ACLS FINAL EXAM STUDY QUESTIONS AND ANSWERS 2024, Exams of Advanced Education

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ACLS FINAL EXAM STUDY QUESTIONS

AND ANSWERS 2023 AND 2024

What is the priority intervention for a patient with a narrow-complex tachycardia ( BPM) and a blood pressure of 72/48 mmHg? A. Perform immediate synchronized cardio version B. Administer amiodarone, 150 mg IV over 10 minutes C. Perform carotid massage D. Administer adenosine, 6 mg via rapid IV push - A. Perform immediate synchronized cardio version Recommended for a aptient with signs of hemodynamic compromise and a superventricualr tachycardia. A vagal maneuver, such as carotid massage, is recommended for a aptient with a narrow-complex tachycardia if the rhythm is regular and there are no signs and syptoms of hemodynaic compromise. 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 alter 40 mmHg. From these readings, the team identifies that the patient is progressing in what stage of respiratory compromise? A. Respiratory distress B. Respiratory arrest C. Respiratory failure D. Respiratory acidosis - A. Respiratory Distress 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 patients medical history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition? A. Metoprolol B. Verapamil C. Digoxin D. Quinapril E. Losartan - A. Metoprolol B. Verapail C. Digoxin Which statements accurately reflect the recommendations for post-cardiac arrest neuroprognostication? A. Status epilepticus can be used to accurately predict a poor neurologic outcome B. Decision making related to the continuation or withdrawal of life-sustaining treatments should be delayed until 72 hours after ROSC and following return of normothermia C. Post-cardiac arrest neuroprognostication should be multimodal

D. Brain imaging studies do not provide useful information for predicting neurologic outcome in the post-cardiac arrest patient - B & C Which areas are evaluated using the National Institute of Health Stroke Scale (NIHSS)? A. Hearing B. Visual function C. Facial palsy D. Level of consciousness E. Language deficits - B, C, D, E What is the correct technique for performing left uterine displacement (LUD) for a pregnant patient in cardiac arrest whose fungus is at or above the umbilicus? - Position yourself at the patients left side. Reach across the patient, place both hands on the right side of the uterus and pull the uterus to the left and up 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? A. Cardiac arrest B. Respiratory Distress C. Respiratory Arrest D. Respiratory Failure - D 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 (slow). Which agent would the team most likely administer? A. Dopamine 5-10 mcg/min B. Amiodarone 150 mg over 10 minutes C. Epinephrine 2-10 mcg/min D. Atropine 1 mg every 3-5 minutes - D A patient is experiencing respiratory distress secondary to an exacerbation of COPD. 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 should provide ventilations at a rate of 1 ventilation: A. Every 3 seconds B. Every 6 seconds C. Every 8 seconds D. Every 10 seconds - B A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member should follow each

peripherally administered drug dose with a normal saline flush. How much would the team member give? A. 5-10 ml B. 10-20 ml C. 20-30 ml D. 30-40 ml - B A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of COPD. Assessment reveals respiratory failure. Which actions would be the initial priority to address the respiratory failure? A. Establishment of vascular access B. Delivery of supplemental oxygen via nasal cannula C. Assisted ventilation with BVM resuscitator D. Initiation of capnography - C A patient in cardiac arrest experiences ROSC. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation at an initial rebate of 10 breaths/min and a fraction of inspired oxygen (FiO2) of 0.30. Which finding(s) would indicated the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation? A. SaO2 96% B. PaCO2 48 mmHg C. ETCO2 55 mmHg D. ETCO2 40 mmHg E.SaO2 90% - B, C, E A 30 year old patient has been brought to the emergency department in cardiac arrest. The cardiac monitor shows the following rhythm (V fib). Interpretation of this rhythm would suggest which of the following as a possible precipitation factor? A. Antibiotic use B. Cardiac tamponade C. Hemorrhage D. Electrocution - D For a patient with third-degree atrioventricular (AV) block and a blood pressure of 70/ mmHg, what interventions should be considered? A. Administer adenosine B. Initiate a dopamine infusion C. Administer atropine D. Initiate transcutaneous pacing - B, C, D A patient is admitted to the emergency department of a large medical center. The patient is diagnosed with STEMI. The facility is capable of administering PCI. To achieve the best outcomes, therapy should be administered to this patient within what time frame?

A. Within 30 minutes of the patient's arrival B. Within 60 minutes of the patient's first medical contact C. Within 90 minutes of the patient's first medical contact D. Within 3 hours of the onset of symptoms - C 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? A. Applying a cool compress to the patient's forehead B. Using an endovascular catheter C. Applying cooling blankets to the patient's body D. Administering cool-mist oxygen therapy E. Giving an ice-cold IV fluid bolus - B, C, E A patient experiences cardiac arrest, and the resuscitation team initiates ventilations using a bag-valve-mask (BVM) resuscitator. The lead development of which condition during the provision of care would lead the team to suspect that improper BVM technique is being used? A. Esophageal injury B. Pneumothorax C. Rib fracture D. Hypertension - B A patient with suspected stroke arrives at the emergency department. The patient is diagnosed with acute ischemic stroke and is a candidate for fibrinolytic therapy. To achieve the best outcomes, this therapy should be initiated within what time frame? A. Within 30 minutes of the patient's arrival B. Within 1 hour of the patient's arrival C. Within 2 hours of the patient's arrival D. Within 3 hours of the patient's arrival - B 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? A. 0.10 mV B. 0.15 mV C. 0.2 mV D. 0.25 mV - B 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 seconds in duration. Which actions would be appropriate at this time? A. Atropine B. Defibrillation

C. Consider an antiarrhythmic medication D. Synchronized cardioversion - C. A patient is being treated in the emergency department and is determined to have NSTE-ACS. Invasive management is planned based on which finding? A. Atrial tachycardia B. Atrial fibrillation C. Ventricular tachycardia D. Hypoxia - C A 42-year-old woman presents to the emergency department with complaints of fatigue, shortness of breath, back pain and nausea. A 12-lead ECG is obtained and shows ST- segment depression in leads II, III, and aVF and intermittent runs of no sustained ventricular tachycardia. Cardiac serum markers are elevated. These findings suggest which condition? A. High-risk non-ST segment elevation ACS (NSTE-ACS) B. Intermittent-risk non-ST-segment elevation ACS (NSTE-ACS) C. ST-segment elevation myocardial infarction (STEMI) D. Low-risk non-ST segment elevation ACS (NSTE-ACS) - A A patient has experienced ROSC after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. Before the arrest, the patient exhibited jugular venous dissension, cyanosis, apnea and hyper resonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause? A. Tension pneumothorax B. Cardiac tamponade C. Acidosis D. Hypothermia - A 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? A. "We initiated chest compressions at a rate of 100-110 per minute to a depth of 2. inches and then gave 1 ventilation every 10 seconds" B. "We provided cheat compressions at a rate of 80-120 per minute to a depth of at least 2 inches and gave 1 ventilation every 3 seconds without pausing for compressions" C. "We kept the rate of compressions around 100 per minute but adjusted their depth to 1.5 inches and gave 1 ventilation every 3 seconds without pausing for compressions" D. "We provided chest compressions at a rate of 100-120 compressions per minute while giving 1 ventilation every 6 seconds without pausing for compressions - D

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? A. Primary assessment B. Rapid assessment C. Basic life support assessment D. Secondary assessment - B Which statement accurately reflects the management of cardiac arrest in a pregnancy of 26 weeks gestation? A. Targeted temperature management (TTM) is contraindicated in the post-cardiac arrest pregnant patient B. Resuscitative cesarean delivery (RCD) should be performed within 5 minutes from the time of arrest C. Fetal monitoring should be immediately initiated after pulselessness is determined D. Intravenous access should be placed below the level of the diaphragm - B Cardiac monitoring of a patient in cardiac arrest reveals ventricular fibrillation. In addition to high-quality CPR, what intervention should be a priority for the team? A. Initiate capnography B. Insert an advanced airway C. Perform a pulse check D. Defibrillation - D Which statements accurately reflect the recommendations for post-cardiac arrest patient care? A. Targeted temperature management (TTM) should not be initiated in a post-cardiac arrest patient who is receiving mechanical circulatory support B. Perfusion should be assessed and maintained to ensure the best outcome for the post-cardiac arrest patient C. Arterial blood gases may be used to guide ventilation and oxygenation in the post- cardiac arrest patient D. Prophylactic anticonvulsants should be administered to attends who remain comatose after cardiac arrest to prevent seizures - C, D 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? A. 10-15 mmHg B. 20-25 mmHg C. 25- 30 mmHg D. 35-45 mmHg - D

A patient is in cardiac arrest. The underlying cause is though to be opioid toxicity. Which statement accurately describes the use of naloxone for this patient? A. Naloxone has not been shown to be effective for opioid toxicity once cardiac arrest has occurred B. Naloxone administered via continuous IV infusion should be considered for short- acting opioid toxicity C. Naloxone should be administered as soon as possible but is not a priority over high- quality CPR and AED use. D. Naloxone should be administered immediately as the first action in resuscitation at a dose of 0.2-2 mg and then repeated every 2-3 minutes as needed - C 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 fungus 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? A. Fetal Monitoring B. Point-of-care ultrasound C. Abdominal radiograph D. Fetal echocardiogram - B Cardiac monitoring reveals a tachyarrhythmia. The patient is hemodynamic ally stable and has a regular heart rate ranging from 120-135 BPM. Which statements by the patient could the team interpret as contributing to the tachyarrhythmia? A. "I've had a terrible cold with a Corrine cough for the past week and today I developed a fever" B. "I has the first shot of the COVID-19 vaccine over a week ago" C. "I've been so anxious lately because I just lost my job" D. "I've been vomiting for the past 2 days from a gastrointestinal bug" - A, C, D 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? A. Respiratory arrest B. Respiratory acidosis C. Respiratory distress D. Respiratory failure - C 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? A. 87% B. 89%

C. 93%

D. 100% - C

A responsive patient is choking. What method should the provider use first to clear the obstructed airway? A. Back blows B. Abdominal thrusts C. McGill forceps extraction D. Chest compressions - A 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 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? A. Bradycardia B. Atrial tachycardia C. Ventricular fibrillation D. Atrial fibrillation - D A patient is brought into the emergency department. The patient does not have a pulse. The cardiac monitor shows a sawtooth pattern without QRS complexes. The team interrupts this as which condition? A. Ventricular Fibrillation B. Ventricular Tachycardia C. Torsades de Pointes D. Asystole - B A patient is in cardiac arrest. The cardiac monitor shows asystole. In addition to providing continuous high-quality CPR, what is the other priority intervention for this patient? A. Inserting an advanced airway B. Administering amiodarone as early as possible C. Administering epinephrine as early as possible D. Defibrillating with 360 joules when available - C 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 (no electrical communication occurs between the atria and ventricles, thus no relationship between P waves and QRS complexes). The provider interprets this strip as indicating which arrhythmia? A. Third-degree AV block B. First-degree atrioventricular (AV) block C. Sinus tachycardia D. Second-degree AV block - A

A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow-complex Supraventricular tachyarrhythmia. The patient is not showing signs of hemodynamic compromise. Which intervention would be initiated first if it does not delay other interventions? A. Sedation B. Synchronized cardioversion C. adenosine administration D. Vagal maneuvers - D. 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? A. Acidosis B. Hypoxia C. Hypothermia D. Hyperkalemia - D 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 o the manufacturer's recommendations, which is usually: A. 75-100 joules B. 120-200 joules C. 300 joules D. 360 joules - B A patient is admitted to the emergency department with signals and symptoms of stroke. The stroke team should complete a comprehensive neurologic assessment and obtain brain imaging results within what time frame? A. Within 10 minutes B. Within 20 minutes C. Within 30 minutes D. Within 40 minutes - B A 2-year-old man with respiratory depression is brought to the emergency department by his parents. Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 PM. The patient does not respond to this initial dose. The team would expect to adminsiter a second dose after how many minutes? A. 2 minutes B. 4 minutes C. 6 minutes D. 8 minutes - A

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? A. 60 mmHg B. 70 mmHg C. 80 mmHg D. 90 mmHg - D 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? A. Presence of wide QRS complexes that are bizarrely and consistently shaped B. Absence of discrete P waves and presence of irregularly irregular QRS complexes C. Narrow QRS complex with PP interval constant or slightly irregular D. Presence of flutter waves and sawtooth patterns - B 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? A. ST-segment changes, T-wave inversion B. Flat T waves, prominent U waves and possibly prolonged QT intervals C. Wide-complex Ventricular rhythm and tall, peaked T waves D. Narrow-complex ventricular tachycardia - C A patient with bradycardia and signs of hemodynamic compromise does not respond to atropine. Which interventions could the healthcare provider use next? A. Epinephrine or dopamine infusion B. Transcutaneous pacing C. Carotid massage D. Synchronized cardioversion - A, B 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? (Sawtooth pattern between regular QRS complexes) A. Ventricular fibrillation B. Ventricular tachycardia C. Atrial flutter D. Atrial fibrillation - C The following capnography is from a patient experiencing respiratory distress. At which point in the waveform would the patients ETCO2 level be measured? A B C

D

E - D, value is measured at the end of exhalation, which represents the peak level