ACLS Final Exam
ACLS Final Exam
A patient with suspected acute coronary syndromes (ACS) is placed on a cardiac monitor. The patient is complaining
... [Show More] of dyspnea and is given supplemental oxygen. The provider determines that the oxygen is effective based on which SaO2 level?
When a patient presents with potential ACS, the patient should have oxygen administered to maintain an SaO2 of at least 94%.
A patient experiences cardiac arrest, and the resuscitation team initiates ventilations using a bag-valve-mask (BVM) resuscitator. The development of which condition during the provision of care would lead the team to suspect that improper BVM technique is being used?
Complications can occur with the use of a BVM resuscitator due to improper technique. Delivering excessive volume or ventilating too fast creates excessive pressure that can damage the airways, lungs and other organs. Excessive volume can lead to tension pneumothorax.
Assessment of a patient reveals an ETCO2 level of 55 mmHg and an arterial oxygen saturation (SaO2) level of 88%. The provider would interpret these findings as indicative of which condition?
An SaO2 level of less than 90% (PaO2 of less than 50 mmHg) accompanied by ETCO2 values greater than 50 mmHg is indicative of respiratory failure.
A healthcare provider initiates ventilations to ensure adequate breathing and oxygenation. While ventilations are being performed, capnography is established to evaluate the adequacy of the ventilations. The healthcare provider determines that ventilations are adequate based on which end-tidal carbon dioxide (ETCO2) value?
End-tidal carbon dioxide values in the range of 35 to 45 mmHg confirm adequacy of ventilation.
A patient comes to the emergency department complaining of palpitations and "some shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm strip. The provider interprets this strip as indicating which arrhythmia?
In atrial flutter, atrial contraction occurs at such a rapid rate that discrete P waves separated 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 flutter waves may be quite prominent, creating a "sawtooth" pattern. Because of the volume of atrial impulses, the AV node allows only some of the impulses to pass through to the ventricles. In atrial flutter, a 2:1 ratio is the most common (i.e., for every two flutter waves, only one impulse passes through the AV node to generate a QRS complex). Ratios of 3:1 and 4:1 are also frequently seen.
A person suddenly collapses while sitting in the sunroom of a healthcare facility. A healthcare provider observes the event and hurries over to assess the situation. The healthcare provider performs which assessment first?
A systematic approach to assessment is necessary. The healthcare provider should first perform a rapid assessment. A rapid assessment is a quick visual survey to ensure safety, to form an initial impression about the patient's condition, and to check for responsiveness, breathing and a pulse if the patient appears to be unresponsive. This would be followed by a primary assessment and then a secondary assessment.
A 35-year-old female patient's ECG is consistent with STEMI. The ECG reveals a new ST-segment elevation at the J point in leads V2 and V3 of at least which size?
New ST-segment elevation at the J point in leads V2 and V3 of at least 0.15 mV (1.5 mm) in women 40 years or younger is considered diagnostic of STEMI.
An ECG strip of a patient in the emergency department reveals the following rhythm. Which feature would the healthcare provider interpret as indicating atrial fibrillation?
The two key features of atrial fibrillation on ECG are the absence of discrete P waves and the presence of irregularly irregular QRS complexes.
A patient presents to the emergency department with mild to moderate recurrent chest pain, without any nausea or vomiting. A 12-lead ECG is obtained and shows ST-segment depression with transient T-wave elevation indicative of NSTE-ACS. Cardiac enzyme levels are obtained and are not elevated. These findings suggest which condition?
A patient who presents with ECG findings consistent with NSTE-ACS and does not have elevated cardiac serum markers is to be considered as having unstable angina.
A healthcare provider is establishing cardiac monitoring using a five-electrode system. The healthcare provider demonstrates proper use of the system by placing the green electrode in which location?
In a five-electrode cardiac monitoring system, the green electrode should be placed on the lower right abdomen.
A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced cardiac life support was initiated. The patient required the placement of an advanced airway to maintain airway patency. Which statement indicates that the team performed high-quality CPR?
When an advanced airway has been placed in a patient who is in cardiac arrest, compressions and ventilations are delivered continuously with no interruptions. One provider delivers 1 ventilation every 6 seconds, while the second provider performs compressions at a rate of 100 to 120 compressions per minute.
A patient's capnogram reveals the following waveform. Which segment would the healthcare provider interpret as reflecting the beginning of exhalation?
The A-B segment is the respiratory baseline that represents the beginning of exhalation.
A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of chronic obstructive pulmonary disease. Assessment reveals respiratory failure. Which action would be the initial priority?
Patients who cannot oxygenate or ventilate adequately despite an open airway or who have insufficient respiratory effort require assisted ventilation initially provided via a BVM resuscitator.
A 20-year-old man with respiratory depression is brought to the emergency department by his parents. The parents state that "[They] found him at home with various needles and syringes around him, but [they] have no idea what he took." Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 p.m. The patient does not respond to this initial dose. The team would expect to administer a second dose after how many minutes?
The dose of naloxone may be repeated after 4 minutes. Additional doses, increased in a stepwise fashion, are often necessary to reverse the respiratory depression.
Assessment of a patient in the emergency department reveals that the patient is experiencing respiratory compromise. From the assessment, the team identifies that the patient is in the earliest stage of this condition. Which stage would this be?
Respiratory compromise occurs along a continuum, beginning with respiratory distress, progressing to respiratory failure and then to respiratory arrest.
The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured?
The ETCO2 value is measured at the end of exhalation (point D), which represents the peak level.
A patient is experiencing respiratory distress secondary to an exacerbation of chronic obstructive pulmonary disease. The patient begins to exhibit signs and symptoms of worsening respiratory function and experiences respiratory arrest. The team intervenes, delivering ventilations via BVM resuscitator. The team would deliver 1 ventilation at which interval?
The team would deliver 1 ventilation every 5 to 6 seconds. Each ventilation should last about 1 second and make the chest begin to rise.
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 respiratory compromise?
Capnography can objectively assess the severity of a patient's respiratory distress. Early on, the patient will often hyperventilate, leading to hypocapnia that is reflected by a low ETCO2 value (less than 35 mmHg). As respiratory distress increases, and the patient begins to tire, the ETCO2 value may return to the normal range (35 to 45 mmHg). However, if the patient progresses to respiratory failure, the ETCO2 level will increase to greater than 45 mmHg, which indicates hypoventilation.
A patient is brought into the emergency department with a suspected opioid overdose. The patient is in cardiac arrest. Which action would be the team's priority?
Although no evidence supports any benefit to naloxone administration during cardiac arrest, administration of naloxone during both respiratory and cardiac arrest is recommended when opioid overdose is suspected. However, for a patient in cardiac arrest, high-quality CPR is prioritized over the administration of naloxone.
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?
In third-degree AV block, no electrical communication occurs between the atria and ventricles, 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 sinus arrhythmia. If pacemaker cells in the AV junction simulate ventricular contraction, the QRS complexes will be narrow (less than 120 milliseconds in duration). Impulses that originate in the ventricles produce wide, bizarre QRS complexes. This arrhythmia may result from damage caused by myocardial infarction.
A patient with dyspnea and a change in mental status arrives at the emergency department. The healthcare team completes the necessary assessments and begins to care for the patient, including initiating cardiac monitoring, pulse oximetry, supplemental oxygen and vascular access. The team reviews the patient's ECG rhythm strip, as shown in the following figure. Which agent would the team most likely administer?
The ECG strip is showing bradycardia. Atropine is an anticholinergic drug that increases sinoatrial node firing by counteracting vagus nerve action to increase the heart rate. It is the first-line therapy for symptomatic bradycardia. A 0.5-mg bolus is given intravenously every 3 to 5 minutes, up to a maximum dose of 3 mg.
The ECG rhythm strip of a patient who arrived in the emergency department complaining of dizziness, syncope and shortness of breath reveals sinus bradycardia. When reviewing the patient's medication history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition?
Medications associated with causing sinus bradycardia include β-blockers such as metoprolol and calcium channel blockers such as verapamil and digoxin. [Show Less]