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1. A man calls EMS because when he was walking in the park, as he usually does every day, he began to have chest pains. He sat down to rest and took one of his prescribed nitroglycerin tablets, which alleviated the pain after approximately 20 minutes. Treatment for this patient should include all of the following, EXCEPT:

A: administering 100% oxygen via a nonrebreathing mask. administering 100% oxygen via a nonrebreathing mask.

B: having the patient take another nitroglycerin tablet. having the patient take another nitroglycerin tablet.

C: reassuring the patient and allowing him to assume a comfortable position. reassuring the patient and allowing him to assume a comfortable position.

D: promptly transporting the patient to the hospital for evaluation and treatment. promptly transporting the patient to the hospital for evaluation and treatment.

2. Which of the following veins carry oxygen-rich blood?

A: Jugular veins Jugular veins

B: Pulmonary veins Pulmonary veins

C: Inferior vena cava Inferior vena cava

D: Superior vena cava Superior vena cava

3. Initial treatment of a patient with a cardiac condition should include:

A: starting CPR. starting CPR.

B: starting an IV. starting an IV.

C: performing defibrillation. performing defibrillation.

D: giving supplemental oxygen. giving supplemental oxygen.

4. If you use an AED, you should do all of the following EXCEPT:

A: change the batteries every 3 months. change the batteries every 3 months.

B: undergo refresher training every 3 months. undergo refresher training every 3 months.

C: check the AED's function at least once daily. check the AED's function at least once daily.

D: review with the medical director every instance in which you use the AED. review with the medical director every instance in which you use the AED.

5. After establishing that a 66-year-old woman is pulseless and apneic, the EMT-B's priority should be to:

A: initiate immediate CPR and call ALS backup. initiate immediate CPR and call ALS backup.

B: provide assisted ventilations with a BVM device. provide assisted ventilations with a BVM device.

C: evaluate the patient for the need for defibrillation. evaluate the patient for the need for defibrillation.

D: load the patient and transport immediately. load the patient and transport immediately.

6. Signs and symptoms of angina pectoris include which of the following?

A: Severe headache and nausea Severe headache and nausea

B: Symptoms that mimic a stroke Symptoms that mimic a stroke

C: Severe bradycardia and hypertension Severe bradycardia and hypertension

D: The same as that of an acute myocardial infarction The same as that of an acute myocardial infarction

7. You should NOT assist with nitroglycerin if the patient:

A: is over 80-years-old. is over 80-years-old.

B: took a pill 5 minutes earlier. took a pill 5 minutes earlier.

C: has a heart rate over 100 beats/min. has a heart rate over 100 beats/min.

D: has a systolic blood pressure of less than 100 mm Hg. has a systolic blood pressure of less than 100 mm Hg.

8. Which of the following conditions does NOT usually occur as a result of acute myocardial infarction?

A: Sudden death Sudden death

B: Cardiogenic shock Cardiogenic shock

C: Reversal of blood flow Reversal of blood flow

D: Congestive heart failure Congestive heart failure

9. The smallest branches of veins are called:

A: alveoli. alveoli.

B: venules. venules.

C: arterioles. arterioles.

D: capillaries. capillaries.

10. Which of the following conditions is considered the most serious?

A: Asystole Asystole

B: Atrial fibrillation Atrial fibrillation

C: Ventricular fibrillation Ventricular fibrillation

D: Ventricular tachycardia Ventricular tachycardia

11. A 56-year-old man has suffered from an acute myocardial infarction. Which of the following blood vessels became blocked and lead to his condition?

A: Coronary veins Coronary veins

B: Pulmonary arteries Pulmonary arteries

C: Coronary arteries Coronary arteries

D: Pulmonary veins Pulmonary veins

12. When using a semiautomated defibrillator, you must:

A: analyze and execute the defibrillation. analyze and execute the defibrillation.

B: stand clear as the defibrillator automatically delivers shock. stand clear as the defibrillator automatically delivers shock.

C: choose the power setting so that the unit can give the shock without input. choose the power setting so that the unit can give the shock without input.

D: wait for the machine to recommend a shock, after which you push the button. wait for the machine to recommend a shock, after which you push the button.

13. Which of the following descriptions is NOT usually associated with the pain of angina pectoris?

A: Tight Tight

B: Crushing Crushing

C: Squeezing Squeezing

D: Long-lasting Long-lasting

14. You respond to a residence, where an elderly woman is complaining of severe chest pain. She states that she took three nitroglycerin tablets prior to your arrival, but the pain has not subsided. You assess her vital signs and find that her blood pressure is 70/40 mm Hg. What is MOST significant about her blood pressure?

A: It is a side effect of the nitroglycerin. It is a side effect of the nitroglycerin.

B: It indicates a decreased cardiac output. It indicates a decreased cardiac output.

C: It is a common finding in the elderly. It is a common finding in the elderly.

D: It is a response to her fear and anxiety. It is a response to her fear and anxiety.

15. If the patient is pulseless and the AED recommends no shock, you should next:

A: restart CPR. restart CPR.

B: shock anyway. shock anyway.

C: provide immediate transport. provide immediate transport.

D: provide transport and deliver three stacked shocks en route. provide transport and deliver three stacked shocks en route.

16. After administering nitroglycerin to a patient, the EMT-B should do which of the following actions?

A: Check the expiration date of the nitroglycerin. Check the expiration date of the nitroglycerin.

B: Ensure that the nitroglycerin is prescribed to the patient. Ensure that the nitroglycerin is prescribed to the patient.

C: Reassess the patient's blood pressure within 5 minutes. Reassess the patient's blood pressure within 5 minutes.

D: Tell the patient to chew the tablet until it is dissolved. Tell the patient to chew the tablet until it is dissolved.

17. The chance to save a patient who is experiencing cardiac arrest from ventricular fibrillation is greater if:

A: CPR is initiated within 10 minutes. CPR is initiated within 10 minutes.

B: oxygen and rapid transport are provided. oxygen and rapid transport are provided.

C: rapid transport to the hospital is provided. rapid transport to the hospital is provided.

D: defibrillation or CPR is initiated within 4 minutes. defibrillation or CPR is initiated within 4 minutes.

18. Which of the following is one of the MOST serious complications associated with an acute myocardial infarction?

A: Severe hypertension Severe hypertension

B: Cardiogenic shock Cardiogenic shock

C: Severe emotional crisis Severe emotional crisis

D: An abnormally fast heart rate An abnormally fast heart rate

19. While palpating the radial pulse of a 56-year-old man with chest pain

that radiates to his jaw, you note that the pulse rate is 86 beats/min and irregular. What does this indicate?

A: Fear Fear

B: Pain Pain

C: Anxiety Anxiety

D: Arrhythmia Arrhythmia

20. All of the following are signs of ischemia except:

A: leg pain. leg pain.

B: chest pain. chest pain.

C: shortness of breath. shortness of breath.

D: nausea and vomiting. nausea and vomiting.

21. Which of the following statements about early defibrillation is true?

A: It is an ACLS skill. It is an ACLS skill.

B: It can be performed only in hospitals. It can be performed only in hospitals.

C: Only one EMT-B is needed to provided defibrillation. Only one EMT-B is needed to provided defibrillation.

D: It is recommended as a standard for BLS ambulance services by the American Heart Association. It is recommended as a standard for BLS ambulance services by the American Heart Association.

22. When you use a semiautomated defibrillator, it is important that you do all of the following except:

A: be en route in the ambulance during analysis of the rhythm. be en route in the ambulance during analysis of the rhythm.

B: avoid touching the patient during analysis of the rhythm. avoid touching the patient during analysis of the rhythm.

C: clear the patient during the shock. clear the patient during the shock.

D: deliver three stacked shocks. deliver three stacked shocks.

23. Most patients who are having a heart attack will experience:

A: unconsciousness. unconsciousness.

B: a feeling of impending doom. a feeling of impending doom.

C: no ill feelings once EMS arrives. no ill feelings once EMS arrives.

D: intermittent periods of unconsciousness. intermittent periods of unconsciousness.

24. Management for a patient in acute congestive heart failure with labored breathing includes all of the following, EXCEPT:

A: placing the patient in the supine position to raise the systolic blood pressure. placing the patient in the supine position to raise the systolic blood pressure.

B: administering nitroglycerin to the patient if it is prescribed and medical control advises you to. administering nitroglycerin to the patient if it is prescribed and medical control advises you to.

C: gathering any of the patient's medications and transporting them to the hospital with the patient. gathering any of the patient's medications and transporting them to the hospital with the patient.

D: providing oxygen, utilizing the most appropriate device for the patient's condition. providing oxygen, utilizing the most appropriate device for the patient's condition.

25. What part of the heart pumps blood to the lungs?

A: Right atrium Right atrium

B: Left atrium Left atrium

C: Right ventricle Right ventricle

D: Left ventricle Left ventricle

26. If AED use is indicated and the patient has a pacemaker, you should:

A: not defibrillate the patient. not defibrillate the patient.

B: place both pads near the pacemaker. place both pads near the pacemaker.

C: avoid placing the pads over the pacemaker. avoid placing the pads over the pacemaker.

D: place one pad over the pacemaker and the other on the left side of the place one pad over the pacemaker and the other on the left side of the back.

ANSWERS:

NO

ANS

REASON

   

Reason: Since nitroglycerin and rest have relieved this patient's pain, there is no need to administer further nitroglycerin. He should however, be

1.

B

transported to the hospital for evaluation, as the typical anginal attack lasts between 3 - 8 minutes. He must be evaluated for an acute myocardial infarction. (ECTSI 8, pp. 351 - 352)

2.

B

Reason: A vein is a vessel that carries blood to the heart. Most veins return blood to the heart after most of the oxygen has been removed. The pulmonary veins are the exception. They carry oxygen-rich blood from the

   

lungs back to the left atrium.(ECTSI 8, pp. 346 - 349)

   

Reason: Initial treatment of a cardiac condition includes providing

3.

D

supplemental oxygen. Oxygen helps reduce areas of ischemia within the heart. (ECTSI 8, p. 356)

4.

A

Reason: The batteries should be checked daily and replaced when indicated. (ECTSI 8, pp. 367 - 369)

   

Reason: Since the majority of cardiac arrest patients are in ventricular fibrillation during the early stages of cardiac arrest, this patient must have an

5.

C

AED attached and be evaluated for the need for defibrillation. Early defibrillation is the most important treatment for patients in ventricular fibrillation. (ECTSI 8, p. 353)

   

Reason: The signs and symptoms of angina pectoris are essentially identical to those of an acute myocardial infarction. This is why the EMT-B

6.

D

must treat all patients with chest pain as though they are having an acute myocardial infarction, whetherangina pectoris is suspected or not. (ECTSI 8, p. 351 - 352)

   

Reason: Do not give nitroglycerin to a patient with a systolic blood pressure

7.

D

of less then 100 mm Hg. Nitroglycerin may further lower the pressure. (ECTSI 8, p. 358)

   

Reason: Acute myocardial infarction has three major consequences:

8.

C

sudden death, cardiogenic shock, and congestive heart failure. Reversal of blood flow does not occur. (ECTSI 8, pp. 352 - 353 )

9.

B

Reason: Venules are the smallest branches of veins. They carry blood back to the heart from the capillaries. (ECTSI 8, p. 348)

10.

A

Reason: Atrial fibrillation, ventricular tachycardia, and ventricular fibrillation all involve some activity of the heart muscle. Asystole does not. A heart that has no activity will probably not recover, despite BLS and ALS. (ECTSI 8, pp. 352 - 353)

   

Reason: The coronary arteries, which branch from the aorta, supply the myocardium with oxygen-rich blood. Occlusion of one or more of these

11.

C

arteries results in a cessation of oxygenated blood beyond the area of occlusion and results in acute myocardial infarction (AMI). (ECTSI 8, pp. 347, 350 - 351)

   

Reason: The semiautomated defibrillator requires the EMT-B to make the

12.

D

final decision to defibrillate. The device analyzes the patient's rhythm and makes a recommendation whether or not to shock. (ECTSI 8, pp. 360-362)

13.

D

Reason: Angina pain usually lasts 3 to 8 minutes. AMI pain lasts longer.

   

Reason: Hypotension in a patient with a suspected acute myocardial infarction indicates that significant damage has occurred, and, as a result,

14.

B

cardiac output from the left ventricle is diminished. It is important to note that most patients with acute myocardial infarction have either a normal or elevated blood pressure. (ECTSI 8, p. 355)

   

Reason: BLS should be performed on all pulseless patients. CPR is

15.

A

immediately indicated after the rhythm is analyzed as requiring no shock, as in asystole. (ECTSI 8, pp. 363 - 364)

16.

C

Reason: Because of the effects of nitroglycerin on vasodilation and its tendency to lower the patient's blood pressure, vital signs, especially blood pressure, should be reassessed within 5 minutes after administering the medication. (ECTSI 8, p. 358)

   

Reason: The best results in resuscitating patients who have sudden cardiac

17.

D

death include rapid BLS (within 4 minutes) and ready availability of defibrillation. (ECTSI 8, pp.352-353)

18.

B

Reason: Cardiogenic shock is a frequent and serious result of an acute myocardial infarction. It occurs when the heart lacks enough power to force an adequate amount of blood to the rest of the body. Cardiogenic shock indicates extensive myocardial damage. (ECTSI 8, p. 353)

   

Reason: An irregular pulse rate in a patient with a cardiac problem is suggestive of an arrhythmia, such as premature ventricular contractions

19.

D

(PVCs). Patients with signs indicative of acute myocardial infarction, who have an irregular pulse rate,must be monitored closely for cardiac arrest. (ECTSI 8, p. 355)

   

Reason: Leg pain is not usually caused by an ischemic heart. (ECTSI 8,

20.

A

pp.350-251)

21.

D

Reason: Early defibrillation is advocated as a BLS ambulance standard by the American Heart Association. (ECTSI 8, pp. 362 - 363)

22.

A

Reason: When using a semiautomated defibrillator, it is important that you stand clear during rhythm analysis and the shock, and that you deliver three stacked shocks. The ambulance should not be moving while the AED is analyzing the heart rhythm.(ECTSI 8, pp. 360 - 362)

23.

B

Reason: Most patients who are having a heart attack experience a feeling of doom or impending death. (ECTSI 8, p. 355)

24.

A

Reason: Acute congestive heart failure, which commonly follows a significant myocardial infarction, most often results in damage to the left ventricle. This causes blood to back up in the lungs. Placing this patient in a supine position will result in increased labored breathing and potential suffocation from the fluid in the lungs. Instead, the patient should be placed in a sitting and upright position. (ECTSI 8, p. 354)

25.

C

Reason: The right ventricle is the only part of the heart that pumps blood directly to the lungs. (ECTSI 8, pp. 346 - 347)

26.

C

Reason: Defibrillator pads should not be placed over or near a pacemaker. (ECTSI 8, p. 360)