Chapter 16: Cardiovascular Emergencies
A 67 y/o 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 bpm. Treatment for this patient includes: A. Nitroglycerine for her chest pain B. placing her in the upright position C. ventilation with a BVM D. Oxygen at 2 L/min via nasal cannula
B
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
In contrast to AMI, a dissecting aortic aneurysm: A. Is typically preceded by other symptoms, such as nausea B. often presents with pain that is maximal from the onset C. is more commonly associated with pressure in the chest D. usually presents gradually, often over a period of hours
B
Major risk factors for AMI include all of the following, EXCEPT: A. Elevated cholesterol B. hypoglycemia C. Diabetes mellitus D. Hypertension
B
Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS. A. 2 B. 3 C. 4 D. 5
B
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must: A. ensure the medication is in tablet form. B. obtain authorization from medical control. C. determine who prescribed the nitroglycerin. D. wait at least 5 minutes after assessing the blood pressure.
B
Sudden death following AMI is MOST often caused by: A. congestive heart failure B. ventricular fibrillation C. cardiogenic shock D. severe brachycardia
B
The myocardium receives oxygenated blood from the _________, which originates from the _________. A. Vena cava, coronary veins B. Coronary arteries, aorta C. Aorta, inferior vena cava D. Coronary sinus, vena cava
B
The purpose of defibrillation is to: A. Improve the chance of CPR being successful in resuscitation B. stop the chaotic, disorganized contraction of cardiac cells C. cause a rapid decrease in the heart rate of an unstable patient D. prevent asystole from deteriorating into ventricular fibrillation
B
The right coronary artery supplies blood to the: A. right atrium and posterior wall of the right ventricle B. right ventricle and inferior wall of the left ventricle C. left ventricle and posterior wall of the right ventricle D. Left ventricle and inferior wall of the right atrium
B
When preparing to obtain a 12-lead EKG, the V1 and V2 electrodes should be paced: A. on the left and right arms B. On either side of the sternum C. In the midaxillary line D. in the midclavicular line
B
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
Which of the following is LEAST important when obtaining a medical history from a patient complaint of chest discomfort? A. History of cigarette smoking B. Family history of hypertension C. Presence of personal risk factors D. History of a previous heart attack
B
Which of the following is NOT a function of the sympathetic nervous system? A. Increase in the heart and respiratory rates B. Constriction of blood vessels in the muscles. C. Dilation of blood vessels in the muscles D. Constriction of blood vessels in the digestive system.
B
Which of the following veins is located inferior to the trunk? A. Subclavian B. Saphenous C. Axillary D. Cephalic
B
You are dispatched to a residence for a 56y/o male with an altered mental status. Upon arrival at the scene, the patient's wife tells you he complained about chest pain the day before but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow representations; and has a thready pulse. You should: A. obtain baseline vital signs B. begin ventilatory assistance C. attach the AED immediately D. Apply a nonrebreathing mask
B
Acute coronary syndrome (ACS) is a term used to describe: A. The exact moment that a coronary artery is completely occluded B. the warning signs that occur shorlty before a heart attack C. a group of symptoms that are caused by myocardial ischemia D. A severe decrease in perfusion caused by changes in heart rate
C
Cardiogenic shock following AMI is caused by: A. a profound increase in the patient's heart rate B. hypovolemia secondary to severe vomiting C. Decreased pumping force of the heart muscle D. widespread dilation of the system vasculature
C
Common side effects of nitroglycerin include all of the following except: A. hypotension B. headache C. hypertension D. bradycardia
C
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: A. the AED has detected asystole. B. the AED detected patient motion. C. she is not in ventricular fibrillation. D. she has a pulse and does not need CPR.
C
In contrast to the sympathetic nervous system, the parasympathetic nervous system: A. dilates the blood vessels in the muscles B. prepares the body to handle stress C. slows the heart and respiratory rates D. causes an increase in the heart rate
C
Ischemic heart disease is defined as: A. absent myocardial blood flow due to blocked coronary artery B. death of a portion of heart muscle due to a decrease of oxygen C. decreased blood flow t o one or more portions of the myocardium D. decreased blood flow to the heart muscle due to coronary dilation
C
It would be most appropriate for a patient to take his or her prescribed nitroglycerin when experiencing: A. difficulty breathing that awakens the patient from sleep B. sharp chest pain that lasts longer than 10-15 minutes C. chest pain that does not immediately subside with rest D. an acute onset of dizziness during a period of exertion
C
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for: A. right ventricular failure B. significant hypotension C. congestive heart failure D. a cardiac arrhythmia
C
The AED has delivered a shock to an elderly male in cardiac arrest. Following two minutes of CPR, you re-analyze the patient's cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpabe carotid pulse. Your next action should be to: A. Place him in the recovery position and apply oxygen B. obtain BP and apply a pulse oximeter C. Reassess airway and breathing and treat accordingly D. transport at once and re-analyze his rhythm en route.
C
What is the function of the left atrium? A. It receives oxygenated blood from the vena cava. B. It recieves blood from the pulmonary arteries. C. It recieves oxygenated blood from the lungs. D. It ejects oxygenated blood into the aorta.
C
A 40 y/o 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. Deliver shock and CPR B. Continue CPR and transport C. Avoid shock to avoid damage to AICD D. Contact medical control and request permission to shock
A
Nitroglycerin relieves cardiac-related chest pain by: A. dilating the coronary arteries and improving cardiac blood flow B. constricting the coronary arteries and improving cardiac blood flow C. contracting the smooth muscles of the coronary and cerebral arteries D. increasing the amount of stress that is placed on the myocardium
A
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is becaue they: A. Are in denial B. Cannot afford it C. Are elderly D. Do not trust EMTs
A
The descending aorta divides into two iliac arteries at the level of the: A. umbilicus B. pubic symphysis C. nipple line D. iliac crest
A
The inferior vena cava returns deoxygenated blood to the right side of the heart from all the following areas, EXCEPT the: A. Brain B. Abdomen C. Legs D. Kidneys
A
The most common error associated with the use of the AED is: A. Failure of 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
Ventricular tachycardia causes hypotension because: A. the left ventricle does not fill adequately with blood B. the volume of blood returning to the atria increases C. the right ventricle does not adequately pump blood. D. blood backs up into the lungs and causes congestion
A
You are assessing a 49y/o man who complains of cest 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 nitroglycerine 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 nitro patch and place him in a supine position, and elevate his lower extremities while preparing for immediate transport. B. Move the nitro patch to the other side of the chest in case you need to shock the patient, keep him warm, and transport without a delay. C. immediately remove the nitro patch and apply the AED in case he develops cardiac arrest and transport immediately. D. ask him if the nitro patch improved his chest pressure, complete your secondary assessment and transport promptly
A
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that: A. The SA node can reset and generate another impulse B. The impulse can spread through the purkinje fibers C. Blood can pass from the atria to the ventricles D. Blood returning from the body can fill the atria.
C
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 usually relieves anginal chest pain within five minutes D. Nitroglycerin should be administered between the cheek and gum.
C
Which of the following statements regarding the AED and defibrillation is correct? A. CPR should be performed for 5 minutes before using the AED. B. Defibrillation is the first link in the AHA chain of survival. C. The AED will not analyze the rhythm of a moving patient. D. The AED will shock any rhythm not accompanied by a pulse.
C
While obtaining a 12-lead EKG prior to ALS arrival, you note the presence of artifacts on the tracing. What is the most likely cause of this? A. Incorrect placement of the leads B. Abnormal cardiac electrical activity C. Excessive movement of the patient D. The patient's pulse is irregular
C
You and your EMT partner are the first to arrive at the scene of an unresponsive 70y/o 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: A. apply the AED while your partner provides rescue breathing B. perform CPR only and wait for the manual defibrillator to arrive C. begin CPR, apply the AED, and deliver a shock if it is indicated. D. Begin CPR and have your partner update the responding paramedics.
C
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. placing a stent inside the coronary artery to keep it from narrowing. C. bypassing the coronary artery with a bessel from the chest or leg. D. Dilating the affected coronary artery with a small inflatable balloon.
D
After assisting a patient with prescribed nitroglycerin, you should: A. Avoid furthur dosing if the patient complains of a severe headache B. Place the patient in a recumbent position in case of fainting C. perform a secondary assessment before administering further doses D. reassess his or her blood pressure within five minutes to detect hypotension
D
Cardiac output may decrease if the heart beats too rapidly because: A. as the heart rate increases, more blood is pumped from the ventricles than the atria. B. the volume of blood that returns to the heart is not sufficient with fast heart rates C. a rapid heartbeat causes a decrease in strength of cardiac contractions. D. there is not enough time in between contractions for the heart to refill completely
D
Common signs and symptoms of AMI include all of the following, EXCEPT: A. Sudden unexplained sweating B. shortness of breath or dyspnea C. irregular heartbeat D. pain exacerbated by breathing
D
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. Somatic nervous system B. Pons and medulla C. parietal lobe D. autonomic nervous system
D
The head and brain receive their supply of oxygenated blood from the: A. subclavian arteries B. iliac arteries C. brachial arteries D. carotid arteries
D
The iliac arteries immediately subdivide into the A. peroneal arteries B. posterior tibial arteries C. anterior tibial arteries D. femoral arteries
D
The posterior tibial pulse can be palated: A. Between the trachea and the neck muscle B. on the dorsum of the foot C. In the fossa behind the knee D. behind the medial malleolus, on the inside of the ankle
D
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to: A. Gain immediate access to the patient B. determine if you need additional help C. request a paramedic unit for assistance D. assess the scene for potential hazards
D
When documenting a patient's description of his or her chest pain or discomfort, the EMT should; A. Document his or her own perception B. Underline the patient's quotes. C. Use medical terminology D. Use the patient's own words
D
When treating a patient with chest pain, you should assume that he or she is having an AMI because: A. angina usually occurs after an AMI B. Most patients with chest pains are experiencing an AMI C. Angina and AMI present identically D. The cause of pain cannot be diagnosed in the field
D
Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm? A. Sinus bradycardia B. Sinus Tachycardia C. Extra ventricular beats D. Ventricular tachycardia
D
Which of the following is the MOST reliable method of estimating a patient's cardiac output? A. Connect the patient to an electrocardiogram B. Listen to the heart sounds with a stethoscope. C. Determine the average diastolic blood pressure D. Assess the heart rate and strength of pulse
D
Which of the following statements regarding the pain associated with AMI is correct? A. It is often described by teh patient as a sharp feeling. B. Nitroglycerin usually resolves the pain within 30 minutes. C. It often fluctuates in intensity when the patient breathes. D. It can occur during exertion or when the patient is at rest.
D
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two off duty EMTs performing CPR on the patient, a 58y/o male. Your initial action should be: A. request a paramedic unit and quickly attach an AED B. quickly attach the AED and push the analyze button C. Have the EMTs stop CPR and assess for a pulse D. Feel for a pulse while compression are ongoing.
D