Chapter 39 Responding to the Field Code

Question 1

An unresponsive, apneic, and pulseless man presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to his arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of his condition? A. No pulse with CPR and jugular venous distention B. Unilaterally absent breath sounds and mottled skin C. Bilaterally absent breath sounds and severe pallor D. Profoundly cyanotic skin and collapsed jugular veins

Answer 1

A. No pulse with CPR and jugular venous distention

Question 2

Your assessment of a 68-year-old man reveals an organized cardiac rhythm at a rate of 80 beats per minute and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT: Choose one A. epinephrine. B. IV fluid boluses. C. vasopressin. D. cardiac pacing

Answer 2

D. cardiac pacing

Question 3

After determining that an unresponsive adult patient is not breathing, you should: Choose one answer. A. assess for a carotid pulse for no longer than 10 seconds. B. perform a finger sweep of the patient’s mouth to remove any debris. C. give two rescue breaths that make the chest visibly rise. D. reposition the patient’s airway and reassess for breathing

Answer 3

A. assess for a carotid pulse for no longer than 10 seconds.

Question 4

You and your partner are performing CPR on a 60-year-old woman who was initially in asystole. After 2 minutes, you look at the cardiac monitor and determine that she is in ventricular fibrillation. Your next action should be to: A. check her cardiac rhythm in two contiguous leads to confirm that she is in ventricular fibrillation. B. continue CPR, establish vascular access, and administer 300 mg of amiodarone or 1.5 mg/kg of lidocaine. C. deliver a single shock and instruct your partner to resume chest compressions while you resume ventilations. D. quickly assess for a carotid or femoral pulse and then deliver a single shock with 200 biphasic joules.

Answer 4

C. deliver a single shock and instruct your partner to resume chest compressions while you resume ventilations.

Question 5

Epinephrine is primarily administered during cardiac arrest because its ________effects cause ________. Choose one answer. A. beta-2 agonistic, dilation of the bronchioles B. vasodilatory, a reduction in cardiac afterload C. antidysrhythmic, decreased cardiac irritability D. vasoconstrictive, enhanced coronary blood flow

Answer 5

D. vasoconstrictive, enhanced coronary blood flow

Question 6

Which of the following roles would the code team leader MOST likely perform? Choose one answer. A. Managing the airway B. Interpreting the ECG C. Chest compressions D. Establishing IV access

Answer 6

B. Interpreting the ECG

Question 7

During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient’s end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should: A. decrease the rate of your ventilations. B. increase the rate of your ventilations. C. suspect inadvertent tube dislodgement. D. assess for a pulse for up to 10 seconds.

Answer 7

D. assess for a pulse for up to 10 seconds.

Question 8

Which of the following should occur when integrating a mechanical CPR device into your resuscitation attempt of an adult patient? Choose one answer. A. One breath should be given every 6 to 8 seconds until an advanced airway is inserted. B. Compressions should be continuous after an advanced airway device is inserted. C. Compression depth should be at least 1½ inches after the device is applied. D. The compression rate should be set to deliver at least 80 compressions per minute.

Answer 8

B. Compressions should be continuous after an advanced airway device is inserted.

Question 9

Following return of spontaneous circulation, a patient remains comatose. Which of the following interventions would MOST likely be performed? A. Induced hypothermia B. Dextrose infusion C. Epinephrine bolus D. Field extubation

Answer 9

A. Induced hypothermia

Question 10

You and your partner arrive at the scene of an unresponsive middle-aged man. Your primary assessment reveals that he is apneic and pulseless. Which of the following interventions will provide the BEST chance of survival for this patient? A. Five minutes of CPR prior to analyzing his cardiac rhythm B. Prompt insertion of an advanced airway to prevent aspiration C. Immediate defibrillation for presumed ventricular fibrillation D. CPR at the appropriate rate and with minimal interruptions

Answer 10

D. CPR at the appropriate rate and with minimal interruptions

Question 11

You and your team are attempting to resuscitate a 45-year-old man who is in cardiac arrest. After 2 minutes, you assess his cardiac rhythm and determine that he is in asystole. After instructing your team to resume CPR, you should: A. insert an advanced airway device and then resume cycles of CPR. B. administer 1 mg of epinephrine 1:10,000 after obtaining vascular access. C. establish IV or IO access and administer 1 mg of atropine sulfate rapidly. D. perform endotracheal intubation and ventilate at a rate of 15 breaths/min.

Answer 11

B. administer 1 mg of epinephrine 1:10,000 after obtaining vascular access.

Question 12

You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next: A. give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes. B. push the synchronize button on the defibrillator and cardiovert with 200 joules. C. give 1 to 2 g of magnesium sulfate without interrupting chest compressions. D. give 300 mg of amiodarone via rapid IV or IO push.

Answer 12

C. give 1 to 2 g of magnesium sulfate without interrupting chest compressions.

Question 13

A code runs MOST efficiently when: Choose one answer. A. tracheal intubation is performed early. B. a designated team leader is assigned. C. at least five paramedics are participating. D. the AED replaces manual defibrillation.

Answer 13

B. a designated team leader is assigned. –correct

Question 14

How does CPR change after an advanced airway device is inserted? Choose one answer. A. Ventilations should be asynchronous with chest compressions. B. Ventilations should be faster after the device is inserted. C. One breath should be delivered every 10 to 12 seconds. D. Cycles of 30 compressions and 2 breaths should be delivered.

Answer 14

A. Ventilations should be asynchronous with chest compressions. –correct

Question 15

Your team is attempting resuscitation of a man in cardiac arrest. One of the team members intubates the patient and confirms proper placement of the endotracheal tube. Your MOST appropriate next action should be to: A. presume that the patient is in severe metabolic acidosis and hyperventilate him for at least 2 to 3 minutes. B. defibrillate the patient with the maximum energy setting, reassess for a pulse, and continue CPR if he remains pulseless. C. instruct the person ventilating to provide one breath every 6 to 8 seconds while chest compressions are continuous. D. administer 2.5 mg of epinephrine 1:10,000 via the endotracheal tube without interrupting chest compressions.

Answer 15

C. instruct the person ventilating to provide one breath every 6 to 8 seconds while chest compressions are continuous.

Question 16

As you are administering 40 units of vasopressin to an adult woman in ventricular fibrillation, your team members continue CPR. After 2 minutes, you reassess her and determine that she is still in ventricular fibrillation. You should: Choose one answer. A. administer 300 mg of amiodarone while CPR remains uninterrupted. B. instruct your team to continue CPR as the defibrillator is charging. C. advise your team to stop CPR as you prepare to deliver another shock. D. deliver a monophasic defibrillation with 200 joules and resume CPR.

Answer 16

B. instruct your team to continue CPR as the defibrillator is charging.

Question 17

Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac care? Choose one answer. A. Defibrillation B. Tracheal intubation C. Chest compressions D. Artificial ventilation

Answer 17

C. Chest compressions –correct

Question 18

After approximately 6 minutes of attempted resuscitation, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus tachycardia. In addition to continuing ventilations, what should be done next? Choose one answer. A. Dopamine infusion B. Amiodarone infusion C. Crystalloid fluid bolus D. Hypothermia treatment

Answer 18

D. Hypothermia treatment —correct

Question 19

Defibrillation of a patient who is in asystole is detrimental to the patient because it: Choose one answer. A. makes ruling out underlying causes impossible. B. causes an unnecessary interruption in chest compressions. C. has been shown to render epinephrine ineffective. D. stops the cardiac cells from spontaneously depolarizing.

Answer 19

B. causes an unnecessary interruption in chest compressions.

Question 20

While applying the defibrillator pads, you note that the patient has a transdermal nitroglycerin patch on the right anterior chest. You should: Choose one answer. A. place the second pad in between the scapulae. B. remove the patch and wipe away any residue. C. place the pads at least 1 inch from the patch. D. move the patch to the left anterior chest.

Answer 20

B. remove the patch and wipe away any residue.

Question 21

You are the team leader in the attempted resuscitation of an adult man in ventricular fibrillation. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensure that: A. compressions are hard and fast, with full chest recoil between compressions. B. the patient is defibrillated one time every 60 seconds as necessary. C. the person managing the airway delivers one breath every 3 to 5 seconds. D. no one person performs chest compressions for more than 5 minutes at a time.

Answer 21

A. compressions are hard and fast, with full chest recoil between compressions.

Question 22

A patient remains in pulseless ventricular tachycardia despite two shocks, a dose of epinephrine, high-quality CPR, and 300 mg of amiodarone. Following the next shock, you should resume CPR and then: Choose one answer.. A. cardiovert with 100 biphasic joules. B. double the dose of the epinephrine. C. administer 1.5 mg/kg of lidocaine. D. administer 150 mg of amiodarone.

Answer 22

D. administer 150 mg of amiodarone.

Question 23

As you are administering 40 units of vasopressin to an adult woman in ventricular fibrillation, your team members continue CPR. After 2 minutes, you reassess her and determine that she is still in ventricular fibrillation. You should: A. instruct your team to continue CPR as the defibrillator is charging. B. administer 300 mg of amiodarone while CPR remains uninterrupted. C. advise your team to stop CPR as you prepare to deliver another shock. D. deliver a monophasic defibrillation with 200 joules and resume CPR.

Answer 23

A. instruct your team to continue CPR as the defibrillator is charging.

Question 24

Your partner returns with the AED as you are performing CPR on a 5-year-old child. As he opens the AED, he tells you that there are no pediatric pads, only adult pads. You should: A. use the adult AED pads, but only provide a total of two defibrillations. B. tell him to resume one-rescuer CPR as you try to locate pediatric pads. C. instruct him to apply the adult pads as you continue one-rescuer CPR. D. continue two-rescuer CPR until a manual defibrillator is available.

Answer 24

C. instruct him to apply the adult pads as you continue one-rescuer CPR.

Question 25

Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac care? A. Artificial ventilation B. Defibrillation C. Tracheal intubation D. Chest compressions

Answer 25

D. Chest compressions

Question 26

During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient’s end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should: A. increase the rate of your ventilations. B. assess for a pulse for up to 10 seconds. C. decrease the rate of your ventilations. D. suspect inadvertent tube dislodgement.

Answer 26

B. assess for a pulse for up to 10 seconds.

Question 27

You and your team are attempting to resuscitate a 45-year-old man who is in cardiac arrest. After 2 minutes, you assess his cardiac rhythm and determine that he is in asystole. After instructing your team to resume CPR, you should: A. administer 1 mg of epinephrine 1:10,000 after obtaining vascular access. B. insert an advanced airway device and then resume cycles of CPR. C. perform endotracheal intubation and ventilate at a rate of 15 breaths/min. D. establish IV or IO access and administer 1 mg of atropine sulfate rapidly.

Answer 27

A. administer 1 mg of epinephrine 1:10,000 after obtaining vascular access

Question 28

You and your partner are off duty and are playing golf. Suddenly, you see an elderly man grab his chest and collapse to the ground. You should: A. tell the man’s golf buddy to perform a precordial thump at once. B. tell your partner to call 9-1-1 as you proceed to assess the man. C. both proceed to the man and begin two-rescuer CPR if needed. D. perform 2 minutes of CPR if needed and then call an ambulance.

Answer 28

B. tell your partner to call 9-1-1 as you proceed to assess the man.

Question 29

Hyperventilation of a patient who is in cardiac arrest: A. causes a marked decrease in intrathoracic pressure. B. is indicated if the arrest interval exceeds 10 minutes. C. increases preload and enhances cardiac output. D. has been shown to reduce coronary artery perfusion.

Answer 29

D. has been shown to reduce coronary artery perfusion.

Question 30

Your assessment of a 68-year-old man reveals an organized cardiac rhythm at a rate of 80 beats per minute and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT: A. cardiac pacing. B. IV fluid boluses. C. vasopressin. D. epinephrine.

Answer 30

A. cardiac pacing.

Question 31

Which of the following roles would the code team leader MOST likely perform? A. Interpreting the ECG B. Managing the airway C. Establishing IV access D. Chest compressions

Answer 31

A. Interpreting the ECG

Question 32

Anterior-posterior placement of the defibrillation pads should be used if the patient is younger than ___ year(s) of age or less than ___ kg. A. 4, 20 B. 5, 30 C. 1, 10 D. 3, 15

Answer 32

C. 1, 10

Question 33

When practicing a -code,- whether in the prehospital or in-hospital setting, the primary focus should be on: A. timely defibrillation and early tracheal intubation. B. the use of technology during a cardiac arrest. C. teamwork and minimal interruptions in CPR. D. independent performance and drug administration.

Answer 33

C. teamwork and minimal interruptions in CPR.

Question 34

Defibrillation of a patient who is in asystole is detrimental to the patient because it: A. stops the cardiac cells from spontaneously depolarizing. B. makes ruling out underlying causes impossible. C. causes an unnecessary interruption in chest compressions. D. has been shown to render epinephrine ineffective.

Answer 34

C. causes an unnecessary interruption in chest compressions.

Question 35

You are performing one-rescuer CPR on a 50-year-old woman in cardiac arrest. A bystander returns with an AED. You ask the bystander to attach the pads to the patient’s chest as you continue CPR. After rhythm analysis, the AED states, -Shock advised.- You should: A. confirm the absence of a pulse and deliver the shock. B. deliver a single shock and immediately resume CPR. C. perform CPR for 2 more minutes and then defibrillate. D. defibrillate the patient and reassess for a carotid pulse.

Answer 35

B. deliver a single shock and immediately resume CPR.

Question 36

You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next: A. give 300 mg of amiodarone via rapid IV or IO push. B. give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes. C. push the synchronize button on the defibrillator and cardiovert with 200 joules. D. give 1 to 2 g of magnesium sulfate without interrupting chest compressions.

Answer 36

D. give 1 to 2 g of magnesium sulfate without interrupting chest compressions.

Question 37

In addition to high-quality CPR, which of the following interventions has clearly made a positive and measurable difference in survival from sudden cardiac arrest? A. Epinephrine therapy B. Defibrillation C. Tracheal intubation D. IV fluid boluses

Answer 37

B. Defibrillation

Question 38

If a cardiac arrest patient’s airway is maintained with an oral airway and ventilation with a bag-mask device is producing adequate chest rise, then: A. there should be no pause in chest compressions to deliver a breath. B. a King LT or Combitube is preferred over tracheal intubation. C. the paramedic should deliver one breath every 5 to 6 seconds. D. insertion of an advanced airway device is not a high priority.

Answer 38

D. insertion of an advanced airway device is not a high priority.

Question 39

In which of the following situations would endotracheal intubation MOST likely be indicated? A. Following return of spontaneous circulation, the patient remains comatose. B. The patient has an end-tidal CO2 reading of 36 mm Hg with a King LT airway in place. C. Bag-mask ventilation is adequate, but the patient has undergone more than 2 minutes of D. The patient is experiencing a ventricular fibrillation that is refractory to defibrillation and

Answer 39

A. Following return of spontaneous circulation, the patient remains comatose.

Question 40

Which of the following should occur when integrating a mechanical CPR device into your resuscitation attempt of an adult patient? A. The compression rate should be set to deliver at least 80 compressions per minute. B. One breath should be given every 6 to 8 seconds until an advanced airway is inserted. C. Compressions should be continuous after an advanced airway device is inserted. D. Compression depth should be at least 1½ inches after the device is applied.

Answer 40

C. Compressions should be continuous after an advanced airway device is inserted.

Question 41

Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac care? A. Defibrillation B. Artificial ventilation C. Tracheal intubation D. Chest compressions

Answer 41

D. Chest compressions

Question 42

Impedance threshold devices, such as the ResQPOD, function by: Choose one answer. A. increasing intrathoracic pressure, which reduces blood return to the heart. B. creating a vacuum in the chest, which increases blood flow to the heart. C. facilitating vasoconstriction, which maintains coronary perfusion pressure. D. dilating the coronary arteries, which reduces cardiac afterload.

Answer 42

B. creating a vacuum in the chest, which increases blood flow to the heart.

Question 43

You have been attempting resuscitation of an 80-year-old woman for approximately 15 minutes. An advanced airway has been placed, ventilations have been delivered at the appropriate rate, high-quality CPR was performed with minimal interruptions, and rhythms-specific medications were administered. Despite your efforts, the patient remains in asystole. Which of the following statements regarding this scenario is correct? A. You have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered. B. Transcutaneous cardiac pacing may restore a perfusing rhythm and should therefore be attempted immediately. C. It would be advisable to attempt a single defibrillation in case the patient was actually in fine ventricular fibrillation. D. Since older people are prone to hypothermia, and hypothermia protects the hypoxic brain, you should continue your efforts for 5 more minutes.

Answer 43

A. You have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered.

Question 44

You and your partner arrive at the scene of an unresponsive middle-aged man. Your primary assessment reveals that he is apneic and pulseless. Which of the following interventions will provide the BEST chance of survival for this patient? A. CPR at the appropriate rate and with minimal interruptions B. Five minutes of CPR prior to analyzing his cardiac rhythm C. Immediate defibrillation for presumed ventricular fibrillation D. Prompt insertion of an advanced airway to prevent aspiration

Answer 44

A. CPR at the appropriate rate and with minimal interruptions

Question 45

When practicing a -code,- whether in the prehospital or in-hospital setting, the primary focus should be on: A. timely defibrillation and early tracheal intubation. B. teamwork and minimal interruptions in CPR. C. the use of technology during a cardiac arrest. D. independent performance and drug administration.

Answer 45

B. teamwork and minimal interruptions in CPR.

Question 46

The paramedic should consider extending the resuscitation effort of a patient with refractory cardiac arrest if: A. the cardiac arrest was caused by submersion in warm water. B. the patient has no known significant past medical history. C. return of spontaneous circulation of any duration occurred. D. ventricular fibrillation occurred at any point during the arrest.

Answer 46

C. return of spontaneous circulation of any duration occurred.

Question 47

A 6-year-old, 40-pound child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to: A. check for a carotid pulse. B. defibrillate with 70 joules. C. insert an IO catheter. D. insert an advanced airway.

Answer 47

B. defibrillate with 70 joules.

Question 48

Which of the following statements regarding the use of vasopressin during cardiac arrest is correct? A. Vasopressin has been shown to be clinically superior to epinephrine. B. Vasopressin may be substituted for the second dose of epinephrine. C. If used during cardiac arrest, vasopressin is given in a dose of 20 units. D. If the patient is in asystole, vasopressin can be given every 5 minutes.

Answer 48

B. Vasopressin may be substituted for the second dose of epinephrine.

Question 49

Full recoil of the chest in between compressions enhances blood return to the heart by which of the following mechanisms? A. Decreased myocardial preload B. Coronary artery vasoconstriction C. Negative intrathoracic pressure D. Increased residual lung volume

Answer 49

C. Negative intrathoracic pressure

Question 50

When using an impedance threshold device during cardiac arrest, it is important to: A. deliver each ventilation over a period of 1 second. B. hyperinflate the lungs to improve coronary perfusion. C. increase the ventilation rate by 6 to 8 breaths/min. D. allow partial chest recoil in between compressions.

Answer 50

A. deliver each ventilation over a period of 1 second.

Question 51

You have an impedance threshold device (ITD) attached to the endotracheal tube as you ventilate an apneic and pulseless patient. Following defibrillation and 2 additional minutes of CPR, it is determined that return of spontaneous circulation has occurred. However, the patient is still apneic. You should: A. remove the ITD and continue ventilations at a rate of 10 to 12 breaths/min. B. leave the ITD attached to the endotracheal tube and continue to ventilate. C. hyperventilate the patient to eliminate excess carbon dioxide from the blood. D. leave the ITD attached, but increase your ventilation rate to 15 breaths/min.

Answer 51

A. remove the ITD and continue ventilations at a rate of 10 to 12 breaths/min.

Question 52

While en route to the scene of a patient in cardiac arrest, the emergency medical dispatcher advises you that she has the caller on the phone, but the caller refuses to do CPR on the patient. With an estimated time of arrival at the scene of 5 minutes, you should: A. have the dispatcher reassure the caller that he will not contract a disease. B. ask the dispatcher to inform the man to do chest compressions only. C. recall that the caller has a legal and moral duty to act in this situation. D. advise the dispatcher to tell the caller that the patient will die without CPR.

Answer 52

B. ask the dispatcher to inform the man to do chest compressions only.

Question 53

An unresponsive, apneic, and pulseless man presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to his arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of his condition? A. No pulse with CPR and jugular venous distention B. Unilaterally absent breath sounds and mottled skin C. Profoundly cyanotic skin and collapsed jugular veins D. Bilaterally absent breath sounds and severe pallor

Answer 53

A. No pulse with CPR and jugular venous distention

Question 54

After determining that an unresponsive adult patient is not breathing, you should: A. reposition the patient’s airway and reassess for breathing. B. assess for a carotid pulse for no longer than 10 seconds. C. perform a finger sweep of the patient’s mouth to remove any debris. D. give two rescue breaths that make the chest visibly rise.

Answer 54

B. assess for a carotid pulse for no longer than 10 seconds.