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:

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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