Chapter 16-Cardiovascular Emergencies
Which of the following is a major difference between angina pectoris and AMI? a) Pain from an AMI subsides within 30 minutes. b) Anginal pain typically subsides with rest. c) AMI is caused by myocardial ischemia. d) Nitroglycerin has no effect on angina pectoris.
b) Anginal pain typically subsides with rest.
Which of the following is NOT a function of the sympathetic nervous system? a) dilation of blood vessels in the muscles b) constriction of blood vessels in the muscles c) constriction of blood vessels in the digestive system d) increases in the heart and respiratory rates
b) constriction of blood vessels in the muscles
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? a) Deliver the shock followed by immediate resumption of CPR. b) Continue CPR and transport the patient to the closest appropriate hospital. c) Avoid defibrillation as this will damage the patient's AICD. d) Contact medical control and request permission to defibrillate.
a) Deliver the shock followed by immediate resumption of CPR.
Which of the following statements regarding nitroglycerin is correct? a) Nitroglycerin usually relieves anginal chest pain within 5 minutes. b) Nitroglycerin should be administered between the cheek and gum. c) The potency of nitroglycerin is increased when exposed to light. d) A maximum of five nitroglycerin doses should be given to a patient.
a) Nitroglycerin usually relieves anginal chest pain within 5 minutes.
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) attach the automated external defibrillator (AED) immediately. c) apply a nonrebreathing mask. d) obtain baseline vital signs.
a) begin ventilatory assistance.
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) dependent edema
Which of the following statements regarding the AED and defibrillation is correct? a) Defibrillation is the first link in the American Heart Association 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 is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? a) generalized weakness b) a rapid heart rate c) heart rate less than 60 beats/min d) syncope or dizziness
b) a rapid heart rate
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray? a) Wait 15 minutes and reassess the blood pressure prior to administering another dose. b) Encourage the patient to chew the tablet to increase its effectiveness. c) Administer the medication sublingually and allow it to dissolve or absorb. d) Place the medication under the tongue and have the patient swallow it.
c) Administer the medication sublingually and allow it to dissolve or absorb.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: a) obtain vital signs and a SAMPLE history. b) administer up to 324 mg of baby aspirin. c) assess the adequacy of his respirations. d) administer up to three doses of nitroglycerin.
c) assess the adequacy of his respirations.
Which of the following blood vessels transports oxygenated blood? a) superior vena cava b) pulmonary arteries c) pulmonary veins d) inferior vena cava
c) pulmonary veins
Which of the following statements regarding the pain associated with AMI is correct? a) It is often described by the patient as a sharp feeling. b) Nitroglycerin usually resolves the pain within 30 minutes. c) It often fluctuates in intensity when the patient breathes. d) It can occur during exertion or when the patient is at rest.
d) It can occur during exertion or when the patient is at rest.
Acute coronary syndrome (ACS) is a term used to describe: a) the exact moment that a coronary artery is completely occluded. b) the warning signs that occur shortly before a heart attack. c) a severe decrease in perfusion caused by changes in heart rate. d) a group of symptoms that are caused by myocardial ischemia.
d) a group of symptoms that are caused by myocardial ischemia.
After assisting your patient with his or her nitroglycerin, you should: a) perform a secondary assessment before administering further doses. b) avoid further dosing if the patient complains of a severe headache. c) place the patient in a recumbent position in case he or she faints. d) reassess the blood pressure within 5 minutes to detect hypotension.
d) reassess the blood pressure within 5 minutes to detect hypotension.
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: a) 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. b) immediately remove the nitroglycerin patch, apply the AED in case he develops cardiac arrest, and transport to the closest hospital. 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.
Which of the following is of LEAST pertinence when obtaining medical history information 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) family history of hypertension
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure? a) hypotension and flat jugular veins b) the presence of rales in the lungs c) hypertension and tachycardia d) trouble breathing while lying down
a) hypotension and flat jugular veins
After the AED has delivered a shock, the EMT should: a) immediately resume CPR. b) reanalyze the cardiac rhythm. c) transport the patient at once. d) assess for a carotid pulse.
a) immediately resume CPR.
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) perform CPR for 2 minutes and reassess. b) immediately assess the patient's airway. c) reanalyze the patient's cardiac rhythm. d) determine if a palpable pulse is present.
a) perform CPR for 2 minutes and reassess.
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: a) stop the ambulance, begin CPR, and attach the AED as soon as possible. b) perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. c) defibrillate with the AED while continuing transport to the hospital. d) alert the receiving hospital and perform CPR for the duration of the transport.
a) stop the ambulance, begin CPR, and attach the AED as soon as possible.
Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm? a) ventricular tachycardia b) sinus bradycardia c) extra ventricular beats d) sinus tachycardia
a) ventricular tachycardia
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: a) oxygen at 4 L/min via nasal cannula. b) placing her in an upright position. c) nitroglycerin for her chest pain. d) ventilations with a bag-mask device.
b) placing her in an upright position
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: a) place him in the recovery position and apply oxygen. b) reassess airway and breathing and treat accordingly. c) obtain a blood pressure and apply the pulse oximeter. d) transport at once and reanalyze his rhythm en route.
b) reassess airway and breathing and treat accordingly.
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 are her signs and symptoms MOST indicative of? a) unstable angina b) hypertensive emergency c) dissecting aortic aneurysm d) AMI
c) dissecting aortic aneurysm
Which of the following would cause the greatest increase in cardiac output? a) decreased heart rate and increased stroke volume b) decreased stroke volume and decreased heart rate c) increased heart rate and increased stroke volume d) decreased stroke volume and increased heart rate
c) increased heart rate and increased stroke volume
A dissecting aortic aneurysm occurs when: a) all layers of the aorta suddenly contract. b) the aorta ruptures, resulting in profound bleeding. c) the inner layers of the aorta become separated. d) a weakened area develops in the aortic wall.
c) the inner layers of the aorta become separated.
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: a) give her 100% oxygen, attach the AED, and transport immediately. b) obtain a SAMPLE history and contact medical control for advice. c) give her one nitroglycerin and reassess her systolic blood pressure. d) administer oxygen, give her 324 mg aspirin, and assess her further.
d) administer oxygen, give her 324 mg aspirin, and assess her further.
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) oxygen c) digoxin (Lanoxin) d) aspirin
d) 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: a) have your partner perform CPR while you question the bystanders. b) immediately apply the AED pads and analyze his cardiac rhythm. c) perform two-rescuer CPR for 5 minutes and request ALS backup. d) begin high-quality CPR and apply the AED without delay.
d) begin high-quality CPR and apply the AED without delay.
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to: a) assess the effectiveness of the bystanders' CPR. b) request a paramedic unit and quickly attach the AED. c) quickly attach the AED and push the analyze button. d) have the bystanders stop CPR and assess the patient.
d) have the bystanders stop CPR and assess the patient.