Chapter 16: Cardiovascular Emergencies

A 56-year-old man has an acute myocardial infarction. Which of the following blood vessels became blocked and led to his condition? A. Coronary veins B. Coronary arteries C. Pulmonary veins D. Pulmonary arteries

B

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

B. Hypotension and flat jugular veins

The main advantage(s) of the AED is: A. it provides quick delivery of a shock. B. it is easier than performing CPR. C. there is no need for ALS providers to be on scene. D. All of the above.

D

While palpating the radial pulse of a 56-year-old man with chest pain, you note that the pulse rate is 86 beats/min and irregular. This indicates: A. pain. B. fear. C. anxiety. D. dysrhythmia.

D

An acute myocardial infarction (AMI) occurs when: A. myocardial tissue dies secondary to an absence of oxygen. B. the heart muscle progressively weakens and dysfunctions. C. coronary artery dilation decreases blood flow to the heart. D. the entire left ventricle is damaged and cannot pump blood.

A. myocardial tissue dies secondary to an absence of oxygen.

The main legal risk in using the AED is: A. negligence on the part of the manufacturer. B. failure of the AED's internal computer chip. C. failing to deliver a shock when one is needed. D. not assessing for a pulse after a shock is delivered.

C. failing to deliver a shock when one is needed.

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

D. Pulmonary veins

All of the following are common signs and symptoms of cardiac ischemia, EXCEPT: A. headache. B. chest pressure. C. shortness of breath. D. anxiety or restlessness.

A

Nitroglycerin is contraindicated in patients: A. with a systolic blood pressure less than 100 mm Hg. B. with chest pain of greater than 30 minutes duration. C. who are currently taking antibiotics for an infection. D. who are younger than 40 years of age and have diabetes.

A

A patient with a left ventricular assist device (LVAD) tells you that the device's pump flow is continuous. Which of the following should you expect to encounter during your assessment? A. Absence of a palpable pulse B. High systolic blood pressure C. Distention of the jugular veins D. Low diastolic blood pressure

A. Absence of a palpable pulse

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 heart rate and increased stroke volume D. Decreased stroke volume and decreased heart rate

A. Increased heart rate and increased stroke volume

In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest: A. delivers high-energy shocks, similar to an AED. B. does not require the EMT to stand clear when it shocks. C. does not warn when a shock is about to be delivered. D. will only deliver a shock if ventricular fibrillation occurs.

A. delivers high-energy shocks, similar to an AED.

A 59-year-old woman presents with chest pressure. She is conscious and alert, but her skin is cool, pale, and clammy. Your first step in providing care (treatment) should be: A. apply the AED. B. administer oxygen. C. ask her if she takes nitroglycerin. D. take a complete set of vital signs.

B

After administering a nitroglycerin tablet to a patient, the EMT should: A. check the expiration date of the nitroglycerin. B. reassess the patient's blood pressure within 5 minutes. C. instruct the patient to chew the tablet until it is dissolved. D. ensure that the nitroglycerin is prescribed to the patient.

B

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

B. Anginal pain typically subsides with rest.

Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger? A. Furosemide (Lasix) B. Aspirin C. Oxygen D. Metoprolol (Toprol)

B. Aspirin

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. Unstable angina B. Dissecting aortic aneurysm C. Acute myocardial infarction D. Hypertensive emergency

B. Dissecting aortic aneurysm

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

B. in a supine position with legs uncrossed.

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

B. it delivers prompt defibrillation to patients with ventricular fibrillation.

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: A. re-analyze the patient's cardiac rhythm. B. perform CPR for 2 minutes and reassess. C. determine if a palpable pulse is present. D. immediately assess the patient's airway.

B. perform CPR for 2 minutes and reassess.

A patient with cardiac arrest secondary to ventricular fibrillation has the greatest chance for survival if: A. CPR is initiated within 10 minutes. B. oxygen and rapid transport are provided. C. defibrillation is provided within 2 minutes. D. paramedics arrive at the scene within 5 minutes.

C

If a patient with an implanted pacemaker is in cardiac arrest, the EMT should: A. avoid defibrillation with the AED and transport at once. B. not apply the AED until he or she contacts medical control. C. place the AED pads away from the pacemaker. D. apply the AED pads directly over the implanted pacemaker.

C

Major controllable risk factors for an AMI include: A. older age. B. family history. C. cigarette smoking. D. male sex.

C

Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray? A. Encourage the patient to chew the tablet to increase its effectiveness. B. Place the medication under the tongue and have the patient swallow it. C. Administer the medication sublingually and allow it to dissolve or absorb. D. Wait 15 minutes and reassess the patient's blood pressure prior to administering another dose.

C. Administer the medication sublingually and allow it to dissolve or absorb.

You and your partner have achieved return of spontaneous circulation (ROSC) in a patient who was in cardiac arrest. An ALS unit will arrive in less than 2 minutes. The patient remains unresponsive and has slow, irregular breathing. Further treatment for this patient should include: A. oxygen via nonrebreathing mask at 15 L/min and immediate transport. B. insertion of an oropharyngeal airway and positioning him on his side. C. elevation of his lower extremities and covering him with warm blankets. D. BVM ventilation at 10-12 breaths/min and assessment of oxygen saturation.

D. BVM ventilation at 10-12 breaths/min and assessment of oxygen saturation.

Common signs and symptoms of a hypertensive emergency include: A. pallor, cool skin, and a temporary loss of hearing. B. syncope, a weak pulse, and bleeding from the ears. C. tachycardia, pain behind the eyes, and weakness. D. a bounding pulse, a severe headache, and dizziness.

D. a bounding pulse, a severe headache, and dizziness.

Narrowing of the coronary arteries caused by a buildup of fatty deposits is called: A. angina pectoris. B. arteriosclerosis. C. acute ischemia. D. atherosclerosis.

D. atherosclerosis.

The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called: A. excitability. B. contractility. C. impulsivity. D. automaticity.

D. automaticity.

Prior to defibrillating a patient with an AED, it is MOST important that you: A. properly position the defibrillation pads. B. perform up to 5 minutes of effective CPR. C. confirm that the patient is in cardiac arrest. D. ensure that no one is touching the patient.

D. ensure that no one is touching the patient.

Defibrillator pads are placed on the patient's chest: A. with one pad to the left of the upper sternum and the other pad just to the right of the left nipple. B. with one pad to the right of the upper sternum and the other pad just to the right of the right nipple. C. with one pad to the left of the upper sternum and the other pad to the right lower chest below the armpit. D. with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit.

D. with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit.