Deck 6: Patient Monitoring Technology

Question 1

You are working at the triage desk in the ED when a young man on crutches approaches the desk. He appears moderately short of breath. He states he had a cast put on his left leg seven days ago after surgery for a ruptured Achilles tendon. This morning, while he was watching television, he suddenly became short of breath. He has a history of asthma, for which he takes Xopenex as needed, and is taking Tylenol with codeine for pain related to his surgery. The patient's lung sounds are clear and equal, SpO₂ is 90 percent on room air, heart rate is 100 and regular, respirations are 24 and slightly labored, blood pressure is 128/88 mmHg, and the patient is afebrile. These findings are most consistent with:

A) allergic reaction to codeine.
B) COPD exacerbated by recent anesthesia.
C) pneumonia secondary to recent anesthesia.
D) pulmonary embolism associated with immobilization of the lower extremity.

Answer 1

pulmonary embolism associated with immobilization of the lower extremity.

Question 2

In which of the following situations is a significant amount of carboxyhemoglobin most likely to be present?

A) A patient who is being treated with nitrites for cyanide poisoning
B) A patient with COPD who is short of breath with an SpO₂ of 90 percent
C) A patient found unresponsive in an apartment in which there is a gas furnace
D) A patient who inhaled anhydrous ammonia fumes

Answer 2

A patient found unresponsive in an apartment in which there is a gas furnace

Question 3

The valve between the right atrium and right ventricle is the ________ valve.

A) bicuspid
B) pulmonic
C) tricuspid
D) aortic

Answer 3

tricuspid

Question 4

Conditions that can cause an inaccurate pule oximetry ready include all EXCEPT?

A) The presence of methemoglobinemia
B) Hyperfusion
C) Anemia
D) Shivering

Question 5

A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR =30, SaO₂ = 88%. Which of the following blood gas values is most likely?

A) pH of 7.6
B) PO₂ of 100 mmHg
C) PCO₂ of 70 mmHg
D) PCO₂ of 35 mmHg

Question 6

ETCO₂ is recorded during phase ________ of the capnogram.

A) I
B) II
C) III
D) IV

Question 7

Lung perfusion depends on all of the following EXCEPT:

A) efficient pumping of blood by the heart.
B) intact pulmonary capillaries.
C) an intact alveolar membrane.
D) adequate blood volume.

Question 8

You are working in the ED, caring for a 55-year-old female patient with a long history of COPD. She is more short of breath today than usual, and states that she has an increased cough. She has a tympanic temperature of 99.8°F. You have drawn arterial blood gases with the patient on room air; when the report comes back, it shows that the patient has a PaO₂ of 92 mmHg. Which of the following is most likely?

A) You have inadvertently drawn a venous sample.
B) The patient is critically hypoxic and requires assisted ventilation.
C) This is the typical value for this patient.
D) The lab performed the test incorrectly.

Question 9

Which of the following is the most important determinant of ventilatory rate?

A) Arterial PO₂
B) Venous PCO₂
C) Venous PO₂
D) Arterial PCO₂

Question 10

Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states that they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. In addition to an IV of normal saline, which of the following is the most appropriate action?

A) Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric chamber.
B) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber.
C) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to the nearest facility.
D) Remove the patient from the garage, intubate, and transport to the nearest hospital.

Question 11

Capnometry measures the partial pressure of CO₂ in:

A) venous blood.
B) arterial blood.
C) expired air.
D) inspired air.

Question 12

You have applied a CO-oximeter to your patient, and it is displaying an SpCO of 15 percent. Which of the following is the most appropriate interpretation of this finding?

A) This is consistent with a fatal level of carbon monoxide poisoning.
B) This is a normal reading for a smoker and nothing to worry about.
C) This is a normal reading for a nonsmoker and nothing to worry about.
D) This is consistent with mild carbon monoxide poisoning.

Question 13

The greater the concentration of hydrogen ions in arterial blood, the ________ the pH.

A) more erratic
B) higher
C) more dangerous
D) lower

Question 14

Which of the following is NOT analyzed in arterial blood gas tests?

A) SaO₂
B) PaO₂
C) pCO₂
D) O₂

Question 15

An arterial blood gas analysis includes all of the following EXCEPT:

A) perfusion.
B) ventilation.
C) electrolyte balance.
D) acid-base balance.

Question 16

Your patient is a 62-year-old woman with a history of COPD. She is slightly more short of breath than usual today. She is alert and speaks three to four words between breaths. Her SpO₂ is 93 percent on room air. Which of the following devices should be used for the administration of oxygen to this patient?

A) Nonrebreather mask
B) Nasal cannula
C) CPAP
D) BVM

Question 17

Your patient is a 44-year-old woman, alert and oriented, in moderate distress and complaining of difficulty breathing. She gives a one-week history of fever and malaise, with shortness of breath developing three days ago. She also has left-sided chest pain with deep inspiration and a "phlegmy" cough. Physical examination reveals hot, pale, dry skin, and rhonchi and crackles throughout the left lung. The right lung sounds are clear. HR = 134, BP = 88/64, RR = 24, SaO₂ = 92%. She has a history of two previous myocardial infarctions and takes nitroglycerin as needed. Which of the following is the best course of prehospital management?

A) Endotracheal intubation, ventilation with supplemental oxygen, nebulized albuterol and Atrovent, and corticosteroids IV
B) Albuterol via nebulizer with 100 percent oxygen
C) Oxygen via nonrebreather mask
D) Oxygen via CPAP

Question 18

Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes, but does not have his Xopenex inhaler with him. Capnography shows an ETCO₂ of 45 mmHg. What is the best way to interpret this finding?

A) This is a normal ETCO₂, indicating that this is a mild asthma attack.
B) The patient's ETCO₂ first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels.
C) This is a high ETCO_2, and the patient requires immediate ventilatory assistance to prevent respiratory arrest.
D) This is a low ETCO₂, indicating that the patient is hyperventilating, and thus in the early stages of an asthma attack.

Question 19

Which of the following statements about pulse oximetry is FALSE?

A) Oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure.
B) Pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia.
C) Pulse oximetry should be used on all patients with respiratory complaints.
D) It may be difficult to obtain a reading in patients experiencing peripheral vasoconstriction.

Question 20

Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:

A) bound to hemoglobin.
B) as bicarbonate ion.
C) dissolved in plasma.
D) as carbonic anhydrase.

Question 21

Your patient is a 73-year-old man who is sitting in a recliner, cyanotic, pulseless, and apneic. The patient's skin is cool and dry. The patient's wife last saw him an hour and a half ago. Which of the following should you do first?

A) Check for rigor mortis.
B) Start CPR.
C) Attach the monitor/defibrillator.
D) Inform the patient's wife that he is dead and nothing can be done for him.

Question 22

Which of the following statements concerning Q waves on the ECG is most accurate?

A) Q waves are not a normal finding on the ECG.
B) The absence of a Q wave is a significant pathophysiological finding.
C) A Q wave is significant if it is 0.04 or more seconds wide.
D) A Q wave is significant only in the presence of chest pain.

Question 23

The QRS complex represents:

A) ventricular depolarization.
B) atrial repolarization.
C) atrial depolarization.
D) ventricular repolarization.

Question 24

Which of the following endocrine substances acts as a marker for congestive heart failure?

A) BNP
B) Angiotensin
C) ACTH
D) Troponin

Question 25

The SA and AV nodes are perfused by the ________ artery.

A) anterior descending
B) right coronary
C) left coronary
D) circumflex coronary

Question 26

The anterior surface of the heart is best viewed by ECG leads:

A) II, III, aVF.
B) V1-V4.
C) I, aVL.
D) aVR, aVL, aVF.

Question 27

There are 15 small boxes between R waves on an ECG tracing. What is the heart rate?

A) 150
B) 120
C) 100
D) 20

Question 28

Which of the following occurs during depolarization of a cardiac cell?

A) Sodium moves out of the cell.
B) The cell becomes relatively more positively charged.
C) Potassium moves into the cell.
D) The cell becomes negatively charged.

Question 29

The lead to the left of the sternum at the fourth intercostal space is:

A) V1.
B) V2.
C) V3.
D) V4.

Question 30

A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of the following?

A) The patient is experiencing myocardial ischemia in her inferior wall that is extending into the septum.
B) The patient is experiencing myocardial injury in her lateral wall.
C) The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle.
D) The patient is experiencing ischemia and injury in her left ventricle and septum.

Question 31

The total duration of ventricular depolarization is represented by the ________ on the ECG.

A) QRS duration
B) QT interval
C) PQ interval
D) R-R interval

Question 32

Which of the following is the correct sequence of cardiac electrical activity?
1) AV node
2) Internodal pathways
3) Bundle of His
4) SA node
5) Purkinje fibers
6) Bundle branches

A) 1, 2, 4, 3, 6, 5
B) 4, 1, 2, 3, 6, 5
C) 1, 2, 4, 3, 5, 6
D) 4, 2, 1, 3, 6, 5

Question 33

To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s).

A) two
B) one
C) three
D) twelve

Question 34

The presence of inverted T waves on an ECG indicates:

A) myocardial infarction.
B) myocardial necrosis.
C) myocardial ischemia.
D) myocardial instability.

Question 35

The mitral valve is open during:

A) systole.
B) cardiac standstill.
C) diastole.
D) repolarization.

Question 36

Blood entering the left atrium arrives via the:

A) bicuspid valve.
B) superior and inferior vena cava.
C) pulmonary vein.
D) pulmonary artery.

Question 37

When the ECG paper is traveling at the standard rate of 25 mm/sec, a large box in the horizontal direction equals:

A) 0.08 seconds.
B) 0.12 seconds.
C) 0.20 seconds.
D) 0.24 seconds.

Question 38

An elevation of the ST segment is associated with:

A) hyperkalemia.
B) left ventricular hypertrophy.
C) slowed conduction through the AV node.
D) myocardial injury.

Question 39

An ECG monitor is useful for:

A) determining cardiac output.
B) evaluating the heart's electrical conduction system for abnormalities.
C) determining stroke volume.
D) evaluating the effectiveness of cardiac contractions.

Question 40

Which of the following is affected by a properly working pacemaker?

A) Automaticity
B) Stroke volume
C) Cardiac rhythm
D) Ejection fraction

Question 41

The precordial leads provide a view of the:

A) lateral plane of the heart, including part of the right ventricle, most of the left ventricle, and the septum.
B) horizontal plane of the heart, including the right ventricle and right atrium.
C) inferior portion of the heart, including the entire right ventricle.
D) horizontal plane of the heart, including the left ventricle and septum.

Question 42

At standard speed, a 1 mm box on ECG paper represents ________ seconds.

A) 0.12
B) 0.04
C) 0.08
D) 0.1

Question 43

There are three large boxes between R waves on an ECG tracing. What is the heart rate?

A) 50
B) 75
C) 150
D) 100

Question 44

Which of the following arteries supplies blood primarily to the left ventricle and posterior wall?

A) Right coronary
B) Left coronary
C) Posterior descending
D) Marginal

Question 45

Which of the following describes the ability of a cardiac cell to propagate the electrical impulse to another cell?

A) Conductivity
B) Contractility
C) Excitability
D) Automaticity

Question 46

Which of the following cells released from the islets of Langerhans produce glucagon, which increases the blood glucose levels?

A) Alpha cells
B) Beta cells
C) Gamma cells
D) Delta cells

Question 47

Artifacts such as muscle tremors can make assessment of cardiac rhythm difficult because:

A) an artifact can obscure the underlying rhythm.
B) an artifact can cause the pacer to fire prematurely.
C) the pacemaker may confuse the artifact with an electrical impulse and not fire.
D) the QRS complexes may be obscured by the pacer spikes.

Question 48

The normal range of hemoglobin (Hb) levels in the adult male patient would be closest to:

A) 9.9-14.5 g/dL.
B) 9.9-14.5 mg/dL.
C) 14-17.4 g/dL.
D) 14-17.4 mg/dL.

Question 49

When oxygen is not bound to the iron molecule of hemoglobin, the iron molecule is in the ferrous (Fe²⁺) charge state, rather than when oxygen changes the charge of iron to the ferric (Fe³⁺) state. A dangerous form of hemoglobin that is unable to oxidize is:

A) methemoglobin (MetHb).
B) deoxyhemoglobin (DeoHb).
C) oxyhemoglobin (OxHb).
D) carboxyhemoglobin (COxHb).

Question 50

Which of the following is LEAST urgent when evaluating a patient suspected of suffering an acute myocardial infarction?

A) Blood pressure
B) ECG
C) Pulse oximetry
D) Breath sounds

Question 51

The middle tissue layer of the heart is the:

A) epicardium.
B) endocardium.
C) myocardium.
D) pericardium.

Question 52

A 45-year-old man is alert and oriented, complaining of chest pain. He describes a two-day history of worsening pain, described as a burning sensation below his left breast that radiates across his chest. He states that the pain seems to get better right after eating, but then worsens again. Medical history includes myocardial infarction, hypertension, and type 2 diabetes. His medications include Inderal, Vasotech, Glucotrol, and Lopid. Physical examination reveals cool, dry skin; clear lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86, RR = 12, SaO₂ = 98%. The patient is on oxygen by nasal cannula at 4 liters per minute. Which of the following should be done next?

A) Give 81 mg aspirin by mouth.
B) Start precautionary IV of normal saline and transport.
C) Give 0.4 mg nitroglycerin sublingually.
D) Do a 12-lead ECG.

Question 53

A 12-lead ECG that reveals ST elevation in all of the precordial leads most indicates myocardial:

A) injury to the right ventricle, left ventricle, and septum.
B) injury to the right ventricle and septum.
C) infarction to the left and right ventricles.
D) ischemia to the left ventricle and septum.

Question 54

Which of the following can be determined by lead II cardiac monitoring?

A) Positive deflection
B) Chamber enlargement
C) Axis deviation
D) Presence of a myocardial infarction, but not its location

Question 55

Which of the following is a traumatic mechanism by which a myocardial injury can be produced?

A) Blunt chest trauma
B) Penetrating chest trauma
C) Traumatic brain injury
D) Rapid deceleration

Question 56

On a properly calibrated ECG machine, 1 mV is equivalent to a height of ________ boxes.

A) five small
B) ten small
C) one large
D) four large

Question 57

Ventricular repolarization of the myocardium is represented by the:

A) T wave.
B) beginning of the QRS complex to the apex of the T wave.
C) ST segment.
D) isoelectric line.

Question 58

Slowing of the electrical impulse at the AV node is necessary to allow time for the ________ to fill with blood.

A) coronary sinus
B) coronary arteries
C) ventricles
D) atria

Question 59

An action potential begins in a myocardial cell when ________ enters the cell, giving it a ________ charge.

A) calcium; positive
B) sodium; positive
C) sodium; negative
D) calcium; negative

Question 60

A patient who has SpMet readings of 40 percent would be expected to have signs and symptoms of methemoglobinemia, such as:

A) all signs and symptoms normal-asymptomatic.
B) headache, dyspnea, confusion, weakness, and chest pain.
C) cyanosis, but otherwise asymptomatic.
D) fatality.

Question 61

Which of the following uses for ultrasound is NOT indicated in the prehospital setting?

A) Suprapubic, to identify the outline of the urinary bladder and uterus
B) Cardiac, to identify the cardiac wall motion and pericardial space
C) Umbilical, to identify the gestation age and sex of the fetus
D) Left upper quadrant, to identify the diaphragm and the spleen

Question 62

Which of the following cardiac enzymes and biomarkers is NOT measured and analyzed to help confirm a myocardial infarction?

A) Creatine kinase (CK-II MB)
B) Myoglobin
C) Troponin I
D) B-natriuretic peptide (BNP)

Question 63

The color of the blood tube that is usually first in sequence for filling and is without an anticoagulant (used for blood typing and cross-matching) is:

A) blue.
B) green.
C) red.
D) gray.

Question 64

Which of the following cells released from the islets of Langerhans produce somatostatin, which inhibits production of glucagon and insulin?

A) Alpha cells
B) Beta cells
C) Gamma cells
D) Delta cells

Question 65

Which of the following cells released from the islets of Langerhans produce insulin, which decreases the blood glucose levels?

A) Alpha cells
B) Beta cells
C) Gamma cells
D) Delta cells