ACLS FINAL EXAM 2024 | 3 DIFFERENT VERSIONS WITH 50 QUESTIONS AND ANSWERS, Exams of Nursing

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ACLS FINAL EXAM 2024 | 3 DIFFERENT VERSIONS WITH 50

QUESTIONS AND ANSWERS EACH AND A STUDY GUIDE |

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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 acidosis Respiratory failure Respiratory distress Respiratory arrest

3

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 ETCO 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 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 Ventricular tachycardia Ventricular fibrillation Atrial flutter

Atrial flutter

A patient is experiencing respiratory distress secondary to an exacerbation of chronic obstructive pulmonary disease. The patient begins to exhibit signs and symptoms of worsening respiratory function and experiences respiratory arrest. The team intervenes, delivering ventilations via BVM resuscitator. The team would deliver 1 ventilation at which interval?

Every 3 to 4 seconds Every 5 to 6 seconds

Every 7 to 8 seconds Every 8 to 9 seconds

The team would deliver 1 ventilation every 5 to 6 seconds. Each ventilation should last about 1 second and make the chest begin to rise.

Assessment of a patient in the emergency department reveals that the patient is experiencing respiratory compromise. From the assessment, the team identifies that the patient is in the earliest stage of this condition. Which stage would this be? Select the correct answer to this question.

Respiratory distress Respiratory arrest Respiratory acidosis Respiratory failure

Respiratory distress

Respiratory compromise occurs along a continuum, beginning with respiratory distress, progressing to respiratory failure and then to respiratory arrest

After cardiac arrest and successful resuscitation, the patient has a return of spontaneous circulation. The patient is unable to follow verbal commands. Targeted temperature management is initiated. Which method(s) would be appropriate for the resuscitation team to use?

Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Administering cool-mist oxygen therapy Applying a cool compress to the patient's forehead Using an endovascular catheter

Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Using an endovascular catheter

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? Select the correct answer to this question.

Rib fracture Esophageal injury Pneumothorax Hypertension

Pneumothorax

1 A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member follows each medication administration with a bolus of fluid. How much would the team member give? Select the correct answer to this question.

5 to 10 mL 10 to 20 mL 20 to 30 mL 30 to 40 mL

When administering medications during a cardiac arrest, all medications administrated through the IV or intraosseous infusion route should be followed by a 10- to 20-mL fluid bolus.

The resuscitation team suspects that hyperkalemia is the cause of cardiac arrest in a patient brought to the emergency department. Which finding on a 12-lead ECG would confirm this suspicion? Wide-complex ventricular rhythm and tall, peaked T waves ST-segment changes, T-wave inversion Flat T waves, prominent U waves and possibly prolonged QT intervals Narrow-complex ventricular tachycardia

Wide-complex ventricular rhythm and tall, peaked T waves

In hyperkalemia the patient's 12-lead ECG rhythm strip will show wide-complex ventricular rhythm and tall, peaked T waves.

A patient with an ischemic stroke arrives at the emergency department at 2 a.m. The patient's symptoms started about 12:30 a.m. After completing the necessary assessments, the healthcare team diagnoses an ischemic stroke, and the patient is determined to be a candidate for fibrinolytic therapy. To achieve the best outcomes, the team should initiate therapy for this patient no later than by which time? Select the correct answer to this question.

3:00 a.m. 5:30 a.m. 6:00 a.m. 8:30 a.m.

1 3:00 a.m.

A patient with a suspected stroke arrives at the emergency department at 7:10 p.m. The stroke team ensures that a comprehensive neurologic assessment using the National Institutes of Health Stroke Scale (NIHSS) is completed and that brain imaging is performed by which time? 7:20 p.m. 7:30 p.m.

7:40 p.m. 7:50 p.m.

2 Within 20 minutes of the patient's arrival, a comprehensive neurologic assessment should be completed and brain imaging should be performed. That would be 7:30 p.m. for this patient.

The emergency department team is providing care to a patient who is experiencing ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the patient's current condition. Which electrolyte imbalance(s) would most likely be involved? Select all correct options that apply.

Hyperkalemia Hypochloremia Hypernatremia Hypomagnesemia Hypocalcemia

Hypomagnesemia Hypocalcemia

A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. The history reveals that before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause? Select the correct answer to this question.

Tension pneumothorax Cardiac tamponade Acidosis Hypothermia

Tension pneumothorax

Prearrest signs of tension pneumothorax in the advanced stage include jugular venous distension, cyanosis, apnea and hyperresonance on percussion. Difficulty ventilating the patient may also be a sign of tension pneumothorax.

A 40-year-old patient in the waiting room of the primary care provider's office approaches a staff member and says, "I'm having really severe, crushing chest pain that is moving to both my arms." The patient is diaphoretic and dyspneic. Which action would be appropriate for the staff member to take?

Activate the emergency medical services system.

Take the patient to an exam room immediately. Give the patient an aspirin. Obtain a 12-lead ECG.

Activate the emergency medical services system.

A patient with dyspnea 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?

Amiodarone 150 mg over 10 minutes Atropine 0.5 mg every 3 to 5 minutes Dopamine 5 to 10 mcg/min Epinephrine 2 to 10 mcg/min

Atropine 0.5 mg every 3 to 5 minutes

A patient is brought to the emergency department by their spouse. The spouse says, "I think it's a stroke." The stroke team assesses the patient using the National Institutes of Health Stroke Scale (NIHSS). Which area(s) would the team include in this assessment? Select all correct options that apply.

Facial palsy Level of consciousness Language deficits Visual function Cranial nerve function

Level of consciousness Language deficits Visual function

A patient is brought into the emergency department with a suspected opioid overdose. The patient is in cardiac arrest. Which action would be the team's priority? Select the correct answer to this question.

Giving naloxone intravenously (IV) Obtaining a 12-lead electrocardiogram (ECG) Administering supplemental oxygen Initiating high-quality CPR

Initiating high-quality CPR

Although no evidence supports any benefit to naloxone administration during cardiac arrest,

administration of naloxone during both respiratory and cardiac arrest is recommended when opioid overdose is suspected. However, for a patient in cardiac arrest, high-quality CPR is prioritized over the administration of naloxone.

A patient with a diagnosis of ACS is experiencing cardiogenic shock. Which adjuvant therapy would be contraindicated? Select the correct answer to this question.

Direct thrombin inhibitor β-Blockers Glycoprotein IIb/IIIa inhibitors Heparin

β-Blockers

The use of β-blockers is contraindicated in patients who are at risk for cardiogenic shock, low cardiac output and acute heart failure.

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: Select the correct answer to this question.

100 to 150 joules 120 to 200 joules 300 joules 360 joules

120 to 200 joules

When using a biphasic defibrillator, the energy dose should be set at 120 to 200 joules

A patient in cardiac arrest experiences return of spontaneous circulation. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation. Which finding(s) would indicate the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation? Select all correct options that apply.

PaCO2 35 mmHg SaO2 96% SaO2 92% ETCO2 50 mmHg ETCO2 40 mmHg

PaCO2 35 mmHg SaO2 92% ETCO2 50 mmHg

A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow- complex supraventricular tachyarrhythmia. The patient is hemodynamically stable. Which intervention would be initiated first? Select the correct answer to this question.

Adenosine administration Sedation Vagal maneuvers Synchronized cardioversion

Vagal maneuvers

A patient experiencing an unstable bradyarrhythmia does not respond to atropine. Which interventions could the healthcare provider use next? Select all correct options that apply.

Carotid massage Epinephrine or dopamine infusio Transcutaneous pacing Synchronized cardioversion

Epinephrine or dopamine infusio Transcutaneous pacing

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

A patient with suspected acute coronary syndromes (ACS) is placed on a cardiac monitor. The patient is complaining of dyspnea and is given supplemental oxygen. The provider determines that the supplemental oxygen dose is correct based on which SaO2 level? Select the correct answer to this question.

87% 91% 93% 95%

95%

A healthcare provider is establishing cardiac monitoring using a five-electrode system. The healthcare provider demonstrates proper use of the system by placing the green electrode in which location? Select the correct answer to this question.

At the fourth intercostal space, right sternal border

On the lower right abdomen On the lower left abdomen Under the left clavicle, at the midclavicular line

On the lower right abdomen

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? Select the correct answer to this question.

Acidosis Hyperkalemia Hypoxia Hypothermia

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.

The ECG rhythm strip of a patient who arrived in the emergency department complaining of dizziness, syncope and shortness of breath reveals sinus bradycardia. When reviewing the patient's medication history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition? Select all correct options that apply.

Quinapril Verapamil Digoxin Metoprolol Losartan

Verapamil Digoxin Metoprolol

Medications associated with causing sinus bradycardia include β-blockers such as metoprolol and calcium channel blockers such as verapamil and digoxin.

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? Select the correct answer to this question.

60 mmHg 70 mmHg

80 mmHg 90 mmHg

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.

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 12-lead ECG reveals an irregular rhythm with QRS complexes greater than 0.12 second in duration. Which action would be appropriate at this time? Select the correct answer to this question.

Synchronized cardioversion Atropine Defibrillation Consider an antiarrhythmic infusion and expert consultation

Consider an antiarrhythmic infusion and expert consultation

A patient experiencing STEMI comes to the emergency department of a large medical center at 9:30 p.m. The patient states that the symptoms started about 8 p.m. After confirming the diagnosis and initiating care, the healthcare team schedules the patient for percutaneous coronary intervention (PCI). The facility is capable of administering PCI. To achieve the best outcomes, therapy should be administered to this patient by which time? Select the correct answer to this question.

11:00 p.m. 12:00 a.m. 1:00 a.m. 1:30 a.m.

11:00 p.m.

Reperfusion therapy should be administered within 1 hour, 30 minutes of the patient's first medical contact if the patient does not need to be transferred to another facility. The patient arrived at 9:30 p.m., so the latest the therapy should be administered would be 11 p.m.

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?

Select the correct answer to this question.

Respiratory distress Cardiac arrest Respiratory failure Respiratory arrest

Respiratory failure

A patient in the telemetry unit is receiving continuous cardiac monitoring. The patient has a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following figure. The provider interprets this strip as indicating which arrhythmia? Second-degree AV block First-degree atrioventricular (AV) block Sinus tachycardia Third-degree AV block

Third-degree AV block

A patient is being treated in the emergency department and is determined to have NSTE-ACS. Invasive management is planned based on which finding? Select the correct answer to this question.

Atrial tachycardia Ventricular tachycardia Atrial fibrillation Ventricular fibrillation

Ventricular tachycardia

An early invasive strategy should be considered for patients with high-risk NSTE-ACS, which would be indicated by ventricular tachycardia.

A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of chronic obstructive pulmonary disease. Assessment reveals respiratory failure. Which action would be the initial priority? Delivery of supplemental oxygen via nasal cannula Initiation of capnography Establishment of vascular access Assisted ventilation with BVM resuscitator

Assisted ventilation with BVM resuscitator

Patients who cannot ventilate adequately despite an open airway or who have insufficient respiratory effort require assisted ventilation initially provided via a BVM resuscitator.

A healthcare provider initiates ventilations to ensure adequate breathing and oxygenation. While ventilations are being performed, capnography is established to evaluate the adequacy of the ventilations. The healthcare provider determines that ventilations are adequate based on which end-tidal carbon dioxide (ETCO2) value? elect the correct answer to this question.

10 to 15 mmHg 20 to 25 mmHg 25 to 30 mmHg 35 to 45 mmHg

35 to 45 mmHg

A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamically stable and has a heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary assessment, which statement(s) by the patient would the team interpret as a possible contributing cause? Select all correct options that apply.

"I've had a terrible cold with a horrible cough and fever the past week." "I've been so anxious lately because I just lost my job." "I had an aortic valve replacement several years ago." "I've had a history of heart disease for the past 3 years." "I've been vomiting for the past 2 days from a gastrointestinal bug."

"I've had a terrible cold with a horrible cough and fever the past week."

"I've been so anxious lately because I just lost my job."

"I've been vomiting for the past 2 days from a gastrointestinal bug."

A patient presents to the emergency department with suspected ACS. Electrocardiogram and cardiac biomarkers show the patient has ST-segment elevation myocardial infarction (STEMI). Physical examination reveals signs of left ventricular dysfunction. Which finding(s) would support this? Select all correct options that apply.

Weak peripheral pulses Chest pain Cool, clammy skin Crackles Hypotension

Weak peripheral pulses Hypotension Crackles

A 20-year-old man with respiratory depression is brought to the emergency department by his parents. The parents state that "[They] found him at home with various needles and syringes around him, but [they] have no idea what he took." Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 p.m. The patient does not respond to this initial dose. The team would expect to administer a second dose after how many minutes? Select the correct answer to this question.

2 minutes 4 minutes 6 minutes 8 minutes

4 minutes

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? Select the correct answer to this question.

Rapid assessment Secondary assessment Primary assessment Basic life support assessment

Rapid assessment

The stroke team is assessing a patient with a suspected stroke. The patient is alert and able to carry on a conversation, although the patient has difficulty getting the words out. Testing confirms that the patient has had an ischemic stroke. Based on the patient's medical history, a history of which arrhythmia would alert the team to the patient's increased risk for stroke? Select the correct answer to this question.

Ventricular fibrillation Atrial fibrillation Atrial tachycardia Bradycardia

atrial fibrillation

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?

Narrow QRS complex with PP interval constant or slightly irregular 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

Absence of discrete P waves and presence of irregularly irregular QRS complexes

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? Select the correct answer to this question.

0.10 mV 0.15 mV 0.2 mV 0.25 mV

0.15 mV

A patient presents to the emergency department with mild to moderate recurrent chest pain, without any nausea or vomiting. A 12-lead ECG is obtained and shows ST-segment depression with transient T-wave elevation indicative of NSTE-ACS. Cardiac serum markers are obtained and are not elevated. The patient's risk-stratification score indicates low risk. These findings suggest which condition? Select the correct answer to this question.

Non-STEMI Myocardial infarction STEMI Unstable angina

Unstable angina

The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured?

D

A patient's capnogram reveals the following waveform. Which segment would the healthcare provider interpret as reflecting the beginning of exhalation?

A-B

Cardiac monitoring of a patient in cardiac arrest reveals ventricular fibrillation. What intervention would the team perform next?

Initiate capnography. Administer 1 shock.

Provide post-cardiac arrest care. Insert an advanced airway.

Administer 1 shock

A patient comes to the emergency department with a suspected stroke. The patient is alert and oriented and accompanied by a family member. The family member says, "I noticed he was slurring his words and had trouble walking, like his leg was numb." Which finding would suggest that the patient is experiencing a condition that mimics a stroke?

Hyperkalemia Hypoglycemia Hyperglycemia Hypokalemia

Hypoglycemia

Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration A. Phosphodiesterase inhibitors B. Oral antiplatelet medications C. Beta blockers D. Calcium channel blockers

Oral antiplatelet medications

What is a benefit of morphine when given for the management of acute coronary syndromes? A. Central nervous system analgesia B. Increases systemic vascular resistance C. Increases left ventricular preload D. Vasoconstriction

A. Central nervous system analgesia

You obtain a 12-lead ECG in a patient with restrosternal chest pain.

Which ECG finding is suggestive of high risk non ST segment elevation acute coronary syndromes A. ST depressions less than 0.5mm B. Dynamic T-wave inversion C. ST-segment elevation D. New bundle branch block

B. Dynamic T-wave inversion

Upon reviewing a patient's 12 lead ECG, you note ST-segment elevation of 2mm in leads II,III, and avf

How would you classify the electrocardiographic findings

A. Normal B. STEMI C. Non-STEMI D. Non-diagnostic

B. STEMI

What happens when teams rapidly assess and intervene when patients have abnormal vital signs

The number of in hospital cardiac arrests decreases

What is the goal for first medical contact-to-ballon inflation time for a patient receiving PCI

90 minutes

What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy

30 minutes

What is the time goal for how quickly you should complete a fibronolytic checklist once the patient arrives in the emergency department

10 minutes

What is the recommended time window after symptom onset for early fibronolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindication

Within 12 hours

A 49 yo says that he has had chest discomfort and excessive sweating for the past 25 minutes. Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of MI, what will your first actions include?

Provide prehospital notification to the receiving hospital

Administer aspirin

if considering prehospital fibrinolysis, use the fibrinolytic checklist

assess ABC

Obtain EKG

consider oxygen, nitroglycerin, and morphine if needed

His initial vital signs are HR 120/min BP 135/88 RR 23 O2 87%

When considering oxygen saturation, what is your course of actions?

Start oxygen at 4L

What additional questions help you determine next steps

When did the symptoms start

Do you take any medication

Do you have any allergies

Your patient continues to say that he has chest discomfort

What treatment can you repeat as long as it is not contraindicated by vital signs

Nitroglycerin sublingual every 3-5min

What is your interpretation of the patient's EKG tracing

STEMI in V2-

Anterior STEMI

With the possible diagnosis of STEMI, what is the most probable treatment

Admission for PCI/fibrinolysis

After you give report to the hospital, staff advise you to proceed to the cath lab for PCI

What is the goal for PCI when treating this patient

First medical contact to balloon inflation time of 90 minutes

Which action is part of the secondary assessment of a conscious patient

Formulate a differential diagnosis

What is the most common type of stroke

Ischemic stroke

What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter based reperfusion for patients with STEMI and no contraindications

12 hours

What validated, abbreviated out of hospital neurologic evaluation tool contains 3 components: facial droop, arm drift, and abormal speech test

Cincinnati Prehospital Stroke scale

What is the estimated probability of the CPSS with 1 abnormal finding when scored by prehospital providers

72%

Which is a stroke severity tool that helps EMS differentiate large vessel occlusion stroke from non-large vessel occlusion stroke

Los Angeles Motor Scale

What is the primary advantage of using a stroke severity tool?

It helps ID large vessel occlusion stroke

During CPR, CCF should be at least ______% and ideally greater than _____%

60/

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 perform more efficient evaluation and management

What is the time goal for neurologic assessment by the stroke team or designee and noncontrast computed tomography or MRI performed after hospital arrival

20 minutes

What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindication after hospital arrival

45 minutes

What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics

60 minutes

What is the door-to-device time goal for direct arriving patients with acute ischemic stroke treated with endovascular therapy

90 minutes

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 maximum time from last known normal when endovascular therapy can be performed

24 hours

What is the max time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment

6 hours

ID the SBP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke

185mmhg

What is the DBP threshold for withholding fibrinolytic to otherwise eligible patients with acute ischemic stroke

110mmhg

Which action is not part of the acute stroke pathway

Seizure prophylaxis

What BG should trigger the administration of IV or subq insulin for a patient with acute ischemic stroke

180

A 74 yo man was brought to the hospital by his wife. She states that her husband started having sudden left arm weakness and left sided paralysis during lunch. He has a past medical history or poorly controlled hypertension

HR 92 RR 14 BP 130/ SPO2 97% Afib on monitor

What additional assessment and stabilization activities should be completed?

Establish time of symptom onset (last known normal)

perform validated prehospital stroke screen and stroke severity tool

provide prehospital notification to the receiving hospital

initiate stroke protocol

check glucose

What needs to be completed for this patient within 20 min after hospital arrival

Neurologic assessment

What are some of the general questions you need to ask

When did the symptoms start

do you have any allergies

do you take any medications

what other symptoms do you have

Within 45 minutes, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. There is no signs of hemorrhage or mass lesions

Is this patient a potential candidate for fibrinolytic therapy?

Yes

What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy

Repeat neurologic exam

You find that the patient's neurologic function is rapidly improving.

Is this patient still a candidate for fibrinolytic therapy?

No

Because the patient is no longer a candidate for fibrinolyic therapy, what are your next steps for him?

Support ABC

Begin stroke pathway

Admit to ICU

What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide

6-8ml/kg

An 18yo is reporting difficulty breathing and is displaying increased respiratory effort

b/l wheeze RR 28 O2 91% PETCO2 44mmhg

Respiratory distress

A 59yo is reporting difficulty breathing nasal flaring, intercostal retractions, and use of accessory muscles RR 28 O2 92% PETCO2 36mmhg

Respiratory distress

75yo patient difficulty breathing

emphysema drowsy b/l wheeze, difficult to appreciate RR 38 O2 85% PETCO2 49mmhg

Respiratory failure

What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure

Hypercapnia

How much tidal volume must you provide with a bag mask device to produce visible chest rise for an adult patient in respiratory arrest

6-7ml/kg

What device on a resuscitation bag mask device may prevent sufficient tidal volume in patients with poor lung compliance

Pressure relief valve

Patients with perfusing rhythms should receive ventilation once every _____ seconds

6

What is the most effective way to deliver bag mask ventilation

2 person technique

How long should the second rescuer squeeze the bag mask device when providing 2 rescuer ventilation

1 second

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

When you use a bag mask device you should deliver 500- _______ml tidal volume

600

In which of the following patients can nasopharangeal airways be used

Unconscious, semi, conscious

Select the first step in the use of an oropharyngeal airway

Clear the mouth and pharynx

What is a potential complication of inserting an oropharyngeal airway

Pushing the base of the tongue back

The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the

Earlobe

What is a potential complication using a nasopharyngeal airway that is too long

Entering the esophagus

What is the most serious potential complication of nasopharyngeal aiway insertion into a patient with facial trauma

Misplacement into the cranial cavity

What is the max length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue

Tip of nose to earlobe

What is the most reliable method of confirming and monitoring correct placement of an ET tube

Quantitative waveform capnography

What is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place

Once every 6 seconds

EMS brings a 54 year old patient to the ED who had been experiencing severe SOB and difficulty breathing. The patient loses consciousness on arrival

What initial actions should be taken

Assess ABC

Call for help

Check for responsiveness

The patient is unresponsive and not breathing but has a strong pulse

What should your initial actions include

Open the patient's airway via a head tilt chin lift or jaw thrust

Initiate ventilation with a bag mask device attached to supplemental oxygen

Patient's HR 84

BP 124/73 SPO2 66% Cyanotic around the mouth and extremities

what is the recommended rate for rescue breaths

1 breath every 6 seconds

What is the single most reliable method of confirming and monitoring correct placement of the ET tube

Quantitative waveform capnography

Which S/S indicate symptomatic bradycardia

Chest pain

SOB

Altered MS

Pulmonary edema

Hypotension

PR intervals uniform but random QRS dropped

Second degree type II

More p waves than QRS. Absence of relationship between the P wave and QRS

3rd degree

Definition of bradycardia

HR <50

First line of treatment for unstable bradycardia

Atropine 1mg every 3-5 min for max dose of 3mg

What is the max time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment

6 hours

What is a complication of IV atropine when administered in doses of less than 0.5mg

Further slowing of HR

What is the recommended infusion rate for epi in management of symptomatic bradycardia unresponsive to atropine

2-10mcg/min

What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine

5-20mcg/kg/min

What therapy is recommended alternative to vasopressor infusion in the management of unstable bradycardia unresponsive to atropine

Transcutaneous pacing

What is your initial impulse setting for transcutaneous pacemaker use in the management of unstable bradycardia

60-80

How much of a safety margin should you allow when using the transcutaneous pacemaker

2ma

75yo male present to the ED. He fainted 45 min ago

HR 30

BP 66/43

RR 20

O2 89%

Alert and responsive

What should your next steps be to assess and treat this patient

Establish IV

Obtain 12 lead

Maintain airway and administer O2 as needed

You determine patient has poor perfusion. What is your next step

Atropine 1mg

Patient does not respond to atropine

HR 34 BP 66/43 RR 18 O2 91%

Responsive, but dizzy.

What option do you have

Initiate transcutaneous pacing

administer epi 2-10mcg/min

adminster dopa 5-20 mvg/kg/min

Patient does not respond to treatments

HR 40

BP 66/43

RR 18

O2 91%

Seek expert consultation

prepare for TV pacing

You are treating a patient with a HR 186/min. Which symptom if present suggests an unstable tachycardia

Hypotension

Symptoms of instability are not usually caused by HR less than ______bpm unless ventricular function is impaired

150/min

What is the first line treatment for unstable tachycardia

Cardioversion

The width of the QRS in a patient presenting with tachycardia is .16 seconds. Each QRS complex has a visible p wave. How would you classify this tachycardia

Wide complex tachycardia

The width of the QRS in a patient presenting with tachycardia is .10 second. There are no clearly discernable P waves

How would you classify this tachycardia

Narrow complex tachycardia

What is the upper HR limit for a patient with stach?

130/min

What is the lower HR limit for a patient with stach

100

What is the recommended initial therapy for a patient with stable narrow complex tachycardia, after establishing an IV and acquiring a 12 lead EKG

Vagal maneuvers

What procedure used in the management of stable narrow complex tachycardia forces a patient to strain against a closed glottis?

Valsalva maneuver