ACLS Final Exam Questions with Correct Answers
A patient with suspected acute coronary syndromes (ACS) is placed on a cardiac monitor. The patient is
... [Show More] complaining 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.
The emergency department team is providing care to a patient who is experiencing ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the patient's current condition. Which electrolyte imbalance(s) would most likely be involved?
Although ventricular tachycardia usually occurs in the presence of heart disease or damage, electrolyte derangements, including hypocalcemia, hypomagnesemia and hypokalemia, can also be involved.
A patient experiencing an unstable bradyarrhythmia does not respond to atropine or transcutaneous pacing. Which intervention would the healthcare provider use next?
Epinephrine or dopamine may be administered to patients with symptomatic bradycardia if atropine and transcutaneous pacing are not effective.
A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamically stable and has a heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary assessment, which statement(s) by the patient would the team interpret as a possible contributing cause?
If the heart rate is between 100 and 150 beats per minute, the underlying cause is most likely a systemic one, such as anxiety, dehydration or infection. That condition is treated first. If the heart rate is 150 beats per minute or more, the tachycardia is likely caused by a cardiac condition, rather than a systemic one.
A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow-complex supraventricular tachyarrhythmia. The patient is hemodynamically stable. Which intervention would be initiated first?
For a patient who is hemodynamically stable and experiencing a narrow-complex supraventricular tachyarrhythmia, vagal maneuvers are attempted first. If ineffective, adenosine is given.
A patient in the telemetry unit is stable. Cardiac monitoring indicates the patient has ventricular tachycardia with a pulse. Further assessment reveals that the corrected QT interval is greater than 0.46 seconds. Which treatment would be appropriate at this time?
For a patient with ventricular tachycardia who is stable, has a pulse and has a corrected QT interval greater than 0.46 seconds, synchronized cardioversion is the recommended treatment.
A patient is brought into the emergency department. The patient does not have a pulse. The cardiac monitor shows the following rhythm. The team interprets this as which condition?
The cardiac monitor reveals ventricular tachycardia. In pulseless ventricular tachycardia, the ventricular rate is usually greater than 180 beats per minute, and the QRS complexes are very wide.
A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest, the patient's ECG showed peaked T waves. What might be causing the patient's cardiac arrest?
Suspect hyperkalemia in all patients with acute or chronic renal failure who exhibit a wide-complex ventricular rhythm or tall, peaked T waves on an ECG before cardiac arrest.
A member of the resuscitation team is preparing to defibrillate a patient in cardiac arrest using a biphasic defibrillator. The team member would set the energy dose according to the manufacturer's recommendations, which is usually:
When using a biphasic defibrillator, the energy dose should be set at 120 to 200 joules.
A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member follows each medication administration with a bolus of fluid. How much would the team member give?
When administering medications during a cardiac arrest, all medications administrated through the IV or intraosseous infusion route should be followed by a 10 to 20 mL fluid bolus.
A 30-year-old patient has been brought to the emergency department in full cardiac arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm would suggest which of the following as a possible precipitating factor?
The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation include electrocution, myocardial ischemia or infarction, shock, stimulant overdose and ventricular tachycardia.
Cardiac monitoring of a patient in cardiac arrest reveals ventricular fibrillation. What intervention would the team perform next?
The cardiac monitor is showing ventricular fibrillation, which is a shockable rhythm; therefore, the treatment is to administer 1 shock and then resume CPR. Medications are a secondary intervention. Advanced airway and capnography are delayed until at least 2 shocks have been given.
The resuscitation team suspects that hyperkalemia is the cause of cardiac arrest in a patient brought to the emergency department. Which finding on a 12-lead ECG would confirm this suspicion?
In hyperkalemia the patient's 12-lead ECG rhythm strip will show wide-complex ventricular rhythm or tall, pointed T waves.
A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. Before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause?
Prearrest signs of tension pneumothorax in the advanced stage include jugular venous distension, cyanosis, apnea and hyperresonance on percussion. Difficulty ventilating the patient may also be a sign of tension pneumothorax.
A patient in cardiac arrest experiences return of spontaneous circulation. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation. Which finding(s) would indicate the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation?
Mechanical ventilation should be started at a rate of 10 to 12 breaths per minute and adjusted as necessary to keep ETCO2 levels in the range of 35 to 40 mmHg and PaCO2 levels in the range of 40 to 45 mmHg. The minimum fraction of inspired oxygen necessary to maintain an SaO2 of at least 94% is used.
After cardiac arrest and successful resuscitation, the patient has a return of spontaneous circulation. The patient is unable to follow verbal commands and has a Glasgow Coma Scale score of 7. Targeted temperature management is initiated. Which method(s) would be appropriate for the resuscitation team to use?
For targeted temperature management, various methods of inducing hypothermia may be used, including administering an ice-cold IV fluid bolus (30.0 mL/kg), using endovascular catheters or applying surface cooling strategies (e.g., cooling blankets, ice packs).
A 40-year-old patient in the waiting room of the primary care provider's office approaches a staff member and says, "I'm having really severe, crushing chest pain that is moving to both my arms." The patient is diaphoretic and dyspneic. Which action would be appropriate for the staff member to take?
Early recognition of signs and symptoms along with activation of the emergency medical services system is the first link in the ST-segment elevation myocardial infarction (STEMI) Chain of Survival.
A patient with STEMI is experiencing chest pain that is refractory to sublingual nitroglycerin. Intravenous nitroglycerin is prescribed. When administering this medication, it would be titrated to maintain which systolic blood pressure?
In patients with STEMI, IV nitroglycerin may be used when chest pain or discomfort is recurrent or refractory to nitroglycerin administered sublingually or by spray. The IV nitroglycerin should be titrated to maintain a systolic blood pressure of 90 mmHg or more.
A patient experiencing STEMI comes to the emergency department of a large medical center at 9:30 p.m. The patient states that the symptoms started about 8 p.m. After confirming the diagnosis and initiating care, the healthcare team schedules the patient for percutaneous coronary intervention (PCI). The facility is capable of administering PCI. To achieve the best outcomes, therapy should be administered to this patient by which time?
Reperfusion therapy should be administered within 1 hour, 30 minutes of the patient's first medical contact if the patient does not need to be transferred to another facility. The patient arrived at 9:30 p.m., so the latest the therapy should be administered would be 11 p.m.
A patient is being treated in the emergency department and is determined to have NSTE-ACS. Invasive management is planned based on which finding?
An early invasive strategy should be considered for patients with high-risk NSTE-ACS, which would be indicated by ventricular tachycardia.
A patient presents to the emergency department with suspected ACS. Electrocardiogram and cardiac biomarkers show the patient has ST-segment elevation myocardial infarction (STEMI). Physical examination reveals signs of left ventricular dysfunction. Which finding(s) would support this?
Physical examination findings in patients with ACS may include signs of left ventricular dysfunction (e.g., hypotension, crackles, pulmonary edema) or cardiogenic shock (e.g., cool, clammy skin).
A patient with a diagnosis of ACS is experiencing cardiogenic shock. Which adjuvant therapy would be contraindicated?
The use of β-blockers is contraindicated in patients who are at risk for cardiogenic shock, low cardiac output and acute heart failure.
A patient with a suspected stroke arrives at the emergency department at 7:10 p.m. The stroke team ensures that a neurologic assessment and brain computed tomography or magnetic resonance imaging is obtained by which time?
In accordance with National Institute of Neurological Disorders and Stroke guidelines, the stroke team, emergency physician or other expert must conduct a neurologic assessment and obtain computed tomography or magnetic resonance imaging within 20 minutes after the patient's arrival in the emergency department. That would be 7:30 p.m. for this patient.
A patient is brought to the emergency department by their spouse. The spouse says, "I think it's a stroke." The stroke team initiates a rapid stroke assessment using the National Institutes of Health Stroke Scale. Which area(s) would the team include in this assessment?
The National Institutes of Health Stroke Scale evaluates level of consciousness, visual function, motor function, sensation and neglect, cerebellar function and language deficits and helps to determine both the location and the severity of the stroke.
A patient comes to the emergency department with a suspected stroke. The patient is alert and oriented and accompanied by a family member. The family member says, "I noticed he was slurring his words and had trouble walking, like his leg was numb." After completing the primary assessment, the stroke team completes a secondary assessment. Which finding would suggest that the patient is experiencing a condition that mimics a stroke?
In stroke assessment, the key to secondary assessment is to rule out stroke mimics such as hypoglycemia.
The stroke team is assessing a patient with a suspected stroke. The patient is alert and able to carry on a conversation, although the patient has difficulty getting the words out. Testing confirms that the patient has had an ischemic stroke. Based on the patient's medical history, a history of which arrhythmia would alert the team to the patient's increased risk for stroke?
Between 15 and 20 percent of embolic strokes are caused by atrial fibrillation.
A patient with an ischemic stroke arrives at the emergency department at 2 a.m. The patient's symptoms started about 12:30 a.m. After completing the necessary assessments, the healthcare team diagnoses an ischemic stroke, and the patient is determined to be a candidate for fibrinolytic therapy. To achieve the best outcomes, the team should initiate therapy for this patient no later than by which time?
For patients with ischemic stroke who meet the eligibility criteria, fibrinolytic therapy is the first-line treatment. Administration of IV recombinant tissue plasminogen activator within 3 hours of the onset of signs and symptoms is optimal (with a goal "door-to-needle" time of less than 1 hour). [Show Less]