EMT (Cardiovascular Emergencies)
Which of the following statements regarding nitroglycerin is correct?
Nitroglycerin usually relieves anginal chest pain within 5 minutes.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:
dilating the affected coronary artery with a small inflatable balloon.
Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort?
family history of hypertension
The iliac arteries immediately subdivide into the:
femoral arteries.
Blood that is ejected from the right ventricle:
flows into the pulmonary arteries.
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.
Ventricular tachycardia causes hypotension because:
the left ventricle does not adequately fill with blood.
Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm?
ventricular tachycardia
Nitroglycerin is contraindicated in patients:
who have experienced a head injury.
Which of the following is a major difference between angina pectoris and AMI?
Anginal pain typically subsides with rest.
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.
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.
Which of the following is NOT a function of the sympathetic nervous system?
constriction of blood vessels in the muscles
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
a rapid heart rate
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.
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:
blood can pass from the atria to the ventricles.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:
brain.
Which of the following statements regarding the AED and defibrillation is correct?
The AED will not analyze the rhythm of a moving patient.
When afterload increases:
it becomes harder for the ventricle to push blood through the blood vessels.
The AED is MOST advantageous to the EMT because:
it delivers prompt defibrillation to patients with ventricular fibrillation.
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.
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.
The left ventricle has the thickest walls because it:
pumps blood into the aorta and systemic circulation.
Prompt transport of a patient with a suspected AMI is important because:
the patient may be eligible to receive thrombolytic therapy.
When documenting a patient's description of his or her chest pain or discomfort, the EMT should:
use the patient's own words.
Sudden death following AMI is MOST often caused by:
ventricular fibrillation.
Which of the following blood vessels transports oxygenated blood?
pulmonary veins
Which of the following veins is located inferior to the trunk?
saphenous
Major risk factors for AMI include all of the following, EXCEPT:
hypoglycemia.
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
After the AED has delivered a shock, the EMT should:
immediately resume CPR.
Which of the following would cause the greatest increase in cardiac output?
increased heart rate and increased stroke volume
What is the function of the left atrium?
It receives oxygenated blood from the lungs.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
assess the adequacy of his respirations.
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.
The posterior tibial pulse can be palpated:
behind the medial malleolus.
Ischemic heart disease is MOST accurately defined as:
decreased blood flow to one or more portions of the myocardium.
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to:
have the bystanders stop CPR and assess the patient.
Common signs and symptoms of AMI include all of the following, EXCEPT:
pain exacerbated by breathing.
In contrast to the sympathetic nervous system, the parasympathetic nervous system:
slows the heart and respiratory rates.
Cardiac output may decrease if the heart beats too rapidly because:
there is not enough time in between contractions for the heart to refill completely.
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.
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?
Deliver the shock followed by immediate resumption of CPR.
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 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should:
administer oxygen, give her 324 mg aspirin, and assess her further.
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
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:
assess the scene for potential hazards.
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
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 without delay.
The head and brain receive their supply of oxygenated blood from the:
carotid arteries.
When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin?
chest pain that does not immediately subside with rest
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:
congestive heart failure.
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.
coronary arteries, aorta
Cardiogenic shock following AMI is caused by:
decreased pumping force of the heart muscle.
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.
A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What are her signs and symptoms MOST indicative of?
dissecting aortic aneurysm
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
dry the chest off if it is wet.
Prior to defibrillating a patient with an AED, it is MOST important that you
ensure that no one is touching the patient.
The main legal risk in using the AED is:
failing to deliver a shock when one is needed.
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.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
have chronic hypertension.
Common side effects of nitroglycerin include all of the following, EXCEPT:
hypertension.
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.
Angina pectoris occurs when:
myocardial oxygen demand exceeds the supply.
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.
A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes:
placing her in an upright position.
The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you reanalyze 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 his or her 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, place him in a supine position and elevate his lower extremities, and prepare for immediate transport
In contrast to monophasic defibrillation, biphasic defibrillation:
requires a lower energy setting.
Deoxygenated blood from the body returns to the:
right atrium
Defibrillator pads are placed on the patient's chest with one pad to the:
right of the upper sternum and the other pad just to the left and below the left nipple.
The right coronary artery supplies blood to the:
right ventricle and inferior wall of the left ventricle.
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.
The electrical impulse generated by the heart originates in the:
sinoatrial (SA) node.
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.
The purpose of defibrillation is to:
stop the chaotic, disorganized contraction of the cardiac cells.
When the myocardium requires more oxygen:
the arteries supplying the heart dilate.
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
