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Emergency Medical Procedures: Cardiac Arrest and Stroke, Exams of Cardiology

Information on various emergency medical procedures related to cardiac arrest and stroke. It covers topics such as identifying symptoms, appropriate medications, and initial interventions. It also discusses the importance of teamwork and following current resuscitation algorithms.

Typology: Exams

2023/2024

Available from 04/10/2024

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ACLS Advanced Cardiovascular Life
Support POST-TEST (2023) 50
QUESTIONS AND ANSWERS
A 48-year-old man became unresponsive shortly after presenting to you with nausea and
generalized chest discomfort. You observe gasping breathing and are unsure if you feel a pulse.
You should know:
A. Call for help and begin chest compressions.
B. Wait until breathing stops and then check again for a pulse.
C. Begin chest compressions only if you are certain a pulse is absent.
D. Observe the patient for 2 minutes, then reassess his breathing and pulse. - answer A. Call for
help and begin chest compressions.
Which of the following is the most likely complication of inferior wall myocardial infarction (MI)?
A. Cardiogenic shock
B. Ventricular rupture
C. Bradydysrhythmias
D. Tachydysrhythmias - answer C. Bradydysrhythmias
A 52-year-old man is complaining of palpitations that came on suddenly after walking up a short
flight of stairs. His symptoms have been present for about 20 minutes. He denies chest pain and
is not short of breath. His skin is warm and dry; breath sounds are clear. His blood pressure (BP)
is 144/88 millimeters of mercury (mm Hg), his heart rate is 186 beats per minute (beats/min),
and his ventilatory rate is 18 breaths/min. The cardiac monitor reveals the rhythm here.
Vascular access has been established. Which of the following medications is most appropriate in
this situation?
A. Dopamine or sotalol
B. Furosemide or atropine
C. Nitroglycerin (NTG) or morphine
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ACLS Advanced Cardiovascular Life

Support POST-TEST (2023) 50

QUESTIONS AND ANSWERS

A 48-year-old man became unresponsive shortly after presenting to you with nausea and generalized chest discomfort. You observe gasping breathing and are unsure if you feel a pulse. You should know: A. Call for help and begin chest compressions. B. Wait until breathing stops and then check again for a pulse. C. Begin chest compressions only if you are certain a pulse is absent. D. Observe the patient for 2 minutes, then reassess his breathing and pulse. - answer A. Call for help and begin chest compressions. Which of the following is the most likely complication of inferior wall myocardial infarction (MI)? A. Cardiogenic shock B. Ventricular rupture C. Bradydysrhythmias D. Tachydysrhythmias - answer C. Bradydysrhythmias A 52-year-old man is complaining of palpitations that came on suddenly after walking up a short flight of stairs. His symptoms have been present for about 20 minutes. He denies chest pain and is not short of breath. His skin is warm and dry; breath sounds are clear. His blood pressure (BP) is 144/88 millimeters of mercury (mm Hg), his heart rate is 186 beats per minute (beats/min), and his ventilatory rate is 18 breaths/min. The cardiac monitor reveals the rhythm here. Vascular access has been established. Which of the following medications is most appropriate in this situation? A. Dopamine or sotalol B. Furosemide or atropine C. Nitroglycerin (NTG) or morphine

D. Procainamide or amiodarone - answer D. Procainamide or amiodarone Your general impression of a 78-year-old woman reveals that her eyes are closed, she is not moving, you can see no rise and fall of her chest or abdomen, and her skincolor is pale. When you arrive at the patient's side, you confirm that she is unresponsive. Your best action in this situation will be to: A. Open her airway and give two breaths. B. Apply an automated external defibrillator (AED). C. Assess breathing and determine whether she has a pulse. D. Prepare the necessary equipment to insert an advanced airway. - answer C. Assess breathing and determine whether she has a pulse. A 60-year-old woman has suffered a cardiac arrest. A health care professional trained in endotracheal intubation has intubated the patient. Which of the following findings would indicate inadvertent esophageal intubation? A. Jugular vein distention B. Subcutaneous emphysema C. Gurgling sounds heard over the epigastrium D. Breath sounds heard on only one side of the chest - answer C. Gurgling sounds heard over the epigastrium Hypotension (ie, a systolic BP of less than 90 mm Hg) after the return of spontaneous circulation (ROSC) may necessitate the use of: A. Fluid boluses and isoproterenol. B. Procainamide, epinephrine, or dopamine. C. Epinephrine, dopamine, or norepinephrine. D. Fluid boluses, procainamide, and isoproterenol. - answer C. Epinephrine, dopamine, or norepinephrine. Which of the following is incorrect with regard to a postevent debriefing?

D. Continue peripheral IV attempts until successful. - answer B. Attempt intraosseous access. Synchronized cardioversion: A. Is used only for atrial dysrhythmias. B. Delivers a shock during ventricular depolarization. C. Delivers a shock between the peak and end of the T wave. D. Is used only for rhythms with a ventricular rate of less than 60 beats/min. - answer B. Delivers a shock during ventricular depolarization. An 84-year-old man presents with an acute onset of altered mental status. The cardiac monitor shows the rhythm here. The patient's BP is 58/30 mm Hg andhis ventilatory rate is 14 breaths/min. His skin is cool, moist, and pale. His blood oxygen saturation level (SpO2) on room air is 95%. An IV has been established. On the basis of the information provided, your best course of action will be to: A. Prepare for transcutaneous pacing. B. Give amiodarone 300 mg IV push. C. Give epinephrine 1 mg IV bolus and reassess. D. Observe the patient and monitor for signs of deterioration. - answer A. Prepare for transcutaneous pacing. Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. Which of the following actions performed at the scene is most likely to reduce subsequent treatment delays at the hospital? A. Giving aspirin B. Obtaining a 12-lead electrocardiogram (ECG) C. Assessing vital signs and oxygen saturation

D. Assessing the patient's degree of discomfort - answer B. Obtaining a 12-lead electrocardiogram (ECG) Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. The patient rates his discomfort 9/10. His BP is 126/72 mm Hg and ventilations 14 breaths/min. His SpO2 on room air is 95%. The cardiac monitor shows a sinus rhythm at 60 beats/min. Immediate management of this patient should include: A. Giving aspirin and NTG. B. Establishing IV access and giving aspirin. C. Administering oxygen and establishing IV access. D. Administering oxygen and obtaining a targeted history. - answer B. Establishing IV access and giving aspirin. Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. Current guidelines recommend obtaining an initial 12-lead ECG within ____ of patient contact when an acute coronary syndrome (ACS) is suspected. A. 10 minutes B. 30 minutes C. 45 minutes D. 60 minutes - answer A. 10 minutes Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. When the patient's 12-lead ECG is reviewed, the results should be used to classify the patient into one of three groups.Which of the following correctly reflects these categories? A. ST elevation (STE), normal ECG, Q waves

A. Posterior B. Inferolateral C. Anterolateral D. Non-ST elevation - answer C. Anterolateral Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. On the basis of the patient's 12-lead ECG findings: A. The patient should be classified as having a nondiagnostic ECG and discharged with follow-up instructions. B. The patient should be classified as having an ST elevation MI (STEMI) and should be evaluated for immediate reperfusion therapy. C. The patient should be classified as having a normal ECG; serial ECGs should be obtained at 30-minute intervals to detect the development of ST elevation. D. The patient should be classified as having a non-ST elevation ACS (NSTE-ACS) and should be admitted to a monitored bed for further evaluation. - answer B. The patient should be classified as having an ST elevation MI (STEMI) and should be evaluated for immediate reperfusion therapy. Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. Vascular access has been established. The patient's BP is 130/70 mm Hg, his pulse is 60 beats/min, and his ventilatory rate is 14 breaths/min. Assuming there are nocontraindications for any of the following medications, which of the following would be appropriate for this patient at this time? A. Aspirin and NTG B. Aspirin and a nonsteroidal antiinflammatory drug (NSAID) C. An oral beta-blocker and an NSAID D. Aspirin and a calcium channel blocker (CCB) - answer A. Aspirin and NTG

Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. NTG has been ordered for administration to this patient. NTG: A. Is contraindicated in hypotensive patients. B. Should be administered via the IV route for maximum benefit. C. Should be used with caution in patients with anterior infarction. D. Should be given every 15 to 20 minutes until chest discomfort is relieved. - answer A. Is contraindicated in hypotensive patients. Paramedics are on the scene with a 55-year-old man who is complaining of severe chest discomfort. He describes his discomfort as a "heavy pressure" in the middle of his chest that has been present for about 1 hour. The patient's chest discomfort was unrelieved after the maximum recommended dosage of NTG tablets. Morphine sulfate was ordered and a 4 mg dose was given IV. The patient's BP is now 80/60 mm Hg and his skin is cool, moist, and pale. His breath sounds are clear. You should: A. Prepare a lidocaine infusion at 1 to 4 mg/min. B. Prepare an epinephrine infusion at 2 mcg/min. C. Give a 250 mL IV fluid bolus of normal saline. D. Prepare a dopamine infusion at 2 to 10 mcg/kg/min. - answer C. Give a 250 mL IV fluid bolus of normal saline. Which of the following is not recommended when performing defibrillation? A. Check for a pulse immediately after defibrillation to determine next steps. B. Visually check and ensure that everyone is clear of the patient before shock delivery. C. Remove transdermal medication patches or ointment from the patient's chest before the procedure. D. All team members with the exception of the chest compressor should clear the patient as the machine charges. - answer A. Check for a pulse immediately after defibrillation to determine next steps.

The preferred method used to verify the proper placement of an endotracheal tube is: A. Obtaining a chest radiograph. B. Using continuous waveform capnography. C. Auscultating the presence of bilateral breath sounds. D. Observing adequate chest rise with positive pressure ventilation. - answer B. Using continuous waveform capnography. Which of the following is incorrect with regard to the events of a typical resuscitation effort? A. The team leader should state his or her instructions one at a time. B. The team leader should encourage a respectful exchange of ideas. C. Team members must be knowledgeable about current resuscitation algorithms. D. Team members should be encouraged to confer among themselves throughout the resuscitation effort. - answer B. The team leader should encourage a respectful exchange of ideas. Which of the following statements is correct about the use of medications during cardiac arrest? A. Amiodarone is the drug of choice for cardiac arrest resulting from asystole. B. Lidocaine is contraindicated in cardiac arrest associated with a shockable rhythm. C. Epinephrine should be given as soon as feasible after the onset of cardiac arrest associated with a nonshockable rhythm. D. Vasopressin can be substituted for either the first or second dose of epinephrine in the treatment of cardiac arrest. - answer C. Epinephrine should be given as soon as feasible after the onset of cardiac arrest associated with a nonshockable rhythm. This 12-lead ECG is from a 50-year-old man complaining of chest discomfort. Which of the following is true regarding this 12-lead ECG? A. This 12-lead reveals no significant findings. B. STE is present in leads V1 to V4. An anterior STEMI is suspected.

C. STE is present in leads I, aVR, and V6. A lateral STEMI is suspected. D. STD is present in leads III and aVF. An inferior STEMI is suspected. - answer B. STE is present in leads V1 to V4. An anterior STEMI is suspected. A 65-year-old man is complaining of a sudden onset of dizziness. He is awake, alert, and diaphoretic. The patient states that his symptoms began 45 minutes ago while cleaning his garage. He denies chest pain, shortness of breath, and nausea. The patient's breath sounds are clear bilaterally. His BP is 78/50 mm Hg, ventilations 18 breaths/min. His SpO2 on room air is 96%. The cardiac monitor reveals the following rhythm. This rhythm is: A. Junctional rhythm. B. Sinus bradycardia. C. Third-degree atrioventricular (AV) block. D. Second-degree AV block (2:1 AV block). - answer D. Second-degree AV block (2:1 AV block). A 65-year-old man is complaining of a sudden onset of dizziness. He is awake, alert, and diaphoretic. The patient states that his symptoms began 45 minutes ago while cleaning his garage. He denies chest pain, shortness of breath, and nausea. The patient's breath sounds are clear bilaterally. His BP is 78/50 mm Hg, ventilations 18 breaths/min. His SpO2 on room air is 96%. An IV is in place. Your best course of action will be to: A. Defibrillate immediately. B. Administer atropine 0.5 mg IV. C. Administer amiodarone 300 mg IV. D. Administer vasopressin 40 units IV. - answer B. Administer atropine 0.5 mg IV. An 89-year-old man is complaining of a "racing heart." He states his symptoms began while playing a card game with friends. He had an MI 15 years ago and a coronary artery bypass graft

A. Regular, polymorphic, wide-QRS tachycardia. B. Regular, monomorphic, wide-QRS tachycardia. C. Irregular, polymorphic, wide-QRS tachycardia. D. Irregular, monomorphic, wide-QRS tachycardia - answer B. Regular, monomorphic, wide-QRS tachycardia. A 72-year-old woman presented with a sudden onset of shortness of breath and collapsed. After confirming the patient was unresponsive, apneic, and pulseless, CPR was begun. Which of the following ACLS treatment guidelines should be used in the initial treatment of this patient? A. Symptomatic bradycardia B. Narrow-QRS tachycardia C. Pulseless electrical activity (PEA) D. ACSs - answer C. Pulseless electrical activity (PEA) A 72-year-old woman presented with a sudden onset of shortness of breath and collapsed. After confirming the patient was unresponsive, apneic, and pulseless, CPR was begun. An IV has been established and the patient is being ventilated with a bag-mask device (BMD). You observe gentle bilateral chest rise with ventilations. Your next action should be to: A. Defibrillate immediately. B. Give 0.5 mg of atropine IV. C. Give 1 mg of epinephrine IV. D. Begin transcutaneous pacing. - answer C. Give 1 mg of epinephrine IV. A 73-year-old woman presents with symptoms of acute stroke 3.5 hours after symptom onset. She has a history of an acute MI 6 years ago, chronic atrial fibrillation, and diabetes mellitus. The patient'sBPis 168/100 mmHg, her heart rateis 88 to 100 beats/min, and her ventilations are 12 breaths/min. Her National Institutes of Health Stroke Scale (NIHSS) score is 22. Daily medications include lisinopril, metformin, and warfarin. Which of the following statements with regard to fibrinolytic therapy for this patient is true?

A. This patient is not a candidate for fibrinolytic therapy because of her age. B. This patient is not a candidate for fibrinolytic therapy because she is hypertensive. C. This patient is not a candidate for fibrinolytic therapy because she is taking an oral anticoagulant. D. This patient is not a candidate for fibrinolytic therapy because too much time has lapsed between symptom onset and hospital arrival. - answer C. This patient is not a candidate for fibrinolytic therapy because she is taking an oral anticoagulant. Which of the following is true with regard to procainamide? A. Procainamide is a potent vasoconstrictor. B. Procainamide may cause widening of the QRS complex. C. Procainamide is indicated in the treatment of asystole and slow PEA. D. Procainamide is a first-line drug in the management of torsades de pointes (TdP). - answer B. Procainamide may cause widening of the QRS complex. A BMD that is used with supplemental oxygen set at a flow rate of 10 to 15 L/min delivers about _____oxygen to the patient when a reservoir is not used. A. 21% B. 40% to 60% C. 60% to 90% D. 90% to 100% - answer B. 40% to 60% A 35-year-old woman presents with a narrow-QRS tachycardia. She is stable but symptomatic. Vagal maneuvers and an initial dose of adenosine were ineffective. You should now: A. Perform synchronized cardioversion. B. Administer 6 mg of adenosine rapid IV push. C. Administer 12 mg of adenosine rapid IV push. D. Administer diltiazem 0.25 mg/kg IV over 2 minutes. - answer C. Administer 12 mg of adenosine rapid IV push

D. Synchronized cardioversion and resuscitation medications. - answer A. CPR and defibrillation. Diltiazem may be used: A. Concurrently with IV beta-blockers. B. In the management of symptomatic bradycardia. C. In the management of a stable patient with a wide-QRS tachycardia. D. To control the ventricular rate with atrial flutter or atrial fibrillation. - answer D. To control the ventricular rate with atrial flutter or atrial fibrillation. CPR is ongoing for a 66-year-old man in cardiac arrest. The cardiac monitor reveals asystole. Vascular access has been achieved and an advanced airway has beeninserted. Which of the following statements is correct with regard to this situation? A. The depth of chest compressions should be 1.5 to 2 inches. B. Chest compressions should be delivered at a rate of 100 per minute. C. The ratio of chest compressions to ventilations delivered should be 30:2. D. Ventilations should be delivered at a rate of one breath every 6 seconds. - answer D. Ventilations should be delivered at a rate of one breath every 6 seconds. What precautions should be taken before giving NTG? A. Make sure the patient's heart rate is at least 70 beats/min. B. Make sure there is no evidence of a right ventricular infarction. C. Make sure the patient's systolic BP is more than 140 mm Hg. D. Make sure the patient has not used a diuretic or an antihypertensive medication in the past 24 hours. - answer B. Make sure there is no evidence of a right ventricular infarction. A simple face mask: A. Requires a minimum oxygen flow rate of 2 L/min. B. Can only be used in a spontaneously breathing patient. C. Does not permit the mixing of the patient's exhaled air with 100% oxygen.

D. Delivers an oxygen concentration of 70% to 85% at recommended flow rates. - answer B. Can only be used in a spontaneously breathing patient.