Cardiology and resuscitation represent critical competency areas for paramedics, accounting for 10-14% of the NREMT Paramedic certification examination and forming the foundation of life-saving emergency care. Mastery of cardiac emergencies, from acute myocardial infarction recognition to advanced cardiac life support protocols, directly impacts patient survival rates in the field. The ability to rapidly interpret ECG findings, identify life-threatening arrhythmias, and implement appropriate interventions distinguishes competent paramedics from exceptional ones. Understanding the pathophysiology of cardiac conditions, including coronary artery anatomy, electrophysiology, and hemodynamic principles, enables paramedics to make critical decisions under pressure. Current American Heart Association guidelines emphasize high-quality CPR with minimal interruptions, appropriate medication administration, and early defibrillation as cornerstones of successful resuscitation. Paramedics must demonstrate proficiency in managing both shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia) and non-shockable rhythms (asystole and pulseless electrical activity) while simultaneously addressing reversible causes. Knowledge of cardiac medications, including their mechanisms of action, proper dosing, indications, and contraindications, is essential for safe and effective patient care. The integration of clinical judgment with technical skills allows paramedics to adapt protocols to individual patient presentations and optimize outcomes. Regular practice with scenario-based questions and systematic review of ACLS algorithms reinforces the decision-making pathways required during actual cardiac emergencies. These practice questions are designed to test your understanding of cardiology and resuscitation principles, preparing you for both the NREMT examination and real-world emergency situations where every second counts.
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## Practice Questions
**Question 1:** A 62-year-old male presents with crushing chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
**Correct Answer:** B) Right coronary artery
**Explanation:** ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is typically caused by occlusion of the right coronary artery (RCA). The RCA supplies the inferior wall of the left ventricle in most patients.
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**Question 2:** During a cardiac arrest, you deliver a shock and immediately resume CPR. What is the correct compression-to-ventilation ratio for adult CPR with two rescuers?
A) 15:2
B) 30:2
C) 15:1
D) 30:1
**Correct Answer:** B) 30:2
**Explanation:** The current AHA guidelines recommend a compression-to-ventilation ratio of 30:2 for adult CPR, regardless of whether there is one or two rescuers. This ratio optimizes perfusion while minimizing interruptions in chest compressions.
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**Question 3:** A patient in ventricular fibrillation has received three shocks and two doses of epinephrine without return of spontaneous circulation. What is the next appropriate medication?
A) Atropine 1 mg IV
B) Amiodarone 300 mg IV
C) Lidocaine 1.5 mg/kg IV
D) Magnesium sulfate 2 g IV
**Correct Answer:** B) Amiodarone 300 mg IV
**Explanation:** After defibrillation and epinephrine, amiodarone 300 mg IV is the first-line antiarrhythmic for refractory ventricular fibrillation or pulseless ventricular tachycardia. A second dose of 150 mg may be given if VF/pVT persists.
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**Question 4:** What is the target rate for chest compressions during adult CPR according to current AHA guidelines?
A) 80-100 compressions per minute
B) 100-120 compressions per minute
C) 120-140 compressions per minute
D) At least 140 compressions per minute
**Correct Answer:** B) 100-120 compressions per minute
**Explanation:** The AHA recommends a compression rate of 100-120 compressions per minute for adult CPR. This rate provides optimal cardiac output while allowing adequate ventricular filling between compressions.
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**Question 5:** A 55-year-old female with a history of atrial fibrillation presents with a rapid, irregular pulse at 160 bpm. She is alert but complaining of palpitations and mild dyspnea. Blood pressure is 110/70 mmHg. What is the most appropriate initial treatment?
A) Synchronized cardioversion at 120 joules
B) Adenosine 6 mg rapid IV push
C) Diltiazem 0.25 mg/kg IV over 2 minutes
D) Amiodarone 150 mg IV over 10 minutes
**Correct Answer:** C) Diltiazem 0.25 mg/kg IV over 2 minutes
**Explanation:** For stable atrial fibrillation with rapid ventricular response, rate control with a calcium channel blocker (diltiazem) or beta-blocker is appropriate. The patient is hemodynamically stable, so cardioversion is not immediately indicated.
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**Question 6:** During resuscitation, what is the recommended depth of chest compressions for an adult patient?
A) At least 1 inch (2.5 cm)
B) At least 1.5 inches (4 cm)
C) At least 2 inches (5 cm)
D) At least 3 inches (7.5 cm)
**Correct Answer:** C) At least 2 inches (5 cm)
**Explanation:** Current AHA guidelines recommend chest compressions of at least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm) in depth for adult patients. Adequate compression depth is essential for generating sufficient cardiac output.
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**Question 7:** A patient presents with a regular, narrow-complex tachycardia at 180 bpm. Vagal maneuvers are unsuccessful. What is the first-line medication?
A) Adenosine 6 mg rapid IV push
B) Diltiazem 0.25 mg/kg IV
C) Amiodarone 150 mg IV
D) Metoprolol 5 mg IV
**Correct Answer:** A) Adenosine 6 mg rapid IV push
**Explanation:** Adenosine is the first-line medication for stable supraventricular tachycardia (SVT) after vagal maneuvers fail. It should be given as a rapid IV push followed immediately by a saline flush. If unsuccessful, a second dose of 12 mg may be given.
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**Question 8:** What is the initial energy level for defibrillation of ventricular fibrillation using a biphasic defibrillator?
A) 120 joules
B) 200 joules
C) 300 joules
D) 360 joules
**Correct Answer:** B) 200 joules
**Explanation:** For biphasic defibrillators, the initial recommended energy is 120-200 joules (manufacturer-specific). If the specific dose is unknown, 200 joules is appropriate. Subsequent shocks should be at the same or higher energy levels.
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**Question 9:** A 70-year-old male in cardiac arrest has been in asystole for 6 minutes despite high-quality CPR and two doses of epinephrine. What medication is indicated?
A) Atropine 1 mg IV
B) Amiodarone 300 mg IV
C) Sodium bicarbonate 1 mEq/kg IV
D) Continue epinephrine every 3-5 minutes
**Correct Answer:** D) Continue epinephrine every 3-5 minutes
**Explanation:** Atropine is no longer recommended for asystole or PEA. The primary medication for asystole is epinephrine 1 mg IV/IO every 3-5 minutes. Focus should remain on high-quality CPR and identifying/treating reversible causes.
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**Question 10:** A patient with an acute myocardial infarction is receiving nitroglycerin. Which vital sign change would require immediate discontinuation of the medication?
A) Heart rate increases from 80 to 95 bpm
B) Systolic blood pressure drops from 130 to 95 mmHg
C) Respiratory rate increases from 16 to 20 breaths/min
D) Oxygen saturation drops from 98% to 94%
**Correct Answer:** B) Systolic blood pressure drops from 130 to 95 mmHg
**Explanation:** Nitroglycerin should be held if systolic blood pressure falls below 90-100 mmHg, as further vasodilation could lead to hypotension and decreased coronary perfusion. Blood pressure should be monitored closely during nitroglycerin administration.
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**Question 11:** What is the correct dose of epinephrine for adult cardiac arrest?
A) 0.1 mg (1:10,000) IV every 3-5 minutes
B) 1 mg (1:10,000) IV every 3-5 minutes
C) 0.5 mg (1:1,000) IV every 3-5 minutes
D) 5 mg (1:10,000) IV every 3-5 minutes
**Correct Answer:** B) 1 mg (1:10,000) IV every 3-5 minutes
**Explanation:** The standard dose of epinephrine for adult cardiac arrest is 1 mg (1:10,000 concentration) IV or IO every 3-5 minutes. This dose provides alpha-adrenergic effects that increase coronary and cerebral perfusion pressure during CPR.
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**Question 12:** A patient presents with chest pain and an ECG showing a new left bundle branch block. What should be your primary concern?
A) This is a benign finding requiring no immediate action
B) The patient may be having an acute myocardial infarction
C) The patient needs immediate cardioversion
D) This indicates chronic heart disease only
**Correct Answer:** B) The patient may be having an acute myocardial infarction
**Explanation:** A new left bundle branch block (LBBB) in the presence of chest pain is considered a STEMI equivalent and requires immediate treatment as an acute MI. The LBBB can mask typical ST-segment changes, making clinical correlation essential.
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**Question 13:** During synchronized cardioversion for unstable atrial fibrillation, what is the recommended initial energy level?
A) 50 joules
B) 100 joules
C) 120-200 joules
D) 360 joules
**Correct Answer:** C) 120-200 joules
**Explanation:** For atrial fibrillation, the recommended initial energy for synchronized cardioversion is 120-200 joules biphasic. Lower energies (50-100 joules) are used for atrial flutter and SVT, while higher energies may be needed for subsequent attempts.
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**Question 14:** A patient in cardiac arrest has a rhythm of pulseless electrical activity (PEA). Which of the following is NOT a common reversible cause?
A) Hypovolemia
B) Hypoxia
C) Hyperglycemia
D) Tension pneumothorax
**Correct Answer:** C) Hyperglycemia
**Explanation:** The reversible causes of PEA are remembered by the “H’s and T’s”: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade (cardiac), Toxins, and Thrombosis (pulmonary/coronary). Hyperglycemia is not a primary reversible cause of PEA.
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**Question 15:** What is the maximum interval that chest compressions should be interrupted during resuscitation?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 20 seconds
**Correct Answer:** B) 10 seconds
**Explanation:** Chest compressions should be interrupted for no more than 10 seconds, even for rhythm checks, defibrillation, or advanced airway placement. Minimizing interruptions in compressions is critical for maintaining coronary and cerebral perfusion pressure.
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## Conclusion
These 15 practice questions cover essential cardiology and resuscitation concepts that every paramedic must master for both the NREMT examination and clinical practice. Focus on understanding the rationale behind each answer, as this will help you apply these principles in various clinical scenarios. Continue practicing with additional questions and reviewing ACLS protocols to build confidence and competence in managing cardiac emergencies.