2013 EMTC Competency

1. Your patient had a chest tube inserted for a hemathorax. When doing your bedside handoff, you notice the patient has become short of breath and his SPO2 is decreasing. This could mean that:

The tubing is kinked

There is a clot obstructing the chest tube

There is a dependent, fluid filled, loop in the tubing

All of the above

2. Which of the following interventions/assessments are indicated for stroke patients receiving alteplase?

NPO until dysphagia screen completed

Vital Signs every 15 minutes x 2 hours

Neuro Checks every 15 minutes x 2 hours

All of the above

3. Your ischemic stroke patient consents to receive alteplase. The patient's weight is 84.1 kg. The calculation for dosage is 0.9 mg/ kg. (round to the nearest tenth) What is the total dose of alteplase to be given? (round to the nearest tenth)

84.1 x 0.9= 75.7

Explanation

84.1 x 0.9= 75.7

Submit

4. Your ischemic stroke patient consents to receive alteplase. The patient's weight is 84.1 kg. The calculation for dosage is 0.9 mg/ kg. (round to the nearest tenth) The bolus dose of Alteplase for this patient is? (Round to the nearest hundredth)

75.7 (total dose) x 0.1= 7.57

Explanation

75.7 (total dose) x 0.1= 7.57

Submit

5. Your ischemic stroke patient consents to receive alteplase. The patient's weight is 84.1kg. The calculation for dosage is 0.9 mg/ kg. (round to the nearest tenth) The infusion (over 1 hour) dose is? (round to the nearest tenth)

75.7 (total dose) x 0.9= 68.1

Explanation

75.7 (total dose) x 0.9= 68.1

Submit

6. I must report that my patient is suicidal to the staff physician in my area and document this in the patient record.

True

False

7. I am told my patient admits to being a victim of domestic violence, I should contact

The Secretaries

The Shift Coordinator

The Forensic Nurse

Secured Holding

8. If I have a blood specimen going to blood bank, I should ask another staff member to come to the patient's bedside. Use two patient identifiers, apply label and have both staff members sign the label

True

False

9. It is very important to prevent shivering/microshivering in induced hypothermia patients. Which drugs prevent this from occurring?

Sedatives

Anticonvulsants

Neuromuscular Blockades

Inotropics

10. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

11. You are ready to initiate induced hypothermia on a post cardiac arrest patient. Which intervention(s) will get the patient to the target temperature the fastest:

Arctic Sun + Ice Packs

Chilled Saline Only

Chilled Saline + Arctic Sun

Arctic Sun Only

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Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

13. You are giving bedside report on a patient with an EVD. Part of the safe handoff inludes both nurses checking that:

The EVD is placed at the correct zero reference level

There is fluctuation in the tubing

All stopcocks are open to the drain

All the above

14. Management of acute brain injury is aimed at decreasing secondary brain injury. Which is not an appropriate intervention for a patient with an acute brain injury?

Maintaining neutral body alignment

Maintaining normathermia

Increasing environmental stimuli

Elevating the head of the bed 30 degrees, unless contraindicated

15. The Alaris pump tubing holds approximately 18-20 mL's of Fluid. This means that there will be 18-20mg of alteplase in the tubing at the end of the infusion time. To complete the infusion you must hang a small bag of Normal Saline and infuse at:

10 mL per hour

100 mL per hour

The same rate as the bolus dose

The same rate as the infusion dose

16. I know that all specimens should be labeled using two patient identifiers. This means specimens may be labeled at the nursing station verifying the correct patient with the computer charting system and the labels printed for the indicated labs.

True

False

ALL specimens should be labeled at the bedside using two patient identifiers

Explanation

ALL specimens should be labeled at the bedside using two patient identifiers

17. When transporting a patient with an EVD, the stopcock should be:

Open to the collection chamber

Closed to the collection chamber

18. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

19. Calculate the Cerebral Perfusion Pressure (CPP) based on the following data; Heart Rate 75bpm, Blood Pressure 120/80, MAP 93, Respiratory Rate 22, ICP 13, CVP 12

80

105

62

68

MAP-ICP=CPP

Explanation

MAP-ICP=CPP

20. Another name for Domestic Violence is Intimate Partner Violence, or IPV. These can both be used interchangeably.

True

False

21. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

22. The anatomical zero reference point for the external ventricular drain is at the location of the Foramen of Monro. This is approximated by leveling the reference point on the drain to the level of the:

Cleft of the chin

Mid Axillary Line

External Auditory Meatus

Base of the Occiput

23. Please select all that apply. As I discharge patients, I know that I am to:

Verify that the discharge paperwork is for the correct patient

Call the Charge Nurse, Shift Coordinator or Manager to help if I get behind.

Verify that the Prescriptions are for the correct patient that I am discharging

Ensure the patient understands their medications to be taken at home.

Ensure the patient understands when to follow-up with PCP/Referral

Ensure the patient understands when they should return to the EMTC, if their condition worsens.

Take Vital Signs, if not taken within the last 60 minutes.

Remove PIV's

Escort them to the waiting room, if necessary

Answer all of the patient's questions

Submit

24. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

25. You are preparing to administer alteplase to a patient with an ischemic stroke. Which of the following actions is correct?

Shake the alteplase vial vigorously to assure medication is thoroughly mixed

Place an in-line filter on the IV tubing that is to be used for administration

Withdraw and waste the excess amount of drug from the vial prior to administering

Withdraw the bolus dose and administr IVP

26. I have watched the EMTC Stroke Education Video on eLMS in 2013. I will print my transcript and show my designated evaluator when completing the EMTC Stroke Module.

Agreed

Answer option2

27. When my patient is a fall risk, I know the following interventions may be implemented:

Yellow Footies

Bed Alarm

Enclosed Bed

Side Railings Up

Bed in Lowest Position

Alert other staff to the potential fall risk

Submit

28. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

29. You are assisting the physician with the placement of an arterial line. When zeroing the transducer, the zero reference point is halfway between the anterior and posterior chest at the 4th intercostal space, when the patient is in supine position. This is called the phlebostatic axis. This approximates the level of the:

Aorta

Right Ventricle

Atria

Left Ventricle

30. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

31. A 68 year old female presents to the ED after slipping on the ice and falling. She tells you, "I put my arm out to break my fall." She did not hit her head or have any dizziness prior to the fall. She has an obvious deformity to her right wrist. Neurovascular status is intact. She has a PMH of arthritis and diabetes. Vital Signs are within normal limits. She rates her pain as 6/10. What is her ESI acuity level?

Level 1

Level 2

Level 3

Level 4

32. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

33. What medication is contraindicated in a Right-Sided Myocardial Infarction?

Aspirin

Plavix

Beta-Blockers

Nitroglcerin

Because the injured right ventricle needs adequate filling pressure, and because nitroglycerin vasodilatation can decrease the filling pressure, giving these patients nitroglycerin can cause profound hypotension.

Explanation

Because the injured right ventricle needs adequate filling pressure, and because nitroglycerin vasodilatation can decrease the filling pressure, giving these patients nitroglycerin can cause profound hypotension.

34. A 31-year-old male presents to triage after sustaining a finger laceration. He tells you, "I cut my finger trying to slice a bagel". He has a 2 cm cut to his left first finger. Bleeding is controlled. Neurovascular status is intact. Vital signs are within normal limits. His last tetanus was 10 years ago. His ESI level is:

Level 2

Level 3

Level 4

Level 5

35. When my patient screens positive for suicide, I must make them an ESI Acuity Level I.

True

False

The patient would be an ESI Acuity level 2

Explanation

The patient would be an ESI Acuity level 2

36. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

37. no image

Ventricular Tachycardia

Ventricular Fibrillation

Asystole

3rd Degree Heart Block

Acute Inferior MI

1st Degree Heart Block

Failure To Capture

2nd Degree Type 2 Heart Block

Acute Anterior MI

Torsades

Supraventricular Tachycardia

Paced Rhythm

Atrial Flutter

Atrial Tachycardia

Sinus Bradycardia

Atrial Fibrillation

38. "I called the pediatrician and she told me to bring my baby in because of his fever", reports the mother of a two-week-old. Vital signs are: Temp 101 degrees Farenheit, HR 154, RR 42, SPO2 98%. The mother reports an uncomplicated delivery. The ESI level is:

Level 1

Level 2

Level 3

Level 4

39. I know a specimen going to blood bank must be:

Initialed by two staff members

Labeled at the bedside using two patient identifiers

Verification must be done by 4 staff members

Verification must be done by 2 staff members at the bedside

All signatures must be legible

Submit

40. A 76-year-old male is brought to the ED because of severe abdominal pain. He tells you, "it feels like someone is ripping me apart." The pain began 45 minutes ago and he rates the intensity as 10/10. He has a PMH of hypertension, for which he takes a duretic and a beta blocker. his skin is cool and diaphoretic. Vital Signs are: B/P 88/68, HR 88, RR 24, SPO2 94%. His ESI level is:

Level 1

Level 2

Level 3

Level 4

41. The mother of a 2-year-old tells you, "I think he has another ear infection. He is pulling at his right ear." The child has a temp of 100.2 degrees Farenheit. Other vital signs are within normal limits for the child's age. He has a history of frequent ear infections. He is alert and grabbing at your stethoscope. Mother denies other symptoms. He is eating and drinking normally. His ESI level is:

Level 2

Level 3

Level 4

Level 5

42. I know that if my patient falls and is injured I must do the following:

Complete an Incident Report

A Fall Huddle is exempt because I am completing an incident report

Call Kathy Hendershot

Call Mary Ross

Complete a Fall Huddle

Notify the Charge Nurse

Notify the Shift Coordinator

ALWAYS complete a Fall Huddle Form, and please don't call Mary Ross!

Explanation

ALWAYS complete a Fall Huddle Form, and please don't call Mary Ross!

Submit

43. Please Match the AIDET letter with each corresponding action or dialogue.

A

I

D

E

T

Submit

2013 Emtc Competency

1. Your patient had a chest tube inserted for a hemathorax. When doing your bedside handoff, you notice the patient has become short of breath and his SPO2 is decreasing. This could mean that:

2.

What first name or nickname would you like us to use?

2. Which of the following interventions/assessments are indicated for stroke patients receiving alteplase?

3. Your ischemic stroke patient consents to receive alteplase. The patient's weight is 84.1 kg. The calculation for dosage is 0.9 mg/ kg. (round to the nearest tenth) What is the total dose of alteplase to be given? (round to the nearest tenth)

4. Your ischemic stroke patient consents to receive alteplase. The patient's weight is 84.1 kg. The calculation for dosage is 0.9 mg/ kg. (round to the nearest tenth) The bolus dose of Alteplase for this patient is? (Round to the nearest hundredth)

5. Your ischemic stroke patient consents to receive alteplase. The patient's weight is 84.1kg. The calculation for dosage is 0.9 mg/ kg. (round to the nearest tenth) The infusion (over 1 hour) dose is? (round to the nearest tenth)

6. I must report that my patient is suicidal to the staff physician in my area and document this in the patient record.

7. I am told my patient admits to being a victim of domestic violence, I should contact

8. If I have a blood specimen going to blood bank, I should ask another staff member to come to the patient's bedside. Use two patient identifiers, apply label and have both staff members sign the label

9. It is very important to prevent shivering/microshivering in induced hypothermia patients. Which drugs prevent this from occurring?

10. no image

11. You are ready to initiate induced hypothermia on a post cardiac arrest patient. Which intervention(s) will get the patient to the target temperature the fastest:

12. no image

13. You are giving bedside report on a patient with an EVD. Part of the safe handoff inludes both nurses checking that:

14. Management of acute brain injury is aimed at decreasing secondary brain injury. Which is not an appropriate intervention for a patient with an acute brain injury?

15. The Alaris pump tubing holds approximately 18-20 mL's of Fluid. This means that there will be 18-20mg of alteplase in the tubing at the end of the infusion time. To complete the infusion you must hang a small bag of Normal Saline and infuse at:

16. I know that all specimens should be labeled using two patient identifiers. This means specimens may be labeled at the nursing station verifying the correct patient with the computer charting system and the labels printed for the indicated labs.

17. When transporting a patient with an EVD, the stopcock should be:

18. no image

19. Calculate the Cerebral Perfusion Pressure (CPP) based on the following data; Heart Rate 75bpm, Blood Pressure 120/80, MAP 93, Respiratory Rate 22, ICP 13, CVP 12

20. Another name for Domestic Violence is Intimate Partner Violence, or IPV. These can both be used interchangeably.

21. no image

22. The anatomical zero reference point for the external ventricular drain is at the location of the Foramen of Monro. This is approximated by leveling the reference point on the drain to the level of the:

23. Please select all that apply. As I discharge patients, I know that I am to:

24. no image

25. You are preparing to administer alteplase to a patient with an ischemic stroke. Which of the following actions is correct?

26. I have watched the EMTC Stroke Education Video on eLMS in 2013. I will print my transcript and show my designated evaluator when completing the EMTC Stroke Module.

27. When my patient is a fall risk, I know the following interventions may be implemented:

28. no image

30. no image

32. no image

33. What medication is contraindicated in a Right-Sided Myocardial Infarction?

35. When my patient screens positive for suicide, I must make them an ESI Acuity Level I.

36. no image

37. no image

38. "I called the pediatrician and she told me to bring my baby in because of his fever", reports the mother of a two-week-old. Vital signs are: Temp 101 degrees Farenheit, HR 154, RR 42, SPO2 98%. The mother reports an uncomplicated delivery. The ESI level is:

39. I know a specimen going to blood bank must be:

42. I know that if my patient falls and is injured I must do the following:

43. Please Match the AIDET letter with each corresponding action or dialogue.