NUR 431L FINAL EXAM (ACLS)
QUESTIONS WITH COMPLETE
ANSWERS
-drug therapy
-synchronized cardioversion - Answer-V-tach WITH a pulse-->
*DO NOT SHOCK
-CPR
-epi - Answer-Asystole/PEA-->
-identify and treat the underlying cause
-we give meds
-transvenous pacing is considered if all other measures fail - Answer-Bradycardia-->
-identify and treat the underlying cause
-synchronized cardioversion
-meds - Answer-Tachycardia-->
-Check carotid pulse for 5-10 seconds. (chest compressions should begin no longer
than 10 sec later)
-If no pulse- begin CPR with chest compression (30:2) until an AED arrives .
-If you witness the patient collapse, activate the EMS first, then begin CPR. If you find a
patient unresponsive, give 5 cycles of CPR then activate the EMS system.
-Start compressions ASAP due to unknown amount of down time.
-Recheck pulse after 5 cycles of CPR (approx. 2 min)
-Switch compressors every 2 minutes to prevent fatigue - Answer-circulation in a code
-Do rescue breathing if the patient has a pulse.oAssisted breathing rate is 1 breath
every 5-6 seconds or 10-12 breaths per minute.
-If the patient does not have a pulse, do 30 compressions: 2 breaths.
-After an advanced airway is placed, no more pauses for ventilation- give breath every 6
seconds or 10 breaths/min without pausing while compressor gives 100-120
compressions/minute.
-Avoid excessive ventilation!! - Answer-BREATHING in a code
-Power- turn on AED
-Attach- Electrode pads (adult pads for age 8 and older)
-Analyze- rhythm (clear the patient during analysis)
-Shock- if advisedoIf no shock advised, continue CPR immediately with chest
compressions.
-Resume CPR if AED does not analyze promptly - Answer-AED
, -V-Fib
-Pulseless V-tach - Answer-SHOCKABLE LETHAL RHYTHMS
-Asystole
-PEA - Answer-NON-SHOCKABLE LETHAL RHYTHMS
-Narrow Regular (SVT): 50-100J
-Narrow Irregular (Afib): 120-200J biphasic or 200J monophasic
-Wide Regular (Vtach): 100J
-Wide Irregular (Polymorphic Vtach/Torsades): Defibrillation dose (not synchronized)
-Enusre "sync" mode is on - Answer-SYNCHRONIZED CARDIOVERSION
-Hemodynamically unstable bradycardia if atropine ineffective
-Do not delay if rapid deterioration or IV unavailable
-Ensure "pacer" mode is on
-Set rate to approximately 60/min (adjust per patient response)
-Dial up current milleamperes until capture and set 2 mA above the dose with consistent
capture for safety margin.
-Sedate if possible - Answer-PACING
-Maintain SBP of at least 90 mmHg and O2 sat of at least 94%.
-May give 1-2 L NS or LR and/or give vasopressor infusion.
-Consider therapeutic hypothermia if patient remains unconscious after ROSC to
optimize neurologic recovery.
-Optimizing oxygenation, ventilation and perfusion, especially to brain and heart, is
primary goal after ROSC is achieved.
-Identify and treat causes of arrest to prevent recurrence.
-Transport to hospital if out of hospital or ICU if on the hospital floor - Answer-RETURN
OF SPONTANEOUS CIRCULATION (ROSC)
-Hypovolemia
-Hypothermia
-Hypo/hyper-kalemia
-Hypoxia
-Hydrogen ion (acidosis)
-Tension pneumothorax
-Tamponade, cardiac
-Thrombosis, pulmonary
-Thrombosis, coronary
-Toxins - Answer-causes of v-fib, pulseless v-tach
shock and CPR are the primary interventions - Answer-V-fib/pulseless V-tach-->
*Epinephrine
-1 mg IV/IO q 3-5 minutes
QUESTIONS WITH COMPLETE
ANSWERS
-drug therapy
-synchronized cardioversion - Answer-V-tach WITH a pulse-->
*DO NOT SHOCK
-CPR
-epi - Answer-Asystole/PEA-->
-identify and treat the underlying cause
-we give meds
-transvenous pacing is considered if all other measures fail - Answer-Bradycardia-->
-identify and treat the underlying cause
-synchronized cardioversion
-meds - Answer-Tachycardia-->
-Check carotid pulse for 5-10 seconds. (chest compressions should begin no longer
than 10 sec later)
-If no pulse- begin CPR with chest compression (30:2) until an AED arrives .
-If you witness the patient collapse, activate the EMS first, then begin CPR. If you find a
patient unresponsive, give 5 cycles of CPR then activate the EMS system.
-Start compressions ASAP due to unknown amount of down time.
-Recheck pulse after 5 cycles of CPR (approx. 2 min)
-Switch compressors every 2 minutes to prevent fatigue - Answer-circulation in a code
-Do rescue breathing if the patient has a pulse.oAssisted breathing rate is 1 breath
every 5-6 seconds or 10-12 breaths per minute.
-If the patient does not have a pulse, do 30 compressions: 2 breaths.
-After an advanced airway is placed, no more pauses for ventilation- give breath every 6
seconds or 10 breaths/min without pausing while compressor gives 100-120
compressions/minute.
-Avoid excessive ventilation!! - Answer-BREATHING in a code
-Power- turn on AED
-Attach- Electrode pads (adult pads for age 8 and older)
-Analyze- rhythm (clear the patient during analysis)
-Shock- if advisedoIf no shock advised, continue CPR immediately with chest
compressions.
-Resume CPR if AED does not analyze promptly - Answer-AED
, -V-Fib
-Pulseless V-tach - Answer-SHOCKABLE LETHAL RHYTHMS
-Asystole
-PEA - Answer-NON-SHOCKABLE LETHAL RHYTHMS
-Narrow Regular (SVT): 50-100J
-Narrow Irregular (Afib): 120-200J biphasic or 200J monophasic
-Wide Regular (Vtach): 100J
-Wide Irregular (Polymorphic Vtach/Torsades): Defibrillation dose (not synchronized)
-Enusre "sync" mode is on - Answer-SYNCHRONIZED CARDIOVERSION
-Hemodynamically unstable bradycardia if atropine ineffective
-Do not delay if rapid deterioration or IV unavailable
-Ensure "pacer" mode is on
-Set rate to approximately 60/min (adjust per patient response)
-Dial up current milleamperes until capture and set 2 mA above the dose with consistent
capture for safety margin.
-Sedate if possible - Answer-PACING
-Maintain SBP of at least 90 mmHg and O2 sat of at least 94%.
-May give 1-2 L NS or LR and/or give vasopressor infusion.
-Consider therapeutic hypothermia if patient remains unconscious after ROSC to
optimize neurologic recovery.
-Optimizing oxygenation, ventilation and perfusion, especially to brain and heart, is
primary goal after ROSC is achieved.
-Identify and treat causes of arrest to prevent recurrence.
-Transport to hospital if out of hospital or ICU if on the hospital floor - Answer-RETURN
OF SPONTANEOUS CIRCULATION (ROSC)
-Hypovolemia
-Hypothermia
-Hypo/hyper-kalemia
-Hypoxia
-Hydrogen ion (acidosis)
-Tension pneumothorax
-Tamponade, cardiac
-Thrombosis, pulmonary
-Thrombosis, coronary
-Toxins - Answer-causes of v-fib, pulseless v-tach
shock and CPR are the primary interventions - Answer-V-fib/pulseless V-tach-->
*Epinephrine
-1 mg IV/IO q 3-5 minutes
