Cardiovascular Emergencies (Chapter 16 EMT)
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: Choose one answer. A. stop the ambulance, begin CPR, and attach the AED as soon as possible. B. alert the receiving hospital and perform CPR for the duration of the transport. C. defibrillate with the AED while continuing transport to the hospital. D. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED.
A
A patient with atherosclerotic heart disease experiences chest pain during exertion because the: Choose one answer. A. lumen of the coronary artery is narrowed and cannot accommodate increased blood flow. B. coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. C. ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing. D. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.
A
After the AED has delivered a shock, the EMT should: Choose one answer. A. immediately resume CPR. B. transport the patient at once. C. reanalyze the cardiac rhythm. D. assess for a carotid pulse.
A
Angina pectoris occurs when: Choose one answer. A. myocardial oxygen demand exceeds the supply. B. a coronary artery is totally occluded by plaque. C. myocardial oxygen supply exceeds the demand. D. one or more coronary arteries suddenly spasm.
A
Blood that is ejected from the right ventricle: Choose one answer. A. flows into the pulmonary arteries. B. has a high concentration of oxygen. C. was received directly from the aorta. D. enters the systemic circulation.
A
Deoxygenated blood from the body returns to the: Choose one answer. A. right atrium. B. right ventricle. C. left ventricle. D. left atrium.
A
Nitroglycerin relieves cardiac-related chest pain by: Choose one answer. A. dilating the coronary arteries and improving cardiac blood flow. B. contracting the smooth muscle of the coronary and cerebral arteries. C. increasing the amount of work that is placed on the myocardium. D. constricting the coronary arteries and improving cardiac blood flow.
A
Prior to attaching the AED to a cardiac arrest patient, the EMT should: Choose one answer. A. dry the chest off if it is wet. B. perform CPR for 30 seconds. C. contact medical control. D. assess for a pulse for 20 seconds.
A
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: Choose one answer. A. obtain a SAMPLE history and contact medical control for advice. B. administer oxygen, give her 324 mg aspirin, and assess her further. C. give her one nitroglycerin and reassess her systolic blood pressure. D. give her 100% oxygen, attach the AED, and transport immediately.
B
After assisting your patient with his or her nitroglycerin, you should: Choose one answer. A. place the patient in a recumbent position in case he or she faints. B. reassess the blood pressure within 5 minutes to detect hypotension. C. perform a secondary assessment before administering further doses. D. avoid further dosing if the patient complains of a severe headache.
B
Cardiac output may decrease if the heart beats too rapidly because: Choose one answer. A. the volume of blood that returns to the heart is not sufficient with fast heart rates. B. there is not enough time in between contractions for the heart to refill completely. C. a rapid heart beat causes a decrease in the strength of cardiac contractions. D. as the heart rate increases, more blood is pumped from the ventricles than the atria.
B
Common side effects of nitroglycerin include all of the following, EXCEPT: Choose one answer. A. severe headache. B. hypertension. C. bradycardia. D. hypotension.
B
Common signs and symptoms of AMI include all of the following, EXCEPT: Choose one answer. A. shortness of breath or dyspnea. B. pain exacerbated by breathing. C. irregular heartbeat. D. sudden unexplained sweating.
B
In contrast to AMI, a dissecting aortic aneurysm: Choose one answer. A. usually presents gradually, often over a period of hours. B. often presents with pain that is maximal from the onset. C. is typically preceded by other symptoms, such as nausea. D. is more commonly associated with pressure in the chest.
B
Narrowing of the coronary arteries due to a buildup of fatty deposits is called: Choose one answer. A. arteriosclerosis. B. atherosclerosis. C. angina pectoris. D. acute ischemia.
B
Nitroglycerin is contraindicated in patients: Choose one answer. A. who have taken up to two doses. B. who have experienced a head injury. C. with a systolic blood pressure less than 120 mm Hg. D. with a history of an ischemic stroke.
B
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: Choose one answer. A. regularly take illegal drugs. B. have chronic hypertension. C. are older than 40 years of age. D. have had a stroke in the past.
B
The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you reanalyze the patient's cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to: Choose one answer. A. obtain a blood pressure and apply the pulse oximeter. B. reassess airway and breathing and treat accordingly. C. place him in the recovery position and apply oxygen. D. transport at once and reanalyze his rhythm en route.
B
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: Choose one answer. A. administer up to three doses of nitroglycerin. B. administer up to 324 mg of baby aspirin. C. assess the adequacy of his respirations. D. obtain vital signs and a SAMPLE history.
C
Acute coronary syndrome (ACS) is a term used to describe: Choose one answer. A. a severe decrease in perfusion caused by changes in heart rate. B. the exact moment that a coronary artery is completely occluded. C. a group of symptoms that are caused by myocardial ischemia. D. the warning signs that occur shortly before a heart attack.
C
Cardiogenic shock following AMI is caused by: Choose one answer. A. hypovolemia secondary to severe vomiting. B. a profound increase in the patient's heart rate. C. decreased pumping force of the heart muscle. D. widespread dilation of the systemic vasculature.
C
A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? Choose one answer. A. Avoid defibrillation as this will damage the patient's AICD. B. Contact medical control and request permission to defibrillate. C. Continue CPR and transport the patient to the closest appropriate hospital. D. Deliver the shock followed by immediate resumption of CPR.
D
An acute myocardial infarction (AMI) occurs when: Choose one answer. A. the heart muscle progressively weakens and dysfunctions. B. coronary artery dilation decreases blood flow to the heart. C. the entire left ventricle is damaged and cannot pump blood. D. myocardial tissue dies secondary to an absence of oxygen.
D
Common signs and symptoms of a hypertensive emergency include: Choose one answer. A. syncope, a weak pulse, and bleeding from the ears. B. pallor, cool skin, and a temporary loss of hearing. C. tachycardia, pain behind the eyes, and weakness. D. a bounding pulse, a severe headache, and dizziness.
D
Ischemic heart disease is MOST accurately defined as: Choose one answer. A. decreased blood flow to the heart muscle due to coronary dilation. B. death of a portion of the heart muscle due to a decrease in oxygen. C. absent myocardial blood flow due to a blocked coronary artery. D. decreased blood flow to one or more portions of the myocardium.
D
