Download AHA ACLS TEST EXAMS WITH ACTUAL CORRECT QUESTIONS and more Exams Nursing in PDF only on Docsity! AHA ACLS TEST EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED RATIONALES ANSWERS ALREADY GRADED A+ LATEST UPDATE 2024 GUARANTEED PASS !!! A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action? Administer 2 to 4 mg of morphine by slow IV bolus Administer Oxygen and Drugs: Morphine Which finding is a sign of ineffective CPR? PETCO2 <10 mm Hg Physiologic Monitoring During CPR A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? Obtain a 12-lead ECG and administer aspirin if not contraindicated. EMS Assessment, Care, and Hospital Preparation A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG? Seeking expert consultation. Application of the Tachycardia Algorithm to the Stable Patient: Wide (Broad)-Complex Tachycardias EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the rhythm strip shown above. What is the most important early intervention? (V-fib) Defibrillation Principle of Early Defibrillation A patient with pulseless ventricular tachycardia is defibrillated. What is the next action? Start chest compressions at a rate of at least 100/min. Resume CPR Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? Intraosseous (IO) Routes of Access for Drugs What is the recommended compression rate for performing CPR? At least 100 per minute (100-120) The BLS Survey You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action? Have a team member attempt to palpate a carotid pulse. Rhythm Check What is the most appropriate intervention for a rapidly deteriorating patient who has the lead II ECG shown above? Synchronized cardioversion Indications for Cardioversion What is the appropriate rate of chest compressions for an adult in cardiac arrest? At least 100/min. Not approximately 120/min. The BLS Survey A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm above. What is the appropriate next intervention? (Wide, regular Tachycardia with a Pulse) What is the first step when using an AED? turn it on What is the 2nd step when using an AED listen to it and follow the instructions What is a team leaders first responsibility 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 bradycardia initially rate in a patient with severe hypoxia? (respiratory arrest) w/ pulse = rescue breathing, 1 breath every 6 seconds, 10 breaths per minute hypoxia - What type of patient requires oral pharyngeal airway? When is it appropriate to place? unconscious/unresponsive no gag reflex After ROSC, what is the target PETCO2 reading? 35-45 mmHg What is the ventilation rate on the pulseless patient after advanced airway placement? Do you pause compressions during ventilation with ETT? (no advanced airway 30:2) advanced airway - 1 breath every 6 seconds, 10 times per minute Agonal breathing may indicate what? 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? least intrusive - head tilt chin lift intrusive - (c spine injury or unsure) jaw thrust Correct treatments for unstable bradycardia 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? 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? 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 there is no relationship, they are working independently from each other What is the most common cause of bradycardias? hypoxia What is the preferred med route for pulseless pt? 2nd choice? IV - antecubital fossa IO is second choice - same fluid rate as a central line When during the CPR cycle should meds be given? 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? epinephrine 1 mg every 3-5 mins What is the second drug given for pulseless VT or VF rhythms, dose, freq 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 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? 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 What is the recommended treatment for stable VT with a pulse? For unstable VT with a pulse? stable VT - meds (amiodarone 150 mg bolus in 100 mL of D5 over 10 mins, can repeat over 10 mins, maintenance 1 mg per min for 6 hours) unstable VT - synchronized cardioversion at 100 J What is the first treatment option for all unstable bradycardias and blocks? atropine 1 mg every 3-5 mins, max 3 mg How is closed loop communication used in med admin during a code? What to do if told to give wrong dose/med? person running the code state the drug they want, repeated out loud by the person giving it SAY SOMETHING List the 5 Hs and 5 Ts H's: hypoxia, hypovolemia (#1 cause), hypothermia, hydrogen ion excess (acidotic - anaerobic cellular respiration - krebbs), hypoglycemia, hypo/hyper kalemia T's: tension pneumothorax, toxin (MC non cardiac related issue), tamponade, thrombosis (PE, coronary - heart attack) What is the most frequent cause of PEA/Asytole hypovolemia What is PEA pulseless electrical activity, any non ventricular organized electrical rhythm without a pulse (ex - second degree type 2 heart block w/o pulse, SVT w/o pulse, etc!) How do you confirm a patient is really in asytole check the pulse of the patient change the lead on the monitor -check in a second lead If your patient has persistent asystole after continuous CPR for 10 mins and several doses of epi, what discussion might be appropriate? d/c efforts During a code of PeTCO2 reading of 8 could indicate what? crappy CPR (needs to be at least 10) What does a PeTCO2 reading that jumps to 35 during compressions indicate? continue to compress until 2 min cycle is over - STOP if patient wakes up patient now has pulse - CHECK THE PULSE What does ROSC stand for? Return of spontaneous circulation 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 12 lead EKG What are the contraindications to NTG admin in patients with chest pain 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 bleeding of some kind (ex - ulcers, brain bleed, etc.) What is common symptom of ACS ACS - chest pain and SOB (same for MI) What is the difference between stable and unstable angina? BP What is the most important info needed on a patient with stroke symptoms? time of symptom onset What is the window of opportunity for fibrinolytic therapy in the CVA patient? 3-4.5 hours What is the adult suspected stroke algorithim? Who uses it? B - balance E - eyes tracking F - facial droop A - arm drift S - slurred speech T - time of symptoms onset Why must non contrast head CT be done ASAP on patients with stroke symptoms, how soon should it be done and if the hospital doesnt have a working CT what should you do r/o hemorrhagic stroke needs to be done within 20 mins if not working CT - need to be transferred Heart rhythm most associated with CVA and why atrial fibrillation blood pooling and clot, those get thrown What is the max off chest time for pulseless patient <10 secs How much air do you use to ventilate your patient and what happened with over ventilation gently chest rise over ventilate causes decreased cerebral perfusion decreased VR = decreased CO What is the primary focus of the CPR coach minimize pause and coordinate the team, also can defib What is CCF, the goal and what affects it chest compression fraction compression time/code time 60-80% is the goal affected by pauses How often can you defib a patient and what rhythms every 2 mins VT, VF, torsades Best way to min interruption of compressions high quality CPR Administration of IV or IO fluid bolus Treat Hypotension (SBP <90 mm Hg) What is the recommendation of the use of cricoid pressure to prevent aspiration during cardiac arrest? Not recommended for routine use What is the danger of routinely administering high concentrations of oxygen during the post-cardiac arrest period for patients who achieve ROSC? Potential oxygen toxicity Optimize Ventilation and Oxygenation What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? 32 to 34 degrees Celsius Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient? Check the patient's pulse What is the recommended next step after a defibrillation attempt? Begin CPR, starting with chest compressions. An AED advises a shock for a pulseless patient lying in snow. What is the next action? Administer the shock immediately and continue as directed by the AED. AED Use in Special Situations What survival advantages does CPR provide to a patient in V-Fib? Produces a small amount of blood flow to the heart. Principle of Early Defibrillation A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to Administer a second shock The Cardiac Arrest Algorithm What is the recommended dose of epinephrine for the treatment of hypotension in a post-cardiac arrest patient who achieves ROSC? 0.1 to 0.5 mcg/kg per minute IV infusion Treat hypotension (SBP <90 mm Hg) Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique? Performing a head tilt-chin lift maneuver Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? Measure from the corner of the mouth to the angle of the mandible Which condition is an indication to stop or withhold resuscitative efforts? Improving patient outcomes by identifying and treating early clinical deterioration. Foundational Facts: Medical Emergency Teams (METs) and Rapid Response Teams (RRTs) Which action improves the quality of chest compressions delivered during resuscitave attemepts? 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? 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? 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? 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? 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? 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? Divert the pt. to a hospital 15 min away with CT capabilities. Foundational Facts: Stroke Centers and Stroke Units Choose an appropriate inidication to stop or withhold resuscitive efforts. Evidence of rigor morti What is your priority in care for a pulseless patient? high quality compressions early and rapid defib What is the compression to ventilation ratio for the pulseless patient without advanced airway? 30:2 How often should we switch CPR compressors? 2 mins is the longest but earlier if tired How soon should compressions be started in the pulseless patient? How long for pulse check? <10 seconds, 5-10 seconds What is the compression rate and depth? at least 2 inches, no more than 2.4 inches worried most about too shallow of a depression 100-120 rate per min no more than 2 compressions per second baby shark song rhythm Quantitive capnography be used for what 2 things? What are PETCO2 readings associated with each? effectiveness of the compressions - read expired CO2 to tell how well pt is oxygenating, how well is the patient perfusing 10 mmHg or better = effective compressions most reliable for ETT placement 35-45 mmHg What is full chest recoil important? 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? turn it on What is the 2nd step when using an AED listen to it and follow the instructions What is a team leaders first responsibility 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) 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? unconscious/unresponsive no gag reflex After ROSC, what is the target PETCO2 reading? 35-45 mmHg What is the ventilation rate on the pulseless patient after advanced airway placement? Do you pause compressions during ventilation with ETT? (no advanced airway 30:2) advanced airway - 1 breath every 6 seconds, 10 times per minute Agonal breathing may indicate what? 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? least intrusive - head tilt chin lift intrusive - (c spine injury or unsure) jaw thrust Correct treatments for unstable bradycardia 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? 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? 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 there is no relationship, they are working independently from each other What is the most common cause of bradycardias? hypoxia What is the preferred med route for pulseless pt? 2nd choice? boluses then go onto pressors) are you awake? (if unresponsive TTM - 32-36 C for at least 24 hrs) EKG 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 minimal systolic 90 (anything less unstable) If the BP reading after ROSC is less than the target what is the initial treatment? 2nd tx? 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? TTM 32-36 C at least 24 hrs If the 12 lead ECG shows ST elevation what is the tx plan? OANM ultimate goal PCI Excessive (hyper) ventilation can lead to what? decreased cerebral perfusion and decreased CO After ROSC what is the risk of extended over oxygenation O2 toxicity If out of hospital arrest what kind of hospital should patient be transported to PCI capable (cath lab) What electric therapy can be used for unstable bradycardia? transcutaneous pacing Synch cardioversion can be used on what rhythms and what joules for each? unstable tachys everything 100J, afib is the exception 200J defibrillation is actually unsynchronized cardioversion Safe defibrillation includes what steps eyes on patient visualize clear verbally clear when you hear clear put up JAZZ HANDS! What should your action be immediately following defibrillation high quality chest compressions Can an AED be used on a patient who is lying in the snow yes How often should we defib a patient that remain in pulseless VT or VF? Should we ever delay defib to give meds? every 2 mins NO What is the purpose of a rapid response team early identification of clinical deterioration and early treatment of clinically unstable patient (KNOW) Where in the rhythm is the shock delivered in synchronized cardioversion peak of R wave What is the door to reperfusion time in STEMI 90 minutes What is MONA (OANM)? Doses 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 12 lead EKG What are the contraindications to NTG admin in patients with chest pain 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 bleeding of some kind (ex - ulcers, brain bleed, etc.) What is common symptom of ACS ACS - chest pain and SOB (same for MI) What is the difference between stable and unstable angina? BP What is the most important info needed on a patient with stroke symptoms? time of symptom onset What is the window of opportunity for fibrinolytic therapy in the CVA patient? 3-4.5 hours What is the adult suspected stroke algorithim? Who uses it? B - balance E - eyes tracking F - facial droop A - arm drift S - slurred speech T - time of symptoms onset Why must non contrast head CT be done ASAP on patients with stroke symptoms, how soon should it be done and if the hospital doesnt have a working CT what should you do r/o hemorrhagic stroke needs to be done within 20 mins if not working CT - need to be transferred Heart rhythm most associated with CVA and why atrial fibrillation blood pooling and clot, those get thrown What is the max off chest time for pulseless patient <10 secs How much air do you use to ventilate your patient and what happened with over ventilation gently chest rise over ventilate causes decreased cerebral perfusion decreased VR = decreased CO What is the primary focus of the CPR coach minimize pause and coordinate the team, also can defib