Chapter 17 - Cardiovascular Emergencies

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: A. administer oxygen, give her 324 mg of aspirin, and assess her further. B. give her one nitroglycerin and reassess her systolic blood pressure. C. give her high-flow oxygen, attach the AED, and transport at once. D. obtain a SAMPLE history and contact medical control for advice.

A

A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should: A. remove the battery from the monitor and then remove the vest. B. perform ventilations only and allow the vest device to defibrillate. C. leave the battery attached to the monitor and remove the vest. D. remove the battery from the monitor and leave the vest in place.

A

A patient with atherosclerotic heart disease experiences chest pain during exertion because: A.the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow. B.the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing. C.the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. D.tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.

A

Major risk factors for AMI include all of the following, EXCEPT: A. hypoglycemia. B. diabetes mellitus. C. elevated cholesterol. D. hypertension.

A

Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS. A. three B. two C. five D. four

A

Prompt transport of a patient with a suspected AMI is important because: A. the patient may be eligible to receive thrombolytic therapy. B. many patients with an AMI die within 6 hours. C. 90% of the cardiac cells will die within the first 30 minutes. D. nitroglycerin can only be given in the emergency department.

A

Risk factors for AMI that cannot be controlled include: A. family history. B. lack of exercise. C. excess stress. D. hyperglycemia.

A

Sudden death following AMI is MOST often caused by: A. ventricular fibrillation. B. severe bradycardia. C. congestive heart failure. D. cardiogenic shock.

A

The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the: A. autonomic nervous system. B. pons and medulla. C. parietal lobe. D. somatic nervous system.

A

Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort? A. Family history of hypertension B. Presence of personal risk factors C. History of previous heart attack D. History of cigarette smoking

A

Which of the following is a major difference between angina pectoris and AMI? A. Anginal pain typically subsides with rest. B. AMI is caused by myocardial ischemia. C. Pain from an AMI subsides within 30 minutes. D. Nitroglycerin has no effect on angina pectoris.

A

Which of the following signs is commonly observed in patients with right-sided heart failure? A. Dependent edema B. Pulmonary edema C. Labored breathing D. Flat jugular veins

A

Which of the following statements regarding nitroglycerin is correct? A. Nitroglycerin usually relieves anginal chest pain within 5 minutes. B. A maximum of five nitroglycerin doses should be given to a patient. C. The potency of nitroglycerin is increased when exposed to light. D. Nitroglycerin should be administered between the cheek and gum.

A

Which of the following would cause the greatest increase in cardiac output? A. Increased heart rate and increased stroke volume B. Decreased stroke volume and increased heart rate C. Decreased stroke volume and decreased heart rate D. Decreased heart rate and increased stroke volume

A

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: A. begin CPR, apply the AED, and deliver a shock if it is indicated. B. begin CPR and have your partner update the responding paramedics. C. apply the AED while your partner provides rescue breathing. D. perform CPR only and wait for the manual defibrillator to arrive.

A

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: A. begin ventilatory assistance. B. obtain baseline vital signs. C. attach the AED immediately. D. apply a nonrebreathing mask.

A

A dissecting aortic aneurysm occurs when: A. a weakened area develops in the aortic wall. B. the inner layers of the aorta become separated. C. all layers of the aorta suddenly contract. D. the aorta ruptures, resulting in profound bleeding.

B

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by: A. placing a stent inside the coronary artery to keep it from narrowing. B. dilating the affected coronary artery with a small inflatable balloon. C. scraping fatty deposits off of the lumen of the coronary artery. D. bypassing the coronary artery with a vessel from the chest or leg.

B

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: 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 re-analyze his rhythm en route.

B

The myocardium receives oxygenated blood from the __________, which originate(s) from the __________. A. vena cava, coronary veins B. coronary arteries, aorta C. coronary sinus, vena cava D. aorta, inferior vena cava

B

When obtaining a 12-lead ECG, the patient should be: A. in a semi-Fowler's position with arms raised. B. in a supine position with legs uncrossed. C. in a supine position with legs elevated. D. in a semi-Fowler's position with legs crossed

B

Which of the following blood vessels transports oxygenated blood? A. Superior vena cava B. Pulmonary veins C. Inferior vena cava D. Pulmonary arteries

B

Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm? A. Extra ventricular beats B. Ventricular tachycardia C. Sinus bradycardia D. Sinus tachycardia

B

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: A. quickly attach the AED and push the analyze button. B. feel for a pulse while compressions are ongoing. C. request a paramedic unit and quickly attach the AED. D. have the EMTs stop CPR and assess for a pulse.

B

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 implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? A. Continue CPR and transport the patient to the closest appropriate hospital. B. Avoid defibrillation because this will damage the patient's AICD. C. Deliver the shock followed by immediate resumption of CPR. D. Contact medical control and request permission to defibrillate.

C

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate? A. Hypertensive emergency B. Acute myocardial infarction C. Dissecting aortic aneurysm D. Unstable angina

C

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: A. oxygen at 2 L/min via nasal cannula. B. nitroglycerin for her chest pain. C. placing her in an upright position. D. ventilations with a BVM.

C

In contrast to AMI, a dissecting aortic aneurysm: A. is more commonly associated with pressure in the chest. B. is typically preceded by other symptoms, such as nausea. C. often presents with pain that is maximal from the onset. D. usually presents gradually, often over a period of hours.

C

Ischemic heart disease is defined as: A. death of a portion of the heart muscle due to a decrease in oxygen. B. absent myocardial blood flow due to a blocked coronary artery. C. decreased blood flow to one or more portions of the myocardium. D. decreased blood flow to the heart muscle due to coronary dilation.

C

Nitroglycerin relieves cardiac-related chest pain by: A. increasing the amount of stress that is placed on the myocardium. B. contracting the smooth muscle of the coronary and cerebral arteries. C. dilating the coronary arteries and improving cardiac blood flow. D. constricting the coronary arteries and improving cardiac blood flow.

C

Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must: A. ensure the medication is in tablet form. B. determine who prescribed the nitroglycerin. C. obtain authorization from medical control. D. wait at least 5 minutes after assessing the blood pressure.

C

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: A. obtain a blood pressure and apply the pulse oximeter. B. place him in the recovery position and apply oxygen. C. reassess airway and breathing and treat accordingly. D. transport at once and re-analyze his rhythm en route.

C

The descending aorta divides into the two iliac arteries at the level of the: A. pubic symphysis. B. iliac crest. C. umbilicus. D. nipple line.

C

The electrical impulse generated by the heart originates in the: A. atrioventricular node. B. coronary sinus. C. sinoatrial node. D. bundle of His.

C

The head and brain receive their supply of oxygenated blood from the: A. brachial arteries. B. subclavian arteries. C. carotid arteries. D. iliac arteries.

C

The posterior tibial pulse can be palpated: A. on the dorsum of the foot. B. in the fossa behind the knee. C. behind the medial malleolus, on the inside of the ankle. D. between the trachea and the neck muscle.

C

When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that: A. blood can pass from the atria to the ventricles. B. the SA node can reset and generate another impulse. C. blood returning from the body can fill the atria. D. the impulse can spread through the Purkinje fibers.

C

Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort? A. History of previous heart attack B. History of cigarette smoking C. Family history of hypertension D. Presence of personal risk factors

C

Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure? A. Trouble breathing while lying down B. The presence of rales in the lungs C. Hypotension and flat jugular veins D. Hypertension and tachycardia

C

After assisting your patient with prescribed nitroglycerin, you should: 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

After the AED has delivered a shock, the EMT should: A. transport the patient at once. B. re-analyze the cardiac rhythm. C. assess for a carotid pulse. D. immediately resume CPR.

D

Common signs and symptoms of AMI include all of the following, EXCEPT: A. irregular heartbeat. B. shortness of breath or dyspnea. C. sudden unexplained sweating. D. pain exacerbated by breathing.

D

Deoxygenated blood from the body returns to the: A. left atrium. B. left ventricle. C. right ventricle. D. right atrium.

D

The AED is MOST advantageous to the EMT because: A. it delivers an unlimited number of shocks with the same amount of energy. B. its use does not require the presence of advanced life support personnel. C. it is lightweight, easy to use, and safe for the EMT who is using it. D. it delivers prompt defibrillation to patients with ventricular fibrillation.

D

Ventricular tachycardia causes hypotension because: A. the right ventricle does not adequately pump blood. B. the volume of blood returning to the atria increases. C. blood backs up into the lungs and causes congestion. D. the left ventricle does not adequately fill with blood.

D

When preparing to obtain a 12-lead ECG, the LL and RL electrodes should be placed: A. on the lower abdomen. B. anywhere on the arms. C. on either side of the chest. D. on the thighs or ankles.

D

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. 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: A. move the nitroglycerin patch to the other side of his chest and administer oxygen. B. remove the nitroglycerin patch and apply the AED in case he develops cardiac arrest. C. complete your secondary assessment and reassess his blood pressure in 5 minutes. D. remove the nitroglycerin patch, administer oxygen, and place him in a supine position.

D