Chapter 20

1) Which of the following is a general term used to refer to a problem with the heart?

A) Myocardial infarction

B) Cardiac dysrhythmia

C) Cardiac compromise

D) Congestive heart failure

C) CORRECT. Acute coronary syndrome (ACS), sometimes called cardiac compromise, is a blanket term that refers to any time the heart may not be getting enough oxygen.

2) What is (are) the first organ(s) perfused by blood leaving the heart?

A) Coronary arteries

B) Lungs

C) Liver

D) Heart

D) CORRECT. The heart is the first organ perfused by oxygenated blood leaving the heart. It receives its supply of blood via the coronary arteries that branch off the very base of the aorta and spread throughout the heart muscle.

3) Which of the following may be a sign or symptom of a problem with the heart?

A) Chest discomfort

B) Fainting or near fainting

C) Nausea, with or without vomiting

D) All of the above

D) CORRECT. Chest discomfort, fainting or near fainting, and nausea are all signs or symptoms of a possible heart problem.

4) Which of the following best describes a fluttering sensation in the chest?

A) Pulseless electrical activity of the heart

B) Palpitations

C) Dysrhythmia

D) Tachycardia

B) CORRECT. Palpitations are irregular or rapid heartbeats that feel like a fluttering sensation in the chest.

5) What stimulates a mechanical contraction of the cells of the heart, creating a mechanical squeeze used to push blood?

A) Left ventricle

B) Right ventricle

C) Left and right atria

D) Electrical energy

D) CORRECT. In the cardiac conduction system, an electrical charge is created, and this energy is passed from cell to cell along a specialized pathway. As energy is distributed along this pathway, it spreads to all the cells of the heart and, if conditions are correct, this energy stimulates a mechanical contraction of those cells that creates the mechanical squeeze used to push blood.

6) You are on-scene with a 48-year-old unresponsive male patient. Bystanders state he complained of chest pain and then suddenly collapsed. Vital signs are blood pressure 68/42, pulse 36, and respiratory rate 3. He is unresponsive to painful stimuli. After performing the primary assessment and treating all life threats, what is your next intervention?

A) Insert an oral airway.

B) Administer high-concentration oxygen at 15 lpm by bag-valve mask.

C) Package the patient for rapid transport.

D) Apply the AED.

C) CORRECT. The patient has systolic blood pressure below 90 to 100. The best action for this patient is rapid transport to the closest appropriate facility.

7) Assuming your protocol allows the administration of nitroglycerin when certain conditions exist, what is the maximum number of tablets to be administered in the prehospital setting?

A) 2

B) 3

C) 4

D) 1

B) CORRECT. Three nitroglycerin tablets is the maximum that should ever be administered during prehospital care, and only if authorized by medical direction.

8) Which of the following is the beneficial action of nitroglycerin in some cardiac emergencies?

A) It relaxes blood vessels throughout the body.

B) It dilates only the coronary arteries.

C) It increases the strength with which the ventricles contract.

D) It slows down the heart.

A) CORRECT. Nitroglycerin is a medication that dilates the blood vessels. This results in more blood staying in the veins of the body, so there is less blood coming back to the heart.

9) Which of the following statements regarding the administration of nitroglycerin tablets is true?

A) An increase in blood pressure should be expected.

B) The patient may complain of a headache following administration.

C) If a patient's pulse rate changes following nitroglycerin administration, it indicates an allergic reaction.

D) It takes 20 to 30 minutes for nitroglycerin to have an effect.

B) CORRECT. Headache is a common side effect of nitroglycerin.

10) Which of the following is the EMT's role in caring for a patient presenting with symptoms of anxiety, irritability, a short temper, and chest pain with shortness of breath?

A) Treat the patient as though he were having a heart problem.

B) Provide automatic external defibrillation.

C) Make an interpretation of the patient's cardiac rhythm.

D) Determine the cause of the patient's chest pain.

A) CORRECT. Because the signs and symptoms of an ACS can vary so greatly, it is much safer for the EMT to treat all patients with a pattern of symptoms consistent with ACS as though they were having a heart problem.

11) In which of the following situations would the administration of aspirin to a cardiac patient be prohibited?

A) The patient does not currently take aspirin.

B) The patient has a gastrointestinal ulcer.

C) The patient has a diastolic blood pressure greater than 90 mmHg.

D) The patient feels dizzy.

B) CORRECT. Administration of aspirin would be contraindicated in a patient with a gastrointestinal ulcer.

12) Which of the following is a condition that can result from fatty deposits forming in the inner lining of the arteries?

A) Arteriosclerosis

B) Coronary artery disease

C) Coronary thrombosis

D) Aneurysm

B) CORRECT. Coronary artery disease is often the result of the buildup of fatty deposits on the inner walls of arteries. This buildup causes a narrowing of the inner vessel diameter, restricting the flow of blood.

13) You are treating a male patient with chest pain caused by the complete occlusion of one of the coronary arteries. What would you most likely expect with this patient?

A) His pain will go away with oxygen.

B) His pain will be reduced with aspirin.

C) His pain will be alleviated with nitroglycerin.

D) His pain will not be alleviated with any of the above medications.

D) CORRECT. The patient's chest pain is being caused by myocardial cells becoming ischemic. The ischemia is being caused by the complete coronary occlusion, which is blocking the flow of oxygen-rich blood to the myocardium. The primary way to reduce the patient's chest pain is to open the clot and get oxygen-rich blood to the heart. Oxygen and aspirin will not reduce the size of the clot or increase the amount of oxygen reaching the heart. Nitroglycerin will vasodilate the affected coronary artery and it is often very successful in reducing chest pain by opening partial occlusions. However, it usually does not open complete occlusions. Most patients with complete occlusions of the coronary artery will still have chest pain after repeated doses of nitroglycerin.

14) A weakened area of an artery that balloons out and may rupture, causing catastrophic bleeding, is called:

A) angina.

B) asystole.

C) an aneurysm.

D) angioplasty.

C) CORRECT. When a weakened section of an artery balloons it is known as an aneurysm, and if it bursts, there can be rapid, life-threatening internal bleeding.

15) What is not a result of a mechanical malfunction of the heart? 

A) Cardiac arrest

B) Dysrhythmia

C) Cardiogenic shock

D) Pulmonary edema

B) CORRECT. Dysrhythmia occurs when electricity is distributed abnormally through the heart, causing harmful changes to rate, rhythm, and pumping ability.

16) You suspect that your patient is suffering from angina pectoris. What signs or symptoms would you expect to see with this condition?

A) Chest pain that is relieved with nitroglycerin

B) Chest pain that is not relieved with nitroglycerin

C) Chest pain that is not relieved with rest

D) Chest pain that radiates to the leg

A) CORRECT. Angina pectoris is defined as chest pain that is caused by vasoconstriction or vasospasm of the coronary arteries. It is usually resolved with nitroglycerin, which dilates the constricted arteries, allowing increased blood flow to the heart.

17) Which of the following statements regarding angina pectoris is true?

A) It can be brought on by exertion or stress.

B) It is generally relieved by over-the-counter medications.

C) It results in death of a smaller portion of myocardium than does a heart attack.

D) It generally lasts 30 to 60 minutes.

A) CORRECT. A common cause of angina is stress or exertion.

18) Which of the following is typical of angina pectoris?

A) Does not respond to nitroglycerin

B) Lasts 10 to 30 seconds

C) Does not present following stress

D) May subside with rest

D) CORRECT. Relaxing may cause angina to go away.

19) Which of the following is the beneficial action of a beta blocker medication?

A) Causes vasoconstriction, increasing the blood pressure

B) Slows the heart rate

C) Increases the amount of oxygen needed by the myocardium

D) Increases the strength of myocardial contraction

B) CORRECT. Beta blocker medications slow the heart and cause it to beat less vigorously.

20) Which of the following is the result of a portion of the heart muscle dying due to a lack of oxygen?

A) Angina pectoris

B) Myocardial infarction

C) Cardiac arrest

D) Heart failure

B) CORRECT. The condition in which a portion of the myocardium (heart muscle) dies as a result of oxygen starvation is known as acute myocardial infarction.

21) You respond to the scene of a 56-year-old obese female complaining of respiratory distress. She states that she has been feeling weak and a "little sick" for the past two days, but the respiratory distress has been getting progressively worse for the past several hours. She states she has "heart problems," suffers from high blood pressure, and takes a "water pill." She is afebrile and has coarse crackles bilaterally. What is most likely the cause of her respiratory distress?

A) Dysrhythmia

B) Acute myocardial infarction

C) Aortic aneurysm

D) Congestive heart failure

D) CORRECT. Pulmonary edema (identified by the presence of crackles on auscultation of the lungs) is the hallmark of congestive heart failure. This finding along with the patient's history of heart problems and taking a water diuretic (water pills) make congestive heart failure the most likely cause.

22) Which of the following is the name given to the condition in which fluid accumulates in the lungs?

A) Congestive heart failure

B) Pulmonary edema

C) Pedal edema

D) Dyspnea

B) CORRECT. Fluid accumulation in the lungs is called pulmonary edema.

23) Which of the following terms refers to swelling of the lower extremities seen in many cardiac patients?

A) Presacral swelling

B) Crackles

C) Congestive heart failure

D) Pedal edema

D) CORRECT. Swelling of the feet and ankles, called pedal edema, is common among cardiac patients.

24) Which of the following is not a typical indication of congestive heart failure (CHF)?

A) Productive cough

B) Jugular venous distension

C) Increased heart rate

D) Weight loss

D) CORRECT. It is not common to find weight loss in a congestive heart failure patient.