JBL230

Question 1

You are assessing a 75-year-old male who experienced a sudden onset of slurred speech, a right-sided facial droop, and left-sided hemiparesis approximately 45 minutes ago. His blood pressure is 170/94 mm Hg, pulse rate is 68 beats/min and irregular, and respirations are 14 breaths/min and unlabored. His oxygen saturation is 92% on room air. The MOST appropriate treatment for this patient includes:

Answer 1

supplemental oxygen via nasal cannula, cardiac monitoring, blood glucose assessment, an IV of normal saline set to keep the vein open, and prompt transport.

Question 2

Which of the following 12-lead ECG findings signifies a left bundle branch block?

Answer 2

QRS duration of 124 ms; terminal S wave in lead V1

Question 3

You are preparing to defibrillate a patient in cardiac arrest with a manual biphasic defibrillator, but are unsure of the appropriate initial energy setting. What should you do?

Answer 3

Deliver one shock with 200 joules and resume CPR.

Question 4

Which of the following pain descriptions is MOST consistent with a cardiac problem?

Answer 4

Crushing

Question 5

Occlusion of the right coronary artery would MOST likely result in:

Answer 5

sinoatrial node failure.

Question 6

A 145-pound man requires a dopamine infusion at 15 µg/kg/min for severe hypotension. You have a premixed bag containing 800 mg of dopamine in 500 mL of normal saline. If you are using a microdrip administration set (60 gtts/mL), how many drops per minute should you deliver to achieve the required dose?

Answer 6

36

Question 7

When administering epinephrine to a patient in cardiac arrest, the MAIN desired effect is:

Answer 7

vasoconstriction, which improves coronary and cerebral perfusion.

Question 8

You are transporting a 60-year-old woman with chest discomfort and shortness of breath. The 12-lead ECG indicates an acute anterior wall MI. The patient is receiving oxygen and an IV has been established. You have administered 324 mg of aspirin, 3 sublingual nitroglycerin, and 5 mg of morphine. Which of the following should concern you the MOST during transport?

Answer 8

An acute cardiac dysrhythmia

Question 9

Unlike a second-degree AV block type I, a second-degree AV block type II is characterized by:

Answer 9

consistent P-R intervals following conducted P waves.

Question 10

Atropine sulfate exerts its therapeutic effect by

Answer 10

opposing the vagus nerve.

Question 11

Paramedics are attempting to resuscitate a 71-year-old female who is pulseless and apneic. The cardiac monitor reveals ventricular fibrillation, which has persisted after four shocks, two doses of epinephrine, and two doses of amiodarone. Upon receiving information that the patient has chronic renal failure, the paramedic should administer:

Answer 11

1 g of calcium chloride.

Question 12

A 78-year-old female experienced a syncopal episode. She is now conscious, but complains of dizziness and generalized weakness, and her pulse is 150 beats/min and irregular. The paramedic should recognize that this patient’s syncope was MOST likely the result of:

Answer 12

An acute cardiac dysrhythmia.

Question 13

After performing synchronized cardioversion on an unstable patient with a wide-complex tachycardia, you look at the monitor and see coarse ventricular fibrillation. The patient is unresponsive, apneic, and pulseless. You should:

Answer 13

Start CPR, ensure the synchronize mode is off, and defibrillate.

Question 14

You are transporting a 44-year-old man with shortness of breath. He is conscious alert and is receiving supplemental oxygen. A patent IV line has been established. Suddenly, he develops the rhythm shown below. He is now responsive to pain only; is profusely diaphoretic; and has weak radial pulses. You should:
(V-Tach)

Answer 14

perform synchronized cardioversion with 100 joules.

Question 15

A 60-year-old female presents with confusion, shortness of breath, and diaphoresis. Her blood pressure is 70/40 mm Hg and her heart rate is 40 beats/min. The cardiac monitor reveals a slow, wide complex rhythm with dissociated P waves. After applying supplemental oxygen, you should:

Answer 15

begin immediate transcutaneous pacing.

Question 16

When administering a sympathomimetic medication, you must be alert for:

Answer 16

cardiac dysrhythmias.

Question 17

Cardioversion involves delivering a shock that is synchronized to occur during the:

Answer 17

R wave.

Question 18

A 59-year-old male with a monomorphic wide-complex tachycardia at a rate of 220 beats/min, a blood pressure of 80/50 mm Hg, and a decreased level of consciousness, should be treated with:

Answer 18

synchronized cardioversion.

Question 19

Which of the following ECG lead configurations is correct?

Answer 19

To assess lead II, place the negative lead on the right arm and the positive lead on the left leg.

Question 20

Immediately after establishing a return of spontaneous circulation in a woman with ventricular fibrillation of short duration, you should:

Answer 20

assess her ventilatory status and treat accordingly.

Question 21

You are treating a patient with ventricular fibrillation. As the defibrillator is charging, you should:

Answer 21

ensure that CPR is continuing until the defibrillator is charged.

Question 22

signifies moderate heart failure.

Answer 22

signifies moderate heart failure.

Question 23

A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you should:

Answer 23

administer up to 325 mg of aspirin.

Question 24

A patient’s medication regimen includes fluoxetine, Toprol, Proscar, lansoprazole, and Klonopin. Which of these medications is used to treat cardiovascular disorders?

Answer 24

Toprol

Question 25

A 70-year-old man presents with the cardiac rhythm shown below. He is confused, is slow to answer your questions, and is profusely diaphoretic. His blood pressure is 76/54 mm Hg, his pulse is rapid and weak, and his respirations are 22 breaths/min and labored. He is receiving high-flow oxygen and your partner has established a patent IV line. You should:
(Vtach)

Answer 25

consider sedation and then cardiovert with 100 joules.

Question 26

Side effects of atropine sulfate may include:

Answer 26

acute urinary retention.

Question 27

A 60-year-old man presents with chest discomfort, diaphoresis, and dyspnea. The 12-lead ECG reveals 4-mm ST segment elevation in leads V1 through V4. You should suspect:

Answer 27

anteroseptal injury.

Question 28

A clinically unstable patient presents with an irregular narrow-complex tachycardia at a rate of 170 per minute. What is the recommended initial energy setting for synchronized cardioversion?

Answer 28

120 to 200 joules

Question 29

A 47-year-old male took two of his prescribed nitroglycerin tablets prior to calling EMS. When you arrive at the scene, the patient tells you that he has a throbbing headache and is still experiencing chest pain. Your MOST immediate suspicion should be that:

Answer 29

he is experiencing continued myocardial ischemia.

Question 30

In the context of an acute coronary syndrome, the presence of dyspnea should make you MOST suspicious for:

Answer 30

pulmonary congestion.

Question 31

What are the therapeutic effects of aspirin when given to patients experiencing an acute coronary syndrome?

Answer 31

Prevents platelet aggregation

Question 32

Which of the following ECG findings indicates a pathologic delay at the AV node?

Answer 32

P-R interval of 0.28 seconds

Question 33

You have defibrillated a patient who presented with ventricular fibrillation. After 2 minutes of CPR, you reassess the patient’s cardiac rhythm and see a wide-complex tachycardia. You should:

Answer 33

check for a carotid pulse and defibrillate if a pulse is absent.

Question 34

Which of the following findings is MOST suggestive of right-sided heart failure?

Answer 34

Engorged jugular veins

Question 35

A patient’s cardiac rhythm is irregular and the rate is 50 per minute. There are more P waves than QRS complexes, and the PR intervals vary in duration. The paramedic should interpret the cardiac rhythm as:

Answer 35

second-degree AV block.

Question 36

During resuscitation of a 60-year-old man with ventricular fibrillation, you restore spontaneous circulation following CPR, defibrillation, two doses of epinephrine, and one dose of amiodarone. The patient remains unresponsive and apneic. Which of the following represents the MOST appropriate post-arrest care for this patient?

Answer 36

Ventilate at a rate of 10 to 12 breaths/min, support blood pressure, and obtain a 12-lead ECG.

Question 37

You are assessing a man with a acute chest pain. As you are inquiring about the quality of his pain, he clenches his fist. This is called __________ sign and nonverbally conveys a feeling of:

Answer 37

Levine’s, pressure

Question 38

A 70-year-old man presents with an acute onset of confusion, slurred speech, and left side weakness. According to his daughter, he has high blood pressure and has had several “small strokes” over the past 6 months. Your partner applies supplemental oxygen; assesses his vital signs, which are stable; and assesses his blood glucose level, which reads 35 mg/dL. You attempt to perform the Cincinnati Prehospital Stroke test, but the patient is unable to understand your instructions. After establishing IV access, you should:

Answer 38

administer 50% dextrose, monitor his cardiac rhythm, protect his impaired extremities, and transport.

Question 39

A 71-year-old male presents with chest pain and shortness of breath. He is conscious, but confused, and is profusely diaphoretic. He has weakly palpable radial pulses, a BP of 70/40 mm Hg, and diffuse crackles in all lung fields. You administer high-flow oxygen and apply the cardiac monitor, which reveals sinus tachycardia. The closest appropriate hospital is 40 miles away. Which of the following is the MOST appropriate next action?

Answer 39

Begin an infusion of dopamine.

Question 40

At the end of ventricular relaxation, the left ventricle contains 110 mL of blood. This is referred to as the:

Answer 40

Preload

Question 41

Sudden cardiac arrest in the adult population is MOST often secondary to:

Answer 41

a cardiac dysrhythmia

Question 42

When attempting transcutaneous cardiac pacing (TCP), you will know that electrical capture has been achieved when:

Answer 42

Each pacemaker spike is followed by a wide QRS complex.

Question 43

You are assessing a 59-year-old woman who complains of chest pressure. When you are looking at her list of medications, you note that she takes Vasotec. What type of medication is this?

Answer 43

ACE inhibitor

Question 44

ECG indicators of Wolff-Parkinson-White (WPW) syndrome include

Answer 44

short PR intervals, delta waves, and QRS widening.

Question 45

A 54-year-old man presents with the following cardiac rhythm. The paramedic’s initial action should be to (Brady)

Answer 45

assess for hemodynamic compromise.

Question 46

The appropriate second dose and method of administration of amiodarone for a patient with refractory ventricular fibrillation is:

Answer 46

150 mg via rapid IV/IO push.
The initial dose of amiodarone for a patient with refractory ventricular fibrillation or pulseless ventricular tachycardia is 300 mg via rapid IV or IO push. A second dose of 150 mg via rapid IV or IO push may be repeated one time in 5 minutes. For supraventricular tachycardia or ventricular tachycardia with a pulse, amiodarone should be given in a dose of 150 mg over 10 minutes; this same dose may be repeated as needed.

Question 47

An older man is suddenly awakened in the middle of the night, gasping for air. He is extremely restless and pale, and is coughing up blood. His clinical presentation is MOST consistent with:

Answer 47

left side heart failure.

Question 48

What are the physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain, pressure, or discomfort?

Answer 48

Smooth muscle relaxation and decreased preload

Question 49

You are called to a local supermarket where a customer collapsed. When you arrive, two bystanders are performing CPR on the patient. You should:

Answer 49

assess the patient to confirm pulselessness and apnea.

Question 50

You and your team are attempting to resuscitate a 66-year-old man in cardiac arrest. The cardiac monitor reveals a slow, wide-complex rhythm. The patient has been successfully intubated and an IV line has been established. As CPR is ongoing, you should:

Answer 50

administer 10 mL of epinephrine 1:10,000 IV.

Question 51

A 59-year-old male presents with chest pressure and nausea. His BP is 106/60 mm Hg, his pulse is 68 beats/min and regular, his respirations are 16 breaths/min and unlabored, and his oxygen saturation is 97%. The 12-lead ECG reveals a sinus rhythm with 3-mm ST elevation in leads II, III, and aVF, and ST depression in leads I and aVL. After administering aspirin, the paramedic should:

Answer 51

obtain a right-sided 12-lead ECG and establish IV access.

Question 52

Where is the point of maximal impulse (PMI) located in most people?

Answer 52

Left anterior chest, in the midclavicular line, at the fifth intercostal space

Question 53

A 72-year-old male presents with an acute onset of confusion, slurred speech, and decreased movement of his right arm. The patient’s wife tells you that this began about 20 minutes ago, and that he was fine before that. He has type II diabetes, hypertension, and atrial fibrillation. Given this patient’s clinical presentation and past medical history, you should be MOST suspicious that he has:

Answer 53

an occluded cerebral artery.

Question 54

A 27-year-old female complains of palpitations. The cardiac monitor reveals a narrow-complex tachycardia at 180/min. She denies any other symptoms, and states that this has happened to her before, but it typically resolves on its own. Her blood pressure is 126/66 mm Hg, pulse is 180 beats/min, and respirations are 16 breaths/min. After attempting vagal maneuvers and giving two doses of adenosine, her cardiac rhythm and vital signs remain unchanged. You should:

Answer 54

transport at once, reassess her frequently, and perform synchronized cardioversion if necessary.

Question 55

What occurs at the beginning of ventricular contraction?

Answer 55

The atrioventricular valves close and the semilunar valves are forced open.

Question 56

Which of the following electrolytes moves slowly into the cardiac cell and maintains the depolarized state of the cell membrane?

Answer 56

Calcium

Question 57

A 49-year-old male complains of generalized weakness that began about a week ago. He is conscious and alert and is breathing adequately. His blood pressure is 138/78 mm Hg, pulse is 130 beats/min and irregular, and respirations are 14 breaths/min. You administer supplemental oxygen and apply the cardiac monitor, which reveals atrial fibrillation; a 12-lead ECG tracing reveals the same. The patient denies any significant medical problems and takes no medications. After establishing IV access, you should:

Answer 57

administer 0.25 mg/kg of diltiazem and transport for evaluation.

Question 58

A 56-year-old man presents with the cardiac rhythm. He complains of chest discomfort, shortness of breath, and is profusely diaphoretic. His blood pressure is 84/64 mm Hg and his radial pulses are barely palpable. You should:
Sinus-Tach 220

Answer 58

consider sedation and perform cardioversion.

Question 59

You are assessing a 67-year-old female with chest discomfort when she becomes unresponsive, apneic, and pulseless. The cardiac monitor reveals coarse ventricular fibrillation. You achieve return of spontaneous circulation after 4 minutes and the cardiac monitor now reveals a narrow complex rhythm. The patient is still unresponsive, has occasional respirations, a blood pressure of 70/40 mm Hg, and a weak pulse of 70 beats/min. The MOST appropriate postresuscitation care for this patient includes:

Answer 59

insertion of an airway adjunct, assisted ventilation with a bag-valve-mask device, vascular access, a 500- to 1,000-mL crystalloid fluid bolus, and an amiodarone infusion at 1 mg/min.

Question 60

Which of the following causes of pulseless electrical activity (PEA) would be the MOST likely to respond to immediate treatment in the prehospital setting?

Answer 60

Hypovolemia

Question 61

A 62-year-old male complains of chest pain, nausea, and weakness. His BP is 118/68 mm Hg, his pulse is 60 beats/min, and his respirations are 18 breaths/min. His medical history includes diabetes, anxiety, and hypertension. He currently takes insulin, tadalafil, lisinopril, and alprazolam. Which of the patient’s medications would MOST likely alter the paramedic’s normal treatment plan?

Answer 61

Tadalafil

Question 62

Which of the following signs or symptoms occurs more commonly in patients with stable angina than in those with unstable angina?

Answer 62

Chest pain that begins during exertion

Question 63

When assessing a patient with suspected cardiac-related chest pain, which of the following questions would be MOST appropriate to ask?

Answer 63

Can you describe the quality of the pain?

Question 64

Which of the following findings would lead the paramedic to suspect pericarditis when assessing a 40-year-old male with chest pain and no cardiac history?

Answer 64

The pain decreases when the patient sits forward

Question 65

You are assessing the cardiac rhythm of a woman with respiratory distress. The rhythm is irregularly irregular with a rate of 120 beats/min. The QRS complexes measure 0.10 seconds in duration, the P wave to QRS ratio is 1:1, and the P waves vary in shape. Which of the following BEST fits this description?

Answer 65

Multifocal atrial tachycardia

Question 66

If a patient was experiencing acute injury involving the interventricular septum and anterior wall of the left ventricle, you would expect the 12-lead ECG to reveal:

Answer 66

ST segment elevation in leads V1 through V4.

Question 67

When treating an adult patient with a blood pressure of 60/40 mm Hg, confusion, a heart rate of 40 beats/min, and sinus bradycardia on the cardiac monitor, you should administer supplemental oxygen, establish vascular access, and then:

Answer 67

administer 0.5 mg of atropine sulfate and consider transcutaneous cardiac pacing.

Question 68

A 39-year-old female presents with an acute onset of lightheadedness. The cardiac monitor reveals a tachycardic rhythm at 185 beats/min with QRS complexes that measure 0.08 seconds in duration. Despite vagal maneuvers and adenosine, her cardiac rhythm remains unchanged. She is conscious and alert, has a blood pressure of 118/72 mm Hg, and denies shortness of breath or chest discomfort. You should:

Answer 68

transport immediately and monitor her en route.

Question 69

In contrast to unstable angina, stable angina occurs when a patient:

Answer 69

experiences chest discomfort after a certain, predictable amount of exertion.

Question 70

You respond to a residence for a 68-year-old male with nausea, vomiting, and blurred vision. As you are assessing him, he tells you that he has congestive heart failure and atrial fibrillation, and takes numerous medications. The cardiac monitor reveals atrial fibrillation with a ventricular rate of 50 beats/min. Which of the following medications is MOST likely responsible for this patient’s clinical presentation?

Answer 70

Digoxin

Question 71

A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes ago. He is diaphoretic, anxious, and rates his pain as an 8 over 10. His past medical history is significant for hypertension, type II diabetes, and coronary stent placement 2 months ago. He takes lisinopril, Plavix, and Glucophage, and is wearing a medical alert bracelet stating “allergic to salicylates.” His blood pressure is 160/100 mm Hg, pulse is 110 beats/min, and respirations are 22 breaths/min. The 12-lead ECG shows sinus tachycardia with 3-mm ST segment elevation in leads V1 through V4. Which of the following treatment modalities is MOST appropriate for this patient?

Answer 71

Supplemental oxygen, vascular access, up to three 0.4 mg doses of nitroglycerin, and 2 to 4 mg of morphine sulfate if his systolic BP is greater than 90 mm Hg and he is still experiencing pain

Question 72

A 59-year-old woman presents with a regular, narrow-complex tachycardia at a rate of 180 beats/min. She is conscious and alert, but complains of chest discomfort and has a blood pressure of 96/56 mm Hg. In addition to giving her supplemental oxygen, you should:

Answer 72

have her chew and swallow 325 mg of aspirin.

Question 73

You are assessing a middle-aged female who complains of chest discomfort. She is conscious, alert, and oriented. Her skin is diaphoretic. Her blood pressure is 122/72 mm Hg, her pulse rate is 120 beats/min, and her respirations are 20 breaths/min. On the basis of her chief complaint, which of your assessment findings is the MOST significant?

Answer 73

Pulse rate of 120 beats/min

Question 74

When assessing a patient with sinus tachycardia at a rate of 135 beats/min, you should recall that:

Answer 74

rate-related symptoms are uncommon in patients with a heart rate less than 150 beats/min.

Question 75

Which of the following is an absolute contraindication for fibrinolytic therapy?

Answer 75

Subdural hematoma 3 years ago

Question 76

On the 12-lead ECG, the high lateral wall of the left ventricle is viewed by leads:

Answer 76

I and aVL.

Question 77

A middle-aged man is found unresponsive, pulseless, and apneic. His cardiac arrest was not witnessed, although his skin is still warm to the touch. You should:

Answer 77

begin immediate high-quality CPR.

Question 78

The main purpose of listening to heart sounds is to:

Answer 78

determine if the cardiac valves are functioning properly.

Question 79

Which of the following represents the appropriate initial drug and dose that is given to all adult patients in cardiac arrest?

Answer 79

10 mL of epinephrine 1:10,000 every 3 to 5 minutes

Question 80

When assessing lead II in a patient with a heart rate of 70 beats/min, the Q-T interval is considered prolonged if it is:

Answer 80

greater than one half of the R-R interval.

Question 81

You are attempting to resuscitate a 50-year-old man in cardiac arrest. The patient has a history of congestive heart failure, hypertension, and cirrhosis of the liver. The cardiac monitor reveals a slow, wide complex rhythm. CPR is ongoing and the patient has been intubated. In addition to looking for potentially reversible causes of the patient’s condition, further treatment should include:

Answer 81

ventilations at a rate of 10 breaths/min and 1 mg of epinephrine 1:10,000 every 3 to 5 minutes.

Question 82

A 70-year-old woman was suddenly awakened with the feeling that she was suffocating. She is anxious, is laboring to breathe, and has dried blood on her lips. The ECG shows the cardiac rhythm below. Which of the following pathophysiologies BEST explains her clinical presentation
SVT pwave

Answer 82

Decreased stroke volume with left heart failure

Question 83

When assessing a patient’s pulse, you note that it is fast and has an irregularly irregular pattern. On the basis of these findings, which of the following cardiac rhythms would MOST likely be seen on the cardiac monitor?

Answer 83

Uncontrolled atrial fibrillation

Question 84

In which of the following situations is transcutaneous cardiac pacing (TCP) clearly indicated?

Answer 84

Third-degree AV block in a patient with pulmonary edema.

Question 85

A 56-year-old man has had chest pain for the past 2 days, but refused to go to the hospital. His wife called EMS when she noticed that he was not acting right. He is conscious, but confused, and is diaphoretic. His BP is 80/40 mm Hg and his pulse is rapid and weak. The patient’s history and your assessment findings are MOST consistent with:

Answer 85

cardiogenic hypoperfusion.

Question 86

What are the therapeutic effects of morphine sulfate when administered to a patient with cardiogenic pulmonary edema?

Answer 86

Increased venous capacitance and decreased preload

Question 87

A 56-year-old man complains of chest pain that began while he was lying in bed reading a book. He appears anxious and frightened. His skin is pink, warm, and moist; his pulse is 74 beats/min and strong; and his respirations are 18 breaths/min and unlabored. His medical history includes hypertension and angina. His medications include lisinopril and nitroglycerin, but he tells you that he ran out of his nitroglycerin tablets a week ago. Which of the following is the MOST clinically significant of these findings?

Answer 87

He was at rest when the chest pain began

Question 88

A 54-year-old man presents with chest pressure, confusion, and profuse diaphoresis. As your partner administers supplemental oxygen, you apply the cardiac monitor. In lead II, you observe a wide QRS complex rhythm with dissociated P waves and a ventricular rate of 35 beats/min. You should:

Answer 88

begin transcutaneous pacing at once.

Question 89

A 30-year-old man complains of nausea and one episode of vomiting. He is conscious and alert and states that he has a slight headache. He denies chest pain or shortness of breath, and his skin is pink, warm, and dry. His BP is 136/88 mm Hg, pulse is 44 beats/min and strong, and respirations are 14 breaths/min and unlabored. The cardiac monitor reveals sinus bradycardia. Treatment for this patient should include:

Answer 89

supportive care and transport to the hospital.

Question 90

Which of the following findings is observed with right bundle branch block?

Answer 90

Terminal R wave in lead V1

Question 91

dialysis every day, but has missed his last three treatments. She also tells you that he has high blood pressure, hyperthyroidism, and had cardiac bypass surgery 3 years ago. Based on the patient’s medical history, which of the following conditions is the MOST likely underlying cause of his condition?

Answer 91

Hyperkalemia

Question 92

After determining that an elderly man is pulseless and apneic, you and your team begin CPR and briefly pause to assess his cardiac rhythm, which is shown below. After resuming CPR, you should:
Sinus-tach

Answer 92

establish vascular access and give 1 mg of epinephrine.

Question 93

Appropriate treatment for asystole includes:

Answer 93

epinephrine 1:10,000 and advanced airway management.

Question 94

The initial dose of diltiazem for a 165-pound patient is approximately:

Answer 94

19 mg. (.25mg per KG)

Question 95

Which of the following represents the correct adult dosing regimen for adenosine?

Answer 95

Which of the following represents the correct adult dosing regimen for adenosine?

Question 96

A 44-year-old man presents with the rhythm shown below. He complains of nausea, but denies vomiting. He is conscious and alert with a BP of 122/62 mm Hg, a pulse rate of 98 beats/min, and respirations of 16 breaths/min and unlabored. Treatment for this patient would MOST likely include:
Fast A-Flutter

Answer 96

ondansetron, 4 mg.

Question 97

You are assessing a 50-year-old man with acute chest pressure, diaphoresis, and nausea. The 12-lead ECG tracing reveals 3-mm ST segment elevation in leads V3 through V6. This indicates:

Answer 97

anterolateral injury.

Question 98

A 35-year-old female experienced a syncopal episode shortly after complaining of palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival, she is conscious and alert, denies any injuries, and states that she feels fine. She further denies any significant medical history. Her vital signs are stable and the cardiac monitor reveals a sinus rhythm with frequent premature atrial complexes. On the basis of this information, which of the following would be the MOST likely cause of her syncopal episode?

Answer 98

Paroxysmal supraventricular tachycardia

Question 99

Which of the following clinical presentations is MOST consistent with an acute ischemic stroke involving the left cerebral hemisphere?

Answer 99

Aphasia, lethargy, right side hemiparesis, right side facial droop

Question 100

Which of the following cardiac rhythms is associated with bradycardia, and is characterized by regular R-R intervals and a greater ratio of P waves to QRS complexes?

Answer 100

Third-degree AV block

Question 101

What is the correct initial dose and rate of administration of amiodarone for a patient with refractory ventricular fibrillation?

Answer 101

300 mg via rapid IV or IO push

Question 102

While assessing a middle-aged man who complains of nausea and weakness, he suddenly becomes unresponsive. The cardiac monitor shows that he is in ventricular fibrillation. After determining that he is apneic and pulseless, you should:
poly-morphic V-tach

Answer 102

start CPR and prepare to defibrillate.

Question 103

Which of the following interventions has the greatest impact on patient survival from sudden cardiac arrest?

Answer 103

Early CPR and defibrillation

Question 104

A patient experiencing a right ventricular infarction would be expected to present with:

Answer 104

ST elevation in leads II, III, and aVF.

Question 105

You are treating a 68-year-old woman with chest pressure and shortness of breath that started 2 days ago. Her BP is 76/52 mm Hg and her pulse is 130 beats/min and weak. The cardiac monitor reveals sinus tachycardia with occasional PVCs and auscultation of her lungs reveals diffuse coarse crackles. Which of the following treatment interventions is MOST appropriate for this patient?

Answer 105

Dopamine, 2 to 20 mcg/kg/min

Question 106

Which of the following assessment findings would be the MOST clinically significant in a 60-year-old patient with a BP of 240/120 mm Hg?

Answer 106

Slurred speech

Question 107

Which of the following clinical presentations is MOST consistent with dissection of the ascending aorta?

Answer 107

Acute tearing pain in between the scapulae, blood pressure discrepancy between arms, maximal pain severity from the onset

Question 108

During your SAMPLE history of an elderly man, he tells you that his cardiologist told him that he has an “irregular heartbeat.” His medications include warfarin sodium and digoxin. On the basis of this information, what underlying cardiac rhythm should you suspect?

Answer 108

Atrial fibrillation

Question 109

You are evaluating a regular cardiac rhythm in lead II. The rate is 90 beats/min, the QRS complexes consistently measure 0.16 seconds, and inverted P waves are seen immediately following each QRS complex. The rhythm described is MOST characteristic of a/an:

Answer 109

accelerated junctional rhythm with ventricular aberrancy.

Question 110

A patient with acute chest discomfort displays the cardiac rhythm shown below. Which of the following is the MOST detrimental effect that this rhythm can have on the patient?
Sinus-Tach

Answer 110

Increased myocardial oxygen demand

Question 111

When obtaining a 12-lead ECG, lead V1 should be placed:

Answer 111

in the fourth intercostal space just to the right of the sternum.

Question 112

You and your team are performing CPR on a middle-aged male who presented with asystole. After 2 minutes of CPR, you reassess him and note that his cardiac rhythm has changed to ventricular fibrillation. You should:

Answer 112

defibrillate and then resume CPR.

Question 113

A 50-year-old woman is pulseless and apneic. Your partner and an emergency medical responder are performing well-coordinated CPR. After 2 minutes of CPR, the cardiac monitor reveals coarse ventricular fibrillation. You should:

Answer 113

deliver a single shock and immediately resume CPR.

Question 114

A 65-year-old man has had vomiting and diarrhea for the past 2 days and complains of severe weakness. His cardiac rhythm is shown below. Treatment for him should include:

Looks like sinus tach maybe SVT pwave intact

Answer 114

crystalloid fluid boluses.

Question 115

What is the therapeutic effect of aspirin when administered to a patient experiencing an acute coronary syndrome (ACS)?

Answer 115

Decreased thromboxane A2 production, which inhibits platelet aggregation

Question 116

In addition to CPR, the recommended treatment sequence for an unresponsive, apneic, and pulseless patient with a regular, wide-complex cardiac rhythm at a rate of 40 beats/min includes:

Answer 116

mg of epinephrine every 3 to 5 minutes and treating reversible causes.

Question 117

Which of the following statements regarding right ventricular failure (RVF) is correct?

Answer 117

Sacral and pedal edema are common signs of RVF.