Advanced Cardiac Life Support

PRE-TEST
1) Which of the following is true about an oropharyngeal airway?
a. It eliminates the need to position the head of the unconscious patient
b. It eliminates the possibility of an upper airway obstruction
c. It is of no value once a tracheal tube is inserted
d. It may stimulate vomiting or laryngospasm if inserted in the
semiconscious patient.
2) You have just attempted tracheal intubation. You hear stomach gurgling over the
epigastriam, you see no chest expansion, and you are unable to hear breath sounds on
either side of the chest during hand ventilation with a bag. Pulse oximetry indicates
that the hemoglobin saturation has failed to rise. Which of the following is the most
likely explanation of this finding?
a. Intubation of the esophagus
b. Intubation of the left main bronchus
c. Intubation of the right main bronchus
d. Unilateral tension pneumothorax
3) Once a tracheal tube is inserted and the position verified (with both primary and
secondary confirmation) during CPR, which of the following best describe the
ventilations that should be provided?
a. An average of 8to 10 ventilations as per minute without pauses for chest
compressions.
b. Ventilations should provide prompt hyperventilation to correct acidosis,
with a pause after every fifth compression
c. Ventilations should be delivered with an estimated tidal volume of 3 to 5 mL/kg
d. Ventilations should be delivered with room air to avoid hyperoxygenation
4) Which of the following is an indication for tracheal intubation?
a. difficulty encountered by qualified rescuers in ventilating an apneic patient
with bag-mask device
b. a respiratory rate of less than 20 breaths per minutes in a patient with
severe chest pain
c. the presence of premature ventricular contractions
d. to provide airway protection in a responsive patient with an adequate gag
reflex

5) You are providing hand ventilations with a bag mask for a patient with no
spontaneous ventilation. You are explaining the use of bag-mask ventilation to a
group of new nurses and residents who are observing your technique. Which of the
following statements would most accurately describe the use of bag-mask ventilation
during resuscitation?
a. bag-mask ventilation can be performed effectively with minimal training
and little practice
b. bag-mask ventilator will deliver nearly 100% oxygen if a reservoir with a
high oxygen flow rate is used
c. bag-mask ventilator cannot be performed effectively by one person during
resuscitation
d. bag-mask ventilator should not be used if the patient makes any
spontaneous respiratory effort
6) Which of the following choices lists in correct order the major steps of CPR and AED
operation for an unresponsive victim?
a. send someone to phone EMS, check for a pulse, attach the AED electrode
pads, open the airway, provide 2 breaths if needed, then turn on the AED
b. wait for AED and barrier device to arrive, then open the airway, provide 2
breaths if needed, check for a pulse, and if no pulse is present, attach the
AED and follow the sequence of AED prompts
c. send someone to phone EMS and get the AED, open the airway , provide 2
breaths if needed, check for a pulse, and if no pulse is present, attach the
AED and follow the sequence of AED prompts
d. provide 2 breaths, check for a pulse, call for the AED, provide chest
compressions until the AED arrives, attach the AED
7) In correct order, what are the 4 universal steps required to operate an AED?
a. POWER ON the AED, attach the AED to the victim, analyze the
rhythm, deliver a shock if indicated
b. Attach the AED to the victim, POWER ON the AED, analyze the
rhythm, deliver a shock if indicated
c. Attach the electrode pads to the victim, attach the electronic cables
to the AED, POWER ON the AED, analyze the rhythm, deliver a
shock if indicated
d. POWR ON the AED, attach the AED to the victim, deliver the first
shock, analyze the rhythm

8-You respond with 2 other rescuers to a 50-year-old man who is unresponsive, pulseless,
and not breathing. What tasks would you assign the other rescuers while you set up the AED?
a. one rescuer should phone EMS and the other rescuer should begin CPR
b. both rescuer should help set up the AED and provide CPR
c. one rescuer should open the airway and begin rescue breathing, and the second rescuer
should begin chest compressions
d. recruit additional first responders to help
9-You attach an AED to a 43-year-old victim who is pulse less and not breathing , and the
AED advises no shock indicated. What should you do?
a. reanalyze immediately
b. perform CPR for 2 minute and reanalyze
c. perform CPR until EMS personnel arrive
d.
remove the AED
10-A patient develops sudden VF arrest during evaluation for chest pain in an outpatient
clinic. The patient has just received the first shock from the clinic AED. The monitor screen on
the AED displays VF. What is the next action rescuers should take?
a. resume CPR for approximately 2 minute; then reanalyze the rhythm
b. establish IV access for medication administration
c. press the ANALYZE control on the AED to reanalyze the rhythm
d. administer epinephrine 1 mg IV as soon as the IV is established
11-Which of the following therapies is the most important intervention for VF/Pulseless VT, with
the greatest effect on survival to hospital discharge?
a. epinephrine
b. defibrillator
c. oxygen
d. amiodarone
12-A 53-year-old man has suffered VF arrest in the ED. He remains in VF after 3
shocks and epinephrine. The team leader asks for amiodarone 300 mg IV. Which of the
following statements is true about amiodarone for refractory VF?
a. Amiodarone is a Class IIb-recommended therapy for treatment of patients
who have not responded to 3 shocks and IV epinephrine
b. Amiodarone is associated with better 10year survival than that for other
therapy for people who remain in VF after 3 shocks and 1 mg epinephrine
Amiodarone is not recommended for refractory VF
c.Amiodarone should be administered as soon as an IV is available and at
least 1 shock has failed to achieve defibrillation

13-A 75-year-old homeless man is in cardiac arrest with pulseless VT at a rate of 220
bpm. After CPR, a DC shock, 1 mg IV epinephrine, then one more shock, the man
continues to be polymorphic pulseless VT. He appears wasted and malnourished. The
paramedics recognize him as a chronic alcoholic known in the neighborhood. Since he
remains in VT after 6 shocks, you are considering an antiarrhythmic. Which of the
following agents would be most appropriate for this patient at this time?
a. amiodarone
c. magnesium
b.
diltiazem
14Which statement is true
about the use of antiarrhythmics for patients with shock-refractory VF/Pulseless VT?
A .antiarrhythmic agents are indicated because of the well-documented, long-term
benefits of increasing 1-year survival for VF/VT victims
B .antiarrhythmic agents can replace the need for continued shocks if infused fast
and early
c.
procainamide antiarrhythmic agents reduce
myocardial damage from continued shocks
d. in prospective, randomized trials, antiarrhythmic agents have not yet been found to
improve survival to hospital discharge of patients with VF/Pulseless VT
15-you are called to assist in the attempted resuscitation of a patient who is demonstrating PEA.
As you hurry to the patients room, you review the information you learned in the ACLS course
about management of PEA. Which one of the following statements about PEA is true?
a. chest compressions should be administered only if patient with PEA develops a
ventricular rate of less than 50 bpm
b.successful treatment of PEA requires identification and treatment of reversible
causes, such as the 5 Hs and 5 Ts
c.atropine is the drug of choice for treatment of PEA, whether the ventricular rate
is slow or fast
d.PEA is rarely caused by hypovolemia, so fluid administration is contraindicated
and should not be attempted
16
-you are participating in the resuscitation of a
patient with PEA. The patient has been intubated (with tube position confirmed) and is
receiving 100% oxygen and effective ventilation with bilateral breath sounds and good
expansion. Epinephrine 1 mg was administered 2 minutes ago. PEA continues, with
ventricular rate of 45 bpm/ While you search for reversible causes of the PEA, which of the
following therapies would now be appropriate?
a.monophasic defibrillation up to 3 times at 200 J, 200 to 300 J, 360 J, or biphasic
defibrillator at approximately 150 J
b.synchronized cardioversion
c.epinephrine 10 mL of 1:10 000 solution IV bolus
d.atropine 1 mg IV

17-For which of the following patients with PEA is sodium bicarbonate therapy (1 mEq/kg)
most likely to be most effective?
a.the patient with hypercarbic acidosis and tension pneumothorax treated with decompression
b.the patient with a brief arrest interval
c.the patient with documented severe hyperkalemia
d.the patient with documented severe hypokalemia
18Which of the following potential causes of prehospital asystole is most likely to respond
to immediate treatment?
a.
prolonged cardiac arrest
b.prolonged submersion in warm water
c.drug overdose
d.blunt multisystem trauma
19-Which of the following is the correct initial drug and dose for treatment of
asystole?
a.Epinephrine 2 mg IV
b.Atropine 0.5 mg IV
c.Lidocaine 1 mg/kg IV
d.Epinephrine 1 mg IV
20-Paramedics have arrived with an asystolic 42-year man who was found
unconscious, breathless, and pulseless in the hallway of his apartment. CPR is ongoing.
The patient is intubated. He has bilateral breath sounds and equal and adequate chest
expansion. IV access has been successfully established, with fluid infusion at a keep
open rate. The patients vital signs are follows: PaO2 = 85 mm Hg; Paco2 = 32 mm PH;
7.3; serum potassium = 4.5 mEq/L; core body temperature = 37 C. In this scenario,
which is the most likely reversible cause to consider before stopping the resuscitation
attempt?
a.Tracheal tube in the esophagus
b.Drug overdose
c.Tension pneumothorax
d.Hypothermia
21-Which of the following should be checked as part of the flat line protocol to confirm the
presence of asystole and rule out operator or monitoring error as the reason for the isoelectric
ECG?
a. Check power switch, all connections between the monitor and patient, monitor/defibrillator
battery, sensitivity or gain, and lead choice
b. Obtain 12-led ECG
b.
Press the SYNCHRONIZE button on the cardi overter/defibrillator
c.
Administer a trail defibrillatory shock to rule out occult VF

22- You are working in the ED when a 34-year-old woman arrives with a
complaint of palpitations. She has a history of mitral valve prolapse and a
heart rate of 165 bpm, respiratory rate of 14 breaths/min, and blood pressure
of 118/82 mm Hg. Her lungs are clear to auscultation, and she has no
hepatomegaly. She denies having any shortness of breath. She is placed on
an ECG monitor, which indicates that s narrow-complex, regular
tachycardia is present. Which of the following phrases best characterizes
this patients condition?
a. Stable tachycardia
b. Unstable tachycardia
c. Heart rate appropriate for clinical condition
d. Tachycardia with poor cardiovascular function
23- You are working in a clinic when a 58-year-old man walks in complaining
of chest pain. He is diaphoretic and complaints of dizziness. He sits in a
chair at the triage desk while you check his pulse, which is rapid. As you
prepare to attach a cardiac monitor to the patient, the man suddenly slumps
over unresponsive. Which of the following best describe his condition?
a. stable tachycardia
b. unstable tachycardia, possible cardiac arrest
c. heart rate appropriate for clinical condition
d. tachycardia with adequate cardiovascular function
24- For which of the following patients would immediate cardioversion be
indicated?
a. a 62-year-old man with rheumatic and aortic valve disease, an
irregularly irregular heart rate of 153 bpm, and a blood pressure of
88/70 mm Hg
b. a 78-year-old woman with fever, pneumonia, mild chronic
congestive heart failure, and sinus tachycardia of 133 bpm
c. a 55-year-old man with multifocal atrial tachycardia, a respiratory
rate of 12 breaths/min, and a blood pressure of 134/86 mm Hg
d. a 69-year-old with a history of coronary artery disease who presents
with chest pain, a heart rate of 118 bpm, and ST-segment elevation
25- Which of the following groups of signs would not be consistent with
evidence of unstable tachycardia?
a. heart rate of 140 bpm, tachypnea, wheezing, and pneumonia in a
patient receiving albuterol
b. heart rate of 140 bpm with rapid atrial in a patient with aortic
stenosis and AMI, blood pressure of 90/55 mm Hg, faint peripheral
pulses, disphoresis, tachypnea and rales
c. VT in a man complaining of chest pain, shortness of breath, and
palpitations
d. Heart of 155bpm in a 55-year-old woman with severe chest pain, difficulty
breathing, extreme weakness and dizziness, & blood pressure of 88/54 mm Hg

26- A 75-year-old man presents to the ED complaining of having

lightheadedness and palpitations for 1 week. His heart rate is 160 bpm and
irregular; his blood pressure is 100/70 mm Hg. The physical examination is
normal, with no evidence of cardiac or circulatory failure. The 12-lead ECG
shows rapid atrial fibrillation but is otherwise normal. Which of the
following should be included in your initial orders for this patient?
a. Oxygen-IV-monitor
b. Immediate defibrillation
c. No therapy is indicated
d. Epinephrine 1 mg IV every 3 to 5 minute
27- A 55-year-old man with known heart failure develops sustained widecomplex tachycardia after an episode of chest pain relieved by nitroglycerin.
Currently HR= 150 bpm, Bp= 100/60 mm HG; ECG before the tachycardia
= old left bundle branch block, which prevents determination of the widecomplex tachycardia as ventricular or supraventricular in origin. Which of
the following is the most appropriate initial medication?
a. IV lidocaine
b. IV adenosine
c. IV amiodarone
d. IV verapamil
28- You decide to convert an unstable, symptomatic tachycardia. You place the
cardiovereter/defibrillator in synchronization mode and administer as
sedative and an analgesic to the patient. Suddenly the patient becomes
unresponsive and pulseless, and the ECG rhythm becomes highly irregular,
resembling VF. When you attempt to deliver the shock, nothing happens: no
shock is delivered and there is no energy transfer. What is the explanation
for failure to deliver a shock?
a. The defibrillator/cardioverter battery has failed
b. The SYNC switch is not functioning properly
c. The patient has developed VF and the defibrillator will not deliver a
charge because it is attempting to synchronize shock delivery with an
R wave
d. The monitor cannot synchronize the cardioversion shock because a
lead has come loose
29- A 25-year-old woman presents to the ED saying Im having another
episode of PSVT! Her prior medical history includes an electrophysiologic
stimulation study that confirmed a reentry tachycardia, no WPW, and no
pre-excitation. Her heart rate is 180 bpm; she reports palpitations and mild
shortness of breath. Vagal maneuvers with carotid sinus massage have no
effect on heart rate or rhythm. Which would be the most appropriate next
intervention?
a. DC cardioversion
b. IV dilitiazem
c. IV propranolol
d. IV adenosine

30) You have just evaluated a 60-year-old woman with known Wolff-Parkinson- White
syndrome. Her chief complaints is palpitations and mild chest discomfort that started 1
hour ago. Her ECG shows rapid atrial fibrillation at a rate of 175 bpm. Which of the
following drugs is contraindicated?
a. IV diltiazem
b. IV propranolol
c. IV digoxin
d. All of the above
31)An elderly male patient complains of chest tightness, palpitations, and dizziness. His
heart rate is 170 bpm; his blood pressure is 90/60 mm Hg. The ECG shows multifocal
atrial tachycardia. Which of the following treatments would be inappropriate?
a. DC cardioversion
b. IV metopolol
c. IV diltiaze
d. IV amiodarone
32)A 66-year-old homeless man with a history of chronic alcoholism presents with
polymorphic tachycardia. He is tolerating the tachycardia well. You correctly diagnose
torsades de poiuntes; HR = 160 bpm; BP = 90/60 mm Hg. On physical examination you
find a malnourished man with no evidence of heart failure. Which of the following
treatments would be most appropriate at this time?
a. Amiodarone
b. IV magnesium
c. IV lidocaine
d. IV procainamide
33)Which of the following conditions can mimic the signs and symptoms of an acute stroke?
a. Hypoglycemia
b. Cardiac arrest
c. Pneumothorax
d. Wolff-Parkinson-White syndrome
34)The following patients were given a diagnosis of an acute ischemic stroke. Which of
the patients as described has no apparent contraindications to IV fibrinolytic therapy?
a. an 80-year-old man presenting within 4 hours of onset of symptoms
b. a 65-year-old woman who lives alone and was found unresponsive by a
relative
c. a 54-year-old man presenting within 3 hours of onset of symptoms
d. a 40-year-old woman diagnosed with bleeding ulcers 2 weeks before onset
of stroke symptoms
35)A 56-year-old woman arrives at the ED with new onset of facial droop when she
smiles, arm drift when she holds both arms out, and inability to speak clearly. Before
beginning fibrinolytic therapy, the most important question you need to answer is
a. have her vital signs remained stable?
b. when exactly did the neurologic signs begin?
c. does she have a history of heart attack?
d. does she have any medication allergies?

36) You are walking through a shopping mall when you encounter a 65-year-old
woman who stumbled and fell as she walked out of a store. She complains of a severe
headache, has a facial droop, and slurs her words. She also complains of numbness in
her right arm and leg. She has difficulty raising her right arm, although her left arm
moves freely. When you ask if she takes medications, she says she has high blood
pressure. Which of the following actions would be most appropriate to take at this
time?
a. phone EMS immediately and tell the dispatcher that you are with a
conscious woman who may be demonstrating signs of a stroke.
b. suggest that the woman sit down for a few minutes and see if the symptoms
disappear
c. offer to drive the woman to the ED of the local hospital
suggest that the woman contact her physician immediately
37)Which of the following statements about the use of magnesium in cardiac arrest is most accurate?
a.Magnesium is indicated in VF/pulseless VT associated with torsades de
pointes
b. Magnesium is indicated for shock-refractory monomorphic VT
c.Magnesium is indicated in VT associated with a normal QT interval
d.Magnesium is indicated for VF refractory to shock and amiodarone or
lidocaine
38)A patient is in pulseless ventricular tachycardia.Two shocks and one dose of
Epinephrine have been given.The next drug/dose to anticipate to administer is
a.Vasopressin 40U
b.Amiodarone 150mg
c.Amoidarone 300mg
d.Lidocaine 0.5mg/kg
e.Epinephrine 3m
39)A patient with possible ACS and bradycardia of 42 per minute has ongoing
chest Discomfort .What in the initial dose of atropine?
a.Atropine 1 mg
b.Atropine 0.5mg
c.Atropine 0.1mg
d.Atropine 3 mg
40) Routine use of vasopressors during management of pulseless VT, VF,or asystole may lead to:
a. Improvement of survival to hospital discharge.
b. Improvement of long term survival
c. No outcome benefit of any type
d. Improvement of initial resuscitation with resumption of spontaneous
circulation.