Cardiology Part 2 Practice Test A The following practice exam is comprised of all multiple-choice questions. Select the response that MOST appropriately answers the question. The questions are designed to assess your knowledge and generally contain two responses that are similar but only one is correct. When you incorrectly answer a question, read the appropriate section in the textbook to find the reason or rationale for the correct response. 1. Which of the following complaints is common for the patient having with cardiovascular disease? a. Chest pain b. Dyspnea c. Syncope d. All of the above 2. Asking the patient, does anything make the pain better or worse? is represented by which factor of the OPQRST line of questioning? a. Onset b. Provocation c. Quality d. Region 3. Your patient has been unable to lay in a supine position because he experiences an increased level of difficulty breathing. What term describes this phenomenon? a. Nocturnal paroxysmal dyspnea b. Orthopnea c. Eupnea d. Apnea 4. You are treating a patient with a history of congestive heart failure who is complaining of cheat pain. Upon auscultation of heart sounds, you note an extra sound that seems to occur late in diastole. What is the designation for this finding? a. S1 b. S2 c. S3 d. S4 5. Bi-polar leads require a positive and a negative lead to sense the electrical activity of the heart, versus the unipolar leads that only require a single lead for monitoring. Of the following, which would be considered bi-polar?
a. II b. V-2 c. I d. III 6. True or false. When the myocardial cells depolarize and the resulting electrical impulses are moving toward a positive electrode, the resulting deflection on the ECG will be positive. a. True b. False 7. Based on your understanding of Einthoven s triangle, you know that the positive lead for lead II is: a. On the right arm b. On the left arm c. On the right leg d. On the left leg 8. Which of the following leads should be placed in the fifth intercostal space between ribs five and six? a. V-1 b. V-2 c. MCL-6 d. MCL-1 9. You have just placed your patient on the ECG monitor. After assessing vital signs you turn your attention to the small screen that shows the ECG tracing. There is only one lead visible on the screen and based on common practice, would most likely be lead: a. avr b. V-4 c. avl d. II 10. One small box measured horizontally on the ECG graph paper is equal to: a. 0.04 seconds b. 0.20 seconds c. 0.1 mv d. 10 mv 11. One large box measured horizontally on the ECG graph paper is equal to: a. 0.04 seconds b. 0.20 seconds c. 0.1 mv d. 10 mv
12. The first negative deflection occurring during the depolarization of the ventricles is known as the: a. Q-wave b. R-wave c. S-wave d. P-wave 13. The first positive deflection occurring during the depolarization of the atria is known as the: a. Q-wave b. R-wave c. S-wave d. P-wave 14. Atrial contraction occurs during the PR interval and cannot be measured by the ECG graph paper. What is the normal time span for the PR interval? a. 0.04 0.12 b. 0.08 0.16 c. 0.12 0.20 d. 0.20 0.24 15. If you were measuring the PR interval using the boxes on the ECG graph paper, what would be the correct measurement for a normal interval? a. 3 5 large boxes, measure horizontally b. 3 5 small boxes, measured horizontally c. 3 5 large boxes, measured vertically d. 3 5 small boxes, measured vertically 16. The positive deflection of the complex that represents depolarization of the ventricles is known as the: a. Q-wave b. T-wave c. S-wave d. R-wave 17. Which of the following ECG tracings would represent the repolarization of the ventricles? a. Q-wave b. T-wave c. S-wave d. R-wave 18. If you have two corresponding positive deflections of the complex that represents ventricular depolarization, the second wave is called a/an: a. R prime
b. S prime c. T prime d. P prime 19. The exact spot where the QRS meets the ST segment is known as the: a. QRS junction b. Osborne wave c. J-point d. U-wave 20. Which interval lasts from the onset of ventricular depolarization until the end of ventricular repolarization? a. PR interval b. ST interval c. RR interval d. QT interval 21. Which of the following can cause the ECG tracing to be obscured by the presence of artifacts? a. Muscle tremor b. 60-cycle interference c. Loose electrodes d. All of the above 22. To determine the rate on the ECG you have counted all the QRS complexes that fall within a set timeframe and multiplied that number by 10. This is known as the: a. 6-second method b. Triplicate method c. R-R method d. Rule of thumb method 23. The American Heart Association would assign which class for a medication that has no evidence of benefit? a. Class I b. Class IIa c. Class IIb d. Class III 24. The American Heart Association would assign which class for a medication supported by good research-based evidence? a. Class I b. Class IIa c. Class IIb d. Class III
25. Your patient is suffering from hypoxia secondary to a bacterial pneumonia. Using the six-second method, interpret the rhythm strip obtained during assessment: a. Sinus tachycardia b. Sinus dysrhythmia c. Sinus bradycardia d. Atrial flutter 26. Which medication would be administered first for this patient given the following vital signs: B/P 88/60, Respiratory rate 28, and pulse oximetry of 96%. a. Atropine 0.5 1.0 mg b. Epinephrine 2 10 mcg/min c. Adenosine 6 mg d. Dopamine 5 20 mcg/kg/min 27. You administered the first line therapy for the patient, but it did not result in any significant changes. Assuming you gave the maximum dose, what would be the next indicated therapy? a. Atropine 0.5 1.0 mg b. Epinephrine 2 10 mcg/min c. Cardizem 0.25 mg/kg d. Dopamine 5 20 mcg/kg/min 28. You are treating a patient who is complaining of feeling, lightheaded. As your partners are connecting the pulse oximetry you connect the ECG leads and obtain the following ECG recording and determine it to be: a. Atrial Tachycardia b. Ventricular tachycardia c. Atrial flutter with a rapid ventricular response d. Atrial fibrillation with a rapid ventricular response 29. You obtain the first set of vital signs for the patient in the prior question and find that the patient is hypotensive, diaphoretic, with cool skin. She has an altered
level of consciousness but responds to painful stimulus. Your first intervention based on the ECG recording and assessment findings is to: a. Administer lidocaine at 1 1.5 mg/kg b. Administer adenosine at 6 mg c. Administer Procainamide at 30 mg/min d. Sedate then synchronized cardioversion at 100 joules 30. During the course of your assessment you obtain the following ECG tracing and interpret it to be: a. Normal sinus rhythm b. Sinus rhythm with PJC s c. Sinus rhythm with PAC s d. Sinus rhythm with PVC s 31. Based on your understanding of the previous ECG you advise your partner that: a. The patient will likely need to have transcutaneous pacing b. The rhythm generally does not need to be treated c. The patient will likely need Cordarone d. The patient will likely need synchronized cardioversion 32. You are assessing a 32 year-old male who is complaining of a fluttering sensation in the center of his chest. You obtain the following ECG and interpret it as: a. Atrial tachycardia b. Sinus tachycardia c. Ventricular tachycardia d. Atrial flutter 33. You have determined that the patient in the previous question is stable enough for medication therapy with normal cardiac function. Which of the following therapies should be performed first?
a. Adenosine 6 mg rapid IVP b. Amiodarone 150 mg infusion over 10 minutes c. Verapamil 2.5 5 mg IVP d. Valsalva maneuver 34. The therapy you selected from the prior choices was unsuccessful in terminating the dysrhythmia. What treatment is indicated next if there has been no significant change in the patient s hemodynamic status? a. Adenosine 6 mg rapid IVP b. Amiodarone 150 mg infusion over 10 minutes c. Verapamil 2.5 5 mg IVP d. Valsalva maneuver 35. In the absence of invasive hemodynamic monitoring, how can the paramedic determine poor ejection fraction or hemodynamic compromise? a. By contacting the receiving facility b. By evaluating the clinical signs and symptoms c. The paramedic is unable to determine and thus must render supportive care only d. By inserting a catheter into the internal jugular vein 36. You are called to a nursing home for a patient with an unknown dysrhythmia. You arrive at the patient s bedside and are presented with the following ECG. Your interpretation is: a. Atrial flutter b. Atrial fibrillation c. Atrial tachycardia d. Sinus tachycardia 37. If the patient were symptomatic with the previous ECG, what therapy would be indicated in the setting of a poor ejection fraction? a. Verapamil 2.5 5 mg b. Amiodarone 150 mg c. Cardizem 0.25 mg/kg
d. Adenosine 6 mg 38. Interpret the following ECG: a. Atrial flutter b. Atrial fibrillation c. Atrial tachycardia d. Sinus tachycardia 39. If you were treating a patient with the ECG shown above, what main concern do you have if it has been greater than 48 hours since its onset? a. Cardiac toxicity b. Embolization c. The likelihood of an inferior myocardial infarction d. The chance of an aortic aneurysm 40. Interpret the following ECG: a. Normal sinus rhythm b. Sinus bradycardia c. Sinus dysrhythmia d. Junctional rhythm 41. You are treating a patient that has been complaining of substernal chest pain for the past two hours. He has had several prior episodes that went away with rest, but this event is more severe. The pain is described as aching, is an 8 on a 1-10 scale, and does not radiate. His vital signs are within normal limits. What treatments are appropriate? a. Oxygen, aspirin, morphine, and heparin b. Oxygen, aspirin, nitroglycerin, and Procardia c. Oxygen, nitroglycerin and norepinephrine d. Oxygen, aspirin, nitroglycerin and morphine
42. For the patient in the previous question, you obtained an ECG tracing and found the following rhythm. What is your interpretation? a. Sinus rhythm with PAC s b. Ventricular tachycardia with PAC s c. Sinus rhythm with couplet PVC s d. Ventricular bigeminy 43. What medication would be appropriate for treating the previous arrhythmia given the fact that they are occurring as a result of ischemia? a. Atropine b. Lidocaine c. Morphine d. Epinephrine 44. In the course of your treatment for the chest pain patient you place the electrodes to perform a 12-lead ECG. You note that there is ST elevation in leads II, III, and a VF. There is inverted T-wave in leads V-2 through V-4. This is most consistent with: a. Myocardial ischemia only b. Anterior wall myocardial infarction c. Inferior wall myocardial infarction d. Lateral wall myocardial infarction Use the following information for questions 45 50. You arrive to find a 54 year-old female lying supine on her kitchen floor with no signs or history of trauma. The husband reports that she clutched her chest, fell into his arms and was lowered to the ground by him. She does not appear to be moving. 45. How would you open her airway if you determined that she is unconscious? a. Jaw thrust b. Head-tilt chin-lift c. Modified jaw thrust
d. Head-tilt neck-lift 46. You have determined that she is not breathing, which prompted you to provide positive pressure ventilations. Your partner advises that there is no carotid pulse. CPR is being performed and the fast patch combination pads are placed on her chest. You obtain the following ECG and interpret it as: a. Ventricular tachycardia b. Ventricular fibrillation c. Agonal d. Idioventricular 47. 48. What is the first priority in treating a patient with this dysrhythmia? a. Immediate unsynchronized cardioversion b. Immediate synchronized cardioversion c. Administration of epinephrine d. Administration of atropine 49. Assuming that you prior intervention/s were unsuccessful, what is the next appropriate action in treating this patient? a. Establish intravenous access b. Administer epinephrine c. Administer Amiodarone d. Briefly hyperventilate, then intubate 50. CPR is being performed, the patient has been intubated, an IV is established and the first appropriate medication has been administered via IV push. What is the next step? a. Reassess, unsynchronized cardioversion, and check pulses after b. Reassess, administer cordarone, and check pulses after c. Reassess, administer sodium bicarbonate, and check pulses after d. Reassess, administer atropine and check pulses after 51. You have converted the patient into a perfusing rhythm, but the patient remains hypotensive despite positioning and fluids. What drug is indicated to increase the patient s blood pressure to an acceptable level in the pre-hospital setting? a. Norvasc b. Dopamine
c. Isuprel d. Epinephrine 52. Which of the following treatable causes of pulseless electrical activity is paired correctly? a. Pericardial tamponade needle decompression b. Hypoxia decrease tidal volumes c. Hyperkalemia bicarbonate administration d. Acidosis hypoventilation 53. An anterior hemiblock is evidenced by: a. Upright QRS complexes in leads I, II and avf b. Downward QRS complexes in leads I, II and avf c. Downward QRS complex in lead I, and upright in leads II and avf d. Upright QRS complex in lead I, and downward in leads II and avf 54. Which ECG finding is consistent with Wolff-Parkinson-White syndrome? a. Wide QRS complexes b. The presence of Osborne waves c. The presence of delta waves d. Bradycardia 55. What is the most common cause of angina pectoris? a. Coronary vasospasm b. Coronary atherosclerosis c. Coronary thrombosis d. Coronary embolization 56. The most common cause of death for patient s suffering from an acute myocardial infarction is: a. Dysrhythmias b. Atherosclerosis c. Myocardial tissue rupture d. Pump failure 57. Which of the following conditions is an absolute contraindication for the administration of fibrinolytics? a. 70 year-old male b. Chest pain for 8 hours c. History of stroke 6 months ago d. Blood pressure reading of 160/100 58. You are treating a patient with cardiogenic pulmonary edema. His blood pressure is 200/108, pulse rate is 118, and respirations are 36. You have administered oxygen at 15 liters/min via non-rebreather mask. What is the next appropriate therapy?
a. Dopamine b. Lasix c. Levophed d. Aramine 59. What other medication may be administered to the patient in the prior question if the first therapy is unsuccessful? a. Nitroglycerin b. Dantrolene c. Aminophylline d. Atropine 60. Which of the following signs are associated with right ventricular failure? a. Pulmonary edema b. Distended neck veins c. Ascites d. b and c 61. An aneurysm often results from long-standing hypertension. If it is located in the abdominal area, it s most common location is: a. Superior to the celiac artery b. Inferior to the renal arteries c. At the bifurcation of the iliac arteries d. In the arch of the aorta