Chapter 14 EMT

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A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours’ duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should

administer oxygen, give her 2 (81mg each tablet) chewable aspirin, and assess her further.

Which of the following blood vessels transports oxygenated blood?

pulmonary veins

You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the scene, the patient’s wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow respirations; and has a thready pulse. You should:

begin ventilatory assistance.

Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:

assess the scene for potential hazards.

Blood that is ejected from the right ventricle:

flows into the pulmonary arteries.

Prompt transport of a patient with a suspected AMI is important because:

the patient may be eligible to receive thrombolytic therapy.

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:

dilating the affected coronary artery with a small inflatable balloon.

The head and brain receive their supply of oxygenated blood from the:

carotid arteries.

An acute myocardial infarction (AMI) occurs when:

myocardial tissue dies secondary to an absence of oxygen.

The iliac arteries immediately subdivide into the

femoral arteries.

Deoxygenated blood from the body returns to the

right atrium.

Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?

aspirin

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:

assess the adequacy of his respirations.

Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?

a rapid heart rate

When the myocardium requires more oxygen

the arteries supplying the heart dilate.

Which of the following would cause the greatest increase in cardiac output?

increased heart rate and increased stroke volume

Ventricular tachycardia causes hypotension because:

the left ventricle does not adequately fill with blood

Angina pectoris most commonly occurs when:

myocardial oxygen demand exceeds the supply

The descending aorta divides into the two iliac arteries at the level of the

umbilicus.

A patient with atherosclerotic heart disease experiences chest pain during exertion because the:

lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

After assisting your patient with his or her nitroglycerin, you should

reassess the blood pressure within 5 minutes to detect hypotension.

Defibrillator pads are placed on the patient’s chest with one pad to the

right of the upper sternum and the other pad just to the left and below the left nipple.

When treating a patient with chest pain, you should assume that he or she is having an AMI because:

the cause of the pain cannot be diagnosed in the field.

The purpose of defibrillation is to:

stop the chaotic, disorganized contraction of the cardiac cells.

When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin?

chest pain that does not immediately subside with rest

Which of the following statements regarding the AED and defibrillation is correct?

The AED will not analyze the rhythm of a moving patient.

The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.

coronary arteries, aorta

Cardiac output may decrease if the heart beats too rapidly because

there is not enough time in between contractions for the heart to refill completely.

A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes:

placing her in an upright position.

Nitroglycerin relieves cardiac-related chest pain by

dilating the coronary arteries and improving cardiac blood flow.

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:

brain

Prior to assisstin a patient with his or her prescribed nitroglycerin, the EMT should:

obtain authorization from medical control

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:

stop the ambulance, begin CPR, and attach the AED as soon as possible

The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:

automaticity.

When the myocardium requires more oxygen:

the arteries supplying the heart dilate.

A dissecting aortic aneurysm occurs when:

the inner layers of the aorta become separated.

In contrast to monophasic defibrillation, biphasic defibrillation:

requires a lower energy setting.

You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:

begin high-quality CPR and apply the AED without delay.

The MOST common error associated with the use of the AED is

failure of the EMT to ensure the battery is charged

Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm?

ventricular tachycardia

Acute coronary syndrome (ACS) is a term used to describe:

a group of symptoms that are caused by myocardial ischemia.

Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:

have chronic hypertension.

Blood that is ejected from the right ventricle

flows into the pulmonary arteries.

The posterior tibial pulse can be palpated

behind the medial malleolus.

The AED is MOST advantageous to the EMT because:

it delivers prompt defibrillation to patients with ventricular fibrillation.

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:

congestive heart failure.

What is the function of the left atrium?

It receives oxygenated blood from the lungs.

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by

dilating the affected coronary artery with a small inflatable balloon.

Risk factors for AMI that cannot be controlled include:

family history.

In contrast to the sympathetic nervous system, the parasympathetic nervous system

slows the heart and respiratory rates.

The purpose of defibrillation is to

stop the chaotic, disorganized contraction of the cardiac cells.

Major risk factors for AMI include all of the following, EXCEPT:

hypoglycemia.

Nitroglycerin is contraindicated in patients

who have experienced a head injury.

when an electrical impulse reaches the AV node, it is slowed for a brief period of time so that :

blood can pass from the atria to the ventricles.

Prior to defibrillating a patient with an AED, it is MOST important that you:

ensure that no one is touching the patient.

Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?

hypotension and flat jugular veins

The electrical stimulus that originates in the heart’s primary pacemaker is controlled by impulses from the brain that arrive by way of the:

autonomic nervous system.

Common side effects of nitroglycerin include all of the following, EXCEPT

hypertension.

After the AED has delivered a shock, the EMT should:

immediately resume CPR.

The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they

are in denial

Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS

three

Which of the following statements regarding nitroglycerin is correct?

Nitroglycerin usually relieves anginal chest pain within 5 minutes.

A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient’s wife tells you that he has an implanted pacemaker. The AED advises that a shock is indicated. What should you do?

Deliver the shock followed by immediate resumption of CPR.

Sudden death following AMI is MOST often caused by:

ventricular fibrillation.

When documenting a patient’s description of his or her chest pain or discomfort, the EMT should:

use the patient’s own words.

Which of the following statements regarding the pain associated with AMI is correct?

It can occur during exertion or when the patient is at rest.

Prior to attaching the AED to a cardiac arrest patient, the EMT should:

dry the chest off if it is wet

Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort?

family history of hypertension

Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a "no shock advised" message. You should:

perform CPR for 2 minutes and reassess

Cardiogenic shock following AMI is caused by:

decreased pumping force of the heart muscle

The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you reanalyze the patient’s cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to:

reassess airway and breathing and treat accordingly

Which of the following is a major difference between angina pectoris and AMI?

angina pain usually subsides with rest

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What are her signs and symptoms MOST indicative of?

dissecting aortic aneurysm

Which of the following signs is commonly observed in patients with right-sided heart failure?

dependent edema

The electrical impulse generated by the heart originates in the:

sinoatrial (SA) node.

In contrast to AMI, a dissecting aortic aneurysm:

often presents with pain that is maximal from the onset

The right coronary artery supplies blood to the:

right ventricle and inferior wall of the left ventricle.

Which of the following is the MOST reliable method of estimating a patient’s cardiac output?

Assess the heart rate and strength of the pulse.

During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that:

she is not in ventricular fibrillation.

Common signs and symptoms of AMI include all of the following, EXCEPT:

pain exacerbated by breathing.

The left ventricle has the thickest walls because it:

pumps blood into the aorta and systemic circulation.

You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to:

have the bystanders stop CPR and assess the patient.

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