10 free EMT practice questions: Cardiovascular Emergencies & Cardiac Arrest

Deliver two ventilations with a BVM before making any change to the compressions: These compressions are not moving blood, so fixing them comes first. Hands over the top of the sternum move very little blood no matter how much oxygen the patient gets. Breaths join in at 30:2 once good compressions are running.

Allow the bystander to continue compressing in the same position until the automated external defibrillator (AED) is ready: 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. The switch in option C is planned to take only a couple of seconds, so taking over costs almost no time.

Instruct the bystander to slide the hands lower on the sternum without taking over compressions: Hands up near the collarbones need more than a small fix. Once trained EMTs are on scene, they 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.

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 a change in the rhythm: 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: If dependent lividity and rigor mortis are present, you do not start CPR, even with no pulse. This patient has both.

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: At 68, diabetic, and diaphoretic, this patient 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: A 68-year-old diabetic with unexplained diaphoresis does not have a minor complaint, and this patient needs transport. The decision to leave a patient at home belongs to medical direction, not to the crew. 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 does not 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.

Transport to the closest hospital because minimizing transport time takes priority: The closer hospital cannot do a cath, so getting there faster only delays PCI, the treatment that opens the artery. A STEMI patient needs the hospital that can open the artery now.

Transport to the closest hospital and request a later transfer if needed: Ten minutes is not out of reach, so there is no reason to stop at the closer hospital. Going there first adds a second transport and delays opening the artery. A later transfer is for a cath center that really is out of reach because of bad weather, a long distance, or diversion.

Ask the patient which hospital they would prefer, and transport there instead: A STEMI is time critical, and protocol decides the destination, not the patient's preference. A difference of 10 minutes is well within the range where you bypass the closer hospital for the cath center.

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.