Chapter 16 Cardiovascular Emergencies
Which of the following signs is commonly observed in patients with right-sided heart failure? Select one: A. Dependent edema B. Labored breathing C. Pulmonary edema D. Flat jugular veins
A. Dependent edema
Which of the following statements regarding the pain associated with AMI is correct? Select one: A. It can occur during exertion or when the patient is at rest. B. Nitroglycerin usually resolves the pain within 30 minutes. C. It often fluctuates in intensity when the patient breathes. D. It is often described by the patient as a sharp feeling.
A. It can occur during exertion or when the patient is at rest.
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they: Select one: A. are in denial. B. are elderly. C. cannot afford it. D. do not trust EMTs.
A. are in denial.
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: Select one: A. assess the scene for potential hazards. B. request a paramedic unit for assistance. C. gain immediate access to the patient. D. determine if you need additional help.
A. assess the scene for potential hazards.
You and your EMT partner are the first to arrive at the scene of an unresponsive 70-year-old man. Your assessment reveals that he is apneic and pulseless. A paramedic unit is en route to the scene and will arrive in approximately 5 minutes. You should: Select one: A. begin CPR, apply the AED, and deliver a shock if it is indicated. B. perform CPR only and wait for the manual defibrillator to arrive. C. apply the AED while your partner provides rescue breathing. D. begin CPR and have your partner update the responding paramedics.
A. begin CPR, apply the AED, and deliver a shock if it is indicated.
The MOST common error associated with the use of the AED is: Select one: A. failure of the EMT to ensure the battery is charged. B. malfunction of the AED's internal computer processor. C. inability of the EMT to recognize ventricular fibrillation. D. inappropriately placed adhesive defibrillation electrodes.
A. failure of the EMT to ensure the battery is charged.
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two off-duty EMTs performing CPR on the patient, a 58-year-old male. Your initial action should be to: Select one: A. feel for a pulse while compressions are ongoing. B. request a paramedic unit and quickly attach the AED. C. have the EMTs stop CPR and assess for a pulse. D. quickly attach the AED and push the analyze button.
A. feel for a pulse while compressions are ongoing.
Common side effects of nitroglycerin include all of the following, EXCEPT: Select one: A. hypertension. B. bradycardia. C. severe headache. D. hypotension.
A. hypertension.
After the AED has delivered a shock, the EMT should: Select one: A. immediately resume CPR. B. assess for a carotid pulse. C. transport the patient at once. D. re-analyze the cardiac rhythm.
A. immediately resume CPR.
Angina pectoris occurs when: Select one: A. myocardial oxygen demand exceeds supply. B. myocardial oxygen supply exceeds the demand. C. one or more coronary arteries suddenly spasm. D. a coronary artery is totally occluded by plaque.
A. myocardial oxygen demand exceeds supply.
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must: Select one: A. obtain authorization from medical control. B. determine who prescribed the nitroglycerin. C. wait at least 5 minutes after assessing the blood pressure. D. ensure the medication is in tablet form.
A. obtain authorization from medical control.
In contrast to AMI, a dissecting aortic aneurysm: Select one: A. often presents with pain that is maximal from the onset. B. is typically preceded by other symptoms, such as nausea. C. is more commonly associated with pressure in the chest. D. usually presents gradually, often over a period of hours.
A. often presents with pain that is maximal from the onset.
The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you re-analyze 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: Select one: A. reassess airway and breathing and treat accordingly. B. place him in the recovery position and apply oxygen. C. transport at once and re-analyze his rhythm en route. D. obtain a blood pressure and apply the pulse oximeter.
A. reassess airway and breathing and treat accordingly.
During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that: Select one: A. she is not in ventricular fibrillation. B. the AED detected patient motion. C. she has a pulse and does not need CPR. D. the AED has detected asystole.
A. she is not in ventricular fibrillation.
While obtaining a 12-lead ECG prior to ALS arrival, you note the presence of artifacts on the tracing. Which of the following is the MOST likely cause of this? Select one: A. The patient's pulse is irregular. B. Excessive movement of the patient C. Abnormal cardiac electrical activity D. Incorrect placement of the leads
B. Excessive movement of the patient
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? Select one: A. Avoid defibrillation as this will damage the patient's AICD. B. Deliver the shock followed by immediate resumption of CPR. C. Continue CPR and transport the patient to the closest appropriate hospital. D. Contact medical control and request permission to defibrillate.
B. Deliver the shock followed by immediate resumption of CPR.
What is the function of the left atrium? Select one: A. It receives blood from the pulmonary arteries. B. It receives oxygenated blood from the lungs. C. It ejects oxygenated blood into the aorta. D. It receives oxygenated blood from the vena cava.
B. It receives oxygenated blood from the lungs.
Which of the following veins is located inferior to the trunk? Select one: A. Subclavian B. Saphenous C. Cephalic D. Axillary
B. Saphenous
Which of the following statements regarding the AED and defibrillation is correct? Select one: A. Defibrillation is the first link in the AHA chain of survival. B. The AED will not analyze the rhythm of a moving patient. C. CPR should be performed for 5 minutes before using the AED. D. The AED will shock any rhythm not accompanied by a pulse.
B. The AED will not analyze the rhythm of a moving patient.
Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm? Select one: A. Sinus bradycardia B. Ventricular tachycardia C. Extra ventricular beats D. Sinus tachycardia
B. Ventricular tachycardia
Cardiogenic shock following AMI is caused by: Select one: A. widespread dilation of the systemic vasculature. B. decreased pumping force of the heart muscle. C. hypovolemia secondary to severe vomiting. D. a profound increase in the patient's heart rate.
B. decreased pumping force of the heart muscle.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: Select one: A. are older than 40 years of age. B. have chronic hypertension. C. have had a stroke in the past. D. regularly take illegal drugs.
B. have chronic hypertension.
Major risk factors for AMI include all of the following, EXCEPT: Select one: A. diabetes mellitus. B. hypoglycemia. C. elevated cholesterol. D. hypertension.
B. hypoglycemia.
The purpose of defibrillation is to: Select one: A. cause a rapid decrease in the heart rate of an unstable patient. B. stop the chaotic, disorganized contraction of the cardiac cells. C. improve the chance of CPR being successful in resuscitation. D. prevent asystole from deteriorating into ventricular fibrillation.
B. stop the chaotic, disorganized contraction of the cardiac cells.
Ventricular tachycardia causes hypotension because: Select one: A. the volume of blood returning to the atria increases. B. the left ventricle does not adequately fill with blood. C. the right ventricle does not adequately pump blood. D. blood backs up into the lungs and causes congestion.
B. the left ventricle does not adequately fill with blood.
Sudden death following AMI is MOST often caused by: Select one: A. severe bradycardia. B. ventricular fibrillation. C. cardiogenic shock. D. congestive heart failure.
B. ventricular fibrillation.
The electrical impulse generated by the heart originates in the: Select one: A. coronary sinus. B. atrioventricular node. C. sinoatrial node. D. bundle of His.
C. sinoatrial node.
Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort? Select one: A. Presence of personal risk factors B. History of cigarette smoking C. Family history of hypertension D. History of previous heart attack
C. Family history of hypertension
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: Select one: A. administer up to three doses of nitroglycerin. B. obtain vital signs and a SAMPLE history. C. assess the adequacy of his respirations. D. administer up to 324 mg of baby aspirin.
C. assess the adequacy of his respirations
The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the: Select one: A. parietal lobe. B. somatic nervous system. C. autonomic nervous system. D. pons and medulla.
C. autonomic nervous system.
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that: Select one: A. the SA node can reset and generate another impulse. B. blood returning from the body can fill the atria. C. blood can pass from the atria to the ventricles. D. the impulse can spread through the Purkinje fibers.
C. blood can pass from the atria to the ventricles.
The head and brain receive their supply of oxygenated blood from the: Select one: A. brachial arteries. B. iliac arteries. C. carotid arteries. D. subclavian arteries.
C. carotid arteries.
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________. Select one: A. aorta, inferior vena cava B. vena cava, coronary veins C. coronary arteries, aorta D. coronary sinus, vena cava
C. coronary arteries, aorta
Ischemic heart disease is defined as: Select one: A. decreased blood flow to the heart muscle due to coronary dilation. B. absent myocardial blood flow due to a blocked coronary artery. C. decreased blood flow to one or more portions of the myocardium. D. death of a portion of the heart muscle due to a decrease in oxygen.
C. decreased blood flow to one or more portions of the myocardium.
Prior to attaching the AED to a cardiac arrest patient, the EMT should: Select one: A. assess for a pulse for 20 seconds. B. perform CPR for 30 seconds. C. dry the chest if it is wet. D. contact medical control.
C. dry the chest if it is wet.
Risk factors for AMI that cannot be controlled include: Select one: A. hyperglycemia. B. lack of exercise. C. family history. D. excess stress.
C. family history.
The iliac arteries immediately subdivide into the: Select one: A. posterior tibial arteries. B. peroneal arteries. C. femoral arteries. D. anterior tibial arteries.
C. femoral arteries.
When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed: Select one: A. on either side of the chest. B. on the lower abdomen. C. on the thighs or ankles. D. anywhere on the arms.
C. on the thighs or ankles.
Deoxygenated blood from the body returns to the: Select one: A. right ventricle. B. left atrium. C. right atrium. D. left ventricle.
C. right atrium.
A patient with atherosclerotic heart disease experiences chest pain during exertion because: Select one: A. the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing. B. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen. C. the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow. D. the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow.
C. the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS. Select one: A. two B. five C. three D. four
C. three
The descending aorta divides into the two iliac arteries at the level of the: Select one: A. pubic symphysis. B. iliac crest. C. umbilicus. D. nipple line.
C. umbilicus.
When documenting a patient's description of his or her chest pain or discomfort, the EMT should: Select one: A. document his or her own perception. B. use medical terminology. C. use the patient's own words. D. underline the patient's quotes.
C. use the patient's own words.
Which of the following is NOT a function of the sympathetic nervous system? Select one: A. Dilation of blood vessels in the muscles B. Increases in the heart and respiratory rates C. Constriction of blood vessels in the digestive system D. Constriction of blood vessels in the muscles
D. Constriction of blood vessels in the muscles
Which of the following statements regarding nitroglycerin is correct? Select one: A. A maximum of five nitroglycerin doses should be given to a patient. B. Nitroglycerin should be administered between the cheek and gum. C. The potency of nitroglycerin is increased when exposed to light. D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.
D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.
Acute coronary syndrome (ACS) is a term used to describe: Select one: A. a severe decrease in perfusion caused by changes in heart rate. B. the exact moment that a coronary artery is completely occluded. C. the warning signs that occur shortly before a heart attack. D. a group of symptoms that are caused by myocardial ischemia.
D. a group of symptoms that are caused by myocardial ischemia.
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, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should: Select one: A. obtain a SAMPLE history and contact medical control for advice. B. give her high-flow oxygen, attach the AED, and transport at once. C. give her one nitroglycerin and reassess her systolic blood pressure. D. administer oxygen, give her 324 mg of aspirin, and assess her further.
D. administer oxygen, give her 324 mg of aspirin, and assess her further.
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: Select one: A. have your partner perform CPR while you question the bystanders. B. perform two-rescuer CPR for 5 minutes and request ALS backup. C. immediately apply the AED pads and analyze his cardiac rhythm. D. begin high-quality CPR and apply the AED as soon as possible.
D. begin high-quality CPR and apply the AED as soon as possible.
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: Select one: A. apply a nonrebreathing mask. B. attach the AED immediately. C. obtain baseline vital signs. D. begin ventilatory assistance.
D. begin ventilatory assistance.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the: Select one: A. kidneys. B. legs. C. abdomen. D. brain.
D. brain.
It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing: Select one: A. sharp chest pain that lasts longer than 10 to 15 minutes. B. an acute onset of dizziness during a period of exertion. C. difficulty breathing that awakens the patient from sleep. D. chest pain that does not immediately subside with rest.
D. chest pain that does not immediately subside with rest.
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for: Select one: A. right ventricular failure. B. significant hypotension. C. a cardiac arrhythmia. D. congestive heart failure.
D. congestive heart failure.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by: Select one: A. scraping fatty deposits off of the lumen of the coronary artery. B. bypassing the coronary artery with a vessel from the chest or leg. C. placing a stent inside the coronary artery to keep it from narrowing. D. dilating the affected coronary artery with a small inflatable balloon.
D. dilating the affected coronary artery with a small inflatable balloon.
Blood that is ejected from the right ventricle: Select one: A. was received directly from the aorta. B. enters the systemic circulation. C. has a high concentration of oxygen. D. flows into the pulmonary arteries.
D. flows into the pulmonary arteries.
The EMT should use an AED on a child between 1 month and 8 years of age if: Select one: A. special pads are used and the child has profound tachycardia. B. his or her condition is rapidly progressing to cardiac arrest. C. he or she is not breathing and has a weakly palpable pulse. D. pediatric pads and an energy-reducing device are available.
D. pediatric pads and an energy-reducing device are available.
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 been 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: Select one: A. oxygen at 2 L/min via nasal cannula. B. nitroglycerin for her chest pain. C. ventilations with a BVM. D. placing her in an upright position.
D. placing her in an upright position.
After assisting your patient with prescribed nitroglycerin, you should: Select one: A. avoid further dosing if the patient complains of a severe headache. B. perform a secondary assessment before administering further doses. C. place the patient in a recumbent position in case of fainting. D. reassess his or her blood pressure within 5 minutes to detect hypotension.
D. reassess his or her blood pressure within 5 minutes to detect hypotension.
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should: Select one: A. leave the battery attached to the monitor and remove the vest. B. perform ventilations only and allow the vest device to defibrillate. C. remove the battery from the monitor and leave the vest in place. D. remove the battery from the monitor and then remove the vest.
D. remove the battery from the monitor and then remove the vest.
You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should: Select one: A. immediately remove the nitroglycerin patch, apply the AED in case he develops cardiac arrest, and transport to the closest hospital. B. move the nitroglycerin patch to the other side of his chest in case you need to apply the AED, keep him warm, and transport without delay. C. ask him if the nitroglycerin patch he is wearing has improved his chest pressure, complete your secondary assessment, and transport promptly. D. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.
D. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.
Most AEDs are set up to adjust the voltage based on the impedance, which is the: Select one: A. direction that the electrical flow takes in the body. B. distance between the two AED pads on the chest. C. actual amount of energy that the AED will deliver. D. resistance of the body to the flow of electricity.
D. resistance of the body to the flow of electricity.
The right coronary artery supplies blood to the: Select one: A. right atrium and posterior wall of the right ventricle. B. left ventricle and posterior wall of the right ventricle. C. left ventricle and inferior wall of the right atrium. D. right ventricle and inferior wall of the left ventricle.
D. right ventricle and inferior wall of the left ventricle.
In contrast to the sympathetic nervous system, the parasympathetic nervous system: Select one: A. causes an increase in the heart rate. B. dilates the blood vessels in the muscles. C. prepares the body to handle stress. D. slows the heart and respiratory rates.
D. slows the heart and respiratory rates.
When the myocardium requires more oxygen: Select one: A. the AV node conducts fewer impulses. B. the heart contracts with less force. C. the heart rate decreases significantly. D. the arteries supplying the heart dilate.
D. 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: Select one: A. most patients with chest pain are experiencing an AMI. B. angina and AMI present identically. C. angina usually occurs after an AMI. D. the cause of the pain cannot be diagnosed in the field.
D. the cause of the pain cannot be diagnosed in the field.
A dissecting aortic aneurysm occurs when: Select one: A. the aorta ruptures, resulting in profound bleeding. B. all layers of the aorta suddenly contract. C. a weakened area develops in the aortic wall. D. the inner layers of the aorta become separated.
D. the inner layers of the aorta become separated.
Cardiac output may decrease if the heart beats too rapidly because: Select one: A. the volume of blood that returns to the heart is not sufficient with fast heart rates. B. as the heart rate increases, more blood is pumped from the ventricles than the atria. C. a rapid heartbeat causes a decrease in the strength of cardiac contractions. D. there is not enough time in between contractions for the heart to refill completely.
D. there is not enough time in between contractions for the heart to refill completely.
Nitroglycerin is contraindicated in patients: Select one: A. who have taken up to two doses. B. with a history of an ischemic stroke. C. with a systolic blood pressure less than 120 mm Hg. D. who have experienced a head injury.
D. who have experienced a head injury.
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? Select one: A. Generalized weakness B. Heart rate less than 60 beats/min C. Syncope or dizziness D. A rapid heart rate
D. A rapid heart rate
A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced? Select one: A. Acute myocardial infarction B. Obstructive lung disease C. Uncontrolled hypertension D. Thoracic aortic aneurysm
A. Acute myocardial infarction
Which of the following is the MOST reliable method of estimating a patient's cardiac output? Select one: A. Assess the heart rate and strength of the pulse. B. Determine the average diastolic blood pressure. C. Connect the patient to an electrocardiogram. D. Listen to heart sounds with a stethoscope.
A. Assess the heart rate and strength of the pulse.
The posterior tibial pulse can be palpated: Select one: A. behind the medial malleolus, on the inside of the ankle. B. in the fossa behind the knee. C. on the dorsum of the foot. D. between the trachea and the neck muscle.
A. behind the medial malleolus, on the inside of the ankle.
Nitroglycerin relieves cardiac-related chest pain by: Select one: A. increasing the amount of stress that is placed on the myocardium. B. dilating the coronary arteries and improving cardiac blood flow. C. contracting the smooth muscle of the coronary and cerebral arteries. D. constricting the coronary arteries and improving cardiac blood flow.
B. dilating the coronary arteries and improving cardiac blood flow.
When preparing to obtain a 12-lead ECG, the V1 and V2 electrodes should be placed: Select one: A. in the midaxillary line. B. in the midclavicular line. C. on the left and right arms. D. on either side of the sternum.
D. on either side of the sternum.
Common signs and symptoms of AMI include all of the following, EXCEPT: Select one: A. sudden unexplained sweating. B. irregular heartbeat. C. shortness of breath or dyspnea. D. pain exacerbated by breathing.
D. pain exacerbated by breathing.