Download ACLS Final Exam 2023/2024 150 Questions and Answers and more Exams Nursing in PDF only on Docsity! ACLS FINAL EXAM COMPLETE VERSION| 150+ QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024 UPDATE GRADED A+ In which situation does bradycardia require treatment? - ANSWER Hypotension Which intervention is most appropriate for the treatment of a patient in asystole? - ANSWER Epinephrine You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? - ANSWER Establish IV or IO access A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38mm Hg, and the pulse oximetry reading is 98%. There is vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirm a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. what is your next action? - ANSWER Administer adenosine 6mg IV push A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a toal does of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which therapy is now indicated? - ANSWER Epinephrine 2 to 10 mcg/min A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? - ANSWER Epinephrine 1 mg IV/IO 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain si ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy? - ANSWER Hold aspirin for at least 24 hours if rtPA is administered A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One does of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next. - ANSWER Epinephrine 1 mg A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration? - ANSWER Use of a phosphodiesterase inhibitor within the previous 24 hours A 57-year-old woman has palpitation, chest discomfort, and tachycardia. The monitor shows a regular wide-QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm HG/ Which action do you take next? - ANSWER Perform electrical cordioversion A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hour are being administered. The patient did not take aspirin because he has a history of gastritis, with was treated 5 years ago. What is your next action? - ANSWER Give aspirin 160-325 mg to chew You are caring for a 66-year-old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2L/min, and an IV has been established. His blood pressure is 180/100mm Hg. Which drug do you anticipate giving to this patient? - ANSWER Aspirin A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? - ANSWER Amiodarone 300mg What is the maximum interval for pausing chest compressions? - ANSWER 10 seconds Your patient is a 56-year-old woman with a history of type 2 diabetes who reports feeling dizzy. She is pale and diaphoretic. Her blood pressure is 80/66mm Hg. The cardiac monitor documents the rhythm shown here. She is receiving oxygen at 4L/min by nasal cannula, and an Iv has been established. What do you administer next? - ANSWER Atropine 0.5mg IV A 35-year-old woman presents with a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her blood pressure is 120/78mm Hg. Which intervention is indicated first? - ANSWER Vagal maneuvers ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation? - ANSWER Ventilating too quickly A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received adensoine 6mg IV for the rhythm shown here (SVT), without conversion of the rhythm. She is now extremely apprehensive. Her blood pressure si 128/70mm Hg. What is the next appropriate intervention? - ANSWER Administer adenosine 12 mg IV Your patient is not responsive and is not breathing, You can palpate a carotid pulse. Which action do you take next? - ANSWER Start rescue breathing You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now? - ANSWER Epinephrine 1 mg IV You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see the rhythm shown here. Team members tell you that the patient was well but reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IV access has been established, Which intervention would be your next action? - ANSWER Epinephrine 1mg What is recommended depth of chest compressions for an adult victim? - ANSWER At least 2 inches How does complete chest recoil contribute to effective CPR? - ANSWER Allows maximum blood return to the heart What is the recommended compression rate for high-quality CPR? - ANSWER 100-120 compressions per minute A patient becomes unresponsive. You are uncertain if a faint pulse is present. They rhythm shown here is seen on the cardiac monitor. An IV is in pace. Which action do you take next? - ANSWER Start high-quality CPR A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm shown here. Which action is indicated next? - ANSWER Give an immediate unsynchronized high-energy shock (defibrillation dose) What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? - ANSWER Provide continuous chest compressions without pauses and 10 ventilations per minute. ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding? - ANSWER Chest compressions may not be effective. The use of quantitative capnography in intubated patients - ANSWER allows for monitoring of CPR quality. For the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole, which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is your next treatment? - ANSWER Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? - ANSWER Be sure oxygen is not blowing over the patient's chest during the shock. During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the patient has a pulse. What is your next action? - ANSWER Begin chest compressions. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? - ANSWER Hands-free pads allow for a more rapid defibrillation. What action is recommended to help minimize interruptions in chest compressions during CPR? - ANSWER Continue CPR while charging the defibrillator. Which action is included in the BLS survey? - ANSWER Early defibrillation Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? - ANSWER Amioderone 300mg What is the appropriate interval for an interruption in chest compressions? - ANSWER 10 seconds or less A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown below: - ANSWER Vagal manuever. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention? - ANSWER Adenosine 6mg IV push You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? - ANSWER Divert the patient to a hospital 15 minutes away with CT capabilities. Choose an appropriate indication to stop or withhold resuscitative efforts. - ANSWER Evidence of rigor mortis. A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE reading is 96%. Which is the most appropriate intervention to perform next? - ANSWER Obtain a 12 lead ECG. A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? - ANSWER Simple airway manuevers and assisted ventilations. What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected? - ANSWER Suction during withdrawal but for no longer than 10 seconds. While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:What is the first intervention ? - ANSWER Atropine 0.5mg A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE radial pulse. The lead II ECG displays a regular wide-complex tachycardia. What intervention should you perform next? - ANSWER Synchronized cardioversion What is the initial priority for an unconscious patient with any tachycardia on the monitor? - ANSWER Determine whether pulses are present. Which rhythm requires synchronized cardioversion? - ANSWER Unstable supraventricular tachycardia What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia? - ANSWER 12mg What is the usual post-cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)? - ANSWER 35- 40mm Hg Which condition is a contraindication to therapeutic hypothermia during the post- cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? - ANSWER Responding to verbal commands What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway? - ANSWER Obstruction of venous return from the brain What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? - ANSWER Continuous waveform capnography hat is the recommended IV fluid (normal saline or Ringer's lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period? - ANSWER 1 to 2 Liters What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? - ANSWER 90mm Hg What is the first treatment priority for a patient who achieves ROSC? - ANSWER Optimizing ventilation and oxygenation. What should be done to minimize interruptions in chest compressions during CPR? - ANSWER Continue CPR while the defibrillator is charging. Which condition is an indication to stop or withhold resuscitative efforts? - ANSWER Safety threat to providers IV/IO drug administration during CPR should be - ANSWER given rapidly during compressions What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? - ANSWER 300 mg ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent? - ANSWER Closed-loop communication How long should it take to perform a pulse check during the BLS Survey? - ANSWER 5 to 10 seconds Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient? - ANSWER Check the patient's pulse. An AED advises a shock for a pulseless patient lying in snow. What is the next action? - ANSWER Administer the shock immediately and continue as directed by the AED. Which treatment or medication is appropriate for the treatment of a patient in asystole? - ANSWER Epinephrine What is the minimum depth of chest compressions for an adult in cardiac arrest? - ANSWER 2 inches A patient with pulseless ventricular tachycardia is defibrillated. What is the next action? - ANSWER Start chest compressions at a rate of at least 100/min. You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action? - ANSWER Have a team member attempt to palpate a carotid pulse. Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? - ANSWER Intraosseous (IO) What is the appropriate rate of chest compressions for an adult in cardiac arrest? - ANSWER At least 100/min You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? - ANSWER Divert the patient to a hospital 15 minutes away with CT capabilities. A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? - ANSWER Obtain a 12-lead ECG and administer aspirin if not contraindicated. An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action? - ANSWER Conduct a problem-focused history and physical examination. What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? - ANSWER 160 to 325 mg A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below. - ANSWER stable supraventricular tachycardia What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? - ANSWER Synchronized cardioversion What is the purpose of a medical emergency team (MET) or rapid response team (RRT)? - ANSWER Improving patient outcomes by identifying and treating early clinical deterioration ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? - ANSWER 10 to 12 breaths per minute Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique? - ANSWER Performing a head tilt-chin lift maneuver A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention? - ANSWER Synchronized cardioversion A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention? - ANSWER Defibrillation What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? - ANSWER 120to200J ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC? - ANSWER Potential oxygen toxicity What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC? - ANSWER 0.1 to 0.5 mcg/kg per minute IV infusion You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the patient has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority? - ANSWER Administer 1mg of epinephrine A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone is ? - ANSWER 150 mg IV push A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was given immediately after the the third shock. What drug should the team leader request to be prepared for administration next? - ANSWER second dose of epinephrine 1 mg A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine has been given. Which is the next drug to anticipate to administer? - ANSWER amiodarone 300 mg You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action? - ANSWER Give a single shock what do you do after return of spontaneous circulation - ANSWER maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion what are the 5 h's and 5 t's - ANSWER The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest.[1] A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts". hypotension altered mental status signs of shock chest pain acute heart failure ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE if persistent tachycardia does not present with symptoms what do you need to consider ANSWER wide QRS? greater than 0.12 seconds Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route? - ANSWER Lidocaine, epinephrine, vasopressin reentry supraventricular tachycardia - ANSWER polymorphic ventricular tachycardia - aka torsades - ANSWER atrial fibrilation - ANSWER sinus tachycardia - ANSWER coarse ventricular fibrillation - ANSWER atrial flutter - ANSWER reentry supraventricular tachycardia - ANSWER sinus bradycardia - ANSWER monomorphic ventricular tachycardia - ANSWER fine ventricular fibrillation - ANSWER second degree AV block type 1 wenckenbach - ANSWER second degree AV block mobitz type 2 - ANSWER third degree AV block - ANSWER asystole - ANSWER normal sinus rhythm - ANSWER a patient is in cardiac arrest. ventricular fibrillation has been refractory to an initial shock. if no pathway for medication is in place, preferred method? - ANSWER IV or IO A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm HG. What is now indicated? - ANSWER EPI 2-10 mcg/min A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. ASA was not taken by the patient because he had a history of gastritis treated 5 years ago. What is the next action? - ANSWER ASA 160-325 mg chew A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do? - ANSWER seek expert consultation A 35 year old woman has palpitations, light headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. What drug should be administered? - ANSWER adenosine 6 mg A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action? - ANSWER cardioversion ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE when does bradycardia require treatment? - ANSWER hypotension You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what? - ANSWER establish IV or IO access you are caring for a 66 year old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. the ct scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving? - ANSWER aspirin A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy? - ANSWER hold aspirin for at least 24 hours if rtPA is administered ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE or respirations. Bag-mask ventilations are producing visible chest rise and IO access has been established. Intervention? - ANSWER EPI 1 mg refractory ventricular fibrillation. 3rd shock just administered. what is next action - ANSWER resume high-quality chest compression 2nd degree mobitz - ANSWER 2nd degree wenckebach - ANSWER coarse V fib - ANSWER PEA - ANSWER fine V Fib - ANSWER A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is? - ANSWER resume high quality chest compressions A patient with sinus bradycardia and a heart rate of 42 bpm has diaphoresis and a BP of 80/60 mm Hg. What is the initial dose of atropine? - ANSWER 0.5 mg When can you use magnesium in cardiac arrest? - ANSWER VF/pulseless VT associated with torsades de pointes A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do? - ANSWER Seek expert consultation A patient with possible ST-segment elevation MI has ongoing chest discomfort. What is a containdication to the administration of nitrates? - ANSWER Phosphodiesterase inhibitor within 12 hours Bradycardia requires treatment when? - ANSWER Chest pain or shortness of breath You patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route? - ANSWER Lidocaine, epinephrine, vasopressin A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. ASA was not taken by the ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE patient because he had a history of gastritis treated 5 years ago. What is the next action? - ANSWER Give ASA 160-325 chewed immediately What is the dose of vasopressin and how is it administered (in cardiac arrest)? - ANSWER 40 units administered IV or IO A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR? - ANSWER IV or IO A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm HG. What is now indicated? - ANSWER Epinephrine 2 to 10 mcg/min You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what? - ANSWER Gain IV or IO access A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 SL NTG tablets. There are no contraindications, and 4 mg of morphine sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest discomfort. What should you do? - ANSWER Give normal saline 250 mL to 500 mL fluid bolus Supraventricular Tachycardia - ANSWER Atrial fibrillation - ANSWER Second deg AV block: Mobitz 1 - ANSWER Second deg AV block: Mobitz 2 - ANSWER Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I). Ventricular fibrillation - ANSWER Third deg AV block - ANSWER If patient is in cardiac arrest and the rhythm is asystole and CPR is beign given. What is the first drug you should give? Atropine 0.5 mg IV/IO Atropine 1 mg IV/IO Dopamine 2 to 20 mcg/kg per min IV/IO Epinephrine 1 mg IV/IO - ANSWER (d) Epinephrine 1 mg IV/IO A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138 bpm. He is asymptomatic, with a blood pressure of 110/70. He has a history of angina. What action is recommended next? Giving adenosine 6 mg IV bolus Giving lidocaine 1 to 1.5 mg IV bolus Performing synchroniczed cardioversion Seeking expert consultation - ANSWER (d) Seeking expert consultation A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? Atropine 1 mg IV/IO Epinephrine 1 mg IV/IO Lidocaine 1 mg/kg IV/IO Sodium bicarbonate 50 mEq IV/IO - ANSWER (b) Epinephrine 1 mg IV/IO You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE Call for a pulse check Establish IV or IO access Insert a laryngeal airway Perform endotracheal intubation - ANSWER (b) Establish IV or IO access A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? Adenosine 6 mg Amiodarone 300 mg Epinephrine 3 mg Lidocaine 0.5 mg/kg - ANSWER (b) Amiodarone 300 mg A 35 yr old female has palpitation, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal manuevers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE Which intervention is most appropriate for the treatment of a patient in asystole? Atropine Defibrillation Epinephrine Transcutaneous pacing - ANSWER (c) Epinephrine You are caring for a 66 yr old man with a hx of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scane is negative for hemorrhage. The pt is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His BP is 180/100. Which drug do you anticipate giving to this pt? Aspirin Glucose (D50) Nicardipine rTPA - ANSWER (a) Aspirin Pt is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. Pt is intubated. Which best describes the recommended second dose of amiodarone for this pt? 1 mg/kg IV push 1 to 2 mg/min infusion 150 mg IV push 300 mg IV push - ANSWER (c) 150 mg IV push A monitored pt in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 200. Pt's BP is 128/58, PETCO2 is 38, and pulse oximetry reading is 98%. There is vascular access in the left arm, and pt has not been given any vasoactive drugs. 12 lead EKG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. Heart rate has not responded to vagal manuevers. What is your next action? Administer adenosine 6 mg IV push Administer amiodarone 300 mg IV push Perform synchronized cardioversion at 50 J Perform synchronized cardioversion at 200 J - ANSWER (a) Administer adenosine 6 mg IV push In which situation does bradycardia require treatment? 12-lead ECG showing a normal sinus rhythm Hypotension Diastolic blood pressure > 90 Systolic blood pressure > 100 - ANSWER (b) Hypotension A patient has sinus bradycardia w/ a heart rate of 36. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The pt is confused, and her BP is 88/56. Which therapy is now indicated? Atropine 1 mg Epinephrine 2 to 10 mcg/min Adenosine 6 mg Normal saline 250 mL to 500 mL bolus - ANSWER (b) Epinephrine 2 to 10 mcg/min A 45 yr old woman with a hx of palpitations develops light-headedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown here, without conversion of ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE the rhythm. She is now extremely apprehensive. Her BP is 128/70 mm Hg. What is the next appropriate intervention? Administer adenosine 12 mg IV Perform unsynchronized cardioversion Perform vagal maneuvers Perform synchronized cardioversion - ANSWER (a) Administer adenosine 12 mg IV Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation? Giving breaths over 1 second Ventilating too quickly Providing a good seal btwn the face and mask Providing just enough volume for chest to rise - ANSWER (b) Ventilating too quickly What is the recommended depth of chest compressions for an adult victim? - ANSWER At least 2 inches You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see electrical activity on the monitor. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IO access has been established. Which intervention would be your next action? Atropine 1 mg Dopamine at 10 to 20 mcg/kg per min Epinephrine 1 mg Intubation and administration of 100% oxygen - ANSWER (c) Epinephrine 1 mg How often should you switch chest compressors to avoid fatigue? - ANSWER Every 2 minutes You are providing bag-mask ventilation to a pt in respiratory arrest. How often should you provide ventilations? - ANSWER About every 5-6 secs Which intervention is most important in reducing this patient's in-hospital and 30 day mortality rate? Perform synchronized cardioversion Repeat amiodarone 300 mg IV - ANSWER (a) Give an immediate unsynchronized high-energy shock (defibrillation dose) What is the recommended compression rate for high-quality CPR? - ANSWER 100-120 compressions per min What action minimizes the risk of air entering the victim's stomach during bag- mask ventilation? Ventilating until you see the chest rise Ventilating as quickly as you can Squeezing the bag with both hands Delivering the largest breath you can - ANSWER (a) Ventilating until you see the chest rise Which action should you take immediately after providing an AED shock? Check pulse rate prepare to deliver a second shock Resume chest compressions Start rescue breathing - ANSWER (c) Resume chest compressions After initiation of CPR and 1 shock for ventricular fibrillation, pt is still in ventricular fibrillation at next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. BBag-mask ventilations are producing visible chest rise. What is your next intervention? Administer 3 sequential (stacked) shocks at 360 J (monophasic defibrillator) Give amiodarone 300 mg IV/IO Give epinephrine 1 mg IV/IO ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE Intubate and administer 100% oxygen - ANSWER (c) Give epinephrine 1 mg IV/IO What is the maximum interval for pausing chest compressions? - ANSWER 10 seconds A 35 yr old woman presents w/ a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her BP is 120/78. On EKG, it shows she is in SVT. Which intervention is indicated first? Adenosine 3 mg IV bolus Adenosine 12 mg IV slow push (over 1 to 2 min) Metoprolol 5 mg IV and repeat if necessary Vagal manuevers - ANSWER (d) Vagal manuevers Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next? Apply an AED Obtain a 12 lead EKG Start an IV ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE __________ can help indicate coronary perfusion pressure - ANSWER Capnography Adequate CPR compression are at least - ANSWER 2 inches Why should chest compressions recoil? - ANSWER To ensure adequate coronary perfusion pressure Chest compression fraction should be around - ANSWER 60-80% Don't spend more than ____ seconds without compressions - ANSWER 10 seconds What should the tidal volume be for adequate ventilations? - ANSWER 500-600 mL or half of a bag squeeze What should be the first thing you do when you arrive on scene? - ANSWER See if patient is conscious or unconscious What do you do next If the patient is unconscious when you first arrive on scene? - ANSWER Initiate BLS If a patient is not responsive when you first arrive on scene, what should you do next? - ANSWER Call code Get AED During BLS, should you check breathing and pulse Separately Simultaenously - ANSWER (b) Simultaenously If pt is not breathing normally but has pulse, what should you do? - ANSWER Bypass chest compressions and ventilate every 5-6 seconds After intubating someone, what should you do next? - ANSWER Provide 1 ventilation every 6 seconds What should you assess for in the Disability function of ABCDE? - ANSWER Neurologic function Alert Pain Voice Unresponsive What are the H's of PEA? - ANSWER Hypovolemia If a patient is in cardiac arrest what are the first two steps? - ANSWER (1) CPR (2) Attach AED What rhythms are shockable? - ANSWER VFib or pulseless VTach What rhythms are NOT shockable - ANSWER Asystole or PEA ACLS FINAL EXAM COMPLETE VERSION WITH MORE THAN 150 QUESTIONS WITH 100% VERIFIED ANSWERS 2023-2024/AGRADE How often should you give epinephrine? - ANSWER Every 3-5 minutes When should you consider giving amiodarone? - ANSWER After you have given 3 shocks and 3 CPR sessions and they are still in VF or pVT When should you determine if the rhythm is shockable for asystole or PEA in the cardiac arrest algorithm? - ANSWER After the first CPR session (2 minutes) When should you start treating reversible causes of asystole or PEA? - ANSWER After the second CPR session Bradycardia is categorized as a HR less than... - ANSWER 50 When should you give atropine? - ANSWER When there is bradycardia and perfusion is low If atropine fails in treating bradycardia, what should you do? - ANSWER (1) Transcutaneous pacing Dopamine Epinephrine If atropine, tcp, dopamine, epinephrine all fail to tx bradycardia, what should you do? - ANSWER (1) Seek expert consultation (2) Transcutaneous pacing When should you use synchronized cardioversion in tachycardia? - ANSWER If the pt is hemodynamically unstable What should you do if you encounter a pt who has a pulseless tachycardia? - ANSWER Manage it like a cardiac arrest algorithm Most symptomatic tachycardias will present with a HR of greater than - ANSWER 150 If a tachycardia patient is hemodynamically stable, what is the next thing you should assess? - ANSWER If QRS is wide (>= 0.120 sec)