ACLS quiz with complete solutions, Exams of Nursing

Download ACLS quiz with complete solutions and more Exams Nursing in PDF only on Docsity! ACLS quiz Which are the elements of a system of care? - Answer- Structure, processes, system, patient outcome What element of a system of care is represented by properly functioning resuscitation equipment? - Answer- Structure Among others, which factor has been associated with improved survival in patients with cardiac arrest? - Answer- Immediate high- quality CPR What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival? - Answer- Activation of emergency response What are signs of clinical deterioration that would prompt the activation of a rapid response system? - Answer- Systemic hypertension, unexplained agitation, seizure What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)? - Answer- To improve patient outcomes by identifying and treating early clinical deterioration What happens when teams rapidly assess and intervene when patients have abnormal vital signs? - Answer- The number of in-hospital cardiac- arrest decreases In addition to decreased IHCA, what are some other benefits of implementing a rapid response system? - Answer- Decrease ICU length of stay, decreased in total hospital length of stay Which component of effective high-performance teams is represented by the use of real-time feedback devices? - Answer- Quality What is the main advantage of effective teamwork? - Answer- Division of tasks Which is the best example of a role of the team leader? - Answer- Models excellent team behavior Which is the best example of a role of a team member? - Answer- Prepared to fulfill their role responsibilities What is primary purpose of the CPR coach on a resuscitation team? - Answer- Increasing CPR quality Which member of the high-performance team has the responsibility for assigning roles (positions)? - Answer- Team leader Which high-performance team member is part of the resuscitation triangle? - Answer- Monitor/ defibrillator/ CPR coach Which is an example of knowledge sharing by a team leader? - Answer- Asking for suggestions about interventions Which is an example of summarizing and reevaluating? - Answer- Increasing monitoring of the patient's condition deteriorates Which is a step of closed-loop communication? - Answer- Confirming task completion before assigning another task Which are examples of mutual respect? - Answer- · Acknowledging correctly completed tasks in a positive way · Ensuring that only 1 person talks at a time What are the components of high-quality CPR? - Answer- · Compression depth of at least 2 inches (5cm) · Complete chest recoil after each compression · Interruptions limited £ 10 seconds · Switching compressions every 2 minutes · Avoiding excessive ventilation Which of the following defines chest compression fraction (CCF)? - Answer- CCF= actual chest compression time/ Total code time During CPR, chest compression fraction (CCF) should be at least --- and ideally greater than 80%. - Answer- 60% How do interruptions in chest compressions negatively impact survival after cardiac arrest? - Answer- Decrease coronary perfusion pressure Coronary perfusion pressure (CPP) equals aortic ---- pressure minus right atrial diastolic pressure. - Answer- diastolic What is the only intervention that can restore on organize rhythm in patients with ventricular fibrillation (VF)? - Answer- Early and effective defibrillation How quickly does the chance of survival describe for every minute of defibrillation delay in patients with ventricular fibrillation (VF) who do not receive bystander CPR? - Answer- 7-10% Upon reviewing a patient's 12-lead EKG, you note ST-segment elevation of 2mm in leads II, III, and AVF. How would you classify the EKG findings? - Answer- ST segment elevation myocardial infraction What is recommended time window after symptom onset for early fibrinolytic therapy or direct catheter- based reperfusion for patients with St-segment elevation myocardial infraction and no contraindications? - Answer- Within 12 hours What is the benefit of morphine when given for the management of ACS? - Answer- Central nervous system analgesia What is the most common type of stroke? - Answer- Ischemic stroke What type of stroke occurs when a blood vessel is the brain suddenly ruptures into the surrounding tissue? - Answer- Hemorrhagic stroke What is the benefit of morphine when given for the management of ACS? - Answer- Central nervous system analgesia Which is a sign of stroke? - Answer- Trouble speaking Which is a symptom of stroke? - Answer- Sudden trouble seeing What validated abbreviated out-of-hospital neurologic evaluation tool contains 3 components: the facial droop, arm drift, and abnormal speech tests? - Answer- (CPSS) Cincinnati Prehospital Stroke Scale What is the estimated probability of the Cincinnati Prehospital Stroke Scale with 1 abnormal finding when scored by prehospital provides? - Answer- 72% Which is a stroke severity tool that helps EMS differentiate occlusion from non-large- vessel occlusion stroke? - Answer- Los Angeles Motor Scale What is the primary advantage of using a stroke severity tool? - Answer- It helps identify large-vessel occlusion stroke What is the most appropriate destination for patients with suspected acute ischemic stroke? - Answer- Certified stroke center What is the highest level of stroke center certification? - Answer- Comprehensive stroke center which is an advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke? - Answer- Responding providers can stabilize critical issues What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy? - Answer- 30 minutes What is the advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? - Answer- The hospital can perform more efficient evaluation and management What is the goal for neurologic assessment by the stroke team or design and noncontrast computed tomography or magnetic resonance imaging performed after hospital arrival? - Answer- 20 minutes What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? - Answer- 45 minutes What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics? - Answer- 60 minutes What is the door-to-device time goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy? - Answer- 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? - Answer- 3 hours What is the maximum time from last known normal when endovascular therapy can be performed? - Answer- 24 hours What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment? - Answer- 6 hours Identify the systolic BP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. - Answer- 185mmHg What is the diastolic blood pressure times hold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke? - Answer- 110mmHg Which action is NOT part of the acute stroke pathway? - Answer- Seizure prophylaxis What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke? - Answer- 180mg/dl What is the average RR for an adult at rest? - Answer- 12 to 20/min What is tidal volume typically maintaining normal oxygenation and elimination of carbon dioxide? - Answer- 6 to 8 mL/kg An 18 yo patient is reporting difficulty breathing and is displaying increased respiratory effort. Auscultation reveals bilateral wheezing; the respiratory rate is 28 breaths per minute. Oxygen saturations is 91%. PETCO2 is 44 mmHg. How would you categorize this patient's condition? - Answer- Respiratory distress A 59 yo patient is reporting difficulty breathing. Physical exam reveals nasal flaring, intercostal interaction and use of accessory muscles. RR is 28 breaths per minute. O2 sat is 92% PTCO2 is 36 mmHg. How would you categorize this patent's condition? - Answer- Respiratory distress A 75 yo patient is having difficulty breathing, with increased respiratory effort. The patient has history of emphysema. The patient is drowsy, auscultation reveals bilateral wheezing, although the lung sounds are difficult to appreciate. RR is 38/min. O2 sat = 85%, PETCO2= 49mmHg. How would you categorize this patient's condition? - Answer- Respiratory failure What is the term of the rise in arterial CO2 levels typically associated with respiratory failure? - Answer- Hypercapnia How much tidal volume must provide with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest? - Answer- 6 to 7 mL/kg What device on a resuscitation bag-mask device may prevent sufficient tidal volume in patients with poor lung compliance? - Answer- Pressure-relief value Patients with perfusing rhythms should receive ventilations once every - Answer- 6 seconds What is the most effective way to deliver bag-mask ventilation? - Answer- Using a 2 person technique How long should the second rescuer squeeze the bag mask device when providing 2- rescuer ventilation? - Answer- 1 second When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers? - Answer- Just under the angel of the lower jaw When you use a bag-mask device, you should deliver approximately ---tidal volume. - Answer- 500 to 600 mL What is a contraindication to the use of an oropharyngeal airway? - Answer- Conscious patient In which of the following patients can nasopharyngeal airways be used? - Answer- Unconscious, semiconscious, conscious The width of the QRS in a patient presenting with tachycardia is 0.10 seconds. There are no clearly discernable P waves. How would you classify this tachycardia? - Answer- Narrow-complex tachycardia What is the upper heart rate limit for a patient with sinus tachycardia? - Answer- 130/min What is the lower heart rate limit for a patient with sinus tachycardia? - Answer- 100/min What is the recommended initial therapy for a patient with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead EKG? - Answer- Vagal maneuvers What procedure used in the management of stable narrow-complex tachycardia forces a patient to strain a closed glottis? - Answer- Valsalva maneuver What is the recommended initial dose of adenosine for the management of supraventricular tachycardia unresponsive to vagal maneuvers? - Answer- 6mg IV What is the follow up dose of adenosine for the management of supraventricular tachycardia unresponsive to the first adenosine dose? - Answer- 12mg IV If the patient is conscious, establish IV access prior to synchronized cardioversion and administer - Answer- sedation Generally speaking, electrical cardioversion is not recommended as the initial therapy for patients unless the heart rate is above - Answer- 150/min You are preparing to provide electrical cardioversion. You are monitoring the patient's EKG and have applied the defibrillation pads to the patient's bare chest. You have delivered sufficient sedation and have turned the defibrillator on. What is the next step you should perform? - Answer- Activate the sync control button Which is contraindicated to the use of procainamide infusion in the management of stable wide-complex tachycardia? - Answer- Prolonged QT interval What is the recommended first dose of amiodarone for the management of stable wide- complex tachycardia? - Answer- 150mg IV In addition to CPR with minimal interruptions in chest compressions what is the most critical intervention during the first minutes of arrest for a patient in ventricular fibrillation? - Answer- Defibrillation During the management of a patient in cardiac arrest, you have initiated CPR, attached the manual defibrillator, delivered the first shock, and immediately resumed high quality CPR, beginning with chest compressions. What is your next intervention? - Answer- Establish IV or IO access What is the recommended first dose of amiodarone for the management of stable wide- complex tachycardia? - Answer- 150 mg IV When is the recommended point to administer the first dose of epinephrine for a patient in a shockable rhythm? - Answer- Between the second and third shocks What is the recommended dose for epinephrine during a resuscitation effort? - Answer- 1mg IV every 3 to 5 minutes What is the recommended first IV/ IO dose of amiodarone for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation? - Answer- 300mg What is the recommended first IV/IO dose of lidocaine for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation? - Answer- 1 to 1.5mg/kg What term best describes an organized rhythm without a pulse? - Answer- PEA PEA can present as which of the following organized rhythms? - Answer- Bundle brunch blocks, Atrial fibrillation or flutter, Sinus rhythm When is the recommended point to administer epinephrine to a patient with a systole? - Answer- As soon as IV/IO access is available In addition to hypoxia, what is the most common underlying, potentially reversible cause of pulseless electrical activity? - Answer- Hypovolemia Which therapy is not supported by evidence for use in patients with cardiac arrest secondary to hypothermia? - Answer- Antiarrhythmics Which alternation to be standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia? - Answer- Medications spared at longer intervals A patient with suspected opioid poisoning is not breathing normally but has a pulse. What is your next step? - Answer- Provide rescue breathing and give naloxone Depending on training and individual circumstances how can rescuers administer naloxone? - Answer- Intranasally, intravenously, intramuscularly What roles does ECPR fill in the management of cardiac arrest? - Answer- Severe as a bridge for left ventricular assist device implantation, provides vital organ support while treating reversible causes How will the current generation of continuous-flow left ventricular assist devices complicate the BLS assessment? - Answer- The devices will not produce a pulse You are assessing an unresponsive patient known to have an implanted left ventricular assist device (LVAD). The patient is not breathing, the patient's skin is pale and cool, and capillary refill is inadequate. How do you assess whether the LVAD is functioning? - Answer- Listen for device hum A patient with ventricular assist device (VAD) is not breathing, has signs of inadequate perfusion, and is unconscious. You determine the VAD is functioning. After endotracheal intubation, the patient has a PETCO2 of 12 mmHg. What is your next action? - Answer- Perform external chest compressions What is the recommended CPR position for a third-trimester gravid patient? - Answer- Supine with normal left uterine displacement What alternations one recommended for resuscitation drug administration to 3rd trimester gravid patients in cardiac arrest? - Answer- No dosing alternations are recommended When should resuscitation team leaders activate the protocol for perimortem cesarean delivery? - Answer- As soon as cardiac arrest is determined in a pregnant patient How quickly should resuscitation Team leaders consider perimortem cesarean delivery after beginning resuscitative efforts it returns of spontaneous circulation has not been achieved? - Answer- 5 minutes When titrating inspired oxygen, which arterial oxyhemoglobin saturation value lies within the recommended range for a patient who achieves return of spontaneous circulation? - Answer- 95% When adjusting ventilation rales, with PETCO2 value lies within the recommended range for a patient who achieves return of spontaneous circulation? - Answer- 40mmHg What is the recommended fluid bolus dose for patients who are hypotensive during the post-cardiac arrest phase? - Answer- 1 to 2 L What is the recommended norepinephrine dose for hypotensive patients during the post-cardiac arrest phase? - Answer- 0.1 to 0.5mcg/kg per minute What is the recommended starting IV infusion dose of epinephrine for patients in cardiac arrest achieve ROSC and need vasopressor support? - Answer- 2 to 10 mcg per minute