AHA ACLS EXAM 2024 AND PRACTICE EXAM TEST BANK, Exams of Nursing

Download AHA ACLS EXAM 2024 AND PRACTICE EXAM TEST BANK and more Exams Nursing in PDF only on Docsity! View Correct Answer Answer Key: A 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 | LATEST UPDATE Identify the choice that best completes the statement or answers the question. Q1. A 48-year-old man became unresponsive shortly after presenting to you with nausea and generalized chest discomfort. You observe gasping breathing and are unsure if you feel a pulse. You should know: A. Call for help and begin chest compressions. B. Wait until breathing stops and then check again for a pulse. C. Begin chest compressions only if you are certain a pulse is absent. D. Observe the patient for 2 minutes, then reassess his breathing and pulse. View Correct Answer Answer Key: C Q2. Which of the following is the most likely complication of inferior wall myocardial infarction (MI)? A. Cardiogenic shock B. Ventricular rupture C. Bradydysrhythmias D. Tachydysrhythmias Q3. A 52-year-old man is complaining of palpitations that came on suddenly after walking up a short flight of stairs. His symptoms have been present for about 20 minutes. He denies chest pain and is not short of breath. His skin is warm and dry; breath sounds are clear. His blood pressure (BP) is 144/88 millimeters of mercury (mm Hg), his heart rate is 186 beats per minute (beats/min), and his ventilatory rate is 18 breaths/min. The cardiac monitor reveals the rhythm here. Vascular access has been established. Which of the following medications is most appropriate in this situation? A. Dopamine or sotalol View Correct Answer Answer Key: C Q7. Which of the following is incorrect with regard to a postevent debriefing? A. The facilitator should use open-ended questions to encourage discussion. B. Team members are encouraged to identify lessons learned in a nonpunitive environment. C. The gather phase of the debriefing includes a comparison of the team’s actions with current resuscitation algorithms. D. Team members are given an opportunity to reflect on their performance and how their performance can be improved. View Correct Answer Answer Key: B Q8. Assuming there are no contraindications, which of the following can be performed as an initial intervention for a stable but symptomatic patient with the rhythm shown? A. Defibrillation B. Vagal maneuvers C. Administration of intravenous (IV) diltiazem D. Administration of IV epinephrine Q9. A 62-year-old man received IV tissue plasminogen activator (tPA) 2 hours ago after a diagnosis of acute ischemic stroke. While assessing the patient’s vital signs, you observe swelling of the patient’s lips and tongue. Your best course of action will be to: View Correct Answer Answer Key: B View Correct Answer Answer Key: B A. Administer aspirin and IV heparin. B. Administer IV antihistamines and steroids. C. Observe and reassess the patient every 15 minutes. D. Request an emergent brain computed tomography scan. Q10. During a cardiac arrest, multiple attempts to establish a peripheral IV have proved unsuccessful. Your best course of action at this time will be to: A. Insert a central line. B. Attempt intraosseous access. C. Discontinue resuscitation efforts. D. Continue peripheral IV attempts until successful. View Correct Answer Answer Key: B Q14. The patient rates his discomfort 9/10. His BP is 126/72 mm Hg and ventilations 14 breaths/min. His SpO2 on room air is 95%. The cardiac monitor shows a sinus rhythm at 60 beats/min. Immediate management of this patient should include: A. Giving aspirin and NTG. B. Establishing IV access and giving aspirin. C. Administering oxygen and establishing IV access. D. Administering oxygen and obtaining a targeted history. View Correct Answer Answer Key: A View Correct Answer Answer Key: D Q15. Current guidelines recommend obtaining an initial 12-lead ECG within of patient contact when an acute coronary syndrome (ACS) is suspected. A. 10 minutes B. 30 minutes C. 45 minutes D. 60 minutes Q16. When the patient’s 12-lead ECG is reviewed, the results should be used to classify the patient into one of three groups.Which of the following correctly reflects these categories? A. ST elevation (STE), normal ECG, Q waves B. Q waves, ST depression (STD), inconclusive ECG C. STD, normal ECG, inconclusive ECG D. STE, STD, normal or nondiagnostic ECG View Correct Answer Answer Key: C Q17. A 12-lead ECG has been obtained. The patient’s 12-lead ECG shows: A. STE in leads II, III, and aVF. B. STD in leads I, II, III, and aVL. C. STE in leads I, aVL, and V2 to V6. D. STD in leads V1, V4, V5, and V6. View Correct Answer Answer Key: A A. Aspirin and NTG B. Aspirin and a nonsteroidal antiinflammatory drug (NSAID) C. An oral beta-blocker and an NSAID D. Aspirin and a calcium channel blocker (CCB) Q22. NTG has been ordered for administration to this patient. NTG: A. Is contraindicated in hypotensive patients. B. Should be administered via the IV route for maximum benefit. C. Should be used with caution in patients with anterior infarction. D. Should be given every 15 to 20 minutes until chest discomfort is relieved. Q23. The patient’s chest discomfort was unrelieved after the maximum recommended dosage of NTG tablets. Morphine sulfate was ordered and a 4 mg dose was given IV. The patient’s BP is now 80/60 mm Hg and his skin is cool, moist, and pale. His breath sounds are clear. You should: View Correct Answer Answer Key: A View Correct Answer Answer Key: C View Correct Answer Answer Key: A A. Prepare a lidocaine infusion at 1 to 4 mg/min. B. Prepare an epinephrine infusion at 2 mcg/min. C. Give a 250 mL IV fluid bolus of normal saline. D. Prepare a dopamine infusion at 2 to 10 mcg/kg/min. Q24. Which of the following is not recommended when performing defibrillation? A. Check for a pulse immediately after defibrillation to determine next steps. B. Visually check and ensure that everyone is clear of the patient before shock delivery. C. Remove transdermal medication patches or ointment from the patient’s chest before the procedure. D. All team members with the exception of the chest compressor should clear the patient as the machine charges. View Correct Answer Answer Key: A Q25. Atypical symptoms of ACSs are more common in: A. Older adults, women, and diabetic individuals. B. Men, older adults, and individuals who have liver disease. C. Women, diabetic individuals, and individuals who have liver disease. D. Men, patients who have a history of coronary artery disease, and patients who have a history of hypertension. Q26. A 53-year-old woman is unresponsive. The cardiac monitor initially showed a narrow-QRS tachycardia at 220 beats/min. Her BP was 50 mm Hg by palpation and her ventilatory rate was 10 breaths/min. Supplemental oxygen therapy was initiated and an IV established before the patient’s collapse. You promptly delivered a synchronized shock. Reassessment reveals the patient is not breathing and has no pulse. The cardiac monitor now reveals the rhythm shown. What course of action should you take at this time? A. Defibrillate immediately. View Correct Answer Answer Key: B View Correct Answer Answer Key: C Q29. Which of the following is incorrect with regard to the events of a typical resuscitation effort? A. The team leader should state his or her instructions one at a time. B. The team leader should encourage a respectful exchange of ideas. C. Team members must be knowledgeable about current resuscitation algorithms. D. Team members should be encouraged to confer among themselves throughout the resuscitation effort. Q30. Which of the following statements is correct about the use of medications during cardiac arrest? A. Amiodarone is the drug of choice for cardiac arrest resulting from asystole. B. Lidocaine is contraindicated in cardiac arrest associated with a shockable rhythm. C. Epinephrine should be given as soon as feasible after the onset of cardiac arrest associated with a nonshockable rhythm. D. Vasopressin can be substituted for either the first or second dose of epinephrine in the treatment of cardiac arrest. View Correct Answer Answer Key: B Q31. This 12-lead ECG is from a 50-year-old man complaining of chest discomfort. Which of the following is true regarding this 12-lead ECG? A. This 12-lead reveals no significant findings. B. STE is present in leads V1 to V4. An anterior STEMI is suspected. C. STE is present in leads I, aVR, and V6. A lateral STEMI is suspected. D. STD is present in leads III and aVF. An inferior STEMI is suspected. View Correct Answer Answer Key: D Questions 32 and 33 pertain to the following scenario A 65-year-old man is complaining of a sudden onset of dizziness. He is awake, alert, and diaphoretic. The patient states that his symptoms began 45 minutes ago while cleaning his garage. He denies chest pain, shortness of breath, and nausea. The patient’s breath sounds are clear bilaterally. His BP is 78/50 mm Hg, ventilations 18 breaths/min. His SpO2 on room air is 96%. Q32. The cardiac monitor reveals the following rhythm. This rhythm is: A. Junctional rhythm. B. Sinus bradycardia. C. Third-degree atrioventricular (AV) block. D. Second-degree AV block (2:1 AV block). View Correct Answer Answer Key: B This rhythm can best be described as a: A. Regular, polymorphic, wide-QRS tachycardia. B. Regular, monomorphic, wide-QRS tachycardia. C. Irregular, polymorphic, wide-QRS tachycardia. D. Irregular, monomorphic, wide-QRS tachycardia Q36. Which of the following statements is true with regard to the management of this patient? A. The patient is unstable. Sedate the patient and defibrillate as quickly as possible. B. The patient is stable. Administration of IV verapamil is recommended for termination of the rhythm. C. The patient is stable. Administration of IV adenosine can be used as a therapeutic and diagnostic maneuver. D. The patient is unstable. Because there are recognizable QRS complexes on the monitor, synchronized cardioversion should be performed. Questions 37 and 38 pertain to the following scenario A 72-year-old woman presented with a sudden onset of shortness of breath and collapsed. After confirming the patient was unresponsive, apneic, and pulseless, CPR was begun. View Correct Answer Answer Key: C Q37. The cardiac monitor shows the following rhythm. Which of the following ACLS treatment guidelines should be used in the initial treatment of this patient? A. Symptomatic bradycardia B. Narrow-QRS tachycardia C. Pulseless electrical activity (PEA) D. ACSs Q38. An IV has been established and the patient is being ventilated with a bag-mask device (BMD). You observe gentle bilateral chest rise with ventilations. Your next action should be to: A. Defibrillate immediately. B. Give 0.5 mg of atropine IV. View Correct Answer Answer Key: C C. Give 1 mg of epinephrine IV. D. Begin transcutaneous pacing. View Correct Answer Answer Key: C Q39. A 73-year-old woman presents with symptoms of acute stroke 3.5 hours after symptom onset. She has a history of an acute MI 6 years ago, chronic atrial fibrillation, and diabetes mellitus. The patient’sBPis 168/100 mmHg, her heart rateis 88 to 100 beats/min, and her ventilations are 12 breaths/min. Her National Institutes of Health Stroke Scale (NIHSS) score is 22. Daily medications include lisinopril, metformin, and warfarin. Which of the following statements with regard to fibrinolytic therapy for this patient is true? A. This patient is not a candidate for fibrinolytic therapy because of her age. B. This patient is not a candidate for fibrinolytic therapy because she is hypertensive. C. This patient is not a candidate for fibrinolytic therapy because she is taking an oral anticoagulant. D. This patient is not a candidate for fibrinolytic therapy because too much time has lapsed between symptom onset and hospital arrival. Q40. Which of the following is true with regard to procainamide? View Correct Answer Answer Key: C Q44. If a patient wakes from sleep or is found with symptoms of a stroke, the time of onset of symptoms is defined as the time: A. Of awakening. B. The patient retired for sleep. C. The patient was last known to be symptom-free. D. The patient was last seen by a health care professional. Q45. The most common adverse effects of giving amiodarone are: A. Nausea and asystole. B. Bradycardia and hypotension. C. Tachycardia and hypertension. D. Blurred vision and abdominal pain. View Correct Answer Answer Key: A View Correct Answer Q46. A 49-year-old man is found unresponsive, not breathing, and pulseless. The cardiac monitor reveals monomorphic ventricular tachycardia. The most important actions in the management of this patient are: A. CPR and defibrillation. B. Defibrillation and resuscitation medications. C. CPR and prompt insertion of an advanced airway. D. Synchronized cardioversion and resuscitation medications. Q47. Diltiazem may be used: A. Concurrently with IV beta-blockers. B. In the management of symptomatic bradycardia. C. In the management of a stable patient with a wide-QRS tachycardia. D. To control the ventricular rate with atrial flutter or atrial fibrillation. View Correct Answer Answer Key: B View Correct Answer Answer Key: D View Correct Answer Answer Key: B Q48. CPR is ongoing for a 66-year-old man in cardiac arrest. The cardiac monitor reveals asystole. Vascular access has been achieved and an advanced airway has been inserted. Which of the following statements is correct with regard to this situation? A. The depth of chest compressions should be 1.5 to 2 inches. B. Chest compressions should be delivered at a rate of 100 per minute. C. The ratio of chest compressions to ventilations delivered should be 30:2. D. Ventilations should be delivered at a rate of one breath every 6 seconds. Q49. What precautions should be taken before giving NTG? A. Make sure the patient’s heart rate is at least 70 beats/min. B. Make sure there is no evidence of a right ventricular infarction. C. Make sure the patient’s systolic BP is more than 140 mm Hg. D. Make sure the patient has not used a diuretic or an antihypertensive medication in the past 24 hours. most reliable for ETT placement 35-45 mmHg What is full chest recoil important? - CORRECT ANSWER Starlings law - as the chest recoils we are using elastic heart muscle to create neg pressure creates a pump in the heart creating systemic BP drives rest of blood back into heart for each compression What is the first step when using an AED? - CORRECT ANSWER turn it on What is the 2nd step when using an AED - CORRECT ANSWER listen to it and follow the instructions What is a team leaders first responsibility - CORRECT ANSWER managing the team - clear roles and responsibilities What is ventilation rate and frequency for the adult patient with a pulse? What happens to the heart rate in a patient with severe hypoxia? (respiratory arrest) - CORRECT ANSWER w/ pulse = rescue breathing, 1 breath every 6 seconds, 10 breaths per minute hypoxia - bradycardia initially What type of patient requires oral pharyngeal airway? When is it appropriate to place? - CORRECT ANSWER unconscious/unresponsive no gag reflex After ROSC, what is the target PETCO2 reading? - CORRECT ANSWER 35-45 mmHg What is the ventilation rate on the pulseless patient after advanced airway placement? Do you pause compressions during ventilation with ETT? - CORRECT ANSWER (no advanced airway 30:2) advanced airway - 1 breath every 6 seconds, 10 times per minute Agonal breathing may indicate what? - CORRECT ANSWER cardiac arrest (brainstem breathing) (ex: almost dead fish breathing on the dock) (ON TEST) What is the easiest way to open the airway of a patient who isnt breathing? - CORRECT ANSWER least intrusive - head tilt chin lift intrusive - (c spine injury or unsure) jaw thrust Correct treatments for unstable bradycardia - CORRECT ANSWER APP A - atropine, 1 mg q3-5 mins up to 3 mg, anticholinergic med working on parasympathetic side therefore competitive antagonist - normalizes HR (unresolved vagal tone) P - pacing, transcutaneous (pads placed on chest, same as defibrillation placement) P - pressers, epi 2-10 mcg/min, DA 5-20 mcg/kg/min, they are equal and accomplish same goal (faster and safer = DA per instructor, premixed) (epi grows bacteria if pre mixed, has to be mixed during code) What is true about PR interval in second degree type 2 block? - CORRECT ANSWER consistent PR, every P wave is there but they dont always have QRS What is true about PR interval in second degree type 1 block? - CORRECT ANSWER continuing prolongation, longer longer longer drop now you have a Weinkibach Relationship between the p wave and QRS in 3rd degree or complete heart block - CORRECT ANSWER there is no relationship, they are working independently from each other What is the most common cause of bradycardias? - CORRECT ANSWER hypoxia What is the preferred med route for pulseless pt? 2nd choice? - CORRECT ANSWER IV - antecubital fossa IO is second choice - same fluid rate as a central line When during the CPR cycle should meds be given? - CORRECT ANSWER while youre doing chest compressions, early during the cycle! Need to be early to circulate the meds through the circulatory system What is the first drug all pulseless patients get? Dose? - CORRECT ANSWER epinephrine 1 mg every 3-5 mins What is the second drug given for pulseless VT or VF rhythms, dose, freq - CORRECT ANSWER amiodarone 300 mg 1st, 150 mg 2nd, 3-5 mins inbetween max - 450 mg IV push, half life 2 mths OR lidocaine 1-1.5 mg/kg, every 5 mins, give 1/2 dose again, but dont exceed 3mg/kg in total What antiarryhtmic is recommended for polymorphic VT or torsades, dose - CORRECT ANSWER magnesium sulfate 1-2 g in D5W 5-20 mins drip realistically placed in syringe and pushed, IVP (real life 2 g push) What diagnostic tool should we use to first screen stable SVT, what is the recommended treatment for stable SVT, unstable SVT? - CORRECT ANSWER diagnostic stable VT - 12 lead EKG tx stable VT - drugs (adenosine 6 mg (dx), then 12 mg (therapeutic) if not working, then non dihydro CCB) vagal maneuver (face in bucket of cold water, asking patient to bear down - blow through coffee stir straw) tried adenosine, tried vagal maneuvers - seek expert consult tx unstable VT - synchronized cardioversion 100 J expert consult everything else: labs, CXR (trauma from CPR, ETT depth (BEST WAY TO CHECK IS WAVEFORM CAPNOGRAPHY - ON TEST) , check for pnathorax), ABG (vent setting, acid base balance) What BP reading is the target for ROSC - CORRECT ANSWER minimal systolic 90 (anything less unstable) If the BP reading after ROSC is less than the target what is the initial treatment? 2nd tx? - CORRECT ANSWER give 1-2 L saline quickly if that doesnt work then admin vasopressors If a patient is non responsive or not following commands what is the recommended treatment and for how long? What is the target temp range? - CORRECT ANSWER TTM 32-36 C at least 24 hrs If the 12 lead ECG shows ST elevation what is the tx plan? - CORRECT ANSWER OANM ultimate goal PCI Excessive (hyper) ventilation can lead to what? - CORRECT ANSWER decreased cerebral perfusion and decreased CO After ROSC what is the risk of extended over oxygenation - CORRECT ANSWER O2 toxicity If out of hospital arrest what kind of hospital should patient be transported to - CORRECT ANSWER PCI capable (cath lab) What electric therapy can be used for unstable bradycardia? - CORRECT ANSWER transcutaneous pacing Synch cardioversion can be used on what rhythms and what joules for each? - CORRECT ANSWER unstable tachys everything 100J, afib is the exception 200J defibrillation is actually unsynchronized cardioversion Safe defibrillation includes what steps - CORRECT ANSWER eyes on patient visualize clear verbally clear when you hear clear put up JAZZ HANDS! What should your action be immediately following defibrillation - CORRECT ANSWER high quality chest compressions Can an AED be used on a patient who is lying in the snow - CORRECT ANSWER yes How often should we defib a patient that remain in pulseless VT or VF? Should we ever delay defib to give meds? - CORRECT ANSWER every 2 mins NO What is the purpose of a rapid response team - CORRECT ANSWER early identification of clinical deterioration and early treatment of clinically unstable patient (KNOW) Where in the rhythm is the shock delivered in synchronized cardioversion - CORRECT ANSWER peak of R wave What is the door to reperfusion time in STEMI - CORRECT ANSWER 90 minutes What is MONA (OANM)? Doses - CORRECT ANSWER O - O2, 94% (ACS 90% - avoid O2 toxic before reperfusion), 2L nasal cannula if needed A - ASA 162-325 mg chewed non enteric coated N - NTG 0.4 mg SL spray or dissolving pills, up to 3x, be careful about BP (vasodilator) (contraindications - hypotension, PDE5i w/in 24 hrs or 48 hrs ER, right sided infarct-need adequate systemic BP, right side EKG to determine) M - morphine, dont need if ASA and NTG manage pain, only if pain is not managed What assessment tool is a priority in patient's with chest pain - CORRECT ANSWER 12 lead EKG What are the contraindications to NTG admin in patients with chest pain - CORRECT ANSWER contraindications - hypotension, PDE5i w/in 24 hrs or 48 hrs ER, right sided infarct-need adequate systemic BP, right side EKG to determine What are the contraindications to ASA - CORRECT ANSWER bleeding of some kind (ex - ulcers, brain bleed, etc.) What is common symptom of ACS - CORRECT ANSWER ACS - chest pain and SOB (same for MI) What is the difference between stable and unstable angina? - CORRECT ANSWER BP What is the most important info needed on a patient with stroke symptoms? - CORRECT ANSWER time of symptom onset What is the window of opportunity for fibrinolytic therapy in the CVA patient? - CORRECT ANSWER 3-4.5 hours 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? - CORRECT ANSWER *Epinephrine 1 mg IV/IO* *Transcutaneous Pacing* - CORRECT 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*? - CORRECT 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*? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER Administer *adenosine 6 mg* IV push A patient with possible STEMI has ongoing chest discomfort. What is a *contraindication to nitrate* administration? - CORRECT ANSWER Use of a *phosphodiesterase inhibitors* (eg. Viagra) within the previous 24 hours A patient is in *pulseless V-tach* (PEA). 2 shocks and 1 dose of epinephrine have been given. Which drug should be given next? - CORRECT ANSWER *Amiodarone 300 mg* (first dose) What is the indication for the use of *magnesium* in cardiac arrest? - CORRECT ANSWER Pulseless V-tach associated with *Torsades des pointes* Which is one way to minimize interruptions in chest compressions during CPR? - CORRECT ANSWER Continue CPR while the defibrillator charges A 35-years-old woman has palpitations, light-headedness, and a stable *tachycardia*. The monitor shows a *regular-narrow-monomorphic-complex QRS* at a rate of 180/minutes. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? - CORRECT ANSWER *Adenosine 6 mg* (first dose) Antiarrhythmic *Infusion* for Stable Wide-QRS Tachycardia: - CORRECT ANSWER 1) Procainamide IV: 20 (max 50) mg/min; 2) Amiodarone IV: 150mg/10 min.; 3) Sotalol IV: 100 mg/5 min.; A 57-years-old woman has palpitations, chest discomfort, and *tachycardia*. The monitor shows a *regular wide-complex QRS* at a rate of 180/min. She becomes diaphoretic, and her BP is 80/60 mm Hg. Which action do you take next? - CORRECT ANSWER Perform *Synchronized Cardioversion* at 100J ROSC - CORRECT ANSWER Return to spontaneous circulation after BLS. A patient is in *refractory V-fib* and has received multiple appropriate defibrillation shocks; Epinephrine 1 mg IV twice; An initial dose of amiodarone 300 mg IV. The patient is intubated. Which best describes the recommended (IV) *2nd dose of amiodarone* for this patient? - CORRECT ANSWER *150 mg* (half); You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds *asystole*. After resuming high-quality compressions, which action do you take next? - CORRECT ANSWER Establish IV or IO access You are caring for a 66-years-old man with a history of a large intracerebral hemorrhage two months ago. He is being evaluated for another acute stroke. The CT scan is *negative for hemorrhage*. The patient is receiving oxygen via nasal cannula at 2L/min., and an IV has been established. His blood pressure is *180/100 mm Hg*. Which drug do you anticipate giving to this patient? - CORRECT ANSWER *Aspirin* A patient is in *refractory V-fib*. What can cause PVCs? - CORRECT ANSWER Stress, exhaustion, alcohol, caffeine, cocaine, methamphetamines, nicotine, etc.; Life Pack - CORRECT 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? - CORRECT 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? - CORRECT ANSWER Vagal maneuvers Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation? - CORRECT 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? - CORRECT 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? - CORRECT 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. Which action do you take next? - CORRECT ANSWER Start high-quality *CPR* Your patient is not responsive and is not breathing. You can detect a palpable *carotid pulse*. Which action do you take next? - CORRECT ANSWER Start *rescue breathing* 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 of this patient? - CORRECT ANSWER Check the patient's breathing and pulse What is an effect of *excessive ventilation*? - CORRECT ANSWER Decreased cardiac output Which is one of the signs that is likely indicative of cardiac arrest in an unresponsive patient? - CORRECT ANSWER Agonal gasps Chest compression will produce a ______ end-tidal CO2 - CORRECT ANSWER low PETCO2 reading > 45 mm Hg suggests __________. - CORRECT ANSWER hypoventilation or asthma, COPD To proper ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? - CORRECT ANSWER Once every 5-6 seconds Which is an *acceptable* method of selecting an appropriate sized oropharingeal airway? - CORRECT ANSWER Measure from the corner of the mouth to the angle of the mandible. Which is one way to minimize interruptions in chest compression during CPR? - CORRECT ANSWER Continue CPR while the defibrillation charges What is the *minimum systolic pressure* one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves ROSC? - CORRECT ANSWER *90mm Hg* In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? - CORRECT ANSWER Continuous Waveform Capnography (35-37mm Hg) 3 minutes into a cardiac resuscitation attempt, one member of your team inserts an endothracheal tube while another performs chest compression. Capnography shows a persistent waveform and a *PETCO2 of 8mm Hg*. Which is significance of this finding? - CORRECT ANSWER Chest compression may not be effective. Contraindication for amiodarone adminstration - CORRECT ANSWER A-fib exceeding 48hrs of duration • It effects Na+, K+ and Ca+ channels and α and β blockers; • Lowers defibrillation threshold; Average *HR* (bpm) - CORRECT 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) - CORRECT ANSWER More than 120 over 80 and less than 140 over 90 (*120/80*-*140/90*) Average *respiratory rate* for adults - CORRECT 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 - CORRECT ANSWER P = ↑1:1; HR < 60; QRS = narrow; *Sinus Tachycardia* on the ECG - CORRECT 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? - CORRECT 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 - CORRECT ANSWER P = ↑1:1; HR = reg. 60-100; *QRS = wide*; *V-fib* on the ECG - CORRECT ANSWER P = ∅; HR = IRR. Chaotic; QRS = ∅ (Shock needed!) *A-fib* on the ECG - CORRECT ANSWER *P = fibrillating*; HR = IRR. AR too fast to measure: (≤100 controlled, ≥100 uncontrolled); *QRS = narrow*; *A-flutter* - CORRECT ANSWER P = fluttering; HR = A Reg. (250-350) and V?; QRS = narrow; *SVT* on the ECG - CORRECT 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*. The patient is experiencing *SOB*, a *BP of 68/50 mmHg*, and *HR of 190/min*. The patient lead II ECG displays the rhythm in the picture. Which best characterizes this patient's rhythm? - CORRECT ANSWER Unstable SVT SR with *1st degree AV block* on the ECG - CORRECT ANSWER P = ↑1:1; HR = reg. 60-100; PR = *wide > .20*; QRS = narrow; *2nd degree AV block type I* on the ECG - CORRECT ANSWER P↑ > QRS; HR = A. reg. V. irr.; *PR = long, longer, longer...drop!*; QRS = narrow; *2nd degree AV block type II* on the ECG - CORRECT ANSWER P↑ > QRS; HR = reg. 60-100; QRS = narrow/wide; *PR = when related with QRS, it's constant*; *3rd degree AV block* on the ECG - CORRECT ANSWER P↑ > QRS, *unrelated*; HR = A reg. V?; PR = non measurable; *Synchronized Electrical Cardioversion* - CORRECT 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* - CORRECT 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): - CORRECT 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 _____________; - CORRECT 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? - CORRECT ANSWER *150 bpm* (60/0.4=150) • Rate > 100 bpm with gradual onset • P to QRS ratio 1:1 - CORRECT ANSWER Tachycardia Which are known as the precordial leads? - CORRECT ANSWER V1-V6 Which rate is equivalent to an interval of 800 ms (*0.8 s*)? - CORRECT ANSWER 60/0.8 = *75 bpm* Which of the following are considered normal durations for the PR and QRS intervals? - CORRECT ANSWER PR = 150 ms; QRS = 80 ms; Which structure accounts for most of the duration of the PR interval? - CORRECT ANSWER AV node The normal glucose level, during fasting, for non-diabetic patients is _______. - CORRECT ANSWER 70-100mg/dL After FAST - CORRECT 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 - CORRECT ANSWER True Fibrinolytic Therapy is recommended within 3 hrs from stroke onset: T/F - CORRECT 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 - CORRECT ANSWER True When stroke is suspected, check glucose level: T/F - CORRECT ANSWER True If hemorrhage is present on CT scan, fibrinolytic Therapy is recommended: T/F - CORRECT ANSWER False Possible causes for stroke - CORRECT ANSWER 1) Diabetes; 2) HTN; 3) Hypercholesterolemia; 4) Family History; Hyperglycemia - CORRECT ANSWER blood glucose level >6.0 mmol/L (*>108 mg/dL*),