RQI 2025 ACLS REVISED EXAM

What element of a system of care is represented by properly functioning resuscitation equipment? - Correct Ans-Structure What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival? - Correct Ans-Activation of emergency reponse What are signs of clinical deterioration that would prompt the activation of rapid response system? - Correct Ans-Symptomatic hypertension Seizure Unexplained agitation What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)? - Correct Ans-To improve patient outcomes by identifying and treating early clinical deterioration What happens when teams rapidly assess and intervene when patients have abnormal vital signs? - Correct Ans-The number of in hospital cardiac arrest decreases In addition to decreased IHCA, what are some other benefits of implementing a rapid response system? Select all that apply. - Correct Ans-Decrease ICU length of stay. Decreased in total hospital length of stay. Which is the main advantage of effective teamwork? - Correct Ans-Division of tasks Which is the best example of a role of the team leader? - Correct Ans-Models excellent team behavior Which is the best example of a role of a team member? - Correct Ans-Prepared to fulfill their role responsibilities What is the primary purpose of the CPR coach on a resuscitation team? - Correct Ans Increasing CPR quality What are the 6 positions for high performance teams in resuscitation? - Correct Ans Team leader Airway Timer/recorder Compressor (rotate every 2 minutes) Monitor/defibrillator/cpr coach ACLS2025 IV/IO/Medications Which member of the high performance team has the responsibility for assigning roles (positions)? - Correct Ans-Team leader Which high performance team member is part of the resuscitation triangle? - Correct Ans-Monitor/defibrillator/cpr coach Which is an example of knowledge sharing by a team leader? - Correct Ans-Asking for suggestions about interventions Which is an example of summarizing and reevaluating? - Correct Ans-Increasing monitoring of the patients condition deteriorates Which is a step of closed-loop communication? - Correct Ans-Confirming task completion before assigning another task Which are examples of mutual respect? Select all that apply: - Correct Ans Acknowledging correctly completed tasks in a positive way Ensuring that only one person talks at a time What are the components of high quality CPR? Select all that apply: - Correct Ans Compression depth of at least 2 inches (5cm) Switching compressors every 2 minutes Avoiding excessive ventilation Complete chest recoil after each compression Interruption limited to under 10 seconds How do you calculate the chest compression fraction (CCF)? What is ideal percentage? - Correct Ans-Divide chest compression time by total code time. You want this at least 60% but ideally greater than 80% Which component of effective high-performance teams is represented by the use of real-time feedback devices? - Correct Ans-Quality How do you calculate Coronary Perfusion Pressure (CPP)? - Correct Ans-Aortic diastolic pressure "minus" Right Atrial Diastolic Pressure How do interruptions in chest compressions negatively impact survival after cardiac arrest? - Correct Ans-Decrease coronary perfusion pressure What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)? - Correct Ans-Early and effective defibrillation ACLS2025 How quickly does the chance of survival decline for every minute of defibrillation delay in patients with ventricular fibrillation who do receive bystander CPR? - Correct Ans-7 10% What is the advantage of a systematic approach to patient assessment? - Correct Ans Reduces the chances of missing important signs and symptoms What is the first step in the systematic approach to patient assessment? - Correct Ans Initial impression What is the maximum amount of time you should simultaneously perform pulse and breathing checks? - Correct Ans-10 seconds While performing the BLS Assessment, you initiate high- quality CPR and assist ventilation with a bag mask device. The AED does not recommend a shock. Which action in the Primary assessment should you perform first? - Correct Ans Determine is the patients airway is patent The initial assessment reveals a conscious patient. The patients airway is patent and an advanced airway is not indicated. Which action in the primary assessment should you perform next? - Correct Ans Administer oxygen as needed Which action is part of secondary assessment of a conscious patient? - Correct Ans Formulate a differential diagnosis Which of the following are the "H's" causes of reversible cardiac arrest? Select all that apply: - Correct Ans-Hypothermia Hypoxia Hyperkalemia/hypokalemia Hypovolemia Acidosis Which of the following are the "T" causes of reversible cardiac arrest? - Correct Ans Tension pneumothorax Toxins Cardiac tamponade Pulmonary thrombosis Coronary thrombosis What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)? - Correct Ans-Early and effective defibrillation ACLS2025 What is the most common symptom of myocardial ischemia and infarction? - Correct Ans-Retrosternal chest pain Which demographic group experiencing acute coronary syndromes is more likely to present without chest pain? - Correct Ans-Females Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than? - Correct Ans-90% Obtaining a what is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndrome? - Correct Ans-12 lead ekg What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department? - Correct Ans-10 minutes When should oxygen be administered? - Correct Ans-If the patient is dyspneic or hypoxemic, has obvious signs of heart failure, or has an arterial o2 saturation that is less than 90% or unknown. Which is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndromes? - Correct Ans-Recent GI bleeding What are the contraindications of nitroglycerin? - Correct Ans--If patient has a confirmed inferior wall stemi or right ventricular infarction -avoid nitro if patient has hypotension, bradycardia, or tachycardia -if patient recently has taken sildenafil, vardenafil, or tadalafil in the past 24-48 hrs What is a physiological effect of nitroglycerin? - Correct Ans-Reduces preload Which clinical findings represents a contraindication to the administration of nitroglycerin? - Correct Ans-Confirmed right ventricular infarction When is morphine indicated? - Correct Ans-In STEMI patients with severe chest discomfort that does not respond to nitrates What should you always monitor after giving morphine? - Correct Ans-Monitor BP and respiratory rate When should you use caution when giving morphine? - Correct Ans-Use caution when patient is in NSTE-ACS because of the association of mortality If someone starts developing hypotension after giving morphine or nitroglycerin? - Correct Ans-Administer fluids ACLS2025 Which class of medications commonly given to patients with acute coronary syndrome may be adversely affected by morphine administration? - Correct Ans-Oral anti platelet meds What is the benefit of morphine when given for management of acute coronary syndrome? - Correct Ans-Central nervous system analgesic You obtain a 12-lead ECG in a patient with retrosternal chest pain. Which ECG finding is suggestive of high risk non-ST-segment elevation acute coronary syndrome? - Correct Ans-Dynamic t wave inversion Upon reviewing a patients 12 lead ECG, you note ST segment elevation of 2mm in leads 2, 3, and aVF. How would you classify the ECG finding? - Correct Ans-ST-segment elevation myocardial infarction What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department? - Correct Ans-10 min Which action is part of the secondary assessment of a conscious patient? - Correct Ans-Formulate a differential diagnosis Upon reviewing a patients 12-lead ECG, you note ST-segment elevation of 2mm in leads II, III and aVF. How would you classify these ECG findings? - Correct Ans-ST-segment elevation myocardial infarction What is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention? - Correct Ans-90 min What is the longest acceptable emergency door to needle time when fibrinolysis is the indented reperfusion strategy? - Correct Ans-30 min What is the recommended window after symptoms onset for early fibrinolytic therapy or direct catheter based reperfusion for patients ST segment elevation myocardial infarction and no contraindications? - Correct Ans-Within 12 hours Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include? Select all that apply - Correct Ans-Administer aspirin Assess ABCs If considering prehospital fibrinolysis, perform fibrinolytic checklist Provide prehospital notification to the reveiving hospital ACLS2025 Consider 02, nitro and morphine Obtain a 12 lead ECG Upon reviewing a patients 12 lead ECG, you note ST elevation of 2mm in leads II, III, and aVF. How would you classify these ECG findings? - Correct Ans-ST segment elevation MI Which action is part of the secondary assessment of a conscious patient? - Correct Ans-Formulate a different diagnosis What is the most common type of stroke? - Correct Ans-Ischemic stroke What type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue? - Correct Ans-Hemorrhagic stroke Which is a sign of a stroke? - Correct Ans-Trouble speaking Which is a symptom of stroke? - Correct Ans-Sudden trouble seeing What are the 3 components of the Cincinnati Prehospital stroke scale? - Correct Ans Facial droop Arm drift Abnormal speech What is the estimated probability of the prehospital stroke scale with 1 abnormal finding when scored by prehospital providers? - Correct Ans-72% What is a stroke severity tool that helps EMS differentiate a large vessel occlusion stroke from a non-large vessel occlusion stroke? - Correct Ans-Los Angeles motor scale What is the primary advantage of using a stroke severity tool? - Correct Ans-It helps identify large vessel occlusion stroke What is the most appropriate destination for patients with suspected acute ischemic stroke? - Correct Ans-Certified stroke center What is the highest level of stroke center certification? - Correct Ans-Comprehensive stroke center Which is an advantage of EMS transport to a stroke hospital for a patient with a suspected acute ischemic stroke? - Correct Ans-Responding providers can stabilize critical issues What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? - Correct Ans-The hospital can perform more efficient evaluation and management ACLS2025 What is the time for neurological assessment by the stroke team or designee and noncontrast computed tomography or magnetic resonance imaging performed after the hospital arrival? - Correct Ans-20 min What is the time goal for initiation of fibrinolytic therapy for patients w/o contraindications after hospital arrival - Correct Ans-45 min What is the door-to device time for direct-arriving patients with acute ischemic stroke treated with endovascular therapy? - Correct Ans-90 min Evidence suggest that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame? - Correct Ans-3 hours What is the maximum time for last known normal when endovascular therapy can be performed? - Correct Ans-24 hours What is the maximum time from last known normal when intra arterial thrombolysis for select patients can be used for treatment? - Correct Ans-6 hours What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? - Correct Ans-45 min Identify the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. - Correct Ans-185 Identify the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. - Correct Ans-110 What blood glucose level should trigger administration of IV or subq insulin for a patient with acute ischemic stroke? - Correct Ans-180 What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide? - Correct Ans-6-8 What is a contraindication of the use of an oropharyngeal airway? - Correct Ans Conscious patient In which of the following patients can nasopharyngeal airways be used? - Correct Ans Unconscious Semiconscious Conscious Select the first step in the use of an oropharyngeal airway - Correct