Volume#3 Chapter#2 HOMEWORK
A junctional escape beat occurs when: A. The rate of the SA node is slower than that of the AV node B. There is a conduction block between the SA node and AV node C. There is an accessory pathway that causes reentry of the impulse at the AV node D. The AV junction becomes irritable and temporarily overrides the SA node
A
A potassium level of 3.0 would commonly be associated with which ECG finding? A. Flattening T wave B. U wave C. Delta wave D. T wave merging with QRS
A
An ECG monitor is useful for: A. Detecting the total electrical activity within the heart. B. Determining cardiac output C. Evaluating the effectiveness of cardiac contractions D. Determining stroke volume
A
An accelerated junctional rhythm has a rate between ________ and ________. A. 60, 100 B. 20, 40 C. 40, 60 D. 100, 150
A
A 35-year-old male is complaining of a headache, blurred vision, nausea, and vomiting. He has a history of hypertension but is noncompliant with his medications. His pupils are equal and reactive, his skin is warm and dry, and his breath sounds are clear and equal bilaterally. HR = 122, BP = 202/138, RR = 12, SaO2 = 99%. In addition to monitoring his cardiac rhythm, administering oxygen, and starting an IV at a KVO rate, which of the following is most appropriate? A. Labetalol, IV B. Morphine, IV C. Nitroglycerin, SL D. Diazepam, IV
A
A 63-year-old male is alert and oriented, complaining of dizziness. He describes an acute onset of dizziness and near-syncope that has lasted for 15 minutes. He is also experiencing substernal chest pain radiating to his jaw, as well as nausea and weakness. Physical examination reveals cool, diaphoretic skin; delayed capillary refill; and mild crackles to the bases bilaterally. He has no significant medical history, but he takes 325 mg of aspirin a day. HR = 220, BP = 88/52, RR = 16, SaO2 = 92%. Which of the following should be done first? A. Oxygen by nonrebreathing mask B. Start an IV of normal saline C. Administer 0.4 mg of nitroglycerin sublingually D. Synchronized cardioversion
A
A 67-year-old male is unconscious, is sitting in a chair, and has agonal respirations. His wife states that he was up all night with difficulty breathing and chest discomfort but would not go to the hospital. Physical examination reveals pink, frothy sputum in the airway; cold, diaphoretic skin; and rales audible without a stethoscope. HR = 108, BP = 74 mmHg by palpation, RR = 4, SaO2 = 82%. The monitor shows sinus tachycardia. Which of the following is the highest priority when treating this patient? A. Intubation B. Dopamine infusion C. Determining whether the patient has a Do Not Resuscitate order D. Immediate transport
A
A patient's ECG shows regular RR intervals of 0.48 seconds, a PR interval of 0.12 seconds, and a QRS of 0.08 seconds. This best fits the criteria for: A. Sinus tachycardia B. Normal sinus rhythm C. Sinus bradycardia D. Supraventricular tachycardia
A
Blood entering the left atrium arrives via the: A. Pulmonary vein B. Bicuspid valve C. Superior and inferior vena cava D. Pulmonary artery
A
Claudication is significant because it: A. Indicates the presence of atherosclerosis B. Results in inadequate cerebral perfusion C. Leads to glaucoma when left untreated D. Results from inadequate coronary artery perfusion
A
Common chief complaints and symptoms associated with cardiac disease include all of the following EXCEPT: A. Vertigo B. Syncope C. Dyspnea D. Chest pain
A
ECG findings associated with hypokalemia include: A. U waves and flat T waves B. U waves and an Osborn wave C. An Osborn wave and a "J" wave D. Flattened T waves and a widened QRS complex
A
If the stroke volume decreased, which of the following would occur to maintain the blood pressure at its current value? A. Increased heart rate and increased peripheral vascular resistance B. Increased heart rate and decreased peripheral vascular resistance C. Decreased heart rate and increased peripheral vascular resistance D. Decreased heart rate and decreased peripheral vascular resistance
A
Pharmacological interventions initiated by prehospital care providers in the treatment of congestive heart failure may include all of the following EXCEPT: A. Atropine B. Dopamine C. Nitroglycerin D. Furosemide
A
The SA and AV nodes are often supplied by both the ________ and ________ arteries. A. Right coronary, circumflex coronary B. Left coronary, posterior descending C. Marginal, anterior descending D. Circumflex, anterior descending
A
The difference between apical and peripheral pulse rates that results from decreased cardiac output when the atria fail to contract is known as: A. Pulse deficit B. Paroxysmal pulse pressure C. Pulsus paradoxus D. Pulsus alternans
A
The intrinsic rate of the SA node is: A. 60-100bpm. B. 40-60bpm. C. set by the sympathetic nervous system. D. 15-40bpm.
A
To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s). A. One B. Twelve C. Two D. Three
A
Which of the following ECG findings is LEAST anticipated in a patient experiencing an acute myocardial infarction? A. Osborn wave B. ST depression C. QRS greater than 0.12 seconds D. ST elevation
A
Which of the following is the LEAST likely cause of PEA? A. Hypertension B. Tension pneumothorax C. Hypovolemia D. Cardiac tamponade
A
Which of the following is the most likely result of increased pulmonary artery pressure? A. Increased right ventricular workload and cor pulmonale B. Increased left ventricular workload and cor pulmonale C. Decreased right atrial workload and right ventricular hypertrophy D. Increased left ventricular workload and congestive heart failure
A
Which of the following most accurately describes the etiology of Wolff-Parkinson-White syndrome? A. Presence of an accessory conduction pathway B. Idiopathic C. Shifting supraventricular pacemaker sites D. Increased automaticity
A
Which of the following most accurately differentiates cardioversion from defibrillation? A. Cardioversion is timed to be synchronous with the patient's R wave. B. The electrical stimulation of cardioversion travels at a slower rate through the myocardium. C. Cardioversion requires fewer than 100 joules. D. Cardioversion cannot be used in patients who have a pulse.
A
You are called for a patient experiencing SOB. The patient is also a diabetic, so you preform a 12-lead ECG. It shows ST segment elevation in leads V1, V2, V3, and V4 with reciprocal changes in leads V5, V6, II, III, and AVF. You suspect: A. septal-anterior MI. B. inferioseptal MI. C. inferior MI. D. lateral MI.
A
You run a 12-lead ECG on a patient exhibiting chest pain. It reveals ST segment elevation in leads II, III, and AVF, with reciprocal in leads AVL and I. You suspect: A.inferior MI. B.lateral MI. C.anterior MI. D.high lateral wall MI.
A
he heart sound produced by the closing of the aortic and pulmonary valves is: A. S2 B. S1 C. S3 D. S4
A
A decrease in preload results in a(n): A. Decrease in afterload B. Decrease in cardiac output C. Increase in stroke volume D. Decrease in peripheral vascular resistance
B
An early sign of hyperkalemia is: A. Flat T waves on an ECG B. Tall, peaked T waves on an ECG C. Widening of the QT interval D. Presence of an Osborn wave
B
A 48-year-old male is complaining of chest pain that he describes as dull, located substernally, but radiating to his neck. He rates the pain a 6 on a scale of 1 to 10 and complains of nausea and lightheadedness. His skin is cool and diaphoretic. HR = 96, BP = 124/82, RR = 14, SaO2 = 97%. The 12-lead ECG is nondiagnostic. In addition to oxygen, an IV of normal saline at a keep open rate, and transport to the emergency department, which of the following would be most appropriate? A. Reassurance that likely his condition is not cardiac in nature B. Aspirin, nitroglycerin, and morphine C. Nitroglycerin, morphine, and furosemide D. Nitroglycerin
B
Blood pressure is defined as: A. heart rate times × preload times × SVR. B. stroke volume times × heart rate times × SVR. C. stroke volume times × diastolic pressure times × SVE. D. afterload times × preload times × SVE.
B
During which phase of the cardiac cycle does ventricular filling begin? A. Refractory B. Diastole C. Absolute refractory D. Systole
B
Measures to treat cardiogenic shock include all of the following EXCEPT: A. Reducing peripheral resistance B. Reducing stroke volume C. Improving preload D. Increasing the contractile force
B
Myocardial ischemia is caused by an imbalance of: A. sodium bicarbonate. B. oxygen supply and demand. C. oxygen bioavailability. D. free radical oxygen.
B
Normal interval time for the QT interval is: A. 0.040.12second. B. 0.33-0.42seconds. C. 0.12-0.20seconds D. 1.20-2.00seconds.
B
On an ECG tracing, negative impulses are seen as: A. J point. B. downward reflections. C. upward reflections. D. ST segment.
B
On an ECG tracing, positive impulses are seen as: A. ST segment. B. upward deflections. C. J point. D. downward deflections.
B
One small box on the ECG paper indicates: A. 2 seconds. B. 0.04 seconds. C. 4 seconds. D. 0.20 seconds.
B
Release of acetylcholine at the neuroeffector junction would result in a(n): A. Positive dromotropic effect B. Negative chronotropic effect C. Positive inotropic effect D. Increase of both sympathetic and parasympathetic tone
B
The lead to the left of the sternum at the fourth intercostal space is: A. V4 B. V2 C. V1 D. V3
B
The mitral valve is also known as the ________ valve. A. Pulmonic B. Left atrioventricular C. Tricuspid D. Right atrioventricular
B
The predominant effect of a drug with primarily alpha properties would result in which of the following? A. Increased heart rate B. Vasoconstriction C. Decreased heart rate D. Vasodilation
B
The pressure in the left ventricle at the end of diastole is called: A. After B. Preload C. Stroke volume D. Ejection fraction
B
The pressure in the ventricle at the end of diastole is called: A.a fterload. B. preload. C. stroke volume. D. Starling's law.
B
The total duration of ventricular depolarization is represented by the ________ on the ECG. A. PQ interval B. QT interval C. QRS duration D. R-R interval
B
There are 15 small boxes between R waves on an ECG tracing. What is the heart rate? A. 20 B. 100 C. 150 D. 120
B
The five-step procedure for analyzing ECGs includes all of the following EXCEPT: A. P wave. B. V1. C. rate. D. QRS complex.
B
Vasospasms associated with chest pain are known as: A. James' angina. B. Prinzmetal's angina. C. Varient angina. D. Stable angina.
B
Which of the following ECG findings would indicate a possible pacemaker failure? A. Occasional QRS complexes without pacer spikes B. Pacemaker spikes without associated QRS complexes C. A pacemaker spike preceding each P wave D. A QRS duration of 0.20 seconds
B
Which of the following is the correct sequence of cardiac electrical activity? 1. AV node 2. Internodal pathways 3. Bundle of His 4. SA node 5. Purkinje fibers 6. Bundle branches A. 4, 1, 2, 3, 6, 5 B. 4, 2, 1, 3, 6, 5 C. 1, 2, 4, 3, 5, 6 D. 1, 2, 4, 3, 6, 5
B
Which of the following will occur with an increase in peripheral vascular resistance? A. Increased preload B. Decreased stroke volume C. Decreased afterload D. Increased ejection fraction
B
You are transporting a cardiac arrest when you achieve ROSC. You now want to keep the patient's systolic blood pressure in the range of: A. 60-70mmHg. B. 80-100mmHg. C. 20-40mmHg. D. 120-130mmHg.
B
You have administered a medication to a patient, resulting in a decreased speed of cardiac impulse conduction. This drug is most accurately described as having a ________ effect. A. Negative chronotropic B. Negative dromotropic C. Positive dromotropic D. Positive chronotropic
B
Your patient goes into polymorphic V-tach. Your primary pharmacological agent is: A. amiodarone, 360 mg bolus. B. magnesium sulfate, 1dash-2 gm C. ASA, 360 mg D. diltiazem, 15 mg/mL drip
B
Your patient is found sitting on the edge of the bathtub with cool, diaphoretic skin. She states she became lightheaded and nearly "passed out" while vomiting. Your cardiac monitor shows a sinus bradycardia at a rate of 48. Which of the following is most likely? A. Sick sinus syndrome B. Increased parasympathetic tone C. Disease of the cardiac conduction system D. Use of sympathomimetic medications
B
A parasympatholytic agent used to treat symptomatic bradycardia is: A. epinephrine. B. Atrovent. C. atropine. D. Levophed.
C
A potassium level of 8.0 would commonly be associated with which ECG finding? A. Flattening T wave B. Delta wave C. T wave merging with QRS D. U wave
C
An elevation of the ST segment is associated with: A. Slowed conduction through the AV node B. Hyperkalemia C. Myocardial injury D. Left ventricular hypertrophy
C
Auscultation of an S3 is associated with: A. Mitral valve prolapse B. Increased force of atrial contraction C. Congestive heart failure D. Aortic stenosis
C
A 64-year-old female is alert and oriented, in moderate respiratory distress, and complaining of chest pain. She describes an acute onset of right-sided chest pain that radiates across her chest. Physical examination reveals cold, diaphoretic skin; lung sounds with crackles bilaterally; JVD; and peripheral edema. Medical history includes hypertension, prior myocardial infarction, and heart failure. HR = 128, BP = 86/56, RR = 26, SaO2 = 92%. Which of the following is appropriate in the prehospital treatment of this patient? A. Amiodarone B. Nitroglycerin C. Dopamine D. Morphine
C
Cardiac muscle is different from smooth muscle in the fact that it has: A. different nerve pathways. B. There is no difference. C. automaticity. D. peristalsis.
C
Excessive preload over time would lead to: A. Increased ejection fraction of the left ventricle B. Strengthening of the left ventricle C. Weakening of the left ventricle D. Decreased capacity of the left ventricle
C
For a resting potential in a cardiac cell to exist, there must be an: A. Influx of calcium ions into the cell B. Ionic equilibrium between the inside and outside of the cell C. Adequate number of potassium ions inside the cell and sodium ions outside the cell D. Adequate number of sodium ions inside the cell and potassium ions outside the cell
C
Normal interval time for the PR interval is: A. 0.04dash-0.12second. B. 0.33dash-0.42second. C. 0.12dash-0.20second. D. 1.20-2.00seconds
C
Normal interval time for the QRS complex is: A. 0.33-0.42second. B. 1.20-2.00seconds. C. 0.04-0.12seconds D. 0.12-0.20second.
C
One large box on the ECG paper indicates: A. 2 seconds. B. 0.04 seconds. C. 0.20 seconds. D. 4 seconds.
C
PSVT is LEAST likely to occur secondary to: A. Wolff-Parkinson-White syndrome B. Stress C. Myocardial infarction D. Ingestion of caffeine
C
Signs and/or symptoms of a dissecting thoracic aneurysm include all of the following EXCEPT: A. Difficulty breathing B. Chest pain C. Palpable pulsating mass D. Hypotension
C
The QRS complex represents: A. Atrial repolarization B. Ventricular repolarization C. Ventricular depolarization D. Atrial depolarization
C
The amount of resistance that must be overcome by the left ventricle during systole is called: A. Stroke volume B. Cardiac output C. Afterload D. Preload
C
The loading dose of norepinephrine is: A. 8-10mg/min. B. 2-4mcg/min. C. 8-10mcg/min D. 2-4mg/ min.
C
The most common cause of death resulting from myocardial infarction is: A. Inadequate tissue perfusion B. Heart failure C. Dysrhythmia D. End-organ failure
C
The right atrioventricular valve is referred to as the ________valve. A. pulmonary B. bicuspid C. tricuspid D. aortic
C
The right ventricle pushes blood to the lungs through the: A. pulmonary pathway. B. pulmonary vein. C. pulmonary artery. D. pulmonary vena cava.
C
Which of the following endocrine substances acts as a marker for congestive heart failure? A. Troponin B. Angiotensin C. BNP D. ACTH
C
Which of the following is NOT a phase of cardiac arrest? A. Circulatory phase B. Electrical phase C. Rigor mortis phase D. metabolic phase
C
Which of the following is NOT considered a modifiable risk factor for coronary heart disease? A. Stress B. Diet C. Gender D. Obesity
C
Which of the following is most commonly associated with multifocal atrial tachycardia? A. Digitalis toxicity B. Acute myocardial infarction C. Pulmonary disease D. Use of cocaine, amphetamines, or caffeine
C
Which of the following occurs during depolarization of a cardiac cell? A. Sodium moves out of the cell. B. Potassium moves into the cell. C. The cell becomes relatively more positively charged. D. The cell becomes negatively charged.
C
Which of the following statements concerning Q waves on the ECG is most accurate? A. Q waves are not a normal finding on the ECG. B. The absence of a Q wave is a significant pathophysiological finding. C. A Q wave is significant if it is 0.04 or more seconds wide. D. A Q wave is only significant in the presence of chest pain.
C
You are evaluating your patient's ECG under fluorescent lights. You notice significant artifact due to: A. machine malfunction. B. poor eyesight. C. 60 hertz interference. D. road noise.
C
Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of the following is most appropriate? A. Valsalva maneuver B. IV diltiazem C. Immediate synchronized cardioversion D. IV adenosine
C
An increase in afterload results in a(n) ________ workload of the heart, especially in the ________ ventricle. A. Decreased, left B. Decreased, right C. Increased, right D. Increased, left
D
A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of the following? A. The patient is experiencing myocardial injury in her lateral wall. B. The patient is experiencing myocardial ischemia in her inferior wall that is extending into the septum. C. The patient is experiencing ischemia and injury in her left ventricle and septum. D. The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle.
D
The anterior surface of the heart is best viewed by ECG leads: A. II, III, aVF B. I, aVL C. aVR, aVL, aVF D. V1-V4
D
The base of the heart lies at the level of the ________ rib. A. First B. Fourth C. Third D. Second
D
The intrinsic rate of the Purkinjie system is: A. set by the sympathetic nervous system B. 60-100 bpm C.40-60 bpm D.15-40 bpm
D
The presence of inverted T waves on an ECG indicates: A. Myocardial injury B. Myocardial infarction C. Myocardial necrosis D. Myocardial ischemia
D
The proportion of the left ventricular volume that is pumped out of the heart during systole is the: A. Preload B. Afterload C. Stroke volume D. Ejection fraction
D
The single largest killer of Americans each year is: A. suicide. B. stroke. C. congestive heart failure. D. coronary artery disease.
D
The valve between the right atrium and right ventricle is the ________ valve. A. Aortic B. Pulmonic C. Bicuspid D. Tricuspid
D
Treatment of sinus tachycardia is aimed at: A. beta blockers. B. adenosine. C. calcium channel blockers. D. treating the underlying cause.
D
Ventricular repolarization is represented on the ECG by the: A. P wave. B. QRS complex. C. J point. D. T wave.
D
Which of the following is affected by a properly working pacemaker? A. Ejection fraction B. Stroke volume C. Automaticity D. Cardiac rhythm
D
While monitoring a patient's cardiac rhythm, you note that there is no electrical activity after a PQRST complex for a period equal to exactly three of the previous R-R intervals. This is most accurately described as: A. Sinus pause B. Sinus arrhythmia C. Sinus arrest D. Sinus block
D
Your patient in atrial fibrillation has a heart rate of 108 on the monitor, but her radial pulse is 88. The patient is experiencing: A. Pulsus obliterans B. Pulsus alternans C. Paradoxical pulse D. Pulse deficit
D
Your patient is a 32-year-old female, 30 weeks' pregnant, complaining of shortness of breath and palpitations. She is alert and oriented, though anxious; her skin is cool and moist, and her radial pulse is weak and rapid, but regular. HR = 180, BP = 100/72, RR = 24. The monitor shows supraventricular tachycardia. After applying oxygen by nonrebreather and starting an IV of normal saline, which of the following is most appropriate? A. 2 mg of Versed and cardioversion beginning at 50 joules B. Transport without further intervention C. 150 mg of amiodarone D. 6 mg of adenosine
D
Your patient is a 54-year-old male who is unresponsive and cyanotic and has agonal respirations. A "quick look" shows ventricular tachycardia. Which of the following is most important when determining the immediate treatment of this patient? A. How long he has been "down" B. Whether he is allergic to lidocaine C. Whether he has an implanted cardioverter-defibrillator D. Whether he has a pulse
D
Your patient is a 55-year-old male who is in moderate distress and complaining of chest pain. He states that he experienced an acute onset of left-sided crushing chest pain while playing basketball with his grandson. He complains of weakness and near-syncope with exertion. His skin is pale, cool, and diaphoretic. HR = 40, BP = 72/40, RR = 20, SaO2 = 95%. The monitor shows a third-degree AV block. Which of the following is most appropriate? A. Aspirin, nitroglycerin, and morphine B. Dopamine at 5 mcg/kg/min C. Atropine, 0.5 mg, up to 2.0 mg D. Sedation and transcutaneous pacing
D
Starling's law states that: A. for every action, there is an equal and opposite reaction. B. the greater the contraction, the higher the afterload. C. the preload determines the cardiac output. D. the more the myocardial muscle is stretched, the greater the contraction.
D
________ is a drop in systolic blood pressure of more than 10 mmHg with inspiration. A. Electrical alternans B. Pulse deficit C. Pulsus alternans D. Pulsus paradoxus
D
