You are reviewing the medications of a semiconscious patient as your partner and another paramedic provide patient care. The patient’s medications include Lanoxin, enalapril, Coumadin, Lasix, and K-Dur. This medication regimen is MOST consistent with a patient who has:

Chief complaints relating to cardiac patients include:

The pain associated with a dissecting aortic aneurysm is typically described as:

Which of the following are ventricular antiarrhythmics?

Nitroglycerin in hypertensive CHF:

A 65-year-old man is complaining of pain in his right leg. Examination reveals the right lower extremity to be warm to the touch and swollen. The pedal pulse in the affected extremity is strong. The temperature and pulse in the patient’s left leg is normal. Your field impression is:

The best interpretation of the above EKG is:

Directions Choose one of the topics below and respond to it in essay form. Your essay should have a clear introduction and thesis statement, at least two focused body paragraphs that have topic sentences, and a conclusion. Support the ideas in the body paragraphs with specific examples from the stories. You will have two hours to complete the exam once you click below. At the end of the two hours, regardless of whether you have finished, the essay will be submitted. Remember that the exam allows for no electronic devices or other aids, unless these are required through an ACCESS accommodation request. Write your own responses to the questions and structure them as best as you can within the two-hour limit. This proctored final essay will be graded according to the following criteria: 20 points – Clearly articulated thesis statement (one or two sentences that responds to the prompt and gives the paper direction)                 10 points – Clear topic sentences in the body paragraphs                                              35 points – Specific details, discussion, and examples from the stories in the body paragraphs                                                                         35 points – Grammar, mechanics, and style adhere to standard conventions  Total Points:  100 points   Choose one of the following topics: The story “The Shawl” by Louise Erdrich is structured into three different sections: the story told about Aanakwad and her family, the story of the 13-year-old narrator who confronts his father, and the final brief section where the narrator describes the situation in the family now. How does this story develop the theme of healing from intergenerational trauma? Both “The Shawl” by Louise Erdrich and “Where Are You Going, Where Have You Been” by Joyce Carol Oates feature adolescent protagonists (one is 13 and one is 15). What are these stories saying about the challenges of adolescence? How are both of these characters similar and/or different? In both The Metamorphosis by Franz Kafka and “The Things They Carried” by Tim O’Brien, the protagonists find themselves alienated from their surroundings. Compare and/or contrast the ways the main characters, Gregor and Jimmy Cross, both in nearly unbearable situations, react to what is happening around them. In Alice Walker’s “Everyday Use,” Mama and Dee/Wangero have different perspectives about how cultural objects, such as the quilt and the butter churn, should be used. How are their perspectives different? Which one do you agree with and why? Joyce Carol Oates’ story “Where Are You Going? Where Have You Been?” can be read on three levels: a crime story, a modern fairy tale, and a story with biblical undertones. Discuss these three levels in the story, providing examples of its true crime, fairy tale, and biblical allusions.

Lynn, a 41-year-old female, was referred to a local hospital after an extensive gastrointestinal evaluation at a walk-in clinic. Tests showed abnormal levels of potassium, nitrogen, and creatinine. Lynn reported she had been feeling nauseous and had bouts of vomiting for the last several months. She said she had lost 15 pounds during that time. A stool examination revealed severe diarrhea. When Lynn was confronted with the results, she admitted she had been taking 30-40 laxatives tablets a day since her symptoms started. When asked why she started taking the laxatives, she said, “I really don’t know. When I started to lose weight, people started paying attention to me. They paid attention to me even more when they thought I was really sick.” And the likely diagnosis is…

Gladys is a 42-year-old Caucasian woman who lives with her husband of 20 years. Her senior year of college, she began experiencing occasional “anxiety” attacks. She described these attacks as a sudden need for escape, accompanied by dry mouth, trembling, heart palpitations, shortness of breath, tingling in her arms, and dizziness. She also feared losing control or going crazy. After graduation, her “anxiety” attacks remitted until recently. Nine months ago, she was shopping at a local grocery store when she had an “attack” with the same symptoms noted above. She felt severe anxiety and a sudden urge to leave. Since then, she became very afraid of having another attack. As a result, she refuses to leave her house. She does not want to be in a store, on a line, or in any public space. She is anxious about having another “attack” in public and looking silly or getting “trapped.” And the likely diagnosis is…