ACLS Test Prep Questions with answers, Exams of Nursing

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ACLS Test Prep Questions with

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The systemic approach first requires ACLS providers to determine? ✔The patient's level of consciousness If the patient appears unconscious? ✔Use the BLS survey (conduct the ACLS survey after completing the BLS survey) If the patient appears conscious? ✔Use the ACLS Survey For BLS how do you check for responsiveness? ✔-Tap and shout "are you all right?" -Check for absent or abnormal (agonal) breathing What do you do after checking responsiveness in BLS? ✔Activate the emergency response system/ get AED How do you check for circulation in BLS? ✔-Check carotid pulse for 5-10 seconds -no pulse, start CPR (30:2) (depth at least 2 inches) (rate at least 100/min) -minimize interruptions for compressions less than 10 seconds

• switch providers every 2 min. Defibrillation in BLS? ✔-check for shockable rhythm with AED -provide shock if indicated
• follow each shock immediately with CPR What O2 saturation is indicated for cardiac arrest? ✔100% Titrate O2 administration to acheive a saturation of? ✔> or = 94% If PetCO2 is <_____ attempt to improve CPR ✔10 mm Hg

If diastolic pressure is <_____ attempt to improve CPR ✔20 mm Hg What is the role of the team leader? ✔- organize the group

• monitor individual performance of team members
• back up team members
• models excellent team behavior
• trains and coaches
• facilitates understanding (why they perform certain tasks in a specific way) ___ consist of concise communication spoken with distinctive speech in a controlled tone of voice ✔Clear message Messages and orders should be delivered in a ___ and ___ manner without yelling or shouting? ✔calm and direct Suggested locations of team leader and members during case stimulations? ✔- airway
• IV/IO meds
• monitor/defibrillator
• team leader
• observer/ recorder
• compressor If you need help? ✔ASK FOR IT EARLY Everyone on the team should know his or her ___? ✔Own limitations and capabilities Five links of the adult chain of survival? ✔- immediate recognition of cardiac arrest and activation of the emergency response system
• early CPR with emphasis on chest compressions
• rapid defibrillation
• effective advanced life support
• integrated post cardiac arrest care- many hospitals have implemented the use of medical emergency teams or rapid response teams

What is the purpose of the METs or RRTs? ✔improve patient outcomes by identifying and treating early clinical deterioration Post cardiac arrest care include? ✔- therapeutic hypothermia

• hemodynamic and ventilation optimization
• immediate coronary reperfusion with percutaneous coronary intervention (PCI)
• glycemic control
• neurologic care and prognostication AHA guidelines recommend cooling comatose adults with ROSC after out of hospital VF cardiac arrest to - ___ for ___ hours for therapeutic hypothermia ✔32oC - 34oC; 12-24 hours Induced hypothermia should also be considered for comatose adult patients with ROSC after in-hospital cardiac arrest from any initial ___ or after out of hospital cardiac arrest with an initial rhythm of ___ or ___ ✔rhythm; PEA; asystole Healthcare providers may start ventilation rates at 10-12/min and titrate to acheive a PetCO2 of ____ or PaCO2 of ___ ✔35-40 mm Hg; 40-45 mm Hg Healthcare providers should titrate fluid administration and vasoactive or inotropic agents as needed to optimize blood pressure, cardiac arrest, and systemic perfusion with a goal for MAP ____? ✔> or = 65 mm Hg Use strategies to acheive moderate glycemic control to target glucose levels of ____ in adult patients with ROSC after cardiac arrest. ✔144 to 180 mg/dL Do not attempt to adjust glucose levels to more normal values () as there is an increased risk of ___ at the lower range. ✔80 to 110 mg/dL; hypoglycemic The goal of post arrest management is to return patients to their ___? ✔pre-arrest functional level Criteria for RRT in adult patient

• ___ airway
• RR __ or __
• HR __ or __
• Systolic BP ___
• Symptomatic ___
• Unexpected decrease in ___
• Unexplained __

• ---

• Significant fall in ___ output
• Subjective concern about the ___ ✔- threatened airway
• RR <6 or > 30/min
• HR <40 or > 140/min
• Systolic BP <90 mm Hg
• Symptomatic hypertension
• Unexpected decrease in level of conciousness (LOC)
• Unexplained agitation
• Seizure
• Significant fall in urine output
• Subjective concern about the patient For every minute that goes by without defibrillation, the chances of survival decrease by . After 10 minutes without defibrillation, the chances of survival are practically . ✔10%; nonexistent The most effective method of terminating ventricular fibrillation is ___ ✔electrical defibrillation The output of defibrillators is quantified in __ (). A defibrillators output is analyzed as ___ () and ___ (_). ✔Joules (watt-seconds); potential (volts); current (amperes) Factors that influence transthoracic resistance to direct current defibrillation ✔1. delivered energy

2. electrode size and composition
3. interface between electrode and skin
4. number of times and tie interval between previous discharges
5. electrode pressure
6. phase of patients ventilation
7. interelectrode distance The best electrode size for adults are circular diamete of ___. ✔13 cm

Resistance decreases with continued shocks-- an average of __ in second shock with adults ✔8% use firm pressure of ___ for electrode pressure ✔25 lbs/paddle Resistance will be at a minimum at a ___. ✔full exhalation if resistance is high, low energy shocks ____ ✔will NOT be successful to defibrillate effectively, current must pass through a critical mass of the ____. ✔left ventricular myocardium One electrode placed to right upper sternum just below clavicle; the other just to the left of the nipple in the midaxillary line. (anterolateral) ✔Standard placement one paddle placed anteriorly over the precordium just to the left of the lower sternal border; other is positioned behind the heart. ✔Anteroposterior Peds defibrillation for V fib dose of energy should be ___ ✔1J/lb or 2 J/lb Electrode size- ___ infants; ___ children ✔4.5 cm; 8.0-10.0 cm When treating a victim in pulseless v-tach or v-fib a ___ shock is followed by __ minutes of CPR. ✔SINGLE; 2 ___ is the therapy of choice for hemodynamically unstable ventricular or supraventricular tachyarrhythmias. ✔Unsynchronized cardioversion

Situations where the patient is hemodyamically stable and the rhythm has not converted in response to pharmacological treatment, ___ may be used. ✔Synchronized cardioversion while performing cardioversion, take steps to maintain ___ and protect airway from ___ if needed. ✔airway patency; aspiration Energy for narrow regular ✔50 - 100 J Energy for narrow irregular ✔120-200 J biphasic or 200 J monophasic Energy for wide regular ✔100 J Energy for wide irregular ✔Defibrillation dose (NOT synchronized) If the first shock is successful, and the patient goes back into dysrhythmia, use energy that was ___ ✔successful in defibrillation If the patient goes into V-fib after synchronized cardioversion, ___ the synchronizer and ___. ✔turn off; defibrillate painful to the patients and also initiates contractions in external muscles. ✔transcutaneous pacing invasive maneuver only provided by skilled physician, preferred method for emergency and long term pacing ✔Transvenous pacing Make sure to place the defibrillator paddles at least ___ from the pulse generator if the patient has a permanent pacemaker. ✔5 inches

___ is an acceptable intervention for healthcare providers to use for a witnessed arrest when the victim has no pulse and no defibrillator is immediately available. ✔precordial thump Deliver to the center of the sternum with the hypothenar aspect of the fist from a height of no more than ___. This is recommended for all ___ arrest when a defibrillator is unavailable. ✔12 inches; witnessed Precordial thump can convert __, ___, or ___. ✔V tach; a-fib; complete heart block The precordial thump should not be used in ___. ✔Infants and children Veins of the hand ✔1. digital dorsal veins

2. dorsal metacarpal veins
3. dorsal venous network
4. cephalic vein
5. basilic vein Veins of the forearm ✔1. cephalic vein
6. median cubital vein
7. accessory cephalic vein
8. basilic vein
9. cephalic vein
10. median antebrachial vein The usual site for insertion is the ___ hand or arm. ✔non-dominant Contraindication for vein selection. ✔- veins below a previous IV infiltration

• post mastectomy
• flaccid arm post CVA
• shunt in arm
• arm with diminished sensation
• edematous arm
• veins below a phlebitic area
• sclerosed or thrombosed veins

• areas of skin inflammation, disease, bruising, or breakdown Veins in hands are usually ___ choice, but veins in lower arm while a ___ choice are larger and will not become ___ as quickly as the hand. ✔first; second; phlebitic Avoid areas of ___ in all patients ✔flexion if a patient has a history of a medical condition that requires blood ___ drugs, or __ solutions, a large vein will be required because it can infuse large quantities. ✔antineoplastic (chemo); hypertonic Veins above the ___ - in front of the elbow- are third choice, but are deeper and a good choice for irritating solutions as they are least ___. ✔antecubital fossa; phlebitic Veins of the legs and feet are a last resort because of the chance of ___ or ___ -- a ___ approval is needed ✔thrombophlebitis or embolism; physicians NEVER use the ____, It is too close to the radial nerve and artery. Permanent damage can occur to these nerves if infiltration occurs and the area is very sensitive to ___. ✔median antebrachial vein; pain This device is a rigid stainless steel needle with plastic wings and tubing. It is available in __, __, __, and __ gauge. ✔Butterfly; 19, 21, 23, and 25 The ___ the gauge number, the larger the diameter of the catheter/needle. ✔smaller This device is a plastic catheter, which is inserted using a needle stylet. The needle stylet is removed once the device is in place. ✔Over-the-needle catheter (angiocath) an angiocath is chosen because of its __. ✔flexibility

Angiocath is usually kept in place longer than the steel needle, which increases the risk of phlebitis or infection (T or F) ✔True Always use the ___ needle diameter that can safely deliver the infusion. ✔smallest Butterfly needle (function)- transfusion of blood and blood products- gauge size? ✔19 gauge Butterfly needle (function)- IV push meds, peripheral fat infusions and blood (if 19 gauge cannot be inserted)- gauge size? ✔21 gauge Butterfly needle (function)- clear liquid infusions- gauge size? ✔23 gauge Butterfly needle (function)- very fragile or small veins- gauge size? ✔25 gauge Over-the-needle catheter (function)- emergencies, anesthetics, blood, blood products- gauge size? ✔14, 16, and 18 gauge Over-the-needle catheter (function)- drug bolus, peripheral fat solutions- gauge size? ✔20 gauge Over-the-needle catheter (function)- clear liquid infusions such as heparin, antibiotics, antineoplastic drugs or routine IV fluid ✔22 guage Over-the-needle catheter (function)- very young or very old patients with small fragile veins ✔24 gauge Apply tourniquet ___ above the site and check the radial pulse. ✔4 - 6 inches The anesthetic of choice is ___.

✔1% lidocaine ___ - pinch wings together with the bevel of the needle up ✔butterfly ___- make sure there are no burrs present in the catheter; enter the vein with the catheter over the needle and the bevel up ✔angiocath Method of inserting directly over the vein. Put the needle into the vein in the direction of venous blood flow (toward the heart) at a ___ angle and then flatten as you use a quick smooth movement. ✔Direct method; 10-45 degree angle This technique works best when the vein is visible and palpable ✔Direct method Method of quickly and smoothly inserting the needle at a 10- 45 degree angle into the skin beside (parallel) to the vein just far enough to penetrate the skin. Lower the needle angle, direct the needle laterally, and within half inch penetrate the vein. ✔Indirect method Use of this technique should decrease the risk of of puncturing the lower aspect of the vein on insertion. ✔Indirect method Butterfly needle: advance the needle by ___ the vein with the needle and threading the needle. Blood should return the entire ___ of the tubing. ✔lifting; length Angiocath: advance the needle and catheter another ___ to make sure the catheter is in the vein. Remove the ___ as you advance the catheter. Blood will return into the __ chamber if one is attached. ✔1/8" to 1/4"; needle; flashback Formula for calculating the IV drip rate ✔Volume (mL) to be infused x drop factor (gtt/mL) divided by infusion time in minutes equals

drops/minute Ex. Give 1000 cc D5W over 8 hours (drop factor 10 gtt/mL) ✔21 gtt/min Ex. Give tagamet 150 IV over 15 minutes (drop factor 15 gtt.mL; tagamet 150 is in 50 mL solution) ✔50 gtt/min. the seepage or diffusion of intravenous infusate into surrounding tissue. ✔Infiltration The term ___ is used to refer to infiltration of a vesicant (substance that causes blisters) medication. ✔extravasation Signs and symptoms of infiltration are: ✔- coolness of skin around the site

• taut skin, swelling of limb, dependent edema
• absent back flow of blood or "pinkish"; blood return
• a solution rate slowing, but continuing to infuse a localized mass of blood (bruising) outside of the vessel. ✔hematoma Signs and symptoms of hematomas include: ✔- discoloration of the skin (ecchymosis- bleeding from the vessel) surrounding the venipuncture
• site swelling and discomfort The formation or presence of a blood clot. This is caused by trauma to the endothelial cells of the venous wall, which causes platelets to adhere to the vein wall and cause clot formation. ✔thrombosis Signs of thrombosis: ✔- a painful, reddened, and swollen vein
• changes in flow of IV solution- drip becomes sluggish or stops or line does not easily flush the inflammation of the intima of a vein.

✔Phlebitis the inflammation of a vein associated with thrombus formation. ✔thrombophlebitis 3 types of phlebitis: ✔- bacterial

• mechanical
• chemical aka septic phlebitis, commonly caused by failure to maintain aseptic technique during insertion or site care. ✔Bacterial Can be attributed to using too large a cannula in a small vein. It can also be caused by improper taping or manipulation of the catheter during infusion, which results in the catheter tip rubbing te vein wall damaging the endothelial cells. ✔Mechanical Caused by increased acidity of the IV fluid. The more acidic the fluid, the greater the risk of chemical phlebitis. Another factor is particulate matter in the IV solution, this increases exposure of the vein lumen to irritating particles increasing the incidence of infusion phlebitis. ✔chemical __ can occur when microorganisms migrate into the bloodstream. Related to poor aseptic technique and contaminated equipment. ✔septicemia or bacteremia Signs and symptoms of septicemia: ✔- fluctuating fever, tremors, sudden rise in temp and pulse
• profuse cold sweat (diaphoresis), chills and shaking
• nausea and vomiting, diarrhea
• blood pressure changes (septic shock) __ caused by infusing any fluid too rapidly in a patient compromised by cardiopulmonary or renal disease. It can occur from failure to monitor the IV infusion; a loose roller clamp allowing the infusion to run freely or miscalculation of fluid requirements. ✔Circulatory overload

Signs and symptoms of circulatory overload: ✔- weight gain

• edema
• puffy eyelids
• rise in BP or CVP
• shortness of breath, rales, respiratory distress
• distended neck veins
• increased difference b/w intake and output ___ a sudden obstruction of a blood vessel by an air bubble introduced into the circulatory system and carried to that point by the bloodstream. It is more common with central lines than with peripheral lines. ✔Air embolism The initial signs and symptoms of air embolism: ✔- hypoxia
• hypertension
• respiratory distress
• changes in cardiac and neurologic status If air embolism is left untreated ___ may occur. ✔- loss of consciousness
• hemiplegia
• seizures
• cardiac arrest __ may occur if the patient has a sensitivity to medications, skin prep process, or to the cannulation device. ✔Allergic reaction Signs and symptoms of allergic reaction: ✔- itching and/or rash
• shortness of breath
• edema at site
• generalized body edema
• increased BP
• decreased pulse and respirations __ is an alternative technique for providing rapid and effective route for fluid resuscitation and med administration for pediatric and adult patients in emergency situations, when IV access cannot be established. ✔Intraosseous infusion

The treatment of hyperkalemia is determined by its ___ and the patient's ___. ✔Severity; clinical condition Stop sources of exogenous ___ administration and evaluate drugs that can ____ serum potassium? ✔potassium; increase What drugs can increase serum potassium? ✔- potassium sparing diuretics

• angiotensin-converting enzyme (ACE) inhibitors
• nonsteroidal anti-inflammatory agents What is mild elevation of K? ✔5 to 6 mEq/L How do you treat mild elevation of K? ✔Remove potassium from the body with

1. diuretics
2. resins Which diuretic is use in mild elevation? ✔furosemide 40 to 80 mg IV Which resin is used in mild elevation? ✔Kayexalate 15 to 30 g in 50 to 100 mL of 20% sorbitol either orally or by retention enema What is moderate elevation of K? ✔6 to 7 mEq/L How do you treat moderate elevation of K? ✔Shift potassium intracellularly with
3. glucose plus insulin
4. sodium bicarb
5. nebulized albuterol How do you administer glucose plus insulin? ✔mix 25 g (50mL of D50) glucose and 10 U regular insulin and give IV over 15 to 30 mins.

What dose of sodium bicarb? ✔50 mEq/L IV over 5 minutes Sodium bicarb alone is ___ effective than glucose plus insulin or nebulized albuterol, particularly for treatment of patients with ___; it is best used in conjunction ✔less; renal failure What dose of nebulized albuterol? ✔10 to 20 mg nebulized over 15 mins What is severe elevation of K? ✔>7 mEq/L with toxic ECG changes How do you treat severe elevation of K? ✔Shift potassium into the cells and eliminate potassium from the body Therapies that shift potassium will act rapidly but are ___; if the serum potassium rebounds you may need to ____. ✔temporary; repeat therapies How do you shift potassium into cells for severe elevation in order? ✔1. calcium chloride

2. sodium bicarb
3. glucose plus insulin
4. nebulized albuterol What dose of calcium chloride? ✔(10%) 500 to 1000 mg (5 to 10 mL) IV over 2 to 5 minutes Calcium chloride is used to reduce the effects of potassium at the ___ (lowers risk of ___) ✔myocardial cell membrane; VF Sodium bicarb may be less effective for patients with __? ✔end stage renal disease How do you promote potassium secretion to treat severe elevation of K? ✔5. diuresis
5. kayexalate enema

7. dialysis