Cardiology and Resuscitation Practice Questions for Paramedics

1,237 free paramedic practice questions on cardiac anatomy, ECG basics, rhythm interpretation, 12-lead and STEMI recognition, acute coronary syndrome, heart failure, cardiac arrest, defibrillation and pacing, cardiac medications, and shock, plus responding to the field code and management and resuscitation of the critical patient. Every question has the answer and a short explanation.

25 sample questions

1. The National Early Warning Score 2 (NEWS2) is calculated from:

   1. A. HR, SBP, GCS, blood glucose, temperature, and a pain score
   2. B. Age, GCS, SBP, and the mechanism of injury
   3. C. RR, SBP, and altered mentation
   4. D. RR, SpO2, oxygen use, temperature, SBP, HR, and alertness
   Show answer

   Answer: D. RR, SpO2, oxygen use, temperature, SBP, HR, and alertness

   NEWS2 scores respiratory rate, oxygen saturation, supplemental oxygen, temperature, systolic pressure, heart rate, and level of consciousness, including new confusion. The three-item list of RR, SBP, and mentation is qSOFA, a much narrower sepsis screen.

2. At a rhythm check during CPR, an organized rhythm at 70 per minute appears. You should:

   1. A. Resume CPR without checking for any pulse
   2. B. Check for a pulse for up to 10 seconds
   3. C. Check a pulse for a full 30 seconds
   4. D. Start pacing before checking a pulse
   Show answer

   Answer: B. Check for a pulse for up to 10 seconds

   When an organized rhythm appears at a scheduled rhythm check, a brief pulse check decides between post-ROSC care and continuing CPR for PEA. A 30-second check is far longer than the 10-second limit and leaves the patient without flow, and pacing has no role until you know whether there is a pulse. This differs from the moment just after a shock, when CPR resumes immediately.

3. A septic 60-year-old receives a 500-mL bolus. Her HR falls from 128 to 110, her mentation improves, her lungs stay clear, and her BP is 90/56 mmHg. You should next:

   1. A. Stop fluid because she has fully recovered
   2. B. Give another bolus, then reassess her lungs
   3. C. Give furosemide now to prevent fluid overload
   4. D. Start a pressor and give no more fluid
   Show answer

   Answer: B. Give another bolus, then reassess her lungs

   She responded to the first bolus (slower heart rate, clearer thinking) and still has clear lungs and a soft pressure, so she is both fluid-responsive and fluid-tolerant; another bolus with reassessment is appropriate, adding a vasopressor if pressure stays low despite fluid. Stopping now leaves her under-resuscitated. Furosemide would remove volume she still needs. Abandoning fluid for a pressor while she is still responding skips a cheap, effective step.

4. A septic patient on norepinephrine has a MAP of 88 mmHg with warm hands and good mentation. The ordered target is 65 mmHg. You should:

   1. A. Increase it to keep the MAP above 85 mmHg
   2. B. Stop it abruptly now that she is better
   3. C. Leave it, since a high MAP is harmless
   4. D. Wean the infusion down toward the target
   Show answer

   Answer: D. Wean the infusion down toward the target

   Vasopressors are titrated to the lowest dose that meets the target, because excess vasoconstriction raises the risk of dysrhythmias and of gut, kidney, and digit ischemia; a MAP well above 65 with good perfusion means the dose can come down in small steps. Raising it further adds risk with no benefit for most patients. Stopping abruptly can drop the pressure sharply because the drug acts for only minutes. A higher MAP is not harmless when it is bought with more drug.

5. Real-time CPR feedback devices are useful mainly because they:

   1. A. Diagnose the arrest rhythm during CPR
   2. B. Help keep rate and depth on target
   3. C. Remove the need to rotate compressors
   4. D. Measure the patient's blood pressure
   Show answer

   Answer: B. Help keep rate and depth on target

   Rescuers are poor judges of their own compression quality, and feedback devices correct rate, depth, and recoil in real time. They do not reduce fatigue, so compressors should still switch every 2 minutes.

6. Public-access defibrillation programs improve survival from cardiac arrest mainly because they:

   1. A. Remove the need for any bystander CPR
   2. B. Let lay rescuers interpret rhythms
   3. C. Reduce EMS response times
   4. D. Shorten the time to the first shock
   Show answer

   Answer: D. Shorten the time to the first shock

   Placing AEDs where arrests happen lets bystanders shock VF minutes before EMS arrives, and survival depends heavily on time to defibrillation. AEDs work alongside CPR rather than replacing it, and the device, not the rescuer, analyzes the rhythm.

7. A patient's stroke volume falls from 70 to 40 mL while her heart rate rises from 80 to 120/min. Her cardiac output has:

   1. A. Fallen from 5.6 to 4.8 L/min
   2. B. Risen from 5.6 to 6.4 L/min
   3. C. Stayed at 5.6 L/min
   4. D. Fallen from 5.6 to 2.4 L/min
   Show answer

   Answer: A. Fallen from 5.6 to 4.8 L/min

   Cardiac output is heart rate × stroke volume: 80 × 70 mL = 5.6 L/min before and 120 × 40 mL = 4.8 L/min after. Tachycardia partly offsets a falling stroke volume, but it cannot fully restore output, which is why tachycardia alone does not mean perfusion is adequate.

8. A negative chronotropic effect means:

   1. A. Decreased heart rate
   2. B. Increased contractility
   3. C. Slowed AV node conduction
   4. D. Increased heart rate and output
   Show answer

   Answer: A. Decreased heart rate

   Beta blockers produce it.

9. A 25-kg child is in refractory pulseless VT, and the agency carries lidocaine instead of amiodarone. What is the initial lidocaine dose?

   1. A. 75 mg IV/IO (3 mg/kg)
   2. B. 2.5 mg IV/IO (0.1 mg/kg)
   3. C. 25 mg IV/IO (1 mg/kg)
   4. D. 125 mg IV/IO (5 mg/kg)
   Show answer

   Answer: C. 25 mg IV/IO (1 mg/kg)

   PALS lidocaine for shock-refractory VF/pVT is a 1 mg/kg IV/IO loading dose.

10. A peripheral dopamine infusion infiltrates, and the skin around the site is pale and cold. After stopping the infusion, which antidote may be infiltrated into the area per the drug label?

    1. A. Hyaluronidase
    2. B. Naloxone
    3. C. Atropine
    4. D. Phentolamine
    Show answer

    Answer: D. Phentolamine

    Phentolamine, an alpha blocker, is infiltrated into the area to reverse the alpha-mediated vasoconstriction from extravasated dopamine or norepinephrine and prevent necrosis. Naloxone reverses opioids. Atropine blocks muscarinic receptors and does not affect vasoconstriction. Hyaluronidase is used for some non-vasopressor extravasations to spread the fluid, not to reverse vasoconstriction.

11. A patient with a hemoglobin of 6 g/dL from slow GI bleeding has a resting heart rate of 118 and bounding pulses. What best explains the tachycardia?

    1. A. Anemia slows conduction through the AV node
    2. B. Low hemoglobin raises systemic vascular resistance
    3. C. The heart raises output to deliver enough oxygen
    4. D. Iron deficiency directly irritates the SA node
    Show answer

    Answer: C. The heart raises output to deliver enough oxygen

    Each liter of blood carries less oxygen in severe anemia, so the body raises cardiac output (faster rate, larger stroke volume, lower vascular resistance) to keep oxygen delivery up. That high-output state also raises myocardial oxygen demand and can provoke angina. Anemia does not slow AV conduction, it lowers rather than raises vascular resistance, and iron deficiency does not directly irritate the SA node.

12. You start transcutaneous pacing at a rate of 70/min. How do you set the current?

    1. A. Start at the highest mA available and leave it
    2. B. Increase mA until capture, then set slightly above
    3. C. Set 20 mA and leave it there
    4. D. Raise the mA until the chest muscles twitch, then stop
    Show answer

    Answer: B. Increase mA until capture, then set slightly above

    Current is increased from a low setting until consistent electrical capture is seen, then set slightly above that threshold. Pacing output is measured in milliamps, not joules. Muscle twitching appears before electrical capture and does not confirm it, a fixed low setting often fails to capture, and starting at maximum and leaving it there causes needless pain.

13. In early left-sided heart failure, where are crackles usually first heard?

    1. A. In the dependent lung bases
    2. B. In the upper lung apices
    3. C. Over the trachea and bronchi
    4. D. Only over the right upper lobe
    Show answer

    Answer: A. In the dependent lung bases

    Fluid accumulates first in the dependent portions of the lungs, so early crackles are heard at the bases. As failure worsens, crackles extend upward.

14. After ROSC, a 70-year-old woman has a BP of 78/48 mmHg, crackles in both lungs, and an SpO2 of 90% on 100% oxygen. The best initial treatment is:

    1. A. A 2-liter normal saline bolus
    2. B. Nitroglycerin 0.4 mg sublingual
    3. C. Epinephrine 1 mg by IV push
    4. D. A titrated vasopressor infusion
    Show answer

    Answer: D. A titrated vasopressor infusion

    Post-arrest hypotension with pulmonary edema suggests myocardial stunning (cardiogenic shock), so a titrated vasopressor such as norepinephrine or an epinephrine infusion is started to reach an SBP of at least 90 and a MAP of at least 65 mmHg, with fluids given only cautiously. A 2-liter bolus would worsen the pulmonary edema and hypoxemia. Nitroglycerin lowers BP further and is contraindicated in hypotension. A 1-mg IV push is an arrest dose and can cause severe hypertension and dysrhythmias in a patient with a pulse. (2025 AHA Part 11.)

15. The goal of defibrillation in VF is to:

    1. A. Restart a heart that is in asystole
    2. B. Pace the ventricles until a rhythm returns
    3. C. Block the reentry circuit in the AV node
    4. D. Depolarize the heart so it can reset
    Show answer

    Answer: D. Depolarize the heart so it can reset

    A shock depolarizes a critical mass of myocardium at once, ending chaotic activity so the heart's own pacemaker can restore an organized rhythm. Defibrillation does not 'restart' asystole, which is why asystole is not shocked. It is a single depolarizing pulse rather than repeated pacing stimuli, and it does not target an AV nodal reentry circuit the way adenosine does in SVT.

16. A hemodynamically stable STEMI patient is 150 minutes by ground from the nearest PCI center, and a non-PCI hospital is 15 minutes away. Under AHA guidance, the best plan is usually:

    1. A. Go directly to the PCI center despite the delay
    2. B. Go to the closer hospital and wait for symptoms to settle
    3. C. Request air transport only if pain persists past an hour
    4. D. Go to the closer hospital for fibrinolytics, then transfer
    Show answer

    Answer: D. Go to the closer hospital for fibrinolytics, then transfer

    When PCI cannot be achieved within about 120 minutes of first contact, fibrinolysis at the nearest capable hospital followed by transfer is recommended for eligible patients. Cardiogenic shock is the exception, favoring direct transport for PCI.

17. The family of a 60-year-old man in cardiac arrest asks to stay in the room during the resuscitation. The best response is to:

    1. A. Refuse, since presence harms the family
    2. B. Allow it, with someone to support them
    3. C. Allow it only after resuscitation ends
    4. D. Refuse, since it raises legal liability
    Show answer

    Answer: B. Allow it, with someone to support them

    Family presence is associated with less anxiety and depression and better grieving, and it does not worsen resuscitation performance, so AHA supports offering it. A designated person should explain events and support the family.

18. Distributive shock is characterized by:

    1. A. Failure of the heart to pump
    2. B. Loss of circulating volume
    3. C. Widespread vasodilation
    4. D. Mechanical obstruction to flow
    Show answer

    Answer: C. Widespread vasodilation

    Vasodilation creates relative hypovolemia. Septic, neurogenic, and anaphylactic shock are all distributive.

19. At standard paper speed, how much time does one large box (five small boxes) represent?

    1. A. 0.04 seconds
    2. B. 0.20 seconds
    3. C. 0.40 seconds
    4. D. 1.00 second
    Show answer

    Answer: B. 0.20 seconds

    Five small boxes of 0.04 seconds each equal 0.20 seconds. Five large boxes equal 1 second, and 30 large boxes equal 6 seconds.

20. During transfer of a patient who had heart surgery yesterday, his chest tube drainage suddenly stops, his BP falls to 78/60 and his neck veins distend. What should you suspect?

    1. A. Normal recovery as the bleeding has stopped
    2. B. Tamponade from blood that cannot drain
    3. C. Tension pneumothorax on the opposite side
    4. D. Hypovolemia from too much chest tube output
    Show answer

    Answer: B. Tamponade from blood that cannot drain

    After cardiac surgery, clotted chest tubes can let blood collect around the heart, causing tamponade with hypotension and distended neck veins; alert the receiving surgical team at once, since reopening may be needed. A sudden stop in drainage with shock is not normal recovery. A tension pneumothorax would cause one-sided breath sound changes, and hypovolemia causes flat, not distended, neck veins.

21. Fentanyl is often chosen over morphine for analgesia because it:

    1. A. Lasts longer than morphine, needing fewer doses
    2. B. Causes no respiratory depression at usual doses
    3. C. Is not a controlled substance in most states
    4. D. Has rapid onset with less histamine release
    Show answer

    Answer: D. Has rapid onset with less histamine release

    It is dosed in micrograms, which makes dosing errors dangerous. It also causes less hypotension.

22. You are preparing to intubate a 54-year-old with pneumonia whose SpO2 is 89% on a nonrebreather. Before induction, the saturation you should aim for, if achievable, is at least:

    1. A. 80% to 85%
    2. B. 85% to 88%
    3. C. 88% to 90%
    4. D. 93% to 95%
    Show answer

    Answer: D. 93% to 95%

    Starting near 95% provides a buffer, because once saturation drops below about 90% it falls rapidly down the steep part of the oxyhemoglobin curve. Starting at 88% leaves almost no safe apnea time.

23. A 28-year-old with a suspected ruptured ectopic pregnancy is pale and confused, with a BP of 76/40 mmHg but a heart rate of only 72. You should:

    1. A. Suspect neurogenic shock from a hidden spine injury
    2. B. Treat it as hemorrhagic shock despite the rate
    3. C. Assume the low pressure is a cuff error
    4. D. Attribute her confusion to a simple faint
    Show answer

    Answer: B. Treat it as hemorrhagic shock despite the rate

    Hypotension with pallor and confusion in a woman with a suspected ruptured ectopic is hemorrhagic shock until proven otherwise. Some patients with intraperitoneal bleeding have a normal or even slow heart rate (relative bradycardia, thought to be a vagal response to blood in the abdomen), and beta-blockers or fitness can do the same, so a normal rate must not reassure you. Neurogenic shock needs a cord injury, which nothing suggests. A low pressure with pallor and confusion should be acted on, not dismissed as a cuff error. A simple faint resolves quickly when the patient is supine and does not leave persistent hypotension and confusion.

24. A deep vein thrombosis commonly forms in the:

    1. A. Deep veins of the legs
    2. B. Pulmonary arteries
    3. C. Superficial veins of the arms
    4. D. Superficial veins of the legs
    Show answer

    Answer: A. Deep veins of the legs

    The pelvic veins are another common site. Immobility is a major risk factor. Clots reach the pulmonary arteries as emboli after forming in the deep veins. Clots in superficial leg veins cause superficial thrombophlebitis, which is not a DVT.

25. In cardiac arrest research using Utstein definitions, what is meant by 'sustained ROSC'?

    1. A. A pulse that lasts at least 20 minutes
    2. B. A pulse felt during one rhythm check
    3. C. A pulse that lasts until hospital discharge
    4. D. A pulse that lasts at least 10 seconds
    Show answer

    Answer: A. A pulse that lasts at least 20 minutes

    Utstein reporting defines sustained ROSC as return of circulation without further compressions for at least 20 consecutive minutes, which helps compare systems fairly. A pulse at one check or for 10 seconds is any ROSC, not sustained ROSC, and survival to discharge is a separate outcome.