ACLS Final Exam 2 Questions & Answers 2024, Exams of Nursing

Download ACLS Final Exam 2 Questions & Answers 2024 and more Exams Nursing in PDF only on Docsity! ACLS Final Exam 2 Questions & Answers 2024 ACLS Final Exam Questions With Complete Solutions graded A+ LATEST 2024 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? Hypertension Esophageal injury Pneumothorax Rib fracture - Correct Answer- Pneumothorax Complications can occur with the use of a BVM resuscitator due to improper technique. Delivering excessive volume or ventilating too fast creates excessive pressure that can damage the airways, lungs and other organs. Excessive volume can lead to tension 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? Rapid assessment Basic life support assessment Secondary assessment Primary assessment - Correct Answer- Rapid assessment A systematic approach to assessment is necessary. The healthcare provider should first perform a rapid assessment. A rapid assessment is a visual survey to ensure safety, form an initial impression about the patient's condition (including looking for lifethreatening bleeding), and determine the need for additional resources. This would be followed by a primary assessment and then a secondary assessment. A patient is receiving ventilation support via bag-valve-mask (BVM) resuscitator. Capnography is established and a blood gas is obtained to evaluate the adequacy of the ventilations. Which arterial carbon dioxide (PaCO2) value signifies adequate ventilations? 10 to 15 mmHg 20 to 25 mmHg 25 to 30 mmHg 35 to 45 mmHg - Correct Answer- 35 to 45 mmHg Arterial carbon dioxide (PaCO2) values in the range of 35 to 45 mmHg confirm adequacy of ventilation. A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced 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? "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 provided chest compressions at a rate of 100 to 120 compressions per minute while giving 1 ventilation every 6 seconds without pausing compressions." "We provided chest compressions at a rate of 80 to 120 per minute to a depth of at least 2 inches and gave 1 ventilation every 6 seconds without pausing compressions." "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 without pausing compressions." - Correct Answer- "We provided chest compressions at a rate of 100 to 120 compressions per minute while giving 1 ventilation every 6 seconds without pausing compressions." When an advanced airway has been placed in a patient who is in cardiac arrest, compressions should be delivered continuously (100 to 120 per minute) with no pauses for ventilations. 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? Respirat ory failure Respirat ory arrest Cardia c arrest Respiratory distress - Correct Answer- Respiratory failure An SaO2 level of less than 90% (PaO2 of less than 50 mmHg) accompanied by ETCO2 1 second and make the chest begin to rise. 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 arrest Respiratory failure Respiratory distress Respiratory acidosis - Correct Answer- Respiratory distress 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 patient is in cardiac arrest. The underlying cause is thought to be opioid toxicity. Which statement accurately describes the use of naloxone for this patient? Naloxone should be administered immediately as the first action in resuscitation at a dose of 0.4 to 2 mg and then repeated every 2 to 3 min as needed. Naloxone has not been shown to be effective for opioid toxicity once cardiac arrest has occurred. Naloxone administered via continuous IV infusion should be considered opioid toxicity. Naloxone should be administered as soon as possible but is not a priority over highquality CPR and AED use. - Correct Answer- Naloxone should be administered as soon as possible but is not a priority over high-quality CPR and AED use. for short-acting In third-degree AV block, no electrical communication occurs between the atria and ventricles, thus no relationship between P waves and QRS complexes exists. The RR interval is constant. The PP interval is constant or slightly irregular, as with sinus arrhythmia. If pacemaker cells in the AV junction simulate ventricular contraction, the QRS complexes will be narrow (less than 120 milliseconds in duration). Impulses that originate in the ventricles produce wide QRS complexes. This arrhythmia may result from damage caused by myocardial infarction. A patient with dyspnea, inadequate blood pressure 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? Epinephrine 2 to 10 mcg/min Dopamine 5 to 10 mcg/min Atropine 1 mg every 3 to 5 minutes Amiodarone 150 mg over 10 minutes - Correct minutes The ECG strip is showing bradycardia. Atropine is an anticholinergic drug that increases sinoatrial node firing by counteracting vagus nerve action to increase the heart rate. It is the first-line therapy for symptomatic bradycardia. A 1-mg bolus is given intravenously every 3 to 5 minutes, up to a maximum dose of 3 mg. 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 fibrillation Atrial flutter Ventricular Ventricular tachycardia - Correct Answer- Atrial flutter Answer- Atropine 1 mg every 3 to 5 In atrial flutter, atrial contraction occurs at such a rapid rate that discrete P waves For a patient who is not showing signs of hemodynamic compromise and is experiencing a narrow-complex supraventricular tachyarrhythmia, vagal maneuvers are attempted first. If ineffective, adenosine is given. 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? 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 Narrow QRS complex with PP interval constant or slightly irregular - Correct Answer- Absence of discrete P waves and presence of irregularly irregular QRS complexes The two key features of atrial fibrillation on ECG are the absence of discrete P waves and the presence of irregularly irregular QRS complexes. 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 12lead ECG reveals an irregular rhythm with QRS complexes greater than 0.12 second in duration. Which action would be appropriate at this time? Defibrillation Synchronized cardioversion Atropine Consider an antiarrhythmic medication - Correct Answer- Consider an antiarrhythmic medication For a patient with a wide-complex tachyarrhythmia and no signs of hemodynamic compromise, consider an antiarrhythmic medication (procainamide, amiodarone or sotalol). 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 Torsade de pointes Asystole Ventricular fibrillation - Correct Answer- Ventricular tachycardia The cardiac monitor reveals ventricular tachycardia. In pulseless ventricular tachycardia, the ventricular rate is usually greater than 180 beats per minute, and the QRS complexes are very wide. 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? Hypoxia Hypothermia Hyperkalemia Acidosis - Correct Answer- 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 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: 75 to 100 joules 120 to 200 joules 300 joules 360 joules - Correct Answer- 120 to 200 joules When using a biphasic defibrillator, the energy dose should be set at 120 to 200 joules. resuscitation team to use? Administering cool-mist oxygen therapy Giving an ice-cold IV fluid bolus Applying a cool compress to the patient's forehead Applying cooling blankets to the patient's body Using an endovascular catheter - Correct Answer- Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Using an endovascular catheter For targeted temperature management, various methods of inducing hypothermia may be used, including administering an ice-cold IV fluid bolus (30 mL/kg), using endovascular catheters or applying surface cooling strategies (e.g., cooling blankets, ice packs). A patient with suspected acute coronary syndromes (ACS) has a pulse oximetry reading of 86% and is given supplemental oxygen. The provider determines that the supplemental oxygen dose is correct based on which SaO2 level? 87% 89% 93% 100% - Correct Answer- 93% A patient with potential acute coronary syndromes (ACS) and an oxygen saturation of less than 90% should have oxygen administered to maintain an SaO2 greater than 90% and less than or equal to 99%. 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? 0.10 mV 0.15 mV 0.2 mV 0.25 mV - Correct Answer- 0.15 mV New ST-segment elevation at the J point in leads V2 and V3 of at least 0.15 mV (1.5 mm) in women 40 years or younger is considered diagnostic of STEMI. 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? 60 mmHg 70 mmHg 80 mmHg 90 mmHg - Correct Answer- 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 is admitted to the emergency department of a large medical center. The Within 3 hours of the patient's arrival - Correct Answer- Within 1 hour of the patient's arrival For patients with ischemic stroke who meet the eligibility criteria, fibrinolytic therapy is the first-line treatment. Administration of IV recombinant tissue plasminogen activator (rtPA) within 1 hour of the patient's arrival and within 3 hours of the onset of signs and symptoms is optimal. Which statement accurately reflects the management of cardiac arrest in a pregnancy of 26 weeks' gestation? Fetal monitoring should be immediately initiated after pulselessness is determined. Resuscitative cesarean delivery (RCD) should be performed within 5 minutes from the time of arrest. Targeted temperature management (TTM) is contraindicated in the post-cardiac arrest pregnant patient. Intravenous access should be placed below the level of the diaphragm. - Correct Answer- Resuscitative cesarean delivery (RCD) should be performed within 5 minutes from the time of arrest. Resuscitative cesarean delivery (RCD) should be performed within 5 minutes from the time of arrest in a pregnant patient if the gestational age is known to be equal to or greater than 20 weeks or if the fundus is at or above the umbilicus. In a pregnant patient, intravenous access should be obtained above, not below, the level of the diaphragm. To keep the focus on the pregnant patient, during arrest fetal monitoring should be removed. Targeted temperature management (TTM) is a viable consideration for postcardiac arrest care in a pregnant patient. A 28-year-old pregnant patient who resides in transitional housing presents to the emergency department with complaints of feeling feverish and very faint. The patient tells the emergency nurse that she does not know when she became pregnant. Upon palpation, the fundus is not at or above the umbilicus. The patient's condition quickly deteriorates and she goes into cardiac arrest. If available and able to be used without impeding or delaying the resuscitation effort, what diagnostic tool could be used to guide decision-making in the care of this patient? Fetal echocardiogram Abdominal radiograph Point-of-care ultrasound Fetal monitoring - Correct Answer- Point-of-care ultrasound Gestational age is an important consideration when determining the approach to a pregnant patient in cardiac arrest. If the gestational age is not known and point-of-care ultrasound is available and able to be performed without impeding or delaying the resuscitation effort, it can be used to quickly estimate gestational age and guide decision-making. What is the priority intervention for a patient with a narrow-complex tachycardia (160 bpm) and a blood pressure of 72/48 mmHg? Perform immediate synchronized cardioversion Administer amiodarone, 150 mg IV over 10 minutes Administer adenosine, 6 mg via rapid IV push Perform carotid massage - Correct Answer- Perform immediate synchronized cardioversion Immediate synchronized cardioversion is recommended for a patient with signs of hemodynamic compromise and a supraventricular tachycardia. A vagal maneuver, such