Acute Coronary Syndromes Practice Test

A 12-lead ECG should be obtained and analyzed within____minutes of the patient’s arrival in the ED (emergency department).

Question 1/10

The most common symptom of ischemia and/or myocardial infarction is:

Question 2/10

Arm, neck or jaw pain

Chest pain behind the sternum (retrosternal chest pain)

Pain between the shoulder blades

Sudden shortness of breath not explained by other reasons

Which of the following patients would you avoid giving aspirin to?

Question 3/10

A patient who is being treated for peptic ulcer disease

A patient with a history of diverticular disease

A patient with a history of gallbladder disease

A patient that has recently undergone a colonoscopy

Which of the following patients would you avoid administering nitroglycerin to?

Question 4/10

A patient with a heart rate of 60 beats per minute

A patient that admits to taking Viagra (sildenafil nitrate) in the last 12 hours

A patient with a systolic blood pressure of 98mm Hg

A patient experiencing an anterolateral infarction

Avoid the use of nitroglycerin if it is suspected or known that the patient has taken sildenafil or vardenafil within the previous 24 hours or tadalafil within 48 hours. These agents are generally used for erectile dysfunction or in cases of pulmonary hypertension and in combination with nitrates may cause sever hypotension refractory to vasopressor agents.

AHA Advanced Cardiovascular Life Support Provider Manual, p. 65

Next question

Morphine is given in ACS because:

Question 5/10

It reverses the effects of catecholamine release on the body, and lowers myocardial oxygen demand

It acts as a venodilator, reducing oxygen requirements and left ventricular preload

Assists in redistributing blood flow in patients with acute pulmonary edema

All of the above

Which intervention is at the center of the decision pathway in the management of ischemic chest pain, according to the ACS Algorithm?

Question 6/10

Fibrinolytic checklist

Initial cardiac marker levels

Targeted history

12-lead ECG (ECG interpretation)

For a patient with STEMI, goals of reperfusion include giving fibrinolytics or performing PCI (percutaneous coronary intervention) within a certain timeframe of the patient’s arrival in the ED. What are these time parameters?

Question 7/10

Fibrinolytics within 15 minutes, PCI within 30 minutes

Fibrinolytics within 90 minutes, PCI within 30 minutes

Fibrinolytics within 20 minutes, PCI within 60 minutes

Fibrinolytics within 30 minutes, PCI within 90 minutes

A major contraindication to the administration of both nitroglycerin and morphine is:

Question 8/10

Hypotension

Recent GI bleed

Recent CVA

Recent phosphodiesterase inhibitor use

Hypotension, including hypotension from an RV or right inferior infarction, is the major contraindication to use of both morphine and nitroglycerin. In the presence of RV or right inferior infarction, administering these drugs may result in severe hypotension. Recent GI bleed or hemorrhagic stroke are contraindications to aspirin administration. Phosphodiesterase inhibitor is a contraindication to administration of nitroglycerin, but not to morphine use.

AHA Advanced Cardiovascular Life Support Provider Manual, p. 65-66

Next question

STEMI is characterized by:

Question 9/10

ST-segment elevation in 2 or more contiguous leads OR new LBBB

Ischemic ST-segment depression greater than or equal to 0.5mm OR dynamic T-wave inversion with pain or discomfort

Nondiagnostic changes in the ST segment or T-wave

Nonpersistent/transient ST elevation greater than or equal to 0.5mm for less than 20 minutes

Which of the following drugs is not included as part of ED general treatment for chest pain?

Question 10/10

Epinephrine

Aspirin

Morphine

Nitroglycerin

Acute Coronary Syndromes Practice Test

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