Cardio HW 2 81-105

Question 1

Which of the following statements regarding second-degree heart block is correct?
Choose one answer.
A. Most second-degree heart blocks are transient in nature and resolve in the prehospital setting without the need for intervention in the emergency department.
B. Second-degree heart block occurs when an impulse reaching the AV node is occasionally prevented from proceeding to the ventricles and causing a QRS complex.
C. More than half of all second-degree heart blocks cause hemodynamic compromise and require transcutaneous cardiac pacing in the prehospital or hospital setting.
D. Second-degree heart block is characterized by inconsistent PR intervals, a QRS complex greater than 0.12 seconds, and a ventricular rate less than 40 beats/min.

Answer 1

B

Question 2

Which of the following statements regarding sinus bradycardia is correct?
Choose one answer.
A. Treatment focuses on the patient’s tolerance to the bradycardia.
B. Symptomatic bradycardia is often caused by a decreased atrial rate.
C. Sinus bradycardia often requires multiple doses of atropine to correct it.
D. Sinus bradycardia is caused by decreased vagal tone in most patients.

Answer 2

A

Question 3

Which of the following statements regarding the right side of the heart is correct?
Choose one answer.
A. It receives blood exclusively from the venae cavae.
B. The right side of the heart is a low-pressure pump.
C. It pumps against the high resistance of the pulmonary circulation.
D. The right side of the heart pumps blood through the pulmonary veins.

Answer 3

B

Question 4

Which of the following statements regarding the SA node is correct?
Choose one answer.
A. The SA node is the dominant cardiac pacemaker in healthy patients.
B. SA nodal ischemia occurs when the left coronary artery is occluded.
C. The SA node is located in the superior aspect of the right ventricle.
D. Impulses generated by the SA node travel through the right atrium only.

Answer 4

A

Question 5

Which of the following statements regarding the use of vasopressin when managing cardiac arrest is correct?
Choose one answer.
A. If the initial drug you give is epinephrine, vasopressin should not be administered to the patient.
B. Vasopressin and epinephrine should be given together to achieve a more potent vasopressor effect.
C. Unlike epinephrine, vasopressin provides greater alpha and beta adrenergic stimulation.
D. A one-time dose of 40 units of vasopressin may be given to replace the first or second dose of epinephrine.

Answer 5

D

Question 6

Which of the following statements regarding treatment for a first-degree heart block is correct?
Choose one answer.
A. Treatment is generally not indicated unless the rate is slow and cardiac output is impaired.
B. Most first-degree heart blocks are associated with significant bradycardia and require atropine.
C. First-degree heart block is often accompanied by a compensatory tachycardia that requires treatment.
D. Transcutaneous cardiac pacing should be initiated without delay for patients with a first-degree heart block.

Answer 6

A

Question 7

Which of the following underlying medical conditions would be of LEAST pertinence when obtaining the past medical history from a patient who complains of acute chest pain or pressure?
Choose one answer.
	 A. Cancer  	
	 B. Diabetes  	
	 C. Renal disease  	
	 D. Hypertension

Answer 7

A

Question 8

Which part of the blood vessel is made up of elastic fibers and muscle, and provides for strength and contractility?
Choose one answer.
	 A. Tunica media  	
	 B. Tunica intima  	
	 C. Tunica adventitia  	
	 D. Arterial lumen

Answer 8

A

Question 9

You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should:
Choose one answer.
A. perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min.
B. instruct the EMT-B to pause after 30 compressions so your partner can deliver two ventilations.
C. administer 2.5 mg of epinephrine via the ET tube and hyperventilate the patient to ensure drug dispersal.
D. direct your partner to deliver one breath every 3 to 5 seconds as the EMT-B continues chest compressions.

Answer 9

A

Question 10

You and your partner arrive at the scene of an unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patient’s wife tells you that he collapsed about 10 minutes ago. You should:
Choose one answer.
A. ask the patient’s wife if her husband has a living will.
B. apply the defibrillator pads and assess his cardiac rhythm.
C. initiate CPR as your partner applies the defibrillator pads.
D. begin CPR with a compression to ventilation ratio of 15:2.

Answer 10

C

Question 11

You are assessing a conscious and alert middle-aged male who complains of chest discomfort and nausea. His blood pressure is 112/70 mm Hg, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patient's past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer?
Choose one answer.
	 A. Aspirin  	
	 B. Fentanyl  	
	 C. Morphine  	
	 D. Nitroglycerin

Answer 11

D

Question 12

You are assessing the 12-lead tracing of a 40-year-old man with chest pain and note ST-segment elevation in leads II, III, and aVF. Lead V4R shows 2-mm ST-segment elevation. The patient’s blood pressure is 88/58 mm Hg, and his heart rate is 72 beats/min and regular. He denies any significant past medical history but is allergic to salicylates. After placing the patient on oxygen and starting an IV line of normal saline, you should:
Choose one answer.
A. administer up to 325 mg of baby aspirin.
B. give 2-mg increments of morphine sulfate.
C. start a dopamine infusion at 2 µg/kg/min.
D. give crystalloid boluses to increase preload.

Answer 12

D

Question 13

You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a “stomach bug.” He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66 mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:
Choose one answer.
A. give 100% oxygen, start two large-bore IV lines, administer 20 mL/kg normal saline boluses, and transport.
B. administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
C. advise him that he can probably drive himself to the emergency department or schedule an appointment with his physician.
D. apply high-flow oxygen via nonrebreathing mask, start an IV line, administer 0.5 mg of atropine, and transport to the closest facility.

Answer 13

B

Question 14

You are dispatched to a grocery store for a 39-year-old woman with a severe headache. The patient advises you that her headache, which was present when she woke up this morning, is located in the back of her head. She is conscious and alert, with a blood pressure of 194/112 mm Hg, pulse of 100 beats/min and strong, and respirations of 14 breaths/min and regular. She denies a history of hypertension or any other significant medical problems. The closest appropriate facility is located 15 miles away. You should:
Choose one answer.
A. administer supplemental oxygen, start an IV line of normal saline at a keep-open rate, and transport.
B. start an IV line of normal saline, give her 0.4 mg of sublingual nitroglycerin, and transport at once.
C. give high-flow oxygen, establish vascular access, begin transport, and administer labetalol en route.
D. administer oxygen as tolerated, give up to 5 mg of morphine IM, and transport promptly.

Answer 14

A

Question 15

You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of “breathing problem,” for which he uses a prescribed inhaler and takes a “heart pill.” You should suspect:
Choose one answer.
	 A. right ventricular failure.  	
	 B. reactive airway disease.  	
	 C. acute COPD exacerbation.  	
	 D. left-sided heart failure.

Answer 15

D

Question 16

You are performing CPR on an 80-year-old woman whose cardiac arrest was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a bag-mask device are producing adequate chest rise. IV access has been obtained and 1 mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rate of 70 beats/min. According to the patient’s husband, she has had numerous episodes of diarrhea over the past 24 hours and has not had much of an appetite. The MOST appropriate next action should be to:
Choose one answer.
A. administer 1 mg of atropine while CPR is ongoing.
B. assess the rhythm and pulse after 3 minutes of CPR.
C. administer 50% dextrose for presumed hypoglycemia.
D. continue CPR and administer crystalloid fluid boluses.

Answer 16

D

Question 17

You are reviewing the medications of a semiconscious patient as your partner and another paramedic provide patient care. The patient’s medications include Lanoxin, enalapril, Coumadin, Lasix, and K-Dur. This medication regimen is MOST consistent with a patient who has:
Choose one answer.
A. CHF, hypertension, and atrial fibrillation.
B. COPD, diabetes, and tachydysrhythmias.
C. ventricular dysrhythmias and hypertension.
D. hypothyroidism, renal failure, and atrial flutter.

Answer 17

A

Question 18

You have applied the cardiac monitor to your 66-year-old male cardiac arrest patient and see what appears to be asystole. You should:
Choose one answer.
A. check for a pulse for a maximum of 10 seconds.
B. resume CPR and place an advanced airway device.
C. continue CPR and reassess the rhythm in 2 minutes.
D. assess another lead or increase the gain sensitivity.

Answer 18

D

Question 19

You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to:
Choose one answer.
	 A. attempt cardiac pacing.  	
	 B. check the carotid pulse.  	
	 C. assess breathing effort.  	
	 D. resume CPR at once.

Answer 19

D

Question 20

You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should:
Choose one answer.
	 A. repeat the nitroglycerin.  	
	 B. reassess her blood pressure.  	
	 C. give her a 250-mL saline bolus.  	
	 D. administer 2 to 4 mg of morphine.

Answer 20

B

Question 21

You have just performed synchronized cardioversion on a patient with unstable ventricular tachycardia. Upon reassessment, you note that the patient is unresponsive, apneic, and pulseless. You should:
Choose one answer.
A. desynchronize the defibrillator, defibrillate one time, and check for a pulse.
B. ensure that the synchronizer is off, defibrillate, and immediately begin CPR.
C. increase the energy setting on the defibrillator and repeat the cardioversion.
D. perform five cycles of CPR, reassess the cardiac rhythm, and defibrillate if needed.

Answer 21

B

Question 22

You have restored spontaneous circulation in a 54-year-old man who was in ventricular fibrillation. During the arrest interval, you delivered 2 shocks, 1 mg of epinephrine, and 300 mg of amiodarone. The patient's blood pressure is 96/60 mm Hg, and the cardiac monitor displays a sinus rhythm at a rate of 70 beats/min with frequent premature ventricular complexes. Appropriate post-resuscitation care for this patient includes:
Choose one answer.
	 A. 0.5 mg of atropine sulfate.  	
	 B. an infusion of amiodarone.  	
	 C. a 20-mL/kg crystalloid bolus.  	
	 D. a low-dose dopamine infusion.

Answer 22

B

Question 23

You receive a call to a residence for a 44-year-old man who is “ill.” The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient’s vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is:
Choose one answer.
A. hypocalcemic.
B. hypernatremic.
C. hyperkalemic.
D. having an acute myocardial infarction.

Answer 23

C

Question 24

You receive a call to a skilled nursing facility for an elderly man with generalized weakness. The patient’s nurse tells you that he has not eaten anything in the past 18 hours. She presents you with his chart, which states that he has a history of atrial fibrillation, congestive heart failure, and hypertension. His medications include Vasotec, digoxin, and warfarin. As you apply the cardiac monitor, your partner takes the patient’s vital signs, which reveal a blood pressure of 136/76 mm Hg, a rapid and irregular pulse, and respirations of 22 breaths/min. The ECG reveals atrial fibrillation with a variable rate between 110 and 130 beats/min, and a 12-lead ECG tracing reveals the same. After applying supplemental oxygen, you should:
Choose one answer.
A. start an IV line set to keep the vein open, administer diltiazem, and transport.
B. place him in a position of comfort and transport with continuous monitoring.
C. establish an IV, administer Versed, and perform synchronized cardioversion.
D. establish IV access, give a beta blocker to slow his heart rate, and transport.

Answer 24

A

Question 25

You respond to the scene of an assault, where a 20-year-old man was struck in the chest with a steel pipe. Your assessment reveals that the patient is unresponsive, apneic, and pulseless. The MOST appropriate next intervention is to:
Choose one answer.
A. perform 5 cycles of well-coordinated CPR.
B. look for evidence of a pericardial tamponade.
C. immediately assess the patient’s cardiac rhythm.
D. give 2 minutes of 15 compressions and 2 breaths.

Answer 25

A