Cardiovascular Emergencies Ch. 15

You are dispatched to a residence for a 4-year-old male who is not breathing. When you and your partner arrive at the scene, you find the child’s father is performing mouth-to-mouth rescue breathing on him. The father tells you that his son stuck a pin in an electrical socket. After assessing the child and determining that he is pulseless and apneic, you should:

A. perform CPR, immobilize his spine, and transport.

B. begin CPR and apply the AED as soon as possible.

C. request a paramedic unit to perform defibrillation.

D. perform CPR and insert a pediatric-sized Combitube.

B. begin CPR and apply the AED as soon as possible

The ability of cells to respond to electrical impulses is referred to as the property of:

A. dromotropy.

B. conductivity.

C. excitability.

D. automaticity.

A 67-year-old male presents with an altered mental status following two days of severe chest pain. His wife tells you that he would not allow her to call EMS. Your assessment reveals a tachycardic, irregular pulse, diaphoresis, and a blood pressure of 80/50 mm Hg. You should suspect:

A. unstable angina with poor perfusion.

B. compensated cardiogenic shock.

C. decompensated cardiogenic shock.

D. acute myocardial infarction and hypovolemia.

Which of the following would likely exacerbate pulmonary edema?

A. Nitroglycerin

B. Increased cardiac preload

C. A positive inotropic drug

D. Decreased cardiac afterload

B. Increased cardiac preload

Which of the following is NOT a component of the cardiac electrical conduction system?

A. Sinoatrial node

B. Atrioventricular node

C. Interatrial septum

D. Purkinje fibers

C. Interatrial septum

A middle-aged male presents with classic signs and symptoms of a dissecting aortic aneurysm. The MOST important intervention that you can perform for this patient is:

A. prompt transport.

B. an IV fluid bolus.

C. high-flow oxygen.

D. thermal management.

A. prompt transport

After defibrillating an adult patient in cardiac arrest with the AED, you should:

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

B. insert a multilumen airway device and resume CPR.

C. immediately reanalyze the patient’s cardiac rhythm.

D. begin or resume CPR starting with chest compressions.

D. begin or resume CPR starting with chest compressions

You receive a call for a 40-year-old female with nausea, dizziness, and a headache. During your assessment, you note that her blood pressure is 190/104 mm Hg. The patient, who is conscious and alert, states that she has a history of hypertension, but admits to being noncompliant with her medications. In addition to IV therapy, appropriate treatment for this patient includes:

A. rapidly lowering her blood pressure with nitroglycerin.

B. placing her in a supine position and lowering her head.

C. assisting the patient with her medication and transporting her.

D. 100% oxygen and transporting to the closest appropriate facility.

D. 100% oxygen and transporting to the closest appropriate facility.

You are assessing a 62-year-old female who has an automatic implantable cardiac defibrillator (AICD). As you are applying oxygen to her, she becomes unconscious, pulseless, and apneic. You should:

A. begin CPR and insert a multilumen airway device.

B. deactivate the AICD with a magnet and begin CPR.

C. allow the AICD to defibrillate her and start CPR.

D. begin CPR and apply the AED as soon as possible.

D. begin CPR and apply the AED as soon as possible

The term that refers to the contraction of the ventricular mass and the pumping of blood into the systemic circulation is called:

A. systole.

B. preload.

C. diastole.

D. afterload.

A. systole

When treating a 56-year-old female with chest pain, you have placed on her oxygen, established IV access, and administered two doses of sublingual nitroglycerin. However, the patient’s pain has not improved. You reassess her blood pressure and note that it is 106/66 mm Hg. You should:

A. request permission to give her morphine.

B. transport at once and closely monitor her.

C. administer one more dose of nitroglycerin.

D. give a 20 mL/kg saline bolus to raise her BP.

C. administer one more dose of nitroglycerin

Ventricular tachycardia often causes hypotension because:

A. there is not enough time between beats for the left ventricle to fill with blood.

B. blood from the atria fills the ventricles too quickly due to the rapid heart rate.

C. tachycardia causes widespread vasodilation, which lowers the blood pressure.

D. afterload increases, which causes the ventricles to work against higher pressure.

Pulseless electrical activity (PEA) exists when:

A. a patient’s heart rate is so weak that it is barely palpable.

B. a patient is in cardiac arrest despite an organized cardiac rhythm

C. the heart is quivering and is not ejecting any blood from the ventricles.

D. a pulse is clearly present, but the cardiac monitor shows a flat line.

B. a patient is in cardiac arrest despite an organized cardiac rhythm

The _____________ arteries arise from the aorta shortly after they leave the left ventricle.

A. cerebral

B. coronary

C. pulmonary

D. brachiocephalic

B. coronary

The visceral pericardium, which lies closely against the heart, is also called the:

A. epicardium.

B. endocardium.

C. foramen ovale.

D. coronary sinus.

A. epicardium

The normal site of origin of electrical impulses in the heart is the ____________, which generates ___________ impulses per minute.

A. sinoatrial node, 50 to 60

B. bundle of His, 80 to 100

C. sinoatrial node, 60 to 100

D. atrioventricular node, 60 to 80

C. sinoatrial node, 60 to 100

When assessing a patient for peripheral edema, you should check the sacral area if the patient is:

A. bedridden.

B. sitting up.

C. ambulatory.

D. semireclined.

A. bedridden

What three major arteries arise from the aortic arch?

A. Innominate, posterior vertebral, and right subclavian

B. Brachiocephalic, left common carotid, and left subclavian

C. Coronary, internal common carotid, and brachiocephalic

D. Brachiocephalic, common iliac, and right common carotid

B. Brachiocephalic, left common carotid, and left subclavian

What are the physiologic effects of nitroglycerin when given to a patient with suspected cardiac-related chest pain?

A. Vascular smooth muscle contraction and increased venous return

B. Vascular smooth muscle relaxation and coronary artery dilation

C. Coronary artery dilation and increased systemic vascular resistance

D. Decreased venous pooling of blood and coronary vasoconstriction

B. Vascular smooth muscle relaxation and coronary artery dilation

The presence of distended jugular veins that do not collapse, even when the patient is sitting, is consistent with:

A. cardiogenic shock.

B. congestive heart failure.

C. a thoracic aortic aneurysm.

D. an acute hypertensive crisis.

B. congestive heart failure

Which of the following represents the correct sequence of electrical conduction through the myocardium?

A. SA node, AV node, Bundle of His, bundle branches, Purkinje fibers

B. AV node, SA node, bundle branches, Bundle of His, Purkinje fibers

C. SA node, Bundle of His, AV node, bundle branches, Purkinje fibers

D. AV node, Purkinje fibers, SA node, Bundle of His, bundle branches

A. SA node, AV node, Bundle of His, bundle branches, Purkinje fibers

You receive a call to a local grocery store for a possible heart attack. Upon arrival at the scene, you find two bystanders performing CPR on the patient, a 49-year-old male. You should:

A. confirm that the patient is in cardiac arrest.

B. apply the AED and analyze his cardiac rhythm.

C. continue CPR and insert a multilumen airway.

D. look, listen, and feel for signs of breathing.

A. confirm that the patient is in cardiac arrest

Which of the following questions would be of LEAST pertinence when obtaining a focused history of a patient with an acute onset of chest discomfort?

A. Have you ever been told you have low blood pressure?

B. Have you experienced paroxysmal nocturnal dyspnea?

C. Do you have any respiratory diseases, such as emphysema?

D. Do you have diabetes or any problems with your blood sugar?

A. Have you ever been told you have low blood pressure

Afterload is defined as the:

A. volume of blood returned to the left or right atrium.

B. amount of blood ejected per ventricular contraction.

C. percentage of blood ejected from the left ventricle.

D. pressure against which the left ventricle must pump.

D. pressure against which the left ventricle must pump

Effectively performed CPR is a crucial treatment for a patient in cardiac arrest because it:

A. often converts V-Fib to a perfusing rhythm.

B. maintains myocardial and cerebral perfusion.

C. enhances perfusion to the body’s periphery.

D. prevents the patient from developing asystole.

B. maintains myocardial and cerebral perfusion

As with angina, the pain associated with acute myocardial infarction is often described as:

A. sharp.

B. pressure.

C. pleuritic.

D. stabbing.

B. pressure

During your assessment of a woman with chronic shortness of breath and fatigue, you ask her how many pillows she sleeps with at night. You are asking her this question to determine if:

A. the right side of her heart is functioning effectively.

B. blood is backing up into her systemic circulation.

C. she has left-sided heart failure and how severe it may be.

D. she experiences sleep apnea, which may explain her fatigue.

C. she has left-sided heart failure and how severe it may be

The fifth link in the cardiac chain of survival includes:

A. recognition of early warning signs and activation of EMS.

B. temperature regulation and maintenance of glucose levels.

C. early, high-quality CPR with emphasis on chest compressions.

D. defibrillation within the first 2 to 3 minutes of the cardiac arrest.

B. temperature regulation and maintenance of glucose levels

Stimulation of the sympathetic nervous system results in:

A. decreased blood pressure and heart rate.

B. increased blood pressure and heart rate.

C. vasoconstriction and decreased heart rate.

D. vasodilation and a mild heart-rate decrease.

B. increased blood pressure and heart rate

Percutaneous coronary intervention (PCI) involves:

A. dilating the coronary artery with drugs.

B. bypassing the blocked coronary artery.

C. mechanically clearing a coronary artery.

D. the administration of a fibrinolytic drug.

C. mechanically clearing a coronary artery

When given to a patient who is experiencing an acute coronary syndrome, aspirin works by:

A. preventing an existing clot from getting larger.

B. dissolving a clot and reestablishing blood flow.

C. dilating the coronary arteries and relieving pain.

D. thinning the blood and preventing clot formation.

What is the approximate cardiac output of a person with a heart rate of 70 beats/min and a stroke volume of 75 mL?

A. 4 L/min

B. 5 L/min

C. 6 L/min

D. 7 L/min

B. 5 L/min

Common signs of left-sided congestive heart failure include all of the following, EXCEPT:

A. chronic pedal edema.

B. tachypnea and tachycardia.

C. increased work of breathing.

D. production of blood-tinged sputum.

A. chronic pedal edema

When assessing a middle-aged male patient with chest pain, you note a large vertical scar in the center of his chest. This indicates that he has MOST likely had:

A. a coronary artery bypass graft.

B. coronary artery stent placement.

C. a percutaneous coronary angioplasty.

D. a surgically implanted cardiac pacemaker.

A. a coronary artery bypass graft

You respond to call at a residence for a “man down.” Your primary assessment reveals that the patient, a 66-year-old male, is unresponsive, pulseless, and apneic. His wife tells you that he has recently had the flu, and that he collapsed about 10 minutes ago. You should:

A. begin CPR and apply the AED as soon as it is available.

B. begin CPR, start an IV, and give a 20 mL/kg fluid bolus.

C. elevate the patient’s legs, begin CPR, and attach an AED.

D. begin CPR, insert a King airway, and request a paramedic unit.

A. begin CPR and apply the AED as soon as it is available

You are transporting a 55-year-old female with chest pain, who has not responded to 3 doses of nitroglycerin. As you are talking to her, she becomes unresponsive and apneic. You should:

A. assess her pulse, begin CPR, analyze her cardiac rhythm with the AED, and tell your partner to stop the vehicle.

B. begin CPR, tell your partner to stop the vehicle, analyze her rhythm with an AED, and defibrillate if needed.

C. assess her pulse, tell your partner to stop the vehicle, begin CPR, and analyze her cardiac rhythm with an AED.

D. immediately analyze her cardiac rhythm with an AED, tell your partner to stop the vehicle, and defibrillate if needed.

C. assess her pulse, tell your partner to stop the vehicle, begin CPR, and analyze her cardiac rhythm with an AED

One of the MOST common signs of an acute hypertensive emergency is:

A. a posterior nosebleed.

B. a sudden, severe headache.

C. pale, cool, clammy skin.

D. acute pulmonary edema.

B. a sudden, severe headache

A 55-year-old male with poorly controlled hypertension presents with respiratory distress and difficulty speaking in complete sentences. He is conscious and alert with a blood pressure of 150/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 28 breaths/min and labored. Auscultation of his lungs reveals diffuse coarse crackles. After placing the position in a comfortable position, you should:

A. give oxygen via nasal cannula.

B. apply the CPAP device.

C. administer nitroglycerin.

D. give an IV fluid bolus.

B. apply the CPAP device

A 49-year-old male complains of acute chest discomfort. He is conscious but restless, and he is noticeably diaphoretic. As your partner is applying 100% oxygen, the patient hands you a bottle of nitroglycerin that was prescribed to him by his family physician. Prior to assisting the patient with his medication, you should:

A. ensure that the patient’s heart rate is no greater than 100.

B. ask the patient if he is currently experiencing a headache.

C. assess his systolic BP to ensure that it is at least 100 mm Hg.

D. ensure that he has taken up to 3 doses prior to your arrival.

C. assess his systolic BP to ensure that it is at least 100 mm Hg

A 50-year-old female is in cardiac arrest. You attach the AED and receive a “no shock advised” message. You should:

A. resume CPR and reanalyze her cardiac rhythm after 2 minutes.

B. assess for a carotid pulse and resume CPR if a pulse is not palpable.

C. ensure the pads are placed correctly and reanalyze her cardiac rhythm.

D. perform 10 cycles of CPR and then reanalyze her cardiac rhythm.

A. resume CPR and reanalyze her cardiac rhythm after 2 minutes

Which of the following patients would be LEAST likely to experience the classic signs and symptoms of an acute myocardial infarction (AMI)?

A. A 52-year-old female with thyroid cancer

B. A 55-year-old male with mild hypertension

C. A 60-year-old male with two prior AMIs

D. A 67-year-old female with diabetes mellitus

After defibrillating a patient in cardiac arrest with the AED, you should:

A. give two rescue breaths.

B. insert a multilumen airway.

C. resume chest compressions.

D. briefly check for a carotid pulse.

C. resume chest compressions

You are dispatched to a residence for a 59-year-old male with an unknown emergency. When you arrive, you find the patient sitting on the couch. He is conscious, noticeably diaphoretic, and complains of dizziness and weakness. During your assessment, you note a large, well-healed vertical scar in the center of his chest and a small bulge just under the skin in the upper left part of his chest. His blood pressure is 90/50 mm Hg, pulse is 44 beats/min and weak, and respirations are 24 breaths/min and unlabored. What is the MOST likely cause of this patient’s condition?

A. Atypical angina pectoris

B. Artificial pacemaker failure

C. Damaged coronary artery graft

D. Decreased parasympathetic tone

B. Artificial pacemaker failure

When treating a patient with a blood pressure of 80/40 mm Hg due to “pump failure,” you should:

A. assist the patient with his or her prescribed nitroglycerin.

B. give a 20 mL/kg crystalloid fluid bolus to improve perfusion.

C. apply a nonrebreathing mask if the patient is breathing shallowly.

D. place the patient in a supine position with his or her legs elevated.

B. give a 20 mL/kg crystalloid fluid bolus to improve perfusion

What part of the cardiac electrical conduction system initiates electrical impulses at the slowest rate?

A. The sinoatrial node

B. Areas below the AV node

C. Any part of the AV node

D. The atrioventricular node

B. Areas below the AV node

Which of the following MOST accurately describes the correct sequence of events after attaching an AED to a patient in cardiac arrest and pushing the analyze button?

A. “Shock advised” message, stand clear, defibrillate, immediately resume CPR, reanalyze after 2 minutes

B. “No shock advised” message, check pulse for up to 10 seconds, resume CPR, reanalyze after 2 minutes

C. “No shock advised” message, stand clear, reanalyze, “no shock advised” message, perform CPR for 2 minutes

D. “Shock advised” message, stand clear, defibrillate, perform CPR for 1 minute, stand clear, reanalyze, defibrillate if needed

A. “Shock advised” message, stand clear, defibrillate, immediately resume CPR, reanalyze after 2 minutes

A 62-year-old female with a history of hypertension and diabetes presents with a sudden tearing sensation in her abdomen. She tells you that the pain has been of maximum intensity since its onset. Based on her chief complaint, what additional assessment findings would you expect to encounter?

A. A rapid, irregular heart rate

B. Jugular venous distention while sitting up

C. Diminished pulses in her lower extremities

D. Radiation of the pain to her arms or jaw

C. Diminished pulses in her lower extremities

When defibrillating a 6-month-old infant, you should recall that:

A. adult AED pads cannot be used.

B. you should only deliver one shock.

C. a manual defibrillator is preferred.

D. all shocks are delivered in sets of three.

C. a manual defibrillator is preferred

Approximately two-thirds of the myocardium lies within the:

A. mediastinum.

B. pleural cavity.

C. left hemithorax.

D. right hemithorax.

A. mediastinum

The _____________ is the end of the great cardiac vein and collects blood returning from the walls of the heart.

A. coronary sinus

B. foramen ovale

C. inferior vena cava

D. superior vena cava

A. coronary sinus

When applying the AED pads to a patient with a surgically-implanted pacemaker, you should:

A. apply the pads no differently than in anyone else.

B. apply the pads at least 1″ away from the pacemaker.

C. apply both pads on the posterior aspect of the chest.

D. apply the pad directly over the implanted pacemaker.

B. apply the pads at least 1″ away from the pacemaker

Which of the following valves of the heart are semilunar valves?

A. Mitral and aortic

B. Aortic and pulmonic

C. Mitral and pulmonic

D. Pulmonic and tricuspid

B. Aortic and pulmonic

The coronary arteries of a person with arteriosclerotic heart disease:

A. are thickened and hardened and lose their elasticity.

B. begin to dissect through the layers of the arterial wall.

C. develop plaque deposits from cholesterol and fatty substances.

D. become engorged with blood as cardiac oxygen demand increases.

A. are thickened and hardened and lose their elasticity

Unstable angina pectoris is characterized by:

A. a fixed frequency of chest pain or pressure that is often relieved by rest and several doses of nitroglycerin.

B. chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency.

C. chest pain or pressure that lasts longer than 15 minutes and is associated with myocardial necrosis.

D. chest pain or pressure that occurs during periods of strenuous activity and promptly subsides with rest.

B. chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency

Shortly after administering a second nitroglycerin dose to a 44-year-old male with chest pain, he becomes lightheaded. You take his blood pressure and is reads 80/50 mm Hg. You have already established IV access and are administering oxygen. You should:

A. place him supine and elevate his legs.

B. give him a 500 mL normal saline bolus.

C. cover him with a blanket to keep him warm.

D. contact medical control for further guidance.

A. place him supine and elevate his legs

Erythropoiesis is the ongoing process by which:

A. red blood cells are made.

B. red blood cells and hemoglobin unite.

C. old red blood cells are sent to the spleen.

D. red blood cells are destroyed by macrophages.

A. red blood cells are made

The aortic valve:

A. closes during ventricular systole and facilitates adequate ventricular filling.

B. contains five cusps that prevent the backflow of blood into the left ventricle.

C. regulates the flow of blood from the left ventricle to the systemic circulation.

D. attaches to papillary muscles that contract and tighten the chordae tendineae.

C. regulates the flow of blood from the left ventricle to the systemic circulation

In addition to oxygen, which of the following medications would the AEMT be the MOST likely to administer to a patient who is experiencing acute chest pain, pressure, or discomfort?

A. Aspirin only

B. Morphine and aspirin

C. Aspirin and nitroglycerin

D. Nitroglycerin and morphine

C. Aspirin and nitroglycerin

While treating a patient who is in cardiogenic shock, your paramedic partner makes the comment that the patient needs an inotropic medication. You should recall that this type of medication is intended to:

A. constrict the blood vessels.

B. increase the patient’s heart rate.

C. affect the strength of cardiac contraction.

D. affect electrical conduction through the heart.

C. affect the strength of cardiac contraction

After applying the AED to your cardiac-arrest patient, you receive a “shock advised” message. You should:

A. quickly check to ensure the pads are correctly placed.

B. ensure that all contact with the patient has ceased.

C. deliver one shock and immediately resume CPR.

D. perform CPR for 2 minutes and then deliver a shock.

B. ensure that all contact with the patient has ceased

The ability of a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source is called:

A. dromotropy.

B. conductivity.

C. excitability.

D. automaticity.

D. automaticity

Asystole has an exceedingly high mortality rate because it:

A. reflects a prolonged period of myocardial ischemia.

B. does not respond favorably to cardiac defibrillation.

C. is usually the result of a massive myocardial infarction.

D. most often occurs in patients with significant heart disease.

A. reflects a prolonged period of myocardial ischemia

A 71-year-old man presents with shortness of breath, facial cyanosis, and a cough that is producing blood. His blood pressure is 144/92 mm Hg, pulse is 130 beats/min and irregular, and respirations of 28 breaths/min and labored. He is confused and is slow follow your commands. You should:

A. use CPAP to attempt to improve his breathing, insert a saline lock, transport, and be prepared to assist his ventilations.

B. insert a multilumen airway device, ventilate him at a rate of 12 breaths/min, transport, and establish IV access en route to the hospital.

C. administer high-flow oxygen via nonrebreathing mask, place him in a position of comfort, insert a saline lock, and transport.

D. assist his ventilations with a bag-mask device, begin transport, and consider establishing IV access en route to the hospital.

D. assist his ventilations with a bag-mask device, begin transport, and consider establishing IV access en route to the hospital

Which of the following cardiac rhythms or conditions requires defibrillation?

A. Asystole

B. Pulseless electrical activity

C. Ventricular tachycardia without a pulse

D. Any tachycardic rhythm with a weak pulse

C. Ventricular tachycardia without a pulse

When errors associated with the AED occur, it is usually the result of:

A. failure of the AED’s internal memory card.

B. failure of the internal analyzing mechanism.

C. inappropriate placement of the chest pads.

D. failure to ensure the batteries are charged.

D. failure to ensure the batteries are charged

Prinzmetal’s angina is caused by:

A. coronary vasospasm.

B. coronary artery rupture.

C. atherosclerotic blockage.

D. an isolated coronary occlusion.

A. coronary vasospasm

Approximately 60% to 70% of deaths due to acute myocardial infarction occur:

A. during the first 2 to 3 hours after symptom onset.

B. in the hospital setting and are the result of asystole.

C. while the patient is in the cardiac catheterization lab.

D. in the workplace, even when an AED is readily available.

A. during the first 2 to 3 hours after symptom onset

Treatment for a patient experiencing a cardiovascular emergency begins by:

A. assessing the rate and regularity of the pulse.

B. applying 100% oxygen via nonrebreathing mask.

C. administering prescribed nitroglycerin if needed.

D. ensuring airway patency and adequate breathing.

D. ensuring airway patency and adequate breathing

A 60-year-old female is in possible cardiogenic shock. She is semiconscious with shallow respirations, an irregular pulse, and hypotension. Appropriate treatment for this patient should include:

A. high-flow oxygen via nonrebreathing mask, a saline lock, thermal management, and transport.

B. continuous positive airway pressure, a 500 mL saline bolus, thermal management, and transport.

C. assisted ventilation with a bag-mask device, thermal management, 20 mL/kg fluid bolus, and transport.

D. insertion of multilumen airway device, mild hyperventilation, a saline lock, and prompt transport.

C. assisted ventilation with a bag-mask device, thermal management, 20 mL/kg fluid bolus, and transport

The MOST common cardiac dysrhythmia associated with sudden cardiac death following an acute myocardial infarction is:

A. ventricular tachycardia.

B. ventricular fibrillation.

C. pulseless electrical activity.

D. tachycardia without a pulse.

B. ventricular fibrillation

Which layer of the blood vessel is composed of elastic tissue and smooth muscle cells, which allow the vessel to expand or contract in response to the body’s demands?

A. Tunica intima.

B. Tunica interna.

C. Tunica media.

D. Tunica adventitia.

C. Tunica media

Nitroglycerin is contraindicated for patients who:

A. have an irregular pulse.

B. have experienced a head injury.

C. took an erectile dysfunction drug within the past week.

D. have a systolic blood pressure less than 120 mm Hg.

B. have experienced a head injury

The primary function of the atrioventricular (AV) node is to:

A. serve as the backup pacemaker if the ventricular conduction system fails.

B. regenerate the atrial-initiated electrical impulse before it enters the ventricles.

C. increase conduction from the atria to the ventricles to allow for atrial filling.

D. slow conduction from the atria to the ventricles to allow for ventricular filling.

D. slow conduction from the atria to the ventricles to allow for ventricular filling

When peripheral vascular resistance is increased:

A. afterload increases and stroke volume decreases.

B. blood return to the heart and cardiac output both increase.

C. systolic blood pressure decreases and cardiac output increases.

D. arterial blood pressure decreases and stroke volume increases.

A. afterload increases and stroke volume decreases

Which of the following clinical presentations is consistent with a malfunctioning implanted pacemaker?

A. Weakness and tachycardia

B. Dizziness and hypertension

C. Tachycardia and hypotension

D. Syncope and bradycardia

D. Syncope and bradycardia

An acute myocardial infarction is more apt to occur in the left ventricle because:

A. its inherently low oxygen demand predisposes it to injury or infarct.

B. its coronary arteries are more susceptible to atherosclerotic disease.

C. it is large and thick and demands more oxygen than the right ventricle.

D. it is a fairly small chamber that is quickly depleted of oxygenated blood.

C. it is large and thick and demands more oxygen than the right ventricle

Blood enters the right atrium through the:

A. left and right coronary arteries.

B. vena cavae and coronary sinus.

C. foramen ovalis and vena cavae.

D. coronary artery and foramen ovale.

B. vena cavae and coronary sinus

When the parasympathetic nervous system is stimulated, it:

A. enhances conduction through the atrioventricular node.

B. slows the heart rate by decreasing SA node discharge.

C. produces epinephrine and increases cardiac contractility.

D. increases the heart rate by increasing SA node discharge.

B. slows the heart rate by decreasing SA node discharge

A 56-year-old male with a history of coronary artery disease complains of an acute onset of substernal chest discomfort and diaphoresis while moving a heavy box. After sitting down and taking one nitroglycerin tablet, the discomfort promptly subsides. This episode is MOST consistent with:

A. stable angina pectoris.

B. unstable angina pectoris.

C. vasospastic angina pectoris.

D. acute myocardial infarction.

A. stable angina pectoris

Damage to the myocardium following infarction can be minimized if fibrinolytic therapy is administered no later than _____ hours following the onset of symptoms.

A. 12

B. 14

C. 16

D. 18

A. 12

During your primary assessment of an unresponsive 47-year-old male, you find that he has occasional gasping breaths. You should:

A. insert a multilumen airway device and assess for a carotid pulse.

B. assess for a carotid pulse and begin chest compressions if needed.

C. deliver 2 slow breaths with a bag-mask device and assess for a pulse.

D. perform 30 chest compressions, open the airway, and deliver 2 breaths.

B. assess for a carotid pulse and begin chest compressions if needed

Which of the following statements regarding the automated external defibrillator (AED) is NOT correct?

A. Human error is the most common reason for AED failure.

B. A pulse should be checked immediately after the AED shocks.

C. The AED will deliver one shock every 2 minutes as needed.

D. Pulseless V-tach may respond to defibrillation with an AED.

B. A pulse should be checked immediately after the AED shocks

Following defibrillation with the AED, you have achieved return of spontaneous circulation (ROSC) in a 42-year-old man. However, he remains unresponsive and apneic. You insert a multilumen airway device, continue ventilations, and begin immediate transport to the hospital. En route, you reassess the patient and determine that he is in cardiac arrest. You should:

A. begin CPR, tell your partner to stop the ambulance, and analyze the patient’s cardiac rhythm with the AED.

B. analyze the patient’s rhythm with the AED, defibrillate if indicated, and tell your partner to stop the ambulance.

C. tell your partner to stop the ambulance, perform CPR for 2 minutes, and analyze the patient’s cardiac rhythm with the AED.

D. tell your partner to continue to the hospital, perform 2 minutes of CPR, and analyze the patient’s cardiac rhythm with the AED.

A. begin CPR, tell your partner to stop the ambulance, and analyze the patient’s cardiac rhythm with the AED

Compared to monophasic defibrillation, biphasic defibrillation is advantageous because it:

A. sends the shock in one direction within the heart.

B. utilizes less energy to achieve effective defibrillation.

C. works more effectively when 360 joules are delivered.

D. automatically defibrillates without AEMT intervention.

B. utilizes less energy to achieve effective defibrillation

A 33-year-old male complains of generalized weakness and chest discomfort that began following his morning workout at the gym. He is conscious and alert, but restless. Your assessment reveals a BP of 130/64 mm Hg, pulse of 78 beats/min and occasionally irregular, respirations of 16 breaths/min and unlabored, and an SpO2 of 98% on room air. He has prescribed nitroglycerin tablets and states that he took one without relief. Appropriate treatment for this patient includes:

A. oxygen via nonrebreathing mask, one chewable baby aspirin, an IV fluid bolus, and prompt transport.

B. oxygen via nasal cannula, up to two more doses of nitroglycerin, saline lock, and transport.

C. oxygen via nonrebreathing mask, up to 324 mg aspirin, supine with his legs elevated, and transport.

D. oxygen via nasal cannula, up to 324 mg aspirin, saline lock, additional nitroglycerin per medical control, and transport.

D. oxygen via nasal cannula, up to 324 mg aspirin, saline lock, additional nitroglycerin per medical control, and transport

According to Starling’s Law of the Heart:

A. afterload.

B. stroke volume.

C. cardiac output.

D. ejection fraction.

If the heart’s natural pacemaker is not functioning properly:

A. the atria will be electrically stimulated but will not contract.

B. the AV node may take over and pace the heart at 40 to 60 beats/min.

C. the electrical stimulus will not be received by the ventricles.

D. the SA node will take over as the heart’s primary pacemaker.

You should be MOST suspicious that a patient is experiencing an acute myocardial infarction if he or she presents with:

A. acute pain to the left jaw that is made worse by movement of the head.

B. an acute tearing sensation in the abdomen that radiates to the lower back.

C. an acute onset of weakness, nausea, and sweating without an obvious cause.

D. an acute onset of sharp chest pain that worsens when he or she takes a breath.

C. an acute onset of weakness, nausea, and sweating without an obvious cause

Which of the following cardiac dysrhythmias requires immediate defibrillation?

A. Sinus tachycardia with a low BP

B. Sinus bradycardia without a pulse

C. Perfusing ventricular tachycardia

D. Nonperfusing ventricular fibrillation

D. Nonperfusing ventricular fibrillation

When the papillary muscles contract, the ______________ tighten, preventing blood from regurgitating from the ventricles to the atria.

A. semilunar valves

B. chordae tendineae

C. coronary sinuses

D. tricuspid valves

B. chordae tendineae

A hypertensive crisis is considered to be a true emergency when:

A. the diastolic blood pressure exceeds 100 mm Hg.

B. the patient is noncompliant with his or her medication.

C. signs of central nervous system dysfunction are present.

D. the patient has a concomitant history of epileptic seizures.

C. signs of central nervous system dysfunction are present

Damage to the ___________ valve may cause blood to regurgitate into the lungs.

A. mitral

B. tricuspid

C. pulmonic

D. papillary

A. mitral

Which of the following MOST accurately describes the pathophysiology of angina pectoris?

A. Irreversible process in which one or more coronary arteries spasm and decrease myocardial blood supply

B. Reversible process in which a brittle intracoronary plaque ruptures and activates the blood-clotting system

C. Irreversible process in which the lumen of the coronary artery is completely occluded with plaque

D. Reversible process in which myocardial oxygen demand exceeds the supply of available oxygen

D. Reversible process in which myocardial oxygen demand exceeds the supply of available oxygen

The term acute coronary syndrome (ACS) is used to describe:

A. a specific condition in which a coronary artery is totally blocked.

B. a variety of cardiac dysrhythmias caused by a myocardial infarction.

C. any change in the pattern or characteristics of a patient’s angina.

D. any group of symptoms consistent with acute myocardial ischemia.

A patient with acute chest discomfort took two of his prescribed nitroglycerin tablets and is now experiencing a pounding headache. However, he tells you that he is still experiencing chest discomfort. You should suspect that:

A. his prescribed nitroglycerin has lost its potency.

B. the nitroglycerin has caused severe hypotension.

C. he has stable angina, but still requires transport.

D. he is experiencing ongoing myocardial ischemia.

D. he is experiencing ongoing myocardial ischemia

The tricuspid and mitral valves of the heart are referred to as:

A. semilunar valves.

B. atrioseptal valves.

C. ventriculoseptal valves.

D. atrioventricular valves.

D. atrioventricular valves

The left main coronary artery rapidly divides into the:

A. left anterior descending and circumflex arteries.

B. right coronary artery and acute marginal branch.

C. posterior descending artery and left atrial branch.

D. left posterior ventricular and acute marginal arteries.

A. left anterior descending and circumflex arteries

The _____________ anchors the heart within the thoracic cavity and prevents cardiac overdistention.

A. epicardium

B. endocardium

C. pericardium

D. cardiac septum

C. pericardium

The middle, muscular layer of the heart is called the:

A. epicardium.

B. myocardium.

C. pericardium.

D. endocardium.

B. myocardium

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