Final prep Flashcards
What is the 1st sign often seen on an ECG in the case of acute MI?
ST segment elevation which normally appears within first few hours of injury
After hours to days what is the next sign often see on an ECG after acute MI within hours to days?
T wave inversion
T or F: ST segment can return to normal baseline within days to weeks following an acute MI
True
T or F: The t wave never fully becomes upright following acute MI
False: The T wave becomes upright after period of week or months
Positive inotropics: A. Increase rate of contraction B. Increase contractility of heart muscle C. Decrease force of contraction D. Decrease rate of contraction
B. increase contactility of heart muscle
When a patient is hypotensive they may be treated with A: vasoconstricting drugs B. Vasodilating drugs C. anti-arrhythmic drugs D. Cardioversion
B. Vasoconstricting drugs such as dopamine or norepinephrine may be used
\_\_\_\_\_\_ is given to reduce afterload, often given in severe HTN A. Nitroprusside B. Epinephrine C. Amiodarone D. Dopamine
A. Nitroprusside
Epinephrine will be a first line drug in ACLS; it increases BP by A. Decreasing HR, Decreasing SV B. Increasing HR, Decreasing SV C. Increasing HR, Increasing SV D. Decreasing HR, Increasing SV
C. It increases HR and increases SV to increase BP
T or F: Epinephrine causes vasoconstriction to raise BP.
True
Hypothermia will cause pupils to
A. Dilate
B. Constrict
A. Dilate
Morphine will cause pupuls to
A. Dilate
B. Constrict
B. Constrict
A fully compensatory pause is seen after which type of heartbeat? A. NSR B. PVC C. Paroxysmal atrial tachycardia D. VT
B. PVC
T or F: The air/O2 intake valve should not open when resuscitation bag is squeezed;
True: this will allow the gas to escape rather than be directed to the patient
A 10 year old child has been intubated, what compression:ventilation ratio should be used with two rescuers?
A. 3:1
B. 5:1
C. 30:2 per minute
D. 100 compressions: 8-10 ventilations per minute
D. 100 compressions: 8-10 ventilations per minute if child is intubated
A mouth to valve resuscitation device is being used on an apneic patient; the RT delivers a breath but no chest rise is seen; what should be done next? A. Begin chest compression B. Request a lateral neck x-ray C. Check the valve for proper position D. Perform abdominal thrusts
C. Check the valve for proper position
What site should an ABG be drawn from during CPR? A. Carotid B. Radial C. Brachial D. Femoral
D. Femoral
When one rescuer is performing CPR on an unintubated adult, what chest compression:ventilation ratio should be used A: 5:1 B. 5:2 C. 15:2 D. 30:2
D. 30:2
To ensure that a manual ventilator is ready for use you would
1. make sure that no gas escapes through the outlet port when it is closed off and the bag is squeezed
2. squeeze the bag, and make sure that the air/O2 reservoir intake valve closes properly
3. Squeeze the bag, and make sure non-rebreathing valve opens properly
4. Feel for air leaving the outlet port when bag is squeezed
5. Squeeze the bag and make sure that the air O2 reservoir intake valve opens properly.
A. 1, 2, 3, 4
B. 1, 2, 5
C. 4,5
D. 2, 3
A. 1, 2, 3, 4
The air intake valve should not open when ambu bag is squeezed
T or F: Gas normally will escape through the outlet port when the bag is squeezed
F; No gas should escape through the outlet port when bag is squeezed
If a breath cannot be delivered with bag/mask ventilation what should you do?
Check 1 way valve to be sure not put together backward
T or F: If supplemental O2 is not being used to ventilate what should you do to the O2 nipple on the mask or t piece?
It must be capped off if not being used or air will leak out during delivered breaths
If an obstruction occurs to the expiratory one way valve it should be cleared within _____ seconds.
20
T or F: You should feel air leave the outlet port of the non rebreathing valve when the bag is squeezed.
True;
If you occlude the outlet port and then squeeze you won’t feel any leaks & pop off valve would open; if not occluded you should feel air leave when bag is squeezed
Where does the initial portion for depolarization of the ventricles normally occur? A. Left ventricle B. Right Ventricle C. Right atria D. Intraventricular septum
D. intraventricular septum
The electrical event represented on the ECG from the impulse sent at the Sinus Node is a. P wave B. Not visible C. Isoelectric base D. T wave E. QRS Segment
B. Not visible
The electrical event visible on the ECG from depolarization of atria is: A. P wave B. Not visible C. Isoelectric base D. T wave E. QRS segment
a P wave
Depolarization of the ventricles is visible by the electrical event viewed from: A. P wave B. Not visible C. Isoelectric base D. T wave E. QRS segment
E QRS Segment
Repolarization of the ventricles is represented on ECG by: A. P wave B. Not visible C. Isoelectric base D. T wave E. QRS segment
D. T wave
Depolarization of AV node may be represented on ECG by: A. P wave B. Not visible C. Isoelectric base D. T wave E. QRS segment
C. Isoelectric base
If PetCO2 is less than _____ & diastolic pressure is less than ______ this tells you that an improvement to CPR quality is needed.
PetCO2 < 10
Diastolic BP < 20
The only rhythms that can be shocked are: 1. SVT 2. V Fib 3. V Tach 4. A Fib 5. A Flutter 6. Junctional Tach A. 2, 3 only B. 2, 3, 4, 5 C. 1, 2, 3 D. 1, 2, 3, 6 E. All can be shocked
C. 1, 2, 3
Only v-fib, v tach, SVT can be shocked
What is the recovery position of a patient following a code if breathing on their own? A. Prone B. Supine C. 90 degree angle upright D. side
D. Recovery position is on the side if breathing on their own
CPP or the coronary perfusion pressure is normally > or equal to: A. 20 mmHg B. 25 mmHg C. 15 mmHg D. 5 mmHg
C. 15 mmHg is normal coronary perfusion pressure
When shocking SVT you would use which type of cardioversion:
A. Synchronized
B. Unsynchronized
A. synchornized
If SVT remains untreated it often will progress to which rhythm?
Ventricular Fibrillation
In ACLS the end tidal CO2 should be ______to_____mmHg
35-40 mmHg
When energy is delivered in 2 phases during defibrillation this is called a \_\_\_\_ current. a. monophasic B. Biphasic C. triphasic D. direct
B. Biphasic
A normal monophasic current is _____ J
360 joules
During acute MI the \_\_\_\_\_ mark is key A. 2 hour B. 4 hour C. 6 hour D. 12 hour E. 24 hour
B. 4 hour mark is key as 52% of deaths from AMI occur out of the hospital
Signs of shock may include 1. Coolness 2. Warmness 3. Clammy 4. Dryness to membranes 5. diaphoresis A. 1, 3 B. 4, 5 C. 2, 3 D. 1, 3, 5 E. 3, 4, 5
D 1, 3, 5
Cool, clammy skin, diaphoresis
During 3rd degree HB this medication/therapy should not be given? A Epinephrine B Atropine C. transcutaneous pacing D. transvenous pacing
B Atropine should be avoided during 3rd degree HB
T or F: In order to pace a bradycardic rhythm symptoms must be present and you must have a QRS complex
True
Contraindications for TCP include: 1. Children > 15 kg 2. Flail Chest 3. Hypothermia 4. Hyperthermia 5. Children < 15 kg A. 1, 2, 4 B. 1, 2, 3 C. 2, 3, 5 D. All of the above
C. 2, 3, 5
Flail chest, hypothermia, and Children less than 15 kg are contra indications for TCP
When delivering cardioversion for Vtach with a pulse you should use: A. Synchronized cardioversion B. Unsynchronized cardioversion C. TCP D. None should be used
A. synchronized cardioversion used with pulse during Vtach
When your rhythm is Wide, irregular V fib what type of cardioversion should be used: A. Synchronized cardioversion B. Unsynchronized cardioversion C. TCP D. None should be used
B. unsynchronized cardioversion or defibrillation should be used
T or F; You should remove a patient from the ventilator prior to delivering cardioversion or defibrillation
True
When delivering a shock at what part of the ECG pattern should it be delivered at? A. P wave B. any time during QRS complex C. Only during deepest part of QRS D. During S-T segment E. during the T wave
C. During deepest part of the QRS complex
Which of the following best describes the PJC seen on an ECG rhythm:
A. Regular rhythm, with premature beats with positive, upright P wave or it may be lost in preceeding t wave
B. P waves not identifiable, may see a saw tooth appearance
C. Irregular rhythm, with inverted p waves if visible
D. Regular rhythm, P wave if visible is inverted and appears before, during, or after QRS
D. regular rhythm, P wave if visible seen before, during, after QRS
What can be used to treat toxic effects of Ca Channel Blocker or Beta Blocker? A. Glucagon B. Nitroglycerin C. Narcan D. None of the above
A Glucagon
Name the three types of leads seen with 12 lead ECG
Standard Limb Leads
Augmented Limb Leads
Chest or precordial limb leads
How many leads are placed during a 12 lead ECG
10 leads
When you see this on a 12 lead ECG you can probably assume they have suffered an old MI A. Elevated S-T segment B. Inverted T wave C. Significant Q waves D. Absent P waves
C. Significant Q waves
During Ischemia you would expect to see: A. Elevated S-T segment B. Inverted T wave C. Significant Q waves D. Absent P waves
B. Inverted T waves
During myocardial injury you would expect to see: A. Elevated S-T segment B. Inverted T wave C. Significant Q waves D. Absent P waves
A. S-T segment rises
____ indicates tissue death due to inadequate blood supply?
A. myocardial infarction
B. myocardial injury
C. myocardial ischemia
A. myocardial infarction
\_\_\_\_\_ is specific to MI; it rises higher and faster than other tests so may be a reliable value to get when looking at cardiac enzyme testing. A. LDH B. AST C. Troponin D. CPK
C. Troponin rises faster & higher and may appear first during acute MI
Which wall is not visible on an ECG? A. Anterior B. Posterior C. Lateral D. latero-anterior
B. Posterior wall is not visible on an ECG
T or F: It is possible to have a QRS with no pulse or BP
False; No QRS will be present with no pulse
What rhythm would you not administer lidocaine during as it could cause serious negative effects, such as death?
A. Ventricular Escape Rhythms
B. Junctional
C. Bradycardia
A. Ventricular Escape Rhythms
A reason that AIVR may develop is: A. to activate the SA node B. Medication therapy that reduces HR C. To act as a benign escape rhythm D. acute MI
C. acts as a benign escape rhythm
T or F: ECG may be used to determine if an old MI has occured, to show that you are having an MI, or to predict a person may have an MI
False; ECG cannot predict a future MI
The order of injury for acute MI is:
A. Injury, ischemia, infarction; none can be reversed
B. Ischemia, injury, ;infarction; all can be reversed with early intervention
C. Ischemia, injury, infarction; only ischemia & injury can be reversed
D. Injury, Ischemia, infarction with only injury and ischemia being reversible
C. Order for MI is: Ischemia Injury Infarction Only inchemia & injury are reversible
ST elevation, inverted T waves, is a sign of: A. Injury B. Ischemia C. Infarction D. Angina
A. Injury: you will see ST elevation, inverted t wave at site of injury
Inverted T waves is a sign of: A. Injury B. Ischemia C. Infarction D. Angina
B. Ischemia
With _____ you often see Rt venticular hypertrophy, where you may have a higher P wave
COPD
_______ should not be treated with anti-arrhythmics.
A. Uncontrolled v tach
B. SVT
C. Ventricular Escape Rhythms
C. Ventricular escape rhythms should not be treated with antiarrhythmics medications
T or F: In a patient experiencing ACS, ST segment elevation in the shape of a smiley face or concave is usually associated with an acute injury pattern.
False–convex would be associated with acute injury
T or F; in most patients the posterior wall of the left ventricle is supplied by the right coronary arter.
False; circumflex artery normally supplies
What is the lead of choice for viewing the right ventricle A. V1R B. V4R C. V9 D. V6R
B. V4R
In a patient experiencing acs, t wave inversion suggests
a. injury
b. ischemia
c. infarction
d. cardiogenic shock
b. ischemia
Which of the following statements is correct regarding the use of Combitube
A. esophageal trauma is possible complication of combitube use
b. direct visualization of the airway is required for insertion of the device
c. once the combitube is placed, ventilation should begin through the pharyngeal tube
d. combitube can be used in patients of all ages as it is available in several sizes from neonates to adults
A. esophageal trauma is a possible complication of combitube use
What medication may be used to suppress PVC? A. epinephrine B. Atropine C. Lidocaine D. norepinephrine
C. Lidocaine
How should drugs be given during CPR to a 50 year old, intubated patient if the physician cannot start an IV line A. Intraosseous injection B. ET instillation C. Intracardiac injection D. Nasal spray
B. Et instillation
You are assisting with the extubation of an adult patient; at what point in the procedure should the tube be removed:
A. at the end of peak inspiratory effort
B. At the end of normal exhalation
C. At the start of a peak inspiratory effort
D. During a forced vital capacity effort
A. At the end of peak inspiratory effort
A patient with a trach has just returned from a series of x-rays. Suddenly, she develops respiratory distress and cannot breathe. Your attempt to pass a suction catheter through trach tube does not work. Your next step is to:
A. Attempt to pass a smaller suction catheter
B. Remove the trach tube
C. Attempt to ventilate the patients lungs with manual resuscitator
D. insert an et tube
B. remove the trach tube
A 55 yr old male patient with trach tube has returned from OR after gastric procedure. The RT finds the cuff pressure on a 6.00 ID trach tube is 35 mmHg. The vent is ml and delivering a Vt of 750 ml and returning a vt of 650 and a leak can be heart at the trach site. what should be done?
A. increase Vt by 100 ml
B. increase cuff pressure to seal the trachea to stop vt leak
C. Replace trach tube with one that is 8.5 mm ID
D. deflate the cuff enough to reduce cuff pressure to 15mmHg
C. Replace with 8.5 mmID
While checking the tract tube cuff pressure on a patient in recovery room, you find pressure is 33mmHg. The cuff pressure will likely cause?
1. loss of capillary flow through the tracheal soft tissues
2. Loss of lymphatic flow through the tracheal soft tissue
3. tracheal wall damage
4. protection of vocal cords from damage caused by trach tube
5. Loss of venous flow through the tracheal soft tissue
A. 1, 2, 3, 5
B. 2, 4
C. 3, 5
D. 1, 2
D. 1, 2
Pressure of 33mmHg will cause loss of capillary flow through the tracheal soft tissue & loss of lymphatic flow through the tracheal soft tissue
After extubation, a patient develops signs of severe respiratory distress with marked inspiratory stridor. It would be best at this time to:
A. administer a vasoconstrictor drug
B. administer IPPB treatment with bronchodilator
C. Administer a cool aerosol with 40% O2
D. reintubate the patient
D. reintubate the patient
