Cardio - Final Review

What is the primary cause of a cardiac arrest for a patient who is struck by lightning? A. Asystole B. Obstruction of coronary circulation C. Hypoxia D. Depression of body functions

A. Asystole Feedback: The massive direct-current discharge from lightning can cause primary ventricular fibrillation or asystole. Hypoxia is the primary cause of cardiac arrest in drowning. Hypoxia can also be a secondary cause of cardiac arrest after a lightning strike if it causes paralysis of respiratory muscles and the patient does not receive immediate care. Depression of body functions may occur in conditions such as hypothermia but not in a lightning strike. Obstruction of coronary circulation (which may be seen in atherosclerosis) is not an effect of a lightning strike.

Question 97 of 115 1.0 Points You are resuscitating an unresponsive 90-year-old male who is in cardiac arrest. After the AED analyzes his rhythm, it advises you to shock him. What cardiac rhythm should you suspect he is in? A. Ventricular fibrillation B. Atrial fibrillation C. Wolff-Parkinson-White syndrome D. Paroxysmal supraventricular tachycardia

A. Ventricular fibrillation

Question 53 of 115 1.0 Points A 61-year-old female complains of pain to the right side of her chest. She tells you that it started while she was mowing her lawn. She rates the pain 7 of 10 and tells you it does not change with movement. She has a history of cardiac and lung disease. Her skin is diaphoretic. You auscultate coarse crackles in bases of her lungs. Her vital signs are P 96, R 16, BP 168/110, and SpO2 is 95% on room air. You should suspect: A. acute coronary syndrome. B. costochondritis. C. congestive heart failure. D. hypertensive crisis.

A. acute coronary syndrome.

An unresponsive 75-year-old female was struck by lightning. EMRs tell you she was apneic and pulseless, so they began CPR. They tell you they have been resuscitating her for five minutes. You should next: A. apply the AED while they continue compressions. B. look for entry and exit wounds. C. have them stop CPR so you can assess her. D. apply a mechanical CPR device.

A. apply the AED while they continue compressions. Feedback: You should apply the AED while they continue compressions. This will allow you to defibrillate her if she is in ventricular fibrillation. They are professional rescuers, and there is no need to stop CPR to assess her unless you see signs of life. Looking for wounds and applying a mechanical CPR device are not the next steps you should perform.

An unresponsive 10-month-old male is apneic and pulseless. While you are performing chest compressions, you observe that he appears to be breathing. You should next: A. assess for a pulse. B. continue compressions. C. analyze his rhythm with the AED. D. auscultate his lung sounds.

A. assess for a pulse. Feedback: Since he has signs of life, you should check for a brachial pulse. If he has a perfusing pulse, you should not continue compression or use the AED. Remember this is a best response question. It is more important to determine if he has a pulse than listening to his lung sounds.

Question 82 of 115 1.0 Points An unresponsive 23-year-old female was rescued from a lake after a waterskiing accident. She is apneic and pulseless. One rescuer is stabilizing her head and opening her airway with a jaw-thrust maneuver while another begins CPR. You should next: A. attach the AED and analyze her rhythm. B. suction her airway. C. apply a cervical collar and secure her to a long backboard. D. begin immediate transport.

A. attach the AED and analyze her rhythm. Feedback: The next thing that you should do is attach the AED and analyze her rhythm. There is no indication that she has fluid in her airway (gurgling sounds) so routine suctioning is not indicated. While she was involved in a waterskiing accident, her spine is being manually stabilized, and the likelihood of ROSC is increased the sooner you defibrillate her if ventricular fibrillation is the cause of her cardiac arrest. You should not transport her until after you have attached the AED and analyzed her rhythm as well as taking spinal motion restriction precautions.

An unresponsive 1-year-old male is lying on the floor with full-thickness burns to his left hand and right knee. He is apneic and pulseless. You should have your partner first: A. begin chest compressions. B. ventilate him. C. apply the AED and analyze his rhythm. D. apply sterile dressings to his wounds.

A. begin chest compressions. Feedback: He is in cardiac arrest. You should immediately have your partner begin chest compressions. While your partner is compressing his chest, you should apply the AED. You should only stop compressions to analyze his rhythm once the AED pads are applied. Ventilation occurs after the first series of compressions. Dressing his wounds are a low priority. His wound pattern may suggest an electrical cause, but that does not affect how you should treat him.

An unresponsive 82-year-old female is apneic and pulseless. You are performing chest compressions while your partner gets the AED. When your partner returns with the AED, you should: A. continue compressions while your partner attaches the AED. B. complete the current cycle of compressions before attaching the AED. C. stop compressions, attach the AED, and analyze the rhythm. D. ensure you have completed five cycles of compressions and ventilations before attaching the AED.

A. continue compressions while your partner attaches the AED. Feedback: You should have your partner attach the AED without interrupting chest compressions. You do not want to stop compressions to attach the AED. In 2005, that AHA recommended that rescuers perform two minutes of chest compressions before shocking ventricular fibrillation or pulseless ventricular tachycardia. Studies showed no improvement in resuscitation outcomes. The AHA has since changed its recommendation. They now recommend the application of the AED as soon as it becomes available.

An 88-year-old male was successfully resuscitated after he collapsed. You performed CPR and defibrillated him once. He tells you that he does not remember the event. His vital signs are P 96, R 12, BP 108/86, and SpO2 is 95% on oxygen by simple face mask. You should transport him and: A. continue your treatment. B. increase the amount of oxygen you are administering. C. disconnect the AED. D. begin to cool him.

A. continue your treatment. Feedback: He is alert, has a pulse, is breathing, and his SpO2 is between 94-99%, so you should continue your treatment while transporting him. There is no reason to increase the amount of oxygen you are administering. After ROSC (return of spontaneous circulation), you should never disconnect the AED until you transfer care to a higher level of care. AHA guidelines for resuscitation advise against out-of-hospital cooling of patients who are post-ROSC.

An unresponsive 91-year-old male was found outside on a cold night. He was in cardiac arrest, so you began chest compressions. His extremities are cold, but his abdomen is warm. The AED indicates that shock is advised. You should: A. defibrillate him and resume chest compressions. B. withhold defibrillation and move him into the ambulance. C. defibrillate him and ventilate him. D. withhold defibrillation and actively rewarm him.

A. defibrillate him and resume chest compressions. Feedback: When resuscitating a hypothermic patient, you should defibrillate him and resume compression. The AHA has not established the temperature at which defibrillation should be attempted. It is reasonable to treat a hypothermic patient according to the standard BLS algorithm while rewarming the patient.

A 68-year-old female who has a history of angina tells you she has chest pain. She describes the pain as sharp and rates it 6 of 10. She tells you she took one aspirin prior to your arrival. Her lungs are clear to auscultation. Her vital signs are P 104, R 18, BP 156/90, and SpO2 is 95% on room air. You should next: A. determine the aspirin dosage and route of administration. B. administer oxygen by non-rebreather mask. C. assist with the administration of her nitroglycerin. D. administer oxygen by nasal cannula.

A. determine the aspirin dosage and route of administration. Feedback: Per AHA guidelines, you should ensure that she took aspirin between 160 and 325 mg and that she chewed them to hasten absorption. The administration of nitroglycerin is contraindicated when a patient has tachycardia in the absence of heart failure. She does not have signs of dyspnea, heart failure, shock, or hypoxia, so oxygen is not indicated.

An unresponsive 94-year-old female was found by her family on the floor. She is apneic and pulseless. Your partner is performing chest compressions. The AED has analyzed her rhythm and advised that you shock the patient. After the AED has charged, you should next: A. ensure no one is touching her. B. resume chest compressions. C. press the Shock button. D. ventilate her.

A. ensure no one is touching her. Feedback: Before you shock the patient, you need to ensure that no one is touching her. Immediately after the shock, compressions should be resumed. You should ventilate her after 30 compressions.

An unresponsive 25-year-old male was pulled out of a swimming pool by rescuers as you arrive. You should first: A. look for signs of breathing and check his pulse. B. immobilize him to a long backboard. C. apply a cervical collar. D. dry his skin, attach the AED and analyze his rhythm.

A. look for signs of breathing and check his pulse. Feedback: You should look for signs of breathing and check his carotid pulse. The initial assessment of an unresponsive patient is unchanged in a suspected drowning patient. If you suspect that he has a spinal injury, you should use a jaw-thrust maneuver when opening his airway to assess his breathing. You should not first apply a cervical collar or immobilize him to a long backboard.

An 84-year-old male is lying in bed complaining of right-sided weakness and nausea. He has a history of hypertension and type 2 diabetes. He tells you he was fine when he went to bed last night. His vital signs are P 68, R 14, BP 142/82, and SpO2 is 95% on room air. His blood glucose level is 168 mg/dL. You should: A. notify the receiving hospital of your findings. B. administer oxygen by nasal cannula. C. assist with the administration of his insulin. D. administer oxygen by non-rebreather mask.

A. notify the receiving hospital of your findings. Feedback: You need to notify the receiving hospital of your findings so that they can ensure he receives time-sensitive care. You should not administer oxygen since his SpO2 is above 94% on room air. His blood glucose level is at the high end of the normal range and assisting with the administration of insulin is not normally an EMT skill.

Question 42 of 115 1.0 Points An unresponsive 54-year-old female is apneic and pulseless. Your partner begins chest compressions while you attach the AED and analyze the rhythm. The AED announces, "Shock advised." You should suspect: A. pulseless ventricular tachycardia. B. pulseless electrical activity. C. supraventricular tachycardia. D. asystole.

A. pulseless ventricular tachycardia. Feedback: The AED recognizes two rhythms that it advises you should shock, ventricular tachycardia and ventricular fibrillation. Based on the possible answers provided, and your assessment that she does not have a pulse, the correct answer is pulseless ventricular tachycardia. The AED cannot determine if a patient has a pulse. This is one of the reasons that you should not attach an AED to a patient who has a pulse. The AED would recommend shocking a patient who has a pulse and is in ventricular tachycardia.

While you are performing chest compressions on an unresponsive 58-year-old male, he begins to cough. You should suspect: A. return of spontaneous circulation. Feedback: A patient coughing during your resuscitation effort is an indication of return of spontaneous circulation (ROSC). Wheezing indicates bronchospasm. Atelectasis is the collapse of the lower airways. You should suspect a patient has gastric distention if the abdomen enlarges as you ventilate the patient. B. atelectasis of the upper airways. C. bronchospasm. D. gastric distention.

A. return of spontaneous circulation. Feedback: A patient coughing during your resuscitation effort is an indication of return of spontaneous circulation (ROSC). Wheezing indicates bronchospasm. Atelectasis is the collapse of the lower airways. You should suspect a patient has gastric distention if the abdomen enlarges as you ventilate the patient.

A 61-year-old female has tonic-clonic seizure activity that started eight minutes ago. Her husband tells you her only medical history is high blood pressure. You observe less stiffening of the muscles in her left arm and leg. You should suspect: A. stroke. Feedback: You should suspect that she is having a stroke. New onset of seizure activity in an older patient is an ominous sign of stroke. She also has signs of weakness on her left side. Hypoglycemia, not hyperglycemia, is a mimic of stroke. Bell's palsy is a stroke mimic that affects one side of the face causing a facial droop, not seizures. Even if you didn't consider seizure as a sign of stroke, it is the best choice of those provided. B. Bell's palsy. C. hyperglycemia. D. epilepsy.

A. stroke. Feedback: You should suspect that she is having a stroke. New onset of seizure activity in an older patient is an ominous sign of stroke. She also has signs of weakness on her left side. Hypoglycemia, not hyperglycemia, is a mimic of stroke. Bell's palsy is a stroke mimic that affects one side of the face causing a facial droop, not seizures. Even if you didn't consider seizure as a sign of stroke, it is the best choice of those provided.

An unresponsive 31-year-old female is lying next to an open electrical panel. She is not breathing and does not have a pulse. Your partner begins chest compressions, and you attach the AED. After the AED analyzes her rhythm, it announces, "Shock advised." You should suspect: A. ventricular fibrillation. Feedback: You should suspect ventricular fibrillation. An AED only recognizes ventricular fibrillation and ventricular tachycardia as shockable rhythms. B. atrial fibrillation. C. supraventricular tachycardia. D. atrial flutter.

A. ventricular fibrillation. Feedback: You should suspect ventricular fibrillation. An AED only recognizes ventricular fibrillation and ventricular tachycardia as shockable rhythms.

What causes the discomfort associated with angina? A) Myocardial tissue strain B) Myocardial tissue hypoxia C) Decreased lactate production D) Increased intracellular pressure

B) Myocardial tissue hypoxia Feedback: The discomfort associated with angina is caused by tissue hypoxia as a result of decreased oxygenated blood flow. Decreased oxygen levels result in anaerobic conditions that produce lactate. Angina is not a result of changes in intracellular pressure or muscle strain.

Why would a 21-year-old female who has a regular pulse of greater than 160 have signs of cardiogenic shock? A. Electrical impulses are not conducted efficiently. B. Preload is reduced due to decreased atrial filling time. C. Oxygen diffusion is decreased because of increased perfusion. D. Myocardial cells do not have enough time to repolarize.

B. Preload is reduced due to decreased atrial filling time. Feedback: Pulse rates greater than 160 in adults can cause decreases in preload because of decreased atrial filling time. A regular pulse indicates an organized depolarization of the myocardium. This rules out a change in impulse conduction or cell repolarization. Perfusion is not increased in a patient who has cardiogenic shock.

A 14-year-old female passed out while running. She is now awake and tells you she feels light-headed and like her heart is pounding out of her chest. Her lungs are clear to auscultation. Her vital signs are P 186, R 20, BP 80/58, and SpO2 is unattainable. What should you suspect caused her to pass out? A. Increased intrathoracic pressure B. Reduced atrial filling pressure C. Reduced intrathoracic pressure D. Increased ventricular filling pressure

B. Reduced atrial filling pressure

A 37-year-old male complains of a sudden onset of severe headache and blurred vision in his left eye. When he speaks, he uses the wrong words to describe his complaint. His pupils are equal and reactive to light. His vital signs are P 84, R 16, BP 148/90, and SpO2 is 95% on room air. You should suspect: A. glaucoma. B. stroke. C. migraine headache. D. opioid overdose.

B. Stroke Feedback: Despite his age, you should suspect that he is having a stroke. He has vision changes in one eye and expressive aphasia. Assessing for abnormal speech (slurred/wrong words/no speech) is part of the Cincinnati Prehospital Stroke Scale. Patients who demonstrate any one of the findings on the Cincinnati Prehospital Stroke Scale have a 70% chance of having an acute stroke. You should have a high level of suspicion when a patient has stroke-like symptoms and not discount your findings.

A 28-year-old female complains that she feels like she is going to pass out. She tells you this started suddenly after ingesting several energy drinks. Her vital signs are P 172, R 18, BP 96/76, and SpO2 is 98% on room air. What should you suspect is causing her complaint? A. Neurogenic shock B. Tachycardia C. Stroke D. Increased cardiac output

B. Tachycardia Feedback: Because of the tachycardia, her heart does not have enough time to fill. This decrease in preload reduces cardiac output and cerebral perfusion, causing her to feel like she is going to pass out. She is in cardiogenic shock, not neurogenic. It is unlikely that the cause of her symptoms is related to a stroke.

After ROSC, a patient has a SpO2 of 100%. Why should you titrate oxygen administration to an SpO2 between 94-99%? A. To reduce intrathoracic pressure B. To reduce production of free radicals Feedback: Titrating oxygen administration to a SpO2 between 94-99% can help reduce the production of oxygen free radicals. An SpO2 of 100% can correspond to an alveolar oxygen partial pressure (PaO2) between 80 and 500 mmHg. Higher PaO2 levels can promote free radical production that leads to further damage to injured cells. Titrating oxygen administration to an SpO2 between 94-99% does not significantly decrease intrathoracic pressure or increase respiratory rate and cardiac output. C. To increase cardiac output D. To increase respiratory rate

B. To reduce production of free radicals Feedback: Titrating oxygen administration to a SpO2 between 94-99% can help reduce the production of oxygen free radicals. An SpO2 of 100% can correspond to an alveolar oxygen partial pressure (PaO2) between 80 and 500 mmHg. Higher PaO2 levels can promote free radical production that leads to further damage to injured cells. Titrating oxygen administration to an SpO2 between 94-99% does not significantly decrease intrathoracic pressure or increase respiratory rate and cardiac output.

A 93-year-old female complains of a sudden onset of sweating and fatigue. She denies chest pain or difficulty breathing but tells you she feels like she is going to die. Her vital signs are P 78, R 16, BP 142/86, and SpO2 is 94% on room air. You should suspect: A. sepsis. B. acute coronary syndrome. C. influenza. D. gastroenteritis.

B. acute coronary syndrome.

Question 95 of 115 1.0 Points A 73-year-old female had a syncopal episode. She tells you that she is taking a new medication for her hypertension. Her vital signs are P 60, R 14, BP 94/72, and SpO2 is 93% on room air. You should: A. assist with the administration of her nitroglycerin. B. administer oxygen by nasal cannula. C. transport her. D. administer oxygen by non-rebreather mask.

B. administer oxygen by nasal cannula.

Question 21 of 22 1.0 Points A 1-year-old male is irritable, and his skin is diaphoretic. His mother tells you that he has coarctation of his aorta. His lungs are clear to auscultation with good chest rise. His vital signs are P 138, R 28, BP 116/68, and SpO2 is 93% on room air. You should: A. administer aspirin. B. administer oxygen. C. assist with the administration of his nitroglycerin. D. assist his ventilation.

B. administer oxygen. Feedback: He is mildly hypoxic so you should administer oxygen. Coarctation of the aorta is not a term you are required to know, but you do need to know how to treat a patient who has the above findings. The condition involves narrowing of the aorta, which causes hypertension. His respiratory rate is normal, and his lungs are clear with good expansion, so there is no need to assist his ventilation. There is no indication to administer aspirin or nitroglycerin.

An unresponsive 63-year-old female is in cardiac arrest. You and your partner were performing CPR and shocked her twice with the AED. After five minutes, you achieve ROSC. You should next: A. begin cooling her. B. assess her breathing. C. place her in the recovery position. D. continue chest compressions for one minute and analyze her rhythm.

B. assess her breathing. Feedback: You should assess her breathing. The acronym ROSC is an abbreviation for the return of spontaneous circulation. Since she has a pulse, you should next assess her breathing. You should not continue compressions since she has a pulse. The AHA does not recommend prehospital cooling of post-ROSC patients. If your next treatment is to place her in the recovery position, you neglected to assess her breathing.

An unresponsive 2-year-old male is lying in his bed. His mother tells you that he has been sick for four days. You should next: A. begin chest compressions. B. assess his breathing and pulse. C. ventilate him. D. attach the AED and analyze his rhythm.

B. assess his breathing and pulse. Feedback: After determining that he is unresponsive, you should check his breathing and pulse at the same time. What you find during your five- to ten-second assessment will determine your next steps. If he has a pulse but has no normal breathing, you should ventilate him. If he is apneic and pulseless, you should begin chest compressions. While you are doing chest compressions, your partner should attach the AED. Once the AED is attached and turned on, you should stop compressions and analyze his rhythm.

Question 83 of 115 1.0 Points An unresponsive 20-year-old male is taking occasional, gasping breaths. You are unable to palpate a carotid pulse. His skin is cyanotic, and his pupils are pinpoint. You should first: A. administer naloxone. B. begin chest compressions. C. ventilate him. D. attach the AED and analyze his rhythm.

B. begin chest compressions.

Question 37 of 115 1.0 Points An unresponsive 63-year-old female is in cardiac arrest after an opioid overdose. You should first: A. ventilate her. B. begin chest compressions. C. attach the AED and analyze her rhythm. D. administer naloxone.

B. begin chest compressions. Feedback: Regardless of the cause, you should first begin chest compressions for a patient who is in cardiac arrest. Naloxone does not restore cerebral or coronary circulation.

You are assessing an unresponsive 42-year-old male who was found lying in the snow. You do not observe any breathing or feel a pulse during the normal assessment time frame. You should next: A. attach the AED and analyze his rhythm. B. begin chest compressions. Feedback: You should next begin chest compressions. AHA guidelines recommend beginning compressions without delay in a hypothermic patient. Ventilating him or applying the AED would delay compressions. C. ventilate him. D. assess for an additional 10 seconds.

B. begin chest compressions. Feedback: You should next begin chest compressions. AHA guidelines recommend beginning compressions without delay in a hypothermic patient. Ventilating him or applying the AED would delay compressions.

An unresponsive 30-year-old female is lying in the snow. You do not observe any breathing or feel a pulse. Her hands are exposed, cold and stiff. Her skin is cyanotic. Her abdomen is warm under her clothing. You should suspect: A. moderate hypothermia and ventilate her. B. cardiac arrest and begin chest compressions. C. severe hypothermia and ventilate her. D. death, attach the AED and analyze her rhythm.

B. cardiac arrest and begin chest compressions. Feedback: You should suspect that she is in cardiac arrest and begin chest compressions. This question asks for your assessment, and then your immediate treatment. She is apneic and pulseless. Your initial management is to begin chest compressions. Her core is warm, so you should not suspect that she is obviously dead.

An 80-year-old female complains of a sudden irregular heartbeat. She tells you she feels weak and nauseated. Her vital signs are P 128 and irregular, R 16, BP 148/92, and SpO2 is 95% on room air. You should suspect: A. stroke. B. cardiac arrhythmia. C. cardiogenic shock. D. ventricular fibrillation.

B. cardiac arrhythmia. Feedback: Since her pulse rate is tachycardic and irregular, she has a cardiac arrhythmia. If she was in ventricular fibrillation, she would have no cardiac output and be unresponsive. She has no signs of shock, so cardiogenic shock is incorrect. There are no neurological deficits, so stroke is unlikely.

A 64-year-old male has exertional dyspnea. He tells you he has had swelling in his lower legs for the last week. You auscultate fine crackles in his lower lungs. His vital signs are P 88, R 22, BP 172/92, and SpO2 is 92% on room air. You should suspect: A. bronchitis. B. heart failure. C. exercise-induced asthma. D. pneumonia.

B. heart failure. Feedback: He has signs of right- and left-sided heart failure. The fine crackling (rales) you hear is the sound of the alveoli opening as air enters them. Pneumonia often creates rhonchi (coarse crackles) as air passes over the mucus in otherwise healthy bronchioles. Bronchitis often creates coarse crackles caused by mucus in the larger bronchioles and smaller bronchi.

An unresponsive 24-year-old female is lying on the floor below an open electrical panel on the ceiling. Coworkers tell you that she was on a ladder working on the panel when she fell to the ground. She is not touching any source of electricity, there are no loose wires, and the ground is dry. You do not see any chest wall movement. You should: A. attach the AED and analyze her rhythm. B. listen for breathing and palpate a pulse. C. apply a cervical collar. D. immobilize her to a long backboard.

B. listen for breathing and palpate a pulse. Feedback: Since there are no scene hazards, you should assess her breathing and pulse while opening her airway. The other distractors delay your assessment of her ABCs. Spinal motion restriction can be maintained during airway maneuvers and pulse checks.

A 45-year-old male complains of a sudden onset of a severe headache. He tells you it started 15 minutes ago. He is unable to hold his right arm outstretched while you assess him. His vital signs are P 68, R 14, BP 132/76, and SpO2 is 97% on room air. His blood glucose level is 71 mg/dL. You should transport him and: A. administer oxygen. B. notify the receiving hospital of your findings. C. administer oral glucose. D. administer aspirin

B. notify the receiving hospital of your findings.

A 3-year-old female complains of pain in her chest. Her father tells you that she has mitral valve prolapse. Her skin is cyanotic. Her lungs are clear on auscultation. Her vital signs are P 136 and irregular, R 30, BP 94/64, and SpO2 is 93% on room air. You should administer: A. oxygen by non-rebreather mask. B. oxygen by nasal cannula. C. nitroglycerin. D. aspirin.

B. oxygen by nasal cannula. Feedback: She has findings that suggest hypoxia (cyanosis), so you should administer oxygen. Since her SpO2 is only a little low, you should administer a low dose of oxygen by nasal cannula. Administration of aspirin has been linked to Reye's syndrome. It is contraindicated in patient under the age of 3 and should be used with caution in children in general. She is tachycardic. This is a contraindication for using nitroglycerin in the absence of pulmonary edema. Before administering nitroglycerin to her, you should consult a specialist.

An unresponsive 88-year-old female is apneic and pulseless. You are performing chest compressions. Your partner attaches the AED and analyzes her rhythm. The AED announces, "No shock advised." You should suspect: A. ventricular fibrillation. B. pulseless electrical activity. C. the patient was moving while the AED was analyzing the rhythm. D. your partner did wait until after two minutes of compressions before analyzing her rhythm.

B. pulseless electrical activity. Feedback: You should suspect that the AED interpreted her rhythm as something other than ventricular fibrillation or ventricular tachycardia. Pulseless electrical activity is the only response that meets this criterion. The AED does not know how long you and your partner have been doing compressions. If the AED sensed movement of the patient while it was analyzing her rhythm, it would have announced that patient movement was detected.

A 32-year-old male complains of nearly passing out and nausea. He tells you he feels a fluttering in his chest. He has a 26 pack-year smoking history. You auscultate scattered rhonchi in the bases of his lungs. His vital signs are P 168, R 14, BP 92/58, and SpO2 is 94% on room air. You should suspect: A. indigestion. B. reduced cardiac output. C. respiratory failure. D. vasovagal syncope.

B. reduced cardiac output. Feedback: His cardiac output is decreased because of reduced preload. His heart is beating too fast to allow for adequate filling of his atria. He has good alveolar ventilation, so he is not in respiratory failure. You can hear lung sounds in the bases (good tidal volume), and his respiratory rate is normal. Vasovagal syncope is caused by a sudden drop in heart rate and blood pressure.

An unresponsive 48-year-old male is in cardiac arrest. Your partner is performing chest compressions while you attach the AED. After you press analyze, the AED announces. "Shock advised." While the AED charges, you should ensure your partner: A. clears the patient. B. resumes compressions. C. ventilates the patient. D. prepares to switch positions.

B. resumes compressions. Feedback: You should ensure that your partner resumes compressions. Every effort should be made to increase the percentage of time that the patient's chest is being compressed (compression fraction). This will help to maintain cerebral perfusion.

An unresponsive 33-year-old female is found lying on the ground after a lightning storm. She is apneic, and you palpate a weak carotid pulse. You observe a fern-like burn pattern on her back. You should suspect she was: A. thrown by the pressure wave from the thunderclap. B. struck by lightning. C. exposed to ozone from a nearby lightning strike. D. struck by flying debris.

B. struck by lightning. Feedback: You should suspect she was struck by lightning. A lightning strike is a massive direct-current shock the depolarizes the entire heart and causes asystole. Often cardiac activity will resume, but in many cases, the patient remains in respiratory arrest. A fern-patterned burn can occur with a lightning strike. Flying debris, ozone, and the pressure wave from thunder are not likely causes of her condition.

A 3-year-old male was in cardiac arrest. You successfully resuscitated him, but he remains unresponsive. His vital signs are P 124, R 22, BP 94/70, and SpO2 is 100% on oxygen by non-rebreather mask. You should: A. assist his ventilation. B. switch to a nasal cannula. C. begin to cool him. D. resume chest compressions.

B. switch to a nasal cannula. Feedback: Post-return of spontaneous circulation (ROSC), you should titrate oxygen administration to 94-99%. This will help to reduce the likelihood of a hyperoxide state that can lead to the production of oxygen free radicals. Oxygen free radicals can lead to further damage to injured cells. His vital signs are all within normal values for a patient his age. The 2015 AHA Guidelines for resuscitation advise against cooling of pediatric patients who are post-ROSC.

An 83-year-old female complains of a headache. She tells you that she has felt tired all week. Her face is symmetrical, and her speech is clear. Her grips are equal, and she does not have arm drift. Her vital signs are P 84, R 16, BP 188/100, and SpO2 is 97% on room air. You should: A. administer aspirin. B. transport her to the hospital. C. activate a Stroke Alert. D. administer oxygen.

B. transport her to the hospital. Feedback: You should transport her to the hospital for further evaluation of her hypertension. The results of your Cincinnati Prehospital Stroke Scale assessment did not indicate a stroke. Oxygen is not indicated since she is not hypoxic. Prehospital administration of aspirin for a headache is not indicated.

Question 46 of 115 1.0 Points An 11-year-old male passed out while playing soccer. When you arrive, he is conscious and tells you he had dizziness and sharp chest pain before he passed out. He points to his mid-sternum when you ask him the location of the pain. He denies any pain currently. His vital signs are P 66, R 18, BP 114/72, and SpO2 is 95% on room air. You should: A. administer oxygen by non-rebreather mask. B. transport him in a position of comfort. C. administer oxygen by nasal cannula. D. transport him fully immobilized to a long backboard.

B. transport him in a position of comfort. Feedback: He complained of chest pain and then had a syncopal episode. He needs to be transported to the hospital for further evaluation by a pediatric cardiologist. Since he is awake and has no symptoms, you should transport him in a position of comfort. Oxygen is contraindicated because his SpO2 is >94% on room air, and he has no signs of shock or hypoxia. Full immobilization to a long spine board is not indicated for this patient.

Question 71 of 115 1.0 Points A 50-year-old male has a new onset of palpitations in his chest. He denies pain or difficulty breathing. He has a history of smoking and hypertension. You auscultate coarse crackles scattered in his lower lungs. His vital signs are P 116 and irregular, R 14, BP 148/92, and SpO2 is 95% on room air. You should: A. administer oxygen by non-rebreather mask. B. transport him. C. administer oxygen by nasal cannula. D. assist with the administration of nitroglycerin.

B. transport him. Feedback: He is stable, and you should transport him to the hospital for further evaluation. His oxygen saturation is above 94% and he has no signs of dyspnea or shock, so oxygen is contraindicated. There is no indication to administer nitroglycerin.

A 39-year-old male complains of severe fatigue. He denies pain or difficulty breathing. He tells you he had myocarditis last year, and since then his heart rate has been slow. His skin is pale. His vital signs are P 54, R 16, BP 114/84, and SpO2 is 94% on room air. You should: A. administer oxygen by non-rebreather mask. B. transport him. C. administer aspirin. D. administer oxygen by nasal cannula.

B. transport him. Feedback: His heart rate is slow, but he has adequate perfusion at this time so you should transport him without further treatment. There is no indication to administer oxygen or aspirin.

An unresponsive 3-month-old female is in cardiac arrest. While you and your partner are resuscitating her, you should compress her chest: A. approximately one half of the anterior-posterior diameter of the chest. B. using a two thumb — encircling hands technique. C. over the upper third of her sternum. D. using a two-finger technique.

B. using a two thumb — encircling hands technique. Feedback: The two thumb — encircling hands technique is recommended when two or more rescuers are present because it generates higher perfusion pressures. The lower third of the sternum should be compressed one third of the anterior-posterior diameter of the chest.

Why do you often auscultate fine crackles when a patient has congestive heart failure? A. Air is passing over mucus in the bronchioles. B. Irritated pleura are rubbing together. C. Alveoli are inflating as the patient inhales. D. Air is passing through constricted bronchioles

C. Alveoli are inflating as the patient inhales. Feedback: Increased pulmonary interstitial pressure causes alveoli to collapse in congestive heart failure. As the patient inhales, the alveoli inflate, causing a popping sound heard on auscultation (rales or fine crackles). Rhonchi is caused by air passing over mucus in the bronchioles and is associated with pneumonia and bronchitis. Wheezes are caused by air passing through constricted bronchioles and are associated with asthma and emphysema. Inflammation of the pleura (pleurisy) can cause a rubbing sound over the affected area.

You are the only responder on the scene of a lightning strike where four people were injured. Based on your triage findings below, which patient should you treat first? A. A 24-year-old male complaining of difficulty breathing whose vital signs are P 88 and R 28 B. A 91-year-old female complaining of chest pain whose vital signs are P 68 and R 18 C. An unresponsive 75-year-old female lying supine who is apneic and pulseless D. A disoriented 22-year-old male complaining of dizziness whose vital signs are P 128 and R 18

C. An unresponsive 75-year-old female lying supine who is apneic and pulseless Feedback: You should treat the 75-year-old female who is in cardiac arrest first. According to the AHA, the leading cause of death from a lightning strike is "primary ventricular fibrillation or asystole." Lightning delivers a massive direct-current (think really big AED) shock to the myocardium. In many cases, the heart initially recovers, but the patient dies because the respiratory muscles are paralyzed and they cannot breathe, leading to a secondary hypoxic cardiac arrest. Patients who do not suffer cardiac or respiratory arrest after a lightning strike have an excellent chance of recovery. This is why after a lightning strike, you should reverse your triage priorities and treat the patient who is in cardiac arrest first.

In a patient who is having an acute thrombotic stroke, what causes paralysis to one side of the body? A. Damage to nerve pathways in the spinal cord B. Increased intracranial pressure C. Decreased oxygenation to an area of the brain D. Decreased levels of neurotransmitters in monosynaptic pathways

C. Decreased oxygenation to an area of the brain Feedback: The symptoms of a stroke are related to the area of the brain that is no longer receiving adequate oxygenation. Atherosclerosis is usually a contributing factor to the formation of a thrombus in cerebral arteries. Patients who have a thrombotic stroke do not normally have an increase in intracranial pressure. An acute stroke does not cause damage to the spinal cord or impact levels of neurotransmitters in reflex (monosynaptic) pathways.

You are resuscitating an 84-year-old male who is in cardiac arrest. Why is it important that you allow his chest to fully recoil while performing chest compressions? A. It helps decrease rescuer fatigue. B. It helps decrease electrical impedance across the chest. C. It helps improve blood flow to the heart. D. It helps improve exhalation.

C. It helps improve blood flow to the heart. Feedback: Full chest recoil after compressions helps to improve blood flow to the heart. Switching compressors after two minutes helps to reduce rescuer fatigue. Full chest recoil does not affect exhalation or electrical impedance.

A 62-year-old female called because she had left-sided weakness and slurred speech. When you arrive, she no longer has the weakness, and her speech is clear. She tells you she is fine and doesn't want to go to the hospital. Why should you transport her to the hospital for further evaluation? A. She is at risk for developing hypoglycemia. B. She needs to have a stent inserted to prevent further incidents. C. She is at risk of developing a stroke. D. She needs to have thrombolytics administered within three hours.

C. She is at risk of developing a stroke. Feedback: Even though her symptoms have resolved (possibly a TIA), she is at an increased risk of developing a stroke. You should transport her to the hospital for further evaluation. Since the symptoms have resolved, she does not need thrombolytics (clot busters) administered. Due to the transient nature, it is unlikely that the hospital would insert a stent. Transient ischemic events do not increase the risk of hypoglycemia.

You are resuscitating an unresponsive 84-year-old female who is in cardiac arrest. Why should you wait until you see signs of life before performing a pulse check? A. To ensure she has an adequate respiratory effort B. To prevent increased intrathoracic pressure C. To maximize cardiac output D. To minimize production of oxygen free radicals

C. To maximize cardiac output Feedback: Waiting for signs of life before performing a pulse check helps to ensure that she has an adequate cardiac output and is perfusing her brain. The AHA has placed emphasis on reducing the time that chest compressions are not being performed. Delaying a pulse check does not impact intrathoracic pressure, respiratory effort, or the production of free radicals.

An 84-year-old male complains of pain in the left side of his chest that woke him up. He has a history of hypertension and hyperlipidemia. He rates the pain 6 of 10. There is no change in the pain with deep inspiration. You auscultate fine crackles in his lower lung fields. His vital signs are P 88, R 16, BP 148/78, and SpO2 is 95% on room air. You should suspect: A. respiratory distress. B. emphysema. C. acute coronary syndrome. D. costochondritis.

C. acute coronary syndrome.

A 49-year-old male complains of left-sided chest pain. He tells you it started an hour ago and it has been constantly 4 of 10. He denies any past medical history. He has a 38 pack-year smoking history. You auscultate fine crackles in his lower lungs. His vital signs are P 96, R 16, BP 154/96, and SpO2 is 96% on room air. You should suspect: A. emphysema. B. Prinzmetal's angina. C. acute myocardial infarction. D. lung cancer.

C. acute myocardial infarction. Feedback: His hypertension and history of smoking along with the fact the pain has been constant for an hour suggests an acute coronary syndrome. Prinzmetal's angina involves spasm of the coronary arteries and normally occurs at rest during the night. In emphysema, coarse crackles (rhonchi) are caused by mucus in larger bronchioles. While smoking increased the incidence of lung cancer, it is unlikely that it would affect both lungs causing fine crackles (rales).

Question 14 of 115 1.0 Points An 84-year-old male complains of pain in his chest that started while he was watching TV. He describes the pain as squeezing and rates it 5 of 10. He tells you he has a history of heart disease. His lungs are clear to auscultation. His vital signs are P 102, R 16, BP 118/80, and SpO2 is 95% on room air. You should: A. administer oxygen by nasal cannula. B. assist with the administration of his nitroglycerin. C. administer aspirin. D. administer oxygen by non-rebreather mask.

C. administer aspirin.

Question 96 of 115 1.0 Points A 59-year-old male complains of dizziness and palpitations. He denies dyspnea. His vital signs are P 178, R 16, BP 92/56, and SpO2 is 94% on room air. You should: A. administer oxygen by non-rebreather mask. B. assist with the administration of nitroglycerin. C. administer oxygen by nasal cannula. D. administer aspirin.

C. administer oxygen by nasal cannula.

A 44-year-old female tells you she feels palpitations and is short of breath. She tells you she is taking medication to treat her atrial fibrillation. Her lungs are clear to auscultation. Her vital signs are P 106 and irregular, R 18, BP 146/84, and SpO2 is 95% on room air. You should: A. administer oxygen by non-rebreather. B. administer aspirin. C. administer oxygen by nasal cannula. D. transport her.

C. administer oxygen by nasal cannula. Feedback: Even though her SpO2 is above 94%, she complains of difficulty breathing. You should administer oxygen by nasal cannula. There is not an indication to administer aspirin.

Question 29 of 115 1.0 Points A 51-year-old male had a near syncopal episode. He has a history of Marfan syndrome. His skin is pale and diaphoretic. His lungs are clear to auscultation. His vital signs are P 108 and irregular, R 20, BP 92/58, and SpO2 is 93% on room air. You should: A. place him in Trendelenburg position. B. administer oxygen by non-rebreather mask. C. administer oxygen by nasal cannula. Feedback: You should administer oxygen by nasal cannula since he is mildly hypoxic. It is likely the cause of his hypotension is cardiac in origin because he has a fast, irregular pulse rate. There is no indication of chest pain, so you should not administer aspirin. Trendelenburg position (head lower than the heart, and feet higher than the heart) is no longer recommended because it does not improve systolic blood pressure. D. administer aspirin.

C. administer oxygen by nasal cannula. Feedback: You should administer oxygen by nasal cannula since he is mildly hypoxic. It is likely the cause of his hypotension is cardiac in origin because he has a fast, irregular pulse rate. There is no indication of chest pain, so you should not administer aspirin. Trendelenburg position (head lower than the heart, and feet higher than the heart) is no longer recommended because it does not improve systolic blood pressure.

An 86-year-old female is confused and is sitting leaning to the left in a chair. You hear snoring respirations. After you reposition her, the snoring stops, and you auscultate clear lung sounds. She tries to answer your questions, but her speech is garbled. Her vital signs are P 94, R 18, BP 138/82, and SpO2 is 91% on room air. Her blood glucose level is 74 mg/dL. You should: A. suction her airway. B. administer oral glucose. C. administer oxygen. D. insert an oropharyngeal airway.

C. administer oxygen.

A 52-year-old female complains of waking up light-headed. Her skin is pale and diaphoretic. You auscultate clear lung sounds. Her vital signs are P 46, R 16, BP 86/58, and SpO2 is unattainable. You should: A. attach the AED. B. administer aspirin. C. administer oxygen. D. assist with the administration of nitroglycerin

C. administer oxygen. Feedback: You should administer oxygen since she has signs of reduced perfusion. You should not attach an AED to a patient who has a pulse. There is no indication to administer aspirin or nitroglycerin.

An unresponsive 71-year-old male is lying in his bed. His wife tells you that she last saw him normal last night when he went to bed. You should first: A. perform a stroke assessment. B. assess his blood glucose level. C. assess his breathing and pulse. Feedback: You should first assess his breathing and carotid pulse. Your primary assessment findings would dictate your next steps. D. move him to the floor.

C. assess his breathing and pulse. Feedback: You should first assess his breathing and carotid pulse. Your primary assessment findings would dictate your next steps.

An unresponsive 10-month-old female is lying in her crib. You observe cyanosis in her lips and tongue. Her vital signs are P 76, R 18 and shallow, and her capillary refill is four seconds. You should first: A. begin chest compressions. B. assess her blood pressure. C. assist her ventilation. D. assess her pulse oximetry.

C. assist her ventilation. Feedback: You should first assist her ventilation because she is in respiratory failure. She has a change in mental status and slow respirations (normal rate is 24-30 for this age group). After you assist her ventilation for two minutes, you should reevaluate her. If her pulse remains below 60 or she has signs of poor perfusion despite ventilation, you will next begin chest compressions. There is no reason to delay life-saving treatment to assess her SpO2 or blood pressure.

An unresponsive 14-year-old female was rescued from the bottom of a pool. Bystanders are performing high-quality CPR and tell you they do not know how long she was submerged. You should first: A. apply a cervical collar. B. perform abdominal thrusts. C. attach the AED. D. determine if the pool is saltwater or chlorinated.

C. attach the AED. Feedback: Bystanders are performing high-quality CPR. You should attach the AED while they continue compressions. She may have a cervical injury, but protecting her spine from further injury is a lower priority than applying the AED. Performing abdominal thrusts is dangerous in a drowning victim and not recommended by the AHA. Your treatment is not affected by the type of water she drowned in.

Question 81 of 115 1.0 Points A 58-year-old male complains of dizziness and shortness of breath. He tells you he has had flu-like symptoms all week. You observe edema in his lower legs that he tells you is new. His lungs are clear to auscultation. His vital signs are P 108, R 18, BP 86/68, and SpO2 is 91% on room air. You should suspect: A. respiratory failure. B. pulmonary edema. C. cardiogenic shock. D. influenza.

C. cardiogenic shock. Feedback: The only answer possible based on his presentation is cardiogenic shock. His cardiac output is reduced despite an increase in his heart rate. His lungs are clear to auscultation, which rules out pulmonary edema. His hypotension and new onset of pedal edema make influenza unlikely. He is speaking with you, and there is no indication of a change in mental status (other than the orthostatic hypotension) which rules out respiratory failure.

An unresponsive 37-year-old female collapsed after she overdosed. You successfully resuscitated her, and her vital signs are P 78, R 14, BP 110/76, and SpO2 is 100% on oxygen by non-rebreather mask. You should: A. administer naloxone. B. continue your treatment and transport her. C. decrease the amount of oxygen you are administering. D. place cold packs in her axilla and begin to cool her.

C. decrease the amount of oxygen you are administering. Feedback: Since her SpO2 is above 99%, you should decrease the amount you are administering. Post-return of spontaneous circulation (ROSC), you should titrate oxygen administration to 94-99%. This will help to reduce the likelihood of a hyperoxide state that can lead to the production of oxygen free radicals. Oxygen free radicals can lead to further damage to injured cells. AHA guidelines for resuscitation advise against out-of-hospital cooling of patients who are post-ROSC. Her respiratory rate is adequate, so you should not administer naloxone. Continuing your treatment and transporting fails to recognize and treat the possible hyperoxide state.

An 89-year-old female complains of right-sided numbness and loss of bladder control. You observe that she is unable to move her right arm and leg. Her vital signs are P 74, R 16, BP 128/84, and SpO2 is 94% on room air. Her blood glucose level is 72 mg/dL. You should: A. administer oxygen by nasal cannula. B. administer oral glucose. C. determine when she was last known normal. D. administer oxygen by simple face mask.

C. determine when she was last known normal. Feedback: You need to determine when the patient was last known normal. The treatment of stroke patients with thrombolytics (clot busters) is time-sensitive. You need to obtain this information if possible and relay it to the receiving hospital. Her oxygen and glucose levels are normal, so you should not administer more.

You should assess the blood glucose level in a patient who has stroke-like symptoms because: A. hypoglycemia can cause vasospasm of cerebral arteries. B. hyperglycemia can occlude cerebral arteries. C. hypoglycemia can mimic signs and symptoms of a stroke. D. hyperglycemia can cause increased cerebral edema.

C. hypoglycemia can mimic signs and symptoms of a stroke.

An unresponsive 74-year-old female complained of a severe headache just prior to having a seizure. Her husband tells you she does not have a history of seizures. Her pupils are 4 mm, and her gaze deviates to the right. You hear snoring respirations every five seconds. You should: A. administer oral glucose. B. suction her airway. C. insert an oropharyngeal airway. D. administer naloxone.

C. insert an oropharyngeal airway. Feedback: You should insert an oropharyngeal airway. She likely is having a stroke and is snoring, indicating that her tongue is partially obstructing her airway. There is no indication that she needs to be suctioned (this would be a gurgling sound). You do not know what her blood glucose level is. Even if you did, you should not administer any medication by mouth to an unresponsive patient. There is no indication of an opioid overdose, so naloxone should not be administered.

A 56-year-old male complains of a sudden onset of difficulty breathing. He has a history of heart problems and high blood pressure. You auscultate fine crackles in the bases of his lungs. His vital signs are P 98, R 18, BP 154/88, and SpO2 is 95% on room air. You should suspect: A. decreased pulmonary interstitial fluid. B. chemical pneumonitis. C. pulmonary edema. D. bronchiolitis.

C. pulmonary edema.

A 66-year-old female complains of a sudden onset of dizziness. She tells you she thinks she has the flu. Her lungs are clear to auscultation, and she has good chest expansion. Her skin is pale, warm, and dry. Her vital signs are P 48, R 16, BP 88/56, and SpO2 is 93% on room air. You should suspect: A. poor alveolar ventilation. B. influenza. C. reduced cardiac output. D. increased sympathetic stimulation.

C. reduced cardiac output. Feedback: She has reduced cardiac output because her pulse rate is too slow. She has a good tidal volume and respiratory rate, so it is likely her alveolar ventilation is good. Sympathetic stimulation would increase the heart rate. Remember, incorrect choices are designed to be plausible, but clearly incorrect. Sometimes terms that are used as distractors will not always be within your scope of practice, but the correct answer will.

You are resuscitating an unresponsive 19-year-old male who is in cardiac arrest. After you defibrillate him, you should: A. check for a pulse. B. ventilate him. C. resume compressions. D. analyze the rhythm.

C. resume compressions. Feedback: You should resume compressions immediately after shocking the patient. After you have completed 30 compressions, you should ventilate him. After you complete five cycles of compressions and ventilation, you should analyze the rhythm. The only time you would check for a pulse again is after you observe signs of life.

EMRs are resuscitating an unresponsive 89-year-old female as you arrive with the AED. After you shock her once, you see movement of her arms. You should suspect: A. muscle spasms. B. incorrect assessment of her condition by the EMRs. C. return of spontaneous circulation. D. seizure activity.

C. return of spontaneous circulation.

You are resuscitating an unresponsive 74-year-old female who is in cardiac arrest. While you are performing chest compressions, you see her take several breaths. You should: A. perform all 30 compressions, then check for a pulse. B. stop compressions and assist her ventilation. C. stop compressions and check for a pulse. D. increase the depth of your compressions.

C. stop compressions and check for a pulse. Feedback: You should stop compressions and check for a pulse since you see signs of life. You need to assess her to determine if she has a pulse and adequate respiratory effort before you continue your treatment.

A 72-year-old male has sagging of his eyelid and mouth on the right side of his face. His daughter called because he is confused and not acting himself. He appears to understand your questions, but he is unable to answer. You should suspect: A. migraine headache. B. transient ischemic attack. C. stroke. D. hyperglycemia.

C. stroke. Feedback: You should suspect a stroke. He has signs of facial droop and aphasia. These findings are not associated with hyperglycemia or migraine. You would only suspect a transient ischemic attack if his findings resolved

The husband of a 56-year-old female called because she has left-sided weakness. When you arrive, her speech is slurred, and you observe a right-sided facial droop. As you transport her to the hospital, her speech becomes clear. Her weakness and facial droop also resolve. You should suspect a(n): A. thrombotic stroke. B. hemorrhagic stroke. C. transient ischemic attack. D. embolic stroke

C. transient ischemic attack. Feedback: Since her findings of a stroke resolve, you should suspect a transient ischemic attack. Symptoms of TIA usually resolve within 30 minutes to one hour. Hemorrhagic, thrombotic, and embolic stroke findings do not resolve without treatment.

A 54-year-old female complains of dizziness. She denies any past medical history and hasn't seen her doctor in years. Her face is slightly red, and her lungs are clear to auscultation. Her vital signs are P 72, R 16, BP 162/98, and SpO2 is 97% on room air. You should: A. administer oxygen by non-rebreather mask. B. place her in Trendelenburg position. C. transport her. D. administer oxygen by nasal cannula.

C. transport her. Feedback: She is hypertensive, and you should transport her to the hospital for further evaluation. Her oxygen saturation is adequate, and she does not have signs of hypoxia, so oxygen should not be administered. Placing her in Trendelenburg position will not improve her condition.

Question 85 of 115 1.0 Points A 62-year-old male passed out while at the gym. He is awake now, and he tells you that he feels dizzy. His vital signs are P 98, R 16, BP 82/58, and SpO2 is 91% on room air. His blood glucose level is 82 mg/dL. After administering oxygen, you should: A. administer aspirin. B. administer oral glucose. C. transport him supine. D. transport him in Fowler's position.

C. transport him supine.

A 6-month-old female is non-responsive to stimuli and has central cyanosis. Her father tells you she has had a cold. Her vital signs are P 80, R 24 and shallow, and her capillary refill is three seconds. What should you suspect is causing her bradycardia? A. Myocardial ischemia B. Atherosclerosis C. Sick sinus syndrome D. Hypoxia

D. Hypoxia Feedback: The leading cause of decreased heart rate and bradycardia in infants and children is hypoxia. The others are all causes of bradycardia that occur due to changes that happen as we age. Sick sinus syndrome is an uncommon dysfunction of the heart's sinus node. Myocardial ischemia occurs when the blood flow to an area of the heart is obstructed. Atherosclerosis is caused by plaque that builds up in arteries (this plaque narrows and hardens the arteries).

Why should you administer aspirin to a patient whom you suspect has cardiac compromise? A. To provide analgesic effects at the site of a ruptured coronary plaque B. To dilate coronary arteries at the site of the ruptured plaque C. To dissolve a ruptured coronary plaque D. To reduce clotting at the site of a ruptured coronary plaque

D. To reduce clotting at the site of a ruptured coronary plaque

An 81-year-old male is experiencing chest pain. He has no signs of dyspnea or shock. Why should you target oxygen administration to a SpO2 between 94%-99%? A. To reduce platelet aggregation B. To increase carbon dioxide removal C. To increase vasodilation D. To reduce production of free-radicals Feedback: Higher levels of oxygen in the blood increase the likelihood of production of oxygen free radicals. These free radicals can destroy cardiac cells injured by cardiac compromise. Vasodilation of blood vessels occurs when tissue is hypoxic, not because oxygen saturation is within normal ranges. Aspirin helps to reduce platelet aggregation. Increasing tidal volume increases carbon dioxide removal.

D. To reduce production of free-radicals Feedback: Higher levels of oxygen in the blood increase the likelihood of production of oxygen free radicals. These free radicals can destroy cardiac cells injured by cardiac compromise. Vasodilation of blood vessels occurs when tissue is hypoxic, not because oxygen saturation is within normal ranges. Aspirin helps to reduce platelet aggregation. Increasing tidal volume increases carbon dioxide removal.

An 81-year-old male complains of chest pain that he describes as a heaviness. He denies any allergies to medication or active bleeding. He denies taking any medication prior to your arrival. You should first: A. determine his pulse oximetry. B. auscultate his lung sounds. C. assess his vital signs. D. administer aspirin.

D. administer aspirin. Feedback: Aspirin should be administered as soon as possible and chewed to speed absorption. Since he did not take aspirin prior to your arrival as the AHA recommends, your first action should be to administer aspirin 162-324 mg, chewed. Afterward, you can complete your assessment.

A 52-year-old male had a syncopal episode when he stood up. He tells you that this has been happening as his doctor adjusts his hypertension medication. He denies any complaint of pain or injury, since he fell back onto the couch when he passed out. His vital signs are P 72, R 16, BP 98/64, and SpO2 is 93% on room air. You should: A. administer oxygen by non-rebreather mask. B. immobilize him to a long backboard. C. give him sips of a sports drink. D. administer oxygen by nasal cannula.

D. administer oxygen by nasal cannula. Feedback: He has signs of cardiogenic shock and mild hypoxia, so you should administer oxygen. Since he is only mildly hypoxic, you should use a nasal cannula. There is no indication of a spinal injury that would justify immobilizing him to a long backboard. You should not administer liquids or sports drinks.

A 7-year-old male passed out while playing soccer. He has a history of asthma. He is alert now and tells you he feels like his heart is beating out of his chest. He is dyspneic, and you auscultate clear lung sounds. His pulse is too fast to count, and the rest of his vital signs are R 32, BP 88/58, and SpO2 is 92% on room air. You should: A. administer aspirin. B. assist with the administration of nitroglycerin. C. assist with the administration of albuterol. D. administer oxygen.

D. administer oxygen.

A 27-year-old female complains of palpitations and dizziness. She denies any past medical history. Her vital signs are P 188, R 18, BP 88/ 62, and SpO2 is 94% on room air. You should first: A. administer aspirin. B. transport her. C. attach the AED. D. administer oxygen. Feedback: Even though her SpO2 is above 94%, you should administer oxygen because she has signs of cardiogenic shock. She has a pulse, so the AED is not used. She does not have chest pain, so aspirin is not indicated. You will transport her, but oxygen should be administered first.

D. administer oxygen. Feedback: Even though her SpO2 is above 94%, you should administer oxygen because she has signs of cardiogenic shock. She has a pulse, so the AED is not used. She does not have chest pain, so aspirin is not indicated. You will transport her, but oxygen should be administered first.

An unresponsive 84-year-old male was found in bed. His skin is pale and diaphoretic. His lungs are clear to auscultation and have equal expansion. His vital signs are P 38, R 16, BP 82/58, and SpO2 is 92% on room air. You should: A. attach the AED. B. assist his ventilation. C. begin chest compressions. D. administer oxygen.

D. administer oxygen. Feedback: He has signs of decreased perfusion and mild hypoxia, so oxygen should be administered. His tidal volume and respiratory rate indicate that he has adequate alveolar ventilation. There is no need to assist his ventilation. You should not perform chest compression or attach the AED to an adult who has a pulse.

An 85-year-old male tells you that he woke up sweaty and nauseated. He tells you he has a funny feeling in his chest that he cannot specifically describe. He tells you he has a history of diabetes and hypertension. His lungs are clear to auscultation. His vital signs are P 104 and irregular, R 14, BP 102/88, and SpO2 is 91% on room air. You should first: A. assess his blood glucose level. B. assist with the administration of nitroglycerin. C. assess for orthostatic hypotension. D. administer oxygen.

D. administer oxygen. Feedback: You should administer oxygen since he has signs of hypoxia (SpO2 is 91%) and poor perfusion (nausea & diaphoresis). Per AHA guidelines, "The use of nitrates in patients with hypotension ..., extreme bradycardia ..., or tachycardia in the absence of heart failure (greater than 100 bpm) and in patients with right ventricular infarction is contraindicated." You should not delay administering oxygen to assess for blood glucose level or orthostatic hypotension.

Question 94 of 115 1.0 Points A 55-year-old female complains of pressure in her upper abdomen. She tells you it started while she was sitting at her desk doing paperwork. She has a history of hypertension and high cholesterol. Her vital signs are P 88 and irregular, R 16, BP 140/86, and SpO2 is 95% on room air. You should administer: A. antacid. B. oxygen by simple face mask. C. oxygen by nasal cannula. D. aspirin.

D. aspirin.

A 45-year-old female has left-sided weakness that started 20 minutes ago. She has difficulty finding the right words to answer your questions. Her vital signs are P 86, R 14, BP 142/74, and SpO2 is 96% on room air. You should next: A. notify the receiving hospital of a Stroke Alert. B. administer oxygen by nasal cannula. C. administer oxygen by simple face mask. D. assess her blood glucose level.

D. assess her blood glucose level. Feedback: You need to determine her blood glucose level. Hypoglycemia is a mimic that needs to be ruled out before confirming a diagnosis of stroke. Glucose monitoring by EMTs is an accepted skill and recently added in the 2018 National EMS Scope of Practice Model. Her SpO2 is over 94% on room air, so administering oxygen is not indicated.

While resuscitating a 1-month-old female, you achieve ROSC. She is unresponsive and has a rapid brachial pulse. You should next: A. analyze her rhythm with the AED. B. begin to cool her. C. continue compressions. D. assess her breathing.

D. assess her breathing. Feedback: The next step in the AHA post-return of spontaneous circulation (ROSC) algorithm is to determine respiratory status. This is especially important in infants and children whose likely cause of arrest is a respiratory cause. She has a detectable cardiac output (a pulse), so there is no indication currently to continue chest compressions. You should not use an AED when the patient has a pulse. The AHA Guidelines for resuscitation advise against cooling of pediatric patients who are post-ROSC.

Question 45 of 115 1.0 Points An unresponsive 78-year-old male was found on the tiled floor of his bathroom. His clothing is wet, and you smell urine. You do not observe chest rise or feel a pulse. His skin is cyanotic. His hands and feet are cold to the touch. His core is warm. You should suspect: A. severe hypothermia and attach the AED. B. death, attach the AED and analyze his rhythm. C. moderate hypothermia and ventilate him. D. cardiac arrest and begin chest compressions. Feedback: He is in cardiac arrest, and you should begin chest compressions. This is a two-part question. He is apneic and pulseless. His core is warm, so you do not have signs of obvious death. So, you should begin chest compressions. Lying on a tile floor with wet clothing can cool the body faster than if he was in bed with dry clothing.

D. cardiac arrest and begin chest compressions. Feedback: He is in cardiac arrest, and you should begin chest compressions. This is a two-part question. He is apneic and pulseless. His core is warm, so you do not have signs of obvious death. So, you should begin chest compressions. Lying on a tile floor with wet clothing can cool the body faster than if he was in bed with dry clothing.

An unresponsive 57-year-old male is not breathing, and you are unable to palpate a carotid pulse. While your partner is performing chest compressions, you attach the AED and analyze his rhythm. The AED announces, "No shock advised." You should next: A. check for a pulse. B. insert an oropharyngeal airway. C. ventilate him. D. resume chest compressions.

D. resume chest compressions. Feedback: You should resume chest compressions. It is important that you maintain as high of a chest compression fraction as possible to improve the outcome. You should ventilate him after 30 compressions. You should only check for a pulse if you see signs of life. An oropharyngeal airway can be inserted by the rescuer who is not compressing at any time.

Question 92 of 115 1.0 Points During your resuscitation efforts, you have defibrillated an unresponsive 42-year-old male twice. While your partner is performing chest compressions, it appears that the patient is taking breaths. You should suspect: A. diaphragmic spasms. B. failure to allow full recoil of the chest. C. incorrect hand positioning. D. return of a pulse.

D. return of a pulse.

An unresponsive 8-year-old female was found outside on a cold night. She is apneic, pulseless, and her skin is cold. You begin chest compressions, attach the AED, and analyze her rhythm. The AED announces, "Shock advised." You should: A. disregard the AED and begin transport. B. disregard the AED and begin to rewarm her actively. C. shock her and reanalyze her rhythm. D. shock her and resume compressions.

D. shock her and resume compressions. Feedback: You should shock her and resume compressions according to AHA Guidelines. After defibrillation, you should immediately resume compressions. Do not delay providing cerebral circulation by assessing for a pulse. The other answers are incorrect because you should not disregard the AED.

You are resuscitating a 45-year-old male who is in cardiac arrest. Your partners are performing chest compressions and operating the AED. You are ventilating him with a BVM and leading the team. When should you check for a pulse? A. After administering two breaths B. After you observe he is breathing on his own C. After the AED announces, "No shock advised" D. After two minutes of chest compressions

B. After you observe he is breathing on his own Feedback: You should check for a pulse after you observe he is breathing on his own. Aside from the initial pulse check during your primary assessment, the only time you should check for a pulse is when there are signs of life.

Which of the following can result in the occlusion of a coronary artery? A. Pulmonary artery embolism B. Atherosclerosis of a coronary artery C. Increased systemic vascular resistance D. Reduced cardiac output

B. Atherosclerosis of a coronary artery

Which of the following may account for why a 62-year-old male who is in cardiac arrest after drowning does not have water in his lungs? A. Increased venous pressure after ROSC B. Bronchospasm after cardiac arrest C. Reduced cardiac output during CPR D. Laryngeal spasm prior to cardiac arrest

B. Bronchospasm after cardiac arrest

You are resuscitating an unresponsive 59-year-old female when you achieve ROSC. She is still unresponsive, has a weak carotid pulse, and is apneic. How often should you ventilate her? A. Twice after 15 chest compressions B. Once every six seconds C. Twice after 30 chest compressions D. Once every 12 seconds

B. Once every six seconds Feedback: Since she is only in respiratory arrest, you should ventilate her once every six seconds (10/minute). Once every 12 seconds is too slow (5/minute). The acronym ROSC is an abbreviation for the return of spontaneous circulation. You should only perform chest compressions on a patient who is in cardiac arrest.

A 52-year-old male is not able to speak or follow your directions. His wife tells you he had no complaints when he went to bed. When he woke up 30 minutes ago, he complained of a severe stiff neck and headache. His eyes are open and deviated to the left. His vital signs are P 62, R 12 and irregular, BP 168/74, and SpO2 is 96% on room air. You should suspect: A. chronic meningitis. B. Bell's palsy. C. spinal cord tumor. D. stroke. Feedback: You should suspect that he is having a stroke. He has a sudden onset of head and neck pain then an alteration of his level of consciousness. This should cause you to suspect an acute cause of his problem. Deviation of his eyes to one side and his vital signs suggest increased ICP. He might be having a hemorrhagic stroke. Chronic meningitis and tumors develop over time and are less likely to have signs that developed overnight. Bell's palsy is a stroke mimic that affects an isolated cranial nerve (7th) causing a facial droop on one side.

D. stroke. Feedback: You should suspect that he is having a stroke. He has a sudden onset of head and neck pain then an alteration of his level of consciousness. This should cause you to suspect an acute cause of his problem. Deviation of his eyes to one side and his vital signs suggest increased ICP. He might be having a hemorrhagic stroke. Chronic meningitis and tumors develop over time and are less likely to have signs that developed overnight. Bell's palsy is a stroke mimic that affects an isolated cranial nerve (7th) causing a facial droop on one side.