Cardiac Emergencies (test 3)
The EMT-B should use an automated external defibrillator (AED) on a child between 1 and 7 years of age if: A) he or she is not breathing and has a weakly palpable pulse. B) his or her condition is rapidly progressing to cardiac arrest. C) pediatric pads are available and the child is in cardiac arrest. D) special pads are used and the child has profound tachycardia.
c) pediatric pads are available and the child is in cardiac arrest.
The left ventricle has the thickest walls because it: A) pumps blood to the lungs to be reoxygenated. B) uses less oxygen than other chambers of the heart. C) pumps blood into the aorta and systemic circulation. D) receives blood directly from the systemic circulation.
c) pumps blood into the aorta and systemic circulation.
Immediate transport of a patient with a suspected myocardial infarction is MOST important because: A) the patient may be eligible to receive thrombolytic therapy. B) 90% of the cardiac cells will die within the first 30 minutes. C) nitroglycerin can only be given in the emergency department. D) many patients with a myocardial infarction die within 6 hours.
a) the patient may be eligible to receive thrombolytic therapy.
Which of the following is a major difference between angina pectoris and acute myocardial infarction (AMI)? A) AMI is caused by myocardial ischemia. B) Anginal pain typically subsides with rest. C) Nitroglycerin has no effect on angina pectoris. D) Pain from an AMI subsides within 30 minutes.
b) Anginal pain typically subsides with rest.
Which of the following medications is commonly given to patients with chest pain to prevent the formation of blood clots? A) Lasix B) Aspirin C) Oxygen D) Digoxin
b) Aspirin
Which of the following signs would MOST likely accompany right-sided heart failure? A) Labored breathing B) Dependent edema C) Pulmonary edema D) Flat jugular veins
b) Dependent edema
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure? A) Hypertension and tachycardia B) Hypotension and flat jugular veins C) The presence of rales in the lungs D) Trouble breathing while lying down
b) Hypotension and flat jugular veins
What is the function of the left atrium? A) It ejects oxygenated blood into the aorta. B) It receives oxygenated blood from the lungs. C) It receives blood from the pulmonary arteries. D) It receives oxygenated blood from the vena cava.
b) It ejects oxygenated blood into the aorta.
Which of the following statements regarding biphasic defibrillation is MOST correct? A) All biphasic shocks deliver 360 joules of energy. B) The energy can be set at 120 joules for all three shocks. C) Biphasic defibrillation begins with 300 joules and escalates. D) Biphasic shocks are only effective for ventricular tachycardia.
b) The energy can be set at 120 joules of energy.
The MOST common reason that many people experiencing a myocardial infarction do not seek immediate medical attention is because they: A) are elderly. B) are in denial. C) cannot afford it. D) don't trust EMTs.
b) are in denial.
You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious, has rapid and shallow respirations, and has a thready pulse. You should: A) obtain baseline vital signs. B) begin ventilatory assistance. C) attach the AED immediately. D) apply a nonrebreathing mask.
b) begin ventilatory assistance.
Ischemic heart disease is MOST accurately defined as: A) absent myocardial blood flow due to a blocked coronary artery. B) decreased blood flow to one or more portions of the myocardium. C) death of a portion of the heart muscle due to a decrease in oxygen. D) decreased blood flow to the heart muscle due to coronary dilation.
b) decreased blood flow to one or more portions of the myocardium.
Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a "no shock advised" message. Your MOST appropriate action should be to: A) reanalyze the patient's cardiac rhythm. B) determine if a palpable pulse is present. C) perform CPR and transport immediately. D) immediately assess the patient's airway.
b) determine if a palpable pulse is present.
Blood that is ejected from the right ventricle: A) enters the systemic circulation. B) flows into the pulmonary arteries. C) has a high concentration of oxygen. D) was received directly from the aorta.
b) flows into the pulmonary arteries.
Potential side effects of nitroglycerin include all of the following, EXCEPT: A) bradycardia. B) hypertension. C) hypotension. D) severe headache.
b) hypertension.
A patient with atherosclerotic heart disease experiences chest pain during exertion because the: A) coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. B) lumen of the coronary artery is narrowed and cannot accommodate increased blood flow. C) tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen. D) ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.
b) lumen of the coronary artery is narrowed and cannot accommodate increased blood flow
Angina pectoris occurs when: A) a coronary artery is totally occluded by plaque. B) myocardial oxygen demand exceeds the supply. C) one or more coronary arteries suddenly spasm. D) myocardial oxygen supply exceeds the demand.
b) myocardial oxygen demand exceeds the supply.
After assisting your patient with his or her nitroglycerin, you should: A) place the patient in a recumbent position in case he or she faints. B) reassess the blood pressure within 5 minutes to detect hypotension. C) avoid further dosing if the patient complains of a severe headache. D) perform a detailed physical exam before administering further doses.
b) reassess the blood pressure within 5 minutes to detect hypotension.
The right coronary artery supplies blood to the: A) left ventricle and inferior wall of the right atrium. B) right ventricle and inferior wall of the left ventricle. C) right atrium and posterior wall of the right ventricle. D) left ventricle and posterior wall of the right ventricle.
b) right ventricle and inferior wall of the left ventricle.
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: A) defibrillate with the AED while continuing transport to the hospital. B) stop the ambulance, begin CPR, and attach the AED as soon as possible. C) perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. D) alert the receiving hospital and perform CPR for the duration of the transport.
b) stop the ambulance, begin CPR, and attach the AED as soon as possible.
When the myocardium requires more oxygen: A) the heart contracts with less force. B) the arteries supplying the heart dilate. C) the heart rate decreases significantly. D) the AV node conducts fewer impulses.
b) the arteries supplying the heart dilate.
The descending aorta divides into the two iliac arteries at the level of the: A) nipple line. B) umbilicus. C) iliac crest. D) pubic symphysis.
b) umbilicus.
When documenting a patient's description of his or her chest pain or discomfort, it is MOST important to: A) use medical terminology. B) use the patient's own words. C) underline the patient's quotes. D) document your own perception.
b) use the patient's own words.
Nitroglycerin is contraindicated in patients: A) who have taken up to two doses. B) who have experienced a head injury. C) with a history of an ischemic stroke. D) with a systolic BP less than 120 mm Hg.
b) who have experienced a head injury.
How many nitroglycerin doses is a patient generally told to take before calling EMS? A) 1 B) 2 C) 3 D) 4
c) 3
If three defibrillations with the AED are necessary, CPR may be stopped for up to: A) 30 seconds. B) 60 seconds. C) 90 seconds. D) 120 seconds.
c) 90 seconds.
When treating a patient with chest pain, you should assume that he or she is having an acute myocardial infarction (AMI) because: A) angina usually occurs after a myocardial infarction. B) most patients with chest pain are experiencing an AMI. C) the cause of the pain cannot be diagnosed in the field. D) angina and a myocardial infarction present identically.
c) the cause of the pain cannot be diagnosed in the field.
The MOST common cause of sudden death following an acute myocardial infarction is: A) cardiogenic shock. B) severe bradycardia. C) ventricular fibrillation. D) congestive heart failure.
c) ventricular fibrillation.
Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort? A) Cigarette smoking for 20 years B) History of previous heart attack C) Presence of personal risk factors D) Family history of hypertension
d) Family history of hypertension
What is the function of the atrioventricular (AV) node? A) It generates the initial electrical impulse. B) It adjusts the heart rate as needed by the body. C) It increases the speed of the electrical impulse. D) It allows time for the blood to pass into the ventricles.
d) It allows time for the blood to pass into the ventricles.
Which of the following statements regarding nitroglycerin is MOST correct? A) The potency of nitroglycerin is increased when exposed to light. B) A maximum of five nitroglycerin doses should be given to a patient. C) Nitroglycerin should be administered between the cheek and gum. D) Nitroglycerin usually relieves anginal chest pain within 5 minutes.
d) Nitroglycerin usually relieves anginal chest pain within 5 minutes.
Which of the following blood vessels transports oxygenated blood? A) Superior vena cava B) Pulmonary arteries C) Inferior vena cava D) Pulmonary veins
d) Pulmonary veins
Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm? A) Sinus tachycardia B) Sinus bradycardia C) Extra ventricular beats D) Ventricular tachycardia
d) Ventricular tachycardia
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: A) administer up to 324 mg of baby aspirin. B) administer up to three doses of nitroglycerin. C) obtain vital signs and a SAMPLE history. D) assess the adequacy of his respirations.
d) assess the adequacy of his respirations.
Narrowing of the coronary arteries due to a buildup of fatty deposits is called: A) angiosclerosis. B) arteriosclerosis. C) acute ischemia. D) atherosclerosis.
d) atherosclerosis.
The posterior tibial pulse can be palpated: A) on the dorsum of the foot. B) above the lateral malleolus. C) in the fossa behind the knee. D) behind the medial malleolus.
d) behind the medial malleolus.
During an attempted resuscitation of an elderly male in cardiac arrest, the AED has delivered two sets of three stacked shocks. After delivery of the sixth shock, the patient remains pulseless. You should: A) perform CPR for 1 minute and reassess his pulse. B) obtain authorization to cease resuscitation efforts. C) transport at once and reanalyze his rhythm en route. D) continue CPR and prepare for immediate transport.
d) continue CPR and prepare for immediate transport.
The myocardium receives oxygenated blood from the ____________, which originate(s) from the __________. A) coronary sinus, vena cava B) aorta, inferior vena cava C) vena cava, coronary veins D) coronary arteries, aorta
d) coronary arteries, aorta
The pain associated with angina pectoris or acute myocardial infarction is MOST commonly described as: A) sharp. B) aching. C) stabbing. D) crushing.
d) crushing.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by: A) scraping fatty deposits off of the lumen of the coronary artery. B) bypassing the coronary artery with a vessel from the chest or leg. C) placing a stent inside the coronary artery to keep it from narrowing. D) dilating the affected coronary artery with a small inflatable balloon.
d) dilating the affected coronary artery with a small inflatable balloon.
Prior to defibrillating a patient with an AED, it is MOST important that you: A) properly position the defibrillation pads. B) perform up to 1 minute of effective CPR. C) confirm that the patient is in cardiac arrest. D) ensure that no one is touching the patient.
d) ensure that no one is touching the patient.
Nitroglycerin should NOT be administered to a patient who: A) has chest discomfort that is unrelieved by rest. B) took a maximum of two doses prior to EMS arrival. C) has a history of medication-controlled hypertension. D) has a systolic blood pressure of less than 100 mm Hg.
d) has a systolic blood pressure of less than 100 mm Hg.
Common signs and symptoms of cardiac compromise include all of the following, EXCEPT: A) feeling of impending doom. B) acute unexplained sweating. C) shortness of breath or dyspnea. D) pain exacerbated by breathing.
d) pain exacerbated by breathing.
A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes: A) nitroglycerin for her chest pain. B) assisted ventilation with a BVM. C) oxygen at 4 L/min via nasal cannula. D) placing her in an upright position.
d) placing her in an upright position.
ECG/defibrillator pads are placed on the patient's chest with one pad to the: A) left of the upper sternum and the other pad just to the right of the left nipple. B) right of the upper sternum and the other pad just to the right of the right nipple. C) left of the upper sternum and the other pad just to the right and below the left nipple. D) right of the upper sternum and the other pad just to the left and below the left nipple.
d) right of the upper sternum and the other pad just to the left an below the left nipple.
Ventricular tachycardia causes hypotension because: A) the volume of blood returning to the atria increases. B) the right ventricle does not adequately pump blood. C) blood backs up into the lungs and causes congestion. D) the left ventricle does not adequately fill with blood.
d) the left ventricle does not adequately fill with blood.
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray? A) Encourage the patient to chew the tablet to increase its effectiveness. B) Place the medication under the tongue and have the patient swallow it. C) Administer the medication sublingually and allow it to dissolve or absorb. D) Wait 15 minutes and reassess the BP prior to administering another dose.
c) Administer the medication sublungually and allow it to dissolve or absorb.
When would it be MOST appropriate for a patient to take nitroglycerin? A) Chest pressure that lasts longer than 10 to 15 minutes B) An acute onset of dizziness during a period of exertion C) Chest pain that does not immediately subside with rest D) Difficulty breathing that awakens the patient from sleep
c) Chest pain that does not immediately subside with rest
Which of the following signs or symptoms of acute myocardial infarction is especially common in older women? A) Pain B) Nausea C) Fatigue D) Dyspnea
c) Fatigue
Which of the following signs indicates the onset of decompensated cardiogenic shock? A) Restlessness B) Pale, clammy skin C) Low blood pressure D) Significant tachycardia
c) Low blood pressure
A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? A) Avoid defibrillation as this will damage the patient's AICD. B) Contact medical control and request permission to defibrillate. C) Perform up to three shocks if indicated and then reassess his pulse. D) Continue CPR and transport to the closest appropriate hospital.
c) Perform up to three shocks if indicated and then reassess his pulse.
Which of the following veins is located inferior to the trunk? A) Cephalic B) Axillary C) Sapheneous D) Subclavian
c) Sapheneous
After delivering up to three shocks with the AED, you should: A) transport immediately. B) perform CPR for 1 minute. C) assess for a palpable pulse. D) reanalyze the cardiac rhythm.
c) assess for a palpable pulse.
The head and brain receive their supply of oxygenated blood from the: A) iliac arteries. B) jugular arteries. C) carotid arteries. D) subclavian arteries.
c) carotid arteries.
Risk factors for a myocardial infarction that CANNOT be controlled include: A) excess stress. B) hyperglycemia. C) family history. D) lack of exercise.
c) family history.
You are dispatched to a convenience store for a possible cardiac arrest. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 48-year-old male. Your initial action should be to: A) assess the effectiveness of the bystander's CPR. B) quickly attach the AED and push the analyze button. C) have the bystanders stop CPR and assess the patient. D) request a paramedic unit and quickly attach the AED.
c) have the bystanders stop CPR and assess the patient.
If necessary, the AED will deliver up to ____ sequential shocks. A) 3 B) 4 C) 6 D) 8
a) 3
Which of the following is NOT a sign or symptom associated with malfunction of an implanted cardiac pacemaker? A) A rapid heart rate B) Syncope or dizziness C) Heart rate less than 60 D) Generalized weakness
a) A rapid heart rate
Which of the following statements regarding the AED and defibrillation is MOST correct? A) The AED will not analyze the rhythm of a moving patient. B) Defibrillation is the first link in the AHA chain of survival. C) The AED will shock any rhythm not accompanied by a pulse. D) CPR should be performed for 2 minutes before using the AED.
a) The AED will not analyze the rhythm of a moving patient
Which of the following statements regarding unstable angina is MOST correct? A) Unstable angina typically follows an unpredictable or unexpected pattern. B) The pain associated with unstable angina readily responds to nitroglycerin. C) Unstable angina is much less likely to occur during sleep or periods of rest. D) The pain caused by unstable angina is more severe than with stable angina.
a) Unstable angina typically follows an unpredictable or unexpected pattern.
Patients with cardiac compromise MOST commonly experience syncope as a result of: A) a cardiac arrhythmia. B) acute pulmonary edema. C) increased cardiac output. D) the associated severe pain.
a) a cardiac arrhythmia.
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, pulse is 100 beats/min and irregular, and respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should: A) administer oxygen, perform a focused exam, and transport at once. B) obtain a SAMPLE history and contact medical control for advice. C) give her 100% oxygen, attach the AED, and transport immediately. D) give her one nitroglycerin and reassess her systolic blood pressure.
a) administer oxygen, perform a focused exam, and transport at once.
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: A) assess the scene for potential hazards. B) determine if you need additional help. C) request a paramedic unit for assistance. D) gain immediate access to the patient.
a) assess the scene for potential hazards.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following organs, EXCEPT the: A) brain. B) kidneys. C) pancreas. D) intestines.
a) brain
Cardiogenic shock following an acute myocardial infarction is usually the result of: A) decreased pumping force of the heart muscle. B) a profound increase in the patient's heart rate. C) hypovolemia secondary to severe vomiting. D) widespread dilation of the systemic vasculature.
a) decreased pumping force of the heart muscle.
Nitroglycerin relieves cardiac-related chest pain by: A) dilating the coronary arteries and improving cardiac blood flow. B) increasing the amount of work that is placed on the myocardium. C) contracting the smooth muscle of the coronary and cerebral arteries. D) constricting the coronary arteries and improving cardiac blood flow.
a) dilating the coronary arteries and improving cardiac blood flow.
You respond to an office building to find a middle-aged male in cardiac arrest. Coworkers are performing CPR and state that the patient has been down for approximately 10 minutes. You attach the AED, push the analyze button, and receive a "shock advised" message. You should A) ensure that nobody is touching the patient and then defibrillate. B) continue CPR for 1 minute and reanalyze the patient's rhythm. C) transport immediately and request a paramedic unit rendezvous. D) call medical control and request permission to stop resuscitation.
a) ensure that nobody is touching the patient and then defibrillate.
The MOST common error associated with the use of the AED is: A) failure of the EMT-B to ensure the battery is charged. B) malfunction of the AED's internal computer processor. C) inappropriately placed adhesive defibrillation electrodes. D) inability of the EMT-B to recognize ventricular fibrillation.
a) failure of the EMT-B to ensure the battery is charged.
The iliac arteries immediately subdivide into the: A) femoral arteries. B) peroneal arteries. C) anterior tibial arteries. D) posterior tibial arteries.
a) femoral arteries.
Major risk factors for a myocardial infarction include all of the following, EXCEPT: A) hypoglycemia. B) hypertension. C) diabetes mellitus. D) elevated cholesterol.
a) hypoglycemia.
The AED is MOST advantageous to the EMT-B because: A) it delivers prompt defibrillation to patients with ventricular fibrillation. B) it is lightweight, easy to use, and safe for the EMT-B that is using it. C) its use does not require the presence of advanced life support personnel. D) it delivers an unlimited number of shocks with the same amount of energy.
a) it delivers prompt defibrillation to patients with ventricular fibrillation.
An acute myocardial infarction occurs when: A) myocardial tissue dies secondary to an absence of oxygen. B) the heart muscle progressively weakens and dysfunctions. C) coronary artery dilation decreases blood flow to the heart. D) the entire left ventricle is damaged and cannot pump blood.
a) myocardial tissue dies secondary to an absence of oxygen.
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT-B must: A) obtain authorization from medical control. B) ensure the medication is in tablet form. C) determine who prescribed the nitroglycerin. D) wait at least 5 minutes after assessing the BP.
a) obtain authorization from medical control
Deoxygenated blood from the body returns to the: A) right atrium. B) right ventricle. C) left atrium. D) left ventricle.
a) right atrium.
The electrical impulse generated by the heart originates in the: A) sinus node. B) aortic walls. C) coronary sinus. D) atrioventricular node.
a) sinus node.
The purpose of defibrillation is to: A) stop the chaotic, disorganized contraction of the cardiac cells. B) cause a rapid decrease in the heart rate of an unstable patient. C) improve the chance of CPR being successful in resuscitation. D) prevent asystole from deteriorating into ventricular fibrillation.
a) stop the chaotic, disorganized contraction of the cardiac cells.