Chapter 22 Cardiovascular emergencies

Created by firefighter195 

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1. Which of the following is the leading cause of death in the United States?
a. Cardiomyopathy
b. Cardiovascular disease
c. Diabetes
d. Trauma

b

2. Which of the following is a nonmodifiable or fixed risk factor?
a. Cholesterol
b. Heredity
c. Hypertension
d. Smoking

b

3. Which of the following would increase cardiac output?
a. Decrease both heart rate and stroke volume.
b. Decrease heart rate, and increase stroke volume.
c. Increase both heart rate and stroke volume.
d. Increase heart rate, and decrease stroke volume.

c

4. Which of the following leads identifies problems with RCA in most people?
a. Lead AVL
b. Lead I
c. Lead II
d. Lead V1

c

5. Which of the following changes in hypertension will alter the risk for coronary artery disease?
a. A decrease in diastolic blood pressure by 10 mmHg will reduce the risk twentyfold.
b. A decrease in systolic blood pressure by 10 mmHg will reduce the risk tenfold.
c. An increase in diastolic blood pressure by 10 mmHg will double the risk
d. An increase in systolic blood pressure by 10 mmHg will increase the risk tenfold.

c

6. Which of the following is an accurate statement regarding the arteries?
a. Arteries are low-pressure blood vessels.
b. Arteries are the smallest and most numerous blood vessels.
c. Arteries carry blood to the heart.
d. Arteries carry oxygen-rich blood from the heart to the body.

d

7. Which of the following statements most accurately describes the right side of the heart?
a. The right side of the heart receives oxygenated blood and pumps it to the body.
b. The right side of the heart has thin walls.
c. The right side of the heart is high pressure.
d. The right side of the heart receives deoxygenated blood and pumps it to the lungs.

d

8. Which of the following valves allows blood to flow from the left atria to the left ventricle?
a. The aortic valve
b. The mitral valve
c. The pulmonic valve
d. The tricuspid valve

b

9. What is the correct name for the valve between the right atrium and the right ventricle?
a. The mitral valve
b. The pulmonic valve
c. The semilunar valve
d. The tricuspid valve

d

10. Which of the following definitions best describes the apical impulse?
a. The site where the carotid pulse is the strongest
b. The site where the ECG is strongest
c. The site where the heartbeat is most strongly felt
d. The site where the radial pulse is strongest

c

11. Which of the following best defines the term diastole?
a. The period of heart contraction
b. The period of relaxation of the heart
c. The period where pressure in the chambers of the heart increase
d. The period where the heart chambers empty

b

12. Relaxation of the heart is best defined by which of the following terms?
a. Diastole
b. Propagation
c. Refractory period
d. Systole

a

13. Which of the following is most accurate when describing blood flow to the coronary arteries?
a. The right and left coronary arteries fill during diastole.
b. The right and left coronary arteries fill during systole.
c. The right and left coronary arteries receive deoxygenated blood.
d. The right and left coronary arteries supply blood to the lungs.

a

14. The circumflex is a branch of which of the following arteries?
a. Left anterior descending artery
b. Left coronary artery
c. Marginal artery
d. Right coronary artery

b

15. The right atrium receives blood from the systemic circulation and from which of the following?
a. Coronary sinus
b. Left ventricle
c. Pulmonary arteries
d. Pulmonary veins

a

16. Stimulation of which of the following fibers can cause an increase in blood pressure?
a. Efferent nerve fibers
b. Parasympathetic nerve fibers
c. Somatic nerve fibers
d. Sympathetic nerve fibers

d

17. Parasympathetic control of the heart is provided by which of the following?
a. Fourth cranial nerve
b. Phrenic nerve
c. Subclavian nerve
d. Vagus nerve

d

18. Which of the following is the correct definition of chronotropic?
a. A change in contractility
b. A change in rate of the heart
c. A change in speed of conduction through the AV junction
d. A change in the size of the heart

b

19. Which of the following is the most accurate definition of cardiac output?
a. The amount of blood pumped into the aorta each hour by the heart
b. The amount of blood pumped into the aorta each minute by the heart
c. The amount of blood pumped into the veins each minute by the heart
d. The amount of oxygen pumped into the veins each minute by the heart

b

20. While on scene, you have determined that a patient has a stroke volume of 80 mL/beat with a heart rate of 70 beats/min. Which statement most accurately reflects the patient's cardiac output?
a. There is not enough information to calculate the patient's cardiac output.
b. This patient's cardiac output is above the normal limits.
c. This patient's cardiac output is below the normal limits.
d. This patient's cardiac output is within normal limits.

d

21. Which of the following would increase a patient's preload?
a. A decrease in afterload
b. A decrease in blood volume
c. An increase in myocardial contraction
d. IV fluid administration

d

22. Stroke volume depends on preload, afterload, and which of the following?
a. Blood pressure
b. Heart rate
c. Myocardial contractility
d. Vascular resistance

c

23. Which of the following is the most correct definition of Starling's law?
a. The greater the blood volume, the greater the afterload.
b. The greater the blood volume, the greater the heart rate.
c. The greater the blood volume, the less forceful the contraction.
d. The greater the blood volume, the more forceful the contraction.

d

24. Which of the following best describes Starling's law?
a. Afterload increases with increased blood pressure.
b. Heart rate increases as oxygen demands decrease.
c. Myocardial fibers contract more forcefully when they are stretched.
d. Stroke volume decreases when the preload increases.

c

25. What is the correct term for the ability of heart muscle cells to generate an electrical impulse?
a. Automaticity
b. Conductivity
c. Excitability
d. Irritability

a

26. Which of the following is an electrolyte that directly affects the function of the heart?
a. CO2
b. Iron
c. K+
d. O2

c

27. Which of the following is the most accurate description of depolarization of cardiac cells?
a. Calcium ions rush out of the cell.
b. Magnesium ions rush into the cell.
c. Potassium ions rush out of the cell.
d. Sodium ions rush into the cell.

d

28. What is the primary function of the sodium-potassium pump?
a. To move potassium ions into the cell and sodium ions out of the cell
b. To move sodium and potassium ions into the cell
c. To move sodium and potassium ions out of the cell
d. To move sodium ions into the cell and potassium ions out of the cell

a

29. Phase 1 of the action potential represents what period of the cardiac cycle?
a. Early repolarization
b. Plateau
c. Rapid depolarization
d. Rest between action potentials

a

30. Which of the following most accurately describes the resting membrane potential?
a. Pacemaker cells are rapidly repolarizing.
b. The inside of the cell is positive in relation to the outside of the cell.
c. There is excessive potassium in the cell.
d. There is excessive sodium in the cell.

d

31. Which of the following statements most accurately describes phase 3 of the action potential?
a. Early repolarization
b. Final rapid repolarization
c. Plateau
d. Rapid depolarization

b

32. Which of the following statements most accurately describes the beginning of phase 0 of the action potential?
a. It begins when it receives an impulse.
b. It begins when the Na+ channels partially close.
c. It begins with the downslope of the action potential.
d. It is the resting membrane potential.

a

33. During which phase does the sodium and potassium pump actively move sodium out of the cell and potassium into the cell?
a. Phase 0
b. Phase 2
c. Phase 3
d. Phase 4

d

34. During which phase will cells not respond to stimulation?
a. Absolute refractory period
b. Relative refractory period
c. Supernormal period
d. Vulnerable period

a

35. Phase 2 of the cardiac cycle is responsible for which portion of the ECG?
a. The PR interval
b. The QRS interval
c. The ST segment
d. The T wave

c

36. Which term most accurately describes the period of time in which the cell will not respond to further stimulation?
a. Absolute refractory period
b. Relative refractory period
c. Threshold period
d. Vulnerable period

a

37. The AV junction is formed by the AV node and which of the following?
a. Bundle of His
b. Left bundle branch
c. Right ventricle
d. SA node

a

38. Under normal conditions, which of the following is the dominant pacemaker of the heart?
a. AV node
b. Bundle of His
c. Purkinje fibers
d. SA node

d

39. You are treating a patient who has a damaged SA node that is no longer pacing the heart. How will this impact the patient's cardiac rhythm?
a. The heart will beat more quickly.
b. The heart will beat more slowly.
c. The heart will fibrillate.
d. The heart will stop beating altogether.

b

40. Which of the following cardiac pacemakers has an intrinsic rate of 40 to 60 beats/min?
a. Atria
b. AV junction
c. Purkinje fibers
d. SA node

b

41. Which of the following is a true statement regarding the conduction of an impulse through the AV node?
a. Conduction through the AV node occurs prior to conduction through the atria.
b. Conduction through the AV node occurs simultaneously with conduction through the atria.
c. There is a delay in the conduction through the AV node.
d. There is no delay in the conduction through the AV node.

c

42. Which of the following statements most accurately describes what occurs during the conduction delay in the AV node?
a. The atria are emptying blood into the ventricles, increasing stroke volume.
b. The AV node is gaining strength to conduct to the ventricles.
c. The coronary arteries are filling with oxygenated blood.
d. The ventricles are emptying their blood volume.

a

43. Which of the following definitions most accurately describes the term triggered activity?
a. Abnormal electrical impulses that sometimes occur during repolarization
b. Normal electrical impulses that occur during repolarization
c. The action of the sinus node when it is firing normally in response to a stressor
d. The action of ventricular Purkinje cells when they are firing at a slower rate than normal

a

44. Which of the following terms is used to describe the condition that occurs when a lower site spontaneously assumes pacing for the heart after the SA node slows or fails to initiate depolarization?
a. Circular conduction
b. Escape
c. Reentry
d. Tachycardia

b

45. Which of the following best describes the pathophysiology of reentrant mechanisms?
a. The heart is stimulated by the same impulse more than once.
b. The impulses are fired more rapidly.
c. There are periods of bradycardia.
d. There is no delay in the conduction of an impulse.

a

46. Which of the following terms best describes the activation of myocardial tissue more than one time by the same impulse?
a. Automaticity
b. Doubling
c. Excitability
d. Reentry

d

47. Which of the following statements most accurately describes the function of the ECG?
a. Monitors the effectiveness of mechanical activity
b. Evaluates contractile condition
c. Monitors for conduction disturbances
d. Monitors stroke volume

c

48. Which statement describes the term baseline?
a. No electrical activity is detected.
b. There is a biphasic waveform.
c. The waveform has equal positive and negative deflections.
d. The waveform is positive only.

a

49. Which lead most closely approximates the normal pathway of current flow in the heart?
a. AVL
b. Lead I
c. Lead II
d. Lead III

c

50. Which of the following is a bipolar lead?
a. aVF
b. aVR
c. Lead II
d. V1

c

51. Which of the following terms most accurately describes leads II and III?
a. Inferior leads
b. Lateral leads
c. Precordial leads
d. Superior leads

a

52. Which of the following terms best describes the view of the heart noted in lead I?
a. Anterior
b. Inferior
c. Lateral
d. Superior

c

53. In which of the following leads would you expect to see ECG changes indicative of a lateral wall AMI?
a. Lead aVR
b. Lead II
c. Lead III
d. Lead V6

d

54. A patient with chest pain is noted to have ST segment elevation in leads V3 and V4. Which of the following areas is most likely ischemic or infracting?
a. Anterior
b. Inferior
c. Lateral
d. Septal

a

55. Which of the following leads provides the best information on the posterior wall?
a. Leads I and aVF
b. Leads II and aVR
c. Leads V2 and V3
d. Leads V7-V9

d

56. In lead-II ECG placement, where should the positive lead be located?
a. Left arm
b. Left leg
c. Right leg
d. Right shoulder

b

57. What is the normal speed at which ECG paper moves through the printer?
a. 10 mm/sec
b. 15 mm/sec
c. 25 m/min
d. 25 mm/sec

d

58. Which of the following is an estimate of heart rate per minute if there are seven complete waveforms in the span of 30 boxes?
a. 60
b. 70
c. 80
d. 120

b

59. During which segment does the activation of the AV node occur?
a. PR segment
b. ST interval
c. ST segment
d. TP segment

a

60. Which of the following is the most accurate statement regarding the length of the PR interval in adults?
a. It lengthens as the heart rate increases.
b. It normally measures between 0.12 and 0.20.
c. It normally measures less than 0.12.
d. The PR interval does not change with heart rate.

b

61. Which of the following is an accurate statement regarding the Q waveform on the ECG?
a. The Q wave is the first negative deflection below the baseline.
b. The Q wave represents the atria being depolarized.
c. The Q wave represents repolarization of the atria.
d. The Q and wave represents depolarization of the right and left ventricles.

a

62. Which of the following would indicate abnormal conduction through the ventricles?
a. Multiple shaped P waves
b. U wave
c. Widened P wave
d. Widened QRS complex

d

63. Which of the following is a cause of tall peaked T waves?
a. Hypercalcemia
b. Hyperkalemia
c. Hypernatremia
d. Hypokalemia

b

64. Which of the following indicates possible myocardial injury?
a. PR depression of 1 mm
b. PR elevation of 1 mm
c. ST depression of ¼ mm
d. ST elevation of more than 1mm

d

65. Which of the following is the most accurate description of an ECG rhythm with a rate of 45, inverted P waves, and a PR interval of 0.08 seconds?
a. Atrial fibrillation
b. Junctional rhythm
c. Sinus bradycardia
d. Sinus rhythm

b

66. Which of the following is the most common cause of bradycardia in the pediatric patient?
a. Acute myocardial infarction
b. Congenital heart problem
c. Hypoxia
d. Sick sinus syndrome

c

67. During the ECG monitoring of a patient, you notice that there is a PAC with a wide QRS complex. Which definition most accurately describes this finding?
a. Blocked PAC
b. Nonconducted PAC
c. Normal PAC
d. PAC with aberrant conduction

d

68. Which definition most accurately describes a nonconducted PAC that occurs close to the T wave of the preceding beat?
a. Aberrant conduction
b. Blocked PAC
c. Escape beat
d. Normal PAC

b

69. Which of the following is the proper monophasic energy setting for the first attempt at synchronous cardioversion for patients in PSVT?
a. 50 J
b. 100 J
c. 200 J
d. 300 J

a

70. You have determined that an unstable patient is in atrial fibrillation and requires electrical therapy. Which of the following treatments is the most appropriate?
a. Synchronized cardioversion at 100 J
b. Synchronized cardioversion at 50 J
c. Unsynchronized cardioversion at 100 J
d. Unsynchronized cardioversion at 50 J

a

71. If vagal maneuvers fail, which of the following is an appropriate pharmacologic treatment for a symptomatic patient with Wolf-Parkinson-White syndrome?
a. Adenosine
b. Amiodarone
c. Atropine
d. Diltiazem

b

72. Which statement most accurately describes the cause for ventricular escape rhythms?
a. They should be aggressively treated to prevent atrial fibrillation.
b. They are a pathologic response to oxygenation.
c. They typically occur at a rate of 60 to 80 beats per minute.
d. They typically occur when the SA and AV nodes fail to fire.

d

73. What is the intrinsic rate for a ventricular pacemaker?
a. 20 to 40 beats/min
b. 40 to 60 beats/min
c. 60 to 100 beats/min
d. 100 to 150 beats/min

a

74. What type of myocardial contractions take place during ventricular fibrillation?
a. Effective contractions are present.
b. No effective contractions take place.
c. Strong contractions take place.
d. Weak contractions may be noted at the peripheral pulse points.

b

75. Which of the following treatments is most effective in termination ventricular fibrillation?
a. Administration of an antiarrhythmic medication
b. Defibrillation
c. Pacing
d. Synchronized cardioversion

b

76. Which of the following factors can affect defibrillation success?
a. Acquisition of IV
b. Loss of synchronization
c. Patch pressure
d. Phase of the patient's respirations

d

77. Which of the following is appropriate for the treatment of a symptomatic ventricular escape rhythm?
a. Defibrillation
b. Pacing
c. Synchronized cardioversion
d. Unsynchronized cardioversion

b

78. Patients with pulseless ventricular tachycardia should be treated as though they have which of the following rhythm disturbances?
a. Asystole
b. PEA
c. Supraventricular tachycardia
d. Ventricular fibrillation

d

79. Which statement best describes how pulseless electrical activity looks on an ECG tracing?
a. It looks like any electrical activity other than ventricular fibrillation or ventricular tachycardia.
b. It looks like asystole.
c. It looks like ventricular fibrillation.
d. It looks like ventricular tachycardia.

a

80. Which definition most accurately describes the clinical situation that exists when a patient is not breathing, has no pulse, and has an ECG with organized electrical activity?
a. Asystole
b. PEA
c. Vfib
d. V-tach

b

81. When is an accelerated idioventricular rhythm (AIVR) most often seen during an MI?
a. After the first 12 hours
b. After the first 24 hours
c. During the first 12 hours
d. This rhythm will not be seen during an MI

c

82. Which statement most accurately describes the condition that exists when the QRS complexes of VT vary in shape and amplitude from beat to beat?
a. Accelerated junctional tachycardia
b. Monomorphic ventricular tachycardia
c. Polymorphic ventricular tachycardia
d. Sinus tachycardia

c

83. An unresponsive patient is found with an unknown down time, no palpable pulse, and there are no signs of electrical activity on the monitor. Which of the following is the most accurate description of the ECG rhythm depicted in this scenario?
a. Asystole
b. Fine ventricular fibrillation
c. Idioventricular rhythm
d. Pulseless electrical activity

a

84. Which statement accurately describes the use of defibrillation in patients in asystole?
a. It is not recommended for treatment of asystole.
b. It is recommended so as to avoid missing cases of ventricular fibrillation.
c. It should be the first choice for treatment of asystole.
d. It should occur at 100 J initially.

a

85. Which of the following is the most correct definition of an AV block?
a. A delay or interruption in the impulse conduction in the bundle of His
b. A delay or interruption in the impulse conduction in the PR complex
c. A delay or interruption in the impulse conduction in the SA node
d. A delay or interruption in the impulse conduction in the ventricles

a

86. Which of the following is the most accurate description of an ECG rhythm with a PR interval of 0.24 seconds, a P wave before every QRS complex, and narrow QRS complexes?
a. First-degree AV block
b. Second-degree AV block type I
c. Second-degree AV block type II
d. Third-degree AV block

a

87. Which of the following best describes the problem that occurs when a pacemaker fails to recognize the patient's ECG waveform?
a. Battery failure
b. Failure to capture
c. Failure to sense
d. Output set too low

c

88. Which of the following best describes how an AV sequential, fixed-rate pacemaker functions?
a. It constantly stimulates the atria at a set rate.
b. It delivers an electrical shock when the heart rate goes above 220.
c. It stimulates both the right atria and the right ventricle.
d. It stimulates the atria when the heart rate drops below 70.

c

89. Which of the following may cause a pacemaker malfunction?
a. AV nodal block
b. ECG monitoring
c. Fracture of wires
d. Sinus rhythm

c

90. Which of the following problems may account for an apparent mismatch between a cardiac monitor rate display and the patient's palpable pulse?
a. The monitor is reading the pacer spikes as beats.
b. The pacemaker is misfiring.
c. The palpable pulse is incorrect.
d. The patient has ventricular fibrillation.

a

91. Which of the following hazards may cause a failure to capture with an implanted pacemaker?
a. Battery failure
b. Changing time zones
c. Hypotension
d. Thickening of the chest wall

a

92. What is the potential lethal complication of a failure to sense the malfunction of an implanted pacemaker?
a. Decreased strength of pacing energy
b. Increased conduction of electrical current
c. Normal sinus rhythm
d. Possible R-on-T leading to VT or VF

d

93. Which of the following is the most accurate description of transcutaneous pacing (TCP)?
a. TCP electrically defibrillates the heart.
b. TCP electrically stimulates the conduction of the heart.
c. TCP electrically stimulates the contraction of the heart.
d. TCP electrically stops the heart.

c

94. Which of the following is an appropriate treatment for a symptomatic child that weighs 20 kg and has bradycardia?
a. Apply TCP using adult transcutaneous patches.
b. Apply TCP using pediatric defibrillation patches.
c. Provide adenosine 6 mg/kg.
d. Provide amiodarone 150 mg bolus.

a

95. Which of the following would be the most appropriate therapy for a patient who has a blood pressure of 60/40 mm Hg, a heart rate of 20 beats/min, and weakness?
a. Adenosine
b. Cardioversion
c. Defibrillation
d. Transcutaneous pacing

d

96. When applying transcutaneous pacing to a symptomatic patient, what is the initial rate setting?
a. Initial rate between 20 and 40 beats/min
b. Initial rate between 40 and 60 beats/min
c. Initial rate between 60 and 80 beats/min
d. Initial rate between 80 and 100 beats/min

c

97. Initial transcutaneous electrical and mechanical capture has been confirmed when you reach 80 mA. At what level should you as the paramedic continue pacing?
a. At an energy output level 20 mA higher than the threshold of initial capture
b. At an energy output level slightly higher than the threshold of initial capture
c. At an energy output level slightly lower than the threshold of initial capture
d. At the same energy output level of initial capture

b

98. Which of the following settings is adjusted to gain capture?
a. Defibrillation setting
b. Electrical energy setting (milliamps)
c. Heart rate setting
d. Pad placement

b

99. A patient has been receiving transcutaneous pacing and is complaining of pain near the patches. Which of the following is the most likely cause of this problem?
a. AMI
b. Coughing
c. Threshold change
d. Skin burns

d

100. An ECG on a patient is noted to have positive deflection in lead I and negative deflection in lead aVF. Which of the following is the axis of the ECG?
a. Indeterminate
b. Left
c. Normal
d. Right

b

101. You are on scene with a patient who is having chest pain. The ECG demonstrates ST segment elevation in leads II, III, and aVF. Which of the following is the area that is most likely being affected?
a. Anterior wall
b. Inferior wall
c. Lateral wall
d. Posterior wall

b

102. Which of the following findings would be associated with right ventricular infarction?
a. Heart murmur
b. Hypertension
c. Jugular venous distention
d. Pulmonary edema

c

103. Which of the following is the best lead to differentiate between a right and left bundle branch block?
a. Lead I
b. Lead II
c. Lead V1
d. Lead V2

c

104. You are reviewing an ECG that demonstrates an RSR' pattern in lead V1 and the QRS is 0.13 sec. Which of the following best describes this pattern?
a. Complete left bundle branch block
b. Incomplete left bundle branch block
c. Nonspecific interventricular conduction delay
d. Right bundle branch block

d

105. An ECG demonstrates a prolonged PR interval, tall peaked tented T waves, and the QRS is wide. Which of the following electrolyte abnormalities should be suspected?
a. Hyperkalemia
b. Hypocalcemia
c. Hypokalemia
d. Hypomagnesemia

a

106. If you visualize the outline of a small box implanted under skin in the left upper abdomen, you should suspect the patient has which of the following implanted devices?
a. Artificial heart
b. Bypass pump
c. Implantable defibrillator or pacemaker
d. Left-ventricular assist device

c

107. Which of the following acronyms should be used to obtain the patient's focused history?
a. ABCD
b. AEIOU & Tips
c. OPQRST
d. SAMPLE

d

108. What does the Q in the memory aid OPQRST stand for?
a. Q wave
b. Quality
c. Quickness
d. Quotient

b

109. Paroxysmal nocturnal dyspnea is often associated with which of the following cardiac problems?
a. Left atrial failure
b. Left ventricular failure
c. Right atrial failure
d. Right ventricular failure

b

110. Paroxysmal nocturnal dyspnea most often begins within what time frame after the onset of sleep?
a. 1 to 2 hours
b. 2 to 4 hours
c. 4 to 6 hours
d. 6 to 8 hours

b

111. Which of the following is the proper position to evaluate jugular vein distention in cardiac patients?
a. Leaning forward
b. Sitting straight up
c. With the head elevated 90 degrees
d. With the head elevated 45 degrees

d

112. While assessing a patient, you identify a carotid bruit. Which of the following statements most accurately describes this problem?
a. The patient has atherosclerosis.
b. The patient has recently had an MI.
c. The patient should receive carotid sinus massage.
d. The patient will develop ventricular fibrillation.

a

113. Which of the following best describes the cause of normal heart sounds?
a. Closing of the valves
b. Contraction of the atria
c. Contraction of the ventricles
d. Opening of the great vessels

a

114. When does the first heart sound occur during a cardiac cycle?
a. During atrial contraction
b. During closing of the mitral and tricuspid valves
c. During pulmonic valve relaxation
d. During ventricular relaxation

b

115. When is an S3 sound found in the cardiac cycle?
a. During atrial diastole
b. During atrial systole
c. During early ventricular diastole
d. During ventricular systole

c

116. Which of the following best describes the S3 heart tone?
a. It is abnormal in children.
b. It is caused by delayed closing of the pulmonic valve.
c. It is heard in ventricular systole.
d. It is often associated with heart failure.

d

117. You are on scene with a patient who was in a motor vehicle crash and notice massive contusion to the chest wall, hypotension, and muffled heart tones. Which of the following best describes how to measure for pulsus paradoxus?
a. Measure beat-to-beat differences in strength of the pulse.
b. Observe the amplitude of each QRS complex.
c. Observe the change in systolic blood pressure with inspiration.
d. Observe the difference between the pulse in the apices and periphery.

c

118. You are taking care of a patient with chest pain and notice a beat-to-beat change in wave amplitude in the ECG QRS complexes. What is this called?
a. Electrical alternans
b. Pulsus alternans
c. Pulse deficit
d. Pulsus paradoxus

a

119. A patient is having chest pain and shortness of breath. You notice that there is a beat-to-beat difference in the strength of the pulse. Which of the following may be the cause of this finding?
a. Cardiac tamponade
b. Pulmonary embolism
c. Ventricular failure
d. Wolff-Parkinson syndrome

c

120. A blood pressure difference of greater than 10 mm Hg between the arms is highly suggestive of which of the following medical problems?
a. Hypertension
b. Hypotension
c. Myocardial infarction
d. Thoracic aorta dissection

d

121. What occurs during a thoracic aorta dissection that would cause a difference in blood pressure reading between the arms?
a. One of the arteries in the arm is blocked by the dissection.
b. One of the arteries in the brain is blocked by the dissection.
c. One of the arteries in the heart is blocked by the dissection.
d. One of the veins in the arm is blocked by the dissection.

a

122. Which of the following definitions most accurately describes acute coronary syndromes?
a. Conditions caused by a temporary or permanent blockage in a cerebral vein
b. Conditions caused by a temporary or permanent blockage in a cerebral artery
c. Conditions caused by a temporary or permanent blockage in a coronary artery
d. Conditions caused by a temporary or permanent blockage in a coronary vein

c

123. What is the usual cause of acute coronary syndrome?
a. The rupture of a coronary artery
b. The rupture of a coronary vein
c. The rupture of an aortic aneurysm
d. The rupture of atherosclerotic plaque

d

124. You are on scene with a patient who is having chest pain. The ECG demonstrates ST segment elevation in leads II, III , and aVF, and the patient has a blood pressure of 90/60 mm Hg. Which of the following is the most appropriate treatment for this patient?
a. Dopamine
b. IV fluids
c. Nitroglycerin sublingual
d. Warfarin

b

125. Which of the following is the most common complication in the first few hours of an AMI?
a. Aneurysm
b. Dysrhythmias
c. Heart failure
d. Shock

b

126. In canine studies, what percentage of tissue loss is estimated to occur within 2 hours of coronary artery blockage?
a. 20%
b. 30%
c. 40%
d. 50 %

d

127. Which of the following conditions is most likely to occur with a patient in left ventricular failure?
a. Activation of the renin-angiotensin-aldosterone system
b. Bradycardia
c. Increased stroke volume
d. Vasodilation

a

128. What is the most comfortable position for a patient with left ventricular failure?
a. Left lateral recumbent
b. Sitting with legs dependent
c. Supine with head raised
d. Trendelenburg

b

129. Right ventricular failure most often results from which of the following conditions?
a. Hypertension
b. Hypoxia
c. Left ventricular failure
d. Myocardial infarction

c

130. Which portion of the heart is affected by myocarditis?
a. Atria
b. Coronary arteries
c. Coronary veins
d. Myocardium

d

131. What is the most common cause of myocarditis?
a. Bacteria
b. Chemicals
c. Parasites
d. Viruses

d

132. Which of the following treatments would be the most appropriate first interventions for a patient with signs and symptoms of myocarditis?
a. Antiarrhythmic administration with fluid bolus
b. Pacing and sedation
c. Oxygen administration and cardiac monitoring
d. Oxygen administration and Trendelenburg positioning

c

133. You are on scene with a patient who is complaining of flulike symptoms, fatigue, mild shortness of breath, and joint and muscle aches and pains. The patient's ECG reveals a sinus rhythm of 120 beats/min, and the patient reports occasional palpitations. Which of the following treatment plans would be most appropriate for this patient?
a. Administer oxygen to maintain saturations of at least 95%.
b. Consider adenosine to slow tachycardia.
c. Prepare for pacing of this patient.
d. Simply monitor and transport the patient.

a

134. Which of the following is the most accurate definition of cardiogenic shock?
a. A condition in which heart muscle function is minimally impaired
b. A condition in which heart muscle function is severely enhanced
c. A condition in which heart muscle function is severely impaired
d. A condition in which heart muscle function is unaffected

c

135. You are on scene with a symptomatic patient who is exhibiting the signs and symptoms of cardiogenic shock. Which of the following therapeutic interventions is most appropriate for this patient?
a. Treatment focuses on supportive care only with transport to a clinical facility.
b. Treatment focuses on decreasing oxygen concentrations in coronary vessels.
c. Treatment focuses on increasing contractility without significant increases to heart rate.
d. Treatment focuses on increasing heart rate to improve cardiac output.

c

136. Which of the following drugs may improve the symptoms of cardiogenic shock patients?
a. Atropine
b. Dopamine
c. Epinephrine
d. Furosemide

b

137. In Western cultures, what is the most frequent cause of sudden cardiac death in adults?
a. Chemical inhalation
b. Respiratory compromise
c. Traumatic injury
d. Underlying coronary artery disease

d

138. Which of the following is the most accurate definition of cardiac arrest?
a. Cardiac pump function confirmed by the presence of a detectable pulse
b. Cerebral perfusion confirmed by the absence of a detectable pulse
c. Cerebral perfusion confirmed by the presence of a detectable pulse
d. The absence of cardiac pump function confirmed by the absence of a detectable pulse

d

139. You are on scene with a 60-year-old male who is pulseless and apneic. ECG analysis reveals ventricular tachycardia. What are the critical tasks of resuscitation for this patient?
a. Airway management and chest compressions only
b. Airway management, chest compressions, monitoring and defibrillation, and vascular access with medication administration
c. CPR and rapid transport to the closest cardiac hospital
d. Defibrillation and monitoring only

b

140. Which statement most accurately describes when chest compressions should be stopped during the treatment of a patient with ventricular fibrillation?
a. Compressions should be stopped after every cycle of 30 chest compressions and two breaths.
b. Compressions should be stopped as frequently as possible to allow the heart to rest.
c. Compressions should be stopped frequently to perform ECG analysis.
d. Compressions should not be stopped for more than seconds at a time.

d

141. Which of the following is the most accurate statement in reference to the temperature regulation of a patient after resuscitation from a cardiac arrest?
a. Actively rewarm all stable patients.
b. Mild hypothermia may be beneficial to neurologic outcome.
c. Rewarm only unstable patients.
d. Firmly wrap all stable patients in blankets and transport them to the closest emergency department.

b

142. What is the expected outcome in patients who have high blood glucose levels after resuscitation from cardiac arrest?
a. A good neurologic outcome is expected.
b. A poor neurologic outcome is expected.
c. No studies have documented findings.
d. There are no noted changes.

b

143. Which of the following is an example of when termination of resuscitation should or may occur in a cardiac arrest situation?
a. No online medical control
b. Pediatric patient in cardiac arrest with early CPR and defibrillation
c. Unwitnessed cardiac arrest with a delayed start of CPR and defibrillation
d. Witnessed cardiac arrest with bystander CPR

c

144. Which of the following groups has recommended factors that should be considered when establishing termination of resuscitation guidelines?
a. CAAHEP
b. NAEMSP
c. NHTSA
d. NREMT

b

145. What type of documentation must be kept when there is a termination of resuscitation efforts in a cardiac arrest?
a. A full and complete record must be maintained.
b. No records are required.
c. The ECG is the only record that must be maintained.
d. The patient care report form is the only required document.

a

146. At what point should law enforcement officials be contacted when resuscitation efforts in a cardiac arrest have been terminated?
a. After the return to quarters
b. As soon as the termination of resuscitation has been confirmed
c. Before responding to the cardiac arrest call
d. There is no need to contact law enforcement officials

b

147. Of the people with high blood pressure, what is the percentage that has essential hypertension?
a. 75% to 80%
b. 80% to 85%
c. 85% to 90%
d. 90% to 95 %

d

148. Which of the following is the correct alternate term for essential hypertension?
a. Peripheral hypertension
b. Primary hypertension
c. Secondary hypertension
d. Tertiary hypertension

b

149. Which of the following is the most appropriate therapeutic prehospital intervention for a patient with a hypertensive emergency?
a. Fluid boluses may be needed for this patient.
b. Lowering of blood pressure and pharmacologic interventions are required.
c. No care is required for this type of emergency.
d. Supportive care and rapid transport to the hospital are required.

d

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