Question 1

The nurse knows that in advanced cardiac life support,the secondary survey includes steps A-B-C-D,in which "D" refers to:
A) defibrillate.
B) differential diagnosis.
C) diltiazem intravenous push.
D) do not resuscitate.

Accepted Answer

The A-B-C-D (airway,breathing,circulation,differential diagnosis)in the Advanced Cardiac Life Support (ACLS)secondary survey involves the performance of more in-depth assessments and interventions.Differential diagnosis involves investigation into the cause of the arrest.If a reversible cause is identified,a specific therapy can be initiated.

Question 2

The code team has just defibrillated a patient in ventricular fibrillation.Following CPR for 2 minutes,what is the next action to take?
A) Administer amiodarone.
B) Administer lidocaine.
C) Assess rhythm and pulse.
D) Prepare for transcutaneous pacing.

Accepted Answer

Reassess the patient frequently.Check for return of pulse,spontaneous respirations,and blood pressure.

Question 3

It is determined that the patient needs a transcutaneous pacemaker until a transvenous pacemaker can be inserted.What is the most appropriate nursing intervention?
A) Apply conductive gel to the skin.
B) Provide adequate sedation and analgesia.
C) Recheck leads to make sure that the rhythm is asystole.
D) Set the milliamperes to 2 mA below the capture level.

Accepted Answer

The alert patient who requires transcutaneous pacing may experience some discomfort.Because the skeletal muscles are stimulated,as well as the heart muscle,the patient may experience a tingling,twitching,or thumping feeling that ranges from mildly uncomfortable to intolerable.Sedation,analgesia,or both may be indicated.

Question 4

During cardioversion,the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex?
A) P
B) R
C) S
D) T

Accepted Answer

During cardioversion,the electrical shock is synchronized to deliver shock on the R wave.This is to prevent the shock from being delivered during repolarization (T wave).Ventricular fibrillation may occur if the shock is delivered on the T wave.

Question 5

The monitor technician notifies the nurse "stat" that the patient has a rapid,chaotic rhythm that looks like ventricular tachycardia.What is the nurse's first action?
A) Call a code overhead.
B) Check the patient immediately.
C) Go to the nurses' station and look at the rhythm strip.
D) Take the crash cart to the room.

Accepted Answer

The first intervention in this situation is to assess unresponsiveness by checking the patient.

Question 6

During a code situation,the nurse would prepare to use which preferred intravenous fluid?
A) 5% dextrose in 0.45% normal saline
B) 5% dextrose in water
C) Dopamine infusion
D) Normal saline

Accepted Answer

Normal saline is the preferred intravenous fluid during resuscitation efforts because it expands intravascular volume better than infusions containing dextrose.

Question 7

Laypersons should use which device to treat lethal ventricular dysrhythmias that occur outside a hospital setting?
A) Automatic external defibrillator
B) Carbon dioxide detector
C) Pocket mask
D) Transcutaneous pacemaker

Accepted Answer

Because of the ease of use and efficacy in treating lethal ventricular dysrhythmias,automatic external defibrillators are recommended to be placed in a variety of public settings where they may be used by laypersons.

Question 8

The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT).The nurse prepares which medication to administer to the patient?
A) Adenosine
B) Amiodarone
C) Diltiazem
D) Procainamide

Accepted Answer

Adenosine is the initial drug of choice for the diagnosis and treatment of supraventricular dysrhythmias.Adenosine has an onset of action of 10 to 40 seconds and duration of 1 to 2 minutes; therefore,it is administered rapidly.

Question 9

When doing manual ventilations during a code,the nurse would administer ventilations following which guideline?
A) Approximately 8 to 10 breaths per minute
B) During the fifth chest compression
C) Every 3 seconds or 20 times per minute
D) While compressions are stopped

Accepted Answer

Manual ventilations are delivered one breath every 6 to 8 seconds or approximately 8 to 10 breaths per minute.

Question 10

The patient has pulseless electrical activity ( PEA ).What action by the nurse takes priority?
A) Begin high-quality CPR.
B) Assist with chest tube placement.
C) Prepare equipment for a pericardiocentesis.
D) Attach the patient to a transcutaneous pacemaker.

Accepted Answer

A patient in PEA does not have a pulse or blood pressure.The nurse initiates high-quality CPR.Chest tube insertion,pericardiocentesis,and transcutaneous pacing are not required.

Question 11

The nurse needs to evaluate arterial blood gases before the administration of which drug?
A) Calcium chloride
B) Magnesium sulfate
C) Potassium
D) Sodium bicarbonate

Accepted Answer

Bicarbonate therapy should be guided by the bicarbonate concentration or calculated base deficit from arterial blood gas analysis or laboratory measurement.

Question 12

The patient's monitor shows bradycardia (heart rate of 40 beats/min)and frequent premature ventricular contractions (PVCs)with a measured blood pressure of 85/50 mm Hg.The nurse anticipates the use of which drug?
A) Atropine 0.5 to 1 mg intravenous push
B) Dopamine drip-continuous infusion
C) Lidocaine 1 mg/kg intravenous push
D) Transcutaneous pacemaker

Accepted Answer

This patient is having PVCs secondary to bradycardia.Atropine is a first-line drug for bradycardia.Administer atropine,0.5 mg IV every 3 to 5 minutes to a total dose of 3 mg.Atropine is not indicated in second-degree atrioventricular (AV)block type II or third-degree AV block.

Question 13

A patient is admitted to the coronary care unit with an inferior wall myocardial infarction and develops symptomatic bradycardia with premature ventricular contractions every third beat (trigeminy).The nurse knows to prepare to administer which drug?
A) Amiodarone
B) Atropine
C) Lidocaine
D) Magnesium

Accepted Answer

Atropine is used to increase the heart rate by decreasing the vagal tone.It is indicated for patients with symptomatic bradycardia.

Question 14

A nursing home patient is admitted to the critical care unit with a severe case of pneumonia.No living will or designation of health care surrogate is noted on the chart.In the event this patient needs intubation and/or cardiopulmonary resuscitation,what should be the nurse's action?
A) Activate the code team, but initiate a "slow" code.
B) Call the nursing home to determine the patient's or family's wishes.
C) Code the patient for 5 minutes and then cease efforts.
D) Initiate intubation and/or cardiopulmonary resuscitation efforts.

Accepted Answer

In the absence of a written order from a physician to withhold resuscitative measures,resuscitation efforts must be initiated if indicated.

Question 15

The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction.Suddenly the monitor alarms and the screen shows a flat line.What action should the nurse take first?
A) Administer epinephrine by intravenous push.
B) Begin chest compressions.
C) Check patient for unresponsiveness.
D) Defibrillate at 360 J.

Accepted Answer

The first intervention is to assess unresponsiveness.

Question 16

Which rhythm would be an emergency indication for the application of a transcutaneous pacemaker?
A) Asystole
B) Bradycardia (heart rate 40 beats/min), normotensive and alert
C) Bradycardia (heart rate 50 beats/min) with hypotension and syncope
D) Supraventricular tachycardia (heart rate 150 beats/min), hypotensive

Accepted Answer

Transcutaneous (external noninvasive)cardiac pacing is used during emergencies to treat symptomatic bradycardia (hypotension,altered mental status,angina,pulmonary edema)that has not responded to atropine.This patient is symptomatic.

Question 17

A patient is brought to the critical care unit after a motor vehicle crash.On admission,the patient reports dyspnea and chest pain.Upon examination,the nurse notes a lack of breath sounds on the left side and a tracheal shift.The patient suddenly experiences cardiac arrest.What assessment by the nurse takes priority?
A) Heart tones
B) Lung sounds
C) Peripheral pulses
D) Neurological status

Accepted Answer

The nurse should listen to lung sounds first.The signs and symptoms the patient experienced are consistent with a tension pneumothorax,which is a reversible cause of cardiac arrest.A tension pneumothorax occurs when air enters the pleural space but cannot escape.Pressure increases in the pleural space and causes the lung to collapse.Symptoms of a tension pneumothorax include dyspnea,chest pain,tachypnea,tachycardia,and jugular venous distension.

Question 18

During a code,the nurse would place paddles for anterior defibrillation in what locations?
A) Second intercostal space, left sternal border and fourth intercostal space, left midclavicular line
B) Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line
C) Second intercostal space, right sternal border and fifth intercostal space, left midclavicular line
D) Fourth intercostal space, right sternal border and fifth intercostal space, left midclavicular line

Accepted Answer

Anterior paddle placement is used most often for defibrillation.In the anterior method,one paddle or adhesive electrode pad is placed at the second intercostal space to the right of the sternum,and the other paddle or adhesive electrode pad is placed at the fifth intercostal space,midaxillary line,to the left of the sternum.

Question 19

A patient develops frequent ventricular ectopy.The nurse prepares to administer which drug?
A) Adenosine
B) Atropine
C) Lidocaine
D) Magnesium

Accepted Answer

Lidocaine is an antidysrhythmic drug that suppresses ventricular ectopic activity.

Question 20

The nurse chooses which method and concentration of oxygen administration until intubation is established in a patient who has sustained a cardiopulmonary arrest? A) Bag-valve-mask at FiO₂ of 100% B) Bag-valve-mask at FiO₂ of 50% C) Mouth-to-mask ventilation with supplemental oxygen D) Non-rebreather mask at FiO₂ of 100%

Accepted Answer

Oxygen can be delivered via mouth to mask or with a bag-valve device connected to a mask or endotracheal tube.During resuscitation efforts,100% oxygen is administered.

Quiz 10: Rapid Response Teams and Code Management

The nurse knows that in advanced cardiac life support,the secondary survey includes steps A-B-C-D,in which "D" refers to:

The code team has just defibrillated a patient in ventricular fibrillation.Following CPR for 2 minutes,what is the next action to take?

It is determined that the patient needs a transcutaneous pacemaker until a transvenous pacemaker can be inserted.What is the most appropriate nursing intervention?

During cardioversion,the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex?

The monitor technician notifies the nurse "stat" that the patient has a rapid,chaotic rhythm that looks like ventricular tachycardia.What is the nurse's first action?

During a code situation,the nurse would prepare to use which preferred intravenous fluid?

Laypersons should use which device to treat lethal ventricular dysrhythmias that occur outside a hospital setting?

The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT) .The nurse prepares which medication to administer to the patient?

When doing manual ventilations during a code,the nurse would administer ventilations following which guideline?

The patient has pulseless electrical activity ( PEA ) .What action by the nurse takes priority?

The nurse needs to evaluate arterial blood gases before the administration of which drug?

The patient's monitor shows bradycardia (heart rate of 40 beats/min) and frequent premature ventricular contractions (PVCs) with a measured blood pressure of 85/50 mm Hg.The nurse anticipates the use of which drug?

A patient is admitted to the coronary care unit with an inferior wall myocardial infarction and develops symptomatic bradycardia with premature ventricular contractions every third beat (trigeminy) .The nurse knows to prepare to administer which drug?

A nursing home patient is admitted to the critical care unit with a severe case of pneumonia.No living will or designation of health care surrogate is noted on the chart.In the event this patient needs intubation and/or cardiopulmonary resuscitation,what should be the nurse's action?

The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction.Suddenly the monitor alarms and the screen shows a flat line.What action should the nurse take first?

Which rhythm would be an emergency indication for the application of a transcutaneous pacemaker?

During a code,the nurse would place paddles for anterior defibrillation in what locations?

A patient develops frequent ventricular ectopy.The nurse prepares to administer which drug?

The nurse chooses which method and concentration of oxygen administration until intubation is established in a patient who has sustained a cardiopulmonary arrest?