Chapter 17 Part 1

Front 1

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

A) retrosternal.

B) hemithoracic.

C) submediastinal.

D) supradiaphragmatic.

Back 1

retrosternal

Front 2

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

A) medial aspect of the chest, just below the third intercostal space.

B) left lateral chest, in the midaxillary line, at the fourth intercostal space.

C) left anterior chest, in the midaxillary line, at the fifth intercostal space.

D) left anterior chest, in the midclavicular line, at the fifth intercostal space.

Back 2

left anterior chest, in the midclavicular line, at the fifth intercostal space.

Front 3

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

A) epicardium, myocardium, and endocardium.

B) endocardium, epicardium, and myocardium.

C) myocardium, epicardium, and endocardium.

D) epicardium, endocardium, and myocardium.

Back 3

epicardium, myocardium, and endocardium

Front 4

The left main coronary artery subdivides into the:

A) left anterior ascending and descending arteries.

B) left anterior descending and circumflex arteries.

C) left posterior ascending and circumflex arteries.

D) right coronary and left posterior descending arteries.

Back 4

left anterior descending and circumflex arteries.

Front 5

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

A) circumflex artery.

B) left anterior descending artery.

C) left main coronary artery.

D) right coronary artery.

Back 5

right coronary artery.

Front 6

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 begins to narrow, are called:

A) cardiac myocytes.

B) the coronary sinus.

C) collateral circulation.

D) coronary microcirculation

Back 6

collateral circulation.

Front 7

What prevents the backflow of blood during ventricular contraction?

A) The aortic valve

B) Semilunar valves

C) The pulmonic valve

D) AV valves

Back 7

AV valves

Front 8

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

A) coronary sulcus

B) chordae tendineae

C) interatrial septum

D) coronary sinus

Back 8

chordae tendineae

Front 9

The mitral valve:

A) is located on the higher-pressure side of the heart.

B) separates the right atrium from the right ventricle.

C) prevents blood regurgitation into the left ventricle.

D) is a tricuspid valve located on the right side of the heart.

Back 9

is located on the higher-pressure side of the heart.

Front 10

The S1 heart sound represents:

A) closure of the mitral and tricuspid valves.

B) the end of ventricular contraction.

C) closure of the aortic and pulmonic valves.

D) the beginning of atrial contraction.

Back 10

closure of the mitral and tricuspid valves.

Front 11

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

A) emphysema.

B) valve rupture.

C) heart failure.

D) pulmonary hypertension.

Back 11

heart failure.

Front 12

Approximately 80% of ventricular filling occurs

A) during systole.

B) during diastole.

C) when the semilunar valves are open.

D) when the AV valves close.

Back 12

during diastole.

Front 13

Atrial kick is defined as:

A) the blood that flows passively into the ventricles.

B) pressure on the AV valves during ventricular contraction.

C) an attempt of the atria to contract against closed valves.

D) increased preload pressure as a result of atrial contraction.

Back 13

increased preload pressure as a result of atrial contraction.

Front 14

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

A) It receives blood exclusively from the venae cavae.

B) The right side of the heart is a low-pressure pump.

C) It pumps against the high resistance of the pulmonary circulation.

D) The right side of the heart pumps blood through the pulmonary veins.

Back 14

The right side of the heart is a low-pressure pump.

Front 15

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

A) drives blood out of the heart against the relatively high resistance of the systemic circulation.

B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs.

C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta.

D) drives blood out of the heart against the relatively low resistance of the pulmonary circulation.

Back 15

drives blood out of the heart against the relatively high resistance of the systemic circulation.

Front 16

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

A) Tunica media

B) Tunica intima

C) Tunica adventitia

D) Arterial lumen

Back 16

Tunica media

Front 17

In contrast to arteries, veins:

A) do not contain valves that prevent backflow of blood.

B) have less capacity to increase the size of their diameter.

C) are more likely to distend when exposed to backpressure.

D) operate on the high-pressure side of the circulatory system.

Back 17

are more likely to distend when exposed to backpressure.

Front 18

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

A) ejection fraction.

B) cardiac output.

C) stroke volume.

D) minute volume.

Back 18

cardiac output

Front 19

If the left ventricle contains 80 mL of blood before a contraction and ejects 60 mL during the contraction, the ejection fraction is:

A) 60%.

B) 65%.

C) 70%.

D) 75%.

Back 19

75%.

Front 20

Cardiac output is influenced by:

A) heart rate.

B) stroke volume.

C) heart rate and/or stroke volume.

D) ejection fraction and heart rate.

Back 20

heart rate and/or stroke volume.

Front 21

If an increased amount of blood is returned to the heart

A) the cardiac muscle must stretch to accommodate the larger volume.

B) stroke volume decreases accordingly because of the larger volume.

C) an increase in stroke volume occurs because the heart rate increases.

D) cardiac workload is decreased, resulting in a decreased cardiac output.

Back 21

the cardiac muscle must stretch to accommodate the larger volume

Front 22

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

A) contractility.

B) chronotropy.

C) automaticity.

D) the Frank-Starling mechanism.

Back 22

automaticity.

Front 23

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

A) the heart rate.

B) the nervous system.

C) physical exertion.

D) the Frank-Starling mechanism.

Back 23

the nervous system.

Front 24

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

A) stroke volume.

B) blood pressure.

C) cardiac output.

D) the heart rate.

Back 24

the heart rate.

Front 25

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

A) vasoactive

B) dromotropic

C) inotropic

D) chronotropic

Back 25

inotropic

Front 26

Automaticity is defined as the ability of the heart to:

A) generate an electrical impulse from the same site every time.

B) spontaneously conduct an electrical impulse between cardiac cells.

C) generate its own electrical impulses without stimulation from nerves.

D) increase or decrease its heart rate based on the body's metabolic needs.

Back 26

generate its own electrical impulses without stimulation from nerves.

Front 27

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

A) myocyte.

B) pacemaker.

C) sinus node.

D) bundle of His.

Back 27

pacemaker.

Front 28

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.

Back 28

The SA node is the dominant cardiac pacemaker in healthy patients.

Front 29

The AV junction:

A) includes the AV node but not the bundle of His.

B) is the dominant and fastest pacemaker in the heart

C) receives its blood supply from the circumflex artery.

D) is composed of the AV node and surrounding tissue.

Back 29

is composed of the AV node and surrounding tissue.

Front 30

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.

Back 30

atria can empty into the ventricles.

Front 31

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

A) inotropic

B) dromotropic

C) chronotropic

D) conductivity

Back 31

dromotropic

Front 32

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

A) bundle branches.

B) internodal pathways.

C) Purkinje fibers.

D) cardiac myocytes.

Back 32

Purkinje fibers

Front 33

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

A) cell wall permeability changes and sodium rushes into the cell.

B) calcium ions rapidly enter the cell, facilitating contraction.

C) potassium ions escape from the cell through specialized channels.

D) cardiac muscle relaxes in response to a cellular influx of calcium.

Back 33

cell wall permeability changes and sodium rushes into the cell

Front 34

Repolarization begins when:

A) the sodium and calcium channels close.

B) calcium ions slowly enter the cardiac cell.

C) potassium ions rapidly escape from the cell.

D) the inside of the cell returns to a positive charge.

Back 34

the sodium and calcium channels close.

Front 35

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

A) moves three sodium ions and three potassium ions back into the cell.

B) moves two sodium ions into the cell for every three potassium ions it moves out of the cell.

C) moves calcium and potassium ions back into the cell by a process called passive transport.

D) moves two potassium ions into the cell for every three sodium ions it moves out of the cell.

Back 35

moves two potassium ions into the cell for every three sodium ions it moves out of the cell

Front 36

Hypomagnesemia would MOST likely result in:

A) decreased cardiac conduction.

B) decreased myocardial irritability.

C) a decrease in cardiac contractility.

D) decreased myocardial automaticity.

Back 36

decreased cardiac conduction.

Front 37

Which of the following electrolytes maintains the depolarization phase?

A) Sodium

B) Calcium

C) Potassium

D) Magnesium

Back 37

Calcium

Front 38

During the refractory period:

A) the heart is in a state of partial repolarization.

B) the heart is partially charged, but cannot contract.

C) the cell is depolarized or in the process of repolarizing.

D) the heart muscle is depleted of energy and needs to recharge.

Back 38

the cell is depolarized or in the process of repolarizing

Front 39

The SA node:

A) cannot depolarize faster than 100 times/min.

B) will outpace any slower conduction tissue.

C) functions as the heart's secondary pacemaker.

D) has an intrinsic firing rate of 40 to 60 times per minute.

Back 39

will outpace any slower conduction tissue.

Front 40

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

A) the slower its intrinsic rate of firing.

B) the longer the PR interval will be.

C) the faster its intrinsic rate of firing.

D) the narrower the QRS complex will be.

Back 40

the slower its intrinsic rate of firing

Front 41

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

A) the AV junction will begin pacing at 40 to 60 times/min.

B) you will see a brief period of bradycardia followed by asystole.

C) the P wave and PR interval will have an abnormal appearance.

D) you should expect to see a heart rate slower than 40 beats/min.

Back 41

you should expect to see a heart rate slower than 40 beats/min.

Front 42

The P wave represents:

A) SA nodal discharge.

B) atrial depolarization.

C) a delay at the AV node.

D) contraction of the atria.

Back 42

atrial depolarization.

Front 43

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

A) depolarization of the inferior part of the atria.

B) the period of time when the atria are repolarizing.

C) full dispersal of electricity throughout both atria.

D) a momentary conduction delay at the AV junction.

Back 43

a momentary conduction delay at the AV junction.

Front 44

Which of the following ECG waveforms represents ventricular depolarization?

A) T wave

B) ST segment

C) QRS complex

D) U wave

Back 44

QRS complex

Front 45

The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration.

A) 0.12, 0.20

B) 0.14, 0.30

C) 0.16, 0.40

D) 0.18, 2.0

Back 45

0.12, 0.20

Front 46

Normally, the ST segment should be:

A) at the level of the isoelectric line.

B) elevated by no more than 1 mm.

C) depressed by no more than 2 mm.

D) invisible on a normal ECG tracing.

Back 46

at the level of the isoelectric line.

Front 47

Stimulation of the parasympathetic nervous system:

A) completely blocks the AV node, preventing ventricular depolarization.

B) causes a decrease in the production of epinephrine and norepinephrine.

C) is characterized by a large P wave and a PR interval that is shorter than normal.

D) slows SA nodal discharge and decreases conduction through the AV node.

Back 47

slows SA nodal discharge and decreases conduction through the AV node.

Front 48

Cholinesterase is a naturally occurring chemical that:

A) increases epinephrine production.

B) regulates acetylcholine in the body.

C) stimulates activity of the vagus nerve.

D) causes a natural slowing of the heart rate

Back 48

regulates acetylcholine in the body.

Front 49

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

A) negative inotropy.

B) increased salivation.

C) dilation of the pupils.

D) negative chronotropy.

Back 49

dilation of the pupils.

Front 50

Unlike the parasympathetic nervous system, the sympathetic nervous system:

A) is not under the direct control of the autonomic nervous system.

B) provides a mechanism for the body to adapt to changing demands.

C) is blocked when drugs such as atropine are administered.

D) constricts the pupils and increases gastrointestinal function when stimulated.

Back 50

provides a mechanism for the body to adapt to changing demands

Front 51

A physiologic effect of sympathetic nervous stimulation includes:

A) dilation of the bronchioles.

B) decreased conduction velocity.

C) a negative dromotropic effect.

D) dilation of the blood vessels.

Back 51

dilation of the bronchioles

Front 52

Sympathetic nerves are regulated primarily by:

A) adrenaline.

B) epinephrine.

C) cholinesterase.

D) norepinephrine.

Back 52

norepinephrine.

Front 53

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

A) Norepinephrine

B) Cholinesterase

C) Atenolol and neostigmine

D) Atropine and epinephrine

Back 53

Atropine and epinephrine

Front 54

Stimulation of alpha and beta receptors affects the:

A) heart only.

B) heart and blood vessels.

C) blood vessels and lungs.

D) heart, lungs, and blood vessels.

Back 54

heart, lungs, and blood vessels

Front 55

Vasoconstriction occurs following stimulation of:

A) beta-1 receptors.

B) beta-2 receptors.

C) alpha receptors.

D) alpha and beta receptors.

Back 55

alpha receptors.

Front 56

Drugs that have alpha or beta sympathetic properties are called:

A) vagolytics.

B) sympathomimetics.

C) parasympatholytics.

D) adrenergic blockers.

Back 56

sympathomimetics.

Front 57

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

A) stimulates beta-1 and beta-2 receptors.

B) stimulates beta-2 and alpha receptors.

C) blocks beta-1 and beta-2 receptors.

D) blocks beta receptors and stimulates alpha receptors.

Back 57

stimulates beta-1 and beta-2 receptors.

Front 58

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.

Back 58

causes marked vasoconstriction.

Front 59

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

A) Dopamine

B) Levophed

C) Proventil

D) Epinephrine

Back 59

Proventil

Front 60

A beta adrenergic blocker would counteract all of the following medications, EXCEPT:

A) atropine.

B) epinephrine.

C) isoproterenol.

D) norepinephrine

Back 60

atropine.

Front 61

Which of the following drugs would be MOST effective when treating a patient with hypotension secondary to vasodilation?

A) Dopamine

B) Propranolol

C) Isoproterenol

D) Norepinephrine

Back 61

Norepinephrine

Front 62

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

A) vasodilation and bronchoconstriction.

B) bronchodilation and vasoconstriction.

C) increased heart rate and automaticity.

D) parasympathetic nervous system blockade.

Back 62

bronchodilation and vasoconstriction.

Front 63

The MOST effective drug for the treatment of non-vagal-induced bradycardia is:

A) atropine.

B) dopamine.

C) epinephrine.

D) metoprolol.

Back 63

epinephrine.

Front 64

Which of the following drugs is contraindicated in patients with asthma?

A) Albuterol

B) Adrenaline

C) Norepinephrine

D) Propranolol

Back 64

Propranolol

Front 65

An increase in peripheral vascular resistance causes:

A) an increase in afterload.

B) a decrease in blood pressure.

C) an increase in cardiac output.

D) a decrease in cardiac workload.

Back 65

an increase in afterload.

Front 66

If you are unsure whether a conscious cardiac patient requires immediate transport versus continued assessment at the scene, you should:

A) continue with the secondary assessment to obtain more information.

B) take the patient's vital signs and then make your transport decision.

C) begin immediate transport and perform a focused assessment en route.

D) contact medical control and inform him or her of the patient's condition.

Back 66

continue with the secondary assessment to obtain more information

Front 67

Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT:

A) fatigue.

B) headache.

C) chest pain.

D) palpitations.

Back 67

headache.

Front 68

Cardiac-related chest pain is often palliated by:

A) stress.

B) exertion.

C) nitroglycerin.

D) mild exercise.

Back 68

nitroglycerin.

Front 69

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.

Back 69

acute shortness of breath that suddenly awakens a person from sleep.

Front 70

A patient with orthopnea:

A) experiences dyspnea during periods of exertion.

B) prefers a semisitting position to facilitate breathing.

C) experiences worsened dyspnea while lying down.

D) sleeps in a recliner due to severe right heart failure.

Back 70

experiences worsened dyspnea while lying down.

Front 71

In the context of cardiac compromise, syncope occurs due to:

A) an increase in vagal tone.

B) a drop in cerebral perfusion.

C) a sudden cardiac dysrhythmia.

D) an acute increase in heart rate.

Back 71

a drop in cerebral perfusion.

Front 72

Which of the following underlying medical conditions would be of LEAST pertinence when obtaining the past medical history from a patient who complains of acute chest pain or pressure?

A) Cancer

B) Diabetes

C) Renal disease

D) Hypertension

Back 72

Cancer

Front 73

A pulse that alternates in strength from one beat to the next beat is called:

A) pulse deficit.

B) pulsus alternans.

C) pulsus paradoxus.

D) paradoxical pulse

Back 73

pulsus alternans.

Front 74

Which of the following medications is a calcium channel blocker?

A) Lanoxin

B) Cardizem

C) Tenormin

D) Capoten

Back 74

Cardizem

Front 75

A patient with a medical condition that requires antiplatelet therapy would MOST likely be taking:

A) Coreg.

B) Altace.

C) Zocor.

D) Plavix.

Back 75

Plavix.

Front 76

Spironolactone is a(n):

A) beta blocker.

B) vasodilator.

C) diuretic.

D) antiarrhythmic.

Back 76

diuretic.