Deck 18: Altered Mental Status, Stroke, and Headache

Question 1

Which patient would be most eligible to receive a fibrinolytic medication for stroke if no other contraindications are found?

A) 37-year-old female diagnosed in the emergency department with a hemorrhagic stroke 2 hours after onset
B) 48-year-old male whose symptoms started while watching the 6 p.m. news at which time he dialed 911
C) 81-year-old male who awoke with stroke symptoms after an 8-hour sleep
D) 62-year-old female whose stroke symptoms started at 8 a.m. and disappeared half an hour later

Answer 1

B

Question 2

Which one of the following questions is it critical that the EMT ask the family of a patient who cannot speak and is suspected of having a stroke?

A) "Does your mother have a history of heart problems?"
B) "What time did the weakness and dizziness start?"
C) "What medications is your mother taking?"
D) "Does your mother have any pain in her arms or legs?"

Answer 2

B

Question 3

For the stroke patient to be eligible for a fibrinolytic, it must be given within:

A) 3 hours of EMS arrival at the scene.
B) 6 hours after arrival at the emergency department.
C) 3 hours of the onset of stroke symptoms.
D) 24 hours of the first signs and symptoms started.

Answer 3

C

Question 4

Which one of the following instructions to a possible stroke patient indicates proper assessment for an arm drift?

A) "Hold out your arms and count to 10."
B) "Grab my fingers and squeeze with both hands as hard as you can."
C) "Raise your hands above your head and close your eyes."
D) "Close your eyes and hold your arms straight out."

Question 5

What condition would the EMT recognize as a neurological deficit?

A) Hypoglycemia
B) Paralysis
C) Constricted pupil
D) Headache

Question 6

Assessment of a 63-year-old female reveals a patent airway, adequate breathing, and strong radial pulse. She has no difficulty speaking and no facial droop, but exhibits a slight left arm drift. The EMT should interpret these findings as:

A) not suggestive of a stroke.
B) suggestive of a stroke if the blood pressure is also elevated.
C) suggestive of a stroke if the blood pressure is increased and pupils are not equal.
D) highly suggestive that a stroke is occurring.

Question 7

While doing a public awareness class about stroke, a participant asks you if all stroke patients are paralyzed on one side of their bodies. Your reply would be:

A) "Yes. Both the arm and leg must be paralyzed for the health professional to recognize a stroke."
B) "No. Some patients suffering stroke will show no signs or symptoms, but still must be evaluated."
C) "Yes. To be diagnosed with a stroke, the arm and/or leg must be very weak and paralyzed."
D) "No. Some stroke patients may have only slight weakness to one side of their bodies."

Question 8

When using a stroke scale to assess a patient for abnormal speech, the EMT should:

A) observe verbal ability during assessment.
B) ask the patient to repeat a common phrase.
C) question family members about the patient's ability to talk.
D) write questions on note cards for the patient to read.

Question 9

When assessing a patient with a suspected stroke, the order of the exam would be:

A) primary assessment, facial droop, arm drift.
B) level of consciousness, facial droop, arm drift, airway.
C) abnormal speech, facial droop, arm drift, primary assessment.
D) secondary assessment, primary assessment, stroke exam.

Question 10

When attempting to distinguish a spinal injury from a stroke, the EMT should remember that:

A) spinal injuries always result in weakness to one side of the body.
B) stroke typically results in weakness or paralysis to one side of the body.
C) stroke does not cause paralysis, while spinal injuries typically do.
D) stroke usually causes weakness to all extremities; spinal injuries do not.

Question 11

When assessing a patient for a facial droop, the EMT should:

A) palpate the face one side at a time.
B) gently lift and then let go of the skin over the cheeks.
C) ask the patient to show you his teeth or smile.
D) observe the patient's ability to turn his head to the right and then to the left.

Question 12

What condition places the patient at greatest risk for an acute neurological deficit?

A) Acute myocardial infarction (AMI)
B) Transient ischemic attack (TIA)
C) Chronic obstructive pulmonary disease (COPD)
D) New onset of Type II diabetes

Question 13

Which of the following statements shows an 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 only be suspected when one arm is paralyzed, not weak."
D) "If one arm is weak, stroke should be suspected only if the blood pressure is also elevated."

Question 14

You have determined an alert elderly male to have garbled speech and weakness to the right arm and leg. His vital signs and SpO₂ level are within normal limits. The family informs you that he has a history of heart problems and diabetes. Which one of the following should you do immediately?

A) Administer oral glucose or sugar water.
B) Attach the automated external defibrillator (AED).
C) Check the patient's blood glucose level (if local protocol allows).
D) Administer high-concentration oxygen through a nonrebreather mask.

Question 15

When a patient smiles, the left side of the face shows significantly less movement than the right side of the face. The EMT would describe this as:

A) left-side facial droop.
B) right-side facial droop.
C) left-side facial paralysis.
D) right-side facial drift.

Question 16

According to the Cincinnati Prehospital Stroke Scale, which of the following must be assessed?

A) Blood glucose level
B) Facial droop
C) Time of symptom onset
D) Age of the patient

Question 17

For the stroke patient to be eligible for a fibrinolytic, the patient must be brought to the hospital emergency department within how many hours of the onset of stroke symptoms?

A) 2
B) 3
C) 6
D) 24

Question 18

A 49-year-old male is unable to speak. You would document this as:

A) apnea.
B) dysarthria.
C) dysplegia.
D) aphasia.

Question 19

You are called for a 69-year-old male with altered mental status. Assessment reveals him to be confused and have left-sided weakness. During transport, you note that the patient is now completely oriented and the weakness has resolved. What condition would you suspect?

A) Stroke
B) Low blood sugar
C) Transient ischemic attack
D) Syncope

Question 20

When assessing a patient with a possible stroke, what is the priority of care?

A) Identifying risk factors for stroke
B) Determining a family history of stroke
C) Recognizing the signs of a stroke
D) Determining the type of stroke

Question 21

Which of the following best describes an ischemic stroke?

A) Rupture of an artery within the brain
B) Blood accumulation within the brain tissue
C) Simultaneous occurrence of stroke and heart attack
D) Obstructive blood clot inside a blood vessel within the brain

Question 22

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, the patient insists on signing a refusal. Which one of the following statements should you make prior to having her sign?

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 persist, call 911."
D) "You really need to be evaluated in the hospital. You are at significant risk for a future stroke."

Question 23

Assessment of a 56-year-old male reveals him to be responsive to verbal stimuli with garbled speech. What statement made by the patient's wife suggests that the patient's problem may be toxic-metabolic?

A) "He has bad kidneys."
B) "He had a stroke two years ago."
C) "He fell and hit his head yesterday."
D) "He was diagnosed last year with Alzheimer's."

Question 24

The EMT shows she understands a hemorrhagic stroke when she states:

A) "It occurs when clots form in blood vessels within the brain."
B) "It occurs when a blood vessel ruptures within the brain."
C) "Its signs and symptoms generally resolve within 24 hours."
D) "It can sometimes be treated by clot-destroying medications."

Question 25

When transporting an alert but nonverbal stroke patient with a blood pressure of 210/110 mmHg, the EMT should:

A) dim the lights and remain out of the patient's sight to avoid unnecessary stimulation.
B) touch the patient only when absolutely necessary, like obtaining vitals.
C) make an effort to explain everything that is happening or being done.
D) remain in the patient's sight but avoid talking or stimulating the patient.

Question 26

Bystanders state that a 72-year-old woman complained of chest pain and dizziness just before she fell down a flight of stairs. She is alert but confused and states that she feels nauseated and may vomit. How should the EMT position this patient for transport?

A) Left lateral recumbent position on a long spine board
B) Supine with her head turned to one side
C) Fully immobilized to a long spine board
D) Semi-Fowler's with a cervical collar in place

Question 27

Which one of the following describes the typical signs and symptoms of a transient ischemic attack (TIA)?

A) Temporary, lasting less than 15 minutes
B) Persistent, lasting at least several hours
C) Mild, but permanent
D) Severe and permanent

Question 28

Which statement shows that the EMT has an accurate understanding of altered mental status?

A) "It describes any change away from a normal state of mental function."
B) "It applies only when the patient is not responsive to verbal or painful stimuli."
C) "It should only be suspected when the patient is on medications that can cause confusion."
D) "It is any mental state for a person with diabetes or other serious chronic disease."

Question 29

You have been called to the house of a young adult male who is unresponsive. The man lives by himself so no family is present. In trying to determine the origin of the patient's altered mental status, which of the following would most likely provide the best information?

A) Contact with medical direction
B) Examination of medication containers
C) Interpretation of assessment findings
D) Observation of the living conditions in the house

Question 30

When performing a secondary assessment on an elderly male who is confused and combative, what assessment finding should be of most concern to the EMT?

A) Respirations of 20 per minute
B) Pulse of 164 beats per minute
C) Bruising to the back of the hand
D) Pulse oximeter reading of 94% on room air

Question 31

When assessing a patient with stroke-like signs and symptoms, it is critical that the EMT also suspect and rule out what condition?

A) Narcotic overdose
B) Syncope
C) Hypoglycemia
D) Shock

Question 32

Patients with an altered mental status due to a stroke may not be able to control their own airways because of:

A) enlargement and swelling of the epiglottis.
B) paralysis of the throat muscles.
C) hypersensitivity of the gag reflex.
D) increased oral secretions .

Question 33

A stroke patient cannot move his left arm or leg. Based on this presentation, the EMT should strongly suspect that the stroke has occurred in what part of the central nervous system?

A) Left side of the brain
B) Left side of the spinal cord
C) Right side of the brain
D) Right and left side of the brain

Question 34

Assessment reveals a drooling 48-year-old male to have gurgling speech and left-arm paralysis. The EMT's immediate priority is to:

A) suction the airway.
B) protect the left arm.
C) determine risk factors for stroke.
D) determine the time of onset.

Question 35

You have gathered and written down all of the medications, including narcotic pain medications, that a confused 46-year-old male currently takes. The patient is placed on the stretcher for transport. At this time, how would you handle the medications?

A) Return them to their original places.
B) Give them to a family member.
C) Turn them over to the police.
D) Transport them with the patient.

Question 36

A patient who is responsive to painful stimuli has a patent airway, inadequate respirations at 28 per minute, and a strong radial pulse with skin that is warm and dry. The patient is not moving his right arm or leg and is incontinent of urine. Which one of the following should the EMT do first?

A) Insert an oropharyngeal airway.
B) Administer oxygen by nonrebreather mask.
C) Administer positive pressure ventilation.
D) Check the blood glucose level.

Question 37

You have been called for a patient who suddenly became confused. What assessment finding should concern you most?

A) Blood pressure of 110/72 mmHg
B) Pupils dilated but reactive
C) Heart rate of 180 but regular
D) Blood glucose level of 72 mg/dL

Question 38

A 73-year-old female is responsive to painful stimuli and cannot move her left arm or leg. You suspect she is having a stroke. What is the best transport position for her?

A) Supine with head elevated 30 degrees
B) Left lateral recumbent position
C) Supine with left arm and leg flexed
D) Prone with left arm and leg flexed

Question 39

A patient has an altered mental status accompanied by loss of motor function on one side of the body. The EMT must suspect what condition as the cause of this presentation?

A) Seizure
B) Hypoglycemia
C) Stroke
D) Syncope

Question 40

An alert and oriented 69-year-old male has slight right-arm weakness but exhibits no deficits to the right leg. The EMT should consider the patient a:

A) non-priority transport since no paralysis exists.
B) priority only if the patient also has a low blood glucose level.
C) non-priority since he is alert and oriented.
D) priority for transport to a hospital with a stroke center.

Question 41

The EMT shows that is performing the Los Angeles Prehospital Stroke Screen (LAPSS) correctly when he asks which one of the following questions?

A) "May I assess your pupils?"
B) "How old are you?"
C) "Did you lose control of your bladder?"
D) "Do you know where you are right now?"

Question 42

Which one of the following statements made by the patient suggests that he is suffering from a tension headache?

A) "The pain starts at the top of my head and spreads down my back."
B) "I get so nauseated with the pain."
C) "The light really seems to bother my eyes when I get these headaches."
D) "The pain seems to get worse as the day goes on."

Question 43

Your 56-year-old patient is in bed and unable to speak. Family members state that he has had a previous stroke and has been bedridden since, but has always been able to talk, until a few hours ago when his speech became garbled. They also state that the last stroke left him paralyzed on his left side. Your assessment reveals him unable to speak, but with an open airway, adequate respirations, and a strong radial pulse. Additionally you note that he is unable to move his right arm. Vital signs are within normal limits. Which of the following would be most appropriate in the care on this patient?

A) Rapid transport
B) Suction the mouth.
C) Administer positive pressure ventilation.
D) Insert an oropharyngeal airway.

Question 44

For altered mental status to occur, what body system must be affected?

A) Cardiovascular
B) Respiratory
C) Central nervous
D) Endocrine

Question 45

Your patient is a 78-year-old male who was found lying on his bathroom floor. Emergency Medical Responders report that the patient is unresponsive with unequal pupils, and vital signs are as follows: pulse 78, respirations 20 and snoring, blood pressure 210/106, SpO₂ at 99%. The EMRs have applied oxygen by nonrebreather, and also report that the patient has a hematoma on the back of his head. Which one of the following should you do first?

A) Replace the nonrebreather with a nasal cannula.
B) Quickly apply a cervical collar.
C) Ensure an open airway with a jaw-thrust maneuver.
D) Lift the patient onto the stretcher for transport.

Question 46

Your patient is a middle-aged male who collapsed while shopping and now responds to verbal stimuli with confused speech. The primary assessment indicates no immediate life-threatening conditions. His pulse is 96, respirations 16, blood pressure 158/88, SpO₂ at 98%, blood glucose level 69 mg/dL. He is carrying a vial of nitroglycerin in his jacket pocket. Which of the following would you do next?

A) Administer oral glucose.
B) Provide high-concentration oxygen through a nonrebreather mask.
C) Administer sublingual nitroglycerin.
D) Perform a secondary assessment.

Question 47

You have been called to a long-term care facility for a 77-year-old female who was found unresponsive in her wheelchair by staff. The nurse reports that the patient complained of a headache earlier in the day and was given 600 mg of Motrin. Your assessment shows her to be unresponsive with a patent airway, slow and irregular respirations, and a weak radial pulse. Her lips are cyanotic and your partner reports the following vital signs: pulse 44, respirations 6, and blood pressure 228/116 mmHg. Which one of the following should you do next?

A) Start positive pressure ventilation.
B) Check the patient's blood glucose level.
C) Attach the pulse oximeter to get an SpO₂ reading.
D) Perform either a Cincinnati or Los Angeles Prehospital Stroke Screen.

Question 48

A 41-year-old female has called 911 for a headache. What assessment finding should make the EMT suspicious that the patient is suffering from a vascular headache?

A) Bright light increases the patient's discomfort.
B) The patient has pain throughout her entire head.
C) Her blood pressure is 192/124 mmHg.
D) She rates the pain as an 8/10.

Question 49

A 82-year-old male presents with right-hand weakness and garbled speech. Which of the following questions should the EMT ask first?

A) "Is he allergic to anything?"
B) "Does he take any blood thinners?"
C) "Does he have a history of high blood pressure?"
D) "What time did these signs start?"

Question 50

A male patient has altered mental status secondary from a brain tumor. The EMT would classify the brain tumor as what type of cause?

A) Central
B) Structural
C) Metabolic
D) Internal

Question 51

Which one of the following questions would the EMT ask when performing the Los Angeles Prehospital Stroke Screen?

A) "Do you take blood thinners?"
B) "Is your hand grip weak?"
C) "Do you smoke cigarettes?"
D) "Have you ever had a seizure?"

Question 52

A 30-year-old patient with a history of migraine headaches has called 911 for a migraine headache. She says the headache follows her usual pattern of headaches, states the pain is a 10/10, and she is nauseated. Her vital signs are: pulse 108, respirations 18, and blood pressure 154/90 mmHg. Which one of the following is indicated in the care of this patient?

A) 81 mg aspirin by mouth
B) Providing a darkened environment
C) Emergent transport
D) Requesting orders for sublingual nitroglycerin

Question 53

Your patient is unresponsive. Which piece of information given to you by the patient's family is most important to the EMT in relation to a possible stroke?

A) "He forgot to take his blood thinner last night."
B) "We think that he had too much to drink last night."
C) "We noticed him acting oddly about 7 p.m."
D) "He took some ibuprofen last night for a fever and cough."

Question 54

The EMT shows that he recognizes the benefit of using the Cincinnati Prehospital Stroke Scale and/or Los Angeles Prehospital Stroke Screen when he makes which one of the following statements?

A) "They allow the EMT to identify the patient at risk for stroke."
B) "They allow the EMT to differentiate the type of stroke a patient is having."
C) "They are very predictive in determining if the patient will die from stroke."
D) "They help to identify stroke, even when it is not the patient's chief complaint."

Question 55

A male patient is confused and combative for no apparent reason. There are no life threats to his airway, breathing, or circulation and his vital signs are: pulse 88, respirations 16 and adequate, blood pressure 144/68 mmHg, and SpO₂ 93% on room air. When addressing the oxygenation status, which of the following would be appropriate?

A) Oxygen at 6 lpm via nasal cannula
B) Oxygen at 15 lpm via a nonrebreather
C) Positive pressure ventilation with room air
D) Oxygen at 2 lpm via nasal cannula

Question 56

You have just arrived by the side of a 46-year-old male dialysis patient with end-stage renal failure. He is positioned in his living room recliner, unresponsive with snoring respirations. Which of the following should you do first?

A) Administer high-concentration oxygen.
B) Perform a head-tilt, chin-lift.
C) Find out when he last received dialysis.
D) Inquire what time the symptoms started.

Question 57

A male patient suddenly found himself unable to talk and with profound weakness to his right arm and leg. Currently he is responsive to verbal stimuli and has the following vital signs: pulse 88, respirations 14 and adequate, and blood pressure 210/80. When transporting this patient to the hospital, what position should you place him?

A) Immobilized to a long board
B) Left lateral recumbent
C) Prone with head elevated
D) Supine with feet elevated

Question 58

You are getting the past medical history of a patient who suffered the sudden onset of right-side weakness. Which one of the following statements made by the patient should you recognize as increasing the patient's risk of stroke?

A) "I take an aspirin every morning."
B) "My blood pressure runs low."
C) "I have a history of migraines."
D) "I have an irregular heartbeat."

Question 59

A patient with a headache informs you that his physician has diagnosed him with cluster headaches. He states that the pain feels just like the last cluster headache that he suffered. The primary assessment reveals no life threats. His vital signs are: pulse 104, respirations 16, blood pressure 124/68 mmHg, and SpO₂ at 98%. You note no neurological deficits. Based on this information, which one of the following is indicated in the treatment of this patient?

A) Massage the neck and obtain a refusal for transport if the pain is alleviated.
B) Administer supplemental oxygen at 15 liters per minute.
C) Place the patient on the cot and allow him to assume a position of comfort.
D) Immediately transport the patient to the hospital for possible stroke.

Question 60

Which one of the following statements made by the EMT indicates a correct understanding of caring for someone with a headache?

A) "Unless the patient has some sort of past medical history, a headache is not a true emergency."
B) "If a patient calls 911 for a headache, it is most likely a life-threatening condition."
C) "Assessment is essential in determining if a patient's headache represents a life-threatening condition."
D) "In general, a headache is only considered serious if the pain is felt throughout the entire head."

Question 61

On scene, a confused 68-year-old female with possible stroke has an SpO₂ of 91% on room air. Which one of the following indicates the most appropriate and beneficial type of oxygen therapy for this patient?

A) SpO₂ 98% with 12 lpm O₂ via nonrebreather
B) SpO₂ 95% with 2 lpm O₂ via nasal cannula
C) SpO₂ 100% with 15 lpm O₂ via nonrebreather
D) SpO₂ 97% with 4 lpm O₂ via nasal cannula

Question 62

What statement indicates that an EMT understands the appropriate use of supplemental oxygen regarding care of a stroke patient?

A) "In the short time that we provide care to a stroke patient, the benefits of high-concentration oxygen outweigh the risks."
B) "If positive pressure ventilation is required, it should be given with room air and not supplemental oxygen."
C) "Since stroke decreases oxygen delivery to the brain, high-concentration oxygen should always be geared toward achieving an SpO₂ as near to 100% as possible."
D) "Oxygen should be administered at a minimal amount, just enough to get the SpO₂ at or above 94%."

Question 63

An elderly male patient with a history of COPD, hypertension, and diabetes presents as lethargic and confused. His airway is patent, and breathing adequate. His skin is hot and radial pulse strong, regular, and bounding. Vital signs are: pulse 112, respirations 20, blood pressure 108/64, SpO₂ 94%, and temperature 102.8 F. Also noted is swelling to his right lower leg. Given these assessment findings, the EMT should suspect what condition as responsible for the patient's altered presentation?

A) Infection
B) Peripheral edema
C) Hypoxia
D) Tachycardia