EMT - Chapter 17 - Cardiovascular Emergencies
17.17.1 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. Apply continuous positive airway pressure (CPAP) B. Insert a nasal airway C. Place the patient in the shock position D. Administer four baby aspirins
A. Apply continuous positive airway pressure (CPAP)
17.14.4 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. Applying oxygen through a nasal cannula B. Administering three baby aspirins to the patient C. Determining the patient's blood glucose D. Palpating the chest wall for tenderness
A. Applying oxygen through a nasal cannula
17.12.4 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. Palpate the flanks and back C. Auscultate the lower abdominal quadrants D. Examine the back for bruising
A. Assess the abdomen
17.2.13 An obstruction of the pulmonary artery will cause: A. Backup of blood in the right side of the heart B. Backup of blood in the left side of the heart C. Increased blood flow through the vena cava D. Increased blood flow through the aorta
A. Backup of blood in the right side of the heart
17.2.15 Which of these statements regarding contraction of the heart is true? A. Both atria contract together just before both ventricles contract together B. The two ventricles contract simultaneously, moving blood into the atria C. The right atria and ventricle contract together, moving blood to the left side D. When the left ventricle contracts, it sends blood into the lungs for oxygenation
A. Both atria contract together just before both ventricles contract together
17.2.7 All arteries: A. Carry blood away from the heart B. Are located in the torso of the body C. Carry oxygen-rich blood D. Have lower pressure than veins
A. Carry blood away from the heart
17.11.7 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. Chest discomfort is not relieved by nitroglycerin B. Pain radiates into the left arm C. The patient complains of mild shortness of breath D. The patient's skin is not diaphoretic
A. Chest discomfort is not relieved by nitroglycerin
17.17.6 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. Contact medical command for advice B. Administer high-concentration oxygen C. Give one baby aspirin D. Try one nitroglycerin for pain relief
A. Contact medical command for advice
17.4.2 On an ECG, the QRS represents: A. Contraction of the ventricles B. Contraction of both the atria and the ventricles C. Contraction of the atria D. The heart at rest following contraction
A. Contraction of the ventricles
17.9.7 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. Crackles in the bases of both lungs B. Heart rate of 62 beats/min C. Difficulty breathing when in an upright position D. SpO2 of 95% with no supplemental oxygen
A. Crackles in the bases of both lungs
17.1.2 What are the protein strands that strengthen a clot called? A. Fibrin B. Thrombin C. Platelets D. Plaque
A. Fibrin
17.2.2 The tricuspid valve prevents blood from: A. Flowing from the right ventricle into the right atrium B. Regurgitating between the right and left ventricles C. Flowing backward through the left atrium D. Bypassing the pulmonary vessels and entering the left heart
A. Flowing from the right ventricle into the right atrium
17.3.2 The primary control or automaticity of the heart rate originates in the: A. Heart B. Endocrine system C. Brainstem D. Nervous system
A. Heart
17.19.1 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. Internal bleeding B. Hypoglycemia C. Hypertension D. Respiratory arrest
A. Internal bleeding
17.6.4 Chronic and untreated hypertension will affect which part of the heart first? A. Left ventricle B. Aorta C. Vena cava D. Right atrium
A. Left ventricle
Chapter Test 17.14.8 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. Nonrebreather 15 lpm C. Nasal cannula 4 lpm D. Nasal cannula 6 lpm
A. Nasal cannula 2 lpm
17.16.11 The EMT should most suspect a patient has angina when he takes which medication? A. Nitroglycerin B. Glucophage C. Lasix D. Aspirin
A. Nitroglycerin
17.11.5 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 oxygen and nitroglycerin, and then transport the patient C. Assist the patient in taking a nitroglycerin tablet D. Administer baby aspirin to the patient
A. Transfer the patient to the stretcher and begin transport
17.5.2 Failure to promptly treat ventricular tachycardia can result in myocardial cell hypoxia and ischemia, which then contributes to the rhythm deteriorating to: A. Ventricular fibrillation B. Asystole C. Sinus rhythm D. Pulseless electrical activity
A. Ventricular fibrillation
17.16.5 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. "I always check for an allergy to sulfa, since most people with an allergy to sulfa also have an allergy to nitroglycerin." D. "If the patient with chest pain also has a headache, the EMT should contact medical command prior to administering nitroglycerin."
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."
17.15.3 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 have this bruising on my arms and legs." C. "My hair has become very brittle." D. "I feel very thirsty right now."
A. "I have a history of left-sided heart failure."
17.16.8 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. "It is best to keep the nitroglycerin in a dark container since light will inactivate it." B. "You should keep your nitroglycerin in the refrigerator since it will keep longer in the cold." C. "The heat from the refrigerator will cause the nitroglycerin to lose its effectiveness." D. "Keeping the nitroglycerin on top of the refrigerator may make it difficult for you to reach it in an emergency."
A. "It is best to keep the nitroglycerin in a dark container since light will inactivate it."
17.16.10 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. "The chest pain does not feel any different." B. "It is easier to breathe now." C. "My tongue is stinging and burning." D. "I seem to be getting a headache."
A. "The chest pain does not feel any different."
17.7.1 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. "The coronary arteries become damaged and narrowed by fat deposits." B. "Atherosclerosis affects the veins in the body and is caused by untreated high blood pressure." C. "Atherosclerosis affects the arteries of the heart and is caused by a heart attack." D. "The walls of the coronary arteries lose elasticity, which can lead to a heart attack."
A. "The coronary arteries become damaged and narrowed by fat deposits."
17.2.16 The EMT understands diastolic blood pressure when he defines it as: A. "The pressure in the arteries between cardiac contractions." B. "The pressure in the venous system when the heart is at rest." C. "The pressure in the arterial system when the heart contracts." D. "The pressure needed to move blood through the cardiovascular system."
A. "The pressure in the arteries between cardiac contractions."
17.18.7 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 SpO2, 97% on room air. The patient took 81 mg of aspirin as prescribed this morning on awakening. What should you do first? A. Administer another aspirin B. Assess breath sounds C. Provide supplemental oxygen D. Assist the patient with taking nitroglycerin
B. Assess breath sounds
17.13.1 Which of these patients is most likely to suffer a silent MI? A. A 60-year-old female with colon cancer B. A 55-year-old female with diabetes C. A 72-year-old male with a syncopal episode D. A 48-year-old male with undiagnosed hypertension
B. A 55-year-old female with diabetes
17.2.3 A patient has a low platelet count. Based on this finding, which complication is he most at risk for? A. Hypotension B. Bleeding C. Angina D. Clot formation
B. Bleeding
17.8.4 Which of these statements regarding cardiac compromise or acute coronary syndrome should the EMT recognize as true? A. The onset of acute coronary syndrome typically occurs with physical activity B. Cardiac compromise should be suspected for any patient with chest discomfort C. Patients suffering from acute coronary syndrome will have pain, not discomfort D. If the pain does not radiate to the arms, then the cause is not typically the heart
B. Cardiac compromise should be suspected for any patient with chest discomfort
17.16.12 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. Check her blood glucose level D. Position her in an upright position
B. Check her blood pressure
17.10.5 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. Attach the AED but do not turn it on B. Check the patient's vital signs C. Administer a nitroglycerin tablet and aspirin D. Provide supplemental oxygen via nonrebreather
B. Check the patient's vital signs
17.17.3 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. Dizziness when going from a supine to standing position suddenly B. Different blood pressure readings in each arm C. Lower back pain described as a constant ache D. History of hypertension and lower back injury
B. Different blood pressure readings in each arm
17.2.5 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 C. Increased heart rate and decreased blood pressure D. Decreased heart rate
B. Increased heart rate
17.5.1 Dysfunction of the heart's electrical conduction cells from ischemia or infarction may cause: A. Lung collapse B. Irregular heartbeats C. Hyperventilation D. Blood loss
B. Irregular heartbeats
17.9.8 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. Multiple pillows stacked at the head of the patient's bed
17.10.3 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. Assist the patient to the ambulance for immediate transport D. Perform a secondary assessment
B. Obtain the patient's heart rate and blood pressure
17.17.4 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. Nocturnal dyspnea D. Tachypnea
B. Orthopnea
17.1.1 In the blood, which component is largely responsible for the formation of blood clots? A. Plasma B. Platelets C. White blood cells D. Red blood cells
B. Platelets
17.12.3 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. Wheezing noted in the bases of both lungs B. Pulsating mass in the abdomen C. Heart rate of 84 beats/min D. SpO2 of 94% despite supplemental oxygen
B. Pulsating mass in the abdomen
17.2.14 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. Red blood cells C. Pulmonary arteries D. Platelets
B. Red blood cells
17.3.1 The primary pacemaker site of the heart is the: A. Brainstem B. Sinoatrial node C. Right atrium D. Ventricular node
B. Sinoatrial node
17.16.2 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. Topical B. Sublingual C. Buccal D. Oral
B. Sublingual
17.16.4 Prior to administering nitroglycerin to a patient with chest pain, the EMT must ensure that: A. The patient is standing in an upright position B. The nitroglycerin is prescribed for the patient C. The patient's systolic blood pressure is greater than 110 mmHg D. The patient rates his chest pain as 10 out of 10
B. The nitroglycerin is prescribed for the patient
17.6.1 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. The right side of the heart will weaken
17.2.12 Which of these identifies the major elements of the pathway that blood takes through the heart in the correct sequence? A. Aorta, left atrium, left ventricle, pulmonary capillary B. Vena cava, right ventricle, pulmonary artery, left ventricle, aorta C. Pulmonary vein, pulmonary capillary, pulmonary artery, right ventricle D. Right atrium, left atrium, left ventricle, right ventricle
B. Vena cava, right ventricle, pulmonary artery, left ventricle, aorta
17.14.1 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 going to put the patient on high-concentration oxygen because she has chest discomfort." C. "I am not going to attach the AED, because the patient is conscious and has a pulse." D. "I am not going to give the patient any aspirin, because she says that she is allergic to it."
B. "I am going to put the patient on high-concentration oxygen because she has chest discomfort."
17.12.1 Which of these statements made by the patient should cause the EMT to suspect an abdominal aortic aneurysm? A. "I seem to be vomiting up some blood." B. "I have belly pain that I also feel in my back." C. "The pain is sharp and spreads to both arms." D. "My heart is beating so hard, you can feel it on my chest."
B. "I have belly pain that I also feel in my back."
17.16.3 Which instruction given by an EMT indicates the proper administration of nitroglycerin? A. "Please chew and swallow this pill." B. "Let this pill dissolve under your tongue." C. "Breathe in when I spray the nitroglycerin into your mouth." D. "This pill will go between your cheek and gum."
B. "Let this pill dissolve under your tongue."
17.8.2 Which of these statements would the EMT expect from a patient with unstable angina? A. "When I stop what I am doing, the pain goes away." B. "The chest pain awakens me from my nighttime sleep." C. "If I take a nitroglycerin tablet, the pain stops." D. "The antacid my doctor prescribed seems to take the pain away."
B. "The chest pain awakens me from my nighttime sleep."
17.6.3 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. "I have to take two blood pressure medications at the same time to get my pressure down." B. "The doctor checks my blood pressure regularly and it's not normally that high." 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."
B. "The doctor checks my blood pressure regularly and it's not normally that high."
17.19.2 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. "My doctor told me to take a baby aspirin every day." B. "Two months ago, I had a stroke on the left side of my brain." C. "I had my appendix removed six months ago." D. "I have high blood pressure for which I take medication."
B. "Two months ago, I had a stroke on the left side of my brain."
17.10.4 When obtaining a medical history, which of these statements made by the patient seemingly indicates that he is suffering from classic angina? A. "I took five nitroglycerin tablets over 20 minutes to get rid of the pain." B. "When I stopped cutting the grass, the pain went away." C. "The pain lasted about 45 minutes before gradually going away." D. "The pain started when I was sitting down reading the paper."
B. "When I stopped cutting the grass, the pain went away."
17.19.5 Which of these therapies is the best option for definitively treating a known myocardial infarction (AMI)? A. Fibrinolytics B. Oxygen C. Angioplasty D. Oxygen, aspirin, and nitroglycerin
C. Angioplasty
17.11.2 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. Assist the patient with his nitroglycerin B. Obtain vital signs and give aspirin C. Apply continuous positive airway pressure (CPAP) D. Apply but do not turn on the AED
C. Apply continuous positive airway pressure (CPAP)
17.18.1 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 SpO2, 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. Perform the secondary exam B. Administer oral glucose C. Apply supplemental oxygen D. Check the patient's blood sugar
C. Apply supplemental oxygen
17.9.3 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. Approval from medical direction D. Patient has a prescription for aspirin
C. Approval from medical direction
17.9.6 When assessing a patient in the prehospital setting, which of these does the EMT recognize as an indication for aspirin? A. Systolic blood pressure greater than 100 mmHg B. An aspirin taken daily for cardiovascular disease C. Chest discomfort that is suggestive of a heart attack D. Complaint of a headache after taking nitroglycerin
C. Chest discomfort that is suggestive of a heart attack
17.8.3 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. Right ventricular failure B. Hypertensive emergency C. Congestive heart failure D. Left ventricular failure
C. Congestive heart failure
17.9.9 Which sign or symptom would the EMT typically associate with congestive heart failure? A. Edema to the left arm B. Feeling of palpitations C. Crackles in both lungs D. Rhonchi to both lungs that is cleared by a cough
C. Crackles in both lungs
17.14.7 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 SpO2 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. Discontinue oxygen therapy B. Increase the oxygen flow to 4 lpm C. Decrease the oxygen flow to 2 lpm D. Leave the oxygen flow unchanged
C. Decrease the oxygen flow to 2 lpm
17.9.4 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. Treating the headache that may occur when nitroglycerin is administered C. Decreasing the ability of the platelets in the blood to form clots D. Decreasing the chest pain caused by the possible heart attack
C. Decreasing the ability of the platelets in the blood to form clots
17.16.9 Which action is it essential that the EMT take prior to assisting the patient in taking his nitroglycerin tablet? A. Determine whether the patient had a stroke within the last 6 months B. Inquire about whether the patient is allergic to sulfa drugs C. Evaluate the patient's systolic blood pressure and heart rate D. Determine the presence or absence of a headache
C. Evaluate the patient's systolic blood pressure and heart rate
17.2.10 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. Decreased blood pressure B. Increase in respirations C. Increase in heart rate D. Decrease in heart rate
C. Increase in heart rate
17.2.11 Sympathetic nervous system stimulation will cause the heart to: A. Decrease automaticity B. Lower the systolic blood pressure C. Increase the heart rate D. Decrease in rate
C. Increase the heart rate
17.12.5 For a patient with a history of an unstable abdominal aortic aneurysm, the EMT should recognize and prepare for: A. Decreased perfusion to the upper extremities B. Vomiting and airway occlusion C. Massive internal bleeding D. Hypoxia caused by lung compression
C. Massive internal bleeding
17.9.10 Which structure of the neck would the EMT examine on a patient she believes to be in congestive heart failure? A. Clavicles B. Lateral muscles C. Neck veins D. Trachea
C. Neck veins
17.11.4 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. Semi-Fowler's position B. Supine with head elevated C. Position of comfort D. Lateral recumbent
C. Position of comfort
17.18.2 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 SpO2, 95%. Which of these actions would be of the most immediate benefit to the patient? A. Administer four baby aspirins B. Elevate both legs to decrease swelling C. Position the patient in a sitting upright position D. Obtain a medical history and test the blood glucose
C. Position the patient in a sitting upright position
17.9.2 When treating a patient with chest discomfort, the EMT's primary goal is to: A. Provide immediate care to eliminate the chest discomfort, and then transport the patient to the hospital B. Administer fibrinolytic drugs with the permission of medical direction C. Recognize the possibility of cardiac compromise and provide proper emergency care D. Determine whether chest discomfort is originating from the heart
C. Recognize the possibility of cardiac compromise and provide proper emergency care
17.19.4 To save additional heart muscle from dying when a patient suffers an acute myocardial infarction (heart attack), which treatment must occur? A. Lowering the blood pressure B. Opening blood flow between the atria and ventricles C. Relieving the obstruction in the coronary arteries D. Increasing the heart rate
C. Relieving the obstruction in the coronary arteries
17.6.2 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. High blood sugar B. Syncope C. Stroke D. Hypertensive emergency
C. Stroke
17.11.1 If a clot occludes the blood flow through the coronary artery, what will be the detrimental effect? A. The flow of oxygen-rich blood through the peripheral arteries will cease B. Blood will not be able to flow between the left atrium and the left ventricle C. The flow of oxygen-rich blood to the muscle of the ventricle will be decreased D. Blood and fluid will back up into the lung tissue, causing pulmonary edema
C. The flow of oxygen-rich blood to the muscle of the ventricle will be decreased
17.16.7 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. Administer half of a nitroglycerin tablet B. Increase the oxygen to 4 lpm C. Transfer the patient to the stretcher and begin transport D. Administer a third nitroglycerin tablet
C. Transfer the patient to the stretcher and begin transport
17.4.1 The EMT understands the ECG when he makes which of these statements about the waveform? A. "The ECG can be used to determine how well the heart is pumping blood." B. "An ECG indicates the amount of blood in the heart." C. "An ECG represents the electrical activity of the heart." D. "The ECG shows how well the heart is oxygenating blood."
C. "An ECG represents the electrical activity of the heart."
17.10.1 You are interviewing a patient whom you suspect has an acute coronary syndrome. Which question is most appropriate initially? A. "Does it hurt when I press on your chest?" B. "Does your chest hurt when you breathe?" C. "Are you having any chest discomfort?" D. "Are you having any pain in your chest?"
C. "Are you having any chest discomfort?"
17.12.6 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 SpO2, 95% on room air. Which of these statements made by the patient would make you intervene immediately? A. "I am going to check my blood sugar with my own glucometer." B. "I am going to leave my home oxygen on 2 liters since it seems to have helped my breathing." C. "I am going to take my daily aspirin since I did not take it this morning." D. "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."
17.18.3 Which of these statements made by the patient should the EMT associate with the condition of congestive heart failure? A. "I can feel my heart pounding in my head and I have a throbbing headache." B. "I noticed that I am having a hard time breathing and have a fever." C. "I have a hard time breathing when I am lying down." D. "When I walk, I feel very weak and get quite dizzy."
C. "I have a hard time breathing when I am lying down."
17.13.2 Regarding women and cardiac compromise, with which of these statements would you agree? A. "Although the risk of MI decreases with age, women should take daily aspirin as they get older." B. "Most women have right-sided chest pain without dyspnea or palpitations when having an MI." C. "The death rate for women suffering a heart attack is higher than that for men." D. "Most women, unless they are diabetic, will suffer from chest discomfort as opposed to pain when having an MI."
C. "The death rate for women suffering a heart attack is higher than that for men."
17.7.2 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 started taking an antianxiety medication last week." B. "I occasionally feel that my heart seems to skip a beat." C. "The pain came on suddenly when I was reading the paper." D. "I have had chest pain on and off for years now."
C. "The pain came on suddenly when I was reading the paper."
17.14.6 On room air, which of these patients requires supplemental oxygen? A. 52-year-old male; chest pain; history of MI; SpO2, 95% B. 39-year-old male; complaint of tingling in hands; headache; respirations, 30 breaths/min; SpO2, 98% C. 47-year-old female; temperature 100.3degreesF; denies dyspnea; SpO2, 91% D. 66-year-old female; generalized weakness; history of diabetes; SpO2, 97%
C. 47-year-old female; temperature 100.3degreesF; denies dyspnea; SpO2, 91%
17.2.9 The three primary components of the cardiovascular system are best described as: A. Heart, lungs, and blood vessels B. Heart, blood vessels, and brainstem C. Heart, blood vessels, and blood D. Arteries, veins, and capillaries
C. Heart, blood vessels, and blood
17.9.5 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 let it dissolve under the tongue D. 325 mg of baby aspirin and instructs the patient to chew it
D. 325 mg of baby aspirin and instructs the patient to chew it
17.18.5 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. Check the heart rate, blood pressure, and SpO2 B. Continue CPR and wait for ALS care C. Place the patient on the stretcher so ALS can provide care en route D. Apply and use the automated external defibrillator
D. Apply and use the automated external defibrillator
17.17.5 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. Administer one baby aspirin D. Apply oxygen
D. Apply oxygen
17.18.4 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. Auscultate his breath sounds C. Obtain a full set of vital signs D. Check his radial pulse
D. Check his radial pulse
17.18.6 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. Attach the AED B. Provide oxygen C. Start the secondary assessment D. Check vital signs
D. Check vital signs
17.2.1 The primary function of the heart is to: A. Store blood B. Produce blood C. Oxygenate blood D. Circulate blood
D. Circulate blood
17.11.3 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. Shortness of breath D. Crackles in the lungs
D. Crackles in the lungs
17.2.4 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. Dilates the arteries
17.17.2 An elderly patient with diabetes who experiences a silent MI will most likely: A. Be taking pain medications that mask the heart pain B. Be on continuous home oxygen C. Experience chest pain but deny that anything is wrong D. Not be awakened by a heart attack as he sleeps
D. Not be awakened by a heart attack as he sleeps
17.10.2 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. Apply supplemental oxygen through a nasal cannula B. Administer the first of up to three nitroglycerin tablets C. Determine if there is a family history of cardiac illness D. Obtain a heart rate, respiratory rate, blood pressure, and SpO2 reading
D. Obtain a heart rate, respiratory rate, blood pressure, and SpO2 reading
17.2.6 After blood enters the right ventricle, it next moves into the: A. Aorta B. Left ventricle C. Left atrium D. Pulmonary artery
D. Pulmonary artery
17.14.5 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. Pulse oximetry reading
17.12.2 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 SpO2, 96% on room air. At this time, you should: A. Assist the patient with his nitroglycerin B. Encourage the patient to take an antacid such as Maalox C. Provide the patient with 325 mg of aspirin D. Recheck the blood pressure in the other arm
D. Recheck the blood pressure in the other arm
17.6.5 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 SpO2, 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 heart rate increase to 92 beats/min B. The SpO2 increase to 94% C. The respirations increase to 24 breaths/min D. The blood pressure increase to 110/64 mmHg
D. The blood pressure increase to 110/64 mmHg
17.14.2 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. Administer aspirin, monitor the patient, and transport B. Assist the patient is trying her husband's nitroglycerin C. Administer the patient's MDI and transport her to the hospital D. Turn down the oxygen to 2 lpm, monitor, and transport
D. Turn down the oxygen to 2 lpm, monitor, and transport
17.19.3 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. Allergy to aspirin and penicillin C. Blood glucose level of 80 mg/dL D. Use of anticoagulant medication
D. Use of anticoagulant medication
17.16.1 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 has a sedative effect on the brain, making you less aware of the pain." C. "It causes the body to relax, decreasing the need for oxygen." D. "It dilates the blood vessels, which decreases the workload of the heart."
D. "It dilates the blood vessels, which decreases the workload of the heart."
17.14.3 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. "Since extra oxygen slows the respiratory rate, it also causes the body to retain CO2, which is not beneficial for heart patients." 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. "It has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful."
D. "It has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful."
17.8.1 Which of these statements made by another EMT, regarding chest pain and acute coronary syndrome, is correct? A. "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. "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." 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. "Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure."
D. "Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure."
