national exam question

[silentneko]

hey guys I just finished taking the national/florida emt exam, I've got a bit of a question. first let me just say that many of the questions are worded in a manner that makes them very confusing, and they are usually incomplete. I was trained with the motto "don't guess, assess!" Just as many of you were, but most of the questions don't give you enough basic information to be totally secure with your answers. most of the people I've spoken with agree with this.

anyway on to the actual question. one of the questions on the test I also had in a practice exam I did, so I knew the answer, kind of. the answer in the practice exam I don't agree with. the question was something like:

you are called to a scene where a 62 year old patient is experiencing dyspnea. the patients BP is 180/120. which drug would be suitable to treat this patient?
A. albuterol
B. epinephrine
C. oxygen
D. all of the above

well with no other information I would answer C. oxygen, but I'd be wrong. according to the test the answer is all of the above.

I guess my question is about the epi. it is a vasoconstrictor right? so wouldn't it spike up the patients BP even further? making a stroke or some type complication very possible? thanks for the replies.

 

[emtbass]

I'm not positive what EPI does to the BP, but I know it does cause tachycardia. My first inpression was All of the above. Because I know that Albuterol, and Oxygen would be used. And if you know that 2 are correct, then my instinct would be all of the above. But at the same time, national registry can be tricky like that.\

Here are the side effects that I found for EPI on the new Mosby Drug Consult that came with my medic textbook:

Side effects of epinephrine may include palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, pallor, dizziness, weakness, tremor, headache, apprehension, nervousness and anxiety.

Here are the indications:

In general, the most common uses of epinephrine are to relieve respiratory distress due to bronchospasm, to provide rapid relief of hypersensitivity reactions to drugs and other allergens, and to prolong the action of infiltration anesthetics. Its cardiac effects may be of use in restoring cardiac rhythm in cardiac arrest due to various causes, but it is not used in cardiac failure or in hemorrhagic, traumatic, or cardiogenic shock.

Here are the contraindications:

There are no absolute contraindications to the use of epinephrine in a life-threatening situation.


Although it is kindof iffy, I would have to agree with ALL OF THE ABOVE.

 

[MMiz]

I would have guess Oxygen because I was never taught about albuterol in my text, and never saw it on any of the practice materials we used. Is this for the EMT-B license? Is albuterol a BLS procedure taught in textbooks?

 

[silentneko]

yes albuterol is in the bls text book, you may recognize refered to a metered dose inhaler, or MDI. actually its the drug in an mdi. its one of the 3 patient drugs we help them take in an emergency.

 

[MMiz]

I had to read over that one a second time. Duhhh.

I'd still like to see what others say.

 

[silentneko]

me too.

the more I read the more I think I'm right here. the question does not state anything about an allergic reaction. and epi as far as I can tell from different texts is a bronchodilator and vasoconstrictor. which means it opens your air passage ways and raises your BP to keep you from going into, or counter act the effects of shock. am I wrong here?

 

[CaptainPanic]

Well while MDIs are a part of the EMT-B SoP, some MDs do not allow EMT-Bs to even assist the pt in taking a MDI.

With that said every MD is different so it would still be wise to look up MDIs study their effects, counteractions, how to assist the pt in using them etc. Some MDs require that you call telemetry before assisting pts with MDIs, some MDs have them in the standing orders.

Also every MDI is different, so please do your homework before you have a respiratory where you will have to assist in giving the pt an MDI. Sometimes the pt doesnt even know how to use their own MDI so you are called out, especially young children that have just received an MDI and have never used them for their asthma. Also be aware that ADVAIR (the purple diskus) is NOT an MDI, it is actually a daily dose to help control asthma it cannot be used in acute asthma attacks.

-Cap'n

 

[KEVD18]

hated the nremt exam. really bad questions to be had there. one went something to the effect of :

you have a 55 y/o male pt c/o sub sternal c/p. radiation down left arm and up into jaw. sob, sweating, etc. pulse rate of xx, resp rate of xx.. do you assist/administer the pt pre prescribed ntg?

mind you, there wasx no mention of the pt's bp. the systolic bp is one of, if not the biggest, contras for administration of ntg.

i found that several times the test asked you to make a clinical decision without at least one very necessary facts. i really didnt lkike taht test and am quite happy i only had to tyake it once. next comes the nremtp exam, which i';m sure is a freakin doosey(sp)

 

[KEVD18]

sorry, mouse went full auto on me

 

[CaptainPanic]

I had similar questions in the NREMT exam when I took it in January, the questions so very ridiculous in some points.

One I can remember is you find a kid who has his feet dangling in a tripod position with a resp rate of xx, BP of xx, SpO2 xx%, HR of xx, then it also mentioned the kid had some abrassions on the genitalia and the mother was complaining of fever and it asked if the kid was being abused I was like WTF?? I dont even have all the necessary info to even make a remotely educated guess so I filled in the "C" bubble on that question. I think that answer called for o2 and transport.

I dont know if I got that one right or wrong but alot of the scenarios dont seem feasible to me.

-Cap'nPanic

 

[Ridryder911]

I am sure the question also included "the most appropiate" or "the best".. oxygen would be the "best"... albuterol and epinephrine do have contraindications in patients with cardiac disorders.

Be safe,
Ridryder 911

 

[silentneko]

I am sure the question also included "the most appropiate" or "the best".. oxygen would be the "best"...

no it didn't, it asked which of the drugs are appropriate, not most or best or anything that would have made sense. the more people I talk to the more stories I hear about bad questions that don't really test our true knowlege.

 

[Wingnut]

Originally posted by silentneko@Sep 7 2005, 06:44 PM

I am sure the question also included "the most appropiate" or "the best".. oxygen would be the "best"...

no it didn't, it asked which of the drugs are appropriate, not most or best or anything that would have made sense. the more people I talk to the more stories I hear about bad questions that don't really test our true knowlege.

MY Emt-B class was the first "altered" EMT program specifically designed to pass the NREMT. Our lab actually taught us the skills we needed and what was actually done on the road but our lecture was changed because we only had a 60% pass rate. The original lecture taught the skills and textbook but since the NREMT was so fubar'd they focused on the types of questions the test asked. Our intructor CONSTANTLY told us to pick the BEST possible answer, and they gave us weekly quizes that emulated the NR test. we had a 96% pass rate in my class, so I guess even my county thinks the NR test is a bit strange.

 

[CaptainPanic]

Well our EMT class started with 24 people, by the end of the course it dwindled down to just 12, all 12 passed the practicals and were able to sit for the written, but 11/12 passed the written, the odd thing was they the one who didnt pass the written had alreayd taken the NR 2-3 times already. :blink:

Dont ask me how or why.....

-Cap'nPanic

 

[Ridryder911]

If I understand what you described, 11 out of 12 passed, and the person that did not pass had taken it 2-3 times before ?...and passed it ? My question is why someone would take the exam 2-3 times and let their Registry laspe ?

Most people fail the examination due to over reading or placing more information than what is asked. It still has a very high pass rate, in comparission of other medical certification examinations. Again, most people do not properly prepare for the examination or are not used to stem key answers.

It will intresting to see the outcome next year when the NR changes to a computer based written examination. This will definitely aid in the result time of the examination.

Be safe,
Ridryder 911

 

[CaptainPanic]

Originally posted by ridryder 911@Sep 12 2005, 02:44 PM
If I understand what you described, 11 out of 12 passed, and the person that did not pass had taken it 2-3 times before ?...and passed it ? My question is why someone would take the exam 2-3 times and let their Registry laspe ?

Most people fail the examination due to over reading or placing more information than what is asked. It still has a very high pass rate, in comparission of other medical certification examinations. Again, most people do not properly prepare for the examination or are not used to stem key answers.

It will intresting to see the outcome next year when the NR changes to a computer based written examination. This will definitely aid in the result time of the examination.

Be safe,
Ridryder 911

The person who did not pass had taken the practicals twice before and never passed, finally when he was in my class he was able to pass the the practicals, and now he has taken the written twice and still hasnt passed from what I've heard. He's currently working as a dispatcher for the S.O.

And yes it will be interesting when the NR goes completely computer based. Of course you wont be able to just take the NR written immediately after the practicals in the same day as we did. As far out in the boonies as some people are around here, they should allow the ATU-Ozark campus and the UA- Morrilton campus have the NR testing site, not just AR-DOH in Little Rock. It would be nice if ATU-Russellville had it to, but they focus on Nursing at their campus.

-Capn

 

[namaste1967]

I just took the nremt-b/Mich. state exam on friday, 9-16. I thought it was a tad brutal myself! The way that I interpit that question is that we, as emt-b's, are allowed to administer or assist with administration of all of the listed treatments provided that med-con gives on line orders for the epi or assistance with the MDI. Doesn't mean that the pt WILL receive "ALL of the above" (except for the o2...pt definately will get that), but that the pt would be a good canidate to receive ANY of the above. If they would have thrown in an answer outside of the emt-b's scope of practice, like starting an IV, then "all of the above" would have been the wrong choice.
That's just the way I would interpit that heinous question.......LOL!

 

[bravofoxtrot]

Just on the question itself, I would've probably put c. just oxygen. Epi, doesn't say that it's an allergic reaction and with the BP the way it is, why raise it? Albuterol is contraindicated in symptomatic tachycardia; with her BP it's probably not an issue, if she was tachycardic I doubt it would be that high, but since it doesn't say, I would think that would not be the best answer and with epi already ruled out, I would go with c.

 

[squid]

Speaking of bad questions, I remember when I took the national emt-b there was a question that began:

"An unresponsive child was riding a bicycle...."

 

[bravofoxtrot]

That's going down in my list of "medicalisms." While we're on the random, funny things that we've read, on the door of the staff bathroom at the hospital here it says, "Close door when not in use." Nobody else seems to find that as funny as I do. So does that mean I don't have to close the door when I'm using it? (The toilet is practically out in the middle of the hall.)