ACLS Final Exam
A 20-year-old man with respiratory depression is brought to the emergency
department by his parents. 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?
2 minutes
4 minutes
6 minutes
8 minutes - ANS-2 minutes
The dose of naloxone may be repeated after 2 to 3 minutes.
\A 28-year-old pregnant patient who resides in transitional housing presents to the
emergency department with complaints of feeling feverish and very faint. The patient
tells the emergency nurse that she does not know when she became pregnant. Upon
palpation, the fundus is not at or above the umbilicus. The patient's condition quickly
deteriorates and she goes into cardiac arrest. If available and able to be used
without impeding or delaying the resuscitation effort, what diagnostic tool could be
used to guide decision-making in the care of this patient?
Fetal echocardiogram
Abdominal radiograph
Point-of-care ultrasound
Fetal monitoring - ANS-Point-of-care ultrasound
Gestational age is an important consideration when determining the approach to a
pregnant patient in cardiac arrest. If the gestational age is not known and
point-of-care ultrasound is available and able to be performed without impeding or
delaying the resuscitation effort, it can be used to quickly estimate gestational age
and guide decision-making.
\A 30-year-old patient has been brought to the emergency department in cardiac
arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm
would suggest which of the following as a possible precipitating factor?
Hemorrhage
Antibiotic use
Electrocution
Cardiac tamponade - ANS-Electrocution
,The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation
include electrocution, myocardial ischemia or infarction, shock, stimulant overdose
and ventricular tachycardia.
\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?
0.10 mV
0.15 mV
0.2 mV
0.25 mV - ANS-0.15 mV
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.
\A 42-year-old woman presents to the emergency department with complaints of
fatigue, shortness of breath, back pain and nausea. A 12-lead ECG is obtained and
shows ST-segment depression in leads II, III, and aVF and intermittent runs of
nonsustained ventricular tachycardia. Cardiac serum markers are elevated. These
findings suggest which condition?
High-risk non-ST-segment elevation ACS (NSTE-ACS)
Low-risk non-ST-segment elevation ACS (NSTE-ACS)
Intermittent-risk non-ST-segment elevation ACS (NSTE-ACS)
ST-segment elevation myocardial infarction (STEMI) - ANS-High-risk
non-ST-segment elevation ACS (NSTE-ACS)
The 12-lead ECG findings of ST-segment depression in three contiguous leads along
with elevated cardiac serum biomarkers are consistent with high-risk
non-ST-segment elevation ACS (NSTE-ACS). The presence of intermittent runs of
ventricular tachycardia also places this patient at high risk. In ST-segment elevation
myocardial infarction (STEMI), cardiac serum markers would be elevated, but this
patient's ECG findings are not consistent with STEMI. Patients with intermediate- or
low-risk NSTE-ACS show nondiagnostic ST-segment or T-wave changes on ECG, or
no changes at all.
\A member of the resuscitation team is preparing to administer medications
intravenously to a patient in cardiac arrest. The team member should follow each
peripherally administered drug dose with a normal saline flush. How much would the
team member give?
5 to 10 mL
10 to 20 mL
20 to 30 mL
30 to 40 mL - ANS-10 to 20 mL
, 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 normal saline flush.
\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:
75 to 100 joules
120 to 200 joules
300 joules
360 joules - ANS-120 to 200 joules
When using a biphasic defibrillator, the energy dose should be set at 120 to 200
joules.
\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 to address the
respiratory failure?
Establishment of vascular access
Delivery of supplemental oxygen via nasal cannula
Assisted ventilation with BVM resuscitator
Initiation of capnography - ANS-Assisted ventilation with BVM resuscitator
Patients who cannot ventilate adequately despite an open airway or who have
insufficient respiratory effort require assisted ventilation initially provided via a BVM
resuscitator.
\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?
Atrial fibrillation
Atrial flutter
Ventricular fibrillation
Ventricular tachycardia - ANS-Atrial flutter
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 20-year-old man with respiratory depression is brought to the emergency
department by his parents. 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?
2 minutes
4 minutes
6 minutes
8 minutes - ANS-2 minutes
The dose of naloxone may be repeated after 2 to 3 minutes.
\A 28-year-old pregnant patient who resides in transitional housing presents to the
emergency department with complaints of feeling feverish and very faint. The patient
tells the emergency nurse that she does not know when she became pregnant. Upon
palpation, the fundus is not at or above the umbilicus. The patient's condition quickly
deteriorates and she goes into cardiac arrest. If available and able to be used
without impeding or delaying the resuscitation effort, what diagnostic tool could be
used to guide decision-making in the care of this patient?
Fetal echocardiogram
Abdominal radiograph
Point-of-care ultrasound
Fetal monitoring - ANS-Point-of-care ultrasound
Gestational age is an important consideration when determining the approach to a
pregnant patient in cardiac arrest. If the gestational age is not known and
point-of-care ultrasound is available and able to be performed without impeding or
delaying the resuscitation effort, it can be used to quickly estimate gestational age
and guide decision-making.
\A 30-year-old patient has been brought to the emergency department in cardiac
arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm
would suggest which of the following as a possible precipitating factor?
Hemorrhage
Antibiotic use
Electrocution
Cardiac tamponade - ANS-Electrocution
,The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation
include electrocution, myocardial ischemia or infarction, shock, stimulant overdose
and ventricular tachycardia.
\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?
0.10 mV
0.15 mV
0.2 mV
0.25 mV - ANS-0.15 mV
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.
\A 42-year-old woman presents to the emergency department with complaints of
fatigue, shortness of breath, back pain and nausea. A 12-lead ECG is obtained and
shows ST-segment depression in leads II, III, and aVF and intermittent runs of
nonsustained ventricular tachycardia. Cardiac serum markers are elevated. These
findings suggest which condition?
High-risk non-ST-segment elevation ACS (NSTE-ACS)
Low-risk non-ST-segment elevation ACS (NSTE-ACS)
Intermittent-risk non-ST-segment elevation ACS (NSTE-ACS)
ST-segment elevation myocardial infarction (STEMI) - ANS-High-risk
non-ST-segment elevation ACS (NSTE-ACS)
The 12-lead ECG findings of ST-segment depression in three contiguous leads along
with elevated cardiac serum biomarkers are consistent with high-risk
non-ST-segment elevation ACS (NSTE-ACS). The presence of intermittent runs of
ventricular tachycardia also places this patient at high risk. In ST-segment elevation
myocardial infarction (STEMI), cardiac serum markers would be elevated, but this
patient's ECG findings are not consistent with STEMI. Patients with intermediate- or
low-risk NSTE-ACS show nondiagnostic ST-segment or T-wave changes on ECG, or
no changes at all.
\A member of the resuscitation team is preparing to administer medications
intravenously to a patient in cardiac arrest. The team member should follow each
peripherally administered drug dose with a normal saline flush. How much would the
team member give?
5 to 10 mL
10 to 20 mL
20 to 30 mL
30 to 40 mL - ANS-10 to 20 mL
, 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 normal saline flush.
\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:
75 to 100 joules
120 to 200 joules
300 joules
360 joules - ANS-120 to 200 joules
When using a biphasic defibrillator, the energy dose should be set at 120 to 200
joules.
\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 to address the
respiratory failure?
Establishment of vascular access
Delivery of supplemental oxygen via nasal cannula
Assisted ventilation with BVM resuscitator
Initiation of capnography - ANS-Assisted ventilation with BVM resuscitator
Patients who cannot ventilate adequately despite an open airway or who have
insufficient respiratory effort require assisted ventilation initially provided via a BVM
resuscitator.
\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?
Atrial fibrillation
Atrial flutter
Ventricular fibrillation
Ventricular tachycardia - ANS-Atrial flutter
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.
