chapter 17 emt
A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced?
-Acute myocardial infarction
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:
-administer oxygen, give her 324 mg of aspirin, and assess her further.
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:
-remove the battery from the monitor and then remove the vest.
what is the minimum systolic blood pressure necessary to administer nitroglycerin?
100 mm Hg
medical control orders you to administer nitroglycerin to an 82 year old male with chest pain.what is the maximum number of doses you should administer?
3
which of the following patients is most likely suffering from congestive heart failure?
A 64 year old male with uncontrolled hypertension, dependent edema, and dyspnea
Which of the following is the MOST reliable method of estimating a patient's cardiac output?
Assess the heart rate and strength of the pulse.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by...
Dilating be affected coronary artery with a small inflatable balloon
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 not being compliant with her regimen of antihypertensive medications. During the primary assessment, you find that her blood pressure is significantly higher in her left arm then it is in her right arm. What do the signs and symptoms MOST likely indicate?
Dissecting aortic aneurysm
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
Dry the chest if it is wet.
Most AEDs are set up to adjust the voltage based on the impedance, which is the:
Resistance of the body to the flow of electricity.
The right coronary artery supplies blood to the:
Right ventricle and inferior wall of the left ventricle.
Which of the following veins is located inferior to the trunk?
Saphenous.
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:
She is not in ventricular fibrillation.
In contrast to the sympathetic nervous system, the parasympathetic nervous system:
Slows the heart and respiratory rates.
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:
assess the scene for potential hazards.
which of the following is the absence of all electrical activity in the heart?
asystole
Narrowing of the coronary arteries due to a buildup of fatty deposits is called:
atherosclerosis
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called...
automaticity
The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the:
autonomic nervous system.
a 70 year old female is complaining of difficulty breathing. she has rales (crackles) bilaterally with dependent edema. what should you suspect?
congestive heart failure
common side effects of nitroglycerin include all of the following, EXCEPT:
hypertension
Major risk factors for AMI include all of the following, EXCEPT:
hypoglycemia
what is area of conduction in the heart where normal electrical impulses originate?
sinus node
An acute myocardial infarction (AMI) occurs when:
myocardial tissue dies secondary to an absence of oxygen.
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must:
obtain authorization from medical control
In contrast to AMI, a dissecting aortic aneurysm:
often presents with pain that is maximal from the onset.
the left side of the heart receives ______ through the _________.
oxygen-rich blood, pulmonary vein
Common signs and symptoms of AMI include all of the following, EXCEPT...
pain exacerbated by breathing
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:
stop the ambulance, begin CPR, and attach the AED as soon as possible.
which of the following equations represents cardiac output?
stroke x heart rate
which of the following routes should you use to administer nitroglycerin?
sublingual
When treating a patient with chest pain, you should assume that he or she is having an AMI because:
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.
Prompt transport of a patient with a suspected AMI is important because:
the patient may be eligible to receive thrombolytic therapy.
cardiac output may decrease if the heart beats too rapidly because:
there is not enough time inn between contractions for the heart to refill completely
Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS.
three
The descending aorta divides into the two iliac arteries at the level of the
umbilicus
what is the primary cause of a dissecting aneurysm?
uncontrolled hypertension
When documenting a patient's description of his or her chest pain or discomfort, the EMT should:
use the patient's own words.
an automated external defibrillator is designed to detect and defibrillate which rhythm?
ventricular fibrillation
what heart rhythm is a disorganized, ineffective quivering of the ventricles and does not pump blood through the body?
ventricular fibrillation
The iliac arteries immediately subdivide into the
femoral arteries
Blood that is ejected from the right ventricle:
flows into the pulmonary arteries.
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:
congestive heart failure
the main legal risk in using the AED is:
failing to deliver a shock when one is needed.
Deoxygenated blood from the body returns to the:
right atrium
When the myocardium requires more oxygen
the arteries supplying the heart dilate.
Ventricular tachycardia causes hypotension because:
the left ventricle does not adequately fill with blood
Nitroglycerin is contraindicated in patients:
who have experienced a head injury.
Defibrillator pads are placed on the patient's chest:
with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit.
a 65 year old female is complaining of chest pain. you suspect she is having an acute myocardial infarction. vital signs are BP 110/80, P 90, R 18, and spo2 97%. what should you administer?
Aspirin
You and your partner have achieved return of spontaneous circulation (ROSC) in a patient who was in cardiac arrest. An ALS unit will arrive in less than 2 minutes. The patient remains unresponsive and has slow, irregular breathing. Further treatment for this patient should include:
BVM ventilation at 10-12 breaths/min and assessment of oxygen saturation.
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:
Begin CPR, apply the AED, and deliver a shock if it is indicated.
You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:
Begin high-quality CPR and apply the AED as soon as possible.
You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow respirations; and has a thready pulse. You should:
Begin ventilatory assistance.
It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing:
Chest pain that does not immediately subside with rest.
Which of the following is NOT a function of the sympathetic nervous system?
Constriction of blood vessels in the muscles.
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 implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do?
Deliver the shock followed by immediate resumption of CPR
While obtaining a 12-lead ECG prior to ALS arrival, you note the presence of artifacts on the tracing. Which of the following is the MOST likely cause of this?
Excessive movement of the patient.
Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort?
Family history of hypertension.
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 58-year-old male. Your initial action should be to:
Feel for a pulse while compressions are ongoing.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
Have chronic hypertension.
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
Which of the following would cause the greatest increase in cardiac output?
Increased heart rate and increased stroke volume
Which of the following statements regarding the pain associated with AMI is correct?
It can occur during exertion or when the patient is at rest.
What is the function of the left atrium?
It receives oxygenated blood from the lungs.
A patient with atherosclerotic heart disease experiences chest pain during exertion because the...
Lumen of the coronary artery is narrowed and cannot accommodate increased blood flow
Which of the following statements regarding nitroglycerin is correct?
Nitroglycerin usually relieves anginal chest pain within 5 minutes.
When preparing to obtain a 12-lead ECG, the V1 and V2 electrodes should be placed:
On either side of the sternum.
When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed:
On the thighs or ankles.
The EMT should use an AED on a child between 1 month and 8 years of age if:
Pediatric pads and an energy-reducing device are available.
A 67-year-old woman presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 96/64 mm Hg and her heart rate is 120 breaths/min. Treatment for this patient includes...
Placing her in an upright position
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
Rapid heart rate.
The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you re-analyze the patient's cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to:
Reassess airway and breathing and treat accordingly.
After assisting your patient with prescribed nitroglycerin, you should:
Reassess the blood pressure within 5 minutes to detect hypotension
You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should:
Remove the nitroglycerin patch, administer oxygen, and place him in a supine position
Which of the following statements regarding the AED and defibrillation is correct?
The AED will not analyze the rhythm of a moving patient.
Sudden death following AMI is MOST often caused by:
Ventricular fibrillation.
Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm?
Ventricular tachycardia.
Common signs and symptoms of a hypertensive emergency include:
a bounding pulse, a severe headache, and dizziness.
Acute coronary syndrome (ACS) is a term used to describe:
a group of symptoms that are caused by myocardial ischemia.
a patient with a left ventricular assist device (LVAD) tells you that the device's pump flow is continuous. which of the following should you expect to encounter during your assessment
absence of a palpable pulse
which of the following represents the most appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?
administer the medication sublingually and allow it to dissolve or absorb
the aorta dilates at a weakened area, which makes it susceptible to rupture. what is this called?
aneurysm
a 55 year old male is complaining of chest pain that was relieved with nitroglycerin. vital signs are BP 100/70, R 20, and a P 100. what should you suspect?
angina pectoris
which of the following is a major difference between angina pectoris and ami?
anginal pain typically subsides with rest
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they
are in denial
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?
aspirin
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
assess the adequacy of his respirations.
The posterior tibial pulse can be palpated
behind the medial malleolus, on the inside of the ankle.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:
brain
the volume of blood that passes through the heart in 1 minute is known as the:
cardiac output
The head and brain receive their supply of oxygenated blood from the:
carotid arteries.
a 65 year old male is not breathing and is pulseless. high quality cpr has been in progress for approximately 2 minutes. the AED states,"no shock advised". what should you do
continue cpr
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.
coronary arteries, aorta
The electrical impulse generated by the heart originates in the:
coronary sinus
Ischemic heart disease is MOST accurately defined as:
decreased blood flow to one or more portions of the myocardium.
cadiogenic shock following AMI is caused by:
decreased pumping force of the heart muscle.
In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest:
delivers high-energy shocks, similar to an AED.
Which of the following signs is commonly observed in patients with right-sided heart failure?
dependent edema
Nitroglycerin relieves cardiac-related chest pain by
dilating the coronary arteries and improving cardiac blood flow
Prior to defibrillating a patient with an AED, it is MOST important that you:
ensure that no one is touching the patient.
The MOST common error associated with the use of the AED is
failure of the EMT to ensure the battery is charged
Risk factors for AMI that cannot be controlled include:
family history
After the AED has delivered a shock, the EMT should:
immediately resume CPR
when obtaining a 12-lead ECG, the patient should be:
in a supine position with legs uncrossed
The AED is MOST advantageous to the EMT because:
it delivers prompt defibrillation to patients with ventricular fibrillation.
which statement regarding the right side of the heart is true?
it receives blood from the vena cava
Angina pectoris occurs when:
myocardial oxygen demand exceeds the supply
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:
perform CPR for 2 minutes and reassess.
Which of the following blood vessels transports oxygenated blood?
pulmonary veins
the left ventricle has the thickest walls because it:
pumps blood into the aorta and systemic circulation
when an electrical impulse reaches the AV node, it is slowed for a brief period of time so that
sinoatrial (SA) node can reset and generate another impulse
Which artery supplies blood to the right atrium, the right ventricle, and part of the left ventricle?
right coronary
