Which of the following would clearly be detrimental to a patient in cardiac arrest?
Interrupting CPR for more than 10 seconds
Reason:
Major emphasis is placed on minimizing interruptions in CPR. Even brief interruptions cause a significant decrease in blood flow to the heart and brain. If you must interrupt CPR, do not exceed 10 seconds.
Prior to administering nitroglycerin to a patient with chest pain, you should:
obtain vital signs to detect hypotension.
Reason:
Prior to assisting a patient with his or her prescribed nitroglycerin, there are two things that you must do: take the patient's vital signs and obtain authorization from medical control. Nitroglycerin is
Which of the following is the BEST indicator of cardiac output?
Pulse rate and quality
Reason:
Cardiac output is the amount of blood ejected from the ventricles each minute. To best obtain an indication of cardiac output, you should assess the rate and quality of the pulse. A rapid, bounding pulse indicates increased
You should suspect that your patient has pulmonary edema if he or she:
cannot breathe while lying down.
Reason:
Pulmonary edema is often caused by failure of the left side of the heart. When the patient is lying down, he or she experiences worsened difficulty breathing (orthopnea) because more blood backs up in the lungs. Pa
Which of the following is a common side effect of nitroglycerin?
Headache
Reason:
Because nitroglycerin (NTG) causes vasodilation, including the vessels within the brain, cerebral blood flow increases following the administration of NTG. This often causes a pounding headache for the patient. As uncomfortable as it is f
You assess an unresponsive 65-year-old man and find that he is apneic and pulseless. The patient's wife tells you that he has an automatic implanted cardioverter/defibrillator. After initiating CPR, you should:
apply the AED as soon as possible and analyze his cardiac rhythm.
Reason:
Some patients who are at high risk for sudden cardiac arrest due to ventricular fibrillation (V-Fib) have a small automatic implanted cardioverter/defibrillator (AICD). The AICD att
Which of the following is MOST indicative of a primary cardiac problem?
Irregular pulse
Reason:
An irregular pulse signifies an abnormality within the electrical conduction system of the heart. Tachycardia, sudden fainting (syncope), and tachypnea (rapid breathing) can indicate many things other than cardiac problems, such as
Aspirin is beneficial to patients experiencing an acute coronary syndrome because it:
prevents a clot from getting larger
Early administration of baby aspirin (160 to 325 mg) to patients with acute coronary syndrome (ACS) has clearly been shown to reduce mortality and morbidity. Aspirin (acetylsalicylic acid [ASA]) prevents the clot in a c
In addition to supplemental oxygen, one of the MOST effective way to minimize the detrimental effects associated with acute coronary syndrome is to:
reassure the patient and provide prompt transport.
Reason:
In addition to increasing the body's oxygen supply with supplemental oxygen, it is extremely important to decrease oxygen demand and consumption. You can most effectively accomplish this by keepin
While assessing a man who is complaining of chest pain, he suddenly becomes unresponsive. You should
assess for breathing.
Reason:
Whether a patient is found unresponsive or becomes unresponsive in your presence, you should immediately assess his or her breathing. Quickly look at the chest for visible rise. If the patient is not breathing (or only has ag
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. As your partner prepares to administer oxygen, you should:
administer up to 325 mg of aspirin if the patient is not allergic to it.
Reason:
Aspirin has clearly been shown to reduce mortality and morbitiy associated with acute coronary syndrome (ACS) and should be given as early as possible; the dose is 160 to 325
How can you help maximize cardiac output during CPR?
Allow the chest to fully recoil in between compressions
Reason:
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 between 25% and 30% of what the patient's card
Aspirin may be contraindicated in patients with:
stomach ulcers.
Reason:
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 expe
Which of the following questions would be MOST appropriate to ask when assessing a patient with chest pain?
What does the pain feel like?
Reason:
When questioning any patient about any type of pain, you should avoid asking leading questions that can simply be answered yes or no. To obtain the most reliable assessment, open-ended questions should be asked to all
During your assessment of a 70-year-old man with crushing chest pain, you note that his blood pressure is 80/50 mm Hg. Your MOST important action should be to:
transport without delay
Reason:
Patients with chest pain, pressure, or discomfort with a systolic BP less than 100 mm Hg should be transported to the hospital without delay. Hypotension in a patient with chest pain indicates cardiogenic shock due to sever
Which of the following types of stroke would MOST likely present with a sudden, severe headache?
Hemorrhagic
Reason:
A stroke occurs when blood flow to a portion of the brain is interrupted. There are two types of stroke: ischemic and hemorrhagic, both of which are acute events. Hemorrhagic stroke is caused by a ruptured artery in the brain, resultin
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:
tell your partner to stop the ambulance.
Reason:
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 recurs en route to the hospital. You should, however, t
When an error occurs while using the AED, it is MOST often the result of:
battery failure secondary to operator error.
Reason:
AEDs have a high specificity for recognizing shockable rhythm (eg, V-Fib, pulseless V-Tach); this means that they are highly reliable. It would be extremely rare for the AED to recommend a shock when on
In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome would MOST likely present with:
ashen skin color, diaphoresis, and anxiety.
Reason:
Chest pain, pressure, or discomfort is the most common symptom of acute coronary syndrome, or ACS (eg, unstable angina, acute myocardial infarction); it occurs in approximately 80% of cases. Patients wit
Sudden cardiac arrest in the adult population MOST often is the result of:
a cardiac arrhythmia.
Reason:
The most common cause of sudden cardiac arrest (SCA) in the adult population is a cardiac arrhythmia�usually ventricular fibrillation�in up to 70% of cases. This fact underscores the importance of early defibrillation to shoc
A middle-aged male was found unresponsive by his wife. When you arrive at the scene, you assess the patient and determine that he is apneic and pulseless. You should:
begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup.
Reason:
As soon as you determine that a patient is unresponsive, pulseless, and apneic, you should begin CPR starting with chest compressions. The appropria
After delivering one shock with the AED and performing 2 minutes of CPR on a woman in cardiac arrest, you reanalyze her cardiac rhythm and receive a no shock advised message. This means that:
she is not in a shockable rhythm.
Reason:
If the AED gives a no shock advised message, it has determined that the patient is not in a shockable rhythm (eg, V-Fib, pulseless V-Tach). It does not indicate that the patient has a pulse, nor does it indicate t
A 66-year-old female presents with an acute onset of confusion, slurred speech, and weakness to her right arm and leg. Her airway is patent and she is breathing adequately. The MOST important initial information to determine regarding this patient is:
when her symptoms were first noted.
Reason:
This patient is experiencing signs of an acute ischemic stroke. She may be a candidate for fibrinolytic therapy, drugs that destroy the clot in the cerebral artery, if her symptoms are of less than 3 hours' dura
The position of comfort for a patient with nontraumatic chest pain MOST commonly is:
semisitting.
Reason:
As with most patients, the position of comfort for cardiac patients typically is the semisitting (semi-Fowler) position. You should allow the patient to remain in the position of comfort both during the assessment phase as well as thr
Which of the following describes pulseless electrical activity (PEA)?
Any organized cardiac rhythm, slow or fast, that does not produce a palpable pulse
Reason:
Pulseless electrical activity (PEA) is a condition in which the heart produces organized electrical activity (slow or fast), despite the absence of a palpable pulse
The energy setting for a biphasic AED:
is manufacturer specific.
Reason:
A biphasic AED sends energy in two directions simultaneously. This is advantageous because it produces a more efficient defibrillation than monophasic defibrillation, which sends energy in only one direction, and uses a l
The automated external defibrillator (AED) should NOT be used in patients who:
are apneic and have a weak carotid pulse.
Reason:
The AED is only applied to patients in cardiac arrest (eg, pulseless and apneic), whether the arrest was witnessed or unwitnessed. According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC),
Which of the following is the MOST appropriate response when a patient with chest pain asks you if he or she is having a heart attack?
I don't know, but we will take good care of you.
Reason:
Patients experiencing chest pain often have a good idea about what is happening, so do not lie or offer false reassurance. Conversely, do not tell the patient they are having a heart attack; this ca
When treating a patient with chest pain, pressure, or discomfort, you should first
place the patient in a position of comfort.
Reason:
An important aspect of treating a patient with chest pain, pressure, or discomfort is to ensure that the patient is in a comfortable position. Most of the time, the patient will already be in this positi
Which of the following structures is the primary pacemaker, which sets the normal rate for the heart?
SA Node
Which of the following statements regarding the automated external defibrillator (AED) is correct?
AEDs can safely be used in infants and children less than 8 years of age
Reason:
According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), the AED can safely be used in infants and children less than 8 years of age. Although a manual defi
Nitroglycerin is contraindicated in all of the following situations, EXCEPT:
history of cardiac bypass surgery.
Reason:
Nitroglycerin (NTG) is a vasodilator drug used to relieve chest pain in patients with cardiac compromise by dilating the coronary arteries and improving blood flow to the heart. Because of its vasodilator effects
The quickest way to reduce cardiac ischemia in a patient experiencing an acute coronary syndrome is to:
sit or lay the patient down.
Reason:
Ischemia is defined as a relative lack of oxygen. In other words, relative to the body's demand for oxygen, its supply is reduced. The quickest way to reduce ischemia in a patient with an acute coronary syndrome, or AC
Which of the following patients is the BEST candidate for the administration of nitroglycerin?
A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg
Reason:
Nitroglycerin should be administered to patients who have the prescribed, unexpired drug with them and a systolic blood pressure of greater than 100 mm Hg. No
Freshly oxygenated blood returns to the heart via the:
pulmonary vein.
Reason:
The pulmonary vein is the only vein that carries oxygen-rich blood. It carries blood from the lungs back to the left atrium. All other veins in the human body, including the vena cavae, carry deoxygenated blood back to the heart. T
Which of the following statements regarding ventricular fibrillation (V-Fib) is correct?
In V-Fib, the heart is not pumping any blood and the patient is pulseless.
Reason:
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 con
A 50-year-old man's implanted defibrillator has fired twice within the last hour. He is conscious and alert and complains of a "sore chest." Further assessment reveals that his chest pain is reproducible to palpation and is localized to the area of his im
prompt transport with continuous monitoring en route.
Reason:
Patients who are high risk for lethal cardiac dysrhythmias (ie, V-Fib, V-Tach) may have an automated implantable cardioverter/defibrillator (AICD). This small device is usually implanted in the
All of the following are components of the Cincinnati stroke scale, EXCEPT:
Pupil Size
Reason:
The Cincinnati Stroke Scale, which tests speech, facial droop, and arm drift, is a reliable tool that should be used during your assessment of a patient suspected of having had a stroke. To test speech, ask the patient to repeat a simpl
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 8
Allowing her to walk to the ambulance
Reason:
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. Giv
Following administration of nitroglycerin to a man with crushing chest pressure, he experiences a significant increase in his heart rate. This is MOST likely the result of
a drop in blood pressure.
Reason:
Nitroglycerin (NTG) is a vasodilator drug. It dilates not only the coronary arteries, but also other arteries in the body. In some patients, NTG may cause a drop in blood pressure, especially if they are taking other medi
In patients with heart disease, acute coronary syndrome is MOST often the result of:
atherosclerosis.
Reason:
In most patients with acute coronary syndrome, or ACS (eg, unstable angina, acute myocardial infarction), atherosclerosis is the underlying problem that causes heart disease. Atherosclerosis is a disorder in which calcium and a fa
Which of the following assessment findings is LEAST suggestive of cardiac compromise?
Palpable pain to the chest
Reason:
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
While transporting an elderly woman who was complaining of nausea, vomiting, and weakness, she suddenly becomes unresponsive. You should:
quickly look at her chest for obvious movement.
Reason:
If a patient is found unresponsive or becomes unresponsive in your presence, your first action should be to assess for breathing; this should be done by quickly (no more than 10 seconds) looking at t
An elderly man is unresponsive and has agonal breathing. You should:
check for a carotid pulse for up to 10 seconds.
Reason:
If a patient is unresponsive and is not breathing or has agonal breathing (also called agonal gasps), you should check for a pulse for at least 5 seconds but no more than 10 seconds. If you can defin
A 45-year-old woman calls EMS because of severe chest pain. When you arrive, she advises you that she has taken two of her husband's nitroglycerin (NTG) tablets without relief. What is your MOST appropriate course of action?
Apply supplemental oxygen and transport the patient to the hospital without delay.
Reason:
You should provide supplemental oxygen and prompt transport to any patient who reports chest pain and does not have prescribed nitroglycerin. An EMT who knowingly a
When assessing a patient who complains of chest pain, which of the following questions would you ask to assess the "R" in OPQRST?
Is the pain in one place or does it move around?
Reason:
The "R" in OPQRST stands for radiation or referred pain. An appropriate way to determine whether the pain radiates or not is to ask the patient if the pain remains in one place or if it moves around
A patient whose artificial pacemaker has failed would MOST likely experience:
weakness and bradycardia.
Reason:
An artificial pacemaker is implanted in a person whose own cardiac electrical conduction system cannot maintain a regular rhythm and rate. If a pacemaker stops working, as when the battery wears out or an internal lead be
Which of the following describes the MOST appropriate method of performing chest compressions on an adult patient in cardiac arrest?
Compress the chest at least 2", allow full recoil of the chest after each compression, minimize interruptions in chest compressions
Reason:
Effective chest compressions are essential for providing blood flow during CPR. To perform adequate chest compressi
A 56-year-old man is found to be pulseless and apneic. His wife states that he collapsed about 5 minutes ago. As your partner gets the AED from the ambulance, you should:
begin CPR, starting with chest compressions.
Reason:
When you arrive on scene and determine that a patient is in cardiac arrest, you should immediately begin CPR, starting with chest compressions. Perform 30 chest compressions and then open the airway and
While assessing a patient with chest pain, you note that his pulse is irregular. This indicates:
abnormalities in the heart's electrical conduction system.
Reason:
An irregular pulse indicates abnormalities in the electrical conduction system of the heart. The electrical conduction system, beginning with the sinoatrial node as the primary pacemaker,
Common signs and symptoms of a hypertensive emergency include:
ringing in the ears, headache, and epistaxis.
Reason:
Although different sources cite various values, most agree that a hypertensive emergency exists when the systolic blood pressure exceeds 180 mm Hg and the diastolic blood pressure exceeds 110 mm Hg. 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 ed
right heart failure.
Reason:
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 sw
Treatment for a patient with congestive heart failure and shortness of breath may include:
up to three doses of sublingual nitroglycerin.
Reason:
Treatment for patients with congestive heart failure (CHF) includes supplemental oxygen as needed to maintain an oxygen saturation equal to or greater than 94%, continuous positive airway pressure (CP
After administering nitroglycerin to a patient with chest discomfort, it is MOST important for you to:
reassess his or her blood pressure within 5 minutes.
Reason:
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 wor
The pain associated with acute aortic dissection:
is typically described as a stabbing or tearing sensation.
Reason:
Aortic dissection occurs when the inner layers of the aorta become separated, allowing blood to flow between the layers at high pressure. This separation of layers significantly weakens th
When performing two-rescuer CPR on an adult patient whose airway has not been secured with an advanced device, you should:
have your partner pause after 30 compressions as you give 2 breaths
Reason:
When performing two-rescuer adult CPR, you should perform cycles of CPR, with a compression to ventilation ratio of 30:2. If the airway is not secured with an advanced device (eg,
A 50-year-old man presents with crushing chest pain of sudden onset. He is diaphoretic, apprehensive, and tachypneic. You should:
apply supplemental oxygen.
Reason:
All of the interventions and assessments listed in this question should be performed on a patient who presents with chest pain, pressure, or discomfort. However, supplemental oxygen is indicated for any patient with a po
You arrive at the scene shortly after a 55-year-old man collapsed. Two bystanders are performing CPR. Your FIRST action should be to:
stop CPR so you can assess breathing and pulse.
Reason:
Upon arriving at a scene where bystander CPR is in progress, you must first confirm that the patient is indeed apneic and pulseless and needs CPR. Bystanders who are not properly trained often perfor
A 58-year-old man is found unresponsive by his wife. According to his wife, he was complaining of a "dull ache" in his chest the day before, but refused to allow her to call 9-1-1. His blood pressure is 70/50 mm Hg, his pulse is 120 beats/min and weak, an
cardiogenic shock.
Reason:
The patient in this scenario likely experienced an acute myocardial infarction the day before. However, because he refused medical care, the infarction has likely damaged a significant portion of his heart, resulting in cardioge
Chest compression effectiveness is MOST effectively assessed by:
palpating for a carotid pulse with each compression.
Reason:
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 p
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:
continue chest compressions until your partner tells you to stand clear.
Reason:
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. How
The myocardium receives its blood supply from the coronary arteries that branch directly from the:
Aorta
Reason:
The aorta, which is the largest artery in the human body, originates immediately from the left ventricle where it branches into the coronary arteries. This allows the myocardium to receive blood that has the highest concentration of oxygen.
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:
assess the patient's breathing effort.
Reason:
If return of spontaneous circulation (ROSC) occurs, your first action should be to reassess the patient's airway status and breathing effort. If the patient is still apneic or is breathing inadequately, conti
Which of the following interventions would the EMT be the LEAST likely to perform while attempting to resuscitate a cardiac arrest patient?
Insertion of a supraglottic airway device.
Reason:
The insertion of advanced airway devices (eg, endotracheal [ET] tube, multilumen airway, supraglottic airway) is generally outside the EMT's scope of practice. However, he or she may be asked to assist a
A 60-year-old man presents with chest pain and difficulty breathing. He is pale, diaphoretic, and in severe pain. As your partner applies supplemental oxygen, you assess his vital signs. His blood pressure is 180/90 mm Hg, pulse is 110 beats/min and irreg
complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital
Reason:
If a patient with suspected cardiac compromise does not have prescribed nitroglycerin (NTG), complete your focused physical exami
You arrive at the scene of a 56-year-old man who collapsed. The patient's wife tells you that he suddenly grabbed his chest and then passed out. Your assessment reveals that he is apneic and pulseless. As your partner begins one-rescuer CPR, you should:
prepare the AED for use.
Reason:
Immediate treatment for a patient in cardiac arrest involves performing CPR and applying the AED as soon as possible. After applying the AED pads to the patient's chest (around your partner's compressing hands), analyze hi
After attaching the AED and pushing the analyze button on an adult patient in cardiac arrest, the AED states that a shock is advised. What cardiac rhythm is the patient MOST likely in?
Ventricular fibrillation
Reason:
Ventricular fibrillation (V-Fib) is the most common initial cardiac dysrhythmia in adult cardiac arrest patients, occurring in up to 75% of all cases. V-Fib is a chaotic quivering of the heart muscle that does not produce
The wall that separates the left and right sides of the heart is called the:
septum.
Reason:
The septum is the wall that separates the left and right sides of the heart. There is a septum for both the atria and the ventricles. The carina is the bifurcation point of the trachea, and the mediastinum is the space between the lungs in
Sudden cardiac arrest in the adult population is MOST often the result of:
a cardiac dysrhythmia.
Reason:
Most cases of sudden cardiac arrest (SCA) in the adult (70% to 75%) are the result of a cardiac dysrhythmia, most commonly ventricular fibrillation (V-Fib). This fact underscores the importance of early defibrillation. Strok
When assessing a patient with a possible stroke, you should recall that:
the patient may be unable to communicate, but can often understand.
Reason:
Some patients who have had a stroke may be unable to communicate (expressive aphasia), but they can often understand what is being said around them; be aware of this possibility.
In which of the following patients is nitroglycerin contraindicated?
53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra
Switching compressors during two-rescuer CPR:
should occur every 2 minutes throughout the arrest.
The chest pain associated with an acute coronary syndrome is often described as:
Pressure
Reason:
The pain associated with acute coronary syndrome (ie, unstable angina, acute myocardial infarction) is commonly described as a feeling of pressure or heaviness, discomfort, or as a crushing pain. Stabbing or sharp (pleuritic) pain is ofte
Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment, she tells you that she is lightheaded and feels like she is going to faint. Her symptoms are MOST likely due to:
low blood pressure.
Reason:
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. Fo
A middle-aged woman took three of her prescribed nitroglycerin tablets after she began experiencing chest pain. She complains of a bad headache and is still experiencing chest pain. You should assume that:
she has ongoing cardiac ischemia.
Reason:
A headache and/or a bitter taste under the tongue are common side effects of nitroglycerin (NTG) that many patients experience. If the patient does not experience these side effects, the NTG may have lost its pote
Ischemic heart disease is a condition in which:
there is a decrease in blood flow to one or more portions of the heart muscle.
Reason:
Chest pain or discomfort that is related to the heart usually stems from a condition called ischemia (insufficient oxygen). Because of a partial or complete blockage of
Which of the following is an abnormal finding when using the Cincinnati stroke scale to assess a patient who presents with signs of a stroke?
One arm drifts down compared with the other side.
Reason:
The Cincinnati Stroke Scale is used to assess patients suspected of experiencing a stroke. It consists of three tests: speech, facial droop, and arm drift. Abnormality in any one of these areas ind
A 60-year-old man is in cardiac arrest. You begin CPR while your partner applies the AED. What should you do if you receive a no shock message?
Resume CPR, starting with chest compressions.
Reason:
If the AED gives a no shock advised message, you should immediately resume CPR, starting with chest compressions. After 2 minutes of CPR, reanalyze the patient's cardiac rhythm and follow the AED voice
Which of the following statements regarding one-rescuer CPR is correct?
The chest should be allowed to fully recoil after each compression
Reason:
When performing CPR on any patient, you should allow the chest to fully recoil after each compression. Incomplete chest recoil causes increased intrathoracic pressure, which may im
The middle, muscular layer of the heart is called the:
myocardium.
Reason:
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
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:
assess his airway and ventilatory status.
Reason:
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, co
Which of the following chambers of the heart has the thickest walls?
Left ventricle
Reason:
The left ventricle is the most powerful chamber of the heart. It does most of the work; therefore, it has the thickest walls. A palpable pulse represents left ventricular contraction. Because the left ventricle does most of the work
Which of the following patients would be the LEAST likely to present with classic signs and symptoms of acute myocardial infarction?
72-year-old female with diabetes and hypertension.
Reason:
Chest pain, pressure, or discomfort (usually lasting greater than 15 minutes) is present in the majority of patients experiencing acute myocardial infarction (AMI). Other common signs and symptoms
Which of the following statements regarding sudden cardiac arrest and ventricular fibrillation is correct?
For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%.
Reason:
Ventricular fibrillation (V-Fib), a chaotic quivering of the heart muscle, is the most common dysrhythmia that results in sudden cardiac arrest (SC
The AED analyzes your pulseless and apneic patient's cardiac rhythm and advises that a shock is NOT indicated. You should:
resume CPR, starting with chest compressions.
Reason:
If the AED advises "no shock," you should immediately resume CPR, starting with chest compressions. Unless the patient starts to move or has other signs of life (ie, coughing), stopping CPR to assess f
You should be MOST suspicious that a patient with chest pressure has an underlying cardiac problem if his or her pulse is:
Irregular
Reason:
Of the choices listed, an irregular pulse should make you the most suspicious that a patient with chest pain, pressure, or discomfort has an underlying cardiac problem. An irregular pulse indicates a cardiac dysrhythmia (abnormal cardiac
You have analyzed a cardiac arrest patient's rhythm three times with the AED, separated by 2-minute cycles of CPR, and have received no shock messages each time. You should:
continue CPR and transport at once.
Reason:
Although protocols vary from system to system, it is generally agreed that if you receive three consecutive no shock messages, separated by 2-minute cycles of CPR, you should continue CPR and transport at once;
Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction?
72-year-old female with diabetes
Reason:
Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfo
Your assessment of a middle-aged female with chest pressure reveals that she is confused, diaphoretic, and has a blood pressure of 70/50 mm Hg. In caring for this patient, it is MOST important for you to:
prepare for immediate transport to the hospital.
Reason:
Your patient is in shock, which is most likely the result of heart failure (cardiogenic shock). Immediate transport to the closest appropriate hospital is critical. Assess for and manage problems wi
Which of the following is the MOST detrimental effect that tachycardia can have on a patient experiencing a cardiac problem?
Increased oxygen demand
Reason:
As the heart beats faster, it consumes and demands more oxygen. Tachycardia can be extremely detrimental to the patient with a compromised heart that is already deprived of oxygen. Keeping the patient calm cannot be overemp
After applying the AED to an adult patient in cardiac arrest, you analyze her cardiac rhythm and receive a shock advised message. Emergency medical responders, who arrived at the scene before you, tell you that bystander CPR was not in progress upon their
deliver the shock as indicated followed immediately by CPR.
Reason:
Information obtained at the scene�whether from emergency medical responders or family members�is not always accurate. If the AED advises you to defibrillate, you should do so and then imm
Tachycardia can be detrimental to a patient who is experiencing a cardiac problem because it causes:
increased cardiac oxygen usage and demand.
Reason:
Many patients experiencing a cardiac problem are tachycardic (heart rate greater than 100 beats/min); others are bradycardic (heart rate less than 60 beats/min). As the heart beats faster, it consumes, an
By which of the following mechanisms does nitroglycerin relieve cardiac-related chest pain or discomfort?
Vasodilation and increased myocardial oxygen supply
Reason:
Nitroglycerin is a smooth muscle relaxant. Smooth muscle is found within the walls of the blood vessels. Nitroglycerin causes vasodilation, including dilation of the coronary arteries, which in t
Which of the following questions would be the MOST effective in determining if a patient's chest pain radiates away from his or her chest?
Does the pain stay in your chest or move anywhere else?
Reason:
When assessing a patient with any type of pain, you should avoid asking leading questions; instead, ask open-ended questions whenever possible. For example, instead of asking the patient if h
After assisting a patient with his or her prescribed nitroglycerin, you would NOT expect him or her to experience a
syncopal episode.
Reason:
Nitroglycerin (NTG) dilates the coronary arteries, thus increasing oxygen supply to the heart and relieving a cardiac patient's chest pain. Before assisting a patient with his or her prescribed NTG, there are some predictable sid
The MOST important initial treatment for a patient whose cardiac arrest was witnessed is:
high-quality CPR.
Reason:
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
You are caring for a 66-year-old woman with severe pressure in her chest. As you administer oxygen to her, your partner should:
obtain a set of vital signs.
Reason:
After you have performed the primary assessment of a patient with a possible cardiac problem and initiated treatment (ie, oxygen, aspirin), your partner should obtain a set of baseline vital signs, which includes asses
A patient reports pain in the upper midabdominal area. This region of the abdomen is called the:
epigastrium
Reason:
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, whi
A patient who is experiencing an acute myocardial infarction:
has chest pain or discomfort that does not change with each breath.
Reason:
The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressu
When the vital organs of an 85-year-old patient need additional blood flow, the heart may not be able to meet the increased need because:
the reserve capacity of the heart is reduced.
Reason:
Like other body systems, the cardiovascular system undergoes changes as we get older. As the heart's muscle mass and tone decrease, the amount of blood pumped out of the heart per beat (stroke volume)