Chapter 17 Cardiovascular Emergencies Flashcards
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Cardiac-related chest pain is often palliated by: A) stress. B) exertion. C) nitroglycerin. D) mild exercise.
Ans: C Page: 928 Type: General Knowledge
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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