Chapter 16 - Cardiovascular Emergencies
he electrical impulse generated by the heart originates in the: A. bundle of His. B. coronary sinus. C. sinoatrial (SA) node. D. atrioventricular (AV) node.
C. sinoatrial (SA) node.
Which of the following statements regarding the AED and defibrillation is correct? A. The AED will not analyze the rhythm of a moving patient. B. Defibrillation is the first link in the American Heart Association chain of survival. C. The AED will shock any rhythm not accompanied by a pulse. D. CPR should be performed for 5 minutes before using the AED.
A. The AED will not analyze the rhythm of a moving patient.
Sudden death following AMI is MOST often caused by: A. cardiogenic shock. B. severe bradycardia. C. ventricular fibrillation. D. congestive heart failure.
C. ventricular fibrillation.
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should: A. administer oxygen, give her 324 mg aspirin, and assess her further. B. obtain a SAMPLE history and contact medical control for advice. C. give her 100% oxygen, attach the AED, and transport immediately. D. give her one nitroglycerin and reassess her systolic blood pressure.
A. administer oxygen, give her 324 mg aspirin, and assess her further.
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: A. assess the scene for potential hazards. B. determine if you need additional help. C. request a paramedic unit for assistance. D. gain immediate access to the patient.
A. assess the scene for potential hazards.
You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should: A. begin high-quality CPR and apply the AED without delay. B. have your partner perform CPR while you question the bystanders. C. perform two-rescuer CPR for 5 minutes and request ALS backup. D. immediately apply the AED pads and analyze his cardiac rhythm.
A. begin high-quality CPR and apply the AED without delay
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that: A. blood can pass from the atria to the ventricles. B. blood returning from the body can fill the atria. C. the impulse can spread through the Purkinje fibers. D. the SA node can reset and generate another impulse.
A. blood can pass from the atria to the ventricles.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the: A. brain. B. kidneys. C. abdomen. D. legs.
A. brain.
Cardiogenic shock following AMI is caused by: A. decreased pumping force of the heart muscle. B. a profound increase in the patient's heart rate. C. hypovolemia secondary to severe vomiting. D. widespread dilation of the systemic vasculature.
A. decreased pumping force of the heart muscle.
Nitroglycerin relieves cardiac-related chest pain by: A. dilating the coronary arteries and improving cardiac blood flow. B. increasing the amount of work that is placed on the myocardium. C. contracting the smooth muscle of the coronary and cerebral arteries. D. constricting the coronary arteries and improving cardiac blood flow.
A. dilating the coronary arteries and improving cardiac blood flow.
The MOST common error associated with the use of the AED is: A. failure of the EMT to ensure the battery is charged. B. malfunction of the AED's internal computer processor. C. inappropriately placed adhesive defibrillation electrodes. D. inability of the EMT to recognize ventricular fibrillation.
A. failure of the EMT to ensure the battery is charged
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: A. have chronic hypertension. B. regularly take illegal drugs. C. have had a stroke in the past. D. are older than 40 years of age.
A. have chronic hypertension.
Major risk factors for AMI include all of the following, EXCEPT: A. hypoglycemia. B. hypertension. C. diabetes mellitus. D. elevated cholesterol
A. hypoglycemia.
You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should: A. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport. B. immediately remove the nitroglycerin patch, apply the AED in case he develops cardiac arrest, and transport to the closest hospital. C. move the nitroglycerin patch to the other side of his chest in case you need to apply the AED, keep him warm, and transport without delay. D. ask him if the nitroglycerin patch he is wearing has improved his chest pressure, complete your secondary assessment, and transport promptly.
A. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.
Deoxygenated blood from the body returns to the: A. right atrium. B. right ventricle. C. left atrium. D. left ventricle.
A. right atrium.
Which of the following is a major difference between angina pectoris and AMI? A. AMI is caused by myocardial ischemia. B. Anginal pain typically subsides with rest. C. Nitroglycerin has no effect on angina pectoris. D. Pain from an AMI subsides within 30 minutes.
B. Anginal pain typically subsides with rest
Acute coronary syndrome (ACS) is a term used to describe: A. the warning signs that occur shortly before a heart attack. B. a group of symptoms that are caused by myocardial ischemia. C. a severe decrease in perfusion caused by changes in heart rate. D. the exact moment that a coronary artery is completely occluded.
B. a group of symptoms that are caused by myocardial ischemia.
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they: A. are elderly. B. are in denial. C. cannot afford it. D. do not trust EMTs.
B. are in denial.
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger? A. furosemide (Lasix) B. aspirin C. oxygen D. digoxin (Lanoxin)
B. aspirin
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for: A. a cardiac arrhythmia. B. congestive heart failure. C. significant hypotension. D. right ventricular failure.
B. congestive heart failure.
Which of the following is NOT a function of the sympathetic nervous system? A. dilation of blood vessels in the muscles B. constriction of blood vessels in the muscles C. increases in the heart and respiratory rates D. constriction of blood vessels in the digestive system
B. constriction of blood vessels in the muscles
Ischemic heart disease is MOST accurately defined as: A. absent myocardial blood flow due to a blocked coronary artery. B. decreased blood flow to one or more portions of the myocardium. C. death of a portion of the heart muscle due to a decrease in oxygen. D. decreased blood flow to the heart muscle due to coronary dilation.
B. decreased blood flow to one or more portions of the myocardium.
Which of the following signs is commonly observed in patients with right-sided heart failure? A. labored breathing B. dependent edema C. pulmonary edema D. flat jugular veins
B. dependent edema
A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What are her signs and symptoms MOST indicative of? A. unstable angina B. dissecting aortic aneurysm C. AMI D. hypertensive emergency
B. dissecting aortic aneurysm
Prior to attaching the AED to a cardiac arrest patient, the EMT should: A. contact medical control. B. dry the chest off if it is wet. C. perform CPR for 30 seconds. D. assess for a pulse for 20 seconds.
B. dry the chest off if it is wet.
Blood that is ejected from the right ventricle: A. enters the systemic circulation. B. flows into the pulmonary arteries. C. has a high concentration of oxygen. D. was received directly from the aorta.
B. flows into the pulmonary arteries
Common side effects of nitroglycerin include all of the following, EXCEPT: A. bradycardia. B. hypertension. C. hypotension. D. severe headache.
B. hypertension.
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure? A. hypertension and tachycardia B. hypotension and flat jugular veins C. the presence of rales in the lungs D. trouble breathing while lying down
B. hypotension and flat jugular veins
After the AED has delivered a shock, the EMT should: A. assess for a carotid pulse. B. immediately resume CPR. C. reanalyze the cardiac rhythm. D. transport the patient at once.
B. immediately resume CPR.
The AED is MOST advantageous to the EMT because: A. it is lightweight, easy to use, and safe for the EMT who is using it. B. it delivers prompt defibrillation to patients with ventricular fibrillation. C. its use does not require the presence of ALS personnel. D. it delivers an unlimited number of shocks with the same amount of energy.
B. it delivers prompt defibrillation to patients with ventricular fibrillation.
Angina pectoris occurs when: A. a coronary artery is totally occluded by plaque. B. myocardial oxygen demand exceeds the supply. C. one or more coronary arteries suddenly spasm. D. myocardial oxygen supply exceeds the demand.
B. myocardial oxygen demand exceeds the supply.
In contrast to AMI, a dissecting aortic aneurysm: A. is more commonly associated with pressure in the chest. B. often presents with pain that is maximal from the onset. C. usually presents gradually, often over a period of hours. D. is typically preceded by other symptoms, such as nausea.
B. often presents with pain that is maximal from the onset.
Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a "no shock advised" message. You should: A. reanalyze the patient's cardiac rhythm. B. perform CPR for 2 minutes and reassess. C. determine if a palpable pulse is present. D. immediately assess the patient's airway.
B. perform CPR for 2 minutes and reassess.
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: A. defibrillate with the AED while continuing transport to the hospital. B. stop the ambulance, begin CPR, and attach the AED as soon as possible. C. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. D. alert the receiving hospital and perform CPR for the duration of the transport.
B. stop the ambulance, begin CPR, and attach the AED as soon as possible.
When the myocardium requires more oxygen: A. the heart contracts with less force. B. the arteries supplying the heart dilate. C. the heart rate decreases significantly. D. the AV node conducts fewer impulses.
B. the arteries supplying the heart dilate.
The descending aorta divides into the two iliac arteries at the level of the: A. nipple line. B. umbilicus. C. iliac crest. D. pubic symphysis.
B. umbilicus.
Which of the following veins is located inferior to the trunk? A. cephalic B. axillary C. saphenous D. subclavian
C. saphenous
A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? A. Avoid defibrillation as this will damage the patient's AICD. B. Contact medical control and request permission to defibrillate. C. Deliver the shock followed by immediate resumption of CPR. D. Continue CPR and transport the patient to the closest appropriate hospital.
C. Deliver the shock followed by immediate resumption of CPR.
The head and brain receive their supply of oxygenated blood from the: A. iliac arteries. B. brachial arteries. C. carotid arteries. D. subclavian arteries.
C. carotid arteries.
When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin? A. sharp chest pain that lasts longer than 10 to 15 minutes B. an acute onset of dizziness during a period of exertion C. chest pain that does not immediately subside with rest D. difficulty breathing that awakens the patient from sleep
C. chest pain that does not immediately subside with rest
The main legal risk in using the AED is: A. negligence on the part of the manufacturer. B. failure of the AED's internal computer chip. C. failing to deliver a shock when one is needed. D. not assessing for a pulse after a shock is delivered.
C. failing to deliver a shock when one is needed.
Risk factors for AMI that cannot be controlled include: A. excess stress. B. hyperglycemia. C. family history. D. lack of exercise.
C. family history.
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to: A. assess the effectiveness of the bystanders' CPR. B. quickly attach the AED and push the analyze button. C. have the bystanders stop CPR and assess the patient. D. request a paramedic unit and quickly attach the AED.
C. have the bystanders stop CPR and assess the patient
When afterload increases: A. the volume of venous blood that returns to the right atrium increases. B. the amount of resistance that the ventricle must beat against decreases. C. it becomes harder for the ventricle to push blood through the blood vessels. D. the blood pressure falls because of significant dilation of the blood vessels.
C. it becomes harder for the ventricle to push blood through the blood vessels.
The EMT should use an AED on a child between 1 month and 8 years of age if: A. he or she is not breathing and has a weakly palpable pulse. B. his or her condition is rapidly progressing to cardiac arrest. C. pediatric pads and an energy-reducing device are available. D. special pads are used and the child has profound tachycardia.
C. pediatric pads and an energy-reducing device are available.
The left ventricle has the thickest walls because it: A. pumps blood to the lungs to be reoxygenated. B. uses less oxygen than other chambers of the heart. C. pumps blood into the aorta and systemic circulation. D. receives blood directly from the systemic circulation
C. pumps blood into the aorta and systemic circulation
Which of the following statements regarding nitroglycerin is correct? A. The potency of nitroglycerin is increased when exposed to light. B. A maximum of five nitroglycerin doses should be given to a patient. C. Nitroglycerin should be administered between the cheek and gum. D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.
D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.
Common signs and symptoms of a hypertensive emergency include: A. pallor, cool skin, and a temporary loss of hearing. B. syncope, a weak pulse, and bleeding from the ears. C. tachycardia, pain behind the eyes, and weakness. D. a bounding pulse, a severe headache, and dizziness.
D. a bounding pulse, a severe headache, and dizziness.
Narrowing of the coronary arteries due to a buildup of fatty deposits is called: A. angina pectoris. B. arteriosclerosis. C. acute ischemia. D. atherosclerosis.
D. atherosclerosis.
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called: A. excitability. B. contractility. C. impulsivity. D. automaticity.
D. automaticity.
The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the: A. parietal lobe. B. pons and medulla. C. somatic nervous system. D. autonomic nervous system.
D. autonomic nervous system.
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________. A. coronary sinus, vena cava B. aorta, inferior vena cava C. vena cava, coronary veins D. coronary arteries, aorta
D. coronary arteries, aorta
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by: A. scraping fatty deposits off of the lumen of the coronary artery. B. bypassing the coronary artery with a vessel from the chest or leg. C. placing a stent inside the coronary artery to keep it from narrowing. D. dilating the affected coronary artery with a small inflatable balloon.
D. dilating the affected coronary artery with a small inflatable balloon.
Prior to defibrillating a patient with an AED, it is MOST important that you: A. properly position the defibrillation pads. B. perform up to 5 minutes of effective CPR. C. confirm that the patient is in cardiac arrest. D. ensure that no one is touching the patient.
D. ensure that no one is touching the patient.
Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort? A. history of cigarette smoking B. history of previous heart attack C. presence of personal risk factors D. family history of hypertension
D. family history of hypertension
A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes: A. nitroglycerin for her chest pain. B. ventilations with a bag-mask device. C. oxygen at 4 L/min via nasal cannula. D. placing her in an upright position.
D. placing her in an upright position.
Defibrillator pads are placed on the patient's chest with one pad to the: A. left of the upper sternum and the other pad just to the right of the left nipple. B. right of the upper sternum and the other pad just to the right of the right nipple. C. left of the upper sternum and the other pad just to the right and below the left nipple. D. right of the upper sternum and the other pad just to the left and below the left nipple
D. right of the upper sternum and the other pad just to the left and below the left nipple
Ventricular tachycardia causes hypotension because: A. the volume of blood returning to the atria increases. B. the right ventricle does not adequately pump blood. C. blood backs up into the lungs and causes congestion. D. the left ventricle does not adequately fill with blood.
D. the left ventricle does not adequately fill with blood.
Cardiac output may decrease if the heart beats too rapidly because: A. a rapid heart beat causes a decrease in the strength of cardiac contractions. B. the volume of blood that returns to the heart is not sufficient with fast heart rates. C. as the heart rate increases, more blood is pumped from the ventricles than the atria. D. there is not enough time in between contractions for the heart to refill completely.
D. there is not enough time in between contractions for the heart to refill completely.
Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm? A. sinus tachycardia B. sinus bradycardia C. extra ventricular beats D. ventricular tachycardia
D. ventricular tachycardia
