Midterm 2 Cardiology Flashcards by Tracy Johnson

A middle-aged woman took three of her prescribed nitroglycerin tablets after she began experiencing chest pain. She complains of a bad headache and is still experiencing chest pain. You should assume that:

A: her nitroglycerin is no longer potent.
B: her blood pressure is elevated.
C: she has ongoing cardiac ischemia.
D: her chest pain is not cardiac-related.

C: she has ongoing cardiac ischemia.

Reason:

A headache and/or a bitter taste under the tongue are common side effects of nitroglycerin (NTG) that many patients experience. If the patient does not experience these side effects, the NTG may have lost its potency. However, if a patient with chest pain takes NTG and experiences these side effects, but still has chest pain, you should assume that his or her pain is the result of cardiac ischemia, a relative deprivation of oxygen to the heart. NTG is a vasodilator drug; if anything, three doses would lower her blood pressure, not raise it. Any patient with nontraumatic chest pain or pressure should be assumed to be experiencing cardiac ischemia, especially if the pain or pressure is not relieved with NTG.

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Which of the following statements regarding the automated external defibrillator (AED) is correct?

A: AEDs will analyze the patient’s rhythm while CPR is in progress
B: AEDs can safely be used in infants and children less than 8 years of age
C: The AED should be applied to patients at risk for cardiac arrest
D: The AED should not be used in patients with an implanted defibrillator

B: AEDs can safely be used in infants and children less than 8 years of age

Reason:
According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), the AED can safely be used in infants and children less than 8 years of age. Although a manual defibrillator is preferred in infants, an AED can be used. When using the AED in infants and children, you should use pediatric pads and a dose-attenuating system (energy reducer); however, if these features are not available, adult AED pads should be used. The AED should only be applied to patients in cardiac arrest; if a patient is at risk for cardiac arrest, have the AED ready but not applied. The AED will not analyze the cardiac rhythm if the patient is moving (ie, CPR is in progress). AEDs can be used in patients with an automated implanted cardioverter/defibrillator (AICD) or implanted pacemaker; ensure that the pads are at least 1” away from the implanted device.

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A middle-aged female with a history of hypertension and high cholesterol complains of chest discomfort. She asks you to take her to the hospital where her personal physician practices, which is 15 miles away. Her blood pressure is 130/70 mm Hg, pulse is 84 beats/min and regular, and respirations are 18 breaths/min and unlabored. Which of the following actions is clearly NOT appropriate for this patient?

A: Taking her to her choice hospital
B: Allowing her to walk to the ambulance
C: Giving oxygen via nasal cannula
D: Contacting her physician via phone

B: Allowing her to walk to the ambulance

Reason:

You should NEVER allow a patient with a possible cardiac problem to walk to the ambulance. This causes exertion, which increases cardiac oxygen consumption and demand and could worsen his or her condition. Give the patient oxygen in a concentration sufficient to maintain his or her oxygen saturation equal to or greater than 94%. In general, you should transport patients to the hospital of their choice. However, transport to a closer hospital should be considered if you believe the patient is unstable or is at high risk for becoming unstable. If necessary, consult with the patient’s physician via phone to determine if he or she thinks the patient should go to a closer hospital.

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Aspirin is beneficial to patients experiencing an acute coronary syndrome because it:

A: prevents a clot from getting larger.
B: effectively relieves their chest pain.
C: decreases cardiac workload by lowering the BP.
D: destroys the clot that is blocking a coronary artery.

A: prevents a clot from getting larger.

Reason:

Early administration of baby aspirin (160 to 325 mg) to patients with acute coronary syndrome (ACS) has clearly been shown to reduce mortality and morbidity. Aspirin (acetylsalicylic acid [ASA]) prevents the clot in a coronary artery from getting larger by inhibiting platelet aggregation; in other words, it makes the platelets less sticky, which means that they will have less of a tendency to clump together. Aspirin does not relieve the chest pain or discomfort associated with ACS, nor does it reduce blood pressure. Furthermore, aspirin does not destroy the clot that is blocking a coronary artery; fibrinolytic (clot-buster) drugs actually destroy the clot.

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In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome would MOST likely present with:

A: profound cyanosis, dry skin, and a headache.
B: severe projectile vomiting and flushed skin.
C: ashen skin color, diaphoresis, and anxiety.
D: irregular breathing and low blood pressure.

C: ashen skin color, diaphoresis, and anxiety.

Reason:

Chest pain, pressure, or discomfort is the most common symptom of acute coronary syndrome, or ACS (eg, unstable angina, acute myocardial infarction); it occurs in approximately 80% of cases. Patients with ACS are usually anxious and may have a feeling of impending doom. Nausea and vomiting are common complaints; however, projectile vomiting, which is typically associated with increased intracranial pressure, is uncommon. The skin is often ashen gray and clammy (diaphoretic) because of poor cardiac output and decreased perfusion. Less commonly, the patient’s skin is cyanotic. Respirations are usually unlabored unless the patient has congestive heart failure, in which case respirations are rapid and labored; irregular breathing, however, is not common. Blood pressure may fall as a result of decreased cardiac output; however, most patients will have a normal or elevated blood pressure. If the patient complains of a headache, it is usually a side effect of the nitroglycerin they took before your arrival; ACS itself usually does not cause a headache.

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You are assessing a 70-year-old male who complains of pain in both of his legs. He is conscious and alert, has a blood pressure of 160/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 14 breaths/min and unlabored. Further assessment reveals edema to both of his feet and legs and jugular venous distention. This patient’s primary problem is MOST likely:

A: chronic hypertension.
B: left heart failure.
C: pulmonary edema.
D: right heart failure.

D: right heart failure.

Reason:

If the right side of the heart is damaged, fluid collects in the body (edema), often showing in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. Another feature of right heart failure is jugular venous distention, which is an indication of blood backing up into the systemic circulation. Left heart failure typically presents with shortness of breath due to fluid in the lungs (pulmonary edema), which indicates blood backing up from the left side of the heart into the lungs. In severe pulmonary edema, the patient may cough up pink, frothy sputum. Right heart failure and/or left heart failure are also referred to as congestive heart failure (CHF). Chronic hypertension cannot be established on the basis of a single blood pressure reading.

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Which of the following questions would be the MOST effective in determining if a patient’s chest pain radiates away from his or her chest?

A: Do you also have pain in your arm, jaw, or back?
B: Does the pain stay in your chest or move anywhere else?
C: Is there any other part of your body where you have pain?
D: Is there anything that makes the pain better or worse?

B: Does the pain stay in your chest or move anywhere else?

Reason:

When assessing a patient with any type of pain, you should avoid asking leading questions; instead, ask open-ended questions whenever possible. For example, instead of asking the patient if his or her pain is dull, crushing, or sharp, ask him or her to describe the pain using his or her own words. Patients with radiating pain often state that the pain moves or travels away from its point of origin, with pain in between point A and point B. Patients with referred pain complain of pain in more than one location, without a trail of pain in between. You should also ask the patient if anything makes the pain worse (provokes) or better (palliates).

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A 60-year-old man is in cardiac arrest. You begin CPR while your partner applies the AED. What should you do if you receive a no shock message?

A: Assess for a carotid pulse for up to 10 seconds.
B: Reanalyze his cardiac rhythm after 30 seconds of CPR.
C: Resume CPR, starting with chest compressions.
D: Ensure that the AED electrodes are properly applied.

C: Resume CPR, starting with chest compressions

Reason:

If the AED gives a no shock advised message, you should immediately resume CPR, starting with chest compressions. After 2 minutes of CPR, reanalyze the patient’s cardiac rhythm and follow the AED voice prompts. You should not assess for a pulse if the AED gives a no shock message; this will only cause an unnecessary delay in performing chest compressions. Rarely, if ever, does CPR alone restore a normal cardiac rhythm and pulse. If the AED electrodes are improperly applied, it will not analyze the patient’s cardiac rhythm; instead, you will receive a “check patient” or “check electrodes” message. Continue CPR, rhythm analysis every 2 minutes, and defibrillation (if indicated) until ALS personnel arrive or the patient starts to move.

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The MOST important initial treatment for a patient whose cardiac arrest was witnessed is:

A: high-quality CPR.
B: cardiac drug therapy.
C: rapid transport.
D: defibrillation.

A: high-quality CPR.

Reason:

Regardless of whether a patient’s cardiac arrest is witnessed or unwitnessed, the single most important initial treatment is high-quality CPR. Delays in performing CPR have been clearly linked to poor patient outcomes. After CPR has been initiated, apply the AED as soon as it is available. Cardiac drug therapy and rapid transport enhance the patient’s chance of survival, but are useless without minimally-interrupted, high-quality CPR.

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Which of the following is a common side effect of nitroglycerin?

A: Hypertension
B: Anxiety
C: Nausea
D: Headache

D: Headache

Reason:

Because nitroglycerin (NTG) causes vasodilation, including the vessels within the brain, cerebral blood flow increases following the administration of NTG. This often causes a pounding headache for the patient. As uncomfortable as it is for the patient, headaches are a common and expected side effect of the drug. The vasodilatory effects of nitroglycerin could result in hypotension; therefore, the patient’s blood pressure should be carefully monitored. Nausea and anxiety are common symptoms of acute coronary syndrome; they are not common side effects of nitroglycerin.

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While assessing a patient with chest pain, you note that his pulse is irregular. This indicates:

A: a dysfunction in the left side of the patient’s heart
B: abnormalities in the heart’s electrical conduction system.
C: acute myocardial infarction or angina pectoris.
D: high blood pressure that is increasing cardiac workload.

B: abnormalities in the heart’s electrical conduction system

Reason:

An irregular pulse indicates abnormalities in the electrical conduction system of the heart. The electrical conduction system, beginning with the sinoatrial node as the primary pacemaker, is responsible for initiating the electrical impulses that stimulate the myocardium to contract. An irregular pulse could indicate potentially lethal arrhythmias that could result in cardiac arrest. You should document an irregular pulse and report this important finding to the emergency department.

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In which of the following patients is nitroglycerin contraindicated?

A: 41-year-old male with crushing substernal chest pressure, a blood pressure of 160/90 mm Hg, and severe nausea
B: 58-year-old male with chest pain radiating to the left arm, a blood pressure of 130/64 mm Hg, and prescribed Tegretol
C: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra
D: 66-year-old female with chest pressure of 6 hours’ duration, lightheadedness, and a blood pressure of 110/58 mm Hg

C: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra

Reason:

Nitroglycerin is contraindicated in patients who do not have a prescription for nitroglycerin, in those with a systolic BP less than 100 mm Hg, and in patients who have taken medications for erectile dysfunction (ED) within the previous 24 to 48 hours. Such medications include sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). Because ED drugs and nitroglycerin both cause vasodilation, concomitant use of these drugs may result in significant hypotension. Carbamazepine (Tegretol) is an anticonvulsant medication; there are no known interactions between Tegretol and nitroglycerin.

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A 56-year-old man is found to be pulseless and apneic. His wife states that he collapsed about 5 minutes ago. As your partner gets the AED from the ambulance, you should:

A: begin CPR, starting with chest compressions.
B: open the airway and give 2 rescue breaths.
C: ask the wife if the patient has a living will.
D: provide rescue breaths until the AED is ready.

A: begin CPR, starting with chest compressions.

Reason:

When you arrive on scene and determine that a patient is in cardiac arrest, you should immediately begin CPR, starting with chest compressions. Perform 30 chest compressions and then open the airway and deliver 2 rescue breaths. Chest compressions are a crucial part of cardiopulmonary resuscitation and must be started without delay. Apply the AED as soon as it is available. In the interest of this patient, whose arrest interval is short, you should begin resuscitative efforts immediately. In some cases, it is appropriate to inquire about the presence of a living will; however, this should be done after resuscitative efforts have begun.

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You have analyzed a cardiac arrest patient’s rhythm three times with the AED, separated by 2-minute cycles of CPR, and have received no shock messages each time. You should:

A: continue CPR and transport at once.
B: request a paramedic unit at the scene.
C: consider terminating resuscitation.
D: remove the AED and continue CPR.

A: continue CPR and transport at once.

Reason:

Although protocols vary from system to system, it is generally agreed that if you receive three consecutive no shock messages, separated by 2-minute cycles of CPR, you should continue CPR and transport at once; it is unlikely that the patient will convert to a shockable rhythm (eg, V-Fib, pulseless V-Tach). En route, coordinate a rendezvous with a paramedic unit if possible; waiting at the scene would only delay further treatment. The decision to terminate resuscitative efforts is made by a physician, and in some cases, a paramedic, after adequately performed BLS and ALS have proven unsuccessful.

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Which of the following would clearly be detrimental to a patient in cardiac arrest?

A: Ventilating just until the chest rises
B: Performing CPR before defibrillation
C: Interrupting CPR for more than 10 seconds
D: Using a pocket face mask without high-flow oxygen

C: Interrupting CPR for more than 10 seconds

Reason:

Major emphasis is placed on minimizing interruptions in CPR. Even brief interruptions cause a significant decrease in blood flow to the heart and brain. If you must interrupt CPR, do not exceed 10 seconds. It is preferable to ventilate a patient with a pocket face mask attached to high-flow oxygen, but failing to do so will not be nearly as detrimental as interrupting CPR for extended periods of time. You should ventilate the patient just until the chest visibly rises; ventilations that are too forceful or too fast can cause hyperinflation of the lungs, which may reduce blood return to the heart. When caring for any patient in cardiac arrest, you should immediately begin CPR, and then apply the AED as soon as possible.

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A 50-year-old man’s implanted defibrillator has fired twice within the last hour. He is conscious and alert and complains of a “sore chest.” Further assessment reveals that his chest pain is reproducible to palpation and is localized to the area of his implanted defibrillator. In addition to supplemental oxygen, treatment for him should include:

A: deactivating his defibrillator by running a magnet over it.
B: prompt transport with continuous monitoring en route.
C: application of the AED and transport to the hospital.
D: up to three doses of nitroglycerin and prompt transport.

B: prompt transport with continuous monitoring en route.

Reason:

Patients who are high risk for lethal cardiac dysrhythmias (ie, V-Fib, V-Tach) may have an automated implantable cardioverter/defibrillator (AICD). This small device is usually implanted in the upper left chest, just below the left clavicle. The AICD detects cardiac dysrhythmias and rapidly delivers a shock. When treating a patient whose AICD has fired, you should determine the number of times the device fired, administer supplemental oxygen as needed, obtain vital signs, and transport to the hospital with continuous monitoring en route. Application of the AED is not indicated; however, if the patient develops cardiac arrest, you should use the AED as you normally would (remember to apply the pads at least 1” away from the implanted device). The pain that the patient is experiencing, which is reproducible and localized near his AICD, is likely musculoskeletal pain as the result of his AICD shocking him; therefore, nitroglycerin is not indicated. Because the AICD works so quickly (much faster than you can apply an AED), you should not make any attempt to deactivate it.

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Which of the following statements regarding one-rescuer CPR is correct?

A: Ventilations should be delivered over a period of 2 to 3 seconds.
B: A compression to ventilation ratio of 15:2 should be delivered.
C: You should assess the patient for a pulse after 3 cycles of CPR.
D: The chest should be allowed to fully recoil after each compression.

D: The chest should be allowed to fully recoil after each compression.

Reason:

When performing CPR on any patient, you should allow the chest to fully recoil after each compression. Incomplete chest recoil causes increased intrathoracic pressure, which may impair blood return to the heart. Assess the patient’s pulse after every 5 cycles (about 2 minutes) of CPR; take no longer than 5 to 10 seconds to do this. A compression to ventilation ratio of 30:2 should be performed during all adult and one-rescuer CPR (adult, child, and infant), except for newborns. A compression to ventilation ratio of 15:2 is used during two-rescuer infant and child CPR. Ventilations should be delivered over a period of 1 second each, just enough to produce visible chest rise.

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Aspirin may be contraindicated in patients with:

A: ibuprofen allergy.
B: diabetes.
C: stomach ulcers.
D: glaucoma.

C: stomach ulcers.

Reason:

Aspirin (acetylsalicylic acid [ASA]) inhibits platelet aggregation, thus preventing clots from forming or preventing an existing clot from getting bigger. Aspirin, in a dose of 160 to 325 mg, should be administered to patients experiencing acute coronary syndrome (ie, unstable angina, acute myocardial infarction) as soon as possible. Aspirin is absolutely contraindicated for patients who are allergic to salicylates. Because aspirin prolongs bleeding time, it may be contraindicated for patients with stomach ulcers; therefore, you should contact medical control before giving aspirin to such patients. Aspirin is not contraindicated for patients with glaucoma or diabetes. Ibuprofen, the active ingredient in Motrin and Advil, is a nonsteroidal anti-inflammatory drug (NSAID), not a salycilate.

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Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction?

A: 66-year-old male with angina
B: 72-year-old female with diabetes
C: 55-year-old obese female
D: 75-year-old male with hypertension

B: 72-year-old female with diabetes

Reason:

Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfort to indigestion. Some patients, however, do not experience any pain. In particular, elderly women with diabetes may present with vague, unusual, or atypical symptoms of AMI; their only presenting complaint may be fatigue or syncope. Do not rule out a cardiac problem just because a patient is not experiencing chest pain, pressure, or discomfort; this is especially true in elderly females with diabetes.

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Which of the following patients is the BEST candidate for the administration of nitroglycerin?

A: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg
B: An elderly man with crushing substernal chest pain and a blood pressure of 80/60 mm Hg
C: A woman who has taken three doses of prescribed nitroglycerin without relief of chest pain
D: A man with chest pain, expired nitroglycerin spray, and a blood pressure of 110/80 mm Hg

A: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg

Reason:

Nitroglycerin should be administered to patients who have the prescribed, unexpired drug with them and a systolic blood pressure of greater than 100 mm Hg. No more than three (3) nitroglycerin tablets or sprays should be administered to a patient in the prehospital setting. An expired medication should never be administered to any patient, even if the medication is otherwise indicated for his or her condition.

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A patient who is experiencing an acute myocardial infarction:

A: often complains of a different type of pain than a patient with angina.
B: has chest pain or discomfort that does not change with each breath.
C: most often describes his or her chest pain as being sharp or tearing.
D: often experiences relief of his or her chest pain after taking nitroglycerin.

B: has chest pain or discomfort that does not change with each breath.

Reason:

The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressure, heaviness); thus, you cannot distinguish AMI from angina pectoris based solely on the type or quality of pain. Furthermore, the pain associated with AMI, like that of angina, often radiates to the arm, jaw, back, or epigastrium. Relative to other causes of chest pain or discomfort (eg, pleurisy, pneumothorax), the pain associated with AMI and angina does not worsen or improve when the patient takes a breath. Rest and nitroglycerin often relieve the pain associated with stable angina, but are less likely to relieve the pain associated with AMI.

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Which of the following interventions would the EMT be the LEAST likely to perform while attempting to resuscitate a cardiac arrest patient?

A: Rhythm analysis with the AED
B: Ventilation with a bag-mask device
C: Insertion of a supraglottic airway device.
D: Assisting a paramedic with intubation

C: Insertion of a supraglottic airway device.

Reason:

The insertion of advanced airway devices (eg, endotracheal [ET] tube, multilumen airway, supraglottic airway) is generally outside the EMT’s scope of practice. However, he or she may be asked to assist a paramedic in the placement of such devices. For example, the paramedic may ask the EMT to retrieve the appropriate equipment or preoxygenate the patient before he or she inserts the device. Operation of the AED and ventilating with a bag-mask device are within the EMT’s scope of practice.

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You arrive at the scene of a 56-year-old man who collapsed. The patient’s wife tells you that he suddenly grabbed his chest and then passed out. Your assessment reveals that he is apneic and pulseless. As your partner begins one-rescuer CPR, you should:

A: obtain a SAMPLE history.
B: notify medical control.
C: prepare the AED for use.
D: insert an airway adjunct.

C: prepare the AED for use.

Reason:

Immediate treatment for a patient in cardiac arrest involves performing CPR and applying the AED as soon as possible. After applying the AED pads to the patient’s chest (around your partner’s compressing hands), analyze his cardiac rhythm, deliver a shock if indicated, and immediately resume CPR (starting with chest compressions). Management of the airway, including insertion of an airway adjunct, should occur during the 2-minute period of CPR in between cardiac rhythm analysis and defibrillation. While CPR is in progress, obtain as much of the patient’s medical history from his wife as possible, and notify medical control when it is practical (ie, you have more help at the scene).

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While transporting an elderly woman who was complaining of nausea, vomiting, and weakness, she suddenly becomes unresponsive. You should:

A: open her airway and ensure that it is clear.
B: feel for a carotid pulse for at least 5 seconds.
C: analyze her heart rhythm with the AED.
D: quickly look at her chest for obvious movement.

D: quickly look at her chest for obvious movement.

Reason:

If a patient is found unresponsive or becomes unresponsive in your presence, your first action should be to assess for breathing; this should be done by quickly (no more than 10 seconds) looking at the chest for obvious movement. If the patient is not breathing or only has agonal gasps, you should check for a pulse for at least 5 seconds but no more than 10 seconds. If the patient has a pulse but is not breathing, open the airway and provide rescue breathing. If the patient does not have a pulse, begin CPR (starting with chest compressions), and apply the AED as soon as possible. If you are transporting a patient who becomes unresponsive, pulseless, and apneic, you should begin CPR and instruct your partner to stop the ambulance and prepare the AED.

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A 66-year-old female presents with an acute onset of confusion, slurred speech, and weakness to her right arm and leg. Her airway is patent and she is breathing adequately. The MOST important initial information to determine regarding this patient is: A: her initial blood pressure reading. B: when her symptoms were first noted. C: whether or not her pupils are equal. D: what she was doing when this began.

B: when her symptoms were first noted. Reason: This patient is experiencing signs of an acute ischemic stroke. She may be a candidate for fibrinolytic therapy, drugs that destroy the clot in the cerebral artery, if her symptoms are of less than 3 hours’ duration. It is vital to determine exactly (or as close to as possible) when the patient’s symptoms were first noted, and pass this information along to the receiving facility. Few, if any, current treatments are effective if they are started more than 3 to 6 hours after the stroke begins. Even if 3 hours have passed, prompt action on your part is essential. Assessment of the patient’s blood pressure, pupils, and events that preceded the symptoms are important; however, identifying the patient as a candidate for an intervention that may reverse the stroke is critical and will afford her the greatest chance for a positive outcome.

After delivering one shock with the AED and performing 2 minutes of CPR on a woman in cardiac arrest, you reanalyze her cardiac rhythm and receive a no shock advised message. This means that: A: she is not in a shockable rhythm. B: she has electrical activity but no pulse. C: the first shock restored a rhythm and pulse. D: her rhythm has deteriorated to asystole.

A: she is not in a shockable rhythm. Reason: If the AED gives a no shock advised message, it has determined that the patient is not in a shockable rhythm (eg, V-Fib, pulseless V-Tach). It does not indicate that the patient has a pulse, nor does it indicate that a normal cardiac rhythm has been restored. The AED does not distinguish pulseless electrical activity (PEA) from asystole; it only recognizes them as nonshockable. PEA is a condition in which organized cardiac electrical activity is present despite the absence of a pulse. Asystole is the absence of all cardiac electrical and mechanical activity. If the AED gives a no shock advised message, immediately resume CPR, starting with chest compressions, until ALS arrives or the patient starts to move.

How can you help maximize cardiac output during CPR? A: Allow the chest to fully recoil in between compressions B: Compress the chest at a rate of no more than 100/min C: Deliver rescue breaths until the chest expands widely D: Ventilate the patient through an advanced airway device

A: Allow the chest to fully recoil in between compressions Reason: Cardiac output is the amount of blood ejected from the left ventricle per minute. Bearing in mind that even the best performed CPR produces only between 25% and 30% of what the patient's cardiac output would otherwise be, there are several actions that you must take to help maximize this. Allowing the chest to fully recoil in between compressions will help draw blood back to the heart; if more blood returns to the heart, more blood can be pumped from the heart with chest compressions. Delivering each rescue breath over a period of 1 second, just enough to produce visible chest rise, will also help maximize cardiac output. If ventilations are given to fast or too forcefully, intrathoracic pressure will increase, resulting in a decrease in the amount of blood that returns to the heart; as a result, cardiac output will decrease. Ventilations are delivered no differently if an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) has been inserted. Deliver chest compressions at a rate of at least 100 per minute to a depth of at least 2" (at least one third the depth of the chest in infants and children).

After attaching the AED and pushing the analyze button on an adult patient in cardiac arrest, the AED states that a shock is advised. What cardiac rhythm is the patient MOST likely in? A: Ventricular tachycardia B: Pulseless electrical activity C: Asystole D: Ventricular fibrillation

D: Ventricular fibrillation Reason: Ventricular fibrillation (V-Fib) is the most common initial cardiac dysrhythmia in adult cardiac arrest patients, occurring in up to 75% of all cases. V-Fib is a chaotic quivering of the heart muscle that does not produce a pulse and is due to a massive, uncontrolled electrical discharge of the cardiac cells. The most effective treatment for V-Fib is defibrillation. Some patients are in ventricular tachycardia (V-Tach) without a pulse, which is also treated with defibrillation. Although asystole and pulseless electrical activity (PEA) do not produce a pulse, they are not treated with defibrillation.

Sudden cardiac arrest in the adult population MOST often is the result of: A: accidental electrocution. B: a cardiac arrhythmia. C: myocardial infarction. D: respiratory failure.

B: a cardiac arrhythmia. Reason: The most common cause of sudden cardiac arrest (SCA) in the adult population is a cardiac arrhythmia—usually ventricular fibrillation—in up to 70% of cases. This fact underscores the importance of early defibrillation to shock the heart back into a perfusing rhythm. Evidence has shown that cardiac arrest—again, most often the result of an arrhythmia—occurs in up to 40% of patients experiencing an acute myocardial infarction (AMI). The risk of cardiac arrest is highest within the first few hours following the onset of an AMI. Respiratory failure is the most common cause of cardiac arrest in children, not adults. Children generally have healthy hearts and rarely experience cardiac arrest due to a primary cardiac event.

Which of the following is an abnormal finding when using the Cincinnati stroke scale to assess a patient who presents with signs of a stroke? A: One of the pupils is dilated and does not react to light. B: One arm drifts down compared with the other side. C: The patient’s face is symmetrical when he or she smiles. D: Both arms drift slowly and equally down to the patient’s side.

B: One arm drifts down compared with the other side. Reason: The Cincinnati Stroke Scale is used to assess patients suspected of experiencing a stroke. It consists of three tests: speech, facial droop, and arm drift. Abnormality in any one of these areas indicates a high probability of stroke. To test arm drift, ask the patient to hold both arms in front of his or her body, palms facing upward, with eyes closed and without moving. Over the next 10 seconds, observe the patient’s arms. If one arm drifts down toward the ground, you know that side is weak; this is an abnormal finding. To test for facial droop, have the patient smile, showing his or her teeth. The face should be symmetrical (both sides of the face should move equally). If only one side of the face moves well, you know that something is wrong with the part of the brain that controls the facial muscles. You should assess the pupils of a patient with a suspected stroke; however, this is not a component of the Cincinnati Stroke Scale.

When treating a patient with chest pain, pressure, or discomfort, you should first: A: place the patient in a position of comfort. B: request an ALS ambulance response to the scene. C: administer supplemental oxygen. D: assess the blood pressure and give nitroglycerin.

A: place the patient in a position of comfort. Reason: An important aspect of treating a patient with chest pain, pressure, or discomfort is to ensure that the patient is in a comfortable position. Most of the time, the patient will already be in this position upon your arrival. A position of comfort will aid in minimizing anxiety, which in turn decreases cardiac oxygen consumption and demand. After ensuring that the patient is in a comfortable position, administer supplemental oxygen in a concentration sufficient to maintain an SpO2 of greater than 94%. Following your assessment, if you feel that ALS support is needed, you should request it. If the patient has prescribed, unexpired nitroglycerin; the systolic blood pressure is greater than 100 mm Hg; and the patient has not taken the maximum of three doses, you should contact medical control to obtain permission to assist the patient in taking the nitroglycerin.

After applying the AED to an adult patient in cardiac arrest, you analyze her cardiac rhythm and receive a shock advised message. Emergency medical responders, who arrived at the scene before you, tell you that bystander CPR was not in progress upon their arrival. You should: A: perform CPR for 2 minutes and then defibrillate. B: detach the AED and prepare for immediate transport. C: notify medical control and request permission to cease resuscitation. D: deliver the shock as indicated followed immediately by CPR.

D: deliver the shock as indicated followed immediately by CPR.

Chest compression effectiveness is MOST effectively assessed by: A: measuring the systolic blood pressure during compressions. B: listening for a heartbeat with each compression. C: palpating for a carotid pulse with each compression. D: carefully measuring the depth of each compression.

C: palpating for a carotid pulse with each compression.

Which of the following is MOST indicative of a primary cardiac problem? A: Tachypnea B: Irregular pulse C: Sudden fainting D: Tachycardia

B: Irregular pulse

Switching compressors during two-rescuer CPR: A: is only necessary if the compressor becomes fatigued. B: should occur every 2 minutes throughout the arrest. C: should take no more than 15 seconds to accomplish. D: is performed after every 10 to 20 cycles of adult CPR.

B: should occur every 2 minutes throughout the arrest.

The quickest way to reduce cardiac ischemia in a patient experiencing an acute coronary syndrome is to: A: give supplemental oxygen. B: keep the patient warm. C: elevate the patient’s legs. D: sit or lay the patient down.

D: sit or lay the patient down.

Sudden cardiac arrest in the adult population is MOST often the result of: A: an acute stroke. B: respiratory failure. C: a cardiac dysrhythmia. D: myocardial infarction.

C: a cardiac dysrhythmia.

Which of the following questions would be MOST appropriate to ask when assessing a patient with chest pain? A: Is the pain worse when you take a deep breath? B: Does the pain radiate to your arm? C: Would you describe the pain as sharp? D: What does the pain feel like?

D: What does the pain feel like?

You should suspect that your patient has pulmonary edema if he or she: A: has a dry, nonproductive cough. B: has swollen feet and ankles. C: is hypertensive and tachycardic. D: cannot breathe while lying down.

D: cannot breathe while lying down.

In addition to supplemental oxygen, one of the MOST effective way to minimize the detrimental effects associated with acute coronary syndrome is to: A: administer nitroglycerin in 15 to 20 minute intervals. B: request ALS support for any patient who has chest pain. C: reassure the patient and provide prompt transport. D: transport the patient rapidly, using lights and siren.

C: reassure the patient and provide prompt transport.

You arrive at the scene shortly after a 55-year-old man collapsed. Two bystanders are performing CPR. Your FIRST action should be to: A: attach the AED and analyze his cardiac rhythm. B: insert an oropharyngeal airway and continue CPR C: stop CPR so you can assess breathing and pulse. D: check the effectiveness of the CPR in progress.

C: stop CPR so you can assess breathing and pulse.

The pain associated with acute aortic dissection: A: is usually preceded by nausea, sweating, and weakness. B: typically comes on gradually and progressively worsens. C: is typically described as a stabbing or tearing sensation. D: originates in the epigastrium and radiates down both legs.

C: is typically described as a stabbing or tearing sensation.

The middle, muscular layer of the heart is called the: A: endocardium. B: pericardium. C: epicardium. D: myocardium.

D: myocardium

After restoring a pulse in a cardiac arrest patient, you begin immediate transport. While en route to the hospital, the patient goes back into cardiac arrest. You should: A: analyze the patient’s rhythm with the AED. B: contact medical control for further advice. C: begin CPR and proceed to the hospital. D: tell your partner to stop the ambulance.

D: tell your partner to stop the ambulance.

The energy setting for a biphasic AED: ``` A: must be manually set by the EMT. B: is manufacturer specific. C: is typically 360 joules. D: increases by 50 joules with each shock. You selected C; The correct answer is B; ```

B: is manufacturer specific. Reason: A biphasic AED sends energy in two directions simultaneously. This is advantageous because it produces a more efficient defibrillation than monophasic defibrillation, which sends energy in only one direction, and uses a lower energy setting. The energy setting on a biphasic AED is device specific, but typically ranges from 120 to 200 joules. AEDs are preprogrammed by the manufacturer to deliver a specific amount of energy, which eliminates the need to manually set the energy level. Some biphasic AEDs deliver the same amount of energy for each shock; others may escalate the energy level for each shock. Refer to the manufacturer's documentation that accompanies the AED you use regarding the amount of biphasic energy it delivers.

A patient reports pain in the upper midabdominal area. This region of the abdomen is called the: A: epigastrium. B: retroperitoneum. C: peritoneum. D: mediastinum.

A: epigastrium Reason: The mid-upper region of the abdomen is referred to as the epigastrium because of its location over the stomach (epi = upon, gastric = stomach). This is a common site of pain or discomfort in patients experiencing a cardiac problem, which frequently causes them to attribute their pain or discomfort to indigestion.

A patient who is experiencing an acute myocardial infarction: A: often complains of a different type of pain than a patient with angina. B: most often describes his or her chest pain as being sharp or tearing. C: often experiences relief of his or her chest pain after taking nitroglycerin. D: has chest pain or discomfort that does not change with each breath.

D: has chest pain or discomfort that does not change with each breath. Reason: The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressure, heaviness); thus, you cannot distinguish AMI from angina pectoris based solely on the type or quality of pain. Furthermore, the pain associated with AMI, like that of angina, often radiates to the arm, jaw, back, or epigastrium. Relative to other causes of chest pain or discomfort (eg, pleurisy, pneumothorax), the pain associated with AMI and angina does not worsen or improve when the patient takes a breath. Rest and nitroglycerin often relieve the pain associated with stable angina, but are less likely to relieve the pain associated with AMI.

After defibrillating a man in cardiac arrest, you resume CPR. As you are about to reanalyze his cardiac rhythm 2 minutes later, your partner tells you she can definitely feel a strong carotid pulse. You should: A: ask her to obtain a blood pressure reading. B: assess the patient’s breathing effort. C: remove the AED pads from the patient’s chest. D: continue with the rhythm analysis.

B: assess the patient’s breathing effort.

After assisting a patient with his or her prescribed nitroglycerin, you would NOT expect him or her to experience a: A: fizzing sensation under the tongue. B: pounding headache. C: burning sensation in the mouth. D: syncopal episode.

D: syncopal episode. Reason: Nitroglycerin (NTG) dilates the coronary arteries, thus increasing oxygen supply to the heart and relieving a cardiac patient’s chest pain. Before assisting a patient with his or her prescribed NTG, there are some predictable side effects you should make him or her aware of. Because NTG dilates the blood vessels throughout the entire body, including those in the brain, a pounding headache is common. A burning sensation in the mouth and/or fizzing sensation under the tongue are also common side effects. Syncope (fainting), however, is not a normal side effect of NTG, and suggests a substantial drop in blood pressure. If the patient becomes dizzy or experiences a syncopal episode after being given NTG, place him or her in a supine position. If necessary, elevate his or her legs to help increase blood pressure.

Following administration of nitroglycerin to a man with crushing chest pressure, he experiences a significant increase in his heart rate. This is MOST likely the result of: A: coronary vasoconstriction. B: a cardiac dysrhythmia. C: a drop in blood pressure. D: preexisting hypertension.

C: a drop in blood pressure.

Common signs and symptoms of a hypertensive emergency include: A: vomiting without nausea and hemiparesis. B: ringing in the ears, headache, and epistaxis. C: unequal pupils, irregular pulse, and pallor. D: chest discomfort, weak pulses, and cool skin.

B: ringing in the ears, headache, and epistaxis.

While transporting an elderly woman who was complaining of nausea, vomiting, and weakness, she suddenly becomes unresponsive. You should: A: open her airway and ensure that it is clear. B: feel for a carotid pulse for at least 5 seconds. C: analyze her heart rhythm with the AED. D: quickly look at her chest for obvious movement.

D: quickly look at her chest for obvious movement

When assessing a patient with a possible stroke, you should recall that: A: the majority of strokes involve bleeding into the brain tissue. B: the patient may be unable to communicate, but can often understand. C: fibrinolytic therapy must be given within 6 hours following the stroke. D: right-sided weakness indicates a stroke in the right cerebral hemisphere.

B: the patient may be unable to communicate, but can often understand

A patient whose artificial pacemaker has failed would MOST likely experience: A: hypertension and a headache. B: irreversible ventricular fibrillation. C: dizziness and excessive tachycardia D: weakness and bradycardia.

D: weakness and bradycardia.

Which of the following statements regarding sudden cardiac arrest and ventricular fibrillation is correct? A: Patients with ventricular fibrillation are typically unconscious, apneic, and have a weak and irregular pulse. B: Most patients develop ventricular fibrillation within 10 minutes after the onset of sudden cardiac arrest. C: High-quality CPR often reverses ventricular fibrillation if it is initiated within 2 minutes of the onset. D: For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%.

D: For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%.

Which of the following types of stroke would MOST likely present with a sudden, severe headache? A: Ischemic B: Thrombotic C: Hemorrhagic D: Embolic

C: Hemorrhagic Reason: A stroke occurs when blood flow to a portion of the brain is interrupted. There are two types of stroke: ischemic and hemorrhagic, both of which are acute events. Hemorrhagic stroke is caused by a ruptured artery in the brain, resulting in intracerebral bleeding, cerebral ischemia, and increased intracranial pressure. A classic feature of a hemorrhagic stroke is a sudden, severe headache (indicates cerebral artery rupture) that is followed by rapid deterioration of the patient’s condition. By contrast, ischemic stroke (accounts for approximately 80% of all strokes) occurs when a clot occludes a cerebral artery. If the clot forms locally, it is referred to as a thrombotic stroke; if the clot travels to the brain from another part of the body, it is referred to as an embolic stroke. Acute ischemic stroke typically presents with a sudden onset of confusion, facial droop, slurred speech, and weakness to one side of the body. A headache is uncommon in patients with acute ischemic stroke.

Your partner has applied the AED to a cardiac arrest patient and has received a shock advised message. While the AED is charging, you should: A: cease all contact with the patient until the AED has delivered the shock. B: perform rescue breathing only until the AED is charged and ready to shock. C: continue chest compressions until your partner tells you to stand clear. D: retrieve the airway equipment and prepare to ventilate the patient.

C: continue chest compressions until your partner tells you to stand clear.

The myocardium receives its blood supply from the coronary arteries that branch directly from the: A: vena cava. B: aorta. C: left atrium. D: right ventricle.

B: aorta

The chest pain associated with an acute coronary syndrome is often described as: A: pressure. B: cramping. C: stabbing. D: sharp.

A: pressure

When assessing a patient who complains of chest pain, which of the following questions would you ask to assess the "R" in OPQRST? A: What were you doing when the pain began? B: Is the pain in one place or does it move around? C: Is there anything that makes the pain worse? D: Did the pain begin suddenly or gradually?

B: Is the pain in one place or does it move around?

During your assessment of a 70-year-old man with crushing chest pain, you note that his blood pressure is 80/50 mm Hg. Your MOST important action should be to: A: give high-flow oxygen. B: assess his oxygen saturation. C: transport without delay. D: keep the patient warm.

C: transport without delay.

Which of the following is the MOST appropriate response when a patient with chest pain asks you if he or she is having a heart attack? A: Yes, so I recommend going to the hospital. B: Probably not, but we should transport you to be safe. C: I don’t know, but we will take good care of you. D: I believe you are, but only a physician can tell for sure.

C: I don’t know, but we will take good care of you.

The position of comfort for a patient with nontraumatic chest pain MOST commonly is: A: lateral recumbent. B: on the side with the head elevated. C: semisitting. D: supine with the legs elevated slightly.

C: semisitting

A 58-year-old man is found unresponsive by his wife. According to his wife, he was complaining of a "dull ache" in his chest the day before, but refused to allow her to call 9-1-1. His blood pressure is 70/50 mm Hg, his pulse is 120 beats/min and weak, and his respirations are 28 breaths/min and labored. Further assessment reveals that his skin is cool, pale, and clammy. You should suspect: A: cardiogenic shock. B: hypovolemic shock. C: pulmonary embolism. D: acute septic shock.

A: cardiogenic shock. Reason: The patient in this scenario likely experienced an acute myocardial infarction the day before. However, because he refused medical care, the infarction has likely damaged a significant portion of his heart, resulting in cardiogenic shock. Cardiogenic shock occurs when the heart fails as a pump and can no longer meet the metabolic needs of the body; it has a very high mortality rate. The patient's labored breathing is likely caused by pulmonary edema, which occurs when blood backs up into the lungs because the heart cannot effectively pump. There is no evidence of hypovolemia (ie, poor skin turgor) or sepsis (ie, fever). A pulmonary embolism typically presents with an acute onset of pleuritic (sharp) chest pain and difficulty breathing, and is also commonly associated with cyanosis.

The automated external defibrillator (AED) should NOT be used in patients who: A: experienced a witnessed cardiac arrest. B: are between 1 and 8 years of age. C: are apneic and have a weak carotid pulse. D: have a nitroglycerin patch applied to the skin.

C: are apneic and have a weak carotid pulse.

The quickest way to reduce cardiac ischemia in a patient experiencing an acute coronary syndrome is to: A: keep the patient warm. B: give supplemental oxygen. C: sit or lay the patient down. D: elevate the patient’s legs.

C: sit or lay the patient down.

In patients with heart disease, acute coronary syndrome is MOST often the result of: A: atherosclerosis. B: coronary artery spasm. C: coronary artery rupture. D: atrial damage.

A: atherosclerosis

Tachycardia can be detrimental to a patient who is experiencing a cardiac problem because it causes: A: increased cardiac filling in between beats. B: a profound decrease in oxygen consumption. C: increased cardiac oxygen usage and demand. D: an associated increase in breathing difficulty.

C: increased cardiac oxygen usage and demand.

Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment, she tells you that she is lightheaded and feels like she is going to faint. Her symptoms are MOST likely due to: A: low blood pressure. B: a drop in her blood sugar. C: an irregular heartbeat.

A: low blood pressure.

Which of the following statements regarding ventricular fibrillation (V-Fib) is correct? A: Loss of consciousness occurs within minutes after the onset of V-Fib. B: Any patient in V-Fib must receive CPR for 2 minutes prior to defibrillation. C: Patients in V-Fib should be defibrillated after every 60 seconds of CPR. D: In V-Fib, the heart is not pumping any blood and the patient is pulseless.

D: In V-Fib, the heart is not pumping any blood and the patient is pulseless.

All of the following are components of the Cincinnati stroke scale, EXCEPT: A: facial droop. B: arm movement. C: pupil size. D: speech pattern.

C: pupil size.

A 60-year-old man presents with chest pain and difficulty breathing. He is pale, diaphoretic, and in severe pain. As your partner applies supplemental oxygen, you assess his vital signs. His blood pressure is 180/90 mm Hg, pulse is 110 beats/min and irregular, and respirations are 24 breaths/min and labored. You ask him if has taken any nitroglycerin and he tells you that he does not have any but his wife does. You should: A: contact medical control and request permission to assist the patient with up to three doses of his wife’s nitroglycerin. B: transport at once, apply the AED in case he develops cardiac arrest, and monitor his vital signs en route to the hospital. C: have him swallow up to four enteric-coated aspirin, continue oxygen therapy, and promptly transport him to the hospital. D: complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital.

D: complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital.

Treatment for a patient with congestive heart failure and shortness of breath may include: A: supine positioning and elevation of the legs. B: up to three doses of sublingual nitroglycerin. C: prophylactic suctioning of the airway. D: hyperventilation with a bag-mask device.

B: up to three doses of sublingual nitroglycerin.

Which of the following is the MOST detrimental effect that tachycardia can have on a patient experiencing a cardiac problem? A: Increased oxygen demand B: Decreased cardiac functioning C: Increased blood pressure D: Increased stress and anxiety

A: Increased oxygen demand

When an error occurs while using the AED, it is MOST often the result of: A: excess patient movement during the analyze phase. B: misinterpretation of the patient’s cardiac rhythm. C: malfunction of the microchip inside the AED. D: battery failure secondary to operator error.

D: battery failure secondary to operator error.

An elderly man in unresponsive and has agonal breathing. You should: A: open his airway and deliver 2 rescue breaths. B: begin CPR, starting with chest compressions. C: perform rescue breathing at 10 to 12 breaths/min. D: check for a carotid pulse for up to 10 seconds.

D: check for a carotid pulse for up to 10 seconds.

You assess an unresponsive 65-year-old man and find that he is apneic and pulseless. The patient's wife tells you that he has an automatic implanted cardioverter/defibrillator. After initiating CPR, you should: A: apply the AED as soon as possible and analyze his cardiac rhythm. B: ask the wife why and when he had the automatic defibrillator implanted. C: deactivate the implanted defibrillator by running a magnet over it. D: avoid using the AED because the implanted defibrillator is more effective.

A: apply the AED as soon as possible and analyze his cardiac rhythm.

Which of the following assessment findings is LEAST suggestive of cardiac compromise? A: Palpable pain to the chest B: Rapid, irregular heart rate C: Nausea and epigastric pain D: Anxiety and pale, cool skin

A: Palpable pain to the chest

A 65-year-old man has generalized weakness and chest pressure. He has a bottle of prescribed nitroglycerin, but states that he has not taken any of his medication. As your partner prepares to administer oxygen, you should: A: assist the patient with his nitroglycerin with medical control approval. B: perform a secondary assessment and obtain baseline vital signs. C: administer up to 325 mg of aspirin if the patient is not allergic to it. D: apply the AED and prepare the patient for immediate transport.

C: administer up to 325 mg of aspirin if the patient is not allergic to it.

Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction? A: 72-year-old female with diabetes B: 55-year-old obese female C: 66-year-old male with angina D: 75-year-old male with hypertension

A: 72-year-old female with diabetes Reason: Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfort to indigestion. Some patients, however, do not experience any pain. In particular, elderly women with diabetes may present with vague, unusual, or atypical symptoms of AMI; their only presenting complaint may be fatigue or syncope. Do not rule out a cardiac problem just because a patient is not experiencing chest pain, pressure, or discomfort; this is especially true in elderly females with diabetes.

Which of the following is the BEST indicator of cardiac output? A: Condition and color of the skin B: Pulse rate and quality C: Quality of the respirations D: Systolic blood pressure

B: Pulse rate and quality

Which of the following structures is the primary pacemaker, which sets the normal rate for the heart? A: Bundle of His B: Sinoatrial node C: Purkinje fibers D: Atrioventricular node

B: Sinoatrial node

Ischemic heart disease is a condition in which: A: a portion of the heart muscle dies because of a prolonged lack of oxygen. B: the coronary arteries dilate, thus preventing effective blood flow to the heart. C: there is a decrease in blood flow to one or more portions of the heart muscle. D: an acute event leads to a significant decrease in the pumping force of the heart.

C: there is a decrease in blood flow to one or more portions of the heart muscle.

The wall that separates the left and right sides of the heart is called the: A: pericardium. B: septum. C: mediastinum. D: carina.

B: septum

When the vital organs of an 85-year-old patient need additional blood flow, the heart may not be able to meet the increased need because: A: the patient’s blood vessels become more elastic. B: stroke volume increases as a person ages. C: the reserve capacity of the heart is reduced. D: blood pressure decreases as a person ages.

C: the reserve capacity of the heart is reduced.

Which of the following describes the MOST appropriate method of performing chest compressions on an adult patient in cardiac arrest? A: Minimize interruptions in chest compressions, provide 70% compression time and 30% relaxation time, deliver compressions at a rate of 100/min B: Do not interrupt chest compressions for any reason, compress the chest no more than 1 1/2”, allow partial recoil of the chest after each compression C: Compress the chest at least 2", allow full recoil of the chest after each compression, minimize interruptions in chest compressions D: Allow full recoil of the chest after each compression, compress the chest to a depth of 2”, deliver compressions at a rate of at least 80/min

C: Compress the chest at least 2", allow full recoil of the chest after each compression, minimize interruptions in chest compressions

Nitroglycerin is contraindicated in all of the following situations, EXCEPT: A: systolic BP of 80 mm Hg. B: recent use of Cialis. C: the presence of a head injury. D: history of cardiac bypass surgery.

D: history of cardiac bypass surgery.

Which of the following describes pulseless electrical activity (PEA)? A: A rapid cardiac rhythm that does not produce a pulse, but responds to defibrillation B: A disorganized, chaotic quivering of the heart muscle that does not generate a pulse C: The presence of a palpable pulse in the absence of any electrical activity in the heart D: Any organized cardiac rhythm, slow or fast, that does not produce a palpable pulse

D: Any organized cardiac rhythm, slow or fast, that does not produce a palpable pulse

A 45-year-old woman calls EMS because of severe chest pain. When you arrive, she advises you that she has taken two of her husband’s nitroglycerin (NTG) tablets without relief. What is your MOST appropriate course of action? A: Apply supplemental oxygen and transport the patient to the hospital without delay. B: Attach the AED, administer 100% oxygen, and contact medical control for advice. C: Apply oxygen, assess the patient's blood pressure, and give a third and final NTG tablet. D: Call medical control and request permission to assist the patient with one more NTG tablet.

A: Apply supplemental oxygen and transport the patient to the hospital without delay.

A middle-aged male was found unresponsive by his wife. When you arrive at the scene, you assess the patient and determine that he is apneic and pulseless. You should: A: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup. B: immediately begin CPR, reassess for a carotid pulse after 60 seconds, and then apply the AED. C: perform CPR with a compression-to-ventilation ratio of 15:2, apply the AED, and request backup. D: immediately apply the AED, analyze his cardiac rhythm, deliver a shock if indicated, and begin CPR.

A: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup.

Which of the following chambers of the heart has the thickest walls? A: Right atrium B: Left ventricle C: Right ventricle D: Left atrium

B: Left ventricle

By which of the following mechanisms does nitroglycerin relieve cardiac-related chest pain or discomfort? A: Vasoconstriction and increased cardiac oxygen demand B: Vasoconstriction and increased myocardial workload C: Vasodilation and increased myocardial oxygen supply D: Vasodilation and decreased myocardial oxygen supply

C: Vasodilation and increased myocardial oxygen supply

When performing two-rescuer CPR on an adult patient whose airway has not been secured with an advanced device, you should: A: have your partner pause after 30 compressions as you give 2 breaths. B: continue ventilations as the AED analyzes the patient’s cardiac rhythm. C: avoid synchronizing compressions with ventilations D: deliver ventilations at a rate of 8 to 10 breaths/min.

A: have your partner pause after 30 compressions as you give 2 breaths

Freshly oxygenated blood returns to the heart via the: A: vena cavae. B: pulmonary vein. C: aorta. D: pulmonary artery.

B: pulmonary vein.

Which of the following assessment findings is LEAST suggestive of cardiac compromise? A: Nausea and epigastric pain B: Rapid, irregular heart rate C: Anxiety and pale, cool skin D: Palpable pain to the chest

D: Palpable pain to the chest

A near-drowning is MOST accurately defined as: A: death greater than 24 hours following submersion in water. B: survival for at least 24 hours following submersion in water. C: complications within 24 hours following submersion in water. D: immediate death due to prolonged submersion in water.

B: survival for at least 24 hours following submersion in water.

Which of the following patients would be the LEAST likely to present with classic signs and symptoms of acute myocardial infarction? A: 59 year-old male with alcoholism and angina pectoris. B: 72-year-old female with diabetes and hypertension. C: 55-year-old female with COPD and frequent infections. D: 64-year-old male with renal disease and depression.

B: 72-year-old female with diabetes and hypertension.

Which of the following statements regarding sudden cardiac arrest and ventricular fibrillation is correct? A: High-quality CPR often reverses ventricular fibrillation if it is initiated within 2 minutes of the onset. B: Most patients develop ventricular fibrillation within 10 minutes after the onset of sudden cardiac arrest. C: For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%. D: Patients with ventricular fibrillation are typically unconscious, apneic, and have a weak and irregular pulse.

C: For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%.

The quickest way to reduce cardiac ischemia in a patient experiencing an acute coronary syndrome is to: A: sit or lay the patient down. B: give supplemental oxygen. C: keep the patient warm. D: elevate the patient’s legs.

A: sit or lay the patient down.

Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction? A: 72-year-old female with diabetes B: 66-year-old male with angina C: 75-year-old male with hypertension D: 55-year-old obese female

A: 72-year-old female with diabetes

Immediately following a generalized seizure involving tonic-clonic activity, most patients: A: return to a normal level of consciousness but cannot recall the event. B: have a slow heart rate because of cardiac depression during the seizure. C: are unresponsive but gradually regain consciousness. D: experience prolonged apnea and require positive-pressure ventilations.

C: are unresponsive but gradually regain consciousness.

Tachycardia can be detrimental to a patient who is experiencing a cardiac problem because it causes: A: increased cardiac oxygen usage and demand. B: a profound decrease in oxygen consumption. C: an associated increase in breathing difficulty. D: increased cardiac filling in between beats.

A: increased cardiac oxygen usage and demand.

While assessing a patient with chest pain, you note that his pulse is irregular. This indicates: A: acute myocardial infarction or angina pectoris. B: abnormalities in the heart’s electrical conduction system. C: high blood pressure that is increasing cardiac workload. D: a dysfunction in the left side of the patient’s heart

B: abnormalities in the heart’s electrical conduction system.

A 60-year-old man presents with chest pain and difficulty breathing. He is pale, diaphoretic, and in severe pain. As your partner applies supplemental oxygen, you assess his vital signs. His blood pressure is 180/90 mm Hg, pulse is 110 beats/min and irregular, and respirations are 24 breaths/min and labored. You ask him if has taken any nitroglycerin and he tells you that he does not have any but his wife does. You should: A: transport at once, apply the AED in case he develops cardiac arrest, and monitor his vital signs en route to the hospital. B: have him swallow up to four enteric-coated aspirin, continue oxygen therapy, and promptly transport him to the hospital. C: complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital. D: contact medical control and request permission to assist the patient with up to three doses of his wife’s nitroglycerin.

C: complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital.

You are caring for a 66-year-old woman with severe pressure in her chest. As you administer oxygen to her, your partner should: A: gather her medications. B: notify medical control. C: obtain a SAMPLE history. D: obtain a set of vital signs.

D: obtain a set of vital signs.

A 40-year-old woman presents with widespread hives that she noticed about 45 minutes after taking penicillin. She is conscious and alert and denies difficulty breathing. Her breath sounds are clear to auscultation bilaterally, her vital signs are stable, and her oxygen saturation is 94%. She tells you she is allergic to wasps and has an epinephrine auto-injector. You should: A: advise her that she can probably drive herself to the hospital. B: assist her in administering epinephrine via her auto-injector. C: give high-flow oxygen and administer 100 mg of Benadryl. D: give supplemental oxygen and transport her to the hospital.

D: give supplemental oxygen and transport her to the hospital.

The myocardium receives its blood supply from the coronary arteries that branch directly from the: A: vena cava. B: right ventricle. C: left atrium. D: aorta.

D: aorta

You assess an unresponsive 65-year-old man and find that he is apneic and pulseless. The patient's wife tells you that he has an automatic implanted cardioverter/defibrillator. After initiating CPR, you should: A: deactivate the implanted defibrillator by running a magnet over it. B: avoid using the AED because the implanted defibrillator is more effective. C: apply the AED as soon as possible and analyze his cardiac rhythm. D: ask the wife why and when he had the automatic defibrillator implanted.

C: apply the AED as soon as possible and analyze his cardiac rhythm.

The pain associated with acute aortic dissection: A: typically comes on gradually and progressively worsens. B: originates in the epigastrium and radiates down both legs. C: is typically described as a stabbing or tearing sensation. D: is usually preceded by nausea, sweating, and weakness.

C: is typically described as a stabbing or tearing sensation.

A middle-aged male was found unresponsive by his wife. When you arrive at the scene, you assess the patient and determine that he is apneic and pulseless. You should: A: perform CPR with a compression-to-ventilation ratio of 15:2, apply the AED, and request backup. B: immediately begin CPR, reassess for a carotid pulse after 60 seconds, and then apply the AED. C: immediately apply the AED, analyze his cardiac rhythm, deliver a shock if indicated, and begin CPR. D: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup.

D: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup.

B: right heart failure. Reason: If the right side of the heart is damaged, fluid collects in the body (edema), often showing in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. Another feature of right heart failure is jugular venous distention, which is an indication of blood backing up into the systemic circulation. Left heart failure typically presents with shortness of breath due to fluid in the lungs (pulmonary edema), which indicates blood backing up from the left side of the heart into the lungs. In severe pulmonary edema, the patient may cough up pink, frothy sputum. Right heart failure and/or left heart failure are also referred to as congestive heart failure (CHF). Chronic hypertension cannot be established on the basis of a single blood pressure reading.

D: has chest pain or discomfort that does not change with each breath.