Megacode 8

1 You are called to evaluate a one-month-old girl. She is on a cardiac monitor and pulse oximeter and has IV access. Alarms have been chiming (which is not unusual) but the rhythm on the monitor is odd. Your initial impression is that the child is grunting and not breathing effectively. She is not responsive to sternal rub. There is a weak, slow pulse (~30 bpm). Which of the following is your first intervention?

1 You are called to evaluate a one-month-old girl. She is on a cardiac monitor and pulse oximeter and has IV access. Alarms have been chiming (which is not unusual) but the rhythm on the monitor is odd. Your initial impression is that the child is grunting and not breathing effectively. She is not responsive to sternal rub. There is a weak, slow pulse (~30 bpm). Which of the following is your first intervention?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

2 The airway seems to be patent, though you are having trouble hearing breath sounds. The patient is breathing, though possibly ineffectively. You know that a normal respiratory rate for a one-month old is:

2 The airway seems to be patent, though you are having trouble hearing breath sounds. The patient is breathing, though possibly ineffectively. You know that a normal respiratory rate for a one-month old is:

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

3 The baby's breathing rate is about 10 breaths per minute at most (quick estimate). Pulse oximetry is unstable, but may be at 94% in room air. Your colleagues have arrived to help. One person takes the infant's pulse and announces the result as 65 beats per minute. This heart rate is consistent with which of the following for this age patient? 

3 The baby's breathing rate is about 10 breaths per minute at most (quick estimate). Pulse oximetry is unstable, but may be at 94% in room air. Your colleagues have arrived to help. One person takes the infant's pulse and announces the result as 65 beats per minute. This heart rate is consistent with which of the following for this age patient? 

  • Key A
    A
  • Key B
    B
  • Key C
    C

4 Despite bradycardia, the baby's pulse is above 60 beats per minute. You use a bag valve mask to support breathing. Which of the following is most appropriate?

4 Despite bradycardia, the baby's pulse is above 60 beats per minute. You use a bag valve mask to support breathing. Which of the following is most appropriate?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

5 The baby has poor capillary refill, but has a palpable pulse. The person assisting you announces a systolic blood pressure of 40 mm Hg. Which of the following is the most appropriate?

5 The baby has poor capillary refill, but has a palpable pulse. The person assisting you announces a systolic blood pressure of 40 mm Hg. Which of the following is the most appropriate?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

6 The patient's heart rate responds to the drug by increasing to 80 bpm and systolic blood pressure is 60 mm Hg. You ask the nurse covering the patient about past medical history and recent medication use. The nurse states that the baby had urgent bowel surgery earlier in the day and is on opioid medications. The most recent dose of opioids was given intravenously about 20 minutes ago. Which drug would you consider administering?

6 The patient's heart rate responds to the drug by increasing to 80 bpm and systolic blood pressure is 60 mm Hg. You ask the nurse covering the patient about past medical history and recent medication use. The nurse states that the baby had urgent bowel surgery earlier in the day and is on opioid medications. The most recent dose of opioids was given intravenously about 20 minutes ago. Which drug would you consider administering?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

7 You administer intravenous naloxone and notice that the baby regains consciousness, tries to cry, and tries to pull at tubes. Which of the following is part of your management?

7 You administer intravenous naloxone and notice that the baby regains consciousness, tries to cry, and tries to pull at tubes. Which of the following is part of your management?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

8 After five minutes, the child once again becomes unconscious. There is no pulse and no breathing. The child’s rhythm strip is shown below. What is the rhythm?   megacode-8-q9 

8 After five minutes, the child once again becomes unconscious. There is no pulse and no breathing. The child’s rhythm strip is shown below. What is the rhythm?   megacode-8-q9 

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

9 Based on the previous rhythm, which of the following interventions would be the most appropriate?

9 Based on the previous rhythm, which of the following interventions would be the most appropriate?

  • Key A
    A
  • Key B
    B
  • Key C
    C
  • Key D
    D

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