med emergency

You are called to a female patient with chest discomfort. She is alert and responsive. She reports taking three nitroglycerin tablets prior to your arrival without a change in her level of discomfort. To check the nitroglycerin for effectiveness you could do all of the following EXCEPT:

• ask if the nitroglycerin tablets are in the original container

• look for signs of irritation or inflammation under the tongue

• check the expiration date on the medication

• ask if the nitroglycerin gave her a headache

Answer explanation

Nitroglycerin tablets must be protected from light. This is why they are in a brown glass bottle. Nitroglycerin may also cause a headache. If the patient reports a headache it may be an indication that the medication was effective. Expired medications may not be as potent or effective.

Nitroglycerin will not cause inflammation or irritation in most cases during short-term use. This will not help determine whether the medication was effective.

A pulseless condition in which the heart's electrical impulses are disorganized, preventing the heart muscle from contracting normally is called? (a)  

• Atrial fibrillation
• Premature ventricular contractions
• Ventricular tachycardia
• Ventricular fibrillation

Answer explanation

Ventricular fibrillation is a chaotic, disorganized rhythm that does not cause compression of the heart's chambers. Ventricular tachycardia is a rapid but organized heart rate which prevents the ventricles from filling enough between beats to allow for the blood flow to meet the demands of the body. Premature ventricular contractions are when the ventricles beat before they should in the normal cycle of a complete heart beat. Atrial fibrillation is when the atria beat in a disorganized fashion but a pulse is still present.

A female patient complains of chest discomfort. She tells you she has a heart condition and that she hasn't been feeling well for three or four days. Which of the following would most lead you to believe the cause wasn't cardiac related? (a)  

• Fever and chills
• Pain in the jaw
• Irregular pulse
• Pain when taking a deep breath

Answer explanation

Fever and chills most likely indicate an infectious process like pneumonia. This is the strongest indication that the problem is not cardiac in nature. While a slight elevation in temperature may be seen in a cardiac event, fever and chills indicate a significant infection. The 3 - 4 day duration of the symptoms also matches an illness like pneumonia. Pain when taking a deep breath may happen in cardiac-related conditions. The jaw is one place cardiac pain may radiate. An irregular pulse may also indicate a cardiac problem.

What are the main two side effects you see with nitroglycerin?

Answer explanation

The common side effects with the administration of sublingual nitroglycerin are hypotension, headache, and pulse rate changes (usually an increase).

Which of the following would be expected as a result of hypoxia?

• wheezing

• decreased resp. rate

• constricted pupils

• increased pulse rate

Answer explanation

As a result of hypoxia the pulse and respiratory rate will increase. Decreased respirations may cause hypoxia but are not a common result of hypoxia. Mild hypoxia will not have a significant change in pupil size although profound hypoxia may cause pupil dilation.

A first responder reports to you that her assessment reveals a patient who is incontinent, confused, and has lacerations on her tongue. These findings are consistent with:

• Hyperglycemia

• A reaction to a bee sting

• A seizure

• Myocardial infarction

Answer explanation

All of these assessments are commonly found in patients who have suffered a generalized tonic-clonic (grand mal) seizure.

Acute coronary syndrome is

• A heart attack

• Fluid build-up causing malfunction of the heart and lungs

• Damage to the ventricular wall that reduces coronary perfusion.

• A group of conditions brought on by reduced blood flow to the heart

Answer explanation

Acute coronary syndrome is a term for a group of conditions that are caused by reduced blood flow to the heart. These conditions include myocardial infarction (heart attack) and unstable angina.

You are called to an oriented male patient complaining of chest pain. It began at rest and radiates to his shoulder and jaw. His pulse is 56/minute and regular, respirations at 18, BP 158/98, oxygen saturation 97%. In reference to oxygenation you would

• Administer oxygen via cannula at 2lpm.

• not adm. oxygen

• adm. oxygen via NRB at 12 lpm

• adm. oxygen via venturi mask at 40-50%

Answer explanation

This patient has a saturation greater than 94% and is oriented. The question does not specify any signs of additional distress such as poor color or respiratory distress. He would not receive oxygen.

You respond to a city park for a 15 year old stung by a bee. The assessment of the patient finds altered mental status, respiratory distress, hives, swelling of the face, hoarseness and pale, clammy skin. When taking vital signs what do you expect to find?

• increased heart rate and decreased blood pressure

• decreased heart rate and decreased blood pressure

• increased heart rate and increased blood pressure

• decreased heart rate and increased blood pressure

Answer explanation

The response to a severe allergic reaction includes the signs and symptoms of shock. You will find an increased pulse rate and as the anaphylactic reaction worsens, the blood pressure will decrease.

Insulin is created in the:

• Pancreas

• Liver

• Spleen

• Gallbladder

Answer explanation

Insulin is produced in the islets of Langerhans in the pancreas.