Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction?

A: 55-year-old obese female

B: 66-year-old male with angina

C: 75-year-old male with hypertension

D: 72-year-old female with diabetes

You selected A; The correct answer is D;

Reason:

Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfort to indigestion. Some patients, however, do not experience any pain. In particular, elderly women with diabetes may present with vague, unusual, or atypical symptoms of AMI; their only presenting complaint may be fatigue or syncope. Do not rule out a cardiac problem just because a patient is not experiencing chest pain, pressure, or discomfort; this is especially true in elderly females with diabetes.

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The energy setting for a biphasic AED:

A: increases by 50 joules with each shock.

B: is typically 360 joules.

C: must be manually set by the EMT.

D: is manufacturer specific.

You selected A; The correct answer is D;

Reason:

A biphasic AED sends energy in two directions simultaneously. This is advantageous because it produces a more efficient defibrillation than monophasic defibrillation, which sends energy in only one direction, and uses a lower energy setting. The energy setting on a biphasic AED is device specific, but typically ranges from 120 to 200 joules. AEDs are preprogrammed by the manufacturer to deliver a specific amount of energy, which eliminates the need to manually set the energy level. Some biphasic AEDs deliver the same amount of energy for each shock; others may escalate the energy level for each shock. Refer to the manufacturer's documentation that accompanies the AED you use regarding the amount of biphasic energy it delivers.

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The automated external defibrillator (AED) should NOT be used in patients who:

A: experienced a witnessed cardiac arrest.

B: are apneic and have a weak carotid pulse.

C: have a nitroglycerin patch applied to the skin.

D: are between 1 and 8 years of age.

You selected A; The correct answer is B;

Reason:

The AED is only applied to patients in cardiac arrest (eg, pulseless and apneic), whether the arrest was witnessed or unwitnessed. According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), AEDs can safely be used in infants and children less than 8 years of age in conjunction with a dose-attenuating system (energy reducer) and pediatric pads. However, if pediatric pads and an energy reducer are unavailable, adult AED pads should be used. A nitroglycerin patch is not a contraindication to the use of an AED; simply remove the patch (with gloved hands) and apply the AED as usual.

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Which of the following would clearly be detrimental to a patient in cardiac arrest?

A: Using a pocket face mask without high-flow oxygen

B: Ventilating just until the chest rises

C: Interrupting CPR for more than 10 seconds

D: Performing CPR before defibrillation

You selected A; The correct answer is C;

Reason:

Major emphasis is placed on minimizing interruptions in CPR. Even brief interruptions cause a significant decrease in blood flow to the heart and brain. If you must interrupt CPR, do not exceed 10 seconds. It is preferable to ventilate a patient with a pocket face mask attached to high-flow oxygen, but failing to do so will not be nearly as detrimental as interrupting CPR for extended periods of time. You should ventilate the patient just until the chest visibly rises; ventilations that are too forceful or too fast can cause hyperinflation of the lungs, which may reduce blood return to the heart. When caring for any patient in cardiac arrest, you should immediately begin CPR, and then apply the AED as soon as possible.

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A patient who is experiencing an acute myocardial infarction:

A: often complains of a different type of pain than a patient with angina.

B: most often describes his or her chest pain as being sharp or tearing.

C: has chest pain or discomfort that does not change with each breath.

D: often experiences relief of his or her chest pain after taking nitroglycerin.

You selected A; The correct answer is C;

Reason:

The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressure, heaviness); thus, you cannot distinguish AMI from angina pectoris based solely on the type or quality of pain. Furthermore, the pain associated with AMI, like that of angina, often radiates to the arm, jaw, back, or epigastrium. Relative to other causes of chest pain or discomfort (eg, pleurisy, pneumothorax), the pain associated with AMI and angina does not worsen or improve when the patient takes a breath. Rest and nitroglycerin often relieve the pain associated with stable angina, but are less likely to relieve the pain associated with AMI.

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When assessing a patient who complains of chest pain, which of the following questions would you ask to assess the "R" in OPQRST?

A: Did the pain begin suddenly or gradually?

B: Is there anything that makes the pain worse?

C: What were you doing when the pain began?

D: Is the pain in one place or does it move around?

You selected A; The correct answer is D;

Reason:

The R in OPQRST stands for radiation or referred pain. An appropriate way to determine whether the pain radiates or not is to ask the patient if the pain remains in one place or if it moves around. When determining if the patient has referred pain, ask him or her if he or she hurts somewhere other than his or her chest. If you use the term radiating pain, chances are the patient will not understand what you are asking.

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When an error occurs while using the AED, it is MOST often the result of:

A: misinterpretation of the patients cardiac rhythm.

B: excess patient movement during the analyze phase.

C: malfunction of the microchip inside the AED.

D: battery failure secondary to operator error.

You selected A; The correct answer is D;

Reason:

AEDs have a high specificity for recognizing shockable rhythm (eg, V-Fib, pulseless V-Tach); this means that they are highly reliable. It would be extremely rare for the AED to recommend a shock when one is not indicated or fail to recommend a shock when one is indicated. When an error does occur, it is usually the operators fault. The most common error is not having a charged battery. To avoid this problem, many AEDs are equipped with an alarm that warns the operator if the battery is not fully charged. Some of the older AEDs, however, are not equipped with this feature. Therefore, it is important to check the AED daily, exercise the battery as often as the manufacturer recommends, and always have a spare, fully-charged, battery on hand.

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When the vital organs of an 85-year-old patient need additional blood flow, the heart may not be able to meet the increased need because:

A: the reserve capacity of the heart is reduced.

B: stroke volume increases as a person ages.

C: the patients blood vessels become more elastic.

D: blood pressure decreases as a person ages.

You selected A; This is correct!

Reason:

Like other body systems, the cardiovascular system undergoes changes as we get older. As the hearts muscle mass and tone decrease, the amount of blood pumped out of the heart per beat (stroke volume) is reduced. The residual (reserve) capacity of the heart is also reduced; therefore, when the vital organs of the body need additional blood flow, the heart is less able to meet that need as effectively as a younger person's heart. The vascular system also is affected by the aging process. Arteriosclerosis (hardening of the arteries) can develop, affecting perfusion of the tissues. In arteriosclerosis, the arteries become less elastic and more narrowed; as a result, blood pressure typically increases with age.

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You are assessing a 70-year-old male who complains of pain in both of his legs. He is conscious and alert, has a blood pressure of 160/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 14 breaths/min and unlabored. Further assessment reveals edema to both of his feet and legs and jugular venous distention. This patient's primary problem is MOST likely:

A: pulmonary edema.

B: left heart failure.

C: right heart failure.

D: chronic hypertension.

You selected A; The correct answer is C;

Reason:

If the right side of the heart is damaged, fluid collects in the body (edema), often showing in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. Another feature of right heart failure is jugular venous distention, which is an indication of blood backing up into the systemic circulation. Left heart failure typically presents with shortness of breath due to fluid in the lungs (pulmonary edema), which indicates blood backing up from the left side of the heart into the lungs. In s