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ACLS Megacode Scenario 4

By Mark Dzwonkiewicz, FP-C, LI | Medically reviewed by Eileen Johnson, RN on October 24, 2024

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Question 1 of 13

1. Question
A 52-year-old woman with a history of hypertension and type II diabetes presents to the ER complaining of chest pain radiating into her jaw.

The pain began over an hour ago. She also complains of shortness of breath. The patient is placed on a cardiac monitor.

On evaluation, you note that she is clammy and diaphoretic. Heart rate and rhythm are regular. You do not hear a murmur, rub, or gallop. Her lungs are clear bilaterally with equal breath sounds. Her respiratory rate is 16 breaths per minute, and her breathing is slightly labored. Although she is alert and oriented to person, time, place, and situation, she appears uncomfortable and anxious.

You observe this cardiac rhythm on the monitor.

1. Identify the rhythm:
- a. Identify the rhythm:
- b. Normal sinus rhythm (NSR) with intermittent premature ventricular contractions (PVC)
- c. Left bundle branch block
- d. Atrial flutter
Correct

Incorrect
Question 2 of 13

2. Question
2. Your immediate intervention is to:
- a. Obtain a 12-lead ECG
- b. Give aspirin
- c. Start a lidocaine infusion
- d. Start a lidocaine infusion
Correct

Incorrect
Question 3 of 13

3. Question
After completing the intervention above, you start an IV. While doing so, the patient vomits and loses consciousness.

The monitor reveals this rhythm:

3. Your next action should be to:
- a. Attach defibrillator pads
- b. Check another lead
- c. Check for a pulse
- d. Begin CPR
Correct

Incorrect
Question 4 of 13

4. Question
4. After shocking the patient with a biphasic defibrillator, you should next:
- a. Check for a pulse
- b. Continue high-quality CPR
- c. Give epinephrine 1 mg IV
- d. Deliver a precordial thump
Correct

Incorrect
Question 5 of 13

5. Question
After two minutes of high-quality CPR, the monitor continues to show ventricular fibrillation.

5. What is your next intervention?
- a. Check pulse
- b. Give epinephrine 1 mg IV
- c. Give amiodarone 300 mg IV
- d. Defibrillate
Correct

Incorrect
Question 6 of 13

6. Question
After you defibrillate, you resume high-quality CPR for two minutes. The monitor shows that the patient remains in ventricular fibrillation.

6. Your next consideration should now be:
- a. Amiodarone 300 mg IV
- b. Adenosine 6 mg IV
- c. Epinephrine 1 mg IV
- d. Atropine 0.5 mg IV
Correct

Incorrect
Question 7 of 13

7. Question
You give 1 mg epinephrine IV.

7. How often can you repeat this dose of epinephrine?
- a. Every 3 to 5 minutes
- b. Every 5 minutes to a total of 3 mg
- c. Every minute to a total of 3 mg
- d. Every 2 to 4 minutes
Correct

Incorrect
Question 8 of 13

8. Question
After giving the epinephrine, you see this rhythm on the monitor.

8. What is your next intervention?
- a. Continue high-quality CPR
- b. Check for a pulse
- c. Defibrillate
- d. Intubate the patient
Correct

Incorrect
Question 9 of 13

9. Question
After completing the administration of epinephrine and the five cycles of high-quality CPR, the patient remains pulseless but now has the following rhythm:

9. What is your next intervention?
- a. Consider amiodarone and a lidocaine infusion
- b. Repeat epinephrine
- c. Defibrillate
- d. Administer vasopressin
Correct

Incorrect
Question 10 of 13

10. Question
You defibrillate and resume high-quality CPR.

10. The next intervention should be:
- a. Defibrillation
- b. Termination of efforts
- c. Administration of amiodarone or lidocaine
- d. Administration of a dopamine infusion
Correct

Incorrect
Question 11 of 13

11. Question
You have given one dose of 300 mg amiodarone. You are ready to give another dose.

11. What is the correct dosage?
- a. 100 mg
- b. 150 mg
- c. 200 mg
- d. 300 mg
Correct

Incorrect
Question 12 of 13

12. Question
After repeating amiodarone and completing five cycles of CPR, you see the following rhythm:

12. Your next intervention is:
- a. Transcutaneous pacing
- b. Consider H's and T's
- c. Resume high-quality CPR
- d. Defibrillate
Correct

Incorrect
Question 13 of 13

13. Question
After another minute of high-quality CPR and another dose of 1 mg epinephrine, the patient has a return of spontaneous circulation.

The patient’s blood pressure is 90/60 mmHg, and she has no spontaneous breathing. The patient is intubated and hooked to the ventilator. The SpO2 is 100% on 100% FiO2. The rhythm strip reveals:

13. What is your next intervention while the patient waits for transport to the ICU?
- a. Wean the FiO2
- b. Arrange for EEG monitoring
- c. Disconnect the patient from the cardiac monitor
- d. Set up a lidocaine infusion
Correct

Incorrect