10 free EMT practice questions: Cardiovascular Emergencies & Cardiac Arrest

Deliver two ventilations with a BVM before making any change to the compressions: Ventilations are part of what you bring to this scene. A bystander doing compressions only needs the airway managed and breaths added at 30:2. Fixing the compressions comes first, because these compressions are not moving blood. Hands over the top of the sternum move very little blood no matter how much oxygen the patient gets. Breaths join in once good compressions are running.

Allow the bystander to continue compressing in the same position until the automated external defibrillator (AED) is ready: Keeping compressions going without a long pause is the right idea. That's why the switch in option C is planned to take only a couple of seconds. Compressions this high on the chest move almost no blood, so they are not worth protecting. Waiting for the AED means minutes of almost no blood flow.

Instruct the bystander to slide the hands lower on the sternum without taking over compressions: Coaching a bystander in place works when the bystander is already doing good compressions and only needs a small fix. Coaching also avoids a pause. Once trained EMTs are on scene, the EMTs take over the most important job instead of handing it off. A bystander who has been doing compressions will get tired, and the rate and depth will slip.

Pulmonary embolism: A pulmonary embolism also causes sudden chest pain that is worse with breathing, along with a fast heart rate and fast breathing. A pulmonary embolism is a clot in the blood vessels of the lung, not air around the lung. Air still moves into both lungs, so the breath sounds stay equal. A pulmonary embolism also usually comes with a risk factor, like being immobile, a long trip, recent surgery, or a swollen, tender calf. This question gives you none of those. The decreased breath sounds on one side point to the pneumothorax.

Acute coronary syndrome: usually pressure or heaviness that does not change with breathing, in a patient with cardiac risk factors. Acute coronary syndrome does not change the breath sounds on one side. This patient is 19, the pain gets worse with a deep breath, and one side of the chest is quiet. Those are signs of a lung problem.

Musculoskeletal chest wall pain: Chest wall pain fits when there is a cause like a fall, heavy lifting, or a hard cough. The pain also gets worse when you press on the spot. This pain started at rest without any injury, and no tenderness is described. Chest wall pain also never decreases the breath sounds.

Supine with the legs elevated: Supine with the legs raised is used for hypovolemic or distributive shock. In those patients, moving blood from the legs back to the core helps, because the vessels are underfilled or too wide open. The crackles tell you the lungs are already getting more fluid than the left ventricle can pump forward. Raising the legs sends more blood to the chest. The pulmonary edema gets worse, and the pump failure does not improve.

Full Trendelenburg position: Full Trendelenburg tips the patient head down and sends even more blood back to the chest. Full Trendelenburg is mostly no longer used, even in hypovolemic shock. With the head down, the abdominal organs also push up on the diaphragm. The pressure on the diaphragm makes breathing harder for a patient who is already struggling.

Left lateral recumbent position: Left lateral recumbent is the position for protecting the airway in a patient who is vomiting or cannot handle secretions. Left lateral also takes pressure off the vena cava in late pregnancy. This patient is conscious and breathing adequately, so the patient is protecting their own airway. The fluid causing the problem is in the air sacs of the lungs, not in the throat. Lying on the side gives up the benefit of sitting upright and does nothing for the fluid in the lungs.

Relief after nitroglycerin shows the medication worked, so repeat vital signs can wait until arrival at the hospital: Giving a medication never lowers the need to reassess. Nitroglycerin dilates veins and arteries and can cause hypotension. A patient who just took nitroglycerin needs the vital signs rechecked because of that dose. Waiting until the hospital means nobody checks the pressure during the time hypotension would show up.

Relief after nitroglycerin confirms the chest discomfort was cardiac in origin, since only cardiac pain responds to it: Nitroglycerin does relieve angina by improving the balance of oxygen supply and demand in the heart muscle. The same smooth muscle relaxation also relieves chest pain that does not come from the heart. Relief alone does not prove the heart is the source.

Relief after nitroglycerin rules out a life-threatening cause and supports lowering the transport priority: A myocardial infarction that is still evolving can have pain-free periods while heart muscle keeps dying. This patient also has a prescription for nitroglycerin, which means known heart disease. Less pain does not mean less danger. The transport priority comes from the presentation and the risk, not from the pain level.

Every 15 minutes, the standard interval used for all patients following a cardiac event: Every 15 minutes is the right interval for a stable patient, and you will use it all the time. The interval depends on how stable the patient is, not on what kind of event happened. This patient is unresponsive with unstable vital signs.

Once at the start of transport and again immediately before arrival at the hospital: Checking once at the start and once before arrival might match an uneventful transport of a stable patient. Ongoing assessment is a repeating cycle of mental status, airway, breathing, circulation, and vital signs. Two checks at the ends of the trip are not enough for a patient who can go back into cardiac arrest.

Continuously, but only if the cardiac monitor shows visible changes in the electronic waveform: A cardiac monitor belongs on this patient, and the word "only" is what makes option D wrong. A monitor shows rate and rhythm. A monitor will not show a drop in mental status, cool, clammy skin, or inadequate breathing. Waiting for the waveform to change misses everything your timed, hands-on reassessment is supposed to catch.

Yes, because CPR must be started on any pulseless patient regardless of other findings: CPR is right for a pulseless patient who has no obvious signs of death. This patient has dependent lividity and rigor mortis. With those present, you do not attempt resuscitation, even though there is no pulse.

No, because resuscitation is rarely successful in patients of this advanced age: Age never decides whether you start CPR. The lividity and rigor mortis decide it here, and CPR would be withheld at any age.

Yes, because only a physician at the hospital can legally pronounce the patient dead: You do not need a physician at the hospital to pronounce this patient before you withhold CPR. With obvious signs of death present, CPR is not started in the field at all. Pronouncing death follows your local protocol, and that process does not require a resuscitation that cannot work.

Reassure the patient this is unlikely to be cardiac since there is no chest pain: No chest pain counts for a lot in a young patient with no risk factors. Reassuring that patient that the problem is probably not cardiac can be reasonable. This patient is 68, diabetic, and diaphoretic. A patient like this is exactly the one who has a heart attack without chest pain. Here the missing chest pain should make you more suspicious, not less.

Advise the patient to follow up with their primary doctor instead of transporting: Follow-up with a primary doctor fits a truly minor complaint. Even then, the decision to leave a patient at home belongs to medical direction, not to the crew. A 68-year-old diabetic with unexplained diaphoresis does not have a minor complaint. If this patient goes into cardiac arrest with you, the patient has a chance. If the arrest happens at home, nobody may find the patient for hours.

Withhold any cardiac-related care since the presentation doesn't fit a classic pattern: Holding back care because the patient does not have the classic symptoms is the same mistake as option A, one step further. Oxygen if hypoxic, monitoring, and prompt transport carry almost no risk. Options A, C, and D all leave this patient without care. The three options only differ in the reason they give.

Apply oxygen via NRB before assisting with any medication: Oxygen by NRB is for a chest pain patient who is hypoxic. This patient's SpO₂ is 98% on room air, so oxygenation is adequate and oxygen is not needed.

Assist with the nitroglycerin now and check the blood pressure afterward: Assisting first would relieve the discomfort sooner. Nitroglycerin can drop the blood pressure quickly, so the reading has to come before the dose, not after.

Administer a second dose of aspirin instead of the nitroglycerin: Aspirin is a one-time dose, and this patient already had it. A second dose of aspirin also does nothing about the patient's request for the nitroglycerin.

It increases the heart rate to strengthen cardiac output: Speeding up the heart sounds like a way to help a struggling heart. A faster heart rate raises the heart's oxygen demand. Relief comes from lowering oxygen demand, so a faster rate does the opposite.

It thins the blood to prevent new clots from forming: Thinning the blood to stop new clots is what aspirin does. Aspirin is the other drug you give for this presentation, and aspirin acts on clot formation. Nitroglycerin's relief comes from lowering the heart's oxygen demand, not from an antiplatelet effect.

It strengthens the heart muscle to increase contraction: Nitroglycerin does not make the heart contract harder. A stronger contraction would raise the heart's oxygen demand. This patient's relief came from lowering that demand.

Situation: 54-year-old patient brought in with chest pain. Background: Nothing significant that I am aware of. Assessment: The patient could be cardiac and the vital signs have stayed stable. Recommendation: The patient should probably be watched closely: Report A uses the SBAR headings but gives no real content. There is no onset time, no vital signs, and no treatment listed. "Nothing significant that I am aware of" is not a history the receiving team can use.

Situation: 54-year-old patient, 45 minutes of chest pain and diaphoresis. Background: No cardiac history, medications, or allergies. Assessment: This is an acute myocardial infarction with early cardiogenic changes. Recommendation: Draw troponins and activate the cath lab: "An acute myocardial infarction with early cardiogenic changes" is a diagnosis. Drawing troponins and activating the cath lab are physician decisions. An EMT reports suspected cardiac chest pain and leaves the diagnosis and the orders to the hospital.

Situation: 54-year-old patient, 45 minutes of chest pain and diaphoresis. Background: No cardiac history, medications, or allergies. Assessment: Alert and anxious, P 108/min, BP 116/72 mmHg, R 18/min, SpO₂ 94%. Recommendation: Suspected cardiac chest pain needing prompt evaluation: Report D matches C in the situation, background, and recommendation, and its assessment gives the vitals and mental status without diagnosing. Report D leaves out "on high-flow oxygen" after the SpO₂ of 94%. Without that detail, the nurse cannot tell the saturation only holds with full oxygen running. The report is incomplete, and the number sounds less urgent than the patient really is.