ACLS Final Exam 74 QUESTIONS WITH COMPLETE SOLUTIONS, Exams of Nursing

Download ACLS Final Exam 74 QUESTIONS WITH COMPLETE SOLUTIONS and more Exams Nursing in PDF only on Docsity! ACLS Final Exam| 74 QUESTIONS| WITH COMPLETE SOLUTIONS This is the rhythm that the telemetry technician observed on the cardiac monitor at the central telemetry station. What is your interpretation of the rhythm on the cardiac monitor? correct answer: Sinus bradycardia Based on the primary assessment findings, what additional actions should the team take? correct answer: Adjust supplemental oxygen Ensure vascular access and administer atropine (1 mg IV/IO). Three minutes after the initial dose of atropine is administered, Mr. Hernandez's heart rate has increased slightly to 34 bpm, but there is no change in his clinical condition. How should Dr. Hudson direct the team's next actions? correct answer: "Valerie, please administer 1 milligram atropine by rapid IV push." "Haley, please prepare Mr. Hernandez for transcutaneous pacing." What has the rhythm changed to? What is the appropriate next action for the team to take at this time? correct answer: Monomorphic ventricular tachycardia Check for responsiveness, breathing and a pulse. Mr. Hernandez is found to be unresponsive, with no pulse and no breathing. What is the appropriate next intervention? correct answer: Begin CPR and administer one shock. After one shock and 2 minutes of CPR, the rhythm check reveals no change in the rhythm. What is the appropriate next intervention? correct answer: Resume CPR, administer one shock and administer epinephrine. As team leader, Dr. Hudson is responsible for monitoring CPR quality. Which of the following actions are necessary to ensure high-quality CPR? correct answer: Providing compressions that are at least 2 inches (5 centimeters), but not more than 2.4 inches (6 centimeters), deep. Avoiding excessive ventilations. Minimizing interruptions to compressions. Providing compressions at a rate of 100 to 120 per minute. Mr. Hernandez remains in pulseless ventricular tachycardia. What is the appropriate next intervention? correct answer: Resume CPR, administer one shock and administer amiodarone. The team resumes CPR, delivers a third shock and administers amiodarone, 300 mg IV push. At the next rhythm check, the monitor displays this rhythm. What action should the team take next? correct answer: Check for a pulse. In addition to resuming CPR, what other actions should the team take at this time? correct answer: Consider underlying causes (Hs and Ts). Administer epinephrine. Consider establishing an advanced airway. The team decides to intubate Mr. Hernandez. How does this affect compressions and ventilations? correct answer: The team should provide ventilations at a rate of 1 ventilation every 6 seconds without pausing compressions. When a patient is in cardiac arrest, it is important to consider reversible underlying causes. What underlying causes should the team consider? correct answer: Hypovolemia Hypoxia Hypothermia Acidosis Potassium imbalance Toxicity Cardiac tamponade Pneumothorax Pulmonary embolism Myocardial infarction What should the team do now? correct answer: Stop CPR and check for a pulse. Mr. Hernandez has a pulse and is making an effort to breathe but is still unresponsive. The monitor shows normal sinus rhythm with a rate of 80 bpm. Mr. Hernandez's vital signs are as follows: Blood pressure: 128/80 mmHg Heart rate: 80 bpm, radial pulses present Respirations: 9 breaths/min SpO2: 90% ETCO2: 60 mmHg What should the team do next? correct answer: Provide the minimal level of supplemental oxygen needed to maintain an oxygen saturation of 94% to 99%. Support ventilations starting at a rate of 10 breaths/min to keep carbon dioxide levels in physiologic range. Obtain a 12-lead ECG. Request laboratory studies. Mr. Hernandez remains unresponsive to verbal commands. What interventions should the team initiate to promote his neurological recovery? correct answer: Targeted temperature management (TTM) Brain imaging EEG monitoring You find an unresponsive pt. who is not breathing. After activating the emergency response system, you determine there is no pulse. What is your next action? correct answer: Start chest compressions of at least 100 per min. You are evaluating a 48-year-old man with crushing substernal chest pain. The patient is pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular wide-complex tachycardia. What intervention should you perform next? correct answer: Synchronized cardioversion What is the initial priority for an unconscious patient with any tachycardia on the monitor? correct answer: Determine whether pulses are present. 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? correct answer: 1 to 2 Liters What is the first treatment priority for a patient who achieves ROSC? correct answer: Optimizing ventilation and oxygenation. What should be done to minimize interruptions in chest compressions during CPR? correct answer: Continue CPR while the defibrillator is charging. After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient's lead II ECG appears below. What is your next action? correct answer: IV or IO access What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest? correct answer: Not recommended for routine use What is the recommended compression rate for performing CPR? correct answer: At least 100 per minute A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to correct answer: administer a second shock. What is the recommended next step after a defibrillation attempt? correct answer: Begin CPR, starting with chest compressions. Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? correct answer: Antecubital vein How often should the team leader switch chest compressors during a resuscitation attempt? correct answer: . Every 2 minutes 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? correct answer: Closed-loop communication How long should it take to perform a pulse check during the BLS Survey? correct 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? correct answer: Check the patient's pulse. An AED advises a shock for a pulseless patient lying in snow. What is the next action? correct answer: Administer the shock immediately and continue as directed by the AED. What is the minimum depth of chest compressions for an adult in cardiac arrest? correct answer: 2 inches 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? correct answer: Intraosseous (IO) 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? correct answer: Divert the patient to a hospital 15 minutes away with CT capabilities. A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action? correct answer: Administer 2 to 4 mg of morphine by slow IV bolus. A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG? correct answer: Seeking expert consultation A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? correct 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? correct 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? correct answer: 160 to 325 mg What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? correct answer: Synchronized cardioversion What is the purpose of a medical emergency team (MET) or rapid response team (RRT)? correct answer: Improving patient outcomes by identifying and treating early clinical deterioration What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? correct 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? correct answer: Performing a head tilt-chin lift maneuver A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention? correct answer: Defibrillation What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? correct answer: 120to200J Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? correct answer: Right ventricular infarction and dysfunction What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC? correct answer: Decreased cerebral blood flow What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC? correct 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? correct 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? correct answer: Administer 1mg of epinephrine