ACLS FINAL STUDY GUIDE ALL VERIFIED QUESTIONS AND ANSWERS EXAM

ACLS FINAL STUDY GUIDE ALL VERIFIED QUESTIONS AND ANSWERS EXAM 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? Hypertension Esophageal injury Pneumothorax Rib fracture - Answer: Pneumothorax Complications can occur with the use of a BVM resuscitator due to improper technique. Delivering excessive volume or ventilating too fast creates excessive pressure that can damage the airways, lungs and other organs. Excessive volume can lead to tension pneumothorax. A person suddenly collapses while sitting in the sunroom of a healthcare facility. A healthcare provider observes the event and hurries over to assess the situation. The healthcare provider performs which assessment first? Rapid assessment Basic life support assessment Secondary assessment Primary assessment - Answer: Rapid assessment A systematic approach to assessment is necessary. The healthcare provider should first perform a rapid assessment. A rapid assessment is a visual survey to ensure safety, form an initial impression about the patient's condition (including looking for life-threatening bleeding), and determine the need for additional resources. This would be followed by a primary assessment and then a secondary assessment. A patient is receiving ventilation support via bag-valve-mask (BVM) resuscitator. Capnography is established and a blood gas is obtained to evaluate the adequacy of the ventilations. Which arterial carbon dioxide (PaCO2) value signifies adequate ventilations? 10 to 15 mmHg 20 to 25 mmHg 25 to 30 mmHg 35 to 45 mmHg - Answer: 35 to 45 mmHg Arterial carbon dioxide (PaCO2) values in the range of 35 to 45 mmHg confirm adequacy of ventilation. A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced 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? "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 provided chest compressions at a rate of 100 to 120 compressions per minute while giving 1 ventilation every 6 seconds without pausing compressions." "We provided chest compressions at a rate of 80 to 120 per minute to a depth of at least 2 inches and gave 1 ventilation every 6 seconds without pausing compressions." "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 without pausing compression - Answer: "We provided chest compressions at a rate of 100 to 120 compressions per minute while giving 1 ventilation every 6 seconds without pausing compressions." When an advanced airway has been placed in a patient who is in cardiac arrest, compressions should be delivered continuously (100 to 120 per minute) with no pauses for ventilations. Assessment of a patient reveals an ETCO2 level of 55 mmHg and an arterial oxygen saturation (SaO2) level of 88%. The provider would interpret these findings as indicative of which condition? Respiratory failure Respiratory arrest Cardiac arrest Respiratory distress - Answer: Respiratory failure An SaO2 level of less than 90% (PaO2 of less than 50 mmHg) accompanied by ETCO2 values greater than 50 mmHg is indicative of respiratory failure. A responsive patient is choking. What method should the provider use first to clear the obstructed airway? Back blows Abdominal thrusts Magill forceps extraction Chest compressions - Answer: Back blows To clear an obstructed airway in a responsive adult, first provide up to 5 back blows to clear the obstruction. A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of chronic obstructive pulmonary disease. Assessment reveals respiratory failure. Which action would be the initial priority to address the respiratory failure? Establishment of vascular access Delivery of supplemental oxygen via nasal cannula Assisted ventilation with BVM resuscitator Initiation of capnography - Answer: Assisted ventilation with BVM resuscitator Patients who cannot ventilate adequately despite an open airway or who have insufficient respiratory effort require assisted ventilation initially provided via a BVM resuscitator. A 20-year-old man with respiratory depression is brought to the emergency department by his parents. Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 p.m. The patient does not respond to this initial dose. The team would expect to administer a second dose after how many minutes? 2 minutes 4 minutes 6 minutes 8 minutes - Answer: 2 minutes The dose of naloxone may be repeated after 2 to 3 minutes. 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? Respiratory distress Respiratory failure Respiratory arrest Respiratory acidosis - Answer: Respiratory distress Respiratory compromise occurs along a continuum, beginning with respiratory distress, progressing to respiratory failure and then to respiratory arrest. The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured? B C D E - Answer: D The ETCO2 value is measured at the end of exhalation (point D), which represents the peak level. 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 should provide ventilations at a rate of 1 ventilation: Every 3 seconds Every 6 seconds Every 8 seconds Every 10 seconds - Answer: Every 6 seconds The team would deliver 1 ventilation every 6 seconds. Each ventilation should last about 1 second and make the chest begin to rise. 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 arrest Respiratory failure Respiratory distress Respiratory acidosis - Answer: Respiratory distress 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 is in cardiac arrest. The underlying cause is thought to be opioid toxicity. Which statement accurately describes the use of naloxone for this patient? Naloxone should be administered immediately as the first action in resuscitation at a dose of 0.4 to 2 mg and then repeated every 2 to 3 min as needed. Naloxone has not been shown to be effective for opioid toxicity once cardiac arrest has occurred. Naloxone administered via continuous IV infusion should be considered for short-acting opioid toxicity. Naloxone should be administered as soon as possible but is not a priority over high-quality CPR and AED use. - Answer: Naloxone should be administered as soon as possible but is not a priority over high-quality CPR and AED use. High-quality CPR and AED use are the priority interventions for cardiac arrest caused by suspected or known opioid toxicity. When opioid toxicity is the suspected or known cause of cardiac arrest, naloxone should be administered as soon as possible without disrupting or delaying high-quality CPR and AED use. The recommended dose of naloxone is 0.4 to 2 mg IV/IO/IM/IN/SC, repeated every 2 to 3 minutes as needed. A continuous naloxone infusion may be considered if there is the potential for recurrence of respiratory depression (for example, if the cause of the opioid toxicity was an extended-release or long- acting opioid) but is not indicated in the immediate treatment of suspected or known opioid toxicity A patient in the telemetry unit is receiving continuous cardiac monitoring. The patient has a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following figure. The provider interprets this strip as indicating which arrhythmia? Sinus tachycardia Third-degree AV block First-degree atrioventricular (AV) block Second-degree AV block - Answer: Third-degree AV block In third-degree AV block, no electrical communication occurs between the atria and ventricles, thus no relationship between P waves and QRS complexes exists. The RR interval is constant. The PP interval is constant or slightly irregular, as with sinus arrhythmia. If pacemaker cells in the AV junction simulate ventricular contraction, the QRS complexes will be narrow (less than 120 milliseconds in duration). Impulses that originate in the ventricles produce wide QRS complexes. This arrhythmia may result from damage caused by myocardial infarction. A patient with dyspnea, inadequate blood pressure 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? Epinephrine 2 to 10 mcg/min Dopamine 5 to 10 mcg/min Atropine 1 mg every 3 to 5 minutes Amiodarone 150 mg over 10 minutes - Answer: Atropine 1 mg every 3 to 5 minutes The ECG strip is showing bradycardia. Atropine is an anticholinergic drug that increases sinoatrial node firing by counteracting vagus nerve action to increase the heart rate. It is the first-line therapy for symptomatic bradycardia. A 1-mg bolus is given intravenously every 3 to 5 minutes, up to a maximum dose of 3 mg. 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 Atrial flutter Ventricular fibrillation Ventricular tachycardia - Answer: Atrial flutter In atrial flutter, atrial contraction occurs at such a rapid rate that discrete P waves separated by a flat baseline cannot be seen on the strip. Instead, the baseline continually rises and falls, producing the "flutter" waves. In leads II and III, the flutter waves may be quite prominent, creating a "sawtooth" pattern. Because of the volume of atrial impulses, the AV node allows only some of the impulses to pass through to the ventricles. In atrial flutter, a 2:1 ratio is the most common (i.e., for every two flutter waves, only one impulse passes through the AV node to generate a QRS complex). Ratios of 3:1 and 4:1 are also frequently seen. The ECG rhythm strip of a patient who arrived in the emergency department complaining of dizziness, syncope and shortness of breath reveals sinus bradycardia. When reviewing the patient's medication history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition?