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Chapter 17

Terms in this set (237)

A right ventricular infarction is characterized by
ST-segment elevation greater than 1 mm in lead V4R and ST-segment elevation in leads II, III, and aVF.
The circumflex branch of the left coronary artery supplies the _________ wall of the left ventricle.
lateral
Electrical capture during transcutaneous cardiac pacing is characterized by
a pacemaker spike followed by a wide QRS complex.
When viewing leads V3 and V4, you are looking at the _________ wall of the _________.
anterior, left ventricle.
The AV junction
is composed of the AV node and surrounding tissue.
A 56-year-old man complains of chest tightness, shortness of breath, and nausea. During your assessment, you note that he appears confused. He is profusely diaphoretic and has a blood pressure of 98/68 mm Hg and a rapid radial pulse. The cardiac monitor reveals a wide QRS complex tachycardia at a rate of 200 beats/min. After administering high-flow oxygen, you should:
establish IV access, consider sedation, and perform synchronized cardioversion.
The treatment for sinus tachycardia should focus on
correcting the underlying cause.
The S1 heart sound represents:
closure of the mitral and tricuspid valves.
When assessing an anxious patient who presents with tachycardia, you must:
determine if the tachycardia is causing hemodynamic instability.
On the ECG graph paper, 6 seconds is represented by how many large boxes?
30
Once an advanced airway device has been inserted into a cardiac arrest patient:
ventilations are delivered at a rate of 8 to 10 breaths/min.
Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of:
clear and equal breath sounds.
Stimulation of the parasympathetic nervous system:
slows SA nodal discharge and decreases conduction through the AV node.
In order to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump:
moves two potassium ions into the cell for every three sodium ions it moves out of the cell.
Which of the following conditions would MOST likely cause the blood pressure to vary between the left arm and right arm?
Aortic aneurysm
If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse:
you should expect to see a heart rate slower than 40 beats/min.
Which of the following chemicals or drugs causes an increase in heart rate?
Atropine and epinephrine
Aberrant conduction is _____________ conduction.
abnormal
After delivering a shock to a patient in pulseless ventricular tachycardia, you should:
cpr
When performing CPR on an adult patient in cardiac arrest, it is important to:
allow the chest to fully recoil between compressions.
Hypertensive disease is characterized by:
persistent elevation of the diastolic pressure.
Automaticity is defined as the ability of the heart to:
generate its own electrical impulses without stimulation from nerves.
What physiologic effect occurs within the first 5 to 10 minutes after administering furosemide (Lasix)?
Peripheral venous pooling
The MOST immediate forms of reperfusion therapy for an injured myocardium are:
fibrinolytics and percutaneous coronary intervention.
Drugs that have alpha or beta sympathetic properties are called:
sympathomimetics.
You are assessing the 12-lead tracing of a 40-year-old man with chest pain and note ST-segment elevation in leads II, III, and aVF. Lead V4R shows 2-mm ST-segment elevation. The patient's blood pressure is 88/58 mm Hg, and his heart rate is 72 beats/min and regular. He denies any significant past medical history but is allergic to salicylates. After placing the patient on oxygen and starting an IV line of normal saline, you should:
give crystalloid boluses to increase preload.
What is the R-on-T phenomenon?
A premature ventricular complex (PVC) that occurs when the ventricles are not fully repolarized
A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient?
Adenosine
The firing of an artificial ventricular pacemaker causes:
a vertical spike followed by a wide QRS complex.
Changes in cardiac contractility may be induced by medications that have a positive or negative ___________ effect.
inotropic
The MOST important initial pieces of equipment to bring to the side of an unresponsive patient are the:
defibrillator and airway management equipment.
Which of the following ECG abnormalities is MOST consistent with hyperkalemia?
Tall, peaked T waves
Which of the following occurs at the AV node during a third-degree heart block?
All impulses are blocked from entering the ventricles.
A "runaway" pacemaker is characterized by:
a tachycardic pacemaker rhythm.
Common signs of left-sided heart failure include all of the following, EXCEPT:
hypotension.
What is the approximate maximum dose of lidocaine for a 200-pound patient?
275mg
A second-degree heart block, Mobitz type I, occurs when:
each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.
A physiologic effect of sympathetic nervous stimulation includes:
dilation of the bronchioles.
An early complex that breaks the regularity of the underlying rhythm and that is characterized by a narrow QRS complex and an upright P wave that differs in shape and size from the P waves of the other complexes MOST accurately describes a(n):
premature atrial complex.
A 33-year-old woman presents with an acute onset of "fluttering" in her chest. She is conscious and alert but is somewhat anxious. She denies any significant medical problems but states that she has been under a lot of stress at work. You apply the cardiac monitor, which reveals a narrow QRS complex tachycardia at a rate of 170 beats/min. The patient's blood pressure is 140/90 mm Hg, and she is breathing without difficulty. The MOST appropriate treatment for this patient involves:
oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.
Jugular venous distention in a patient sitting at a 45° angle:
indicates right-sided heart compromise.
An electrical wave moving in the direction of a positive electrode will:
cause a positive deflection on the ECG.
When managing cardiac arrest, the appropriate dosing regimen for epinephrine is:
1 mg of a 1:10,000 solution every 3 to 5 minutes.
Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT:
headache.
In sinus bradycardia, the:
pacemaker site is the SA node.
Which of the following medications is a calcium channel blocker?
Cardizem
Death in the prehospital setting following an acute myocardial infarction is MOST often the result of:
ventricular fibrillation.
When analyzing a cardiac rhythm strip in lead II, you should routinely evaluate all of the following components, EXCEPT the:
ST segment.
Regardless of the patient's presenting cardiac arrest rhythm, the first IV or IO drug that should be given is:
a vasopressor.
Patients who are experiencing an infarction of the right ventricle:
may present with significant hypotension.
A 55-year-old man complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain?
Difference in blood pressure between the two arms
In contrast to coarse ventricular fibrillation, fine ventricular fibrillation indicates that:
energy reserves of the cardiac cells have been expended.
A beta adrenergic blocker would counteract all of the following medications, EXCEPT:
atropine.
During the refractory period:
the cell is depolarized or in the process of repolarizing.
You have restored spontaneous circulation in a 54-year-old man who was in ventricular fibrillation. During the arrest interval, you delivered 2 shocks, 1 mg of epinephrine, and 300 mg of amiodarone. The patient's blood pressure is 96/60 mm Hg, and the cardiac monitor displays a sinus rhythm at a rate of 70 beats/min with frequent premature ventricular complexes. Appropriate post-resuscitation care for this patient includes:
an infusion of amiodarone.
Cardiac-related chest pain is often palliated by:
nitroglycerin.
A patient with orthopnea:
experiences worsened dyspnea while lying down.
Monomorphic ventricular tachycardia:
presents with wide QRS complexes of a common shape.
A patient is considered a potential candidate for fibrinolytic therapy if he or she has experienced chest discomfort for:
less than 12 hours.
An ST segment that is more than 1 mm above the isoelectric line:
must be substantiated by a 12-lead ECG.
You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a "stomach bug." He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66 mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:
administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of:
a reduction in cardiac output.
The administration of dopamine or any other vasopressor drug requires:
careful titration and blood pressure monitoring.
If the R-R interval spans more than ____ large boxes on the ECG graph paper, the heart rate is less than 60/min.
5
Which of the following clinical findings is LEAST suggestive of left-sided heart failure?
Sacral edema
A "run" of ventricular tachycardia occurs if at least ____ PVCs occur in a row.
three
The proper compression-to-ventilation ratio for two-rescuer adult CPR when an oropharyngeal airway is in place is:
30:2
The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration.
0.12, 0.20
A right ventricular infarction is characterized by:
ST-segment elevation greater than 1 mm in lead V4R and ST-segment elevation in leads II, III, and aVF.
On the 12-lead ECG, extreme right axis deviation is characterized by:
a negative QRS in lead I and a negative QRS in lead aVF.
The effect on the velocity of electrical conduction is referred to as the _________ effect.
dromotropic
Cardiogenic shock occurs when:
more than 40% of the left ventricle has infarcted.
If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles:
an inverted P wave will appear before the QRS complex.
Ventricular fibrillation occurs when:
many different cells in the heart depolarize independently rather than in response to an impulse from the SA node.
Unlike the parasympathetic nervous system, the sympathetic nervous system:
provides a mechanism for the body to adapt to changing demands.
When examining the chest of a patient who has an automated implanted cardioverter defibrillator, you would MOST likely find it:
below the left or right clavicle.
In contrast to arteries, veins:
are more likely to distend when exposed to backpressure.
Which of the following mechanisms causes hypertension?
Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
Which of the following pulseless rhythms is NOT treated as pulseless electrical activity?
Ventricular tachycardia
The amount of blood that is pumped out by either ventricle per minute is called:
cardiac output.
Hypomagnesemia would MOST likely result in:
decreased cardiac conduction.
Which of the following statements regarding the right side of the heart is correct?
The right side of the heart is a low-pressure pump.
Stimulation of alpha and beta receptors affects the:
heart, lungs, and blood vessels.
In contrast to stable angina, unstable angina:
often awakens the patient from his or her sleep.
Treatment for a patient with bradycardia and significantly compromised cardiac output includes:
transcutaneous cardiac pacing.
A hypertensive emergency is MOST accurately defined as:
an acute elevation in blood pressure with signs of end-organ damage.
You are assessing a conscious and alert middle-aged male who complains of chest discomfort and nausea. His blood pressure is 112/70 mm Hg, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patient's past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer?
Nitroglycerin
Atrial fibrillation can be interpreted by noting:
an irregularly irregular rhythm and absent P waves.
Depolarization, the process by which muscle fibers are stimulated to contract, occurs when:
cell wall permeability changes and sodium rushes into the cell.
You and your partner arrive at the scene of an unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patient's wife tells you that he collapsed about 10 minutes ago. You should:
initiate CPR as your partner applies the defibrillator pads.
A patient experiencing an acute coronary syndrome should receive morphine sulfate in an initial dose of:
2 to 4mg
A wandering atrial pacemaker:
may have variable PR intervals.
On the ECG graph paper, amplitude is measured in _____________ and width is measure in ____________.
millimeters, milliseconds
A patient with a medical condition that requires antiplatelet therapy would MOST likely be taking:
Plavix.
A 56-year-old man presents with an acute onset of chest pressure and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should:
administer supplemental oxygen.
You respond to the scene of an assault, where a 20-year-old man was struck in the chest with a steel pipe. Your assessment reveals that the patient is unresponsive, apneic, and pulseless. The MOST appropriate next intervention is to:
perform 5 cycles of well-coordinated CPR.
A patient with cardiogenic shock and pulmonary edema should be positioned:
in a semi-Fowler's position.
When applying the precordial leads, lead V1 should be placed in the:
fourth intercostal space at the right sternal border.
The area of conduction tissue in which electrical activity arises at any given time is called the:
pacemaker.
Untreated ventricular tachycardia would MOST likely deteriorate to:
ventricular fibrillation.
If you are unsure whether a conscious cardiac patient requires immediate transport versus continued assessment at the scene, you should:
continue with the secondary assessment to obtain more information.
Which of the following interventions should be performed en route to the hospital during a lengthy transport of a patient with a suspected myocardial infarction?
IV therapy and analgesia
When monitoring a patient's cardiac rhythm, it is MOST important to remember that:
the ECG does not provide data regarding the patient's cardiac output.
Fibrinolysis may be contraindicated in all of the following, EXCEPT:
a history of anaphylactic shock caused by salicylates.
The normal P wave duration is less than ___ milliseconds and the amplitude is less than ___ millimeters tall.
110; 2.5
Which of the following statements is correct?
Lead III is contiguous with leads II and aVF.
Any electrical impulse that originates in the ventricles will produce:
wide QRS complexes and a rate between 20 and 40 beats/min.
Common causes of cardiac arrest include all of the following, EXCEPT:
hyperglycemia.
The precordial leads do NOT view the __________ wall of the heart.
inferior
In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm:
is maximal from the onset.
The numerous connections among the arterioles of the various coronary arteries, which allow for the development of alternate routes of blood flow if a larger coronary artery begins to narrow, are called:
collateral circulation.
Sinus dysrhythmia is:
an irregular sinus rhythm.
Patients with a heart rate greater than 150 beats/min usually become unstable because of:
reduced ventricular filling.
You have just performed synchronized cardioversion on a patient with unstable ventricular tachycardia. Upon reassessment, you note that the patient is unresponsive, apneic, and pulseless. You should:
ensure that the synchronizer is off, defibrillate, and immediately begin CPR.
The MOST effective drug for the treatment of non-vagal-induced bradycardia is:
epinephrine.
Premature ventricular complexes:
are ectopic complexes that originate from a different pacemaker site.
All of the following are strategies for decreasing the risk for cardiovascular disease, EXCEPT:
anaerobic exercise.
Which of the following underlying medical conditions would be of LEAST pertinence when obtaining the past medical history from a patient who complains of acute chest pain or pressure?
Cancer
When reviewing a cardiac patient's medication list, you note that she is taking bisoprolol. You recognize that this drug is also called _____________ and is classified as a(n) _____________.
Zebeta, beta blocker
Which of the following statements regarding treatment for a first-degree heart block is correct?
Treatment is generally not indicated unless the rate is slow and cardiac output is impaired.
A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from:
rapid transport to an appropriate hospital
A key to interpreting a Mobitz type II second-degree heart block is to remember that:
the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.
Patients with Wolff-Parkinson-White syndrome:
have an accessory pathway that bypasses the AV node and causes early ventricular depolarization.
Injury to or disease of the ______________ may cause prolapse of a cardiac valve leaflet, allowing blood to regurgitate from the ventricle into the atrium.
chordae tendineae
The heart's anatomic location is MOST accurately described as being:
retrosternal.
Percutaneous coronary interventions involve:
recanalizing a blocked coronary artery by passing a balloon or stent through a catheter via a peripheral artery.
Infarctions of the inferior myocardial wall are MOST often caused by:
occlusion of the right coronary artery.
Abnormal neurologic signs that accompany hypertensive encephalopathy occur when:
pressure causes a breach in the blood-brain barrier and fluid leaks out, causing an increase in intracranial pressure.
Which of the following statements regarding the use of vasopressin when managing cardiac arrest is correct?
A one-time dose of 40 units of vasopressin may be given to replace the first or second dose of epinephrine.
Which of the following electrolytes maintains the depolarization phase?
Calcium
In contrast to treatment for supraventricular tachycardia, treatment for multifocal atrial tachycardia in the prehospital setting:
is generally not effective.
In contrast to the right side of the heart, the left side of the heart:
drives blood out of the heart against the relatively high resistance of the systemic circulation.
A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by:
decreases in stroke volume and ventricular filling.
If a particular interval on the ECG graph paper is 1.5 small boxes in width, the interval would be measured as:
0.06 seconds.
A demand pacemaker:
generates pacing impulses only when it senses that the heart's natural pacemaker has fallen below a preset rate.
In the context of cardiac compromise, syncope occurs due to:
a drop in cerebral perfusion.
Administering a drug that possesses a positive chronotropic effect will have a direct effect on:
the heart rate.
On the ECG strip, a third-degree AV block usually appears as a:
slow, wide QRS complex rhythm with inconsistent PR intervals.
A delta wave is identified on a cardiac rhythm strip as a(n):
rapid upslope to the R wave immediately after the end of the P wave.
In which of the following situations would you likely NOT be able to palpate a pulse despite effective chest compressions?
Tension pneumothorax
Which of the following ECG waveforms represents ventricular depolarization?
QRS complex
You are reviewing the medications of a semiconscious patient as your partner and another paramedic provide patient care. The patient's medications include Lanoxin, enalapril, Coumadin, Lasix, and K-Dur. This medication regimen is MOST consistent with a patient who has:
CHF, hypertension, and atrial fibrillation.
The SA node:
will outpace any slower conduction tissue.
The MOST common symptom directly related to blood pressure elevation is:
headache
The right atrium, right ventricle, and part of the left ventricle are supplied by the:
right coronary artery.
Immediate treatment for a patient with an acute myocardial infarction involves:
reducing myocardial oxygen demand.
If the ECG leads are applied correctly, the PQRST configuration should be inverted in lead:
aVR
A 67-year-old man presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. He has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect?
Positive end-expiratory pressure ventilation
Q waves are considered abnormal or pathologic if they are:
more than one third the overall height of the QRS complex in lead II.
Vasoconstriction occurs following stimulation of:
alpha receptors.
A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should:
keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.
If a patient's aortic aneurysm is not compressing on any adjacent structures:
he or she will likely be asymptomatic.
The AV junction:
is composed of the AV node and surrounding tissue.
Leads V1 to V3 allow you to view the ________ wall of the left ventricle.
anteroseptal
The presence of a J wave (Osborn wave) on the ECG is an indicator of:
hypothermia.
A pure alpha agent:
causes marked vasoconstriction.
Patients experiencing a right ventricular infarction:
may present with hypotension.
Which of the following actions should NOT occur while CPR is in progress?
Cardiac rhythm assessment
The 6-second method for calculating the rate of a cardiac rhythm:
involves counting the number of QRS complexes in a 6-second strip and multiplying that number by 10.
If an increased amount of blood is returned to the heart:
the cardiac muscle must stretch to accommodate the larger volume.
Atrial kick is defined as:
increased preload pressure as a result of atrial contraction.
Torsade de pointes:
is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.
Thousands of fibrils that are distributed throughout the ventricles, which represent the end of the cardiac conduction system, are called the:
Purkinje fibers.
You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should:
reassess her blood pressure.
Disruption of blood flow through the innominate artery due to dissection is likely to produce:
pulse or blood pressure deficits.
The MOST significant risk associated with the use of fibrinolytic therapy is:
hemorrhage.
If the R-R interval spans ___ large boxes or less, the heart rate is greater than 100/min.
3
Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia?
Aberrant conduction
The layers of the wall of the heart, beginning with the outermost layer, are the:
epicardium, myocardium, and endocardium.
You are dispatched to a grocery store for a 39-year-old woman with a severe headache. The patient advises you that her headache, which was present when she woke up this morning, is located in the back of her head. She is conscious and alert, with a blood pressure of 194/112 mm Hg, pulse of 100 beats/min and strong, and respirations of 14 breaths/min and regular. She denies a history of hypertension or any other significant medical problems. The closest appropriate facility is located 15 miles away. You should:
administer supplemental oxygen, start an IV line of normal saline at a keep-open rate, and transport.
The treatment for sinus tachycardia should focus on:
correcting the underlying cause.
Acute coronary syndrome is a term used to describe:
any group of clinical symptoms consistent with acute myocardial ischemia.
Ventricular bigeminy occurs when:
every second complex is a PVC.
The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is:
transcutaneous pacing.
Common causes of bradycardia include:
beta blocker use.
A "run" of ventricular tachycardia occurs if at least ____ PVCs occur in a row.
three
Which part of the blood vessel is made up of elastic fibers and muscle, and provides for strength and contractility?
Tunica media
Spironolactone is a(n):
diuretic.
If a patient remains comatose following return of spontaneous circulation, you should:
provide mild hyperventilation.
The AV junction:
is composed of the AV node and surrounding tissue.
Which of the following is NOT characteristic of multifocal atrial tachycardia?
Regular R-R intervals with a rate less than 150 beats/min
The SA node:
will outpace any slower conduction tissue.
Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction?
58-year-old diabetic woman
An accelerated idioventricular rhythm is characterized by all of the following, EXCEPT:
irregular R-R intervals and a rate less than 40 beats/min.
Stimulation of the parasympathetic nervous system causes all of the following effects, EXCEPT:
dilation of the pupils.
The ability of the heart to vary the degree of its contraction without stretching is called:
contractility.
Which of the following blood pressure readings is MOST suggestive of a patient who has arteriosclerosis?
160/70 mm Hg
An electrical impulse is slightly delayed at the AV node so that the:
atria can empty into the ventricles.
Which of the following situations would contraindicate the administration of nitroglycerin?
Tadalafil use within the last 24 hours
Hypertension is present when the blood pressure:
is consistently greater than 140/90 mm Hg while at rest.
Which of the following drugs would be MOST effective when treating a patient with hypotension secondary to vasodilation?
Norepinephrine
The __________ represents the end of ventricular depolarization and the beginning of repolarization.
J point
Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct?
Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%.
You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a "stomach bug." He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66 mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:
administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
Unlike an idioventricular rhythm, an agonal rhythm:
does not produce a palpable pulse.
The MOST common cause of right-sided heart failure is:
left-sided heart failure.
A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well-coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next?
Administer 300 mg of amiodarone via rapid IV push
A 70-year-old man called 9-1-1 because of generalized weakness. When you arrive at the scene, you find the patient seated in his recliner. He is conscious and alert and is breathing without difficulty. Your physical exam reveals tenderness to his right upper abdominal quadrant, edema to his ankles, and distended jugular veins. The patient tells you that he takes Vasotec for hypertension and Maxide for his swollen ankles. His vital signs are stable. The MOST appropriate treatment for this patient includes:
oxygen, cardiac monitoring, an IV line at a keep-open rate, and transport.
You receive a call to a skilled nursing facility for an elderly man with generalized weakness. The patient's nurse tells you that he has not eaten anything in the past 18 hours. She presents you with his chart, which states that he has a history of atrial fibrillation, congestive heart failure, and hypertension. His medications include Vasotec, digoxin, and warfarin. As you apply the cardiac monitor, your partner takes the patient's vital signs, which reveal a blood pressure of 136/76 mm Hg, a rapid and irregular pulse, and respirations of 22 breaths/min. The ECG reveals atrial fibrillation with a variable rate between 110 and 130 beats/min, and a 12-lead ECG tracing reveals the same. After applying supplemental oxygen, you should:
start an IV line set to keep the vein open, administer diltiazem, and transport.
Normally, the ST segment should be:
at the level of the isoelectric line.
Cardiac arrhythmias following an acute myocardial infarction:
tend to originate from ischemic areas around the infarction.
A loud S3 heart sound, when heard in older adults, often signifies:
heart failure.
A normal QT interval lasts:
0.36 to 0.44 seconds.
In addition to prompt transport, the goal of prehospital management for a patient with a suspected aortic dissection includes:
adequate pain relief.
The point of maximal impulse usually can be felt on the:
left anterior chest, in the midclavicular line, at the fifth intercostal space.
Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take?
Digitalis and Coumadin
The downslope of the T wave:
represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.
You are performing CPR on an 80-year-old woman whose cardiac arrest was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a bag-mask device are producing adequate chest rise. IV access has been obtained and 1 mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rate of 70 beats/min. According to the patient's husband, she has had numerous episodes of diarrhea over the past 24 hours and has not had much of an appetite. The MOST appropriate next action should be to:
continue CPR and administer crystalloid fluid boluses.
All of the following medications are angiotensin II receptor blockers, EXCEPT:
Niaspan.
When applying the limb leads, the negative lead should be placed on the:
right arm.
Injury to the inferior wall of the myocardium would present with:
ST-segment elevation in leads II, III, and aVF.
Epinephrine is used to treat patients in anaphylactic shock because of its effects of:
bronchodilation and vasoconstriction.
The pain associated with an acute myocardial infarction:
is not influenced by deep breathing or body movement.
Paroxysmal nocturnal dyspnea is defined as:
acute shortness of breath that suddenly awakens a person from sleep.
You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should:
perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min.
Atherosclerosis is a process in which:
plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen.
It is MOST important to evaluate a cardiac arrhythmia in the context of the:
patient's overall condition.
A diagnosis of acute myocardial infarction is made if ST-segment __________ of ___ mm or more is seen in ___ or more contiguous leads.
elevation, 1, two
To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:
stimulates beta-1 and beta-2 receptors.
Which of the following drugs possesses beta-2-specific properties?
Proventil
The QT interval would MOST likely be prolonged in patients:
who are hypocalcemic.
Supraventricular tachycardia is MOST accurately defined as:
a tachycardic rhythm originating from a pacemaker site above the level of the ventricles.
The mitral valve:
is located on the higher-pressure side of the heart.
A bedridden patient with right-sided heart failure would be LEAST likely to present with:
edema to the feet.
Stable angina:
occurs after a predictable amount of exertion.
Which of the following drugs is contraindicated in patients with asthma?
Propranolol
Lowering of a significantly elevated blood pressure:
is best accomplished in a hospital setting.
Normal sinus rhythm is characterized by all of the following, EXCEPT:
QRS complexes that are less than 140 milliseconds.
What prevents the backflow of blood during ventricular contraction?
AV valves
Following 2 minutes of CPR, you reassess an unresponsive man's pulse and cardiac rhythm. He remains pulseless and the monitor displays coarse ventricular fibrillation. You should:
resume CPR as the defibrillator is charging.
A patient with an elevated cholesterol level would MOST likely take:
Altacor.
Disruption of blood flow into the left common carotid artery would MOST likely produce signs and symptoms of a(n):
ischemic stroke.
According to the Einthoven triangle, lead II is assessed by placing the:
negative lead on the right arm and the positive lead on the left leg.
Shortly after administering a second dose of 4 mg of morphine to a 49-year-old woman who is experiencing chest pain, the patient's level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should:
assist her ventilations and administer naloxone.
A "runaway" pacemaker is characterized by:
a tachycardic pacemaker rhythm.
When administering aspirin to a patient with an acute coronary syndrome, you should:
have him or her chew and swallow 160 to 325 mg of baby aspirin.
Which of the following statements regarding asystole is correct?
Asystole is the result of prolonged myocardial hypoxia
Sets with similar terms