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ACLS Megacode Scenario 5

By Mark Dzwonkiewicz, FP-C, LI | Medically reviewed by Jennifer Bunn, RN on October 26, 2024

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Question 1 of 9

1. Question
You are a recovery room nurse at an ambulatory surgical unit. The unit is not attached to a hospital.

While recovering from liposuction, a 35-year-old female patient with no comorbidities develops trouble breathing. You auscultate her lungs and note decreased breath sounds and crackles. She suddenly becomes unresponsive. You assess her vital signs. She is pulseless and apneic.

1. What is your first action for this patient?
- a. Shout for help and activate the emergency response team
- b. Begin high-quality CPR
- c. Attach a cardiac monitor and defibrillator
- d. Intubate the patient
Correct

Incorrect
Question 2 of 9

2. Question
The American Heart Association has described the goals of successful resuscitation in the following order:
1. 1. Immediate recognition of cardiac arrest with activation of the emergency response system
  2. Early CPR with emphasis on high-quality chest compressions
  3. Rapid defibrillation when a shockable rhythm is present
  4. Effective advanced life support
  5. Integrated post-cardiac arrest care
Your team has connected the patient to a monitor attached to a biphasic defibrillator while chest compressions are in progress.

You review the monitor and see the following rhythm:

2. What is your interpretation of the ECG reading above?
- a. Ventricular fibrillation
- b. Ventricular tachycardia
- c. Atrial fibrillation
- d. Second-degree AV block Mobitz Type II
Correct

Incorrect
Question 3 of 9

3. Question
3. You want to defibrillate the patient but are unsure of the manufacturer’s recommended settings. What should you do?
- a. Defibrillate with 360 J
- b. Defibrillate with a dose of 120 J–200 J
- c. Change to synchronized cardioversion with 200 J
- d. Delay defibrillation and proceed with pharmacologic treatment with adenosine 6 mg rapid IV push followed by a normal saline flush
Correct

Incorrect
Question 4 of 9

4. Question
You deliver a shock at 120 J and immediately resume high-quality CPR for two minutes.

4. While performing CPR, what is your next action?
- a. Insert an advanced airway
- b. Measure quantitative waveform capnography
- c. Administer epinephrine 1 mg intramuscular route
- d. Obtain IV or IO access
Correct

Incorrect
Question 5 of 9

5. Question
After 2 minutes of high-quality CPR, you evaluate vital signs. The patient still has no pulse and is not breathing.

The blood pressure is also not detectable. The ECG monitor shows the following ECG morphology:

5. What is your assessment of the ECG finding?
- a. Complete AV block
- b. Normal sinus rhythm
- c. Ventricular fibrillation
- d. Pulseless electrical activity
Correct

Incorrect
Question 6 of 9

6. Question
6. What is your next action?
- a. Defibrillate
- b. Synchronized cardioversion
- c. Continue CPR for 2 minutes and give 1 mg epinephrine IV every 3 to 5 minutes
- d. Administer procainamide 150 mg slow IV push over 10 minutes
Correct

Incorrect
Question 7 of 9

7. Question
After 2 minutes of CPR and one dose of epinephrine, you observe the following ECG rhythm:

Since the patient is now in asystole, you continue high-quality CPR and prepare to give another dose of epinephrine. Following the algorithm, you search for the reversible causes of sudden cardiac arrest.

7. Following the adult cardiac arrest algorithm, which of the following is not a reversible cause of cardiac arrest?
- a. Hemorrhagic cerebrovascular accident
- b. Cardiac tamponade
- c. Coronary thrombosis
- d. Acidosis
Correct

Incorrect
Question 8 of 9

8. Question
The physician concludes that the patient has a high probability of pulmonary thromboembolic disease.

She decides to administer anticoagulation therapy with heparin. After the fourth cycle of CPR and the third dose of epinephrine, you check the ECG monitor and find the following:

8. What is the ECG interpretation?
- a. Ventricular tachycardia
- b. Ventricular fibrillation
- c. Supraventricular fibrillation
- d. Supraventricular tachycardia
Correct

Incorrect
Question 9 of 9

9. Question
9. What is your next course of action?
- a. Defibrillate
- b. Prepare for synchronized cardioversion
- c. Continue high-quality CPR for 2 minutes and administer epinephrine 1 mg every 3 to 5 minutes
- d. Adenosine 6 mg IV bolus followed by a normal saline flush
Correct

Incorrect