Chapter 17 - Cardiovascular Emergencies

Question 1

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

Select one:

A. administer up to three doses of nitroglycerin.
B. administer up to 324 mg of baby aspirin.
C. assess the adequacy of his respirations.
D. obtain vital signs and a SAMPLE history

Answer 1

C. assess the adequacy of his respirations.

Question 2

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:

Select one:

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

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

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

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

Answer 2

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

Question 3

A dissecting aortic aneurysm occurs when:

Select one:

A. the aorta ruptures, resulting in profound bleeding.
B. all layers of the aorta suddenly contract.
C. the inner layers of the aorta become separated.
D. a weakened area develops in the aortic wall.

Answer 3

C. the inner layers of the aorta become separated.

Question 4

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

Select one:

A. remove the battery from the monitor and then remove the vest.

B. leave the battery attached to the monitor and remove the vest.

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

D. remove the battery from the monitor and leave the vest in place.

Answer 4

A. remove the battery from the monitor and then remove the vest.

Question 5

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?

Select one:

A. Thoracic aortic aneurysm
B. Uncontrolled hypertension
C. Obstructive lung disease
D. Acute myocardial infarction

Answer 5

D. Acute myocardial infarction

Question 6

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

Select one:

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

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

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

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

Answer 6

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

Question 7

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

Select one:

A. re-analyze the cardiac rhythm.
B. assess for a carotid pulse.
C. transport the patient at once.
D. immediately resume CPR.

Answer 7

D. immediately resume CPR.

Question 8

Angina pectoris occurs when:

Select one:

A. myocardial oxygen demand exceeds supply.
B. a coronary artery is totally occluded by plaque.
C. one or more coronary arteries suddenly spasm.
D. myocardial oxygen supply exceeds the demand.

Answer 8

A. myocardial oxygen demand exceeds supply.

Question 9

Deoxygenated blood from the body returns to the:

Select one:

A. right atrium.
B. right ventricle.
C. left ventricle.
D. left atrium.

Answer 9

A. right atrium.

Question 10

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

Select one:

A. direction that the electrical flow takes in the body.
B. distance between the two AED pads on the chest.
C. actual amount of energy that the AED will deliver.
D. resistance of the body to the flow of electricity.

Answer 10

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

Question 11

Nitroglycerin is contraindicated in patients:

Select one:

A. with systolic blood pressure less than 120 mm Hg.
B. who have taken up to two doses.
C. who have experienced a head injury.
D. with a history of an ischemic stroke.

Answer 11

C. who have experienced a head injury.

Question 12

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

Select one:

A. perform CPR for 30 seconds.
B. dry the chest if it is wet.
C. contact medical control.
D. assess for a pulse for 20 seconds.

Answer 12

B. dry the chest if it is wet.

Question 13

Risk factors for AMI that cannot be controlled include:

Select one:

A. family history.
B. hyperglycemia.
C. excess stress.
D. lack of exercise.

Answer 13

A. family history.

Question 14

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

Select one:

A. are older than 40 years of age.
B. have chronic hypertension.
C. have had a stroke in the past.
D. regularly take illegal drugs.

Answer 14

B. have chronic hypertension.

Question 15

The electrical impulse generated by the heart originates in the:

Select one:

A. atrioventricular node.
B. coronary sinus.
C. bundle of His.
D. sinoatrial node.

Answer 15

D. sinoatrial node.

Question 16

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

Select one:

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

B. special pads are used and the child has profound tachycardia.

C. his or her condition is rapidly progressing to cardiac arrest.

D. pediatric pads and an energy-reducing device are available.

Answer 16

D. pediatric pads and an energy-reducing device are available.

Question 17

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

Select one:

A. anywhere on the arms.
B. on the lower abdomen.
C. on either side of the chest.
D. on the thighs or ankles.

Answer 17

D. on the thighs or ankles.

Question 18

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

Select one:

A. Syncope or dizziness
B. A rapid heart rate
C. Heart rate less than 60 beats/min
D. Generalized weakness

Answer 18

B. A rapid heart rate

Question 19

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

Select one:

A. Labored breathing
B. Pulmonary edema
C. Flat jugular veins
D. Dependent edema

Answer 19

D. Dependent edema

Question 20

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:

Select one:

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

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

C. have your partner perform CPR while you question the bystanders.

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

Answer 20

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

Question 21

Paroxysmal nocturnal dyspnea (PND), rales, and dependent edema are clinical indicators of:

Select one:

A. emphysema.
B. severe pneumonia.
C. bronchitis or asthma.
D. congestive heart failure.

Answer 21

D. congestive heart failure.
Paroxysmal nocturnal dyspnea (PND) is a condition that triggers sudden shortness of breath during sleep. This difficulty in breathing can cause a person to wake up gasping for air. It usually occurs several hours after a person falls asleep and improves when they sit upright

Question 22

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

Select one:

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.

Answer 22

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

Question 23

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

Select one:

A. bradycardia.
B. hypertension.
C. hypotension.
D. severe headache.

Answer 23

B. hypertension.

Question 24

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

Select one:

A. excitability.
B. contractility.
C. impulsivity.
D. automaticity.

Answer 24

D. automaticity.

Question 25

The AED is MOST advantageous to the EMT because:

Select one:

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

Answer 25

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

Question 26

The left ventricle has the thickest walls because it:

Select one:

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.

Answer 26

C. pumps blood into the aorta and systemic circulation.

Question 27

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:

Select one:

A. reanalyze 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

Answer 27

B. perform CPR for 2 minutes and reassess.

Question 28

Perfusion is MOST accurately defined as the:

Select one:

A. effective transfer of oxygen from the venules across the systemic capillary membrane walls.

B. ability of the systemic arteries to constrict as needed to maintain an adequate blood pressure.

C. effective removal of carbon dioxide and other metabolic waste products from the body’s cells.

D. circulation of blood within an organ in adequate amounts to meet the body’s metabolic needs.

Answer 28

D. circulation of blood within an organ in adequate amounts to meet the body’s metabolic needs.

Question 29

A hematoma develops when:

Select one:

A. small amounts of blood leak into the epidermis.
B. large blood vessels beneath the skin are damaged.
C. severe swelling compromises arterial circulation.
D. cells and small vessels in the dermis are damaged.

Answer 29

B. large blood vessels beneath the skin are damaged.

Question 30

All of the following are common signs and symptoms of cardiac ischemia, EXCEPT:
A. headache.
B. chest pressure.
C. shortness of breath.
D. anxiety or restlessness.

Answer 30

A. headache.

Cardiac ischemia occurs when the heart’s demand for oxygen exceeds the available supply. Common signs and symptoms of cardiac ischemia include chest pain or discomfort, shortness of breath (dyspnea), and anxiety or restlessness. Headache is not a common symptom of cardiac ischemia.

Question 31

While palpating the radial pulse of a 56-year-old man with chest pain, you note that the pulse rate is 86 beats/min and irregular. This indicates:
A. pain.
B. fear.
C. anxiety.
D. dysrhythmia.

Answer 31

D. dysrhythmia.

Question 32

A 56-year-old man has an acute myocardial infarction. Which of the following blood vessels became blocked and led to his condition?
A. Coronary veins
B. Coronary arteries
C. Pulmonary veins
D. Pulmonary arteries

Answer 32

B. Coronary arteries

Question 33

Major controllable risk factors for an AMI include:
A. older age.
B. family history.
C. cigarette smoking.
D. male sex.

Answer 33

C. cigarette smoking.

Question 34

A patient with cardiac arrest secondary to ventricular fibrillation has the greatest chance for survival if:
A. CPR is initiated within 10 minutes.
B. oxygen and rapid transport are provided.
C. defibrillation is provided within 2 minutes.
D. paramedics arrive at the scene within 5 minutes.

Answer 34

C. defibrillation is provided within 2 minutes.

Question 35

A 59-year-old woman presents with chest pressure. She is conscious and alert, but her skin is cool, pale, and clammy. Your first step in providing care (treatment) should be:
A. apply the AED.
B. administer oxygen.
C. ask her if she takes nitroglycerin.
D. take a complete set of vital signs.

Answer 35

B. administer oxygen.

Obtaining vital signs and inquiring about the use of nitroglycerin are appropriate; however, you should administer oxygen first. The AED is only applied to patients in cardiac arrest.

Question 36

If a patient with an implanted pacemaker is in cardiac arrest, the EMT should:
A. avoid defibrillation with the AED and transport at once.
B. not apply the AED until he or she contacts medical control.
C. place the AED pads away from the pacemaker.
D. apply the AED pads directly over the implanted pacemaker.

Answer 36

C. place the AED pads away from the pacemaker.

Question 37

After administering a nitroglycerin tablet to a patient, the EMT should:
A. check the expiration date of the nitroglycerin.
B. reassess the patient’s blood pressure within 5 minutes.
C. instruct the patient to chew the tablet until it is dissolved.
D. ensure that the nitroglycerin is prescribed to the patient.

Answer 37

B. reassess the patient’s blood pressure within 5 minutes.

Question 38

Nitroglycerin is contraindicated in patients:
A. with a systolic blood pressure less than 100 mm Hg.
B. with chest pain of greater than 30 minutes duration.
C. who are currently taking antibiotics for an infection.
D. who are younger than 40 years of age and have diabetes.

Answer 38

A. with a systolic blood pressure less than 100 mm Hg.

Nitroglycerin is a vasodilator and may cause a drop in BP; therefore, it is contraindicated in patients with a systolic BP of less than 100 mm Hg and in patients who have taken erectile dysfunction (ED) drugs within the past 24 to 48 hours. ED drugs are also vasodilators; if given in combination with nitroglycerin, severe hypotension may occur.

Question 39

Which of the following statements regarding the AED and defibrillation is correct?
Select one:
A. CPR should be performed for 5 minutes before using the AED.
B. The AED will not analyze the rhythm of a moving patient.
C. Defibrillation is the first link in the AHA chain of survival.
D. The AED will shock any rhythm not accompanied by a pulse.

Answer 39

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

Question 40

Ventricular tachycardia causes hypotension because:
Select one:
A. the left ventricle does not adequately fill with blood.
B. blood backs up into the lungs and causes congestion.
C. the volume of blood returning to the atria increases.
D. the right ventricle does not adequately pump blood.

Answer 40

A. the left ventricle does not adequately fill with blood.

Question 41

The MOST common error associated with the use of the AED is:
Select one:
A. failure of the EMT to ensure the battery is charged.
B. malfunction of the AED’s internal computer processor.
C. inability of the EMT to recognize ventricular fibrillation.
D. inappropriately placed adhesive defibrillation electrodes

Answer 41

A. failure of the EMT to ensure the battery is charged.

Question 42

When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:
Select one:
A. blood returning from the body can fill the atria.
B. the SA node can reset and generate another impulse.
C. blood can pass from the atria to the ventricles.
D. the impulse can spread through the Purkinje fibers.

Answer 42

C. blood can pass from the atria to the ventricles.

Question 43

The right coronary artery supplies blood to the:
Select one:
A. right atrium and posterior wall of the right ventricle.
B. left ventricle and inferior wall of the right atrium.
C. right ventricle and inferior wall of the left ventricle.
D. left ventricle and posterior wall of the right ventricle.

Answer 43

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

Question 44

When the myocardium requires more oxygen:
Select one:
A. the arteries supplying the heart dilate.
B. the heart rate decreases significantly.
C. the heart contracts with less force.
D. the AV node conducts fewer impulses.

Answer 44

A. the arteries supplying the heart dilate.