Acls

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ACLS Provider Course

SAMPLE ACLS PRE-TEST EXAM

This is a single-answer multiple-choice examination. There is only one correct answer to each question.

1. What would you do first to restore oxygenation and ventilation to an unresponsive,breathless, near-drowning victim?

a. force water from the victim's lungs by performing the Heimlich maneuverb. force water from the victim's lungs by starting chest compressionsc. stabilize cervical spine with c-collar and spine board, then start the ABCsd. open the airway with a jaw-thrust maneuver, provide in-line cervical stabilization, start the ABCs

2. You have just attempted to intubate your patient who is in respiratory arrest. When checking for tube placement you auscultatestomach gurgling over the epigastrium, and oxygen saturation (per pulseoximetry) fails to rise. What would you think the most likely answer would be for these findings?

a. intubation of the hypopharyngeal areab. intubation of the left main bronchusc. intubation of the right main bronchusd. bilateral tension pneumothorax

3. Immediate intubation would be indicated for which of the following patients?

a. an elderly woman with severe chest pain and shallow respirations at 30 breaths/minb. a 55-year-old insulin-dependent diabetic with ST-segment elevation and runs of VTc. an apneic patient whose chest does not rise with bag-mask ventilationsd. a subdued, alcohol-intoxicated college student with a reduced gag reflex

4. What is the airway of choice for a trauma victim who is unresponsive and in shock?

a. a tracheal tubeb. the patient's own airwayc. a nasopharyngeal airwayd. an oropharyngeal airway

5. Pleae choose from the list below the proper sequence of events indicated for the performance of CPR and the operation of an AED.

a. send someone to call 911, attach AED electrode pads, open the airway, turn on the AED, provide

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2 breaths, check for a pulseb. wait for the AED and barrier device to arrive, open the airway, provide 2 breaths, check for a pulse,if no pulse attach AED electrode pads, follow AED promptsc. send someone to call 911, open the airway, provide 2 breaths, check for a pulse, if no pulseattach the AED, follow AED promptsd. provide 2 breaths, check for a pulse, if no pulse perform chest compressions for 1 minute, call forthe AED, when the AED arrives attach electrode pads

6. You are operating an AED on a man who is unresponsive, pulseless and apnec that has just collapsed on the job. Afterdelivery of 3 successive shocks, your pulse check indicates no carotid pulse What is the nextthing you would do?

a. reanalyze the victim's rhythmb. perform CPR until EMS personnel arrivec. perform CPR for 1 minute, then reanalyze the victim's rhythmd. leave the AED attached and start transport to the nearest ED, stopping every 3 minutes for theAED to reanalyze

7. What drug is indicated next for a patient who remains in VF cardiac arrest after 3 stacked shocks, tracheal intubation, epinephrine 1 mgIV, and a 4th shock?

a. amiodarone 150 mg IV given over 10 minutesb. lidocaine 1 to 1.5 mg/kg IV pushc. procainamide 50 mg/min, up to a total dose of 17 mg/kgd. magnesium 1 to 2 g, appropriately diluted, IV push

8. A patient in VF cardiac arrest has failed to respond to 3 shocks, epinephrine 1 mg IV, and a 4thshock. You give the nurse an order to administer epinephrine every 3 minutes during the code.Which of the following dose regimens is recommended?

a. epinephrine 1 mg, 3 mg, 5 mg, and 7 mg (escalating regimen)b. epinephrine 0.2 mg/kg per dose (high-dose regimen)c. epinephrine 1 mg IV push, repeated every 3 minutesd. epinephrine 1 mg IV push, followed in 3 minutes by vasopressin 40 U IV

9. Your ambulance arrives at the scene of a 49-year-old woman in cardiac arrest. The first AED analysis registers "shockindicated." But before the shock can be delivered, you learn that the woman has gone 12 minuteswithout any bystander CPR. What actions should you the EMTs take next?


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a. resume CPR, supplement with 100% 02, continue until paramedics arriveb. allow the AED to charge and shockc. resume CPR, supplement with 100% 02 for 3 minutes, reanalyze, shock if indicatedd. resume CPR, contact medical control, request permission to stop resuscitative efforts

10. When using vasopressin on a patient who remains in persistent VF arrest after 3 shocks. Whichof the following guidelines for use of vasopressin is true?ue?

a. give vasopressin 40 U every 3 to 5 minutesb. give vasopressin for better vasoconstriction and -adrenergic; stimulation than provided byepinephrinec. give vasopressin as an alternative to epinephrine in shock-refractory VFd. give vasopressin as the first-line pressor agent for clinical shock caused by hypovolemia

11. A patient presents to your unit. CPR continues with ventilations provided through a endotracheal tube insertedin the hallway. Chest compressions produce a femoral pulse that disappears during a "stopcompressions" pause. During the pause the cardiac monitor shows narrow QRS complexes at a rateof 67 bpm. What is the next action you should take?

a. check for tracheal tube dislodgment and improper tube placementb. start an IV, administer atropine 1 mg IV pushc. start an IV, send blood samples for measurement of serum electrolytes and a toxic drug screend. analyze arterial blood gases to check for acidosis, hypoxia, and hypoventilation

12. Your patient presents with PEA. You auscultate excellent bilateral breath sounds bilateral, and you see excellentbilateral chest rise. Two minutes after epinephrine 1 mg IV is given, PEA continues at 30 bpm. Whataction would you take next?

a. administer atropine 1 mg IVb. initiate transcutaneous pacing at a rate of 60 bpmc. start a doparnine IV infusion at 15 to 20 pg/kg per minuted. give epinephrine (1 mL of 1:10 000 solution) IV bolus

13. Your patient presents with PEA. When would sodium bicarbonate therapy (1 mEq/kg) be mosteffective?

a. a patient with hypercarbic acidosis due to a tension pneumothoraxb. a patient with a brief arrest interval


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c. a patient with documented severe hyperkalemiad. a patient with documented severe hypokalemia

14. An unresponsive, pulseless, apnec patient arrives in your unit in PEA at 30 bpm. CPR continues, ET tube placement isconfirmed, and IV access is secured. Which of the following medications would you give next?

a. calcium chloride 5 mL of 10% solution IVb. epinephrine 1 mg IVc. synchronized cardioversion at 200 Jd. sodium bicarbonate 1 mEq/kg IV

15. What drug-dose combination is recommended as the first line medication to give to apatient in asystole?

a. epinephrine 3 mg IVb. atropine 3 mg IVc. epinephrine 10 mL of a 1:10 000 solution IVd. atropine 0.5 mg IV

16. When a monitor attached to a person in cardiac arrest displays a "flat line," you should execute the"flat line protocol." Which of the following actions is included in this protocol?

a. check monitor display for sensitivity or "gain"b. obtain a right-sided 12-lead ECGc. change LEAD SELECT control from lead // to paddles and backd. administer a lower energy (100 J) defibrillatory shock to "bring out" possible occult VF

17. A 76-year-old woman in cardiac arrest arrives in the ED after 15 minutes of continuousasystole. The patiente is intubated, proper tube placement is confirmed, IV access established, andepinephrine 1 mg IV x 3 and atropine 1 mg IV x 2 have been administered. Which of the following actions is most likely to havethe most advantageous effect and is consistent with the recommendations in ECC Guidelines2001?

a. ask the nurse to bring members of the immediate family to a private area, where you discuss codetermination and family presence at the resuscitationb. stop efforts at 10 minutes if there is no response to epinephrine 3 mg IV every 3 minutesc. stop efforts at 10 minutes if there is no response to transcutaneous pacing given with CPRd. stop efforts if there is no response to 3 empiric defibrillatory shocks of 360 J given 3 minutes apart


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18. A 60-year-old woman has a 4-mm ST-elevation in leads V2 to V4. The women has severe chest pain despiteoxygen, aspirin, nitroglycerin SL x 6, and morphine 10 mg IV. BP = 168/112 mm Hg; HR = 118 bpm.Which of the following treatment combinations is most appropriate for this patient at this time(assume no contraindications to any medication)?

a. calcium channel blocker IV + heparin bolus IVb. ACE inhibitor IV + lidocaine infusionc. magnesium sulfate IV + enoxaparin (Lovenox) SQd. reteplase, recombinant (Retavase) + heparin bolus IV

19. Which of the following treatments is included in the definitive therapy for a 62-year-old manwith >3mm ST-segment elevation within 30 minutes of the onset of symptoms of acute myocardial infarction?

a. fibrinolytics or PCI, aspirin, -blockers, heparinb. heparin, aspirin, glycoprotein Ilb/Illa inhibitors, IV -blockers, nitratesc. serum cardiac markers, serial ECGs, perfusion scan or stress testd. prophylactic lidocaine, fluid bolus, vasopressor infusion

20. Within 45 minutes of arrival in your ED, which of the following evaluation sequences should be performed for a56-year-old woman with facial droop, garbled speech, rapid onset of headache,and right arm and leg weakness?

a. history, physical and neurologic exams, noncontrast head CT with radiologist interpretationb. history, physical and neurologic exams, noncontrast head CT, start of fibrinolytic treatment if scanis positive for strokec. history, physical and neurologic exams, lumbar puncture, contrast head CT if LP is negative forbloodd. history, physical and neurologic exams, contrast head CT, start of fibrinolytic treatment whenimprovement in neurologic signs is noted

21. An acute stroke may exhibit signs and symptoms of which of the following conditions?

a. acute insulin-induced hypoglycemiab. acute hypoxiac. isotonic dehydration and hypovolemiad. acute vasovagal or orthostatic hypotension

22. For which of the following rhythms would transcutaneous cardiac pacing be indicated?


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a. sinus bradycardia with no symptomsb. normal sinus rhythm with hypotension and shockc. complete heart block with pulmonary edemad. asystole that follows 6 or more defibrillation shocks

23. A man with a HR of 30 to 35 bpm complains of SOB, cool clammy extremities, and dizzinesswith minimal exercise. What drug would be indicated first to treat this patient?

a. atropine 0.5 to I mgb. epinephrine 1 mg IV pushc. isoproterenol infusion 2 to 10 4mind. adenosine 6 mg rapid IV push

24. Syncronized cardioversion is indicated for which of the following patients?

a. a 78-year-old woman with fever, pneumonia, chronic congestive heart failure, and sinustachycardia at 125 bpmb. a 55-year-old man with multifocal atrial tachycardia at 125 bpm, respiratory rate of 12breaths/minute, and BP of 134/86 mm Hgc. a 69-year-old woman with a history of coronary artery disease, chest pain, a 2-mm STelevation, and sinus tachycardia at 130 bpmd. a 62-year-old man with a history of rheumatic mitral valve disease, obvious shortness of breath,HR of 160 bpm, and BP of 80/50 mm Hg

25. In which of the senerio's below would you not cardiovert a patient with stable tachycardia

a. a 25-year-old wheezing asthmatic woman who has pneumonia on chest x-ray, who is takingalbuterol, and who has the following vital signs: temp = 101.2'F, HR = 140 bpm, resp = 20breaths/minb. a 55-year-old man with diaphoresis, bilateral rales, and the following vital signs: HR = 140 bpm,BP = 90/55 mrn Hg, resp = 18 breaths/min, rhythm = rapid atrial flutterc. a 62-year-old man with a wide-complex tachycardia at a rate of 140 bpm, chest pain,shortness of breath, and palpitationsd. a 55-year-old woman with chest pain, shortness of breath, extreme weakness anddizziness, BP of 88/54 mm Hg, and a narrow-complex tachycardia at a rate of 145 bpm

26. You prepare to cardiovert an unstable 44-year-old tachycardic man with the monitor/defibrillator in"synchronization" mode. He suddenly becomes unresponsive and pulseless as the rhythmchanges to a VF-like pattern. You charge the defibrillator to 200 J and press the SHOCK button,but the defibrillator fails to deliver a shock. Why?


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a. the defibrillator/monitor battery failedb. the "sync" switch failedc. you cannot shock VF in "sync" moded. a monitor lead has lost contact, producing the "pseudo-VF" rhythm

27. A 60-year-old man complains of mild lightheadedness and palpitations, but the findings of hisexam are unremarkable. The ECG shows a regular, narrow-complex tachycardia at 150bpm. The Valsalva maneuver slows the ventricular rate to reveal atrial flutter, but it doesnot convert the atrial flutter. Which of the following therapies should you try next?

a. IV adenosine to slow ventricular rateb. IV diftiazem to slow ventricular ratec. urgent DC cardioversiond. IV dopamine to strengthen cardiac contractions

28. A healthy 49-year-old woman complains of tightness in her chest, dizziness, and palpitations. HR is165 bpm, BP is 88/58 mm Hg, and the ECG shows a narrow-complex tachycardia. You decide thatthe rhythm is multifocal atrial tachycardia. He has failed to respond to vagal maneuvers and 2 roundsof adenosine. Which of the following treatments is inappropriate?

a. IV amiodaroneb. IV metoprololc. IV diltiazemd. DC cardioversion

29. A 71-year-old woman presents with 6 days of lightheadedness, palpitations, and slightexercise intolerance. The 12-lead reveals atrial fibrillation, which continuesat a HR of 130 to 160 bpm and SP = 102/72 mm Hg. Which of the following treatments is themost appropriate intervention?

a. sedation, analgesia, then immediate cardioversionb. oxygen via nasal cannula at 2 to 6 Umin, normal saline at 60 to 120 mL/hc. amiodarone 300 mg IV bolusd. metoprolol 5 mg IV; repeat every 5 minutes to a total dose of 15 mg

30. A 56-year-old, malnourished, chronic alcoholic presents with polymorphic ventricular tachycardia thatresembles torsades de pointes. His HR is irregular at 120 to 160 bpm, and his BP is 95/65 mm Hg.He has no related symptoms and no signs of impaired heart function. Which of the followingtreatments is most appropriate at this time?


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a. IV amiodaroneb. IV magnesiumc. IV lidocained. IV procainamide

31. You are performing CPR on a uresponsive pulseless apnec woman in cardiac arrest when a co-worker arrives and attaches an AED.With the first AED analysis a shock is "indicated" and delivered, but the next rhythm analysissignals "no shock advised." What acton would you take next?

a. check for a pulseb. press the manual OVERRIDE button and operate the AED as a manual defibrillatorc. insert an oropharyngeal airway and start 100% oxygen at 6 Umind. support breathing and place the patient in the recovery position until the hospital code team arrives

32. Which patient below is most likely to present with vague signs and symptoms of anatypical AMI?

a. a 65-year-old woman with moderate coronary artery disease recently confirmed byangiographyb. a 56-year-old man who smokes 3 packs per day but has no history of heart diseasec. a 45-year-old woman diagnosed with type I diabetes 22 years agod. a 48-year-old man in the ICU after coronary artery bypass surgery

33. A 50-year-old woman (weight = 60 kg) with recurrent VF has converted to a wide complexperfusing rhythm after epinephrine 1 mg IV and a 4th shock (HR = 70 bpm, BP = 92/62 mmHg). Which drug therapy is most appropriate to give next?

a. amiodarone 300 mg IV pushb. adenosine 6 mg rapid IV pushc. magnesium 3 g IV push, diluted in 10 mL of D5Wd. procainamide 20 to 50 mg/min, up to a maximum dose of 17 mg/kg

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