ACLS Practice Quiz

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1: Which of the following actions is done first to restore oxygenation and ventilation to an unresponsive, breathless, near-drowning victim?

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

2: Tracheal intubation has just been attempted for a victim of respiratory arrest. During hand ventilation with a bag, you hear stomach gurgling over the epigastrium, and oxygen saturation (per pulse oximetry) fails to rise. Which of the following is the most likely explanation for these findings?

intubation of the hypopharyngeal area
intubation of the left main bronchus
intubation of the right main bronchus
bilateral tension pneumothorax

3: Which of the following patients needs immediate intubation?

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

4: When treating a trauma victim who is in shock and deeply comatose, which of the following is the airway of choice?

a tracheal tube
the patient's own airway
a nasopharyngeal airway
an oropharyngeal airway

5: Which of these lists CPR performance and AED operation is correct and in the right sequence?

send someone to call 911, attach AED electrode pads, open airway, turn on the AED, provide 2 breaths, check for a pulse
wait for the AED and barrier device to arrive, open airway, provide 2 breaths, check for a pulse, if no pulse attach AED electrode pads, follow AED prompts
send someone to call 911, open airway, provide 2 breaths, check for a pulse, if no pulse attach the AED, follow AED prompts
provide 2 breaths, check for a pulse, if no pulse perform ches compressions for 1 minute, call for the AED, when the AED arrives attach electrode pads

6: You are operating an AED in an attempted resusciatation of a man who collapsed in the airport. After delivery of 1 shock, what is the next thing you do?

reanalyze the victim's rhythm
perform CPR until EMS personnel arrive
perform CPR for 2 minutes, then reanalyze the victim's rhythm
leave the AED attached and start transport to the nearest ED, stopping every 3 minutes for the AED reanalyze

7: A patient remains in VF cardiac arrest after defibrillation, tracheal intubation, epinephrine 1 mg IV, and a 4th shock. Which of the following drug-dose combinations should this patient receive next?

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

8: A patient in VF cardiac arrest had failed to respond to 3 shocks, epinephrine 1 mg IV, and a 4th shock. You give the medication nurse a "standing order" to administer epinephrine every 3-5 minutes as long as the resuscitation continues. Which of the following dose regimens is recommended?

epinephrine 1 mg, 3 mg, 5 mg, and 7 mg (escalating regimen)
epinephrine0.2 mg/kg per dose (high-dose regimen)
epinephrine 1 mg IV push, repeated every 3 minutes
epinephrine 1 mg IV push, followed in 3 minutes by vasopressin 40 U IV

9: EMTs arrive at the side of a 55-year-old man in cardiac arrest. The first AED analysis registers "shock indicated." But before the shock can be delivered, the EMTs learn that the man has gone 12 minutes without any bystander CPR. What actions should the EMTs take next?

resume CPR, supplement with 100% O2, continue until paramedics asrrive
allow the AED to charge and shock
resume CPR, supplement with 100% O2 for 3 minutes, reanalyze, shock if indicated
resume CPR, contact medical control, request permission to stop resuscitative efforts

10: While treating a patient in persistent VF arrest after 3 shocks, you consider using vasopressin. Which of the following guidelines for use of vasopressin is true?

give vasopressin 40 U every 3 to 5 minutes
give vasopressin for better vasoconstriction and beta- adrenergic stimulation than provided by epinephrine
give vasopressin as an alternative to epinephrine in shock-refractory VF
give vasopressin as the first-line pressor agent for clinical shock caused by hypovolemia

11: A patient arrives in the ED. CPR continues with ventilations provided through a tracheal tube inserted in the field. Chest compressions produce a femoral pulse that disappears during a "stop compressions" pause. During tha pause the cardiac monitor shoes narrow QRS complexes at a rate of 65 bpm. At this point what is the next action you should take?

check for tracheal tube dislodgement and improper tube placement
start an IV, administer atrophine 1 mg IV push
start an IV, send blood samples for measurement of serum electrolytes and a toxic drug screen
analyze arterial blood gases to check for acidosis, hypoxia, and hypoventilation

12: You have intubated a patient with PEA. You hear good bilateral breath sounds, and you see obvious bilateral chest rise. Two minutes after epinephrine 1 mg IV is given , PEA continues at 30 bpm. Which of the following actions should be done next?

administer atropine 1 mg IV
initiate transcutaneous pacing at a rate of 60 bpm
start a dopamine IV infusion at 15 to 20 micrograms/kg per minute
give epinephrine ( 1 mL of 1:10 000 solution) IV bolus

13: For which of the following PEA patients is sodium bicarbonate therapy ( 1 mEq/kg) likely to be most effective?

a patient with hypercarbic arrest acidosis due to a tension pneumothorax
a patient with a brief arrest interval
a patient with documented severe hyperkalemia
a patient with severe hypokalemia

14: A cardiac arrest patient arrives in the ED in PEA at 30 bpm. CPR continues, proper tube placement is confirmed, and IV access is esablished. Which of the following medications is most appropriate to give next?

calcium chloride 5 mL of 10% solution IV
epinephrine 1 mg IV
synchronized cardioversion at 200 J
sodium bicarbonate 1 mEq/kg IV

15: Which of the following drug-dose combination is recommended as the intial medication to give to a patient in documented asystole?

epinephrine 3 mg IV
atropine 3 mg IV
epinephrine 10 mL of a 1:10 000 solution IV
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?

check monitor display for sensitivity or "gain"
obtain a right-sided 12-lead ECG
change LEAD SELECT control from lead 2 to paddles and back
administer a lower energy (100 J) defibrillatory shock to "bring out" possible occult VF

17: An 88- year-old man in normothermic cardiac arrest arrives in the ED after 15 minutes of continuous asystole. Paramedics intubated him, comfirmed proper tube placement, gained IV access, and gave epinephrine 1 mg IV * 3 and stropine 1 mg IV * 2. Which of the following actions is most likely to have a positive therapeutic effect and is most consistant with the recommendations in ECC Guidelines 2000?

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

18: A 50-year-old man hs 3-mm ST-elevation in leads V2 to V4. Severe chest pain continues despite oxygen, aspirin, nitroglycerin SL*6, and morphine 10 mg IV. BP=170/110 mm Hg; HR=120 bmp. Which of the following treatment combinations is most appropriate for this patient at this time (assume no cintraindications to any medication)?

calcium channel blocker IV + heparin bolus IV
ACE inhibitor IV + lidocaine infusion
magnesium sulfate IV + enoxaparin (Lovenox ) SQ
reteplase, recombinant (Retavase) + heparub bolus IV

19: Which of the following includes the major componets of definitive therapy for a 60-year-old patient with >2mm ST-segment elevation within 30 minutes of the onset of symptoms of acue ischemic chest pain?

fibrinolytics or PCI, aspirin, beta-blockers, heparin
heparin, aspirin, glycoprotien, llb/llla inhibitors, IV beta-blockers, nitrates
serum cardiac markers, serial ECGs, perfusion scan or stress test
prophylactic lidocaine, fluid bolus, vasopresspr infusion

20: Within 45 minutes of ED arrival, which of the following evaluatuoin sequences should be performed for a 70-year-old woman with rapid onset of headache, garbled speech, and right arm and leg waekness?

history, physical and neurologic exams, noncontrast head CT with radiologist
history, physical and neurologic exams, noncontrast head CT, start of fibrinolytic treatment if scan is positive for stroke
history, physical and neurologic exams, lumbar puncture, contrast head CT if LP is negative for blood
history, physical and neurologic exams, contrast head CT, start of fibrinolytic treatment when improvement in neurologic signs is noted

21: Which of following conditions most closely mimics the signs and symptoms of an acute stroke?

acute unsulin-induced hypoglycemia
acute hypoxia
isotonic dehydration and hypovolemia
acute vasovagal or orthostatic hypotension

22: Which of the following rhythms is an appropriate indication for transcutaneous cardiac pacing?

sinus bradycardia with no symptoms
normal sinus rhythm with hypotension and shock
complete heart block with pulmonary edema
asystole that follows 6 or more defibrillation shocks

23: A patient with HR of 30 to 40 bpm ocmplains of dizziness, cool, clammy extremities, and dyspnea with minimal exercise. What is the first drug to give this patient?

atropine 0.5 to 1 mg
epinephrine 1 mg IV push
isoproterenol infusion 2 to 10 micrograms/min
adenosine 6 mg rapid IV push

24: Which of the following patients needs immediate synchronzied cardioversion?

a 78-year-old woman with a fever, pneumonia, chronic congestive heart failure, and sinus tachycardia at 125 bpm
a 55-year-old man with multifocal atrial tachycardia at 125 bpm, respiratory rate of 12 breaths/minute, and BP of 134/86 mm Hg
a 69-year-old woman with a history of coronary artery disease, chest pain, a 2-mm ST elevation, and sinus tachycardia at 130 bpm
a 62-year-old man with a history of rheumatic mitrsl valve disease, obvious shortness of breath, HR of 160 bpm, and BP of 88/70 mm Hg

25: Which one of the following patients is most likely presenting with stable tachycardia that you should not cardovert?

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

26: You prepare to cardovert an unstable 48-year-old tachycardia woman with the onitor/defibrillator in "synchronization" mode. She suddenly becomes unresponsive and pulseless right when the rhythm changes to an irregular, chaotic, VF-like pattern. You charge to 200 J and press SHOCK button, but the defibrillator fails to deliver the shock. Why?

the defibrillator/monitor battery failec
sthe "sync" switch failed
you cannot shock VF in "sync" mode
a monitor lead has lost contact, producing the "pseudo-VF" rhythm

27: An 80-year-old woman complains of palpitations and mild lightheadedness, but the findings of her physical exam are unremarkable. The 1st ECG shows regular, narrow-complex tachycardia at 150 bpm. The Valsalva maneuver slows the ventricular rate to revel classic atrial flutter waves, but it does not convert the atrial flutter. Which of the following interventions should you try next?

IV adenosine to slow ventricular rate
IV diltiazem to slow ventricular rate
urgent DC cardioversion
IV dopamine to strengthen cardiac contractions

28: A previously healthy 50-year-old man complains of chest tightness, palpitaions, and dizziness. HR is 170 bpm, BP is 90/60 mm Hg, and the ECG shows narrow-complex tachycardia. You decide that the rhythm is multifocal atrial tachycardia. He failed to respond to initial vagal maneuvers and 2 rounds of adenosine. As your next action, which of the following treatments is in approprate?

IV amiodarone
IV metoprolol
IV diltiazem
DC cardioversion

29: A 75-year-old man presents to the ED with 1 week of lightheadedness, irregular palpitaions, and mild exercise intolerance. The initial 12-lead ECG displays atrial fibrillation, which continues to show on the monitor at a HR of 120 to 150 bpm and BP= 100/70 mm Hg. Which of the following therapies is the most appropriate next intervention?

sedation, analgesia, then immediate cardioversion
oxygen via nascal cannula at 2 to 6 L/min, normal saline at 60 to 120 mL/h
amiodarone 300 mg IV bolus
metoprolol 5 mg IV; repeat every 5 minutes to a total dose of 15 mg

30: A 66-year-old, malnourished, chronic alcoholic presents with polymorphic ventricular tachycardia that resembles 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 following treatments is most appropriate at this time?

IV amiodarone
IV magnesium
IV lidocaine
IV procainamide

31: You are performing CPR on a man in cardiac arrest when a technician arrives and attaches an AED. After the rhythm analysis it signals "no shock advised." What is the most appropriate next action?

Begin CPR for 2 minutes
press manual OVERRIDE button and operate the AED as a manual defibrillator
insert an oropharyngeal airway and start 100% oxygen at 6 L/min
support breathing and place the patient in the recovery position until the hospital code team arrives

32: Which of the following patients is most likely to present with vague signs and unusual symptoms of an atypical AMI?

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

33: ACLS care for cardiac arrest should center around

Defibrillation and intubation
Medicatios and deibrillation
2 minutes of high quality CPR
EKG analysis and defibrillation