Flashcards in Phase 3 Final Review Deck (122)
127. The administration of dopamine or any other vasopressor drug requires:
A) online medical control approval.
B) careful titration and blood pressure monitoring.
C) an electromechanical infusion pump.
D) concomitant crystalloid fluid boluses.
269. A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should:
A) start an IV line, administer 5 mg of midazolam, intubate the patient's trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 µg/kg/min en route to the hospital.
B) keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.
C) place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure.
D) elevate the patient's legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.
26. Changes in cardiac contractility may be induced by medications that have a positive or negative ___________ effect.
29. Which of the following statements regarding the SA node is correct?
A) The SA node is the dominant cardiac pacemaker in healthy patients.
B) SA nodal ischemia occurs when the left coronary artery is occluded.
C) The SA node is located in the superior aspect of the right ventricle.
D) Impulses generated by the SA node travel through the right atrium only.
28. The area of conduction tissue in which electrical activity arises at any given time is called the:
C) sinus node.
D) bundle of His.
31. An electrical impulse is slightly delayed at the AV node so that the:
A) bundle of His can depolarize fully.
B) ventricles can contract completely.
C) primary cardiac pacemaker can reset.
D) atria can empty into the ventricles.
169. In sinus bradycardia, the:
A) heart rate is less than 70 beats/min.
B) pacemaker site is the SA node.
C) QRS complexes are often wide.
D) P waves are consistently upright.
213. The firing of an artificial ventricular pacemaker causes:
A) a change in the shape of the preceding P waves.
B) a vertical spike followed by a wide QRS complex.
C) a small spike followed by a narrow QRS complex.
D) a wide QRS complex followed by a vertical spike.
211. Which of the following statements regarding asystole is correct?
A) A disconnected ECG lead often mimics asystole.
B) Defibrillation is indicated in some cases of asystole.
C) Most cases of asystole present with P waves only.
D) Asystole is the result of prolonged myocardial hypoxia
219. The presence of a J wave (Osborn wave) on the ECG is an indicator of:
A) a delta wave.
255. Common causes of cardiac arrest include all of the following, EXCEPT:
C) cardiac tamponade.
D) pulmonary embolism.
59. A pure alpha agent:
A) causes marked vasoconstriction.
B) has a direct effect on the heart rate.
C) causes moderate bronchoconstriction.
D) decreases the blood pressure by dilating the vessels.
68. Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT:
C) chest pain.
70. Paroxysmal nocturnal dyspnea is defined as:
A) dyspnea that is brought on by excessive movement during sleep.
B) sitting upright in a chair in order to facilitate effective breathing.
C) the inability to function at night due to severe difficulty breathing.
D) acute shortness of breath that suddenly awakens a person from sleep.
93. In contrast to stable angina, unstable angina:
A) occurs following periods of strenuous exertion.
B) often awakens the patient from his or her sleep.
C) indicates that myocardial necrosis has occurred.
D) is less frequent but is associated with more pain.
92. Stable angina:
A) typically subsides within 10 to 15 minutes.
B) occurs after a predictable amount of exertion.
C) usually requires both rest and nitroglycerin to subside.
D) is characterized by sharp chest pain rather than pressure.
96. Cardiac arrhythmias following an acute myocardial infarction:
A) tend to originate from ischemic areas around the infarction.
B) typically manifest as atrial fibrillation or atrial tachycardia.
C) generally originate from the center of the infarcted tissues.
D) are uncommon within the first 24 hours after the infarction.
272. You are assessing the 12-lead tracing of a 40-year-old man with chest pain and note ST-segment elevation in leads II, III, and aVF. Lead V4R shows 2-mm ST-segment elevation. The patient's blood pressure is 88/58 mm Hg, and his heart rate is 72 beats/min and regular. He denies any significant past medical history but is allergic to salicylates. After placing the patient on oxygen and starting an IV line of normal saline, you should:
A) administer up to 325 mg of baby aspirin.
B) give 2-mg increments of morphine sulfate.
C) start a dopamine infusion at 2 µg/kg/min.
D) give crystalloid boluses to increase preload.
103. What is the MOST appropriate sequence of treatment for a patient with a suspected acute myocardial infarction?
A) Oxygen, aspirin, nitroglycerin, morphine
B) Oxygen, nitroglycerin, aspirin, morphine
C) Aspirin, nitroglycerin, oxygen, morphine
D) Morphine, oxygen, aspirin, nitroglycerin
105. When administering aspirin to a patient with an acute coronary syndrome, you should:
A) first check to make sure the patient is not severely hypertensive.
B) administer half the usual dose if the patient has a history of stroke.
C) have him or her chew and swallow 160 to 325 mg of baby aspirin.
D) give up to 325 mg of enteric-coated aspirin for the patient to swallow.
110. When monitoring a patient's cardiac rhythm, it is MOST important to remember that:
A) a heart rate below 60 beats per minute must be treated immediately.
B) many patients with acute myocardial infarction experience asystole.
C) the ECG does not provide data regarding the patient's cardiac output.
D) the presence of a QRS complex correlates with the patient's pulse.
116. In a patient with left heart failure and pulmonary edema:
A) the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood.
B) diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart.
C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.
D) an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.
135. Which of the following mechanisms causes hypertension?
A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity.
B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion.
C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
D) Heart rate that is persistently above 80 beats/min causes an increase in cardiac output and a resultant increase in blood pressure.
138. A hypertensive emergency is MOST accurately defined as:
A) an increase in the blood pressure due to medication noncompliance.
B) an elevated blood pressure that is accompanied by a frontal headache.
C) a blood pressure greater than 170/90 mm Hg with a severe nosebleed.
D) an acute elevation in blood pressure with signs of end-organ damage
141. It is MOST important to evaluate a cardiac arrhythmia in the context of the:
A) patient's heart rate.
B) patient's medical history.
C) patient's overall condition.
D) width of the QRS complex.
148. According to the Einthoven triangle, lead II is assessed by placing the:
A) negative lead on the left arm and the positive lead on the left leg.
B) positive lead on the left leg and the negative lead on the right arm.
C) positive lead on the left arm and the negative lead on the right arm.
D) negative lead on the right arm and the positive lead on the left leg.
171. Which of the following statements regarding sinus bradycardia is correct?
A) Treatment focuses on the patient's tolerance to the bradycardia.
B) Symptomatic bradycardia is often caused by a decreased atrial rate.
C) Sinus bradycardia often requires multiple doses of atropine to correct it.
D) Sinus bradycardia is caused by decreased vagal tone in most patients.
287. You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a “stomach bug.” He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66 mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:
A) give 100% oxygen, start two large-bore IV lines, administer 20 mL/kg normal saline boluses, and transport.
B) administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
C) advise him that he can probably drive himself to the emergency department or schedule an appointment with his physician.
D) apply high-flow oxygen via nonrebreathing mask, start an IV line, administer 0.5 mg of atropine, and transport to the closest facility.
173. The treatment for sinus tachycardia should focus on:
A) decreasing the heart rate.
B) correcting the underlying cause.
C) administering IV fluid boluses.
D) relieving pain and anxiety.