EMT Ch. 17

When assessing a responsive adult patient with a possible cardiac​ compromise, you​ should:

insert an airway adjunct.

ventilate with​ high-concentration oxygen.

begin CPR.

apply oxygen at a dose that maintains a pulse ox reading of more than 90 percent.

apply oxygen at a dose that maintains a pulse ox reading of more than 90 percent.

Which of these indicates an aortic​ aneurysm?

Syncope

Pulsating mass

​"Ripping" flank pain

Difference in extremity pulse amplitude

Pulsating mass

In a patient experiencing a cardiovascular​ emergency, hypertension would be likely to each of the​ following, EXCEPT:

AMI with a strong pulse.

pump failure secondary to an MI to the right ventricle.

a stroke patient.

a developing abdominal aneurism.

pump failure secondary to an MI to the right ventricle.

The cardiac conduction system allows the heart to generate electrical impulses. Trace an electrical impulse through the structures of the​ heart, in order.

SA​ node, bundle of​ His, AV​ node, and Purkinje fibers

SA​ node, AV​ node, bundle of​ His, and Purkinje fibers

AV​ node, Purkinje​ fibers, SA​ node, and bundle of His

AV​ node, bundle of​ His, SA​ node, and Purkinje fibers

SA​ node, AV​ node, bundle of​ His, and Purkinje fibers

In obtaining a​ patient's history of present​ illness, avoid asking leading questions.​ Instead, ask​ open-ended questions such​ as:

​"Is your chest pain sharp or​ dull?"

​"Your chest pain is​ crushing, isn't​ it?"

​"How would you describe your chest​ pain?"

​"Does your arm​ ache, too?"

​"How would you describe your chest​ pain?"

A​ 42-year-old male patient complains of crushing chest discomfort and shortness of breath. His vital signs are P​ 102, R​ 20, BP​ 88/60, and SpO2 is 88 percent on room air. You should​ administer:

oxygen at 2 lpm via a nasal cannula.

one tablet of nitroglycerin.

oxygen at 10 lpm via a nonrebreather mask.

350 mg of aspirin.

oxygen at 2 lpm via a nasal cannula.

The process by which oxygen and nutrients are delivered from the blood through the thin capillary walls into the​ cells, and carbon dioxide and other waste products are removed is known​ as:

circulation

perfusion

pulse pressure.

blood pressure.

perfusion

Chest discomfort that occurs without exertion is known​ as:

stable angina.

unstable angina.

myocardial infarction.

acute coronary syndrome.

unstable angina.

The capillaries are a network of tiny blood​ vessels:

that carry​ oxygen-depleted blood to the tissues to be oxygenated.

whose thick walls prevent waste products from entering the blood.

that are the smallest branches of the veins.

that connect arterioles to venules.

that connect arterioles to venules.

You have just administered nitroglycerin to a patient who has chest pain that he rated as a 9 on a scale of 1 to 10. He suddenly gets very weak and feels dizzy. What should you​ do?

Immediately start chest compressions.

Administer another nitroglycerin tablet to relieve his pain.

Begin ventilations with a​ bag-valve-mask device.

Lay the patient down and check his vitals.

Lay the patient down and check his vitals.

Which of the following statements regarding a silent heart attack is​ CORRECT?

A silent heart attack results in chest pain​ only, without other related symptoms.

The term silent heart attack arises from the​ patient's reluctance to seek help.

The only symptoms to a silent heart attack may be weakness and fatigue.

A silent heart attack is one in which the patient suddenly collapses in cardiac arrest.

The only symptoms to a silent heart attack may be weakness and fatigue.

You are caring for an elderly male patient with dyspnea. You hear coarse rales during auscultation. Given​ this, select the correct pathophysiology and field​ impression:

swelling of lung​ tissue; congestive heart failure.

a decrease of hydrostatic​ pressure; hypertensive crisis.

fluid in the​ lungs; pulmonary edema.

excess fluid in the​ heart; myocardial infarction.

fluid in the​ lungs; pulmonary edema.

A​ 44-year-old female patient complains of chest pressure. Her vital signs are P​ 92, R​ 16, BP​ 118/72, and SpO2 is 95 percent on room air. She denies past medical history. You should​ administer:

one nitroglycerin tablet.

oxygen via nasal cannula.

160–325 mg of aspirin.

oxygen via a nonrebreather mask.

160–325 mg of aspirin.

When a patient tells you that he called EMS due to chest​ pain, but now also feels​ dizzy, the dizziness is referred to as​ a/n:

associated sign or symptom.

diagnosis.

degree of distress.

compounding factor.

associated sign or symptom.

Congenital heart disease is typically due​ to:

abnormal heart valves or chambers.

conduction abnormalities.

thoracic malformations

deformity of the musculature.

abnormal heart valves or chambers.

Which of these is likely a contraindication for receiving fibrinolytic​ therapy?

History of hypertension

Current use of anticoagulants

History of an recent intracranial bleed

History of a surgical procedure within the last 3 months

History of an recent intracranial bleed

Which of these is a common risk factor for endothelial​ injury?

High levels of​ high-density lipoproteins

Low levels of​ low-density lipoproteins

Hypertension

Atrial fibrillation

Hypertension

Signs and symptoms associated with cardiac compromise may vary​ widely, so it is important to remember​ that:

the typical chest pain due to cardiac compromise is a​ sharp, stabbing pain.

​often, the patient will describe chest​ "pressure" rather than​ "pain."

true chest pain is rarely misinterpreted as upper abdominal pain or indigestion.

a sudden onset of sweating usually is not related to a cardiac emergency.

​often, the patient will describe chest​ "pressure" rather than​ "pain."

Which of these blood vessels directly interface with tissues throughout the​ body?

Arterioles

Capillaries

Venules

Veins

Capillaries

Which statement accurately differentiates angina and myocardial​ infarction?

Myocardial infarction is usually caused by stress.

The pain of myocardial infarction usually goes away on its own.

The pain of angina usually goes away on its​ own, or with nitroglycerin.

Angina typically occurs at rest.

The pain of angina usually goes away on its​ own, or with nitroglycerin.

You are assessing a​ 58-year-old male patient with a chief complaint of chest pain and difficulty breathing. He states that he has had crushing substernal pain for the past hour. He has his nitroglycerin with him but forgot to take it. Should you assist him in the administration of his​ nitroglycerin?

​No, as this will cause his BP to increase.

​Yes, if his BP is above 90 mmHg systolic.

​Yes, as long as he still has a pulse.

Not if you plan to administer aspirin.

​Yes, if his BP is above 90 mmHg systolic.

Hyperoxygenating the acute coronary syndrome patient can lead​ to:

improved perfusion.

increased cardiac cell damage.

coronary artery dilation.

improved outcome.

increased cardiac cell damage.

When the cardiac conduction system becomes​ irritated, the conduction cells may begin to​ "fire off" impulses on their own. This can lead​ to:

vasoconstriction.

vasodilation.

repolarization.

dysrhythmias.

dysrhythmias.

You are assessing a​ 55-year-old male patient complaining of chest pain. Your paramedic partner advises you that the patient is experiencing PVCs. You know that this patient is at risk​ for:

asystole.

pulseless electrical activity.

atrial fibrillation.

ventricular tachycardia.

ventricular tachycardia.

If a patient with an acute coronary syndrome presents to​ EMS, and the providers are able to resolve all pain through the use of nitrates and​ oxygen, why should this patient still be taken to a hospital capable of percutaneous coronary​ interventions?

So that the cause of the MI can be more permanently resolved within a very narrow and​ time-sensitive window of opportunity

In order to decrease the likelihood that the EMS service will have to return to the hospital and transfer the patient elsewhere

Because cardiologists with more knowledge of initial MI management will work there

So that the​ patient's insurance company will pay out the full benefits to the EMS service and hospital

So that the cause of the MI can be more permanently resolved within a very narrow and​ time-sensitive window of opportunity

When treating a child who is 8 years of age or​ younger, is​ unresponsive, and has no breathing or​ pulse, the EMT should do all of the following​ EXCEPT:

apply an automated external defibrillator.

intubate the trachea.

begin CPR for 2 minutes.

ventilate with​ high-concentration oxygen.

intubate the trachea.

Cardiac muscle cells have one property that MOST skeletal and smooth muscle cells do NOT have. This property​ is:

automaticity.

contractility.

memory.

excitability.

automaticity.

Besides​ females, what​ high-risk demographic is likely to present with atypical findings when they experience acute coronary syndrome​ (ACS) or a myocardial​ infarction?

Infants

Athletic competitors

Diabetics

Hemophiliacs

Diabetics

Of the three main portions of the ECG​ tracing, the portion that corresponds with the depolarization of the ventricles is​ the:

T wave.

P wave.

QRS complex.

U wave.

QRS complex.

If blood is NOT circulated adequately through the​ body's capillaries, cells become starved for oxygen and nutrients and overloaded with carbon dioxide and waste products. This condition is known​ as:

hypoperfusion.

cardiac compromise.

circulatory depression.

hypotension.

hypoperfusion.

The number one killer worldwide in economically developed countries​ is:

acute myocardial infarction.

atherosclerosis.

myocardial ischemia.

unstable angina.

atherosclerosis.

Two conditions related to cardiac compromise are angina pectoris and myocardial infarction. In comparing the​ two, remember​ that:

nitroglycerin may give incomplete or no relief of myocardial infarction pain.

angina pectoris usually includes other​ symptoms, such as​ pale, sweaty skin.

pain from a myocardial infarction​ radiates, while pain from angina does not.

pain from both angina pectoris and myocardial infarction usually subsides within 10 minutes or stops after a period of inactivity.

nitroglycerin may give incomplete or no relief of myocardial infarction pain.

If you are treating an elderly male patient in his 80s who has a very slow pulse but is still​ alert, what would be one of your top​ priorities?

Immediately begin chest compressions.

Apply the AED right away.

Lay him down and raise his legs.

Inquire about his history and monitor his vital signs.

Inquire about his history and monitor his vital signs.

You are assessing a​ 58-year-old male patient who is short of breath and has very little energy. He normally leads a very sedentary lifestyle. You note that he has edema to his lower extremities and a history of two past heart attacks. What is MOST likely to be his​ problem?

An ischemic stroke

A STEMI

Acute pulmonary edema

Congestive heart failure

Congestive heart failure

What is the leading cause of death in adult​ females?

Hypertensive crisis

Transient ischemic attack

Cerebrovascular accident

Coronary heart disease

Coronary heart disease

The electrical impulse within the Purkinje fibers normally​ causes:

the opening of atrioventricular valves.

stimulation of the AV node.

ventricular contraction.

atrial contraction.

ventricular contraction.

How long does it take the heart muscle to begin dying without adequate​ perfusion?

50–60 minutes

5–15 minutes

35–45 minutes

20–30 minutes

20–30 minutes

A​ 45-year-old male patient complains of tearing pain in his back. You measure the blood pressure in both arms. The blood pressure on the left is​ 122/74 and the blood pressure on the right is​ 100/76. You should​ suspect:

aortic dissection.

acute coronary syndrome.

myocardial infarction.

stroke.

aortic dissection.

Most pediatric cardiac arrests are a result​ of:

heart attack.

respiratory distress.

congenital heart disease.

trauma.

respiratory distress.

Which of these blood vessels primarily carry deoxygenated​ blood?

Veins

Capillaries

Arterioles

Arteries

Veins

Which of these disorders would NOT likely result in heart​ failure?

A suspected stroke

Hypertension

A massive pulmonary embolism

A cardiac valve disorder

A suspected stroke

The term​ "depolarization" refers​ to:

the electrical cells of the heart​ recharging, getting ready to fire again.

a synchronized form of defibrillation using a very low energy setting.

the relaxation of the heart muscles between contractions.

the contraction of the heart muscle.

the contraction of the heart muscle.

When assessing an elderly patient with upper back​ pain, which of these assessment findings would make you very suspicious of a thoracic aortic​ dissection?

Lower back pain described as a constant ache

History of hypertension and lower back injury

Dizziness when going from a supine to standing position suddenly

Different blood pressure readings in each arm

Different blood pressure readings in each arm

Which of these scene​ size-up observations would make you suspicious that a patient who complains of shortness of breath has congestive heart​ failure?

Multiple pillows stacked at the head of the​ patient's bed

Patient in dirty pajamas and appears unkempt

Home oxygen tank in the bedroom

Dramatic edema to the right arm

Multiple pillows stacked at the head of the​ patient's bed

A​ 67-year-old male patient has chest pain. After you assist him with taking two of his nitroglycerin​ tablets, his chest pain remains 7 out of 10 and he is still diaphoretic. His vital signs are as​ follows: pulse,​ 72; respirations, 18​ breaths/min and​ adequate; blood​ pressure, 82/60​ mmHg; and SpO2 ​ 97% on 2 lpm of oxygen. You​ should:

Transfer the patient to the stretcher and begin transport

Increase the oxygen to 4 lpm

Administer half of a nitroglycerin tablet

Administer a third nitroglycerin tablet

Transfer the patient to the stretcher and begin transport

Which of these patients is most likely to suffer a silent​ MI?

A​ 60-year-old female with colon cancer

A​ 48-year-old male with undiagnosed hypertension

A​ 55-year-old female with diabetes

A​ 72-year-old male with a syncopal episode

A​ 55-year-old female with diabetes

You are transporting a patient with chest pain to the hospital emergency department. In regard to possible fibrinolytic​ therapy, what should you relay during your hospital report as a possible relative contraindication to this​ therapy?

Allergy to aspirin and penicillin

History of previous heart attack

Blood glucose level of 80​ mg/dL

Use of blood thinning medication

Use of blood thinning medication

A patient with chest pain has an

SpO2 of​ 90% on room air. How would you start providing oxygen to this​ patient?

Nasal cannula 2 lpm

Nasal cannula 4 lpm

Nonrebreather 15 lpm

Nasal cannula 6 lpm

Nasal cannula 2 lpm

You are interviewing a patient whom you suspect has an acute coronary syndrome. Which question is MOST appropriate​ initially?

​"Does it hurt when I press on your​ chest?"

​"Are you having any chest​ discomfort?"

​"Does your chest hurt when you​ breathe?"

​"Are you having any pain in your​ chest?"

​"Are you having any chest​ discomfort?"

A patient has pulmonary hypertension. In​ response, what will most likely occur over a long period of​ time?

The heart muscle will become stronger.

The aorta will weaken and potentially rupture.

The left side of the heart will weaken and fail.

The right side of the heart will weaken.

The right side of the heart will weaken.

What are the protein strands that strengthen a clot​ called?

Fibrin

Plaque

Thrombin

Platelets

Fibrin

A patient has been diagnosed with high blood pressure. A medication that can effectively serve to lower this​ patient's blood pressure is one​ that:

Dilates the arteries

Increases the heart rate

Dilates the coronary arteries

Constricts the veins

Dilates the arteries

A mother has called 911 because her​ 6-year-old son told her he had chest pain. On​ scene, the mother informs you that her son suffers from a congenital heart defect called aortic coarctation. The boy admits to chest pain and appears distressed. His airway is​ patent, breathing​ adequate, and radial pulse present and regular. Vital signs are​ pulse, 108;​ respirations, 24​ breaths/min; blood​ pressure, 148/92​ mmHg; and SpO2​, 98%. Your next action would be​ to:

Contact medical command for advice

Try one nitroglycerin for pain relief

Administer​ high-concentration oxygen

Give one baby aspirin

Contact medical command for advice

A patient is very dizzy and has an altered mental status. Vital signs are​ pulse, 84;​ respirations, 16​ breaths/min; blood​ pressure, 74/32​ mmHg; and SpO2​, 93%. Medical direction has ordered the paramedic to start an IV infusion of a medication that causes blood vessel constriction. You would recognize that the medication is benefiting the patient when you​ observe:

The heart rate increase to 92​ beats/min

The blood pressure increase to​ 110/64 mmHg

The SpO2 increase to​ 94%

The respirations increase to 24​ breaths/min

The blood pressure increase to​ 110/64 mmHg

You are caring for an​ 83-year-old male patient with pain across his​ chest, mild​ dyspnea, and edema to the lower ankles. The heart rate is​ 58/minute, respirations are​ 22, and the systolic blood pressure is​ 112/86. If you decide to administer aspirin in the prehospital​ setting, which of these criteria must be​ met?

Patient has a prescription for aspirin

Approval from medical direction

Systolic blood pressure greater than 100 mmHg

Age younger than 65 years

Approval from medical direction

Which of these identifies the major elements of the pathway that blood takes through the heart in the correct​ sequence?

Pulmonary​ vein, pulmonary​ capillary, pulmonary​ artery, and right ventricle

Vena​ cava, right​ ventricle, pulmonary​ artery, left​ ventricle, and aorta

​Aorta, left​ atrium, left​ ventricle, and pulmonary capillary

Right​ atrium, left​ atrium, left​ ventricle, and right ventricle

Vena​ cava, right​ ventricle, pulmonary​ artery, left​ ventricle, and aorta

The EMT understands the electrocardiogram​ (ECG) when he makes which of these statements about the​ waveform?

​"An ECG represents the electrical activity of the​ heart."

​"The ECG shows how well the heart is oxygenating​ blood."

​"An ECG indicates the amount of blood in the​ heart."

​"The ECG can be used to determine how well the heart is pumping​ blood."

​"An ECG represents the electrical activity of the​ heart."

An alert and oriented patient presents with shortness of​ breath, crackles in both​ lungs, jugular venous​ distention, and edema to the feet and ankles. Her pulse is​ 132, respirations 26​ breaths/min, blood pressure​ 160/86 mmHg, and SpO2 at​ 88%. Based on these​ findings, the EMT should​ suspect:

Left ventricular failure

Hypertensive emergency

Right ventricular failure

Congestive heart failure

Congestive heart failure

A patient complaining of shortness of breath and dizziness has called 911. Her history includes chronic obstructive pulmonary disease​ (COPD). When assessing the​ patient, which of these findings would cause you to immediately prepare the patient for​ transport?

SpO2 of​ 94% despite supplemental oxygen

Pulsating mass in the abdomen

Wheezing noted in the bases of both lungs

Heart rate of 84​ beats/min

Pulsating mass in the abdomen

You are caring for an alert and oriented patient with chest pain. Emergency Medical Responders have initiated supplemental​ oxygen, and your EMT partner assisted in the administration of aspirin and two nitroglycerin tablets.​ Currently, the​ patient's vital signs are​ pulse, 76;​ respirations, 16​ breaths/min; blood​ pressure, 110/56​ mmHg; and SpO2​, 95%. When transporting this patient on the​ stretcher, which position is​ best?

​Semi-Fowler's position

Supine with head elevated

Position of comfort

Lateral recumbent

Position of comfort

A​ 44-year-old male patient is experiencing chest pain. He has a history of angina and is prescribed​ nitroglycerin, which he has not taken yet. He is also taking another medication. Which of these medications is a contraindication to the administration of​ nitroglycerin?

Levitra

Methadone

Albuterol

Coumadin

Levitra

Failure to promptly treat ventricular tachycardia can result in myocardial cell hypoxia and​ ischemia, which then contributes to the rhythm deteriorating​ to:

Ventricular fibrillation

Pulseless electrical activity

Asystole

Sinus rhythm

Ventricular fibrillation

You have been called to a residence for an obese​ 52-year-old male patient who complains of chest pain. When obtaining a history from the​ patient, which of these statements made by the patient would you find most​ concerning?

​"I started taking an antianxiety medication last​ week."

​"I have had chest pain on and off for years​ now."

​"The pain came on suddenly when I was reading the​ paper."

​"I occasionally feel that my heart seems to skip a​ beat."

​"The pain came on suddenly when I was reading the​ paper."

A patient with chest pain and shortness of breath informs you that the last time he had a heart​ attack, he went into heart failure. When performing your secondary​ assessment, which sign or symptom is most indicative that the patient is in heart failure​ again?

Hypertension

Crackles in the lungs

Flat neck veins

Shortness of breath

Crackles in the lungs

You are caring for a​ 62-year-old female patient with chest discomfort and shortness of breath. She is alert and oriented with an open airway. Her breathing is adequate and radial pulse strong. Her skin is warm and dry. What should you do​ next?

Perform a secondary assessment

Assist the patient in taking a nitroglycerin tablet

Assist the patient to the ambulance for immediate transport

Obtain the​ patient's heart rate and blood pressure

Obtain the​ patient's heart rate and blood pressure

Which of these statements would the EMT expect from a patient with unstable​ angina?

​"When I stop what I am​ doing, the pain goes​ away."

​"The chest pain awakens me from my nighttime​ sleep."

​"The antacid my doctor prescribed seems to take the pain​ away."

​"If I take a nitroglycerin​ tablet, the pain​ stops."

​"The chest pain awakens me from my nighttime​ sleep."