RQI 2025 ACLS HEALTHCARE PROVIDER
Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of
myocardial ischemia, what will your first actions include (if not completed by EMS before
arrival)?
o Obtain a 12-lead electrocardiogram (ECG)
o Administer a blood thinner
o Administer aspirin and establish IV access
o Activate the ST-segment elevation myocardial infarction (STEMI) team
o If SPO2 is less than 90%, start oxygen
o Assess airway, breathing, and circulation (ABCs)
o Administer epinephrine 1 mg IV
o Consider nitroglycerin, morphine and a P2Y inhibitor - Answers - o Obtain a 12-lead
electrocardiogram (ECG)
o Administer aspirin and establish IV access
o Activate the ST-segment elevation myocardial infarction (STEMI) team
o If SPO2 is less than 90%, start oxygen
o Assess airway, breathing, and circulation (ABCs)
o Consider nitroglycerin, morphine and a P2Y inhibitor
His initial vital signs are HR 120/min, BP 135/88 mm Hg, RR 23/min, SpO2 87%, and
temperature 37.3C. When considering oxygen saturation, what is your course of action?
o Intubate the patient immediately
o Administer albuterol nebulizer
o Do not start oxygen
o Start oxygen at 4L/min via nasal cannula - Answers - o Start oxygen at 4L/min via
nasal cannula
What additional question help you determine next steps?
o Do you take any medication?
o Do you have any allergies?
o When was the last time you went to the doctor?
o When did the symptoms start?
o Have you had any recent falls? - Answers - o Do you take any medication?
o Do you have any allergies?
o When did the symptoms start?
Your patient continues to say that he has chest discomfort. What treatment can you
repeat as long as it is not contradicted by vital signs?
o Morphine sublingual every 1 to 3 minutes
o Morphine IV every 1 to 3 minutes
o Nitroglycerine sublingual or translingual every 3 to 5 minutes
o Nitroglycerine every 1 to 3 minutes - Answers - o Nitroglycerine sublingual or
translingual every 3 to 5 minutes
, What is your interpretation of the patient's ECG tracing?
o Anterior ST-segment elevation of myocardial infarction (STEMI)
o Ventricular tachycardia
o Posterior ST-segment elevation myocardial infarction (STEMI)
o Normal sinus rhythm with premature ventricular contractions - Answers - o Anterior
ST-segment elevation of myocardial infarction (STEMI)
With the diagnosis of STEMI, what is the most probable treatment?
o Release to home
o Admission to an intensive car unit
o Admission for observation
o Admission for PCI or fibrinolysis - Answers - o Admission for PCI or fibrinolysis
What is your goal for PCI when treating this patient?
o Door-to-balloon inflation time of 30 minutes
o First medical contact-to-balloon inflation time of 90 minutes
o Door-to-needle time of 90 minutes
o First medical contact-to-needle time of 30 minutes - Answers - o First medical contact-
to-balloon inflation time of 90 minutes
The patient's vital signs show HR 92/min, RR 14/min, BP 130/86 mm Hg, SpO2 97%,
and atrial fibrillation on the monitor. What additional assessment and stabilization
activities should be completed with the first 10 minutes after the patient's arrival?
o Establish IV access
o Order an emergent CT scan or MRI of the brain and review patient history
o Monitor for worsening symptoms
o Activate the stroke team
o Complete neurologic screening
o Check glucose
o Administer O2 - Answers - o Establish IV access
o Order an emergent CT scan or MRI of the brain and review patient history
o Activate the stroke team
o Complete neurologic screening
o Check glucose
What needs to be completed for this patient within 20 minutes after hospital arrival?
o Neurologic assessment
o Admission to a monitored bed
o Interpretation of the emergent CT scan or MRI of the brain
o Administration of fibrinolytic therapy - Answers - o Neurologic assessment
As part of the neurologic assessment, you perform a physical and neurologic
examination. What are some of the general questions you need to ask?
o What other symptoms do you have?
o Has your wife been sick as well?
o Do you take any medications?
Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of
myocardial ischemia, what will your first actions include (if not completed by EMS before
arrival)?
o Obtain a 12-lead electrocardiogram (ECG)
o Administer a blood thinner
o Administer aspirin and establish IV access
o Activate the ST-segment elevation myocardial infarction (STEMI) team
o If SPO2 is less than 90%, start oxygen
o Assess airway, breathing, and circulation (ABCs)
o Administer epinephrine 1 mg IV
o Consider nitroglycerin, morphine and a P2Y inhibitor - Answers - o Obtain a 12-lead
electrocardiogram (ECG)
o Administer aspirin and establish IV access
o Activate the ST-segment elevation myocardial infarction (STEMI) team
o If SPO2 is less than 90%, start oxygen
o Assess airway, breathing, and circulation (ABCs)
o Consider nitroglycerin, morphine and a P2Y inhibitor
His initial vital signs are HR 120/min, BP 135/88 mm Hg, RR 23/min, SpO2 87%, and
temperature 37.3C. When considering oxygen saturation, what is your course of action?
o Intubate the patient immediately
o Administer albuterol nebulizer
o Do not start oxygen
o Start oxygen at 4L/min via nasal cannula - Answers - o Start oxygen at 4L/min via
nasal cannula
What additional question help you determine next steps?
o Do you take any medication?
o Do you have any allergies?
o When was the last time you went to the doctor?
o When did the symptoms start?
o Have you had any recent falls? - Answers - o Do you take any medication?
o Do you have any allergies?
o When did the symptoms start?
Your patient continues to say that he has chest discomfort. What treatment can you
repeat as long as it is not contradicted by vital signs?
o Morphine sublingual every 1 to 3 minutes
o Morphine IV every 1 to 3 minutes
o Nitroglycerine sublingual or translingual every 3 to 5 minutes
o Nitroglycerine every 1 to 3 minutes - Answers - o Nitroglycerine sublingual or
translingual every 3 to 5 minutes
, What is your interpretation of the patient's ECG tracing?
o Anterior ST-segment elevation of myocardial infarction (STEMI)
o Ventricular tachycardia
o Posterior ST-segment elevation myocardial infarction (STEMI)
o Normal sinus rhythm with premature ventricular contractions - Answers - o Anterior
ST-segment elevation of myocardial infarction (STEMI)
With the diagnosis of STEMI, what is the most probable treatment?
o Release to home
o Admission to an intensive car unit
o Admission for observation
o Admission for PCI or fibrinolysis - Answers - o Admission for PCI or fibrinolysis
What is your goal for PCI when treating this patient?
o Door-to-balloon inflation time of 30 minutes
o First medical contact-to-balloon inflation time of 90 minutes
o Door-to-needle time of 90 minutes
o First medical contact-to-needle time of 30 minutes - Answers - o First medical contact-
to-balloon inflation time of 90 minutes
The patient's vital signs show HR 92/min, RR 14/min, BP 130/86 mm Hg, SpO2 97%,
and atrial fibrillation on the monitor. What additional assessment and stabilization
activities should be completed with the first 10 minutes after the patient's arrival?
o Establish IV access
o Order an emergent CT scan or MRI of the brain and review patient history
o Monitor for worsening symptoms
o Activate the stroke team
o Complete neurologic screening
o Check glucose
o Administer O2 - Answers - o Establish IV access
o Order an emergent CT scan or MRI of the brain and review patient history
o Activate the stroke team
o Complete neurologic screening
o Check glucose
What needs to be completed for this patient within 20 minutes after hospital arrival?
o Neurologic assessment
o Admission to a monitored bed
o Interpretation of the emergent CT scan or MRI of the brain
o Administration of fibrinolytic therapy - Answers - o Neurologic assessment
As part of the neurologic assessment, you perform a physical and neurologic
examination. What are some of the general questions you need to ask?
o What other symptoms do you have?
o Has your wife been sick as well?
o Do you take any medications?
