NREMT PARAMEDIC CARDIOLOGY EXAM 2024 ORIGINAL VERSION WITH 110 QUESTIONS WITH CORRECT ANSWERS & RATIONALES NEWEST EXAM ALREADY APPROVED BY PROFESSIONALS (BRAND NEW!! | GUARANTEED PASS A+!!)

NREMT PARAMEDIC CARDIOLOGY EXAM 2024 ORIGINAL VERSION WITH 110 QUESTIONS WITH CORRECT ANSWERS & RATIONALES NEWEST EXAM ALREADY APPROVED BY PROFESSIONALS (BRAND NEW!! | GUARANTEED PASS A+!!) A 60-year-old female presents with confusion, shortness of breath, and diaphoresis. Her blood pressure is 70/40 mm Hg and her heart rate is 40 beats/min. The cardiac monitor reveals a slow, wide complex rhythm with dissociated P waves. After applying supplemental oxygen, you should: - ANSWER- Begin immediate transcutaneous pacing. RATIONALE: The cardiac rhythm described is a third-degree (complete) AV block, and the patient is clinically unstable (ie, hypotension, altered mental status, shortness of breath). Third-degree AV block is characterized by a slow ventricular rate and no P-to-QRS relationship (AV dissociation). Patients with high-grade AV blocks (eg, second-degree type II, third-degree) are often clinically unstable and require immediate transcutaneous cardiac pacing (TCP). Atropine is an appropriate drug for clinically unstable patients with sinus bradycardia and bradycardia associated with low-grade AV blocks (eg, first-degree, second-degree type I); it is not recommended for high-grade AV blocks. If TCP is unsuccessful for this patient, consider an epinephrine infusion (2 to 10 µg/min) or a dopamine infusion (5 to 10 µg/kg/min), either of which may increase her heart rate and blood pressure. The patient's hypotension is secondary to severe bradycardia, not hypovolemia; therefore, a rapid IV fluid bolus is not indicated. If you have reason to suspect that the patient is experiencing an acute coronary syndrome (ACS), aspirin should be given. The initial dose of diltiazem for a 165-pound patient is approximately: - ANSWER- 19. RATIONALE: Diltiazem hydrochloride (Cardizem) is a calcium channel blocking drug that is used to treat rapid ventricular rates associated with atrial fibrillation or atrial flutter. It can also be used after adenosine to treat refractory reentry supraventricular tachycardia in hemodynamically stable patients. The initial dose of diltiazem is 0.25 mg/kg IV over 2 minutes; the average initial dose is 15 to 20 mg. It may be repeated in 15 minutes in a dose of 0.35 mg/kg IV over 2 minutes; the average second dose is 20 to 25 mg. A 165-pound patient weighs 75 kg. Therefore, the initial dose of diltiazem for a patient of this weight would be 18.75 mg (approximately 19 mg), and the second dose would be 26.25 mg (approximately 26 mg). A 65-year-old man with difficulty breathing and palpitations presents with the cardiac rhythm shown below, which you should interpret as: - ANSWER- Supraventricular tachycardia. RATIONALE: Since this rhythm has narrow (less than 0.12 seconds) QRS complexes and a rate greater than 150 beats/min, it should be interpreted as supraventricular tachycardia (SVT), which means that its site of origin is above (supra) the level of the ventricles. SVT can be either atrial or junctional in origin. Atrial fibrillation is characterized by an irregularly irregular rhythm and no discernable P waves. Atrial flutter is characterized by flutter (F) waves that resemble a saw tooth. Ventricular tachycardia (V-Tach), in contrast to SVT, is characterized by wide (greater than 0.12 seconds) QRS complexes and no visible P waves. You and your team are attempting to resuscitate a 66-year-old man in cardiac arrest. The cardiac monitor reveals a slow, wide-complex rhythm. The patient has been successfully intubated and an IV line has been established. As CPR is ongoing, you should: - ANSWER- Aadminister 10 mL of epinephrine 1:10,000 IV. RATIONALE: The first drug given to any patient in cardiac arrest is epinephrine in a dose of 1 mg (10 mL of a 1:10,000 solution) via the IV or IO route. This dose should be repeated every 3 to 5 minutes. Alternatively, a one-time dose of vasopressin (40 units) can be given to replace the first or second dose of epinephrine, but not both. Do NOT hyperventilate the patient as doing so increases intrathoracic pressure and can impair venous return (preload) and cardiac output, which would decrease the effectiveness of chest compressions. After an advanced airway has been placed during cardiac arrest, deliver one breath every 6 to 8 seconds (8 to 10 breaths/min) and ensure that chest compressions are uninterrupted. There is presently no evidence to support the efficacy of transcutaneous cardiac pacing (TCP) in patients with bradycardic PEA or asystole. Which of the following signs or symptoms occurs more commonly in patients with stable angina than in those with unstable angina? - ANSWER- Chest pain that begins during exertion. RATIONALE: Angina pectoris occurs when the heart's demand for oxygen exceeds it's available supply (ischemia) and is a sign of coronary artery disease (CAD). Angina is classified as being stable or unstable. Stable angina typically follows a predictable pattern (ie, chest pain, pressure, or discomfort induced by exertion), lasts less than 15 minutes, and is usually relieved with rest and/or nitroglycerin. While unstable angina (preinfarction angina) can also occur during exertion, it more commonly occurs when the patient otherwise would not expect it to, such as when he or she is asleep or is otherwise resting. Furthermore, unstable angina is often not relieved by rest and/or nitroglycerin and typically lasts longer than 15 minutes. Chest pressure, tightness, or discomfort occurs in patients with both stable and unstable angina. If a patient is experiencing angina, you would expect to see ST segment depression and/or T wave inversion on the 12-lead ECG as these are indicators of myocardial ischemia. ST segment elevation indicates myocardial injury (eg, acute MI in progress). You are assessing the cardiac rhythm of a woman with respiratory distress. The rhythm is irregularly irregular with a rate of 120 beats/min. The QRS complexes measure 0.10 seconds in duration, the P wave to QRS ratio is 1:1, and the P waves vary in shape. This cardiac rhythm is MOST likely: - ANSWER- Multifocal atrial tachycardia. RATIONALE: In multifocal atrial tachycardia (MAT), the pacemaker of the heart moves within various areas of the atria. MAT is characterized by a ventricular rate that is greater than 100 beats/min. MAT is irregularly irregular, with variation between R-R intervals based on the site of the pacemaker for that particular complex. P waves are present, upright, and precede each QRS complex; however, the shapes of the P waves vary as an indication of their different sites of origin. The P-R interval generally measures between 0.12 and 0.20 seconds, but also varies slightly based on the origin of the particular complex. Atrial fibrillation (A-Fib) is also an irregularly irregular rhythm; however, there are no discernable P waves. A wandering atrial pacemaker essentially contains all the components of MAT; unlike MAT, however, the ventricular rate is typically less than 100 beats/min. Atrial flutter (A-Flutter) has characteristic flutter waves (F waves) that resemble a saw tooth. If accompanied by aberrancy, A-flutter has QRS complexes that are greater than 0.12 seconds in duration, which indicates abnormal (aberrant) ventricular conduction.