ACLS practice questions
What are the contraindications of nitroglycerin?
-If patient has a confirmed inferior wall stemi or right ventricular infarction -avoid nitro if patient has hypotension, bradycardia, or tachycardia -if patient recently has taken sildenafil, vardenafil, or tadalafil in the past 24-48 hrs
What is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention? 120 min 45 min 30 min 90 min
90 min
Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than?
90%
Which is the main advantage of effective teamwork? Early defibrillation Division of tasks Mastery or resuscitation skills Immediate CPR
Division of tasks
You obtain a 12-lead ECG in a patient with retrosternal chest pain. Which ECG finding is suggestive of high risk non-ST-segment elevation acute coronary syndrome? ST-depression less than 0.5mm New left Bundle branch block ST-segment elevation Dynamic T-wave inversion
Dynamic t wave inversion????
What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)?
Early and effective defibrillation
Which action is part of the secondary assessment of a conscious patient? Attach a monitor/defibrillator Formulate a different diagnosis Determines patients LOC Give IV/IO fluids if needed
Formulate a different diagnosis
Which action is part of secondary assessment of a conscious patient? Give IV/IO fluids if needed Formulate a differential diagnosis Determine the patients level of consciousness Attach a monitor defibrillator
Formulate a differential diagnosis
Which action is part of the secondary assessment of a conscious patient? Determine the patients LOC Formulate a differential diagnosis Give IV/IO fluids if needed Attach a monitor/defibrillator
Formulate a differential diagnosis
Which class of medications commonly given to patients with acute coronary syndrome may be adversely affected by morphine administration? B-blockers Calcium channel blockers Phosphodiasterase inhibitors Oral anti platelet meds
Oral anti platelet meds
Which is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndromes? Shortness of breath Recent GI bleeding Nausea Vomitting
Recent GI bleeding
What is the advantage of a systematic approach to patient assessment? Reduces the need for secondary assessment Reduces the chance of missing important signs and symptoms Permits assessment modification based on patient symptoms Standardizes treatment across systems of care
Reduces the chances of missing important signs and symptoms
Identify the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.
185 180 177 190
What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide? 12-14 ml/kg 6-8 ml/kg 9-11 ml/kg 3-5 ml/kg
6-8
What is the maximum time from last known normal when intra arterial thrombolysis for select patients can be used for treatment? 12hrs 3hrs 6hrs 4hrs
6hrs
What is the most common symptom of myocardial ischemia and infarction?
Retrosternal chest pain
What is the primary purpose of the CPR coach on a resuscitation team? Recording CPR data Resolving team conflicts Increasing CPR quality Giving encouragement
Increasing CPR quality
Which is an example of summarizing and reevaluating? "1mg of epinephrine given" Questioning a colleague who is about to make a mistake "Compressions are at a good rate" Increasing monitoring if the patients condition deteriorates
Increasing monitoring of the pati
What is the first step in the systematic approach to patient assessment? BLS assessment Initial impression Primary assessment Secondary assessment
Initial impression
What is the most common type of stroke?
Ischemic stroke
Which is the best example of a role of a team member? Monitors individual team members Helps train future team leaders Focuses on comprehensive patient care Prepared to fulfill their role responsibilities
Prepared to fulfill their role responsibilities
What do fibrinolytic meds end in?
"ase"
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department? 30 min 10 min 20 min 15 min
10 min
What is the maximum time for last known normal when endovascular therapy can be performed? 3hrs 12hrs 6hrs 24hrs
24hrs
What is the longest acceptable emergency door to needle time when fibrinolysis is the indented reperfusion strategy? 15 min 30 min 45 min 60 min
30 min
What is the estimated probability of the prehospital stroke scale with 1 abnormal finding when scored by prehospital providers? 72% 88% 80% 50%
72%
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?
10 minutes
Which are examples of mutual respect? Select all that apply: Acknowledging correctly completed task in a positive way Requesting a clear response and eye contact from the team member Giving drugs only after verbally confirming the order Ensuring that only 1 person talks at a time
Acknowledging correctly completed tasks in a positive way Ensuring that only one person talks at a time
What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival? Activation of emergency response Defibrillation Advanced resuscitation High-quality CPR
Activation of emergency reponse
Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include? Select all that apply Administer epinephrine 1 mg IV Administer a blood thinner Administer aspirin Assess airway, breathing, and circulation (ABCs) If considering prehospital fibrinolysis, use fibrinolytic checklist Provide prehospital notification to the receiving hospital Consider oxygen, nitroglycerin, and morphine if needed Obtain a 12 lead ECG
Administer aspirin Assess ABCs If considering prehospital fibrinolysis, perform fibrinolytic checklist Provide prehospital notification to the reveiving hospital Consider 02, nitro and morphine Obtain a 12 lead ECG
If someone starts developing hypotension after giving morphine or nitroglycerin?
Administer fluids
What is the first line treatment for unstable tachycardia? Lidocaine Cardioversion Amiodarone Adenosine
Cardioversion
What is the benefit of morphine when given for management of acute coronary syndrome? Increases left ventricular preload Vasoconstriction Central nervous system preload Increases systemic vascular resistance
Central nervous system analgesic
Which clinical findings represents a contraindication to the administration of nitroglycerin? Anterior wall infarction Posterior wall infarction Lateral wall infarction Confirmed right ventricular infarction
Confirmed right ventricular infarction
What is a contraindication of the use of an oropharyngeal airway? Bag mask ventilation Conscious patient Pediatric patient Absent gag reflex
Conscious patient
How do interruptions in chest compressions negatively impact survival after cardiac arrest? Increase intracranial pressure Decrease coronary perfusion pressure Reduce right ventricular period Increase intrathoracic pressure
Decrease coronary perfusion pressure
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 if the patients airway is patent Asses the patients oxygen status Perform fluid resuscitation Attach a quantitative waveform capnography device
Determine is the patients airway is patent
How do you calculate the chest compression fraction (CCF)? What is ideal percentage?
Divide chest compression time by total code time. You want this at least 60% but ideally greater than 80%
What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)? High-quality CPR Epinephrine administration Early and effective defibrillation Advanced airway insertion
Early and effective defibrillation
Which of the following patients can NPAs be used in? Unconscious Patient with nasal trauma Conscious Semiconscious
Everything but nasal trauma
What are the 3 components of the Cincinnati Prehospital stroke scale?
Facial droop Arm drift Abnormal speech
Which demographic group experiencing acute coronary syndromes is more likely to present without chest pain? Smokers Patients taking B-blockers Females Adolescents
Females
What type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue? Hemorrhagic stroke Transient ischemic attack Cryptogenic stroke Ischemic stroke
Hemorrhagic stroke
You are treating a patient with a heart rate of 186/min. Which symptom (if present) suggest unstable tachycardia? SOB Weakness Hypotension Fatigue
Hypotension
When is morphine indicated?
In STEMI patients with severe chest discomfort that does not respond to nitrates
When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers? Just under the angle of the lower jaw Behind the patients ears Under the patients chin On top of the patients jaw
Just under the angle of the lower jaw
Which is the best example of a role of the team leader? Proficient at endotracheal intubation Does not over ventilate the patient Performs within scope of practice Models excellent team behavior
Models excellent team behavior
What should you always monitor after giving morphine?
Monitor BP and respiratory rate
Which high performance team member is part of the resuscitation triangle? Timer/recorder Monitor/defibrillator/Cpr coach IV/IO/medications Team leader
Monitor/defibrillator/cpr coach
Which component of effective high-performance teams is represented by the use of real-time feedback devices? Quality Administration Timing Coordination
Quality
What is a physiological effect of nitroglycerin? Bronchodilation Reduces preload Binds to opioid receptors Platelet aggregation inhibition
Reduces preload
What element of a system of care is represented by properly functioning resuscitation equipment? System Structure Process Patient outcome
Structure
Which is a symptom of stroke? Diaphoresis Fever Sudden trouble seeing Diarrhea
Sudden trouble seeing
What are signs of clinical deterioration that would prompt the activation of rapid response system? Symptomatic hypertension Seizure Unexplained agitation Diastolic blood pressure greater than 60 mm Hg or less than 100 mm Hg
Symptomatic hypertension Seizure Unexplained agitation
Which member of the high performance team has the responsibility for assigning roles (positions)? Compressor Time/recorder Airway Team leader
Team leader
What are the 6 positions for high performance teams in resuscitation?
Team leader Airway Timer/recorder Compressor (rotate every 2 minutes) Monitor/defibrillator/cpr coach IV/IO/Medications
Which of the following are the "T" causes of reversible cardiac arrest? Cardiac tamponade Deep vein thrombosis Thyrotoxicosis Coronary thrombosis Tension pneumothorax Pulmonary thrombosis Toxins Simple pneumothorax Thoracic outlet syndrome Tachycardiomyopathy
Tension pneumothorax Toxins Cardiac tamponade Pulmonary thrombosis Coronary thrombosis
What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? The hospital can determine the most appropriate patient destination The hospital can have fibrinolytic drugs already prepared The emergency department can quickly determine glucose levels The hospital can perform more efficient evaluation and management
The hospital can perform more efficient evaluation and management
What happens when teams rapidly assess and intervene when patients have abnormal vital signs? Morbidity and mortality rates are maintained The number of out of hospital cardiac arrest increases The number of in hospital cardiac arrest decreases Morbidity and mortality rates increase
The number of in hospital cardiac arrest decreases
What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)? To provide diagnostic consultation to emergency department patients To improve care for patients admitted to critical care units To improve patient outcomes by identifying and treating early clinical deterioration To provide online consultation to emergency medical services personnel in the field
To improve patient outcomes by identifying and treating early clinical deterioration
Which is a sign of a stroke? Abdominal pain Shortness of breath Trouble speaking Retrosternal chest pain
Trouble speaking
When should you use caution when giving morphine?
Use caution when patient is in NSTE-ACS because of the association of mortality
What is the recommended window after symptoms onset for early fibrinolytic therapy or direct catheter based reperfusion for patients ST segment elevation myocardial infarction and no contraindications? Within 18 hours Within 12 hours Within 24 hours Within 48 hours
Within 12 hours
What is the door-to device time for direct-arriving patients with acute ischemic stroke treated with endovascular therapy?
90 min
What is the maximum amount of time you should simultaneously perform pulse and breathing checks? 10 seconds 5 seconds 20 seconds 15 seconds
10 seconds
What is the lower heart rate limit for a patient with sinus tachycardia?
100
Identify the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. 110 105 115 100
110
Obtaining a what is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndrome?
12 lead ekg
What is the upper heart rate limit for a patient with sinus tachycardia? 200/min 130 180 150
130
What blood glucose level should trigger administration of IV or subq insulin for a patient with acute ischemic stroke? 170 160 150 180
180
How long should the second rescuer squeeze the bag mask device when providing 2-rescuer ventilation? 1 sec 3 sec 4 sec 2 sec
1sec
What is the time for neurological assessment by the stroke team or designee and noncontrast computed tomography or magnetic resonance imaging performed after the hospital arrival? 20 min 25 min 15 min 10 min
20 min
Evidence suggest 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? 12 hours 3 hours 24 hours 6 hours
3hrs
What is the time goal for initiation of fibrinolytic therapy for patients w/o contraindications after hospital arrival
45 min
What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? 30 min 45 min 35 min 40 min
45 min
How quickly does the chance of survival decline for every minute of defibrillation delay in patients with ventricular fibrillation who do receive bystander CPR? 3-4% 5-6% 11-13% 7-10%
7-10%
The initial assessment reveals a conscious patient. The patients airway is patent and an advanced airway is not indicated. Which action in the primary assessment should you perform next? Remove clothing to perform a physical examination Check for neuro function Administer oxygen as needed Check for the presence of a pulse
Administer oxygen as needed
How do you calculate Coronary Perfusion Pressure (CPP)?
Aortic diastolic pressure "minus" Right Atrial Diastolic Pressure
Which is an example of knowledge sharing by a team leader? Changing a treatment strategy when supported by new information Maintaining an ongoing record of treatments Asking for suggestions about interventions Asking the compressor to decrease or increase rate
Asking for suggestions about interventions
What is the most appropriate destination for patients with suspected acute ischemic stroke? Certified stroke center Trauma center Hospital catheterization lab Closest emergency department
Certified stroke center
What is the highest level of stroke center certification? Comprehensive stroke center Thrombectomy-capable stroke center Primary stroke center Acute stroke ready hospital
Comprehensive stroke center
What are the components of high quality CPR? Select all that apply: Synchronous ventilation with chest compressions Avoiding excessive ventilation Compression rate around 10/min Complete chest recoil after each compression Interruptions limited to less than or equal to 10 seconds Low coronary perfusion pressure Switching compressors every 2 minutes Compression depth of at least 2 inches (5cm)
Compression depth of at least 2 inches (5cm) Switching compressors every 2 minutes Avoiding excessive ventilation Complete chest recoil after each compression Interruption limited to under 10 seconds
Which is a step of closed-loop communication? Confirming task completion before assigning another task Encouraging all team members to speak clearly Abandoning ego Using distinctive speech and a controlled voice
Confirming task completion before assigning another task
If a patient with stable ventricular tachycardia does not response to vagal maneuvers, what drug and dose regimen is to be given?
Give Adenosine 6mg over 1 second followed by a flush in a large vein and elevate arm quickly after If they don't response in 1-2 minutes, Administer 12 mg IV followed by a flush and elevate arm quickly
What is the first line treatment for bradycardia?
Give atropine 1mg IV may repeat for a total does of 3mg IV If this is ineffective provide transcutaneous pacing and/or dopamine 5 to 20 mcg/kg per minute or epinephrine 2 to 10 mcg/min
Which of the following are the "H's" causes of reversible cardiac arrest? Select all that apply: Hyperkalemia/hypokalemia Hypertensive crisis Acidosis HELLP syndrome Hyperventilation Hypoxia Hypothermia Heydes syndrome Hypocalcemia Hypovolemia
Hypothermia Hypoxia Hyperkalemia/hypokalemia Hypovolemia Acidosis Hypocalcemia Hyperventilation Hypertensive crisis
When should oxygen be administered?
If the patient is dyspneic or hypoxemic, has obvious signs of heart failure, or has an arterial o2 saturation that is less than 90% or unknown.
What is the primary advantage of using a stroke severity tool? It helps identify large vessel occlusion stroke It helps determine the last known normal time It helps identify level of weakness It helps EMS providers identify signs of a stroke
It helps identify large vessel occlusion stroke
What is a stroke severity tool that helps EMS differentiate a large vessel occlusion stroke from a non-large vessel occlusion stroke? Miami emergency neurologic deficit score Cincinnati prehospital stroke scale Melbourne ambulance stroke screen Los Angeles Motor Scale
Los Angela's motor scale
Which is an advantage of EMS transport to a stroke hospital for a patient with a suspected acute ischemic stroke? Family members can ride to the hospital with the patient Responding providers can stabilize critical issues Patients transported by ambulance are seen first EMS transport is faster than being driven by a friend
Responding providers can stabilize critical issues
Upon reviewing a patients 12 lead ECG, you note ST elevation of 2mm in leads II, III, and aVF. How would you classify these ECG findings? Non-st segment elevation MI ST-segment elevation myocardial infarction Normal findings
ST segment elevation MI
Upon reviewing a patients 12 lead ECG, you note ST segment elevation of 2mm in leads 2, 3, and aVF. How would you classify the ECG finding?
ST-segment elevation myocardial infarction
Upon reviewing a patients 12-lead ECG, you note ST-segment elevation of 2mm in leads II, III and aVF. How would you classify these ECG findings?
ST-segment elevation myocardial infarction
What is the recommended initial therapy for a patient with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead ecg? Adenosine B-blockers Cardioversion Vagal maneuvers
Vagal maneuvers