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The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will:
A) reduce the likelihood and severity of nasal bleeding.
B) sedate the patient and facilitate his or her compliance.
C) dilate the nasal vasculature and facilitate tube insertion.
D) anesthetize the nasopharynx and reduce patient discomfort.
A) reduce the likelihood and severity of nasal bleeding.
B) sedate the patient and facilitate his or her compliance.
C) dilate the nasal vasculature and facilitate tube insertion.
D) anesthetize the nasopharynx and reduce patient discomfort.
. Biot respirations are characterized by:
A) slow, shallow irregular respirations or occasional gasping breaths.
B) an irregular pattern of breathing with intermittent periods of apnea.
C) deep, gasping respirations that are often rapid but may be slow.
D) increased respirations followed by apneic periods.
A) slow, shallow irregular respirations or occasional gasping breaths.
B) an irregular pattern of breathing with intermittent periods of apnea.
C) deep, gasping respirations that are often rapid but may be slow.
D) increased respirations followed by apneic periods.
Apneustic breathing is characterized by:
A) a sustained pattern of tachypnea and increased tidal volume.
B) short, brisk inhalations with a long pause before exhalation.
C) regular respirations with a normal rate and adequate tidal volume.
D) a crescendo-decrescendo pattern of breathing with apneic periods.
A) a sustained pattern of tachypnea and increased tidal volume.
B) short, brisk inhalations with a long pause before exhalation.
C) regular respirations with a normal rate and adequate tidal volume.
D) a crescendo-decrescendo pattern of breathing with apneic periods.
Apneustic breathing is characterized by:
A) an irregular respiratory pattern with unpredictable periods of apnea.
B) a gradual increase and decrease in breathing with periods of apnea.
C) extreme tachypnea and hyperpnea with a fruity or acetone breath odor.
D) a prolonged inspiratory phase with a shortened expiratory phase and bradypnea.
A) an irregular respiratory pattern with unpredictable periods of apnea.
B) a gradual increase and decrease in breathing with periods of apnea.
C) extreme tachypnea and hyperpnea with a fruity or acetone breath odor.
D) a prolonged inspiratory phase with a shortened expiratory phase and bradypnea.
. A patient with orthopnea:
A) has blood-tinged sputum.
B) awakens at night with dyspnea.
C) has dyspnea while lying flat.
D) is breathing through pursed lips.C) has dyspnea while lying flat.. Normal inhalation is the result of:
A) diaphragmatic relaxation.
B) air passively entering the lungs.
C) negative pressure in the thoracic cavity.
D) positive pressure in the thoracic cavity.C) negative pressure in the thoracic cavity.Negative-pressure ventilation occurs when:
A) the diaphragm ascends and the intercostal muscles retract.
B) air is drawn into the lungs when intrathoracic pressure decreases.
C) pressure within the chest decreases and air is forced from the lungs.
D) the phrenic nerves stop sending messages to the diaphragm.B) air is drawn into the lungs when intrathoracic pressure decreases.. In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when:
A) the diaphragm contracts.
B) air is drawn into the lungs.
C) intrathoracic pressure falls.
D) air is forced into the lungs.D) air is forced into the lungs.In contrast to negative-pressure ventilation, positive-pressure ventilation:
A) is the forcing of air into the lungs.
B) occurs when the diaphragm descends.
C) is provided with a nonrebreathing mask.
D) can only be provided to intubated patients.A) is the forcing of air into the lungs.. In contrast to negative-pressure ventilation, positive-pressure ventilation:
A) may impair blood return to the heart.
B) moves air into the esophagus and trachea.
C) causes decreased intrathoracic pressure.
D) is the act of normal, unassisted breathing.A) may impair blood return to the heart.Which of the following patients is LEAST likely in need of positive-pressure ventilation?
A) Confused 46-year-old woman with labored respirations, adventitious breath sounds, and pallor
B) Conscious 41-year-old woman with two-word dyspnea, perioral cyanosis, and tachycardia
C) Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea
D) Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skinD) Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin. In contrast to negative-pressure ventilation, positive-pressure ventilation:
A) is the forcing of air into the lungs.
B) occurs when the diaphragm descends.
C) is provided with a nonrebreathing mask.
D) can only be provided to intubated patients.A) is the forcing of air into the lungs.. Patients with decompensated asthma or COPD who require positive-pressure ventilation:
A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease.
B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.
C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide.
D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.A 39-year-old woman presents with signs and symptoms of an acute hemorrhagic stroke. She is responsive to deep painful stimuli only and has bilaterally dilated and sluggishly reactive pupils. Her respirations are slow and irregular, blood pressure is 80/50 mm Hg, and pulse is 40 and bounding. Initial treatment for this patient involves:
A) positive-pressure ventilatory support.
B) rapid infusion of a crystalloid solution.
C) high-flow oxygen via nonrebreathing mask.
D) immediate transcutaneous cardiac pacing.A) positive-pressure ventilatory support.An inflammatory condition of the respiratory system that results in intermittent wheezing and excess mucus production is called:
A) sinusitis.
B) asthma.
C) bronchitis.
D) emphysema.B) asthma.. The King airway should NOT be used in patients:
A) with known esophageal disease.
B) with prolonged cardiac arrest.
C) with a traumatic brain injury.
D) who weigh less than 25 kg.A) with known esophageal disease.Which of the following findings is MOST clinically significant in a 30-year-old woman with difficulty breathing and a history of asthma?
A) Oral temperature of 97.9°F
B) Expiratory wheezing on exam
C) Prior ICU admission for her asthma
D) 3 mm Hg drop in systolic BP during inhalationC) Prior ICU admission for her asthmaReactive airway disease is characterized by:
A) bronchospasm, edema, and mucus production.
B) chronic bronchoconstriction of varying severity.
C) acute, reversible swelling of the laryngeal muscles.
D) excessive mucus production and a chronic cough.A) bronchospasm, edema, and mucus production.A patient with status asthmaticus commonly presents with:
A) compensatory respiratory alkalosis and stridor.
B) accessory muscle use and inspiratory wheezing.
C) audible expiratory wheezing and severe cyanosis.
D) physical exhaustion and inaudible breath sounds.D) physical exhaustion and inaudible breath sounds.A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she:
A) takes a bronchodilator and a corticosteroid.
B) was previously intubated for his or her condition.
C) was recently evaluated in an emergency department.
D) has used his or her inhaler twice in the previous week.B) was previously intubated for his or her condition.. Patients with decompensated asthma or COPD who require positive-pressure ventilation:
A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease.
B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.
C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide.
D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.. Beta blockers should be used with extreme caution in patients with reactive airway because:
A) beta-1 receptor antagonism will result in profound bronchoconstriction.
B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.
C) there are no beta-blockers that selectively target beta-1 receptors only.
D) they inhibit catecholamine release, potentially causing bronchoconstriction.B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.. Intubation of a patient with severe asthma:
A) is clearly indicated if the patient's condition does not resolve following field corticosteroid therapy.
B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces.
C) should only be performed after hyperventilating the patient with a bag-mask device for 2 to 3 minutes.
D) is generally contraindicated because weaning the patient off of a ventilator can take several days.B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces.. A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should:
A) assist his ventilations and establish vascular access.
B) start an IV of normal saline and administer a steroid.
C) apply high-flow oxygen via a nonrebreathing mask.
D) assist him with a metered-dose inhaler bronchodilator.A) assist his ventilations and establish vascular access.. A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:
A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.
B) begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea.
C) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible.
D) attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.A pH of 7.30 indicates:
A) a neutral pH.
B) a basic pH.
C) alkalosis.
D) acidosis.D) acidosis.Carpopedal spasm that occurs during respiratory alkalosis is caused by a(n):
A) decrease in arterial CO2.
B) intracellular calcium shift.
C) extracellular sodium shift.
D) intracellular potassium shift.B) intracellular calcium shift.The use of capnography in patients with prolonged cardiac arrest may be limited because:
A) of an excess buildup of nitrogen in the blood.
B) the paramedic often ventilates the patient too slowly.
C) of acidosis and minimal carbon dioxide elimination.
D) metabolic alkalosis damages the colorimetric paper.C) of acidosis and minimal carbon dioxide elimination.. Which of the following occurs during compensated shock?
A) Cerebral hypoperfusion causes pupillary constriction
B) Increased rate of breathing causes respiratory alkalosis
C) Urine output decreases to less than 20 mL/hour
D) Vasomotor failure leads to a drop in systolic blood pressureB) Increased rate of breathing causes respiratory alkalosis. Hypoventilating patients:
A) eliminate too much carbon dioxide.
B) become hypercapneic and acidotic.
C) experience an increase in blood pH.
D) typically do not have an open airway.B) become hypercapneic and acidotic.The hypoxic drive is a phenomenon in which:
A) a chronically hypoxic patient's primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood.
B) a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen.
C) high levels of oxygen rapidly depress a COPD patient's respiratory rate and depth, leading to worsened hypoxia and severe acidosis.
D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.. A hyperventilating patient:
A) may be acidotic and is trying to decrease his or her pH level.
B) is most effectively treated by administering a sedative drug.
C) should rebreathe his or her carbon dioxide to effect resolution.
D) presents with tachypnea and marked use of accessory muscles.A) may be acidotic and is trying to decrease his or her pH level.. Respiratory alkalosis is the result of:
A) carbon dioxide retention.
B) slow and shallow respirations.
C) increased hydrogen ion production.
D) excess carbon dioxide elimination.D) excess carbon dioxide elimination.The by-product of cellular respiration is:
A) oxygen.
B) lactic acid.
C) pyruvic acid.
D) carbon dioxide.D) carbon dioxide.A patient who overdosed on heroin and is unconscious with slow, shallow respirations would MOST likely experience:
A) increased CO2 retention.
B) acute metabolic acidosis.
C) excess CO2 elimination.
D) a pH well above 7.45.A) increased CO2 retention.. Which of the following conditions would be the LEAST likely to cause hyperventilation?
A) Ketoacidosis
B) Severe infection
C) Aspirin overdose
D) Metabolic alkalosisA) KetoacidosisDiabetic ketoacidosis occurs when:
A) blood glucose levels rise above 250 mg/dL.
B) the renal system begins to excrete ketones.
C) the cells metabolize fat and produce ketones.
D) insulin production exceeds glucagon production.C) the cells metabolize fat and produce ketones.. A patient with diabetic ketoacidosis experiences polydipsia as a result of:
A) hyperglycemia.
B) dehydration.
C) metabolic acidosis.
D) inefficient nutrient utilization.B) dehydration.. Severe dehydration that commonly accompanies diabetic ketoacidosis is caused by:
A) prolonged compensatory hyperventilation.
B) decreased fluid intake secondary to hyperglycemia.
C) hyperglycemia-induced osmotic diuresis and vomiting.
D) the loss of key electrolytes such as sodium and potassium.C) hyperglycemia-induced osmotic diuresis and vomiting.Acidosis is characterized by a(n):
A) increase in hydrogen ions and a decrease in pH.
B) decrease in hydrogen ions and an increase in pH.
C) increase in hydrogen ions and an increase in pH.
D) decrease in hydrogen ions and a decrease in pH.A) increase in hydrogen ions and a decrease in pH.The hyperpnea and tachypnea associated with methyl alcohol intoxication is secondary to:
A) hypoxemia.
B) heart failure.
C) metabolic acidosis.
D) an elevated blood pH.C) metabolic acidosis.Severe salicylate toxicity produces:
A) bradypnea.
B) metabolic acidosis.
C) increased pH levels.
D) respiratory acidosis.B) metabolic acidosis.A person who ingests an excessive amount of salicylate would MOST likely experience:
A) alkalosis.
B) bradycardia.
C) a fall in pH.
D) hypoventilation.C) a fall in pH.The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT:
A) a decreased pH.
B) metabolic alkalosis.
C) hyperkalemia.
D) renal dysfunction.B) metabolic alkalosis.. Ipratropium bromide (Atrovent) causes bronchodilation by:
A) antagonizing muscarinic receptors.
B) agonizing nicotinic receptors.
C) agonizing beta-2 receptors.
D) antagonizing beta-2 receptors.A) antagonizing muscarinic receptors.. Ipratropium (Atrovent) dilates the bronchioles by:
A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors.
B) selectively stimulating beta-2 receptors found in the bronchial smooth muscle.
C) competitively binding to beta-2 receptors found in the bronchial smooth muscle.
D) increasing the interaction of acetylcholine at bronchial smooth muscle receptors.A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors.. The trachea and mainstem bronchi:
A) constrict violently when their beta-2 receptors are stimulated excessively.
B) are approximately 10 to 12 cm in length and are joined together at the hilum.
C) do not contain mucous-producing cells in patients without a respiratory disease.
D) are lined with beta-2 receptors that result in bronchodilation when stimulated.D) are lined with beta-2 receptors that result in bronchodilation when stimulated.Massive doses of atropine may be required when:
A) a patient strains to defecate and stimulates muscarinic-2 receptors.
B) acetylcholine increases dramatically due to acetylcholinesterase inhibition.
C) severe bradycardia is the result of a block in the cardiac conduction system.
D) a patient's heart rate significantly increases and lowers the cardiac output.B) acetylcholine increases dramatically due to acetylcholinesterase inhibition.Ipratropium bromide (Atrovent) causes bronchodilation by:
A) antagonizing muscarinic receptors.
B) agonizing nicotinic receptors.
C) agonizing beta-2 receptors.
D) antagonizing beta-2 receptors.A) antagonizing muscarinic receptors.. Which of the following inhaled medications is NOT a beta2 agonist bronchodilator?
A) Proventil
B) Albuterol
C) Isoetharine
D) IpratropiumD) IpratropiumSide effects of atropine sulfate when given in therapeutic doses and at the proper rate may include:
A) pupillary constriction.
B) excessive urination.
C) paradoxical bradycardia.
D) dry mouth and nausea.D) dry mouth and nausea.. Ipratropium (Atrovent) dilates the bronchioles by:
A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors.
B) selectively stimulating beta-2 receptors found in the bronchial smooth muscle.
C) competitively binding to beta-2 receptors found in the bronchial smooth muscle.
D) increasing the interaction of acetylcholine at bronchial smooth muscle receptors.A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors.Methylprednisoline (Solu-Medrol) is classified as a:
A) beta-2 agonist.
B) glucocorticoid.
C) corticosteroid.
D) nonsteroidal anti-inflammatory.Methylprednisoline (Solu-Medrol) is classified as a:
A) beta-2 agonist.
B) glucocorticoid.
C) corticosteroid.
D) nonsteroidal anti-inflammatory.. Which of the following medications is a parasympathetic bronchodilator?
A) Alupent
B) Albuterol
C) Bronkosol
D) IpratropiumD) IpratropiumUnlike bronchodilator therapy, corticosteroid therapy:
A) causes immediate improvement in breathing.
B) takes a few hours to reduce bronchial edema.
C) is administered exclusively in a hospital setting.
D) is the primary treatment for acute bronchospasm.B) takes a few hours to reduce bronchial edema.The trachea and mainstem bronchi:
A) constrict violently when their beta-2 receptors are stimulated excessively.
B) are approximately 10 to 12 cm in length and are joined together at the hilum.
C) do not contain mucous-producing cells in patients without a respiratory disease.
D) are lined with beta-2 receptors that result in bronchodilation when stimulated.D) are lined with beta-2 receptors that result in bronchodilation when stimulated.Which of the following conditions would LEAST likely present with an acute onset of respiratory distress?
A) Pneumonia
B) Anaphylaxis
C) Pneumothorax
D) Pulmonary embolismA) PneumoniaAbnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the:
A) right middle lobe.
B) bases of the lungs.
C) apices of the lungs.
D) midaxillary line.B) bases of the lungs.Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD?
A) Nonproductive cough
B) White sputum and rales
C) Fever and localized crackles
D) Dyspnea and diffuse wheezingC) Fever and localized crackles. Patients with COPD typically experience an acute exacerbation of their condition because of:
A) a secondary condition such as congestive heart failure or a pneumothorax.
B) progressively worsening pneumonia that results in a diminished cough reflex.
C) chronic noncompliance with their prescribed medications and home oxygen.
D) environmental changes such as weather or the inhalation of trigger substances.D) environmental changes such as weather or the inhalation of trigger substances.. Bedridden patients with excessive pulmonary secretions are MOST prone to developing:
A) pneumonia.
B) bronchospasm.
C) a pneumothorax.
D) a pulmonary embolism.A) pneumonia.Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:
A) movement loosens pulmonary secretions and stimulates coughing.
B) most cases of pneumonia occur in conjunction with bronchospasm.
C) the secretions in their lungs suddenly disperse and impair breathing.
D) pneumonia often occurs in the lung bases, typically on only one side.D) pneumonia often occurs in the lung bases, typically on only one side.You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing:
A) bronchitis.
B) pneumonia.
C) end-stage COPD.
D) COPD exacerbation.B) pneumonia.. A 90-year-old nursing home resident presents with confusion and a cough after several days of complaining of being weak. She is bedridden, has numerous medical conditions, and takes a variety of medications. Your assessment reveals that her temperature is 99.0°F, her skin is cool and dry, her blood pressure is 118/66 mm Hg, and her heart rate is 68 beats/min and regular. She is not experiencing obvious respiratory distress, and her oxygen saturation is 93% on room air. This patient is MOST likely experiencing:
A) pneumonia.
B) heart failure.
C) hypoglycemia.
D) a pulmonary embolism.A) pneumonia.The leading cause of death from infection in Americans older than 65 years of age is:
A) nephritis.
B) pneumonia.
C) encephalitis.
D) meningitis.B) pneumonia.Which of the following is a complication associated with dysfunction of cranial nerves VI, VII, IX, and XII?
A) Hearing impairment
B) Acute ischemic stroke
C) Aspiration pneumonia
D) Upper airway obstructionC) Aspiration pneumoniaThe presence of rhonchi during auscultation of the lungs is MOST suggestive of:
A) asthma.
B) pneumonia.
C) pneumothorax.
D) toxic inhalation.B) pneumonia.. COPD is characterized by:
A) narrowing of the smaller airways that is often reversible with prompt treatment.
B) changes in pulmonary structure and function that are progressive and irreversible.
C) small airway spasms during the inhalation phase, resulting in progressive hypoxia.
D) widespread alveolar collapse due to increased pressure during the exhalation phase.B) changes in pulmonary structure and function that are progressive and irreversible.Patients with COPD typically experience an acute exacerbation of their condition because of:
A) a secondary condition such as congestive heart failure or a pneumothorax.
B) progressively worsening pneumonia that results in a diminished cough reflex.
C) chronic noncompliance with their prescribed medications and home oxygen.
D) environmental changes such as weather or the inhalation of trigger substances.D) environmental changes such as weather or the inhalation of trigger substances.An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and Vasotec for high blood pressure. You should:
A) expect to hear crackles when you auscultate her lungs.
B) suspect acute right heart failure and administer oxygen.
C) start an IV of normal saline and give her a 250-mL bolus.
D) conclude that she has been noncompliant with her diuretic.B) suspect acute right heart failure and administer oxygen.You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should:
A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport.
B) provide aggressive airway management unless the daughter can produce a valid DNR order.
C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order.
D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.A 77-year-old man with end-stage COPD and renal failure is found unresponsive by his daughter. Your assessment reveals that the patient is apneic and pulseless. The daughter presents you with an out-of-hospital DNR order; however, the document expired 3 months ago. You should:
A) begin CPR only and contact medical control for further guidance.
B) realize that the patient cannot be resuscitated and notify the coroner.
C) begin full resuscitative efforts because the DNR order is no longer valid.
D) confirm that the order has expired before initiating any patient treatment.A) begin CPR only and contact medical control for further guidance.Strength of a person's peripheral pulses is related to:
A) heart rate and preload.
B) stroke volume and pulse pressure.
C) physical size and blood pressure.
D) cardiac output and heart rate.B) stroke volume and pulse pressure.A pulse that alternates in strength from one beat to the next beat is called:
A) pulse deficit.
B) pulsus alternans.
C) pulsus paradoxus.
D) paradoxical pulse.B) pulsus alternans.Disruption of blood flow through the innominate artery due to dissection is likely to produce:
A) pulse or blood pressure deficits.
B) a rapid, irregular pulse.
C) collapsed jugular veins.
D) a widened pulse pressure.A) pulse or blood pressure deficits.A) pulse or blood pressure deficits.
. Vascular injury following trauma to the anterior neck would MOST likely present with:
A) hemoptysis.
B) parasthesia.
C) pulse deficits.
D) dysphagia.C) pulse deficits.. Vascular compromise in a lower extremity is characterized by:
A) unilateral pulse deficit and pallor.
B) bilaterally diminished pedal pulses.
C) warm, flushed skin to the extremity.
D) inability to feel or move the extremity.A) unilateral pulse deficit and pallor.. Normally, the ST segment should be:
A) at the level of the isoelectric line.
B) elevated by no more than 1 mm.
C) depressed by no more than 2 mm.
D) invisible on a normal ECG tracing.A) at the level of the isoelectric line.Most patients with an ST-elevation myocardial infarction:
A) will develop Q waves.
B) heal without treatment.
C) experience cardiac arrest.
D) present without chest pain.A) will develop Q waves.A diagnosis of acute myocardial infarction is made if ST-segment __________ of ___ mm or more is seen in ___ or more contiguous leads.
A) elevation, 1, two
B) depression, 2, one
C) elevation, 2, one
D) depression, 1, twoA) elevation, 1, two. Which of the following statements is correct?
A) Lead I is contiguous with lead II.
B) Lead II is contiguous with leads V6 and aVL.
C) Lead V6 is contiguous with leads V4 and V5.
D) Lead III is contiguous with leads II and aVF.D) Lead III is contiguous with leads II and aVF.Injury to the inferior wall of the myocardium would present with:
A) T-wave inversion in leads V1 through V4.
B) ST-segment elevation in leads II, III, and aVF.
C) pathologic Q waves in leads V4 and V5.
D) ST-segment depression in leads V5, V6, and aVL.B) ST-segment elevation in leads II, III, and aVF.. Ischemia to the anterior wall of the myocardium would present with:
A) T-wave inversion in leads V3 and V4.
B) ST-segment depression in leads I and aVL.
C) T-wave inversion in leads II, III, and aVF.
D) ST-segment elevation in leads V3 and V4.A) T-wave inversion in leads V3 and V4.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:
A) administer up to 325 mg of baby aspirin.
B) give 2-mg increments of morphine sulfate.
C) start a dopamine infusion at 2 µg/kg/min.
D) give crystalloid boluses to increase preload.D) give crystalloid boluses to increase preload.. An ST segment that is more than 1 mm above the isoelectric line:
A) indicates myocardial ischemia.
B) is clinically insignificant in lead II.
C) must be substantiated by a 12-lead ECG.
D) is a definitive sign of myocardial injury.C) must be substantiated by a 12-lead ECG.. Aberrant conduction is _____________ conduction.
A) rapid
B) abnormal
C) very slow
D) irregularB) abnormal. Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia?
A) Aberrant conduction
B) Absence of P waves
C) Retrograde conduction
D) The rate of the rhythmA) Aberrant conductionThe decline in cardiac function associated with aging is largely related to:
A) hypotension.
B) bradycardia.
C) atherosclerosis.
D) rheumatic heart disease.C) atherosclerosis.Atherosclerosis is a process in which:
A) the outer wall of a coronary artery becomes lined with masses of fatty tissue.
B) calcium precipitates into the arterial walls, greatly reducing the artery's elasticity.
C) plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen.
D) plaque ruptures from a distant location and lodges in one of the coronary arteries.C) plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen.All of the following are examples of acute cerebrovascular emergencies, EXCEPT:
A) embolic blockage of a cerebral artery.
B) accumulation of atherosclerotic plaque.
C) rupture of a cerebral arterial aneurysm.
D) stroke secondary to thrombus rupture.B) accumulation of atherosclerotic plaque.Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons, EXCEPT:
A) impaired circulation.
B) chronic hyperthyroidism.
C) atherosclerotic vessels.
D) decreased sweat production.B) chronic hyperthyroidism.. Postmenopausal women:
A) often experience hot flashes and bradycardia.
B) tend to experience fewer urinary tract infections.
C) are usually over 35 years of age and tend to be obese.
D) are more susceptible to atherosclerosis and osteoporosis.D) are more susceptible to atherosclerosis and osteoporosis.Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of:
A) jugular venous distention.
B) a narrowing pulse pressure.
C) clear and equal breath sounds.
D) alterations in the QRS amplitude.C) clear and equal breath sounds.. Which of the following injuries or conditions would cause obstructive shock?
A) Severe burns
B) Massive sepsis
C) Pelvic fracture
D) Cardiac tamponadeD) Cardiac tamponadeYou would NOT expect to encounter decreased breath sounds in a patient with:
A) opiate intoxication.
B) cardiac tamponade.
C) status asthmaticus.
D) pulmonary edema.B) cardiac tamponade.Which of the following statements regarding a pericardial tamponade is correct?
A) Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.
B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.
C) Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.
D) The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.Which of the following blood pressures is MOST consistent with a pericardial tamponade?
A) 80/50 mm Hg
B) 90/70 mm Hg
C) 100/60 mm Hg
D) 110/80 mm HgB) 90/70 mm HgYou should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and:
A) loud heart tones.
B) respiratory distress.
C) a bounding pulse.
D) normal lung sounds.D) normal lung sounds.. An unresponsive, apneic, and pulseless man presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to his arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of his condition?
A) Bilaterally absent breath sounds and severe pallor
B) No pulse with CPR and jugular venous distention
C) Unilaterally absent breath sounds and mottled skin
D) Profoundly cyanotic skin and collapsed jugular veinsB) No pulse with CPR and jugular venous distention. Cor pulmonale is defined as:
A) increased preload caused by severe hypertension.
B) left heart failure secondary to mitral valve damage.
C) rupture of the alveoli due to increased surface tension.
D) right heart failure secondary to chronic lung disease.D) right heart failure secondary to chronic lung disease.Hepatomegaly and jugular venous distention are MOST suggestive of:
A) left heart failure.
B) right heart failure.
C) pulmonary edema.
D) severe pneumonia.B) right heart failure.Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the:
A) right middle lobe.
B) bases of the lungs.
C) apices of the lungs.
D) midaxillary line.B) bases of the lungs.Frothy sputum that has a pink tinge to it is MOST suggestive of:
A) tuberculosis.
B) antihistamine use.
C) chronic bronchitis.
D) congestive heart failure.D) congestive heart failure.An untreated patent ductus arteriosus may cause subsequent development of:
A) congestive heart failure.
B) ventricular septal defect.
C) pulmonary stenosis.
D) a patent foramen ovale.A) congestive heart failure.An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and Vasotec for high blood pressure. You should:
A) expect to hear crackles when you auscultate her lungs.
B) suspect acute right heart failure and administer oxygen.
C) start an IV of normal saline and give her a 250-mL bolus.
D) conclude that she has been noncompliant with her diuretic.B) suspect acute right heart failure and administer oxygen.. A loud S3 heart sound, when heard in older adults, often signifies:
A) emphysema.
B) valve rupture.
C) heart failure.
D) pulmonary hypertension.C) heart failure.. Jugular venous distention in a patient sitting at a 45° angle:
A) is not clinically significant.
B) is a sign of reduced preload.
C) suggests left-sided heart failure.
D) indicates right-sided heart compromise.D) indicates right-sided heart compromise.. Which of the following clinical findings is LEAST suggestive of left-sided heart failure?
A) An S3 gallop
B) Sacral edema
C) Crackles in the lungs
D) Shortness of breathB) Sacral edema. In a patient with left heart failure and pulmonary edema:
A) the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood.
B) diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart.
C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.
D) an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.. Common signs of left-sided heart failure include all of the following, EXCEPT:
A) confusion.
B) tachycardia.
C) hypotension.
D) hypertension.C) hypotension.In contrast to a patient with asthma, a patient with left-sided heart failure:
A) presents with a dry, nonproductive cough and diffuse wheezing in all lung fields.
B) experiences acute weight gain and takes medications such as digoxin and a diuretic.
C) presents with a hyperinflated chest, use of accessory muscles, and expiratory wheezing.
D) is typically a younger patient with a history of a recent upper respiratory infection.B) experiences acute weight gain and takes medications such as digoxin and a diuretic.. In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes:
A) a saline lock, a selective beta-2 adrenergic medication, and bicarbonate.
B) an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication.
C) a saline lock, fentanyl, and intubation facilitated by pharmacologic agents.
D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.. The MOST common cause of right-sided heart failure is:
A) left-sided heart failure.
B) pulmonary hypotension.
C) acute pulmonary embolism.
D) long-standing emphysema.A) left-sided heart failure.. A bedridden patient with right-sided heart failure would be LEAST likely to present with:
A) edema to the feet.
B) presacral edema.
C) hepatomegaly.
D) jugular venous distention.A) edema to the feet.. You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of "breathing problem," for which he uses a prescribed inhaler and takes a "heart pill." You should suspect:
A) right ventricular failure.
B) reactive airway disease.
C) acute COPD exacerbation.
D) left-sided heart failure.D) left-sided heart failure.. The heart hypertrophies with age, MOST likely in response to:
A) a progressive increase in preload and chronic myocardial stretching.
B) left-sided heart failure that results in chronic pulmonary hypertension.
C) a chronically increased afterload caused by arteriosclerotic blood vessels.
D) a significant decline in cardiac output due to a reduction in stroke volume.C) a chronically increased afterload caused by arteriosclerotic blood vessels.. Distention of the jugular veins indicates:
A) a state of hypovolemia.
B) left-sided heart failure.
C) decreased venous pressure.
D) increased venous capacitance.D) increased venous capacitance.The heart's primary pacemaker, which is located in the right atrium, is the:
A) AV node.
B) SA node.
C) AV junction.
D) bundle of His.B) SA node.As an electrical impulse travels down the electrical conduction system, it transiently slows at the:
A) AV node.
B) bundle of His.
C) sinoatrial node.
D) interatrial septum.B) SA node.As an electrical impulse travels down the electrical conduction system, it transiently slows at the:
A) AV node.
B) bundle of His.
C) sinoatrial node.
D) interatrial septum.A) AV node.The projection of the neurons that receives electrical impulses from other neurons is called a(n):
A) dendrite.
B) axon.
C) neuroglia.
D) motor fiber.A) dendrite.The myocardium is the only muscle that can generate its own electrical impulses. This process is called:
A) automaticity.
B) excitability.
C) conductivity.
D) dromotropy.A) automaticity.The basic structure of nervous tissue that responds to environmental changes by transmitting impulses is the:
A) axon.
B) neuron.
C) dendrite.
D) neuroglia.B) neuron.Which type of nerve cells conduct electrical impulses away from the cell body?
A) Axons
B) Neurons
C) Dendrites
D) NeurocytesC) Dendrites. The area of conduction tissue in which electrical activity arises at any given time is called the:
A) myocyte.
B) pacemaker.
C) sinus node.
D) bundle of His.B) pacemaker.. Which of the following statements regarding the SA node is correct?
A) The SA node is the dominant cardiac pacemaker in healthy patients.
B) SA nodal ischemia occurs when the left coronary artery is occluded.
C) The SA node is located in the superior aspect of the right ventricle.
D) Impulses generated by the SA node travel through the right atrium only.A) The SA node is the dominant cardiac pacemaker in healthy patients.The AV junction:
A) includes the AV node but not the bundle of His.
B) is the dominant and fastest pacemaker in the heart
C) receives its blood supply from the circumflex artery.
D) is composed of the AV node and surrounding tissue.D) is composed of the AV node and surrounding tissue.. An electrical impulse is slightly delayed at the AV node so that the:
A) bundle of His can depolarize fully.
B) ventricles can contract completely.
C) primary cardiac pacemaker can reset.
D) atria can empty into the ventricles.D) atria can empty into the ventricles.. The P wave represents:
A) SA nodal discharge.
B) atrial depolarization.
C) a delay at the AV node.
D) contraction of the atria.B) atrial depolarization.Stimulation of the parasympathetic nervous system:
A) completely blocks the AV node, preventing ventricular depolarization.
B) causes a decrease in the production of epinephrine and norepinephrine.
C) is characterized by a large P wave and a PR interval that is shorter than normal.
D) slows SA nodal discharge and decreases conduction through the AV node.D) slows SA nodal discharge and decreases conduction through the AV node.. Bombardment of the AV node by more than one impulse, potentially blocking the pathway for one impulse and allowing the other impulse to stimulate cardiac cells that have already depolarized, is called:
A) fusion.
B) reentry.
C) ectopy.
D) excitability.B) reentry.A prolonged PR interval:
A) is greater than 120 milliseconds.
B) indicates that the AV node was bypassed.
C) indicates an abnormal delay at the AV node.
D) is a sign of rapid atrial depolarization.C) indicates an abnormal delay at the AV node.In sinus bradycardia, the:
A) heart rate is less than 70 beats/min.
B) pacemaker site is the SA node.
C) QRS complexes are often wide.
D) P waves are consistently upright.B) pacemaker site is the SA node.If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles:
A) the PR intervals will be greater than 0.20 seconds.
B) an upright P wave will appear after the QRS complex.
C) an inverted P wave will appear before the QRS complex.
D) a small inverted P wave will be buried in the QRS complex.C) an inverted P wave will appear before the QRS complex.. The point of maximal impulse usually can be felt on the:
A) medial aspect of the chest, just below the third intercostal space.
B) left lateral chest, in the midaxillary line, at the fourth intercostal space.
C) left anterior chest, in the midaxillary line, at the fifth intercostal space.
D) left anterior chest, in the midclavicular line, at the fifth intercostal space.D) left anterior chest, in the midclavicular line, at the fifth intercostal space.. A decreased number of pacemaker cells in the sinoatrial node would MOST likely contribute to a decline in cardiac output secondary to:
A) heart block.
B) bradycardia.
C) tachycardia.
D) atrial fibrillation.B) bradycardia.. Automaticity is defined as the ability of the heart to:
A) generate an electrical impulse from the same site every time.
B) spontaneously conduct an electrical impulse between cardiac cells.
C) generate its own electrical impulses without stimulation from nerves.
D) increase or decrease its heart rate based on the body's metabolic needs.C) generate its own electrical impulses without stimulation from nerves.. If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse:
A) the AV junction will begin pacing at 40 to 60 times/min.
B) you will see a brief period of bradycardia followed by asystole.
C) the P wave and PR interval will have an abnormal appearance.
D) you should expect to see a heart rate slower than 40 beats/min.D) you should expect to see a heart rate slower than 40 beats/min.. The SA node:
A) cannot depolarize faster than 100 times/min.
B) will outpace any slower conduction tissue.
C) functions as the heart's secondary pacemaker.
D) has an intrinsic firing rate of 40 to 60 times per minute.B) will outpace any slower conduction tissue.The farther removed the conduction tissue is from the SA node:
A) the slower its intrinsic rate of firing.
B) the longer the PR interval will be.
C) the faster its intrinsic rate of firing.
D) the narrower the QRS complex will be.A) the slower its intrinsic rate of firing.If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse:
A) the AV junction will begin pacing at 40 to 60 times/min.
B) you will see a brief period of bradycardia followed by asystole.
C) the P wave and PR interval will have an abnormal appearance.
D) you should expect to see a heart rate slower than 40 beats/min.D) you should expect to see a heart rate slower than 40 beats/min.. Which of the following electrolytes maintains the depolarization phase?
A) Sodium
B) Calcium
C) Potassium
D) MagnesiumB) CalciumRepolarization begins when:
A) the sodium and calcium channels close.
B) calcium ions slowly enter the cardiac cell.
C) potassium ions rapidly escape from the cell.
D) the inside of the cell returns to a positive charge.A) the sodium and calcium channels close.. The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration.
A) 0.12, 0.20
B) 0.14, 0.30
C) 0.16, 0.40
D) 0.18, 2.0A) 0.12, 0.20During the refractory period:
A) the heart is in a state of partial repolarization.
B) the heart is partially charged, but cannot contract.
C) the cell is depolarized or in the process of repolarizing.
D) the heart muscle is depleted of energy and needs to recharge.C) the cell is depolarized or in the process of repolarizing.The P wave represents:
A) SA nodal discharge.
B) atrial depolarization.
C) a delay at the AV node.
D) contraction of the atria.B) atrial depolarization.The brief pause between the P wave and QRS complex represents:
A) depolarization of the inferior part of the atria.
B) the period of time when the atria are repolarizing.
C) full dispersal of electricity throughout both atria.
D) a momentary conduction delay at the AV junction.D) a momentary conduction delay at the AV junction.D) a momentary conduction delay at the AV junction.The __________ represents the end of ventricular depolarization and the beginning of repolarization.
A) J point
B) T wave
C) ST segment
D) T-P intervalA) J point. The downslope of the T wave:
A) is the point of ventricular repolarization to which a defibrillator is synchronized to deliver electrical energy.
B) is the strongest part of ventricular depolarization and is often the origin of dangerous ventricular arrhythmias.
C) represents a state of absolute ventricular refractoriness in which another impulse cannot cause depolarization.
D) represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.D) represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.Depolarization, the process by which muscle fibers are stimulated to contract, occurs when:
A) cell wall permeability changes and sodium rushes into the cell.
B) calcium ions rapidly enter the cell, facilitating contraction.
C) potassium ions escape from the cell through specialized channels.
D) cardiac muscle relaxes in response to a cellular influx of calcium.A) cell wall permeability changes and sodium rushes into the cell.. Which of the following ECG waveforms represents ventricular depolarization?
A) T wave
B) ST segment
C) QRS complex
D) U waveC) QRS complex. A prolonged PR interval:
A) is greater than 120 milliseconds.
B) indicates that the AV node was bypassed.
C) indicates an abnormal delay at the AV node.
D) is a sign of rapid atrial depolarization.C) indicates an abnormal delay at the AV node.Which of the following occurs during phase 1 of the cardiac cellular action potential?
A) Sodium influx decreases while potassium slowly exits the cell
B) Rapid influx of sodium ions through channels in the cardiac cell
C) Calcium enters the cell while potassium continues to leave the cell
D) Calcium movement ceases with continued outflow of potassiumA) Sodium influx decreases while potassium slowly exits the cellRepolarization and myocardial contraction are occurring through phases:
A) 0 and 1.
B) 1 and 2.
C) 2 and 3.
D) 3 and 4.C) 2 and 3.What phases of the cardiac cellular action potential comprise the absolute refractory period?
A) 1 and 2 only
B) 2 and 3 only
C) 0 through 3
D) 0 through 4C) 0 through 3Stimulation of the parasympathetic nervous system:
A) completely blocks the AV node, preventing ventricular depolarization.
B) causes a decrease in the production of epinephrine and norepinephrine.
C) is characterized by a large P wave and a PR interval that is shorter than normal.
D) slows SA nodal discharge and decreases conduction through the AV node.D) slows SA nodal discharge and decreases conduction through the AV node.A prolonged QT interval indicates that the heart:
A) has a shorter-than-normal refractory period, increasing the likelihood of severe bradycardia.
B) is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias.
C) is depolarizing too quickly, which significantly increases the potential for reentry in the AV junction.
D) has a shortened refractory period and may be caused by factors such as hypocalcemia or pericarditis.B) is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias.In order to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump:
A) moves three sodium ions and three potassium ions back into the cell.
B) moves two sodium ions into the cell for every three potassium ions it moves out of the cell.
C) moves calcium and potassium ions back into the cell by a process called passive transport.
D) moves two potassium ions into the cell for every three sodium ions it moves out of the cell.D) moves two potassium ions into the cell for every three sodium ions it moves out of the cell.. First-degree heart block in children:
A) is typically asymptomatic and does not require special treatment.
B) should be suspected when a randomly dropped QRS is observed.
C) should be treated with cardiac pacing, even if the child is stable.
D) does not respond to atropine and should be treated with dopamine.A) is typically asymptomatic and does not require special treatment.Damage to the cardiac electrical conduction system caused by an acute myocardial infarction MOST commonly results in:
A) severe tachycardia.
B) ventricular dysrhythmias.
C) acute bundle branch block.
D) bradycardia or heart block.D) bradycardia or heart block.A first-degree heart block has a PR interval greater than 0.20 seconds because:
A) depolarization of the atria occurs at a slightly slower rate than one would expect.
B) each impulse that reaches the AV node is delayed slightly longer than expected.
C) impulses generated by the SA node traverse the AV node at an accelerated rate.
D) the primary pacemaker is not the SA node, but rather an ectopic atrial pacemaker.B) each impulse that reaches the AV node is delayed slightly longer than expected.Which of the following statements regarding treatment for a first-degree heart block is correct?
A) Treatment is generally not indicated unless the rate is slow and cardiac output is impaired.
B) Most first-degree heart blocks are associated with significant bradycardia and require atropine.
C) First-degree heart block is often accompanied by a compensatory tachycardia that requires treatment.
D) Transcutaneous cardiac pacing should be initiated without delay for patients with a first-degree heart block.A) Treatment is generally not indicated unless the rate is slow and cardiac output is impaired.Which of the following statements regarding second-degree heart block is correct?
A) Most second-degree heart blocks are transient in nature and resolve in the prehospital setting without the need for intervention in the emergency department.
B) Second-degree heart block occurs when an impulse reaching the AV node is occasionally prevented from proceeding to the ventricles and causing a QRS complex.
C) More than half of all second-degree heart blocks cause hemodynamic compromise and require transcutaneous cardiac pacing in the prehospital or hospital setting.
D) Second-degree heart block is characterized by inconsistent PR intervals, a QRS complex greater than 0.12 seconds, and a ventricular rate less than 40 beats/min.B) Second-degree heart block occurs when an impulse reaching the AV node is occasionally prevented from proceeding to the ventricles and causing a QRS complex.A second-degree heart block, Mobitz type I, occurs when:
A) every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles.
B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.
C) the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex.
D) more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles.B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.. A key to interpreting a Mobitz type II second-degree heart block is to remember that:
A) unlike a Mobitz type I second-degree heart block, a type II heart block is always regular.
B) in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted.
C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.
D)most type II second degree AV blocks have more than two nonconducted P waves that occur in successionC) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.. Which of the following occurs at the AV node during a third-degree heart block?
A) There is an abnormal delay in conducting impulses.
B) Every third impulse is allowed to enter the ventricles.
C) Impulses bypass the AV node and enter the ventricles.
D) All impulses are blocked from entering the ventricles.D) All impulses are blocked from entering the ventricles.On the ECG strip, a third-degree AV block usually appears as a:
A) wide QRS complex rhythm with a rate between 50 and 70 beats/min.
B) slow, narrow QRS complex rhythm with irregular P-P intervals.
C) slow, wide QRS complex rhythm with inconsistent PR intervals.
D) narrow QRS complex rhythm with a rate less than 60 beats/min.C) slow, wide QRS complex rhythm with inconsistent PR intervals.. The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is:
A) atropine sulfate.
B) a dopamine infusion.
C) an epinephrine infusion.
D) transcutaneous pacing.D) transcutaneous pacing.. A 68-year-old woman presents with an acute onset of confusion, shortness of breath, and diaphoresis. Her blood pressure is 72/50 mm Hg, her heart rate is slow and weak, and her respirations are increased and shallow. The ECG reveals a third-degree heart block at a rate of 38 beats/min. After placing the patient on high-flow oxygen, you should:
A) start an IV and administer 0.5 mg atropine.
B) obtain a 12-lead ECG to detect an acute myocardial infarction.
C) obtain vascular access and give a fluid bolus.
D) immediately attempt transcutaneous pacing.D) immediately attempt transcutaneous pacing.. Which of the following is one of the 10 system elements developed by the National Highway Traffic Safety Administration (NHTSA) in an effort to sustain EMS systems?
A) Medical direction
B) Fully enhanced 9-1-1
C) Paramedic supervisors
D) Continued federal fundingA) Medical directionEMS providers who work 24-hour shifts are prone to poor nutritional habits on the job because:
A) they have a higher call volume.
B) their meals are interrupted frequently.
C) they are faced with greater stress.
D) their water intake often is increased.B) their meals are interrupted frequently.. In general, normal psychosocial factors that affect the life of a 35-year-old person include all of the following, EXCEPT:
A) work.
B) stress.
C) family.
D) anxiety.D) anxiety.Which of the following statements regarding stress is correct?
A) Eustress is the leading cause of suicide among EMS, fire, and law enforcement personnel.
B) By itself, any kind of stress has a negative effect on the human body and should be avoided.
C) The human stress reaction is exclusive to physical demands that are placed on the body.
D) The way one person reacts to stress may differ significantly from another person's reaction.D) The way one person reacts to stress may differ significantly from another person's reaction.Biologic stress is MOST accurately defined as:
A) a predictable sequence of physiologic events caused by a stressor.
B) the nonspecific response of the body to any demand made upon it.
C) stress that most often occurs following a positive event or situation.
D) a prolonged and severe discharge of the sympathetic nervous system.B) the nonspecific response of the body to any demand made upon it.______________ of one sort or another is necessary all the time, for growth, for development, or just for meeting the demands of everyday life.
A) Stress
B) Digression
C) Redirection
D) AdaptationD) Adaptation. The kind of stress that motivates an individual to achieve is called:
A) eustress.
B) distress.
C) adapted stress.
D) displaced stress.A) eustress.Negative or injurious stress is also called:
A) distress.
B) eustress.
C) projected stress.
D) redirected stress.A) distress.Which of the following statements regarding stress is correct?
A) Most people see distress as noninjurious and are able to adapt to it easily.
B) Nearly everyone finds the same events or situations stressful to some degree.
C) The specific event that triggers a stress reaction varies from person to person.
D) Eustress is the type of stress that a person finds overwhelming and debilitating.C) The specific event that triggers a stress reaction varies from person to person.. All of the following are common triggers of distress, EXCEPT:
A) the loss of a loved one.
B) planning a lengthy vacation.
C) excessive responsibility at work.
D) having children that leave home.B) planning a lengthy vacation.The MOST effective way to deal with stress is to:
A) seek psychiatric assistance and request a mild sedative drug.
B) recognize what causes the stress and eliminate it from your life.
C) avoid caffeine and get a minimum of 12 hours of sleep every day.
D) identify the stress triggers and take action to minimize their effects.D) identify the stress triggers and take action to minimize their effects.The part of the nervous system that prepares the body to deal with an emergency is the __________ nervous system.
A) somatic
B) voluntary
C) sympathetic
D) parasympatheticC) sympatheticAccording to the Social Readjustment Rating Scale, which of the following stressors has the MOST profound effect on a person?
A) Gain of a new family member
B) Spouse begins or stops working
C) Change to a different line of work
D) Foreclosure of mortgage or loanA) Gain of a new family member. During a crisis, the paramedic is able to focus and function, but afterwards, he or she may be left with nervous, excited energy that continues to build. This is indicative of:
A) burnout.
B) an acute stress reaction.
C) a delayed stress reaction.
D) a cumulative stress reaction.C) a delayed stress reaction.Signs and symptoms of cumulative stress include:
A) insomnia or hypersomnia.
B) increased sexual function.
C) bradycardia and hypotension.
D) decreased interest in alcohol.A) insomnia or hypersomnia.. Prolonged or excessive stress has been proven to be a strong contributor to:
A) depression.
B) hypotension.
C) schizophrenia.
D) bipolar disorder.D) bipolar disorder.. Chronic stress:
A) has actually been shown to lower one's risk for cancer.
B) places the body in a continuous, unrelieved state of alert.
C) most commonly results from a single acute stress reaction.
D) is preferentially treated with a benzodiazepine medication.B) places the body in a continuous, unrelieved state of alert.Unrecognized or unrelieved stress:
A) is less harmful than acute stress.
B) results in nervous system failure.
C) can result in poor physical health.
D) requires antipsychotic medications.C) can result in poor physical health.Which of the following is NOT an early warning sign of stress?
A) Heart palpitations
B) Dry, irritated skin
C) Chest pain or tightness
D) Difficult or rapid breathingB) Dry, irritated skinWhen managing stress, it is important to:
A) consume only moderate amounts of alcohol.
B) avoid taking sleeping aids after a stressful event.
C) avoid vigorous exercise because it raises your heart rate.
D) increase your caffeine intake to increase your alertness.B) avoid taking sleeping aids after a stressful event.To prepare for or handle stress, you should:
A) increase your caffeine intake to facilitate the fight-or-flight mechanism.
B) stop taking any prescribed anxiolytic medications so you can stay focused.
C) exercise vigorously and regularly during the 12 hours preceding your shift.
D) avoid using alcohol during the 12-hour period before the start of your shift.C) exercise vigorously and regularly during the 12 hours preceding your shift.A patient's response to an emergency is determined by:
A) the type of illness or injury that is involved.
B) the patient's personal methods of adapting to stress.
C) the patient's inherent ability to accept the situation.
D) the paramedic's perception of the patient's condition.B) the patient's personal methods of adapting to stress.Most of a patient's psychological stress responses to an illness or injury are:
A) predictable, so the paramedic can prepare for them.
B) not under his or her conscious control.
C) related to the patient's level of maturity.
D) a direct result of the paramedic's presence.B) not under his or her conscious control.When you enter a situation in which everyone is under stress, it is important to remember that:
A) most people respond to stress with isolated bouts of violence.
B) all human beings respond to stress in almost identical ways.
C) an authoritative tone of voice will quickly defuse the situation.
D) there is no guarantee that people are going to behave appropriately.D) there is no guarantee that people are going to behave appropriately.. Burnout is a consequence of:
A) a high call volume.
B) many years in EMS.
C) underlying depression.
D) chronic, unrelieved stress.D) chronic, unrelieved stress.Burnout is MOST accurately defined as:
A) an acute reaction to an overwhelming situation.
B) the exhaustion of physical or emotional strength.
C) cynicism after being a paramedic for many years.
D) a person's emotional reaction to a stressful event.B) the exhaustion of physical or emotional strength.Which of the following statements regarding distress is correct?
A) Paramedics most commonly become distressed because of what other people believe about them.
B) Distress is a learned reaction, based on the way the paramedic perceives and interprets a given situation.
C) A paramedic who becomes distressed at the sight of a mutilating injury should consider a different line of work.
D) The same situations or events that cause distress in one paramedic usually cause distress in another paramedic.B) Distress is a learned reaction, based on the way the paramedic perceives and interprets a given situation.. Which of the following is NOT a symptom of impending burnout?
A) Requesting additional shifts
B) Chronic fatigue and irritability
C) Decreased ability to concentrate
D) Frequent stomach upset or coldsA) Requesting additional shiftsThe FIRST thing you should do if you think you are beginning to experience symptoms of burnout is:
A) take at least 3 weeks off from work and go on a vacation.
B) see a psychologist and try to identify the underlying cause.
C) reexamine your beliefs and your ways of responding to stress.
D) request to work at a busier station to keep your mind occupied.C) reexamine your beliefs and your ways of responding to stress.In general, paramedics who do not experience burnout are those who:
A) regularly see a psychiatrist or psychologist.
B) have been paramedics for fewer than 10 years.
C) consider the patient's needs before their own.
D) have learned to value and respect themselves.D) have learned to value and respect themselves.A critical incident is MOST accurately defined as:
A) a delayed stress reaction to an incident that is similar to what has been experienced in the past.
B) a situation that completely incapacitates a person's ability to cope with the acute stress reaction at the scene.
C) any incident that completely overwhelms a paramedic's ability to manage the short-term stress caused by the incident.
D) an incident that overwhelms the ability of an EMS worker or system to cope with the experience, either at the scene or later.D) an incident that overwhelms the ability of an EMS worker or system to cope with the experience, either at the scene or later.Which of the following situations would be the LEAST likely to require a critical incident stress debriefing (CISD)?
A) Death of a 91-year-old patient with lung cancer
B) Serious injury of a coworker in the line of duty
C) Intense media attention during a major incident
D) An airliner crash involving multiple casualtiesA) Death of a 91-year-old patient with lung cancerThe resistance stage of the stress reaction is characterized by:
A) an immediate release of the catecholamines epinephrine and norepinephrine, which causes the fight-or-flight response
B) a reduction of cortisol in the body, which predisposes the person to acute inflammatory processes.
C) stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure.
D) adrenal gland depletion, which leads to decreased blood glucose levels, physical exhaustion, and immunocompromise.C) stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure.Severe, prolonged stress:
A) is frequently a direct cause of death.
B) results in the destruction of cholesterol and fat.
C) causes the body to lose its ability to fight disease.
D) results in chronically low levels of cortisol.C) causes the body to lose its ability to fight disease.. In response to shock or stress, sympathetic nervous system stimulation causes:
A) vasoconstriction.
B) slowing of the heart rate.
C) increased gastrointestinal function.
D) shunting of blood to the body's periphery.A) vasoconstriction.A 33-year-old woman presents with an acute onset of "fluttering" in her chest. She is conscious and alert but is somewhat anxious. She denies any significant medical problems but states that she has been under a lot of stress at work. You apply the cardiac monitor, which reveals a narrow QRS complex tachycardia at a rate of 170 beats/min. The patient's blood pressure is 140/90 mm Hg, and she is breathing without difficulty. The MOST appropriate treatment for this patient involves:
A) oxygen, vagal maneuvers, and emotional support.
B) vagal maneuvers, IV access, and 0.25 mg/kg of diltiazem.
C) oxygen, emotional support, and 2.5 mg of midazolam IM.
D) oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.D) oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.Possible stress points in the day-to-day operations of the EMS system that would likely be identified by a comprehensive CQI program include all of the following, EXCEPT:
A) personal finance issues.
B) receiving facility issues.
C) medical direction issues.
D) education and training issues.A) personal finance issues.. One of the major differences between laws and ethics is that laws:
A) allow a person to determine right from wrong.
B) are usually broken because of an unethical act.
C) have sanctions for violation that are enforceable.
D) are reflective of a person's moral responsibilities.C) have sanctions for violation that are enforceable.. The BEST legal protection for the paramedic is to:
A) always transport the patient to the hospital of the patient's choice, regardless of the patient's clinical condition.
B) provide a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation.
C) routinely obtain more than the minimum number of continuing education credits required by the state department of health.
D) treat all patients with respect and remain aware that patients' cultural beliefs may differ from those of the paramedic.B) provide a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation.The wrongful act that gives rise to a civil suit is called:
A) a tort.
B) damage.
C) liability.
D) negligence.A) a tort.. Most lawsuits against EMS providers result from:
A) unethical acts.
B) ambulance collisions.
C) substandard patient care.
D) gross infractions of the law.B) ambulance collisions.While off duty and outside of your jurisdiction, you encounter a motor vehicle crash. You can see one patient lying motionless on the ground near her overturned vehicle. As an off-duty paramedic, you:
A) should call 9-1-1 but not stop to provide care.
B) may feel an ethical obligation to stop and assist.
C) have a legal responsibility to stop and render aid.
D) should stop if you have an EMS decal on your car.B) may feel an ethical obligation to stop and assist.. Ethics is MOST accurately defined as:
A) the philosophy of right and wrong, of moral duties, and of ideal professional behavior.
B) the professional behavior that a person's peers as well as the general public expect.
C) behavior that is consistent with the law and an attitude that society in general expects.
D) a code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.A) the philosophy of right and wrong, of moral duties, and of ideal professional behavior.. Ethics related to the practice and delivery of health care is called:
A) bioethics.
B) valued ethics.
C) applied ethics.
D) medical morality.A) bioethics.Which of the following general statements is correct?
A) When faced with an ethical dilemma, you should ask yourself, "What is in my best interest?"
B) A patient's religious beliefs should be respected but should not affect how you provide care.
C) The EMT code of ethics simply amplifies the concept of being concerned for the welfare of others.
D) If you place your welfare ahead of the patient's, you will rarely commit an unethical act in medical care.C) The EMT code of ethics simply amplifies the concept of being concerned for the welfare of others.Current bioethical guidelines regarding the decision not to initiate resuscitation efforts rely mainly on the use of:
A) flexible algorithms and protocols.
B) the personal beliefs of the paramedic.
C) common sense and reasonable judgment.
D) criteria established by the local coroner.C) common sense and reasonable judgment.. Interventions that have been proven by studies to be of no benefit to the patient in cardiac arrest:
A) are illegal for the paramedic to perform.
B) are not medically or ethically indicated.
C) are commonly authorized by medical control.
D) should be performed unless the family objects.B) are not medically or ethically indicated.. Conducting EMS research studies on critically ill or injured patients without their informed consent is:
A) inappropriate.
B) ethically acceptable.
C) a true ethical dilemma.
D) legal under the law of implied consent.C) a true ethical dilemma.. Which of the following statements regarding ethics in the workplace is correct?
A) Acknowledging a patient's cultural beliefs is a low priority if he or she is critically ill or injured.
B) Off-duty misconduct on the part of the paramedic may lessen the public's confidence in EMS in general.
C) EMS has long been recognized and funded in the same manner as the other health care professions.
D) Paramedics are accountable only to the EMS system's medical director and to the director of EMS operations.B) Off-duty misconduct on the part of the paramedic may lessen the public's confidence in EMS in general.Performing the functions of a paramedic prior to licensure is:
A) immoral.
B) unlawful.
C) unethical.
D) permissible.B) unlawful.. A _____________ receives a weak signal and retransmits it at a higher power on another frequency.
A) repeater
B) base station
C) multiplex system
D) duplex systemA) repeaterThe combination of two or more signals, which allows the paramedic to talk and transmit an ECG simultaneously on one frequency, is called a
A) simplex system.
B) trunking system.
C) multiplex system.
D) half-duplex system.C) multiplex system.The term "frequency," as it applies to radio communications, is MOST accurately defined as:
A) how frequently a radio wave recurs in a given time.
B) a predefined station designed for emergency use only.
C) a relatively long wavelength that produces audible sound.
D) the number of megahertz per cycle that the radio transmits.A) how frequently a radio wave recurs in a given time.. Low-band frequencies:
A) have a range of up to 500 miles and are not associated with skip interference.
B) are unpredictable because changes in ionospheric conditions may cause losses in communication.
C) function at 150 to 175 MHz and have a range that is nearly triple that of high-band frequencies.
D) have a longer range than high-band frequencie, but are more readily absorbed by rain, trees, and brush.B) are unpredictable because changes in ionospheric conditions may cause losses in communication.The ability of multiple agencies or systems to share the same radio frequency is called:
A) a duplex.
B) trunking.
C) patching.
D) telemetry.B) trunking.. Biotelemetry is MOST accurately defined as:
A) linking two frequencies together so that the paramedic and physician can converse directly.
B) a common radio frequency assigned to EMS by the Federal Communications Commission.
C) the ability of more than one public safety agency to share the same radio frequency during a crisis.
D) the capability of measuring vital signs and ECG tracings and transmitting them to a distant terminal.D) the capability of measuring vital signs and ECG tracings and transmitting them to a distant terminal.. Cellular telephones are more advantageous than regular two-way radios in that cellular telephones:
A) enable laypeople to call 9-1-1 for a minimal service charge.
B) incorporate GPS technology to help rescuers find the patient.
C) can transmit long distances with the use of a mobile antenna.
D) do not utilize computer technology and are less likely to fail.B) incorporate GPS technology to help rescuers find the patient.In order for the paramedic to talk and transmit an ECG simultaneously on one frequency, a __________ system is required.
A) duplex
B) simplex
C) low-band
D) multiplexD) multiplex. Radio transmission distances from a mobile transceiver are reduced:
A) by fog or light rain.
B) over mountainous areas.
C) over water or flat terrain.
D) with greater than 7.5 W of power.B) over mountainous areas.A(n) __________ receives a weak signal and retransmits it at a higher power on another frequency.
A) duplex
B) simplex
C) repeater
D) encoderC) repeater. A base station decoder within the emergency department:
A) amplifies the voice signal from the field transmitter.
B) is used to increase the range of the radio transmission.
C) translates a telemetry signal into an oscilloscope tracing.
D) converts a low-band frequency to a high-band frequency.C) translates a telemetry signal into an oscilloscope tracing.Which of the following statements regarding the use of cellular telephones and landline telephones is MOST correct?
A) Cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies.
B) Cellular phones are more expensive than radios and give a weaker signal.
C) Landline phones are in a fixed location and transmit with a simplex system.
D) Cellular phones do not rely on a repeater to increase the coverage distance.A) Cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies.When communicating medical information via radio, you should be:
A) thorough yet rapid.
B) comprehensive but brief.
C) as expeditious as possible.
D) simple, brief, and direct.D) simple, brief, and direct.. The FIRST principle of communicating by radio is:
A) clarity.
B) accuracy.
C) calmness.
D) thoroughness.A) clarity.When transmitting information via radio, you should:
A) break long messages into 60-second segments.
B) use a normal conversational tone of voice.
C) speak with your voice slightly elevated.
D) keep your mouth 1" from the microphone.B) use a normal conversational tone of voice.. When transmitting data over the radio, you should NOT disclose the patient's:
A) vital signs.
B) chief complaint.
C) HIV status.
D) age and sex.C) HIV status.Which of the following words would be the MOST difficult to hear over the radio?
A) Yes
B) Negative
C) Affirmative
D) ReceivedA) YesWhen transmitting your radio report to the hospital, you should:
A) use ten-codes whenever possible.
B) allow the patient to hear the report.
C) answer questions with the word "yes."
D) not be sitting right next to the patient.D) not be sitting right next to the patient.The use of ten-codes over the radio:
A) should be carried out whenever possible to ensure effective communication.
B) is not recommended by the National Incident Management System (NIMS).
C) increases the likelihood of miscommunication during the radio transmission.
D) is prohibited by the Federal Communications Commission and should be avoided.B) is not recommended by the National Incident Management System (NIMS).Which of the following patient data is NOT typically communicated during your radio report to the hospital?
A) Brief, pertinent history
B) Underlying medical conditions
C) The patient's ethnicity
D) ECG findingsC) The patient's ethnicityBefore you begin to transmit over the radio, you should check the volume and then:
A) press the transmit key for 1 second before talking.
B) listen to make sure that the channel is clear of traffic.
C) turn the squelch setting to zero to ensure a good signal.
D) key the microphone two or three times to reach the repeater.B) listen to make sure that the channel is clear of traffic.. Which of the following statements regarding ten-codes is correct?
A) All EMS agencies utilize a universal ten-code system.
B) They should be avoided during a mass-casualty situation.
C) The purpose of ten-codes is to ensure transmission clarity.
D) Most services use ten-codes for regular day-to-day operations.B) They should be avoided during a mass-casualty situation.. Barotrauma secondary to bag-mask ventilations in an infant means that your ventilations:
A) were too forceful.
B) caused gastric distention.
C) were too slow for the infant's age.
D) did not produce visible chest rise.A) were too forceful.. Patients with decompensated asthma or COPD who require positive-pressure ventilation:
A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease.
B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.
C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide.
D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.All of the following are complications associated with orotracheal intubation, EXCEPT:
A) laryngeal swelling.
B) damage to the vocal cords.
C) necrosis of the nasal mucosa.
D) barotrauma from forceful ventilation.
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