ACLS A/B

Question 1

You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next?

A. Start a dopamine infusion

B. Give atropine 0.5 mg

C. Give epinephrine 1 mg IV

D. Insert an advanced airway

Answer 1

C. Give epinephrine 1 mg IV

Give epinephrine as soon as IV/IO access become available. A dose of 1 mg IV/IO should be given and repeated every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: Pulseless Electrical Activity Case > Managing PEA: The Adult Cardiac Arrest Algorithm > Administer Epinephrine; page 111]

Question 2

A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take?

A. Ask for a new task or role

B. Assign it to another team member

C. Do it anyway

D. Seek expert advice

Answer 2

A. Ask for a new task or role Not only should everyone on the team know his or her own limitations and capabilities, but the team leader should also be aware of them. This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. High-performance team members should anticipate situations in which they might require assistance and inform the team leader. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > Roles; page 28]

Question 3

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.

Based on this patient’s initial presentation, which condition do you suspect led to the cardiac arrest?

A. Acute coronary syndrome

B. Acute ischemic stroke

C. Acute heart failure

D. Supraventricular tachycardia with ischemic chest pain

Answer 3

A. Acute coronary syndrome Acute life-threatening complications of acute coronary syndromes include ventricular fibrillation, pulseless ventricular tachycardia, symptomatic bradycardias, and unstable tachycardias. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Coronary Syndromes Case > Goals for ACS Patients; page 60]

Question 4

You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions?

A. Less than 80/min

B. More than 120/min

C. 80 to 90/min

D. 100 to 120/min

Answer 4

D. 100 to 120/min When performing chest compressions, you should compress at a rate of 100 to 120/min. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Critical Concepts: Quality Compressions; page 37]

Question 5

To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag?

A. Once every 10 seconds

B. Once every 12 seconds

C. Once every 3 to 4 seconds

D. Once every 5 to 6 seconds

Answer 5

D. Once every 5 to 6 seconds For a patient in respiratory arrest with a pulse, deliver ventilations once every 5 to 6 seconds with a bag-mask device or any advanced airway. [ACLS Provider Manual, Part 5: The ACLS Cases > Respiratory Arrest Case > The BLS Assessment > Ventilation and Pulse Check; page 46]

Question 6

Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?

A. 100 mg

B. 150 mg

C. 250 mg

D. 300 mg

Answer 6

D. 300 mg Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Antiarrhythmic Agents > Amiodarone; page 106]

Question 7

Which best describes the length of time it should take to perform a pulse check during the BLS Assessment?

A. 1 to 4 seconds

B. 5 to 10 seconds

C. 11 to 15 seconds

D. 16 to 20 seconds

Answer 7

B. 5 to 10 seconds Check the pulse for 5 to 10 seconds. If there is no pulse within 10 seconds, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Overview of the BLS Assessment; page 36]

Question 8

Which type of atrioventricular block best describes this rhythm?

A. First-degree

B. Second-degree type I

C. Second-degree type II

D. Third-degree

Answer 8

C. Second-degree type II This ECG rhythm strip shows second-degree type II atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]

Question 9

Which is the primary purpose of a medical emergency team or rapid response team?

A. Improving care for patients admitted to critical care units

B. Improving patient outcomes by identifying and treating early clinical deterioration

C. Providing diagnostic consultation to emergency department patients

D. Providing online consultation to EMS personnel in the field

Answer 9

B. Improving patient outcomes by identifying and treating early clinical deterioration Many hospitals have implemented the use of medical emergency teams or rapid response teams. The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. [ACLS Provider Manual, Part 2: Systems of Care > Cardiopulmonary Resuscitation > Foundational Facts: Medical Emergency Teams and Rapid Response Teams; page 15]

Question 10

Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field?

A. Comprehensive stroke care unit

B. Acute rehabilitation care unit

C. Acute long-term care unit

D. Coronary reperfusion–capable medical center

Answer 10

D. Coronary reperfusion–capable medical center

After return of spontaneous circulation in patients in whom coronary artery occlusion is suspected, providers should transport the patient to a facility capable of reliably providing coronary reperfusion (eg, percutaneous coronary intervention) and other goal-directed post–cardiac arrest care therapies. [ACLS Provider Manual, Part 2: Systems of Care > Post–Cardiac Arrest Care > Immediate Coronary Reperfusion With PCI; page 20]

Question 11

You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient?

A. Hold fibrinolytic therapy for 24 hours

B. Start fibrinolytic therapy as soon as possible

C. Order an echocardiogram before fibrinolytic administration

D. Wait for the results of the MRI

Answer 11

B. Start fibrinolytic therapy as soon as possible

Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Approach to Stroke Care > Goals of Stroke Care; page 76]

Question 12

You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now?

A. Obtaining a 12-lead ECG

B. Evaluating the PETCO 2 reading

C. Requesting a chest x-ray

D. Requesting laboratory testing

Answer 12

A. Obtaining a 12-lead ECG

The 12-lead ECG is at the center of the decision pathway in the management of ischemic chest discomfort and is the only means of identifying STEMI. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Coronary Syndromes Case > Immediate ED Assessment and Treatment > Introduction; page 67]

Question 13

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.

In addition to defibrillation, which intervention should be performed immediately?

A. Advanced airway insertion

B. Chest compressions

C. Vasoactive medication administration

D. Vascular access

Answer 13

B. Chest compressions Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93]

Question 14

A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment?

A. Defibrillation

B. Synchronized cardioversion

C. Administration of adenosine 6 mg IV push

D. Administration of epinephrine 1 mg IV push

Answer 14

A. Defibrillation Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Principle of Early Defibrillation; page 97]

Question 15

A. First-degree atrioventricular block

B. Second-degree atrioventricular block type I

C. Second-degree atrioventricular block type II

D. Third-degree atrioventricular block

Answer 15

D. Third-degree atrioventricular block

This ECG rhythm strip shows third-degree atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]

Question 16

A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member?

A. “OK.”

B. “Are you sure?”

C. “Amiodarone 500 mg IV has been given.”

D. “I have an order to give 500 mg of amiodarone IV. Is this correct?”

Answer 16

D. “I have an order to give 500 mg of amiodarone IV. Is this correct?” Unclear communication can lead to unnecessary delays in treatment or to medication errors. Team members should question an order if the slightest doubt exists. [ACLS Provider Manual, Part 4: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > How to Communicate; page 31]

Question 17

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.

Based on this patient’s initial assessment, which adult ACLS algorithm should you follow?

A. Acute coronary syndromes

B. Tachycardia

C. Suspected stroke

D. Cardiac arrest

Answer 17

B. Tachycardia

This ECG rhythm strip shows ventricular tachycardia. The Adult Tachycardia With a Pulse Algorithm outlines the steps for assessment and management of a patient presenting with symptomatic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Managing Unstable Tachycardia: The Tachycardia Algorithm > Overview; page 132]

Question 18

Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do?

A. Monitor the patient’s PETCO 2

B. Obtain a 12-lead ECG

C. Check the patient’s pulse

D. Obtain a chest x-ray

Answer 18

A. Monitor the patient’s PETCO 2

The AHA recommends using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Physiologic Monitoring During CPR; page 102]

Question 19

EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment?

A. Alert the hospital

B. Establish IV access

C. Review the patient’s history

D. Treat hypertension

Answer 19

A. Alert the hospital Prearrival notification allows the hospital to prepare to evaluate and manage the patient effectively. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Identification of Signs of Possible Stroke > Activate EMS System Immediately; page 78]

Question 20

A. First-degree

B. Second-degree type I

C. Second-degree type II

D. Third-degree

Answer 20

C. Second-degree type II This ECG rhythm strip shows second-degree type II atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]

Question 21

During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range?

A. 0 to 8hours

B. At least 24 hours

C. At least 36 hours

D. At least 48 hours

Answer 21

B. At least 24 hours For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases > Immediate Post–Cardiac Arrest Care Case > Application of the Immediate Post–Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 151]

Question 22

For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention?

A. 90 minutes

B. 120 minutes

C. 150 minutes

D. 180 minutes

Answer 22

A. 90 minutes

For the patient with STEMI, the goals of reperfusion are to give fibrinolytics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. The goal for emergency department door–to–balloon inflation time is 90 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases: Acute Coronary Syndromes Case > Immediate ED Assessment and Treatment > Introduction; page 67]

Question 23

You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient?

A. Wait for the results of the MRI

B. Hold fibrinolytic therapy for 24 hours

C. Order an echocardiogram before fibrinolytic administration

D. Start fibrinolytic therapy as soon as possible

Answer 23

D. Start fibrinolytic therapy as soon as possible Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Approach to Stroke Care > Goals of Stroke Care; page 76]

Question 24

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.

The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post–cardiac arrest care intervention do you choose for this patient?

A. Initiate targeted temperature management

B. Check the glucose level

C. Administer epinephrine

D. Extubate

Answer 24

A. Initiate targeted temperature management To protect the brain and other organs, the high-performance team should start targeted temperature management in patients who remain comatose (lack of meaningful response to verbal commands) with return of spontaneous circulation after cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases > Immediate Post–Cardiac Arrest Care Case > Application of the Immediate Post–Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 151]

Question 25

Which is the maximum interval you should allow for an interruption in chest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25 to 30 seconds

Answer 25

A. 10 seconds ACLS providers must make every effort to minimize any interruptions in chest compressions. Try to limit interruptions in chest compressions (eg, defibrillation and rhythm analysis) to no longer than 10 seconds. When you stop chest compressions, blood flow to the brain and heart stops. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Critical Concepts: Minimizing Interruptions; page 37]

Question 26

What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest? A. 26°C to 28°C B. 29°C to 31°C C. 32°C to 36°C D. 35°C to 37°C

Answer 26

C. 32°C to 36°C For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases \> Immediate Post–Cardiac Arrest Care Case \> Application of the Immediate Post–Cardiac Arrest Care Algorithm \> Targeted Temperature Management; page 151]

Question 27

Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? A. 40mg B. 81mg C. 160 to 325 mg D. 350 to 650 mg

Answer 27

C. 160 to 325 mg If the patient has not taken aspirin and has no history of true aspirin allergy and no evidence of recent gastrointestinal bleeding, give the patient aspirin (160 to 325 mg) to chew. In the initial hours of an acute coronary syndrome, aspirin is absorbed better when chewed than when swallowed. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Coronary Syndromes Case \> EMS Assessment, Care, and Hospital Preparation \> Administer Oxygen and Drugs; page 65]

Question 28

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take? A. Apply oxygen B. Perform bag-mask ventilation C. Intubate the patient D. Check the pulse oximeter probe

Answer 28

A. Apply oxygen In the application of the Tachycardia Algorithm to an unstable patient, identify and treat the underlying cause. Give oxygen, if indicated, and monitor oxygen saturation. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Application of the Tachycardia Algorithm to the Unstable Patient \> Identify and Treat the Underlying Cause; page 134]

Question 29

As the team leader, when do you tell the chest compressors to switch? A. Only when they tell you that they are fatigued B. About every 2 minutes C. About every 5 minutes D. About every 7 minutes

Answer 29

B. About every 2 minutes Switch compressors about every 2 minutes, or earlier if they are fatigued. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Critical Concepts: High-Quality CPR; page 38]

Question 30

A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment? A. Administration of adenosine 6 mg IV push B. Administration of epinephrine 1 mg IV push C. Defibrillation D. Synchronized cardioversion

Answer 30

C. Defibrillation Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm \> VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Principle of Early Defibrillation; page 97]

Question 31

Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? A. 12-lead ECG B. Noncontrast CT scan of the head C. Cardiac enzymes D. Coagulation studies

Answer 31

B. Noncontrast CT scan of the head A critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a noncontrast CT scan to differentiate ischemic from hemorrhagic stroke. The CT scan should be completed within 25 minutes of the patient’s arrival in the emergency department and should be read within 45 minutes from emergency department arrival. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Stroke Case \> CT Scan: Hemorrhage or No Hemorrhage \> Introduction; page 84]

Question 32

If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? A. Reassign the team tasks B. Address the team member immediately C. Conduct a debriefing after the resuscitation attempt D. Remove the team member from the area

Answer 32

B. Address the team member immediately During a resuscitation attempt, the leader or a member of a high-performance team may need to intervene if an action that is about to occur may be inappropriate at the time. Team members should question a colleague who is about to make a mistake. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High-Performance Team Dynamics \> Roles; page 29]

Question 33

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority? A. Administer amiodarone 300 mg B. Administer atropine 0.5 mg C. Insert an advanced airway D. Perform defibrillation

Answer 33

D. Perform defibrillation Pulseless ventricular tachycardia is included in the algorithm because it is treated as ventricular fibrillation. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm \> VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VT/pVT Pathway \> Principle of Early Defibrillation; page 97]

Question 34

For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention? A. 180 minutes B. 150 minutes C. 120 minutes D. 90 minutes

Answer 34

D. 90 minutes For the patient with STEMI, the goals of reperfusion are to give fibrinolytics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. The goal for emergency department door–to–balloon inflation time is 90 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases: Acute Coronary Syndromes Case \> Immediate ED Assessment and Treatment \> Introduction; page 67]

Question 35

Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient? A. Agonal gasps B. Cyanosis C. Irregular, weak pulse rate D. Slow, weak pulse rate

Answer 35

A. Agonal gasps Agonal gasps are not normal breathing. They are a sign of cardiac arrest. Agonal gasps may be present in the first minutes after sudden cardiac arrest. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Caution: Agonal Gasps; page 35]

Question 36

In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? A. Arterial blood gases B. Chest radiography C. Continuous waveform capnography D. Hemoglobin levels

Answer 36

C. Continuous waveform capnography The AHA recommends continuous waveform capnography in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> The Primary Assessment \> FYI 2015 Guidelines: Correct Placement of ET Tube; page 46]

Question 37

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A. Amiodarone 300 mg B. Atropine 1 mg C. Epinephrine 1 mg D. Lidocaine 1 mg/kg

Answer 37

C. Epinephrine 1 mg For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. When IV/IO access is available, give epinephrine 1 mg IV/IO during CPR after the second shock and repeat epinephrine 1 mg IV/IO every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Shock and Vasopressors; page 99]

Question 38

A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm? A. Perfusing ventricular tachycardia B. Sinus tachycardia C. Stable supraventricular tachycardia D. Unstable supraventricular tachycardia

Answer 38

D. Unstable supraventricular tachycardia This ECG rhythm strip shows supraventricular tachycardia, and the patient is showing signs and symptoms of unstable tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Rhythms for Unstable Tachycardia; pages 129-130, and The Approach to Unstable Tachycardia \> Signs and Symptoms; page 131]

Question 39

A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment? A. Performing vagal maneuvers B. Administering adenosine 6 mg IV push C. Performing synchronized cardioversion D. Performing defibrillation

Answer 39

C. Performing synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Cardioversion \> Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137]

Question 40

Which is the primary purpose of a medical emergency team or rapid response team? A. Improving patient outcomes by identifying and treating early clinical deterioration B. Improving care for patients admitted to critical care units C. Providing online consultation to EMS personnel in the field D. Providing diagnostic consultation to emergency department patients

Answer 40

A. Improving patient outcomes by identifying and treating early clinical deterioration Many hospitals have implemented the use of medical emergency teams or rapid response teams. The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. [ACLS Provider Manual, Part 2: Systems of Care \> Cardiopulmonary Resuscitation \> Foundational Facts: Medical Emergency Teams and Rapid Response Teams; page 15]

Question 41

A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block

Answer 41

B. Second-degree atrioventricular block type I This ECG rhythm strip shows second-degree atrioventricular block type I. [ACLS Provider Manual, Part 5: The ACLS Cases \> Bradycardia Case \> Rhythms for Bradycardia; page 121]

Question 42

Which is one way to minimize interruptions in chest compressions during CPR? A. Administer IV medications only when delivering breaths B. Check the pulse immediately after defibrillation C. Use an AED to monitor the patient’s rhythm D. Continue CPR while the defibrillator charges

Answer 42

D. Continue CPR while the defibrillator charges Shortening the interval between the last compression and the shock by even a few seconds can improve shock success (defibrillation and return of spontaneous circulation). Thus, it is reasonable for healthcare providers to practice efficient coordination between CPR and defibrillation to minimize the hands-off interval between stopping compressions and administering the shock. For example, after verifying a shockable rhythm and initiating the charging sequence on the defibrillator, another provider should resume chest compressions and continue until the defibrillator is fully charged. The defibrillator operator should deliver the shock as soon as the compressor removes his or her hands from the patient’s chest and all providers are “clear” of contact with the patient. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Foundational Facts: Resume CPR While Manual Defibrillator Is Charging; page 96]

Question 43

A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take? A. Do it anyway B. Assign it to another team member C. Seek expert advice D. Ask for a new task or role

Answer 43

D. Ask for a new task or role Not only should everyone on the team know his or her own limitations and capabilities, but the team leader should also be aware of them. This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. High-performance team members should anticipate situations in which they might require assistance and inform the team leader. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High-Performance Team Dynamics \> Roles; page 28]

Question 44

Which is the recommended next step after a defibrillation attempt? A. Check the ECG for evidence of a rhythm B. Determine if a carotid pulse is present C. Open the patient’s airway D. Resume CPR, starting with chest compressions

Answer 44

A. Check the ECG for evidence of a rhythm Follow each shock immediately with CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Overview of the BLS Assessment; page 36]

Question 45

Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to the more experienced team members B. Perform the most complicated tasks C. Clearly delegate tasks D. Assign the same tasks to more than one team member

Answer 45

C. Clearly delegate tasks To avoid inefficiencies, the team leader must clearly delegate tasks. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High- Performance Team Dynamics \> Roles; page 28]

Question 46

Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C. Estimate by using the formula Weight (kg)/8 + 2 D. Estimate by using the size of the patient’s finger

Answer 46

A. Measure from the corner of the mouth to the angle of the mandible To select the appropriate size for an oropharyngeal airway (OPA), place the OPA against the side of the face. When the flange of the OPA is at the corner of the mouth, the tip is at the angle of the mandible. A properly sized and inserted OPA results in proper alignment with the glottic opening. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> Basic Airway Adjuncts: Oropharyngeal Airway \> Technique of OPA Insertion; page 51]

Question 47

Which is the recommended next step after a defibrillation attempt? A. Check the ECG for evidence of a rhythm B. Open the patient’s airway C. Determine if a carotid pulse is present D. Resume CPR, starting with chest compressions

Answer 47

D. Resume CPR, starting with chest compressions Follow each shock immediately with CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Overview of the BLS Assessment; page 36]

Question 48

Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to the more experienced team members B. Assign the same tasks to more than one team member C. Perform the most complicated tasks D. Clearly delegate tasks

Answer 48

D. Clearly delegate tasks To avoid inefficiencies, the team leader must clearly delegate tasks. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High- Performance Team Dynamics \> Roles; page 28]

Question 49

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. After your initial assessment of this patient, which intervention should be performed next? A. Immediate defibrillation B. Synchronized cardioversion C. Administration of amiodarone 150 mg IM D. Endotracheal intubation

Answer 49

B. Synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Cardioversion \> Recommendations; page 137]

Question 50

You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next? A. Give atropine 0.5 mg B. Give epinephrine 1 mg IV C. Insert an advanced airway D. Start a dopamine infusion

Answer 50

B. Give epinephrine 1 mg IV Give epinephrine as soon as IV/IO access become available. A dose of 1 mg IV/IO should be given and repeated every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: Pulseless Electrical Activity Case \> Managing PEA: The Adult Cardiac Arrest Algorithm \> Administer Epinephrine; page 111]

Question 51

A. Supraventricular tachycardia B. Monomorphic ventricular tachycardia C. Polymorphic ventricular tachycardia D. Ventricular fibrillation

Answer 51

B. Monomorphic ventricular tachycardia This ECG rhythm strip shows a monomorphic ventricular tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Rhythms for Unstable Tachycardia; page 130]

Question 52

You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication? A. “OK.” B. “Are you sure that is what you want given?” C. “I’ll draw up 0.5 mg of atropine.” D. “I’ll give it in a few minutes.”

Answer 52

C. “I’ll draw up 0.5 mg of atropine.” When communicating with high-performance team members, the team leader should use closed-loop communication. By receiving a clear response and eye contact, the team leader confirms that the team member heard and understood the message. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High-Performance Team Dynamics \> How to Communicate; page 31]

Question 53

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next? A. Epinephrine 1 mg B. Atropine 1 mg C. Magnesium sulfate 1 g D. Amiodarone 300 mg

Answer 53

D. Amiodarone 300 mg Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Antiarrhythmic Agents \> Amiodarone; page 106]

Question 54

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. Based on this patient’s initial assessment, which adult ACLS algorithm should you follow? A. Tachycardia B. Suspected stroke C. Cardiac arrest D. Acute coronary syndromes

Answer 54

A. Tachycardia This ECG rhythm strip shows ventricular tachycardia. The Adult Tachycardia With a Pulse Algorithm outlines the steps for assessment and management of a patient presenting with symptomatic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Managing Unstable Tachycardia: The Tachycardia Algorithm \> Overview; page 132]

Question 55

What is an effect of excessive ventilation? A. Increased perfusion pressures B. Increased venous return C. Decreased cardiac output D. Decreased intrathoracic pressure

Answer 55

C. Decreased cardiac output Excessive ventilation can be harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> Management of Respiratory Arrest \> Critical Concepts: Avoiding Excessive Ventilation; page 47]

Question 56

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A. Epinephrine 1 mg B. Amiodarone 300 mg C. Lidocaine 1 mg/kg D. Atropine 1 mg

Answer 56

A. Epinephrine 1 mg For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. When IV/IO access is available, give epinephrine 1 mg IV/IO during CPR after the second shock and repeat epinephrine 1 mg IV/IO every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Shock and Vasopressors; page 99]

Question 57

Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? A. 160 to 325 mg B. 350 to 650 mg C. 40mg D. 81mg

Answer 57

A. 160 to 325 mg If the patient has not taken aspirin and has no history of true aspirin allergy and no evidence of recent gastrointestinal bleeding, give the patient aspirin (160 to 325 mg) to chew. In the initial hours of an acute coronary syndrome, aspirin is absorbed better when chewed than when swallowed. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Coronary Syndromes Case \> EMS Assessment, Care, and Hospital Preparation \> Administer Oxygen and Drugs; page 65]

Question 58

You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? A. Less than 80/min B. 80 to 90/min C. 100 to 120/min D. More than 120/min

Answer 58

C. 100 to 120/min When performing chest compressions, you should compress at a rate of 100 to 120/min. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Critical Concepts: Quality Compressions; page 37]

Question 59

A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block

Answer 59

D. Third-degree atrioventricular block This ECG rhythm strip shows third-degree atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases \> Bradycardia Case \> Rhythms for Bradycardia; page 121]

Question 60

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Which would you have done first if the patient had not gone into ventricular fibrillation? A. Established IV access B. Obtained a 12-lead ECG C. Given atropine 1 mg D. Performed synchronized cardioversion

Answer 60

D. Performed synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Cardioversion \> Recommendations; page 137]

Question 61

If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? A. Conduct a debriefing after the resuscitation attempt B. Reassign the team tasks C. Address the team member immediately D. Remove the team member from the area

Answer 61

C. Address the team member immediately During a resuscitation attempt, the leader or a member of a high-performance team may need to intervene if an action that is about to occur may be inappropriate at the time. Team members should question a colleague who is about to make a mistake. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High-Performance Team Dynamics \> Roles; page 29]

Question 62

Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? A. 1 to 4 seconds B. 5 to 10 seconds C. 11 to 15 seconds D. 16 to 20 seconds

Answer 62

B. 5 to 10 seconds Check the pulse for 5 to 10 seconds. If there is no pulse within 10 seconds, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Overview of the BLS Assessment; page 36]

Question 63

Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? A. Open the patient’s airway B. Apply the AED C. Check for a medical alert bracelet D. Check the patient’s breathing and pulse

Answer 63

D. Check the patient’s breathing and pulse After you determine that a patient is unresponsive and activate your emergency team, a breathing check and pulse check should be performed. Ideally, these checks are done simultaneously to minimize delay in detection of cardiac arrest and initiation of CPR. After determining that a patient is not breathing and has no pulse, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Overview of the BLS Assessment; page 36]

Question 64

EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment? A. Establish IV access B. Alert the hospital C. Review the patient’s history D. Treat hypertension

Answer 64

B. Alert the hospital Prearrival notification allows the hospital to prepare to evaluate and manage the patient effectively. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Stroke Case \> Identification of Signs of Possible Stroke \> Activate EMS System Immediately; page 78]

Question 65

A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm? A. Unstable supraventricular tachycardia B. Stable supraventricular tachycardia C. Perfusing ventricular tachycardia D. Sinus tachycardia

Answer 65

A. Unstable supraventricular tachycardia This ECG rhythm strip shows supraventricular tachycardia, and the patient is showing signs and symptoms of unstable tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Rhythms for Unstable Tachycardia; pages 129-130, and The Approach to Unstable Tachycardia \> Signs and Symptoms; page 131]

Question 66

A. Monomorphic ventricular tachycardia B. Polymorphic ventricular tachycardia C. Supraventricular tachycardia D. Ventricular fibrillation

Answer 66

A. Monomorphic ventricular tachycardia This ECG rhythm strip shows a monomorphic ventricular tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Rhythms for Unstable Tachycardia; page 130]

Question 67

You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now? A. Evaluating the PETCO 2 reading B. Requesting a chest x-ray C. Obtaining a 12-lead ECG D. Requesting laboratory testing

Answer 67

C. Obtaining a 12-lead ECG The 12-lead ECG is at the center of the decision pathway in the management of ischemic chest discomfort and is the only means of identifying STEMI. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Coronary Syndromes Case \> Immediate ED Assessment and Treatment \> Introduction; page 67]

Question 68

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Based on this patient’s initial presentation, which condition do you suspect led to the cardiac arrest? A. Acute coronary syndrome B. Acute heart failure C. Acute ischemic stroke D. Supraventricular tachycardia with ischemic chest pain

Answer 68

A. Acute coronary syndrome Acute life-threatening complications of acute coronary syndromes include ventricular fibrillation, pulseless ventricular tachycardia, symptomatic bradycardias, and unstable tachycardias. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Coronary Syndromes Case \> Goals for ACS Patients; page 60]

Question 69

To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? A. Once every 3 to 4 seconds B. Once every 5 to 6 seconds C. Once every 10 seconds D. Once every 12 seconds

Answer 69

B. Once every 5 to 6 seconds For a patient in respiratory arrest with a pulse, deliver ventilations once every 5 to 6 seconds with a bag-mask device or any advanced airway. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> The BLS Assessment \> Ventilation and Pulse Check; page 46]

Question 70

As the team leader, when do you tell the chest compressors to switch? A. Only when they tell you that they are fatigued B. About every 2 minutes C. About every 5 minutes D. About every 7 minutes

Answer 70

B. About every 2 minutes Switch compressors about every 2 minutes, or earlier if they are fatigued. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Critical Concepts: High-Quality CPR; page 38]

Question 71

Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding? A. Chest compressions may not be effective B. The endotracheal tube is in the esophagus C. The patient meets the criteria for termination of efforts D. The team is ventilating the patient too often (hyperventilation)

Answer 71

A. Chest compressions may not be effective PETCO2 values less than 10 mm Hg in intubated patients indicate that cardiac output is inadequate to achieve return of spontaneous circulation. It is reasonable to consider trying to improve quality of CPR by optimizing chest compression parameters. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Physiologic Monitoring During CPR; page 103]

Question 72

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Which would you have done first if the patient had not gone into ventricular fibrillation? A. Established IV access B. Obtained a 12-lead ECG C. Given atropine 1 mg D. Performed synchronized cardioversion

Answer 72

D. Performed synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Cardioversion \> Recommendations; page 137]

Question 73

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take? A. Perform bag-mask ventilation B. Intubate the patient C. Apply oxygen D. Check the pulse oximeter probe

Answer 73

C. Apply oxygen In the application of the Tachycardia Algorithm to an unstable patient, identify and treat the underlying cause. Give oxygen, if indicated, and monitor oxygen saturation. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Application of the Tachycardia Algorithm to the Unstable Patient \> Identify and Treat the Underlying Cause; page 134]

Question 74

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. After your initial assessment of this patient, which intervention should be performed next? A. Synchronized cardioversion B. Administration of amiodarone 150 mg IM C. Immediate defibrillation D. Endotracheal intubation

Answer 74

A. Synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Cardioversion \> Recommendations; page 137]

Question 75

You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication? A. “I’ll give it in a few minutes.” B. “OK.” C. “I’ll draw up 0.5 mg of atropine.” D. “Are you sure that is what you want given?”

Answer 75

C. “I’ll draw up 0.5 mg of atropine.” When communicating with high-performance team members, the team leader should use closed-loop communication. By receiving a clear response and eye contact, the team leader confirms that the team member heard and understood the message. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics \> Elements of Effective High-Performance Team Dynamics \> How to Communicate; page 31]

Question 76

Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient? A. Slow, weak pulse rate B. Cyanosis C. Agonal gasps D. Irregular, weak pulse rate

Answer 76

C. Agonal gasps Agonal gasps are not normal breathing. They are a sign of cardiac arrest. Agonal gasps may be present in the first minutes after sudden cardiac arrest. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Caution: Agonal Gasps; page 35]

Question 77

A. Third-degree atrioventricular block B. Second-degree atrioventricular block type I C. First-degree atrioventricular block D. Second-degree atrioventricular block type II

Answer 77

B. Second-degree atrioventricular block type I This ECG rhythm strip shows second-degree atrioventricular block type I. [ACLS Provider Manual, Part 5: The ACLS Cases \> Bradycardia Case \> Rhythms for Bradycardia; page 121]

Question 78

Which is one way to minimize interruptions in chest compressions during CPR? A. Administer IV medications only when delivering breaths B. Check the pulse immediately after defibrillation C. Continue CPR while the defibrillator charges D. Use an AED to monitor the patient’s rhythm

Answer 78

C. Continue CPR while the defibrillator charges Shortening the interval between the last compression and the shock by even a few seconds can improve shock success (defibrillation and return of spontaneous circulation). Thus, it is reasonable for healthcare providers to practice efficient coordination between CPR and defibrillation to minimize the hands-off interval between stopping compressions and administering the shock. For example, after verifying a shockable rhythm and initiating the charging sequence on the defibrillator, another provider should resume chest compressions and continue until the defibrillator is fully charged. The defibrillator operator should deliver the shock as soon as the compressor removes his or her hands from the patient’s chest and all providers are “clear” of contact with the patient. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Foundational Facts: Resume CPR While Manual Defibrillator Is Charging; page 96]

Question 79

Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do? A. Check the patient’s pulse B. Monitor the patient’s PETCO2 C. Obtain a 12-lead ECG D. Obtain a chest x-ray

Answer 79

B. Monitor the patient’s PETCO2 The AHA recommends using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Physiologic Monitoring During CPR; page 102]

Question 80

Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C. Estimate by using the formula Weight (kg)/8 + 2 D. Estimate by using the size of the patient’s finger

Answer 80

A. Measure from the corner of the mouth to the angle of the mandible To select the appropriate size for an oropharyngeal airway (OPA), place the OPA against the side of the face. When the flange of the OPA is at the corner of the mouth, the tip is at the angle of the mandible. A properly sized and inserted OPA results in proper alignment with the glottic opening. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> Basic Airway Adjuncts: Oropharyngeal Airway \> Technique of OPA Insertion; page 51]

Question 81

Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? A. 12-lead ECG B. Cardiac enzymes C. Coagulation studies D. Noncontrast CT scan of the head

Answer 81

D. Noncontrast CT scan of the head A critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a noncontrast CT scan to differentiate ischemic from hemorrhagic stroke. The CT scan should be completed within 25 minutes of the patient’s arrival in the emergency department and should be read within 45 minutes from emergency department arrival. [ACLS Provider Manual, Part 5: The ACLS Cases \> Acute Stroke Case \> CT Scan: Hemorrhage or No Hemorrhage \> Introduction; page 84]

Question 82

A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? A. “OK.” B. “Are you sure?” C. “Amiodarone 500 mg IV has been given.” D. “I have an order to give 500 mg of amiodarone IV. Is this correct?”

Answer 82

D. “I have an order to give 500 mg of amiodarone IV. Is this correct?” Unclear communication can lead to unnecessary delays in treatment or to medication errors. Team members should question an order if the slightest doubt exists. [ACLS Provider Manual, Part 4: Effective High-Performance Team Dynamics \> Elements of Effective High-Performance Team Dynamics \> How to Communicate; page 31]

Question 83

What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post–cardiac arrest patient who achieves return of spontaneous circulation? A. 75mmHg B. 80mmHg C. 85mmHg D. 90mmHg

Answer 83

D. 90mmHg If the patient’s volume status is adequate, infusions of vasoactive agents may be initiated and titrated to achieve a minimum systolic blood pressure of 90 mm Hg or greater or a mean arterial pressure of 65 mm Hg or more. [ACLS Provider Manual, Part 5: The ACLS Cases \> Immediate Post–Cardiac Arrest Care Case \> Overview of Post–Cardiac Arrest Care; page 146]

Question 84

Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? A. 100 mg B. 300 mg C. 150 mg D. 250 mg

Answer 84

B. 300 mg Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Antiarrhythmic Agents \> Amiodarone; page 106]

Question 85

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority? A. Administer amiodarone 300 mg B. Administer atropine 0.5 mg C. Insert an advanced airway D. Perform defibrillation

Answer 85

D. Perform defibrillation Pulseless ventricular tachycardia is included in the algorithm because it is treated as ventricular fibrillation. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm \> VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VT/pVT Pathway \> Principle of Early Defibrillation; page 97]

Question 86

Which is the maximum interval you should allow for an interruption in chest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25 to 30 seconds

Answer 86

A. 10 seconds ACLS providers must make every effort to minimize any interruptions in chest compressions. Try to limit interruptions in chest compressions (eg, defibrillation and rhythm analysis) to no longer than 10 seconds. When you stop chest compressions, blood flow to the brain and heart stops. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Critical Concepts: Minimizing Interruptions; page 37]

Question 87

A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment? A. Administering adenosine 6 mg IV push B. Performing synchronized cardioversion C. Performing vagal maneuvers D. Performing defibrillation

Answer 87

B. Performing synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Cardioversion \> Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137]

Question 88

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. In addition to defibrillation, which intervention should be performed immediately? A. Advanced airway insertion B. Vasoactive medication administration C. Chest compressions D. Vascular access

Answer 88

C. Chest compressions Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm \> VF/pVT (Left Side); page 93]

Question 89

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post–cardiac arrest care intervention do you choose for this patient? A. Extubate B. Initiate targeted temperature management C. Check the glucose level D. Administer epinephrine

Answer 89

B. Initiate targeted temperature management To protect the brain and other organs, the high-performance team should start targeted temperature management in patients who remain comatose (lack of meaningful response to verbal commands) with return of spontaneous circulation after cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases \> Immediate Post–Cardiac Arrest Care Case \> Application of the Immediate Post–Cardiac Arrest Care Algorithm \> Targeted Temperature Management; page 151]

Question 90

Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? A. Apply the AED B. Check the patient’s breathing and pulse C. Open the patient’s airway D. Check for a medical alert bracelet

Answer 90

B. Check the patient’s breathing and pulse After you determine that a patient is unresponsive and activate your emergency team, a breathing check and pulse check should be performed. Ideally, these checks are done simultaneously to minimize delay in detection of cardiac arrest and initiation of CPR. After determining that a patient is not breathing and has no pulse, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach \> The BLS Assessment \> Overview of the BLS Assessment; page 36]

Question 91

What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post–cardiac arrest patient who achieves return of spontaneous circulation? A. 75mmHg B. 80mmHg C. 85mmHg D. 90mmHg

Answer 91

D. 90mmHg If the patient’s volume status is adequate, infusions of vasoactive agents may be initiated and titrated to achieve a minimum systolic blood pressure of 90 mm Hg or greater or a mean arterial pressure of 65 mm Hg or more. [ACLS Provider Manual, Part 5: The ACLS Cases \> Immediate Post–Cardiac Arrest Care Case \> Overview of Post–Cardiac Arrest Care; page 146]

Question 92

Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field? A. Acute long-term care unit B. Acute rehabilitation care unit C. Coronary reperfusion–capable medical center D. Comprehensive stroke care unit

Answer 92

C. Coronary reperfusion–capable medical center After return of spontaneous circulation in patients in whom coronary artery occlusion is suspected, providers should transport the patient to a facility capable of reliably providing coronary reperfusion (eg, percutaneous coronary intervention) and other goal-directed post–cardiac arrest care therapies. [ACLS Provider Manual, Part 2: Systems of Care \> Post–Cardiac Arrest Care \> Immediate Coronary Reperfusion With PCI; page 20]

Question 93

What is an effect of excessive ventilation? A. Decreased cardiac output B. Decreased intrathoracic pressure C. Increased perfusion pressures D. Increased venous return

Answer 93

A. Decreased cardiac output Excessive ventilation can be harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> Management of Respiratory Arrest \> Critical Concepts: Avoiding Excessive Ventilation; page 47]

Question 94

During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range? A. 0 to 8hours B. At least 24 hours C. At least 36 hours D. At least 48 hours

Answer 94

B. At least 24 hours For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases \> Immediate Post–Cardiac Arrest Care Case \> Application of the Immediate Post–Cardiac Arrest Care Algorithm \> Targeted Temperature Management; page 151]

Question 95

What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest? A. 26°C to 28°C B. 29°C to 31°C C. 32°C to 36°C D. 35°C to 37°C

Answer 95

C. 32°C to 36°C For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases \> Immediate Post–Cardiac Arrest Care Case \> Application of the Immediate Post–Cardiac Arrest Care Algorithm \> Targeted Temperature Management; page 151]

Question 96

Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding? A. The endotracheal tube is in the esophagus B. The patient meets the criteria for termination of efforts C. The team is ventilating the patient too often (hyperventilation) D. Chest compressions may not be effective

Answer 96

D. Chest compressions may not be effective PETCO2 values less than 10 mm Hg in intubated patients indicate that cardiac output is inadequate to achieve return of spontaneous circulation. It is reasonable to consider trying to improve quality of CPR by optimizing chest compression parameters. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway \> Physiologic Monitoring During CPR; page 103]

Question 97

A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? A. 3mg B. 12mg C. 20mg D. 40mg

Answer 97

B. 12mg Adenosine is indicated for most forms of stable narrow-complex supraventricular tachycardia. If the patient is not responsive to the first dose, a second dose of adenosine (12 mg rapid IV push) should be given. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Application of the Tachycardia Algorithm to the Stable Patient \> Narrow QRS, Regular Rhythm; page 143]

Question 98

In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? A. Arterial blood gases B. Chest radiography C. Hemoglobin levels D. Continuous waveform capnography

Answer 98

D. Continuous waveform capnography The AHA recommends continuous waveform capnography in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube. [ACLS Provider Manual, Part 5: The ACLS Cases \> Respiratory Arrest Case \> The Primary Assessment \> FYI 2015 Guidelines: Correct Placement of ET Tube; page 46]

Question 99

A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? A. 3mg B. 12mg C. 20mg D. 40mg

Answer 99

B. 12mg Adenosine is indicated for most forms of stable narrow-complex supraventricular tachycardia. If the patient is not responsive to the first dose, a second dose of adenosine (12 mg rapid IV push) should be given. [ACLS Provider Manual, Part 5: The ACLS Cases \> Tachycardia: Stable and Unstable \> Application of the Tachycardia Algorithm to the Stable Patient \> Narrow QRS, Regular Rhythm; page 143]

Question 100

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next? A. Amiodarone 300 mg B. Atropine 1 mg C. Epinephrine 1 mg D. Magnesium sulfate 1 g

Answer 100

A. Amiodarone 300 mg Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases \> Cardiac Arrest: VF/Pulseless VT Case \> Antiarrhythmic Agents \> Amiodarone; page 106]