Emergency Medical Scenarios, Exams of Nursing

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Paramedic Cardiology Final Exam AND Paramedic

FISDAP Final Compiled by Global Authorities Top-

Tier Questions with Detailed Solutions With In-

Depth Answer Analysis

The innermost layer of the heart is known as what? - CORRECT ANSWER- - The Endocardium What is the intrinsic firing rate of the SA node? - CORRECT ANSWER- - 60 - 100 What is the intrinsic firing rate of the AV node/junction? - CORRECT ANSWER- - 40 - 60 What is the intrinsic firing rate of the ventricles? - CORRECT ANSWER- - 20 - 40 After leaving the SA node, where is the electrical impulse next conducted at? - CORRECT ANSWER- - The internodal pathways How is a complete cardiac cycle described? - CORRECT ANSWER- - The end of one contraction to the end of the next During the diastolic phase of the cardiac cycle , which valve remains open? - CORRECT ANSWER- - The tricuspid valve What age population has a normal heart range of 70-110? - CORRECT ANSWER- - School Age According to the 2020 AHA guidelines, the rate of compressions for an adult victim of cardiac arrest is what? - CORRECT ANSWER- - Anywhere between 100-120 per minute

While ascultating a patient's heart sounds, you hear an extra beat prior to S1 or the normal lub sound of the heart. What is this known as? - CORRECT ANSWER- - S What is responsible for the second ascultated heart sound? (S2) - CORRECT ANSWER- - Closure of the aortic and pulmonic valves by diastolic pressure What is S1 produced by? - CORRECT ANSWER- - Closure of the atrioventricular valves Which heart sound is heard by the closure of the semilunar valves? - CORRECT ANSWER- - S Fatty deposits collecting within the walls of the arterial system are known as what? - CORRECT ANSWER- - Atherosclerosis You are assessing a patient with carotid bruits who is currently in a narrow complex tachycardia at a rate of 200. What would most likely occur if a carotid sinus massage was performed? - CORRECT ANSWER- - An embolic stroke You have just defibrillated a patient from V-fib into what appears to be a rhythm which should produce a pulse. In cases where the arrest was unwitnessed, what is the most likely reason why we continue to provide chest compressions? - CORRECT ANSWER- - The patient is typically in PEA At the scene of a termination of resuscitation, what detail of documentation is typically required to be included on a death certificate? - CORRECT ANSWER- - Time of death Contraction of cardiac muscle tissue occurs after what? - CORRECT ANSWER- - Depolarization

Your patient is unresponsive, hypotensive, and has a bradycardia with a wide complex, second degree type 2 block. What is most likely to correct the issue? - CORRECT ANSWER-

• Transcutaneous pacing Your CHF patient takes a potassium supplement on a daily basis. What drug would you suspect this patient also takes, based off of this information? - CORRECT ANSWER- - Furosemide (Lasix) What is inotropy defined as? - CORRECT ANSWER- - Force of cardiac contraction After leaving the SA node, where is an electrical impulse next conducted at? - CORRECT ANSWER- - Internodal pathways You are transcutaneously pacing a patient with a second degree type 2 heart block. The patient remains unresponsive and apneic while your partner continues ventilations. What is your most important intervention after starting pacing? - CORRECT ANSWER- - Verifying mechanical capture After passing through the AV node, the next electrical pathway of cardiac conduction would be what? - CORRECT ANSWER- - Bundle of His You are assessing a 2 year old boy who has been healthy up until today. The patient is now pale, lethargic and difficult to arouse and earlier was anxious, clammy and acting inappropriately. The pulse is now fast and thready. What do you expect to see on the cardiac monitor? - CORRECT ANSWER- - SVT An 8 year old presents with cardiac arrest. The parents state that the child has had vomiting and diarrhea for 3 days. There is no other medical history and no signs of trauma. The most likely explanation for the cardiac arrest is what? - CORRECT ANSWER- - Electrolyte imbalance

When the cardiac rhythm is ventricular fibrillation, the muscle cells are still contracting but there is no what? - CORRECT ANSWER- - Cardiac output Lidocaine is an example of what type of antidysrhythmic? - CORRECT ANSWER- - Sodium Channel Blocker You're called to a local school, you are presented with a 4 year old, 45 pound patient who appears to be in cardiac arrest. There is a weak carotid pulse present and your cardiac monitor shows ventricular tachycardia. What should you do first? - CORRECT ANSWER- - Cardiovert at 10-20 joules What is the primary reason for the use of continuous 4 lead EKG monitoring? - CORRECT ANSWER- - To quickly identify negative changes in the patient's rhythm Torsades des pointes is primarily treated by the administration of which drug? - CORRECT ANSWER- - Magnesium Sulfate What common dysrhythmia is a risk factor for stroke? - CORRECT ANSWER- - Atrial Fibrillation You are called to a patient complaining of dizziness, nausea and blurred vision after taking too many digoxin pills avvidentally over a 2-3 day period. What treatment is appropriate for this patient? - CORRECT ANSWER- - Pace a symptomatic bradycardia You are treating a 27 year old adult patient who has just been removed from a burning industrial building. The patient had severe dyspnea, complained of chest pain, had a seizure and is now unresponsive. What is your FIRST priority in treating this patient? - CORRECT ANSWER- - Rapid Airway intervention and ventillatory support

What type of artifact will make identification of the presence of a paced rhythm virtually impossible? - CORRECT ANSWER- - 60 cycle interference What is another term for asynchronous cardioversion? - CORRECT ANSWER- - Defibrillation The use of defibrillation pads to obtain a single-lead ECG is best used in what circumstance? - CORRECT ANSWER- - Cardiac arrest You are treating an adult victim of an unwitnessed cardiac arrest in accordance with the 2020 AHA guidelines. If indicated, how can you increase the effectiveness of defibrillation?

• CORRECT ANSWER- - Deliver a shock immediately, if available, even prior to performing compressions What is the best explanation as to why we push hard, push fast, and minimize interruptions when performing chest compressions? - CORRECT ANSWER- - To maintain an adequate blood pressure You are assisting in the care of a cardiac arrest patient. Your partner is ventilating the patient with a BVM. Other rescuers arrive and take over chest compressions and possible defibrillation. You can see there is no chest rise when your partner ventilates the patient. What should you choose to do to improve this situation? - CORRECT ANSWER- - Assist your partner in maintaining a seal on the BVM What is the unit of measurement for the component of a transcutaneous pacemaker regarding the amount of current delivered? - CORRECT ANSWER- - Milliamps You are treating a 57 year old male in cardiac arrest and his wife tells you he has an implanted defibrillator. You quickly realize that the patient is in pulseless v-tach and the patient's implanted device is failing to deliver any shocks. What is the most appropriate action to treat? - CORRECT ANSWER- - Defibrillate the patient using your pads or paddles, but avoid the implanted defibrillator site

What ECG finding would confirm your suspicion that the patient is experiencing angina? - CORRECT ANSWER- - ST segment depression You have just positioned a patient complaining of chest pain on the stretcher. What position will the patient most likely prefer for transport? - CORRECT ANSWER- - Semi- fowler's You are assessing a patient experiencing severe chest pain. A blood pressure assessment reveals a differene of greater than 20 mmHg in systolic readings between the left and right arm. What is the best explanation for this difference? - CORRECT ANSWER- - A possible tearing aortic aneurysm What is the most common complication of acute myocardial infarction? - CORRECT ANSWER- - Dysrhtymias You are called to treat a 48 year old complaining of chest pain and the 12 lead indicates an extensive anterior wall MI. The patient denies any shortness of rbeath, the pulse oximeter reading is 96% and the patient informs you of a smoking history of two packs a day. You administer high-concentration oxygen and the patient indicates that the chest pain has increased. What is the most likely cause of the increase in pain? - CORRECT ANSWER- - The elevated oxygen level caused a constriction in the coronary arteries What is the proper treatment for a patient with a suspected cocaine overdose who is exhibiting chest pain, nervousness, tachycardia, increased blood pressure and dilated pupils? - CORRECT ANSWER- - Cardiac monitor, oxygen therapy, and IV normal saline TKO ST elevation in 2 contiguous leads indicates that what is occurring? - CORRECT ANSWER- - An MI

4. An alert 22 year old male was just disentangled from debris in a house collapse. He denies head or neck pain, but complains of server hip pain. Vital signs are BP 88/40. P120 R 16 you should administer. - CORRECT ANSWER- - sodium bicarbonate
5. Braxton Hicks contractions - CORRECT ANSWER- - occur in the second trimester and are false labor.
6. A 40 year old male crashed his motorcycle. He had a brief loss of consciousness, woke up and walked home. You find him 2 hours later at home unconscious. You should suspect. - CORRECT ANSWER- - epidural hematoma
7. A 47 year old male who was found unconscious on the side of the road respond only to painful stimulus. When you attempt to establish IV access he stiffens his arms and legs. He has minor abrasions all over his body. Vital signs are BO 178/122 P56 R irregular ETCO2 30. What should you do? - CORRECT ANSWER- - Assist ventilations at 12 breaths per minHg.
8. A 28 year old female has a sudden onset of tightness in her chest and server difficulty breathing. Her tongue face and neck appear swollen and she has red itchy hives on her torso. Her signs are BP 80/40 P 130. You should administer - CORRECT ANSWER- - Epinephrine 0.3mg
9. You are asked to set up a patient treatment area after a box labeled "radio active" was found unattended in a park. Which of the following would be the best location. - CORRECT ANSWER- - Building in the park
10. You are at a house fire with multiple patients. Which patient should be transported First to a burn center? - CORRECT ANSWER- - 52 year old with second degree burns to face and right hand

11. What is the most common cause of status epilepticus in adults. - CORRECT ANSWER- - Failure to take prescribed medications
12. A 58 year old male with history of renal failure complains of dizziness lethargy and difficulty breathing. He says he missed his last dialysis appointment. Vital signs are BP 160/90 P 100 R 28 with rales heard in the basses. SPO2 92% you should suspect. - CORRECT ANSWER- - Fluid Overload.
13. A 12 year old girl is seizing. Her mom tells you that her daughter has been feeling tired for days. Her skin is dry and she has been very thirsty. Vital signs are BP 118/80 P115 R you should suspect. - CORRECT ANSWER- - Diabetic ketoacidosis
14. A 42 year old female has fallen down a flight of stairs. She appears anxious her skin is cool and clammy her radial pulses are weak at 112 beats per min and she complains of abdominal pain in the left upper quadrant with radiation to the left scapula. You should suspect. - CORRECT ANSWER- - Torn or lacerated spleen.
15. Emergency medical responders are ventilating an apneic medical patient with a bag valve mask. You note abdominal distention and minimal chest rise. What should you do? - CORRECT ANSWER- - Reposition the head.
16. A 6 month old male was found lying face down in the crib. He is cyanotic and apneic. A weak brachial pulse is present. You are unable to see a chest rise with your second attempt at rescue breathing after repositioning the head. What should you do. - CORRECT ANSWER- - Start CPR

23. To successfully accomplish nasotracheal intubation you should advance the endotracheal tube though the glottic opening to coincide with patient - CORRECT ANSWER- - Inhalation
24. An alert 23 year old male presents with a sudden onset of shortness of breath and chest pain after running upstairs. Breath sounds are diminished in the right side. The most likely cause is. - CORRECT ANSWER- - Spontaneous pneumothorax
25. First responders are treating an apneic adult female. You notice that they are applying frequent long ventilations with an oxygen resuscitator. What effects with their actions create. - CORRECT ANSWER- - Increased capillary elasticity.
26. You are called to a nursing home on a hot summer day for a 88 year old male. The nurse tells you he missed his dialysis appointment because he was complaining of nausea vomiting headache and running a fever. Which differential diagnosis should you consider first. - CORRECT ANSWER- - Sepsis and hyperkalemia
27. You have just administered adenosine to a 62 year old patient with narrow complex tach. The ECG shows an irregular rate of 50 then steadily climbs back to a rate of 169. What would should suspect - CORRECT ANSWER- - rapid atrial fibrillation.
28. A 63 year old male is having a diabetic emergency. He is unresponsive R12 glucometer
29. You cannot establish IV access. You should - CORRECT ANSWER- - administer glucagon IM
30. When setting up a night time landing zone for a helicopter what is the recommended area needed. - CORRECT ANSWER- - 100x
31. A 67 year old with hypo-tension and bradycardia has no responded to pacing or atropine. You should - CORRECT ANSWER- - administer dopamine infusion

32. A 19 year old male has suffered blunt trauma on his left chest. He complains of server dyspnea and pain over the affected area. Vital signs are BP 92/60 P 128 R 32. Breath sounds are very diminished over the left chest. You should - CORRECT ANSWER- - perform needle thoracostomy
33. A 44 year old patient has a persistent cough and occasional spits up bloody sputum. He has been living in a a shelter for the past three weeks and he smells like alcohol you should. - CORRECT ANSWER- - Put on N95 mask and eye protection.
34. While treating a patient with suspected TB. What type of personal protective equipment is essential - CORRECT ANSWER- - HEPA respirator
35. A 2 year old male has been sick over the last 48 hours with a low grade fever runny nose and upper respiratory infection. He has a seal bark cough. The patient is using accessory muscles to breath and appears fatigued his upper airway has stridours sounds. His lung sounds appear clear. SPO2 92% how would you treat the patient. - CORRECT ANSWER- - Oxygen nebulized racemic epinephrine transport.
36. 78 year old male lying unresponsive in his bed vital signs are BP unobtainable. R 12 and normal depth radial pulse rate matches ECG below ECG bradycardia - CORRECT ANSWER-

• Perform transcutaneous pacing.

37. A 48 year old patient is chocking on a hot dog. He is unresponsive apneic and has a strong pulse. Chest compression are infective at relieving the obstruction. You should. - CORRECT ANSWER- - use lagosopy and magill forceps to remove the object.
38. 87 year male is complaining of dizziness. Physical exam revals pale cool and diaphoretic skin. Pulse matches ECG bradycardia. You should - CORRECT ANSWER- - administer atropine

are BP 70/50 P64 R 20. The patient is most likely suffering from - CORRECT ANSWER- - neurogenic shock

46. A 63 year old female chocked on a piece of steak and is apneic. You partner has visualized a partial obstruction in the trachea. He has been trying to grab it with forceps for more than 2 minutes. What should you advise him to do? - CORRECT ANSWER- - Remove the blade and attempt to ventilate.
47. An unconscious 13 year old patient has minor abrasion on his torso after being struck by a vehicle. The child's parents are not on scene law enforcement and an EMS supervisor are on scene You should? - CORRECT ANSWER- - transport the patent to hospital
48. A 38 year old female is crowing. You note the amniotic fluid contains a substance resembling pea soup. An apneic blue limp infant with a heart rate of 80 beats is delivers. How should you treat the infant. - CORRECT ANSWER- - Suction with a bulb syringe and ventilate.
49. A 56 year old female has a sudden onset of substernal chest pressure. She denies any shortness of breath or nausea. She has a history of arthrosporic heart disease and is talking verapamil. Vital signs are BP 160/90 pulse matches the ECG rhythm below R 16 skin warm and dry. and lungs clear bilateral. What should you do. - CORRECT ANSWER- - Nitroglycerin
50. A 64 year old is sitting in his living room in moderate distress. He is able to speak to you in full sentences but claims he is not feeling right. Vitals signs are BP 1110/64 R 16. Pulse matches monitor (super vertical tachycardia) what should you do. - CORRECT ANSWER- - vagal fluids adenosine.
51. Which I V will be able to administer the most fluid in the least amount of time. - CORRECT ANSWER- - 14 gauge 1/2 inch IV catheter.

52. A 30 year old man is breathing fast and deep. He works at a preschool and believes that the children plan to harm him. Which of the following statement is most helpful when treating the patient. - CORRECT ANSWER- - I understand that you are concerned. Can you tell me more about why you fell this way.
53. A 67 year old man has collapsed and is on the floor. He is pale clammy and moaning with vomit around his mouth. Vital signs are BP 180/30 P110 and weak R28 and shallow. Oropharynx is clear and lungs are clear bilaterally. His ECG shows ventricular tachycardia. That should you do? - CORRECT ANSWER- - Synchronized cardio100J
54. You arrive at the scene of a single vehicle crash. A woman walks up to a your ambulance with a cut on her forehead. You should - CORRECT ANSWER- - determine if she is the only victim
55. A 73 year old male has several fractured ribs on his right side with unequal chest wall movement. He has dyspnea and diminished breath sounds on the right. Vital signs are BP 124/76 P124 R 26 and shallow. His trachea is mid line and neck veins are flat. Most likely has - CORRECT ANSWER- - a flail chest segment
56. You have just converted a 318 lb cardiac arrest patient into a normal sinus rhythm. She is hypotensive and you have been ordered to start the an epinephrine drip at 3mcg/min using a 60 drip set. You have mixed a 4:1 concentration of epinephrine and should set the drip rate at - CORRECT ANSWER- - 45 drops/min (clock)
57. You are assisting with a deliver and the infants head has been deviled. You notice the umbilical cord is wrapped around the infants neck. You should - CORRECT ANSWER- - gently slip the cord over the infants head or clamp the cord in two places and cut between the clamps to release the cord.

65. An 86 year old female presents with a rhythm in the ECG she is immobile due to server arthritis and has a history or atherosclerosis and hypertension. What should you suspect - CORRECT ANSWER- - Left ventricular hypertrophy LVH
66. A 37 year old suicidal male is bing violent. Police has pinned him in a prone position but he continues to struggle and fight. You should - CORRECT ANSWER- - sedate the patient and place him supine on the stretcher in soft restraints
67. The termination of pregnancy for maternal health reasons is called a - CORRECT ANSWER- - therapeutic abortion
68. While using the START system at a major incident you encounter a patient not breathing. After positioning the airway the patient breaths 16 a min. You should catagorize him as? - CORRECT ANSWER- - Immediate
69. You are transporting the victim of a major trauma which occurred yesterday to a larger facility. This patient has been experiencing progressive hypoxemia. You hear coarse crackles blatantly during auscultation of the lungs and the pulse oximetry reading is falling in spite of the patent being intubated. You should suspect - CORRECT ANSWER- - that acute respiratory distress syndrome has developed
70. A 19 year old female is 25 weeks pregnant. She has server headache blurred vision and edema she has not regularly seen a doctor during her pregnancy. What other symptom should you expect. - CORRECT ANSWER- - hypertension
71. Which of the following is a cause of multifocal atrial tachycardia - CORRECT ANSWER- - Electrolyte imbalance
72. After receiving Narcan. A patient is waking up quickly and pulling at the airway you have placed. Before removing it you should - CORRECT ANSWER- - prepare to begin suctioning

73. A 66 year old male complains of server dyspnea. His has breath sounds on the right and diminished on the left. He has a long history of cigarette smoking. Vital signs are BP 80/ P124 R 26 and shallow SPO2 88% on 4 lpm What should you suspect? - CORRECT ANSWER- - Emphysema exacerbation
74. A patient is complains of left calf pain. The left leg is cool to the touch and paler than the right leg. You should suspect - CORRECT ANSWER- - Arterial occlusion
75. After placing a combitube bilateral breath sounds are present and chest rise is equal. You notice quiet gurgling in the stomach with each ventilation. You should. - CORRECT ANSWER- - add air to the distal cuff
76. A seven month old is breathing at a rate of 60 per min. He has nasal flaring and intercostal retractions. You hear stridorous noises on inspiration. This is most likely caused by a - CORRECT ANSWER- - foreign body obstruction the upper airway
77. A 28 year old suffered a head injury. Vital signs a BP 140/120 P 55 R 30 and irregular. Which of the following signs would you expect to see in this patient. - CORRECT ANSWER- - Decerebrate posturing
78. During transportation you PT becomes very upset complaining about her medical expenses. How should you respond? - CORRECT ANSWER- - You seem angry is there any way hat i can help
79. Which of the following pharmacological agents are most likely to cause premature arterial contractions. - CORRECT ANSWER- - stimulants