Chapter 16
The iliac arteries immediately subdivide into the: anterior tibial arteries. femoral arteries. posterior tibial arteries. peroneal arteries.
femoral arteries
The AED is MOST advantageous to the EMT because: it delivers an unlimited number of shocks with the same amount of energy. its use does not require the presence of advanced life support personnel. it delivers prompt defibrillation to patients with ventricular fibrillation. it is lightweight, easy to use, and safe for the EMT who is using it.
it delivers prompt defibrillation to patients with ventricular fibrillation
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: immediately assess the patient's airway. re-analyze the patient's cardiac rhythm. determine if a palpable pulse is present. perform CPR for 2 minutes and reassess.
perform CPR for 2 minutes and reassess
Which of the following blood vessels transports oxygenated blood? Inferior vena cava Pulmonary veins Superior vena cava Pulmonary arteries
pulmonary veins
When documenting a patient's description of his or her chest pain or discomfort, the EMT should: use the patient's own words. document his or her own perception. underline the patient's quotes. use medical terminology.
use the patient's own words
Which of the following veins is located inferior to the trunk? Subclavian Cephalic Saphenous Axillary
saphenous
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure? Hypotension and flat jugular veins Trouble breathing while lying down The presence of rales in the lungs Hypertension and tachycardia
hypotension and flat jugular veins
When obtaining a 12-lead ECG, the patient should be: in a supine position with legs elevated. in a semi-Fowler's position with legs crossed. in a semi-Fowler's position with arms raised. in a supine position with legs uncrossed.
in a supine position with legs uncrossed
The main advantage of the AED is: A. it provides quick delivery of a shock. B. it is easier than performing CPR. C. there is no need for ALS providers to be on scene. D. All of the above.
all of the above
You and your EMT partner are the first to arrive at the scene of an unresponsive 70-year-old man. Your assessment reveals that he is apneic and pulseless. A paramedic unit is en route to the scene and will arrive in approximately 5 minutes. You should: apply the AED while your partner provides rescue breathing. begin CPR and have your partner update the responding paramedics. begin CPR, apply the AED, and deliver a shock if it is indicated. perform CPR only and wait for the manual defibrillator to arrive.
begin CPR, apply the AED, and deliver a shock if it is indicated
In contrast to the sympathetic nervous system, the parasympathetic nervous system: slows the heart and respiratory rates. dilates the blood vessels in the muscles. prepares the body to handle stress. causes an increase in the heart rate.
slows the heart and respiratory rates
Cardiac output may decrease if the heart beats too rapidly because: as the heart rate increases, more blood is pumped from the ventricles than the atria. there is not enough time in between contractions for the heart to refill completely. the volume of blood that returns to the heart is not sufficient with fast heart rates. a rapid heart beat causes a decrease in the strength of cardiac contractions.
there is not enough time in between contractions for the heart to refill completely
Common signs and symptoms of a hypertensive emergency include: tachycardia, pain behind the eyes, and weakness. pallor, cool skin, and a temporary loss of hearing. a bounding pulse, a severe headache, and dizziness. syncope, a weak pulse, and bleeding from the ears.
a bounding pulse, a severe headache, and dizziness
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? Syncope or dizziness Heart rate less than 60 beats/min Generalized weakness A rapid heart rate
a rapid heart rate
A 59-year-old woman presents with chest pressure. She is conscious and alert, but her skin is cool, pale, and clammy. Your first step in providing care (treatment) should be: A. apply the AED. B. administer oxygen. C. ask her if she takes nitroglycerin. D. take a complete set of vital signs.
administer oxygen
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should: obtain a SAMPLE history and contact medical control for advice. give her one nitroglycerin and reassess her systolic blood pressure. give her high-flow oxygen, attach the AED, and transport at once. administer oxygen, give her 324 mg of aspirin, and assess her further.
administer oxygen, give her 324 mg of aspirin, and assess her further
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they: cannot afford it. are in denial. do not trust EMTs. are elderly.
are in denial
Which of the following is the MOST reliable method of estimating a patient's cardiac output? Connect the patient to an electrocardiogram. Assess the heart rate and strength of the pulse. Determine the average diastolic blood pressure. Listen to heart sounds with a stethoscope.
assess the heart rate and strength of the pulse
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: request a paramedic unit for assistance. determine if you need additional help. gain immediate access to the patient. assess the scene for potential hazards.
assess the scene for potential hazards
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called: excitability. contractility. automaticity. impulsivity.
automaticity
The posterior tibial pulse can be palpated: between the trachea and the neck muscle. in the fossa behind the knee. on the dorsum of the foot. behind the medial malleolus, on the inside of the ankle.
behind the medial malleolus, on the inside of the ankle
Major controllable risk factors for an AMI include: A. older age. B. family history. C. cigarette smoking. D. male sex.
cigarette smoking
A 56-year-old man has an acute myocardial infarction. Which of the following blood vessels became blocked and led to his condition? A. Coronary veins B. Coronary arteries C. Pulmonary veins D. Pulmonary arteries
coronary arteries
Cardiogenic shock following AMI is caused by: a profound increase in the patient's heart rate. decreased pumping force of the heart muscle. hypovolemia secondary to severe vomiting. widespread dilation of the systemic vasculature.
decreased pumping force of the heart muscle
A patient with cardiac arrest secondary to ventricular fibrillation has the greatest chance for survival if: A. CPR is initiated within 10 minutes. B. oxygen and rapid transport are provided. C. defibrillation is provided within 2 minutes. D. paramedics arrive at the scene within 5 minutes.
defibrillation is provided within 2 minutes
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? Avoid defibrillation as this will damage the patient's AICD. Continue CPR and transport the patient to the closest appropriate hospital. Contact medical control and request permission to defibrillate. Deliver the shock followed by immediate resumption of CPR.
deliver the shock followed by immediate resumption of CPR
Which of the following signs is commonly observed in patients with right-sided heart failure? Dependent edema Labored breathing Flat jugular veins Pulmonary edema
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 do these signs and symptoms MOST likely indicate? Acute myocardial infarction Unstable angina Hypertensive emergency Dissecting aortic aneurysm
dissecting aortic aneurysm
While palpating the radial pulse of a 56- year-old man with chest pain, you note that the pulse rate is 86 beats/min and irregular. This indicates: A. pain. B. fear. C. anxiety. D. dysrhythmia.
dysrhythmia
The main legal risk in using the AED is: negligence on the part of the manufacturer. failure of the AED's internal computer chip. not assessing for a pulse after a shock is delivered. failing to deliver a shock when one is needed.
failing to deliver a shock when one is needed
Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort? Presence of personal risk factors Family history of hypertension History of previous heart attack History of cigarette smoking
family history of hypertension
All of the following are common signs and symptoms of cardiac ischemia, EXCEPT: A. headache. B. chest pressure. C. shortness of breath. D. anxiety or restlessness.
headache
Which of the following statements regarding nitroglycerin is correct? A maximum of five nitroglycerin doses should be given to a patient. The potency of nitroglycerin is increased when exposed to light. Nitroglycerin should be administered between the cheek and gum. Nitroglycerin usually relieves anginal chest pain within 5 minutes.
nitroglycerin usually relieves anginal chest pain within 5 minutes
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must: determine who prescribed the nitroglycerin. obtain authorization from medical control. wait at least 5 minutes after assessing the blood pressure. ensure the medication is in tablet form.
obtain authorization from medical control
In contrast to AMI, a dissecting aortic aneurysm: usually presents gradually, often over a period of hours. often presents with pain that is maximal from the onset. is typically preceded by other symptoms, such as nausea. is more commonly associated with pressure in the chest.
often presents with pain that is maximal from the onset
If a patient with an implanted pacemaker is in cardiac arrest, the EMT should: A. avoid defibrillation with the AED and transport at once. B. not apply the AED until he or she contacts medical control. C. place the AED pads away from the pacemaker. D. apply the AED pads directly over the implanted pacemaker.
place the AED pads away from the pacemaker
A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has been prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes: ventilations with a BVM. nitroglycerin for her chest pain. oxygen at 2 L/min via nasal cannula. placing her in an upright position.
placing her in an upright position
After assisting your patient with prescribed nitroglycerin, you should: reassess his or her blood pressure within 5 minutes to detect hypotension. avoid further dosing if the patient complains of a severe headache. place the patient in a recumbent position in case of fainting. perform a secondary assessment before administering further doses.
reassess his or her blood pressure within 5 minutes to detect hypotension
After administering a nitroglycerin tablet to a patient, the EMT should: A. check the expiration date of the nitroglycerin. B. reassess the patient's blood pressure within 5 minutes. C. instruct the patient to chew the tablet until it is dissolved. D. ensure that the nitroglycerin is prescribed to the patient.
reassess the patient's blood pressure within 5 minutes
During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that: the AED detected patient motion. she has a pulse and does not need CPR. she is not in ventricular fibrillation. the AED has detected asystole.
she is not in ventricular fibrillation
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: alert the receiving hospital and perform CPR for the duration of the transport. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. stop the ambulance, begin CPR, and attach the AED as soon as possible. defibrillate with the AED while continuing transport to the hospital.
stop the ambulance, begin CPR, and attach the AED as soon as possible
The purpose of defibrillation is to: stop the chaotic, disorganized contraction of the cardiac cells. prevent asystole from deteriorating into ventricular fibrillation. cause a rapid decrease in the heart rate of an unstable patient. improve the chance of CPR being successful in resuscitation.
stop the chaotic, disorganized contraction of the cardiac cells
When treating a patient with chest pain, you should assume that he or she is having an AMI because: most patients with chest pain are experiencing an AMI. angina and AMI present identically. the cause of the pain cannot be diagnosed in the field. angina usually occurs after an AMI.
the cause of the pain cannot be diagnosed in the field
A dissecting aortic aneurysm occurs when: the inner layers of the aorta become separated. the aorta ruptures, resulting in profound bleeding. a weakened area develops in the aortic wall. all layers of the aorta suddenly contract.
the inner layers of the aorta become separated
Nitroglycerin is contraindicated in patients: who have taken up to two doses. with a systolic blood pressure less than 120 mm Hg. who have experienced a head injury. with a history of an ischemic stroke.
who have experienced a head injury
Nitroglycerin is contraindicated in patients: A. with a systolic blood pressure less than 100 mm Hg. B. with chest pain of greater than 30 minutes duration. C. who are currently taking antibiotics for an infection. D. who are younger than 40 years of age and have diabetes.
with a systolic blood pressure less than 100 mm Hg
