CHAPTER 17 EMT

The iliac arteries immediately subdivide into the A. posterior tibial arteries. B. anterior tibial arteries. C. peroneal arteries. D. femoral arteries

D

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: A. assess the adequacy of his respirations. B. obtain vital signs and a SAMPLE history. C. administer up to three doses of nitroglycerin. D. administer up to 324 mg of baby aspirin

A

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

C

Prior to attaching the AED to a cardiac arrest patient, the EMT should: A. dry the chest if it is wet. B. assess for a pulse for 20 seconds. C. perform CPR for 30 seconds. D. contact medical control.

A

When documenting a patient's description of his or her chest pain or discomfort, the EMT should: A. use the patient's own words. B. use medical terminology. C. document his or her own perception. D. underline the patient's quotes

A

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

D

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. Contact medical control and request permission to defibrillate. B. Continue CPR and transport the patient to the closest appropriate hospital. C. Deliver the shock followed by immediate resumption of CPR. D. Avoid defibrillation because this will damage the patient's AICD

C

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

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

A

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

A

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

A

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for: A. congestive heart failure. B. a cardiac arrhythmia. C. significant hypotension. D. right ventricular failure

A

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. 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

The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they A. are in denial. B. do not trust EMTs. C. are elderly. D. cannot afford it.

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. somatic nervous system. C. parietal lobe. D. pons and medulla

A

What is the function of the left atrium? A. It receives oxygenated blood from the lungs. B. It receives oxygenated blood from the vena cava. C. It ejects oxygenated blood into the aorta. D. It receives blood from the pulmonary arteries

A

When preparing to obtain a 12-lead ECG, the V 1 and V 2 electrodes should be placed: A. on either side of the sternum. B. in the midclavicular line. C. in the midaxillary line. D. on the left and right arms

A

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

A

Which of the following is the MOST likely cause of artifact on an ECG tracing? A. Excessive movement of the patient B. Irregular patient pulse C. Incorrect placement of the leads D. Abnormal cardiac electrical activity

A

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

A

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. Trouble breathing while lying down C. The presence of rales in the lungs D. Hypertension and tachycardia

A

Which of the following veins is located inferior to the trunk? A. Saphenous B. Cephalic C. Axillary D. Subclavian

A

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

A

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. begin high-quality CPR and apply the AED as soon as possible. B. have your partner perform CPR while you question the bystanders. C. perform two-rescuer CPR for 5 minutes and request ALS backup. D. immediately apply the AED pads and analyze his cardiac rhythm

A

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. bag-mask ventilation at 10 breaths/min and assessment of oxygen saturation. B. oxygen via nonrebreathing mask at 15 L/min and immediate transport. C. insertion of an oropharyngeal airway and positioning him on his side. D. elevation of his lower extremities and covering him with warm blankets.

A

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

Cardiogenic shock following AMI is caused by: A. widespread dilation of the systemic vasculature. B. decreased pumping force of the heart muscle. C. a profound increase in the patient's heart rate. D. hypovolemia secondary to severe vomiting.

B

It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing: A. difficulty breathing that awakens the patient from sleep. B. chest pain that does not immediately subside with rest. C. an acute onset of dizziness during a period of exertion. D. sharp chest pain that lasts longer than 10 to 15 minutes.

B

Nitroglycerin is contraindicated in patients: A. who have taken up to two doses. B. who have experienced a head injury. C. with a history of an ischemic stroke. D. with a systolic blood pressure less than 120 mm Hg.

B

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

B

Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: A. regularly take illegal drugs. B. have chronic hypertension. C. have had a stroke in the past. D. are older than 40 years of age.

B

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

B

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

B

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the: A. kidneys. B. brain. C. legs. D. abdomen.

B

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

B

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

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

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

B

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

B

Which of the following is NOT a function of the sympathetic nervous system? A. Increases in the heart and respiratory rates B. Constriction of blood vessels in the muscles C. Constriction of blood vessels in the digestive system D. Dilation of blood vessels in the muscles

B

Which of the following statements regarding the AED and defibrillation is correct? A. The AED will shock any rhythm not accompanied by a pulse. 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. Defibrillation is the first link in the AHA chain of survival.

B

Which of the following statements regarding the pain associated with AMI is correct? A. It often fluctuates in intensity when the patient breathes. B. It can occur during exertion or when the patient is at rest. C. It is often described by the patient as a sharp feeling. D. Nitroglycerin usually resolves the pain within 30 minutes.

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

C

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

C

Acute coronary syndrome (ACS) is a term used to describe: A. a severe decrease in perfusion caused by changes in heart rate. B. the exact moment that a coronary artery is completely occluded. C. a group of symptoms that are caused by myocardial ischemia. D. the warning signs that occur shortly before a heart attack

C

After assisting your patient with prescribed nitroglycerin, you should A. perform a secondary assessment before administering further doses. B. place the patient in a recumbent position in case of fainting. C. reassess his or her blood pressure within 5 minutes to detect hypotension. D. avoid further dosing if the patient complains of a severe headache.

C

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

C

Common side effects of nitroglycerin include all of the following, EXCEPT A. hypotension. B. severe headache. C. hypertension. D. bradycardia.

C

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

C

In contrast to the sympathetic nervous system, the parasympathetic nervous system: A. causes an increase in the heart rate. B. prepares the body to handle stress. C. slows the heart and respiratory rates. D. dilates the blood vessels in the muscles.

C

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

C

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

C

Most AEDs are set up to adjust the voltage based on the impedance, which is the A. distance between the two AED pads on the chest. B. actual amount of energy that the AED will deliver. C. resistance of the body to the flow of electricity. D. direction that the electrical flow takes in the body.

C

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

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. wait at least 5 minutes after assessing the blood pressure. C. obtain authorization from medical control. D. determine who prescribed the nitroglycerin.

C

The EMT should use an AED on a child between 1 month and 8 years of age if: A. his or her condition is rapidly progressing to cardiac arrest. B. he or she is not breathing and has a weakly palpable pulse. C. pediatric pads and an energy-reducing device are available. D. special pads are used and the child has profound tachycardia.

C

The MOST common error associated with the use of the AED is: A. inappropriately placed adhesive defibrillation electrodes. B. malfunction of the AED's internal computer processor. C. failure of the EMT to ensure the battery is charged. D. inability of the EMT to recognize ventricular fibrillation.

C

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

C

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

C

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

C

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

C

Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? A. Heart rate less than 60 beats/min B. Generalized weakness C. Rapid heart rate D. Syncope or dizziness

C

Which of the following is the MOST reliable method of estimating a patient's cardiac output? A. Connect the patient to an electrocardiogram. B. Listen to heart sounds with a stethoscope. C. Assess the heart rate and strength of the pulse. D. Determine the average diastolic blood pressure

C

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

C

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

C

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

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

D

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: A. defibrillate with the AED while continuing transport to the hospital. B. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. C. alert the receiving hospital and perform CPR for the duration of the transport. D. stop the ambulance, begin CPR, and attach the AED as soon as possible.

D

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 leave the vest in place. 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 then remove the vest

D

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? A. Obstructive lung disease B. Uncontrolled hypertension C. Thoracic aortic aneurysm D. Acute myocardial infarction

D

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

D

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. bypassing the coronary artery with a vessel from the chest or leg. C. scraping fatty deposits off of the lumen of the coronary artery. D. dilating the affected coronary artery with a small inflatable balloon.

D

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

D

Angina pectoris occurs when A. a coronary artery is totally occluded by plaque. B. myocardial oxygen supply exceeds the demand. C. one or more coronary arteries suddenly spasm. D. myocardial oxygen demand exceeds supply.

D

Blood that is ejected from the right ventricle A. enters the systemic circulation. B. has a high concentration of oxygen. C. was received directly from the aorta. D. flows into the pulmonary arteries.

D

When the myocardium requires more oxygen: A. the heart rate decreases significantly. B. the heart contracts with less force. C. the AV node conducts fewer impulses. D. the arteries supplying the heart dilate.

D

Cardiac output may decrease if the heart beats too rapidly because: 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

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

D

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 A. the AED detected patient motion. B. she has a pulse and does not need CPR. C. the AED has detected asystole. D. she is not in ventricular fibrillation.

D

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

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

D

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

D

The left ventricle has the thickest walls because it A. receives blood directly from the systemic circulation. B. uses less oxygen than other chambers of the heart. C. pumps blood to the lungs to be reoxygenated. D. pumps blood into the aorta and systemic circulation.

D

The purpose of defibrillation is to: A. prevent asystole from deteriorating into ventricular fibrillation. B. cause a rapid decrease in the heart rate of an unstable patient. C. improve the chance of CPR being successful in resuscitation. D. stop the chaotic, disorganized contraction of the cardiac cells.

D

The right coronary artery supplies blood to the: A. left ventricle and inferior wall of the right atrium. B. right atrium and posterior wall of the right ventricle. C. left ventricle and posterior wall of the right ventricle. D. right ventricle and inferior wall of the left ventricle

D

Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: A. request a paramedic unit for assistance. B. gain immediate access to the patient. C. determine if you need additional help. D. assess the scene for potential hazards

D

When treating a patient with chest pain, you should assume that he or she is having an AMI because: A. angina and AMI present identically. B. most patients with chest pain are experiencing an AMI. C. angina usually occurs after an AMI. D. the cause of the pain cannot be diagnosed in the field.

D

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

D

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

D

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

D

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

D

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

D

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

D

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

c