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Final Pt.5

Terms in this set (233)

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 veins
B) No pulse with CPR and jugular venous distention
You and your team are attempting to resuscitate a 45-year-old man who is in cardiac arrest. After 2 minutes, you assess his cardiac rhythm and determine that he is in asystole. After instructing your team to resume CPR, you should:
A) insert an advanced airway device and then resume cycles of CPR.
B) establish IV or IO access and administer 1 mg of atropine sulfate rapidly.
C) administer 1 mg of epinephrine 1:10,000 after obtaining vascular access.
D) perform endotracheal intubation and ventilate at a rate of 15 breaths/min.
C) administer 1 mg of epinephrine 1:10,000 after obtaining vascular access.
As you are administering 40 units of vasopressin to an adult woman in ventricular fibrillation, your team members continue CPR. After 2 minutes, you reassess her and determine that she is still in ventricular fibrillation. You should:
A) instruct your team to continue CPR as the defibrillator is charging.
B) administer 300 mg of amiodarone while CPR remains uninterrupted.
C) deliver a monophasic defibrillation with 200 joules and resume CPR.
D) advise your team to stop CPR as you prepare to deliver another shock.
A) instruct your team to continue CPR as the defibrillator is charging.
You are the team leader in the attempted resuscitation of an adult man in ventricular fibrillation. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensure that:
A) the patient is defibrillated one time every 60 seconds as necessary.
B) the person managing the airway delivers one breath every 3 to 5 seconds.
C) no one person performs chest compressions for more than 5 minutes at a time.
D) compressions are hard and fast, with full chest recoil between compressions.
D) compressions are hard and fast, with full chest recoil between compressions.
Your assessment of a 68-year-old man reveals an organized cardiac rhythm at a rate of 80 beats per minute and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT:
A) epinephrine.
B) cardiac pacing.
C) vasopressin.
D) IV fluid boluses.
B) cardiac pacing.
After approximately 6 minutes of attempted resuscitation, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus tachycardia. In addition to continuing ventilations, what should be done next?
A) Amiodarone infusion
B) Hypothermia treatment
C) Dopamine infusion
D) Crystalloid fluid bolus
B) Hypothermia treatment
You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next:
A) give 300 mg of amiodarone via rapid IV or IO push.
B) give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes.
C) push the synchronize button on the defibrillator and cardiovert with 200 joules.
D) give 1 to 2 g of magnesium sulfate without interrupting chest compressions.
D) give 1 to 2 g of magnesium sulfate without interrupting chest compressions.
You have an impedance threshold device (ITD) attached to the endotracheal tube as you ventilate an apneic and pulseless patient. Following defibrillation and 2 additional minutes of CPR, it is determined that return of spontaneous circulation has occurred. However, the patient is still apneic. You should:
A) leave the ITD attached to the endotracheal tube and continue to ventilate.
B) remove the ITD and continue ventilations at a rate of 10 to 12 breaths/min.
C) leave the ITD attached, but increase your ventilation rate to 15 breaths/min.
D) hyperventilate the patient to eliminate excess carbon dioxide from the blood.
B) remove the ITD and continue ventilations at a rate of 10 to 12 breaths/min.
. You have been attempting resuscitation of an 80-year-old woman for approximately 15 minutes. An advanced airway has been placed, ventilations have been delivered at the appropriate rate, high-quality CPR was performed with minimal interruptions, and rhythms-specific medications were administered. Despite your efforts, the patient remains in asystole. Which of the following statements regarding this scenario is correct?
A) Transcutaneous cardiac pacing may restore a perfusing rhythm and should therefore be attempted immediately.
B) It would be advisable to attempt a single defibrillation in case the patient was actually in fine ventricular fibrillation.
C) You have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered.
D) Since older people are prone to hypothermia, and hypothermia protects the hypoxic brain, you should continue your efforts for 5 more minutes.
C) You have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered.
A 6-year-old, 40-pound child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to:
A) defibrillate with 70 joules.
B) insert an advanced airway.
C) check for a carotid pulse.
D) insert an IO catheter.
A) defibrillate with 70 joules.
. While applying the defibrillator pads, you note that the patient has a transdermal nitroglycerin patch on the right anterior chest. You should:
A) place the pads at least 1 inch from the patch.
B) place the second pad in between the scapulae.
C) move the patch to the left anterior chest.
D) remove the patch and wipe away any residue.
D) remove the patch and wipe away any residue.
Which of the following statements regarding the use of vasopressin during cardiac arrest is correct?
A) Vasopressin may be substituted for the second dose of epinephrine.
B) If the patient is in asystole, vasopressin can be given every 5 minutes.
C) If used during cardiac arrest, vasopressin is given in a dose of 20 units.
D) Vasopressin has been shown to be clinically superior to epinephrine.
A) Vasopressin may be substituted for the second dose of epinephrine.
A patient remains in pulseless ventricular tachycardia despite two shocks, a dose of epinephrine, high-quality CPR, and 300 mg of amiodarone. Following the next shock, you should resume CPR and then:
A) cardiovert with 100 biphasic joules.
B) administer 150 mg of amiodarone.
C) double the dose of the epinephrine.
D) administer 1.5 mg/kg of lidocaine.
B) administer 150 mg of amiodarone.
. During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient's end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should:
A) increase the rate of your ventilations.
B) suspect inadvertent tube dislodgement.
C) assess for a pulse for up to 10 seconds.
D) decrease the rate of your ventilations.
C) assess for a pulse for up to 10 seconds.
Which of the following should occur when integrating a mechanical CPR device into your resuscitation attempt of an adult patient?
A) Compression depth should be at least 1½ inches after the device is applied.
B) Compressions should be continuous after an advanced airway device is inserted.
C) The compression rate should be set to deliver at least 80 compressions per minute.
D) One breath should be given every 6 to 8 seconds until an advanced airway is inserted.
B) Compressions should be continuous after an advanced airway device is inserted.
. The paramedic should consider extending the resuscitation effort of a patient with refractory cardiac arrest if:
A) the cardiac arrest was caused by submersion in warm water.
B) ventricular fibrillation occurred at any point during the arrest.
C) the patient has no known significant past medical history.
D) return of spontaneous circulation of any duration occurred.
D) return of spontaneous circulation of any duration occurred.
Which of the following roles would the code team leader MOST likely perform?
A) Interpreting the ECG
B) Establishing IV access
C) Managing the airway
D) Chest compressions
A) Interpreting the ECG
Which of the following is an example of a peri-arrest condition?
A) Ventricular tachycardia and a systolic blood pressure of 60 mm Hg
B) Sinus tachycardia secondary to fever and a mild infection
C) Ventricular fibrillation that has persisted for 6 minutes
D) Bradycardia in the absence of chest pain or other symptoms
A) Ventricular tachycardia and a systolic blood pressure of 60 mm Hg
When attempting to resuscitate a patient in cardiac arrest, which of the following questions would you pose if you suspect that the patient is hyperkalemic?
A) "Does this patient undergo dialysis?"
B) "Is this patient a known diabetic?"
C) "Does this patient take blood thinners?"
D) "Has this patient had vomiting or diarrhea?"
A) "Does this patient undergo dialysis?"
Systemic effects of epinephrine include:
A) bronchoconstriction.
B) decreased preload.
C) increased afterload.
D) diffuse vasodilation.
C) increased afterload.
According to the Frank-Starling mechanism:
A) systemic venous pooling of blood results in a decrease in preload.
B) an increase in systolic blood pressure causes a reflex bradycardia.
C) coronary artery perfusion is directly proportional to cardiac output.
D) the length of myocardial fibers determines force of cardiac contraction.
D) the length of myocardial fibers determines force of cardiac contraction.
Increased myocardial contractility secondary to stretching of the myocardial walls is called the:
A) Ernest-Henry effect.
B) Frank-Starling effect.
C) Beck-Cushing's reflex.
D) Frank-Beck mechanism.
B) Frank-Starling effect.
Which of the following mechanisms causes hypertension?
A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity.
B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion.
C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
D) Heart rate that is persistently above 80 beats/min causes an increase in cardiac output and a resultant increase in blood pressure.
C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
. The ability of the heart to vary the degree of its contraction without stretching is called:
A) contractility.
B) chronotropy.
C) automaticity.
D) the Frank-Starling mechanism.
A) contractility.
The mean arterial pressure must be greater than or equal to ____ mm Hg to ensure that the brain, coronary arteries, and kidneys remained perfused.
A) 50
B) 60
C) 70
D) 80
B) 60
What is the mean arterial pressure of a person who has a blood pressure of 140/90 mm Hg?
A) 82 mm Hg
B) 97 mm Hg
C) 101 mm Hg
D) 107 mm Hg
D) 107 mm Hg
What is the cerebral perfusion pressure of a patient with a mean arterial pressure of 80 mm Hg and an intracranial pressure of 5 mm Hg?
A) 60 mm Hg
B) 75 mm Hg
C) 90 mm Hg
D) 95 mm Hg
B) 75 mm Hg
Which of the following hemodynamic parameters decreases, regardless of the etiology of the shock?
A) Pulse rate
B) Mean arterial pressure
C) Central venous pressure
D) Peripheral vascular resistance
B) Mean arterial pressure
Autoregulation is defined as:
A) reflex bradycardia that occurs secondary to systemic hypertension.
B) an increase in mean arterial pressure to maintain cerebral blood flow.
C) the forcing of cerebrospinal fluid into the spinal cord as intracranial pressure increases.
D) a decrease in cerebral perfusion pressure that reduces intracranial pressure.
B) an increase in mean arterial pressure to maintain cerebral blood flow.
. If a woman's prepregnancy resting heart rate is 70 beats per minute, you would expect her heart rate to range between ____ and ____ at term.
A) 75, 85
B) 85, 90
C) 90, 100
D) 100, 110
B) 85, 90
. Which of the following assessment parameters is MOST difficult to interpret when a pregnant woman is injured?
A) Pupils
B) Pulse rate
C) Mental status
D) Blood glucose
B) Pulse rate
The typical upper limit of the fetal heart rate is:
A) 120 beats/min.
B) 140 beats/min.
C) 160 beats/min.
D) 180 beats/min.
C) 160 beats/min.
Which of the following statements regarding the Apgar score is correct?
A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.
B) The Apgar score is determined on the basis of the newborn's condition at 2 and 10 minutes after birth.
C) If resuscitation is needed, it should commence immediately after you obtain the 1-minute Apgar score.
D) A newborn with a heart rate of greater than 80 beats/min would be assigned a score of 2 on the Apgar score.
A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.
According to the Apgar score, a newborn with a heart rate of 80 beats/min and slow, irregular breathing should receive a combined score of:
A) 2.
B) 3.
C) 4.
D) 5.
A) 2.
An infant born with a pink body and blue extremities, a pulse rate of 90 beats/min, a strong cry, and active movement should be assigned an initial Apgar score of:
A) 5.
B) 6.
C) 7.
D) 8.
D) 8.
. The correct positive-pressure ventilation rate for an apneic newborn is:
A) 12 to 20 breaths/min.
B) 20 to 30 breaths/min.
C) 30 to 40 breaths/min.
D) 40 to 60 breaths/min.
D) 40 to 60 breaths/min.
When an atrial septal defect is present:
A) blood flow to the lungs is significantly decreased, which leads to severe hypoxemia.
B) the heart must push harder to force blood flow past a narrowed aorta, resulting in increased afterload.
C) deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood.
D) blood is allowed to bypass the right ventricle and lungs due to the fetus's lungs being filled with fluid.
C) deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood.
Which of the following factors is associated with the HIGHEST risk of newborn hypoglycemia?
A) Neonatal polycythemia
B) Morbid obesity in the mother
C) The larger of discordant twins
D) 5-minute Apgar score of less than 7
B) Morbid obesity in the mother
Newborn hypoglycemia is defined as a blood glucose level lower than:
A) 45 mg/dL.
B) 50 mg/dL.
C) 55 mg/dL.
D) 60 mg/dL.
A) 45 mg/dL.
What dose and concentration of glucose would be MOST appropriate for a 6-pound hypoglycemic newborn?
A) 5.5 mL of 10% dextrose (D10)
B) 6 mL of 25% dextrose (D25)
C) 6.5 mL of 10% dextrose (D10)
D) 7.5 mL of 25% dextrose (D25)
A) 5.5 mL of 10% dextrose (D10)
In addition to an IV dextrose bolus, the MOST important treatment for newborn hypoglycemia is:
A) IV fluid boluses.
B) assisted ventilation.
C) a 25% dextrose infusion.
D) proper thermal management.
D) proper thermal management.
Beta blocker ingestion in small children would MOST likely cause:
A) acute hypoglycemia.
B) agitation or irritability.
C) marked hypertension.
D) ventricular fibrillation.
A) acute hypoglycemia.
Early hypoxia in a child would MOST likely present with:
A) tachycardia.
B) bradypnea.
C) mottled skin.
D) bradycardia.
A) tachycardia.
When an infant or child is in respiratory failure:
A) tachypnea is usually present despite a marked decrease in heart rate.
B) decreased cerebral perfusion leads to restlessness and a weak, rapid pulse.
C) he or she can no longer compensate, which causes hypoxia and hypercarbia.
D) oxygen via nonrebreathing mask should be given if tidal volume is reduced.
C) he or she can no longer compensate, which causes hypoxia and hypercarbia.
. Signs of compensated shock in the infant or child include all of the following, EXCEPT:
A) abnormal mentation.
B) tachycardia and pallor.
C) prolonged capillary refill.
D) decreased peripheral perfusion.
A) abnormal mentation.
The presence of tachycardia in children:
A) commonly reflects an underlying cardiac pathology that requires emergent intervention.
B) often causes hypotension and is usually associated with a QRS complex greater than 0.08 seconds.
C) should be interpreted in the context of the pediatric assessment triangle and the primary assessment.
D) necessitates a 20-mL/kg bolus of an isotonic crystalloid solution until the cardiac rhythm is assessed.
C) should be interpreted in the context of the pediatric assessment triangle and the primary assessment.
Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia?
A) Pulse rate
B) P wave presence
C) Systolic blood pressure
D) QRS complex width
D) QRS complex width
Unlike sinus tachycardia, reentry supraventricular tachycardia in infants is characterized by:
A) a presence of P waves.
B) an unvarying pulse rate.
C) a history of fever or dehydration.
D) a pulse rate greater than 180 beats/min.
B) an unvarying pulse rate.
Hemodynamically stable children with a wide QRS complex tachycardia:
A) should receive amiodarone.
B) respond well to adenosine.
C) are likely experiencing supraventricular tachycardia.
D) will respond to vagal maneuvers.
A) should receive amiodarone.
Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform:
A) intubation.
B) cardioversion.
C) defibrillation.
D) CPR for 5 minutes.
C) defibrillation.
. Which of the following clinical presentations is MOST consistent with cocaine ingestion in a child?
A) Diaphoresis, miosis, tachycardia, and bronchospasm
B) Miosis, bradycardia, hypoventilation, and hypotension
C) Mydriasis, diarrhea, hypothermia, and hallucinations
D) Hypertension, tachycardia, diaphoresis, and mydriasis
D) Hypertension, tachycardia, diaphoresis, and mydriasis
. Signs of pain in an infant would MOST likely include:
A) tachycardia and inconsolability.
B) a heart rate that is not variable.
C) diaphoresis and dilated pupils.
D) labored tachypnea and pallor.
A) tachycardia and inconsolability.
A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves:
A) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.
B) conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls.
C) recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation.
D) assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin.
A) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.
. Upon arriving at the scene of a 4-year-old girl who is ill, you assess her and note that she is tachypneic and tachycardic. Her skin is warm and moist, and there are no signs of increased work of breathing. The child's mother denies any vomiting or diarrhea. This child's tachycardia and tachypnea are MOST likely the result of:
A) fever and anxiety.
B) early hypoxemia.
C) a cardiac problem.
D) moderate dehydration.
A) fever and anxiety.
. A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. After applying high-flow oxygen, you should:
A) apply chemical ice packs to the child's face to try to slow her heart rate.
B) establish vascular access and administer a 20-mL/kg normal saline bolus.
C) start an IV line and give adenosine while monitoring her cardiac rhythm.
D) transport immediately and establish vascular access en route to the hospital.
B) establish vascular access and administer a 20-mL/kg normal saline bolus.
You and your partner are caring for a child with stable supraventricular tachycardia that was refractory to initial treatment. As your partner is preparing to establish vascular access, the child's level of consciousness decreases markedly. You reassess the child and note that his femoral pulse is rapid and weak. You should:
A) perform immediate synchronized cardioversion and reassess.
B) begin chest compressions as your partner establishes the IV line.
C) preoxygenate the child and then perform endotracheal intubation.
D) establish vascular access and administer 0.1 mg/kg of adenosine.
A) perform immediate synchronized cardioversion and reassess.
. You are assessing a 10-year-old child with apparent ventricular tachycardia, but cannot decide whether electrical or pharmacologic therapy is the most appropriate initial treatment approach. Which of the following interventions would pose the GREATEST potential for harm?
A) Administering high-flow oxygen and obtaining a 12-lead ECG tracing
B) Establishing IO access, administering a sedative, and cardioverting at 15 joules
C) Starting an IV line and administering amiodarone followed by procainamide
D) Establishing vascular access and rapidly administering 3 mg of adenosine
C) Starting an IV line and administering amiodarone followed by procainamide
. A 4-year-old girl presents with a fever of 103.2°F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child includes all of the following, EXCEPT:
A) 81 mg of aspirin.
B) free-flow oxygen.
C) 250 mg of acetaminophen.
D) simple cooling measures.
A) 81 mg of aspirin.
An intra-aortic balloon pump functions by:
A) deflating a balloon during systole, which pushes blood into the central circulation.
B) deflating a balloon during diastole, which creates a vacuum and decreases afterload.
C) inflating a balloon during diastole, which pushes blood into the systemic circulation.
D) inflating a balloon during systole, which creates a vacuum and decreases afterload.
C) inflating a balloon during diastole, which pushes blood into the systemic circulation.
The vagus nerve releases _________________, which acts on _________________ receptors.
A) acetylcholine, muscarinic-2
B) norepinephrine, alpha-1
C) epinephrine, beta-2
D) acetylcholinesterase, nicotinic
A) acetylcholine, muscarinic-2
Acetylcholinesterase is an enzyme that:
A) decreases the heart rate.
B) slows cardiac conduction.
C) breaks down acetylcholine.
D) promotes acetylcholine secretion.
C) breaks down acetylcholine.
. 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.
Paradoxical bradycardia may occur if atropine is given:
A) too rapidly.
B) in doses greater than 2 mg.
C) for acetylcholinesterase inhibition.
D) in doses less than 0.1 mg.
D) in doses less than 0.1 mg.
Which of the following statements regarding sympathomimetic chemicals is correct?
A) They are not synthetically manufactured.
B) They block the release of acetylcholine.
C) They only stimulate alpha-1 receptors.
D)They are not found naturally in the body
D) They are not found naturally in the body.
Cholinesterase is a naturally occurring chemical that:
A) increases epinephrine production.
B) regulates acetylcholine in the body.
C) stimulates activity of the vagus nerve.
D) causes a natural slowing of the heart rate.
B) regulates acetylcholine in the body.
. 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.
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.
Which of the following ECG abnormalities is MOST suggestive of cocaine toxicity?
A) Narrowing of the PR interval
B) Marked flattening of the T wave
C) Narrowing of the QRS complex
D) Prolongation of the QT interval
D) Prolongation of the QT interval
The QT interval would MOST likely be prolonged in patients:
A) who take digitalis.
B) who are hypocalcemic.
C) with a rapid heart rate.
D) who are hypercalcemic.
B) who are hypocalcemic.
Torsade de pointes:
A) presents with wide QRS complexes that are all of the same shape, size, and vector direction.
B) is a lethal ventricular rhythm that is usually caused by ingestion or injection of CNS-depressant drugs.
C) is generally less serious than monomorphic ventricular tachycardia and is usually not treated in the field.
D) is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.
D) is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.
Patients with congenital prolongation of the Q-T interval are at GREATEST risk for:
A) sudden asystole.
B) ventricular arrhythmias.
C) coronary artery disease.
D) acute myocardial infarction.
B) ventricular arrhythmias.
. You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high-flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for:
A) QRS widening.
B) AV heart block.
C) QT interval narrowing.
D) a prolonged PR interval.
A) QRS widening.
A normal QT interval lasts:
A) 0.15 to 0.25 seconds.
B) 0.30 to 0.40 seconds.
C) 0.36 to 0.44 seconds.
D) 0.38 to 0.48 seconds.
C) 0.36 to 0.44 seconds.
Which of the following ECG abnormalities is MOST suggestive of cocaine toxicity?
A) Narrowing of the PR interval
B) Marked flattening of the T wave
C) Narrowing of the QRS complex
D) Prolongation of the QT interval
D) Prolongation of the QT interval
. Which of the following medications possesses positive inotropic effects, allows the cellular uptake of glucose, and is used in the treatment of hyperkalemia?
A) Insulin
B) Osmitrol
C) Glucophage
D) Clopidogrel
A) Insulin
. Succinylcholine should not be used in patients with:
A) a closed head injury.
B) known hyperkalemia.
C) a rapid heart rate.
D) suspected hypokalemia.
B) known hyperkalemia.
Which of the following medications promotes the cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia?
A) Terbutaline
B) Ipratropium
C) Levalbuterol
D) Albuterol
D) Albuterol
Which of the following ECG abnormalities is MOST consistent with hyperkalemia?
A) Tall, peaked T waves
B) Prominent U waves
C) Prolonged QT interval
D) The presence of a J wave
A) Tall, peaked T waves
Hyperkalemia is defined as:
A) excess potassium in the cells.
B) a relative deficit of sodium.
C) an elevated serum potassium level.
D) a critically low magnesium level.
C) an elevated serum potassium level.
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.
You are dispatched to a residence for an elderly woman who is "sick." When you arrive and assess her, you note that she is responsive to pain only and has hot, moist skin and rapid, shallow respirations. You find prednisone, Paxil, and multivitamins on her nightstand. Further assessment of this patient will MOST likely reveal:
A) a normal blood glucose level and a "moon face" appearance.
B) severe hypertension, flattened T waves, and asymmetric pupils.
C) hypoglycemia, hypotension, and ECG evidence of hyperkalemia.
D) a blood glucose reading above 400 mg/dL and a fruity breath odor.
C) hypoglycemia, hypotension, and ECG evidence of hyperkalemia.
. Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of:
A) hypovolemia.
B) hypokalemia.
C) hyperkalemia.
D) air embolism.
B) hypokalemia.
Which of the following is a potentially life-threatening complication of missing one or more dialysis treatments?
A) Uremic frost
B) Hyperkalemia
C) Hypocalcemia
D) Peripheral edema
B) Hyperkalemia
Hyperkalemia would MOST likely result in:
A) abnormal gastrointestinal function.
B) decreased skeletal muscle function.
C) hyperstimulation of neural cell transmission.
D) severe bradycardia due to increased vagal tone.
C) hyperstimulation of neural cell transmission.
Sodium bicarbonate may be indicated for all of the following conditions, EXCEPT:
A) aspirin overdose.
B) cardiac arrest.
C) hypokalemia.
D) crush injury.
C) hypokalemia.
Which of the following clinical findings is LEAST suggestive of a peripheral vascular disorder?
A) A bruit heard over the carotid artery
B) Pain in the calf muscle while walking
C) Swelling and pain along the course of a vein
D) An S3 sound during auscultation of the heart
D) An S3 sound during auscultation of the heart
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?
A) Disappearance of radial pulses during inspiration
B) Difference in blood pressure between the two arms
C) ST-segment depression on the 12-lead ECG tracing
D) Bruits to both carotid arteries during auscultation
B) Difference in blood pressure between the two arms
Peristalsis is defined as:
A) the churning of food.
B) rhythmic contraction.
C) turbulent blood flow.
D) passive regurgitation.
B) rhythmic contraction.
. A bruit differs from a murmur in that a bruit:
A) represents widespread arteriosclerosis.
B) is a benign physiologic abnormality.
C) is auscultated over a main blood vessel.
D) indicates turbulent blood flow in the heart.
C) is auscultated over a main blood vessel.
As a result of the increase in diastolic blood pressure associated with aging:
A) the heart valves become stiff and impede blood flow through the heart.
B) the left ventricle works harder, becomes thicker, and loses its elasticity.
C) cardiac output progressively increases secondary to decreased afterload.
D) the ventricles overfill with blood, resulting in chronic congestive heart failure.
B) the left ventricle works harder, becomes thicker, and loses its elasticity.
Vascular compensation for changes in blood pressure decreases with age due to:
A) a 60% to 70% decrease in sympathetic nervous system stimulation and catecholamine release.
B) a marked reduction in renal function with increased sodium reabsorption in the renal tubules.
C) left ventricular hypertrophy and the subsequent decrease in cardiac output that it causes.
D) reduced elasticity of the peripheral vessels secondary to decreases in elastin and collagen.
D) reduced elasticity of the peripheral vessels secondary to decreases in elastin and collagen.
If an increased amount of blood is returned to the heart:
A) the cardiac muscle must stretch to accommodate the larger volume.
B) stroke volume decreases accordingly because of the larger volume.
C) an increase in stroke volume occurs because the heart rate increases.
D) cardiac workload is decreased, resulting in a decreased cardiac output.
An increase in peripheral vascular resistance causes:
A) an increase in afterload.
B) a decrease in blood pressure.
C) an increase in cardiac output.
D) a decrease in cardiac workload.
The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of:
A) fear and anxiety.
B) the effects of nitroglycerin.
C) acute left-sided heart failure.
D) a reduction in cardiac output.
D) a reduction in cardiac output.
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.
Treatment for a patient with bradycardia and significantly compromised cardiac output includes:
A) 1 mg of epinephrine 1:10,000.
B) 1 mg of atropine via IV push.
C) transcutaneous cardiac pacing.
D) a dopamine infusion at 20 mg/min.
C) transcutaneous cardiac pacing.
. 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.
Which of the following two factors DIRECTLY affect cardiac output?
A) Preload and afterload
B) Vessel size and stroke volume
C) Stroke volume and pulse rate
D) Blood pressure and pulse rate
C) Stroke volume and pulse rate
Which of the following conditions would be the LEAST likely to produce psychotic symptoms?
A) Hyperglycemia
B) Closed head injury
C) Low cardiac output
D) Temporal lobe seizures
A) Hyperglycemia
Blood pressure is the product of:
A) stroke volume and heart rate.
B) left ventricular ejection fraction and afterload.
C) cardiac output and peripheral vascular resistance.
D) right atrial preload and ventricular stroke volume.
C) cardiac output and peripheral vascular resistance.
. Decreases in the PaCO2 result in _____________ pH levels in the respiratory center and a(n) _____________ in ventilation.
A) decreased, decrease
B) increased, increase
C) decreased, increase
D) increased, decrease
D) increased, decrease
The hypoxic drive, a backup system to control breathing, is stimulated when:
A) arterial PaO2 levels decrease.
B) arterial PaCO2 levels increase.
C) arterial PaO2 levels increase.
D) arterial PaCO2 levels decrease.
A) arterial PaO2 levels decrease.
What happens when the PaCO2 of the arterial blood increases?
A) pH increases and respirations increase
B) pH decreases and respirations decrease
C) pH increases and respirations decrease
D) pH decreases and respirations increase
D) pH decreases and respirations increase
Which of the following changes occurs in the respiratory system of a pregnant woman?
A) Progesterone increases the threshold of the medullary respiratory center to carbon dioxide.
B) Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm Hg.
C) Oxygen consumption decreases by approximately 20%, causing a 40% decrease in tidal volume.
D) An increase in blood bicarbonate levels causes a slight decrease in the pH level of the blood.
B) Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm Hg.
Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves.
A) PaO2, vagus and intercostal
B) PaCO2, glossopharyngeal and vagus
C) PaCO2, phrenic and glossopharyngeal
D) PaO2, hypoglossal, vagus, and intercostal
B) PaCO2, glossopharyngeal and vagus
The hypoxic drive stimulates breathing in patients with:
A) chronically decreased PaO2 levels.
B) emphysema or chronic bronchitis.
C) chronically decreased PaCO2 levels.
D) mild bronchospasm caused by asthma.
A) chronically decreased PaO2 levels.
. Typically, ETCO2 is approximately:
A) 2 to 5 mm Hg higher than the arterial PaCO2.
B) 2 to 5 mm Hg lower than the arterial PaCO2.
C) 5 to 10 mm Hg higher than the arterial PaCO2.
D) 5 to 10 mm Hg lower than the arterial PaCO2.
B) 2 to 5 mm Hg lower than the arterial PaCO2.
When renin is released:
A) the conversion of angiotensin I to angiotensin II is inhibited, which facilitates excretion of sodium via the kidneys.
B) the lungs convert the plasma protein angiotensinogen to angiotensin I, which dilates the renal blood vessels and increases kidney function.
C) the pancreatic alpha cells secrete the hormone glucagon, which facilitates the conversion of glycogen to glucose in the liver.
D) the angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, which stimulates sodium resorption by the renal tubules.
D) the angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, which stimulates sodium resorption by the renal tubules.
The conversion of glycogen to glucose occurs in the:
A) blood.
B) liver.
C) spleen.
D) pancreas.
B) liver.
. Liver disease predisposes a patient to hypothermia secondary to:
A) decreased glucagon uptake.
B) inadequate glycogen stores.
C) severe portal hypertension.
D) increased bilirubin production.
B) inadequate glycogen stores.
In addition to facilitating the uptake of sugar into the cells, insulin is responsible for:
A) the chemical conversion of glycogen to glucose.
B) stimulating the liver and kidneys to produce glucose.
C) the production of amino acids and carbohydrates.
D) the chemical conversion of glucose to glycogen.
D) the chemical conversion of glucose to glycogen.
Glycogenolysis is the physiologic process in which:
A) the pancreas secretes glycogen.
B) glycogen is converted to glucose.
C) glucose is converted to glycogen.
D) the kidneys produce additional glucose.
B) glycogen is converted to glucose.
. What physiologic reaction occurs when a person's blood sugar level falls?
A) The pancreas secretes more insulin.
B) More glycogen is stored in the liver.
C) Glucagon production is increased.
D) The pancreatic beta cells become hyperactive.
C) Glucagon production is increased.
The release of glucagon into the bloodstream stimulates:
A) the liver to convert glycogen to glucose.
B) the liver to take in and store more glucose.
C) the cells to uptake sugar from the bloodstream.
D) the vessels to constrict, thus increasing blood pressure.
A) the liver to convert glycogen to glucose.
Which of the following statements regarding insulin is correct?
A) Insulin stimulates the conversion of glycogen to glucose.
B) An increase in insulin levels causes an increase in blood glucose.
C) Insulin is a pancreatic hormone that performs exocrine functions.
D) Insulin is the only hormone that decreases blood glucose levels.
D) Insulin is the only hormone that decreases blood glucose levels.
. Excessive alcohol consumption can lead to low blood glucose levels because:
A) alcohol destroys any insulin that is produced.
B) alcohol antagonizes the pancreatic beta cells.
C) alcohol blocks the pancreatic release of insulin.
D) alcohol depletes glycogen stores in the liver.
D) alcohol depletes glycogen stores in the liver.
. Glucagon increases the blood glucose level by:
A) stimulating glycogenesis.
B) inhibiting gluconeogenesis.
C) agonizing the effects of insulin.
D) facilitating glucose entry into the cell.
A) stimulating glycogenesis.
Glucagon would be ineffective in patients with:
A) significant hypertension.
B) low serum glucose levels.
C) severe beta-blocker toxicity.
D) depleted glycogen stores.
D) depleted glycogen stores.
A patient is found to have a high blood sugar level (hyperglycemia). What is a cause of this?
A) Excessive insulin levels in the blood
B) Decreased production of glucagon
C) Deficient insulin levels in the blood
D) Hyperactivity of the pancreatic beta cells
C) Deficient insulin levels in the blood
. The process in which glucose is broken down to yield lactic or pyruvic acid is called:
A) crenation.
B) gluconeogenesis.
C) glycogenolysis.
D) glycolysis.
D) glycolysis.
Stimulation of alpha-1 receptors results in:
B) vasoconstriction.
. Which adrenergic receptor, when stimulated, inhibits norepinephrine release?
C) Alpha-2
In general, alpha-adrenergic receptor antagonists:
A) decrease the heart rate.
B) lower the blood pressure.
C) are used for hypotension.
D) increase vascular resistance.
B) lower the blood pressure.
. Patients who take alpha-blocking medications at home are frequently prone to:
A) postural hypotension.
B) hypertensive crisis.
C) narrow-angle glaucoma.
D) vagal-induced bradycardia.
A) postural hypotension.
Stimulation of alpha-2 receptors:
A) constricts the vascular smooth muscle.
B) suppresses the release of norepinephrine.
C) causes profound systemic hypertension.
D) increases the release of norepinephrine.
B) suppresses the release of norepinephrine.
In contrast to epinephrine, norepinephrine:
A) specifically targets beta-1 receptors.
B) has minimal effect on blood pressure.
C) primarily stimulates alpha receptors.
D) stimulates beta-1 and beta-2 receptors.
C) primarily stimulates alpha receptors.
Which of the following medications would be the LEAST likely to increase a person's risk for a heat-related illness?
A) Diuretics
B) Beta blockers
C) Antihistamines
D) Alpha antagonists
D) Alpha antagonists
Stimulation of alpha receptors of the sympathetic nervous system results in:
A) tachycardia.
B) bronchodilation.
C) peripheral vasodilation.
D) peripheral vasoconstriction.
D) peripheral vasoconstriction.
The catecholamine epinephrine (adrenaline) has an affinity for:
A) alpha and beta receptors.
B) alpha-1 receptors only.
C) beta-1 receptors only.
D) alpha-1 and beta-2 receptors.
A) alpha and beta receptors.
. Stimulation of alpha and beta receptors affects the:
A) heart only.
B) heart and blood vessels.
C) blood vessels and lungs.
D) heart, lungs, and blood vessels.
D) heart, lungs, and blood vessels.
Vasoconstriction occurs following stimulation of:
A) beta-1 receptors.
B) beta-2 receptors.
C) alpha receptors.
D) alpha and beta receptors.
C) alpha receptors.
Drugs that have alpha or beta sympathetic properties are called:
A) vagolytics.
B) sympathomimetics.
C) parasympatholytics.
D) adrenergic blockers.
B) sympathomimetics.
To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:
A) stimulates beta-1 and beta-2 receptors.
B) stimulates beta-2 and alpha receptors.
C) blocks beta-1 and beta-2 receptors.
D) blocks beta receptors and stimulates alpha receptors.
A) stimulates beta-1 and beta-2 receptors.
. A pure alpha agent:
A) causes marked vasoconstriction.
B) has a direct effect on the heart rate.
C) causes moderate bronchoconstriction.
D) decreases the blood pressure by dilating the vessels.
A) causes marked vasoconstriction.
Afterload is increased following alpha-1 stimulation because of:
A) decreased preload.
B) arteriolar constriction.
C) increased contractility.
D) widespread vasodilation.
B) arteriolar constriction.
Hypotension that is associated with neurogenic shock is the result of:
A) loss of alpha receptor stimulation.
B) concomitant internal hemorrhage.
C) increased peripheral vascular tone.
D) profound peripheral vasoconstriction.
A) loss of alpha receptor stimulation.
The antihypertensive properties of labetalol (Normodyne) are due to its:
A) selective alpha and nonselective beta-adrenergic blocking effects.
B) nonselective alpha and selective beta-1 adrenergic blocking effects.
C) selective alpha and selective beta-adrenergic blocking effects.
D) nonselective dopaminergic and selective alpha-adrenergic blocking effects.
A) selective alpha and nonselective beta-adrenergic blocking effects.
Norepinephrine increases the blood pressure by:
A) antagonizing beta receptors.
B) increasing cardiac contractility.
C) increasing the heart rate.
D) stimulating alpha receptors.
D) stimulating alpha receptors.
. Promethazine hydrochloride (Phenergan) can be classified as all of the following, EXCEPT as a(n):
A) antiemetic.
B) phenothiazine.
C) alpha agonist.
D) antihistamine.
C) alpha agonist.
Stimulation of beta-1 adrenergic receptors would produce all of the following effects, EXCEPT:
D) decreased myocardial contractility.
In order to cause a negative inotropic effect on the heart, you would have to administer a(n):
A) beta-1 adrenergic antagonist.
Stimulation of beta-2 receptors will cause:
B) the airway diameter to dilate.
The desired clinical effect after administering a beta-2 agonist medication is:
A) dilation of the systemic vasculature.
B) relaxation of bronchiole smooth muscle.
C) increased cardiac contractility
D) contraction of vascular smooth muscle.
B) relaxation of bronchiole smooth muscle.
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.
Patients who take alpha-blocking medications at home are frequently prone to:
A) postural hypotension.
B) hypertensive crisis.
C) narrow-angle glaucoma.
D) vagal-induced bradycardia.
A) postural hypotension.
Glucagon is used in the treatment of beta-blocker overdose because it:
A) causes vasoconstriction and increases blood pressure.
B) produces positive inotropic and chronotropic effects.
C) activates beta-1 receptors and increases the heart rate.
D) blocks alpha-2 receptors and increases blood pressure.
B) produces positive inotropic and chronotropic effects.
To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:
A) stimulates beta-1 and beta-2 receptors.
B) stimulates beta-2 and alpha receptors.
C) blocks beta-1 and beta-2 receptors.
D) blocks beta receptors and stimulates alpha receptors.
A) stimulates beta-1 and beta-2 receptors.
Which of the following drugs possesses beta-2-specific properties?
A) Dopamine
B) Levophed
C) Proventil
D) Epinephrine
C) Proventil
A beta adrenergic blocker would counteract all of the following medications, EXCEPT:
A) atropine.
B) epinephrine.
C) isoproterenol.
D) norepinephrine.
A) atropine.
. Beta receptor stimulation results in all of the following effects, EXCEPT:
A) positive cardiac inotropy.
B) positive cardiac chronotropy.
C) vascular smooth muscle contraction.
D) relaxation of bronchiole smooth muscle.
C) vascular smooth muscle contraction.
. Hypotension that is associated with neurogenic shock is the result of:
A) loss of alpha receptor stimulation.
B) concomitant internal hemorrhage.
C) increased peripheral vascular tone.
D) profound peripheral vasoconstriction.
A) loss of alpha receptor stimulation.
Which of the following is NOT a physiologic effect of epinephrine?
A) Beta-1 receptor agonist
B) Beta-2 receptor agonist
C) Histamine receptor agonist
D) Alpha-1 receptor agonist
C) Histamine receptor agonist
. 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.
Norepinephrine increases the blood pressure by:
A) antagonizing beta receptors.
B) increasing cardiac contractility.
C) increasing the heart rate.
D) stimulating alpha receptors.
D) stimulating alpha 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.
Any cell that ingests microorganisms or other cells is called a(n):
A) phagocyte.
B) endocyte.
C) exocyte.
D) pinocyte.
A) phagocyte.
. The ongoing process by which red blood cells are made is called:
A) diapedesis.
B) phagocytosis.
C) hematopoiesis.
D) erythropoiesis.
D) erythropoiesis.
Type 1 diabetes that is secondary to an autoimmune disorder occurs when:
A) the body builds up antibodies that destroy the islets of Langerhans.
B) insufficient white blood cells predispose the pancreas to infection.
C) glucagon and insulin are destroyed by phagocytic white blood cells.
D) the patient experiences an allergic reaction to his or her own glucose.
A) the body builds up antibodies that destroy the islets of Langerhans.
. Phagocytosis is the process by which:
A) phagocytes are produced.
B) phagocytes are destroyed.
C) monocytes digest microbes.
D) microbes destroy monocytes.
C) monocytes digest microbes.
The most inferior portion of the heart is called the:
A) base.
B) apex.
C) volar.
D) dorsum.
B) apex.
. The thick fibrous membrane that surrounds the heart is called the:
A) pericardium.
B) myocardium.
C) epicardium.
D) endocardium.
A) pericardium.
. Blood enters the right atrium of the heart from the:
A) vena cava and aorta.
B) aorta and coronary sinus.
C) pulmonary vein and aorta.
D) vena cavae and coronary sinus.
D) vena cavae and coronary sinus.
What type of valves are the aortic and pulmonic valves?
A) Papillary
B) Chordis
C) Semilunar
D) Atrioventricular
C) Semilunar
Freshly oxygenated blood is returned to the left atrium through the:
A) pulmonary veins.
B) pulmonary arteries.
C) superior vena cava.
D) inferior vena cava.
A) pulmonary veins.
The second heart sound (S2) represents:
A) opening of the pulmonic valve.
B) closure of the atrioventricular valves.
C) opening of the aortic valve.
D) closure of the semilunar valves.
D) closure of the semilunar valves.
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.
. Dysfunction of the mitral valve may cause backflow of blood into the:
A) right ventricle.
B) right atrium.
C) left atrium.
D) left ventricle.
C) left atrium.
Ventricular muscle contraction and the pumping of blood throughout the body occur during:
A) systole.
B) diastole.
C) asystole.
D) the cardiac cycle.
A) systole.
Which of the following lists, in the correct order, the return of blood from the systemic circulation to the heart?
A) Capillaries, venules, veins, vena cava
B) Venules, capillaries, veins, vena cava
C) Capillaries, arterioles, arteries, aorta
D) Arterioles, capillaries, arteries, aorta
A) Capillaries, venules, veins, vena cava
The pulmonary circulation is responsible for:
A) sending deoxygenated blood to the atria.
B) perfusing the vital organs of the body.
C) ensuring that blood gets reoxygenated.
D) filtering the blood of toxic chemicals.
C) ensuring that blood gets reoxygenated.
Which of the following vessels or structures is NOT part of the pulmonary circulation?
A) Pulmonary artery
B) Descending aorta
C) Alveolar capillary
D) Pulmonic valve
B) Descending aorta
. The first artery to branch from the aortic arch is the:
A) brachiocephalic artery.
B) internal carotid artery.
C) external carotid artery.
D) common iliac artery.
A slight dilation at the carotid bifurcation, called the ________________, contains structures that are important in regulating blood pressure.
A) foramen ovale
B) circle of Willis
C) fossa ovalis
D) carotid sinus
As blood enters the lungs, it enters the alveoli by passing across the:
A) pulmonary arteriole.
B) pulmonary capillary.
C) pulmonary venule.
D) pulmonary artery.
B) pulmonary capillary.
The heart's anatomic location is MOST accurately described as being:
A) retrosternal.
B) hemithoracic.
C) submediastinal.
D) supradiaphragmatic.
A) retrosternal.
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.
The layers of the wall of the heart, beginning with the outermost layer, are the:
A) epicardium, myocardium, and endocardium.
B) endocardium, epicardium, and myocardium.
C) myocardium, epicardium, and endocardium.
D) epicardium, endocardium, and myocardium.
A) epicardium, myocardium, and endocardium.
The left main coronary artery subdivides into the:
A) left anterior ascending and descending arteries.
B) left anterior descending and circumflex arteries.
C) left posterior ascending and circumflex arteries.
D) right coronary and left posterior descending arteries.
B) left anterior descending and circumflex arteries.
The right atrium, right ventricle, and part of the left ventricle are supplied by the:
A) circumflex artery.
B) left anterior descending artery.
C) left main coronary artery.
D) right coronary artery.
D) right coronary artery.
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:
A) cardiac myocytes.
B) the coronary sinus.
C) collateral circulation.
D) coronary microcirculation.
C) collateral circulation.
. What prevents the backflow of blood during ventricular contraction?
A) The aortic valve
B) Semilunar valves
C) The pulmonic valve
D) AV valves
D) AV valves
. The mitral valve:
A) is located on the higher-pressure side of the heart.
B) separates the right atrium from the right ventricle.
C) prevents blood regurgitation into the left ventricle.
D) is a tricuspid valve located on the right side of the heart.
A) is located on the higher-pressure side of the heart.
The S1 heart sound represents:
A) closure of the mitral and tricuspid valves.
B) the end of ventricular contraction.
C) closure of the aortic and pulmonic valves.
D) the beginning of atrial contraction.
A) closure of the mitral and tricuspid valves.
. 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.
Approximately 80% of ventricular filling occurs:
A) during systole.
B) during diastole.
C) when the semilunar valves are open.
D) when the AV valves close.
B) during diastole.
Which of the following statements regarding the right side of the heart is correct?
A) It receives blood exclusively from the venae cavae.
B) The right side of the heart is a low-pressure pump.
C) It pumps against the high resistance of the pulmonary circulation.
D) The right side of the heart pumps blood through the pulmonary veins.
B) The right side of the heart is a low-pressure pump.
In contrast to the right side of the heart, the left side of the heart:
A) drives blood out of the heart against the relatively high resistance of the systemic circulation.
B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs.
C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta.
D) drives blood out of the heart against the relatively low resistance of the pulmonary circulation.
A) drives blood out of the heart against the relatively high resistance of the systemic circulation.
. Which part of the blood vessel is made up of elastic fibers and muscle, and provides for strength and contractility?
A) Tunica media
B) Tunica intima
C) Tunica adventitia
D) Arterial lumen
A) Tunica media
In contrast to arteries, veins:
A) do not contain valves that prevent backflow of blood.
B) have less capacity to increase the size of their diameter.
C) are more likely to distend when exposed to backpressure.
D) operate on the high-pressure side of the circulatory system.
In contrast to arteries, veins:
A) do not contain valves that prevent backflow of blood.
B) have less capacity to increase the size of their diameter.
C) are more likely to distend when exposed to backpressure.
D) operate on the high-pressure side of the circulatory system.
The outer adrenal cortex produces which of the following substances?
A) Aldosterone
B) Epinephrine
C) Norepinephrine
D) Dopamine
A) Aldosterone
Aldosterone acts on the kidneys by:
A) increasing potassium reabsorption into the blood and enhancing sodium elimination in the urine.
B) dilating the renal vasculature, thus enhancing renal blood flow and facilitating sodium excretion.
C) increasing sodium reabsorption into the blood and enhancing potassium elimination in the urine.
D) constricting the renal vasculature, thus slowing renal blood flow and decreasing the glomerular filtration rate.
C) increasing sodium reabsorption into the blood and enhancing potassium elimination in the urine.
A fall in blood pressure and the resultant changes in plasma osmolality cause the release of:
A) glycogen and luteinizing hormone.
B) T3 and T4 from the thyroid gland.
C) aldosterone and antidiuretic hormone.
D) acetylcholine and angiotensin I.
C) aldosterone and antidiuretic hormone.
. If the body experiences a drop in volume or blood pressure:
A) aldosterone stimulates the sweat glands, resulting in diaphoretic skin.
B) adrenocorticotropic hormone causes a reduction in the secretion of cortisol.
C) aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.
D) catecholamine release inhibits the conversion of glycogen to glucose in the liver.
C) aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.
Adrenal insufficiency is characterized by decreased function of the ______________ and consequent underproduction of ______________.
A) adrenal glands, catecholamines
B) adrenal medulla, norepinephrine
C) adrenal cortex, cortisol and aldosterone
D) adrenal glands, epinephrine and norepinephrine
C) adrenal cortex, cortisol and aldosterone
Aldosterone produces all of the following physiologic effects, EXCEPT:
A) increased water reabsorption by the kidneys.
B) retention of potassium ions in the body.
C) increased sodium and chloride reabsorption.
D) decreased reabsorption of potassium ions.
B) retention of potassium ions in the body.
Insulin and glucagon are produced in specialized groups of cells in the pancreas known as the:
A) adrenal islets.
B) islets of Langerhans.
C) medullary cortex.
D) adrenal medulla.
B) islets of Langerhans.
What is the action of adrenocorticotropic hormone (ACTH)?
A) Controls hormone secretion from the adrenal cortex
B) Increases the size and division rate of body cells
C) Develops egg-containing follicles in females
D) Controls conservation of water in the kidneys
A) Controls hormone secretion from the adrenal cortex
The 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.
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Which of the following is/are NOT an exocrine gland?
A) Liver
B) Sweat glands
C) Salivary glands
D) Adrenal glands
D) Adrenal glands
Which of the following is an example of endocrine regulation via a negative feedback mechanism?
A) As blood glucose levels fall, glucagon is secreted and stimulates the liver to convert glycogen to glucose.
B) A stress response stimulates the sympathetic nervous system to release epinephrine into the bloodstream.
C) When circulating volume is decreased, the pituitary gland secretes antidiuretic hormone into the bloodstream.
D) The neural regulating mechanism decreases its signals to the adrenal medulla, decreasing epinephrine release.
D) The neural regulating mechanism decreases its signals to the adrenal medulla, decreasing epinephrine release.
. The adrenal cortex produces hormones called _______________, which:
A) catecholamines, increase the blood pressure.
B) glucocorticoids, stimulate energy production.
C) gonadotropin, regulate testosterone production.
D) corticosteroids, regulate the body's metabolism.
D) corticosteroids, regulate the body's metabolism.
. A decrease in adrenal hormone production will result in all of the following, EXCEPT:
A) weakness.
B) hypertension.
C) dehydration.
D) inability to respond to stress.
B) hypertension.
Which of the following statements regarding Addison disease is MOST correct?
A) Addison disease most often occurs when the immune system creates antibodies that attack and destroy the adrenal cortex.
B) Addison disease is also known as secondary adrenal insufficiency and is most often the result of a viral infection.
C) The signs and symptoms of Addison disease are a direct result of the overproduction of cortisol and aldosterone.
D) Hallmark signs of Addison disease are hypertension and fluid retention that result from excess sodium reabsorption.
A) Addison disease most often occurs when the immune system creates antibodies that attack and destroy the adrenal cortex.
While preparing equipment for newborn resuscitation, which of the following items is/are NOT considered optional?
A) Pulse oximeter
B) Cardiac monitor
C) Endotracheal tubes
D) Laryngeal mask airway
C) Endotracheal tubes
You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should:
A) insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport.
B) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
C) insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital.
D) insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.
B) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
. In general, patients suspected of having a partial tracheal tear should be managed with:
A) immediate endotracheal intubation.
B) an oxygen-powered ventilation device.
C) the least invasive airway techniques possible.
D) placement of a laryngeal mask airway device.
C) the least invasive airway techniques possible.
When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA):
A) enters the esophagus and provides complete obturation.
B) is proximal to the esophagus and seals the hypopharynx.
C) is in almost perfect alignment with the esophageal opening.
D)rests against the arytenoid cartilage and enters the glottis
B) is proximal to the esophagus and seals the hypopharynx.
. Which of the following statements regarding translaryngeal catheter ventilation is correct?
A) It is more difficult to perform than an open cricothyrotomy.
B) It provides a more definitive airway than an open cricothyrotomy.
C) Ventilation is achieved by the use of a high-pressure jet ventilator.
D) The technique uses the tracheal wall as an entry point to the airway.
C) Ventilation is achieved by the use of a high-pressure jet ventilator.
You are in the process of assisting a woman in labor. She is 38 weeks pregnant with her second child, and her contractions are 3 minutes apart and are strong and regular. Her first baby was delivered by cesarean section. As you prepare for imminent delivery, the woman tells you that her contractions have decreased significantly and that she is very dizzy. Assessment of her vaginal area reveals moderate vaginal bleeding. You quickly assess her and note that she is diaphoretic, tachycardic, and hypotensive. You should be MOST suspicious for:
A) uterine rupture.
B) placenta previa.
C) abruptio placenta.
D) threatened abortion.
A) uterine rupture.
A 25-year-old woman was involved in a motor vehicle accident in which she struck the rear end of another car at a low speed. When you arrive at the scene and exit the ambulance, you immediately hear the patient screaming, "My baby, my baby!" After calming the patient down, she tells you that she is 10 weeks pregnant and that she is afraid that the car accident injured her child. She confirms that she was properly restrained at the time of impact. She is conscious and alert, denies abdominal pain, and has stable vital signs. She refuses spinal motion restriction precautions but does consent to EMS transport. You should:
A) administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.
B) be concerned that the traumatic injury may have caused an abruptio placenta, administer high-flow oxygen, establish a large-bore IV, and transport her to a trauma center.
C) reassure her that her baby was not injured, offer her oxygen via nasal cannula, defer IV therapy, and transport her to the closest hospital with continuous emotional support en route.
D) provide emotional support, administer diazepam to prevent her from becoming frantic, administer oxygen via nasal cannula at 6 L/min, and transport her to a minor emergency clinic.
A) administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.
. A spontaneous abortion:
A) affects one out of every three pregnancies and is typically idiopathic.
B) occurs naturally and may or may not have an identifiable cause.
C) is generally performed by a physician to prevent maternal death.
D) is most often the result of a congenital abnormality of the placenta.
B) occurs naturally and may or may not have an identifiable cause.
. In contrast to an abruptio placenta, a placenta previa:
A) typically presents with tearing abdominal pain.
B) is usually caused by maternal abdominal trauma.
C) is associated with an absence of fetal heart tones.
D) usually presents with painless vaginal bleeding.
D) usually presents with painless vaginal bleeding.
Abruptio placenta is MOST accurately defined as:
A) separation of the placenta secondary to blunt maternal abdominal trauma.
B) premature separation of a normally implanted placenta from the uterine wall.
C) a condition in which the placenta progressively detaches from the uterine wall.
D) a placenta that implants low in the uterus and partially or fully covers the cervix.
B) premature separation of a normally implanted placenta from the uterine wall.
Uterine inversion occurs when:
A) the musculature of the uterine fundus is inherently weak, causing the uterus to prolapse.
B) the placenta fails to detach properly and adheres to the uterine wall when it is expelled.
C) postpartum bleeding is improperly managed with inadequate massage of the uterine fundus.
D) excessive postpartum hemorrhage causes uterine ischemia and subsequent expulsion from the vagina.
B) the placenta fails to detach properly and adheres to the uterine wall when it is expelled.
A 20-year-old female presents with severe lower abdominal pain. She does not believe that she is pregnant, but states that her breasts have been unusually tender and that she has been nauseated. What is the pathophysiology of this patient's suspected condition?
A) A fertilized ovum is implanted somewhere other than the uterus.
B) The placenta has prematurely detached from the uterine wall.
C) The normal flow of bile from the liver has been interrupted.
D) High levels of estrogen are affecting the gastrointestinal system.
A) A fertilized ovum is implanted somewhere other than the uterus.
Which of the following is NOT an antepartum risk factor that increases the potential that a newborn may require resuscitation?
A) Preeclampsia
B) Prolapsed cord
C) Polyhydramnios
D) Multiple gestations
B) Prolapsed cord
. The onset of eclampsia is marked by the presence of:
A) hypertension.
B) protein in the urine.
C) thrombocytopenia.
D) generalized seizures.
D) generalized seizures.
A pregnant woman with a past history of a cesarean section is at GREATEST risk for:
A) breech birth.
B) preeclampsia.
C) prolapsed cord.
D) uterine rupture.
D) uterine rupture.
In pregnancy, magnesium sulfate is used principally for:
A) eclamptic seizures.
B) tocolytic therapy.
C) ventricular dysrhythmias.
D) hyperemesis gravidarum.
A) eclamptic seizures.
Gestational hypertension:
A) often requires an antihypertensive.
B) is common in underweight women.
C) may be an early sign of preeclampsia.
D) is benign in the vast majority of cases.
C) may be an early sign of preeclampsia.
Common signs and symptoms of preeclampsia include:
A) edema, hypertension, and headache.
B) weight loss, blurred vision, and diarrhea.
C) ketones in the urine and rapid weight gain.
D) facial swelling, dysuria, and chest pain.
A) edema, hypertension, and headache.
A 30-year-old woman presents with bright red vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has high blood pressure and admits to using cocaine throughout her pregnancy. This patient is MOST likely experiencing:
A) placenta previa.
B) a ruptured uterus.
C) abruptio placenta.
D) a threatened abortion.
C) abruptio placenta.
. Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves.
A) PaO2, vagus and intercostal
B) PaCO2, glossopharyngeal and vagus
C) PaCO2, phrenic and glossopharyngeal
D) PaO2, hypoglossal, vagus, and intercostal
B) PaCO2, glossopharyngeal and vagus
. 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.
A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of:
A) C2.
B) C5.
C) C7.
D) T2.
D) T2.
The crista galli:
A) is the anatomic point of attachment of the meninges.
B) is divided into the anterior, middle, and posterior fossae.
C) is a horizontal bone perforated with numerous foramina.
D) allows the passage of the olfactory nerves from the nasal cavity.
A) is the anatomic point of attachment of the meninges.
Older adults are prone to subdural hematomas because:
A) age-related shrinkage of the brain stretches the bridging veins that return blood from the brain to the dura mater.
B) older adults experience an increase in intracranial blood flow as well as a predisposition to falls.
C) excessive alcohol use, which is very common in older adults, causes the brain to atrophy prematurely.
D) age-related hypertension weakens the cerebral veins, which predisposes them to damage from even minor trauma.
A) age-related shrinkage of the brain stretches the bridging veins that return blood from the brain to the dura mater.
The _______________ is a deep ridge of nerve fibers, which is separated by a layer of dura mater and connects the two cerebral hemispheres.
A) cerebral cortex
B) corpus collosum
C) presynaptic terminal
D) coroid plexus
B) corpus collosum
Which of the following statements regarding a closed head injury is correct?
A) In a closed head injury, the dura mater remains intact.
B) Diffuse brain injury occurs with all open head injuries.
C) Closed head injuries are less common than open head injuries.
D) Intracranial pressure is usually minimal in a closed head injury.
A) In a closed head injury, the dura mater remains intact.
. Beginning with the outermost layer, the three meningeal layers of the central nervous system are the:
A) dura mater, pia mater, and arachnoid.
B) arachnoid, pia mater, and dura mater.
C) dura mater, arachnoid, and pia mater.
D) pia mater, dura mater, and arachnoid.
C) dura mater, arachnoid, and pia mater.
Any child with unexplained hyperpnea should be suspected of having _________ toxicity.
A) opiate
B) salicylate
C) beta blocker
D) organophosphate
B) salicylate
Organophosphates exert their effect by:
A) destroying the body's acetylcholine.
B) agonizing the sympathetic nervous system.
C) stimulating the cholinergic nervous system.
D) blocking the parasympathetic nervous system.
C) stimulating the cholinergic nervous system.
Signs and symptoms of organophosphate poisoning include:
A) vomiting.
B) tachycardia.
C) constipation.
D) pupillary dilation.
A) vomiting.
A) vomiting.
A) establish vascular access and begin administering atropine sulfate.
. Which of the following toxins causes the MOST serious consequences when absorbed through the skin?
A) Dry lime
B) Poison oak
C) Pesticides
D) Sulfuric acid
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