Chapter 17
Which statement made by the EMT indicates a safe understanding of the administration of nitroglycerin in the prehospital setting?
"A total of three nitroglycerin tablets may be administered in the prehospital setting, and this includes what the patient takes prior to EMS arrival."
The EMT understands the EKG when he states:
"An EKG represents the electrical activity of the heart."
Which one of the following statements should the EMT associate with the condition of congestive heart failure?
"I have a hard time breathing when I am in bed at night."
You are approached by an EMR who informs you that last week, he was on a call in which a patient with chest pain and a known history of coronary artery disease was not given oxygen by the EMTs. You would reply:
"Ironically, it has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful."
Which statement would the EMT expect from a patient with unstable angina?
"The chest pain awakens me from my nighttime sleep."
Which one of the following patient statements should make an EMT suspect primary hypertension?
"The doctor does not know what is causing my blood pressure to be high."
Who is most likely to suffer a silent MI?
55-year-old female with diabetes
The site in the heart's conduction system where the electrical impulse is temporarily slowed down to allow the ventricles to fill with blood is the:
AV node
You have just arrived by the side of a male patient who is in cardiac arrest. Emergency Medical Responders have been on scene for 6 minutes performing CPR. Advanced life support (ALS) has been contacted and is 1 minute out. Which one of the following should you do immediately?
Apply and use the automated external defibrillator
A 67-year-old male with a history of coronary artery disease called 911 for chest pain. He states that the pain started when he was cleaning out his garage, but after a period of rest, the pain has resolved. His airway is patent, his breathing is adequate, his radial pulse is irregular, and his skin is warm and dry. He has a past medical history of atrial fibrillation (irregular heartbeat), coronary artery disease, and diabetes, for which he takes insulin. Vital signs are pulse 68, respiration 16, blood pressure 148/88, and SpO2 97% on room air. He took 81 mg of aspirin as prescribed this morning on awakening. Which of the following would you do first?
Check breath sounds
What sign or symptom would the EMT typically associate with congestive heart failure?
Crackles in both lungs
You are assisting a paramedic in the transport of a patient from a community hospital emergency department to a large medical center. The patient was diagnosed with an acute myocardial infarction (heart attack) and received fibrinolytic therapy in the ED. Currently, you are transporting the patient with the fibrinolytic medication infusing through an IV. In regards to the fibrinolytic therapy, you know that during this transport, you will need to closely monitor the patient for what complication?
Internal bleeding
The EMT should most suspect a patient suffers from heart failure when he takes what medication
Lasix
Chronic and untreated hypertension will affect which part of the heart first?
Left Ventricle
Which of the following scene size-up observations would make you suspicious that a patient complaining of shortness of breath is suffering from congestive heart failure?
Multiple pillows stacked at the head of his bed
A 64-year-old male presents with a blood pressure of 210/132 mmHg. What patient statement would you recognize as most concerning and most likely associated with the elevated blood pressure?
My ears are continually ringing.
In the blood, what component is responsible for the formation of blood clots?
Platelets
You are caring for an alert and oriented patient with chest pain. He is receiving supplemental oxygen, and two nitroglycerin tablets and aspirin have been administered. Currently, his vital signs are pulse 76, respirations 16, blood pressure 110/56, and SpO2 95%. When transporting him on the stretcher, which position is best?
Position of comfort
If a patient has a clot occluding the blood flow through his left coronary artery, which of the following will occur first?
The flow of oxygen-rich blood to the muscle of the left ventricle will be decreased.
A patient suffers from pulmonary hypertension, which has increased the resistance in the pulmonary blood vessels. In response, which of the following will most likely occur?
The right side of the heart will weaken.
Which of the following best indicates the pathway of blood through the heart?
Vena cava, pulmonary artery, left ventricle, aorta
A female patient is complaining of feeling tired over the past two days, associated with swelling of the ankles, epigastric pain, and nausea. This patient may be suffering from:
a coronary event.
To administer aspirin in the prehospital setting, which of the following must be satisfied?
approval from medical direction
You have been called for a patient with angina. On scene the 67-year-old man reports that he has a history of angina and the pain started when he was moving firewood from the garage into his house. Unfortunately, the pain has yet to go away, despite three nitroglycerin tablets and 20 minutes of rest. Your next action should be to
check the patient's vital signs.
The primary function of the heart is to
circulate blood
An alert and oriented patient presents with shortness of breath, crackles in both lungs, jugular venous distention, and edema to the feet and ankles. Her pulse is 132, respirations 26, blood pressure 160/86, and SpO2 at 88%. Based on this, the EMT should suspect:
congestive heart failure.
When administering aspirin to a patient with chest pain that is suggestive of a heart attack, the EMT recognizes that this medication will benefit the patient by:
decreasing the ability of the platelets in the blood to form clots.
A person has been diagnosed with high blood pressure. A medication that can effectively serve to lower his blood pressure is one that:
dilates the artieries
You suspect that a patient with a history of chronic obstructive pulmonary disease (COPD) is suffering from right ventricular disease. From your assessment, which of the following findings reinforce this suspicion?
edema to both feet
The tricuspid valve prevents blood from:
flowing from the right ventricle into the right atrium.
The primary control or automaticity of the heart rate originates in the:
heart
The three primary components of the cardiovascular system are best described as:
heart, blood vessels, and blood.
The EMT recognizes the cause of heart failure as:
inadequate ejection of blood
A patient informs you that he has a history of an abdominal aortic aneurysm. To best assess the status of this condition, you should:
palpate the abdomen.
Your elderly patient complains of chest pain. She has a history of previous heart attack and diabetes. You should:
prepare for possible cardiac arrest.
After blood has entered the right ventricle, it is next moved into the:
pulmonary artery.
A patient who is chronically hypoxic because of anemia most likely has a problem with what component of the cardiovascular system?
red blood cells
The primary pacemaking site of the heart is the:
sinoatrial node.
You have been called for a 56-year-old female complaining of chest pain. She informs you that she takes nitroglycerin and asks you to get it off of the top of her refrigerator. You find it is a clear glass jar hand labeled "nitroglycerin." Which of the following is the most appropriate response?
"It is best to keep the nitro in a dark container since light will inactivate it."
Your patient has chest pain, and you have just assisted him in taking his nitroglycerin tablet. Which of the following patient statements is the cause for greatest concern?
"The chest pain does not feel any different."
Which one of the following instructions given by an EMT indicates the proper administration of nitroglycerin?
"Let this pill dissolve under your tongue."
A patient has a low platelet count in his blood. Based on this, for which of the following is he most at risk?
Bleeding
Which one of the following actions is it essential that the EMT take prior to assisting the patient in taking his nitroglycerin tablet?
Evaluate the patient's blood pressure.
A patient with chest pain has an SpO2 of 90% on room air. How would you start providing oxygen to this patient?
Nasal cannula 2 lpm
A 71-year-old female patient is lying in bed and complaining of respiratory distress. She exhibits moderate dyspnea, crackles in both lungs, and edema to the abdomen and lower extremities. Supplemental oxygen is being provided to the patient by Emergency Medical Responders. Her vital signs are: pulse 132, respirations 18, blood pressure 138/86, and SpO2 at 95%. Which one of the following would be the most benefit to the patient?
Position the patient upright
An obstruction of the pulmonary artery will cause:
backup of blood in the right side of the heart
On scene, you are treating a 62-year-old female with chest pain, diaphoresis, and nausea. She states she has a history of heart problems as well as diabetes, for which she takes medications. She is allergic to penicillin and iodine. She is alert, oriented, and calm and there are no threats to the airway, breathing, or circulation. She took 81 mg of aspirin this morning as she always does. Her vital signs are: pulse 100, respirations 16, blood pressure 118/90, and SpO2 97% on room air. In overseeing the care of this patient, which of the following actions would demand immediate and corrective intervention?
Applying oxygen through a nasal cannula
A 56-year-old female with a smoking history and COPD complains of the sudden onset of shortness of breath and diaphoresis. History indicates no cardiac diagnosis but previous drug abuse 8 years ago. Vital signs are pulse 96, respiration 18 and mildly labored, blood pressure 168/102 mmHg, and SpO2 97% on home oxygen at 4 lpm, which she has for COPD. Her lung sounds are clear but diminished bilaterally. You would:
turn down the oxygen to 2 lpm, monitor, and transport.
Which one of the following statements made by another EMT, regarding chest pain and acute coronary syndrome, should you agree with?
"Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure"
Prior to administering nitroglycerin to a patient with chest pain, the EMT must ensure that the:
nitroglycerin is prescribed for the patient.
A patient who suffers a silent MI will most likely:
not be awakened by a heart attack as he sleeps.
You are caring for a 69-year-old male who is short of breath and in congestive heart failure. He is alert, anxious, and panicked with an open airway and rapid shallow respirations. His heart rate is tachycardic, and his skin is cool and diaphoretic with cyanosis noted to the lips and fingers. There are crackles noted to both lungs, as well as pedal edema to both feet. He denies chest pain or discomfort, but is having a difficult time speaking due to the shortness of breath. When caring for this patient, you should:
apply continuous positive airway pressure (CPAP)
You are interviewing a patient you suspect to be suffering from acute coronary syndrome. Which of the following questions is most appropriate?
"Are you having any chest discomfort or pain?"
You have arrived at a residence to help another crew with a 62-year-old woman who is complaining of fatigue, chest discomfort, and diaphoresis. The EMTs on scene report that she has a history of hypertension for which she takes a blood pressure pill and is prescribed nitroglycerin because she has atherosclerosis. She also reports an allergy to aspirin. Vitals are pulse 64, respirations 16, blood pressure 128/86, and SpO2 97% on room air. Which of the following statements made by the EMTs would require immediate intervention on your part?
"I am going to put her on high-concentration oxygen because she had chest pain."
Which of the following patient statements should cause the EMT to suspect an abdominal aortic aneurysm?
"I have belly pain that I also feel in my back."
You are transporting a patient who had an episode of chest pain. On scene you assisted him in taking his nitroglycerin, which completely alleviated the chest pain. En route to the hospital, he asks you why the nitroglycerin takes the chest pain away. Your response would be:
"It dilates the blood vessels, which decreases the workload of the heart."
A TV reporter has been assigned to your ambulance for a ride-along. He is doing a segment on the local EMS services for EMS week. In your down time, he tells you that his wife was diagnosed with atherosclerosis. He is unsure what the condition is and asks you to explain it to him. Your response would be:
"The coronary arteries become narrowed by fat deposits."
The EMT understands diastolic blood pressure when he describes it as which of the following
"The pressure in the arteries after cardiac contraction"
When obtaining a medical history, which of the following patient statements seemingly indicates that he is suffering from classic angina?
"When I stopped cutting the grass, the pain went away."
The EMT shows she is correctly administering aspirin to a patient with chest pain when she provides:
325 mg of baby aspirin and instructs the patient to chew it.
You are assessing a 73-year-old male complaining of altered mental status and shortness of breath. The patient is conscious, but confused. He is breathing at a rate of 20 breaths per minute. His pulse is rapid and weak, and his skin cool and diaphoretic. An Emergency Medical Responder provides you with the following vital signs: pulse 136, respirations 20, blood pressure 168/88, and SpO2 at 89%. Family states that he is diabetic and takes insulin. He also has a history of hypertension, colon cancer, irregular heartbeat, and transient ischemic attacks (TIA). Which one of the following should you do next?
Apply supplemental oxygen
A patient is very dizzy and altered in mental status. Vital signs are: pulse 84, respiration 16, blood pressure 74/32, and SpO2 93%. Medical direction has ordered the paramedic to start and IV infusion of a medication that causes vasoconstriction. You would recognize that the medication is benefiting the patient when you observe:
Blood pressure 110/64
Which of the following statements regarding cardiac compromise or acute coronary syndrome should the EMT recognize as true?
Cardiac compromise should be suspected for any patient with chest discomfort.
Immediately after assisting a diabetic patient with her nitroglycerin, she states that she feels weak, dizzy, and nauseated. Which of the following should the EMT do next?
Check her blood pressure.
A patient with a past medical history of angina is complaining of chest discomfort. When assessing the patient, which sign or symptom should alert the EMT that the patient is probably suffering an acute myocardial infarction and not an anginal attack?
Chest discomfort is not relieved by nitroglycerin.
When assessing a patient in the prehospital setting, which of the following does the EMT recognize as an indication for aspirin?
Chest discomfort that is suggestive of a heart attack
You are assessing a patient in heart failure. Which of the following signs or symptoms seemingly indicates that the left ventricle is the cause of the heart failure?
Crackles in the bases of both lungs
You are treating a 67-year-old male with chest pain and a history of prior heart attacks as well as diabetes and hypertension. The patient has taken three nitroglycerin tablets which have decreased the pain from 7 to 4/10; however, the pain persists. Initially, his SpO2 was 91% on room air. Oxygen was applied by nasal cannula and now, on 3 lpm O2, his SpO2 is 97%. How would you address the oxygen, given that he still has chest pain?
Decrease the oxygen to 2 lpm
You have been called to an office building for a 47-year-old male complaining of chest pain. He is alert, oriented, and complaining of pain in his chest that came on suddenly about 15 minutes ago. His skin is diaphoretic and cool. Which one of the following should you do first?
Obtain a heart rate, respiratory rate, blood pressure, and SpO2 reading.
A patient informs you that he has a hard time breathing when he lies in bed. You would best document this as:
Orthopnea
You are caring for a 62-year-old female with chest pain and shortness of breath. She is alert and oriented with an open airway. Her breathing is adequate and radial pulse strong. Her skin is warm and dry. Which one of the following should you do next?
Perform a secondary assessment.
A patient complaining of shortness of breath has called 911. Her history includes chronic obstructive pulmonary disease (COPD). When assessing the patient, which one of the following causes you to immediately prepare the patient for transport?
Pulsating mass in the abdomen
When administering oxygen to a patient with chest pain, which of the following should be a guide to its use and maintenance?
Pulse oximetry reading
To save additional heart muscle from dying when a patient suffers an acute myocardial infarction (heart attack), what treatment must occur?
Relieving the obstruction in the coronary arteries
Your patient is complaining of chest pain that radiates into his neck and arms. The primary assessment reveals a patent airway, adequate breathing, and a strong, regular radial pulse. His skin is warm and dry, and reveals no signs of inadequate perfusion. Which of the following should you do next?
Start the secondary assessment
Which one of the following signs or symptoms should the EMT directly relate to a patient who has a high white blood cell count?
Temperature of 103.4 °F
You are by the side of a patient complaining of severe chest pain that radiates into his right arm and neck. He is alert and oriented with an open airway and adequate breathing. His radial pulse is strong, and his skin is cool and diaphoretic. Your partner reports his pulse rate is 84, respirations are 18, blood pressure is 86/62 mmHg, and SpO2 is 98% on room air. You have obtained a medical history and performed the secondary assessment. The patient states that he has had two heart attacks in the past and is allergic to aspirin and sulfa medications. Which one of the following should you do next?
Transfer him to the stretcher and transport.
You are transporting a patient with chest pain to the hospital emergency department. In regards to possible fibrinolytic therapy, which of the following should you relay as a possible relative contraindication to this therapy?
Use of anticoagulant medication
The EMT would recognize which therapy as the best for definitively treating an ST elevation myocardial infarction (AMI)?
angioplasty
Regarding arteries, the EMT should recognize that all arteries:
carry blood away from the heart.
The sympathetic nervous system will cause the heart to:
increase the heart rate
You have just arrived by the side of a 68-year-old male complaining of chest pain. After determining his airway is patent and breathing adequate, it is imperative that you perform which action next?
check his radial pulse
A mother has called 911 because her 6-year-old son told her he had chest pain. On scene, the mother informs you that her son suffers from a congenital heart defect called aortic coarctation. The boy admits to chest pain and appears distressed. His airway is patent, breathing adequate, and radial pulse present and regular. Vital signs are pulse 108, respirations 24, blood pressure 148/92, and SpO2 98%. Your next action would be to:
contact medical command for advisement.
On an EKG, the EMT would understand the QRS to represent:
contraction of the ventricles.
A patient with chest pain and shortness of breath informs you that the last time he had a heart attack, he went into heart failure. When performing your secondary assessment, which one of the following signs or symptoms is most indicative that the patient is in heart failure again?
crackles in the lungs
You are treating a patient complaining of altered mental status, shortness of breath, and chest pain. A paramedic has just administered a medication that causes the sympathetic nervous system to increase its influence in the body. Which one of the following actions should you anticipate?
increased heart rate
A paramedic administers a medication to decrease the effect of the parasympathetic nervous system on the heart. As a result, the EMT would expect which of the following?
increase in heart rate
Which portion of the heart, when weakened by a heart attack, is responsible for causing fluid to back up into and engorge the lung tissue?
left ventricle
For a patient with a history of an unstable abdominal aortic aneurysm, the EMT should recognize and prepare for:
massive internal bleeding
What structure of the neck would the EMT examine on a patient she believes to be in congestive heart failure?
neck veins
Dysfunction of the heart's conductive cells most likely will cause:
palpitations.
A patient has called 911 for chest pain that he describes as "tearing" and radiating between his shoulders. His airway is patent, breathing accelerated but adequate, and radial pulse intact. Your partner reports the following vital signs: pulse 120, respirations 22, blood pressure 88/64, and SpO2 at 96% on room air. At this time, you should:
recheck the blood pressure in the other arm.
When treating a patient with chest pain, the primary goal of the EMT is to:
recognize the possibility of cardiac compromise and provide proper care.
You have been called for a 58-year-old male with an unknown medical emergency. On scene you find the alert and oriented patient to be complaining of headache as well as weakness and "tingling" to his right arm and leg. He is diabetic and suffers from high blood pressure, for which he takes the appropriate medications. When asked, he states that he thinks he may have passed out earlier in the day, immediately after taking his morning dose of insulin. His pulse is 96, respirations 16, and blood pressure 180/106 mmHg. Based on this presentation, you should treat the patient for:
stroke
You are caring for an older patient with chest pain. Your paramedic partner tells you the patient's ECG is showing some conduction abnormalities. You should assume:
the patient may be experiencing a cardiac emergency
Your patient is a 67-year-old male who has chest pain. After assisting with his nitroglycerin, his chest pain remains 7 out of 10 and he is still diaphoretic. His vital signs are: pulse 72 beats per minute, respirations 18 per minute and adequate, blood pressure 82/60 mmHg, and SpO2 at 97% on 2 liters per minute of oxygen. To the present, the patient has taken two nitroglycerin tablets. You should
transfer him to the stretcher and transport
The EMT shows that she understands the difference between classic angina and an acute myocardial infarction (MI) when she states:
"An acute myocardial infarction results in the death of cardiac tissue; classic angina does not."
You have been called to a residence for a 52-year-old male complaining of chest pain. When obtaining a history from the patient, what statement, made by the patient, would you find most concerning?
"The pain came on suddenly when I was reading the paper."
Which one of the following statements should the EMT recognize as an absolute contraindication to the use of fibrinolytic medications in the emergency department?
"Two months ago I had a stroke on the left side of my brain."
On room air, which patient requires supplemental oxygen?
47-year-old female; temperature 100.3degrees°F; denies sob; SpO2 91%
When assessing a patient with upper back pain, what assessment finding would make you very suspicious of a thoracic aortic dissection?
Different blood pressure readings in each arm
A 72-year-old male with an extensive COPD and other lung history is in cardiac arrest. What instruction would you provide to the EMT ventilating the patient with the bag-valve mask?
"Have someone monitor for breath sounds in both lungs as we ventilate."
A 71-year-old male with a cardiac history and lower abdominal and back pain has called 911 for help. On scene, you detect a large pulsatile mass in his abdomen. With the exception of skin that is diaphoretic, the primary assessment indicates no life threats to the airway, breathing, or circulation. He has a history of hypertension, high cholesterol, diabetes, and is allergic to sulfa-based medications. Vital signs are pulse 92, respirations 20, blood pressure 130/66, and SpO2 95% on room air. What action would make you intervene immediately?
"I am going to take my daily aspirin since I did not take it this morning."
You have been called for a patient who is not feeling well. Assessment indicates an open airway, adequate breathing, and regular radial pulse. He states that his left arm is weak and has had a stroke in the past which caused paralysis in his right arm. He is also a diabetic and has not taken any insulin today because he is out of the medication. Vital signs are pulse 88, respirations 20, blood pressure 186/104, and SpO2 95% on home oxygen for his COPD. What assessment finding is most concerning to you?
Left arm weakness
A 44-year-old male is experiencing chest pain. He has a history of angina and is prescribed nitroglycerin, which he has not taken yet. He is also taking another medication. Which of the following contraindicates the administration of nitroglycerin?
Levitra
You have been called for a 4-year-old female who told her mother that her chest hurts. On scene, the child is crying and points to her chest when asked if she has pain. Her airway is patent, respirations slightly labored, pulse rapid and regular, and skin warm and pale. Vital signs are: pulse 132, respirations 28, blood pressure 108/74, and SpO2 86%. Mother denies any medical history, medications, or allergies for her daughter. Your first action would be to
apply oxygen
After being dispatched for a male patient experiencing shortness of breath, you arrive to find the confused 67-year-old man sitting upright at his kitchen table in severe respiratory distress. You also note remarkable swelling to his lower legs and feet. He has an open airway, but cannot speak more than two to three words without attempting to breathe. His breathing is extremely labored and his skin is cool, diaphoretic, and dusky in color. Family states a history of hypertension, congestive heart failure, and angina, for which he takes nitroglycerin. Your immediate action in caring for this patient is to
apply continuous positive airway pressure (CPAP).
You are completing the prehospital care report and are documenting the fact that you assisted a patient in taking his nitroglycerin pill. How will you document the route of administration?
sublingual
