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ACLS Megacode Scenario 9

By Mark Dzwonkiewicz, FP-C, LI | Medically reviewed by Lisa Wright, MHA, RRT-NPS on November 3, 2024

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Question 1 of 10

1. Question
You are a recovery room nurse at a general hospital. You receive an 80-year-old female from the OR who has just undergone a successful hip replacement surgery.

She has oxygen support from a nonrebreather mask and has an IV in place running normal saline. After 2 hours of observing the patient, the cardiac monitor alarms. You check the monitor and see the following ECG tracing:

1. What is your interpretation of the ECG tracing?
- a. Pulseless electrical activity
- b. Ventricular tachycardia
- c. Atrial fibrillation
- d. Ventricular fibrillation
Correct

Incorrect
Question 2 of 10

2. Question
You check the patient’s level of consciousness. She is unresponsive. She also has no pulse and is not breathing.

2. What is your next course of action?
- a. Shout for help and activate the emergency response protocol
- b. Give epinephrine 1 mg IV bolus followed by a normal saline flush
- c. Start high-quality CPR
- d. Deliver a precordial thump
Correct

Incorrect
Question 3 of 10

3. Question
You begin high-quality compressions while waiting for the ACLS team and a crash cart to arrive.

3. What can you do to support the patient’s oxygen delivery?
- a. Increase oxygen via the nonrebreather mask
- b. Give two rescue breaths
- c. Look for a bag-mask device and deliver rescue breaths at a rate of 10 breaths per minute
- d. Nothing needs to be done; continue chest compressions and wait for the emergency team to arrive
Correct

Incorrect
Question 4 of 10

4. Question
The ACLS team arrives. While you and a coworker perform high-quality two-person CPR, another code team member attaches a biphasic defibrillator to the patient.

The ECG monitor on the defibrillator presents the following tracing:

4. What is your next course of action?
- a. Stop CPR and check for a pulse
- b. Stop CPR and give 1 mg epinephrine followed by a normal saline flush
- c. Stop CPR and immediately defibrillate
- d. Stop CPR and insert an advanced airway
Correct

Incorrect
Question 5 of 10

5. Question
After this intervention, you check the cardiac monitor and see the following tracing:

You check the patient. She has a pulse and is spontaneously breathing; however, she is not arousable.

You check her vital signs: HR 42 bpm with a regular rate, BP 100/60 mmHg, RR 10 breaths per minute, SpO₂ 89%, temperature 36.2°C.

5. What is your next course of action?
- a. Infuse norepinephrine 0.5 mcg/kg per minute
- b. Deliver an intravenous bolus of 2 liters of normal saline
- c. Look for treatable causes of cardiac arrest
- d. Intubate and connect to mechanical ventilation with waveform capnography
Correct

Incorrect
Question 6 of 10

6. Question
6. Optimal oxygenation is achieved at an oxygen saturation of:
- a. 92%–98%
- b. 96%–100%
- c. 98%–100%
- d. 100%
Correct

Incorrect
Question 7 of 10

7. Question
7. Which of the following procedures optimizes ventilation?
- a. Hyperventilating the patient to prevent an increase in intracranial pressure
- b. Measuring oxyhemoglobin saturation by pulse oximetry
- c. Maintaining ETCO2 at 35 to 40 mmHg
- d. All the above
Correct

Incorrect
Question 8 of 10

8. Question
The following statements pertain to key issues in post-cardiac arrest care. Answer “true” if a statement is correct and “false” if it is inaccurate.

8. Clinicians should actively prevent fever in comatose patients.
- a. True
- b. False
Correct

Incorrect
Question 9 of 10

9. Question
9. All comatose patients should be actively maintained at a temperature between 32°C and 36°C for at least 24 hours after ROSC.
- a. True
- b. False
Correct

Incorrect
Question 10 of 10

10. Question
10. Avoiding or delaying the correction of hypotension in patients in the immediate post-arrest period is acceptable.
- a. True
- b. False
Correct

Incorrect