EMT Chapter 17 Cardiovascular Emergencies

Major risk factors for AMI include all of the following, EXCEPT:

A. elevated cholesterol.

B. hypertension.

C. hypoglycemia.

D. diabetes mellitus.

C. hypoglycemia

Nitroglycerin is contraindicated in patients:

A. who have experienced a head injury.

B. with a history of an ischemic stroke.

C. who have taken up to two doses.

D. with a systolic blood pressure less than 120 mm Hg.

A. who have experienced a head injury

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?

A. Avoid defibrillation because this will damage the patient's AICD.

B. Continue CPR and transport the patient to the closest appropriate hospital.

C. Contact medical control and request permission to defibrillate.

D. Deliver the shock followed by immediate resumption of CPR.

D. Deliver the shock followed by immediate resumption of CPR

Defibrillator pads are placed on the patient's chest:

A. with one pad to the right of the upper sternum and the other pad just to the right of the right nipple.

B. with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit.

C. with one pad to the left of the upper sternum and the other pad to the right lower chest below the armpit.

D. with one pad to the left of the upper sternum and the other pad just to the right of the left nipple.

B. with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit

The electrical impulse generated by the heart originates in the:

A. atrioventricular node.

B. bundle of His.

C. sinoatrial node.

D. coronary sinus.

D. coronary sinus

Which of the following is the MOST likely cause of artifact on an ECG tracing?

A. Excessive movement of the patient

B. Abnormal cardiac electrical activity

C. Incorrect placement of the leads

D. Irregular patient pulse

A. Excessive movement of the patient

Common side effects of nitroglycerin include all of the following, EXCEPT:

A. bradycardia.

B. severe headache.

C. hypertension.

D. hypotension.

C. hypertension

Ischemic heart disease is defined as:

A. death of a portion of the heart muscle due to a decrease in oxygen.

B. decreased blood flow to the heart muscle due to coronary dilation.

C. absent myocardial blood flow due to a blocked coronary artery.

D. decreased blood flow to one or more portions of the myocardium.

D. decreased blood flow to one or more portions of the myocardium

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:

A. perform CPR for 2 minutes and reassess.

B. re-analyze the patient's cardiac rhythm.

C. immediately assess the patient's airway.

D. determine if a palpable pulse is present.

A. perform CPR for 2 minutes and reassess

What is the function of the left atrium?

A. It receives oxygenated blood from the lungs.

B. It ejects oxygenated blood into the aorta.

C. It receives blood from the pulmonary arteries.

D. It receives oxygenated blood from the vena cava.

A. it receives oxygenated blood from the lungs

The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:

A. automaticity.

B. impulsivity.

C. excitability.

D. contractility.

A. automaticity

After the AED has delivered a shock, the EMT should:

A. assess for a carotid pulse.

B. immediately resume CPR.

C. re-analyze the cardiac rhythm.

D. transport the patient at once.

B. immediately resume CPR

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?

A. Thoracic aortic aneurysm

B. Uncontrolled hypertension

C. Obstructive lung disease

D. Acute myocardial infarction

D. Acute myocardial infarction

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?

A. Unstable angina

B. Hypertensive emergency

C. Acute myocardial infarction

D. Dissecting aortic aneurysm

D. Dissecting aortic aneurysm

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:

A. transport at once and re-analyze his rhythm en route.

B. obtain a blood pressure and apply the pulse oximeter.

C. reassess airway and breathing and treat accordingly.

D. place him in the recovery position and apply oxygen.

C. reassess airway and breathing and treat accordingly

Nitroglycerin relieves cardiac-related chest pain by:

A. contracting the smooth muscle of the coronary and cerebral arteries.

B. dilating the coronary arteries and improving cardiac blood flow.

C. increasing the amount of stress that is placed on the myocardium.

D. constricting the coronary arteries and improving cardiac blood flow.

B. dilating the coronary arteries and improving cardiac blood flow

Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?

A. Generalized weakness

B. Rapid heart rate

C. Syncope or dizziness

D. Heart rate less than 60 beats/min

B. Rapid heart rate

Most AEDs are set up to adjust the voltage based on the impedance, which is the:

A. direction that the electrical flow takes in the body.

B. distance between the two AED pads on the chest.

C. actual amount of energy that the AED will deliver.

D. resistance of the body to the flow of electricity.

D. resistance of the body to the flow of electricity

The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they:

A. are elderly.

B. do not trust EMTs.

C. are in denial.

D. cannot afford it.

D. cannot afford it

Which of the following is NOT a function of the sympathetic nervous system?

A. Constriction of blood vessels in the digestive system

B. Dilation of blood vessels in the muscles

C. Constriction of blood vessels in the muscles

D. Increases in the heart and respiratory rates

C. constriction of blood vessels in the muscles

When the myocardium requires more oxygen:

A. the AV node conducts fewer impulses.

B. the heart contracts with less force.

C. the heart rate decreases significantly.

D. the arteries supplying the heart dilate.

D. the arteries supplying the heart dilate

Which of the following is a major difference between angina pectoris and AMI?

A. Nitroglycerin has no effect on angina pectoris.

B. Anginal pain typically subsides with rest.

C. Pain from an AMI subsides within 30 minutes.

D. AMI is caused by myocardial ischemia.

B. anginal pain typically subsides with rest

The posterior tibial pulse can be palpated:

A. between the trachea and the neck muscle.

B. in the fossa behind the knee.

C. behind the medial malleolus, on the inside of the ankle.

D. on the dorsum of the foot.

C. behind the medial malleolus, on the inside of the ankle

Cardiogenic shock following AMI is caused by:

A. widespread dilation of the systemic vasculature.

B. hypovolemia secondary to severe vomiting.

C. a profound increase in the patient's heart rate.

D. decreased pumping force of the heart muscle.

D. decreased pumping force of the heart muscle

After assisting your patient with prescribed nitroglycerin, you should:

A. perform a secondary assessment before administering further doses.

B. avoid further dosing if the patient complains of a severe headache.

C. place the patient in a recumbent position in case of fainting.

D. reassess his or her blood pressure within 5 minutes to detect hypotension.

D. reassess his or her blood pressure within 5 minutes to detect hypotension

Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?

A. The presence of rales in the lungs

B. Hypotension and flat jugular veins

C. Hypertension and tachycardia

D. Trouble breathing while lying down

B. hypotension and flat jugular veins

Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?

A. Metoprolol (Toprol)

B. Oxygen

C. Furosemide (Lasix)

D. Aspirin

D. aspirin

Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm?

A. Sinus tachycardia

B. Ventricular tachycardia

C. Sinus bradycardia

D. Extra ventricular beats

B. ventricular tachycardia

The right coronary artery supplies blood to the:

A. right ventricle and inferior wall of the left ventricle.

B. right atrium and posterior wall of the right ventricle.

C. left ventricle and inferior wall of the right atrium.

D. left ventricle and posterior wall of the right ventricle.

A. right ventricle and inferior wall of the left ventricle

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:

A. obtain a SAMPLE history and contact medical control for advice.

B. administer oxygen, give her 324 mg of aspirin, and assess her further.

C. give her one nitroglycerin and reassess her systolic blood pressure.

D. give her high-flow oxygen, attach the AED, and transport at once.

B. administer oxygen, give her 324 mg of aspirin, and assess her further

Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort?

A. History of previous heart attack

B. History of cigarette smoking

C. Family history of hypertension

D. Presence of personal risk factors

C. family history of hypertension

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:

A. legs.

B. brain.

C. abdomen.

D. kidneys.

B. brain

It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing:

A. chest pain that does not immediately subside with rest.

B. an acute onset of dizziness during a period of exertion.

C. difficulty breathing that awakens the patient from sleep.

D. sharp chest pain that lasts longer than 10 to 15 minutes.

A. chest pain that does not immediately subside with rest

Which of the following blood vessels transports oxygenated blood?

A. Inferior vena cava

B. Pulmonary arteries

C. Pulmonary veins

D. Superior vena cava

C. pulomnary veins

Blood that is ejected from the right ventricle:

A. enters the systemic circulation.

B. has a high concentration of oxygen.

C. was received directly from the aorta.

D. flows into the pulmonary arteries.

D. flows into the pulmonary arteries

Common signs and symptoms of AMI include all of the following, EXCEPT:

A. pain exacerbated by breathing.

B. shortness of breath or dyspnea.

C. sudden unexplained sweating.

D. irregular heartbeat.

A. pain exacerbated by breathing

The main legal risk in using the AED is:

A. failing to deliver a shock when one is needed.

B. failure of the AED's internal computer chip.

C. not assessing for a pulse after a shock is delivered.

D. negligence on the part of the manufacturer.

A. failing to deliver a shock when one is needed

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:

A. placing her in an upright position.

B. oxygen at 2 L/min via nasal cannula.

C. ventilations with a BVM.

D. nitroglycerin for her chest pain.

A. placing her in an upright position

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:

A. right ventricular failure.

B. congestive heart failure.

C. a cardiac arrhythmia.

D. significant hypotension

B. congestive heart failure

Which of the following is the MOST reliable method of estimating a patient's cardiac output?

A. Determine the average diastolic blood pressure.

B. Listen to heart sounds with a stethoscope.

C. Connect the patient to an electrocardiogram.

D. Assess the heart rate and strength of the pulse.

D. assess the herat rate and strength of the pulse