ACLS Practice Test2

ACLS Provider Course – “Practice” Test

January 2007

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

1. CPR has been started on an elderly female. After attaching a monitor, it shows fine VF. Which action would you take next? a. Deliver up to 3 precordial thumps while observing the patient’s response on the monitor. b. Perform at least 5 minutes of vigorous CPR before attempting defibrillation. c. Deliver about 2 minutes or 5 cycles of CPR, and deliver a 360-J monophasic or equivalent-current biphasic shock. d. Insert an endotracheal tube, administer 2 to 2.5 mg epinephrine in 10 mL NS through the tube and then defibrillate. 2. Which of the following facts about identification of VF is true? a. b. c. d.

Turning the signal amplitude (“gain”) to zero can enhance the VF signal A sudden drop in blood pressure indicates VF Artifact signals displayed on the monitor can look like VF A peripheral pulse that is both weak and irregular indicated VF

3. After a cardiac arrest, the patient is assessed as having PEA at 30 bpm. CPR continues, an airway is placed and confirmed and an IV has been established. Which of the following medications is most appropriate to give next? a. b. c. d.

Sodium bicarbonate 1 mEq/kg IV Synchonized cardioversion at 200 J Epinephrine 1 mg IV Calcium chloride 5 mL/kg IV

4. Which of the following causes of PEA is most likely to respond to quick treatment? a. b. c. d.

Massive pulmonary embolism Hypovolemia Massive acute myocardial infarction Myocardial rupture

5. Identify the true statement about IV administration of medications during attempted resuscitation. a. b. c. d.

Run normal saline missed with sodium bicarbonate (100 mEq/l) while continuing CPR Follow IV medications through peripheral veins with a fluid bolus Give epinephrine via the intracardiac route if IV access is not obtained within 3 minutes Do not follow IV medications through central veins with a fluid bolus

6. An elderly woman with a history of narrow-complex PSVT has just arrived in the ED. She is alert and oriented but very pale. Her HR is 165 bpm, and the ECG documents SVT. BP is 105/70 mm Hg. Supplemental oxygen is being provided, and IV has been started. Which of the following drug-dose combinations is the most appropriate first treatment? a. b. c. d.

Adenosine 6 mg rapic IV push Atropine 1 mg IV push Synchronized cardioversion with 25 to 50 J Epinephrine 1 mg IV push

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7. A patient in the ED is reporting 30 minutes of severe, crushing substernal chest pain. His BP is 110/70, his heart rate is 58 and the monitor shows regular sinus bradycardia. He has already been given 325 mg of aspirin PO, has oxygen via nasal cannula at 4 L/min and has already received 3 sublingual nitroglycerin 5 minutes apart, but he continues to have severe pain. Which should be given next? a. b. c. d.

Atropine 0.5 sto 1 mg IV Furosemide 20 to 40 mg IV Lidocaine 1 to 1.5 mg/kg Morphine sulfate 2 to 4 mg IV

8. Early management of acute cardiac ischemia frequently can be handled by using…. a. b. c. d.

Calcium channel blockers plus IV furosemide Bolus of amiodarone followed by an oral ACE inhibitor Chewable aspirin, sublingual nitroglycerine and IV morphine Lidocaine bolus followed by a continuous infusion of lidocaine.

9. Transcutaneous cardiac pacing is indicated for which of the following rhythms? a. b. c. d.

Asystole that follows 6 or more defibrillation shocks Normal sinus rhythm with hypotension and shock Complete heart block with pulmonary edema Sinus bradycardia with no symptoms

10. Which of the following causes of out-of-hospital asystole is most likely to respond to treatment? a. b. c. d.

Blunt multisystem trauma Drug overdose Prolonged submersion in warm water Prolonged cardiac arrest

11. You are working with an unstable 49 year-old woman with tachycardia. The monitor/defibrillator is in “synchronization” mode. The patient suddently becomes unresponsive and pulseless and then the rhythm changes to an irregular, chaotic, VF-like pattern. You charge to 200 J and then press the SHOCK button, but the defibrillator does not deliver a shock. Why? a. b. c. d.

A monitor lead has lost contact, producing the “pseudo-VF” rhythm You cannot shock VF in “sync” mode The defibrillator/monitor battery failed The “sync” switch failed

12. For which of the following arrest patterns would you recommend Vasopressin? a. b. c. d.

VF Asystole PEA All of the above

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13. The patient is in cardiac arrest. One of the team members is providing effective bag-mask ventilations. Compressions are adequate. The ECG documents asystole. Two minutes has passed since epinephrine 1 mg has been given. Which of the following actions should be done next? a. b. c. d.

Administer atropine 1 mg IV Initiate transcutaneous pacing at a rate of 60 bpm Start a dopamine IV at 15 to 20 μg/kg per minute Give epinephrine (1 mL of 1:10 000 solution) IV bolus

14. Each of the following patients were diagnosed with acute ischemic stroke. Which of these patients has NO stated contraindication for IV fibrinolytic therapy? a. b. c. d.

A 65 year old who lives along and was found unresponsive by a neighbor A 65 year old man presenting approximately 4 hours after onset of symptoms A 65 year old woman presenting 1 hour after onset of symptoms A 65 year old man diagnosed with bleeding ulcers 1 week before the onset of symptoms

15. When a 25 year old woman presents to the ED, she says that she is having another episode of PSVT. Her medical history includes a electrophysiologic stimulation study (EPS) that confirmed that there was a reentry tachycardia, no Wolfe-Parkinson-White syndrome and no preexcitation. Heart rate is 180 bpm. The patient tells you that she hasj palpitations and mild shortness of breath. Vagal maneuvers with carotid sinus massage have no effect on HR or rhythm. Which of the following actions is your best intervention? a. b. c. d.

IV adenosine IV propranolol IV diltiazem DC cardioversion

16. A patient with a heart rate of 30 to 40 bpm complains of feeling dizzy, cool and has clammy extremities and short of breath. He is in third-degree AV block. All treatment modalities are present. What would you do first? a. b. c. d.

Give epinephrine 1 mg IV push Start dopamine infusion 1 to 10 μg/min Begin immediate transcutaneous pacing, sedate if possible Give atropine 0.5 to 1 mg IV

IDENTIFY THE FOLLOWING RHYTHMS: 17.

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

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18.

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

19.

20.

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21.

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

22.

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

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23.

† † † † † †

Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Atrial Fibrillation Atrial Flutter Reentry Supraventricular Tachycardia

† † † † †

Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block

Answers: 1. C 2. C 3. C 4. B 5. B 6. A 7. D 8. C 9. C 10. B 14. C 15. A 16. C 17. Normal Sinus Rhythm 18. Sinus Bradycardia 19. Atrial Flutter 20. Third-Degree Atrioventricular Block 21. Atrial Fibrillation 22. Monomorphic Ventricular Tachycardia 23. Ventricular Fibrillation

11. B

12. D

13. A

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