BOOK: Blue Book II SECTION:1st Responder Protocols Practice Test-50 questions (SERGEANT) OCFD.com

1. First Response personnel respond to a motor vehicle accident in which a man had sustained burns and blunt traumatic injuries to the head and chest. The patient, after physical examination at the scene, is determined to be pulseless/apneic, (not breathing), and his injuries are NOTconsidered incompatible with life. First analysis with the AED indicates a shockable rhythm. The First Responders by protocol should: Protocol 1.2: NoCode Orders and Discontinuance of CPR

  1. Halt the resuscitation, because the patient is clinically dead.
  2. Continue care commensurate with the situation.
  3. Halt the resuscitation because conclusive signs of death are present.
  4. Halt the resuscitation because the patient is a victim of blunt trauma, resuscitative measures are not indicated.

2. First Responders arrive on scene and begin caring for this patient who is in cardiac arrest. History of present illness: It was reported by the baby sitter that the child a, 3 year old male patient, has a complex cardiac history and through-out his life has required specialized medical needs that have been managed by Children's Hospital. It was reported that the child was placed in his bed 2 hours ago for his daily nap. When the baby-sitter went to check on him she noticed he was not breathing and she could not find a pulse. The baby-sitter called for help then initiated CPR. Upon physical examination, it was noted that the child was warm and his skin was purplish around the face, chest, and abdomen, indicating possible lividity. The patient's pupils were fixed and dilated. Some stiffness, possible rigor, was noted in the upper extremities and jaw. The FirstResponders by protocol should: Protocol 1.3: No Code Orders and Discontinuance of CPR

  1. continue resuscitative efforts since basic life support had been instituted prior to their arrival.
  2. halt CPR in an obvious prolonged death.
  3. continue with the resuscitative efforts because hypothermia was the significant component in this patient's arrested state.
  4. continue with basic life support.

3. The 911 emergency dispatch center received numerous calls at 2:00 a.m. requesting that police, fire, and ambulances respond to a local bar. The various callers reported "a large crowd," "an assault," "calls for help," "a shooting," and "a person down and injured on the street." First Response personnel respond along with several police units. The ambulance is not yet on-scene when First Responders arrive. The initial scene survey revealed 75 to 100 bystanders; the police were already present and in the process of apprehending the suspected perpetrator. After determining the scene was safe the First Responder locate the patient who was lying supine on the street. He was not moving. Upon questioning some of the bystanders, the First Responders were told that the patient had been involved in a fight in the bar. He was stabbed and staggered out to the street. An assessment was performed. The patient's shirt had a trickle of blood on it and a tiny tear on the left side just below the pocket. Visual inspection, a well developed male in his twenties, skin was pale, cold, and cyanotic. The patient was not breathing and no pulses were detected. His pupils were fixed and dilated. A single knife-puncture woundapproximately 6 cm below the nipple in the midclavicular line is noted. The First Responders, by protocol, should: Protocol 1.2: Crime Scene Management

  1. initiate CPR and seal the chest wound.
  2. not attempt to resuscitate the patient.
  3. initiate CPR, seal the chest wound, analyze the underlying rhythm and if non-shock is advised, halt the resuscitation.
  4. not attempt to resuscitate the patient, go through the patient's personnel effects to assist the police in identifying the victim then cover the body with a sheet.

4. A 70 year-old male suffers a cardiac arrest in a nursing home. Bystander CPR was started immediately by nursing staff. The first analysis indicated a shockable rhythm. The patient was defibrillated with a200 joule shock. Over the course of the resuscitation while on-scene, recurrent shock message advisements necessitated delivery of four additional shocks. On the sixth analysis a no shock was advised. There were no pulses. CPR was continued and the patient was ventilated by bag-valve-mask. While managing the patient the nurse presents the First Responders with an Oklahoma DNR Consent Form which was signed by the patient. By protocol the First Responders should: Protocol 1.3: No Code Orders and Discontinuance of CPR.

  1. halt any further attempts at resuscitating the patient.
  2. disregard the DNR order because there is no legal precedent
  3. continue the resuscitation until the transport service arrives before any irrevocable treatment decision is made.
  4. continue with the resuscitation and contact the personnel physician to determine the validity of the DNR order.

5. A 67 year-old male with a history of ethanol abuse, terminal liver cancer, and hypertension, (high blood pressure), experienced a cardiac arrest at a local restaurant and CPR was not initiated. Upon arrival on-scene, the First Responders are approached by a woman who identifies herself as the patient's wife. She informs the First Responders that the patient has terminal cancer and she does not want them to treat her husband. By protocol the First Responders should: Protocol 1.3: No Code Orders and Discontinuance of CPR

  1. provide the level of care commensurate with the situation.
  2. not resuscitate the patient because by Oklahoma Law, the spouse of the patient can provide delegated consent.
  3. initiate basic life support and out of respect for the patient's wife, contact medical control to discuss the terms of halting the resuscitation.
  4. contact the police department and have the wife placed under arrest for interfering with the actions of First Response Personnel.

6. The Primary Survey of the trauma patient assessment includes: Protocol pages 11.2/3: Trauma Patient Assessment — Primary Survey

  1. Evaluation of the airway
  2. Evaluation of breathing
  3. Evaluation of circulation
  4. Protect cervical spine from movement
  1. 1 and 3
  2. 1, 2, 3, and 4
  3. 1, 2, and 3
  4. 1, 2, and 4

7. It's 3:30 p.m. on a Friday afternoon when your unit is toned out for a shooting in a nearby low-income area. The scene is roughly 4 minutes away. Dispatch advises that law enforcement is on scene. You arrive at a local pool hall known for violent confrontations, and immediately note a crowd of roughly 100 agitated people. There is a single victim, a male approximately 30 years of age lying prone in a large pool of blood. You note that the patient is badly wounded. The patient appears to have been shot multiple times at close range with a small caliber handgun, possibly a .22 or .25, with wounds to the head, chest, abdomen, arms and legs. Bystanders get across that the patient was only a few feet away from his attacker and that the gun was "small and black." You assess the patient and determine that he is pulseless, apneic, and that his pupils are fixed and dilated. Your next action by protocol is to: Protocol 1.2: Crime Scene Management

  1. Initiate BLS and attach the AED. If a no shock is advised, halt any further resuscitative effort.
  2. Do not attempt resuscitation.
  3. Take the time to seal the chest wall injuries, control any external bleeding, and continue with the resuscitation.
  4. Egress from the scene as quickly as possible with the patient because the crowd seems hostile.

8. As you begin your initial evaluation of a trauma victim, by protocol, when are you suppose to stabilize the neck: Protocol 11.2: Trauma and Shock Supportive Care

  1. As soon as you are sure that the patient has an open airway
  2. As soon as you finish the primary survey
  3. At the same time that you evaluate the airway
  4. You stabilize the spine only if you are sure there has been an injury to the head or neck

9. If a patient is a victim of blunt trauma with injuries incompatible with life and no signs of life, by protocol the First Responder SHOULD initiate CPR until the arrival of Advanced Life Support Personnel

  1. True
  2. False

10. Which of the following conditions identified in the primary trauma patientassessment would necessitate immediate transport. Protocol 11.2: Trauma and Shock Supportive Care

  1. Difficulty with breathing
  2. Difficulty with circulation
  3. Decrease level of consciousness
  4. Bilateral upper arm (humerus) fractures
  1. 1 and 3
  2. 2 and 3
  3. 1, 2, and 3
  4. All of the above

11. Signs of upper airway obstruction typically include: Protocol 11.6, Respiratory Distress

  1. Inspiratory stridor, hoarseness, drooling, exaggerated chest wall movements
  2. Chest pain
  3. Decreased pulse rate
  4. All of the above

12. Your patient is a 29 year-old male. He has been involved in a significant altercation. After you arrive on scene, bystanders report that the patient was struck repetitively about the head and shoulders with a baseball bat. You find the patient lying prone (face down) and motionless on the ground. Your initial action by protocol should be to: Protocol 11.2: Trauma and Shock Supportive Care

  1. Insert an oral or nasal airway and place the patient on high-flow oxygen
  2. position the patient and chin-lift to open the airway
  3. position the patient and jaw-thrust to open the airway
  4. Insert an oral or nasal airway and assist the patient's breathing

13. After performing the treatment in Question 12, you determine that the patient is unconscious. His respiratory rate is eight-(8) breaths per minute and shallow. His pulse rate is 70 and bounding. Your next treatment decision by protocol should beto: Protocol 11.2: Trauma and Shock Supportive Care, Protocol 11.26 Head Trauma, Protocol III Airway Management

  1. Place the patient on high-flow oxygen
  2. Insert an oral or nasal airway and begin to assist ventilations at twelve-(12) breaths per minute
  3. Insert an oral or nasal airway and begin to assist ventilations at twenty-four-(24) breaths per minute
  4. Insert an oral or nasal airway and place the patient on high-flow oxygen

14. The care of the expectant mother presenting with prolapsed cord by protocol is: Protocol 11.19 Obstetrical Emergencies

  1. Delivery of 100% oxygen via non-rebreather mask
  2. Trendelenburg positioning
  3. Insert gloved hand for counter-pressure against head to allow blood flow through cord
  4. Clamp and cut the cord
  1. 1, 2, 3
  2. 1, 3, 4
  3. 1, 2, 4
  4. 1, 2, 3, 4

15. If an expectant mother's contractions are 2 - 3 minutes apart, by protocol you should: Protocol II.19 Obstetrical Emergencies

  1. Initiate general supportive care and position patient on her left side to avoid pressure on the vena cava
  2. Suspect the infant has suffered positional asphyxia
  3. Initiate general supportive care, place the patient on her back with knees flexed and prepare her and yourself for delivery
  4. Assume the infant is in acute distress and in danger of suffocation

16. When a newborn presents with meconium staining (tarry, neonatal, fecal material) the First Responder by protocol should: Protocol 11.19, Obstetrical Emergencies

  1. Suction the infant's hypopharynx, mouth, then nose before the first breath
  2. Suction the infant's nose, then mouth before the first breath
  3. Suction the infant's mouth, then nose before the first breath. Avoid suctioning the hypopharynx because it may result in a vagal response (slowing of the heart).
  4. Do not place the infant on the mother's abdomen or let the mother hold the infant due to the infection

17. Nuchal cord (umbilical cord wrapped around the baby's neck) by protocol:Protocol II.19 Obstetrical Emergencies

  1. Occurs in 50% of all deliveries and is seldom fatal
  2. Is treated immediately by placing two-(2) clamps about two-(2) inches apart and cut in between
  3. Requires an emergent transport of the mother and infant for cesarean delivery
  4. Is first treated by gently removing the cord from around the infant's neck

18. A baby has just been delivered, the child is observed to be pink and crying. The airways are cleared of mucous by suctioning. The First Responder's next action, (by protocol), should be to: Protocol: 11.19, Obstetrical Emergencies

  1. Continue suctioning as needed; Clamp and cut the cord immediately after the child is dried
  2. Clamp and cut the cord once spontaneous respirations begin
  3. Clamp and do not cut the cord until the placenta is delivered
  4. Clamp and cut the cord only if the heart rate is greater than 100 b/m

19. Infants less than four months of age are obligate nose breathers, (restricted to one particular characteristic mode of breathing), therefore nasal congestion can present with apparent severe respiratory distress. Protocol II.1: General Supportive Care

  1. True
  2. False

20. The patient with respiratory distress should be positioned: Protocol 11.6, Respiratory Distress

  1. on his side
  2. supine
  3. sitting or position of comfort
  4. prone

21. Initially, how should oxygen be administered to a cyanotic asthma patient? Protocol 11.1, General Supportive Care

  1. Nasal cannula at 4 to 6 liters per minute
  2. Simple face mask at 6 to 8 liters per minute
  3. Partial rebreather face mask at 8 to 10 liters per minute
  4. Non-rebreather face mask at 10 to 15 liters per minute

22. Signs of inhalation burns include: Protocol 11.22, Burns

  1. Respiratory distress; cough; hoarseness; singed nasal or facial hair; soot or erythema, (redness of the skin), around the mouth
  2. Vomiting; seizure; coma
  3. 3rd degree burns greater than 5% of the total body surface area
  4. Altered mental status; headache

23. The initial goal of prehospital burn treatment is to: Protocol 11.22, Burns

  1. Stop the burning process
  2. Pain management
  3. Preventing further injury; decreasing the chance of further infection; relieving pain
  4. Infection control; rapid transport to a burn center

24. Which of the following is NOT a component of the trauma patient assessment - primary survey? Trauma Patient Assessment - Primary Survey

  1. Airway
  2. Blood pressure
  3. Breathing
  4. Level of consciousness

25. The first responder is trying to correct a complete airway obstruction in a conscious adult patient. The first maneuver is to deliver: Protocol 11.5: Airway Obstruction

  1. Abdominal thrusts, (Heimlich Maneuver)
  2. Back blows
  3. Finger sweep
  4. Ventilations

26. The first clamp placed on the umbilical cord should be____inches from thebaby.Protocol 11.19: Obstetrical Emergencies

  1. 5
  2. 12
  3. 10
  4. 15

27. When dealing with a head trauma victim the First Responder's most important priority is to: Protocol 11.26, Head Trauma

  1. Look for leaking cerebrospinal fluid
  2. Maintain meticulous attention to suction and stablization of tongue and mandible (lower jaw)
  3. Identify changes in the level of response to painful stimuli
  4. Control external hemorrhaging

28. You have begun treatment for a motor vehicle accident victim who is still sitting in his vehicle. The patient is complaining of pain in his upper back and tingling in his fingers and toes. You should: Protocol 111.6: Splinting: Axial

  1. Rapidly extricate the patient directly onto a long spineboard
  2. Encourage the patient to find the position of comfort before moving him to a long spineboard.
  3. Secure the patient's trunk to a KED in preparation for extrication to along spineboard.
  4. Immobilize the cervical spine with a rigid cervical collar and then insert a KED to support the patient's trunk prior to extrication.

29. According to the Communication – Radio Report Protocol: Generally speaking, medical information should be communicated to the lead paramedic in a specific order. Select the grouping that best corresponds to the order in which information is communicated to the arriving paramedic. Protocol I., Communication — Radio Report Protocol

  1. History, Objective findings, and Treatment
  2. Treatment, Objective findings, and History
  3. Objective findings, History, Treatment

30. When children with croup/epiglottis/or laryngeal edema develop respiratory arrest, it is usually due to: Protocol II. Respiratory Distress

  1. Exhaustion or spasm
  2. Pulmonary edema (fluid in the lungs)
  3. Hyper-inflation of the chest
  4. Allergic reaction

31. You are called for a "possible OB." The patient is a 24-year-old woman in the ninth month of her second pregnancy. She states that her contractions are less than two (2) minutes apart, and she feels a strong urge to move her bowels. You should: Protocol 11.19, Obstetrical Emergencies

  1. Help her to the toilet
  2. Lie her on her left side because of fetal distress
  3. Prepare for an episiotomy
  4. Set her up for delivery, since birth of the baby is imminent

32. In the management of traumatic respiratory insufficiency, the most appropriate initial airway maneuver is: Protocol 111.1, Airway Management

  1. Head tilt - Chin lift
  2. Head tilt – Neck lift
  3. Jaw Thrust
  4. Orotracheal intubation

33. When you arrive at the scene a shabby apartment building, you find a man who appears to be in his late 20s. The patient is lying on the floor in a prone (face down) position with a group of his friends around him. The patient does not respond to voice or painful stimuli. The patient has a pulse and his breathing seems labored. By protocol, what should be the next action by the First Responder: Protocol II: General Supportive Care

Patient positioning and opening the airway

Insertion on an OPA and application of high-flow oxygen

Oral tracheal intubation

Insertion of an OPA and assist the patient's ventilations

34. Which of the following are critical components for immobilizing the spine: Protocol III. 6: Axial splinting

  1. Apply in-line cervical immobilization
  2. Immobilize the cervical spine with a rigid cervical collar, side supports, and tape
  3. Use long spineboard or KED to support patient as the situation dictates
  4. Use straps to secure patient effectively
  1. 1 and 2
  2. 2 and 4
  3. 1, 2, and 3
  4. All of the above

35. A 5-year old child was running with pencil in hand when she fell, and the pencil became impaled in her left eye. In managing this patient, you should: Protocol 11.25: Eye Injuries