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JBL CARDIOLOGY ACTUAL EXAM
COMPLETE ACCURATE EXAM 120
QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS)
ALREADY GRADED A+
"You are assessing a 70-year-old male who complains of pain in both of his legs. He is conscious and alert, has a blood pressure of 160/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 14 breaths/min and unlabored. Further assessment reveals edema to both of his feet and legs and jugular venous distention. What should you suspect? A) Left heart failure B) Right heart failure C) Pulmonary edema
D) Chronic hypertension - CORRECT ANSWER=> B
If the right side of the heart is damaged, fluid collects in the body (edema), often showing in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. Another feature of right heart failure is jugular venous distention, which is an indication of blood backing up into the systemic circulation. Left heart failure typically presents with shortness of breath due to fluid in the lungs (pulmonary edema), which indicates blood backing up from the left side of the heart into the lungs. In severe pulmonary edema, the patient may cough up pink, frothy sputum. Right heart failure and/or left heart failure are also referred to as congestive heart failure (CHF). Chronic hypertension cannot be established on the basis of a single blood pressure reading." "A 62-year-old male with a history of coronary artery disease began experiencing chest pain and nausea while on his daily jog. After sitting down and resting for 5 minutes, his pain and nausea resolve. Which of the following BEST describes this patient's condition? A) Musculoskeletal chest pain B) Acute myocardial infarction C) Unstable angina pectoris
D) Stable angina pectoris - CORRECT ANSWER=> D
Angina pectoris is the principle symptom of coronary artery disease (CAD). It occurs when the heart's demand for oxygen exceeds its supply, usually during periods of physical or emotional stress when the heart is working hard. When the increased oxygen demand goes away, the pain typically resolves. Some patients with angina may also experience shortness of breath, nausea, or diaphoresis. Angina is classified as being "stable" or "unstable." Stable angina is characterized by cardiac-related chest pain that resolves
with rest and/or nitroglycerin. Unstable angina is characterized by cardiac-related chest pain that occurs in response to progressively less physical exertion (for example, during rest). Unstable angina is also referred to as pre-infarction angina because it indicates a more severe degree of CAD and can lead to acute myocardial infarction if untreated. In contrast to stable angina, unstable angina typically does not resolve with rest and/or nitroglycerin. Given the patient's medical history, his chest pain should not be assumed to have simply been of a musculoskeletal origin." "At the end of ventricular relaxation, the left ventricle contains 110 mL of blood. This is referred to as the: A) preload. B) afterload. C) stroke volume.
D) cardiac output. - CORRECT ANSWER=> A
Preload is the amount of pressure on the ventricular wall at the end of ventricular relaxation (diastole) and is influenced by the volume of blood in the ventricle just before it contracts. Afterload refers to the resistance that the ventricles must contract against. A patient with hypertension, for example, would have an increased afterload due to systemic vasoconstriction; the smaller the arteries, the greater the resistance the heart must contract against. Stroke volume is the volume of blood ejected from the ventricles in a single beat. Cardiac output is the volume of blood pumped by the heart each minute; it is calculated by multiplying the stroke volume and heart rate." "The maximum pressure generated in the arms and legs during contraction of the left ventricle is called: A) afterload. B) pulse pressure. C) systolic blood pressure.
D) diastolic blood pressure. - CORRECT ANSWER=> C
Blood pressure is the force of circulating blood against the arterial walls. Systolic blood pressure (SBP) is the maximum pressure generated in the arms and legs during contraction of the left ventricle, during the time period known as systole. As the left ventricle relaxes in the stage known as diastole, the arterial pressure falls. When the left ventricle relaxes, the aortic valve closes and blood flow between the left ventricle and the aorta stops. The diastolic blood pressure (DBP) is the pressure exerted against the arterial walls while the left ventricle is at rest, during the time period known as diastole. Pulse pressure is the numeric difference between the SBP and DBP; it represents the force generated by the heart each time it contracts. If the patient's BP is 120/80 mm Hg, the pulse pressure would be 40 mm Hg. Afterload refers to the amount of resistance the left ventricle must contract against. Conditions such as hypertension cause an increase in afterload; as the arteries narrow, the left ventricle must work harder to overcome the increases resistance to forward blood flow." "A 65-year-old man has generalized weakness and chest pressure. He has a bottle of prescribed nitroglycerin, but states that he has not taken any of his medication. The EMT should: A) apply the AED and prepare the patient for immediate transport. B) administer up to 325 mg of aspirin if the patient is not allergic to it. C) assist the patient with his nitroglycerin with medical control approval.
D) perform a secondary assessment and obtain baseline vital signs. - CORRECT ANSWER=> B
that a normal cardiac rhythm has been restored. The AED does not distinguish pulseless electrical activity (PEA) from asystole; it only recognizes them as nonshockable. PEA is a condition in which organized cardiac electrical activity is present despite the absence of a pulse. Asystole is the absence of all cardiac electrical and mechanical activity. If the AED gives a no shock advised message, immediately resume CPR, starting with chest compressions, until ALS arrives or the patient starts to move." "You are treating a 60-year-old man in cardiac arrest. After delivering a shock with the AED and performing CPR for 2 minutes, you achieve return of spontaneous circulation. Your next action should be to: A) provide rapid transport to the hospital. B) reanalyze his rhythm for confirmation. C) assess his airway and ventilatory status.
D) remove the AED and apply 100% oxygen. - CORRECT ANSWER=> C
If return of spontaneous circulation (ROSC) occurs (eg, a palpable pulse is restored), your first action should be to reassess the patient's airway and ventilatory status. If the patient remains apneic, continue rescue breathing at a rate of 10 breaths/min (one breath every 6 seconds). If the patient is breathing adequately, administer supplemental oxygen in a concentration that is sufficient to maintain an oxygen saturation that is between 92% and 98%. After reassessing the airway and breathing, and treating the patient accordingly, you should prepare for immediate transport. Because of the high risk that cardiac arrest can recur following resuscitation, you should not remove the AED pads; simply turn the AED off instead. Analysis of the patient's cardiac rhythm is not indicated because he now has a pulse." "How can you help maximize cardiac output during CPR? A) Compress the chest at a rate of no more than 100/min B) Ventilate the patient through an advanced airway device C) Deliver rescue breaths until the chest expands widely
D) Allow the chest to fully recoil in between compressions - CORRECT ANSWER=> D
Cardiac output is the amount of blood ejected from the left ventricle per minute. Bearing in mind that even the best-performed CPR produces only a fraction of what the patient's cardiac output would otherwise be, there are several actions that you must take to help maximize this. Allowing the chest to fully recoil in between compressions will help draw blood back to the heart; if more blood returns to the heart, more blood can be pumped from the heart with chest compressions. Do not lean on the patient's chest between compressions. Delivering each rescue breath over a period of 1 second, just enough to produce visible chest rise, will also help maximize cardiac output. If ventilations are given too fast or too forcefully, intrathoracic pressure will increase, resulting in a decrease in the amount of blood that returns to the heart; as a result, cardiac output will decrease. Ventilations are delivered no differently if an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) has been inserted. Deliver chest compressions at a rate of 100 to 120 per minute to a depth of at least 2 inches (at least one-third the depth of the chest in infants and children). Chest compression depth in the adult should not exceed 2.4 inches; however, this is not possible to determine without a CPR device that provides immediate feedback" "Your partner has applied the AED to a cardiac arrest patient and has received a shock advised message. While the AED is charging, you should:
A) continue chest compressions until your partner tells you to stand clear. B) perform rescue breathing only until the AED is charged and ready to shock. C) cease all contact with the patient until the AED has delivered the shock.
D) retrieve the airway equipment and prepare to ventilate the patient. - CORRECT ANSWER=> A
It is important to minimize interruptions in CPR, especially chest compressions, when at all possible. All contact with the patient must cease while the AED is analyzing. However, if the AED gives a shock advised message and begins charging, you should resume chest compressions until the AED is charged and ready to deliver the shock; at this point, you should cease contact with the patient. As soon as the AED delivers the shock, immediately resume CPR starting with chest compressions." "Because of the property of automaticity, cardiac muscle cells are able to: A) contract spontaneously without a stimulus from a nerve source. B) rest for up to 2 minutes before initiating another electrical impulse. C) survive for long periods of time if oxygen does not reach the heart.
D) generate an electrical impulse from the same pacemaker every time. - CORRECT ANSWER=> A
Automaticity refers to the ability of the cardiac cells to spontaneously generate an electrical impulse without being stimulated by an outside nerve source. When cardiac muscle cells contract, so does the muscle. Clearly, the heart cannot rest for 2 minutes before initiating another impulse; extended "rest" of the heart is called cardiac arrest. Automaticity does not enable the heart to survive for any length of time without oxygen. The property of automaticity is present in every cardiac cell; it does not dictate where the common pacemaker site is located." "Switching compressors during two-rescuer CPR: A) should take no more than 15 seconds to accomplish. B) should occur every 2 minutes throughout the arrest. C) is necessary only if the compressor becomes fatigued.
D) is performed after every 10 to 20 cycles of adult CPR. - CORRECT ANSWER=> B
Rescuer fatigue leads to inadequate chest compression rate and/or depth. Fatigue is common after 1 minute of CPR, although the rescuer may not recognize it for 5 minutes or longer. Therefore, compressors should be changed every 2 minutes (after 5 cycles of CPR at a 30:2 ratio) throughout the resuscitation attempt. If the compressor is not switched until he or she recognizes the fatigue, the patient has likely been without effective chest compressions for at least 4 or 5 minutes. In general, interruptions in CPR should be infrequent and should not exceed 10 seconds. However, every effort should be made to switch compressors in less than 5 seconds" "A patient reports pain in the upper midabdominal area. This region of the abdomen is called the: A) peritoneum. B) epigastrium. C) mediastinum.
D) retroperitoneum. - CORRECT ANSWER=> B
The mid-upper region of the abdomen is referred to as the epigastrium because of its location over the stomach (epi = upon, gastric = stomach). This is a common site of pain or discomfort in patients experiencing a cardiac problem, which frequently causes them to attribute their pain or discomfort to indigestion."
A) defibrillation. B) cardiac drug therapy. C) rapid transport.
D) high-quality CPR. - CORRECT ANSWER=> D
Regardless of whether a patient's cardiac arrest is witnessed or unwitnessed, the single most important initial treatment is high-quality CPR. Delays in performing CPR have been clearly linked to poor patient outcomes. After CPR has been initiated, apply the AED as soon as it is available. Cardiac drug therapy may enhance the patient's chance of survival. There is evidence suggesting that transport to the hospital with CPR in progress does not improve survival; resuscitation at the scene may be more beneficial for the patient; follow your local protocols and current research trends. Minimally interrupted, high-quality CPR, however, is clearly linked to good patient outcomes." "Blood is returned from the kidneys to the heart by way of the: A) renal arteries. B) splenic arteries. C) coronary sinus.
D) inferior vena cava. - CORRECT ANSWER=> D
The inferior vena cava returns deoxygenated blood from the abdomen, kidneys, and legs back to the right side of the heart. The renal arteries branch from the aorta and supply oxygenated blood to the kidneys. The splenic arteries also branch from the aorta and supply oxygenated blood to the spleen. The coronary sinus returns deoxygenated blood from the heart to the right atrium" "Which of the following patients is the BEST candidate for fibrinolytic therapy? A) 50-year-old man who has slurred speech and left arm weakness that started 45 minutes ago; history of a heart attack 8 months ago B) 53-year-old woman who experienced a sudden, severe headache and is now unresponsive; history of a hemorrhagic stroke 3 years ago C) 59-year-old man whose mental status has declined over the past 12 hours; history of renal failure, hypertension, and type 2 diabetes D) 63-year-old woman had a syncopal episode and is now confused; she takes blood thinners and has a
history of deep vein thrombosis - CORRECT ANSWER=> A
To be the most effective, fibrinolytic medications for stroke should be administered within the first 3 hours following the onset of signs and symptoms. In some patients, this time frame may be extended to 4.5 hours. Any history of intracranial hemorrhage, regardless of how long ago it was, is a contraindication for fibrinolytic therapy. Other contraindications include bleeding disorders (ie, hemophilia), use of blood thinning medications (ie, Coumadin, Eliquis, Pradaxa), and any active hemorrhage. The ultimate decision to initiate fibrinolytic therapy is the physician at the emergency department, in consultation with the neurologist. However, EMS can, through a targeted assessment, identify those who would most likely benefit from it." "The middle, muscular layer of the heart is called the: A) epicardium. B) pericardium. C) myocardium.
D) endocardium. - CORRECT ANSWER=> C
The heart has four layers. The inner layer is called the endocardium, the middle layer is composed of muscle and is called the myocardium (myo = muscle), and the outer layer of the heart itself is called the epicardium. The pericardium, which is a thin, fibrous membrane, encapsulates the entire heart." "Following return of spontaneous circulation, the patient remains apneic. The EMT should: A) ventilate at 12 breaths/min and maintain an oxygen saturation of 95% to 99%. B) ventilate at 12 to 15 breaths/min and maintain an oxygen saturation of 100%. C) elevate the patient's lower extremities and ventilate at a rate of 20 breaths/min.
D) remove the AED pads and ventilate the patient at a rate of 24 breaths/min. - CORRECT ANSWER=> A
Following return of spontaneous circulation (ROSC) in a patient who remains apneic, you should ventilate at a rate of 10 breaths/min and maintain an oxygen saturation of 92% to 98%. An oxygen saturation of 100% should not be achieved; there is evidence that such a high oxygen saturation post- ROSC can have a negative impact on neurologic recovery. Keep the patient supine, leave the AED pads in place, and transport without delay." "After restoring a pulse in a cardiac arrest patient, you begin immediate transport. While en route to the hospital, the patient goes back into cardiac arrest. You should: A) advise your partner to stop the ambulance. B) begin CPR and proceed to the hospital. C) begin rescue breathing with a bag-mask device.
D) analyze the patient's rhythm with the AED. - CORRECT ANSWER=> A
If you restore a pulse in a cardiac arrest patient, the AED pads should remain attached to the patient's chest during transport in case cardiac arrest reoccurs en route to the hospital. You should, however, turn the AED off or disconnect the pads from the AED. If cardiac arrest reoccurs, you should immediately tell your partner to stop the ambulance and assist you as you begin CPR. Remember that the AED will not analyze the cardiac rhythm if the patient is moving. Once your partner is available to assist, you should analyze the cardiac rhythm, defibrillate if indicated, and immediately resume CPR. Contact medical control as soon as possible, but not before performing CPR and defibrillation." "Which of the following assessment findings is LEAST suggestive of a cardiac problem? A) Rapid, irregular heart rate B) Anxiety and pale, cool skin C) Palpable pain to the chest
D) Nausea and epigastric pain - CORRECT ANSWER=> C
Signs and symptoms of cardiac compromise include nonreproducible pain, pressure, or discomfort in the chest or epigastric region; nausea; pale, cool, clammy (diaphoretic) skin; and an irregular pulse that is either fast or slow. Pain of cardiac origin typically is not reproducible by palpation. Palpable pain to the chest suggests a musculoskeletal problem, not a cardiac problem. However, because some patients with a cardiac problem present atypically, you should transport any patient with chest pain, pressure, or discomfort to the hospital." "After defibrillating a man in cardiac arrest, you resume CPR. As you are about to reanalyze his cardiac rhythm 2 minutes later, your partner tells you she can definitely feel a strong carotid pulse. You should:
nitroglycerin; the systolic blood pressure is greater than 100 mm Hg; and the patient has not taken the maximum of three doses, you should contact medical control to obtain permission to assist the patient in taking the nitroglycerin." "A rapid heart rhythm, usually at a rate of 150 to 200 beats/min, that originates in the ventricles and can cause hemodynamic compromise is called: A) asystole. B) ventricular fibrillation. C) ventricular tachycardia.
D) pulseless electrical activity. - CORRECT ANSWER=> C
Ventricular tachycardia (V-Tach) is a rapid heart rhythm, usually at a rate of 150 to 200 beats/min, that originates in the ventricle instead of the atrium. V-Tach usually does not allow adequate time between beats for the left ventricle to fill with blood; therefore, the blood pressure may fall. V-Tach may occur with or without a pulse. Ventricular fibrillation (V-Fib) is a disorganized, chaotic dysrhythmia that does not produce a pulse; it occurs when cardiac cells randomly discharge to the point that regular cardiac contraction is impossible. Asystole (flatline) represents an absence of cardiac electrical and mechanical activity; obviously, asystole does not produce a pulse. Pulseless electrical activity (PEA) is a phenomenon in which organized electrical activity is present on the cardiac monitor, despite the absence of a pulse" "A 71-year-old woman presents with an acute onset of confusion, slurred speech, and left-sided weakness. She is conscious and her airway is patent. Her BP is 180/94 mm Hg, her pulse is 70 beats/min and irregular, her respirations are 14 breaths/min and unlabored, and her oxygen saturation is 97% on room air. What should you do? A) Administer up to 325 mg of chewable aspirin B) Position her supine and assist her ventilations C) Give oxygen via nasal cannula at 4 to 6 L/min
D) Keep her sitting up and transport without delay - CORRECT ANSWER=> D
The patient's presentation is obvious for a stroke. Second ONLY to addressing problems with airway, breathing, and circulation, the most important intervention is to transport the patient to a stroke center, where fibrinolytic medications can be given or other interventions can be performed. Keep the patient sitting up in order to protect her airway, and transport without delay. The patient in this scenario is breathing adequately; therefore, assisted ventilation is not indicated. Although her BP is elevated (common with a stroke), this is not treated by the EMT in the field. The patient's oxygen saturation does not indicate hypoxemia and she is not experiencing respiratory distress; therefore, supplemental oxygen is not indicated. Do NOT administer aspirin to a patient with stroke-like symptoms; if the cause of the stroke is hemorrhage in the brain, aspirin could worsen the situation" "Chest compression effectiveness is MOST effectively assessed by: A) listening for a heartbeat with each compression. B) carefully measuring the depth of each compression. C) palpating for a carotid pulse with each compression.
D) measuring the systolic blood pressure during compressions. - CORRECT ANSWER=> C
When chest compressions are in progress, the most reliable method of determining their effectiveness is to palpate for a carotid or femoral pulse. If compressions are of adequate depth for the patient's age,
you should be able to feel a pulsation during each compression. It should be noted that you may not be able to feel a pulse in some patients, despite adequately performed chest compressions. For example, if the patient has lost a significant amount of blood, there is less volume to create the pressure wave against the arterial wall. If the patient has a pericardial tamponade or tension pneumothorax (examples of obstructive shock), then the forward flow of blood may be obstructed; in these cases, you may not feel a pulse during chest compressions" "Which of the following clinical signs would indicate increased sympathetic nervous system activity? A) Tachycardia B) Hypotension C) Constricted pupils
D) Slow respiratory rate - CORRECT ANSWER=> A
The autonomic nervous system is comprised of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system, also called the "fight or flight" system, is responsible for making adjustments that allow the body to compensate for increased metabolic demand (ie, fear, shock, fever, etc.). The sympathetic nervous system increases the heart rate, increases respiratory rate and depth, dilates blood vessels in the muscles, constricts blood vessels in the digestive system, and causes pupillary dilation. Therefore, increased sympathetic activity would be expected to cause hypertension, tachycardia, and tachypnea. By contrast, the parasympathetic nervous system, also called the "rest and digest" system, is responsible for slowing the respiratory and heart rates, constricting blood vessels in the muscles, dilating the blood vessels in the digestive system, and constricting the pupils." "Which of the following structures stimulates the ventricles and causes them to contract? A) Sinus node B) Sinoatrial node C) Purkinje fibers
D) Atrioventricular node - CORRECT ANSWER=> C
In a normal heart, the sinoatrial (SA) node, also referred to as the sinus node, is the heart's primary pacemaker. Electrical impulses generated by the sinus node travel throughout both atria via special conduction pathways, causing simultaneous atrial contraction. The impulse continues down the conduction pathway to the atrioventricular (AV) node. At the AV node, the impulse is delayed for a brief period of time in order to allow the ventricles to fill with blood. The impulse then exits the AV node and spreads throughout both ventricles via the bundle of His, the right and left bundle branches, and the Purkinje fibers, causing the ventricular muscle cells to contract." "Which of the following structures is the primary pacemaker, which sets the normal rate for the heart? A) Bundle of His B) Purkinje fibers C) Sinoatrial node
D) Atrioventricular node - CORRECT ANSWER=> C
Cardiac pacemakers are bundles of nerves that generate electrical impulses and conduct them to the cardiac cells, resulting in contraction of the myocardium (heart muscle). In a normal healthy heart, the sinoatrial (SA) node is the primary pacemaker that sets the inherent rate for the heart. The SA node generates electricity at a rate of 60 to 100 electrical discharges per minute; hence the normal adult heart
is another sign of blood backing up in the lungs. A dry, nonproductive cough is not common. Hypertension and tachycardia are common in patients with pulmonary edema; however, many other conditions can cause these findings. Swelling of the feet and ankles is commonly seen in patients with right heart failure, and occurs when blood backs up beyond the right atrium; it is not a common sign of left heart failure and pulmonary edema." "Aspirin may be contraindicated in patients with: A) glaucoma. B) diabetes. C) stomach ulcers.
D) ibuprofen allergy. - CORRECT ANSWER=> C
Aspirin (acetylsalicylic acid [ASA]) inhibits platelet aggregation, thus preventing clots from forming or preventing an existing clot from getting bigger. Aspirin, in a dose of 160 to 325 mg, should be administered to patients experiencing acute coronary syndrome (ie, unstable angina, acute myocardial infarction) as soon as possible. Aspirin is absolutely contraindicated for patients who are allergic to salicylates. Because aspirin prolongs bleeding time, it may be contraindicated for patients with stomach ulcers; therefore, you should contact medical control before giving aspirin to such patients. Aspirin is not contraindicated for patients with glaucoma or diabetes. Ibuprofen, the active ingredient in Motrin and Advil, is a nonsteroidal anti-inflammatory drug (NSAID), not a salycilate." "Use of the automated external defibrillator is contraindicated in patients who: A) are between 1 and 8 years of age. B) experienced a witnessed cardiac arrest. C) are apneic and have a weak carotid pulse.
D) have a nitroglycerin patch applied to the skin. - CORRECT ANSWER=> C
The AED is applied only to patients in cardiac arrest (eg, pulseless and apneic), whether the arrest was witnessed or unwitnessed. According to the 2015 guidelines for CPR and Emergency Cardiac Care (ECC), AEDs can safely be used in infants and children less than 8 years of age in conjunction with a dose- attenuating system (energy reducer) and pediatric pads. However, if pediatric pads and an energy reducer are unavailable, adult AED pads should be used. A nitroglycerin patch is not a contraindication to the use of an AED; simply remove the patch (with gloved hands) and apply the AED as usual." "An 88-year-old female experienced a syncopal episode. She is now conscious, but complains of dizziness and generalized weakness, and her pulse is 170 beats/min and irregular. The EMT should recognize that this patient's syncope was MOST likely caused by: A) an acute cardiac dysrhythmia. B) increased parasympathetic tone. C) widespread systemic vasodilation.
D) decreased sympathetic tone. - CORRECT ANSWER=> A
Because her heart is beating so fast, you should suspect that her syncope occurred because of a drop in her blood pressure secondary to reduced ventricular filling time; the faster the heart beats, the less time there is for the ventricles to fill in between contractions. A fast, irregular pulse indicates the presence of a cardiac dysrhythmia. The sympathetic nervous system is responsible for increasing the heart rate, whereas the parasympathetic nervous system is responsible for slowing it down. Therefore, if
parasympathetic nervous system function was increased or sympathetic nervous system function was decreased, you would expect the patient to experience bradycardia, not tachycardia." "Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment, she tells you that she is lightheaded and feels as if she is going to faint. Her symptoms are MOST likely due to: A) low blood pressure. B) an irregular heartbeat. C) nervousness and anxiety.
D) a drop in her blood sugar. - CORRECT ANSWER=> A
Nitroglycerin (NTG) is a vasodilator; as such, it may cause a drop in blood pressure (hypotension) in some patients. Signs and symptoms of hypotension include dizziness, lightheadedness, and fainting (syncope), among others. For this reason, you should always assess a patient's blood pressure before and after administering nitroglycerin. If the patient's systolic BP is less than 100 mm Hg, NTG should not be given. The patient is probably nervous and anxious, and may even have an irregular heartbeat; however, hypotension is a more likely cause of her symptoms. NTG does not affect a patient's blood sugar level." "Which of the following statements regarding sudden cardiac arrest and ventricular fibrillation is correct? A) For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%. B) High-quality CPR often reverses ventricular fibrillation if it is initiated within 2 minutes of the onset. C) Most patients develop ventricular fibrillation within 10 minutes after the onset of sudden cardiac arrest. D) Patients with ventricular fibrillation are typically unconscious, are apneic, and have a weak and
irregular pulse. - CORRECT ANSWER=> A
Ventricular fibrillation (V-Fib), a chaotic quivering of the heart muscle, is the most common dysrhythmia that results in sudden cardiac arrest (SCA). In V-Fib, the heart is not beating effectively and is not pumping blood; therefore, the patient will not have a pulse. The single most important treatment for V- Fib is early defibrillation. Even if CPR is begun right at the time of the patient's collapse, the likelihood of survival decreases by as much as 10% for each minute that defibrillation is delayed. CPR alone rarely, if ever, converts V-Fib to a cardiac rhythm with a pulse. V-Fib is often a transient dysrhythmia, and the window of opportunity for successful defibrillation is very narrow. After 10 minutes of cardiac arrest, most patients deteriorate to asystole (absence of electrical and mechanical activity in the heart)." "In which of the following patients is nitroglycerin contraindicated? A) 41-year-old male with crushing substernal chest pressure, a blood pressure of 160/90 mm Hg, and severe nausea B) 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra C) 58-year-old male with chest pain radiating to the left arm, a blood pressure of 130/64 mm Hg, and prescribed Tegretol D) 66-year-old female with chest pressure of 6 hours' duration, lightheadedness, and a blood pressure of
110/58 mm Hg - CORRECT ANSWER=> B
Nitroglycerin is contraindicated in patients who do not have a prescription for nitroglycerin, in those with a systolic BP less than 100 mm Hg, and in patients who have taken medications for erectile dysfunction (ED) within the previous 24 to 48 hours. Such medications include sildenafil (Viagra), vardenafil (Levitra),
B) both of the atria can relax. C) the ventricles can contract.
D) ventricular filling can occur. - CORRECT ANSWER=> D
The heart functions as a double pump; when the atria are contracting, the ventricles are filling, and when the ventricles are contracting, the atria are filling. In order to maintain the double pump effect, the electrical impulse coming from the sinoatrial node must undergo a brief delay at the atrioventricular node; this delay allows the ventricles to fill with blood. Most of the blood that fills the ventricles does so passively, with final filling occurring during atrial contraction; this is called the atrial kick. The brief delay at the AV node does not affect when the aortic valve opens, when the ventricles contract, or when the atria relax." "A 65-year-old woman complains of severe chest pain that radiates to her back, in between her shoulder blades. She tells you that this is the most severe pain that she has ever experienced, and that it has been intense since it began. Her past medical history includes hypertension. When you palpate her radial pulses, you note that they are unequal in strength. What should you suspect? A) Acute aortic dissection B) Unstable angina pectoris C) Acute hypertensive crisis
D) Acute myocardial infarction - CORRECT ANSWER=> B
The patient's clinical presentation is classic for acute dissection of the aorta. Dissection occurs when high pressure causes damage (dissection) through the layers of the artery until an aneurysm eventually forms. Hypertension is a major risk factor for aortic dissection. The patient with acute aortic dissection typically presents with a sudden onset of severe chest pain, which is often described as the worst pain they have ever felt. In many cases, the patient radiates to the back, in between the scapulae. In contrast to the pain associated with acute cardiac ischemia (ie, unstable angina, myocardial infarction), which often begins acutely and progressively worsens, the pain from aortic dissection is of maximal intensity from the onset. Depending on the degree of dissection, blood pressure changes (greater than 15 mm Hg) may be noted between arms, and pulses in the upper extremities may be unequal in strength. Since there is no blood pressure provided, and the patient's symptoms are not consistent with acute hypertensive crisis (ie, headache, photophobia, nausea, vomiting), there is no evidence that this is what is causing her symptoms." "A middle-aged female with a history of hypertension and high cholesterol complains of chest discomfort. She asks you to take her to the hospital where her personal physician practices, which is 15 miles away. Her blood pressure is 130/70 mm Hg, pulse is 84 beats/min and regular, and respirations are 18 breaths/min and unlabored. Which of the following actions is clearly NOT appropriate for this patient? A) Giving oxygen via nasal cannula B) Taking her to her choice hospital C) Contacting her physician via phone
D) Allowing her to walk to the ambulance - CORRECT ANSWER=> D
You should NEVER allow a patient with a possible cardiac problem to walk to the ambulance. This causes exertion, which increases cardiac oxygen consumption and demand and could worsen his or her condition. Give the patient oxygen in a concentration sufficient to maintain his or her oxygen saturation
equal to or greater than 94%. In general, you should transport patients to the hospital of their choice. However, transport to a closer hospital should be considered if you believe the patient is unstable or is at high risk for becoming unstable. If necessary, consult with the patient's physician via phone to determine if he or she thinks the patient should go to a closer hospital" "Which of the following is a common side effect of nitroglycerin? A) Nausea B) Anxiety C) Headache
D) Hypertension - CORRECT ANSWER=> C
Because nitroglycerin (NTG) causes vasodilation, including the vessels within the brain, cerebral blood flow increases following its administration. This often causes a pounding headache for the patient. As uncomfortable as it is for the patient, headaches are a common and expected side effect of the drug. The vasodilatory effects of nitroglycerin could result in hypotension; therefore, the patient's blood pressure should be carefully monitored. Nausea and anxiety are common symptoms of acute coronary syndrome; they are not common side effects of nitroglycerin." "By which of the following mechanisms does nitroglycerin relieve cardiac-related chest pain or discomfort? A) Vasodilation and increased myocardial oxygen supply B) Vasodilation and decreased myocardial oxygen supply C) Vasoconstriction and increased myocardial workload
D) Vasoconstriction and increased cardiac oxygen demand - CORRECT ANSWER=> A
Nitroglycerin is a vasodilator that causes smooth muscle relaxation. Smooth muscle is found within the walls of the blood vessels. Nitroglycerin causes vasodilation, including dilation of the coronary arteries, which in turn increases the flow of oxygenated blood to the heart and reduces myocardial workload. However, care must be taken when administering nitroglycerin to a patient. Because of its vasodilatory effects, nitroglycerin can cause hypotension; therefore, it should not be given to patients with a systolic blood pressure of less than 100 mm Hg." "After attaching the AED and pushing the analyze button on an adult patient in cardiac arrest, the AED states that a shock is advised. Which cardiac rhythm is the patient MOST likely in? A) Asystole B) Ventricular fibrillation C) Ventricular tachycardia
D) Pulseless electrical activity - CORRECT ANSWER=> B
Ventricular fibrillation (V-Fib) is the most common initial cardiac dysrhythmia in adult cardiac arrest patients. V-Fib is a chaotic quivering of the heart muscle that does not produce a pulse and is due to a massive, uncontrolled electrical discharge of the cardiac cells. The most effective treatment for V-Fib is defibrillation. Some patients are in ventricular tachycardia (V-Tach) without a pulse, which is also treated with defibrillation. Although asystole and pulseless electrical activity (PEA) do not produce a pulse, they are not treated with defibrillation" "The wall that separates the left and right sides of the heart is called the:
artery rupture) that is followed by rapid deterioration of the patient's condition. By contrast, ischemic stroke (accounts for approximately 87% of all strokes) occurs when a clot occludes a cerebral artery. If the clot forms locally, it is referred to as a thrombotic stroke; if the clot travels to the brain from another part of the body, it is referred to as an embolic stroke. Acute ischemic stroke typically presents with a sudden onset of confusion, facial droop, slurred speech, and weakness to one side of the body. A headache is uncommon in patients with acute ischemic stroke." "While transporting an elderly woman who was complaining of nausea, vomiting, and weakness, she suddenly becomes unresponsive. You should: A) analyze her cardiac rhythm with the AED. B) open her airway and ensure that it is clear. C) assess for signs of breathing and a pulse.
D) place her on her side in case she vomits. - CORRECT ANSWER=> C
If a patient is found unresponsive or becomes unresponsive in your presence, your first action should be to assess for breathing and a pulse; this assessment can occur simultaneously and should take no more than 10 seconds. If the patient is breathing adequately and has a pulse, position her on her side and administer oxygen if needed. If the patient has a pulse but is not breathing, open the airway and provide rescue breathing. If the patient is not breathing (or has agonal gasps) and does not have a pulse, begin CPR (starting with chest compressions) and apply the AED as soon as possible. If you are transporting a patient who becomes unresponsive, pulseless, and apneic, you should begin CPR and instruct your partner to stop the ambulance and prepare the AED." "After administering nitroglycerin to a patient with chest discomfort, it is MOST important for you to: A) ask the patient if the discomfort has improved. B) find out how long the discomfort has been present. C) position the patient supine and transport immediately.
D) reassess the patient's blood pressure within 5 minutes. - CORRECT ANSWER=> D
Nitroglycerin (NTG) relaxes the muscle of blood vessel walls, dilates the coronary arteries, increases blood flow and the supply of oxygen to the heart muscle (myocardium), and decreases the workload of the heart. NTG also dilates blood vessels in other parts of the body, potentially resulting in hypotension. For this reason, you should reassess the patient's blood pressure within 5 minutes after each dose of NTG. If the systolic blood pressure is less than 100 mm Hg, do not give anymore NTG. If significant hypotension occurs, position the patient supine and transport without delay. Asking the patient if his or her chest pain or discomfort has improved following NTG helps you determine if the drug is working and whether additional dosing is needed; however, detecting hypotension is clearly more important. You should determine when the chest pain or discomfort began during the focused history, which is typically performed before assisting a patient with his or her prescribed NTG." "Which of the following statements regarding ventricular fibrillation (V-Fib) is correct? A) Loss of consciousness occurs within minutes after the onset of V-Fib. B) In V-Fib, the heart is not pumping any blood and the patient is pulseless. C) Patients in V-Fib should be defibrillated after every 60 seconds of CPR.
D) Any patient in V-Fib must receive CPR for 2 minutes prior to defibrillation. - CORRECT ANSWER=> B
Ventricular fibrillation (V-Fib) is a disorganized, ineffective quivering of the heart muscle. No blood is pumped through the body and the patient is pulseless. Loss of consciousness occurs within seconds following the onset of V-Fib. Patients in V-Fib are treated with high-quality CPR and defibrillation every 2 minutes if needed. When treating a patient in cardiac arrest, whether the patient's arrest was witnessed or unwitnessed, begin immediate CPR and apply the AED as soon as it is available." "A 50-year-old man presents with crushing chest pain that suddently began about 30 minutes ago. He is diaphoretic and anxious. The EMT should: A) obtain baseline vital signs. B) apply supplemental oxygen. C) administer chewable aspirin.
D) perform a complete physical exam. - CORRECT ANSWER=> C
Aspirin (up to 325 mg) has clearly been shown to reduce mortality and morbidity from acute myocardial infarction (AMI) and should be given as soon as possible to patients with suspected cardiac chest pain (unless they are allergic to aspirin). Not all patients get oxygen, even those experiencing AMI. Give oxygen if the patient is hypoxemic (oxygen saturation less than 94%) or is experiencing respiratory distress. Clearly, it is important to perform a physical exam and obtain vital signs. Of the interventions listed, however, aspirin administration has the highest priority in this patient." "When applying the ECG electrodes, the negative (white) lead is placed on the: A) left arm. B) right arm. C) left leg.
D) right leg. - CORRECT ANSWER=> B
Proper lead placement is paramount in obtaining an accurate electrocardiographic tracing of the heart. Misplaced leads can produce erroneous ECG findings, or hide an abnormality that correct lead placement would otherwise have revealed. The negative (white) lead is placed on the right arm, the ground (black) lead is placed on the left arm, the positive (red) lead is placed on the left leg, and the green lead (completes the circuit) is placed on the right leg." "A 57-year-old male presents with flu-like symptoms. He is conscious and alert; his skin is pink, warm, and dry; and he denies chest pain or respiratory distress. During your assessment, you cannot feel radial or carotid pulses, and are unable to obtain a blood pressure. Which of the following would MOST likely explain this? A) He is in the advanced stages of shock B) He has a left ventricular assist device C) He has a dissecting aortic aneurysm
D) He recently had a coronary artery bypass - CORRECT ANSWER=> B
The patient is clearly stable, as evidenced by his level of consciousness; normal skin, color, condition, and temperature; and absence of chest pain or respiratory distress. These findings rule out shock, especially advanced shock. Patients with acute aortic dissection typically present with severe, tearing chest pain that often radiates to the back; the patient has none of these symptoms. A coronary artery bypass graft (CABG) would not explain the absence of pulses and blood pressure. The only possible option is that he has a left ventricular assist device (LVAD) with a continuous flow pump. Patients with this type of LVAD
