1.
Which of the following hazards would you least likely encounter at the scene of a motor vehicle crash
Correct Answer
A. Unruly patient
Explanation
At the scene of a motor vehicle crash, the least likely hazard to encounter would be an unruly patient. While moving traffic, broken glass, and hazardous materials are commonly found at crash scenes, an unruly patient is less likely to be present. The focus of emergency responders is primarily on providing medical assistance and ensuring the safety of those involved, rather than dealing with unruly behavior from patients.
2.
The general type of illness a patient is experiencing is called the
Correct Answer
B. Nature of illness
Explanation
The general type of illness a patient is experiencing is referred to as the "nature of illness." This term encompasses the overall condition or category of the patient's symptoms or complaints. It helps healthcare professionals to understand the underlying cause or nature of the illness, which can guide further evaluation, treatment, and management decisions. The nature of illness provides a broad description of the patient's health status, allowing healthcare providers to determine the appropriate course of action.
3.
Whether your patients problem is medical or traumatic in origin, you must
Correct Answer
C. Qualify and quantify the patients condition
Explanation
In order to provide appropriate medical care and determine the best course of action, it is important to qualify and quantify the patient's condition. This involves assessing and evaluating the severity and nature of the problem, such as identifying symptoms, taking vital signs, and gathering relevant medical history. By doing so, healthcare professionals can make informed decisions regarding treatment and determine the urgency of transport or the need to contact medical control.
4.
After performing your initial assessment of a patient, your next action should be to
Correct Answer
D. Decide what care is needed at the scene versus en route to the hospital
Explanation
After performing an initial assessment of a patient, the next action should be to decide what care is needed at the scene versus en route to the hospital. This is important because it allows the healthcare provider to prioritize and provide appropriate care based on the patient's condition. It helps in determining whether the patient requires immediate treatment at the scene or if it is safe to transport them to the hospital for further care. This decision-making process ensures that the patient receives the most suitable and timely care for their specific needs.
5.
Which of the following terms is most descriptive of an abnormal mental status
Correct Answer
B. Confused
Explanation
Confused is the most descriptive term for an abnormal mental status because it indicates a state of disorientation, lack of clarity, and difficulty in understanding and processing information. It suggests a cognitive impairment or dysfunction that is not present in the other options. Lethargic refers to a state of extreme drowsiness or sluggishness, obtuned indicates a decreased level of alertness, and semiconscious suggests a state between consciousness and unconsciousness. While these terms may also indicate abnormal mental states, confused specifically highlights the cognitive aspect of the abnormality.
6.
Sonorous respirations are most likely caused by
Correct Answer
A. An anatomic airway obstruction
Explanation
Sonorous respirations, also known as snoring, are most likely caused by an anatomic airway obstruction. This means that there is a physical blockage or narrowing in the airway, which can occur due to various reasons such as enlarged tonsils, deviated septum, or a tumor. This obstruction disrupts the normal flow of air during breathing, causing the characteristic snoring sound. Other options such as secretions or blood in the airway, swelling of upper airway structures, or severe inflammation of the epiglottis can also cause respiratory issues, but they are less likely to result in sonorous respirations.
7.
If manual positioning of a patients head is required to keep his or her airway upon, you should
Correct Answer
B. Insert an airway adjunct
Explanation
When manual positioning of a patient's head is necessary to maintain their airway, it indicates that the patient is experiencing difficulty in keeping their airway open on their own. In such cases, inserting an airway adjunct, such as an oropharyngeal airway or a nasopharyngeal airway, can help to maintain a patent airway. These devices are designed to keep the tongue from obstructing the airway and allow for effective ventilation. Intubating the trachea may be necessary in more severe cases, but it is not the first-line intervention in this scenario. Suctioning the oropharynx is not indicated unless there is an actual obstruction present.
8.
A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is
Correct Answer
B. Bounding
Explanation
A patient with a blood pressure of 210/100 mm Hg would be expected to have a bounding pulse. This is because a high blood pressure indicates increased force and volume of blood being pumped by the heart. As a result, the pulse would feel strong and forceful, indicating a bounding pulse.
9.
An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would most likely have _________skin
Correct Answer
A. Cyanotic
Explanation
An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would most likely have cyanotic skin. Cyanosis is a bluish discoloration of the skin caused by a lack of oxygen in the blood. In this scenario, the patient's slow and shallow breathing suggests inadequate oxygenation, leading to cyanosis. This is a common sign seen in individuals with respiratory distress or respiratory failure.
10.
The body's reaction to increased internal or external temperature would most likely cause the skin to become
Correct Answer
D. Hot and moist
Explanation
When the body's temperature increases, the blood vessels in the skin dilate, causing the skin to become hot. Additionally, the body responds to increased temperature by sweating, which leads to moisture on the skin. Therefore, the correct answer is "hot and moist."
11.
Which of the following clinical presentations warrants immediate transport
Correct Answer
D. Chest discomfort, heart rate of 104 beats/min, systolic BP of 90 mmHg
Explanation
The clinical presentation that warrants immediate transport is chest discomfort, heart rate of 104 beats/min, and systolic BP of 90 mmHg. This combination of symptoms suggests a potential cardiac event, such as a heart attack or unstable angina. The chest discomfort, along with the elevated heart rate and low blood pressure, indicates a compromised cardiovascular system that requires urgent medical attention. Immediate transport is necessary to ensure prompt evaluation and appropriate treatment for this potentially life-threatening condition.
12.
The history of present illness is most accurately described as
Correct Answer
A. An elaboration of the chief complaint
Explanation
The history of present illness refers to a detailed explanation and description of the patient's chief complaint. It includes information about the onset, duration, severity, and any associated symptoms. This helps the healthcare provider understand the patient's main concern and gather relevant information for diagnosis and treatment. It is different from a clinically significant physical finding, which refers to a specific abnormality observed during the examination. It is also different from the patient's most significant problem or the reason why the patient called 911, as these may not necessarily provide a comprehensive understanding of the chief complaint.
13.
Lung fields with areas of consolidation are most suggestive of
Correct Answer
B. Pneumonia
Explanation
Areas of consolidation in the lung fields are indicative of pneumonia. Consolidation refers to the filling of the air spaces in the lungs with fluid, pus, or other substances, causing a solid appearance on imaging. This is commonly seen in pneumonia, where the alveoli become inflamed and filled with fluid and inflammatory cells. Heart failure can also cause lung congestion, but it typically presents with diffuse interstitial edema rather than consolidation. Pneumothorax is the presence of air in the pleural space, which would not cause consolidation. Toxic inhalation may cause lung injury, but consolidation is not a typical finding.
14.
Diffuse pain caused by hollow organ obstruction and stretching of the smooth muscle wall is called _______ pain
Correct Answer
D. Visceral
Explanation
Visceral pain refers to diffuse pain caused by the obstruction or stretching of hollow organs and the smooth muscle wall. This type of pain is often described as a deep, dull, or cramp-like sensation and is typically not well localized. It is different from somatic pain, which is more localized and originates from the skin, muscles, or joints. Referred pain is felt in a different area than the actual source of the pain, while radiating pain spreads from one area to another. Therefore, the correct answer is visceral.
15.
A patient is generally considered to ave orthostatic vital signs ( a positive tilt test) when
Correct Answer
B. The heart rate increases by 20 beats/min or more when going from a supine to a standing position
Explanation
The correct answer is that the heart rate increases by 20 beats/min or more when going from a supine to a standing position. This is a characteristic of orthostatic vital signs, indicating a drop in blood pressure upon standing, which triggers the body to increase heart rate to compensate and maintain blood flow to the brain and other vital organs. The other options do not accurately describe orthostatic vital signs.
16.
Serial vital signs
Correct Answer
C. Provide comparative data regarding the patients condition
Explanation
Serial vital signs provide comparative data regarding the patient's condition. By taking repeated measurements over a period of time, healthcare professionals can track changes in the patient's vital signs and compare them to previous readings. This helps in assessing the patient's progress or deterioration, identifying trends, and making informed decisions about their treatment. It allows for a more comprehensive understanding of the patient's condition and helps in monitoring their response to interventions or medications.
17.
Which of the following significant mechanisms of injury is unique to the infant and child
Correct Answer
D. Fall from greater than 10 feet
Explanation
A fall from greater than 10 feet is a significant mechanism of injury that is unique to infants and children. This is because their bodies are still developing and are more susceptible to serious injuries from falls compared to adults. Infants and children have a higher center of gravity and their bones are not fully developed, making them more prone to fractures and other injuries when falling from a greater height. Therefore, a fall from greater than 10 feet is a particularly dangerous mechanism of injury for infants and children.
18.
An unresponsive trauma patient
Correct Answer
A. May be acutely hypoglycemic
Explanation
An unresponsive trauma patient may be acutely hypoglycemic. In cases of trauma, the body's stress response can cause a decrease in blood sugar levels. This can lead to symptoms such as confusion, loss of consciousness, and even coma. Therefore, it is important to consider hypoglycemia as a possible cause of the patient's unresponsiveness and to administer glucose if necessary.
19.
When performing a rapid trauma assessment on a critically injured patient, it is most important to remember that
Correct Answer
C. Grossly obvious injuries are often not the most life threatening
Explanation
When performing a rapid trauma assessment on a critically injured patient, it is important to remember that grossly obvious injuries are often not the most life-threatening. This means that even though an injury may be visibly severe, it may not be the primary concern in terms of saving the patient's life. Other hidden injuries or internal bleeding may pose a greater risk and should be prioritized during the assessment and treatment process.
20.
Upon completing your rapid assessment of an unresponsive trauma patients head and neck you should next
Correct Answer
D. Apply a properly sized rigid cervical collar
Explanation
After completing a rapid assessment of an unresponsive trauma patient's head and neck, the next step should be to apply a properly sized rigid cervical collar. This is important to immobilize the cervical spine and prevent any further movement or potential injury. The collar helps stabilize the neck and minimizes the risk of spinal cord damage. It is a crucial step in the management of trauma patients to ensure their safety and prevent any exacerbation of their condition.
21.
Which of the following tasks should you assign to anothe provider as you perform a rapid trauma assessment while your partner maintains cspine control and manages the patients airway
Correct Answer
A. Baseline vital signs
Explanation
As you perform a rapid trauma assessment, it is important to assign the task of obtaining baseline vital signs to another provider. This task involves measuring the patient's heart rate, blood pressure, respiratory rate, and temperature, which are crucial in assessing the patient's overall condition and identifying any signs of potential complications. Assigning this task to another provider allows you to focus on the primary assessment and immediate interventions, such as maintaining c-spine control and managing the patient's airway.
22.
When assessing the head and face during the detailed physical exam, you should
Correct Answer
C. Avoid palpating any cranial depression
Explanation
When assessing the head and face during the detailed physical exam, it is important to avoid palpating any cranial depression. Palpating or touching any areas of cranial depression can potentially cause further harm or injury to the patient. It is crucial to be cautious and gentle when examining the head and face to ensure the safety and well-being of the patient.
23.
During the detailed physical exam of a trauma patient with a significant cardiac history, you should
Correct Answer
D. Obtain a 12 lead ECG and look for signs of cardiac compromise
Explanation
During a detailed physical exam of a trauma patient with a significant cardiac history, obtaining a 12 lead ECG and looking for signs of cardiac compromise is the correct answer. This is important because trauma can cause cardiac injury, and patients with a cardiac history may be at higher risk for complications. The 12 lead ECG can help identify any abnormal cardiac rhythms or ischemic changes that may require immediate intervention. This information is crucial for guiding appropriate management and ensuring the best possible outcome for the patient.
24.
Vascular compromise in a lower extremity is characterized by
Correct Answer
A. Unilateral pulse deficit and pallor
Explanation
Vascular compromise in a lower extremity is characterized by unilateral pulse deficit and pallor. This means that there is a decrease or absence of pulses on one side of the extremity, indicating reduced blood flow. Pallor, or paleness, is also present, indicating poor oxygenation of the tissues. These symptoms suggest a possible blockage or obstruction in the blood vessels supplying the affected area, leading to compromised circulation.
25.
The care plan that you implement based on your working field diagnosis of a patient is almost always
Correct Answer
A. Your ems systems patient care protocols or standing orders
Explanation
The correct answer is "your EMS systems patient care protocols or standing orders." This means that the care plan implemented is based on the established protocols and guidelines set by the EMS system. These protocols outline the appropriate procedures and treatments for specific medical conditions or situations. Following these protocols ensures standardized and evidence-based care for patients.
26.
The main disadvantage of patient care algorithms is that they
Correct Answer
C. Only address classic patient presentations
Explanation
Patient care algorithms only address classic patient presentations, which means they are designed to provide guidance for common and well-known medical conditions. This can be a disadvantage because it may not account for unique or atypical cases that healthcare professionals may encounter. The algorithms may not be applicable or effective in these situations, leading to potential errors in patient care.
27.
Documenting difficulties such as darkness, limited access, and unruly crowds that you encounter while caring for a patient is most important because it
Correct Answer
C. Will help justify the patient care decisions you make
Explanation
Documenting difficulties such as darkness, limited access, and unruly crowds that you encounter while caring for a patient is most important because it will help justify the patient care decisions you make. By documenting these challenges, you provide evidence of the circumstances that influenced your decisions and actions. This can be crucial in explaining why certain choices were made and demonstrating that you acted in the best interest of the patient. It helps to establish a clear rationale for your decisions and can be valuable in any potential review or evaluation of your patient care.
28.
Once you determine that your patient is sick, you must next
Correct Answer
B. Quantify how sick he or she is
Explanation
After determining that the patient is sick, the next step is to quantify the severity of their illness. This involves assessing their symptoms, vital signs, and overall condition to determine the level of medical intervention required. This step is crucial in order to provide appropriate and effective care for the patient. It helps in determining the urgency of treatment and the need for immediate transport or contacting online medical control for further guidance.
29.
Comments such as " i cant believe you called ems for this"
Correct Answer
A. Show a lack of compassion and interest in providing the best possible care
Explanation
The given correct answer suggests that comments like "i cant believe you called ems for this" show a lack of compassion and interest in providing the best possible care. This means that paramedics should prioritize empathy and professionalism in their interactions with patients, rather than making dismissive or judgmental remarks. Such comments can undermine the trust and confidence that patients have in their healthcare providers, and may negatively impact the quality of care provided.
30.
Which of the following situations is most challenging with regard to your critical thinking and decision making skills
Correct Answer
C. A driver who passed out and then struck a tree
Explanation
The situation of a driver who passed out and then struck a tree is most challenging with regard to critical thinking and decision-making skills because it involves multiple factors that need to be considered. Firstly, the immediate concern would be the driver's health and ensuring their safety. Secondly, the cause of the blackout needs to be determined to prevent a recurrence. Thirdly, the driver's ability to operate a vehicle safely in the future needs to be assessed. Lastly, the accident itself and any potential legal or insurance implications must be addressed. This situation requires quick thinking, prioritization, and the ability to make sound decisions under pressure.
31.
Which of the following is not a typical element to evaluate when reading the scene of a motor vehicle crash
Correct Answer
A. The person at fault
Explanation
When evaluating the scene of a motor vehicle crash, one typically considers various elements to determine the cause and severity of the accident. These elements include access and exit routes, environmental conditions, and the overall safety of the situation. However, determining the person at fault is not a typical element to evaluate when reading the scene of a motor vehicle crash. Fault is usually determined through further investigation and analysis, such as witness statements, police reports, and insurance claims.
32.
Which of the following scenarios most accurately depicts reflection in action
Correct Answer
C. Reassessing a patients blood pressure after administering nitro
Explanation
Reflection in action refers to the process of actively thinking and evaluating one's actions and decisions in real-time. In the given scenarios, reassessing a patient's blood pressure after administering nitro aligns with reflection in action. This is because the healthcare provider is taking a moment to reflect on the effects of the medication and evaluate its impact on the patient's blood pressure. By reassessing, the healthcare provider can make informed decisions and potentially adjust the treatment plan if necessary.
33.
When you introduce yourself to your patient and ask why 911 was called, the patient looks at you, shakes your hand and answers your questions appropriately. From these findings, you can gather that the patient.
Correct Answer
B. Has a glasgow coma scale score of 15
Explanation
From the given findings, it can be inferred that the patient has a Glasgow Coma Scale (GCS) score of 15. The GCS is a neurological scale that assesses a patient's level of consciousness. A score of 15 indicates that the patient is fully conscious, alert, and able to respond appropriately. This suggests that the patient's mental status is intact and they are not experiencing any significant neurological impairment.
34.
When caring for a critically ill patient, three or more sets of vital signs will allow you to
Correct Answer
B. Assess trends and to reassess whether the patient's condition is stabilizing, getting better, or getting worse
Explanation
When caring for a critically ill patient, three or more sets of vital signs will allow you to assess trends and to reassess whether the patient's condition is stabilizing, getting better, or getting worse. By monitoring vital signs at regular intervals, healthcare professionals can track any changes in the patient's condition over time. This helps in identifying patterns or trends that may indicate improvement or deterioration in their health. It allows for timely interventions and adjustments in the treatment plan to ensure the best possible outcome for the patient.
35.
Given the number of possible diagnosis in any situation and the limited physical and technical resources of the field, you will most likely
Correct Answer
A. Regularly be treating patients who can only be diagnosed at the hospital
Explanation
In situations where there are numerous possible diagnoses and limited resources, it is likely that the patients can only be accurately diagnosed at the hospital. This means that the field setting may not have the necessary tools or expertise to determine the exact condition of the patient. Therefore, regularly treating patients who can only be diagnosed at the hospital is the most plausible outcome in such circumstances.
36.
No matter how sure he or she is of the working diagnosis, the thinking paramedic must
Correct Answer
B. Always keep part of the thought process open to other possibilities
Explanation
The correct answer is to always keep part of the thought process open to other possibilities. This is because even if a paramedic is confident in their working diagnosis, it is important to consider other potential diagnoses. Keeping an open mind allows for a thorough assessment and consideration of all possible options, ensuring the best possible care for the patient. It also helps to prevent tunnel vision and biases that may lead to overlooking important information or alternative diagnoses.
37.
Which of the following is a subjective finding
Correct Answer
C. A complain of chest pressure
Explanation
A complaint of chest pressure is a subjective finding because it is based on the patient's personal perception and description of their symptoms. Objective findings, on the other hand, can be directly observed or measured by a healthcare provider, such as pale, cool, clammy skin or a blood pressure reading.
38.
When providing patient care, it is most important that you maintain effective commnication with
Correct Answer
D. Your partner
Explanation
When providing patient care, maintaining effective communication with your partner is crucial. Your partner is the person who is assisting you in providing care to the patient, and effective communication with them ensures that you both are on the same page and can work together efficiently. This communication allows for the coordination of tasks, sharing of important information, and making quick decisions. It also helps in providing a seamless and coordinated approach to patient care, ultimately leading to better outcomes for the patient.
39.
Notification of EMS usually occurs when
Correct Answer
B. A bystander notifies the dispatcher via telepHone
Explanation
The correct answer is "a bystander notifies the dispatcher via telephone." This is because when an emergency situation occurs, it is often a bystander who witnesses the event and calls for help by contacting an emergency dispatcher through a telephone. This is a common and effective way for individuals to report emergencies and seek assistance from EMS services.
40.
In recent years, the use of telemetry has returned because
Correct Answer
C. The american heart association recommends the acquisition and transmittal of a 12 lead ECG to the receiving facility for all patients with potential acute coronary syndrome
Explanation
In recent years, the use of telemetry has returned because emergency department physicians have become less trusting of the paramedic's ability to interpret an ECG, and would rather interpret it themselves. Additionally, by law, a licensed physician must evaluate a patient's ECG tracing before the paramedic can administer any medications other than supplemental O2. Furthermore, the American Heart Association recommends the acquisition and transmittal of a 12 lead ECG to the receiving facility for all patients with potential acute coronary syndrome. This is because numerous reports and studies indicate that paramedics have an unacceptable high rate of ECG misinterpretation, which has resulted in inappropriate care of cardiac patients.
41.
All of the following factors may cause distortion of an ECG signal, except
Correct Answer
C. Severe tachycardia
Explanation
Severe tachycardia refers to an abnormally fast heart rate, which can be a result of various underlying conditions. However, it is not a factor that directly causes distortion of an ECG signal. Muscle tremors, loose electrodes, and distant transmission range can all interfere with the accuracy of an ECG signal, leading to distortion.
42.
In order for the paramedic to talk and transmit an ECG simultaneously on one frequency, a _________ system is required
Correct Answer
D. Multiplex
Explanation
To talk and transmit an ECG simultaneously on one frequency, a multiplex system is required. A multiplex system allows multiple signals to be combined and transmitted over a single channel, enabling simultaneous communication and data transmission. This is essential for the paramedic to communicate verbally and transmit the ECG readings at the same time, ensuring efficient and effective communication during emergency situations.
43.
A/an__________ receives a weak signal and retransmits it at a higher power on another frequency
Correct Answer
C. Repeater
Explanation
A repeater is a device that receives a weak signal and retransmits it at a higher power on another frequency. It acts as an amplifier for the signal, enhancing its strength and allowing it to reach a larger distance or overcome obstacles. This is particularly useful in telecommunications and wireless communication systems, where signals may become weak or distorted over long distances. By retransmitting the signal at a higher power and on a different frequency, a repeater helps to ensure that the signal remains strong and clear throughout the transmission.
44.
Which of the following statements reqarding the use of cellular telephones and landline telephones is most correct
Correct Answer
A. Cellular and landline telepHones overcome problems caused by overcrowded EMS radio frequencies
Explanation
Both cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies. This means that both types of phones are designed to work efficiently even in areas with high radio frequency interference. They use different technologies to transmit signals, allowing them to bypass the issues caused by overcrowded frequencies. This statement implies that both cellular and landline phones are reliable communication devices in areas with heavy radio frequency traffic.
45.
The first principle of communicating by radio is
Correct Answer
A. Clarity
Explanation
The first principle of communicating by radio is clarity. This means that the message being transmitted should be clear and easily understood by the recipient. Clear communication is crucial in radio communication as there may be noise or interference that can affect the quality of the message. By ensuring clarity, the chances of misunderstandings or misinterpretations are minimized, leading to effective and efficient communication.
46.
When transmitting data over the radio, you should not disclose the patient's
Correct Answer
C. HIV status
Explanation
When transmitting data over the radio, it is important not to disclose the patient's HIV status. This is because HIV status is considered sensitive and confidential information that should be protected to ensure patient privacy and prevent stigmatization. Disclosing this information without the patient's consent can violate their rights and compromise their confidentiality. It is crucial to maintain patient confidentiality and only share necessary information to ensure proper care and protect the patient's privacy.
47.
When transmitting your radio report to the hospital, you should
Correct Answer
D. Not be sitting right next to the patient
Explanation
When transmitting a radio report to the hospital, it is important not to be sitting right next to the patient. This is because the patient may overhear sensitive or confidential information being discussed, which could potentially cause distress or violate their privacy rights. By maintaining a distance from the patient, healthcare professionals can ensure that the radio report is transmitted securely and confidentially.
48.
When communicating with the hospital via radio during patient transport, which of the following information should be included in your report?
Correct Answer
B. The patient's brief, pertinent history
Explanation
When paramedics communicate with the hospital via radio during patient transport, it's crucial to provide information that will help the receiving medical team prepare for the patient's arrival. This includes a brief, pertinent history of the patient's condition and events leading up to the current situation, any underlying medical conditions, and relevant clinical findings such as ECG results. Information like the patient's favorite food, family tree, or their exact height and weight is not typically relevant to immediate medical treatment.
49.
If the EMD suspects that your patient has a life-threatening emergency, the EMD should make you aware of the situation and then
Correct Answer
B. Give pre-arrival instructions to the caller
Explanation
If the EMD suspects that the patient has a life-threatening emergency, giving pre-arrival instructions to the caller is the correct action to take. This is because providing instructions to the caller can help them provide immediate care to the patient while waiting for the arrival of emergency medical services. These instructions may include performing CPR, controlling bleeding, or administering basic first aid, depending on the nature of the emergency. Dispatching law enforcement to the scene or obtaining the caller's name and physical address may be necessary in certain situations, but giving pre-arrival instructions is the most immediate and effective way to assist the patient in a life-threatening emergency.
50.
The patient care report
Correct Answer
A. Provides for a continuum of patient care upon arrival at the hospital
Explanation
The patient care report is a document that ensures continuity of patient care when they arrive at the hospital. It contains important information about the patient's condition, treatment provided by the paramedic, and any relevant medical history. This report is crucial for the healthcare team at the hospital to understand the patient's needs, provide appropriate care, and make informed decisions. It helps to bridge the gap between pre-hospital and hospital care, ensuring a smooth transition and better outcomes for the patient.