ACLS

1. A
12-lead ECG should be obtained and analyzed within____minutes of the
patient's arrival in the ED (emergency department).

A.10

B.20

C.30

D.60

2.The most common symptom of ischemia and/or myocardial infarction is:

A.Arm, neck or jaw pain

B.Chest pain behind the sternum (retrosternal chest pain)

C.Pain between the shoulder blades

D.Sudden shortness of breath not explained by other reason

3.Which of the following patients would you avoid giving aspirin to?

A.A patient who is being treated for peptic ulcer disease

B.A patient with a history of diverticular disease

C.A patient with a history of gallbladder disease

D.A patient that has recently undergone a colonoscopy

Which of the following patients would you avoid administering

nitroglycerin to?

A.A patient with a heart rate of 60 beats per minute

B.A patient that admits to taking Viagra (sildenafil nitrate) in the last
12 hours

C.A patient with a systolic blood pressure of 98mm Hg

D.A patient experiencing an anterolateral infarction

4.Morphine is given in ACS because:

A.It reverses the effects of catecholamine release on the body, and lowers
myocardial oxygen demand
B.It acts as a venodilator, reducing oxygen requirements and left
ventricular preload

C.Assists in redistributing blood flow in patients with acute pulmonary

edema

D.All of the above

5.Which intervention is at the center of the decision pathway in the

management of ischemic chest pain, according to the ACS Algorithm?

A.Fibrinolytic checklist

B.Initial cardiac marker levels

C.Targeted history

D.12-lead ECG (ECG interpretation)

6.For a patient with STEMI, goals of reperfusion include giving

fibrinolytics or performing PCI (percutaneous coronary intervention)
within a certain timeframe of the patient's arrival in the ED. What are
these time parameters?

A.Fibrinolytics within 15 minutes, PCI within 30 minutes

B.Fibrinolytics within 90 minutes, PCI within 30 minutes

C.Fibrinolytics within 20 minutes, PCI within 60 minutes

D.Fibrinolytics within 30 minutes, PCI within 90 minutes

7.A major contraindication to the administration of both nitroglycerin

and morphine is:

A.Hypotension

B.Recent GI bleed

C.Recent CVA

D.Recent phosphodiesterase inhibitor use

8.STEMI is characterized by:

A.ST-segment elevation in 2 or more contiguous leads OR new LBBB

B.Ischemic ST-segment depression greater than or equal to 0.5mm OR dynamic

T-wave inversion with pain or discomfort

C.Nondiagnostic changes in the ST segment or T-wave

D.Nonpersistent/transient ST elevation greater than or equal to 0.5mm for
less than 20 minutes

9. Which of the following drugs is not included as part of ED general

treatment for chest pain?

A.Epinephrine

B.Aspirin

C.Morphine

D.Nitroglycerin

10.What are the 2 most common causes of Pulseless Electrical Activity?

A.Hypothermia and hypoxia

B.Hypovolemia and hypoxia

C.Hypovolemia and hyperkalemia

D.Hypoxia and hyperkalemia

11.What is the correct dosing regimen of epinephrine to treat PEA or

Asystole?

A.300 mg bolus

B.1 mg IV/IO - repeated every 8 to 10 minutes

C.1 mg IV/IO - repeated every 3 to 5 minutes

D.0.5 mg IV/IO - repeated every 8 to 10 minutes

12.Pulseless Electrical Activity is defined as:

A.No electrical activity present on an ECG

B.A perfusing rhythm without spontaneous respirations

C.Ventricular Fibrillation

D.Any organized rhythm without a pulse

12.Possible causes of an isoelectric ECG (Flat line) include:

A.Loose leads or leads not connected to the patient or

defibrillator/monitor

B.No power to the monitor

C.Gain or amplitude too low

D.All of the above

13.Which of the following is not a reason to stop or withhold resuscitative
efforts?

A.Rigor mortis

B.Indicators of do-not-attempt-resuscitation (DNAR) status

C.Threat to safety of providers

D.Resuscitation effort have been unsuccessful for 20 minutes or more

14.Routine insertion of an advanced airway in asystole:

A.Is contraindicated in a patient in asystole

B.Should take priority over gaining IV/IO access

C.Should only be performed if ventilations with a BVM are ineffective

D.Is necessary so the epinephrine can be given

15.The first dose of amiodarone for PEA treatment is:

A.150 mg

B.300 mg

C.100 mg

D.Amiodarone is not used in PEA

16.Which of the following statements is not true?

A.CPR should not be stopped to administer drugs to PEA or Asystole patients

B.Treatment of PEA is limited to interventions outlined in the algorithm

C.IV/IO access is a priority over advanced airway management

D.Epinephrine is a common treatment for PEA and Asystole

17.Which of the following statements is true?

A.There is no evidence that attempting to "defibrillate" asystole is

beneficial

B.The AHA recommends the use of TCP for patients with asystolic cardiac
arrest

C.CPR should be interrupted while establishing IV or IO access in asystole

patients
D.Identifying the cause of asystole is not important

17.PEA and Asystole are shockable rhythms

A.True

B.False

18.A symptomatic bradycardia exists when what 3 criteria are present?

A.1. The heart rate is slow. 2. The patient has symptoms. 3. The symptoms
are due to the slow heart rate.

B.1. The heart rate is fast. 2. The patient has symptoms. 3. The symptoms
are due to the fast heart rate.

C.1. The heart rate is slow. 2. The patient has no symptoms. 3. The lack
of symptoms are due to the slow heart rate.

D. None of the above

19.The primary decision point in the ACLS Bradycardia Algorithm is:

A.The patient's heart rate

B.The patient's blood pressure

C.The determination of adequate perfusion

D.The presence of chest pain

20.Identify the correct dosing regimen of atropine to treat symptomatic

bradycardia:

A.Atropine 0.5 mg IV every 2 minutes to a maximum of 2 mg

B.Atropine 1 mg IV every 3-5 minutes to a maximum of 3 mg

C.Atropine 1 mg every 5 minutes to a maximum of 3 mg

D.Atropine 0.5 mg IV every 3-5 minutes to a maximum of 3 mg

21.What is not a precaution for TCP?

A.TCP is contraindicated in severe hypothermia and is not recommended for

asystole.

B.Conscious patients require analgesia for discomfort unless delay for

sedation will cause/contribute to deterioration.

C.Avoid AV nodal blocking agents

D.Do not assess the carotid pulse to confirm mechanical capture;
electrical stimulation causes muscular jerking that may mimic the carotid
pulse.

21.Identify the correct sequence of steps to performs TCP (transcutaneous

pacing):

A.
1. Turn the pacer on.
2. Place pacing electrodes on the chest.
3. Set the demand rate to 50 beats/min.
4. Set the current milliamperes output 2 mA above the dose at which consistent capture is
observed.

B.
1. Place pacing electrodes on the chest.
2. Turn the pacer on.
3. Set the current milliamperes output 2 mA above the dose at which consistent capture is
observed.
4. Set the demand rate to 50 beats/min.
C.
1. Turn the pacer on.
2. Place pacing electrodes on the chest.
3. Set the demand rate to 50 beats/min.
4. Set the current milliamperes output 2 mA above the dose at which consistent capture is
observed.

D.
1. Place pacing electrodes on the chest.
2. Turn the pacer on.
3. Set the demand rate to 60 beats/min. This rate can be adjusted up or down once pacing is
established.
4. Set the current milliamperes output 2 mA above the dose at which consistent capture is
observed.
22.What drugs are appropriate forms of treatment according to the Adult
Bradycardia with a Pulse Algorithm?

A.Atropine

B.Dopamine

C.Epinephrine

D.All of the above

23.The initial treatment for bradycardia is:

A.Dopamine

B.Atropine

C.TCP

D.Epinephrine

24.A patient has a third degree heart block. He is complaining of chest

pain and he is hypotensive and diaphoretic. He also has pulmonary
congestion. He has a large-bore intravenous in his left antecubital fossa.
He has been given atropine 0.5 mg intravenously x3 with only a transient
increase in heart rate and no improvement of symptoms. The next
intervention should be:

A.Start a dopamine infusion at 2-10 mcg/kg/minute

B.Start an epinephrine infusion at 2-10 mcg/minute

C.Attempt TCP (transcutaneous pacing)

D.Any of these are acceptable interventions when atropine is ineffective

25.Signs and symptoms of bradycardia may include:

A.Syncope or near syncope

B.Decreased level of consciousness

C.Hypotension

D.All of these

26.The type of AV block most likely to cause cardiovascular collapse is:

A.Sinus bradycardia

B.First-degree AV block

C.Second-degree AV block

D.Third-degree AV block

27.Tachycardia is defined as:

A.An arrhytmia with a rate greater than 150/min

B.An arrhytmia with a rate greater than 100/min

C.Any rhythm disorder with a heart rate less than 60/min

D.An organized rhythm without a pulse

28.Synchronized cardioversion is recommended for::

A.Monomorphic VT in a stable patient

B.Pulseless rhythms

C.Unstable SVT

D.Polymorphic VT

28.What is the correct energy dose for unstable atrial fibrillation when
delivering monophasic synchronized shocks?

A.50 to 100 J

B.100 J

C.Treat with high-energy shocks (defibrillation doses)

D.200 J

29.AV nodal blocking agents should be avoided in:

A.Patients with a regular SVT

B.Patients with a regular VT

C.Patients with an irregular wide-complex tachycardia

D.All of the above

30.Which drug is the preferred intervention for terminating

narrow-complex tachycardias that are symptomatic (but stable) and
supraventricular in origin (SVT)?

A.Epinephrine

B.Amiodarone

C.Atropine

D.Adenosine

31.Adenosine should not be given to:

A.Patients with asthma

B.Pregnant women

C.Patients with SVT

D.Patients with a narrow QRS with regular rhythm

32.If SVT does not respond to vagal maneuvers, how much adenosine do you
give:

A.20mL rapid IV push

B.12 mg rapid IV push

C.6 mg IV push over 10 seconds

D.6mg rapid IV push over 1 second

33.Which of the following statements is not true?

A.Sinus tachycardia is a heart rate that is greater than 100/min and is

generated by sinus node discharge

B.Sinus tachycardia is caused by cardiac conditions

C.In sinus tachycardia, the goal is to identify and treat the underlying
systemic cause.

D.Cardioversion is contraindicated in Sinus Tachycardia

34.Vagal maneuvers alone will terminate about what percentage of SVTs?

A.25%

B.90%

C.75%

D.50%

35.End points for the administration of procainamide include:

A.Hypotension

B.Duration of QRS increases by 25%

C.Maximum dose of 7 mg/kg is reached

D.Increase in heart rate by 30 points

 1. Arrange the BLS Chain of Survival in the proper order:*

 Look, listen, and feel

 Check responsiveness, call EMS and get AED, defibrillation, and
circulation
 Check responsiveness, call EMS and get AED, chest compressions,
and early defibrillation
 Call for help, shock, check pulse, shock, and transport

 2. A known alcoholic collapses and is found to be in torsades de pointes. What

intervention is most likely to correct the underlying problem?*

 Rewarm the individual to correct hypothermia.

 Administer magnesium sulfate 1 to 2 gm IV diluted in 10 mL D5W to
correct low magnesium.
 Administer glucose to correct hypoglycemia.
 Administer naloxone to correct narcotic overdose.
 3. Choose the correct sequence of electrical activity in the heart for normal
sinus rhythm?*

 SA node, AV node, Bundle of His, Purkinje fibers

 AV node, SA node, Bundle of Hers, Purkinje fibers
 Purkinje, Bundle of His, AV node, SA node
 SA node, Purkinje, AV node, Bundle of His

 4. You are transporting an individual who goes into cardiac arrest during
transport. IV access is unsuccessful. What is the next step?*

 Terminate resuscitation.
 Obtain intraosseous access.
 Place a central line.
 Administer all medications through ET tube.

 5. What does the QRS complex on an ECG represent?*

 Ventricular contraction
 AV valve closure
 Atrial contraction
 Septum relaxation

 6. A 79-year-old individual is in SVT. BP is 80/50, and he is complaining of

chest discomfort and feels like passing out. What is the next appropriate step?*

 Carotid massage
 Synchronized cardioversion
 Amiodarone
 Lidocaine

 7. The following medication(s) can be used to treat hypotension during the

post-cardiac arrest phase:*

 Dopamine
 Milrinone
 Amiodarone
 Both A and B

 8. A 55-year-old male has stroke symptoms, and the CT scan shows multilobar
infarction (more than one third of the cerebral hemisphere). What therapy is
contraindicated?*

 Oxygen
 Monitoring glucose
 Thrombolytic therapy
 Blood pressure monitoring

 9. True or False: The goal of stroke care is to complete the ED initial evaluation
within 10 minutes, the neurologic evaluation within 25 minutes of arrival, and have the
head CT read within 45 minutes of arrival.*

 True
 False

 10. You are treating an individual who presented in ventricular fibrillation. After
CPR and one attempt at defibrillation, his new rhythm is third degree AV block. What is
the next step in management?*
 Repeat defibrillation
 Vasopressin
 Transcutaneous pacing
 High dose epinephrine

Which of the following identifies this ECG rhythm?

A Polymorphic VTach (Torsades)

B Atrial Fibrillation

C Asystole

D Normal Sinus Rhythm (NSR)

E Supraventricular Tachycardia (SVT)

F Atrial Flutter

G Coarse Ventricular Fibrillation

H Sinus Tachycardia

I Monomorphic VTach

J 3rd Degree Block

K Sinus Bradycardia

L 2nd Degree Type II Block

M Fine Ventricular Fibrillation

N 2nd Degree Type I Block

Which of the following identifies this ECG rhythm?

A Fine Ventricular Fibrillation

B Sinus Bradycardia

C 2nd Degree Type II Block

D Supraventricular Tachycardia (SVT)

E Asystole

F Sinus Tachycardia

G 3rd Degree Block

H Atrial Fibrillation

I Monomorphic VTach

J Atrial Flutter

K 2nd Degree Type I Block

L Normal Sinus Rhythm (NSR)

M Polymorphic VTach (Torsades)

N Coarse Ventricular Fibrillation

Which of the following identifies this ECG rhythm?

A Monomorphic VTach

B Normal Sinus Rhythm (NSR)

C 3rd Degree Block

D 2nd Degree Type II Block

E Atrial Flutter

F Asystole

G Supraventricular Tachycardia (SVT)

H Sinus Tachycardia

I Fine Ventricular Fibrillation

J Sinus Bradycardia

K Atrial Fibrillation

L Coarse Ventricular Fibrillation

M 2nd Degree Type I Block

N Polymorphic VTach (Torsades)