Emergency Cardiac Drugs

Adenosine is the generic name for
a. Nucleoside.
b. Adenocard.
c. Actidose.
d. Alupent.
B. Adenocard

Adenosine is primarily used in the treatment of
a. Wide complex junctional dysrhythmia.
b. Narrow complex pulseless bradycardia.
c. Narrow complex supraventricular tachycardia.
d. Wide complex ventricular tachycardia with pulses.
c. Narrow complex supraventricular tachycardia.

The typical initial dose of adenosine in the adult patient is:
a. 60 mg slow IV push followed by a saline flush and elevation of the extremity.
b. 6 mg rapid IV bolus followed by a saline flush and elevation of the extremity.
c. 12 mg rapid IV bolus followed by a saline flush and elevation of the extremity.
d. 3 mg/kg rapid IV bolus followed by a saline flush and elevation of the extremity.
6 mg rapid IV bolus followed by a saline flush and elevation of the extremity.

The patient is a 39 year-old woman complaining of chest pain and slight dyspnea. She states that her heart suddenly started racing. The ECG shows sinus tachycardia at a rate of 140 per minute. After giving adenosine, the patient develops a ‘strange look’ and the monitor shows asystole. The best immediate response is:
a. Monitor the patient as the asystole is transient.
b. Immediately start chest compressions and ventilation.
c. Administer 1 mg of epinephrine IV and begin CPR.
d. Administer 1 mg of atropine and begin CPR.
a. Monitor the patient as the asystole is transient.

Which of the following is not an adverse effect of adenosine?
a. Paresthesias.
b. Headache.
c. Palpitations.
d. Hypertension.
d. Hypertension.

Amiodarone is used in the treatment of:
a. Ventricular fibrillation.
b. Hemodynamically stable ventricular tachycardia.
c. Pulmonary edema secondary to congestive heart failure.
d. Sinus tachycardia accompanied by hypotension.
b. Hemodynamically stable ventricular tachycardia

The patient has a history of hypertension and has been treated with labetalol. If you give amiodarone to treat a paroxysm of supraventricular tachycardia that is refractory to adenosine, it may precipitate
a. Severe hypertension and worsen the tachycardia.
b. Hypotension accompanied by bradycardia.
c. Atrial fibrillation with pulmonary edema.
d. Bradycardia with prolongation of the P-R interval.
d. Bradycardia with prolongation of the P-R interval.

The typical dose of amiodarone in persistent ventricular fibrillation is:
a. 300 mg IV push.
b. 150 mg IV drip.
c. 1.5 mg/kg IV push.
d. 30 mg IV drip.
a. 300 mg IV push.

In an acute myocardial infarction, aspirin is used to:
a. Dilate the coronary arteries.
b. Decrease platelet aggregation.
c. Relieve the patient’s anxiety.
d. Control nausea and vomiting.
b. Decrease platelet aggregation.

The typical dose of aspirin for an adult patient with an acute myocardial infarction is:
a. 160-325 mg orally.
b. 40-100 mg orally.
c. 81 mg/kg IV drip.
d. 800 mg.
a. 160-325 mg orally.

Aspirin should be given as soon as possible to patients with:
a. Hemorrhagic stroke.
b. Gastrointestinal bleeding.
c. Unstable angina.
d. Active ulcer disease.
c. Unstable angina.

Atenolol is classified as a:
a. Calcium channel blocker.
b. ACE inhibitor.
c. Beta blocker.
d. Antipyretic.
c. Beta blocker.

Atenolol is indicated in the treatment of:
a. Cardiogenic shock.
b. Atrial fibrillation.
c. Third degree AV block.
d. Exacerbation of COPD.
b. Atrial fibrillation.

The patient has been diagnosed with an acute myocardial infarction. The typical dose of atenolol for the patient is:
a. 5 mg slow IV.
b. 15 mg rapid IV.
c. 20 mg slow IV
d. 25 mg rapid IV.
a. 5 mg slow IV.

The patient is a 56-year-old man with an acute anterior wall myocardial infarction. The ECG indicates sinus tachycardia at with no ectopy and his vital signs are BP – 82/64, P – 108, R – 22 and non-labored. After maintaining adequate oxygenation, the most appropriate drug of choice to elevate the man’s blood pressure is:
Atenolol. Dobutamine
Adenosine. Dopamine
Dopamine

Which of the following best describes the actions of atropine sulfate?
a. Atropine is a sympathomimetic drug.
b. Atropine is a parasympathomimetic drug.
c. Atropine is a sympatholytic drug.
d. Atropine is a parasympatholytic drug.
d. Atropine is a parasympatholytic drug.

In which of the following conditions is atropine is indicated?
a. Symptomatic tachycardia.
b. Ventricular ectopy.
c. Organophosphate poisoning.
d. Atrial flutter of fibrillation.
c. Organophosphate poisoning.

The patient is a 62 year-old male complaining of chest pain and shortness of breath. His ECG shows sinus bradycardia at 50 beats per minute that is accompanied by a blood pressure of 88/50. Upon further examination, the patient reveals that he is being treated for urinary retention. Because this patient is hemodynamically unstable, the dose of atropine is:
a. 1 mg slow IV push.
b. 0.5 mg rapid IV push.
c. 0.5 mg/kg slow IV push.
d. not indicated in this patient.
b. 0.5 mg rapid IV push.

Which of the following may occur if atropine is given too slowly?
a. Decreased heart rate .
b. Overcorrection of the blood pressure.
c. Tachycardia and palpitations.
d. Flushed, hot, dry skin.
a. Decreased heart rate .

Calcium chloride is contraindicated in:
a. Hyperkalemia.
b. Digitalis toxicity.
c. Hypocalcemia.
d. Overdose of calcium channel blocker.
b. Digitalis toxicity.

A 6 y/o child who accidentally ingested his mother’s verapamil is found unresponsive and profoundly hypotensive. Emergency management of this child consists of:
a. Calcium chloride, 20 mg/kg slowly IV or IO.
b. Dopamine, 2-20 mcg/kg/min.
c. Epinephrine, 0.5-1.0 mg/kg slowly IV or IO.
d. Atropine, 0.5 mg slowly IV or IO.
a. Calcium chloride, 20 mg/kg slowly IV or IO.

The patient is a 58 year-old woman with end stage renal disease who been on dialysis for nearly 4 years. She became ill during her last dialysis treatment two days earlier and was unable to complete it. This morning, her husband found her unresponsive. Initial examination reveals hypotension, bilateral rales in the lung bases, and what appears to be ventricular tachycardia on the ECG. The widened QRS complexes appear to be sine waves and no P waves are noted. Pharmacologic treatment for this patient includes:
a. Lidocaine hydrochloride..
b. Amiodarone.
c. Calcium chloride.
d. Atenolol.
c. Calcium chloride.

It is important to flush the IV tubing between the administration of calcium chloride and sodium bicarbonate because:
a. Sodium bicarbonate inactivates calcium chloride.
b. Calcium chloride inactivates sodium bicarbonate.
c. Calcium chloride binds with the IV tubing rendering it inactive.
d. Calcium chloride and sodium bicarbonate cause precipitation.
d. Calcium chloride and sodium bicarbonate cause precipitation.

The patient is a 60 year-old male complaining of severe chest discomfort. His ECG shows ventricular tachycardia; however, he is conscious, alert, and stable with a blood pressure of 104/60. Antiarrythmic treatment has been ineffective and the patient will undergo synchronized cardioversion. A major concern with giving diazepam to the patient is:
a. Reflex bradycardia.
b. Respiratory depression.
c. Status seizures.
d. Confusion and ataxia.
b. Respiratory depression.

Digoxin is a cardiac glycoside derived from a plant known as:
a. Deadly nightshade.
b. Morning glory.
c. Foxglove.
d. Night blooming jasmine.
c. Foxglove.

Digoxin is used in the treatment of:
a. Atrial flutter or fibrillation.
b. Ventricular tachycardia.
c. Ventricular fibrillation.
d. Atrioventricular block.
a. Atrial flutter or fibrillation.

The adverse effects of digitalis toxicity include:
a. Hyperactivity.
b. Blurred, yellow, or green vision.
c. Ataxia.
d. Chest pain.
d. Chest pain.

The patient is a 72 year-old woman with a history of atrial fibrillation and congestive heart failure. She is being treated with digoxin to control her ventricular response. She has recently been diagnosed with hypertension and was prescribed the calcium channel blocker, verapamil. This combination of medications:
a. Is of little concern as they have no significant interaction.
b. May decrease the effectiveness of her digitalis preparation.
c. Reduces the absorption of digitalis from the GI tract.
d. May lead to an increased serum concentration of digitalis.
b. May decrease the effectiveness of her digitalis preparation.

Diltiazem is in a class or medications known as:
a. Calcium channel blockers.
b. Beta blockers.
c. Beta sympathomimetics.
d. Cardiac glycosides.
a. Calcium channel blockers.

Diltiazem acts by:
a. Slowing conduction in the atrioventricular node.
b. Reducing the inotropic state of the heart.
c. Increasing the heart rate and contractility.
d. Stimulates tone of the vagus nerve.
a. Slowing conduction in the atrioventricular node.

Diltiazem is indicated for the treatment of:
a. Sick sinus syndrome.
b. Cardiogenic shock.
c. Atrial fibrillation or flutter.
d. Ventricular tachycardia.
c. Atrial fibrillation or flutter.

The typical initial dose of diltiazem for the adult patient is:
a. 25 mg/kg IV over 2 minutes.
b. 25 mg IV over 2 minutes.
c. 0.25 mg/kg IV over 2 minutes.
d. 0.25 mg rapid IV push.
c. 0.25 mg/kg IV over 2 minutes.

Choose the correct statement about dobutamine.
a. It is related to epinephrine and is an alpha, beta1 and beta2 specific agonist.
b. It is an alpha-specific agonist used to elevate blood pressure in shock.
c. It is a synthetic catecholamine that is primarily a beta1 agonist.
d. It increases both the chronotropic and inotropic states of the heart.
c. It is a synthetic catecholamine that is primarily a beta1 agonist.

The indications for dobutamine include:
a. Congestive heart failure accompanied by hypotension.
b. Symptomatic bradycardia with pulmonary hypertension.
c. Bronchial asthma accompanied by hypotension.
d. Hypotension caused by systemic vasodilation.
a. Congestive heart failure accompanied by hypotension.

The typical dose range of dobutamine for adult and pediatric patients is:
a. 1-5 mcg/kg/minute.
b. 10-20 mcg/kg/minute.
c. 5-10 mcg/kg/minute.
d. 2-20 mcg/kg/minute.
d. 2-20 mcg/kg/minute.

You are preparing to give dobutamine and furosemide to treat a patient with congestive heart failure. What special considerations may be needed to administer these two drugs at the same time?
a. Give both medications concurrently to enhance the effects of each drug.
b. Give via separate IV lines since they are incompatible in the same tubing.
c. Give furosemide just after starting dobutamine to potentiate furosemide.
d. There are no special considerations pertaining to dobutamine and furosemide.
b. Give via separate IV lines since they are incompatible in the same tubing.

Choose the correct statement about dopamine.
a. It is related to epinephrine and is an alpha1 and beta1 agonist.
b. It is an alpha-specific agonist used to elevate blood pressure in shock.
c. It is a synthetic catecholamine that is primarily a beta1 agonist.
d. It decreases both the chronotropic and inotropic states of the heart.
b. It is an alpha-specific agonist used to elevate blood pressure in shock.

Which of the following is an indication for dopamine?
a. Hypotension from cardiogenic shock.
b. Hypotension caused by hypovolemia.
c. Ventricular fibrillation.
d. Pheochromocytoma.
a. Hypotension from cardiogenic shock.

The patient is a 60 year-old man with hypotension secondary to an acute myocardial infarction. Past medical history indicates that he has been taking labetalol for hypertension. Which of the following statements is correct regarding the interactions between labetalol and dopamine?
a. There are no significant interactions between the two drugs.
b. Labetalol may reduce the beta effects of dopamine.
c. Dopamine may enhance the effects of labetalol.
d. Labetalol may enhance the effects of dopamine.
b. Labetalol may reduce the beta effects of dopamine.

The patient is a 70 year-old woman in cardiogenic shock following an acute myocardial infarction. In assessing the woman, she states that she has a history of depression and has been taking Nardil® for the past several years. To correct this patient’s hypotension, dopamine may be indicated. Care must be taken when giving dopamine to this patient, because:
a. MAO inhibitors such as Nardil potentiate catecholamines.
b. Dopamine inhibits Nardil and depression can worsen.
c. Dopamine will have no effect on increasing her blood pressure.
d. Nardil and dopamine have no significant interactions.
d. Nardil and dopamine have no significant interactions.

Epinephrine is best described as
a. An endogenous catecholamine and is an alpha and beta agonist.
b. An alpha-specific agonist used to elevate blood pressure in shock.
c. A synthetic catecholamine that is primarily a beta1 agonist.
d. A drug that decreases the chronotropic and inotropic states of the heart.
d. A drug that decreases the chronotropic and inotropic states of the heart.

Epinephrine is used in the emergency management of:
a. Hypovolemic shock.
b. Ventricular fibrillation.
c. Ventricular tachycardia.
d. Premature ventricular contractions.
b. Ventricular fibrillation.

A 60 year-old male patient with symptomatic bradycardia has not responded to the maximum dose of atropine or higher dose levels of dopamine. The treatment options at this time include:
a. Amiodarone, 300 mg IV push.
b. Propranolol, 1-3 mg over 2-5 minutes IV.
c. Epinephrine infusion, 2-10 mcg/minute.
d. Inamrinone, 0.75 mg/kg over 10-15 minutes.
c. Epinephrine infusion, 2-10 mcg/minute.

Which of the following is not a typical adverse effect of epinephrine?
a. Headache.
b. Dysrhythmias.
c. Chest pain.
d. Hypotension.
d. Hypotension

Racemic epinephrine is used in the emergency management of:
a. Ventricular fibrillation.
b. Hypovolemic shock.
c. Laryngotracheobronchitis.
d. Supraventricular tachycardia.
c. Laryngotracheobronchitis.

The dose of racemic epinephrine in the treatment of croup is:
a. 5 ml drug in 5ml of saline then given slowly IV
b. 5ml drug in 5ml sailine administered by nebulizer.
c. 0.25-0.5 ml drug in 2.5 ml sailine given slowly IV.
d. 0.25-0.5 ml drug in 2.5 ml saline given by nebulizer.
D. 0.25-0.5 ml drug in 2.5 ml saline given by nebulizer

The pateint is a conscious adult male in stable ventricular tachycardia that is unresponsive to lidocaine or other pharmacologic therapy. In preparation for synchronized cardioversion, the patient should be given:
a. Diazepam, 25 mg IV push
b. Lorazepam, 1-4 mg IV over 2-4 min
c. Etomidate, 0.2-0.6 mg/kg IV over 30-60 seconds
d. Fentanyl, 0.2 mg over 15 seconds
B. Lorazepam, 1-4 mg IV over 2-4 min… possibly Etomidate 0.2-0.6 mg/kg IV over 30-60 seconds

The patient was sedated with etomidate prior to cardioversion and tolerated the procedure well. He is now in normal sinus rhythm, but his ventilatory rate is 4-6 breaths per minute. At this time, emergency treatment includes:
a. Naloxone, 0.4-2.0 mg IV push
b. Monitor breathing and consider intubation
c. Epinephrine, 0.5 mg slowly IV
d. Diphenhydramine, 25 mg IV push
b. Monitor breathing and consider intubation

The patient is a 29 year old woman complaining of heart palpatations. She says that her pulse “feels like it is racing.” She also states she was drinking coffee when her “heart took off.” The woman’s ECG reveals supraventricular tachycardia at a rate of 160. After treating the patient with an intial and repeat dose of adenosine, there is no change in her ECG. The lack of response to adenosine is most likely because:
a. The ECG is a rapid AV junctional rhythm and not PSVT.
b. Coffee (caffeine) antagonizes the action of adenosine.
c. The woman is allergic to adenosine
d. Adenosine is ineffective in treating PSVT.
b. Coffee (caffeine) antagonizes the action of adenosine.

A 56 year old male had hemodynamically stable ventricular tachycardia. He was given amiodarone including a maintenance amiodarone infusion. Then, he received daizepam followed by synchronized cardioversion. Following the cardioversion, the patient’s ECG displayed normal sinus rhythm that gradually slowed to sinus bradycardia. At this point, treatment would include:
a. Adminstration of atropine
b. Infusion of dopamine or dobutamine
c. Slowing or discontinuing of amiodarone
d. Administration of atenolol or lebatolol.
c. Slowing or discontinuing of amiodarone

The patient has retrosternal chest discomfort with referred pain to the left arm and fingers. After placing the patient into a semi-fowler’s position, administering supplemental oxygen, the patient is given nitroglycerin 0.4 mg SL. He states that his chest discomfort is less severe, but he feels weak and very dizzy. Assessing the patient’s vital signs reveals a blood pressure of 76 by palpation, pulse of 120, ventilatory rate of 22. Urgent treatment at this time includes:
a. Adenosine to slow the heart rate and increase blood pressure
b. Placing the patient in a supine position and reassessing vitals.
c. Initiating a dopamine drip at the lowest dose possible.
d. Labetalol and dopamine to stabalize the blood pressure and pulse
b. Placing the patient in a supine position and reassessing vitals

Furosemide works by inhibiting reabsorption of sodium and chloride in the:
a. bloodstream
b. distal renule tubules
c. liver
d. loop of Henle
d. loop of Henle

IV doses if furosemide can reduce cardiac preload by:
a. altering potassium regulation
b. decreasing capillary sphincter tone
c. increasing creatinine clearance
d. increasing venous capacitance
d. increasing venous capacitance

Which of the following is a correct dose of furosemide for a pediatric patient?
a. 0.6 mg/kg
b. 1 mg/kg
c. 6 mg
d. 10 mg
b. 1 mg/kg

You are treating a patient with calcium channel blocker cardiotoxicity who does not respond to conventional therapy. Another drug to consider is:
a. furosemide
b. glucagon
c. insulin
d. romazicon
b. glucagon

1 mg of glucagon is typically mixed with how much dilutent?
a. 1 mL
b. 5 mL
c. 10 mL
d. 20 mL
a. 1 mL

Which of the following is an indication of heparin administration?
a. acute myocardial infarction
b. allergic reaction
c. hypotension
d. severe thrombocytopenia
a. acute myocardial infarction

Before administering heparin with fibrinolytic therapy, a blood sample should be obtained for control of:
a. decrease red blood cells
b. low platelet count
c. partial thromboplastin time
d. thrombocytopenia
b. low platelet count

Heparin is given as an IV bolus of:
a. 30 IU/ kg
b. 60 IU/ kg
c. 90 IU/ kg
d. 120 IU/ kg

Hydralazine is used almost exclusively for the treatment of:
a. congestive heart failure
b. increased intracranial pressure
c. preeclampsia and eclampsia
d. seizure disorder
a. congestive heart failure

Your patient is prescribed diazoxide and you have received an order for hydralazine. Which side effect would you expect?
a. CNS depression
b. muscle fatigue
c. respiratory depression
d. severe hypotension
d. severe hypotension

After an initial dose of 10 mg of hydralazine, you begin an infusion at a rate of:
a. 0.5 mg/ hour
b. 0.5 mg/ min
c. 5 mg/ hour
d. 5 mg/ min
c. 5 mg/ hour

Which of the following drugs would act as an adjunct to electrical cardioversion for a patient in atrial flutter?
a. adenosine
b. ibutilide
c. isoproterenol
d. verapamil
b. ibutilide

Ibutilide aids in treatment of dysrhythmias by:
a. decreases the refractory period of cardiac tissue
b. increasing the Q-T interval
c. prolonging the action potential duration
d. temporarily halting the transmission of impulses through the AV junction
c. prolonging the action potential duration

Ibutilide is indicated for which of the following dysrhythmias?
a. atrial fibrillation
b. asystole
c. ventricular fibrillation
d. ventricular tachycardia
a. atrial fibrillation

Inamrinone increases cardiac output without affecting:
a. alpha-adrenergic receptors
b. heart rate
c. myocardial contractility
d. vessel dilation
c. myocardial contractility

You are treating a 50-year-old man in severe congestive heart failure that is refractory to diuretics, vasodilators and other inotropic agents. A drug to consider administering is:
a. amiodarone
b. atenolol
c. diltiazem
d. inamrinone
d. inamrinone

Which of the following is a contraindication to inamrinone?
a. hypotension
b. prior administration of dopamine
c. severe congestive heart failure
d. tachycardia
d. tachycardia

In cases of hyperkalemia, 50% dextrose is administered with what drug to lower potassium levels?
a. digoxin
b. insulin
c. magnesium sulfate
d. verapamil
b. insulin

Which of the following is true of the mechanism of action of labetalol?
a. labetalol is a beta blocker only
b. labetalol is a beta2 selective blocker
c. labetalol is an alpha blocker only
d. labetalol is a more potent beta-blocker than alpha-blocker

To lower blood pressure in hypertensive crisis, labetalol:
a. decreases cardiac output
b. decreases peripheral resistance
c. increases preload
d. produces a reflex tachycardia
b. decreases peripheral resistance

Which of the following patient conditions would be an indication for labetalol?
a. cardiogenic shock
b. congestive heart failure
c. hypertensive crisis
d. second and third-degree heart block
c. hypertensive crisis

If you administer lidocaine to a patient with liver dysfunction, you would expect:
a. decreased metabolic clearance
b. decreased ventricular fibrillation threshold
c. lessened dysrhythmic effects
d. reflex tachycardia

The maximum total dose of lidocaine is:
a. 1 mg/ kg
b. 2 mg/ kg
c. 3 mg/ kg
d. 4 mg/ kg
c. 3 mg/ kg

Magnesium sulfate reduces muscle contractions by blocking:
a. Acetycholine
b. Dopamine
c. Epinephrine
d. Norepinephrine
a. Acetycholine

Which drug can be used as an antagonist to magnesium sulfate?
a. calcium gluconate
b. dexamethasone
c. procainamide
d. sodium bicarbonate
a. calcium gluconate

Which of the following best describes metaproterenol? It is a(n):
a. Parasympatholytic medication.
b. Beta2 sympathomimetic.
c. Alpha2-adrenergic sympathomimetic.
d. Parasympathomimetic medication.
b. Beta2 sympathomimetic.

Metoprolol is classified as a:
a. Beta sympathomimetic.
b. Alpha sympatholytic.
c. Cholinesterase inhibitor.
d. Beta sympatholytic.
d. Beta sympatholytic.

The patient is a 48 year-old male complaining of severe pressure in the chest. The ECG indicates a suspected acute myocardial infarction. In order to reduce the area of ischemia as well as reduce the work load and oxygen demand of the heart, urgent care of the patient may include:
a. Naloxone.
b. Metoprolol.
c. Metaproterenol.
d. Dobutamine
b. Metoprolol.

While assessing an individual complaining of chest pain and dyspnea, the patient reveals of history of COPD for which he self-administers albuterol. In this case, treating the patient with metoprolol:
a. Should be followed by an infusion of dobutamine.
b. Is indicated at half the typical dose.
c. Is not indicated and should be avoided.
d. Should be followed by an infusion of lidocaine.
c. Is not indicated and should be avoided.

The patient is experiencing a paroxysm of supraventricular tachycardia that has been unresponsive to other, non-pharmacologic interventions. The dose of metoprolol for the patient is:
a. 1-3 mg slowly IV to a total of 0.1 mg/kg.
b. 5 mg slowly IV to a total of 15 mg.
c. 0.25-0.50 mg/kg slow IV push.
d. 10-25 mg slowly IV to a total of 100 mg.
b. 5 mg slowly IV to a total of 15 mg.

Choose the correct statement pertaining to the concurrent administration of metoprolol and verapamil?
a. The combination may cause severe hypotension.
b. The combination has no interaction and is safe.
c. Administer half of the typical dose for each drug.
d. Administer twice the typical dose for each drug.

Morphine sulfate is classified as a:
a. Narcotic analgesic.
b. Beta agonist.
c. Benzodiazepine.
d. Sedative hypnotic.
a. Narcotic analgesic.

Morphine acts to reduce pain as well as:
a. Decrease seizure activity.
b. Decrease venous return to the heart.
c. Dilate bronchi and bronchioles.
d. Block beta receptors and slow the heart rate.
b. Decrease venous return to the heart.

Which of the following best describes the effect that morphine has on reducing the myocardial oxygen demand?
a. Morphine decreases preload and afterload.
b. Morphine dilates the coronary arteries.
c. Morphine increases the ventricular response rate.
d. Morphine increases the inotropic state of the heart.
a. Morphine decreases preload and afterload.

For which of the following is morphine sulfate indicated?
a. Symptomatic bradycardia from acute myocardial infarction.
b. Headache from significant head injury.
c. Chest pain from acute myocardial infarction.
d. To lower blood pressure in hypertensive crisis.
c. Chest pain from acute myocardial infarction.

A 48 year-old male is complaining of severe chest pain and shortness of breath. His ECG shows first degree heart block at 46 beats per minute that is accompanied by a blood pressure of . Which of the following is correct regarding the treatment of the patient’s chest pain?
a. Give 1 mg morphine slow IV push.
b. Morphine should be given at a normal dose.
c. Monitor the patient’s rate and depth of breathing.
d. Morphine is not indicated in this patient.
d. Morphine is not indicated in this patient.

After receiving 5 mg morphine to alleviate his chest pain, the patient’s rate and depth of breathing slows dramatically. Even though the patient is receiving supplemental oxygen, there is slight cyanosis around the patient’s lips. The pulse oximetry reveals a SpO2 of 80% with supplemental oxygen being delivered. The appropriate emergency management of this patient includes:
a. Immediately intubate the patient.
b. Increase the oxygen being delivered.
c. Administer naloxone and monitor.
d. Give etomidate and intubate.

A 60 year-old male complains of severe chest pain and dyspnea. His skin is pale, cool, and clammy. The 12-lead ECG shows ST-segment elevation in leads V3 and V4. Vital signs indicate Pulse – 88 bpm and regular, BP – 92/56 , and Respiration 22. Choose the correct statement about administering nitroglycerin to the patient.
a. Nitroglycerin is contraindicated for the patient due to hypotension.
b. Nitroglycerin may be given, but monitor the blood pressure.
c. Nitroglycerin may only be given after increasing the blood pressure.
d. Nitroglycerin may be given concurrently with an infusion of dopamine.
b. Nitroglycerin may be given, but monitor the blood pressure.

The patient is a 55 year-old male with a suspected acute myocardial infarction. During the examination the man admits to using tadalafil (Cialis) approximately 12 hours earlier. In treating this patient, nitroglycerin:
a. Is permissible since tadalafil was taken more than 8 hours earlier.
b. Can be given and one-half the typical adult dose.
c. Should be avoided to prevent severe hypotension.
d. May be given along with dopamine to maintain blood pressure.

In small doses, nitroglycerin acts to reduce chest pain due to myocardial ischemia by:
a. Reducing preload and myocardial oxygen demand.
b. Dilating the coronary arteries and providing addition flow.
c. Increasing afterload to ensure adequate myocardial perfusion.
d. Providing analgesia of the ischemic myocardium.
a. Reducing preload and myocardial oxygen demand.

Nitroglycerin should not be used in suspected:
a. Ischemia chest pain.
b. Congestive heart failure.
c. Pulmonary hypertension.
d. Intracranial hemorrhage.
d. Intracranial hemorrhage.

The patient is a 56 year-old male who will be receiving an IV infusion of nitroglycerin to control refractory chest pain. IV therapy should be initiated using tubing that is free of polyvinyl chloride (PVC) because:
a. The tubing can absorb up to 80% of the nitroglycerin.
b. Nitroglycerin reacts with the tubing to form a precipitate.
c. Nitroglycerin mixes with the tubing and becomes toxic.
d. There is no concern regarding the type of IV tubing used.

A 59 year-old male is complaining of severe chest discomfort. His ECG shows normal sinus rhythm with ST-segment elevation in leads II, III and aVF. He is conscious, alert, and stable with a blood pressure of . Nitroglycerin is administered to help alleviate the chest pain. A major concern with giving nitroglycerin to this patient is:
a. Reflex bradycardia.
b. Hypotension.
c. Headache.
d. Nystagmus.
b. Hypotension.

Nitropaste is as absorbent paste containing:
a. 1% nitroglycerin.
b. 2% nitroglycerin.
c. 3% nitroglycerin.
d. 4% nitroglycerin.
b. 2% nitroglycerin.

The typical dosage of nitropaste for the adult with a suspected acute myocardial infarction is:
a. ½ inch of paste
b. 1-2 inches of paste
c. 2-3 inches of paste
d. 3-4 inches of paste
a. ½ inch of paste

Wear gloves when applying nitropaste to a patient because:
a. It is easier to spread over the patient’s skin.
b. Nitropaste may be absorbed by bare hands.
c. Gloves ensure even distribution of the paste.
d. Nitropaste can be effectively massaged into the skin.
b. Nitropaste may be absorbed by bare hands.

After applying nitropaste to a patient’s chest, cover the application with a transparent wrap and secure with tape. This procedure is performed to:
a. Ensure transfer of the paste to another person while moving the patient.
b. Enhance absorption of the paste and ensures potency of the delivered drug.
c. Slow degradation of the medication after the nitroglycerin is exposed to air.
d. Allow the site to be visible in the event of a skin reaction to nitropaste.

Norepinephrine is classified as a:
a. Alpha sympathomimetic.
b. Beta sympathomimetic.
c. Alpha and beta sympathomimetic.
d. Alpha and beta parasympathomimetic.
c. Alpha and beta sympathomimetic.

The use of norepinephrine should be considered:
a. After other catecholamines have been tried.
b. As a first line drug in cardiogenic shock.
c. Immediately after atropine in unstable bradycardia.
d. In cardiac arrest prior to giving vasopressin.

When used to treat hemodynamically significant hypotension from cardiogenic shock in an adult who has not responded to sympathomimetics, norepinephrine can be administered at:
a. 0.5-1 mcg/minute initially.
b. 2-5 mcg/kg/minute initially.
c. 5-10 mcg/minute initially.
d. 0.1-2 mcg/kg/minute initially.
c. 5-10 mcg/minute initially.

The patient is a 60 year-old woman post-acute myocardial infarction in cardiogenic shock. She is to receive norepinephrine infusion to stabilize her blood pressure. A large stable vein should be used for the infusion because:
a. A large quantity of fluid must be given rapidly.
b. Extravasation may result in tissue necrosis.
c. The large vein ensures an inotropic response.
d. An IV infusion pump requires a large stable vein.
b. Extravasation may result in tissue necrosis.

Procainamide is classified as a:
a. Narcotic analgesic.
b. Antidysrhythmic.
c. Benzodiazepine.
d. Beta blocker.
b. Antidysrhythmic.

Procainamide is used in emergency care to:
a. Treat atrial fibrillation or flutter.
b. Induce sedation prior to and after cardioversion.
c. Treat ventricular tachycardia.
d. Treat hemodynamically stable junctional tachycardia.
c. Treat ventricular tachycardia.

A conscious adult male is in stable ventricular tachycardia that is unresponsive to lidocaine or other pharmacologic therapy. In lieu of synchronized cardioversion, the patient may be given:
a. Dobutamine, 2-5 mcg/minute IV infusion.
b. Lorazepam, 1-4 mg IV over 2-4 minutes.
c. Procainamide, 20 mg/min IV.
d. Etomidate, 0.2-0.6 mg/kg over 15 seconds.
c. Procainamide, 20 mg/min IV.

The patient is a 62 year-old male complaining of chest pain. The initial impression of his ECG is ventricular tachycardia. Careful assessment of the patient reveals a history of depression treated with Elavil. The patient admits to taking four times the average dose of Elavil. Management of the dysrhythmia with procainamide:
a. Is contraindicated in tricyclic antidepressant toxicity.
b. Should immediately resolve the ventricular tachycardia.
c. Is followed by lidocaine and a lidocaine infusion.
d. May be followed by atropine for post-treatment bradycardia.
a. Is contraindicated in tricyclic antidepressant toxicity.

Contraindications to the administration of procainamide include:
a. Ventricular tachycardia with normal QT interval.
b. Torsades de pointes.
c. PSVT refractory to other measures.
d. Atrial fibrillation with rapid rate in WPW.
b. Torsades de pointes.

A 76-year-old female calls 9-1-1 because her heart is “skipping.” Her vital signs are BP 128/76 mmHg, P 152 bpm, R 20/min. and SaO2 93%. She denies chest pain but admits she has trouble catching her breath if she walks across the room. Her lungs are clear to auscultation. She tells you that she has a history of Wolff-Parkinson-White syndrome. Her ECG shows a narrow QRS complex tachycardia that is irregularly irregular. You are unable to identify any P waves. Which of the following drug treatments would be appropriate for this patient?
a. Adenosine 6 mg rapid IVP
b. Diltiazem 15-20 mg IV over 2 minutes
c. Procainamide 20 mg/min IV infusion
d. Verapamil 20 mg slow IV
a. Adenosine 6 mg rapid IVP

When should you stop the infusion of procainamide in a 70 kg patient?
a. Blood pressure is 104/76 mm Hg
b. Sinus tachycardia with PACs is seen
c. QRS is 0.08 seconds
d. Total dose of 700 mg has been given
a. Blood pressure is 104/76 mm Hg

Your patient was diagnosed with a myocardial infarction. His vital signs are stable and his ECG shows a normal sinus rhythm with frequent multifocal PVCs. You have given aspirin and nitroglycerin and he is pain free. Which of the following drugs would be appropriate to administer at this time?
a. Amiodarone 150 mg IV infusion over 10 minutes
b. Lidocaine 1 mg/kg IVP until PVCs are suppressed
c. Procainamide 20 mg/minute until blood pressure drops
d. Propranolol 0.1 mg/kg divided into 3 doses
b. Lidocaine 1 mg/kg IVP until PVCs are suppressed

Which of the following post-myocardial infarct patients would be a candidate for administration of propranolol
a. Auscultation of the lungs reveals bilateral rales audible to the scapulae.
b. Blood pressure is 106/74 mmHg
c. Heart rate is 48 bpm and irregular
d. Home medicine includes albuterol and maxair

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