304 ACLS Exam Study Questions COMPILED IN 2022 – COMPLETE SOLUTION. Graded A+

304 ACLS Exam Study Questions COMPILED IN 2022 – COMPLETE SOLUTION Concept that helps to promote effective/efficient teamwork & reduces likelihood of errors is called _____. - ✔✔Problem solving In 6-person high-perfo ...

304 ACLS Exam Study Questions COMPILED IN 2022 – COMPLETE SOLUTION Concept that helps to promote effective/efficient teamwork & reduces likelihood of errors is called _____. - ✔✔Problem solving In 6-person high-performance resuscitation team, which tasks are responsibilities of team members? (3) - ✔✔Recoding key data, sharing pertinent observations, & performing chest compressions Which assessments would be included in primary assessment? - ✔✔Checking for life-threatening injuries & checking airway patency When performing high-quality CPR on adult w/o advanced airway in place, what is correct ratio of compressions to ventilations? - ✔✔30:2 When providing high-quality CPR on adult, what is proper rate for chest compressions? - ✔✔100-120 bpm Responsibilities of team leader? (3) - ✔✔Sets clear expectations, leads debriefing, assigns roles Team leader instructs team member to perform intervention. To practice good communication, team member should do which of the following? (3) - ✔✔Acknowledge completion of intervention, use nonverbal communication methods to indicate follow through w. intervention, & acknowledge initiation of intervention Which blood tests are often indicated in evaluation of pts experiencing cardiovascular, cerebrovascular or respiratory emergency? - ✔✔CMP, Toxicology, CBC, Cardiac markers, ABGs, Blood glucose You need to set up cardiac monitoring w. 5-electrode system. Where should you place white electrode? - ✔✔Top right chest anatomically orientedWhat is rapid assessment? - ✔✔Quick assessment to ensure safety, form initial impression of pt, & if pt appears to be unresponsive check for responsiveness/breathing/pulse During primary assessment, what tool would you use to determine pts LOC? - ✔✔AVPU Model When providing high-quality CPR on adult, what is proper depth for chest compressions? - ✔✔2-2.4" Team member confirms message is received & understood. What communication technique is team member using? - ✔✔Closed-Loop Communication What end-tidal carbon dioxide (ETCO2) value confirms adequate ventilation in intubated pt w. respiratory arrest? - ✔✔35-45 mmHg CPR: Which statements apply to providing high-quality chest compressions? (3) - ✔✔Minimize interruptions, proper depth, proper rate Closed-loop communication - ✔✔Communication technique used to prevent misunderstandings; receiver confirms message has been received & understood. Critical thinking uses - ✔✔Obtaining an initial impression, determining course of action, anticipating roles & functions as part of team based on pts presentation/condition, consistently re-evaluating situation for changes, interpreting changes & applying them to pts care & tx, & modifying actions based on changes you observe. Team Leader Responsibilities - ✔✔Assigns & understands team roles - Sets clear expectations - Prioritizes, directs & acts decisively - Encourages/allows team input & interaction - Focuses on big picture - Monitors performance while providing support - Acts as role model - Coaches team - Reevaluates & summarizes progress - Leads debriefing Team Member Responsibilities - ✔✔Have necessary knowledge/skills to perform assigned role - Stay in assigned role but assist others PRN, as long as they're able to maintain own responsibilities - Communicate effectively w. team leader if they: Feel they're lacking any knowledge/skills to performassigned roles, identify something team leader may have overlooked, or recognize dangerous situation/need for urgent action - Share info w. other team members - Focus on achieving goals - Ask pertinent questions & share pertinent observations - Participate in debriefing sessions - Crew Crew Resource Management - ✔✔Concept helps to promote effective/efficient teamwork & reduce likelihood of errors. Emphasizes using all available resources (people, equipment, procedures) to reduce likelihood of human error & promote effective/efficient teamwork. Guides team members to communicate directly & effectively w. team leader about dangerous or time-critical decisions. When problem arises, team members must get attention of team leader, state concern, describe problem as they see it & suggest solution. Team leader provides direction, enabling team to work together to resolve issue. 6-Person High-Performance Resuscitation Team - ✔✔Includes 3 who fulfill CPR/defib roles & 3 who perform leadership/supportive roles Data Manager - ✔✔Responsible for communicating & recording key data during resuscitation effort (i.e. data r/t med admin & interruptions to chest compressions) Airway manager & ventilator - ✔✔Responsible for managing airway & providing ventilations. Trained RT, if available, would fill role Compressor - ✔✔Responsible for chest compressions AED/Defibrillator Operator - ✔✔Responsible for managing AED or defibrillator & establishing any other monitoring. Also, relieves team member performing compressions Team Leader - ✔✔Responsible for prioritizing & directing other team members' actions. Medication Administrator - ✔✔Responsible for establishing vascular access & administering medications. Assess, Recognize & Care - ✔✔Describes ongoing process of gathering data about pt condition, using data to identify problem & intervening to address problem. Acutely ill pt condition can change rapidly(for better or worse), you must continuously assess pt, recognize whats happening & provide care accordingly Assess - ✔✔Process of gathering data to help determine whats happening. To ensure most pressing problems addressed first, take phased, systematic approach to assessment: perform rapid assessment, primary assessment & when condition allows, secondary assessment. In emergency situation, assessment ongoing. Recognize - ✔✔After you gather assessment data, use critical thinking, your past clinical experience and your general knowledge to correctly interpret the meaning of the data and gain an understanding of the patient's clinical situation and care needs. This understanding enables you to determine your next steps. Care - ✔✔Implement appropriate care based on understanding of condition. Proper care can't be provided w/o effective assessment & accurate recognition of condition Primary assessment - ✔✔Focused assessment of airway, breathing, circulation, disability, & exposure (ABCDE) to identify potentially life-threatening conditions & address them immediately Secondary assessment - ✔✔Broader assessment to narrow list of differential dx & discover underlying causes. Includes focused hx, exam, & diagnostic testing When advanced airway in place & pt in cardiac arrest, compressions & ventilations delivered continuously w. no interruptions. 1 provider delivers __________ q6s while 2nd provider performs compressions at rate of 100-120/min - ✔✔1 ventilation Provide minimal level of supplemental oxygen needed to maintain oxygen saturation of at least _____ - ✔✔94%. Based on visual survey, pt appears to be unresponsive. What should your immediate next action be? - ✔✔Check for responsiveness using shout-tap-shout sequenceIf they're unresponsive, call for additional resources & simultaneously check breathing/pulse for 5-10 seconds Brown lead going right side of chest in __________ - ✔✔Middle (~3-4th ICS) Which complications can occur when providing ventilations w. BVM resuscitator? - ✔✔Regurgitation/Aspiration (d/t gastric insufflation) - Tension Pneumothorax (d/t barotrauma) - Decreased Cardiac Output (d/t decreased venous return) You need to obtain intraosseous (IO) access. Identify preferred site. - ✔✔Anterior proximal tibia often used bc it provides flat surface w. relatively thin outer layer of bone, large marrow cavity, & easily identifiable landmarks to facilitate placement. Proximal humerus also used. Which airway device is most appropriate as initial intervention for semiconscious pt who requires ventilation w. BVM resuscitator? - ✔✔NPA (nasopharyngeal airway) may be used w. conscious, semiconscious or unconscious pts You have just placed advanced airway. How should you verify correct placement? - ✔✔Confirm initially, if pt moved & ongoing basis. Methods: Physical assessment (observing for bilateral chest rise & auscultating over lungs/epigastrium) & confirmation tool (i.e. capnography) Fogging in tube & improved O2 saturation on pulse oximetry aren't reliable methods of confirmation Resuscitation team decides to place advanced airway in pt whose in cardiac arrest. How should ventilations be provided following placement of airway? - ✔✔Provide 1 ventilation q6s w/o pausing compressions Which assessment could be made during rapid assessment? - ✔✔Pt is diaphoretic When obtaining 12-lead ECG, where should electrodes for limb leads be placed? - ✔✔On upper arms and on the thighs/calves Avoid bony areas like the anklesECG rhythm strip part that's time from beginning of atrial depolarization to beginning of ventricular depolarization - ✔✔PR Interval EKG: Heart's electrical conduction system part that generates electrical impulses initiating heartbeat rhythm/rate: - ✔✔Sinoatrial (SA) node Which anatomic landmark should be used to ensure proper placement of precordial electrodes for 12- lead ECG? - ✔✔Angle of Louis (sternal angle), which is adjacent to 2nd rib. Then palpate down along sternal border to identify 4th ICS Don't place AED pads over___________ - ✔✔Pacemaker Hover hands over chest but don't touch during: - ✔✔AED shock (to minimize time not performing compressions) Bag ventalition device holds ______mL - ✔✔700 If capnography is < 10 there may be probelm with _________ - ✔✔Compressions Chest Compression Fraction - ✔✔Total percentage of time during resuscitation attempt in which active chest compressions are being performed. Needs to be >= 60% w. goal of 80 You'd expect to see ETCO2 < ___ in presence of hyperventilation - ✔✔35 mmHg Which underlying mechanism can lead to hypoxia in pt w. right shift of oxygen-hemoglobin dissociation curve? - ✔✔Decreased affinity for oxygen bindingHyperventilation leads to alkalosis & a _______ shift of oxygen-hemoglobin dissociation curve. - ✔✔Left On rapid assessment, you note increased work of breathing, AEB tripod positioning, inability to speak > 1-2 words at a time & diaphoresis. What assessments should you obtain during primary assessment? - ✔✔Pulse ox & VS Changes in what can affect rate & depth of breathing? (3) - ✔✔Arterial pH - Arterial O2 levels - Arterial CO2 levels Respiratory: What is body's primary muscle of inspiration? - ✔✔Diaphragm When assessing pt w. respiratory compromise, it's important to determine where pt is on continuum of respiratory compromise. T/F - ✔✔True Which non-respiratory differential dx would you consider when assessing pt w. respiratory compromise? - ✔✔Acute valvular insufficiency, cardiac tamponade, cardiogenic pulmonary edema In pt showing s/s of respiratory compromise, provide minimum level of supplemental O2 needed to maintain O2 saturation of at least: - ✔✔94% What is capnography waveform graphical representation of? - ✔✔Movement of CO2 through respiratory system Oxygen-hemoglobin dissociation curve depicts relationship btw partial pressure of oxygen (PaO2) & the: - ✔✔Arterial oxygen saturation When Hgb's affinity for O2 is increased, O2 binds to Hgb easily, but offloading is difficult. This is reflected on oxygen-hemoglobin dissociation curve as shift to the _________. - ✔✔LeftRespiratory Baseline - ✔✔Phase on capnography waveform representing beginning of exhalation. During phase, "dead space" air (i.e. air in airways from bronchioles to nasal cavity that doesn't contain CO2) is exhaled from body. Respiratory upstroke - ✔✔Phase on capnography waveform representing exhalation of air containing CO2 from alveoli. For most pts, respiratory upstroke should be nearly vertical. Inspiratory downslope - ✔✔Phase of capnography waveform representing inhalation. Inhalation occurs & CO2 is rapidly purged from airways & alveoli. Expiratory Plateau - ✔✔During this phase, the last of CO2-laden air from most distal alveoli exhaled from body. ETCO2 measured at end of exhalation (point D), representing peak level. In 12-lead ECG, the 4 limb leads produce views in frontal plane. What are those views? (6) - ✔✔aVL - I - aVR - II - III - aVF What parts of heart's electrical conduction system play role in ventricular contraction? (3) - ✔✔Purkinje fibers - Bundle of His - Bundle Branches To estimate atrial rate, count number of P waves over 6s period & multiply by ________. - ✔✔10 12-lead ECG reveals tachyarrhythmia w. narrow QRS complexes (< 0.12s). You would classify this arrhythmia as ________. - ✔✔SVT In 3rd-degree AV block, there is no electrical communication btw atria & ventricles, so no relationship btw P waves & the _________ - ✔✔QRS Complexes In _________, atrial contraction occurs at such a rapid rate that discrete P waves separated by flat baseline can't be seen. - ✔✔Atrial Flutter When providing transcutaneous pacing, appearance of wide QRS complexes & tall, broad T waves after each pacing spike confirms mechanical capture has been achieved. T/F? - ✔✔FalseIn event of primary pacemaker dysfunction/failure, what part of heart's conduction system can function as backup pacemaker? - ✔✔Atrioventricular (AV) Node Sinus bradycardia is identical to normal sinus rhythm, except rate is less than _____ bpm - ✔✔60 What is 1st-line therapy for unstable pt w. symptomatic bradycardia? - ✔✔Atropine Healthcare provider conducting secondary assessment of pt w. arrhythmia. Which questions should provider seek answers to while obtaining pt hx? (3) - ✔✔Meds currently being taken, what pt was doing when s/s began, & hx of pulmonary/thyroid disease Which findings may suggest pt is experiencing hemodynamic compromise c/b bradyarrhythmia? (5) - ✔✔Hypotension - Ischemic CP - S/S of shock - AMS - Acute HF What part of heart's electrical conduction system helps to protect ventricles from atrial tachyarrhythmias? - ✔✔Atrioventricular (AV) node What part of ECG rhythm strip represents repolarization of ventricular myocardial cells? - ✔✔T-waves Goals of secondary assessment in pt w. suspected arrhythmia? (2) - ✔✔Determining potentially reversible causes of arrhythmia & determining the severity of s/s What drugs may be used as 2nd-line therapy for unstable pt w. symptomatic bradycardia? - ✔✔Epinephrine - Dopamine Arrhythmias that are narrow-complex tachyarrhythmias? (3) - ✔✔Sinus tachycardia - AFlutter - AFib Synchronized cardioversion indicated for tx of which arrhythmias? (3) - ✔✔AFib - Monomorphic VTach w. regular rhythm - AFlutterIn ventricular tachycardia, QRS complexes are wide, lasting longer than: - ✔✔120 milliseconds 12-lead ECG shows wide-complex ventricular tachycardia in stable pt w. pulse. Which may be indicated in mgmt of pt? - ✔✔Expert consultation and/or antiarrhythmic infusion Which statement about electrocardiography is true? - ✔✔5-lead ECG uses 4 limb leads & 1 precordial lead to provide 7 views of electrical activity of heart On capnography, absent expiratory plateau indicates: - ✔✔Dynamic Hyperinflation aka auto-PEEP (autopositive end expiratory pressure). Plateau loss produced by uneven alveolar emptying secondary to severe bronchospasm leading to air trapping. Respiratory compromise manifests along continuum. When pt is breathing but respiratory system unable to meet metabolic demands, pt is in: - ✔✔Respiratory Failure On capnography waveform, what finding indicates pt isn't rebreathing CO2? - ✔✔Flat Baseline What ETCO2 value would you expect to see in presence of hypoventilation? - ✔✔50 mmHg Waveform indicates - ✔✔Presence of CO2 - Even abnormal waveform is indication CO2 is present Normal Respiratory Baseline - ✔✔Flat & consistent from breath to breath Respiratory baseline that slopes upward & increases w. each breath suggests - ✔✔Pt rebreathing CO2 Prolonged respiratory upstroke that isn't vertical indicates - ✔✔Uneven alveolar emptying d/t bronchospasm In inflammatory conditions, waveform may still be square, despite narrowing of airway, bc - ✔✔Alveoli are still empty at same rateNormal Capnogram Consists of: - ✔✔Flat baseline, steep upstroke/downstroke, flat plateau, & ETCO2 btw 35-45 mmHg CO2 Facts - ✔✔Byproduct of cellular metabolism - Transported by Hgb to lungs - Eliminated from alveoli (during ventilation) CO2 Monitor Detects Complete Airway Obstruction & Extubation Faster Than - ✔✔Pulse ox & VS monitoring