
D. Macrodrip administration sets are used to keep the vein open.
Answer: A
Page: 1480
47. A microdrip administration set delivers 1 mL of fluid after every ______ drops.
A. 20
B. 40
C. 60
D. 80
Answer: C
Page: 1480
48. You should routinely inspect a bag of IV fluid for all of the following, EXCEPT:
A. the solution type.
B. the manufacturer.
C. the clarity of the fluid.
D. the expiration date.
Answer: B
Page: 1481
49. After sliding the piercing spike of the administration set into the IV bag port, you
should next:
A. ensure that the drip chamber is completely filled.
B. adjust the drip chamber until fluid slowly drains.
C. prime the line and flush the air out of the tubing.
D. remove the protective cap and allow air to escape.
Answer: C
Page: 1481
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50. The purpose of a saline lock is to:
A. clamp off the IV tubing to decrease the rate at which the fluid flows.
B. maintain an active IV site without running fluids through the vein.
C. keep an IV line patent in patients who do not require medications.
D. allow the delivery of large volumes of isotonic crystalloid solutions.
Answer: B
Page: 1481
51. ALS providers choose the type and size of the IV catheter based on all of the
following factors, EXCEPT the:
A. vein’s location
B. purpose of the IV.
C. condition of the vein.
D. gender of the patient.
Answer: D
Page: 1482
52. Which of the following over-the-needle IV catheters has the largest diameter?
A. 14-gauge
B. 16-gauge
C. 18-gauge
D. 20-gauge
Answer: A
Page: 1482
53. Which of the following IV catheters would deliver fluid at the slowest rate?
A. 14-gauge
B. 16-gauge
C. 18-gauge
D. 22-gauge
Answer: D
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Page: 1482
54. Intraosseous (IO) needles are used when:

A. at least two large-bore IV lines have been established.
B. immediate IV access is difficult or impossible to obtain.
C. blood products must be administered to elderly patients.
D. the patient does not require large volumes of IV fluid.
Answer: B
Page: 1487
55. An IO needle is inserted into the:

A. proximal tibia.
B. distal humerus.
C. distal femur.
D. proximal fibula.
Answer: A
Page: 1487
56. Signs of an infiltrated IV include:

A. edema at the catheter site.
B. acute shortness of breath.
C. redness at the catheter site.
D. an extremely fast IV flow.
Answer: A
Page: 1488
57. If an IV line is found to be infiltrated, you should:

A. apply a chemical heat pack to the IV site.
B. slow the flow rate down to keep the vein open.
C. remove the catheter and apply direct pressure.
D. immediately change the IV administration set.
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Answer: C
Page: 1488
58. Local reactions associated with IV therapy include all of the following, EXCEPT:
A. phlebitis.
B. hematoma.
C. infiltration.
D. catheter shear.
Answer: D
Page: 1488
59. Approximately 20 minutes after initiating an IV line of normal saline, your patient
complains of generalized itching and develops a generalized rash. These are signs and
symptoms of:
A. a vasovagal reaction.
B. acute air embolism.
C. an allergic reaction.
D. circulatory overload.
Answer: C
Page: 1489
60. A 50-year-old male develops acute respiratory distress and cyanosis shortly after an
IV line has been established. You should administer high-flow oxygen and:
A. position him supine with his legs elevated.
B. place him on his left side with his head down.
C. position him supine with his head elevated 45°.
D. place him on his right side with his head elevated.
Answer: B
Page: 1489
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61. Signs and symptoms of acute circulatory overload include all of the following,
EXCEPT:
A. shortness of breath.
B. jugular vein distention.
C. acute peripheral edema.
D. a drop in blood pressure.
Answer: D
Page: 1489
62. Vasovagal reactions that occur in patients receiving IV therapy are MOST often the
result of:
A. the pain associated with venipuncture.
B. a fear of needles or the sight of blood.
C. too much IV fluid being administered.
D. an unexpected reaction to the IV fluid.
Answer: B
Page: 1489
63. An IV line is not running as fast as it should be. There are no signs of infiltration.
You should:
A. ensure that the tourniquet has been released.
B. lower the IV bag as low as you possibly can.
C. manipulate the catheter until the flow improves.
D. suspect that the patient has circulatory overload.
Answer: A
Page: 1490
64. What is a Volutrol and when should it be used?

A. Volutrol is a 100-mL calibrated drip chamber that can be shut off from the IV bag. It
should be used to prevent fluid overload in pediatric and geriatric patients.
B. Volutrol is a filter that is located inline between the IV bag and the IV insertion site.
It should be used to minimize the risk of vein irritation caused by the IV fluid.
C. Volutrol is a special type of macrodrip that has two large drip chambers that attach to
the IV bag. It should be used to administer large amounts of fluid to shock patients.
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D. Volutrol is an electronic pump that delivers a precise amount of fluid over a specific
period of time. It should be used to rehydrate patients who are not in shock.
Answer: A
Page: 1490
65. Which of the following statements regarding vascular access in geriatric patients is
correct?
A. IO infusions are more effective in elderly patients.
B. Fluid overload occurs less commonly in the geriatric patient.
C. Elderly patients often have fragile skin that is easily damaged.
D. Large-bore IV catheters should be used in all geriatric patients.
Answer: C
Page: 1490
66. The heart’s primary pacemaker is the:

A. sinoatrial (SA) node.
B. internodal pathway.
C. atrioventricular (AV) node.
D. ventricular bundle of His.
Answer: A
Page: 1491
67. The left and right bundle branches:

A. cause a slight delay of the electrical impulse at the AV node.
B. transmit the electrical impulses from the SA node to the AV node.
C. divide into the internodal pathways that stimulate the atria to contract.
D. travel through the interventricular septum and lead to the Purkinje fibers.
Answer: D
Page: 1491
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68. Which of the following correctly describes the normal path of electricity through the
cardiac conduction system?
A. SA node, AV node, internodal pathways, bundle of His, Purkinje system, left and
right bundle branches
B. SA node, internodal pathways, AV node, bundle of His, left and right bundle
branches, Purkinje system
C. AV node, internodal pathways, SA node, bundle of His, left and right bundle
branches, Purkinje system
D. internodal pathways, SA node, AV node, left and right bundle branches, bundle of
His, Purkinje system
Answer: B
Page: 1491
69. The SA node normally paces at a rate of:

A. 40 to 60/min.
B. 60 to 100/min.
C. 80 to 110/min.
D. 110 to 120/min.
Answer: B
Page: 1492
70. When an electrical impulse moves toward a positive electrode:

A. the electrocardiogram (ECG) records a negative wave.
B. the patient’s heart rate decreases.
C. the ECG records an upward wave.
D. the cardiac rhythm will be irregular.
Answer: C
Page: 1492
71. A single ECG complex consists of all of the following components, EXCEPT:
A. a T wave.
B. an R-R interval.
C. a QRS complex.
D. an ST segment.
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Answer: B
Page: 1492
72. When looking at ECG graph paper, one large box represents:
A. 0.04 seconds.
B. 0.08 seconds.
C. 0.12 seconds.
D. 0.20 seconds.
Answer: D
Page: 1492
73. If each small box on the ECG graph paper represents 0.04 seconds, and there are 5
small boxes in one large box, how many large boxes represent 6 seconds?
A. 10
B. 15
C. 20
D. 30
Answer: D
Page: 1492
74. A normal sinus rhythm (NSR) is characterized by all of the following, EXCEPT:
A. an irregular heart rate.
B. a heart rate of 80 beats/min.
C. consistent P-R intervals.
D. P waves of the same shape.
Answer: A
Page: 1492
75. A P wave is created when:

A. the heart is in its resting phase.
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B. the SA node generates an impulse.
C. electricity travels through the atria.
D. ventricular depolarization is complete.
Answer: C
Page: 1493
76. The only route of communication between the atria and the ventricles is/are the:
A. AV node.
B. SA node.
C. bundle of His.
D. bundle branches.
Answer: A
Page: 1493
77. The QRS complex is an electrical representation of:

A. atrial contraction.
B. ventricular contraction.
C. ventricular filling.
D. atrial filling.
Answer: B
Page: 1493
78. Which of the following statements regarding sinus bradycardia is correct?

A. It is significant and must always be treated.
B. The heart rate is usually less than 70 beats/min.
C. It is characterized by inconsistent P-R intervals.
D. It may be a normal variant in some individuals.
Answer: D
Page: 1493
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79. Sinus tachycardia is differentiated from a normal sinus rhythm by the:
A. shape of the P waves.
B. irregular heart rate.
C. width of the QRS complexes.
D. consistency of the P-R intervals.
Answer: B
Page: 1493
80. When the heart rate becomes exceedingly high:

A. ventricular filling time decreases.
B. cardiac output markedly increases.
C. stroke volume remains unaffected.
D. the patient’s blood pressure rises.
Answer: A
Page: 1493
81. Any electrical impulse that originates in the ventricular conduction system has:
A. peaked P waves and narrow P-R intervals.
B. narrow, inverted QRS complexes.
C. upright QRS complexes and broad P waves.
D. wide, abnormally shaped QRS complexes.
Answer: D
Page: 1495
82. Ventricular tachycardia is characterized by:

A. a markedly irregular rhythm and narrow QRS complexes.
B. wide QRS complexes and a heart rate greater than 100 beats/min.
C. QRS complexes greater than 0.08 seconds in duration.
D. a heart rate greater than 200 beats/min and identifiable P waves.
Answer: B
Page: 1495
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83. A rapid, chaotic rhythm that is completely disorganized is called:
A. asystole.
B. atrial fibrillation.
C. ventricular fibrillation.
D. pulseless electrical activity.
Answer: C
Page: 1495
84. The MOST effective treatment for ventricular fibrillation or pulseless ventricular
tachycardia of short duration is:
A. high-quality CPR.
B. cardiac drug therapy.
C. advanced airway care.
D. prompt, rapid defibrillation.
Answer: D
Page: 1495
85. Which of the following cardiac arrhythmias is characterized by a complete absence of

myocardial electrical and mechanical activity?
A. asystole
B. ventricular fibrillation
C. ventricular tachycardia
D. pulseless electrical activity
Answer: A
Page: 1495
86. When applying the 4-lead ECG electrodes to a patient, the white (negative) lead
should be placed:
A. on the left upper arm.
B. on the right arm.
C. to the left of the sternum.
D. on the left side of the abdomen.
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Answer: B
Page: 1496
87. It does not matter if you place the arm leads on the patient’s shoulders or arms, as
long as:
A. you apply the green lead first.
B. the patient is in a supine position.
C. the red lead is placed on the right side.
D. they are at least 10 cm from the heart.
Answer: D
Page: 1496
88. Leads V1 and V2 in a 12-lead ECG should be positioned:

A. approximately 1″ apart, directly over the sternum.
B. 2″ away from both sides of the xiphoid process.
C. on each side of the sternum at the fourth intercostal space.
D. on each side of the upper sternum at the first intercostal space.
Answer: C
Page: 1496
89. Obtaining an accurate ECG tracing can be difficult in patients experiencing a cardiac
emergency because:
A. the patient is often diaphoretic.
B. the rhythm is typically chaotic.
C. the pulse is often very weak.
D. severe bradycardia is common.
Answer: A
Page: 1496
90. A 12-lead ECG:
25
A. is only performed in the hospital setting.
B. may identify myocardial ischemia or injury.
C. is used by the EMT to diagnose a heart attack.
D. does not indicate the heart’s primary pacemaker.
Answer: B
Page: 1496
91. Which of the following leads views the lateral wall of the left ventricle?
A. V1 only
B. V1 and V2
C. V3 and V4
D. V5 and V6
Answer: D
Page: 1497
92. Your paramedic partner has just acquired a 12-lead ECG on a middle-aged man with
chest discomfort. The patient is conscious, but anxious. His blood pressure is 140/84
mm Hg and his heart rate is 80 beats/min. He has a history of hypertension and type 2
diabetes. Your partner states that she believes the patient is experiencing a myocardial
infarction of the anterior wall. Which of the following is the MOST likely basis for
her statement?
A. She has detected ST segment elevation in leads V3 and V4.
B. The patient’s vital signs suggest injury to the anterior wall.
C. Chest discomfort is more common with an anterior wall myocardial infarction.
D. The patient’s past medical history places him at high risk for a myocardial infarction.
Answer: A
Page: 1497
93. The ultimate goal in treating a patient who is experiencing an ST-segment elevation
myocardial infarction (STEMI) is to:
A. apply high-flow oxygen and administer aspirin.
B. rapidly restore perfusion to the injured heart.
C. give nitroglycerin to dilate the coronary arteries.
D. send the prehospital 12-lead ECG to the physician.
26
Answer: B
Page: 1497
27

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Chapter 40

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Chapter 40

1. Advanced airway management techniques should performed ONLY after:

2. After opening a patient’s airway, you should:

3. Endotracheal intubation is MOST accurately defined as:

4. Endotracheal intubation is indicated for patients:

5. If a patient is being adequately ventilated with a bag-mask device attached to high-

6. Visualized orotracheal intubation requires all of the following equipment, EXCEPT a:

7. Prior to performing orotracheal intubation in a cardiac arrest patient, it is MOST

12. When inserting the stylet inside an ET tube, you should:

14. Prior to attempting endotracheal intubation, the EMT should:

16. Intubating a patient who is in cardiac arrest should occur after:

33. A major benefit when using a multilumen airway device is that:

34. You should NOT attempt to insert a Combitube in a patient who:

35. If it is necessary to remove a multilumen airway in the field, you should:

37. A disadvantage of the King LT airway is that it:

40. Proper confirmation of correct gastric tube placement includes:

44. D5W is MOST commonly used for:

54. Intraosseous (IO) needles are used when:

55. An IO needle is inserted into the:

56. Signs of an infiltrated IV include:

57. If an IV line is found to be infiltrated, you should:

64. What is a Volutrol and when should it be used?

66. The heart’s primary pacemaker is the:

67. The left and right bundle branches:

69. The SA node normally paces at a rate of:

70. When an electrical impulse moves toward a positive electrode:

75. A P wave is created when:

77. The QRS complex is an electrical representation of:

78. Which of the following statements regarding sinus bradycardia is correct?

80. When the heart rate becomes exceedingly high:

82. Ventricular tachycardia is characterized by:

85. Which of the following cardiac arrhythmias is characterized by a complete absence of

88. Leads V1 and V2 in a 12-lead ECG should be positioned:

90. A 12-lead ECG:

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