Deck 8: Acute Interventions for the Chronic Care Patient

Question 1

Which of the following is NOT a common reason for ALS intervention with a chronic care patient?

A) Equipment failure
B) Desire for hospice care
C) Absence of a caregiver
D) Change in condition

Answer 1

Desire for hospice care

Question 2

A 13-day-old infant is suffering from bronchopulmonary dysplasia. His family, along with a home health nurse, called 911 after the child's oxygen saturation began to fluctuate. The home health nurse reports that although the baby is on a ventilator, the nurse has been weaning him to lower intermittent mandatory ventilation settings. The child has a heart rate of 160 bpm and is ventilator dependent with an SpO₂ of 86%. Lung sounds reveal crackles and rhonchi in the left lung; the child is hot to the touch and has cyanotic extremities and central mottling. You suspect:

A) pneumothorax secondary to bronchopulmonary dysplasia.
B) aspiration secondary to ventilator usage.
C) sepsis secondary to lower respiratory infection.
D) barotrauma secondary to high ventilator pressure settings.

Answer 2

sepsis secondary to lower respiratory infection.

Question 3

What is the term for the skin's ability to return to its normal appearance after being subjected to pressure?

A) Turgor
B) Elasticity
C) Ductility
D) Sepsis

Answer 3

Turgor

Question 4

What does PEEP stand for?

A) Positive exhalation and excretion pressure
B) Preliminary exhaustive expiratory plan
C) Pulmonary expulsion/end perfusion
D) Positive end-expiratory pressure

Question 5

Your patient has Guillain-Barré syndrome. Which of the following sets of symptoms would you expect to find?

A) Fever, followed by weakness and paralysis
B) Headache, respiratory distress, and neuropathy
C) Visual disturbances and motor deficits
D) Rash, GI upset, and dizziness

Question 6

You are dispatched to an extended care facility for a "sick person." On arrival, you speak with the staff who tells you that Ms. Johnson "just started acting differently and is slow to respond." Your assessment reveals that she is febrile and has vomited. When you move her to the gurney, you notice a stage 3 ulcer on her lower back that has a foul smell. Which of the following statements is most likely to be TRUE?

A) This is most probably due to neglect. Report the facility to the appropriate authorities.
B) This is most likely a GI emergency, such as norovirus or C. diff.
C) The signs could be masking a more serious issue, such as a cardiac event.
D) The ulcer may be infected, causing sepsis and requiring immediate intervention.

Question 7

The majority of home health care patients fall into which demographic category?

A) Males age 55+
B) Females between ages 70 and 82
C) Females age 65+
D) Males between ages 75 and 85

Question 8

You are dispatched to a residence for a report of a "man down." Upon arrival, you find a well-kept home with the door open, and a van in the driveway with "palliative care specialist" printed on the side. As you enter the home, a woman meets you and says, "It's my mother. She has terminal cancer and we can't seem to wake her up." Which of the following questions would be most appropriate to ask at this time?

A) "Did anyone check for a pulse?"
B) "What type of cancer does your mother have?"
C) "Is your mother receiving hospice care?"
D) "What hospital does she normally go to?"

Question 9

A wheelchair transport driver has called 911 after transporting a 68-year-old man from a dialysis center back to his residential care home. The patient has a blood-soaked bandage on his right forearm and states, "My fistula has been bleeding since I left dialysis. I can't get it to stop!" You should:

A) lift the bandage to ascertain whether the bleeding is from the dialysis fistula or another source.
B) immediately apply a tourniquet proximal to the fistula.
C) apply firm, direct pressure over the fistula with your gloved hand.
D) apply pressure to the brachial artery pressure point to slow the bleeding.

Question 10

You are caring for a child with muscular dystrophy who is on a home ventilator. The boy's father called 911 after noticing his son repeatedly attempting to cough-something that is atypical for this patient. The father states that he believes the child's tracheostomy tube may be dislodged, and he is unsure what to do. Your assessment reveals that the inner cannula appears to be dislodged. Which of the following is your best course of action?

A) Detach the home ventilator, orally intubate the trachea, and reattach the ventilator to the ET tube.
B) Deflate the cannula cuff and remove the cannula, then hyperventilate the patient.
C) Transport, with an early alert that a respiratory therapist will be needed.
D) Attempt to reposition the inner cannula with sterile Magill forceps.

Question 11

Many patients with neuromuscular degenerative diseases receive chronic respiratory support at home. Ultimately, what step may you, as a paramedic, have to take immediately, regardless of the type of respiratory support available in the patient's home?

A) Alter dosages of medications already in use to achieve a better effect.
B) Intubate and ventilate.
C) Call the patient's physician and get orders not addressed by your protocols.
D) Rapidly become familiar with the patient's medical equipment.

Question 12

You are called to the home of a 75-year-old patient with end-stage lung cancer. The patient's daughter states that she called because the patient is experiencing increasing dyspnea. The patient is on home oxygen at 4 liters per minute; however, the daughter states that the patient's SpO₂ is "way lower than normal." What would be the best course of action in this situation?

A) Transport the patient to the ED.
B) Ask the daughter if the patient has a DNR.
C) Examine the patient's oxygen equipment to be sure it is working.
D) Prepare to administer oxygen via CPAP.

Question 13

Which of the following factors has contributed to the increase in individuals who receive health care at home?

A) More families can afford home health care.
B) Research shows that patients recover faster at home.
C) Fewer people have insurance and therefore cannot afford hospital care.
D) There are tax breaks for individuals who provide care for a loved one at home.

Question 14

You are sent to a home for a cardiac arrest. You find a patient in cardiac arrest who has been under hospice care for end-stage AIDS. The palliative care nurse tells you that some family members who were present when the patient went into cardiac arrest became very upset and called 911. The patient has been pulseless and apneic for approximately 15 minutes without resuscitation. A relative interrupts and says she doesn't care what the nurse says; she wants you to help her brother. What should your next action(s) be?

A) Have the nurse provide the DNR, ask the sister if she was aware of her brother's end-of-life wishes, and explain that you are ethically bound to honor the DNR.
B) Provide all the interventions you can-immediate family are always able to override the DNR.
C) Explain to the sister that because the family did not start CPR right away, the chances of resuscitation are extremely small.
D) Start CPR and ACLS. Do a round of drugs, then call for orders for field termination of resuscitative efforts.

Question 15

What might you notice before entering a residence that would lead you to assume that a home health care situation might exist?

A) A "No Smoking, Oxygen in Use" sign
B) A wheelchair ramp
C) A vehicle in the driveway that appears to be used for convalescent transport
D) All of the above

Question 16

While assessing a chronically ill 85-year-old male patient who is cared for at home, you notice that his wife appears tired and unkempt. The patient is well cared for; however, he has multiple health problems and requires constant attention. Understanding the psychosocial needs of a family member who provides care, which of the following would be appropriate to say to the wife?

A) "It is obviously difficult for you to care for him. It might be best to put him in a nursing facility."
B) "It is very expensive to pay for a home health aide, but perhaps you could ask your children to help with the cost."
C) "I can see that you provide excellent care for your husband. Would you like some information on a support group for spouses who provide care?"
D) "You are compromising your well-being for your husband and may require medical attention."

Question 17

You have arrived at the home of an elderly man who called 911 for pain in his penis. He has a Foley catheter in place. He is supposed to have a home health aide visiting him daily, but, although it is 1500 hours, she has not yet visited today. You visualize the catheter and bag and note that the Foley bag is full of urine, so much so that it appears to be pulling the tube taut. You should:

A) call the home health care service and ask when the health aide is scheduled to arrive.
B) access the drain, drain the urine into a container, and reassess the patient's discomfort.
C) transport to the ED, as any procedure involving a Foley requires special training.
D) remove the Foley catheter using aseptic technique and transport.

Question 18

Which of the following best describes a tracheostomy?

A) An opening from the esophagus to the trachea
B) A temporary opening made from the posterior neck through the trachea
C) A surgical opening from the anterior neck into the trachea
D) An opening made by incision from the larynx through the neck

Question 19

Which of the following is NOT a common sign of sepsis?

A) Nausea and vomiting
B) Fever
C) Altered mental status
D) Hyperactivity

Question 20

When you arrive on the scene of an incident in which a home health care provider is present, which of the following is the best way to deal with the situation?

A) Tell the home care provider that your certification overrides theirs and that you are in charge now.
B) Respect the home care provider's position, use the person's information accordingly, and request the person's help should the need arise.
C) Let the person talk to a member of the crew not involved in patient care to keep the person busy and out of the way.
D) Ascertain the person's certification level. If the person is not an RN, ask the person to stand back.

Question 21

A 24-year-old man has called 911 after experiencing heart palpitations and dizziness. You direct your partner to apply a 4-lead ECG and see a narrow complex tachycardia on the monitor at a rate of 196 bpm. The patient is wearing a halter monitor and states, "My doctor is making me wear this because I keep having these episodes." How should you handle the presence of the halter monitor?

A) Leave it in place and alter your treatment so as not to disturb the monitor.
B) Remove the monitor and treat the patient per protocol.
C) Leave the monitor on and delay treatment until you arrive at the ED.
D) Contact the hospital for medical direction.

Question 22

You are caring for a patient with a gastrostomy tube. The patient complains of pain around the tube, and states that the surrounding area has been sore for a few days. Your physical exam reveals red, swollen skin around the G tube that is warm to the touch. You suspect:

A) an obstruction in the G tube.
B) an infection at the insertion site.
C) that the tube has been dislodged.
D) that the patient is not properly caring for the device.

Question 23

Which of the following most accurately describes why it is best to avoid taking a blood pressure on an arm with an AV graft in place?

A) The blood pressure cuff will compress the graft, causing damage.
B) The pressure created by the cuff is guaranteed to rupture the AV graft.
C) Restricting circulation through the graft is likely to cause clot formation, a common problem with AV grafts.
D) It is uncomfortable for a patient with an AV graft to have blood pressure taken on that arm.