EMT Practice Exam Cardiac and Resuscitation Flashcards
If a patient has suffered a myocardial infarction to the right ventricle, blood flow to what structure may become impaired initially?
a. Aorta
b. Lungs
c. Brain
d. Pulmonary veins
D. Rationale: The right ventricle pumps blood to the lungs for reoxygenation. If the right side of the heart is failing from an infarction, then lung perfusion could falter. This commonly causes the patient to experience dyspnea, but the lung sounds are often clear. The brain and aorta are perfused by blood flow coming from the left ventricle, and the pulmonary veins carry oxygenated blood from the lungs to the left atrium.
The best-known and most common finding associated with a patient suffering an acute coronary syndrome is what?
a. Nausea
b. Dyspnea
c. Sweating
d. Chest pain
D. Rationale: Although it may not be present in every single MI, and at times it may present as chest “pressure” rather than chest “pain,” chest pain is the most common and most readily recognized finding when a person experiences some type of acute coronary syndrome event. This commonly signals heart muscle that is starving for more oxygen than the diseased arteries can provide. Nausea, dyspnea, and sweating may all be present during an MI (commonly from stimulation of the sympathetic nervous system), but they individually are not more common than chest pain.
A patient experiencing bradycardia would have what finding?
a. A heart rate of 48/min
b. A pulse rhythm that is irregular
c. A respiratory rate that is 6/min
d. A pulse pressure less than 20 mm Hg
A. Rationale: Bradycardia is a term that is used to describe a heart rate that is less than 60 beats per minute. That’s not to say the bradycardia is detrimental to the patient’s condition, but simply that it is less than 60/minute. An irregular heart rhythm is described exactly like that—irregular. Bradypnea describes a slow respiratory rate, and a narrow pulse pressure is used to describe the finding of a pulse pressure that is too low.
Of the following segments of the population, which is most likely to experience atypical presentations of a myocardial infarction?
a. Asian males
b. Elderly females
c. Younger African Americans
d. American Indian descendants
B. Rationale: Females and the elderly are the most common segments of the population to not have a typical presentations of an MI. Many times they will not experience outright chest pain; rather, they may complain of fatigue, swollen ankles, and mild dyspnea. The other segments of the population listed do not have a specific predisposition to alterations in MI presentation.
EMTs are treating a patient suspected of experiencing a myocardial infarction. Her initial vital signs are pulse 124, BP 158/100, respiration 22 and shallow, skin pale and sweaty, oxygen saturation 92 percent. Of the following options, which one should the EMT perform first (assuming all could be done immediately)?
a. Apply oxygen
b. Administer nitro
c. Administer baby aspirin
d. Attach the AED and press “analyze”
A. Rationale: Although oxygen is not administered to as many EMS patients with chest pain as was the case years ago, it is still an important part of the treatment for a patient with documented hypoxia. The use of baby aspirin typically occurs after taking the SAMPLE and OPQRST histories, as does the administration of nitro. An AED should be applied only when the patient is unresponsive, apneic, and pulseless (i.e., in cardiac arrest).
The patient’s use of which drug class of medications can be problematic if the EMT wishes to help an MI patient administer a sublingual nitro?
a. Antianginals
b. Erectile dysfunction
c. Metered-dose inhalers
d. Cholesterol-lowering drugs
B. Rationale: Erectile dysfunction drugs work, in part, by causing vasodilation of certain tissues to facilitate an erection. The problem, however, is that if a patient needs nitro for an MI or angina and has taken an erectile dysfunction drug with the past 24 to 72 hours (depending on the drug), the combination of these two medications can lower the blood pressure critically (and even fatally). The other medications listed do not share this precaution with the concurrent use of nitro.
Which of the following conditions is LEAST likely to be present in a patient suffering a myocardial infarction?
a. Headache
b. Diaphoresis
c. Tachycardia
d. Respiratory distress
A. Rationale: When a patient experiences a heart attack, there are a multitude of symptoms that are commonly present. For example, the patient typically becomes diaphoretic and tachycardic from the sympathetic discharge that often accompanies an MI. Respiratory distress could be from concurrent failure of the right or left ventricle during the MI. A headache, however, is not a consistent finding in a patient with an MI.
An elderly male patient is experiencing typical signs and symptoms of a myocardial infarction?
a. Request an ALS intercept
b. Have the patient chew baby aspirin
c. Allow the patient to take his wife’s nitro
d. Place the patient in a semi-Fowler’s position
C. Rationale: Although nitroglycerin may be warranted in a patient such as this, the EMT cannot assist in the administration of a medication that is not prescribed for that patient. The EMT can assist with the administration of only medication that is not prescribed to the patient for use with its appropriate indication, and it must be given via the correct route, at the correct redosing schedule, and be a current prescription (i.e., not expired). The other interventions—oxygen, aspirin, and requesting an ALS intercept—are things the EMT can and should do.
Assuming all of the following patients were experiencing an MI, which patient’s medical history would preclude her from receiving aspirin administration?
a. Stroke
b. Aspirin allergy
c. Diabetic
d. Hypertension
B. Rationale: Although aspirin has been shown to reduce death from MI, a known allergy to the drug still precludes its administration.
A patient with coronary artery disease is predisposed to what coronary event?
a. CVA
b. Seizures
c. Tachycardia
d. Myocardial infarction
D. Rationale: Coronary artery disease is a disease process in which the lumen of the coronary blood vessels becomes clogged and possibly occluded. When this occurs, a myocardial infarction or ischemic episode may occur. While the same disease process can occur in the rest of the arterial system, causing things such as seizures or strokes, occlusion of coronary blood vessels will result in damage to the coronary muscle.
Expedient transport of a patient experiencing an MI to the hospital is recommended so the hospital can administer what kind of medication in the hopes of stopping the MI progression?
a. Fibrinolytic
b. Beta2 specific
c. Antidysrhythmic
d. Antihypertensive
A. Rationale: One goal of MI management is to restore blood flow to the injured heart as soon as possible. This done in the hospital by one of two methods: the use of drugs to dissolve the clot (fibrinolytics) or the insertion of a catheter into the artery to reopen the blocked blood vessel. Finally, beta2-specific agents are used to dilate bronchial smooth muscle and have nothing to do with coronary dilation.
A patient with an apparent cardiac complaint asks the EMTs why they are administering nitro to him. What would be an appropriate response?
a. “Nitro makes it easier to breathe.”
b. “Nitro makes the blood pressure drop.”
c. “Nitro increases blood flow to your heart muscle.”
d. “Nitro causes the heart to beat harder and raise blood pressure.”
C. Rationale: Nitroglycerin is a coronary and peripheral smooth muscle relaxer of the muscles that surround the blood vessels. This results in coronary vasodilation, which increases blood flow to an ischemic heart. Although the relief of chest pain may ease breathing, this is not why nitro is given. Likewise, nitro can cause the blood pressure to drop, but again this is not its desired effect during an MI. Finally, nitro does not cause the heart to beat harder, nor does it cause an elevation in blood pressure.
A patient with a history of congestive heart failure is likely to have what other emergency when she deteriorates?
a. Pulmonary edema
b. Hypertensive crisis
c. Cerebral vascular accident
d. Severe headache with visual disturbances
A. Rationale: Congestive heart failure occurs when the heart weakens to a point where it fails to pump all the blood it receives. When fluid starts to back up, especially behind the left ventricle, the fluid will seep into the alveoli, causing pulmonary edema. A hypertensive crisis and CVA can both occur from the same pathology as CHF, but CHF does not in and of itself cause either. Finally, a severe headache with visual disturbances is more common with certain types of strokes.
You are caring for a fifty-nine-year-old male thought to be experiencing a heart attack. The patient initially described the pain as substernal and dull in character. The patient now, however, is becoming more and more lethargic and difficult to wake up. You also note the patient’s heart rate is becoming irregular. Vitals are blood pressure 82/62, heart rate 82 and irregular, and respirations 20. During the ongoing management of this MI, what part of normal MI management should you elect NOT to perform?
a. Administer oxygen
b. Ready the AED for application
c. Provide four 81-mg baby aspirin
d. Contact ALS for intercept en route to the hospital
C. Rationale: Although it may be evident to the EMT that this patient has physical findings consistent with an MI, warranting the use of aspirin (and nitro), the fact that the patient’s mental status is declining serves as a contradiction since the patient may aspirate the medication if the EMT cannot control the patient’s airway normally. Otherwise, the use of oxygen, preparing (but not applying) the AED, and contacting ALS for intercept are appropriate interventions if the patient’s status remains unchanged or declines further.
What is the most common reason an AED may shock a patient inappropriately?
a. Human failure in proper use
b. Inappropriate sensing of electrodes on the chest
c. Inability of the machine to charge quick enough to defibrillate a shockable rhythm
d. Failure of the AED processor to determine a shockable rhythm is either present or absent
A. Rationale: The technology that has gone into AED research, revision, and production has made this device almost flawless when used properly. In fact, the biggest contributor to inappropriate shocks is when it is used incorrectly by the EMT (i.e., the EMT did not confirm the patient was pulseless prior to application). Otherwise, when used appropriately, the device is nearly perfect in its execution.
