Quiz - 14 Cardiac Emergency Care & Responding to the Field Code

Question 1

Defibrillation of a patient who is in asystole is detrimental to the patient because it:

A. makes ruling out underlying causes impossible.

B. causes an unnecessary interruption in chest compressions.

C. has been shown to render epinephrine ineffective.

D. stops the cardiac cells from spontaneously depolarizing.

Answer 1

B. causes an unnecessary interruption in chest

Question 2

While applying the defibrillator pads, you note that the patient has a transdermal nitroglycerin patch on the
right anterior chest. You should:

A. move the patch to the left anterior chest.

B. place the pads at least 1 inch from the patch.

C. place the second pad in between the scapulae.

D. remove the patch and wipe away any residue.

Answer 2

D. remove the patch and wipe away any residue.

Question 3

Which of the following statements regarding the use of vasopressin during cardiac arrest is correct?

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

B. Vasopressin has been shown to be clinically superior to epinephrine.

C. If used during cardiac arrest, vasopressin is given in a dose of 20 units.

D. If the patient is in asystole, vasopressin can be given every 5 minutes.

Answer 3

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

Question 4

You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a “stomach bug.” He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:

A. apply high-flow oxygen via nonrebreathing mask, start an IV line, administer 0.5 mg of atropine, and transport to the closest facility.

B. administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.

C. give 100% oxygen, start two large-bore IV lines, administer 20 mL/kg normal saline boluses, and transport.

D. advise him that he can probably drive himself to the emergency department or schedule an appointment with his physician.

Answer 4

B. administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.

Question 5

A 67-year-old man presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. He has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect?

A. Positive end-expiratory pressure ventilation

B. 0.4 mg sublingual nitroglycerin, up to three doses

C. Supplemental oxygen via nonrebreathing mask

D. IV or IO access and 20 to 40 mg of furosemide

Answer 5

A. Positive end-expiratory pressure ventilation

Question 6

A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on:

A. providing mild hyperventilation.

B. transcutaneous cardiac pacing

C. establishing a peripheral IV line

D. searching for reversible causes.

Answer 6

D. searching for reversible causes.

Question 7

Hyperventilation of a patient who is in cardiac arrest:

A. causes a marked decrease in intrathoracic pressure.

B. increases preload and enhances cardiac output.

C. has been shown to reduce coronary artery perfusion.

D. is indicated if the arrest interval exceeds 10 minutes.

Answer 7

C. has been shown to reduce coronary artery perfusion.

Question 8

You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should:

A. administer 2 to 4 mg of morphine.

B. reassess her blood pressure.

C. give her a 250-mL saline bolus.

D. repeat the nitroglycerin.

Answer 8

B. reassess her blood pressure.

Question 9

You receive a call to a residence for a 44-year-old man who is “ill.” The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient’s vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is:

A. hypocalcemic.

B. hyperkalemic.

C. having an acute myocardial infarction.

D. hypernatremic.

Answer 9

B. hyperkalemic.

Question 10

During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient’s end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should:

A. suspect inadvertent tube dislodgement.

B. increase the rate of your ventilations.

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

D. decrease the rate of your ventilations.

Answer 10

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

Question 11

Which of the following roles would the code team leader MOST likely perform?

A. Managing the airway

B. Chest compressions

C. Establishing IV access

D. Interpreting the ECG

Answer 11

D. Interpreting the ECG

Question 12

You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next:

A. push the synchronize button on the defibrillator and cardiovert with 200 joules.

B. give 300 mg of amiodarone via rapid IV or IO push.

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

D. give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes

Answer 12

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

Question 13

A 70-year-old woman remains in asystole following 10 minutes of well-coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to:

A. defibrillate one time in case she is in V-Fib.

B. attempt transcutaneous cardiac pacing.

C. transport at once with CPR continuing en route.

D. seriously consider ceasing resuscitative efforts.

Answer 13

D. seriously consider ceasing resuscitative efforts.

Question 14

You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should:

A. direct your partner to deliver one breath every 3 to 5 seconds as the EMT-B continues chest compressions.

B. instruct the EMT-B to pause after 30 compressions so your partner can deliver two ventilations.

C. perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min.

D. administer 2.5 mg of epinephrine via the ET tube and hyperventilate the patient to ensure drug dispersal.

Answer 14

C. perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min.

Question 15

If a cardiac arrest patient’s airway is maintained with an oral airway and ventilation with a bag-mask device is producing adequate chest rise, then:

A. a King LT or Combitube is preferred over tracheal intubation.

B. there should be no pause in chest compressions to deliver a breath.

C. the paramedic should deliver one breath every 5 to 6 seconds.

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

Answer 15

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

Question 16

You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to:

A. resume CPR at once.

B. check the carotid pulse.

C. attempt cardiac pacing.

D. assess breathing effort

Answer 16

A. resume CPR at once.

Question 17

You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of “breathing problem,” for which he uses a prescribed inhaler and takes a “heart pill.” You should suspect:

A. reactive airway disease.

B. acute COPD exacerbation.

C. right ventricular failure.

D. left-sided heart failure.

Answer 17

D. left-sided heart failure.

Question 18

A 56-year-old man complains of chest tightness, shortness of breath, and nausea. During your assessment, you note that he appears confused. He is profusely diaphoretic and has a blood pressure of 98/68 mm Hg and a rapid radial pulse. The cardiac monitor reveals a wide QRS complex tachycardia at a rate of 200 beats/min. After administering high-flow oxygen, you should:

A. attempt to slow his heart rate with vagal maneuvers and then start an IV line.

B. establish vascular access and administer 150 mg of amiodarone over 10 minutes.

C. obtain a 12-lead ECG tracing to determine the origin of his tachycardic rhythm.

D. establish IV access, consider sedation, and perform synchronized cardioversion.

Answer 18

D. establish IV access, consider sedation, and perform synchronized cardioversion.

Question 19

You are assessing a conscious and alert middle-aged male who complains of chest discomfort and nausea. His blood pressure is 112/70 mm Hg, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patient’s past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer?

A. Aspirin

B. Morphine

C. Nitroglycerin

D. Fentanyl

Answer 19

C. Nitroglycerin

Question 20

A 55-year-old man complains of severe pain between his shoulder blades, which he describes as “ripping” in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain?

A. ST-segment depression on the 12-lead ECG tracing

B. Difference in blood pressure between the two arms

C. Bruits to both carotid arteries during auscultation

D. Disappearance of radial pulses during inspiration

Answer 20

B. Difference in blood pressure between the two arms

Question 21

An unresponsive, apneic, and pulseless man presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to his arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of his condition?

A. No pulse with CPR and jugular venous distention

B. Profoundly cyanotic skin and collapsed jugular veins

C. Unilaterally absent breath sounds and mottled skin

D. Bilaterally absent breath sounds and severe pallor

Answer 21

A. No pulse with CPR and jugular venous distention

Question 22

When practicing a “code,” whether in the prehospital or in-hospital setting, the primary focus should be on:

A. independent performance and drug administration.

B. timely defibrillation and early tracheal intubation.

C. teamwork and minimal interruptions in CPR.

D. the use of technology during a cardiac arrest.

Answer 22

C. teamwork and minimal interruptions in CPR.

Question 23

Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac
care?

A. Artificial ventilation

B. Tracheal intubation

C. Defibrillation

D. Chest compressions

Answer 23

D. Chest compressions

Question 24

You have restored spontaneous circulation in a 54-year-old man who was in ventricular fibrillation. During the arrest interval, you delivered 2 shocks, 1 mg of epinephrine, and 300 mg of amiodarone. The patient’s blood pressure is 96/60 mm Hg, and the cardiac monitor displays a sinus rhythm at a rate of 70 beats/min with frequent premature ventricular complexes. Appropriate post-resuscitation care for this patient includes:

A. 0.5 mg of atropine sulfate.

B. a 20-mL/kg crystalloid bolus.

C. a low-dose dopamine infusion.

D. an infusion of amiodarone.

Answer 24

D. an infusion of amiodarone.

Question 25

A 33-year-old woman presents with an acute onset of “fluttering” in her chest. She is conscious and alert but is somewhat anxious. She denies any significant medical problems but states that she has been under a lot of stress at work. You apply the cardiac monitor, which reveals a narrow QRS complex tachycardia at a rate of 170 beats/min. The patient’s blood pressure is 140/90 mm Hg, and she is breathing without difficulty. The MOST appropriate treatment for this patient involves:

A. oxygen, emotional support, and 2.5 mg of midazolam IM.

B. oxygen, vagal maneuvers, and emotional support.

C. vagal maneuvers, IV access, and 0.25 mg/kg of diltiazem.

D. oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.

Answer 25

D. oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.

Question 26

Shortly after administering a second dose of 4 mg of morphine to a 49-year-old woman who is experiencing chest pain, the patient’s level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should:

A. immediately intubate her to protect her airway.

B. assist her ventilations and administer naloxone.

C. administer 0.5 mg of atropine and reassess her.

D. elevate her legs and give a 500-mL saline bolus.

Answer 26

B. assist her ventilations and administer naloxone.

Question 27

A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should:

A. place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure.

B. keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.

C. elevate the patient’s legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.

D. start an IV line, administer 5 mg of midazolam, intubate the patient’s trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 μg/kg/min en route to the hospital.

Answer 27

B. keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.

Question 28

Following return of spontaneous circulation, a patient remains comatose. Which of the following interventions would MOST likely be performed?

A. Dextrose infusion

B. Epinephrine bolus

C. Induced hypothermia

D. Field extubation

Answer 28

C. Induced hypothermia

Question 29

A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next?

A. Give amiodarone followed by 1.5 mg/kg of lidocaine

B. Rapidly infuse 2 liters of normal saline solution

C. Give 40 units of vasopressin followed by defibrillation

D. Administer 300 mg of amiodarone via rapid IV push

Answer 29

D. Administer 300 mg of amiodarone via rapid IV push

Question 30

After approximately 6 minutes of attempted resuscitation, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus tachycardia. In addition to continuing ventilations, what should be done next?

A. Amiodarone infusion

B. Hypothermia treatment

C. Crystalloid fluid bolus

D. Dopamine infusion

Answer 30

B. Hypothermia treatment

Question 31

Anterior-posterior placement of the defibrillation pads should be used if the patient is younger than ___ year(s) of age or less than ___ kg.

A. 4, 20

B. 5, 30

C. 1, 10

D. 3, 15

Answer 31

C. 1, 10

Question 32

You have just performed synchronized cardioversion on a patient with unstable ventricular tachycardia. Upon reassessment, you note that the patient is unresponsive, apneic, and pulseless. You should:

A. increase the energy setting on the defibrillator and repeat the cardioversion.

B. desynchronize the defibrillator, defibrillate one time, and check for a pulse.

C. ensure that the synchronizer is off, defibrillate, and immediately begin CPR.

D. perform five cycles of CPR, reassess the cardiac rhythm, and defibrillate if needed.

Answer 32

C. ensure that the synchronizer is off, defibrillate, and immediately begin CPR.

Question 33

How does CPR change after an advanced airway device is inserted?

A. One breath should be delivered every 10 to 12 seconds.

B. Cycles of 30 compressions and 2 breaths should be delivered.

C. Ventilations should be faster after the device is inserted.

D. Ventilations should be asynchronous with chest compressions.

Answer 33

D. Ventilations should be asynchronous with chest compressions.

Question 34

You are reviewing the medications of a semiconscious patient as your partner and another paramedic provide patient care. The patient’s medications include Lanoxin, enalapril, Coumadin, Lasix, and K-Dur. This medication regimen is MOST consistent with a patient who has:

A. COPD, diabetes, and tachydysrhythmias.

B. ventricular dysrhythmias and hypertension.

C. CHF, hypertension, and atrial fibrillation.

D. hypothyroidism, renal failure, and atrial flutter.

Answer 34

C. CHF, hypertension, and atrial fibrillation.

Question 35

A 6-year-old, 40-pound child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to:

A. defibrillate with 70 joules.

B. insert an advanced airway.

C. check for a carotid pulse.

D. insert an IO catheter

Answer 35

A. defibrillate with 70 joules.