ACLS Final Review: Comprehensive Guide for Healthcare Professionals 2024, Exams of Medicine

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ACLS Final Review Questions with

Answers 2024

When a shockable rhythm is present during cardiac arrest and a biphasic manual defibrillator is available, the initial energy level selected should be: ✔ Most biphasic models display the appropriate dose range clearly on the device- follow the manufacturer recommendations. A patient presents to you in the emergency department having a rapid irregular wide- complex tachycardia. The ventricular rate is 150. He is asymptomatic with a BP of 120/80. His only history is ACS and type 2 diabetes. Which of the following actions is recommended? ✔ Seek expert consultation You have a patient in the emergency department with a return of spontaneous circulation. On assessment, the patient's blood pressue is 82/40. Optimum blood pressure for the patient should be ______, achieved by using ______. ✔ 90 mmHg; normal saline When treating a patient with chest pain and nitroglycerin is indicated, what precautions should be taken prior to its administration? ✔ Because nitroglycerin is a vasodilator, it should be administered with the following precautions in mind. Inferior MI and RV infarction: Patients must have adequate ventricular preload. Patients that have acute RV infarction are heavily dependent on the maintenance of RV filling pressures to regulate both blood pressure and cardiac output. Vasodilators and other nitrates are contraindicated in these instances. In order to meet criteria for an ECG tracing to be called a STEMI, the provider must find: ✔ ST Segment Elevation Myocardial Infarction (STEMI) is diagnosed if there is ST segment elevation greater than 1 mm (0.1 mV) in 2 or more contiguous precordial leads (2 mm in leads V2 and V3) or two or more adjacent limb leads, or by new (or presumed new) left bundle branch block. Use the following scenario for the next 2 questions: While working as part of a multi- discipline team in a cardiac ICU, you have achieved ROSC of your 60-year-old cardiac arrest patient. ✔ Ensure adequate airway and breathing care, Which of the following is possible reversible causes of a PEA rhythm? ✔ try to identify and treat reversible causes (H's and T's). Hypotension following cardiac arrest is treated with: ✔ NoE

A 62-year-old man in the ICU reports that he is developing substernal chest pain. His level of responsiveness is rapidly decreasing. His blood pressure is 50/P, pulse is 188, and his respirations are 10. The cardiac monitor reveals monomorphic ventricular tachycardia. Your best course of action is: ✔ Defibrillate with 100J When setting up to transcutaneous pace for a patient, the first step a provider must do is: ✔ Place pacing pads on the patient What is the primary pacemaker of the heart? ✔ SA node The optimal mean arterial pressure (MAP) for a patient post cardiac arrest is: ✔ 65 mmHg While working as a paramedic, you arrive to find a 56-year-old woman who presents with a sudden onset of chest discomfort that has been present for about 1 hour. The patient describes her discomfort as a "squeezing" sensation in the middle of her chest. She rates her discomfort an 8 on a 0 to 10 scale. Her blood pressure is 126/72, respirations 14. Oxygen has been applied, an IV has been started, and the cardiac monitor reveals the rhythm below. Immediate management of this patient should include: ✔ Vagal maneuvers and 6 mg adenosine via a rapid IVP If the initial dose of adenosine is ineffective in terminating the dysrhythmia, this medication can be given again within _____ minutes. ✔ 1 to 2 While working the emergency department, a 56-year-old woman is complaining of palpitations. When questioned, she denies chest pain or shortness of breath. Her blood pressure is 134/82, pulse 180, respirations 18. The cardiac monitor shows a narrow QRS tachycardia without visible P-waves. Which of the following reflects your best course of action to take at this time? ✔ Oxygen, IV, vagal maneuvers, and adenosine 6 mg rapid IV bolus You are a paramedic who is treating a patient presenting with chest pain. The 12-lead ECG shows ST segment elevation of 1 mm in leads V2 and V3. Based off of this information, what is the ACS classification for this patient? ✔ ST Segment Elevation Myocardial Infarction (STEMI) is diagnosed if there is ST segment elevation greater than 1 mm (0.1 mV) in 2 or more contiguous precordial leads (2 mm in leads V2 and V3) or two or more adjacent limb leads, or by new (or presumed new) left bundle branch block. High-Risk Unstable Angina (UA) / Non-ST Segment Elevation Myocardial Infarction (NSTEMI) {Now known as NSTE-ACS per 2015 ECC Guidelines} is diagnosed if there is ST segment depression of 0.5 mm (0.05 mV) or greater, or dynamic T-wave inversion, associated with chest pain or discomfort. Also

included in this category is non-persistent or transient ST segment elevation of 0.5 mm or greater. What is the maximum allotted doses of nitroglycerin allowed by the Acute Coronary Syndromes Algorithm for EMS? ✔ 3 While working an out-of-hospital arrest, which would be a reason to stop efforts? ✔ Online medical authorization is given to cease efforts Use the following scenario for the next 2 questions: As a paramedic, you are caring for a 78-year-old female with a history of congestive heart failure. She called you due to extreme dyspnea that has been constant all night. ✔ Sinus tachycardia The patient presents with a blood pressure of 134/60. However you note she is using all accessory muscles to breath and has an SPO2 of 74% with a PETCO2 of 20 mmHg and central cyanosis. Based on this information, the best treatment of choice for her cardiac presentation is: ✔ Synchronized cardioversion When delivering a shock, when you should clear the patient? ✔ always You are working a standby event to provide simple first aid. A spectator waves you over to the side of a male found unresponsive. The first three steps that should be taken in order to stabilize the patient are: ✔ 1.) Check responsiveness, 2.) Activate 911/AED, 3.) Check breathing and pulse CPR is vital to patient resuscitation success. It is defined that for every minute that goes past without CPR, the chance of survival decreases by ________________. ✔ 7-10% You are an emergency department nurse triaging a patient with positive stroke symptoms. His/her onset for symptoms was 4 hours ago. Based solely off of these findings, what treatment may he/she be a candidate for? ✔ Mechanical clot disruption/stent retrieval A patient presents to the emergency department (ED) with stroke-like symptoms. Given the time sensitivity of stroke care, a CT scan should be completed within _______________ of the patient's arrival in the ED. ✔ 25 mins You are asked to interpret the 12-lead ECG of a patient presenting with non-specific, sub-sternal chest pain. You note in your interpretation that the patient has ST depression of 0.6 mm in 3 contiguous leads. Based off this identification, you classify

the patient into what ST-segment group under the Acute Coronary Syndromes Algorithm? ✔ NSTEMI/High-risk The correct IV/IO dose of epinephrine for a patient in cardiac arrest is: ✔ 1 mg IV/IO should be administered every 3-5 minutes. After shocking this rhythm using your monitor's manufacturer's recommendations for shock, you as the team leader should immediately: ✔ Continue compressions The first drug of choice utilizing the cardiac arrest algorithm for this rhythm, when indicated, is: ✔ amiodarone If this patient remains in persistent VF/pVT, the next drug of choice, as indicated by the ECC Guidelines, is: ✔ lidocaine What route is preferred for drug administration to patients in cardiac arrest? ✔ IV The correct sequence for basic life support is: ✔ Compressions, airway, breathing (CAB) When using an AED, the first step is: ✔ turn on A patient with a possible ST-segment elevation MI has ongoing chest discomfort. Which of the following would be a contraindication for administration of nitrates? ✔ viagra usage in last 6 hours The recommended chest compression depth for an adult in cardiac arrest is: ✔ 2-2.4 inches As a healthcare provider you respond to a reported cardiac arrest. As you approach the patient, you start to recall reasons that would lead you to stop or withhold resuscitative efforts. Which of the following would cause you not to initiate resuscitation? ✔ Rigor mortis Once the scene is deemed safe, what is the first step required of the Healthcare provider when following the systematic approach to patient assessment? ✔ check responsiveness When suctioning, you should limit your time to suction to: ✔ 10 sec

While suctioning, which of the following should be monitored? ✔ the patient's heart rate, pulse, oxygen saturation, and clinical appearance should be monitored An 84-year-old man is in cardiac arrest. Which of the following statements is true? ✔ The rescuer giving chest compressions should switch roles with the rescuer overseeing the AED operation about every 2 minutes to prevent rescuer fatigue Paramedics arrive in the emergency department with a 40-year-old man. When they arrived at the patient's home, the patient was complaining of severe chest pain. While taking the patient's history and vital signs, he experienced a cardiac arrest. The cardiac monitor showed VF. The paramedics defibrillated immediately with successful conversion to a sinus rhythm. The patient responds to a painful stimulus, but does not response to verbal stimuli. His blood pressure is 104/70, respirations 12/min. Which of the following should be done at this time? ✔ The patient should be cooled to 32° C to 36° C for 24 hours Fibrinolytics may be administered to patients when door-to-balloon (D2B) time is anticipated to exceed ___ minutes getting to the cath lab for PCI therapy. ✔ 120 mins Which of the following tasks is the team leader responsible for during a code resuscitation? ✔ Determine treatment of rhythms The team leader orders you to defibrillate the patient per ACLS guidelines. Knowing that this is not the correct choice, how do you address the leader? ✔ Constructive interventions After the team leader acknowledges your error he orders you to follow ACLS and administer a synchronized cardioversion dose as indicated under ACLS. Knowing your ACLS tachycardia algorithm and using a biphasic monitor, what should your first dose setting be? ✔ 120-200 J Your team leader asks for follow-up to the order once it is executed. What is this known as? ✔ Closed-loop communication While functioning as a team leader for a code resuscitation in the recovery room, which would be the best action to ensure mistakes do not occur among team members and all jobs are done effectively and efficiently? ✔ Clearly assign tasks

Currently, to use IV rtPA to treat ischemic stroke patients, it should be administered within _____ hour(s) of the onset of symptoms. ✔ 3 You have been dispatched to the home of a 78-year-old female who is experiencing signs and symptoms that correlate with a stroke. What critical action can you take for the best possible patient outcome? ✔ Notify the receiving hospital A 50-year-old man presents to the ER having suddenly begun to experience facial drooping and left-sided weakness. In order for him to meet guidelines for fibrinolytic therapy you must first: ✔ Order a CT scan Which of the following statements is true regarding the NPA and OPA? ✔ An OPA should not be used in a conscious or semi-conscious patient as it may stimulate gagging and/or vomiting. Therefore, if the patient has an intact cough and gag reflex, do not use an OPA. What should you measure to properly insert a nasopharyngeal airway? ✔ If you choose to use a nasopharyngeal airway, selecting the proper size is also important. To determine the correct size, measure from the tip of your patient's nose to the tip of their earlobe. When should cricoid pressure be used in the treatment of a patient following the ACLS algorithms? ✔ Cricoid pressure is not recommended for routine treatment of cardiac arrest patients. Cricoid pressure may help prevent aspiration and regurgitation of gastric contents when used during bag-mask ventilation, but it may also impede ventilation and appropriate placement of an advanced airway. Which drug/therapy is no longer indicated in ACLS for routine use in patient care? ✔ vasopressin Following the Post-Cardiac Arrest Care Algorithm, this patient should have their arterial oxygen saturation titrated to: ✔ At least 94% When a shockable rhythm is present during cardiac arrest and a biphasic manual defibrillator is available, the initial energy level selected should be: ✔ 100 J A 62-year-old man in the ICU reports that he is developing substernal chest pain. His level of responsiveness is rapidly decreasing. His blood pressure is 50/P, pulse is 188, and his respirations are 10. The cardiac monitor reveals monomorphic ventricular tachycardia. Your best course of action is:

✔ For tachycardic patients with wide regular rhythm on the monitor, perform immediate synchronized cardioversion with 100 J. While working as a paramedic, you arrive to find a 56-year-old woman who presents with a sudden onset of chest discomfort that has been present for about 1 hour. The patient describes her discomfort as a "squeezing" sensation in the middle of her chest. She rates her discomfort an 8 on a 0 to 10 scale. Her blood pressure is 126/72, respirations 14. Oxygen has been applied, an IV has been started, and the cardiac monitor reveals the rhythm below. Immediate management of this patient should include: ✔ Aspirin, nitroglycerin, and morphine