ACEDS PRACTICE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS | ALREADY GRADED A+RECENT VERSIO

ACEDS PRACTICE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS | ALREADY GRADED A+RECENT VERSIO 1. Which descriptions of chest pain would be associated with ACS? - answer - Pain that may be intermittent - Pain that feels like pressure, squeezing, tightness, aching or heaviness - Pain that radiates to one or both arms - Pain lasting longer than 3 to 5 minutes 2. A patient presents to the ED with s/sx suggestive of ACS. The 12-lead ECG shows T-wave inversion 2 mm. To which clinical category would you assign this patient? - answer Low- or intermediate-risk NSTE-ACS 3. Which conditions are included in the category of non-ST-segment elevation acute coronary syndromes (NSTE-ACS)? - answer Non-ST-segment elevation myocardial infarction (NSTEMI) & Unstable angina (UA) 4. When auscultating lung sounds in a patient with left ventricular dysfunction, you will hear _______________________. - answer crackles 5. When a pt presents with possible ACS, a 12-lead ECG should be obtained & interpreted within ______ of the patient's arrival at the facility. - answer 10 minutes 6. What is the dose of nitroglycerin (sublingual tablet or spray) to be administered to a pt suspected of having an ACS? - answer 0.4 mg every 5 minutes 7. Which signs and symptoms can indicate myocardial infarction? - answer - Retrosternal chest pain - Dyspnea - Nausea and vomiting - Fatigue and weakness - Loss of consciousness 8. Cardiac troponin levels should be measured at initial presentation & then ___________ hours later. - answer 3 - 6 9. What is the ideal time frame for performing percutaneous coronary intervention (PCI) in a patient with STEMI? - answer 90 min of the patient's arrival at the facility 10. When IV nitroglycerin is used to improve pulmonary edema or HTN, it should be titrated to maintain a SBP that is _________% less than the baseline pressure in pts with BP in the normal range (and 30 mmHg below baseline in patients with hypertension). - answer 10 11. New ST-segment elevation in two or more contiguous leads on a 12-lead ECG suggests __________. - answer Myocardial infarction 12. What finding on ECG is diagnostic for ST-segment elevation myocardial infarction (STEMI) in a man 40 years or older? - answer New ST-segment elevation at the J point in leads V2 and V3 of at least 0.2 mV (≥ 2 mm) 13. What changes on an ECG suggest ischemia? - answer ST-segment depression & T-wave inversion 14. Which conditions contribute to the pathophysiology of ACS? - answer - - Development of an occlusive intracoronary thrombus - Transient platelet aggregation - Plaque erosion 15. For a patient experiencing STEMI, management focuses on early reperfusion therapy with: - answer Percutaneous coronary intervention (PCI) & Fibrinolytic therapy 16. Which interventions are appropriate as part of the primary assessment of a patient with suspected ACS? - answer - Establish pulse oximetry - Obtain vascular access - Order a 12-lead ECG - Establish cardiac monitoring 17. Physical examination findings in pts with ACS may include which conditions? - answer Hypotension & Pulmonary edema (crackles) 18. Patients with low- to intermediate-risk NSTE-ACS may show which changes on an ECG? - answer Nondiagnostic T-wave changes & nondiagnostic ST-segment changes 19. What findings on ECG suggest non-ST-segment elevation ACS (NSTE-ACS)? - answer ST-segment depression, T-wave inversion & transient T-wave elevation 20. Which findings on a 12-lead ECG would be expected in a patient with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACS)? - answer ST-segment depression & T-wave inversion in two or more contiguous leads 21. After screening for potential contraindications, which of the following medications should be administered to the pt with s/sx of myocardial ischemia or infarction? - answer Nitroglycerin & aspirin 22. Which conditions are contraindications to therapy with β-blockers in patients with ACS? - answer - Acute heart failure - Recent myocardial infarction - Low cardiac output - Risk for cardiogenic shock 23. What dx test is typically obtained at presentation to r/o other causes of acute chest pain and to identify pulmonary congestion? - answer Chest radiography 24. In addition to myocardial infarction, which are life-threatening causes of chest pain? - answer - Ruptured esophagus - Perforating peptic ulcer disease - Pneumothorax - Aortic dissection - Pulmonary embolism 25. In NSTE-ACS, what is the main difference between NSTEMI & unstable angina (UA)? - answer Pts w/ NSTEMI will have elevated serum cardiac markers & pts w/ UA will not have elevated serum cardiac markers 26. In about _____% of pts who present with ACS each year, arterial occlusion results in myocardial ischemia without persistent ST-segment elevation (UA or NSTEMI). In the other approximately ___% of patients who present with ACS, arterial occlusion results in STEMI. - answer 70; 30 27. A pt presents to the ED w/ s/sx of ACS. The 12-lead ECG reveals ST-segment elevation in leads II, III and aVF. Which of the following would be an appropriate next action? - answer When a 12-lead ECG shows evidence of inferior wall myocardial infarction (i.e., ST-segment elevation in leads II, III and aVF), the next appropriate step is to obtain a 15-lead ECG to screen for R ventricular infarction. 28. A pt presents to the ED w/ s/sx of ACS. The 12-lead ECG shows T-wave inversion in two contiguous leads. To which clinical category should this patient be assigned? - answer High-risk NSTE-ACS (Remember: pts with high-risk NSTE-ACS show changes suggestive of ischemia, such as ST-segment depression or T-wave inversion, in two or more contiguous leads) 29. MED DOSING: Aspirin; what if unable to take PO? - answer If not already administered by prehospital providers, initiate antiplatelet therapy by having the patient chew *162 to 325 mg of aspirin* 30. If unable to take PO consider administering aspirin as a rectal suppository (300 mg) 31. MED DOSING: Nitroglycerin; what is the max dosage? - answer Administer *nitroglycerin 0.4 mg every 5 minutes* by SL tablet or spray (up to three doses) to relieve ischemic chest pain 32. MED DOSING: Morphine; cautions? - answer Consider administering morphine 1 to 5 mg to patients who continue to experience CP despite antianginal therapy. 33. What makes a pt high-risk vs low- or intermediate-risk NSTE-ACS? - answer Pts with high-risk NSTE-ACS show changes suggestive of ischemia, such as ST-segment depression or T-wave inversion, in two or more contiguous leads. Pts with low- or intermediate-risk NSTE-ACS exhibit *no changes* or nondiagnostic ST-segment or T-wave changes on ECG. 34. Mr. Martin continues to experience episodes of CP despite 3 doses of nitroglycerin therapy. His cardiac biomarkers are elevated and his ECG shows ST-segment depression. What intervention should be considered for Mr. Martin at this time? - answer *Coronary angiography.* For patients with high-risk NSTE-ACS, an early invasive strategy such as coronary angiography w/ or w/o revascularization should be considered. Because Mr. Martin also has refractory ischemic chest discomfort, this procedure would be indicated. 35. Fibrinolytic therapy should be initiated within _____ minutes of the patient's first medical contact when primary PCI cannot be performed within 90 minutes of the patient's arrival. - answer 30 36. When would a 15-lead ECG be indicated? - answer - To screen for posterior wall MI when ACS is suspected but the 12-lead ECG does not show ST-segment elevation. - To screen for right ventricular infarction when the 12-lead ECG reveals evidence of inferior wall myocardial infarction (i.e., ST-segment elevation in leads II, III and aVF). - Whenever there is strong suspicion for posterior wall or right ventricular involvement. 37. Half mask or mouthpiece - answer The respirator that would be used where dust or solid particles might be inhaled 38. Blood - answer Hepatitis can be caused by contact with 39. type c soil - answer Benching systems are prohibited in