Quiz Packet Flashcards by Daniel Fadok

A patient asks you about his risk of cardiovascular disease. He is 50 years old and has diabetes, is overweight, and smokes cigarettes. What should the paramedic advise him?

A) His risk for cardiovascular disease cannot be modified because of his hereditary risk factors
B) He can modify his risk for cardiovascular disease by losing weight and not smoking
C) His risk for cardiovascular disease will remain high and modifying his lifestyle will not significantly reduce his risk
D) His age and gender raise his risk for cardiovascular disease more than his lifestyle does

B) He can modify his risk for cardiovascular disease by losing weight and not smoking

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Which statement is true of the coronary arteries?

A) The right coronary artery supplies most of the blood to the heart
B) The coronary arteries run inside the myocardium
C) The coronary arteries begin just above the aortic valve
D) There are three primary coronary arteries

C) The coronary arteries begin just above the aortic valve

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Of what branch is the circumflex artery?

A) Left coronary artery
B) Left anterior descending artery
C) Right coronary artery
D) Marginal artery

A) Left coronary artery

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In the event of coronary artery blockage, how could the muscle of the heart still receive blood?

A) Anastomoses
B) Aorta
C) Vasoconstriction
D) Coronary veins

A) Anastomoses

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The right atrium receives blood from the systemic circulation and the _________.

A) Left ventricle
B) Coronary vein
C) Pulmonary arteries
D) Pulmonary veins

B) Coronary vein

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What is the valve between the right atrium and the right ventricle?

A) Tricuspid valve
B) Mitral valve
C) Semilunar valve
D) Pulmonic valve

A) Tricuspid valve

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What term describes the relaxation of the heart?

A) Systole
B) Diastole
C) Refractory period
D) Propagation

B) Diastole

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Stroke volume depends on preload, afterload, and what other factor?

A) Blood pressure
B) Vascular resistance
C) Heart rate
D) Myocardial contractility

D) Myocardial contractility

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What does Sartling’s law state?

A) Heart rate increases as oxygen demands increase
B) Myocardial fibers contract more forcefully when they are stretched
C) Afterload increases with increased blood pressure
D) Stroke volume decreases when the preload decreases

B) Myocardial fibers contract more forcefully when they are stretched

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What is the most important factor in determining stroke volume in a healthy heart?

A) Preload
B) Afterload
C) Heart rate
D) Myocardial contractility

A) Preload

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What does an increase in peripheral vascular resistance cause?

A) Increased stroke volume
B) Decreased stroke volume
C) Only minimally affects stroke volume
D) Doubles stroke volume

B) Decreased stroke volume

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To increase cardiac output, what action must take place?

A) Increase heart rate and decrease stoke volume
B) Decrease heart rate and increase stroke volume
C) Increase both heart rate and stroke volume
D) Decrease both heart rate and stroke volume

C) Increase both heart rate and stroke volume

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The right coronary artery and the left anterior descending artery supply most of the blood to what part of the cardiac muscle?

A) Septum
B) Left atrium
C) Lateral left ventricle
D) Right atrium and ventricle

D) Right atrium and ventricle

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The circumflex branch of the left coronary artery mainly supplies blood to what part of the cardiac muscle?

A) Right atrium
B) Right Ventricle
C) Left ventricle
D) Intrinsic pacemakers

C) Left ventricle

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The left anterior descending coronary artery mainly supplies blood to what part of the cardiac muscle?

A) Septum
B) Left atrium
C) Lateral right ventricle
D) Intrinsic pacemakers

A) Septum

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How is preload defined?

A) Ventricular end-diastolic volume
B) Ventricular pre-diastolic volume
C) Atrial end-diastolic volume
D) Atrial pre-diastolic volume

A) Ventricular end-diastolic volume

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What is the group of nerves that innervates the atria and ventricles know as?

A) Brachial plexus
B) Aortic plexus
C) Cardiac plexus
D) Carotid plexus

C) Cardiac plexus

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What is the major neurotransmitter for the parasympathetic system?

A) Norepinephrine
B) Epinephrine
C) Dopamine
D) Acetylcholine

D) Acetylcholine

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Which of these nerve fibers mainly innervate the ventricles of the heart?

A) Parasympathetic nerve fibers
B) Sympathetic nerve fibers
C) Somatic nerve fibers
D) Efferent nerve-fibers

B) Sympathetic nerve fibers

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What is parasympathetic control of the heart provided by?

A) Subclavian nerve
B) Fourth cranial nerve
C) Phrenic nerve
D) Vagus nerve

D) Vagus nerve

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The resting membrane potential is determined primarily by the difference between the intracellular potassium ion level and what ion level?

A) Extracellular potassium
B) Intracellular sodium
C) Extracellular magnesium
D) Intracellular calcium

A) Extracellular potassium

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When depolarization takes place, what action occurs?

A) Magnesium ions rush into the cell
B) Sodium ions rush into the cell
C) Potassium ions rush out of the cell
D) Calcium ions rush out of the cell

B) Sodium ions rush into the cell

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What is the movement function of the sodium-potassium pump?

A) Sodium ions into the cell and potassium ions out of the cell
B) Potassium ions into the cell and sodium ions out of the cell
C) Sodium and potassium ions into the cell
D) Sodium and potassium ions out of the cell

B) Potassium ions into the cell and sodium ions out of the cell

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Phase I of the action potential represents what period?

A) Rapid depolarization
B) Early rapid repolarization
C) Plateau
D) Rest between action potentials

B) Early rapid repolarization

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What occurs during the period between action potentials? A) The inside of the cell is positive in relation to the outside of the cell B) There is excessive sodium in the cell C) There is excessive potassium in the cell D) Pacemaker cells are rapidly repolarizing

B) There is excessive sodium in the cell

The AV junction is formed by the AV node and what other part of the cardiovascular electrical system? A) SA node B) Right ventricle C) Bundle of His D) Left bundle branch

C) Bundle of His

Under normal conditions, what is the dominant pacemaker of the heart? A) AV node B) Bundle of His C) SA node D) Purkinje fibers

C) SA node

You are treating a patient who has a damaged SA node that is no longer pacing the heart. What cardiac finding should the paramedic expect to find? A) Bradycardia B) Tachycardia C) Asystole D) Fibrillation

A) Bradycardia

Which cardiac pacemaker has an intrinsic rate of 40-60 beats per minute? A) SA node B) Atria C) AV junction D) Purkinje fibers

C) AV junction

How does acetylcholine affect the heart? A) Increasing heart rate B) Decreasing heart rate C) Increasing contractility D) Decreasing contractility

B) Decreasing heart rate

What is the activation of myocardial tissue more than one time by the same impulse called? A) Automaticity B) Excitability C) Doubling D) Reentry

D) Reentry

Which is a bipolar lead? A) V1 B) aVF C) aVR D) Lead II

D) Lead II

In lead II ECG placement, where is the positive lead located? A) Left arm B) Left leg C) Right shoulder D) Right leg

B) Left leg

A paramedic places 10 leads: 4 on the limbs and 6 on the chest. What type of ECG is the paramedic obtaining? A) Standard 3-lead B) 10-lead C) 12-lead D) Modified

C) 12-lead

Paramedics are preparing for a 12-lead ECG. The paramedic has located the 4th intercostal space just to the right of the sternum. What lead should be placed in this location? A) V1 B) V2 C) V3 D) V4

A) V1

What kind of leads are leads II and III? A) Inferior B) Superior C) Lateral D) Precordial

A) Inferior

Standard ECG paper is divided into 1-mm blocks and moves past the stylus of the ECG at 25 mm per second. What does each small block represent? A) 0.01 second B) 0.04 second C) 0.10 second D) 0.20 second

B) 0.04 second

Each small square of graph paper represents _____ mV. A) 0.001 B) 0.01 C) 0.1 D) 1

C) 0.1

Each square on ECG paper is ____ mm in height and width. A) 1 B) 2 C) 3 D) 4

A) 1

In a 12-lead ECG, what cardiac position are the leads V1 and V2? A) Anterior B) Inferior C) Septal D) Lateral

C) Septal

_____ second is measured in each large box on the ECG graph paper. A) 0.01 B) 0.04 C) 0.10 D) 0.20

D) 0.20

What statement best describes the triplicate method of determining heart rate? A) Most accurate for children B) Accurate when the heart rhythm is regular and greater than 50 beats per minute C) Used when the heart rate is irregular D) Preferred for patients with rapid ventricular rhythms

B) Accurate when the heart rhythm is regular and greater than 50 beats per minute

When analyzing an ECG tracing, you notice that the rhythm is irregular. What is the best method to calculate the rate? A) Triplicate method B) R-R method C) Six-second count method D) Caliper method

C) Six-second count method

What can an ECG help determine? A) Whether there is ischemic cardiac muscle B) The force of contractions C) The quality of the patient's pulse D) A range of expected blood pressures

A) Whether there is ischemic cardiac muscle

Lead I looks at the heart from what view? A) Inferior B) Superior C) Lateral D) Anterior

C) Lateral

What is the first upward deflection on an ECG tracing? A) A wave B) P wave C) Q wave D) T wave

B) P wave

The PR interval represents the time that it takes an electrical impulse to do which action? A) Generate ventricular contraction B) Be formed in the SA node C) Travel through the Purkinje fibers D) Be conducted through the atria and the AV node

D) Be conducted through the atria and the AV node

The duration of the QRS complex should be _____ second. A) 0.01 to 0.04 B) 0.04 to 0.20 C) 0.08 to 0.10 D) 0.08 to 0.20

C) 0.08 to 0.10

While analyzing an ECG, you cannot identify a Q wave. What does this most likely indicate? A) The patient's heart is ischemic B) The Q wave may not be visible in the lead you are viewing C) The patient has previously had an MI D) The electrodes are placed incorrectly

B) The Q wave may not be visible in the lead you are viewing

What does the ST segment reflect? A) Early repolarization of the ventricles B) Time delay for depolarization of the ventricles C) Absolute refractory period of the ventricles D) Time of ventricular contraction

A) Early repolarization of the ventricles

What lead is routinely used for monitoring dysrhythmias? A) Lead I B) Lead II C) aVL D) V2

B) Lead II

What is a characteristic of normal sinus rhythm? A) Electrical impulse originates from the SA node B) Purkinje fibers delay electrical transmission C) PR interval is greater than 0.24 second D) The QRS complex is greater than 0.18 second

A) Electrical impulse originates from the SA node

ECG analysis reveals that each P wave in the tracing has a different shape. The heart rate is 80 beats per minute. What rhythm should the paramedic suspect? A) P-P morphology B) Wandering pacemaker C) Sinus arrhythmia D) Type II AV block

B) Wandering pacemaker

You see an irregular rhythm on the monitor with a rate of 66 to 80, a normal PR interval, and a P wave for every QRS. The rate speeds up and slows down with the patient's respiratory rate. What rhythm should the paramedic suspect? A) Atrial fibrillation with controlled response B) Atrial flutter with controlled response C) Sinus rhythm with frequent PACs D) Sinus dysrhythmia

D) Sinus dysrhythmia

What is the most likely cause of atrial flutter? A) Hyperexcitability syndrome B) Rapid reentry C) Enhanced conduction channels D) Ectopic atrial pacemakers

B) Rapid reentry

What is a characteristic of the junctional escape rhythm? A) Pathologic response to bradycardia B) Occurs when the SA node fails to fire at a rate higher than the AV node C) Typically occurs at a rate of 60-80 beats per minute D) Should be aggressively treated to prevent ventricular fibrillation

B) Occurs when the SA node fails to fire at a rate higher than the AV node

An ECG strip shows a rhythm with a rate of 45, a QRS of 0.08, and a P wave that appears after the QRS. What dysrhythmia should the paramedic suspect? A) Idioventricular B) Sinus bradycardia C) Atrial fibrillation D) Junctional

D) Junctional

The intrinsic rate for a ventricular pacemaker is ____ beats per minute. A) 20 to 40 B) 40 to 60 C) 60 to 100 D) 100 to 150

A) 20 to 40

A patient has a regular bradycardic rhythm with a rate of 40, no P waves, and a QRS greater than 0.12. The paramedic should diagnose what rhythm? A) Sinus bradycardia with aberrancy B) Junctional escape with aberrancy C) Atrial fibrillation with slow response D) Ventricular escape rhythm

D) Ventricular escape rhythm

What is the meaning of sinus bradycardia? A) The patient has chest pain associated with the rhythm B) The patient has fainted with this rhythm C) The heart rate is less than 60 beats per minute D) There is associated hypotension

C) The heart rate is less than 60 beats per minute

What does an elevated ST segment suggest? A) Ischemia B) Injury C) Infarction D) Necrosis

B) Injury

What does a depressed ST segment suggest? A) Ischemia B) Injury C) Infarction D) Necrosis

A) Ischemia

What part of the ECG tracing is most important for detecting life-threatening arrhythmias? A) P wave B) PR interval C) QRS complex D) ST segment

C) QRS complex

Use the following information to answer the next two questions: While evaluating a 22-year-old female runner, paramedics discover her heart rate is 46. The P waves are normal and upright, the PR interval is 0.16 second and the QRS complex looks normal. There is a QRS complex following each P wave. Her skin condition, mental status, and blood pressure are normal. What rhythm does the ECG tracing reflect? A) Normal sinus rhythm B) First-degree block C) Sinus arrhythmia D) Sinus bradycardia Treatment for this patient's heart rate should include: A) No treatment at this time B) 0.5 mg Atropine IVP C) Dopamine drip D) Epinephrine drip

D) Sinus bradycardia A) No treatment at this time

An ECG strip shows a regular rhythm with a QRS complex of 0.08, a rate of 145, a PR interval of 0.12, and one upright P wave before each QRS complex. What rhythm should the paramedic suspect? A) Sinus tachycardia B) Supraventricular tachycardia C) Atrial tachycardia D) Atrial fibrillation

A) Sinus tachycardia

You are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. Which rhythm should the paramedic most likely suspect? A) SVT B) Atrial fibrillation C) Atrial flutter D) Multifocal atrial tachycardia

A) SVT

What may be a lethal treatment for a patient with a ventricular escape rhythm? A) Atropine B) Dopamine C) Transcutaneous pacing D) Lidocaine

D) Lidocaine

Paramedics are treating a patient who is complaining that his heart is "skipping beats". On ECG evaluation, paramedics see frequent PVC's that are occurring in groups of two. The patient's blood pressure is 110 systolic. What should the treatment for this patient include? A) Withhold treatment until serious signs and symptoms develop B) Immediate transcutaneous pacing C) High flow oxygen and lidocaine D) Atropine and dopamine

A) Withhold treatment until serious signs and symptoms develop

What is the treatment of choice for a severe symptomatic ventricular escape rhythm? A) Atropine B) Pacing C) Lidocaine D) Epinephrine

B) Pacing

Which statement is true regarding ventricular tachycardia? A) The rate must be higher than 150 beats per minute B) It may be triggered by a PVC C) Caused when the ventricles beat before the atria D) Cannot be associated with stable vital signs

B) It may be triggered by a PVC

Patients with pulseless ventricular tachycardia should be treated in the same way as what other dysrhythmia? A) Asystole B) PEA C) Ventricular fibrillation D) Supraventricular tachycardia

C) Ventricular fibrillation

What is the class I intervention for all symptomatic bradycardia? A) Atropine B) Dopamine C) Transcutaneous pacing D) There are no class I interventions

D) There are no class I interventions

A patient with SVT develops chest pain and the blood pressure drops to 100/60. What treatment should be implemented next? A) Adenosine rapid IV push B) Diltiazem IVP bolus C) Carotid sinus massage D) Synchronous cardioversion

D) Synchronous cardioversion

What is the joule setting for the initial synchronous cardioversion of SVT? A) 25 J B) 50 J C) 120 J D) 300 J

B) 50 J

When attempting to perform a vagal maneuver on a child, what action is most appropriate? A) Deep carotid massage B) Placement in the Trendelenburg's position C) Jugular vein massage D) Placing ice packs to the neck

D) Placing ice packs to the neck

What is a hallmark trait of atrial fibrillation? A) An irregularly irregular rhythm B) Multifocal PVCs C) P waves following the QRS complex D) 1:3 conduction through the AV node

A) An irregularly irregular rhythm

Paramedics have determined that a patient is in atrial fibrillation, unstable, and requires electrical therapy. Paramedics should perform _____ countershock with ____joules. A) Unsynchronized: 50 B) Synchronized: 50 C) Unsynchronized: 100 D) Synchronized: 120

D) Synchronized: 120

Which of the following is NOT a laboratory assessment for determining if a patient is suffering from acute myocardial infarction? A) CK B) CK-MB C) Troponin D) KCL

D) KCL

On an electrocardiogram (ECG), how will pulseless electrical activity present? A) Ventricular fibrillation B) Ventricular tachycardia C) Any electrical activity other than ventricular fibrillation or ventricular tachycardia D) Asystole

C) Any electrical activity other than ventricular fibrillation or ventricular tachycardia

Second-degree type II heart block occurs when the impulse is not conducted through what portion of the cardiac electrical system? A) SA node B) AV node C) Purkinje fibers D) Bundle branches

D) Bundle branches

Paramedics are evaluating an ECG tracing that shows wide QRS complexes that were produced by supraventricular activity. On V1, paramedics see a QS pattern. What should paramedics suspect? A) The patient has had an MI B) Right bundle-branch block C) Left bundle-branch block D) Myocardial ischemia

C) Left bundle-branch block

A right axis shift of the ECG is noted when the QRS deflection has what characteristic? A) Positive in leads I, II, and III B) Positive in leads I and II but negative in lead III C) Positive in lead I and negative in leads II and III D) Negative in lead I, negative or positive in lead II and positive in lead III

D) Negative in lead I, negative or positive in lead II and positive in lead III

What is emergency care for a bundle-branch block? A) Aimed at the cause of the block if it is identifiable B) Administration of atropine C) High-level doses of dopamine D) Transcutaneous pacing

A) Aimed at the cause of the block if it is identifiable

Paramedics are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, paramedics note that his ventricular heart rate is 56 and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are widened. What type of heart block should the paramedic suspect? A) First-degree B) Second-degree type I C) Second-degree type II D) Third-degree

C) Second-degree type II

Which statement is true in regards to the identification of bundle-branch blocks? A) Not important in the prehospital setting B) Helpful in identifying patients who have had an MI C) Can only be determined with a 12-lead ECG D) Impossible without specialized equipment such as a Doppler

C) Can only be determined with a 12-lead ECG

What is typically found on an ECG with a bundle-branch block? A) A narrow QRS complex B) QRS complexes of ventricular origin C) A widened QRS complex D) A normal PR interval

C) A widened QRS complex

What is a characteristic of a left bundle-branch block? A) Less serious than in a right bundle-branch block B) A Q wave is seen instead of an R wave in MCL1 C) The conduction is delayed through the right ventricle D) The QRS complex is less than 0.12 second

B) A Q wave is seen instead of an R wave in MCL1

What does T wave inversion suggest? A) Ischemia B) Injury C) Infarction D) Necrosis

A) Ischemia

What is the most common arrhythmia in sudden cardiac arrest? A) Ventricular tachycardia B) Ventricular fibrillation C) Asystole D) PEA

B) Ventricular fibrillation

A paramedic notes deep and symmetrically inverted T waves. Of what may this be indicative? A) Current myocardial infarction B) Hyperkalemia C) Cardiac ischemia D) Sodium depletion

C) Cardiac ischemia

How should a second-degree type II heart block be considered? A) Benign arrhythmia B) Serious arrhythmia only if there are serious signs and symptoms C) Serious arrhythmia regardless of signs and symptoms D) Lethal arrhythmia if not immediately treated

C) Serious arrhythmia regardless of signs and symptoms

What is the most likely cause of a second-degree type II heart block? A) Septal MI B) Lateral MI C) Drug toxicity D) Hypoxia

A) Septal MI

What is a typical characteristic of a third-degree heart block? A) Regular atrial rhythm with irregular ventricular rhythm B) Irregular atrial rhythm with regular ventricular rhythm C) Regular but independent atrial and ventricular rhythms D) No regularity in the atrial or ventricular rhythms

D) No regularity in the atrial or ventricular rhythms

What sound is heard when the AV valves close during ventricular systole? A) S1 B) S2 C) S3 D) S4

A) S1

After paramedics administer nitroglycerine 0.4 mg SL to a patient with chest pain who has ST-segment elevation in leads II, III, and AVF, the patient's blood pressure drops to 78/50 mm Hg. Where is the most likely location of the cardiac muscle damage? A) Anterior wall, which impairs left ventricular function B) Inferior wall and right ventricle, which increases the dependence on preload C) Lateral wall, which impairs conduction D) Septal wall, which increases the sensitivity to nitrates

B) Inferior wall and right ventricle, which increases the dependence on preload

The patient's ST segment elevation is seen in leads II, III, and aVF. What should the paramedic suspect? A) Inferior-wall MI B) Lateral-wall MI C) Anterior MI D) Septal-wall MI

A) Inferior-wall MI

In what patient position should jugular vein distention in cardiac patients be evaluated? A) Sitting straight up B) Leaning forward C) Lying flat D) With the head elevated 45 degrees

D) With the head elevated 45 degrees

What is the first recommended treatment for SVT? A) Valsalva maneuver B) Carotid sinus massage C) Synchronous cardioversion D) No treatment required

A) Valsalva maneuver

What is the prehospital care for a patient in second-degree type II heart block? A) Lidocaine administration B) Amiodarone administration C) Synchronous cardioversion D) Transcutaneous pacing

D) Transcutaneous pacing

Which home medicines would indicate that your patient has a strong risk factor for heart disease? A) Carbamazepine B) Levodopa C) Metformin D) Levothyroxine

C) Metformin

An inferior-wall MI is usually caused by occlusion of the ______artery. A) Right coronary B) Left anterior descending C) Circumflex D) Left coronary

A) Right coronary

If atrial fibrillation has been present for more than 48 hours, conversion of the rhythm may lead to what complication? A) Release of emboli B) Sudden ventricular fibrillation C) Refractory hypotension D) Rebound tachycardia

A) Release of emboli

Paramedics discover a patient in asystole. In regards to electrical therapy, how should the paramedic proceed? A) Attempt to pace immediately B) Synchronize cardioversion at 100 joules initially C) Deliver an initial unsynchronized shock of 200 joules D) Electrical therapy is not recommended

D) Electrical therapy is not recommended

Which rhythm is an absolute indication for unsynchronized cardioversion? A) Ventricular tachycardia B) Pulseless electrical activity C) Ventricular fibrillation D) Asystole

C) Ventricular fibrillation

Which is not a correctable cause of PEA in the field? A) Tension pneumothorax B) Pulmonary embolism C) Myocardial infarction D) Ischemia during resuscitation

D) Ischemia during resuscitation

What is a characteristic of Wolff-Parkinson-White syndrome? A) Preexcitation syndrome B) Type of AV block C) Bradycardic rhythm caused by sick sinus syndrome D) Tachycardia rhythm as a result of increased automaticity in the cardiac cells

A) Preexcitation syndrome

Wolff-Parkinson-White syndrome is of little clinical importance unless the patient is experiencing what condition? A) Hypoxia B) Tachycardia C) Bradycardia D) Heart murmur

B) Tachycardia

The three characteristics of Wolff-Parkinson-White syndrome are a short PR interval, QRS widening and a(n) ________. A) J notch B) Q complex C) Delta wave D) Alpha spike

C) Delta wave

What is the definitive treatment for second-degree type II? A) Atropine administration B) Dopamine administration C) Transcutaneous pacemaker placement D) Transvenous pacemaker insertion

D) Transvenous pacemaker insertion

Paramedics are treating a patient who is in PEA following home dialysis. Which drug may be indicated? A) Lidocaine B) Sodium bicarbonate C) Calcium chloride D) Potassium chloride

B) Sodium bicarbonate

Pacemakers are usually set to a rate of ____ beats per minute beginning with _____ milliamps. A) 80 to 120; 80 B) 40 to 70; 75 C) 60 to 100; 100 D) 70 to 80; 50

D) 70 to 80; 50

What is a major effect of norepinephrine? A) Bronchoconstriction B) Uterine relaxation C) Renal artery dilation D) Vasoconstriction

D) Vasoconstriction

How will parasympathetic stimulation affect the heart? A) A decreased heart rate B) An increased force of contraction C) Dilation of the coronary arteries D) No effect at all

A) A decreased heart rate

Which statement best describes the firing characteristics of demand pacemakers? A) Continuously at a rate of 80 beats per minute B) When the patient's rate drops below a preset number C) In the atria first and then in the ventricles D) At an adjusted rate based on the patient's activities

B) When the patient's rate drops below a preset number

When is synchronized cardioversion most acceptable for patients with ventricular tachycardia? A) When the patient is pulseless B) If they have decreased cardiovascular function C) Following two trials of drug therapy D) When the patient is symptomatic

B) If they have decreased cardiovascular function

You are treating a 75-year-old woman who has a history of diabetes and atherosclerosis. Her chief complaint is persistent heartburn. What should the paramedic suspect? A) This event is not related to her heart because she feels no chest pain B) This may be a cardiovascular problem C) It this is a cardiovascular event, she will develop chest pain or shortness of breath D) Treatment for diabetes is more appropriate than treatment for cardiovascular problems

B) This may be a cardiovascular problem

What is a compensatory mechanism of the heart in the presence of chronic hypertension? A) Enlarge the muscle mass of the heart B) Reduce the stroke volume C) Lower the heart rate D) Produce lower cardiac output

A) Enlarge the muscle mass of the heart

What organ(s) is at most risk in a hypertensive crisis? A) Kidneys B) Lungs C) Liver D) Eyes

A) Kidneys

During an assessment, the paramedic discovers a carotid bruit. What underlying condition should the paramedic suspect? A) A previous MI B) An irregular heart rhythm C) Atherosclerosis D) Pulmonary hypertension

C) Atherosclerosis

What is a characteristic of atherosclerosis? A) Progressive narrowing of the lumen of medium and large arteries B) Blood clots forming because of high blood cholesterol C) Occluded coronary arteries D) Plaques forming in the smallest arteries where there is smooth blood flow

A) Progressive narrowing of the lumen of medium and large arteries

What is a characteristic of Prinzmetal angina? A) Coronary arteries are totally blocked B) Patients have angina on exertion only C) Angina is progressively worsening D) Coronary arteries spasm

D) Coronary arteries spasm

What are most myocardial infarctions caused by? A) Acute thrombotic occlusion B) Coronary spasm C) Coronary embolism D) Severe hypoxia

A) Acute thrombotic occlusion

The majority of acute myocardial infarctions involve what section of the heart? A) Left ventricle B) Right ventricle C) The anterior portion of both ventricles D) The inferior portion of both ventricles

A) Left ventricle

What is a sign of cardiac tamponade? A) Bradycardia B) Flat neck veins C) Decreased venous pressure D) Muffled heart tones

D) Muffled heart tones

What is a patient in left ventricular failure expected to have? A) Bradycardia B) Vasodilation C) Activation of the renin-angiotensin-aldosterone system D) Increased stroke volume

C) Activation of the renin-angiotensin-aldosterone system

If the left ventricle loses 25% of its muscle mass because of myocardial infarction, what affect will that have? A) The patient is likely to die B) The heart can still pump effectively C) The patient will always have angina D) The right ventricle must take over some of the pumping activities of the left ventricle

B) The heart can still pump effectively

When performing CPR on an adult, how many inches should the paramedics compress the chest? A) ½ to 1 inches B) 1 to 1 ½ inches C) 1 ½ to 2 inches D) At least 2 inches

D) At least 2 inches

What is the first medication a paramedic should administer to a patient with angina? A) Oxygen B) Aspirin C) Nitroglycerin D) Morphine

A) Oxygen

What is the position of comfort for a patient with left ventricular failure? A) Sitting with legs dependent B) Trendelenburg's C) Left lateral recumbent D) Supine with head raised

A) Sitting with legs dependent

What is the desired action of prehospital medications when treating a patient with left ventricular failure? A) Increase preload B) Reduce afterload C) Reduce contractile function of the heart D) Increase venous return

B) Reduce afterload

What sign is most indicative of a right ventricular infarct? A) Foamy, blood-tinged sputum B) Adventitious lung sounds C) Peripheral edema D) Orthopnea

C) Peripheral edema

If a patent is in cardiogenic shock, when should signs of cardiogenic shock develop? A) When chest pain has been relived B) After hypovolemia and dysrhythmias have been corrected C) After fibrinolytic therapy has been administered D) When the patient has received surgical interventions

B) After hypovolemia and dysrhythmias have been corrected

What drug may improve the symptoms of cardiogenic shock patients in the field? A) Diltiazem B) Furosemide C) Dopamine D) Atropine

C) Dopamine

What will occur if the paddle positions are switched (if the apex paddle is applied to the sternum and the sternum paddle to the apex) during defibrillation? A) Only half the energy will be delivered B) The monitor will not fire C) QRS complexes will be upright on a quick look D) Defibrillation will occur as usual

D) Defibrillation will occur as usual

If a patient with cardiac tamponade becomes hypotensive in the field, what should the paramedic do? A) Administer nitroglycerin B) Begin CPR C) Administer a fluid bolus D) Intubate

C) Administer a fluid bolus

What are aneurysms most commonly the result of? A) Atherosclerotic disease B) Infectious disease C) Traumatic injury D) Genetic disorders

A) Atherosclerotic disease

Which is true of abdominal aortic aneurysm (AAA)? A) AAA is more commonly seen in women B) AAA occurs most commonly in patients between the ages of 35 and 50 C) AAA may be asymptomatic as long as it is stable D) AAA is commonly found above the renal arteries

C) AAA may be asymptomatic as long as it is stable

How do patients usually describe the pain of an aortic dissection? A) Mild and tolerable B) Ripping or tearing C) Crushing pressure D) Dull and throbbing

B) Ripping or tearing

Paramedics are called to the local airport to evaluate a 40-year-old obese woman who is complaining of pain in her left lower leg. She has just completed a 12-hour flight and the pain developed as she got off of the plane. Her leg is warm, swollen, and painful. What should paramedics suspect? A) Arterial occlusion of the popliteal artery B) Dissection of the femoral artery C) Deep-vein thrombosis D) A venous aneurysm

C) Deep-vein thrombosis

Which illness/complication may cause sinus bradycardia? A) Hyperthermia B) Intrinsic sinus node disease C) Hypercapnia D) Increased sympathetic tone

B) Intrinsic sinus node disease

What is the most common cause of death following myocardial infarction? A) Acidosis B) Electrolyte imbalance C) Ruptured myocardium D) Fatal dysrhythmia

D) Fatal dysrhythmia

What is right ventricular failure most often the result of? A) Hypoxia B) Hypertension C) Myocardial infarction D) Left ventricular failure

D) Left ventricular failure

When does synchronous cardioversion deliver the energy? A) 10 ms after the peak of the R wave B) During the relative refractory period C) On top of the QRS complex D) At the beginning of the P wave

A) 10 ms after the peak of the R wave

What is an undesirable side effect of atropine? A) Ventricular conduction delays B) Decreased conduction through the SA node C) Increased heart rate D) Increased myocardial oxygen demand

A) Ventricular conduction delays

What property of dopamine causes an increased heart rate? A) Alpha agonist B) Alpha antagonist C) Beta agonist D) Beta antagonist

C) Beta agonist

What does the medication atropine inhibit? A) Alpha receptors B) Beta receptors C) Sympathetic response D) Parasympathetic response

D) Parasympathetic response

When is fibrinolytic therapy for an MI patient most effective? A) If a patient has an inferior-wall MI B) If the patient is less than 45 years of age C) When administered within 12 hours after the onset of symptoms D) When chest pain cannot be resolved with nitroglycerin or morphine

D) When chest pain cannot be resolved with nitroglycerin or morphine

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