Chapter 17 Cardiovascular Emergencies Flashcards by Madame Rotch

The numerous connections among the arterioles of the various coronary arteries, which allow for the development of alternate routes of blood flow if a larger coronary artery begins to narrow, are called: A) cardiac myocytes. B) the coronary sinus. C) collateral circulation. D) coronary microcirculation.

Ans: C Page: 911 Type: General Knowledge

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The Levine sign is defined as: A) pushing on the sternum with the fingertips. B) rubbing the arm to which pain is radiating. C) a subconsciously clenched fist over the chest. D) a state of denial in patients with an acute myocardial infarction.

Ans: C Page: 1014 Type: General Knowledge

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Common signs of left-sided heart failure include all of the following, EXCEPT: A) confusion. B) tachycardia. C) hypotension. D) hypertension.

Ans: C Page: 1019 Type: General Knowledge

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A regular rhythm with inverted P waves before each QRS complex, a ventricular rate of 70 beats/min, narrow QRS complexes, and a PR interval of 0.16 seconds should be interpreted as a(n): A) ectopic atrial rhythm. B) junctional escape rhythm. C) supraventricular tachycardia. D) accelerated junctional rhythm.

Ans: D Page: 955 Type: General Knowledge

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Damage to the cardiac electrical conduction system caused by an acute myocardial infarction MOST commonly results in: A) severe tachycardia. B) ventricular dysrhythmias. C) acute bundle branch block. D) bradycardia or heart block.

Ans: D Page: 936-937 Type: General Knowledge

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Which of the following ECG abnormalities is MOST consistent with hyperkalemia? A) Tall, peaked T waves B) Prominent U waves C) Prolonged QT interval D) The presence of a J wave

Ans: A Page: 985 Type: General Knowledge

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Unlike the parasympathetic nervous system, the sympathetic nervous system: A) is not under the direct control of the autonomic nervous system. B) provides a mechanism for the body to adapt to changing demands. C) is blocked when drugs such as atropine are administered. D) constricts the pupils and increases gastrointestinal function when stimulated.

Ans: B Page: 922-923 Type: General Knowledge

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Hypertension is present when the blood pressure: A) increases by 20 mm Hg above a person’s normal blood pressure. B) is consistently greater than 140/90 mm Hg while at rest. C) is above 160 mm Hg systolic during strenuous exertion. D) rises acutely during an emotionally stressful situation.

Ans: B Page: 1024 Type: General Knowledge

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If the ECG leads are applied correctly, the PQRST configuration should be inverted in lead: A) I. B) II. C) aVR. D) aVL.

Ans: C Page: 968-969 Type: General Knowledge

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What is the MOST appropriate sequence of treatment for a patient with a suspected acute myocardial infarction? A) Oxygen, aspirin, nitroglycerin, morphine B) Oxygen, nitroglycerin, aspirin, morphine C) Aspirin, nitroglycerin, oxygen, morphine D) Morphine, oxygen, aspirin, nitroglycerin

Ans: A Page: 1015 Type: General Knowledge

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A 17-year-old man complains of palpitations and lightheadedness that began suddenly about 20 minutes ago. His blood pressure is 118/74 mm Hg, heart rate is rapid and regular, and respirations are 18 breaths/min. The cardiac monitor reveals a narrow QRS complex tachycardia at 180 beats/min. As you are applying supplemental oxygen, the cardiac rhythm spontaneously converts to a sinus rhythm. Closer evaluation of his rhythm reveals a rapid upslope to the R wave immediately after the end of the P wave. Which of the following statements regarding this scenario is correct? A) This patient likely has Wolff-Parkinson-White syndrome. B) The patient’s ECG abnormality is called an Osborn wave. C) The ECG abnormality is caused by failure of the AV node. D) In this patient, there is a delay in ventricular depolarization.

Ans: A Page: 974 Type: Critical Thinking

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A patient experiencing an acute coronary syndrome should receive morphine sulfate in an initial dose of: A) 0.5 mg/kg. B) 1 to 2 mg. C) 2 to 4 mg. D) 5 to 10 mg.

Ans: C Page: 1016 Type: General Knowledge

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Infarctions of the inferior myocardial wall are MOST often caused by: A) blockage of the left coronary artery. B) acute spasm of the circumflex artery. C) occlusion of the right coronary artery. D) a blocked left anterior descending artery.

Ans: C Page: 1013 Type: General Knowledge

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A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient? A) Aspirin B) Adenosine C) IV access D) 12-Lead ECG

Ans: B Page: 1001, 1005, 1015 Type: Critical Thinking

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Disruption of blood flow through the innominate artery due to dissection is likely to produce: A) pulse or blood pressure deficits. B) a rapid, irregular pulse. C) collapsed jugular veins. D) a widened pulse pressure.

Ans: A Page: 1023 Type: General Knowledge

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A beta adrenergic blocker would counteract all of the following medications, EXCEPT: A) atropine. B) epinephrine. C) isoproterenol. D) norepinephrine.

Ans: A Page: 926-927 Type: General Knowledge

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The preferred antiarrhythmic medication and initial dose for a patient with refractory ventricular fibrillation or pulseless ventricular tachycardia is: A) lidocaine, 1.5 mg/kg. B) amiodarone, 300 mg. C) lidocaine, 0.75 mg/kg. D) procainamide, 20 mg/min.

Ans: B Page: 1007-1008 Type: General Knowledge

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A regular cardiac rhythm with a rate of 104 beats/min, upright P waves, a PR interval of 0.14 seconds, and QRS complexes that measure 0.10 seconds should be interpreted as: A) supraventricular tachycardia. B) normal sinus rhythm. C) sinus tachycardia. D) junctional tachycardia.

Ans: C Page: 948 Type: General Knowledge

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A patient with an elevated cholesterol level would MOST likely take: A) Inderal. B) Altacor. C) Isordil. D) Diovan.

Ans: B Page: 933 Type: General Knowledge

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On the ECG graph paper, amplitude is measured in _____________ and width is measure in ____________. A) centimeters, seconds B) milliseconds, millimeters C) seconds, centimeters D) millimeters, milliseconds

Ans: D Page: 944 Type: General Knowledge

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In contrast to coarse ventricular fibrillation, fine ventricular fibrillation indicates that: A) energy reserves of the cardiac cells have been expended. B) the arrhythmia is more likely to respond to defibrillation. C) a perfusing rhythm is not possible following defibrillation. D) the cardiac cells temporarily have adequate energy stores.

Ans: A Page: 962 Type: General Knowledge

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The MOST common cause of right-sided heart failure is: A) left-sided heart failure. B) pulmonary hypotension. C) acute pulmonary embolism. D) long-standing emphysema.

Ans: A Page: 1020 Type: General Knowledge

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It is MOST important to evaluate a cardiac arrhythmia in the context of the: A) patient’s heart rate. B) patient’s medical history. C) patient’s overall condition. D) width of the QRS complex.

Ans: C Page: 936 Type: General Knowledge

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When performing CPR on an adult patient in cardiac arrest, it is important to: A) deliver at least 80 to 90 compressions per minute. B) limit interruptions in chest compressions to 20 seconds. C) deliver forceful ventilations between compressions. D) allow the chest to fully recoil between compressions.

Ans: D Page: 1004 Type: General Knowledge

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254. Which of the following actions should NOT occur while CPR is in progress? A) Advanced airway placement B) Cardiac rhythm assessment C) Assessment for a palpable pulse D) Establishment of vascular access

Ans: B Page: 995, 1008 Type: General Knowledge

214. A demand pacemaker: A) generates pacing impulses only when it senses that the heart's natural pacemaker has fallen below a preset rate. B) sends out single electrical impulses when the patient's inherent pacemaker rate exceeds 150 beats/min. C) is easily identified on a cardiac rhythm strip by noting the presence of pacer spikes before all of the QRS complexes. D) attaches to the atria and the ventricles and only generates an impulse if it senses that the patient is in ventricular fibrillation.

Ans: A Page: 964 Type: General Knowledge

99. Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction? A) 49-year-old obese man B) 58-year-old diabetic woman C) 60-year-old man with anxiety D) 71-year-old woman with hypertension

Ans: B Page: 1014 Type: General Knowledge

246. After delivering a shock to a patient in pulseless ventricular tachycardia, you should: A) resume CPR. B) check for a pulse. C) reassess the cardiac rhythm. D) deliver two effective ventilations.

Ans: A Page: 1007 Type: General Knowledge

83. Which of the following conditions would MOST likely cause the blood pressure to vary between the left arm and right arm? A) Cor pulmonale B) Aortic aneurysm C) Left heart failure D) Cardiac tamponade

Ans: B Page: 935 Type: General Knowledge

5. The left main coronary artery subdivides into the: A) left anterior ascending and descending arteries. B) left anterior descending and circumflex arteries. C) left posterior ascending and circumflex arteries. D) right coronary and left posterior descending arteries.

Ans: B Page: 911 Type: General Knowledge

63. Epinephrine is used to treat patients in anaphylactic shock because of its effects of: A) vasodilation and bronchoconstriction. B) bronchodilation and vasoconstriction. C) increased heart rate and automaticity. D) parasympathetic nervous system blockade.

Ans: B Page: 926 Type: General Knowledge

112. The MOST immediate forms of reperfusion therapy for an injured myocardium are: A) high-dose aspirin and high-flow supplemental oxygen. B) fibrinolytics and percutaneous coronary intervention. C) angioplasty and coronary artery bypass grafting. D) supplemental oxygen and an infusion of nitroglycerin.

Ans: B Page: 1017 Type: General Knowledge

91. Most patients with an ST-elevation myocardial infarction: A) will develop Q waves. B) heal without treatment. C) experience cardiac arrest. D) present without chest pain.

Ans: A Page: 1013 Type: General Knowledge

158. The downslope of the T wave: A) is the point of ventricular repolarization to which a defibrillator is synchronized to deliver electrical energy. B) is the strongest part of ventricular depolarization and is often the origin of dangerous ventricular arrhythmias. C) represents a state of absolute ventricular refractoriness in which another impulse cannot cause depolarization. D) represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.

Ans: D Page: 943 Type: General Knowledge

173. The treatment for sinus tachycardia should focus on: A) decreasing the heart rate. B) correcting the underlying cause. C) administering IV fluid boluses. D) relieving pain and anxiety.

Ans: B Page: 949 Type: General Knowledge

192. Which of the following statements regarding treatment for a first-degree heart block is correct? 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.

Ans: A Page: 957 Type: General Knowledge

130. Disruption of blood flow into the left common carotid artery would MOST likely produce signs and symptoms of a(n): A) ischemic stroke. B) pericardial tamponade. C) hemorrhagic stroke. D) myocardial infarction.

Ans: A Page: 1023 Type: General Knowledge

101. Death in the prehospital setting following an acute myocardial infarction is MOST often the result of: A) asystole. B) myocardial rupture. C) cardiogenic shock. D) ventricular fibrillation.

Ans: D Page: 1015 Type: General Knowledge

65. Which of the following drugs is contraindicated in patients with asthma? A) Albuterol B) Adrenaline C) Norepinephrine D) Propranolol

Ans: D Page: 927 Type: General Knowledge

151. If a particular interval on the ECG graph paper is 1.5 small boxes in width, the interval would be measured as: A) 0.06 seconds. B) 2 millimeters. C) 45 milliseconds. D) 600 milliseconds.

Ans: A Page: 941-942, 944 Type: General Knowledge

168. Normal sinus rhythm is characterized by all of the following, EXCEPT: A) minimal variation between the R-R intervals. B) QRS complexes that are less than 140 milliseconds. C) consistent PR intervals and upright P waves. D) a consistent heart rate between 60 and 100 beats/min.

Ans: B Page: 947 Type: General Knowledge

39. During the refractory period: A) the heart is in a state of partial repolarization. B) the heart is partially charged, but cannot contract. C) the cell is depolarized or in the process of repolarizing. D) the heart muscle is depleted of energy and needs to recharge.

Ans: C Page: 920 Type: General Knowledge

129. In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm: A) often waxes and wanes. B) gradually becomes severe. C) is maximal from the onset. D) is preceded by other symptoms.

Ans: C Page: 1023 Type: General Knowledge

120. What physiologic effect occurs within the first 5 to 10 minutes after administering furosemide (Lasix)? A) Increased preload B) Peripheral venous pooling C) Excretion of water by the kidneys D) Increase in cardiac afterload

Ans: B Page: 1020 Type: General Knowledge

223. When viewing leads V3 and V4, you are looking at the _________ wall of the \_\_\_\_\_\_\_\_\_. A) septal, heart. B) lateral, left ventricle. C) anterior, left ventricle. D) inferior, right ventricle.

Ans: C Page: 970 Type: General Knowledge

215. A “runaway” pacemaker is characterized by: A) an absence of pacemaker spikes. B) profound slowing of the heart rate. C) a tachycardic pacemaker rhythm. D) a narrowing of the QRS complexes.

Ans: C Page: 964 Type: General Knowledge

235. A right ventricular infarction is characterized by: A) ST-segment elevation greater than 1 mm in lead V5R and ST-segment depression in leads II, III, and aVF. B) ST-segment elevation greater than 1 mm in lead V4R and ST-segment elevation in leads II, III, and aVF. C) ST-segment depression greater than 2 mm in lead V4R and ST-segment elevation in leads II, III, and aVF. D) ST-segment elevation greater than 2 mm in lead V5R and ST-segment elevation in leads II, III, and aVF.

Ans: B Page: 978 Type: General Knowledge

164. If the R-R interval spans ___ large boxes or less, the heart rate is greater than 100/min. A) 3 B) 4 C) 5 D) 6

Ans: A Page: 946 Type: General Knowledge

40. The SA node: A) cannot depolarize faster than 100 times/min. B) will outpace any slower conduction tissue. C) functions as the heart's secondary pacemaker. D) has an intrinsic firing rate of 40 to 60 times per minute.

Ans: B Page: 920 Type: General Knowledge

203. Untreated ventricular tachycardia would MOST likely deteriorate to: A) asystole. B) torsade de pointes. C) ventricular fibrillation. D) pulseless electrical activity.

Ans: C Page: 960 Type: General Knowledge

257. Treatment for a patient with bradycardia and significantly compromised cardiac output includes: A) 1 mg of epinephrine 1:10,000. B) 1 mg of atropine via IV push. C) transcutaneous cardiac pacing. D) a dopamine infusion at 20 mg/min.

Ans: C Page: 1001 Type: General Knowledge

64. The MOST effective drug for the treatment of non-vagal-induced bradycardia is: A) atropine. B) dopamine. C) epinephrine. D) metoprolol.

Ans: C Page: 926 Type: General Knowledge

258. Electrical capture during transcutaneous cardiac pacing is characterized by: A) the presence of a strong pulse, despite a slow rate. B) a pacemaker spike followed by a wide QRS complex. C) narrow QRS complexes that are preceded by a pacemaker spike. D) low-amplitude QRS complexes preceded by a pacemaker spike.

Ans: B Page: 999, 1001 Type: General Knowledge

70. Paroxysmal nocturnal dyspnea is defined as: A) dyspnea that is brought on by excessive movement during sleep. B) sitting upright in a chair in order to facilitate effective breathing. C) the inability to function at night due to severe difficulty breathing. D) acute shortness of breath that suddenly awakens a person from sleep

Ans: D Page: 929 Type: General Knowledge

11. The S1 heart sound represents: A) closure of the mitral and tricuspid valves. B) the end of ventricular contraction. C) closure of the aortic and pulmonic valves. D) the beginning of atrial contraction.

Ans: A Page: 934 Type: General Knowledge

275. Following 2 minutes of CPR, you reassess an unresponsive man's pulse and cardiac rhythm. He remains pulseless and the monitor displays coarse ventricular fibrillation. You should: A) continue CPR and intubate his trachea. B) resume CPR as the defibrillator is charging. C) perform 2 minutes of CPR and then reassess. D) continue CPR and establish IV or IO access.

Ans: B Page: 1008 Type: Critical Thinking

189. If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles: A) the PR intervals will be greater than 0.20 seconds. B) an upright P wave will appear after the QRS complex. C) an inverted P wave will appear before the QRS complex. D) a small inverted P wave will be buried in the QRS complex.

Ans: C Page: 954 Type: General Knowledge

251. Which of the following pulseless rhythms is NOT treated as pulseless electrical activity? A) Sinus bradycardia B) Idioventricular rhythm C) Ventricular tachycardia D) Junctional escape rhythm

Ans: C Page: 1009 Type: General Knowledge

66. An increase in peripheral vascular resistance causes: A) an increase in afterload. B) a decrease in blood pressure. C) an increase in cardiac output. D) a decrease in cardiac workload.

Ans: A Page: 927 Type: General Knowledge

290. 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: A) hypocalcemic. B) hypernatremic. C) hyperkalemic. D) having an acute myocardial infarction.

Ans: C Page: 969, 985 Type: Critical Thinking

36. In order to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump: A) moves three sodium ions and three potassium ions back into the cell. B) moves two sodium ions into the cell for every three potassium ions it moves out of the cell. C) moves calcium and potassium ions back into the cell by a process called passive transport. D) moves two potassium ions into the cell for every three sodium ions it moves out of the cell.

Ans: D Page: 919-920 Type: General Knowledge

78. Which of the following medications has a direct blood-thinning effect? A) Plavix B) Aspirin C) Accupril D) Warfarin

Ans: D Page: 932-933 Type: General Knowledge

286. A 68-year-old woman presents with an acute onset of confusion, shortness of breath, and diaphoresis. Her blood pressure is 72/50 mm Hg, her heart rate is slow and weak, and her respirations are increased and shallow. The ECG reveals a third-degree heart block at a rate of 38 beats/min. After placing the patient on high-flow oxygen, you should: A) start an IV and administer 0.5 mg atropine. B) obtain a 12-lead ECG to detect an acute myocardial infarction. C) obtain vascular access and give a fluid bolus. D) immediately attempt transcutaneous pacing.

Ans: D Page: 1001 Type: Critical Thinking

75. Which of the following medications is a calcium channel blocker? A) Lanoxin B) Cardizem C) Tenormin D) Capoten

Ans: B Page: 931 Type: General Knowledge

268. A 70-year-old man called 9-1-1 because of generalized weakness. When you arrive at the scene, you find the patient seated in his recliner. He is conscious and alert and is breathing without difficulty. Your physical exam reveals tenderness to his right upper abdominal quadrant, edema to his ankles, and distended jugular veins. The patient tells you that he takes Vasotec for hypertension and Maxide for his swollen ankles. His vital signs are stable. The MOST appropriate treatment for this patient includes: A) an IV of D5W, 0.4 mg of sublingual nitroglycerin, ECG, and transport. B) high-flow oxygen, vascular access, 1 mg/kg of furosemide, and transport. C) oxygen, cardiac monitoring, an IV line at a keep-open rate, and transport. D) 12-lead ECG acquisition, vascular access, 4 mg of morphine, and transport.

Ans: C Page: 1020-1021 Type: Critical Thinking

193. Which of the following statements regarding second-degree heart block is correct? 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.

Ans: B Page: 957 Type: General Knowledge

43. The P wave represents: A) SA nodal discharge. B) atrial depolarization. C) a delay at the AV node. D) contraction of the atria.

Ans: B Page: 920 Type: General Knowledge

81. All of the following medications are angiotensin II receptor blockers, EXCEPT: A) Niaspan. B) Diovan. C) Avapro. D) Atacand.

Ans: A Page: 933 Type: General Knowledge

272. 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: 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.

Ans: D Page: 978-979, 982 Type: Critical Thinking

47. Normally, the ST segment should be: A) at the level of the isoelectric line. B) elevated by no more than 1 mm. C) depressed by no more than 2 mm. D) invisible on a normal ECG tracing.

Ans: A Page: 921 Type: General Knowledge

182. Which of the following is NOT characteristic of multifocal atrial tachycardia? A) Nonvisible P waves with a rapid ventricular rate B) QRS complexes less than 0.12 seconds in duration C) Variable PR intervals and P waves of differing size D) Regular R-R intervals with a rate less than 150 beats/min

Ans: D Page: 953 Type: General Knowledge

124. Cardiogenic shock occurs when: A) blood backs up into the pulmonary circulation. B) more than 40% of the left ventricle has infarcted. C) left ventricular ejection fraction is less than 50%. D) any condition causes an increase in atrial preload.

Ans: B Page: 1021 Type: General Knowledge

277. 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: 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.

Ans: A Page: 1004, 1008 Type: Critical Thinking

294. 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: 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

Ans: B Page: 997 Type: Critical Thinking

244. The MOST important initial pieces of equipment to bring to the side of an unresponsive patient are the: A) drug kit and stretcher with a long backboard. B) defibrillator and airway management equipment. C) intubation kit and equipment for vascular access. D) pocket face mask and equipment for intubation.

Ans: B Page: 1006 Type: General Knowledge

32. The effect on the velocity of electrical conduction is referred to as the _________ effect. A) inotropic B) dromotropic C) chronotropic D) conductivity

Ans: B Page: 919 Type: General Knowledge

138. A hypertensive emergency is MOST accurately defined as: A) an increase in the blood pressure due to medication noncompliance. B) an elevated blood pressure that is accompanied by a frontal headache. C) a blood pressure greater than 170/90 mm Hg with a severe nosebleed. D) an acute elevation in blood pressure with signs of end-organ damage

Ans: D Page: 1025 Type: General Knowledge

281. A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well-coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next? A) Rapidly infuse 2 liters of normal saline solution B) Administer 300 mg of amiodarone via rapid IV push C) Give 40 units of vasopressin followed by defibrillation D) Give amiodarone followed by 1.5 mg/kg of lidocaine

Ans: B Page: 1007-1009 Type: Critical Thinking

1. All of the following are strategies for decreasing the risk for cardiovascular disease, EXCEPT: A) smoking cessation. B) lipid management. C) anaerobic exercise. D) behavior modification.

Ans: C Page: 910 Type: General Knowledge

137. The MOST common symptom directly related to blood pressure elevation is: A) epistaxis. B) headache. C) dizziness. D) blurred vision.

Ans: B Page: 1024 Type: General Knowledge

163. The 6-second method for calculating the rate of a cardiac rhythm: A) involves counting the number of QRS complexes in a 6-second strip and multiplying that number by 10. B) is an accurate method for calculating the heart rate if the cardiac rhythm is grossly irregular and very fast. C) will yield an estimated heart rate that is typically within 2 to 3 beats per minute of the actual heart rate. D) takes longer than other methods of calculating the rate and is thus impractical to use with critical patients.

Ans: A Page: 945-946 Type: General Knowledge

84. Jugular venous distention in a patient sitting at a 45° angle: A) is not clinically significant. B) is a sign of reduced preload. C) suggests left-sided heart failure. D) indicates right-sided heart compromise.

Ans: D Page: 933 Type: General Knowledge

4. The layers of the wall of the heart, beginning with the outermost layer, are the: A) epicardium, myocardium, and endocardium. B) endocardium, epicardium, and myocardium. C) myocardium, epicardium, and endocardium. D) epicardium, endocardium, and myocardium.

Ans: A Page: 911 Type: General Knowledge

143. A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by: A) myocardial stretching due to increased preload. B) decreases in stroke volume and ventricular filling. C) increased automaticity of the cardiac pacemaker. D) ectopic pacemaker sites in the atria or ventricles.

Ans: B Page: 952 Type: General Knowledge

280. You have applied the cardiac monitor to your 66-year-old male cardiac arrest patient and see what appears to be asystole. You should: 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.

Ans: D Page: 1009 Type: Critical Thinking

111. Which of the following interventions should be performed en route to the hospital during a lengthy transport of a patient with a suspected myocardial infarction? A) Supplemental oxygen B) Aspirin administration C) IV therapy and analgesia D) 12-lead electrocardiography

Ans: C Page: 1016-1017 Type: General Knowledge

42. If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse: A) the AV junction will begin pacing at 40 to 60 times/min. B) you will see a brief period of bradycardia followed by asystole. C) the P wave and PR interval will have an abnormal appearance. D) you should expect to see a heart rate slower than 40 beats/min.

Ans: D Page: 920 Type: General Knowledge

153. A prolonged PR interval: A) is greater than 120 milliseconds. B) indicates that the AV node was bypassed. C) indicates an abnormal delay at the AV node. D) is a sign of rapid atrial depolarization.

Ans: C Page: 942 Type: General Knowledge

21. Cardiac output is influenced by: A) heart rate. B) stroke volume. C) heart rate and/or stroke volume. D) ejection fraction and heart rate.

Ans: C Page: 917 Type: General Knowledge

233. Ischemia to the anterior wall of the myocardium would present with: A) T-wave inversion in leads V3 and V4. B) ST-segment depression in leads I and aVL. C) T-wave inversion in leads II, III, and aVF. D) ST-segment elevation in leads V3 and V4.

Ans: A Page: 978-979 Type: General Knowledge

92. Stable angina: A) typically subsides within 10 to 15 minutes. B) occurs after a predictable amount of exertion. C) usually requires both rest and nitroglycerin to subside. D) is characterized by sharp chest pain rather than pressure.

Ans: B Page: 1012 Type: General Knowledge

35. Repolarization begins when: A) the sodium and calcium channels close. B) calcium ions slowly enter the cardiac cell. C) potassium ions rapidly escape from the cell. D) the inside of the cell returns to a positive charge.

Ans: A Page: 919 Type: General Knowledge

260. When assessing an anxious patient who presents with tachycardia, you must: A) obtain a 12-lead ECG tracing before initiating any treatment. B) determine if the tachycardia is causing hemodynamic instability. C) prepare for cardioversion if the rate is less than 150 beats/min. D) administer diazepam or midazolam to facilitate your assessment.

Ans: B Page: 1001 Type: General Knowledge

150. On the ECG graph paper, 6 seconds is represented by how many large boxes? A) 20 B) 30 C) 40 D) 50

Ans: B Page: 941-942, 944 Type: General Knowledge

29. Which of the following statements regarding the SA node is correct? 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.

Ans: A Page: 918 Type: General Knowledge

6. The right atrium, right ventricle, and part of the left ventricle are supplied by the: A) circumflex artery. B) left anterior descending artery. C) left main coronary artery. D) right coronary artery.

Ans: D Page: 911 Type: General Knowledge

237. On the 12-lead ECG, extreme right axis deviation is characterized by: A) a positive QRS in lead I and a negative QRS in lead aVF. B) a negative QRS in lead I and a negative QRS in lead aVF. C) a negative QRS in lead I and a positive QRS in lead aVF. D) a positive QRS in lead I and a positive QRS in lead aVF.

Ans: B Page: 971 Type: General Knowledge

69. Cardiac-related chest pain is often palliated by: A) stress. B) exertion. C) nitroglycerin. D) mild exercise.

Ans: C Page: 928 Type: General Knowledge

44. The brief pause between the P wave and QRS complex represents: A) depolarization of the inferior part of the atria. B) the period of time when the atria are repolarizing. C) full dispersal of electricity throughout both atria. D) a momentary conduction delay at the AV junction.

Ans: D Page: 920-921 Type: General Knowledge

256. If a patient remains comatose following return of spontaneous circulation, you should: A) provide mild hyperventilation. B) begin hypothermia treatment. C) immediately obtain a 12-lead. D) begin an infusion of dopamine.

Ans: A Page: 1010 Type: General Knowledge

184. A classic sign of atrial flutter is: A) a constant 2:1 conduction ratio. B) the presence of sawtooth F waves. C) a ventricular rate less than 100 beats/min. D) an irregular but consistent R-R interval.

Ans: B Page: 951 Type: General Knowledge

201. Monomorphic ventricular tachycardia: A) is characterized by QRS complexes that vary in size. B) presents with wide QRS complexes of a common shape. C) is treated as ventricular fibrillation if a pulse is present. D) is often irregular with occasional nonconducted P waves.

Ans: B Page: 960 Type: General Knowledge

68. Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT: A) fatigue. B) headache. C) chest pain. D) palpitations.

Ans: B Page: 928 Type: General Knowledge

242. The proper compression-to-ventilation ratio for two-rescuer adult CPR when an oropharyngeal airway is in place is: A) 5:1. B) 15:2. C) 30:2. D) asynchronous.

Ans: C Page: 1004 Type: General Knowledge

126. A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from: A) supplemental oxygen. B) a high-dose vasopressor infusion. C) a 250-mL bolus of a crystalloid solution. D) rapid transport to an appropriate hospital.

Ans: D Page: 1022 Type: General Knowledge

239. Fibrinolysis may be contraindicated in all of the following, EXCEPT: A) major trauma or surgery within the past 4 weeks. B) a history of structural central nervous system disease. C) a history of anaphylactic shock caused by salicylates. D) significant closed head trauma within the past 3 weeks.

Ans: C Page: 991 Type: General Knowledge

238. When applying the precordial leads, lead V1 should be placed in the: A) fourth intercostal space at the right sternal border. B) fourth intercostal space at the left sternal border. C) fifth intercostal space at the left midclavicular line. D) fourth intercostal space at the left midclavicular border.

Ans: A Page: 967-968 Type: General Knowledge

225. Leads V1 to V3 allow you to view the ________ wall of the left ventricle. A) septal B) lateral C) anterior D) anteroseptal

Ans: D Page: 970 Type: General Knowledge

113. The MOST significant risk associated with the use of fibrinolytic therapy is: A) reocclusion. B) coagulation. C) anaphylaxis. D) hemorrhage.

Ans: D Page: 1017 Type: General Knowledge

104. Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct? A) Evidence has shown that high (greater than 90%) concentrations of oxygen reduce mortality. B) In order to prevent hypoxic injury, do not give any patient with an acute myocardial infarction more than 2 L/min of oxygen. C) Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%. D) Any patient experiencing an acute myocardial infarction should receive high-flow oxygen.

Ans: C Page: 1015 Type: General Knowledge

34. Depolarization, the process by which muscle fibers are stimulated to contract, occurs when: A) cell wall permeability changes and sodium rushes into the cell. B) calcium ions rapidly enter the cell, facilitating contraction. C) potassium ions escape from the cell through specialized channels. D) cardiac muscle relaxes in response to a cellular influx of calcium.

Ans: A Page: 919 Type: General Knowledge

229. Anatomically contiguous leads view: A) opposite walls of the heart. B) only the lateral wall of the heart. C) the same general area of the heart. D) only the anterior wall of the heart

Ans: C Page: 978 Type: General Knowledge

187. Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take? A) Plavix and Vasotec B) Lisinopril and aspirin C) Digitalis and Coumadin D) Cordarone and furosemide

Ans: C Page: 952 Type: General Knowledge

271. 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: 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.

Ans: A Page: 1024-1025 Type: Critical Thinking

283. 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: 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.

Ans: A Page: 1006 Type: Critical Thinking

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

Ans: A Page: 914 Type: General Knowledge

57. Drugs that have alpha or beta sympathetic properties are called: A) vagolytics. B) sympathomimetics. C) parasympatholytics. D) adrenergic blockers.

Ans: B Page: 924 Type: General Knowledge

86. Which of the following clinical findings is LEAST suggestive of left-sided heart failure? A) An S3 gallop B) Sacral edema C) Crackles in the lungs D) Shortness of breath

Ans: B Page: 933-934 Type: General Knowledge

167. The MOST common cause of cardiac arrest in adult patients is: A) acute myocardial infarction. B) electrocution. C) a dysrhythmia. D) respiratory failure.

Ans: C Page: 947 Type: General Knowledge

114. Fibrinolytic medications are beneficial to certain patients with an acute myocardial infarction because they: A) decrease circulating platelets and thin the blood. B) convert plasminogen to plasmin and destroy a clot. C) destroy a clot by releasing fibrin into the bloodstream. D) break down the plasmin concentration inside a blood clot.

Ans: B Page: 1017 Type: General Knowledge

222. The precordial leads do NOT view the __________ wall of the heart. A) septal B) inferior C) anterior D) lateral

Ans: B Page: 970 Type: General Knowledge

22. If an increased amount of blood is returned to the heart: A) the cardiac muscle must stretch to accommodate the larger volume. B) stroke volume decreases accordingly because of the larger volume. C) an increase in stroke volume occurs because the heart rate increases. D) cardiac workload is decreased, resulting in a decreased cardiac output.

Ans: A Page: 917 Type: General Knowledge

232. Injury to the inferior wall of the myocardium would present with: A) T-wave inversion in leads V1 through V4. B) ST-segment elevation in leads II, III, and aVF. C) pathologic Q waves in leads V4 and V5. D) ST-segment depression in leads V5, V6, and aVL.

Ans: B Page: 978-979 Type: General Knowledge

147. When applying the limb leads, the negative lead should be placed on the: A) left arm. B) left leg. C) right arm. D) right leg.

Ans: C Page: 938 Type: General Knowledge

295. 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: A) CHF, hypertension, and atrial fibrillation. B) COPD, diabetes, and tachydysrhythmias. C) ventricular dysrhythmias and hypertension. D) hypothyroidism, renal failure, and atrial flutter.

Ans: A Page: 1018-1019 Type: Critical Thinking

37. Hypomagnesemia would MOST likely result in: A) decreased cardiac conduction. B) decreased myocardial irritability. C) a decrease in cardiac contractility. D) decreased myocardial automaticity.

Ans: A Page: 920 Type: General Knowledge

118. In contrast to a patient with asthma, a patient with left-sided heart failure: A) presents with a dry, nonproductive cough and diffuse wheezing in all lung fields. B) experiences acute weight gain and takes medications such as digoxin and a diuretic. C) presents with a hyperinflated chest, use of accessory muscles, and expiratory wheezing. D) is typically a younger patient with a history of a recent upper respiratory infection.

Ans: B Page: 1019 Type: General Knowledge

195. A key to interpreting a Mobitz type II second-degree heart block is to remember that: A) unlike a Mobitz type I second-degree heart block, a type II heart block is always regular. B) in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted. C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant. D) most type II second degree AV blocks have more than two nonconducted P waves that occur in succession.

Ans: C Page: 958 Type: General Knowledge

45. Which of the following ECG waveforms represents ventricular depolarization? A) T wave B) ST segment C) QRS complex D) U wave

Ans: C Page: 921 Type: General Knowledge

53. Sympathetic nerves are regulated primarily by: A) adrenaline. B) epinephrine. C) cholinesterase. D) norepinephrine.

Ans: D Page: 922 Type: General Knowledge

221. Lead I views the ________ wall of the heart, while lead aVF views the _________ wall of the heart. A) lateral, inferior B) septal, anterior C) posterior, septal D) anterior, inferior

Ans: A Page: 970 Type: General Knowledge

125. A patient with cardiogenic shock and pulmonary edema should be positioned: A) in the Trendelenburg position. B) in a semi-Fowler's position. C) supine with the legs elevated. D) in a lateral recumbent position.

Ans: B Page: 1022 Type: General Knowledge

161. A prolonged QT interval indicates that the heart: A) has a shorter-than-normal refractory period, increasing the likelihood of severe bradycardia. B) is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias. C) is depolarizing too quickly, which significantly increases the potential for reentry in the AV junction. D) has a shortened refractory period and may be caused by factors such as hypocalcemia or pericarditis.

Ans: B Page: 987 Type: General Knowledge

205. Premature ventricular complexes (PVCs) that originate from different sites in the ventricle: A) are called unifocal PVCs. B) produce a palpable pulse. C) are also called fusion PVCs. D) will appear differently on the ECG.

Ans: D Page: 960 Type: General Knowledge

12. A loud S3 heart sound, when heard in older adults, often signifies: A) emphysema. B) valve rupture. C) heart failure. D) pulmonary hypertension.

Ans: C Page: 934 Type: General Knowledge

85. When examining the chest of a patient who has an automated implanted cardioverter defibrillator, you would MOST likely find it: A) just below the xiphoid process. B) below the left or right clavicle. C) in the lower aspect of the chest. D) just lateral to the lower sternum.

Ans: B Page: 933 Type: General Knowledge

209. Ventricular fibrillation occurs when: A) the ventricles quiver rather than contract normally, while organized atrial contractions continue as normal. B) the ventricles become the primary pacemaker for the heart, resulting in a rapid and irregular ventricular rhythm. C) many different cells in the heart depolarize independently rather than in response to an impulse from the SA node. D) cardiac cells in the ventricles fail to completely repolarize, resulting in a decrease in ventricular automaticity.

Ans: C Page: 962 Type: General Knowledge

285. 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: 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.

Ans: B Page: 1010 Type: Critical Thinking

116. In a patient with left heart failure and pulmonary edema: A) the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood. B) diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart. C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli. D) an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.

Ans: C Page: 1018 Type: General Knowledge

292. A 33-year-old woman presents with an acute onset of “fluttering” in her chest. She is conscious and alert but is somewhat anxious. She denies any significant medical problems but states that she has been under a lot of stress at work. You apply the cardiac monitor, which reveals a narrow QRS complex tachycardia at a rate of 170 beats/min. The patient's blood pressure is 140/90 mm Hg, and she is breathing without difficulty. The MOST appropriate treatment for this patient involves: A) oxygen, vagal maneuvers, and emotional support. B) vagal maneuvers, IV access, and 0.25 mg/kg of diltiazem. C) oxygen, emotional support, and 2.5 mg of midazolam IM. D) oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.

Ans: D Page: 1001-1003, 1005 Type: Critical Thinking

14. Atrial kick is defined as: A) the blood that flows passively into the ventricles. B) pressure on the AV valves during ventricular contraction. C) an attempt of the atria to contract against closed valves. D) increased preload pressure as a result of atrial contraction.

Ans: D Page: 912-913 Type: General Knowledge

135. Which of the following mechanisms causes hypertension? A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity. B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion. C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart. D) Heart rate that is persistently above 80 beats/min causes an increase in cardiac output and a resultant increase in blood pressure.

Ans: C Page: 1024 Type: General Knowledge

77. Spironolactone is a(n): A) beta blocker. B) vasodilator. C) diuretic. D) antiarrhythmic.

Ans: C Page: 932 Type: General Knowledge

159. An ST segment that is more than 1 mm above the isoelectric line: A) indicates myocardial ischemia. B) is clinically insignificant in lead II. C) must be substantiated by a 12-lead ECG. D) is a definitive sign of myocardial injury.

Ans: C Page: 977 Type: General Knowledge

102. Immediate treatment for a patient with an acute myocardial infarction involves: A) elevating the patient's legs 6 to 12 in. B) reducing myocardial oxygen demand. C) giving oxygen via nonrebreathing mask. D) administering up to three doses of nitroglycerin.

Ans: B Page: 1015 Type: General Knowledge

202. Torsade de pointes: A) presents with wide QRS complexes that are all of the same shape, size, and vector direction. B) is a lethal ventricular rhythm that is usually caused by ingestion or injection of CNS-depressant drugs. C) is generally less serious than monomorphic ventricular tachycardia and is usually not treated in the field. D) is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.

Ans: D Page: 960 Type: General Knowledge

227. The circumflex branch of the left coronary artery supplies the _________ wall of the left ventricle. A) septal B) lateral C) anterior D) inferior

Ans: B Page: 970 Type: General Knowledge

30. The AV junction: A) includes the AV node but not the bundle of His. B) is the dominant and fastest pacemaker in the heart C) receives its blood supply from the circumflex artery. D) is composed of the AV node and surrounding tissue.

Ans: D Page: 918 Type: General Knowledge

80. When reviewing a cardiac patient's medication list, you note that she is taking bisoprolol. You recognize that this drug is also called _____________ and is classified as a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_. A) Zebeta, beta blocker B) Betapace, antiarrhythmic C) Ticlid, antiplatelet agent D) Norvasc, calcium channel blocker

Ans: A Page: 931 Type: General Knowledge

136. Hypertensive disease is characterized by: A) persistent elevation of the diastolic pressure. B) a diastolic blood pressure above 90 mm Hg. C) constant fluctuation in the systolic blood pressure. D) a systolic blood pressure greater than 140 mm Hg

Ans: A Page: 1024 Type: General Knowledge

48. Stimulation of the parasympathetic nervous system: A) completely blocks the AV node, preventing ventricular depolarization. B) causes a decrease in the production of epinephrine and norepinephrine. C) is characterized by a large P wave and a PR interval that is shorter than normal. D) slows SA nodal discharge and decreases conduction through the AV node.

Ans: D Page: 921-922 Type: General Knowledge

207. Ventricular bigeminy occurs when: A) two premature ventricular complexes (PVCs) occur in a row. B) every second complex is a PVC. C) at least two differently shaped PVCs occur. D) a 6-second strip contains at least two PVCs.

Ans: B Page: 961-962 Type: General Knowledge

240. A patient is considered a potential candidate for fibrinolytic therapy if he or she has experienced chest discomfort for: A) less than 12 hours. B) more than 5 minutes. C) less than 15 minutes D) more than 24 hours.

Ans: A Page: 991 Type: General Knowledge

274. 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: A) attempt cardiac pacing. B) check the carotid pulse. C) assess breathing effort. D) resume CPR at once.

Ans: D Page: 1008-1009 Type: Critical Thinking

10. The mitral valve: A) is located on the higher-pressure side of the heart. B) separates the right atrium from the right ventricle. C) prevents blood regurgitation into the left ventricle. D) is a tricuspid valve located on the right side of the heart.

Ans: A Page: 911-912 Type: General Knowledge

231. Which of the following statements is correct? A) Lead I is contiguous with lead II. B) Lead II is contiguous with leads V6 and aVL. C) Lead V6 is contiguous with leads V4 and V5. D) Lead III is contiguous with leads II and aVF.

Ans: D Page: 978 Type: General Knowledge

216. Patients with Wolff-Parkinson-White syndrome: A) have a diseased SA node, resulting in ectopic atrial pacemakers and abnormal AV nodal conduction. B) are highly susceptible to a variety of bradycardic rhythms due to an abnormal delay at the AV node. C) have an accessory pathway that bypasses the AV node and causes early ventricular depolarization. D) experience independent atrial depolarization due to failure of the Bachmann bundle between the atria.

Ans: C Page: 974 Type: General Knowledge

176. Which of the following differentiates an atrial rhythm from a sinus rhythm? A) Tachycardia B) Profound bradycardia C) Dissociated P waves D) Varying shapes in P waves

Ans: D Page: 951 Type: General Knowledge

19. The amount of blood that is pumped out by either ventricle per minute is called: A) ejection fraction. B) cardiac output. C) stroke volume. D) minute volume.

Ans: B Page: 915 Type: General Knowledge

166. When analyzing a cardiac rhythm strip in lead II, you should routinely evaluate all of the following components, EXCEPT the: A) QRS width. B) PR interval. C) ST segment. D) R-R interval.

Ans: C Page: 944 Type: General Knowledge

9. Injury to or disease of the ______________ may cause prolapse of a cardiac valve leaflet, allowing blood to regurgitate from the ventricle into the atrium. A) coronary sulcus B) chordae tendineae C) interatrial septum D) coronary sinus

Ans: B Page: 911-912 Type: General Knowledge

177. A wandering atrial pacemaker: A) has consistent P-wave shapes. B) is generally faster than 100 beats/min. C) may have variable PR intervals. D) is generally treated with atropine.

Ans: C Page: 953 Type: General Knowledge

52. A physiologic effect of sympathetic nervous stimulation includes: A) dilation of the bronchioles. B) decreased conduction velocity. C) a negative dromotropic effect. D) dilation of the blood vessels.

Ans: A Page: 922-923 Type: General Knowledge

218. Aberrant conduction is _____________ conduction. A) rapid B) abnormal C) very slow D) irregular

Ans: B Page: 972 Type: General Knowledge

178. An early complex that breaks the regularity of the underlying rhythm and that is characterized by a narrow QRS complex and an upright P wave that differs in shape and size from the P waves of the other complexes MOST accurately describes a(n): A) atrial escape complex. B) wandering atrial pacemaker. C) junctional escape complex. D) premature atrial complex.

Ans: D Page: 952-953 Type: General Knowledge

76. A patient with a medical condition that requires antiplatelet therapy would MOST likely be taking: A) Coreg. B) Altace. C) Zocor. D) Plavix.

Ans: D Page: 932-933 Type: General Knowledge

181. Patients with a heart rate greater than 150 beats/min usually become unstable because of: A) reduced ventricular filling. B) an increase in the atrial kick. C) increased right atrial preload. D) a significantly reduced afterload.

Ans: A Page: 952 Type: General Knowledge

3. The point of maximal impulse usually can be felt on the: A) medial aspect of the chest, just below the third intercostal space. B) left lateral chest, in the midaxillary line, at the fourth intercostal space. C) left anterior chest, in the midaxillary line, at the fifth intercostal space. D) left anterior chest, in the midclavicular line, at the fifth intercostal space.

Ans: D Page: 911 Type: General Knowledge

154. The duration of the QRS complex should be ____ milliseconds or less. A) 100 B) 120 C) 140 D) 150

Ans: B Page: 942 Type: General Knowledge

270. A 55-year-old man complains of severe pain between his shoulder blades, which he describes as “ripping” in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain? A) Disappearance of radial pulses during inspiration B) Difference in blood pressure between the two arms C) ST-segment depression on the 12-lead ECG tracing D) Bruits to both carotid arteries during auscultation

Ans: B Page: 1022-1023 Type: Critical Thinking

183. In contrast to treatment for supraventricular tachycardia, treatment for multifocal atrial tachycardia in the prehospital setting: A) is often more effective. B) involves atropine sulfate. C) is generally not effective. D) includes synchronized cardioversion.

Ans: C Page: 953 Type: General Knowledge

212. Unlike an idioventricular rhythm, an agonal rhythm: A) is associated with a faster rate. B) does not produce a palpable pulse. C) is associated with a lower mortality rate. D) indicates a regular ventricular pacemaker.

Ans: B Page: 963 Type: General Knowledge

122. A bedridden patient with right-sided heart failure would be LEAST likely to present with: A) edema to the feet. B) presacral edema. C) hepatomegaly. D) jugular venous distention.

Ans: A Page: 1020-1021 Type: General Knowledge

284. A 70-year-old woman remains in asystole following 10 minutes of well-coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to: A) attempt transcutaneous cardiac pacing. B) defibrillate one time in case she is in V-Fib. C) seriously consider ceasing resuscitative efforts. D) transport at once with CPR continuing en route.

Ans: C Page: 1010-1011 Type: Critical Thinking

252. Regardless of the patient's presenting cardiac arrest rhythm, the first IV or IO drug that should be given is: A) a vasopressor. B) calcium chloride. C) an inotrope. D) an antidysrhythmic.

Ans: A Page: 1008-1009 Type: General Knowledge

263. 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: 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.

Ans: B Page: 1015-1016 Type: Critical Thinking

128. The process of aortic dissection begins when: A) the intimal layer of the aortic wall is torn. B) hypertension causes acute rupture of the aorta. C) the aorta is weakened due to excessive pressure. D) blood accumulates between the layers of the aorta.

Ans: A Page: 1022 Type: General Knowledge

127. The administration of dopamine or any other vasopressor drug requires: A) online medical control approval. B) careful titration and blood pressure monitoring. C) an electromechanical infusion pump. D) concomitant crystalloid fluid boluses.

Ans: B Page: 1022 Type: General Knowledge

264. 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? A) Aspirin B) Fentanyl C) Morphine D) Nitroglycerin

Ans: D Page: 1015-1016 Type: Critical Thinking

16. In contrast to the right side of the heart, the left side of the heart: A) drives blood out of the heart against the relatively high resistance of the systemic circulation. B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs. C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta. D) drives blood out of the heart against the relatively low resistance of the pulmonary circulation.

Ans: A Page: 913 Type: General Knowledge

109. Patients experiencing a right ventricular infarction: A) may present with hypotension. B) should not be given baby aspirin. C) often require higher doses of morphine. D) usually have anterior myocardial damage.

Ans: A Page: 1016 Type: General Knowledge

108. Which of the following medications would be the MOST acceptable alternative to morphine for analgesia in patients with an acute coronary syndrome? A) Versed B) Fentanyl C) Diazepam D) Ibuprofen

Ans: B Page: 1016 Type: General Knowledge

180. In order to call a cardiac rhythm “paroxysmal” supraventricular tachycardia, you would have to: A) witness its onset and/or spontaneous termination. B) confirm the pacemaker origin with a 12-lead ECG. C) observe a consistent heart rate greater than 150 beats/min. D) ask the patient when he or she began feeling palpitations.

Ans: A Page: 952 Type: General Knowledge

31. An electrical impulse is slightly delayed at the AV node so that the: A) bundle of His can depolarize fully. B) ventricles can contract completely. C) primary cardiac pacemaker can reset. D) atria can empty into the ventricles.

Ans: D Page: 918 Type: General Knowledge

148. According to the Einthoven triangle, lead II is assessed by placing the: A) negative lead on the left arm and the positive lead on the left leg. B) positive lead on the left leg and the negative lead on the right arm. C) positive lead on the left arm and the negative lead on the right arm. D) negative lead on the right arm and the positive lead on the left leg.

Ans: D Page: 939-940 Type: General Knowledge

262. A 56-year-old man presents with an acute onset of chest pressure and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should: A) establish vascular access. B) obtain baseline vital signs. C) administer supplemental oxygen. D) acquire a 12-lead ECG tracing.

Ans: C Page: 1015 Type: Critical Thinking

185. Atrial fibrillation can be interpreted by noting: A) PR intervals that vary from complex to complex. B) an irregularly irregular rhythm and absent P waves. C) a regularly irregular rhythm with abnormal P waves. D) the presence of wide QRS complexes and a rapid rate.

Ans: B Page: 951-952 Type: General Knowledge

200. An accelerated idioventricular rhythm is characterized by all of the following, EXCEPT: A) QRS complexes greater than 0.12 seconds in duration. B) irregular R-R intervals and a rate less than 40 beats/min. C) wide QRS complexes with P waves buried in the T waves. D) regular R-R intervals and a rate between 40 and 100 beats/min.

Ans: B Page: 960 Type: General Knowledge

230. A diagnosis of acute myocardial infarction is made if ST-segment __________ of ___ mm or more is seen in ___ or more contiguous leads. A) elevation, 1, two B) depression, 2, one C) elevation, 2, one D) depression, 1, two

Ans: A Page: 978 Type: General Knowledge

25. Administering a drug that possesses a positive chronotropic effect will have a direct effect on: A) stroke volume. B) blood pressure. C) cardiac output. D) the heart rate.

Ans: D Page: 918 Type: General Knowledge

13. Approximately 80% of ventricular filling occurs: A) during systole. B) during diastole. C) when the semilunar valves are open. D) when the AV valves close.

Ans: B Page: 912 Type: General Knowledge

197. On the ECG strip, a third-degree AV block usually appears as a: A) wide QRS complex rhythm with a rate between 50 and 70 beats/min. B) slow, narrow QRS complex rhythm with irregular P-P intervals. C) slow, wide QRS complex rhythm with inconsistent PR intervals. D) narrow QRS complex rhythm with a rate less than 60 beats/min.

Ans: C Page: 958 Type: General Knowledge

56. Vasoconstriction occurs following stimulation of: A) beta-1 receptors. B) beta-2 receptors. C) alpha receptors. D) alpha and beta receptors.

Ans: C Page: 924-925 Type: General Knowledge

293. A 56-year-old man complains of chest tightness, shortness of breath, and nausea. During your assessment, you note that he appears confused. He is profusely diaphoretic and has a blood pressure of 98/68 mm Hg and a rapid radial pulse. The cardiac monitor reveals a wide QRS complex tachycardia at a rate of 200 beats/min. After administering high-flow oxygen, you should: A) attempt to slow his heart rate with vagal maneuvers and then start an IV line. B) establish IV access, consider sedation, and perform synchronized cardioversion. C) establish vascular access and administer 150 mg of amiodarone over 10 minutes. D) obtain a 12-lead ECG tracing to determine the origin of his tachycardic rhythm.

Ans: B Page: 1001, 1003, 1005 Type: Critical Thinking

58. To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that: A) stimulates beta-1 and beta-2 receptors. B) stimulates beta-2 and alpha receptors. C) blocks beta-1 and beta-2 receptors. D) blocks beta receptors and stimulates alpha receptors.

Ans: A Page: 924-925 Type: General Knowledge

213. The firing of an artificial ventricular pacemaker causes: A) a change in the shape of the preceding P waves. B) a vertical spike followed by a wide QRS complex. C) a small spike followed by a narrow QRS complex. D) a wide QRS complex followed by a vertical spike.

Ans: B Page: 963-964 Type: General Knowledge

20. If the left ventricle contains 80 mL of blood before a contraction and ejects 60 mL during the contraction, the ejection fraction is: A) 60%. B) 65%. C) 70%. D) 75%.

Ans: D Page: 915 Type: General Knowledge

73. 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? A) Cancer B) Diabetes C) Renal disease D) Hypertension

Ans: A Page: 929 Type: General Knowledge

174. Sinus dysrhythmia is: A) observed in all patients. B) an irregular sinus rhythm. C) a sign of myocardial ischemia. D) most common in hypotensive patients.

Ans: B Page: 949-950 Type: General Knowledge

49. Cholinesterase is a naturally occurring chemical that: A) increases epinephrine production. B) regulates acetylcholine in the body. C) stimulates activity of the vagus nerve. D) causes a natural slowing of the heart rate.

Ans: B Page: 921-922 Type: General Knowledge

62. Which of the following drugs would be MOST effective when treating a patient with hypotension secondary to vasodilation? A) Dopamine B) Propranolol C) Isoproterenol D) Norepinephrine

Ans: D Page: 926 Type: General Knowledge

27. Automaticity is defined as the ability of the heart to: A) generate an electrical impulse from the same site every time. B) spontaneously conduct an electrical impulse between cardiac cells. C) generate its own electrical impulses without stimulation from nerves. D) increase or decrease its heart rate based on the body's metabolic needs.

Ans: C Page: 918 Type: General Knowledge

265. Shortly after administering a second dose of 4 mg of morphine to a 49-year-old woman who is experiencing chest pain, the patient's level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should: A) administer 0.5 mg of atropine and reassess her. B) assist her ventilations and administer naloxone. C) elevate her legs and give a 500-mL saline bolus. D) immediately intubate her to protect her airway.

Ans: B Page: 1016 Type: Critical Thinking

243. Once an advanced airway device has been inserted into a cardiac arrest patient: A) you should deliver one breath every 5 to 6 seconds. B) ventilations are delivered at a rate of 8 to 10 breaths/min. C) the compressor should pause so ventilations can be given. D) chest compressions should be increased to 120 per minute.

Ans: B Page: 1004 Type: General Knowledge

139. Abnormal neurologic signs that accompany hypertensive encephalopathy occur when: A) pressure in the brain causes transient dysfunction of the parietal lobe and cerebral vasodilation. B) the mean arterial pressure exceeds 100 mm Hg and blood is forced from the brain and into the spinal cord. C) neurons sustain permanent damage secondary to a single increase in blood pressure above 200/130 mm Hg. D) pressure causes a breach in the blood-brain barrier and fluid leaks out, causing an increase in intracranial pressure.

Ans: D Page: 1025 Type: General Knowledge

273. 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: 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.

Ans: C Page: 1006 Type: Critical Thinking

15. Which of the following statements regarding the right side of the heart is correct? 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.

Ans: B Page: 913 Type: General Knowledge

133. If a patient's aortic aneurysm is not compressing on any adjacent structures: A) the pain is often confined to the back. B) he or she will likely be asymptomatic. C) a pulsatile mass will usually be absent. D) his or her pain will likely be less severe.

Ans: B Page: 1024 Type: General Knowledge

234. A pathologic Q wave: A) generally indicates that an acute myocardial infarction has occurred within the past hour. B) is deeper than one quarter of the height of the R wave and indicates injury. C) is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past. D) can only be substantiated by viewing at least two previous 12-lead ECGs

Ans: C Page: 977 Type: General Knowledge

94. Which of the following MOST accurately describes an acute myocardial infarction? A) Death of the myocardium secondary to spasm of a major coronary artery B) Injury to a portion of the heart muscle secondary to atherosclerotic disease C) Damage to the left ventricle following occlusion of the left coronary artery D) Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

Ans: D Page: 1013 Type: General Knowledge

188. Junctional escape rhythms are CONSISTENTLY characterized by: A) an absence of P waves. B) QRS complexes greater than 0.12 seconds. C) inverted P waves before the QRS complex. D) a ventricular rate of 40 to 60 beats/min.

Ans: D Page: 955 Type: General Knowledge

46. The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration. A) 0.12, 0.20 B) 0.14, 0.30 C) 0.16, 0.40 D) 0.18, 2.0

Ans: A Page: 921 Type: General Knowledge

250. What is the approximate maximum dose of lidocaine for a 200-pound patient? A) 275 mg B) 300 mg C) 325 mg D) 350 mg

Ans: A Page: 1008-1009 Type: General Knowledge

217. A delta wave is identified on a cardiac rhythm strip as a(n): A) apparent P wave that occurs at the end of the QRS complex. B) acute widening of the QRS complex immediately after the R wave. C) rapid upslope to the R wave immediately after the end of the P wave. D) delay between the end of the P wave and the beginning of the R wave.

Ans: C Page: 974 Type: General Knowledge

219. The presence of a J wave (Osborn wave) on the ECG is an indicator of: A) a delta wave. B) hyponatremia. C) hypercalcemia. D) hypothermia.

Ans: D Page: 985 Type: General Knowledge

160. A normal QT interval lasts: A) 0.15 to 0.25 seconds. B) 0.30 to 0.40 seconds. C) 0.36 to 0.44 seconds. D) 0.38 to 0.48 seconds.

Ans: C Page: 944 Type: General Knowledge

89. Which of the following clinical findings is LEAST suggestive of a peripheral vascular disorder? A) A bruit heard over the carotid artery B) Pain in the calf muscle while walking C) Swelling and pain along the course of a vein D) An S3 sound during auscultation of the heart

Ans: D Page: 1012 Type: General Knowledge

162. The QT interval would MOST likely be prolonged in patients: A) who take digitalis. B) who are hypocalcemic. C) with a rapid heart rate. D) who are hypercalcemic.

Ans: B Page: 987 Type: General Knowledge

196. Which of the following occurs at the AV node during a third-degree heart block? A) There is an abnormal delay in conducting impulses. B) Every third impulse is allowed to enter the ventricles. C) Impulses bypass the AV node and enter the ventricles. D) All impulses are blocked from entering the ventricles.

Ans: D Page: 958 Type: General Knowledge

105. When administering aspirin to a patient with an acute coronary syndrome, you should: A) first check to make sure the patient is not severely hypertensive. B) administer half the usual dose if the patient has a history of stroke. C) have him or her chew and swallow 160 to 325 mg of baby aspirin. D) give up to 325 mg of enteric-coated aspirin for the patient to swallow.

Ans: C Page: 1015 Type: General Knowledge

279. 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: 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.

Ans: D Page: 1008 Type: Critical Thinking

186. A major complication associated with atrial fibrillation is: A) clot formation in the fibrillating atria. B) a significant reduction in atrial filling. C) pulmonary congestion and hypoxemia. D) a profound increase in the atrial kick.

Ans: A Page: 952 Type: General Knowledge

50. Stimulation of the parasympathetic nervous system causes all of the following effects, EXCEPT: A) negative inotropy. B) increased salivation. C) dilation of the pupils. D) negative chronotropy.

Ans: C Page: 922 Type: General Knowledge

155. A wide QRS complex that is preceded by a normal P wave indicates: A) that the rhythm is ventricular in origin. B) rapid conduction through the ventricles. C) a delay in conduction at the AV junction. D) an abnormality in ventricular conduction.

Ans: D Page: 942 Type: General Knowledge

87. Myocardial ischemia occurs when the heart muscle: A) is deprived of oxygen because of a blocked coronary artery. B) undergoes necrosis because of prolonged oxygen deprivation. C) suffers oxygen deprivation secondary to coronary vasodilation. D) experiences a decreased oxygen demand and an increased supply.

Ans: A Page: 1011 Type: General Knowledge

198. Any electrical impulse that originates in the ventricles will produce: A) wide QRS complexes and a rate between 20 and 40 beats/min. B) a rapid rhythm with wide QRS complexes and no pulse. C) low-amplitude QRS complexes and dissociated P waves. D) bizarre-looking QRS complexes and a rate less than 60 beats/min.

Ans: A Page: 958-959 Type: General Knowledge

132. In addition to prompt transport, the goal of prehospital management for a patient with a suspected aortic dissection includes: A) lowering the blood pressure. B) IV fluid boluses. C) high-flow oxygen. D) adequate pain relief.

Ans: D Page: 1023 Type: General Knowledge

98. The pain associated with an acute myocardial infarction: A) radiates to the left or right arm in the majority of cases. B) is not influenced by deep breathing or body movement. C) is most often described as a sharp sensation in the chest. D) is often relieved by two or three doses of sublingual nitroglycerin.

Ans: B Page: 1014 Type: General Knowledge

248. Which of the following statements regarding the use of vasopressin when managing cardiac arrest is correct? 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.

Ans: D Page: 1008-1009 Type: General Knowledge

60. Which of the following drugs possesses beta-2-specific properties? A) Dopamine B) Levophed C) Proventil D) Epinephrine

Ans: C Page: 926 Type: General Knowledge

206. A “run” of ventricular tachycardia occurs if at least ____ PVCs occur in a row. A) two B) three C) four D) five

Ans: B Page: 961 Type: General Knowledge

269. A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should: A) start an IV line, administer 5 mg of midazolam, intubate the patient's trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 µg/kg/min en route to the hospital. B) keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine. C) place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure. D) elevate the patient's legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.

Ans: B Page: 1021-1022 Type: Critical Thinking

169. In sinus bradycardia, the: A) heart rate is less than 70 beats/min. B) pacemaker site is the SA node. C) QRS complexes are often wide. D) P waves are consistently upright.

Ans: B Page: 947 Type: General Knowledge

267. A 67-year-old man presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. He has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect? A) Positive end-expiratory pressure ventilation B) IV or IO access and 20 to 40 mg of furosemide C) 0.4 mg sublingual nitroglycerin, up to three doses D) Supplemental oxygen via nonrebreathing mask

Ans: A Page: 1019 Type: Critical Thinking

82. Which of the following blood pressure readings is MOST suggestive of a patient who has arteriosclerosis? A) 140/90 mm Hg B) 150/80 mm Hg C) 160/70 mm Hg D) 180/110 mm Hg

Ans: C Page: 925 Type: General Knowledge

276. An unresponsive, pulseless, apneic patient presents with ventricular tachycardia on the cardiac monitor. After defibrillating the patient, you should: A) take no more than 10 seconds to assess for a pulse. B) resume CPR and reassess the patient after 2 minutes. C) reassess the cardiac rhythm to see if it has changed. D) deliver another shock if his cardiac rhythm is unchanged.

Ans: B Page: 1008 Type: Critical Thinking

119. In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes: A) a saline lock, a selective beta-2 adrenergic medication, and bicarbonate. B) an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication. C) a saline lock, fentanyl, and intubation facilitated by pharmacologic agents. D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.

Ans: D Page: 1019-1020 Type: General Knowledge

38. Which of the following electrolytes maintains the depolarization phase? A) Sodium B) Calcium C) Potassium D) Magnesium

Ans: B Page: 920 Type: General Knowledge

253. In which of the following situations would you likely NOT be able to palpate a pulse despite effective chest compressions? A) Profound hypoxia B) Severe acidosis C) Hyperkalemia D) Tension pneumothorax

Ans: D Page: 1008 Type: General Knowledge

74. A pulse that alternates in strength from one beat to the next beat is called: A) pulse deficit. B) pulsus alternans. C) pulsus paradoxus. D) paradoxical pulse.

Ans: B Page: 935 Type: General Knowledge

88. Atherosclerosis is a process in which: A) the outer wall of a coronary artery becomes lined with masses of fatty tissue. B) calcium precipitates into the arterial walls, greatly reducing the artery's elasticity. C) plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen. D) plaque ruptures from a distant location and lodges in one of the coronary arteries.

Ans: C Page: 1011 Type: General Knowledge

211. Which of the following statements regarding asystole is correct? A) A disconnected ECG lead often mimics asystole. B) Defibrillation is indicated in some cases of asystole. C) Most cases of asystole present with P waves only. D) Asystole is the result of prolonged myocardial hypoxia

Ans: D Page: 962-963 Type: General Knowledge

33. Thousands of fibrils that are distributed throughout the ventricles, which represent the end of the cardiac conduction system, are called the: A) bundle branches. B) internodal pathways. C) Purkinje fibers. D) cardiac myocytes.

Ans: C Page: 919 Type: General Knowledge

236. Patients who are experiencing an infarction of the right ventricle: A) should not be given IV fluid boluses. B) often require high doses of nitroglycerin. C) are usually hypertensive and tachycardic. D) may present with significant hypotension.

Ans: D Page: 979, 982 Type: General Knowledge

204. Premature ventricular complexes: A) are ectopic complexes that originate from a different pacemaker site. B) are extra systolic beats that break the regularity of the underlying rhythm. C) are in themselves considered arrhythmias, but are generally insignificant. D) occur later than the next expected complex, causing an irregular rhythm.

Ans: A Page: 960 Type: General Knowledge

191. A first-degree heart block has a PR interval greater than 0.20 seconds because: A) depolarization of the atria occurs at a slightly slower rate than one would expect. B) each impulse that reaches the AV node is delayed slightly longer than expected. C) impulses generated by the SA node traverse the AV node at an accelerated rate. D) the primary pacemaker is not the SA node, but rather an ectopic atrial pacemaker.

Ans: B Page: 957 Type: General Knowledge

266. 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: A) right ventricular failure. B) reactive airway disease. C) acute COPD exacerbation. D) left-sided heart failure.

Ans: D Page: 1018-1019 Type: Critical Thinking

24. Under normal conditions, the strength of cardiac contraction is regulated by: A) the heart rate. B) the nervous system. C) physical exertion. D) the Frank-Starling mechanism

Ans: B Page: 918 Type: General Knowledge

152. The normal P wave duration is less than ___ milliseconds and the amplitude is less than ___ millimeters tall. A) 110; 2.5 B) 120; 3.0 C) 130; 3.5 D) 140; 4.0

Ans: A Page: 942 Type: General Knowledge

278. A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on: A) establishing a peripheral IV line B) providing mild hyperventilation. C) searching for reversible causes. D) transcutaneous cardiac pacing

Ans: C Page: 1009-1010 Type: Critical Thinking

2. The heart's anatomic location is MOST accurately described as being: A) retrosternal. B) hemithoracic. C) submediastinal. D) supradiaphragmatic.

Ans: A Page: 911 Type: General Knowledge

115. Percutaneous coronary interventions involve: A) recanalizing a blocked coronary artery by passing a balloon or stent through a catheter via a peripheral artery. B) passing a 2-mm catheter through the femoral artery and administering a fibrinolytic agent through the catheter. C) using a large vein from one of the lower extremities to reroute blood flow past an occluded coronary artery. D) passing a guide wire through one of the external jugular veins to directly visualize an occluded coronary artery.

Ans: A Page: 1017-1018 Type: General Knowledge

179. Supraventricular tachycardia is MOST accurately defined as: A) any tachycardic rhythm with a heart rate greater than 130 beats/min and absent P waves. B) a tachycardic rhythm originating from a pacemaker site above the level of the ventricles. C) an irregular tachycardic rhythm that originates just below the AV junction. D) a regular tachycardic rhythm between 150 and 180 beats/min with P waves buried in the QRS complexes.

Ans: B Page: 952 Type: General Knowledge

247. When managing cardiac arrest, the appropriate dosing regimen for epinephrine is: A) 1 mL of a 1:10,000 solution every 3 to 5 minutes. B) 0.1 mg/kg of a 1:10,000 solution every 3 minutes. C) 10 mL of a 1:1,000 solution every 3 to 5 minutes. D) 1 mg of a 1:10,000 solution every 3 to 5 minutes.

Ans: D Page: 1008-1009 Type: General Knowledge

165. If the R-R interval spans more than ____ large boxes on the ECG graph paper, the heart rate is less than 60/min. A) 1.5 B) 2 C) 3.5 D) 5

Ans: D Page: 946 Type: General Knowledge

18. In contrast to arteries, veins: A) do not contain valves that prevent backflow of blood. B) have less capacity to increase the size of their diameter. C) are more likely to distend when exposed to backpressure. D) operate on the high-pressure side of the circulatory system.

Ans: C Page: 914 Type: General Knowledge

41. The farther removed the conduction tissue is from the SA node: A) the slower its intrinsic rate of firing. B) the longer the PR interval will be. C) the faster its intrinsic rate of firing. D) the narrower the QRS complex will be.

Ans: A Page: 920 Type: General Knowledge

140. Lowering of a significantly elevated blood pressure: A) is best accomplished in a hospital setting. B) is contraindicated in the prehospital setting. C) should be initiated in the field with labetalol. D) is routinely accomplished with nitroglycerin.

Ans: A Page: 1025 Type: General Knowledge

144. Bombardment of the AV node by more than one impulse, potentially blocking the pathway for one impulse and allowing the other impulse to stimulate cardiac cells that have already depolarized, is called: A) fusion. B) reentry. C) ectopy. D) excitability.

Ans: B Page: 949 Type: General Knowledge

110. When monitoring a patient's cardiac rhythm, it is MOST important to remember that: A) a heart rate below 60 beats per minute must be treated immediately. B) many patients with acute myocardial infarction experience asystole. C) the ECG does not provide data regarding the patient's cardiac output. D) the presence of a QRS complex correlates with the patient's pulse.

Ans: C Page: 1016 Type: General Knowledge

28. The area of conduction tissue in which electrical activity arises at any given time is called the: A) myocyte. B) pacemaker. C) sinus node. D) bundle of His.

Ans: B Page: 918 Type: General Knowledge

255. Common causes of cardiac arrest include all of the following, EXCEPT: A) hypovolemia. B) hyperglycemia. C) cardiac tamponade. D) pulmonary embolism.

Ans: B Page: 1008 Type: General Knowledge

55. Stimulation of alpha and beta receptors affects the: A) heart only. B) heart and blood vessels. C) blood vessels and lungs. D) heart, lungs, and blood vessels.

Ans: D Page: 924-925 Type: General Knowledge

170. Common causes of bradycardia include: A) exercise. B) hyperthermia. C) amphetamines. D) beta blocker use.

Ans: D Page: 947 Type: General Knowledge

282. After administering 40 units of vasopressin to an elderly woman in bradycardic pulseless electrical activity, you should: A) pause CPR for no longer than 10 seconds and assess for a pulse. B) continue CPR and flush the IV line with 20 mL of normal saline. C) administer 1 mg of epinephrine 1:10,000 while CPR is ongoing. D) give naloxone to rule out opiate overdose as the cause of her arrest.

Ans: B Page: 1009 Type: Critical Thinking

194. A second-degree heart block, Mobitz type I, occurs when: A) every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles. B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles. C) the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex. D) more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles.

Ans: B Page: 957 Type: General Knowledge

100. The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of: A) fear and anxiety. B) the effects of nitroglycerin. C) acute left-sided heart failure. D) a reduction in cardiac output.

Ans: D Page: 1014 Type: General Knowledge

157. The __________ represents the end of ventricular depolarization and the beginning of repolarization. A) J point B) T wave C) ST segment D) T-P interval

Ans: A Page: 942-943 Type: General Knowledge

72. In the context of cardiac compromise, syncope occurs due to: A) an increase in vagal tone. B) a drop in cerebral perfusion. C) a sudden cardiac dysrhythmia. D) an acute increase in heart rate.

Ans: B Page: 929 Type: General Knowledge

106. Which of the following situations would contraindicate the administration of nitroglycerin? A) Hypersensitivity to salicylates B) Systolic BP less than 110 mm Hg C) Tadalafil use within the last 24 hours D) Use of Plavix within the last 12 hours

Ans: C Page: 1015-1016 Type: General Knowledge

54. Which of the following chemicals or drugs causes an increase in heart rate? A) Norepinephrine B) Cholinesterase C) Atenolol and neostigmine D) Atropine and epinephrine

Ans: D Page: 922-923 Type: General Knowledge

145. If a patient's ECG rhythm shows any artifact, you should: A) ensure the electrodes are applied firmly to the skin. B) reverse the limb leads to obtain a clearer ECG tracing. C) place the ground lead in a different anatomic location. D) remove the negative lead and reassess the cardiac rhythm.

Ans: A Page: 937-938 Type: General Knowledge

245. If you are using a biphasic defibrillator, but are unsure of the appropriate starting energy setting, you should set the defibrillator to: A) 120 J. B) 150 J. C) 200 J. D) 360 J.

Ans: C Page: 1007 Type: General Knowledge

175. Sinus arrest is characterized by: A) a dropped PQRST complex. B) an irregularly irregular rhythm. C) PR intervals greater than 0.12 seconds. D) irregularity during the inspiratory phase.

Ans: A Page: 950 Type: General Knowledge

96. Cardiac arrhythmias following an acute myocardial infarction: A) tend to originate from ischemic areas around the infarction. B) typically manifest as atrial fibrillation or atrial tachycardia. C) generally originate from the center of the infarcted tissues. D) are uncommon within the first 24 hours after the infarction

Ans: A Page: 1013 Type: General Knowledge

171. Which of the following statements regarding sinus bradycardia is correct? 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.

Ans: A Page: 948 Type: General Knowledge

261. Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia? A) Aberrant conduction B) Absence of P waves C) Retrograde conduction D) The rate of the rhythm

Ans: A Page: 1003 Type: General Knowledge

23. The ability of the heart to vary the degree of its contraction without stretching is called: A) contractility. B) chronotropy. C) automaticity. D) the Frank-Starling mechanism.

Ans: A Page: 917 Type: General Knowledge

146. An electrical wave moving in the direction of a positive electrode will: A) cause a positive deflection on the ECG. B) produce a significant amount of artifact. C) cause a negative deflection on the ECG. D) manifest with narrow QRS complexes.

Ans: A Page: 941 Type: General Knowledge

287. 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: 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.

Ans: B Page: 1002 Type: Critical Thinking

59. A pure alpha agent: A) causes marked vasoconstriction. B) has a direct effect on the heart rate. C) causes moderate bronchoconstriction. D) decreases the blood pressure by dilating the vessels.

Ans: A Page: 925 Type: General Knowledge

8. What prevents the backflow of blood during ventricular contraction? A) The aortic valve B) Semilunar valves C) The pulmonic valve D) AV valves

Ans: D Page: 911 Type: General Knowledge

226. The inferior wall of the left ventricle is supplied by the: A) right coronary artery. B) left coronary artery. C) circumflex artery. D) left anterior descending artery.

Ans: A Page: 970 Type: General Knowledge

199. Which of the following statements regarding an idioventricular rhythm is correct? A) Most patients with an idioventricular rhythm are hemodynamically unstable. B) Treatment for an idioventricular rhythm focuses on increasing blood pressure. C) Idioventricular rhythms are typically accompanied by nonconducted P waves. D) The most common cause of an idioventricular rhythm is failure of the SA node.

Ans: A Page: 959-960 Type: General Knowledge

71. A patient with orthopnea: A) experiences dyspnea during periods of exertion. B) prefers a semisitting position to facilitate breathing. C) experiences worsened dyspnea while lying down. D) sleeps in a recliner due to severe right heart failure.

Ans: C Page: 929 Type: General Knowledge

259. The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is: A) atropine sulfate. B) a dopamine infusion. C) an epinephrine infusion. D) transcutaneous pacing.

Ans: D Page: 1001 Type: General Knowledge

93. In contrast to stable angina, unstable angina: A) occurs following periods of strenuous exertion. B) often awakens the patient from his or her sleep. C) indicates that myocardial necrosis has occurred. D) is less frequent but is associated with more pain

Ans: B Page: 1013 Type: General Knowledge

67. If you are unsure whether a conscious cardiac patient requires immediate transport versus continued assessment at the scene, you should: A) continue with the secondary assessment to obtain more information. B) take the patient's vital signs and then make your transport decision. C) begin immediate transport and perform a focused assessment en route. D) contact medical control and inform him or her of the patient's condition.

Ans: A Page: 928 Type: General Knowledge

156. Q waves are considered abnormal or pathologic if they are: A) greater than 0.02 seconds wide and consistently precede the R wave. B) more than one third the overall height of the QRS complex in lead II. C) not visible in leads I or II when the QRS gain sensitivity is increased. D) present in a patient who is experiencing chest pressure or discomfort.

Ans: B Page: 942, 977 Type: General Knowledge

90. Acute coronary syndrome is a term used to describe: A) acute chest pressure or discomfort that subsides with rest or nitroglycerin. B) a clinical condition in which patients experience chest pain during exertion. C) any group of clinical symptoms consistent with acute myocardial ischemia. D) a sudden cardiac rhythm disturbance that causes a decrease in cardiac output.

Ans: C Page: 1013 Type: General Knowledge

123. Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of: A) jugular venous distention. B) a narrowing pulse pressure. C) clear and equal breath sounds. D) alterations in the QRS amplitude.

Ans: C Page: 1021 Type: General Knowledge

224. Which of the following leads provides the BEST view of the anterolateral wall of the left ventricle? A) V2 to V3 B) V4 to V6 C) V4 to V5 D) V5 to V6

Ans: B Page: 970 Type: General Knowledge

208. What is the R-on-T phenomenon? A) A premature ventricular complex (PVC) that occurs when the ventricles are not fully repolarized B) When the R wave occurs at the J point of the next cardiac cycle C) A unifocal PVC that occurs during the upslope of any given T wave D) A PVC that occurs during a time when the ventricles are depolarizing

Ans: A Page: 962 Type: General Knowledge

26. Changes in cardiac contractility may be induced by medications that have a positive or negative ___________ effect. A) vasoactive B) dromotropic C) inotropic D) chronotropic

Ans: C Page: 917 Type: General Knowledge

289. 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: 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.

Ans: A Page: 951-952, 1005 Type: Critical Thinking