Ch 17 Cardiovascular Emergencies

1. Deoxygenated blood from the body returns to the:

A) right atrium.

B) right ventricle.

C) left atrium.

D) left ventricle.

ANS: A

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 677

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

2. 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.

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 677

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

3. Which of the following blood vessels transports oxygenated blood?

A) Superior vena cava

B) Pulmonary arteries

C) Inferior vena cava

D) Pulmonary veins

ANS: D

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

4. What is the function of the left atrium?

A) It ejects oxygenated blood into the aorta.

B) It receives oxygenated blood from the lungs.

C) It receives blood from the pulmonary arteries.

D) It receives oxygenated blood from the vena cava.

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

5. The left ventricle has the thickest walls because it:

A) pumps blood to the lungs to be reoxygenated.

B) uses less oxygen than other chambers of the heart.

C) pumps blood into the aorta and systemic circulation.

D) receives blood directly from the systemic circulation.

ANS: C

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

6. The electrical impulse generated by the heart originates in the:

A) bundle of His.

B) coronary sinus.

C) sinoatrial node.

D) atrioventricular node.

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

7. When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:

A) blood can pass from the atria to the ventricles.

B) blood returning from the body can fill the atria.

C) the impulse can spread through the Purkinje fibers.

D) the SA node can reset and generate another impulse.

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

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

A) excitability.

B) contractility.

C) impulsivity.

D) automaticity.

ANS: D

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

9. 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) parietal lobe.

B) pons and medulla.

C) somatic nervous system.

D) autonomic nervous system.

ANS: D

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

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

A) Dilation of blood vessels in the muscles

B) Constriction of blood vessels in the muscles

C) Increases in the heart and respiratory rates

D) Constriction of blood vessels in the digestive system

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

11. In contrast to the sympathetic nervous system, the parasympathetic nervous system:

A) prepares the body to handle stress.

B) causes an increase in the heart rate.

C) slows the heart and respiratory rates.

D) dilates the blood vessels in the muscles.

ANS: C

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

12. 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.

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

13. The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.

A) coronary sinus, vena cava

B) aorta, inferior vena cava

C) vena cava, coronary veins

D) coronary arteries, aorta

ANS: D

Complexity: Moderate

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

14. Which of the following would cause the greatest increase in cardiac output?

A) Increased heart rate and increased stroke volume

B) Decreased stroke volume and increased heart rate

C) Decreased heart rate and increased stroke volume

D) Decreased stroke volume and decreased heart rate

ANS: A

Complexity: Moderate

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

15. The right coronary artery supplies blood to the:

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

B) right ventricle and inferior wall of the left ventricle.

C) right atrium and posterior wall of the right ventricle.

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

ANS: B

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

16. The head and brain receive their supply of oxygenated blood from the:

A) iliac arteries.

B) brachial arteries.

C) carotid arteries.

D) subclavian arteries.

ANS: C

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

17. The descending aorta divides into the two iliac arteries at the level of the:

A) nipple line.

B) umbilicus.

C) iliac crest.

D) pubic symphysis.

ANS: B

Complexity: Difficult

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

18. Which of the following veins is located inferior to the trunk?

A) Cephalic

B) Axillary

C) Saphenous

D) Subclavian

ANS: C

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 681

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

19. The iliac arteries immediately subdivide into the:

A) femoral arteries.

B) peroneal arteries.

C) anterior tibial arteries.

D) posterior tibial arteries.

ANS: A

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 679

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

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

A) brain.

B) kidneys.

C) abdomen.

D) legs.

ANS: A

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 678

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

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

A) Listen to heart sounds with a stethoscope.

B) Connect the patient to an electrocardiogram.

C) Assess the heart rate and strength of the pulse.

D) Determine the average diastolic blood pressure.

ANS: C

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 682

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Application

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

22. Cardiac output may decrease if the heart beats too rapidly because:

A) a rapid heartbeat causes a decrease in the strength of cardiac contractions.

B) the volume of blood that returns to the heart is not sufficient with fast heart rates.

C) as the heart rate increases, more blood is pumped from the ventricles than the atria

D) there is not enough time in between contractions for the heart to refill completely.

ANS: D

Complexity: Moderate

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 682

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

23. The posterior tibial pulse can be palpated:

A) on the dorsum of the foot.

B) between the trachea and the neck muscle.

C) in the fossa behind the knee.

D) behind the medial malleolus, on the inside of the ankle.

ANS: D

Complexity: Easy

Ahead: Anatomy and Physiology

Subject: Chapter 17, Page 682

Title: Cardiovascular Emergencies

Feedback: See Anatomy and Physiology

Taxonomy: Recall

Objective: 17-1 Discuss the basic anatomy and physiology of the cardiovascular system.

24. Ischemic heart disease is defined as:

A) absent myocardial blood flow due to a blocked coronary artery.

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

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

D) decreased blood flow to the heart muscle due to coronary dilation.

ANS: B

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 684

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

25. Narrowing of the coronary arteries caused by a buildup of fatty deposits is called:

A) angina pectoris.

B) arteriosclerosis.

C) acute ischemia.

D) atherosclerosis.

ANS: D

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 684

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

26. A patient with atherosclerotic heart disease experiences chest pain during exertion because:

A) the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow.

B) the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

C) tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.

D) the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.

ANS: B

Complexity: Difficult

Ahead: Pathophysiology

Subject: Chapter 17, Page 684

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Application

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

27. An acute myocardial infarction (AMI) occurs when:

A) myocardial tissue dies secondary to an absence of oxygen.

B) the heart muscle progressively weakens and dysfunctions.

C) coronary artery dilation decreases blood flow to the heart.

D) the entire left ventricle is damaged and cannot pump blood.

ANS: A

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

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

A) hypoglycemia.

B) hypertension.

C) diabetes mellitus.

D) elevated cholesterol.

ANS: A

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

29. Risk factors for AMI that cannot be controlled include:

A) excess stress.

B) hyperglycemia.

C) family history.

D) lack of exercise.

ANS: C

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

30. Acute coronary syndrome (ACS) is a term used to describe:

A) the warning signs that occur shortly before a heart attack.

B) a group of symptoms that are caused by myocardial ischemia.

C) a severe decrease in perfusion caused by changes in heart rate.

D) the exact moment that a coronary artery is completely occluded.

ANS: B

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

31. Angina pectoris occurs when:

A) a coronary artery is totally occluded by plaque.

B) myocardial oxygen demand exceeds supply.

C) one or more coronary arteries suddenly spasm.

D) myocardial oxygen supply exceeds the demand.

ANS: B

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-4 Describe the anatomy, physiology, pathophysiology, assessment, and management of angina pectoris.

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

A) AMI is caused by myocardial ischemia.

B) Anginal pain typically subsides with rest.

C) Nitroglycerin has no effect on angina pectoris.

D) Pain from an AMI subsides within 30 minutes.

ANS: B

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Analysis

Objective: 17-4 Describe the anatomy, physiology, pathophysiology, assessment, and management of angina pectoris.

33. 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 pain are experiencing an AMI.

C) the cause of the pain cannot be diagnosed in the field.

D) angina and AMI present identically.

ANS: C

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 685

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Analysis

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

34. Prompt transport of a patient with a suspected AMI is important because:

A) the patient may be eligible to receive thrombolytic therapy.

B) 90% of the cardiac cells will die within the first 30 minutes.

C) nitroglycerin can only be given in the emergency department.

D) many patients with an AMI die within 6 hours.

ANS: A

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 686

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

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

A) irregular heartbeat.

B) sudden unexplained sweating.

C) shortness of breath or dyspnea.

D) pain exacerbated by breathing.

ANS: D

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 686

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

36. Which of the following statements regarding the pain associated with AMI is correct?

A) It is often described by the patient as a sharp feeling.

B) It often fluctuates in intensity when the patient breathes.

C) Nitroglycerin usually resolves the pain within 30 minutes.

D) It can occur during exertion or when the patient is at rest.

ANS: D

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 686

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

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

A) are elderly.

B) are in denial.

C) cannot afford it.

D) do not trust EMTs.

ANS: B

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 686

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Analysis

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

38. When documenting a patient's description of his or her chest pain or discomfort, the EMT should:

A) use medical terminology.

B) use the patient's own words.

C) underline the patient's quotes.

D) document his or her own perception.

ANS: B

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 687

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

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

A) a cardiac arrhythmia.

B) congestive heart failure.

C) significant hypotension.

D) right ventricular failure.

ANS: B

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 686

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Analysis

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

40. Sudden death following AMI is MOST often caused by:

A) cardiogenic shock.

B) severe bradycardia.

C) ventricular fibrillation.

D) congestive heart failure.

ANS: C

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 687

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

41. Ventricular tachycardia causes hypotension because:

A) the volume of blood returning to the atria increases.

B) the right ventricle does not adequately pump blood.

C) blood backs up into the lungs and causes congestion.

D) the left ventricle does not adequately fill with blood.

ANS: D

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 688

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Analysis

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

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

A) Sinus tachycardia

B) Sinus bradycardia

C) Extra ventricular beats

D) Ventricular tachycardia

ANS: D

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 688

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

43. The purpose of defibrillation is to:

A) stop the chaotic, disorganized contraction of the cardiac cells.

B) cause a rapid decrease in the heart rate of an unstable patient.

C) improve the chance of CPR being successful in resuscitation.

D) prevent asystole from deteriorating into ventricular fibrillation.

ANS: A

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 688

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

44. Cardiogenic shock following AMI is caused by:

A) decreased pumping force of the heart muscle.

B) a profound increase in the patient's heart rate.

C) hypovolemia secondary to severe vomiting.

D) widespread dilation of the systemic vasculature.

ANS: A

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 688

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

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

A) Hypertension and tachycardia

B) Hypotension and flat jugular veins

C) The presence of rales in the lungs

D) Trouble breathing while lying down

ANS: B

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 688

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

46. 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:

A) obtain baseline vital signs.

B) begin ventilatory assistance.

C) attach the AED immediately.

D) apply a nonrebreathing mask.

ANS: B

Complexity: Difficult

Ahead: Pathophysiology

Subject: Chapter 17, Page 689

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Application

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

47. 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) nitroglycerin for her chest pain.

B) ventilations with a BVM.

C) oxygen at 2 L/min via nasal cannula.

D) placing her in an upright position.

ANS: D

Complexity: Difficult

Ahead: Pathophysiology

Subject: Chapter 17, Page 689

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Application

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

48. 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. 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:

A) remove the nitroglycerin patch, administer oxygen, and place him in a supine position.

B) remove the nitroglycerin patch and apply the AED in case he develops cardiac arrest.

C) move the nitroglycerin patch to the other side of his chest and administer oxygen.

D) complete your secondary assessment and reassess his blood pressure in 5 minutes.

ANS: A

Complexity: Difficult

Ahead: Pathophysiology

Subject: Chapter 17, Page 689

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Application

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

49. Which of the following signs is commonly observed in patients with right-sided heart failure?

A) Labored breathing

B) Dependent edema

C) Pulmonary edema

D) Flat jugular veins

ANS: B

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 690

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-2 Discuss the pathophysiology of the cardiovascular system.

50. Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:

A) have chronic hypertension.

B) regularly take illegal drugs.

C) have had a stroke in the past.

D) are older than 40 years of age.

ANS: A

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 691

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-6 Describe the anatomy, signs and symptoms, and management of hypertensive emergencies.

51. Common signs and symptoms of a hypertensive emergency include:

A) pallor, cool skin, and a temporary loss of hearing.

B) syncope, a weak pulse, and bleeding from the ears.

C) tachycardia, pain behind the eyes, and weakness.

D) a bounding pulse, a severe headache, and dizziness.

ANS: D

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 691

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-6 Describe the anatomy, signs and symptoms, and management of hypertensive emergencies.

52. A dissecting aortic aneurysm occurs when:

A) all layers of the aorta suddenly contract.

B) a weakened area develops in the aortic wall.

C) the inner layers of the aorta become separated.

D) the aorta ruptures, resulting in profound bleeding.

ANS: C

Complexity: Easy

Ahead: Pathophysiology

Subject: Chapter 17, Page 691

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-6 Describe the anatomy, signs and symptoms, and management of hypertensive emergencies.

53. In contrast to AMI, a dissecting aortic aneurysm:

A) is more commonly associated with pressure in the chest.

B) often presents with pain that is maximal from the onset.

C) usually presents gradually, often over a period of hours.

D) is typically preceded by other symptoms, such as nausea.

ANS: B

Complexity: Moderate

Ahead: Pathophysiology

Subject: Chapter 17, Page 691

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Recall

Objective: 17-6 Describe the anatomy, signs and symptoms, and management of hypertensive emergencies.

54. 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) Dissecting aortic aneurysm

C) Acute myocardial infarction

D) Hypertensive emergency

ANS: B

Complexity: Difficult

Ahead: Pathophysiology

Subject: Chapter 17, Page 691

Title: Cardiovascular Emergencies

Feedback: See Pathophysiology

Taxonomy: Application

Objective: 17-6 Describe the anatomy, signs and symptoms, and management of hypertensive emergencies.

55. Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:

A) assess the scene for potential hazards.

B) determine if you need additional help.

C) request a paramedic unit for assistance.

D) gain immediate access to the patient.

ANS: A

Complexity: Easy

Ahead: Patient Assessment

Subject: Chapter 17, Page 692

Title: Cardiovascular Emergencies

Feedback: See Patient Assessment

Taxonomy: Recall

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

56. A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:

A) administer up to 324 mg of baby aspirin.

B) administer up to three doses of nitroglycerin.

C) obtain vital signs and a SAMPLE history.

D) assess the adequacy of his respirations.

ANS: D

Complexity: Difficult

Ahead: Patient Assessment

Subject: Chapter 17, Page 692

Title: Cardiovascular Emergencies

Feedback: See Patient Assessment

Taxonomy: Analysis

Objective: 17-9 Explain the relationship between airway management and the patient with cardiac compromise.

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

B) obtain a SAMPLE history and contact medical control for advice.

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

D) give her one nitroglycerin and reassess her systolic blood pressure.

ANS: A

Complexity: Difficult

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Application

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

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

A) History of cigarette smoking

B) History of previous heart attack

C) Presence of personal risk factors

D) Family history of hypertension

ANS: D

Complexity: Easy

Ahead: Patient Assessment

Subject: Chapter 17, Page 694

Title: Cardiovascular Emergencies

Feedback: See Patient Assessment

Taxonomy: Recall

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

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

A) Furosemide (Lasix)

B) Aspirin

C) Oxygen

D) Metoprolol (Toprol)

ANS: B

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

60. Nitroglycerin relieves cardiac-related chest pain by:

A) dilating the coronary arteries and improving cardiac blood flow.

B) increasing the amount of stress that is placed on the myocardium.

C) contracting the smooth muscle of the coronary and cerebral arteries.

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

ANS: A

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

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

A) bradycardia.

B) hypertension.

C) hypotension.

D) severe headache.

ANS: B

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

62. Nitroglycerin is contraindicated in patients:

A) who have taken up to two doses.

B) who have experienced a head injury.

C) with a history of an ischemic stroke.

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

ANS: B

Complexity: Moderate

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

63. 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.

ANS: B

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

64. 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 should be administered between the cheek and gum.

D) Nitroglycerin usually relieves anginal chest pain within 5 minutes.

ANS: D

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

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

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

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

C) chest pain that does not immediately subside with rest.

D) difficulty breathing that awakens the patient from sleep.

ANS: C

Complexity: Moderate

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

66. Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS.

A) two

B) three

C) four

D) five

ANS: B

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 697

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Recall

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

67. Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?

A) Encourage the patient to chew the tablet to increase its effectiveness.

B) Place the medication under the tongue and have the patient swallow it.

C) Administer the medication sublingually and allow it to dissolve or absorb.

D) Wait 15 minutes and reassess the patient's blood pressure prior to administering another dose.

ANS: C

Complexity: Moderate

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 699

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Application

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

68. After assisting your patient with prescribed nitroglycerin, you should:

A) place the patient in a recumbent position in case of fainting.

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

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

D) perform a secondary assessment before administering further doses.

ANS: B

Complexity: Easy

Ahead: Emergency Medical Care for Chest Pain or Discomfort

Subject: Chapter 17, Page 699

Title: Cardiovascular Emergencies

Feedback: See Emergency Medical Care for Chest Pain or Discomfort

Taxonomy: Application

Objective: 17-10 Give the indications and contraindications for the use of aspirin and nitroglycerin.

69. 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

ANS: A

Complexity: Easy

Ahead: Cardiac Monitoring

Subject: Chapter 17, Page 700

Title: Cardiovascular Emergencies

Feedback: See Cardiac Monitoring

Taxonomy: Application

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

70. When obtaining a 12-lead ECG, the patient should be:

A) in a semi-Fowler's position with legs crossed

B) in a supine position with legs uncrossed.

C) in a semi-Fowler's position with arms raised.

D) in a supine position with legs elevated.

ANS: B

Complexity: Easy

Ahead: Cardiac Monitoring

Subject: Chapter 17, Page 700

Title: Cardiovascular Emergencies

Feedback: See Cardiac Monitoring

Taxonomy: Recall

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

71. When preparing to obtain a 12-lead ECG, the LL and RL electrodes should be placed:

A) on the lower abdomen.

B) anywhere on the arms.

C) on the thighs or ankles.

D) on either side of the chest.

ANS: C

Complexity: Easy

Ahead: Cardiac Monitoring

Subject: Chapter 17, Page 702

Title: Cardiovascular Emergencies

Feedback: See Cardiac Monitoring

Taxonomy: Application

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

72. When preparing to obtain a 12-lead ECG, the V1 and V2 electrodes should be placed:

A) in the midclavicular line.

B) on either side of the sternum.

C) in the midaxillary line.

D) on the left and right arms.

ANS: B

Complexity: Moderate

Ahead: Cardiac Monitoring

Subject: Chapter 17, Page 702

Title: Cardiovascular Emergencies

Feedback: See Cardiac Monitoring

Taxonomy: Application

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

73. 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) bypassing the coronary artery with a vessel from the chest or leg.

C) placing a stent inside the coronary artery to keep it from narrowing.

D) dilating the affected coronary artery with a small inflatable balloon.

ANS: D

Complexity: Moderate

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 703

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Application

Objective: 17-8 Explain the assessment for patients with cardiovascular problems.

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

A) Rapid heart rate

B) Syncope or dizziness

C) Heart rate less than 60 beats/min

D) Generalized weakness

ANS: A

Complexity: Moderate

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 703

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Recall

Objective: 17-11 Recognize that many patients will have had cardiac surgery and may have implanted pacemakers or defibrillators.

75. 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) Contact medical control and request permission to defibrillate.

C) Deliver the shock followed by immediate resumption of CPR.

D) Continue CPR and transport the patient to the closest appropriate hospital.

ANS: C

Complexity: Moderate

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 704

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Application

Objective: 17-11 Recognize that many patients will have had cardiac surgery and may have implanted pacemakers or defibrillators.

76. In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest:

A) delivers high-energy shocks, similar to an AED.

B) does not require the EMT to stand clear when it shocks.

C) does not warn when a shock is about to be delivered.

D) will only deliver a shock if ventricular fibrillation occurs.

ANS: A

Complexity: Difficult

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 704

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Recall

Objective: 17-14 Describe the different types of AEDs.

77. A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:

A) leave the battery attached to the monitor and remove the vest.

B) remove the battery from the monitor and leave the vest in place.

C) perform ventilations only and allow the vest device to defibrillate.

D) remove the battery from the monitor and then remove the vest.

ANS: D

Complexity: Moderate

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 704

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Application

Objective: 17-14 Describe the different types of AEDs.

78. 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) Acute myocardial infarction

C) Uncontrolled hypertension

D) Obstructive lung disease

ANS: B

Complexity: Moderate

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 704

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Analysis

Objective: 17-14 Describe the different types of AEDs.

79. 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?

A) Absence of a palpable pulse

B) High systolic blood pressure

C) Distention of the jugular veins

D) Low diastolic blood pressure

ANS: A

Complexity: Moderate

Ahead: Heart Surgeries and Cardiac Assistive Devices

Subject: Chapter 17, Page 704

Title: Cardiovascular Emergencies

Feedback: See Heart Surgeries and Cardiac Assistive Devices

Taxonomy: Analysis

Objective: 17-14 Describe the different types of AEDs.

80. The EMT should use an AED on a child between 1 month and 8 years of age if:

A) he or she is not breathing and has a weakly palpable pulse.

B) his or her condition is rapidly progressing to cardiac arrest.

C) pediatric pads and an energy-reducing device are available.

D) special pads are used and the child has profound tachycardia.

ANS: C

Complexity: Easy

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 706

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-14 Describe the different types of AEDs.

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

A) resistance of the body to the flow of electricity.

B) direction that the electrical flow takes in the body.

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

D) distance between the two AED pads on the chest.

ANS: A

Complexity: Moderate

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 706

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-14 Describe the different types of AEDs.

82. The AED is MOST advantageous to the EMT because:

A) it is lightweight, easy to use, and safe for the EMT who is using it.

B) it delivers prompt defibrillation to patients with ventricular fibrillation.

C) its use does not require the presence of advanced life support personnel.

D) it delivers an unlimited number of shocks with the same amount of energy.

ANS: B

Complexity: Easy

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 705

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-14 Describe the different types of AEDs.

83. 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.

ANS: C

Complexity: Difficult

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 707

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Analysis

Objective: 17-16 Recognize that not all patients in cardiac arrest require an electric shock.

84. The MOST common error associated with the use of the AED is:

A) failure of the 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.

ANS: A

Complexity: Easy

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 708

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-19 Explain the circumstances that may result in inappropriate shocks from an AED.

85. Which of the following statements regarding the AED and defibrillation is correct?

A) The AED will not analyze the rhythm of a moving patient.

B) Defibrillation is the first link in the AHA chain of survival.

C) The AED will shock any rhythm not accompanied by a pulse.

D) CPR should be performed for 5 minutes before using the AED.

ANS: A

Complexity: Moderate

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 708

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-20 Explain the reason not to touch the patient, such as by delivering CPR, while the AED is analyzing the heart rhythm and delivering shocks.

86. The main legal risk in using the AED is:

A) negligence on the part of the manufacturer.

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

C) failing to deliver a shock when one is needed.

D) not assessing for a pulse after a shock is delivered.

ANS: C

Complexity: Easy

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 708

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-25 Explain the need for a case review of each incident in which an AED is used.

87. Prior to defibrillating a patient with an AED, it is MOST important that you:

A) properly position the defibrillation pads.

B) perform up to 5 minutes of effective CPR.

C) confirm that the patient is in cardiac arrest.

D) ensure that no one is touching the patient.

ANS: D

Complexity: Easy

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 708

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-20 Explain the reason not to touch the patient, such as by delivering CPR, while the AED is analyzing the heart rhythm and delivering shocks.

88. Prior to attaching the AED to a cardiac arrest patient, the EMT should:

A) contact medical control.

B) dry the chest if it is wet.

C) perform CPR for 30 seconds.

D) assess for a pulse for 20 seconds.

ANS: B

Complexity: Easy

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 710

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-19 Explain the circumstances that may result in inappropriate shocks from an AED.

89. 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:

A) feel for a pulse while compressions are ongoing.

B) quickly attach the AED and push the analyze button.

C) have the EMTs stop CPR and assess for a pulse.

D) request a paramedic unit and quickly attach the AED.

ANS: A

Complexity: Difficult

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 711

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-18 Discuss the reasons for early defibrillation.

90. Defibrillator pads are placed on the patient's chest:

A) 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 just to the right of the right nipple.

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

ANS: D

Complexity: Moderate

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 713

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-27 Discuss the procedures to follow for standard operation of the various types of AEDs.

91. 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:

A) begin high-quality CPR and apply the AED as soon as possible.

B) have your partner perform CPR while you question the bystanders.

C) perform two-rescuer CPR for 5 minutes and request ALS backup.

D) immediately apply the AED pads and analyze his cardiac rhythm.

ANS: A

Complexity: Difficult

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 711

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-18 Discuss the reasons for early defibrillation.

92. 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) re-analyze the patient's cardiac rhythm.

B) perform CPR for 2 minutes and reassess.

C) determine if a palpable pulse is present.

D) immediately assess the patient's airway.

ANS: B

Complexity: Difficult

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 706

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-16 Recognize that not all patients in cardiac arrest require an electric shock.

93. 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.

ANS: B

Complexity: Moderate

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 713

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Recall

Objective: 17-29 Describe the components of patient care following AED shocks.

94. 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) obtain a blood pressure and apply the pulse oximeter.

B) place him in the recovery position and apply oxygen.

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

D) reassess airway and breathing and treat accordingly.

ANS: D

Complexity: Difficult

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 714

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-29 Describe the components of patient care following AED shocks.

95. A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:

A) defibrillate with the AED while continuing transport to the hospital.

B) stop the ambulance, begin CPR, and attach the AED as soon as possible.

C) perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED.

D) alert the receiving hospital and perform CPR for the duration of the transport.

ANS: B

Complexity: Difficult

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 714

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-30 Explain criteria for transport of the patient for advanced life support (ALS) following CPR and defibrillation.

96. 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:

A) apply the AED while your partner provides rescue breathing.

B) begin CPR, apply the AED, and deliver a shock if it is indicated.

C) perform CPR only and wait for the manual defibrillator to arrive.

D) begin CPR and have your partner update the responding paramedics.

ANS: B

Complexity: Moderate

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 711

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-18 Discuss the reasons for early defibrillation.

97. 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:

A) oxygen via nonrebreathing mask at 15 L/min and immediate transport.

B) insertion of an oropharyngeal airway and positioning him on his side.

C) elevation of his lower extremities and covering him with warm blankets.

D) bag-mask ventilation at 10 breaths/min and assessment of oxygen saturation.

ANS: D

Complexity: Moderate

Ahead: Cardiac Arrest

Subject: Chapter 17, Page 716

Title: Cardiovascular Emergencies

Feedback: See Cardiac Arrest

Taxonomy: Application

Objective: 17-28 Describe the emergency medical care for the patient with cardiac arrest.