ACLS Review Questions
What is the recommended norepinephrine dose for hypotensive pts during the post-cardiac arrest phase?
0.1 to 0.5 mcg/kg per minute
The pt's signs are HR 84/min, BP 124/73 mmHg, SpO2 is. 66%, and the skin is cyanotic around the mouth and extremities. What is the recommended rate for rescue breaths?
1 breath every 6 seconds
What is the average respiratory rate for an adult at rest?
12 to 20/min
What do your next steps include?
12-lead EKG Vagal maneuvers IV access
What blood glucose level should trigger the administration of IV or subcutaneous insulin for a pt with an acute ischemic stroke?
180 mg/dL
What is the recommended infusion rate for epinephrine in the management of symptomatic bradycardia unresponsive to atropine?
2 to 10 mcg per minute
What is the time goal for neurologic assessment by the stroke team or designee and noncontrast CT or MRI performed after hospital arrival? 20 mins 25 mins 10 mins 15 mins
20 mins
What is the maximum time from last known normal when endovascular therapy can be performed?
24 hrs
Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame?
3 hours
What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine?
5 to 20 mcg/kg per minute
What is the recommended initial dose of adenosine for the management to SVT unresponsive to vagal maneuvers?
6 mg IV
Which of the following defines chest compression fraction (CCF)?
Actual chest compression time/total code time
Vagal maneuvers are unsuccessful. His VS are HR 178/min, RR 24/min, and BP 110/78 mmHg. What medication is appropriate for this pt?
Adenosine 6 mg IV (follow with saline flush)
You determine that the pt has poor perfusion. What is your next step?
Administer atropine 1 mg IV
The pt does not respond to atropine. The VS are HR 34/min, BP 66/43 mmHg, RR 18/min, and SpO2 is 91%. He is responsive, but dizzy. What options do you have to treat the pt?
Administer epinephrine 2 to 10 mcg per minute infusion Initiate transcutaneous pacing Administer dopamine 5 to 20 mcg/kg per minute infusion
With the diagnosis of STEMI, what is the most probable treatment? Admission for observation Admission for PCI or fibrinolysis Admission to ICU Release to home
Admission for PCI or fibrinolysis
What is your interpretation of the pt's EKG tracing?
Anterior STEMI
What is the first-line treatment for unstable bradycardia?
Atropine
The EMS team brings a 54-year-old pt to the emergency department who had been experiencing severe SOB and difficulty breathing. The pt loses consciousness on arrival. What initial actions should be taken?
Check for responsiveness Assess ABCs Call for additional help
A 74-year-old man was brought to the hospital by his wife. She states that her husband started having sudden left-arm weakness and left-sided facial paralysis during lunch. He has a past medical history of poorly controlled HTN. The pt's VS show HR 92/min, RR 14/min, BP 130/86 mmHg, SpO2 97%, and AFib on the monitor. What additional assessment and stabilization activities should be completed within the first 10 mins after the pt's arrival?
Check glucose Activate stroke team Establish IV access Complete neuro screening Order an emergent CT scan or MRI of the brain and review pt history
Which clinical finding is a contraindication to the administration of nitroglycerin?
Confirmed RV infarction
Which is a step of closed-loop communication? Encouraging all team members to speak clearly Abandoning ego Using distinctive speech and a controlled voice Confirming task completion before assigning another task
Confirming task completion before assigning another task
In which of the following can nasopharyngeal airways be used?
Conscious Unconscious Semiconscious
In addition to decreased IHCA, what are some other benefits of implementing a rapid response team?
Decrease in total hospital length of stay Decreased ICU length of stay
While performing the BLS assessment, you initiate high-quality CPR and assist ventilation with a bag-mask device. The AED does NOT recommend a shock. Which action in the primary assessment should you perform first?
Determine is the pt's airway is patent
As part of the neurologic assessment, you perform a physical and neurologic examination. What are some general questions you need to ask?
Do you take any medications? When did the symptoms start? Do you have any allergies? What other symptoms do you have?
What is your goal for PCI when treating this patient? First medical contact-to-balloon inflation time of 90 mins First medical contact-to-needle time of 30 mins Door-to-needle time of 90 mins Door-to-balloon inflation time of 30 mins
First medical contact-to-balloon inflation time of 90 mins
You are treating a pt with a HR of 186/min. Which symptom (if present) suggests an unstable tachycardia?
Hypotension
A 49-year-old man arrives at the emergency department with chest discomfort. He states that he was working in the garden this morning when his chest started hurting. The last episode lasted about 25 minutes, and he was sweaty. The chest discomfort is not relieved with rest. Within the first 10 minutes, on the basis of the pt showing symptoms suggestive of MI, what will your first actions include (if not completed by EMS before arrival)?
If SpO2 is less than 90%, start oxygen Obtain a 12-lead EKG Administer aspirin and establish IV access Assess ABCs Consider nitroglycerin, morphine, and a P2Y inhibitor Activate the STEMI team
Among others, which of the following factors has been associated with improved survival in pts with cardiac arrest? Immediate high-quality CPR Presence of 2 or more rescuers Compression-only CPR Manual defibrillation
Immediate high-quality CPR
A 72-year-old male pt has been suffering from progressive dizziness and bouts of palpitations after exercising last night. His symptoms reappeared and worsened this am. The pt is conscious and alert, has a HR of 180/min, a weak radial pulse, BP 110/78 mmHg, and SpO2 of 96% What are the most appropriate initial interventions?
Maintain a patent airway and monitor Attach a 12-lead EKG
A 75-year-old man presents to the emergency department. His wife states that he fainted 45 mins ago, while watching TV. She said he has had episodes of confusion and fatigue during the past week. The pt presents with HR 30/min (weak pulse), BP 66/43 mmHg, RR 20/min, and SpO2 89%. He is alert and responsive. What should your next steps be to assess and treat this pt?
Maintain the airway and administer oxygen if needed Establish IV access Obtain a 12-lead EKG
What needs to be completed for this pt within 20 mins after hospital arrival?
Neurologic assessment
Your pt continues to say that he has chest discomfort. What treatment can you repeat as long as it is not contraindicated by vital signs? Nitroglycerin IV every 1 to 3 mins Morphine sublingual every 1 to 3 mins Nitroglycerin sublingual or translingual every 3 to 5 mins Morphine IV every 1 to 3 mins
Nitroglycerin sublingual or translingual every 3 to 5 mins
You find that the pt's neurologic function is rapidly improving. Is this pt still a candidate for fibrinolytic therapy? Yes No Not enough info
No
The pt is unresponsive and not breathing but has a strong pulse. What should your initial actions include?
Open the pt's airway via a head tilt-chin lift or jaw thrust Initiate ventilation with a bag-mask device attached to supplemental oxygen
What term best describes an organized rhythm without a pulse?
PEA
After administration of adenosine, the pt's VS are now HR 184/min, RR 26/min, and BP 78/54 mmHg. He now only responds to noxious stimuli. What is your next action?
Perform synchronized cardioversion
The pt does not respond to treatments. The vital signs are HR 40/min (weak pulse), BP 66/43 mmHg, RR 18/min, and SpO2 91%. He is responsive, but states that he feels tired. What should you consider?
Prepare for transvenous pacing Seek expert consultation
The pt is not responding well to ventilation and suctioning. You decide to intubate the pt. In addition to clinical assessment, what is the single most reliable method of confirming and monitoring correct placement of the ET tube?
Quantitative waveform capnography
What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?
Quantitative waveform capnography
To determine whether the pt is a candidate for fibrinolytic therapy, what actions should be taken?
Repeat neurologic exam
Upon reviewing a pt's 12-lead EKG, you note ST-segment elevation of 2 mm in leads II, III, and aVF. How would you classify the electrocardiographic findings?
ST segment elevation myocardial infarction
What rhythm is shown on the monitor?
SVT
During analysis of the pt's EKG, you note the presence of more P waves than QRS complexes. You also note all PR intervals have a uniform length, but random QRS complexes are dropped. What type of AV block is most likely present?
Second degree type II
PEA can present as which of the following organized rhythms? Sinus rhythm Asystole Bundle branch blocks Afib or flutter VF
Sinus rhythm Bundle branch blocks Afib or flutter
Would you consider the pt stable or unstable?
Stable
His initial VS are HR 120/min, BP 135/88 mmHg, RR 23/min, SpO2 87%, and temperature 37.3 degrees C. When considering oxygen saturation, what is your course of action? Start oxygen at 4L/min via nasal cannula Do not start oxygen Intubate pt immediately Administer albuterol nebulizer
Start oxygen at 4L/min via nasal cannula
What is the recommended CPR position for a 3rd trimester gravid pt?
Supine with manual left lateral uterine displacement
Bc this pt is no longer a candidate for fibrinolytic therapy, what are your next steps for him?
Support ABCs Begin stroke pathway Admit the pt to an ICU
What additional questions help you determine next steps?
When did the symptoms start? Do you have any allergies? Do you take any medication?
Within 45 mins, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. There are no signs of hemorrhage or mass lesions. Is this pt a potential candidate for fibrinolytic therapy? Yes No Not enough info
Yes
What is the most appropriate destination for pts with suspected acute ischemic stroke?
certified stroke center
What is a contraindication to the use of an oropharyngeal airway?
conscious patient
The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the pt's nose to the __________.
earlobe
What is a complication of IV atropine when administered in doses of less than 0.5 mg?
further slowing of the heart rate
What is the primary purpose of the CPR coach on a resuscitation team?
increasing CPR quality
What is the most common type of stroke?
ischemic stroke
What is the primary advantage of using a stroke severity tool?
it helps identify large-vessel occlusion stroke
What blood component is acted upon by aspirin administration during the management of a pt with ACS?
platelets
What is a contraindication to the administration of aspirin for the management of a pt with acute coronary syndromes?
recent gastrointestinal bleeding
If the pt is conscious, establish IV access prior to synchronized cardioversion and administer ________.
sedation
While ventilating the pt, you hear loud gurgling sounds coming from the airway. What is your next action?
suction the airway
What is the pt's rhythm?
third-degree AV block
What is the recommended initial therapy for a pt with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead EKG?
vagal maneuvers
