FINAL EXAM ACLS| 48 QUESTIONS AND ANSWERS

A patient experiences cardiac arrest, and the resuscitation team initiates ventilations using a bag-valve-mask (BVM) resuscitator. The development of which condition during the provision of care would lead the team to suspect that improper BVM technique is being used? Select the correct answer to this question. Rib fracture Esophageal injury Pneumothorax Hypertension Pneumothorax 1 A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member follows each medication administration with a bolus of fluid. How much would the team member give? Select the correct answer to this question. 5 to 10 mL 10 to 20 mL 20 to 30 mL 30 to 40 mL When administering medications during a cardiac arrest, all medications administrated through the IV or intraosseous infusion route should be followed by a 10- to 20-mL fluid bolus. The resuscitation team suspects that hyperkalemia is the cause of cardiac arrest in a patient brought to the emergency department. Which finding on a 12-lead ECG would confirm this suspicion? Wide-complex ventricular rhythm and tall, peaked T waves ST-segment changes, T-wave inversion Flat T waves, prominent U waves and possibly prolonged QT intervals Narrow-complex ventricular tachycardia Wide-complex ventricular rhythm and tall, peaked T waves In hyperkalemia the patient's 12-lead ECG rhythm strip will show wide-complex ventricular rhythm and tall, peaked T waves. A patient with an ischemic stroke arrives at the emergency department at 2 a.m. The patient's symptoms started about 12:30 a.m. After completing the necessary assessments, the healthcare team diagnoses an ischemic stroke, and the patient is determined to be a candidate for fibrinolytic therapy. To achieve the best outcomes, the team should initiate therapy for this patient no later than by which time? Select the correct answer to this question. 3:00 a.m. 5:30 a.m. 6:00 a.m. 8:30 a.m. 1 3:00 a.m. A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced cardiac life support was initiated. The patient required the placement of an advanced airway to maintain airway patency. Which statement indicates that the team performed high-quality CPR? Select the correct answer to this question. "We kept the rate of chest compressions to around 100 per minute but adjusted their depth to 1.5 inches while giving 1 ventilation every 3 seconds." "We delivered chest compressions at a rate of 80 to 100 per minute to a depth of at least 2 inches and gave 1 ventilation every 6 seconds." "We initiated chest compressions at a rate of 100 to 110 per minute to a depth of 2.4 inches and then gave 1 ventilation every 10 seconds." "We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute." 4 "We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute." A patient with a suspected stroke arrives at the emergency department at 7:10 p.m. The stroke team ensures that a comprehensive neurologic assessment using the National Institutes of Health Stroke Scale (NIHSS) is completed and that brain imaging is performed by which time? 7:20 p.m. 7:30 p.m. 7:40 p.m. 7:50 p.m. 2 Within 20 minutes of the patient's arrival, a comprehensive neurologic assessment should be completed and brain imaging should be performed. That would be 7:30 p.m. for this patient. The emergency department team is providing care to a patient who is experiencing ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the patient's current condition. Which electrolyte imbalance(s) would most likely be involved? Select all correct options that apply. Hyperkalemia Hypochloremia Hypernatremia Hypomagnesemia Hypocalcemia Hypomagnesemia Hypocalcemia A 30-year-old patient has been brought to the emergency department in cardiac arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm would suggest which of the following as a possible precipitating factor? The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation include electrocution, myocardial ischemia or infarction, shock, stimulant overdose and ventricular tachycardia. electrocution A patient enters the emergency department in respiratory compromise. The team is monitoring the patient using capnography and identifies that ETCO2 levels are initially 33 mmHg and later 40 mmHg. From these readings, the team identifies that the patient is progressing in what stage of respiratory compromise? Respiratory acidosis Respiratory failure Respiratory distress Respiratory arrest 3 Capnography can objectively assess the severity of a patient's respiratory distress. Early on, the patient will often hyperventilate, leading to hypocapnia that is reflected by a low ETCO2 value (less than 35 mmHg). As respiratory distress increases, and the patient begins to tire, the ETCO2 value may return to the normal range (35 to 45 mmHg). However, if the patient progresses to respiratory failure, the ETCO2 level will increase to greater than 45 mmHg, which indicates hypoventilation. A patient comes to the emergency department complaining of palpitations and "some shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm strip. The provider interprets this strip as indicating which arrhythmia? Atrial fibrillation Ventricular tachycardia Ventricular fibrillation Atrial flutter Atrial flutter A patient is experiencing respiratory distress secondary to an exacerbation of chronic obstructive pulmonary disease. The patient begins to exhibit signs and symptoms of worsening respiratory function and experiences respiratory arrest. The team intervenes, delivering ventilations via BVM resuscitator. The team would deliver 1 ventilation at which interval? Every 3 to 4 seconds Every 5 to 6 seconds Every 7 to 8 seconds Every 8 to 9 seconds The team would deliver 1 ventilation every 5 to 6 seconds. Each ventilation should last about 1 second and make the chest begin to rise. Assessment of a patient in the emergency department reveals that the patient is experiencing respiratory compromise. From the assessment, the team identifies that the patient is in the earliest stage of this condition. Which stage would this be? Select the correct answer to this question. Respiratory distress Respiratory arrest Respiratory acidosis Respiratory failure Respiratory distress Respiratory compromise occurs along a continuum, beginning with respiratory distress, progressing to respiratory failure and then to respiratory arrest After cardiac arrest and successful resuscitation, the patient has a return of spontaneous circulation. The patient is unable to follow verbal commands. Targeted temperature management is initiated. Which method(s) would be appropriate for the resuscitation team to use? Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Administering cool-mist oxygen therapy Applying a cool compress to the patient's forehead Using an endovascular catheter Giving an ice-cold IV fluid bolus Applying cooling blankets to the patient's body Using an endovascular catheter A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. The history reveals that before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause? Select the correct answer to this question. Tension pneumothorax Cardiac tamponade Acidosis Hypothermia Tension pneumothorax Prearrest signs of tension pneumothorax in the advanced stage include jugular venous distension, cyanosis, apnea and hyperresonance on percussion. Difficulty ventilating the patient may also be a sign of tension pneumothorax. A 40-year-old patient in the waiting room of the primary care provider's office approaches a staff member and says, "I'm having really severe, crushing chest pain that is moving to both my arms." The patient is diaphoretic and dyspneic. Which action would be appropriate for the staff member to take? Activate the emergency medical services system. Take the patient to an exam room immediately. Give the patient an aspirin. Obtain a 12-lead ECG. Activate the emergency medical services system. A patient with dyspnea and a change in mental status arrives at the emergency department. The healthcare team completes the necessary assessments and begins to care for the patient, including initiating cardiac monitoring and pulse oximetry; providing supplemental oxygen and ensuring adequate ventilation; and obtaining vascular access. The team reviews the patient's ECG rhythm strip, as shown in the following figure. Which agent would the team most likely administer? Amiodarone 150 mg over 10 minutes Atropine 0.5 mg every 3 to 5 minutes Dopamine 5 to 10 mcg/min Epinephrine 2 to 10 mcg/min Atropine 0.5 mg every 3 to 5 minutes A patient is brought to the emergency department by their spouse. The spouse says, "I think it's a stroke." The stroke team assesses the patient using the National Institutes of Health Stroke Scale (NIHSS). Which area(s) would the team include in this assessment? Select all correct options that apply. Facial palsy Level of consciousness Language deficits Visual function Cranial nerve function Level of consciousness Language deficits Visual function A patient is brought into the emergency department with a suspected opioid overdose. The patient is in cardiac arrest. Which action would be the team's priority? Select the correct answer to this question. Giving naloxone intravenously (IV) Obtaining a 12-lead electrocardiogram (ECG) Administering supplemental oxygen Initiating high-quality CPR Initiating high-quality CPR Although no evidence supports any benefit to naloxone administration during cardiac arrest, administration of naloxone during both respiratory and cardiac arrest is recommended when opioid overdose is suspected. However, for a patient in cardiac arrest, high-quality CPR is prioritized over the administration of naloxone. A patient with a diagnosis of ACS is experiencing cardiogenic shock. Which adjuvant therapy would be contraindicated? Select the correct answer to this question. Direct thrombin inhibitor β-Blockers Glycoprotein IIb/IIIa inhibitors Heparin β-Blockers The use of β-blockers is contraindicated in patients who are at risk for cardiogenic shock, low cardiac output and acute heart failure. A member of the resuscitation team is preparing to defibrillate a patient in cardiac arrest using a biphasic defibrillator. The team member would set the energy dose according to the manufacturer's recommendations, which is usually: Select the correct answer to this question. 100 to 150 joules 120 to 200 joules 300 joules 360 joules 120 to 200 joules When using a biphasic defibrillator, the energy dose should be set at 120 to 200 joules A patient in cardiac arrest experiences return of spontaneous circulation. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation. Which finding(s) would indicate the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation? Select all correct options that apply. PaCO2 35 mmHg SaO2 96% SaO2 92% ETCO2 50 mmHg ETCO2 40 mmHg PaCO2 35 mmHg SaO2 92% ETCO2 50 mmHg