Emergency Medical Care and Resuscitation Guidelines, Exams of Nursing

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1. Your patient is in cardiac arrest and has been intubated. To assess CPRquality, which should you do? A. Monitor the patients PETCO B. Obtain a 12-lead ECG C. Check the patients pulse D. Obtain a chest X-Ray Answer : A. Monitor the patients PETCO
2. Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in thefield? A. Comprehensive stroke care unit B. Acute rehabilitation care unit C. Acute long-term care unit D. Coronary reperfusion- capable medical center Answer : D. Coronary reperfusion-capable medical center
3. Which of the following signs is a likely indicator of cardiac arrest in anunresponsive patient? A. Slow, weak pulse rate B. Cyanosis C. Agonal gasps D. Irregular, weak pulse rate Answer : C. Agonal gasps

4. To properly ventilate a patient with a perfusing how rhythm, often do yousqueeze the bag? A. Once every 3 to 4 seconds B. Once every 5 to 6 seconds C. Once every 10 seconds D. Once every 12 seconds Answer : B. Once every 5 to 6 seconds
5. In addition to clinical assessment, which is the most reliable method toconfirm and monitor correct placement of the endotracheal tube? A. Arterial Blood Gases B. Chest radiography C. Continuous waveform capnography D. Hemoglobin levels Answer : C. Continuous waveform capnography
6. You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage.The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is the best for this patient? A. Hold fibrinolytic therapy for 24 hours B. Start fibrinolytic therapy as soon as possible C. Order an echocardiogram before fibrinolytic administration D. Wait for the results of the MRI Answer : B. Start fibrinolytic therapy as soon as possible
7. What is the recommended range from which a temperature

should be selected and maintained constantly to achieve targeted

temperature management after cardiac arrest? A. 26 C to 28 C B. 29 C to 31 C C. 32 C to 36 C D. 35 C to 37 C Answer : C. 32 C to 36 C

8. Which is the recommended first intravenous dose of amiodarone for apatient with refractory ventricular fibrillation? A. 100 mg B. 150 mg C. 250 mg D. 300 mg Answer : D. 300 mg
9. Which is the primary purpose of a medical emergency team or rapidresponse team? A. Improving care for patients admitted to critical care units B. Improving patient outcomes by identifying and treating early clinicaldeterioration C. providing diagnostic consultation to emergency department patients D. Providing online consultation to EMS personnel in the field Answer : B. Improvingpatient outcomes by identifying and treating early clinical deterioration 10.Which is the recommended next step after a defibrillation attempt?

A. Check the ECG for evidence of a rhythm

B. Open the patients airway C. Determine if a carotid pulse is present D. Resume CPR, starting with chest compressions Answer : D. Resume CPR, startingwith chest compressions 11.EMS providers are treating a patient with suspected stroke. According tothe Adult Suspected Stroke Algorithm, which critical action performed by theEMS team will expedite the patients care on arrival and reduce the time to treatment? A. Alert the hospital B. Establish IV access C. Review the patient history D. Treat hypertension Answer : A. Alert the hospital 12.Your rescue team arrives to find a 59 year old man lying on the kitchenfloor. You determine that he is unresponsive. Which is the next step in yourassessment and management of this patient? A. Apply the AED B. Check the patient's breathing and pulse C. Open the patients airway D. Check for a medical alert bracelet Answer : B. Check the patient's breathing and pulse 13.Which best describes the length of time it should take to perform a pulsecheck during the BLS assessment? A. 1 to 4 seconds B. 5 to 10 seconds C. 11 to 15 seconds

D. 16 to 20 seconds

Answer : B. 5 to 10 seconds 14.You instruct a team member to give 0.5 mg atropine IV. Which responseis an example of a closed-loop communication? A. "I'll give it in a few minutes" B. "OK" C. "I'll draw up 0.5 mg of atropine" D. "Are you sure that is what you want given?" Answer : C. "I'll draw up 0.5 mg ofatropine." 15.What is an effect of excessive ventilation? A. Decreased cardiac output B. Decreased intrathoracic pressure C. Increased perfusion pressures D. Increased venous return Answer : A. Decreased cardiac output 16.If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other teammembers should take? A. Conduct a debriefing after the resuscitation attempt B. Reassign the team tasks C. Address the team member immediately D. Remove the team member from the area Answer : C. Address the team memberimmediately 17.For STEMI patients, which best describes the recommended maximumgoal time for ED door-to-balloon inflation time for percutaneous coronaryintervention?

A. 180 minutes B. 150 minutes C. 120 minutes D. 90 minutes Answer : D. 90 minutes 18.Which is the maximum interval you should allow for an interruption inchest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25-30 seconds Answer : A. 10 seconds 19.Which is one way to minimize interruptions in chest compressions duringCPR? A. Administer IV medications only when delivery breaths B. Check the pulse immediately after defibrillation C. Use an AED to monitor the patients rhythm D. Continue CPR while the defibrillator charges Answer : D. Continue CPR while thedefibrillator charges 20.Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to more experienced members B. Perform the most complicated tasks C. Clearly delegate tasks D. Assign the same tasks to more than one team member Answer : C. Clearly delegatetasks

21.Which is an acceptable method of selecting an appropriately sizedoropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C. Estimate by using the formula weight D. Estimate by using the size of the patient's finger Answer : A. Measure from the cornerof the mouth to the angle of the mandible

22. You are evluating a 58 year old man with chest discomfort. His blood pressure is 92/50 mmHg, his HR is 92/min, his nonlabored RR is 14 breaths/min, and his pulse oximetry is 97%. Which assessment is more important now? A. Evaluating the PETCO2 reading B. Requesting a chest x-ray C. Obtaining a 12-lead ECG D. Requesting lab testing Answer : C. Obtaining a 12-lead ECG 23.A patient in respiratory distress and with BP of 70/ mmHg presents withthe lead II ECG rhythm in Ventricular tachycardia. Which is the appropriate treatment? A. Administering adenosine 6 mg IV Push B. Performing synchronized cardioversion C. Perform vagal maneuvers D. Perform defibrillation Answer : B. Performing synchronized cardioversion

24.During post-cardiac arrest care, which is the recommended duration oftargeted temperature management after reaching the correct temperature range? A. 0 to 8 hours B. At least 24 hours C. At least 36 hours D. At least 48 hours Answer : B. At least 24 hours 25.Three minutes into cardiac arrest resuscitation attempt, one member ofyour team inserts endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mmHg.Which is significance of this finding? A. Chest compression may not be effective B. The ET tube is in the esophagus C. Patient meets the criteria for termination of efforts D. The team is ventilating the patient too often (hyperventilation) Answer : A. Chestcompressions may not be effective 26.Which is the recommended oral dose of aspirin for a patient with asuspected acute coronary syndrome? A. 40 mg B. 81 mg C. 160 to 325 mg D. 350 to 650 mg Answer : C. 160 to 325 mg 27.A team member is unable to perform an assigned task because

it is beyond the team member's scope of practice. Which action

should the teammember take? A. Ask for a new task or role B. Assign it to another team member C. Do it anyway D. Seek expert advice Answer : A. Ask for a new task or role 28.As the team leader, when do you tell the chest compressions to switch? A. Only when they tell you that they are fatigued B. About every 2 minutes C. About every 5 minutes D. About every 7 minutes Answer : B. About every 2 minutes 29.You are performing chest compressions during an adult resuscitationattempt. Which rate should you use to perform the compressions? A. Less than 80/min B. 80 to 90/min C. 100 to 120/min D. More than 120/min Answer : C. 100 to 120/min 30.A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? A. "OK"

B. "Are you sure?"

C. "Amiodarone 500 mg IV has been given" D. "I have an order to give 500 mg of amiodarone IV. Is this correct?" Answer : D. "Ihave an order to give 500 mg of amiodarone IV. Is this correct?" 31.A patient in stable narrow-complex tachycardia witha peripheral IV in place is refractory to the first dose of adenosine. Which dose would youadminister next? A. 3 mg B. 12 mg C. 20 mg D. 40 mg Answer : B. 12 mg 32.Which of these tests should be performed for a patient with suspectedstroke within 25 minutes of hospital arrival? A. 12-lead ECG B. Cardiac Enzymes C. Coagulation studies D. Noncontrast CT scan of the head Answer : D. Noncontrast CT scan of the head 33.What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves return of spontaneous circulation? A. 75 mmHg B. 80 mmHg

C. 85 mmHg

D. 90 mmHg Answer : D. 90 mmHg 34.A 45-year old man had coronary artery stents placed 2 days ago. Today,he is in severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. his radial pulse is very weak, blood pressures is 64/40 mmHg, respiratory rate is 28/min, and oxygen sat is 89% on RA. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Based on the initial presentation, which condition do you suspect led to the cardiac arrest? A. Acute coronary syndrome B. Acute heart failure C. Acute ischemic stroke D. Supraventricular tachycardia with ischemic chest pain Answer : A. Acute coronarysyndrome 35.A 45-year old man had coronary artery stents placed 2 days ago. Today,he is in severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. his radial pulse is very weak, blood pressures is 64/40 mmHg, respiratory rate is 28/min, and oxygen sat is 89% on RA. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. In addition to defibrillation, which intervention should be performed immediately? A. Advanced airway insertion

B. vasoactive medication administration

C. Chest compressions D. Vascular access Answer : C. chest compressions 36.A 45-year old man had coronary artery stents placed 2 days ago. Today,he is in severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. his radial pulse is very weak, blood pressures is 64/40 mmHg, respiratory rate is 28/min, and oxygen sat is 89% on RA. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer to the patient? A. Epinephrine 1 mg B. Amiodarone 300 mg C. Lidocaine 1 mg/kg D. Atropine 1 mg Answer : A. Epinephrine 1 mg 37.A 45-year old man had coronary artery stents placed 2 days ago. Today,he is in severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. his radial pulse is very weak, blood pressures is 64/40 mmHg, respiratory rate is 28/min, and oxygen sat is 89% on RA. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Despite Epinephrine 1 mg provided and continued CPR, the patient reaminsin V-Fib. Which other drug should be administered

next?

A. Epinephrine 1 mg B. Atropine 1 mg C. Magnesium Sulfate 1 g D. Amiodarone 300 mg Answer : D. Amiodarone 300 mg 38.A 45-year old man had coronary artery stents placed 2 days ago. Today,he is in severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. his radial pulse is very weak, blood pressures is 64/40 mmHg, respiratory rate is 28/min, and oxygen sat is 89% on RA. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post-cardiac arrest care intervention do youchoose for this patient? A. Initiate targeted temperature management B. Check glucose level C. Administer epinephrine D. Extubate Answer : A. Initiate targeted temperature management 39.A 45-year old man had coronary artery stents placed 2 days ago. Today,he is in severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. his radial pulse is very weak, blood pressures is 64/40 mmHg, respiratory rate is 28/min, and oxygen sat is 89% on RA. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation.

Which would you have done first if the patient had not gone into V-

Fib? A. Establish IV access B. Obtain a 12 lead ECG C. Given atropine 1 mg D. Performed syncrhonized cardioversion? Answer : D. Performed synchronized cardioversion 40.A 68-year old women presents with light-headedness, nausea, and chestdiscomfort. Your assessment finds her awake and responsive but ill-appear-ing, pale, and grossly diaphoretic. Her radial pulse is weak thready, and fast.You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderaterales present bilaterally. The cardiac rhythm is tachycardia. The patient's pulse oximeter shows a reading of 84% on RA. Which initialaction do you take? A. Perform bag-mask ventilation B. Intubate the patient C. Apply oxygen D. Check the pulse oximeter probe Answer : C. Apply oxygen 41.A 68-year old women presents with light-headedness, nausea, and chestdiscomfort. Your assessment finds her awake and responsive but ill-appear-ing, pale, and grossly diaphoretic. Her radial pulse is weak thready, and fast.You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderaterales present bilaterally. The cardiac rhythm is tachycardia.

After your initial assessment of this patient, which intervention should beperformed next? A. Synchronized cardioversion B. Administration of amiodarone 150 mg IM C. Immediate defibrillation D. Endotracheal intubation Answer : A. Synchronized cardioversion 42.A 68-year old women presents with light-headedness, nausea, and chestdiscomfort. Your assessment finds her awake and responsive but ill-appear-ing, pale, and grossly diaphoretic. Her radial pulse is weak thready, and fast.You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderaterales present bilaterally. The cardiac rhythm is tachycardia. If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority? A. Administer amiodarone 300 mg B. Administer atropine 0.5 mg C. Insert an advanced airway D. Perform defibrillation Answer : D. Perform defibrillation