Sanders: Mosby's Paramedic Practice Today, 4th Edition

Chapter 22: Cardiology

Test Bank

MULTIPLE CHOICE

1. 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.
ANS: B PTS: 1 REF: 575 OBJ: 1

2. 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.
ANS: C PTS: 1 REF: 576 OBJ: 2

3. Of what branch is the circumflex artery?

A. Left coronary artery C. Right coronary artery
B. Left anterior descending artery D. Marginal artery
ANS: A PTS: 1 REF: 576 OBJ: 2

4. In the event of a coronary artery blockage, how could the muscle of the
heart still receive blood?
A. Anastomoses C. Vasoconstriction
B. Aorta D. Coronary veins
ANS: A PTS: 1 REF: 576 OBJ: 2

5. The right atrium receives blood from the systemic circulation and the
_____.
A. Left ventricle C. Pulmonary arteries
B. Coronary veins D. Pulmonary veins
ANS: B PTS: 1 REF: 575 OBJ: 2

6. What is the valve between the right atrium and the right ventricle?
A. Tricuspid valve C. Semilunar valve
B. Mitral valve D. Pulmonic valve
ANS: A PTS: 1 REF: 575 OBJ: 2
 7. What term describes relaxation of the heart?
A. Systole C. Refractory period
B. Diastole D. Propagation
ANS: B PTS: 1 REF: 578 OBJ: 2

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

A. Blood pressure C. Heart rate
B. Vascular resistance D. Myocardial contractility
ANS: D PTS: 1 REF: 578 OBJ: 2

9. What does the Starling 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.
ANS: B PTS: 1 REF: 580 OBJ: 2

10. What is the most important factor in determining stroke volume in a

healthy heart?
A. Preload C. Heart rate
B. Afterload D. Myocardial contractility
ANS: A PTS: 1 REF: 580 OBJ: 2

11. What does an increase in peripheral vascular resistance cause?

A. Increased stroke volume C. Only minimally affects stroke volume
B. Decreased stroke volume D. Doubles stroke volume
ANS: B PTS: 1 REF: 580 OBJ: 2

12. To increase cardiac output, what action must take place?

A. Increase heart rate and decrease stroke 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.
ANS: C PTS: 1 REF: 580 OBJ: 2

13. The right coronary artery and the left anterior descending artery supply
most of the blood to what part of the cardiac muscle?
A. Septum C. Lateral left ventricle
B. Left atrium D. Right atrium and ventricle
ANS: D PTS: 1 REF: 576 OBJ: 2

14. The circumflex branch of the left coronary artery mainly supplies blood to
what part of the cardiac muscle?
A. Septum C. Lateral right ventricle
B. Left atrium D. Intrinsic pacemakers
ANS: B PTS: 1 REF: 576 OBJ: 2

15. The left anterior descending coronary artery mainly supplies blood to what
part of the cardiac muscle?
A. Septum C. Lateral right ventricle
 B. Left atrium D. Intrinsic pacemakers
ANS: A PTS: 1 REF: 577 OBJ: 2

16. How is preload defined?

A. Ventricular end-diastolic volume C. Atrial end-diastolic volume
B. Ventricular pre-diastolic volume D. Atrial pre-diastolic volume
ANS: A PTS: 1 REF: 578 OBJ: 2

17. What is the group of nerves that innervates the atria and ventricles known
as?
A. Brachial plexus C. Cardiac plexus
B. Aortic plexus D. Carotid plexus
ANS: C PTS: 1 REF: 581 OBJ: 2

18. What is the major neurotransmitter for the parasympathetic system?

A. Norepinephrine C. Dopamine
B. Epinephrine D. Acetylcholine
ANS: D PTS: 1 REF: 588 OBJ: 2

19. Which of these nerve fibers mainly innervate the ventricles of the heart?
A. Parasympathetic nerve fibers C. Somatic nerve fibers
B. Sympathetic nerve fibers D. Efferent nerve fibers
ANS: B PTS: 1 REF: 581 OBJ: 3

20. What is parasympathetic control of the heart provided by?

A. Subclavian nerve C. Phrenic nerve
B. Fourth cranial nerve D. Vagus nerve
ANS: D PTS: 1 REF: 581 OBJ: 3

21. The resting membrane potential is determined primarily by the difference

between the intracellular potassium ion level and what ion level?
A. Extracellular potassium C. Extracellular magnesium
B. Intracellular sodium D. Intracellular calcium
ANS: A PTS: 1 REF: 582 OBJ: 3

22. When depolarization takes place, what action occurs?

A. Magnesium ions rush into the cell. C. Potassium ions rush out of the cell.
B. Sodium ions rush into the cell. D. Calcium ions rush out of the cell.
ANS: B PTS: 1 REF: 583 OBJ: 3

23. 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
ANS: B PTS: 1 REF: 583 OBJ: 3

24. Phase I of the action potential represents what period?

A. Rapid depolarization C. Plateau
 B. Early rapid repolarization D. Rest between action potentials
ANS: B PTS: 1 REF: 586 OBJ: 3

25. 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.
ANS: B PTS: 1 REF: 586 OBJ: 3

26. 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
ANS: C PTS: 1 REF: 659 OBJ: 3

27. The AV junction is formed by the AV node and what other part of the
cardiovascular electrical system?
A. SA node C. Bundle of His
B. Right ventricle D. Left bundle branch
ANS: C PTS: 1 REF: 586 OBJ: 4

28. Under normal conditions, what is the dominant pacemaker of the heart?
A. AV node C. SA node
B. Bundle of His D. Purkinje fibers
ANS: C PTS: 1 REF: 586 OBJ: 4

29. 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 C. Asystole
B. Tachycardia D. Fibrillation
ANS: A PTS: 1 REF: 588 OBJ: 4

30. Second degree type II heart block occurs when the impulse is not
conducted through what portion of the cardiac electrical system?
A. SA node C. Purkinje fibers
B. AV node D. Bundle branches
ANS: D PTS: 1 REF: 652 OBJ: 4

31. Which cardiac pacemaker has an intrinsic rate of 40 to 60 beats per

minute?
A. SA node C. AV junction
B. Atria D. Purkinje fibers
ANS: C PTS: 1 REF: 588 OBJ: 4

32. How does acetylcholine affect the heart?

A. Increasing heart rate C. Increasing contractility
B. Decreasing heart rate D. Decreasing contractility
ANS: B PTS: 1 REF: 588 OBJ: 4

33. What is the activation of myocardial tissue more than one time by the
same impulse called?
A. Automaticity C. Doubling
B. Excitability D. Reentry
ANS: D PTS: 1 REF: 589 OBJ: 4

34. Paramedics are evaluating an ECG tracing that shows wide QRS
complexes that were produced by supraventricular activity. On MCL1 paramedics see a
QS pattern. What should paramedics suspect?
A. The patient has had an MI. C. Left bundle-branch block
B. Right bundle-branch block D. Myocardial ischemia
ANS: C PTS: 1 REF: 666 OBJ: 4 | 6

35. 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
ANS: D PTS: 1 REF: 668 OBJ: 4 | 6

36. Which is a bipolar lead?

A. V1 C. aVR
B. aVF D. Lead II
ANS: D PTS: 1 REF: 590 OBJ: 5

37. In lead II ECG placement, where is the positive lead located?

A. Left arm C. Right shoulder
B. Left leg D. Right leg
ANS: B PTS: 1 REF: 590 OBJ: 5

38. 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 C. 12-lead
B. 10-lead D. Modified
ANS: C PTS: 1 REF: 591 OBJ: 5

39. 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 C. V3
B. V2 D. V4
ANS: A PTS: 1 REF: 592 OBJ: 5

40. What kind of leads are leads II and III?

A. Inferior C. Lateral
B. Superior D. Precordial
ANS: A PTS: 1 REF: 590 OBJ: 5

41. 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 C. 0.10 second
B. 0.04 second D. 0.20 second
ANS: B PTS: 1 REF: 596 OBJ: 5

42. Each small square of graph paper represents _____ mV.

A. 0.001 C. 0.1
B. 0.01 D. 1
ANS: C PTS: 1 REF: 596 OBJ: 5

43. Each square on ECG paper is _____ mm in height and width.

A. 1 C. 3
B. 2 D. 4
ANS: A PTS: 1 REF: 596 OBJ: 5

44. In a 12-lead ECG, what cardiac position are the leads V1 and V2?
A. Anterior C. Septal
B. Inferior D. Lateral
ANS: C PTS: 1 REF: 592 OBJ: 5 | 6

45. _____ second is measured in each large box on ECG graph paper.
A. 0.01 C. 0.10
B. 0.04 D. 0.20
ANS: D PTS: 1 REF: 596 OBJ: 5 | 6

46. 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
ANS: B PTS: 1 REF: 604 OBJ: 5 | 7

47. When analyzing an ECG tracing, you notice that the rhythm is highly
irregular. What is the best method to calculate the rate?
A. Triplicate method C. Six-second count method
B. R-R method D. Caliper method
ANS: C PTS: 1 REF: 604 OBJ: 5 | 7

48. 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
ANS: A PTS: 1 REF: 589 OBJ: 6

49. Lead I looks at the heart from what view?

 A. Inferior C. Lateral
B. Superior D. Anterior
ANS: C PTS: 1 REF: 590 OBJ: 6

50. What is the first upward deflection on an ECG tracing?

A. A wave C. Q wave
B. P wave D. T wave
ANS: B PTS: 1 REF: 597 OBJ: 6

51. 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
ANS: A PTS: 1 REF: 659 OBJ: 6

52. 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
ANS: D PTS: 1 REF: 598 OBJ: 6 | 7

53. The duration of the QRS complex should be _____ second.

A. 0.01 to 0.04 C. 0.08 to 0.10
B. 0.04 to 0.20 D. 0.08 to 0.20
ANS: C PTS: 1 REF: 598 OBJ: 6 | 7

54. 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.
ANS: B PTS: 1 REF: 598 OBJ: 6 | 7 | 9

55. 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
ANS: A PTS: 1 REF: 598 OBJ: 6 | 7 | 9

56. What lead is routinely used for monitoring dysrhythmias?

A. Lead I C. aVL
B. Lead II D. V2
ANS: B PTS: 1 REF: 595 OBJ: 7 | 9
 57. What is a characteristic of normal sinus rhythm?
A. Electrical impulse originates from SA node.
B. Purkinje fibers delay electrical transmission.
C. PR internal is greater than 0.24 second.
D. QRS complex is greater than 0.18 second.
ANS: A PTS: 1 REF: 588 OBJ: 8

58. 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 C. Sinus arrhythmia
B. Wandering pacemaker D. Type II AV block
ANS: B PTS: 1 REF: 617 OBJ: 9

59. 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
ANS: D PTS: 1 REF: 616 OBJ: 9

60. What is the most likely cause of atrial flutter?

A. Hyperexcitability syndrome C. Enhanced conduction channels
B. Rapid reentry D. Ectopic atrial pacemakers
ANS: B PTS: 1 REF: 626 OBJ: 9

61. 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 [Link] type of
heart block should the paramedic suspect?
A. First-degree C. Second-degree type II
B. Second-degree type I D. Third-degree
ANS: C PTS: 1 REF: 652 OBJ: 9

62. What is a characteristic of junctional escape rhythm?

A. Pathologic response to bradycardia
B. Occurs when the SA node fails to fire
C. Typically occurs at a rate of 60 to 80 beats per minute
D. Should be aggressively treated to prevent ventricular fibrillation
ANS: B PTS: 1 REF: 633 OBJ: 9

63. 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
ANS: C PTS: 1 REF: 657 OBJ: 9
 64. What is typically found on an ECG with a bundle-branch block?
A. A narrow QRS complex C. A widened QRS complex
B. QRS complexes of ventricular origin D. A normal PR interval
ANS: C PTS: 1 REF: 657 OBJ: 9

65. 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.
ANS: B PTS: 1 REF: 658 OBJ: 9

66. 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 C. Atrial fibrillation
B. Sinus bradycardia D. Junctional
ANS: D PTS: 1 REF: 633 OBJ: 9

67. The intrinsic rate for a ventricular pacemaker is _____ beats per minute.
A. 20 to 40 C. 60 to 100
B. 40 to 60 D. 100 to 150
ANS: A PTS: 1 REF: 636 OBJ: 9

68. 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 C. Atrial fibrillation with slow response
B. Junctional escape with aberrancy D. Ventricular escape rhythm
ANS: D PTS: 1 REF: 635 OBJ: 9

69. 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.
ANS: C PTS: 1 REF: 611 OBJ: 9

70. What does an elevated ST segment suggest?

A. Ischemia C. Infarction
B. Injury D. Necrosis
ANS: B PTS: 1 REF: 598 OBJ: 9

71. What does a depressed ST segment suggest?

A. Ischemia C. Infarction
B. Injury D. Necrosis
ANS: A PTS: 1 REF: 598 OBJ: 9

72. What does T wave inversion suggest?

A. Ischemia C. Infarction
B. Injury D. Necrosis
ANS: A PTS: 1 REF: 671 OBJ: 9

73. What is the most common arrhythmia in sudden cardiac arrest?

A. Ventricular tachycardia C. Asystole
B. Ventricular fibrillation D. PEA
ANS: B PTS: 1 REF: 644 OBJ: 9

74. A paramedic notes deep and symmetrically inverted T waves. Of what

may this be indicative?
A. Current myocardial infarction C. Cardiac ischemia
B. Hyperkalemia D. Sodium depletion
ANS: C PTS: 1 REF: 672 OBJ: 9 | 10

75. What part of the ECG tracing is most important for detecting life-
threatening arrhythmias?
A. P wave C. QRS complex
B. PR interval D. ST segment
ANS: C PTS: 1 REF: 598 OBJ: 9 | 10

76. 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
ANS: B PTS: 1 REF: 711 OBJ: 9 | 11

77. 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
ANS: C PTS: 1 REF: 652 OBJ: 9 | 11

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.

78. What rhythm does the ECG tracing reflect?

A. Normal sinus rhythm C. Sinus arrhythmia
B. First-degree block D. Sinus bradycardia
ANS: D PTS: 1 REF: 611 OBJ: 9

79. Treatment for this patient’s heart rate should include:

A. No treatment at this time C. Dopamine drip
B. 0.5 mg Atropine IVP D. Epinephrine drip
ANS: A PTS: 1 REF: 613 OBJ: 9 | 11
 80. 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 C. Atrial tachycardia
B. Supraventricular tachycardia D. Atrial fibrillation
ANS: A PTS: 1 REF: 621 OBJ: 9 | 10

81. 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 C. Atrial flutter
B. Atrial fibrillation D. Multifocal atrial tachycardia
ANS: A PTS: 1 REF: 621 OBJ: 9 | 10

82. What may be a lethal treatment for a patient with a ventricular escape
rhythm?
A. Atropine C. Transcutaneous pacing
B. Dopamine D. Lidocaine
ANS: D PTS: 1 REF: 637 OBJ: 9 | 11 | 14

83. Paramedics are treating a patient who is complaining that his heart is
“skipping beats.” On ECG evaluation, paramedics see frequent PVCs that are occurring
in groups. The patient’s blood pressure is 100 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
ANS: A PTS: 1 REF: 641 OBJ: 9 | 11

84. What is the treatment of choice for a symptomatic ventricular escape

rhythm?
A. Atropine C. Lidocaine
B. Pacing D. Epinephrine
ANS: B PTS: 1 REF: 633 OBJ: 9 | 11 | 13

85. 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
ANS: B PTS: 1 REF: 641 OBJ: 9 | 11

86. Patients with pulseless ventricular tachycardia should be treated in the

same way as what other dysrhythmia?
A. Asystole C. Ventricular fibrillation
B. PEA D. Supraventricular tachycardia
ANS: C PTS: 1 REF: 644 OBJ: 9 | 11

87. 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
ANS: B PTS: 1 REF: 710 OBJ: 9 | 11 | 13

88. What is the most likely cause of second degree type II heart block?
A. Septal MI C. Drug toxicity
B. Lateral MI D. Hypoxia
ANS: A PTS: 1 REF: 652 OBJ: 9 | 11

89. What is a typical characteristic of 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
ANS: C PTS: 1 REF: 654 OBJ: 9 | 11

90. What is the class I intervention for all symptomatic bradycardia?

A. Atropine C. Transcutaneous pacing
B. Dopamine D. There are no class I interventions
ANS: D PTS: 1 REF: 613 OBJ: 9 | 11

91. 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. If 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.
ANS: B PTS: 1 REF: 675 OBJ: 10

92. What sound is heard when the AV valves close during ventricular systole?
A. S1 C. S3
B. S2 D. S4
ANS: A PTS: 1 REF: 679 OBJ: 10 | 11

93. A patient with SVT begins to develop chest pain, and the blood pressure
drops to 100/60. What treatment should be implemented next?
A. Adenosine rapid IV bolus C. Carotid sinus massage
B. Diltiazem IVP bolus D. Synchronous cardioversion
ANS: D PTS: 1 REF: 626 OBJ: 10 | 11 | 13

94. What is the joule setting for the initial synchronous cardioversion of SVT?
A. 25 J C. 200 J
 B. 100 J D. 300 J
ANS: B PTS: 1 REF: 626 OBJ: 10 | 11 | 13

95. When attempting to perform a vagal maneuver, 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
ANS: D PTS: 1 REF: 625 OBJ: 10 | 11

96. 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
ANS: B PTS: 1 REF: 672 OBJ: 10 | 11

97. What is a hallmark trait of atrial fibrillation?

A. An irregularly irregular rhythm C. P waves following the QRS complex
B. Multifocal PVCs D. 1:3 conduction through the AV node
ANS: A PTS: 1 REF: 628 OBJ: 10 | 11

98. Paramedics have determined that a patient is in atrial fibrillation, unstable,

and requires electrical therapy. Paramedics should perform _____ countershock with
_____ joules.
A. Unsynchronized; 50 C. Unsynchronized; 100
B. Synchronized; 50 D. Synchronized; 120-200
ANS: D PTS: 1 REF: 629 OBJ: 10 | 11 | 13

99. What is a compensatory mechanism of the heart in the presence of chronic

hypertension?
A. Enlarge the muscle mass of the heart. C. Lower the heart rate.
B. Reduce the stroke volume. D. Produce lower cardiac output.
ANS: A PTS: 1 REF: 698-699 OBJ: 10 | 11

Use the following information to answer the next three questions:

You are transporting a patient to a cardiac center after a suspected myocardial infarction.
The patient’s vital signs are stable. ECG shows sinus rhythm with elevated ST segments.

100. The ST segment is elevated because the damaged muscle is _____.

A. Hyperpolarized C. High in sodium ions
B. Constantly depolarized D. Lacking potassium ions
ANS: B PTS: 1 REF: 683 OBJ: 10 | 11

101. In order to determine ST segment elevation, what is the amount that the
ST segment must be elevated?
A. By more than 0.1 mV in at least two leads
B. By at least 5 mV in leads I and II
C. Above the level of the highest part of the QRS complex
D. By any amount above the isoelectric line
ANS: A PTS: 1 REF: 671 OBJ: 9 | 10

102. The patient’s ST segment elevation is seen in leads II, III, and aVF. What
should the paramedic suspect?
A. Inferior-wall MI C. Anterior MI
B. Lateral-wall MI D. Septal-wall MI
ANS: A PTS: 1 REF: 672 OBJ: 9 | 11

103. What organ(s) are at most risk in a hypertensive crisis?

A. Kidneys C. Liver
B. Lungs D. Eyes
ANS: A PTS: 1 REF: 699 OBJ: 10 | 11

104. In what patient position should jugular vein distention in cardiac patients
be evaluated?
A. Sitting straight up C. Lying flat
B. Leaning forward D. With the head elevated 45 degrees
ANS: D PTS: 1 REF: 678 OBJ: 11

105. During assessment, the paramedic discovers a carotid bruit. What

underlying condition should the paramedic suspect?
A. A previous MI C. Atherosclerosis
B. An irregular heart rhythm D. Pulmonary hypertension
ANS: C PTS: 1 REF: 679 OBJ: 11

106. What is the first recommended treatment for SVT?

A. Valsalva maneuver C. Synchronous cardioversion
B. Carotid sinus massage D. No treatment is required.
ANS: A PTS: 1 REF: 623 OBJ: 11

107. What is a blood pressure reading of 180/110 in an adult considered?

A. Stage 1 hypertension C. Stage 3 hypertension
B. Stage 2 hypertension D. Stage 4 hypertension
ANS: C PTS: 1 REF: 698-699 OBJ: 11

108. What is the prehospital care for a patient in second degree type II heart
block?
A. Lidocaine administration C. Synchronous cardioversion
B. Amiodarone administration D. Transcutaneous pacing
ANS: D PTS: 1 REF: 652 OBJ: 11

109. What is 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
ANS: A PTS: 1 REF: 680 OBJ: 11

110. Which home medicines would indicate that your patient has a strong risk
factor for heart disease?
A. Carbamazepine C. Metformin
B. Levodopa D. Levothyroxine
ANS: C PTS: 1 REF: 575 OBJ: 11

111. What is a characteristic of Prinzmetal angina?

A. Coronary arteries are totally blocked. C. Angina is progressively worsening.
B. Patients have angina on exertion only. D. Coronary arteries spasm.
ANS: D PTS: 1 REF: 680 OBJ: 11

112. What are most myocardial infarctions caused by?

A. Acute thrombotic occlusion C. Coronary embolism
B. Coronary spasm D. Severe hypoxia
ANS: A PTS: 1 REF: 681 OBJ: 11

113. The majority of acute myocardial infarctions involve what section of the
heart?
A. Left ventricle C. Anterior portion of both ventricles
B. Right ventricle D. Inferior portion of both ventricles
ANS: A PTS: 1 REF: 681 OBJ: 11

114. An inferior-wall MI is usually caused by occlusion of the _____ artery.

A. Right coronary C. Circumflex
B. Left anterior descending D. Left coronary
ANS: A PTS: 1 REF: 672 OBJ: 11

115. What is a sign of a cardiac tamponade?

A. Bradycardia C. Decreased venous pressure
B. Flat neck veins D. Muffled heart tones
ANS: D PTS: 1 REF: 693 OBJ: 11

116. What is a characteristic of ischemia caused by unstable angina?

A. Causes permanent, irreversible damage
B. Responds well to treatment with antiplatelet agents
C. Should be aggressively treated with fibrinolytic therapy
D. Generally responds to surgical interventions only
ANS: B PTS: 1 REF: 681 OBJ: 11

117. 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
ANS: C PTS: 1 REF: 687 OBJ: 11
 118. 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.
ANS: B PTS: 1 REF: 692 OBJ: 11 | 12

119. When performing CPR on an adult, how many inches should the
paramedics compress the chest?
A. 1/2 to 1 C. 1 1/2 to 2
B. 1 to 1 1/2 D. At least 2
ANS: D PTS: 1 REF: 704 OBJ: 11 | 13

120. If atrial fibrillation has been present for more than 48 hours, conversion of
the rhythm may lead to what complication?
A. Release of emboli C. Refractory hypotension
B. Sudden ventricular fibrillation D. Rebound tachycardia
ANS: A PTS: 1 REF: 629 OBJ: 11 | 13

121. 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.
ANS: D PTS: 1 REF: 646 OBJ: 11 | 13

122. Which rhythm is an absolute indication for unsynchronized cardioversion?

A. Ventricular tachycardia C. Ventricular fibrillation
B. Pulseless electrical activity D. Asystole
ANS: C PTS: 1 REF: 644 OBJ: 11 | 13

123. Which is a cause of PEA correctable in the field?

A. Tension pneumothorax C. Myocardial infarction
B. Pulmonary embolism D. Ischemia during resuscitation
ANS: A PTS: 1 REF: 659 OBJ: 11 | 13

124. 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. Tachycardic rhythm as a result of increased automaticity in the cardiac cells
ANS: A PTS: 1 REF: 661 OBJ: 11 | 13

125. Wolff-Parkinson-White syndrome is of little clinical importance unless the

patient is experiencing what condition?
A. Hypoxia C. Bradycardia
B. Tachycardia D. Heart murmur
ANS: B PTS: 1 REF: 661 OBJ: 11 | 13

126. The three characteristics of Wolff-Parkinson-White syndrome are a short

PR interval, QRS widening, and a(n) _____.
A. J notch C. Delta wave
B. Q complex D. Alpha spike
ANS: C PTS: 1 REF: 661 OBJ: 11 | 13

127. What is the first medication a paramedic should administer to a patient

with angina?
A. Oxygen C. Nitroglycerin
B. Aspirin D. Morphine
ANS: A PTS: 1 REF: 681 OBJ: 11 | 14

128. What is the position of comfort for a patient with left ventricular failure?
A. Sitting with legs dependent C. Left lateral recumbent
B. Trendelenburg’s D. Supine with head raised
ANS: A PTS: 1 REF: 688 OBJ: 11 | 13

129. 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
ANS: B PTS: 1 REF: 688 OBJ: 11 | 13

130. What sign is most indicative of a right ventricular infarct?

A. Foamy, blood-tinged sputum C. Peripheral edema
B. Adventitious lung sounds D. Orthopnea
ANS: C PTS: 1 REF: 689 OBJ: 11

131. If a patient is in cardiogenic shock, when should signs of cardiogenic

shock develop?
A. When chest pain has been relieved
B. After hypovolemia and dysrhythmias have been corrected
C. After fibrinolytic therapy has been administered
D. When the patient has received surgical interventions
ANS: B PTS: 1 REF: 692 OBJ: 11

132. What drug may improve the symptoms of cardiogenic shock patients in
the field?
A. Epinephrine C. Dopamine
B. Furosemide D. Atropine
ANS: C PTS: 1 REF: 692 OBJ: 11 | 13

133. 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.
ANS: D PTS: 1 REF: 706 OBJ: 11 | 13

134. What is the initial pediatric defibrillation joule setting?

A. 1 J/kg C. 3 J/kg
B. 2 J/kg D. 4 J/kg
ANS: B PTS: 1 REF: 706 OBJ: 11 | 13

135. After an initial defibrillation, what should the second and subsequent
defibrillations for pediatric patients be set at?
A. 1 J/kg C. 3 J/kg
B. 2 J/kg D. 4 J/kg
ANS: D PTS: 1 REF: 706 OBJ: 11 | 13

136. How can a paramedic help reduce impedance of the electrical current?
A. Apply pediatric pads to smaller sized adults.
B. Wait at least 3 minutes between defibrillation attempts.
C. Ensure that excessive chest hair is shaven before patch placement.
D. Place the patches no more than 3 inches apart from each other on the chest wall.
ANS: C PTS: 1 REF: 706 OBJ: 11 | 13

137. What medical device should the paramedic suspect if an outline of a small
box implanted under the skin in the left upper chest is observed?
A. Artificial heart C. Left-ventricular assist device
B. Implantable cardioverter-defibrillator D. Bypass pump
ANS: B PTS: 1 REF: 708 OBJ: 11 | 13

138. If a patient with cardiac tamponade becomes hypotensive in the field, what
should the paramedic do?
A. Administer nitroglycerin. C. Administer a fluid bolus.
B. Begin CPR. D. Intubate.
ANS: C PTS: 1 REF: 693 OBJ: 11 | 13

139. What are aneurysms most commonly the result of?

A. Atherosclerotic disease C. Traumatic injury
B. Infectious disease D. Genetic disorders
ANS: A PTS: 1 REF: 693 OBJ: 11

140. 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.
ANS: C PTS: 1 REF: 693 OBJ: 11

141. While assessing a patient, paramedics note a pulsatile mass in the

abdomen. Suddenly this mass is no longer palpable, and the patient’s blood pressure
begins to drop. What is the most likely cause?
A. Mass is no longer a problem.
 B. Mass can’t be felt because of guarding in the abdominal muscles.
C. Patient’s blood pressure will recover with a fluid bolus.
D. Patient’s aneurysm has ruptured.
ANS: D PTS: 1 REF: 694 OBJ: 11

142. Where are dissections of the aorta typically found?

A. In the ascending aorta C. In the abdominal section of the aorta
B. Just past the curve of the aorta D. Near the renal arteries
ANS: A PTS: 1 REF: 694 OBJ: 11

143. How do patients usually describe the pain of an aortic dissection?

A. Mild and tolerable C. Crushing pressure
B. Ripping or tearing D. Dull and throbbing
ANS: B PTS: 1 REF: 695 OBJ: 11

144. 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
ANS: C PTS: 1 REF: 697 OBJ: 11

Use the following information to answer the next two questions:

Paramedics are treating a patient with blood pressure of 200/140. The patient initially
complained of headache and nausea. During your 3-hour transport, the patient began to
seize and is now unresponsive to any stimulus.

145. What illness/condition should the paramedic suspect?

A. Stroke C. Epilepsy
B. Aortic aneurysm D. Hypertensive encephalopathy
ANS: D PTS: 1 REF: 699 OBJ: 11 | 13

146. What is the treatment for this condition?

A. Labetalol C. Fibrinolytic therapy
B. Morphine D. Diazepam
ANS: A PTS: 1 REF: 699 OBJ: 11 | 13

147. Which illness/complication may cause sinus bradycardia?

A. Hyperthermia C. Hypercapnia
B. Intrinsic sinus node disease D. Increased sympathetic tone
ANS: B PTS: 1 REF: 611 OBJ: 12

148. What is the most common cause of death following myocardial infarction?
A. Acidosis C. Ruptured myocardium
B. Electrolyte imbalance D. Fatal dysrhythmia
ANS: D PTS: 1 REF: 684 OBJ: 12
 149. What is a characteristic of chest pain associated with MI?
A. Occurs with exertion
B. Is constant
C. Is always relieved by nitroglycerin
D. Is alleviated with changes in body position
ANS: B PTS: 1 REF: 701 OBJ: 12

150. What is right ventricular failure most often the result of?
A. Hypoxia C. Myocardial infarction
B. Hypertension D. Left ventricular failure
ANS: D PTS: 1 REF: 689 OBJ: 12

151. What is the definitive treatment for second degree type II?
A. Atropine administration C. Transcutaneous pacemaker placement
B. Dopamine administration D. Transvenous pacemaker insertion
ANS: D PTS: 1 REF: 652 OBJ: 13

152. Paramedics are treating a patient who is in PEA following home dialysis.
Which drug may be indicated?
A. Lidocaine C. Calcium chloride
B. Sodium bicarbonate D. Potassium chloride
ANS: B PTS: 1 REF: 660 OBJ: 13 | 14

153. What statement is true about most new AEDs?

A. Have monophasic technology instead of biphasic
B. Deliver a standardized shock to patients of every size
C. Use waveforms that are more effective at lower energy settings
D. Deliver only two successive countershocks instead of three
ANS: C PTS: 1 REF: 705 OBJ: 13

154. What will occur after an implantable cardioverter-defibrillator has

delivered five shocks?
A. Not deliver more shocks until a slower rate is restored for 30 seconds
B. Continue to deliver shocks at the same joule setting
C. Switch to biphasic waveforms
D. Increase the joule setting by 10 J
ANS: A PTS: 1 REF: 709 OBJ: 13

155. When does synchronous cardioversion deliver the energy?

A. 10 ms after the peak of the R wave C. On top of the QRS complex
B. During the relative refractory period D. At the beginning of the P wave
ANS: A PTS: 1 REF: 711 OBJ: 13

156. Pacemakers are usually set to a rate of _____ beats per minute beginning
with _____ milliamps.
A. 80 to 120; 80 C. 60 to 100; 100
B. 40 to 70; 75 D. 70 to 80; 50
ANS: D PTS: 1 REF: 648 OBJ: 13
 157. What is a major effect of norepinephrine?
A. Bronchoconstriction C. Renal artery dilation
B. Uterine relaxation D. Vasoconstriction
ANS: D PTS: 1 REF: 581 OBJ: 14

158. How will parasympathetic stimulation affect the heart?

A. A decreased heart rate C. Dilation of the coronary arteries
B. An increased force of contraction D. No effect at all
ANS: A PTS: 1 REF: 581 OBJ: 14

159. 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
ANS: D PTS: 1 REF: 614 OBJ: 14

160. What property of dopamine causes an increased heart rate?

A. Alpha agonist C. Beta agonist
B. Alpha antagonist D. Beta antagonist
ANS: C PTS: 1 REF: 614 OBJ: 14

161. What does the medication atropine inhibit?

A. Alpha receptors C. Sympathetic response
B. Beta receptors D. Parasympathetic response
ANS: D PTS: 1 REF: 614 OBJ: 14

162. Which class I (recommended) drug is used for the treatment of SVT?
A. Adenosine C. Digitalis
B. Amiodarone D. Lidocaine
ANS: A PTS: 1 REF: 626 OBJ: 14

163. How does atropine affect the ventricular rate of third-degree heart block?
A. Produces a reflex bradycardia C. Increases the heart rate significantly
B. Increases the heart rate slightly D. Has no effect on the rate
ANS: D PTS: 1 REF: 614 OBJ: 14

164. When is fibrinolytic therapy for an MI patient most effective?

A. If patient has an inferior-wall MI
B. If 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
ANS: C PTS: 1 REF: 685 OBJ: 14

165. When is fibrinolytic therapy contraindicated?

A. When chest pain is still unresolved after 20 minutes
B. If there is T segment elevation of 3 mm in two or more contiguous leads
C. If patient has had recent laser eye surgery of less than 3 weeks
D. If patient is older than 60 years of age
ANS: C PTS: 1 REF: 685 OBJ: 14

166. When contacting medical control to terminate resuscitation efforts, what

information is most important for the paramedic relay?
A. Location of patient on scene C. Patient home medications
B. Any treatment provided D. Known allergies and medical history
ANS: B PTS: 1 REF: 713 OBJ: 15