Final Exam ACLS

A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamically stable and has a heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary assessment, which statement(s) by the patient would the team interpret as a possible contributing cause? Select all correct options that apply. "I've had a terrible cold with a horrible cough and fever the past week." "I've been so anxious lately because I just lost my job." "I had an aortic valve replacement several years ago." "I've had a history of heart disease for the past 3 years." "I've been vomiting for the past 2 days from a gastrointestinal bug."

"I've had a terrible cold with a horrible cough and fever the past week." "I've been so anxious lately because I just lost my job." "I've been vomiting for the past 2 days from a gastrointestinal bug."

A 35-year-old female patient's ECG is consistent with STEMI. The ECG reveals a new ST-segment elevation at the J point in leads V2 and V3 of at least which size? Select the correct answer to this question. 0.10 mV 0.15 mV 0.2 mV 0.25 mV

0.15 mV

A patient with an ischemic stroke arrives at the emergency department at 2 a.m. The patient's symptoms started about 12:30 a.m. After completing the necessary assessments, the healthcare team diagnoses an ischemic stroke, and the patient is determined to be a candidate for fibrinolytic therapy. To achieve the best outcomes, the team should initiate therapy for this patient no later than by which time? Select the correct answer to this question. 3:00 a.m. 5:30 a.m. 6:00 a.m. 8:30 a.m.

1 3:00 a.m.

A patient experiencing STEMI comes to the emergency department of a large medical center at 9:30 p.m. The patient states that the symptoms started about 8 p.m. After confirming the diagnosis and initiating care, the healthcare team schedules the patient for percutaneous coronary intervention (PCI). The facility is capable of administering PCI. To achieve the best outcomes, therapy should be administered to this patient by which time? Select the correct answer to this question. 11:00 p.m. 12:00 a.m. 1:00 a.m. 1:30 a.m.

11:00 p.m. Reperfusion therapy should be administered within 1 hour, 30 minutes of the patient's first medical contact if the patient does not need to be transferred to another facility. The patient arrived at 9:30 p.m., so the latest the therapy should be administered would be 11 p.m.

A member of the resuscitation team is preparing to defibrillate a patient in cardiac arrest using a biphasic defibrillator. The team member would set the energy dose according to the manufacturer's recommendations, which is usually: Select the correct answer to this question. 100 to 150 joules 120 to 200 joules 300 joules 360 joules

120 to 200 joules When using a biphasic defibrillator, the energy dose should be set at 120 to 200 joules

A patient with a suspected stroke arrives at the emergency department at 7:10 p.m. The stroke team ensures that a comprehensive neurologic assessment using the National Institutes of Health Stroke Scale (NIHSS) is completed and that brain imaging is performed by which time? 7:20 p.m. 7:30 p.m. 7:40 p.m. 7:50 p.m.

2 Within 20 minutes of the patient's arrival, a comprehensive neurologic assessment should be completed and brain imaging should be performed. That would be 7:30 p.m. for this patient.

A patient enters the emergency department in respiratory compromise. The team is monitoring the patient using capnography and identifies that ETCO2 levels are initially 33 mmHg and later 40 mmHg. From these readings, the team identifies that the patient is progressing in what stage of respiratory compromise? Respiratory acidosis Respiratory failure Respiratory distress Respiratory arrest

3 Capnography can objectively assess the severity of a patient's respiratory distress. Early on, the patient will often hyperventilate, leading to hypocapnia that is reflected by a low ETCO2 value (less than 35 mmHg). As respiratory distress increases, and the patient begins to tire, the ETCO2 value may return to the normal range (35 to 45 mmHg). However, if the patient progresses to respiratory failure, the ETCO2 level will increase to greater than 45 mmHg, which indicates hypoventilation.

A healthcare provider initiates ventilations to ensure adequate breathing and oxygenation. While ventilations are being performed, capnography is established to evaluate the adequacy of the ventilations. The healthcare provider determines that ventilations are adequate based on which end-tidal carbon dioxide (ETCO2) value? elect the correct answer to this question. 10 to 15 mmHg 20 to 25 mmHg 25 to 30 mmHg 35 to 45 mmHg

35 to 45 mmHg

A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced cardiac life support was initiated. The patient required the placement of an advanced airway to maintain airway patency. Which statement indicates that the team performed high-quality CPR? Select the correct answer to this question. "We kept the rate of chest compressions to around 100 per minute but adjusted their depth to 1.5 inches while giving 1 ventilation every 3 seconds." "We delivered chest compressions at a rate of 80 to 100 per minute to a depth of at least 2 inches and gave 1 ventilation every 6 seconds." "We initiated chest compressions at a rate of 100 to 110 per minute to a depth of 2.4 inches and then gave 1 ventilation every 10 seconds." "We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute."

4 "We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute."

A 20-year-old man with respiratory depression is brought to the emergency department by his parents. The parents state that "[They] found him at home with various needles and syringes around him, but [they] have no idea what he took." Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 p.m. The patient does not respond to this initial dose. The team would expect to administer a second dose after how many minutes? Select the correct answer to this question. 2 minutes 4 minutes 6 minutes 8 minutes

4 minutes

A patient with STEMI is experiencing chest pain that is refractory to sublingual nitroglycerin. Intravenous nitroglycerin is prescribed. When administering this medication, it would be titrated to maintain which systolic blood pressure? Select the correct answer to this question. 60 mmHg 70 mmHg 80 mmHg 90 mmHg

90 mmHg In patients with STEMI, IV nitroglycerin may be used when chest pain or discomfort is recurrent or refractory to nitroglycerin administered sublingually or by spray. The IV nitroglycerin should be titrated to maintain a systolic blood pressure of 90 mmHg or more.

A patient with suspected acute coronary syndromes (ACS) is placed on a cardiac monitor. The patient is complaining of dyspnea and is given supplemental oxygen. The provider determines that the supplemental oxygen dose is correct based on which SaO2 level? Select the correct answer to this question. 87% 91% 93% 95%

95%

A patient's capnogram reveals the following waveform. Which segment would the healthcare provider interpret as reflecting the beginning of exhalation?

A-B

An ECG strip of a patient in the emergency department reveals the following rhythm. Which feature would the healthcare provider interpret as indicating atrial fibrillation? Narrow QRS complex with PP interval constant or slightly irregular Presence of wide QRS complexes that are bizarrely and consistently shaped Presence of flutter waves and sawtooth patterns Absence of discrete P waves and presence of irregularly irregular QRS complexes

Absence of discrete P waves and presence of irregularly irregular QRS complexes

A 40-year-old patient in the waiting room of the primary care provider's office approaches a staff member and says, "I'm having really severe, crushing chest pain that is moving to both my arms." The patient is diaphoretic and dyspneic. Which action would be appropriate for the staff member to take? Activate the emergency medical services system. Take the patient to an exam room immediately. Give the patient an aspirin. Obtain a 12-lead ECG.

Activate the emergency medical services system.

Cardiac monitoring of a patient in cardiac arrest reveals ventricular fibrillation. What intervention would the team perform next? Initiate capnography. Administer 1 shock. Provide post-cardiac arrest care. Insert an advanced airway.

Administer 1 shock

A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of chronic obstructive pulmonary disease. Assessment reveals respiratory failure. Which action would be the initial priority? Delivery of supplemental oxygen via nasal cannula Initiation of capnography Establishment of vascular access Assisted ventilation with BVM resuscitator

Assisted ventilation with BVM resuscitator Patients who cannot ventilate adequately despite an open airway or who have insufficient respiratory effort require assisted ventilation initially provided via a BVM resuscitator.

A patient comes to the emergency department complaining of palpitations and "some shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm strip. The provider interprets this strip as indicating which arrhythmia? Atrial fibrillation Ventricular tachycardia Ventricular fibrillation Atrial flutter

Atrial flutter

A patient with dyspnea and a change in mental status arrives at the emergency department. The healthcare team completes the necessary assessments and begins to care for the patient, including initiating cardiac monitoring and pulse oximetry; providing supplemental oxygen and ensuring adequate ventilation; and obtaining vascular access. The team reviews the patient's ECG rhythm strip, as shown in the following figure. Which agent would the team most likely administer? Amiodarone 150 mg over 10 minutes Atropine 0.5 mg every 3 to 5 minutes Dopamine 5 to 10 mcg/min Epinephrine 2 to 10 mcg/min

Atropine 0.5 mg every 3 to 5 minutes

Cardiac monitoring indicates that a patient has a ventricular tachyarrhythmia. The patient has a pulse and is not showing any signs of hemodynamic compromise. A 12-lead ECG reveals an irregular rhythm with QRS complexes greater than 0.12 second in duration. Which action would be appropriate at this time? Select the correct answer to this question. Synchronized cardioversion Atropine Defibrillation Consider an antiarrhythmic infusion and expert consultation

Consider an antiarrhythmic infusion and expert consultation

The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured?

D

A patient experiencing an unstable bradyarrhythmia does not respond to atropine. Which interventions could the healthcare provider use next? Select all correct options that apply. Carotid massage Epinephrine or dopamine infusio Transcutaneous pacing Synchronized cardioversion

Epinephrine or dopamine infusio Transcutaneous pacing

After cardiac arrest and successful resuscitation, the patient has a return of spontaneous circulation. The patient is unable to follow verbal commands. Targeted temperature management is initiated. Which method(s) would be appropriate for the resuscitation team to use? Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Administering cool-mist oxygen therapy Applying a cool compress to the patient's forehead Using an endovascular catheter

Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Using an endovascular catheter

A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest, the patient's ECG showed peaked T waves. What might be causing the patient's cardiac arrest? Select the correct answer to this question. Acidosis Hyperkalemia Hypoxia Hypothermia

Hyperkalemia Suspect hyperkalemia in all patients with acute or chronic renal failure who exhibit a wide-complex ventricular rhythm or tall, peaked T waves on an ECG before cardiac arrest.

A patient comes to the emergency department with a suspected stroke. The patient is alert and oriented and accompanied by a family member. The family member says, "I noticed he was slurring his words and had trouble walking, like his leg was numb." Which finding would suggest that the patient is experiencing a condition that mimics a stroke? Hyperkalemia Hypoglycemia Hyperglycemia Hypokalemia

Hypoglycemia

The emergency department team is providing care to a patient who is experiencing ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the patient's current condition. Which electrolyte imbalance(s) would most likely be involved? Select all correct options that apply. Hyperkalemia Hypochloremia Hypernatremia Hypomagnesemia Hypocalcemia

Hypomagnesemia Hypocalcemia

A patient is brought into the emergency department with a suspected opioid overdose. The patient is in cardiac arrest. Which action would be the team's priority? Select the correct answer to this question. Giving naloxone intravenously (IV) Obtaining a 12-lead electrocardiogram (ECG) Administering supplemental oxygen Initiating high-quality CPR

Initiating high-quality CPR Although no evidence supports any benefit to naloxone administration during cardiac arrest, administration of naloxone during both respiratory and cardiac arrest is recommended when opioid overdose is suspected. However, for a patient in cardiac arrest, high-quality CPR is prioritized over the administration of naloxone.

A patient is brought to the emergency department by their spouse. The spouse says, "I think it's a stroke." The stroke team assesses the patient using the National Institutes of Health Stroke Scale (NIHSS). Which area(s) would the team include in this assessment? Select all correct options that apply. Facial palsy Level of consciousness Language deficits Visual function Cranial nerve function

Level of consciousness Language deficits Visual function

A healthcare provider is establishing cardiac monitoring using a five-electrode system. The healthcare provider demonstrates proper use of the system by placing the green electrode in which location? Select the correct answer to this question. At the fourth intercostal space, right sternal border On the lower right abdomen On the lower left abdomen Under the left clavicle, at the midclavicular line

On the lower right abdomen

A patient in cardiac arrest experiences return of spontaneous circulation. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation. Which finding(s) would indicate the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation? Select all correct options that apply. PaCO2 35 mmHg SaO2 96% SaO2 92% ETCO2 50 mmHg ETCO2 40 mmHg

PaCO2 35 mmHg SaO2 92% ETCO2 50 mmHg

A patient experiences cardiac arrest, and the resuscitation team initiates ventilations using a bag-valve-mask (BVM) resuscitator. The development of which condition during the provision of care would lead the team to suspect that improper BVM technique is being used? Select the correct answer to this question. Rib fracture Esophageal injury Pneumothorax Hypertension

Pneumothorax

A person suddenly collapses while sitting in the sunroom of a healthcare facility. A healthcare provider observes the event and hurries over to assess the situation. The healthcare provider performs which assessment first? Select the correct answer to this question. Rapid assessment Secondary assessment Primary assessment Basic life support assessment

Rapid assessment

Assessment of a patient in the emergency department reveals that the patient is experiencing respiratory compromise. From the assessment, the team identifies that the patient is in the earliest stage of this condition. Which stage would this be? Select the correct answer to this question. Respiratory distress Respiratory arrest Respiratory acidosis Respiratory failure

Respiratory distress Respiratory compromise occurs along a continuum, beginning with respiratory distress, progressing to respiratory failure and then to respiratory arrest

Assessment of a patient reveals an ETCO2 level of 55 mmHg and an arterial oxygen saturation (SaO2) level of 88%. The provider would interpret these findings as indicative of which condition? Select the correct answer to this question. Respiratory distress Cardiac arrest Respiratory failure Respiratory arrest

Respiratory failure

A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. The history reveals that before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause? Select the correct answer to this question. Tension pneumothorax Cardiac tamponade Acidosis Hypothermia

Tension pneumothorax Prearrest signs of tension pneumothorax in the advanced stage include jugular venous distension, cyanosis, apnea and hyperresonance on percussion. Difficulty ventilating the patient may also be a sign of tension pneumothorax.

A 30-year-old patient has been brought to the emergency department in cardiac arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm would suggest which of the following as a possible precipitating factor?

The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation include electrocution, myocardial ischemia or infarction, shock, stimulant overdose and ventricular tachycardia. electrocution

A patient is experiencing respiratory distress secondary to an exacerbation of chronic obstructive pulmonary disease. The patient begins to exhibit signs and symptoms of worsening respiratory function and experiences respiratory arrest. The team intervenes, delivering ventilations via BVM resuscitator. The team would deliver 1 ventilation at which interval? Every 3 to 4 seconds Every 5 to 6 seconds Every 7 to 8 seconds Every 8 to 9 seconds

The team would deliver 1 ventilation every 5 to 6 seconds. Each ventilation should last about 1 second and make the chest begin to rise.

A patient in the telemetry unit is receiving continuous cardiac monitoring. The patient has a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following figure. The provider interprets this strip as indicating which arrhythmia? Second-degree AV block First-degree atrioventricular (AV) block Sinus tachycardia Third-degree AV block

Third-degree AV block

A patient presents to the emergency department with mild to moderate recurrent chest pain, without any nausea or vomiting. A 12-lead ECG is obtained and shows ST-segment depression with transient T-wave elevation indicative of NSTE-ACS. Cardiac serum markers are obtained and are not elevated. The patient's risk-stratification score indicates low risk. These findings suggest which condition? Select the correct answer to this question. Non-STEMI Myocardial infarction STEMI Unstable angina

Unstable angina

A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow-complex supraventricular tachyarrhythmia. The patient is hemodynamically stable. Which intervention would be initiated first? Select the correct answer to this question. Adenosine administration Sedation Vagal maneuvers Synchronized cardioversion

Vagal maneuvers

A patient is being treated in the emergency department and is determined to have NSTE-ACS. Invasive management is planned based on which finding? Select the correct answer to this question. Atrial tachycardia Ventricular tachycardia Atrial fibrillation Ventricular fibrillation

Ventricular tachycardia An early invasive strategy should be considered for patients with high-risk NSTE-ACS, which would be indicated by ventricular tachycardia.

The ECG rhythm strip of a patient who arrived in the emergency department complaining of dizziness, syncope and shortness of breath reveals sinus bradycardia. When reviewing the patient's medication history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition? Select all correct options that apply. Quinapril Verapamil Digoxin Metoprolol Losartan

Verapamil Digoxin Metoprolol Medications associated with causing sinus bradycardia include β-blockers such as metoprolol and calcium channel blockers such as verapamil and digoxin.

A patient presents to the emergency department with suspected ACS. Electrocardiogram and cardiac biomarkers show the patient has ST-segment elevation myocardial infarction (STEMI). Physical examination reveals signs of left ventricular dysfunction. Which finding(s) would support this? Select all correct options that apply. Weak peripheral pulses Chest pain Cool, clammy skin Crackles Hypotension

Weak peripheral pulses Hypotension Crackles

1 A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member follows each medication administration with a bolus of fluid. How much would the team member give? Select the correct answer to this question. 5 to 10 mL 10 to 20 mL 20 to 30 mL 30 to 40 mL

When administering medications during a cardiac arrest, all medications administrated through the IV or intraosseous infusion route should be followed by a 10- to 20-mL fluid bolus.

The stroke team is assessing a patient with a suspected stroke. The patient is alert and able to carry on a conversation, although the patient has difficulty getting the words out. Testing confirms that the patient has had an ischemic stroke. Based on the patient's medical history, a history of which arrhythmia would alert the team to the patient's increased risk for stroke? Select the correct answer to this question. Ventricular fibrillation Atrial fibrillation Atrial tachycardia Bradycardia

atrial fibrillation

The resuscitation team suspects that hyperkalemia is the cause of cardiac arrest in a patient brought to the emergency department. Which finding on a 12-lead ECG would confirm this suspicion? Wide-complex ventricular rhythm and tall, peaked T waves ST-segment changes, T-wave inversion Flat T waves, prominent U waves and possibly prolonged QT intervals Narrow-complex ventricular tachycardia

Wide-complex ventricular rhythm and tall, peaked T waves In hyperkalemia the patient's 12-lead ECG rhythm strip will show wide-complex ventricular rhythm and tall, peaked T waves.

A patient is brought into the emergency department. The patient does not have a pulse. The cardiac monitor shows the following rhythm. The team interprets this as which condition?

ventricular tachycardia

A patient with a diagnosis of ACS is experiencing cardiogenic shock. Which adjuvant therapy would be contraindicated? Select the correct answer to this question. Direct thrombin inhibitor β-Blockers Glycoprotein IIb/IIIa inhibitors Heparin

β-Blockers The use of β-blockers is contraindicated in patients who are at risk for cardiogenic shock, low cardiac output and acute heart failure.