Chapter 17 : Cardio Emergencies

QUESTION: The primary control or automaticity of the heart rate originates in the: A) Heart B) Endocrine system C) Nervous system D) Brainstem

A

QUESTION: The primary function of the heart is to: A) Circulate blood B) Store blood C) Produce blood D) Oxygenate blood

A

QUESTION: Dysfunction of the heart's electrical conduction cells from ischemia or infarction may cause: A) Hyperventilation B) Irregular heartbeats C) Lung collapse D) Blood loss

B

QUESTION: Immediately after assisting a patient with diabetes to take her nitroglycerin, she states that she feels weak, dizzy, and nauseated. What should the EMT do next? A) Inform her that this feeling is normal B) Check her blood pressure C) Position her in an upright position D) Check her blood glucose level

B

QUESTION: The EMT should most suspect a patient has angina when he takes which medication? A) Aspirin B) Nitroglycerin C) Glucophage D) Lasix

B

QUESTION: Which of these scene size-up observations would make you suspicious that a patient who complains of shortness of breath has congestive heart failure? A) Home oxygen tank in the bedroom B) Multiple pillows stacked at the head of the patient's bed C) Patient in dirty pajamas and appears unkempt D) Dramatic edema to the right arm

B

QUESTION: After blood enters the right ventricle, it next moves into the: A) Left ventricle B) Aorta C) Pulmonary artery D) Left atrium

C

QUESTION: Sympathetic nervous system stimulation will cause the heart to: A) Decrease automaticity B) Lower the systolic blood pressure C) Decrease in rate D) Increase the heart rate

D

QUESTION: A 64-year-old male patient presents with a blood pressure of 210/132 mmHg. Which of these statements made by this patient would you recognize as most concerning and most likely associated with the elevated blood pressure? A) "I have a history of left-sided heart failure." B) "I feel very thirsty right now." C) "I have this bruising on my arms and legs." D) "My hair has become very brittle."

A

QUESTION: A 67-year-old male patient has chest pain. After you assist him with taking two of his nitroglycerin tablets, his chest pain remains 7 out of 10 and he is still diaphoretic. His vital signs are as follows: pulse, 72; respirations, 18 breaths/min and adequate; blood pressure, 82/60 mmHg; and SpO2, 97% on 2 lpm of oxygen. You should: A) Transfer the patient to the stretcher and begin transport B) Administer half of a nitroglycerin tablet C) Administer a third nitroglycerin tablet D) Increase the oxygen to 4 lpm

A

QUESTION: A paramedic administers a medication to decrease the effect of the parasympathetic nervous system on the heart. In response to this treatment, the EMT would expect which vital sign change? A) Increase in heart rate B) Decrease in heart rate C) Decreased blood pressure D) Increase in respirations

A

QUESTION: A patient complaining of shortness of breath and dizziness has called 911. Her history includes chronic obstructive pulmonary disease (COPD). When assessing the patient, which of these findings would cause you to immediately prepare the patient for transport? A) Pulsating mass in the abdomen B) SpO2 of 94% despite supplemental oxygen C) Wheezing noted in the bases of both lungs D) Heart rate of 84 beats/min

A

QUESTION: A patient has called 911 for chest pain that he describes as "tearing" and radiating between his shoulders. His airway is patent, breathing accelerated but adequate, and radial pulse intact. Your partner reports the following vital signs: pulse, 120; respirations, 22 breaths/min; blood pressure, 88/64 mmHg; and SpO 2, 96% on room air. At this time, you should: A) Recheck the blood pressure in the other arm B) Provide the patient with 325 mg of aspirin C) Assist the patient with his nitroglycerin D) Encourage the patient to take an antacid such as Maalox

A

QUESTION: A patient informs you that he has a history of an abdominal aortic aneurysm. To best assess the status of this condition, you should: A) Assess the abdomen B) Auscultate the lower abdominal quadrants C) Examine the back for bruising D) Palpate the flanks and back

A

QUESTION: A patient is very dizzy and has an altered mental status. Vital signs are pulse, 84; respirations, 16 breaths/min; blood pressure, 74/32 mmHg; and SpO 2, 93%. Medical direction has ordered the paramedic to start an IV infusion of a medication that causes blood vessel constriction. You would recognize that the medication is benefiting the patient when you observe: A) The blood pressure increase to 110/64 mmHg B) The respirations increase to 24 breaths/min C) The heart rate increase to 92 beats/min D) The SpO 2 increase to 94%

A

QUESTION: A patient with chest pain has an SpO2 of 90% on room air. How would you start providing oxygen to this patient? A) Nasal cannula 2 lpm B) Nasal cannula 4 lpm C) Nonrebreather 15 lpm D) Nasal cannula 6 lpm

A

QUESTION: All arteries: A) Carry blood away from the heart B) Carry oxygen-rich blood C) Have lower pressure than veins D) Are located in the torso of the body

A

QUESTION: Chronic and untreated hypertension will affect which part of the heart first? A) Left ventricle B) Right atrium C) Vena cava D) Aorta

A

QUESTION: In the blood, which component is largely responsible for the formation of blood clots? A) Platelets B) Red blood cells C) White blood cells D) Plasma

A

QUESTION: On an ECG, the QRS represents: A) Contraction of the ventricles B) The heart at rest following contraction C) Contraction of both the atria and the ventricles D) Contraction of the atria

A

QUESTION: Prior to administering nitroglycerin to a patient with chest pain, the EMT must ensure that: A) The nitroglycerin is prescribed for the patient B) The patient is standing in an upright position C) The patient rates his chest pain as 10 out of 10 D) The patient's systolic blood pressure is greater than 110 mmHg

A

QUESTION: The EMT understands the ECG when he makes which of these statements about the waveform? A) "An ECG represents the electrical activity of the heart." B) "The ECG can be used to determine how well the heart is pumping blood." C) "The ECG shows how well the heart is oxygenating blood." D) "An ECG indicates the amount of blood in the heart."

A

QUESTION: The three primary components of the cardiovascular system are best described as: A) Heart, blood vessels, and blood B) Heart, blood vessels, and brainstem C) Heart, lungs, and blood vessels D) Arteries, veins, and capillaries

A

QUESTION: The tricuspid valve prevents blood from: A) Flowing from the right ventricle into the right atrium B) Bypassing the pulmonary vessels and entering the left heart C) Regurgitating between the right and left ventricles D) Flowing backward through the left atrium

A

QUESTION: To save additional heart muscle from dying when a patient suffers an acute myocardial infarction (heart attack), which treatment must occur? A) Relieving the obstruction in the coronary arteries B) Increasing the heart rate C) Opening blood flow between the atria and ventricles D) Lowering the blood pressure

A

QUESTION: When assessing an elderly patient with upper back pain, which of these assessment findings would make you very suspicious of a thoracic aortic dissection? A) Different blood pressure readings in each arm B) History of hypertension and lower back injury C) Lower back pain described as a constant ache D) Dizziness when going from a supine to standing position suddenly

A

QUESTION: Which instruction given by an EMT indicates the proper administration of nitroglycerin? A) "Let this pill dissolve under your tongue." B) "Breathe in when I spray the nitroglycerin into your mouth." C) "Please chew and swallow this pill." D) "This pill will go between your cheek and gum."

A

QUESTION: Which of these patients is most likely to suffer a silent MI? A) A 55-year-old female with diabetes B) A 48-year-old male with undiagnosed hypertension C) A 60-year-old female with colon cancer D) A 72-year-old male with a syncopal episode

A

QUESTION: Which of these statements from a patient should the EMT recognize as an absolute contraindication to the use of fibrinolytic medications in the emergency department? A) "Two months ago, I had a stroke on the left side of my brain." B) "I have high blood pressure for which I take medication." C) "My doctor told me to take a baby aspirin every day." D) "I had my appendix removed six months ago."

A

QUESTION: Which of these statements made by the EMT indicates a safe understanding of the administration of nitroglycerin in the prehospital setting? A) "A total of three nitroglycerin tablets may be administered in the prehospital setting, and this includes what the patient recently took prior to EMS arrival." B) "Since nitroglycerin constricts the blood vessels, you must always check the blood pressure before and after giving it." C) "If the patient with chest pain also has a headache, the EMT should contact medical command prior to administering nitroglycerin." D) "I always check for an allergy to sulfa, since most people with an allergy to sulfa also have an allergy to nitroglycerin."

A

QUESTION: Which of these statements made by the patient should cause the EMT to suspect an abdominal aortic aneurysm? A) "I have belly pain that I also feel in my back." B) "My heart is beating so hard, you can feel it on my chest." C) "I seem to be vomiting up some blood." D) "The pain is sharp and spreads to both arms."

A

QUESTION: Which of these statements made by the patient should the EMT associate with the condition of congestive heart failure? A) "I have a hard time breathing when I am lying down." B)"I can feel my heart pounding in my head and I have a throbbing headache." C) "I noticed that I am having a hard time breathing and have a fever." D) "When I walk, I feel very weak and get quite dizzy

A

QUESTION: Which portion of the heart, when weakened by a heart attack, is responsible for causing fluid to back up into the alveoli? A) Left ventricle B) Right atrium C) Right ventricle D) Pulmonary vein

A

QUESTION: Which sign or symptom should the EMT expect in a patient who has a chronically low white blood cell count? A) Temperature of 103.4°F B) SpO2 of 91% on room air C) Blood pressure of 156/100 mmHg D) Bruising to the extremities

A

QUESTION: You are approached by an EMR who informs you that last week, he was on a call in which a patient with chest pain and a known history of coronary artery disease was not given oxygen by the EMTs. You would reply: A) "It has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful." B) "If the patient also had a history of COPD, oxygen was most likely withheld since it would be contraindicated." C) "That may have been an oversight, given that chest pain is caused by a lack of oxygen-rich blood delivery through the coronary arteries." D) "Since extra oxygen slows the respiratory rate, it also causes the body to retain CO 2, which is not beneficial for heart patients."

A

QUESTION: You are assessing a 73-year-old male patient who complains of altered mental status and shortness of breath. The patient is conscious, but confused. His pulse is rapid and weak, and his skin cool and diaphoretic. An Emergency Medical Responder provides you with the following vital signs: pulse, 136; respirations, 20 breaths/min; blood pressure, 168/88 mmHg; and SpO 2, 89%. A family member states that the patient has diabetes and takes insulin. He also has a history of hypertension, colon cancer, irregular heartbeat, and transient ischemic attacks (TIA). Which action should the EMT take next? A) Apply supplemental oxygen B) Administer oral glucose C) Perform the secondary exam D) Check the patient's blood sugar

A

QUESTION: You are by the side of a patient who complains of severe chest pain that radiates into his right arm and neck. He is alert and oriented, with an open airway and adequate breathing. His radial pulse is strong, and his skin is cool and diaphoretic. Your partner reports his pulse rate is 84, respirations are 18 breaths/min, blood pressure is 86/62 mmHg, and SpO2 is 98% on room air. You have obtained a medical history and performed the secondary assessment. The patient states that he has had two heart attacks in the past and is allergic to aspirin and sulfa medications. What should you do next? A) Transfer the patient to the stretcher and begin transport B) Administer baby aspirin to the patient C) Administer oxygen and nitroglycerin, and then transport the patient D) Assist the patient in taking a nitroglycerin tablet

A

QUESTION: You are caring for an alert and oriented patient with chest pain. Emergency First Responders have initiated supplemental oxygen, and your EMT partner assisted in the administration of aspirin and two nitroglycerin tablets. Currently, the patient's vital signs are pulse, 76; respirations, 16 breaths/min; blood pressure, 110/56 mmHg; and SpO2, 95%. When transporting this patient on the stretcher, which position is best? A) Position of comfort B) Semi-Fowler's position C) Supine with head elevated D) Lateral recumbent

A

QUESTION: You are completing the prehospital care report and are documenting the fact that you assisted a patient in taking his nitroglycerin pill. How will you document the route of administration? A) Sublingual B) Topical C) Buccal D) Oral

A

QUESTION: You are treating a patient for mild chest pain but notice that his blood pressure is elevated. Which of these statements made by the patient would make you suspect he has acute hypertension? A) "The doctor checks my blood pressure regularly and it's not normally that high." B) "I have to take two blood pressure medications at the same time to get my pressure down." C) "My high blood pressure caused my heart to go bad." D) "The doctor said that my blood pressure is high because my kidneys are bad."

A

QUESTION: You have arrived at a residence to help another crew with a 62-year-old woman who is complaining of fatigue, chest discomfort, and diaphoresis. The EMTs on scene report that she has a history of hypertension from atherosclerosis, for which she takes a blood pressure pill, and is also prescribed nitroglycerin. She reports an allergy to aspirin. Vital signs are pulse, 64; respirations, 16 breaths/min; blood pressure, 128/86 mmHg; and SpO2, 97% on room air. Which of these statements made by your EMT partner would require immediate correction on your part? A) "I will contact medical direction for permission to administer the patient's nitroglycerin." B) "I am not going to attach the AED, because the patient is conscious and has a pulse." C) "I am not going to give the patient any aspirin, because she says that she is allergic to it." D) "I am going to put the patient on high-concentration oxygen because she has chest discomfort."

A

QUESTION: You suspect that a patient with a history of chronic obstructive pulmonary disease (COPD) is has right ventricular failure. In your assessment, which finding would reinforce this suspicion? A) Edema to the feet B) Bounding radial pulse C) Crackles in both lungs D) Elevated blood pressure

A

QUESTION: A patient has a low platelet count. Based on this finding, which complication is he most at risk for? A) Clot formation B) Angina C) Bleeding D) Hypotension

C

QUESTION: On scene, you are treating a 62-year-old female patient with chest pain, diaphoresis, and nausea. She has a history of heart problems as well as diabetes, for which she takes medications. She is allergic to penicillin and iodine. She is alert, oriented, and calm, and there are no threats to the airway, breathing, or circulation. The patient took 81 mg of aspirin this morning, as she always does. Her vital signs are pulse, 100; respirations, 16 breaths/min; blood pressure, 118/90 mmHg; and SpO2, 97% on room air. In overseeing the care of this patient, which of these actions would demand immediate and corrective intervention? A) Palpating the chest wall for tenderness B) Administering three baby aspirins to the patient C) Applying oxygen through a nasal cannula D) Determining the patient's blood glucose

C

QUESTION: The EMT shows she is correctly administering aspirin to a patient with chest pain when she provides: A) 160 mg of baby aspirin and instructs the patient to swallow it with a glass of water B) 325 mg of enteric-coated aspirin and instructs the patient to swallow it C) 325 mg of baby aspirin and instructs the patient to chew it D) 325 mg of baby aspirin and instructs the patient to let it dissolve under the tongue

C

QUESTION: Which of these statements regarding cardiac compromise or acute coronary syndrome should the EMT recognize as true? A) If the pain does not radiate to the arms, then the cause is not typically the heart B) The onset of acute coronary syndrome typically occurs with physical activity C) Cardiac compromise should be suspected for any patient with chest discomfort D) Patients suffering from acute coronary syndrome will have pain, not discomfort

C

QUESTION: Which of these statements regarding contraction of the heart is true? A) The right atria and ventricle contract together, moving blood to the left side B) The two ventricles contract simultaneously, moving blood into the atria C) Both atria contract together just before both ventricles contract together D) When the left ventricle contracts, it sends blood into the lungs for oxygenation

C

QUESTION: Which sign or symptom would the EMT typically associate with congestive heart failure? A) Feeling of palpitations B) Edema to the left arm C) Crackles in both lungs D) Rhonchi to both lungs that is cleared by a cough

C

QUESTION: Which structure of the neck would the EMT examine on a patient she believes to be in congestive heart failure? A) Trachea B) Clavicles C) Neck veins D) Lateral muscles

C

QUESTION: You are caring for a 69-year-old male patient who is short of breath and in acute congestive heart failure. He is alert, anxious, and panicked, with an open airway and rapid shallow respirations. His heart rate is tachycardic, and his skin is cool and diaphoretic, with cyanosis noted to the lips and fingers. There are crackles noted in both lungs, as well as pedal edema in both feet. The patient denies chest pain or discomfort, but is having a difficult time speaking due to the shortness of breath. When caring for this patient, you should: A) Administer four baby aspirins B) Insert a nasal airway C) Apply continuous positive airway pressure (CPAP) D) Place the patient in the shock position

C

QUESTION: You are interviewing a patient whom you suspect has an acute coronary syndrome. Which question is most appropriate initially? A) "Are you having any pain in your chest?" B) "Does it hurt when I press on your chest?" C) "Are you having any chest discomfort?" D) "Does your chest hurt when you breathe?"

C

QUESTION: You have been called for a 4-year-old female patient who told her mother that her chest hurts. On scene, the child is crying and points to her chest when asked if she has pain. Her airway is patent, respirations slightly labored, pulse rapid and regular, and skin warm and pale. Vital signs are pulse, 132; respirations, 28 breaths/min; blood pressure, 108/74 mmHg; and SpO2, 89%. The mother denies any medical history, medications, or allergies for her daughter. Your first action would be to: A) Contact medical direction B) Give the patient one -half nitroglycerin tablet C) Apply oxygen D) Administer one baby aspirin

C

QUESTION: You have been called for a 56-year-old female patient who complains of chest pain. She informs you that she takes nitroglycerin and asks you to get it from the top of her refrigerator. You find it is a clear glass jar hand-labeled "nitroglycerin." What of these statements, based on this observation, would be the most appropriate one to make to the patient? A) "The heat from the refrigerator will cause the nitroglycerin to lose its effectiveness." B) "Keeping the nitroglycerin on top of the refrigerator may make it difficult for you to reach it in an emergency." C) "It is best to keep the nitroglycerin in a dark container since light will inactivate it." D) "You should keep your nitroglycerin in the refrigerator since it will keep longer in the cold."

C

QUESTION: You have been called for a 58-year-old male patient with an unknown medical emergency. On scene, you find the alert and oriented patient complains of headache as well as weakness and "tingling" to his right arm and leg. He has diabetes and high blood pressure, for which he takes the appropriate medications. When asked, he reports that he may have passed out earlier in the day, immediately after taking his morning dose of insulin. His pulse is 96, respirations 16 breaths/min, and blood pressure 180/106 mmHg. Based on this presentation, you should treat the patient for: A) Syncope B) Hypertensive emergency C) Stroke D) High blood sugar

C

QUESTION: A 44-year-old male patient is experiencing chest pain. He has a history of angina and is prescribed nitroglycerin, which he has not taken yet. He is also taking another medication. Which of these medications is a contraindication to the administration of nitroglycerin? A) Coumadin B) Methadone C) Albuterol D) Levitra

D

QUESTION: A 67-year-old male patient with a history of coronary artery disease and COPD called 911 for chest discomfort and mild dyspnea. When you are at the patient's side, he states that the pain started when he was cleaning out his garage, but after a period of rest, the pain has resolved. His airway is patent, breathing adequate, radial pulse irregular, and skin warm and dry. He has a past medical history of atrial fibrillation (irregular heartbeat), coronary artery disease, and diabetes, for which he takes insulin. Vital signs are pulse, 68; respirations, 16 breaths/min; blood pressure, 148/88 mmHg; and SpO 2, 97% on room air. The patient took 81 mg of aspirin as prescribed this morning on awakening. What should you do first? A) Provide supplemental oxygen B) Assist the patient with taking nitroglycerin C) Administer another aspirin D) Assess breath sounds

D

QUESTION: A 71-year-old female patient is lying in bed and complaining of respiratory distress. She exhibits moderate dyspnea, crackles in both lungs, and edema to the abdomen and lower extremities. Supplemental oxygen is being provided to the patient by Emergency Medical Responders. Her vital signs are as follows: pulse, 132; respirations, 18 breaths/min; blood pressure, 138/86 mmHg; and SpO 2, 95%. Which of these actions would be of the most immediate benefit to the patient? A) Elevate both legs to decrease swelling B) Obtain a medical history and test the blood glucose C) Administer four baby aspirins D) Position the patient in a sitting upright position

D

QUESTION: A mother has called 911 because her 6-year-old son told her he had chest pain. On scene, the mother informs you that her son suffers from a congenital heart defect called aortic coarctation. The boy admits to chest pain and appears distressed. His airway is patent, breathing adequate, and radial pulse present and regular. Vital signs are pulse, 108; respirations, 24 breaths/min; blood pressure, 148/92 mmHg; and SpO2, 98%. Your next action would be to: A) Try one nitroglycerin for pain relief B) Administer high-concentration oxygen C) Give one baby aspirinD) Contact medical command for advice

D

QUESTION: A patient has been diagnosed with high blood pressure. A medication that can effectively serve to lower this patient's blood pressure is one that: A) Increases the heart rate B) Dilates the coronary arteries C) Constricts the veins D) Dilates the arteries

D

QUESTION: For a patient with a history of an unstable abdominal aortic aneurysm, the EMT should recognize and prepare for: A) Vomiting and airway occlusion B) Decreased perfusion to the upper extremities C) Hypoxia caused by lung compression D) Massive internal bleeding

D

QUESTION: If a clot occludes the blood flow through the coronary artery, what will be the detrimental effect? A) Blood and fluid will back up into the lung tissue, causing pulmonary edema B) Blood will not be able to flow between the left atrium and the left ventricle C) The flow of oxygen-rich blood through the peripheral arteries will cease D) The flow of oxygen-rich blood to the muscle of the ventricle will be decreased

D

QUESTION: When administering oxygen to a patient with chest pain, which of these should be used a guide to its use and maintenance? A) The heart rate B) Patient rating of pain C) The respiratory rate D) Pulse oximetry reading

D

QUESTION: When treating a patient with chest discomfort, the EMT's primary goal is to: A) Administer fibrinolytic drugs with the permission of medical direction B) Determine whether chest discomfort is originating from the heart C) Provide immediate care to eliminate the chest discomfort, and then transport the patient to the hospital D) Recognize the possibility of cardiac compromise and provide proper emergency care

D

QUESTION: Which of these statements would the EMT expect from a patient with unstable angina? A) "If I take a nitroglycerin tablet, the pain stops." B) "When I stop what I am doing, the pain goes away." C) "The antacid my doctor prescribed seems to take the pain away." D) "The chest pain awakens me from my nighttime sleep."

D

QUESTION: Which of these therapies is the best option for definitively treating a known myocardial infarction (AMI)? A) Fibrinolytics B) Oxygen C) Oxygen, aspirin, and nitroglycerin D) Angioplasty

D

QUESTION: You are assessing a patient in heart failure. Which sign or symptom seemingly indicates that the left ventricle is the cause of the heart failure? A) Heart rate of 62 beats/min B) SpO2 of 95% with no supplemental oxygen C) Difficulty breathing when in an upright position D) Crackles in the bases of both lungs

D

QUESTION: You are assisting a paramedic in the transport of a patient from a community hospital emergency department to a large medical center. The patient was diagnosed with an acute myocardial infarction and received fibrinolytic therapy in the ED. Currently, you are transporting the patient with the fibrinolytic medication infusing through an IV. In regard to the fibrinolytic therapy, you know that during this transport, you will need to closely monitor the patient for which complication? A) Respiratory arrest B) Hypertension C) Hypoglycemia D) Internal bleeding

D

QUESTION: You are treating a 67-year-old male patient with chest pain and a history of prior heart attacks as well as diabetes and hypertension. The patient has taken three nitroglycerin tablets, which have decreased his pain from 7/10 to 4/10; however, the pain persists. Initially, his SpO 2 was 91% on room air. Oxygen was applied by nasal cannula and now, on 3 lpm O2, his SpO2 is 97%. How would you address the oxygen administration, given that the patient still has chest pain? A) Leave the oxygen flow unchanged B) Discontinue oxygen therapy C) Increase the oxygen flow to 4 lpm D) Decrease the oxygen flow to 2 lpm

D

QUESTION: You are treating a patient who complains of altered mental status, shortness of breath, and chest pain. A paramedic has just administered a medication that causes the sympathetic nervous system to increase its influence in the body. Which finding should you anticipate after this treatment? A) Decreased blood pressure B) Increased heart rate and decreased blood pressure C) Decreased heart rate D) Increased heart rate

D

QUESTION: You have been called for a patient with angina. On scene, the 67-year-old man reports that he has a history of angina and the pain started when he was moving firewood from the garage into his house. Unfortunately, the pain has yet to go away, despite three nitroglycerin tablets and 20 minutes of rest. Your next action should be to: A) Provide supplemental oxygen via nonrebreather B) Attach the AED but do not turn it on C) Administer a nitroglycerin tablet and aspirin D) Check the patient's vital signs

D

QUESTION: You have just arrived by the side of a male patient who is in cardiac arrest. Emergency Medical Responders have been on scene for 6 minutes performing CPR. Advanced life support (ALS) has been contacted and is 1 minute out. What should you do immediately? A) Continue CPR and wait for ALS care B) Check the heart rate, blood pressure, and SpO2 C) Place the patient on the stretcher so ALS can provide care en route D) Apply and use the automated external defibrillator

D

QUESTION: A 56-year-old female patient with a smoking history and COPD complains of the sudden onset of shortness of breath and diaphoresis. Her history indicates no cardiac diagnosis but previous drug abuse 8 years ago. Vital signs are pulse, 96; respirations, 18 breaths/min and mildly labored; blood pressure, 168/102 mmHg; and SpO2, 96% on home oxygen at 4 lpm, which she wears for COPD. The patient's lung sounds are clear but diminished bilaterally. What is your best action? A) Assist the patient is trying her husband's nitroglycerin B) Turn down the oxygen to 2 lpm, monitor, and transport C) Administer the patient's MDI and transport her to the hospital D) Administer aspirin, monitor the patient, and transport

B

QUESTION: A patient complains of chest pain that radiates into his neck and arms. The primary assessment reveals a patent airway, adequate breathing, and a strong, regular radial pulse. The patient's skin is warm and dry, and reveals no signs of inadequate perfusion. What should you do next? A) Provide oxygen B) Check vital signs C) Start the secondary assessment D) Attach the AED

B

QUESTION: A patient informs you that he has a hard time breathing when he lies in bed. You would best document this report as: A) Dyspnea B) Orthopnea C) Tachypnea D) Nocturnal dyspnea

B

QUESTION: After being dispatched for a male patient experiencing dyspnea, you arrive to find the confused 67-year-old man sitting upright at his kitchen table in severe respiratory distress. You also note remarkable swelling to his lower legs and feet. He has an open airway, but cannot speak more than two to three words without attempting to breathe. His breathing is extremely labored, with inspiratory crackles heard upon auscultation. His skin is cool, diaphoretic, and dusky in color. A family member at the scene reports a history of hypertension, congestive heart failure, and angina, for which the patient takes nitroglycerin. The baseline vital signs are acceptable and the room-air pulse oximeter reading is 45%. What is your immediate action in caring for this patient? A) Obtain vital signs and give aspirin B) Apply continuous positive airway pressure (CPAP) C) Assist the patient with his nitroglycerin D) Apply but do not turn on the AED

B

QUESTION: An elderly patient with diabetes who experiences a silent MI will most likely: A) Be taking pain medications that mask the heart pain B) Not be awakened by a heart attack as he sleeps C) Experience chest pain but deny that anything is wrong D) Be on continuous home oxygen

B

QUESTION: Regarding women and cardiac compromise, with which of these statements would you agree? A) "Most women, unless they are diabetic, will suffer from chest discomfort as opposed to pain when having an MI." B) "The death rate for women suffering a heart attack is higher than that for men." C) "Most women have right-sided chest pain without dyspnea or palpitations when having an MI." D) "Although the risk of MI decreases with age, women should take daily aspirin as they get older."

B

QUESTION: The EMT shows that she understands the difference between classic angina and an acute myocardial infarction (MI) when she states: A) "Classic angina is not accompanied by other symptoms like shortness of breath; the chest pain with an acute MI is." B) "An acute myocardial infarction results in the death of cardiac tissue; classic angina does not." C) "The pain in an acute MI is typically described as stabbing; the pain with classic angina is more pressure-like." D) "Classic angina occurs when the heart rate becomes too fast; an acute MI is the result of coronary artery disease."

B

QUESTION: The pathophysiology of heart failure that causes the common signs and symptoms of cardiogenic shock is: A) Fluid accumulation within the lung tissue B) Inadequate ejection of blood from the left ventricle C) Poor gas exchange in the lungs D) Backup of fluid in the lower extremities

B

QUESTION: The primary pacemaker site of the heart is the: A) Ventricular node B) Sinoatrial node C) Brainstem D) Right atrium

B

QUESTION: When administering aspirin to a patient with chest discomfort that is suggestive of a heart attack, the EMT recognizes that this medication will benefit the patient by: A) Breaking up the blood clot that is occluding the coronary artery B) Decreasing the ability of the platelets in the blood to form clots C) Decreasing the chest pain caused by the possible heart attack D) Treating the headache that may occur when nitroglycerin is administered

B

QUESTION: When assessing a patient in the prehospital setting, which of these does the EMT recognize as an indication for aspirin? A) Complaint of a headache after taking nitroglycerin B) Chest discomfort that is suggestive of a heart attack C) Systolic blood pressure greater than 100 mmHg D) An aspirin taken daily for cardiovascular disease

B

QUESTION: When obtaining a medical history, which of these statements made by the patient seemingly indicates that he is suffering from classic angina? A) "The pain lasted about 45 minutes before gradually going away." B) "When I stopped cutting the grass, the pain went away." C) "The pain started when I was sitting down reading the paper." D) "I took five nitroglycerin tablets over 20 minutes to get rid of the pain."

B

QUESTION: Which action is it essential that the EMT take prior to assisting the patient in taking his nitroglycerin tablet? A) Determine the presence or absence of a headache B) Evaluate the patient's systolic blood pressure and heart rate C) Inquire about whether the patient is allergic to sulfa drugs D) Determine whether the patient had a stroke within the last 6 months

B

QUESTION: Which of these identifies the major elements of the pathway that blood takes through the heart in the correct sequence? A) Pulmonary vein, pulmonary capillary, pulmonary artery, right ventricle B) Vena cava, right ventricle, pulmonary artery, left ventricle, aorta C) Right atrium, left atrium, left ventricle, right ventricle D) Aorta, left atrium, left ventricle, pulmonary capillary

B

QUESTION: Which of these statements made by another EMT, regarding chest pain and acute coronary syndrome, is correct? A) "If the patient experiences chest pain that radiates into the left arm, it is most likely a heart attack. If the pain radiates anywhere else, it is most likely not cardiac in origin." B) "Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure." C) "If the chest pain started during activity, it is most likely cardiac. If the pain started while the patient was at rest, it is most likely not cardiac." D) "If the patient's chest pain does not go away with nitroglycerin treatment, the EMT should assume that the medication is expired and ineffective."

B

QUESTION: You are caring for a 62-year-old female patient with chest discomfort and shortness of breath. She is alert and oriented with an open airway. Her breathing is adequate and radial pulse strong. Her skin is warm and dry. What should you do next? A) Assist the patient in taking a nitroglycerin tablet B) Obtain the patient's heart rate and blood pressure C) Perform a secondary assessment D) Assist the patient to the ambulance for immediate transport

B

QUESTION: You are transporting a patient who had an episode of chest pain. On scene, you assisted him in taking his nitroglycerin medication, which completely alleviated the chest pain. En route to the hospital, the patient asks you why the nitroglycerin took the chest pain away. Beyond telling the patient that nitroglycerin can increase coronary artery blood flow, you would add: A) "It causes the heart rate to decrease, which relaxes it and decreases pain." B) "It dilates the blood vessels, which decreases the workload of the heart." C) "It has a sedative effect on the brain, making you less aware of the pain." D) "It causes the body to relax, decreasing the need for oxygen."

B

QUESTION: You have been called to a residence for an obese 52-year-old male patient who complains of chest pain. When obtaining a history from the patient, which of these statements made by the patient would you find most concerning? A) "I occasionally feel that my heart seems to skip a beat." B) "The pain came on suddenly when I was reading the paper." C) "I started taking an antianxiety medication last week." D) "I have had chest pain on and off for years now."

B

QUESTION: You have been called to an office building for a 47-year-old male patient complaining of chest pain. He is alert, oriented, and complaining of mild pain in his chest that came on suddenly about 15 minutes ago. Airway, breathing, and circulation are intact, and his skin is diaphoretic and cool. What should you do first? A) Determine if there is a family history of cardiac illness B) Obtain a heart rate, respiratory rate, blood pressure, and SpO 2 reading C) Administer the first of up to three nitroglycerin tablets D) Apply supplemental oxygen through a nasal cannula

B

QUESTION: You have just arrived by the side of a 68-year-old male patient who complains of chest pain. After determining his airway is patent and breathing adequate, it is imperative that you perform which action next? A) Determine whether he takes nitroglycerin B) Check his radial pulse C) Obtain a full set of vital signs D) Auscultate his breath sounds

B

QUESTION: What are the protein strands that strengthen a clot called? A) Fibrin B) Plaque C) Platelets D) Thrombin

A

QUESTION: A patient has pulmonary hypertension, which has increased the resistance in the pulmonary blood vessels. In response, what will most likely occur over a long period of time? A) The heart muscle will become stronger B) The right side of the heart will weaken C) The aorta will weaken and potentially rupture D) The left side of the heart will weaken and fail

B

QUESTION: You are transporting a patient with chest pain to the hospital emergency department. In regard to possible fibrinolytic therapy, what should you relay during your hospital report as a possible relative contraindication to this therapy? A) History of previous heart attack B) Use of anticoagulant medication C) Blood glucose level of 80 mg/dL D) Allergy to aspirin and penicillin

B

QUESTION: A patient who is chronically hypoxic because of anemia most likely has a problem with which component of the cardiovascular system? A) White blood cells B) Platelets C) Red blood cells D) Pulmonary arteries

C

QUESTION: A patient with chest pain and shortness of breath informs you that the last time he had a heart attack, he went into heart failure. When performing your secondary assessment, which sign or symptom is most indicative that the patient is in heart failure again? A) Flat neck veins B) Hypertension C) Crackles in the lungs D) Shortness of breath

C

QUESTION: An alert and oriented patient presents with shortness of breath, crackles in both lungs, jugular venous distention, and edema to the feet and ankles. Her pulse is 132, respirations 26 breaths/min, blood pressure 160/86 mmHg, and SpO2 at 88%. Based on these findings, the EMT should suspect: A) Hypertensive emergency B) Right ventricular failure C) Congestive heart failure D) Left ventricular failure

C

QUESTION: Failure to promptly treat ventricular tachycardia can result in myocardial cell hypoxia and ischemia, which then contributes to the rhythm deteriorating to: A) Pulseless electrical activity B) Sinus rhythm C) Ventricular fibrillation D) Asystole

C

QUESTION: A 71-year-old male patient with a cardiac history and lower abdominal and back pain has called 911 for help. On scene, you detect a large pulsatile mass in his abdomen. With the exception of skin that is diaphoretic, the primary assessment indicates no life threats to the airway, breathing, or circulation. The patient has a history of hypertension, high cholesterol, and diabetes, and is allergic to sulfa-based medications. Vital signs are pulse, 92/min; respirations, 20 breaths/min; blood pressure, 130/66 mmHg; and SpO 2, 95% on room air. Which of these statements made by the patient would make you intervene immediately? A) "I am going to leave my home oxygen on 2 liters since it seems to have helped my breathing." B) "Since I am not having chest pain, I am not going to take my nitroglycerin." C) "I am going to take my daily aspirin since I did not take it this morning." D) "I am going to check my blood sugar with my own glucometer."

C

QUESTION: A TV reporter has been assigned to your ambulance for a ride-along. He is doing a segment on the local EMS system for EMS Week. In your down time, the reporter tells you that his wife was diagnosed with atherosclerosis. He is unsure what this condition is and asks you to explain it to him. Your response would be: A) "Atherosclerosis affects the arteries of the heart and is caused by a heart attack." B) "Atherosclerosis affects the veins in the body and is caused by untreated high blood pressure." C) "The coronary arteries become damaged and narrowed by fat deposits." D) "The walls of the coronary arteries lose elasticity, which can lead to a heart attack."

C

QUESTION: On room air, which of these patients requires supplemental oxygen? A) 52-year-old male; chest pain; history of MI; SpO 2, 95% B) 39-year-old male; complaint of tingling in hands; headache; respirations, 30 breaths/min; SpO2, 98% C) 47-year-old female; temperature 100.3°F; denies dyspnea; SpO2, 91% D) 66-year-old female; generalized weakness; history of diabetes; SpO 2, 97%

C

QUESTION: The EMT understands diastolic blood pressure when he defines it as: A) "The pressure in the venous system when the heart is at rest." B) "The pressure in the arterial system when the heart contracts." C) "The pressure in the arteries between cardiac contractions." D) "The pressure needed to move blood through the cardiovascular system."

C

QUESTION: A patient has chest pain, and you have just assisted him in taking his nitroglycerin tablet. Which of these statements made by the patient is the cause for greatest concern? A) "My tongue is stinging and burning." B) "I seem to be getting a headache." C) "It is easier to breathe now." D) "The chest pain does not feel any different."

D

QUESTION: A patient with a past medical history of angina is now complaining of chest discomfort. When assessing this patient, which sign or symptom should alert the EMT that the patient is probably experiencing an acute myocardial infarction and not an anginal attack? A) The patient's skin is not diaphoretic B) Pain radiates into the left arm C) The patient complains of mild shortness of breath D) Chest discomfort is not relieved by nitroglycerin

D

QUESTION: An obstruction of the pulmonary artery will cause: A) Increased blood flow through the vena cava B) Backup of blood in the left side of the heart C) Increased blood flow through the aorta D) Backup of blood in the right side of the heart

D

QUESTION: For the EMT to administer aspirin in the prehospital setting, which of these criteria must be met? A) Systolic blood pressure greater than 100 mmHg B) Age younger than 65 years C) Patient has a prescription for aspirin D) Approval from medical direction

D