ACLS FINAL EXAM 2
1. 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 respiratorycompromise?
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 reflectedby a low ETCO2 value
(less than 35 mmHg). As respiratory distress increases, andthe patient begins to tire, the
ETCO2 value may return to the normal range (35 to 45mmHg). However, if the patient
progresses to respiratory failure, the ETCO2 level will increase to greater than 45 mmHg,
which indicates hypoventilation.
2. A patient is in cardiac arrest.The underlying cause is thought to be opioidtoxicity. 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 cardiacarrest has
occurred.
Naloxone administered via continuous IV infusion should be considered forshort-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 soonas 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 suspectedor 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 indicatedin the immediate treatment of suspected or known opioid toxicity
,3. 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 andventricles,
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 sinusarrhythmia. If pacemaker cells in
the AV junction simulate ventricular contraction, theQRS 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.
4. A patient with dyspnea, inadequate blood pressure and a change in mentalstatus arrives at
the emergency department. The healthcare team completesthe necessary assessments and
begins to care for the patient, including initi-ating cardiac monitoring and pulse oximetry;
providing supplemental oxygenand ensuring adequate ventilation; and obtaining vascular
access. The teamreviews 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 theheart 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.
5. A patient comes to the emergency department complaining of palpitationsand "some
shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm
strip.The provider interprets this strip as indicatingwhich 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 wavesseparated 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 flutterwaves may be quite prominent,
creating a "sawtooth" pattern. Because of the volumeof atrial impulses, the AV node allows only
some of the impulses to pass through tothe ventricles. In atrial flutter, a 2:1 ratio is the most
common (i.e., for every two flutterwaves, only one impulse passes through the AV node to
generate a QRS complex).Ratios of 3:1 and 4:1 are also frequently seen.
6. The ECG rhythm strip of a patient who arrived in the emergency department complaining
of dizziness, syncope and shortness of breath reveals sinusbradycardia. When reviewing the
patient's medication history, the healthcareprovider identifies which agent(s) as a potential
cause of the patient's currentcondition?
Digoxin Losartan Metoprolol Verapamil Quinapril
Answer:
Digoxin
Metoprolol
Verapamil
Medications associated with causing sinus bradycardia include ²-blockers (such asmetoprolol),
calcium channel blockers (such as verapamil) and digoxin.
7. A patient with bradycardia and signs of hemodynamic compromise doesnot respond to
atropine. Which interventions could the healthcare provider use next?
Transcutaneous pacing
Carotid massage
Epinephrine or dopamine infusion
Synchronized cardioversion
Answer:
Transcutaneous pacing
Epinephrine or dopamine infusion
Second-line therapies for symptomatic bradycardia include transcutaneous pacingor an
epinephrine or dopamine infusion.
1. 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 respiratorycompromise?
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 reflectedby a low ETCO2 value
(less than 35 mmHg). As respiratory distress increases, andthe patient begins to tire, the
ETCO2 value may return to the normal range (35 to 45mmHg). However, if the patient
progresses to respiratory failure, the ETCO2 level will increase to greater than 45 mmHg,
which indicates hypoventilation.
2. A patient is in cardiac arrest.The underlying cause is thought to be opioidtoxicity. 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 cardiacarrest has
occurred.
Naloxone administered via continuous IV infusion should be considered forshort-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 soonas 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 suspectedor 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 indicatedin the immediate treatment of suspected or known opioid toxicity
,3. 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 andventricles,
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 sinusarrhythmia. If pacemaker cells in
the AV junction simulate ventricular contraction, theQRS 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.
4. A patient with dyspnea, inadequate blood pressure and a change in mentalstatus arrives at
the emergency department. The healthcare team completesthe necessary assessments and
begins to care for the patient, including initi-ating cardiac monitoring and pulse oximetry;
providing supplemental oxygenand ensuring adequate ventilation; and obtaining vascular
access. The teamreviews 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 theheart 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.
5. A patient comes to the emergency department complaining of palpitationsand "some
shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm
strip.The provider interprets this strip as indicatingwhich 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 wavesseparated 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 flutterwaves may be quite prominent,
creating a "sawtooth" pattern. Because of the volumeof atrial impulses, the AV node allows only
some of the impulses to pass through tothe ventricles. In atrial flutter, a 2:1 ratio is the most
common (i.e., for every two flutterwaves, only one impulse passes through the AV node to
generate a QRS complex).Ratios of 3:1 and 4:1 are also frequently seen.
6. The ECG rhythm strip of a patient who arrived in the emergency department complaining
of dizziness, syncope and shortness of breath reveals sinusbradycardia. When reviewing the
patient's medication history, the healthcareprovider identifies which agent(s) as a potential
cause of the patient's currentcondition?
Digoxin Losartan Metoprolol Verapamil Quinapril
Answer:
Digoxin
Metoprolol
Verapamil
Medications associated with causing sinus bradycardia include ²-blockers (such asmetoprolol),
calcium channel blockers (such as verapamil) and digoxin.
7. A patient with bradycardia and signs of hemodynamic compromise doesnot respond to
atropine. Which interventions could the healthcare provider use next?
Transcutaneous pacing
Carotid massage
Epinephrine or dopamine infusion
Synchronized cardioversion
Answer:
Transcutaneous pacing
Epinephrine or dopamine infusion
Second-line therapies for symptomatic bradycardia include transcutaneous pacingor an
epinephrine or dopamine infusion.
