Cardiovascular Emergencies
Shortly after administering a second nitroglycerin dose to a 44-year-old male with chest pain, he becomes lightheaded. You take his blood pressure and is reads 80/50 mm Hg. You have already established IV access and are administering oxygen. You should: A. place him supine and elevate his legs. B. give him a 500 mL normal saline bolus. C. cover him with a blanket to keep him warm. D. contact medical control for further guidance.
A. place him supine and elevate his legs
Which of the following is the MOST reliable method of estimating a patient's cardiac output?
Assess the heart rate and strength of the pulse.
What is the approximate cardiac output of a person with a heart rate of 70 beats/min and a stroke volume of 75 mL? A. 4 L/min B. 5 L/min C. 6 L/min D. 7 L/min
B. 5 L/min
Which of the following statements regarding the automated external defibrillator (AED) is NOT correct? A. Human error is the most common reason for AED failure. B. A pulse should be checked immediately after the AED shocks. C. The AED will deliver one shock every 2 minutes as needed. D. Pulseless V-tach may respond to defibrillation with an AED.
B. A pulse should be checked immediately after the AED shocks
Which of the following valves of the heart are semilunar valves? A. Mitral and aortic B. Aortic and pulmonic C. Mitral and pulmonic D. Pulmonic and tricuspid
B. Aortic and pulmonic
What part of the cardiac electrical conduction system initiates electrical impulses at the slowest rate? A. The sinoatrial node B. Areas below the AV node C. Any part of the AV node D. The atrioventricular node
B. Areas below the AV node
You are dispatched to a residence for a 59-year-old male with an unknown emergency. When you arrive, you find the patient sitting on the couch. He is conscious, noticeably diaphoretic, and complains of dizziness and weakness. During your assessment, you note a large, well-healed vertical scar in the center of his chest and a small bulge just under the skin in the upper left part of his chest. His blood pressure is 90/50 mm Hg, pulse is 44 beats/min and weak, and respirations are 24 breaths/min and unlabored. What is the MOST likely cause of this patient's condition? A. Atypical angina pectoris B. Artificial pacemaker failure C. Damaged coronary artery graft D. Decreased parasympathetic tone
B. Artificial pacemaker failure
Which of the following MOST accurately describes the pathophysiology of angina pectoris? A. Irreversible process in which one or more coronary arteries spasm and decrease myocardial blood supply B. Reversible process in which a brittle intracoronary plaque ruptures and activates the blood-clotting system C. Irreversible process in which the lumen of the coronary artery is completely occluded with plaque D. Reversible process in which myocardial oxygen demand exceeds the supply of available oxygen
D. Reversible process in which myocardial oxygen demand exceeds the supply of available oxygen
When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin?
chest pain that does not immediately subside with rest
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:
assess the scene for potential hazards.
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:
automaticity.
The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the:
autonomic nervous system.
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:
congestive heart failure.
Which of the following is NOT a function of the sympathetic nervous system?
constriction of blood vessels in the muscles
The electrical impulse generated by the heart originates in the:
sinoatrial (SA) node.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
have chronic hypertension.
Common side effects of nitroglycerin include all of the following, EXCEPT:
hypertension
Common side effects of nitroglycerin include all of the following, EXCEPT
hypertension.
Major risk factors for AMI include all of the following, EXCEPT:
hypoglycemia
In contrast to the sympathetic nervous system, the parasympathetic nervous system
slows the heart and respiratory rates.
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?
hypotension and flat jugular veins
In contrast to an Acute Myocardial Infarct (AMI), angina pectoris most commonly occurs when:
myocardial oxygen demand exceeds the supply
Angina pectoris occurs when:
myocardial oxygen demand exceeds the supply.
An acute myocardial infarction (AMI) occurs when:
myocardial tissue dies secondary to an absence of oxygen.
According to the NM EMT-Basic Scope of Practice, which of the following MUST be in place prior to the administration of Nitro to a patient complaining of chest pain?
obtain authorization from medical control
Common signs and symptoms of AMI include all of the following, EXCEPT:
pain exacerbated by breathing.
The EMT should use an AED on a child older than 1 year if:
pediatric pads and an energy-reducing device are available.
In contrast to the sympathetic nervous system, the parasympathetic nervous system:
slows the heart and respiratory rates.
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:
stop the ambulance, begin CPR, and attach the AED as soon as possible.
The purpose of defibrillation is to
stop the chaotic, disorganized contraction of the cardiac cells.
The purpose of defibrillation is to:
stop the chaotic, disorganized contraction of the cardiac cells.
When the myocardium requires more oxygen
the arteries supplying the heart dilate.
When the myocardium requires more oxygen:
the arteries supplying the heart dilate.
When treating a patient with chest pain, you should assume that he or she is having an AMI because:
the cause of the pain cannot be diagnosed in the field.
A dissecting aortic aneurysm occurs when:
the inner layers of the aorta become separated.
Ventricular tachycardia causes hypotension because:
the left ventricle does not adequately fill with blood.
Prompt transport of a patient with a suspected AMI is important because:
the patient may be eligible to receive thrombolytic therapy.
Cardiac output may decrease if the heart beats too rapidly because
there is not enough time in between contractions for the heart to refill completely.
Cardiac output may decrease if the heart beats too rapidly because:
there is not enough time in between contractions for the heart to refill completely.
Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS
three
The descending aorta divides into the two iliac arteries at the level of the
umbilicus.
When documenting a patient's description of his or her chest pain or discomfort, the EMT should:
use the patient's own words.
Sudden death following AMI is MOST often caused by:
ventricular fibrillation.
Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm?
ventricular tachycardia
Nitroglycerin is contraindicated in patients
who have experienced a head injury.
Nitroglycerin is contraindicated in patients:
who have experienced a head injury.
Risk factors for AMI that cannot be controlled include:
family history.
The iliac arteries immediately subdivide into the
femoral arteries.
Blood that is ejected from the right ventricle
flows into the pulmonary arteries.
Blood that is ejected from the right ventricle:
flows into the pulmonary arteries.
Which of the following MOST accurately describes the correct sequence of events after attaching an AED to a patient in cardiac arrest and pushing the analyze button? A. "Shock advised" message, stand clear, defibrillate, immediately resume CPR, reanalyze after 2 minutes B. "No shock advised" message, check pulse for up to 10 seconds, resume CPR, reanalyze after 2 minutes C. "No shock advised" message, stand clear, reanalyze, "no shock advised" message, perform CPR for 2 minutes D. "Shock advised" message, stand clear, defibrillate, perform CPR for 1 minute, stand clear, reanalyze, defibrillate if needed
A. "Shock advised" message, stand clear, defibrillate, immediately resume CPR, reanalyze after 2 minutes
Damage to the myocardium following infarction can be minimized if fibrinolytic therapy is administered no later than _____ hours following the onset of symptoms. A. 12 B. 14 C. 16 D. 18
A. 12
Which of the following questions would be of LEAST pertinence when obtaining a focused history of a patient with an acute onset of chest discomfort? A. Have you ever been told you have low blood pressure? B. Have you experienced paroxysmal nocturnal dyspnea? C. Do you have any respiratory diseases, such as emphysema? D. Do you have diabetes or any problems with your blood sugar?
A. Have you ever been told you have low blood pressure
Which of the following represents the correct sequence of electrical conduction through the myocardium? A. SA node, AV node, Bundle of His, bundle branches, Purkinje fibers B. AV node, SA node, bundle branches, Bundle of His, Purkinje fibers C. SA node, Bundle of His, AV node, bundle branches, Purkinje fibers D. AV node, Purkinje fibers, SA node, Bundle of His, bundle branches
A. SA node, AV node, Bundle of His, bundle branches, Purkinje fibers
When assessing a middle-aged male patient with chest pain, you note a large vertical scar in the center of his chest. This indicates that he has MOST likely had: A. a coronary artery bypass graft. B. coronary artery stent placement. C. a percutaneous coronary angioplasty. D. a surgically implanted cardiac pacemaker.
A. a coronary artery bypass graft
When peripheral vascular resistance is increased: A. afterload increases and stroke volume decreases. B. blood return to the heart and cardiac output both increase. C. systolic blood pressure decreases and cardiac output increases. D. arterial blood pressure decreases and stroke volume increases.
A. afterload increases and stroke volume decreases
Approximately two-thirds of the myocardium lies within the: A. mediastinum. B. pleural cavity. C. left hemithorax. D. right hemithorax.
A. mediastinum
The coronary arteries of a person with arteriosclerotic heart disease: A. are thickened and hardened and lose their elasticity. B. begin to dissect through the layers of the arterial wall. C. develop plaque deposits from cholesterol and fatty substances. D. become engorged with blood as cardiac oxygen demand increases.
A. are thickened and hardened and lose their elasticity
When assessing a patient for peripheral edema, you should check the sacral area if the patient is: A. bedridden. B. sitting up. C. ambulatory. D. semireclined.
A. bedridden
You respond to call at a residence for a "man down." Your primary assessment reveals that the patient, a 66-year-old male, is unresponsive, pulseless, and apneic. His wife tells you that he has recently had the flu, and that he collapsed about 10 minutes ago. You should: A. begin CPR and apply the AED as soon as it is available. B. begin CPR, start an IV, and give a 20 mL/kg fluid bolus. C. elevate the patient's legs, begin CPR, and attach an AED. D. begin CPR, insert a King airway, and request a paramedic unit.
A. begin CPR and apply the AED as soon as it is available
Following defibrillation with the AED, you have achieved return of spontaneous circulation (ROSC) in a 42-year-old man. However, he remains unresponsive and apneic. You insert a multilumen airway device, continue ventilations, and begin immediate transport to the hospital. En route, you reassess the patient and determine that he is in cardiac arrest. You should: A. begin CPR, tell your partner to stop the ambulance, and analyze the patient's cardiac rhythm with the AED. B. analyze the patient's rhythm with the AED, defibrillate if indicated, and tell your partner to stop the ambulance. C. tell your partner to stop the ambulance, perform CPR for 2 minutes, and analyze the patient's cardiac rhythm with the AED. D. tell your partner to continue to the hospital, perform 2 minutes of CPR, and analyze the patient's cardiac rhythm with the AED.
A. begin CPR, tell your partner to stop the ambulance, and analyze the patient's cardiac rhythm with the AED
Common signs of left-sided congestive heart failure include all of the following, EXCEPT: A. chronic pedal edema. B. tachypnea and tachycardia. C. increased work of breathing. D. production of blood-tinged sputum.
A. chronic pedal edema
You receive a call to a local grocery store for a possible heart attack. Upon arrival at the scene, you find two bystanders performing CPR on the patient, a 49-year-old male. You should: A. confirm that the patient is in cardiac arrest. B. apply the AED and analyze his cardiac rhythm. C. continue CPR and insert a multilumen airway. D. look, listen, and feel for signs of breathing.
A. confirm that the patient is in cardiac arrest
The _____________ is the end of the great cardiac vein and collects blood returning from the walls of the heart. A. coronary sinus B. foramen ovale C. inferior vena cava D. superior vena cava
A. coronary sinus
Prinzmetal's angina is caused by: A. coronary vasospasm. B. coronary artery rupture. C. atherosclerotic blockage. D. an isolated coronary occlusion.
A. coronary vasospasm
Approximately 60% to 70% of deaths due to acute myocardial infarction occur: A. during the first 2 to 3 hours after symptom onset. B. in the hospital setting and are the result of asystole. C. while the patient is in the cardiac catheterization lab. D. in the workplace, even when an AED is readily available.
A. during the first 2 to 3 hours after symptom onset
The visceral pericardium, which lies closely against the heart, is also called the: A. epicardium. B. endocardium. C. foramen ovale. D. coronary sinus.
A. epicardium
The left main coronary artery rapidly divides into the: A. left anterior descending and circumflex arteries. B. right coronary artery and acute marginal branch. C. posterior descending artery and left atrial branch. D. left posterior ventricular and acute marginal arteries.
A. left anterior descending and circumflex arteries
Damage to the ___________ valve may cause blood to regurgitate into the lungs. A. mitral B. tricuspid C. pulmonic D. papillary
A. mitral
A middle-aged male presents with classic signs and symptoms of a dissecting aortic aneurysm. The MOST important intervention that you can perform for this patient is: A. prompt transport. B. an IV fluid bolus. C. high-flow oxygen. D. thermal management.
A. prompt transport
Erythropoiesis is the ongoing process by which: A. red blood cells are made. B. red blood cells and hemoglobin unite. C. old red blood cells are sent to the spleen. D. red blood cells are destroyed by macrophages.
A. red blood cells are made
Asystole has an exceedingly high mortality rate because it: A. reflects a prolonged period of myocardial ischemia. B. does not respond favorably to cardiac defibrillation. C. is usually the result of a massive myocardial infarction. D. most often occurs in patients with significant heart disease.
A. reflects a prolonged period of myocardial ischemia
A 50-year-old female is in cardiac arrest. You attach the AED and receive a "no shock advised" message. You should: A. resume CPR and reanalyze her cardiac rhythm after 2 minutes. B. assess for a carotid pulse and resume CPR if a pulse is not palpable. C. ensure the pads are placed correctly and reanalyze her cardiac rhythm. D. perform 10 cycles of CPR and then reanalyze her cardiac rhythm.
A. resume CPR and reanalyze her cardiac rhythm after 2 minutes
A 56-year-old male with a history of coronary artery disease complains of an acute onset of substernal chest discomfort and diaphoresis while moving a heavy box. After sitting down and taking one nitroglycerin tablet, the discomfort promptly subsides. This episode is MOST consistent with: A. stable angina pectoris. B. unstable angina pectoris. C. vasospastic angina pectoris. D. acute myocardial infarction.
A. stable angina pectoris
The term that refers to the contraction of the ventricular mass and the pumping of blood into the systemic circulation is called: A. systole. B. preload. C. diastole. D. afterload.
A. systole
Which of the following is a major difference between angina pectoris and AMI?
Anginal pain typically subsides with rest.
What three major arteries arise from the aortic arch? A. Innominate, posterior vertebral, and right subclavian B. Brachiocephalic, left common carotid, and left subclavian C. Coronary, internal common carotid, and brachiocephalic D. Brachiocephalic, common iliac, and right common carotid
B. Brachiocephalic, left common carotid, and left subclavian
Which of the following would likely exacerbate pulmonary edema? A. Nitroglycerin B. Increased cardiac preload C. A positive inotropic drug D. Decreased cardiac afterload
B. Increased cardiac preload
What are the physiologic effects of nitroglycerin when given to a patient with suspected cardiac-related chest pain? A. Vascular smooth muscle contraction and increased venous return B. Vascular smooth muscle relaxation and coronary artery dilation C. Coronary artery dilation and increased systemic vascular resistance D. Decreased venous pooling of blood and coronary vasoconstriction
B. Vascular smooth muscle relaxation and coronary artery dilation
Pulseless electrical activity (PEA) exists when: A. a patient's heart rate is so weak that it is barely palpable. B. a patient is in cardiac arrest despite an organized cardiac rhythm C. the heart is quivering and is not ejecting any blood from the ventricles. D. a pulse is clearly present, but the cardiac monitor shows a flat line.
B. a patient is in cardiac arrest despite an organized cardiac rhythm
One of the MOST common signs of an acute hypertensive emergency is: A. a posterior nosebleed. B. a sudden, severe headache. C. pale, cool, clammy skin. D. acute pulmonary edema.
B. a sudden, severe headache
A 55-year-old male with poorly controlled hypertension presents with respiratory distress and difficulty speaking in complete sentences. He is conscious and alert with a blood pressure of 150/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 28 breaths/min and labored. Auscultation of his lungs reveals diffuse coarse crackles. After placing the position in a comfortable position, you should: A. give oxygen via nasal cannula. B. apply the CPAP device. C. administer nitroglycerin. D. give an IV fluid bolus.
B. apply the CPAP device
When applying the AED pads to a patient with a surgically-implanted pacemaker, you should: A. apply the pads no differently than in anyone else. B. apply the pads at least 1" away from the pacemaker. C. apply both pads on the posterior aspect of the chest. D. apply the pad directly over the implanted pacemaker.
B. apply the pads at least 1" away from the pacemaker
During your primary assessment of an unresponsive 47-year-old male, you find that he has occasional gasping breaths. You should: A. insert a multilumen airway device and assess for a carotid pulse. B. assess for a carotid pulse and begin chest compressions if needed. C. deliver 2 slow breaths with a bag-mask device and assess for a pulse. D. perform 30 chest compressions, open the airway, and deliver 2 breaths.
B. assess for a carotid pulse and begin chest compressions if needed
You are dispatched to a residence for a 4-year-old male who is not breathing. When you and your partner arrive at the scene, you find the child's father is performing mouth-to-mouth rescue breathing on him. The father tells you that his son stuck a pin in an electrical socket. After assessing the child and determining that he is pulseless and apneic, you should: A. perform CPR, immobilize his spine, and transport. B. begin CPR and apply the AED as soon as possible. C. request a paramedic unit to perform defibrillation. D. perform CPR and insert a pediatric-sized Combitube.
B. begin CPR and apply the AED as soon as possible
Unstable angina pectoris is characterized by: A. a fixed frequency of chest pain or pressure that is often relieved by rest and several doses of nitroglycerin. B. chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency. C. chest pain or pressure that lasts longer than 15 minutes and is associated with myocardial necrosis. D. chest pain or pressure that occurs during periods of strenuous activity and promptly subsides with rest.
B. chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency
When the papillary muscles contract, the ______________ tighten, preventing blood from regurgitating from the ventricles to the atria. A. semilunar valves B. chordae tendineae C. coronary sinuses D. tricuspid valves
B. chordae tendineae
The presence of distended jugular veins that do not collapse, even when the patient is sitting, is consistent with: A. cardiogenic shock. B. congestive heart failure. C. a thoracic aortic aneurysm. D. an acute hypertensive crisis.
B. congestive heart failure
The _____________ arteries arise from the aorta shortly after they leave the left ventricle. A. cerebral B. coronary C. pulmonary D. brachiocephalic
B. coronary
After applying the AED to your cardiac-arrest patient, you receive a "shock advised" message. You should: A. quickly check to ensure the pads are correctly placed. B. ensure that all contact with the patient has ceased. C. deliver one shock and immediately resume CPR. D. perform CPR for 2 minutes and then deliver a shock.
B. ensure that all contact with the patient has ceased
When treating a patient with a blood pressure of 80/40 mm Hg due to "pump failure," you should: A. assist the patient with his or her prescribed nitroglycerin. B. give a 20 mL/kg crystalloid fluid bolus to improve perfusion. C. apply a nonrebreathing mask if the patient is breathing shallowly. D. place the patient in a supine position with his or her legs elevated.
B. give a 20 mL/kg crystalloid fluid bolus to improve perfusion
Nitroglycerin is contraindicated for patients who: A. have an irregular pulse. B. have experienced a head injury. C. took an erectile dysfunction drug within the past week. D. have a systolic blood pressure less than 120 mm Hg.
B. have experienced a head injury
Stimulation of the sympathetic nervous system results in: A. decreased blood pressure and heart rate. B. increased blood pressure and heart rate. C. vasoconstriction and decreased heart rate. D. vasodilation and a mild heart-rate decrease.
B. increased blood pressure and heart rate
Effectively performed CPR is a crucial treatment for a patient in cardiac arrest because it: A. often converts V-Fib to a perfusing rhythm. B. maintains myocardial and cerebral perfusion. C. enhances perfusion to the body's periphery. D. prevents the patient from developing asystole.
B. maintains myocardial and cerebral perfusion
The middle, muscular layer of the heart is called the: A. epicardium. B. myocardium. C. pericardium. D. endocardium.
B. myocardium
As with angina, the pain associated with acute myocardial infarction is often described as: A. sharp. B. pressure. C. pleuritic. D. stabbing.
B. pressure
When the parasympathetic nervous system is stimulated, it: A. enhances conduction through the atrioventricular node. B. slows the heart rate by decreasing SA node discharge. C. produces epinephrine and increases cardiac contractility. D. increases the heart rate by increasing SA node discharge.
B. slows the heart rate by decreasing SA node discharge
The fifth link in the cardiac chain of survival includes: A. recognition of early warning signs and activation of EMS. B. temperature regulation and maintenance of glucose levels. C. early, high-quality CPR with emphasis on chest compressions. D. defibrillation within the first 2 to 3 minutes of the cardiac arrest.
B. temperature regulation and maintenance of glucose levels
Compared to monophasic defibrillation, biphasic defibrillation is advantageous because it: A. sends the shock in one direction within the heart. B. utilizes less energy to achieve effective defibrillation. C. works more effectively when 360 joules are delivered. D. automatically defibrillates without AEMT intervention.
B. utilizes less energy to achieve effective defibrillation
Blood enters the right atrium through the: A. left and right coronary arteries. B. vena cavae and coronary sinus. C. foramen ovalis and vena cavae. D. coronary artery and foramen ovale.
B. vena cavae and coronary sinus
The MOST common cardiac dysrhythmia associated with sudden cardiac death following an acute myocardial infarction is: A. ventricular tachycardia. B. ventricular fibrillation. C. pulseless electrical activity. D. tachycardia without a pulse.
B. ventricular fibrillation
In addition to oxygen, which of the following medications would the AEMT be the MOST likely to administer to a patient who is experiencing acute chest pain, pressure, or discomfort? A. Aspirin only B. Morphine and aspirin C. Aspirin and nitroglycerin D. Nitroglycerin and morphine
C. Aspirin and nitroglycerin
A 62-year-old female with a history of hypertension and diabetes presents with a sudden tearing sensation in her abdomen. She tells you that the pain has been of maximum intensity since its onset. Based on her chief complaint, what additional assessment findings would you expect to encounter? A. A rapid, irregular heart rate B. Jugular venous distention while sitting up C. Diminished pulses in her lower extremities D. Radiation of the pain to her arms or jaw
C. Diminished pulses in her lower extremities
Which of the following is NOT a component of the cardiac electrical conduction system? A. Sinoatrial node B. Atrioventricular node C. Interatrial septum D. Purkinje fibers
C. Interatrial septum
Which layer of the blood vessel is composed of elastic tissue and smooth muscle cells, which allow the vessel to expand or contract in response to the body's demands? A. Tunica intima. B. Tunica interna. C. Tunica media. D. Tunica adventitia.
C. Tunica media
Which of the following cardiac rhythms or conditions requires defibrillation? A. Asystole B. Pulseless electrical activity C. Ventricular tachycardia without a pulse D. Any tachycardic rhythm with a weak pulse
C. Ventricular tachycardia without a pulse
When defibrillating a 6-month-old infant, you should recall that: A. adult AED pads cannot be used. B. you should only deliver one shock. C. a manual defibrillator is preferred. D. all shocks are delivered in sets of three.
C. a manual defibrillator is preferred
When treating a 56-year-old female with chest pain, you have placed on her oxygen, established IV access, and administered two doses of sublingual nitroglycerin. However, the patient's pain has not improved. You reassess her blood pressure and note that it is 106/66 mm Hg. You should: A. request permission to give her morphine. B. transport at once and closely monitor her. C. administer one more dose of nitroglycerin. D. give a 20 mL/kg saline bolus to raise her BP.
C. administer one more dose of nitroglycerin
Which of the following cardiac dysrhythmias requires immediate defibrillation? A. Sinus tachycardia with a low BP B. Sinus bradycardia without a pulse C. Perfusing ventricular tachycardia D. Nonperfusing ventricular fibrillation
D. Nonperfusing ventricular fibrillation
While treating a patient who is in cardiogenic shock, your paramedic partner makes the comment that the patient needs an inotropic medication. You should recall that this type of medication is intended to: A. constrict the blood vessels. B. increase the patient's heart rate. C. affect the strength of cardiac contraction. D. affect electrical conduction through the heart.
C. affect the strength of cardiac contraction
You should be MOST suspicious that a patient is experiencing an acute myocardial infarction if he or she presents with: A. acute pain to the left jaw that is made worse by movement of the head. B. an acute tearing sensation in the abdomen that radiates to the lower back. C. an acute onset of weakness, nausea, and sweating without an obvious cause. D. an acute onset of sharp chest pain that worsens when he or she takes a breath.
C. an acute onset of weakness, nausea, and sweating without an obvious cause
You are transporting a 55-year-old female with chest pain, who has not responded to 3 doses of nitroglycerin. As you are talking to her, she becomes unresponsive and apneic. You should: A. assess her pulse, begin CPR, analyze her cardiac rhythm with the AED, and tell your partner to stop the vehicle. B. begin CPR, tell your partner to stop the vehicle, analyze her rhythm with an AED, and defibrillate if needed. C. assess her pulse, tell your partner to stop the vehicle, begin CPR, and analyze her cardiac rhythm with an AED. D. immediately analyze her cardiac rhythm with an AED, tell your partner to stop the vehicle, and defibrillate if needed.
C. assess her pulse, tell your partner to stop the vehicle, begin CPR, and analyze her cardiac rhythm with an AED
A 49-year-old male complains of acute chest discomfort. He is conscious but restless, and he is noticeably diaphoretic. As your partner is applying 100% oxygen, the patient hands you a bottle of nitroglycerin that was prescribed to him by his family physician. Prior to assisting the patient with his medication, you should: A. ensure that the patient's heart rate is no greater than 100. B. ask the patient if he is currently experiencing a headache. C. assess his systolic BP to ensure that it is at least 100 mm Hg. D. ensure that he has taken up to 3 doses prior to your arrival.
C. assess his systolic BP to ensure that it is at least 100 mm Hg
A 60-year-old female is in possible cardiogenic shock. She is semiconscious with shallow respirations, an irregular pulse, and hypotension. Appropriate treatment for this patient should include: A. high-flow oxygen via nonrebreathing mask, a saline lock, thermal management, and transport. B. continuous positive airway pressure, a 500 mL saline bolus, thermal management, and transport. C. assisted ventilation with a bag-mask device, thermal management, 20 mL/kg fluid bolus, and transport. D. insertion of multilumen airway device, mild hyperventilation, a saline lock, and prompt transport.
C. assisted ventilation with a bag-mask device, thermal management, 20 mL/kg fluid bolus, and transport
An acute myocardial infarction is more apt to occur in the left ventricle because: A. its inherently low oxygen demand predisposes it to injury or infarct. B. its coronary arteries are more susceptible to atherosclerotic disease. C. it is large and thick and demands more oxygen than the right ventricle. D. it is a fairly small chamber that is quickly depleted of oxygenated blood.
C. it is large and thick and demands more oxygen than the right ventricle
Percutaneous coronary intervention (PCI) involves: A. dilating the coronary artery with drugs. B. bypassing the blocked coronary artery. C. mechanically clearing a coronary artery. D. the administration of a fibrinolytic drug.
C. mechanically clearing a coronary artery
The _____________ anchors the heart within the thoracic cavity and prevents cardiac overdistention. A. epicardium B. endocardium C. pericardium D. cardiac septum
C. pericardium
The aortic valve: A. closes during ventricular systole and facilitates adequate ventricular filling. B. contains five cusps that prevent the backflow of blood into the left ventricle. C. regulates the flow of blood from the left ventricle to the systemic circulation. D. attaches to papillary muscles that contract and tighten the chordae tendineae.
C. regulates the flow of blood from the left ventricle to the systemic circulation
After defibrillating a patient in cardiac arrest with the AED, you should: A. give two rescue breaths. B. insert a multilumen airway. C. resume chest compressions. D. briefly check for a carotid pulse.
C. resume chest compressions
During your assessment of a woman with chronic shortness of breath and fatigue, you ask her how many pillows she sleeps with at night. You are asking her this question to determine if: A. the right side of her heart is functioning effectively. B. blood is backing up into her systemic circulation. C. she has left-sided heart failure and how severe it may be. D. she experiences sleep apnea, which may explain her fatigue.
C. she has left-sided heart failure and how severe it may be
A hypertensive crisis is considered to be a true emergency when: A. the diastolic blood pressure exceeds 100 mm Hg. B. the patient is noncompliant with his or her medication. C. signs of central nervous system dysfunction are present. D. the patient has a concomitant history of epileptic seizures.
C. signs of central nervous system dysfunction are present
The normal site of origin of electrical impulses in the heart is the ____________, which generates ___________ impulses per minute. A. sinoatrial node, 50 to 60 B. bundle of His, 80 to 100 C. sinoatrial node, 60 to 100 D. atrioventricular node, 60 to 80
C. sinoatrial node, 60 to 100
You receive a call for a 40-year-old female with nausea, dizziness, and a headache. During your assessment, you note that her blood pressure is 190/104 mm Hg. The patient, who is conscious and alert, states that she has a history of hypertension, but admits to being noncompliant with her medications. In addition to IV therapy, appropriate treatment for this patient includes: A. rapidly lowering her blood pressure with nitroglycerin. B. placing her in a supine position and lowering her head. C. assisting the patient with her medication and transporting her. D. 100% oxygen and transporting to the closest appropriate facility.
D. 100% oxygen and transporting to the closest appropriate facility.
Which of the following clinical presentations is consistent with a malfunctioning implanted pacemaker? A. Weakness and tachycardia B. Dizziness and hypertension C. Tachycardia and hypotension D. Syncope and bradycardia
D. Syncope and bradycardia
A 71-year-old man presents with shortness of breath, facial cyanosis, and a cough that is producing blood. His blood pressure is 144/92 mm Hg, pulse is 130 beats/min and irregular, and respirations of 28 breaths/min and labored. He is confused and is slow follow your commands. You should: A. use CPAP to attempt to improve his breathing, insert a saline lock, transport, and be prepared to assist his ventilations. B. insert a multilumen airway device, ventilate him at a rate of 12 breaths/min, transport, and establish IV access en route to the hospital. C. administer high-flow oxygen via nonrebreathing mask, place him in a position of comfort, insert a saline lock, and transport. D. assist his ventilations with a bag-mask device, begin transport, and consider establishing IV access en route to the hospital.
D. assist his ventilations with a bag-mask device, begin transport, and consider establishing IV access en route to the hospital
The tricuspid and mitral valves of the heart are referred to as: A. semilunar valves. B. atrioseptal valves. C. ventriculoseptal valves. D. atrioventricular valves.
D. atrioventricular valves
The ability of a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source is called: A. dromotropy. B. conductivity. C. excitability. D. automaticity.
D. automaticity
You are assessing a 62-year-old female who has an automatic implantable cardiac defibrillator (AICD). As you are applying oxygen to her, she becomes unconscious, pulseless, and apneic. You should: A. begin CPR and insert a multilumen airway device. B. deactivate the AICD with a magnet and begin CPR. C. allow the AICD to defibrillate her and start CPR. D. begin CPR and apply the AED as soon as possible.
D. begin CPR and apply the AED as soon as possible
After defibrillating an adult patient in cardiac arrest with the AED, you should: A. assess for a carotid pulse for no more than 10 seconds. B. insert a multilumen airway device and resume CPR. C. immediately reanalyze the patient's cardiac rhythm. D. begin or resume CPR starting with chest compressions.
D. begin or resume CPR starting with chest compressions
Treatment for a patient experiencing a cardiovascular emergency begins by: A. assessing the rate and regularity of the pulse. B. applying 100% oxygen via nonrebreathing mask. C. administering prescribed nitroglycerin if needed. D. ensuring airway patency and adequate breathing.
D. ensuring airway patency and adequate breathing
When errors associated with the AED occur, it is usually the result of: A. failure of the AED's internal memory card. B. failure of the internal analyzing mechanism. C. inappropriate placement of the chest pads. D. failure to ensure the batteries are charged.
D. failure to ensure the batteries are charged
A patient with acute chest discomfort took two of his prescribed nitroglycerin tablets and is now experiencing a pounding headache. However, he tells you that he is still experiencing chest discomfort. You should suspect that: A. his prescribed nitroglycerin has lost its potency. B. the nitroglycerin has caused severe hypotension. C. he has stable angina, but still requires transport. D. he is experiencing ongoing myocardial ischemia.
D. he is experiencing ongoing myocardial ischemia
A 33-year-old male complains of generalized weakness and chest discomfort that began following his morning workout at the gym. He is conscious and alert, but restless. Your assessment reveals a BP of 130/64 mm Hg, pulse of 78 beats/min and occasionally irregular, respirations of 16 breaths/min and unlabored, and an SpO2 of 98% on room air. He has prescribed nitroglycerin tablets and states that he took one without relief. Appropriate treatment for this patient includes: A. oxygen via nonrebreathing mask, one chewable baby aspirin, an IV fluid bolus, and prompt transport. B. oxygen via nasal cannula, up to two more doses of nitroglycerin, saline lock, and transport. C. oxygen via nonrebreathing mask, up to 324 mg aspirin, supine with his legs elevated, and transport. D. oxygen via nasal cannula, up to 324 mg aspirin, saline lock, additional nitroglycerin per medical control, and transport.
D. oxygen via nasal cannula, up to 324 mg aspirin, saline lock, additional nitroglycerin per medical control, and transport
Afterload is defined as the: A. volume of blood returned to the left or right atrium. B. amount of blood ejected per ventricular contraction. C. percentage of blood ejected from the left ventricle. D. pressure against which the left ventricle must pump.
D. pressure against which the left ventricle must pump
The primary function of the atrioventricular (AV) node is to: A. serve as the backup pacemaker if the ventricular conduction system fails. B. regenerate the atrial-initiated electrical impulse before it enters the ventricles. C. increase conduction from the atria to the ventricles to allow for atrial filling. D. slow conduction from the atria to the ventricles to allow for ventricular filling.
D. slow conduction from the atria to the ventricles to allow for ventricular filling
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 implanted pacemaker. The AED advises that a shock is indicated. What should you do?
Deliver the shock followed by immediate resumption of CPR.
Which of the following statements regarding the pain associated with AMI is correct?
It can occur during exertion or when the patient is at rest.
What is the function of the left atrium?
It receives oxygenated blood from the lungs.
Which of the following statements regarding nitroglycerin is correct?
Nitroglycerin usually relieves anginal chest pain within 5 minutes.
Which of the following statements regarding the AED and defibrillation is correct?
The AED will not analyze the rhythm of a moving patient.
Common signs and symptoms of a hypertensive emergency include:
a bounding pulse, a severe headache, and dizziness.
Acute coronary syndrome (ACS) is a term used to describe:
a group of symptoms that are caused by myocardial ischemia.
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
a rapid heart rate
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, her pulse is 100 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should
administer oxygen, give her 2 (81mg each tablet) chewable aspirin, and assess her further.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
assess the adequacy of his respirations.
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they
are in denial
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?
aspirin
You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:
begin high-quality CPR and apply the AED without delay.
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, shallow respirations; and has a thready pulse. You should:
begin ventilatory assistance.
The posterior tibial pulse can be palpated
behind the medial malleolus.
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:
blood can pass from the atria to the ventricles.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:
brain
The head and brain receive their supply of oxygenated blood from the:
carotid arteries.
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.
coronary arteries, aorta
Cardiogenic shock following AMI is caused by:
decreased pumping force of the heart muscle.
Which of the following signs is commonly observed in patients with right-sided heart failure?
dependent edema
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by
dilating the affected coronary artery with a small inflatable balloon.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:
dilating the affected coronary artery with a small inflatable balloon.
Nitroglycerin relieves cardiac-related chest pain by:
dilating the coronary arteries and improving cardiac blood flow.
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
dry the chest off if it is wet.
Prior to defibrillating a patient with an AED, it is MOST important that you:
ensure that no one is touching the patient.
The MOST common error associated with the use of the AED is
failure of the EMT to ensure the battery is charged
The MOST common error associated with the use of the AED is:
failure of the EMT to ensure the battery is charged.
Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort?
family history of hypertension
After the AED has delivered a shock, the EMT should:
immediately resume CPR.
Which of the following would cause the greatest increase in cardiac output?
increased heart rate and increased stroke volume
When afterload increases:
it becomes harder for the ventricle to push blood through the blood vessels.
The AED is MOST advantageous to the EMT because:
it delivers prompt defibrillation to patients with ventricular fibrillation.
A patient with atherosclerotic heart disease experiences chest pain during exertion because the:
lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
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. You should:
perform CPR for 2 minutes and reassess
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:
placing her in an upright position.
Which of the following blood vessels transports oxygenated blood?
pulmonary veins
The left ventricle has the thickest walls because it:
pumps blood into the aorta and systemic circulation.
After assisting your patient with his or her nitroglycerin, you should
reassess the blood pressure within 5 minutes to detect hypotension.
Nitroglycerin relieves cardiac-related chest pain by
reducing the overall workload on the heart through vasodilation and reduced blood pressure.
In contrast to monophasic defibrillation, biphasic defibrillation:
requires a lower energy setting.
Deoxygenated blood from the body returns to the
right atrium.
Defibrillator pads are placed on the patient's chest with one pad to the
right of the upper sternum and the other pad just to the left and below the left nipple.