Ch. 27 Study Guide

Front 1

Which of the following is NOT a goal for decreasing the risk of cardiovascular disease?

Back 1

RISKS INCLUDE: age, family history, hypertension, elevated cholesterol level, smoking, and carbohydrate intolerance

Front 2

The heart's anatomic location is MOST accurately described as being:

Back 2

sits in the chest, above the diaphragm, behind and slightly to the left of the lower sternum

Front 3

The point of maximal impulse (PMI) usually can be felt on the:

Back 3

on the left anterior part of the chest, in the mid-clavicular line, at the fifth intercostal space

Front 4

The layers of the wall of the heart, beginning with the outermost layer, are the:

Back 4

Epicardium (outer), Myocardium (middle), Endocardium (inner)

Front 5

The left main coronary artery subdivides into the:

Back 5

left anterior descending and circumflex coronary arteries

Front 6

The right atrium, right ventricle, and part of the left ventricle are supplied by the:

Back 6

(RCA) right coronary artery

Front 7

The numerous connections among the arterioles of the various coronary arteries, which allow for the development of alternate routes of blood flow if a larger coronary artery is blocked, are called:

Back 7

anastomoses

Front 8

What prevents the backflow of blood during ventricular contraction?

Back 8

atrioventricular (AV) valves - tricuspid valve and mitral valve

Front 9

Injury to or disease of the ____ may cause prolapse of a cardiac valve leaflet, allowing blood to regurgitate from the ventricle into the atrium.

Back 9

chordae tendineae

Front 10

The mitral valve:

Back 10

separates the left atrium from the left ventricle

Front 11

The S1 heart sounds represent:

Back 11

near the beginning of ventricular contraction (systole), when the tricuspid and mitral valves close

Front 12

A loud S3 heart sound, when heard in older adults, often signifies:

Back 12

heart failure

Front 13

Approximately 80% of ventricular filling occurs:

Back 13

during the relaxation phase (diastole)

Front 14

Atrial kick is MOST accurately defined as:

Back 14

the contribution to ventricular filling made by contraction of the atrium

Front 15

Which of the following statements regarding the right side of the heart is MOST correct?

Back 15

is a low-pressure pump: it pumps against the relatively low resistance of the pulmonary circulation

Front 16

In contrast to the right side of the heart, the left side of the heart:

Back 16

is a high-pressure pump: it drives blood out of the heart against the relatively high resistance of the systemic arteries

Front 17

Which layer of the blood vessel is made up of elastic fibers and muscle, and provides for strength and contractility?

Back 17

tunica media

Front 18

In contrast to arteries, veins:

Back 18

carry blood to the heart--as a rule, oxygen-poor blood (with the exception of the pulmonary veins, which carry oxygenated blood to the left side of the heart)

Front 19

The amount of blood that is pumped out by either ventricle per minute is called:

Back 19

Cardiac Output (CO)

Front 20

With regard to stroke volume, the healthy heart:

Back 20

can easily increase stroke volume by at least 50%

Front 21

Cardiac output is influenced by:

Back 21

any increase in SV, with the HR held constant, will cause an increase in the overall CO

Front 22

If an increased amount of blood is returned to the heart:

Back 22

the muscle surrounding the cardiac chambers must stretch to accommodate the larger volume.

Front 23

The ability of the heart to vary the degree of its contraction without stretching is called:

Back 23

contractility

Front 24

Under normal conditions, the strength of cardiac contraction is regulated by:

Back 24

stroke volume

Front 25

Administering a drug that possesses a positive chronotropic effect will have a direct effect on:

Back 25

heart rate

Front 26

Changes in cardiac contractility may be induced by medications that have a positive or negative ___ effect.

Back 26

Inotropic

Front 27

Automaticity is MOST accurately defined as the ability of the heart to:

Back 27

generate its own electrical impulses without stimulation from nerves.

Front 28

The area of conduction tissue in which electrical activity arises at any given time is called the:

Back 28

pacemaker

Front 29

Which of the following statements regarding the sinoatrial (SA) node is MOST correct?

Back 29

dominant pacemaker, fastest pacemaker in the heart.

Front 30

The atrioventricular (AV) junction:

Back 30

include the AV node and its surrounding tissue along the bundle of his.

Front 31

An electrical impulse is slightly delayed at the AV node so that the:

Back 31

the atria can empty into the ventricles

Front 32

The effect on the velocity of electrical conduction is referred to as the ____ effect.

Back 32

dromotropic

Front 33

Thousands of fibrils that are distributed throughout the ventricles, which represent the end of the cardiac condition system, are called the:

Back 33

purkinje fibers

Front 34

Depolarization, the process by which muscle fibers are stimulated to contract, occurs when:

Back 34

cell wall permeability changes and sodium rushes into the cell.

Front 35

Repolarization begins when:

Back 35

the closing of the sodium and calcium channels, which stops the rapid inflow of the ions.

Front 36

In order to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump:

Back 36

helps move sodium and potassium ions back to their respective locations. for every 3 sodium ions that move out, 2 potassium move in, maintaining the polarity of cell membranes.

Front 37

Hypocalcemia and hypomagnesemia would MOST likely result in:

Back 37

increased myocardial irritability

Front 38

Which of the following electrolytes maintains the depolarization phase?

Back 38

calcium (Ca++)

Front 39

During the refractory period:

Back 39

the cell is depolarized or in the process of repolarizing.

Front 40

The sinoatrial node:

Back 40

normally has the most rapid intrinsic rate of firing (60-100 x/min), so it will literally outpace any lower conduction tissue.

Front 41

The farther removed the conduction tissue is from the sinoatrial node:

Back 41

the slower its intrinsic rate of firing.

Front 42

If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse:

Back 42

the AV junction might then begin firing @ its own rate (40-60 x/min)

Front 43

The P wave represents:

Back 43

the depolarization of the atria

Front 44

The brief pause between the P wave and QRS complex represents:

Back 44

A momentarily slowed conduction through the AV junction.

Front 45

Which of the following ECG waveforms represents ventricular depolarization?

Back 45

QRS complex occurs representing depolarization of the ventricles

Front 46

The P-R interval should be no shorter than ____ seconds and no longer than ____ seconds in duration.

Back 46

0.12-0.20 (3-5 boxes on the ECG paper)

Front 47

Normally, the S-T segment should be:

Back 47

At the same level of the baseline(isoelectric line)

Front 48

Stimulation of the parasympathetic nervous system:

Back 48

(No exact answer for statement) But basically sends it messages through the vagus nerve i.e. brain sends a signal to slow the heart in the form of an electrical impulse, Vagus sends it to the SA node and acetylcholine is released where it crosses over the SA and AV node telling the heart to slow down.

Front 49

Cholinesterase is a naturally occurring chemical that:

Back 49

causes ACh (acetylcholine) to be released from the receptors to which it has attached.

Front 50

Stimulation of the parasympathetic nervous system causes all of the following effects, EXCEPT:

Back 50

Effect of stimulation of parasympathetic. Decreases contractility(negative inotropic effect), Slows conduction velocity(negative dromotropic effect), slows heart rate(negative chronotropic effect), constricts pupils, increases salivation, increases gut motility.

Front 51

Unlike the parasympathetic nervous system, the sympathetic nervous system:

Back 51

Prepares the body to respond to various stresses.

Front 52

Which of the following chemicals or drugs causes an increase in heart rate?

Back 52

Epi, atropine, isoproterenol, nor epi, dopamine

Front 53

Stimulation of alpha and beta receptors affects the:

Back 53

heart, lungs, and arteries. Alpha I-Vaso constriction, Beta I increased HR, force, and automaticity, beta II lung effecting(bronchodialation)

Front 54

Vasoconstriction occurs following stimulation of:

Back 54

Alpha receptors

Front 55

Drugs that have alpha or beta sympathetic properties are called:

Back 55

Sympathomimetic drugs

Front 56

To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:

Back 56

Is a beta sympathetic agent.

Front 57

A pure alpha agent:

Back 57

Has no direct effect on the heart but causes slight bronchoconstriction and marked vasoconstriction.

Front 58

Which of the following drugs possesses beta-2-specific properties?

Back 58

Albuterol( proventil beta 2 specific), isotharine, terbutaline.

Front 59

Epinephrine is used to treat patients in anaphylactic shock because of its effects of:

Back 59

Vasoconstriction, increased hr, output, and automaticity, and bronchodialation. Also blocks histamine release

Front 60

Atherosclerosis is a process in which:

Back 60

begins probably in childhood, when small amounts of fatty material are deposited along the inner wall (intima) of arteries, usually at points of turbulent blood flow (such as where the arteries bifurcate or where the arterial wall has been damaged).

Front 61

Which of the following clinical findings is LEAST suggestive of a peripheral vascular disorder?

Back 61

MOST SUGGESTIVE: pain, redness, swelling, warmth, and tenderness in the extremity, presence of claudification or an arterial bruit.

Front 62

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

Back 62

any group of clinical symptoms consistent with acute myocardial ischemia.

Front 63

Most patients with an ST-elevation myocardial infarction (STEMI):

Back 63

will ultimately develop a “Q-wave AMI” (heart attack)

Front 64

Stable angina:

Back 64

follows a recurrent pattern: A person with stable angina experiences pain after a certain, predictable amount of exertion, such as climbing one flight of stairs or walking for three blocks. The pain also has a predictable location, intensity, and duration.

Front 65

In contrast to stable angina, unstable angina:

Back 65

is much more serious than stable angina and indicates a greater degree of obstruction of the coronary arteries. It is characterized by noticeable changes in the frequency, severity, and duration of pain and often occurs without predictable stress.

Front 66

Which of the following statements MOST accurately describes an acute myocardial infarction (AMI)?

Back 66

AMI occurs when a portion of the cardiac muscle is deprived of coronary blood flow long enough that portions of the muscle die (undergoes necrosis, or infarcts).

Front 67

Infarctions of the inferior myocardial wall are MOST often caused by:

Back 67

Right coronary artery (RCA) occlusion.

Front 68

Cardiac arrhythmias following an acute myocardial infarction:

Back 68

account for 90% of all deaths from AMI, usually ventricular fibrillation, which typically occurs during the early hours of infarct.

Front 69

Levine sign is MOST accurately defined as:

Back 69

the pt unconsciously clenching a fist when describing the pain to convey in body language the squeezing nature of the pain

Front 70

The pain associated with an acute myocardial infarction:

Back 70

is typically felt just beneath the sternum and is variously described as heavy, squeezing, crushing or tight. It also radiates to the neck, jaw upper back or epigastrium.

Front 71

Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction?

Back 71

Diabetics, older people, heart transplant patients, and WOMEN

Front 72

The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of:

Back 72

reduced circulation to the brain

Front 73

Death in the pre-hospital setting following an acute myocardial infarction is MOST often the result of:

Back 73

arrhythmias (often ventricular fibrillation), and most occur during the first 4 hours after onset of symptoms.

Front 74

Immediate treatment for a patient with an acute myocardial infarction involves:

Back 74

decreasing the patients myocardial oxygen requirements

Front 75

What is the MOST correct sequence of treatment for a patient with a suspected acute myocardial infarction?

Back 75

oxygen, aspirin, nitroglycerin, morphine

Front 76

A conscious and alert patient with chest pressure and a room air oxygen saturation of 98% can be given oxygen at:

Back 76

4-6L/min via nasal cannula

Front 77

When administering aspirin to a patient with an acute coronary syndrome, you should:

Back 77

check to see if they’ve had any before your arrival, if not have them chew 160 to 325 mg of non-enteric-coated aspirin.

Front 78

Which of the following situations would contraindicate the administration of nitroglycerin?

Back 78

Systolic BP < 100 mmHg, or if the pt is on any sexually enhancing medication

Front 79

The appropriate initial dose of morphine sulfate is:

Back 79

in 2-4 mg IV doses as needed, being sure to reassess the pts BP, pulse, and respiratory rate after each dose, until the pt experiences relief of pain or experiences a drop in pulse or BP.

Front 80

Which of the following medications would be the MOST acceptable alternative to morphine for analgesia in patients with an acute coronary syndrome?

Back 80

Fentanyl

Front 81

Patients experiencing a right ventricular infarction:

Back 81

may already be hypotensive or the administration of nitrogylcerin and morphine may cause hypotension

Front 82

The MOST immediate forms of reperfusion therapy for an injured myocardium are:

Back 82

fibrinolinic therapy and percutaneous coronary intervention PCI.

Front 83

The MOST significant risk associated with the use of fibrinolytic therapy is:

Back 83

the risk of bleeding, hemorrhagic complications

Front 84

Fibrinolytic medications are beneficial to certain patients with an acute myocardial infarction because they:

Back 84

triggers the body to dissolve clots potentially causing the AMI

Front 85

Percutaneous coronary interventions (PCI) involve:

Back 85

balloons, stents, other devices passed through a 2mm catherter via a peripheral artery to recanalize the blocked artery

Front 86

In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes:

Back 86

CPAP, aspirin, nitro, lasix, morphine, ect.

Front 87

What physiologic effect occurs within the first 5 to 10 minutes after administering furosemide (Lasix)?

Back 87

venodilation (blood pooling in the periphery)

Front 88

The MOST common cause of right-sided heart failure is:

Back 88

Left sided heart failure

Front 89

A bedridden patient with right-sided heart failure would be LEAST likely to present with:

Back 89

edema in the lower back (presaccral edema)

Front 90

Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of:

Back 90

equal bilateral breath sounds and a midline trachea

Front 91

Cardiogenic shock occurs when:

Back 91

the heart is so damaged that it can no longer pump a volume adequate for tissue perfusion

Front 92

A patient with cardiogenic pulmonary edema and shock should be positioned:

Back 92

semi-fowlers

Front 93

A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from:

Back 93

expititous transport to the hospital

Front 94

The administration of dopamine or any other vasopressor drug requires:

Back 94

careful titration and frequent monitoring of BP

Front 95

The process of aortic dissection begins when:

Back 95

once the intima is torn

Front 96

In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm:

Back 96

is abrupt without prodromal symptoms (no warning)

Front 97

Disruption of blood flow into the left common carotid artery would MOST likely present with signs and symptoms of a/an:

Back 97

stroke

Front 98

In addition to prompt transport, the goal of prehospital management for a patient with a suspected aortic dissection includes:

Back 98

primarily to provide adequate pain relief.

(the steps of prehospital management are:)
1. Calm and reassure the patient.
2. 100% O2 NRB
3. IV, Give crystalloid solution
4. Obtain ECG strip
5. If Patient is not hypotensive, admin morphine, 2mg at a time, up to 10mg over 10-15min
6. Transport without delay.

Front 99

If a patient's aortic aneurysm is not compressing on any adjacent structures:

Back 99

an EXPANDING aneurysm that is getting larger will produce symptoms by compressing on adjacent structures

Front 100

Hypertension is present when the blood pressure:

Back 100

at rest is consistently greater than about 140/90 mmHg

Front 101

Which of the following mechanisms causes hypertension?

Back 101

Most hypertension is the result of advanced atherosclerosis or arteriosclerosis, which decreases the lumen of the arteries and reduces their elasticity.

Front 102

Hypertensive disease is characterized by:

Back 102

Persistent elevation of the diastolic pressure.

Front 103

The MOST common symptom directly related to hypertension is:

Back 103

Headache

Front 104

A hypertensive emergency is MOST accurately defined as:

Back 104

an acute elevation of blood pressure with evidence of end-organ damage.

Front 105

Abnormal neurologic signs that accompany hypertensive encephalopathy occur when:

Back 105

when the MAP exceeds 150mmHg, the pressure breaches the blood-brain barrier and fluid leaks out, increasing intracranial pressure

Front 106

Lowering of a significantly elevated blood pressure:

Back 106

is best accomplished under controlled condition in a hospital.

Front 107

It is MOST important to evaluate a cardiac arrhythmia in the context of the:

Back 107

patient’s overall clinical condition.

Front 108

Damage to the cardiac electrical conduction system caused by an acute myocardial infarction MOST commonly results in:

Back 108

arrhythmias or abnormal cardiac contractions.

Front 109

A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by:

Back 109

tachycardia, because the ventricles have less time to fill between beats

Front 110

Bombardment of the AV node by more than one impulse, potentially blocking the pathway for one impulse and allowing the other impulse to stimulate cardiac cells that have already depolarized, is called:

Back 110

Circus reentry.

Front 111

If a patient's ECG rhythm shows any artifact, you should:

Back 111

verify that the electrodes are firmly applied to the skin and the monitor cable is plugged in correctly.

Front 112

When using limb leads, any impulse moving toward a positive electrode will:

Back 112

cause a positive deflection on the ECG.

Front 113

When assessing lead II via the limb leads, the negative lead should be placed on the:

Back 113

right arm/limb (RA)

Front 114

How many large boxes on the ECG graph paper represent 6 seconds?

Back 114

30

Front 115

If a particular interval on the ECG graph paper is 1.5 small boxes in width, the interval would be measured as:

Back 115

0.06 sec

Front 116

If a QRS complex is not preceded by a P wave:

Back 116

the pacemaker site for that beat is not in the SA node, but rather in some ectopic focus (a location other than the SA node).

Front 117

A prolonged P-R interval:

Back 117

may give clues that the AV node is diseased or damaged , as in an MI.

Front 118

The duration of the QRS complex should be less than:

Back 118

0.12 s (three small boxes on the ECG strip)

Front 119

Q waves are considered abnormal or pathologic if they are:

Back 119

One small square (0.04 s) wide on the ECG strip.

Front 120

The ___ represents the end of ventricular depolarization and the beginning of repolarization.

Back 120

J-Point

Front 121

The downslope of the T wave:

Back 121

(The vulnerable period) A strong impulse could cause depolarization overpowering the primary pacemaker control.

Front 122

An ST segment that is more than 1 mm above the isoelectric line:

Back 122

Is highly suggestive of myocardial ischemia or injury.

Front 123

A normal Q-T interval lasts:

Back 123

0.36 to 0.44 s.

Front 124

A prolonged Q-T interval indicates that the heart:

Back 124

Is experiencing an extended refractory period, making the ventricle more vulnerable to arrhythmia's.

Front 125

The Q-T interval would MOST likely be prolonged in patients:

Back 125

With hypocalcemia, an AMI, pericarditis, or administration of some drugs.

Front 126

The 6-second method for calculating the rate of a cardiac rhythm:

Back 126

Simplest and most accurate method. Count the number or QRS complexes in a 6 second strip, and multiply that number by 10 to obtain the rate per minute.

Front 127

When calculating the rate of a slightly irregular cardiac rhythm using a strip that is less than 6 seconds long, you should:

Back 127

Use the sequence method. 300,150,100,75,60,50

Front 128

If the R-R interval spans more than _ large boxes on the ECG graph paper, the rate is less than 60 beats/min.

Back 128

5

Front 129

The MOST common cause of cardiac arrest in adult patients is:

Back 129

Cardiac arrhythmia's.

Front 130

Normal sinus rhythm (NSR) is characterized by all of the following, EXCEPT:

Back 130

(ALL CORRECT) Has an intrinsic rate of 60 to 100 beats/min, the rhythm is regular with minimal variation between R-R intervals, the pulse is present upright and proceeds each QRS complex, the PRI is 0.12 s and the QRS complex is 0.04 to 0.12 s.

Front 131

In sinus bradycardia, the:

Back 131

Pacemaker is still the SA node, but with a rate of less than 60 beats/min. (27.47)

Front 132

Common causes of bradycardia include:

Back 132

Hypothermia, SA node disease, AMI, increased intracranial pressure, and use of beta blockers, calcium blockers, morphine, quinidine or digitalis.

Front 133

Which of the following statements regarding sinus bradycardia is MOST correct?

Back 133

Sinus bradycardia can be an asymptomatic phenomenon in healthy adults and conditioned athletes and may be exhibited during sleep.

Front 134

A regular cardiac rhythm with a rate of 104 beats/min, upright P waves, a P-R interval of 0.14 seconds, and narrow QRS complexes should be interpreted as:

Back 134

Sinus Tachycardia.

Front 135

The treatment for sinus tachycardia should focus on:

Back 135

The underlying cause.

Front 136

Sinus arrhythmia is:

Back 136

Defined as a slight variation in cycling of a sinus rhythm, usually one that exceeds 0.12 s between the longest and shortest cycles.

Front 137

Sinus arrest is characterized by:

Back 137

The SA node fails to initiate an impulse, eliminating the P wave, QRS complex, or/and T wave for one cycle. After this missed set of complexes the SA node resumes normal functioning just as nothing ever happened.

Front 138

Any electrical impulse that originates in the ventricles will produce:

Back 138

very wide QRS complexes--more than 0.12 s in duration

Front 139

Which of the following statements regarding an idioventricular rhythm is MOST correct?

Back 139

(all correct) Occurs when the SA and AV nodes fail and the ventricles must take over pacing the heart. It has a rate of 20 to 40 beats/min owing the intrinsic rate of the ventricles as pacemakers. An idioventricular rhythm is usually regular, with little variation between R-R intervals. P waves are absent owing to the failure of the SA and AV nodes. B/C there is no P wave, there is no PRI.

Front 140

An accelerated idioventricular rhythm is characterized by all of the following:

Back 140

Rhythm greater than 40 beats/min and less than 100 beats/min. Regular with little variation between R-R intervals. The P waves are absent, so the PRI does not exist.

Front 141

Monomorphic ventricular tachycardia:

Back 141

usually presents with QRS complexes that have uniform tops and bottoms. (having one common shape of QRS complex)

Front 142

Torsade de pointes:

Back 142

Is the most common polymorphic V-tach, which is usually seen in patients who have a condition of a prolonged Q-T interval. May be normal for patient or induced by meds such as quinidine.

Front 143

Untreated ventricular tachycardia would MOST likely deteriorate to:

Back 143

Ventricular failure or fibrillation.

Front 144

Premature ventricular complexes (PVCs):

Back 144

are also known as ectopic complexes, meaning that they occur out of the normal location.

Front 145

Premature ventricular complexes (PVCs) that originate from different sites in the ventricle:

Back 145

are multifocal.

Front 146

A run of ventricular tachycardia occurs if at least __ PVCs occur in a row.

Back 146

3

Front 147

Ventricular bigeminy occurs when:

Back 147

A “run” of V-tach becomes so frequent that they alternate w/ normal complexes, causing a normal-premature ventricular complex-normal-premature ventricular pattern.

Front 148

What is the R-on-T phenomenon?

Back 148

a cardiac event in which a ventricular stimulus causes premature depolarization of cells that have not completely repolarized

Front 149

Ventricular fibrillation occurs when:

Back 149

Many different cells in the heart become depolarized independently rather than in response to an impulse from the SA node.

Front 150

In contrast to coarse ventricular fibrillation, fine ventricular fibrillation indicates that:

Back 150

Many different cells in the heart become depolarized independently rather than in response to an impulse from the SA node.

Front 151

Which of the following statements regarding asystole is MOST correct?(ALL CORRECT)

Back 151

Occurs when cells of the heart have been hypoxic for so long that they no longer have any energy for any kind of contraction. Asystole presents w/ absence of activity: no P waves, no PRIs, no QRS complexes, and no T waves.

Front 152

Unlike an idioventricular rhythm, an agonal rhythm:

Back 152

is a residual electrical discharge from a dead heart that can not result in a palpable pulse.

Front 153

The firing of an artificial ventricular pacemaker causes:

Back 153

a unique vertical spike on the ECG tracing.

Front 154

A demand pacemaker:

Back 154

Is equipped w/ sensors that can identify the rate of spontaneous depolarization of the heart. Generate pacing impulses only when they sense the natural pace has slowed below a specific number (usually 60 per min)

Front 155

A “runaway” pacemaker is characterized by:

Back 155

a very tachycardic pacemaker rhythm that must be slowed to preserve the patient’s cardiac function. A strong magnet placed over the pacemaker will reset it.

Front 156

Patients with Wolff-Parkinson-White (WPW) syndrome:

Back 156

have an accessory pathway between the atria and the ventricles called the bundle of Kent.

Front 157

A delta wave is identified on a cardiac rhythm strip as a/an:

Back 157

rapid up slope to the R wave immediately after the end of the P wave.

Front 158

Aberrant conduction is ___ conduction.

Back 158

Abnormal

Front 159

The presence of an apparent P wave at the end of the QRS complex is MOST consistent with:

Back 159

Junctional Tachycardia

Front 160

Which of the following ECG abnormalities is MOST consistent with hyperkalemia?

Back 160

No ECG samples to verify, but the book says the following: “Hyperkalemia often presents with very tall, pointed T waves; these T ways may be as tall or taller than the QRS complex.”

Front 161

Lead I views the ___ side of the heart, while lead aVF views the ___ part of the heart.

Back 161

Left / Bottom

Front 162

The precordial leads do NOT view the ___ wall of the heart.

Back 162

Posterior

Front 163

When viewing leads V3 and V4, you are looking at the ___ wall of the:

Back 163

Anterior / Left Ventricle

Front 164

Which of the following leads provides the BEST view of the anterolateral wall of the left ventricle?

Back 164

Leads V4 through V6

Front 165

Leads V1 to V3 allow you to view the ___ wall of the left ventricle.

Back 165

Anterioseptal

Front 166

The inferior wall of the left ventricle is supplied by the:

Back 166

II, III, and aVF leads

Front 167

The circumflex branch of the left coronary artery supplies the ___ wall of the left ventricle.

Back 167

anterior

Front 168

If the ECG leads are applied correctly, the PQRST configuration should be inverted in lead:

Back 168

aVR

Front 169

Anatomically contiguous leads view:

Back 169

the same general area of the heart

Front 170

To confirm ischemia or injury to the heart, you must see evidence in __ or more contiguous leads.

Back 170

2

Front 171

Ischemia to the anterior wall of the myocardium would present with:

Back 171

ST-segment elevation in leads V3 through V5

Front 172

A pathologic Q wave:

Back 172

usually is a sign of infarction

Front 173

A right ventricular infarction is characterized by:

Back 173

ST-segment elevation of greater than 1 mm in the V4R lead

Front 174

Patients who are experiencing an infarction of the right ventricle:

Back 174

May already be hypotensive or may become extremely hypotensive if nitroglycerin is given

Front 175

When assessing a patient's 12-lead ECG, it is MOST important to remember that:

Back 175

it provides you with information that can help you choose the most appropriate emergency management in the field

Front 176

When applying the precordial leads, lead I should be placed in the:

Back 176

Fourth intercostal space at right sternal border

Front 177

Potential contraindications to fibrinolysis include all of the following, EXCEPT:

Back 177

Fibrinolysis is contraindicated in patients likely to experience hemorrhagic complications.

Front 178

A patient is generally considered a potential candidate for fibrinolytic therapy if he or she has experienced chest discomfort for less than _ hours.

Back 178

3

Front 179

When performing CPR on an adult in cardiac arrest, it is important to:

Back 179

Allow the chest to fully recoil between compressions

Front 180

The proper compression-to-ventilation ratio for two-rescuer adult CPR when an oropharyngeal airway is in place is:

Back 180

30:2

Front 181

Once an advanced airway device has been inserted into a cardiac arrest patient:

Back 181

Ventilations are delivered at a rate of 8-10/min

Front 182

The MOST important initial pieces of equipment to bring to the side of an unconscious patient are the:

Back 182

Defibrillator / airway management

Front 183

If you are using a biphasic defibrillator, but are unsure of the appropriate starting energy setting, you should set the defibrillator to:

Back 183

200J

Front 184

After delivering a shock to a patient in pulseless ventricular tachycardia, you should:

Back 184

Resume CPR

Front 185

The appropriate dosing regimen for epinephrine in cardiac arrest is:

Back 185

1 mg of 1:10000 solution every 3-5 min

Front 186

Which of the following statements regarding the use of vasopressin in cardiac arrest is MOST correct?

Back 186

Vasopressin is given to replace the first or second dose of epi. It’s a one time dose of 40 units.

Front 187

The preferred antiarrhythmic medication and initial dose for a patient with refractory ventricular fibrillation or pulseless ventricular tachycardia is:

Back 187

Amiodarone 300 mg

Front 188

What is the approximate maximum dose of lidocaine for a 200-pound patient?

Back 188

275 mg. (1mg/kg up to a max of 3mg/kg)

Front 189

Which of the following pulseless rhythms is NOT treated as pulseless electrical activity (PEA)?

Back 189

VT or VF

Front 190

In addition to epinephrine, you should routinely administer _________ to patients with PEA at a rate of 40 beats/min.

Back 190

Atropine

Front 191

In which of the following situations would you likely NOT be able to palpate a pulse during chest compressions?

Back 191

Tension pneumothorax.

Front 192

Which of the following actions should NOT occur while CPR is in progress?

Back 192

Cardiac Rhythm assessment

Front 193

Common causes of cardiac arrest include all of the following, EXCEPT:

Back 193

All correct: Hypovolemia, Hypoxemia, hypoglycemia, hypothermia, hyperkalemia, tension pneumothorax, cardiac tamponade.

Front 194

Common postresuscitative interventions include all of the following, EXCEPT:

Back 194

All correct: Stabilize HR. Stabilize cardiac rhythm, antiarrhythmic drugs followed by infusions, O2 to brain.

Front 195

Treatment for a patient with symptomatic bradycardia includes:

Back 195

TCP

Front 196

The initial dose of atropine sulfate for a patient in asystole is:

Back 196

1 mg

Front 197

The recommended first-line treatment for third-degree heart block associated with bradycardia is:

Back 197

TCP

Front 198

When assessing an anxious patient who presents with tachycardia, you must:

Back 198

determine if the tachy is causing hemodynamic instability.

Front 199

Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia?

Back 199

Absence of p-waves

Front 200

A classic sign of atrial flutter is?

Back 200

F waves, which resemble a sawtooth or picket fence.

Front 201

Atrial fibrillation can be interpreted by noting?

Back 201

"Irregulary irregular" appearance.

Front 202

A major complication associated with atrial fibrillation is?

Back 202

Blood clots

Front 203

Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take?

Back 203

Warfarin (Coumadin), dig

Front 204

Junctional escape rhythms are CONSISTENTLY characterized by?

Back 204

40-60 bpm intrinsic with AV as a pacemaker, usually regular with little variation between R/R intervals. If P wave, then usually inverted but may appear to be absent.

Front 205

If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles?

Back 205

An upside-down P wave will be visible.

Front 206

A regular rhythm with inverted P waves before each QRS complex, a ventricular rate of 70 bpm, narrow QRS complexes, and a P-R interval of 0.16 seconds should be interpreted as a/an?

Back 206

Accelerated junctional rhythm

Front 207

A first-degree heart block has a P-R interval greater than 0.20 seconds because?

Back 207

Impulse is delayed slightly longer than is expected before reaching the SA node.

Front 208

Which of the following statements regarding treatment for a first-degree heart block is MOST correct?

Back 208

Rarely treated in pre-hospital setting unless associated with bradycardia that severely reduces CO.

Front 209

A second-degree heart block, Mobitz type I, occurs when?

Back 209

Each successive impulse is delayed a little longer until finally one impulse is not allowed to continue.

Front 210

A key to interpreting a Mobitz type II second-degree heart block is to remember that?

Back 210

It can be regular or irregular.

Front 211

What occurs at the AV node during a third-degree heart block?

Back 211

All impulses are prevented from proceeding to the ventricles.

Front 212

On the ECG strip, a third-degree AV block usually appears as a?

Back 212

Wide QRS with irregular, noncorresponding P waves.