Chapter 17 Workbook Flashcards by Tom Bowl

Upper chambers of the heart

Atria

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Blood vessels that supply blood to the myocardium

Coronary arteries

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Electrical impulses slow here to allow blood to move from the atria to the ventricles

Atrioventricular node

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Heart muscle

Myocardium

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Electrical impulses begin here

Sinus node

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Carry oxygen-poor blood back to the heart

Venae cavae

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Lower chambers of the heart

Ventricles

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The body’s main artery

Aorta

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Calcium and cholesterol buildup inside blood vessels

Atherosclerosis

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An abnormal heart rhythm

Dysrhythmia

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Decreased blood flow and poor oxygenation

Ischemia

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The death of tissue

Infarction

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A rapid heart rhythm, greater than 100 beats/min

Tachycardia

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An absence of heart electrical activity

Asystole

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An unusually slow heart rhythm, less than 60 beats/min

Bradycardia

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A blood clot floating through blood vessels until it reaches a narrow area and blocks blood flow

Thromboembolism

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The complete blockage of a coronary artery

Acute myocardial infarction

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A lack of cardiac pumping activity

Cardiac arrest

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Exertional chest pain, relieved by nitroglycerin

Angina pectoris

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The heart lacks power to effectively pump blood to the body, resulting in low blood pressure

Cardiogenic shock

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A condition where the heart cannot effectively pump blood, leading to fluid backing up into the lungs and edema

Congestive heart failure

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Systolic blood pressure greater than 180 mm Hg

Hypertensive emergency

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The sudden tearing and separation of the inner layers of the aorta, with the potential for great blood loss

Dissecting aneurysm

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________ allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source.
A. Repetition
B. Reactivity
C. Automaticity
D. Autonomy

C. Automaticity

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The aorta receives its blood supply from the A. right atrium B. left atrium C. right ventricle D. left ventricle

D. left ventricle

Blood enters the right atrium from the body through the: A. vena cava B. aorta C. pulmonary artery D. pulmonary vein

A. vena cava

The only vein(s) in the body that carry oxygenated blood is/are the: A. external jugular veins B. pulmonary veins C. subclavian veins D. inferior vena cava

B. pulmonary veins

Normal electrical impulses originate in the sinus node, in the upper part of the right: A. atrium B. ventricle C. superior vena cava D. aortic arch

A. atrium

Dilation of the coronary arteries ________ blood flow: A. shuts off B. increases C. decreases D. regulates

B. increases

The ________ are tiny blood vessels that are approximately one cell thick. A. arterioles B. venules C. capillaries D. ventricles

C. capillaries

________ carry oxygen to the body’s tissues and then remove carbon dioxide. A. Red blood cells B. White blood cells C. Platelets D. Veins

A. Red blood cells

________ is the maximum pressure exerted by the left ventricle as it contracts. A. Cardiac output B. Diastolic blood pressure C. Systolic blood pressure D. Stroke volume

C. Systolic blood pressure

Atherosclerosis can lead to a complete ______ of a coronary artery. A. occlusion B. disintegration C. dilation D. contraction

A. occlusion

The lumen of an artery may be partially or completely blocked by the blood clotting system due to a ______ that exposes the inside of the atherosclerotic wall. A. tear B. crack C. clot D. rupture

B. crack

Tissues downstream from a blood clot will suffer from lack of oxygen. If blood flow is resumed in a short time, the ______ tissues will recover. A. sclerotic B. hypoxic C. necrotic D. rheumatic

B. hypoxic

Risk factors for myocardial infarction include all of the following EXCEPT: A. male gender B. high blood pressure C. stress D. increased activity level

D. increased activity level

When, for a brief period of time, heart tissues do not get enough oxygen, the pain is called: A. necrosis B. angina C. ischemia D. atherosclerosis

B. angina

Angina pain may be felt in the: A. epigastrium B. legs C. lower back D. lower abdomen

A. epigastrium

The underlying cause of a dissecting aortic aneurysm is: A. controlled hypertension B. uncontrolled hypertension C. transient hypertension D. benign hypertension

B. uncontrolled hypertension

Because the oxygen supply to the heart is diminished with angina, the ______ can become compromised, putting the person at risk for significant cardiac rhythm problems. A. respiratory system B. clotting cascade C. electrical system D. vasculature

C. electrical system

About ______ minutes after blood flow is cut off, some heart muscle cells begin to die. A. 10 B. 20 C. 30 D. 40

C. 30

An acute myocardial infarction is more likely to occur in the larger, thick walled left ventricle, which needs more ______ than the right ventricle. A. oxygen and glucose B. force to pump C. blood and oxygen D. electrical activity

C. blood and oxygen

Which of the following statements regarding congestive heart failure is FALSE A. Stridor is a common lung sound heard on exam. B. It can be caused by diseased heart valves C. It can be treated with nitroglycerin D. Ankle edema is a common finding

A. Stridor is a common lung sound heard on exam

Cardiogenic shock often occurs soon after a(n): A. hypertensive emergency B. acute myocardial infarction C. aortic aneurysm D. unstable angina attack

B. acute myocardial infarction

Sudden death is usually the result of __________, in which the heart fails to generate an effective blood flow. A. acute myocardial infarction B. atherosclerosis C. premature ventricular contractions D. cardiac arrest

D. cardiac arrest

Disorganized, ineffective quivering of the ventricles is known as: A. ventricular fibrillation B. asystole C. ventricular standstill D. ventricular tachycardia

A. ventricular fibrillation

Which of the following is NOT a cause of congestive heart failure? A. chronic hypotension B. heart valve damage C. myocardial infarction D. long standing high blood pressure

A. chronic hypotension

Signs and symptoms of shock include all of the following EXCEPT: A. elevated heart rate B. pale, clammy skin C. air hunger D. elevated blood pressure

D. elevated blood pressure

Which of the following changes in heart function occurs in patients with congestive heart failure? A. a decrease in heart rate B. enlargement of the left ventricle C. enlargement of the right ventricle D. a decrease in blood pressure

B. enlargement of the left ventricle

Physical findings of acute myocardial infarction include skin that is __________ because of poor cardiac output and the loss of perfusion. A. pink B. white C. gray D. red

C. gray

All patient assessments begin by determining whether the patient: A. is breathing B. can talk C. is responsive D. has a pulse

C. is responsive

To assess chest pain, use the mnemonic: A. AVPU B. OPQRST C. SAMPLE D. CHART

B. OPQRST

When using the mnemonic OPQRST, the “P” stands for: A. paresthesia B. pain C. provocation D. predisposing factors

C. provocation

In addition to angina and myocardial infarction, nitroglycerin can be used to treat: A. CHF B. cardiogenic shock C. aortic aneurysm D. hypertensive emergency

A. CHF

When administering nitroglycerin to a patient, you should make sure the patient has not taken any medications for ______ ______ in the last 24 hours. A. angina B. erectile dysfunction C. migraine headaches D. gallbladder dysfunction

B. erectile dysfunction

In general, a maximum of three dose(s) of nitroglycerin is/are given for any one episode of chest pain. A. one B. two C. three D. four

C. three

_______ are inserted when the electrical control system of the heart is so damaged that it cannot function properly. A. stents B. pacemakers C. balloon angioplasties D. defibrillations

B. pacemakers

When the battery wears out in a pacemaker, the patient may experience: A. syncope B. chest pain C. nausea D. tachycardia

A. syncope

The computer inside the AED is specifically programmed to recognize rhythms that require defibrillation to correct, most commonly: A. asystole B. ventricular tachycardia C. ventricular fibrillation D. supraventricular tachycardia

C. ventricular fibrillation

The AED should be applied only to unresponsive patients with no: A. significant medical problems B. cardiac history C. pulse D. brain activity

C. pulse

________ usually refers to a state of cardiac arrest despite an organized electrical complex. A. asystole B. pulseless electrical activity C. ventricular fibrillation D. ventricular tachycardia

B. pulseless electrical activity

The links in the chain of survival include all of the following EXCEPT: A. immediate high quality CPR B. ALS and postarrest care C. administration of nitroglycerin D. rapid defibrillation

C. administration of nitroglycerin

Defibrillation works best if it takes place within ___ minutes of the onset of cardiac arrest. A. 2 B. 4 C. 6 D. 10

A. 2

D. size up the scene

At 0500, you respond to the home of a 76‑year‑old man complaining of chest pain. On arrival, the patient states that he had been sleeping in the recliner all night due to indigestion. He also tells you he has taken two nitroglycerin tablets. He continues to have pain and reports trouble breathing. His vital signs are as follows: respirations, 16 breaths/min; pulse, 98 beats/min; blood pressure, 92/76 mm Hg. He is still complaining of chest pain. What actions should you take to intervene? A. provide high flow oxygen B. administer a third nitroglycerin tablet C. apply an AED D. begin chest compressions

A. provide high flow oxygen

At 0500, you respond to the home of a 76‑year‑old man complaining of chest pain. On arrival, the patient states that he had been sleeping in the recliner all night due to indigestion. He also tells you he has taken two nitroglycerin tablets. He continues to have pain and reports trouble breathing. Your patient suddenly becomes unresponsive. Assessment reveals no breathing and no pulse. Your partner begins chest compressions while you apply the AED. When operating an AED, what is the first step in the defibrillation sequence? A. plug the pads connector to the AED B. apply the AED pads to the patient’s chest C. remove clothing from the patient’s chest D. turn on the AED

D. turn on the AED

At 0500, you respond to the home of a 76‑year‑old man complaining of chest pain. On arrival, the patient states that he had been sleeping in the recliner all night due to indigestion. He also tells you he has taken two nitroglycerin tablets. He continues to have pain and reports trouble breathing. After applying an AED to this patient, the AED states, “No shock advised.” What is your next step of action A. load and transport the patient B. push to reanalyze C. perform CPR for 2 minutes, starting with chest compressions, then have the AED reanalyze D. consider termination

C. perform CPR for 2 minutes, starting with chest compressions, then have the AED reanalyze

At 0500, you respond to the home of a 76‑year‑old man complaining of chest pain. On arrival, the patient states that he had been sleeping in the recliner all night due to indigestion. He also tells you he has taken two nitroglycerin tablets. He continues to have pain and reports trouble breathing. Your patient is now conscious, and you are en route to the hospital. You are six blocks away when the patient stops breathing again and no longer has a pulse. You should: A. continue to the hospital B. continue to the hospital and analyze the rhythm C. stop the vehicle and analyze the rhythm D. only perform chest compressions

C. stop the vehicle and analyze the rhythm

True/False The right side of the heart pumps oxygen‑rich blood to the body.

False

True/False In the normal heart, the need for increased blood flow to the myocardium is easily met by an increase in heart rate.

False

True/False Atherosclerosis results in narrowing of the lumen of coronary arteries.

True

True/False Infarction is a temporary interruption of the blood supply to the tissues.

False

True/False Angina can result from a spasm of the artery.

True

True/False The pain of angina and the pain of AMI are easily distinguishable.

False

True/False Nitroglycerin works in most patients within 5 minutes to relieve the pain of AMI.

True

True/False If an AED malfunctions during use, you must report that problem to the manufacturer and the US Food and Drug Administration.

True

True/False Angina occurs when the heart’s need for oxygen exceeds its supply.

True

True/False White blood cells are the most numerous cells in the blood and help the blood to clot.

False

True/False Cardiac arrest in children is less common than in adults and is usually caused by a breathing problem.

True

True/False An AED with special pediatric pads may be used on pediatric medical patients between the ages of 1 month and 8 years who have been assessed to be unresponsive, not breathing, and pulseless.

True

True/False Dissecting aortic aneurysms are rarely considered life threatening.

False

True/False Heart disease is the number‑one killer of women in the United States.

True

True/False If a patient complaining of chest pain has a history of a previous AMI, you should ask if this pain feels similar to the previous AMI.

True

The heart is divided down the middle by a wall called the ________.

septum

The ________ is the body’s main artery.

aorta

The ________ ventricle pumps blood in through the pulmonary circulation.

right

Electrical impulses spread from the ________ node to the ventricles.

atrioventricular

Blood supply to the heart is increased by ________ of the coronary arteries.

dilation

________ ______ cells remove carbon dioxide from the body’s tissues.

Red blood

________ blood pressure reflects the pressure on the walls of the arteries when the ventricle is at rest.

Diastolic

The heart has ________ chambers.

four

The ________ side of the heart is more muscular because it must pump blood into the aorta and all the other arteries of the body.

left

________ is the most effective way to assist a person with CHF to breathe effectively and to prevent an invasive airway management technique.

CPAP

The collection of fluid in the part of the body that is closest to the ground is called _______ ______.

dependent edema

A hypertensive emergency usually occurs only with a systolic pressure greater than ________.

180 mm Hg

In CHF, blood tends to back up in the _______ ______, increasing the pressure in the capillaries of the lungs.

pulmonary veins

A late finding in cardiogenic shock would be a systolic blood pressure of less than ________.

90 mm Hg

Damage to the ________ area of the heart often presents with bradycardia.

Inferior

A. Superior vena cava (oxygen‑poor blood from head and upper body) B. Left pulmonary artery (blood to left lung) C. Right pulmonary artery (blood to right lung) D. Right atrium E. Inferior vena cava (oxygen‑poor blood from lower body) F. Right ventricle

G. Oxygen‑rich blood to head and upper body H. Right pulmonary veins (oxygen‑rich blood from right lung) I. Left pulmonary veins (oxygen‑rich blood from left lung) J. Left atrium K. Left ventricle L. Oxygen‑rich blood to lower body

A. Atrioventricular (AV) node B. Bundle of His C. SA node D. Left bundle branch E. Internodal pathways F. Left posterior fascicle G. Right bundle branch H. Purkinje fibers I. Left anterior fascicle

The 6 pulse points.

1. Carotid 2. Femoral 3. Brachial 4. Radial 5. Posterior tibial 6. Dorsalis pedis

Short Answers Explain the differentiating features between an AMI and a dissecting aortic aneurysm.

* In an AMI, the onset of pain is gradual, with additional symptoms. The pain is typically described as a tightness or pressure. The severity of pain increases with time and may wax and wane. The pain is usually substernal and very rarely radiates to the back. Peripheral pulses are equal. * With a dissecting aneurysm, the onset of pain is abrupt, without additional symptoms. The pain is typically described as sharp or tearing. The severity of pain is at its maximum from the onset and does not abate once started. The pain can be located in the chest, with radiation to the back, between the shoulder blades. There can be a blood pressure discrepancy between the arms or a decrease in a femoral or carotid pulse.

Short Answers What are the three most common errors of AED use?

1. Failure of the machine to not shock fine ventricular fibrillation 2. Applying the AED to a patient who is moving, squirming, or being transported 3. Turning off the AED before analysis or shock is complete

Short Answers If ALS is not responding to the scene, what are the three points at which transport should be initiated for a cardiac arrest patient?

1. If the patient regains a pulse 2. After six to nine shocks have been delivered 3. If the machine gives three consecutive “no shock” messages

Short Answers List four safety considerations for operating an AED.

1. Be aware of the surface the patient is lying on. Wet and metal surfaces may conduct electricity, making defibrillation of the patient dangerous to EMTs. 2. What is the age of the patient? Use pediatric AED pads when appropriate. 3. Does the patient have a medication patch in the area where the AED pads will be placed? If so, remove the medication patch, wipe the area clean, and then attach the AED pad. 4. Does the patient have an implantable pacemaker or internal defibrillator in the same area where the AED pads will be located? If so, place the AED pad below the pacemaker or defibrillator, or place the pads in anterior and posterior positions.

Short Answers Explain the difference between stable angina and unstable angina.

Stable angina is characterized by pain in the chest of coronary origin that is relieved by rest or nitroglycerin. Unstable angina is characterized by pain in the chest of coronary origin that occurs in response to progressively less exercise or fewer stimuli than ordinarily required to produce angina. If untreated, it can lead to AMI.

Short Answers List three ways in which AMI pain differs from angina pain.

1. It may or may not be caused by exertion, but it can occur at any time. 2. It does not resolve in a few minutes. 3. It may or may not be relieved by rest or nitroglycerin.

Short Answers List three serious consequences of AMI.

1. Sudden death 2. Cardiogenic shock 3. Congestive heart failure (CHF)

Short Answers Name at least five signs and symptoms associated with AMI.

1. Sudden onset of weakness, nausea, or sweating without an obvious cause 2. Chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath 3. Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck 4. Irregular heartbeat with syncope 5. Shortness of breath, or dyspnea 6. Nausea/vomiting 7. Pink, frothy sputum 8. Sudden death

Short Answers List six steps in the treatment of a patient with CHF.

1. Take vital signs, and give oxygen via a nonrebreathing mask with an oxygen flow of 10 to 15 L/min. Medical control may order the use of CPAP. 2. Allow the patient to remain sitting in an upright position with the legs down. 3. Be reassuring; many patients with CHF are quite anxious because they cannot breathe. 4. Patients who have had problems with CHF before will usually have specific medications for its treatment. Gather these medications and take them to the hospital. 5. Nitroglycerin may be of value if the patient’s systolic blood pressure is greater than 100 mm Hg. If the patient has been prescribed nitroglycerin, and medical control or standing orders advise you to do so, you can administer it sublingually. 6. Prompt transport to the emergency department is essential.

Ambulance Calls You are dispatched to the residence of a 58 year old man complaining of chest pain. He states that it feels like “somebody is standing on my chest.” He sat down when it started and took a nitroglycerin tablet. He is still a little nauseated and sweaty but feels better. He is very anxious. How would you best manage this patient?

The patient is feeling better, so it is likely that he was experiencing an episode of angina; however, because you cannot rule out an AMI, this patient should be strongly encouraged to go to the hospital for evaluation. Place the patient in a position of comfort. Provide oxygen therapy, if appropriate. Monitor his vital signs and provide normal transport. If the patient continues to have chest pain, reassess and consider administering an additional nitroglycerin tablet, if local protocol permits. In addition to BLS care, this patient will also benefit from ALS care; therefore, an attempt to rendezvous with an ALS unit should be made.

Ambulance Calls You are dispatched to the home of a 45 year old man experiencing chest pain. He told his wife that he was fine, but she decided to call 9 1 1. When you arrive, you find your patient sitting in the living room, looking anxious. He is sweaty and pale and admits the pain is worse than just a few moments ago. He tells you that he is a very athletic person, so the pain must just be stress related and will go away after he relaxes for a while. He tells you he does not want to be taken to the hospital. How would you best manage this patient?

Denial is one of the biggest indicators of heart attack. Although this patient is considered “younger” and otherwise healthy, he is having signs and symptoms of a myocardial infarction. It may take some convincing of the need for treatment and transport, but you must be clear on the potential consequences of his refusal of care (informed refusal). If he initially refuses, explain what physical signs you see that lead you to believe he is likely having a heart attack, express genuine concern for his well being, and allow him to speak directly with medical control. More often than not, when patients hear the same or similar information from a physician, it has a different effect. If he allows you to examine, treat, and transport him, apply oxygen (if appropriate), transport promptly, and follow local protocols.

Ambulance Calls You are dispatched to the home of a 60 year old woman complaining of sudden weakness. She tells you that she usually has enough energy to perform daily tasks around the house, but today she’s suddenly very tired, has some pain in her jaw, and has some nausea. She denies any history of recent illness, including cough, cold, or fever. She is otherwise healthy and does not take any medications. How would you best manage this patient?

This patient could be having a heart attack. A common symptom that women (especially postmenopausal women) experience when having a heart attack is the sudden onset of generalized weakness. Although chest pain is a common indicator of heart attack, if a patient is not experiencing pain or pressure, it does not necessarily mean that he or she is not experiencing a cardiac event. It is important to note that heart disease is the number one killer of women in the United States, taking more lives than cancer and killing more women than men every year. If your patient exhibits any combination of the “associated symptoms” of heart attack, such as nausea; vomiting; shortness of breath; pain or numbness in the neck, jaw, back, or arm(s); or cool, pale, sweaty skin, you should suspect the possibility of a heart attack. You should apply oxygen (if appropriate), obtain vital signs, allow the patient to maintain a position of comfort, and provide immediate transport to the nearest appropriate facility.

What type of additional resource is typically required for someone with chest pain? A. Lift assistance B. Advanced life support C. Police D. Rescue team

B. Advanced life support

When taking a SAMPLE history of a conscious person with chest pain, what specific question should the EMT ask of the patient? A. Has he or she had a heart attack before B. How long does he or she want to stay in the hospital C. Did the patient’s physician inform him or her of risk factors associated with heart disease D. Does he or she exercise on a regular basis

A. Has he or she had a heart attack before

Which step should NOT be taken to complete a history and physical exam on an unconscious patient with a suspected cardiac problem? A. Perform a full body scan. B. Obtain vital signs. C. Obtain history from family or bystanders. D. Look through the patient’s wallet for medical information.

D. Look through the patient’s wallet for medical information.

A patient taking medications such as Lasix or digoxin is likely to have which of the following underlying medical conditions? A. Hypertension B. Hyperglycemia C. CHF D. Cerebral vascular accident

C. CHF

When assessing a cardiac arrest patient, you notice what appears to be a pacemaker implanted in the upper left chest. Care for this patient should include: A. attempting to deactivate the device by placing a magnet over it B. making sure the AED patches are not directly over the pacemaker device C. waiting for ALS to arrive before applying the AED D. not using the AED in this situation

B. making sure the AED patches are not directly over the pacemaker device

Chapter 17 Workbook Flashcards

(119 cards)