Chapter 17: Cardiovascular Emergencies
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: Select one: A. "Atherosclerosis affects the arteries of the heart and is caused by a heart attack." B. "The coronary arteries become damaged and narrowed by fat deposits." C. "Atherosclerosis affects the veins in the body and is caused by untreated high blood pressure." D. "The walls of the coronary arteries lose elasticity, which can lead to a heart attack."
. "The coronary arteries become damaged and narrowed by fat deposits."
Which of these statements made by the EMT indicates a safe understanding of the administration of nitroglycerin in the prehospital setting? Select one: 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. "I always check for an allergy to sulfa, since most people with an allergy to sulfa also have an allergy to nitroglycerin." C. "Since nitroglycerin constricts the blood vessels, you must always check the blood pressure before and after giving it." 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."
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? Select one: A. "I am going to put the patient on high-concentration oxygen because she has chest discomfort." B. "I will contact medical direction for permission to administer the patient's nitroglycerin." 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."
A. "I am going to put the patient on high-concentration oxygen because she has chest discomfort."
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? Select one: A. "I have a history of left-sided heart failure." B. "I have this bruising on my arms and legs." C. "I feel very thirsty right now." D. "My hair has become very brittle."
A. "I have a history of left-sided heart failure."
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: Select one: 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. "Since extra oxygen slows the respiratory rate, it also causes the body to retain CO2, which is not beneficial for heart patients." D. "That may have been an oversight, given that chest pain is caused by a lack of oxygen-rich blood delivery through the coronary arteries."
A. "It has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful."
Which instruction given by an EMT indicates the proper administration of nitroglycerin? Select one: A. "Let this pill dissolve under your tongue." B. "This pill will go between your cheek and gum." C. "Please chew and swallow this pill." D. "Breathe in when I spray the nitroglycerin into your mouth."
A. "Let this pill dissolve under your tongue."
Which of these statements made by another EMT, regarding chest pain and acute coronary syndrome, is correct? Select one: A. "Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure." 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 patient's chest pain does not go away with nitroglycerin treatment, the EMT should assume that the medication is expired and ineffective." D. "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."
A. "Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure."
Which of these statements would the EMT expect from a patient with unstable angina? Select one: A. "The chest pain awakens me from my nighttime sleep." B. "If I take a nitroglycerin tablet, the pain stops." C. "The antacid my doctor prescribed seems to take the pain away." D. "When I stop what I am doing, the pain goes away."
A. "The chest pain awakens me from my nighttime sleep."
The EMT understands diastolic blood pressure when he defines it as: Select one: 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
On room air, which of these patients requires supplemental oxygen? Select one: A. 47-year-old female; temperature 100.3°F; denies dyspnea; SpO2, 91% B. 52-year-old male; chest pain; history of MI; SpO2, 95% C. 66-year-old female; generalized weakness; history of diabetes; SpO2, 97% D. 39-year-old male; complaint of tingling in hands; headache; respirations, 30 breaths/min; SpO2, 98%
A. 47-year-old female; temperature 100.3°F; denies dyspnea; SpO2, 91%
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? Select one: A. Assess breath sounds B. Assist the patient with taking nitroglycerin C. Provide supplemental oxygen D. Administer another aspirin
A. Assess breath sounds
An obstruction of the pulmonary artery will cause: Select one: A. Backup of blood in the right side of the heart B. Increased blood flow through the aorta C. Increased blood flow through the vena cava D. Backup of blood in the left side of the heart
A. Backup of blood in the right side of the heart
All arteries: Select one: A. Carry blood away from the heart B. Have lower pressure than veins C. Carry oxygen-rich blood D. Are located in the torso of the body
A. Carry blood away from the heart
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: Select one: A. Contact medical command for advice B. Try one nitroglycerin for pain relief C. Give one baby aspirin D. Administer high-concentration oxygen
A. Contact medical command for advice
On an ECG, the QRS represents: Select one: A. Contraction of the ventricles B. Contraction of the atria C. Contraction of both the atria and the ventricles D. The heart at rest following contraction
A. Contraction of the ventricles
Chronic and untreated hypertension will affect which part of the heart first? Select one: A. Left ventricle B. Vena cava C. Aorta D. Right atrium
A. Left ventricle
In the blood, which component is largely responsible for the formation of blood clots? Select one: A. Platelets B. Plasma C. Red blood cells D. White blood cells
A. Platelets
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? Select one: A. Position the patient in a sitting upright position B. Elevate both legs to decrease swelling C. Administer four baby aspirins D. Obtain a medical history and test the blood glucose
A. Position the patient in a sitting upright position
After blood enters the right ventricle, it next moves into the: Select one: A. Pulmonary artery B. Aorta C. Left ventricle D. Left atrium
A. Pulmonary artery
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? Select one: A. Pulsating mass in the abdomen B. Wheezing noted in the bases of both lungs C. Heart rate of 84 beats/min D. SpO2 of 94% despite supplemental oxygen
A. Pulsating mass in the abdomen
A patient who is chronically hypoxic because of anemia most likely has a problem with which component of the cardiovascular system? Select one: A. Red blood cells B. White blood cells C. Pulmonary arteries D. Platelets
A. Red blood cells
The primary pacemaker site of the heart is the: Select one: A. Sinoatrial node B. Right atrium C. Brainstem D. Ventricular node
A. Sinoatrial node
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: Select one: A. Stroke B. Hypertensive emergency C. Syncope D. High blood sugar
A. Stroke
Prior to administering nitroglycerin to a patient with chest pain, the EMT must ensure that: Select one: A. The nitroglycerin is prescribed for the patient B. The patient's systolic blood pressure is greater than 110 mmHg C. The patient is standing in an upright position D. The patient rates his chest pain as 10 out of 10
A. The nitroglycerin is prescribed for the patient
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: Select one: A. Transfer the patient to the stretcher and begin transport B. Increase the oxygen to 4 lpm C. Administer a third nitroglycerin tablet D. Administer half of a nitroglycerin tablet
A. Transfer the patient to the stretcher and begin transport
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? Select one: A. Use of anticoagulant medication B. History of previous heart attack C. Blood glucose level of 80 mg/dL D. Allergy to aspirin and penicillin
A. Use of anticoagulant medication
Failure to promptly treat ventricular tachycardia can result in myocardial cell hypoxia and ischemia, which then contributes to the rhythm deteriorating to: Select one: A. Ventricular fibrillation B. Pulseless electrical activity C. Sinus rhythm D. Asystole
A. Ventricular fibrillation
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? Select one: A. "I am going to check my blood sugar with my own glucometer." B. "I am going to take my daily aspirin since I did not take it this morning." C. "I am going to leave my home oxygen on 2 liters since it seems to have helped my breathing." D. "Since I am not having chest pain, I am not going to take my nitroglycerin."
B. "I am going to take my daily aspirin since I did not take it this morning."
Which of these statements made by the patient should cause the EMT to suspect an abdominal aortic aneurysm? Select one: A. "I seem to be vomiting up some blood." B. "I have belly pain that I also feel in my back." C. "My heart is beating so hard, you can feel it on my chest." D. "The pain is sharp and spreads to both arms."
B. "I have belly pain that I also feel in my back."
Regarding women and cardiac compromise, with which of these statements would you agree? Select one: 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. "The death rate for women suffering a heart attack is higher than that for men."
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? Select one: A. "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." C. "My high blood pressure caused my heart to go bad." D. "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.
When obtaining a medical history, which of these statements made by the patient seemingly indicates that he is suffering from classic angina? Select one: 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."
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? Select one: A. Auscultate his breath sounds B. Check his radial pulse C. Determine whether he takes nitroglycerin D. Obtain a full set of vital signs
B. Check his radial pulse
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: Select one: A. Administer a nitroglycerin tablet and aspirin B. Check the patient's vital signs C. Provide supplemental oxygen via nonrebreather D. Attach the AED but do not turn it on
B. Check the patient's vital signs
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? Select one: A. Start the secondary assessment B. Check vital signs C. Attach the AED D. Provide oxygen
B. Check vital signs
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: Select one: A. Hypertensive emergency B. Congestive heart failure C. Left ventricular failure D. Right ventricular failure
B. Congestive heart failure
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? Select one: A. Increase the oxygen flow to 4 lpm B. Decrease the oxygen flow to 2 lpm C. Discontinue oxygen therapy D. Leave the oxygen flow unchanged
B. Decrease the oxygen flow to 2 lpm
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? Select one: A. Bounding radial pulse B. Edema to the feet C. Crackles in both lungs D. Elevated blood pressure
B. Edema to the feet
Which action is it essential that the EMT take prior to assisting the patient in taking his nitroglycerin tablet? Select one: A. Inquire about whether the patient is allergic to sulfa drugs B. Evaluate the patient's systolic blood pressure and heart rate C. Determine the presence or absence of a headache D. Determine whether the patient had a stroke within the last 6 months
B. Evaluate the patient's systolic blood pressure and heart rate
Sympathetic nervous system stimulation will cause the heart to: Select one: A. Decrease in rate B. Increase the heart rate C. Lower the systolic blood pressure D. Decrease automaticity
B. Increase the heart rate
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? Select one: A. Coumadin B. Levitra C. Albuterol D. Methadone
B. Levitra
A patient with chest pain has an SpO2 of 90% on room air. How would you start providing oxygen to this patient? Select one: A. Nasal cannula 6 lpm B. Nasal cannula 2 lpm C. Nasal cannula 4 lpm D. Nonrebreather 15 lpm
B. Nasal cannula 2 lpm
A patient informs you that he has a hard time breathing when he lies in bed. You would best document this report as: Select one: A. Dyspnea B. Orthopnea C. Nocturnal dyspnea D. Tachypnea
B. Orthopnea
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? Select one: A. Semi-Fowler's position B. Position of comfort C. Lateral recumbent D. Supine with head elevated
B. Position of comfort
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: Select one: A. Encourage the patient to take an antacid such as Maalox B. Recheck the blood pressure in the other arm C. Assist the patient with his nitroglycerin D. Provide the patient with 325 mg of aspirin
B. Recheck the blood pressure in the other arm
Which sign or symptom should the EMT expect in a patient who has a chronically low white blood cell count? Select one: A. SpO2 of 91% on room air B. Temperature of 103.4°F C. Bruising to the extremities D. Blood pressure of 156/100 mmHg
B. Temperature of 103.4°F
If a clot occludes the blood flow through the coronary artery, what will be the detrimental effect? Select one: A. Blood will not be able to flow between the left atrium and the left ventricle B. The flow of oxygen-rich blood to the muscle of the ventricle will be decreased C. Blood and fluid will back up into the lung tissue, causing pulmonary edema D. The flow of oxygen-rich blood through the peripheral arteries will cease
B. The flow of oxygen-rich blood to the muscle of the ventricle will be decreased
Which of these statements regarding contraction of the heart is true? Select one: A. The two ventricles contract simultaneously, moving blood into the atria B. When the left ventricle contracts, it sends blood into the lungs for oxygenation C. Both atria contract together just before both ventricles contract together D. The right atria and ventricle contract together, moving blood to the left side
Both atria contract together just before both ventricles contract together
Which of these statements made by the patient should the EMT associate with the condition of congestive heart failure? Select one: A. "When I walk, I feel very weak and get quite dizzy." 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. "I can feel my heart pounding in my head and I have a throbbing headache."
C. "I have a hard time breathing when I am lying down."
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: Select one: A. "It has a sedative effect on the brain, making you less aware of the pain." B. "It causes the body to relax, decreasing the need for oxygen." C. "It dilates the blood vessels, which decreases the workload of the heart." D. "It causes the heart rate to decrease, which relaxes it and decreases pain."
C. "It dilates the blood vessels, which decreases the workload of the heart."
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? Select one: A. "It is easier to breathe now." B. "My tongue is stinging and burning." C. "The chest pain does not feel any different." D. "I seem to be getting a headache."
C. "The chest pain does not feel any different."
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? Select one: 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."
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? Select one: A. "My doctor told me to take a baby aspirin every day." B. "I had my appendix removed six months ago." C. "Two months ago, I had a stroke on the left side of my brain." D. "I have high blood pressure for which I take medication."
C. "Two months ago, I had a stroke on the left side of my brain."
Which of these patients is most likely to suffer a silent MI? Select one: A. A 72-year-old male with a syncopal episode B. A 60-year-old female with colon cancer C. A 55-year-old female with diabetes D. A 48-year-old male with undiagnosed hypertension
C. A 55-year-old female with diabetes
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: Select one: 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. Apply continuous positive airway pressure (CPAP)
ou 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? Select one: A. Administer oral glucose B. Perform the secondary exam C. Apply supplemental oxygen D. Check the patient's blood sugar
C. Apply supplemental oxygen
or the EMT to administer aspirin in the prehospital setting, which of these criteria must be met? Select one: 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
A patient informs you that he has a history of an abdominal aortic aneurysm. To best assess the status of this condition, you should: Select one: A. Palpate the flanks and back B. Examine the back for bruising C. Assess the abdomen D. Auscultate the lower abdominal quadrants
C. Assess the abdomen
A patient has a low platelet count. Based on this finding, which complication is he most at risk for? Select one: A. Angina B. Hypotension C. Bleeding D. Clot formation
C. Bleeding
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? Select one: A. Position her in an upright position B. Inform her that this feeling is normal C. Check her blood pressure D. Check her blood glucose level
C. Check her blood pressure
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? Select one: A. The patient's skin is not diaphoretic B. The patient complains of mild shortness of breath C. Chest discomfort is not relieved by nitroglycerin D. Pain radiates into the left arm
C. Chest discomfort is not relieved by nitroglycerin
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? Select one: A. Difficulty breathing when in an upright position B. SpO2 of 95% with no supplemental oxygen C. Crackles in the bases of both lungs D. Heart rate of 62 beats/min
C. Crackles in the bases of both lungs
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? Select one: A. Shortness of breath B. Flat neck veins C. Crackles in the lungs D. Hypertension
C. Crackles in the lungs
The primary control or automaticity of the heart rate originates in the: Select one: A. Brainstem B. Endocrine system C. Heart D. Nervous system
C. Heart
The pathophysiology of heart failure that causes the common signs and symptoms of cardiogenic shock is: Select one: A. Backup of fluid in the lower extremities B. Poor gas exchange in the lungs C. Inadequate ejection of blood from the left ventricle D. Fluid accumulation within the lung tissue
C. Inadequate ejection of blood from the left ventricle
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? Select one: A. Decreased blood pressure B. Decreased heart rate C. Increased heart rate D. Increased heart rate and decreased blood pressure
C. Increased heart rate
Which portion of the heart, when weakened by a heart attack, is responsible for causing fluid to back up into the alveoli? Select one: A. Pulmonary vein B. Right atrium C. Left ventricle D. Right ventricle
C. Left ventricle
Which of these scene size-up observations would make you suspicious that a patient who complains of shortness of breath has congestive heart failure? Select one: A. Patient in dirty pajamas and appears unkempt B. Dramatic edema to the right arm C. Multiple pillows stacked at the head of the patient's bed D. Home oxygen tank in the bedroom
C. Multiple pillows stacked at the head of the patient's bed
Which structure of the neck would the EMT examine on a patient she believes to be in congestive heart failure? Select one: A. Lateral muscles B. Trachea C. Neck veins D. Clavicles
C. Neck veins
An elderly patient with diabetes who experiences a silent MI will most likely: Select one: A. Experience chest pain but deny that anything is wrong B. Be taking pain medications that mask the heart pain C. Not be awakened by a heart attack as he sleeps D. Be on continuous home oxygen
C. Not be awakened by a heart attack as he sleeps
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? Select one: A. Apply supplemental oxygen through a nasal cannula B. Determine if there is a family history of cardiac illness C. Obtain a heart rate, respiratory rate, blood pressure, and SpO2 reading D. Administer the first of up to three nitroglycerin tablets
C. Obtain a heart rate, respiratory rate, blood pressure, and SpO2 reading
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? Select one: A. Assist the patient in taking a nitroglycerin tablet B. Assist the patient to the ambulance for immediate transport C. Obtain the patient's heart rate and blood pressure D. Perform a secondary assessment
C. Obtain the patient's heart rate and blood pressure
When administering oxygen to a patient with chest pain, which of these should be used a guide to its use and maintenance? Select one: A. Patient rating of pain B. The heart rate C. Pulse oximetry reading D. The respiratory rate
C. Pulse oximetry reading
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? Select one: A. Oral B. Topical C. Sublingual D. Buccal
C. Sublingual
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: Select one: A. The respirations increase to 24 breaths/min B. The heart rate increase to 92 beats/min C. The blood pressure increase to 110/64 mmHg D. The SpO2 increase to 94%
C. The blood pressure increase to 110/64 mmHg
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? Select one: A. Administer oxygen and nitroglycerin, and then transport the patient B. Assist the patient in taking a nitroglycerin tablet C. Transfer the patient to the stretcher and begin transport D. Administer baby aspirin to the patient
C. Transfer the patient to the stretcher and begin transport
The EMT understands the ECG when he makes which of these statements about the waveform? Select one: A. "An ECG indicates the amount of blood in 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 represents the electrical activity of the heart."
D. "An ECG represents the electrical activity of the heart."
The EMT shows that she understands the difference between classic angina and an acute myocardial infarction (MI) when she states: Select one: A. "The pain in an acute MI is typically described as stabbing; the pain with classic angina is more pressure-like." B. "Classic angina is not accompanied by other symptoms like shortness of breath; the chest pain with an acute MI is." C. "Classic angina occurs when the heart rate becomes too fast; an acute MI is the result of coronary artery disease." D. "An acute myocardial infarction results in the death of cardiac tissue; classic angina does not."
D. "An acute myocardial infarction results in the death of cardiac tissue; classic angina does not."
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? Select one: A. "The heat from the refrigerator will cause the nitroglycerin to lose its effectiveness." B. "You should keep your nitroglycerin in the refrigerator since it will keep longer in the cold." C. "Keeping the nitroglycerin on top of the refrigerator may make it difficult for you to reach it in an emergency." D. "It is best to keep the nitroglycerin in a dark container since light will inactivate it."
D. "It is best to keep the nitroglycerin in a dark container since light will inactivate it."
The EMT shows she is correctly administering aspirin to a patient with chest pain when she provides: Select one: A. 160 mg of baby aspirin and instructs the patient to swallow it with a glass of water B. 325 mg of baby aspirin and instructs the patient to let it dissolve under the tongue C. 325 mg of enteric-coated aspirin and instructs the patient to swallow it 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
Which of these therapies is the best option for definitively treating a known myocardial infarction (AMI)? Select one: A. Oxygen, aspirin, and nitroglycerin B. Oxygen C. Fibrinolytics D. Angioplasty
D. Angioplasty
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? Select one: A. Obtain vital signs and give aspirin B. Apply but do not turn on the AED C. Assist the patient with his nitroglycerin D. Apply continuous positive airway pressure (CPAP)
D. Apply continuous positive airway pressure (CPAP)
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: Select one: A. Contact medical direction B. Administer one baby aspirin C. Give the patient one-half nitroglycerin tablet D. Apply oxygen
D. Apply oxygen
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? Select one: A. Determining the patient's blood glucose B. Administering three baby aspirins to the patient C. Palpating the chest wall for tenderness D. Applying oxygen through a nasal cannula
D. Applying oxygen through a nasal cannula
Which of these statements regarding cardiac compromise or acute coronary syndrome should the EMT recognize as true? Select one: A. The onset of acute coronary syndrome typically occurs with physical activity B. If the pain does not radiate to the arms, then the cause is not typically the heart C. Patients suffering from acute coronary syndrome will have pain, not discomfort D. Cardiac compromise should be suspected for any patient with chest discomfort
D. Cardiac compromise should be suspected for any patient with chest discomfort
When assessing a patient in the prehospital setting, which of these does the EMT recognize as an indication for aspirin? Select one: A. Systolic blood pressure greater than 100 mmHg B. Complaint of a headache after taking nitroglycerin C. An aspirin taken daily for cardiovascular disease D. Chest discomfort that is suggestive of a heart attack
D. Chest discomfort that is suggestive of a heart attack
The primary function of the heart is to: Select one: A. Produce blood B. Store blood C. Oxygenate blood D. Circulate blood
D. Circulate blood
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: Select one: A. Treating the headache that may occur when nitroglycerin is administered B. Breaking up the blood clot that is occluding the coronary artery C. Decreasing the chest pain caused by the possible heart attack D. Decreasing the ability of the platelets in the blood to form clots
D. Decreasing the ability of the platelets in the blood to form clots
When assessing an elderly patient with upper back pain, which of these assessment findings would make you very suspicious of a thoracic aortic dissection? Select one: A. Dizziness when going from a supine to standing position suddenly B. Lower back pain described as a constant ache C. History of hypertension and lower back injury D. Different blood pressure readings in each arm
D. Different blood pressure readings in each arm
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: Select one: A. Increases the heart rate B. Constricts the veins C. Dilates the coronary arteries D. Dilates the arteries
D. Dilates the arteries
The tricuspid valve prevents blood from: Select one: A. Bypassing the pulmonary vessels and entering the left heart B. Regurgitating between the right and left ventricles C. Flowing backward through the left atrium D. Flowing from the right ventricle into the right atrium
D. Flowing from the right ventricle into the right atrium
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? Select one: A. Decrease in heart rate B. Decreased blood pressure C. Increase in respirations D. Increase in heart rate
D. Increase in heart rate
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? Select one: A. Hypoglycemia B. Hypertension C. Respiratory arrest D. Internal bleeding
D. Internal bleeding
Dysfunction of the heart's electrical conduction cells from ischemia or infarction may cause: Select one: A. Blood loss B. Hyperventilation C. Lung collapse D. Irregular heartbeats
D. Irregular heartbeats
For a patient with a history of an unstable abdominal aortic aneurysm, the EMT should recognize and prepare for: Select one: A. Vomiting and airway occlusion B. Decreased perfusion to the upper extremities C. Hypoxia caused by lung compression D. Massive internal bleeding
D. Massive internal bleeding
The EMT should most suspect a patient has angina when he takes which medication? Select one: A. Lasix B. Glucophage C. Aspirin D. Nitroglycerin
D. Nitroglycerin
When treating a patient with chest discomfort, the EMT's primary goal is to: Select one: 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. Determine whether chest discomfort is originating from the heart D. Recognize the possibility of cardiac compromise and provide proper emergency care
D. Recognize the possibility of cardiac compromise and provide proper emergency care
To save additional heart muscle from dying when a patient suffers an acute myocardial infarction (heart attack), which treatment must occur? Select one: A. Lowering the blood pressure B. Opening blood flow between the atria and ventricles C. Increasing the heart rate D. Relieving the obstruction in the coronary arteries
D. Relieving the obstruction in the coronary arteries
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? Select one: A. The left side of the heart will weaken and fail B. The aorta will weaken and potentially rupture C. The heart muscle will become stronger D. The right side of the heart will weaken
D. The right side of the heart will weaken
Which of these identifies the major elements of the pathway that blood takes through the heart in the correct sequence? Select one: A. Pulmonary vein, pulmonary capillary, pulmonary artery, right ventricle B. Aorta, left atrium, left ventricle, pulmonary capillary C. Right atrium, left atrium, left ventricle, right ventricle D. Vena cava, right ventricle, pulmonary artery, left ventricle, aorta
D. Vena cava, right ventricle, pulmonary artery, left ventricle, aorta
