Bad Deck

Question 1

The majority of in-hospital cardiac arrests (IHCAs) are preceded by which of the following conditions?
A. Primary arrhythmia without warning
B. Respiratory failure or hypovolemic shock
C. Stroke
D. Acute myocardial infarction without preceding symptoms

Answer 1

Answer: B. Respiratory failure or hypovolemic shock
Explanation:
More than half of IHCAs result from respiratory failure or hypovolemic shock. Warning signs such as tachypnea, tachycardia, and hypotension often foreshadow these events, but they are sometimes missed in general wards.

Question 2

Question 3
Where are patients most likely to experience unrecognized physiologic deterioration that leads to cardiac arrest?
A. Intensive care unit (ICU)
B. General wards
C. Operating room
D. Emergency department

Answer 2

Answer: B. General wards
Explanation:
General wards have higher patient-to-nurse ratios and less continuous monitoring compared to ICUs or procedural areas. This increases the risk of delayed recognition of deterioration.

Question 3

Which of the following is a unique but valid criterion for activating a rapid response system, even without abnormal vital signs?
A. Patient reports chest pain
B. Family or staff member expresses concern
C. Patient refuses medication
D. Laboratory result shows mild anemia

Answer 3

Answer: B. Family or staff member expresses concern
Explanation:
Subjective concern—by nurses, physicians, or even family—can be enough to activate the rapid response system. This recognizes that clinical intuition often detects deterioration before vital signs confirm it.

Question 4

Which component of a rapid response system is responsible for tracking outcomes and improving the process?
A. Event detection
B. Planned response arm (RRT/MET)
C. Quality monitoring
D. Administrative support

Answer 4

Answer: C. Quality monitoring
Explanation:
Quality monitoring ensures that the rapid response system is functioning effectively, identifies missed opportunities, and drives process improvement. Event detection and response activation identify the patient, while administrative support ensures resources and staff are available.

Question 5

Which of the following respiratory rates would trigger a rapid response activation in an adult?
A. 20/min
B. 28/min
C. 34/min
D. 16/min

Answer 5

Answer: C. 34/min
Explanation:
A respiratory rate >30/min or <6/min is concerning for clinical deterioration. Normal or mildly abnormal rates (16–28/min) do not typically trigger rapid response activation.

Question 6

Which heart rate should trigger consideration for rapid response activation?
A. 55/min
B. 72/min
C. 138/min
D. 35/min

Answer 6

Answer: D. 35/min
Explanation:
Rapid response criteria include HR <40/min or >140/min. A HR of 35/min represents severe bradycardia and requires urgent evaluation.

Question 7

What is the systolic blood pressure threshold for adult rapid response activation?
A. <120 mmHg
B. <100 mmHg
C. <90 mmHg
D. <80 mmHg

Answer 7

Answer: C. <90 mmHg
Explanation:
Hypotension (SBP <90 mmHg) is an RRT trigger. Severe hypertension with symptoms can also warrant activation.

Question 8

Which of the following is the most common cause of in-hospital cardiac arrest (IHCA)?
A. Primary ventricular arrhythmia
B. Respiratory failure or hypovolemic shock
C. Electrolyte abnormalities
D. Stroke

Answer 8

Answer: B. Respiratory failure or hypovolemic shock
Explanation:
More than half of IHCAs stem from respiratory failure or hypovolemic shock, often preceded by physiologic warning signs.

Question 9

In which hospital location are patients most vulnerable to delayed recognition of deterioration leading to cardiac arrest?
A. Intensive care unit (ICU)
B. Emergency department
C. General wards
D. Operating room

Answer 9

Answer: C. General wards
Explanation:
On general wards, nurse-to-patient ratios are higher and monitoring is less frequent, increasing the risk of delayed recognition of deterioration.

Question 10

Which of the following is an appropriate subjective criterion for activating a rapid response team?
A. Mild anemia on lab results
B. Nurse or family expresses concern
C. Patient misses one medication dose
D. Low-grade fever

Answer 10

Answer: B. Nurse or family expresses concern
Explanation:
Concern by staff or family is a recognized trigger, as intuition often detects deterioration before objective changes occur.

Question 11

Which component of the rapid response system provides the clinical team that responds to patient deterioration?
A. Event detection arm
B. Planned response arm (RRT/MET)
C. Quality monitoring arm
D. Administrative support

Answer 11

Answer: B. Planned response arm (RRT/MET)
Explanation:
The planned response arm is the Rapid Response Team (RRT) or Medical Emergency Team (MET), which provides critical care expertise at the bedside.

Question 12

Which component of a rapid response system is designed to identify early signs of deterioration and trigger a response?
A. Event detection arm
B. Planned response arm
C. Quality monitoring arm
D. Administrative support

Answer 12

Answer: A. Event detection arm
Explanation:
The event detection/response-triggering arm identifies when a patient meets criteria for rapid response activation.

Question 13

What is the role of quality monitoring in a rapid response system?
A. Provides staff for bedside interventions
B. Tracks outcomes and missed opportunities
C. Assigns resources and equipment
D. Detects early physiologic changes

Answer 13

Answer: B. Tracks outcomes and missed opportunities
Explanation:
Quality monitoring ensures system effectiveness, evaluates missed cases, and informs improvements.

Question 14

Why are intermittent manual vital signs on general wards a risk for delayed deterioration recognition?
A. Patients often refuse monitoring
B. Clinicians focus only on lab data
C. Vital sign changes can occur between checks
D. Electronic monitors always malfunction

Answer 14

Answer: C. Vital sign changes can occur between checks
Explanation:
On general wards, infrequent vital sign assessments mean deterioration (e.g., tachypnea, hypotension) may go unnoticed for hours, delaying intervention.

Question 15

What is the primary goal of Rapid Response Teams (RRTs) or Medical Emergency Teams (METs)?
A. To provide code leadership during cardiac arrest
B. To provide early intervention and prevent IHCA
C. To replace bedside nursing assessments
D. To handle only respiratory emergencies

Answer 15

Answer: B. To provide early intervention and prevent IHCA
Explanation:
RRTs/METs are designed to identify and intervene early in deteriorating patients, preventing progression to in-hospital cardiac arrest (IHCA).

Question 16

Which healthcare providers are commonly included in an RRT or MET?
A. Only physicians
B. Nurses, respiratory therapists, and critical care clinicians
C. Only paramedics
D. Laboratory technicians and pharmacists

Answer 16

Answer: B. Nurses, respiratory therapists, and critical care clinicians
Explanation:
Teams usually include ICU-trained staff such as nurses, physicians, and respiratory therapists with critical care skills.

Question 17

RRTs and METs function in the hospital much like which prehospital service?
A. Emergency Medical Services (EMS)
B. Dialysis teams
C. Outpatient urgent care
D. Physical therapy services

Answer 17

Answer: A. Emergency Medical Services (EMS)
Explanation:
Like EMS in the field, RRTs/METs bring equipment, assess patients rapidly, and intervene in emergencies within the hospital.

Question 18

Which of the following has been shown in published studies as a benefit of RRT/MET implementation?
A. Increased ICU length of stay
B. Decreased unplanned ICU transfers
C. Increased postoperative morbidity
D. Higher rates of unwanted interventions

Answer 18

Answer: B. Decreased unplanned ICU transfers
Explanation:
RRT/METs reduce unplanned ICU transfers, shorten ICU and hospital length of stay, reduce postoperative complications, and improve survival from cardiac arrest.

Question 19

Although RRT/MET programs may not always reduce overall mortality, one additional benefit is:
A. Decreased use of antibiotics
B. Improved end-of-life care discussions
C. Fewer laboratory tests ordered
D. Reduced staffing needs

Answer 19

Answer: B. Improved end-of-life care discussions
Explanation:
RRTs/METs often initiate goals-of-care conversations before cardiac arrest, which can prevent unwanted resuscitation attempts in critically ill patients.

Question 20

Which of the following is a documented benefit of rapid response systems?
A. Increased hospital length of stay
B. Increased ICU readmissions
C. Reduced postoperative morbidity and mortality
D. Higher incidence of IHCA

Answer 20

Answer: C. Reduced postoperative morbidity and mortality
Explanation:
Studies show reduced morbidity/mortality, shorter hospital stays, fewer unplanned ICU transfers, and improved survival rates with rapid response systems.

Question 21

Which of the following is a barrier to successful rapid response system implementation?
A. Overstaffing in critical care
B. Fear of calling the team
C. Too much education about the process
D. Excessive administrative support

Answer 21

Answer: B. Fear of calling the team
Explanation:
Barriers include fear of calling, resistance from staff, inadequate resources, poor education, and cultural reluctance to escalate care.

Question 22

Which of the following is required for sustaining an effective RRT/MET program?
A. Once-a-year refresher course only
B. Ongoing education, data collection, and feedback
C. No involvement from hospital administration
D. Allowing only physicians to activate the team

Answer 22

Answer: B. Ongoing education, data collection, and feedback
Explanation:
Effective programs need continuous education, data tracking, review, and feedback to maintain quality and cultural acceptance.

Question 23

Implementing an RRT/MET requires which type of commitment from hospital administration?
A. Short-term, minimal funding
B. Long-term cultural and financial support
C. Delegating responsibility entirely to bedside nurses
D. Avoiding involvement in patient safety culture

Answer 23

Answer: B. Long-term cultural and financial support
Explanation:
Successful rapid response systems demand sustained resources, cultural change, and strong administrative commitment to patient safety.

Question 24

Which diagnostic test is essential for classifying a patient with suspected ACS into STEMI or NSTE-ACS?
A. Chest X-ray
B. 12-lead ECG
C. Echocardiogram
D. Troponin blood test

Answer 24

Answer: B. 12-lead ECG
Explanation:
The 12-lead ECG is the primary tool for early classification into STEMI or NSTE-ACS, guiding time-sensitive management strategies.

Question 25

Which of the following ECG findings indicates STEMI? A. ST-segment depression B. T-wave inversion C. Persistent ST-segment elevation D. Nondiagnostic ECG

Answer 25

Answer: C. Persistent ST-segment elevation Explanation: STEMI is defined by new ST-segment elevation in ≥2 contiguous leads or new left bundle branch block, requiring urgent reperfusion therapy.

Question 26

Which of the following ECG changes suggests NSTE-ACS rather than STEMI? A. Persistent ST elevation B. T-wave inversion C. Pathologic Q waves D. Hyperacute T waves

Answer 26

Answer: B. T-wave inversion Explanation: NSTE-ACS may present with ST-segment depression, T-wave inversion, or transient ST elevation, but not persistent ST elevation.

Question 27

What is the primary management goal for patients with STEMI? A. Stabilize blood pressure B. Early reperfusion therapy C. Oxygen for all patients D. Immediate intubation

Answer 27

Answer: B. Early reperfusion therapy Explanation: The cornerstone of STEMI management is time-sensitive reperfusion, either via PCI or fibrinolytic therapy, to salvage myocardium.

Question 28

In ACS management, when should the first 12-lead ECG be obtained? A. Within 30 minutes of ED arrival B. Within 10 minutes of ED arrival C. Only if chest pain persists >30 minutes D. After cardiac enzymes are elevated

Answer 28

Answer: B. Within 10 minutes of ED arrival Explanation: Guidelines recommend obtaining and interpreting the first 12-lead ECG within 10 minutes of arrival for suspected ACS.

Question 29

Which of the following is an appropriate initial treatment step in suspected ACS before definitive reperfusion therapy? A. Oxygen for all patients regardless of saturation B. Aspirin administration C. High-dose IV beta-blocker immediately D. Delay therapy until biomarkers are confirmed

Answer 29

Answer: B. Aspirin administration Explanation: Aspirin (chewed, 160–325 mg) should be given promptly unless contraindicated. Oxygen is given only if SpO₂ <90%.

Question 30

Which of the following reperfusion strategies is preferred for a patient with STEMI presenting to a PCI-capable hospital within 90 minutes? A. Immediate fibrinolytic therapy B. Immediate percutaneous coronary intervention (PCI) C. Medical management only D. Delay until troponins are positive

Answer 30

Answer: B. Immediate percutaneous coronary intervention (PCI) Explanation: Primary PCI within 90 minutes of first medical contact is the preferred reperfusion strategy for STEMI at PCI-capable centers.

Question 31

If PCI cannot be performed within 120 minutes for a STEMI patient, what is the next best strategy? A. Delay until PCI is available B. Immediate fibrinolytic therapy C. Supportive medical therapy only D. Repeat ECG every 2 hours

Answer 31

Answer: B. Immediate fibrinolytic therapy Explanation: If PCI cannot be performed within 120 minutes, fibrinolytic therapy should be initiated within 30 minutes of hospital arrival.

Question 32

Which of the following is NOT part of the typical initial treatment for ACS/STEMI? A. Aspirin B. Nitroglycerin (if no contraindication) C. Morphine for refractory pain D. Routine oxygen for all patients

Answer 32

Answer: D. Routine oxygen for all patients Explanation: Oxygen is not given routinely; it is indicated only if oxygen saturation <90%, the patient is in respiratory distress, or has high-risk features

Question 33

What is the main rationale for rapid reperfusion therapy in STEMI? A. Reduce chest pain B. Restore coronary blood flow and salvage myocardium C. Normalize troponin levels D. Prevent arrhythmias only

Answer 33

Answer: B. Restore coronary blood flow and salvage myocardium Explanation: Early reperfusion limits myocardial injury, preserves ventricular function, and reduces mortality.