AHA ACLS EXAM 2024 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE( POST TEST AND PRE TEST), Exams of Nursing

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AHA ACLS EXAM 2024 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE( POST TEST AND PRE TEST) | ACCURATE AND VERIFIED QUESTIONS WITH ANSWERS | VERIFIED FOR GUARANTEED PASS A patient has a rapid *irregular wide-complex tachycardia*; The ventricular rate is 138/min.; It is asymptomatic, with a BP of 110/70 mmHG; He has a h/o angina; What action is recommended next? - ANSWER>>a) Giving Adenosine: 6 mg IV bolus; b) Giving Lidocaine: 1.5 mg IV bolus; c) Performing synchronized cardioversion; d) *Seeking expert consultation ✅*; What tests should be performed for a patient with a suspected stroke within 2 hours of arrival? - ANSWER>>non contrast CT scan of the head SVT types - ANSWER>>1) Atrial fibrillation (A-fib); 2) Paroxysmal Supraventricular Tachycardia (PSVT): 3) Atrial Flutter (A-flutter); 4) Wolff-Parkinson-White syndrome; The patient is in *cardiac arrest*. High-quality chest compressions are being given. The patient is intubated, and an IV is being started. The rhythm is *asystole*. What is the first drug/dose to administer? - ANSWER>>*Epinephrine 1 mg IV/IO* *Transcutaneous Pacing* - ANSWER>>Aka external pacing: is a temporary means of pacing a patient's heart during a medical emergency. It is accomplished by *gradually delivering pulses* of electric current (*50-100 mA*) through the patient's chest until capture is reached (usually at a selected rate of 70), which stimulates the *heart to contract* at a regular pace. Which intervention is most appropriate for the treatment of a patient in *asystole*? - ANSWER>>*Epinephrine* A patient with sinus *bradycardia* and a heart rate of 42/min is diaphoretic and with a blood pressure of 80/60 mm Hg. What is the *initial dose of atropine*? - ANSWER>>*0.5 mg* of *Atropine* A patient has sinus *bradycardia* with a heart rate of 36/min. *Atropine* has been administered to a total dose of 3 mg. A *transcutaneous pacing* has failed to capture. The patient is confused, and her BP is *88/56 mmHg*. Which therapy is now indicated? - ANSWER>>*Epinephrine infusion: 2-10 mcg/min*. A monitored patient in the ICU developed a sudden onset of *regular narrow- complex tachycardia* at a rate of 220/min. The patient's BP is 128/88 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is a vascular (IV) access in the left arm, and the patient has not been given any basic active drugs. A 12-lead ECG confirms *SVT* with no evidence of ischemia or infraction. The HR has not responded to vagal maneuvers. What is your next action? - ANSWER>>Administer *adenosine 6 mg* IV push A patient with possible STEMI has ongoing chest discomfort. What is a *contraindication to nitrate* administration? - ANSWER>>Use of a *phosphodiesterase inhibitors* (eg. Viagra) within the previous 24 hours Targeted Temperature Management (TTM) - ANSWER>>Post-cardiac arrest care: mild induced hypothermia (32°C-36°C) for 24-28 hrs to improve health outcomes during recovery after a period of stopped blood flow to the brain; *Vagal Maneuvers* - ANSWER>>Techniques used to stimulate the vagal nerve in order to *slow the HR and halt* an episode of superventricular tachycardia (*SVT*): 1) Bearing Down: Valsalva Maneuver to increase intrathoracic pressure and stimulate the vagus nerve; 2) Coughing: forceful and sustained; 3) Cold Stimulus to the Face: should last about 10 seconds (the reaction is similar to the "diver's reflex"); 4) Gagging: a tongue depressor is briefly inserted into the mouth, touching the back of the throat; 5) Carotid Massage: pressure is applied underneath the angle of the jaw in a gentle circular motion for about 10 seconds: not be recommended with carotid artery stenosis and a history of smoking; A 62-years-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibronolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for *antiplatelet and fibrinolytic therapy*? - ANSWER>>Hold aspirin for at least 24 hours if rtPA is administered A patient with *STEMI* has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hour are being administered. The patient did not take aspirin because he has a history of gastritis, which was treated 5 years ago. What is your next action? - ANSWER>>Give *aspirin* 160 to 325 mg to chew In which situation does *bradycardia* require treatment? - ANSWER>>*Hypotension* What is the recommended depth of chest compression for an adult victim? - ANSWER>>At least *2"* PVC Bigemini - ANSWER>>When a sinus beat is shortly followed by an premature ectopic beat (PVC), a pause, another normal beat, and then another PVC. PVC Trigeminy - ANSWER>>When 2 sinus beats are shortly followed by an premature ectopic beat (PVC), a pause, another 2 normal beat, and then another PVC and so on; JER - ANSWER>>• Present on an underlined rhythm (HR: 40-60); • delayed heartbeat originating from an ectopic focus somewhere in the AV junction; • P inverted after QRS or not detected; • usually irregular; • prolonged PR; What can cause PVCs? - ANSWER>>Stress, exhaustion, alcohol, caffeine, cocaine, methamphetamines, nicotine, etc.; Life Pack - ANSWER>>Set to shock: • turn on and place paddles; • set on 'paddles'; • set on 200-360J; A patient was in *refractory V-fib*. A 3rd shock has just been administered. Your team looks to you for instructions. What is your next action? - ANSWER>>Resume high-quality CPR A 35-year-old woman presents with a chief complaint of *palpitations*. She has no chest discomfort, shortness of breath, or light-headedness. Her bloody pressure is 120/78 mm Hg. Which intervention is indicated first? - ANSWER>>Vagal maneuvers Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation? - ANSWER>>Ventilating too quickly A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with *V-fib*. Which action is indicated next? - ANSWER>>Give immediate unsynchronized high-energy shock: *defibrillation dose* A patient's 12-lead ECG is transmitted by the paramedics and shows a *STEMI*. When the patient arrives in the emergency department, rhythm shows ST elevation. The patient has resolution of moderate (5/10) chest pain after 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention is most important in reducing this patient's in-hospital and 30-day mortality rate? - ANSWER>>Reperfusion therapy (*PCI* and *CABG*) A patient becomes unresponsive. You are uncertain if a faint pulse is present. The rhythm is *PEA*. An IV is in place. *V-tach* on the ECG - ANSWER>>P=∅; HR = V only >100 Reg.; *QRS = wide*; Vasopressin IV/IO dose of ______ units can replace the first or second dose of epineprhine; - ANSWER>>40 _______ breaths/min with *continuos chest compression* - ANSWER>>8-10 With Capnography in place, placement of the colorimetric CO2 is necessary. T/F? - ANSWER>>False CPR Quality Criteria - ANSWER>>1) Push hard ≥ 2" and fast ≥100/min; 2) Minimize interruption: max 10 seconds; 3) If no advanced airway are in place, compress at 30:2 rate and rotate every 2 minutes; 4) If PETCO2 <10mm HG, improve CPR; 5) If diastolic Pressure <20mm Hg, improve CPR; Biphasic Shock Energy - ANSWER>>120-200J Monophasic Shock Energy - ANSWER>>360J *STEMI* on ECG - ANSWER>> STEMI evolution over time - ANSWER>> ED Assessment - ANSWER>>• Check vital signs; • Obtain medical history; • Review fibrinolytic checklist; • Obtain blood studies; • Obtain portable x-ray; You are evaluating a 58-year-old man with chest discomfort. His BP is 92/50 mmHg, his HR is 92/min, 14 breaths/min, and his pulse oximetry is 97%. Which assessment step is most important now? - ANSWER>>Obtaining a *12-lead ECG* *Epinephrine* acts as a _________, which _______ cerebral and coronary blood flow. - ANSWER>>vasoconstrictor; increases; *Amiodarone* - ANSWER>>An *antiarrhythmic drug* used with refractory *V- FIB* or *pulseless VT*: • Prevents the heart from speeding; • It effects Na+, K+ and Ca+ channels and α and β blockers; • Lowers defibrillation threshold; Average *HR* (bpm) - ANSWER>>The average adult male heart rate is *70-72 bpm*; There average for adult women is *78-82 bpm*. Average *BP* in adults (mmHg) - ANSWER>>More than 120 over 80 and less than 140 over 90 (*120/80*-*140/90*) Average *respiratory rate* for adults - ANSWER>>The normal respiration rate for an adult at rest is *12-20 breaths per minute*. (A respiration rate under 12 or over 25 breaths per minute while resting is considered abnormal); *Bradycardia* on a ECG - ANSWER>>P = ↑1:1; HR < 60; QRS = narrow; *Sinus Tachycardia* on the ECG - ANSWER>>P = ↑1:1; *HR > 100* (even higher than 200); QRS = narrow; Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do? - ANSWER>>Monitor the patient's *PETCO2* (The normal values is around 5% or 35-37 mm Hg); SR with *B*undle *B*ranch *B*lock on ECG - ANSWER>>P = ↑1:1; HR = reg. 60-100; *QRS = wide*; *V-fib* on the ECG - ANSWER>>P = ∅; HR = IRR. Chaotic; QRS = ∅ (Shock needed!) *A-fib* on the ECG - ANSWER>>*P = fibrillating*; HR = IRR. AR too fast to measure: (≤100 controlled, ≥100 uncontrolled); *QRS = narrow*; *A-flutter* - ANSWER>>P = fluttering; HR = A Reg. (250-350) and V?; QRS = narrow; *SVT* on the ECG - ANSWER>>(Impulse generated above the ventricles) P = hidden in QRS; HR = 150-250 reg.; QRS = narrow; A responder is caring for a patient with a *h/o CHF*. 2) After your initial assessment of this patient, which intervention should be performed next? 3) The patient's pulse oximeter shows a reading of *84%* on room air. Which initial action do you take? 4) If the patient became apneic and pulsess but the rhythm remained the same, which would take the highest priority? - ANSWER>>1) Tachycardia; 2) Synchronized Cardioversion; 3) Apply oxygen; 4) Perform defribillation; A patient has a witnessed loss of consciousness. The lead II ECG reveals *V-fib*. Which is the appropriate treatment? - ANSWER>>Defibrillation (SHOCK IT!) Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? - ANSWER>>Check the patient's breathing and pulse For STEMI patience, which best describes the recommended maximum goal time for emergency department door-to-balloon-inflation time for percutaneous coronary intervention? - ANSWER>>90 minutes During CPR, 1 mg IV of epinephrine is recommended every _____ minutes - ANSWER>>3-5 Consider continuos ________ with asynchronous _______ when the patient has an advanced airway - ANSWER>>compressions; ventilations; *Synchronized Electrical Cardioversion* - ANSWER>>therapeutic dose of electric current to the heart at a *specific moment* in the cardiac cycle, restoring the activity of the electrical conduction system of the heart with a stable patient with a QRS-t complex (100J). *Defibrillation* - ANSWER>>Therapeutic dose of electric current to the heart at a *random moment* (unsynchronized cardioversion) in the cardiac cycle with unstable patient, and is the most effective resuscitation measure for cardiac arrest associated with: V-fib and pulseless V-tach. With the *drop in cardiac output*, a patient may experience the following symptoms (these symptoms occur more frequently with a heart rate >150 beats per minute): - ANSWER>>• Shortness of air (*S*table but serious symptoms) • Palpitation feeling in chest (S) • Dizziness (S) • Rapid breathing (S) • Numbness of body parts (S) • Ongoing chest pain (*U*nstable) • Loss of consciousness (U) The pathway of choice for SVT in the tachycardia algorithm is based on whether the patient is stable or unstable: Unstable patients with *SVT* (w/pulse) are always treated with _____________; - ANSWER>>*Synchronized cardioversion* (the appropriate voltage for cardioverting SVT is 50-100 J); In cycle length of 400 ms (*0.4 s*) is what rate? - ANSWER>>*150 bpm* (60/0.4=150) • Rate > 100 bpm with gradual onset • P to QRS ratio 1:1 - ANSWER>>Tachycardia Which are known as the precordial leads? - ANSWER>>V1-V6 Which rate is equivalent to an interval of 800 ms (*0.8 s*)? - ANSWER>>60/0.8 = *75 bpm* Which of the following are considered normal durations for the PR and QRS intervals? - ANSWER>>PR = 150 ms; QRS = 80 ms; Which structure accounts for most of the duration of the PR interval? - ANSWER>>AV node The normal glucose level, during fasting, for non-diabetic patients is _______. - ANSWER>>70-100mg/dL After FAST - ANSWER>>1) Support ABCs; 2) Apply oxygen to bring above 94% 3) Check LKW; 4) Check blood count, coags, *glucose*; If the CT scan shows *no hemorrhage*, an Acute Ischemic Stroke is probable and *Fibrinolytic Therapy* is recommended after NIHSS screening: T/F - ANSWER>>True Fibrinolytic Therapy is recommended within 3 hrs from stroke onset: T/F - ANSWER>>True If the patient is not a candidate for Fibrinolytic Therapy on the NIH Stroke Scale, administer aspirin and send for a CT scan w/o contrast and obtain ECG: T/F - ANSWER>>True When stroke is suspected, check glucose level: quality CPR. What is your next treatment? - ANSWER>>Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? - ANSWER>>Be sure O2 is NOT blowing over the pt's chest during shock. During your assessment, your pt suddenly loses consciousness. After calling for help and determining that the pt. is not breathing, you are unsure whether the pt. has a pulse. What is your next action? - ANSWER>>Begin chest compressions. What is an advantage of using hands-free d-fib pads instead of d-fib paddles? - ANSWER>>Hands-free allows for more rapid d-fib. What action is recommended to help minimize interruptions in chest compressions during CPR? - ANSWER>>Continue CPR while charging the defibrillator. Which action is included in the BLS survey? - ANSWER>>Early defibrillation Which drug and dose are recommended for the management of a pt. in refractory V-FIB? - ANSWER>>Amioderone 300mg What is the appropriate intervalfor an interruption in chest compressions? - ANSWER>>10 seconds or less Which of the following is a sign of effective CPR? - ANSWER>>PETCO2 = or > 10mm Hg What is the primary purpose of a medical emergency team or rapid response team? - ANSWER>>Identifying and treating early clinical deterioration. Which action improves the quality of chest compressions delivered during resuscitave attemepts? - ANSWER>>Shitch providers about every 2 min or every 5 compression cycles. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse of 80 beats/min? - ANSWER>>1 breath every 5-6 seconds A pt. presents to the ER with a new onset of dizziness and fatugue. Onexamination, the pt's heart rate is 35 beats/min, BP is 70/50, resp. rate is 22 per min, O2 sat is 95%. What is the appropriate 1st medication? - ANSWER>>Atropine 0.5mg A pt. presents to the ER with dizziness and SOB with a sinus brady of 40/min. The initial atropine dose was ineffective and your monitor does not provide TCP. What is the appropriate dose of Dopamine for this pt? - ANSWER>>2- 10mcg/kg/min A pt. has an onset of dizziness. The pt.s heart rate is 180, BP is 110/70, resp. rate is 18, O2 sat is 98%. This is a reg narrow complex tach rythm. What is the next intervention? - ANSWER>>Vagal manuever. A monitored pt. in the ICU developed a suddent onset of narrow complex tach at a rate of 220/min. The pt's BP is 128/58, the PETCO2 is 38mm Hg, and the O2 sat is 98%. There is an EJ established for vascular access. The pt. denies taking any vasodialators. A 12 lead shows no ischemia or infarction. Vagal manuevers are ineffective. What is the next intervention? - ANSWER>>Adenosine 12mg IV You receiving a radio report from an EMS team enroute with a pt. who may be having a stroke. The hospital CT scanner is broken. What should you do? - ANSWER>>Divert the pt. to a hospital 15 min away with CT capabilities. Choose an appropriate inidication to stop or withhold resuscitive efforts. - ANSWER>>Evidence of rigor mortis. A 49 y/ofmaile arrives in the ER with persistant epigastric pain. She has been taking antacids PO for the past 6 hours because she she had heartburn. BP is 118/72, heart rate is 92/min, resp. rate is 14 non-labored and O2 sat is 96%. What is the most appropriate next action? - ANSWER>>Obtain a 12 lead ECG. A pt. in respiratory failure becomes apneic but contineues to have a strong pulse. The heart rate is dropping paridly and now shows a sinus brady rate at 30/min. What intervention has the highest priority? - ANSWER>>Simple airway manuevers and assisted ventilations. What is the appropriate procedure for ET suctioning after the catheter is selected? - ANSWER>>Suction during withdrawl, but not for longer than 10 seconds. While treating a stable pt for dizziness, a BP of 68/30, cool and clammy, you see a brady rythm on the ECG. How do you treat this? - ANSWER>>Atropine 0.5mg A 68 y/o female pt. experienced a sudden onset of right arm weakness. BP is 140/90, pulse is 78/min, resp rate is non-labored 14/min, 02 sat is 97%. Lead 2 in the ECG shows a sinus rythm. What would be your next action? - ANSWER>>Cinncinati Stroke Scale You are transporting a pt. with a positive stroke assessment. BP is 138, pulse is 80/min, resp rate is 12/min, 02 sat is 95% room air. Glucose levels are normal and the ECG shows a sinus rythm. What is next. - ANSWER>>Head CT scan What is the proper ventilation rate for a pt. in cardiac arrest who has an advanced airway in place? - ANSWER>>8-10 breaths per minute or 5-10mcg/kg/min of dopamine 3. treatable causes? (H's and T's) 4. obtain ECG Do you shock PEA? - ANSWER>>do not shock asystole or PEA! treatment is vasopressor only! reperfusion goal: time from door to balloon inflation (PCI) - ANSWER>>90 minutes reperfusion goal of 30 minutes is for... - ANSWER>>door-to-needle (fibrinolysis) if pt is hemodynamically unstable do you give nitroglycerin? - ANSWER>>No, must have SBP >90mmHg when is nitroglycerin contraindicated? - ANSWER>>inferior wall MI or RT ventricular infarction hypotension, brady or tachycardia recent phosphodiesterase use (Viagra) 4 D's of in-hospital therapy - ANSWER>>door to data to decision to drug (or PCI) treatment of bradyarrhythmia - ANSWER>>0.5 mg Atropine every 3-5 minutes, max of 3 mg if ineffective: transutaneous pacing or dopamine 2-10mcg/kg/min or epi 2-10mcg/min when do you use synchronized shocks - ANSWER>>unstable SVT unstable afib unstable a flutter unstable, regular, monomorphic tachycardia w/a pulse therapy for pt w/narrow QRS w/regular rhythm - ANSWER>>vagal maneuver or give adenosine stroke general assessment w/in __ minutes of arrival CT w/in __ minutes interpret CT within __ minutes initiate fibrinolytic therapy within ? door-to-admission time of 3 hours - ANSWER>>general assessment w/in 10 minutes of arrival CT w/in 25 minutes interpret CT within 45 minutes -initiate fibrinolytic therapy within 1 hour of arrival and 3 hours from symptom onset