Advanced Cardiovascular Life Support
Question 1 - Single Best Answer
Which of the following actions is most effective in restoring oxygenation and ventilation to an unresponsive, breathless, near-drowning victim?
A) force water from the victims lungs by performing the Heimlich maneuver
B) force water from the victim's lungs by starting chest compressions
C) stabilize the cervical spine with c-collar and spine board, then start the ABCs
D) open the airway with a jaw-thrust maneuver, provide inline cervical stabilization, start the ABCs
Question 2 - Single Best Answer
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During the "analyze" phase of AED operation, which of the following actions is indicated?
A) continue chest compressions
B) continue neshtations without chest compressions
C) prepare the patient for transport
D) avoid all contact with and movement of the patient
Question 3 - Single Best Answer
Which of the following actions helps deliver maximum current during defibrillation?
A) place alcohol pads between the paddles and skin
B) reduce the pressure used to push down on the defibrillator paddles
C) apply conductive paste to the paddles
D) decrease shock energy after the 2nd shock
Question 4 - Single Best Answer
Which of the following facts about identification of VF is true?
A) a peripheral pulse that is both weak and irregular indicates VF
B) a sudden drop in cardiac output to 5O% of normal indicates VF
C) artifact signals displayed on the monitor can look like VF
D) turning the signal amplitude ("gain") to zero can enhance the VF signal
Question 5 - Single Best Answer
Which of the following actions is NOT performed when you "clear" a patient just before defibrillator discharge?
A) check the person managing the airway body not touching bag musk or tracheal tube, oxygen flow turned OFF
B) check yourself: hands correctly placed on paddles, body not touching patient or bed
C) check monitor leads: leads disconnected to prevent shock damage to monitor
D) check others; no one touching patient, bed, or equipment connected to patient
Question 6 - Single Best Answer
A woman with a history of narrow-complex PSVT arrives at the ED. She is alert and oriented but pale. Her HR is 165 bpm, and the ECG documents SVT. Her BP is 105/70 mm Hg. Supplemental oxygen is provided, and IV access has been established. Which of the following drug-dose combinations is the most appropriate initial treatment?
A) adenosine 6 mg rapid IV push
B) propranolol 1 mg IV bolus
C) synchronized cardioversion with 25 to 50 J
D) verapamil 5 mg IV bolus
Question 7 - Single Best Answer
A patient with pulmonary edema has just been intubated after becoming obtunded and cyanotic. You hear bilateral breath sounds, and with each ventilation you note condensation in the tube. Which of the following statements is true?
A) confirmation of correct tube placement is unnecessary in a person with bilateral breath sounds and condensation in the tube
B) use of a commercial purpose-built device to secure the tracheal tube is recommended
C) immediate confirmation of correct placement of the tracheal tube with a chest x-ray is required to rule out esophageal intubation
D) end-tidal CO2 detectors may erroneously suggest esophageal intubation in patients with perfus ing rhythms
Question 8 - Single Best Answer
Tracheal intubation has just been attempted for a victim of respiratory arrest. During hand ventilation with a bag you hear stomach gurgling over the epigastrium but no breath sounds, and oxygen saturation (per pulse oximetry) stays very tow. Which of the following is the most likely explanation for these findings?
A) intubation of the hypopharyngeal area
B) intubation of the left main bronchus
C) intubation of the right main bronchus
D) bilateral tension pneumothorax
Question 9 - Single Best Answer
Which of these statements about IV administration of medications during resuscitation is true?
A) give epinephrine via the intracardiac route if IV access is not obtained within 3 minutes
B) follow IV medications through peripheral veins with a field bolus
C) do not follow IV medications through central veins with a fluid bolus
D) run normal saline mixed with sodium bicarbonate (100 mEq/L) during continuing CPR
Question 10 - Single Best Answer
Ten minutes after an 85-year-old woman collapses, paramedics arrive and start CPR for the first time. Their monitor screen shows fine (low-amplitude) VF. Which at these actions should they take next?
A) perform at least 5 minutes of vigorous CPR before attempting defibrillation
B) insert a tracheal airway, administer 2 to 2.5 mg epinephrine in 10 mL NS through the tracheal tube, and then defibrillate
C) deliver up to 3 precordial thumps while observing response on the monitor screen
D) start CPR, stop when ready to shock, and deliver a 200-J monophasic or equivalent-current biphasic shock
Question 11 - Single Best Answer
A 60-year-old man (weight = 50 kg) with a history of recurrent VF has converted from VF to a wide-complex perfusing rhythm after epinephrine 1 mg IV and a 4th shock (HR = 60 bpm, BP = 90/60 mm Hg). Which of the following drug regimens is most appropriate to give next?
A) amiodarone 300 mg IV push
B) lidocaine 150 mg IV push
C) magnesium 3 g IV push, diluted in 10 mL of D5W
D) procainamide 20 to 50 mg/min, up to a maximum dose of 17 mg/kg
Question 12 - Single Best Answer
While treating a patient in persistent VF arrest after 3 shocks, you consider using vasopressin. Which of the following guidelines for use of vasopressin is true?
A) give vasopressin 40 U every 3 to 5 minutes
B) give vasopressin for better vasoconstriction and beta-adrenergic stimulation than provided by epinephrine
C) give vasopressin as an alternative to epinephrine in shock-refractory VF
D) give vasopressin as the first-line pressor agent for clinical shock caused by hypovolemia
Question 13 - Single Best Answer
You are performing CPR on a man in cardiac arrest when a technician arrives and attaches an AED. With first rhythm analysis a shock is "indicated" and delivered, but the neat rhythm analysis signals "no shock advised." What is the most appropriate neat action?
A) check for a pulse
B) press the manual OVERRIDE button to operate the AED as a manual defibrillator
C) insert an oropharyngeal airway and start 100% oxygen at 6 L/min
D) support breathing and place the patient in the recovery position until the hospital code team arrives
Question 14 - Single Best Answer
A cardiac arrest patient arrives in the ED in PEA at 30 bpm. CPR continues, proper tube placement is confirmed, and IV access is established. Which of the following medications is most appropriate to give next?
A) calcium chloride 5 mL of 10% solution IV
B) epinephrine 1 mg IV
C) synchronized cardioversion at 200 J
D) sodium bicarbonate 1 mEq/kg IV
Question 15 - Single Best Answer
Which of the following causes of PEA is most likely to respond to immediate treatment?
A) massive pulmonary embolism
B) hypovolemia
C) massive acute myocardial infarction
D) myocardial rupture and stroke
Question 16 - Single Best Answer
Which of the following statements about treating a patient with a rapid atrial fibrillation (HR >180 bpm) is true?
A) do not cardiovert if the tachycardia is producing serious signs and symptoms
B) you must have an exact rhythm diagnosis before cardioversion, especially in unstable patients
C) calcium channel blockers help control the rate in rapid atrial fibrillation
D) use amiodarone only for ventricular tachycardias, never for supraventricular tachycardias
Question 17 - Single Best Answer
Which of the following drug-dose combinations is recommended as the initial medication to give a patient in documented asystole?
A) epinephrine 3 mg IV
B) atropine 3 mg IV
C) epinephrine I0 mL of a 1:10,000 solution IV
D) atropine 0.5 mg IV
Question 18 - Single Best Answer
Which of the following rhythms is an appropriate indication for transcutaneous cardiac pacing?
A) sinus bradycardia with no symptoms
B) normal sinus rhythm with hypotension and shock
C) complete heart block with pulmonary edema
D) asystole that follows 6 or more defibrillation shocks
Question 19 - Single Best Answer
A patient with a heart rate of 45 bpm and a prolonged capillary refill time complains of dizziness and cool and clammy extremities. After oxygen what is the first drug you should administer to this patient?
A) atropine 0.5 to 1 mg
B) epinephrine 1 mg IV push
C) isoproterenol infusion 2 to 10 micrograms/min
D) adenosine b mg rapid IV push
Question 20 - Single Best Answer
Which of the following statements correctly describes the ventilations that should be provided after tracheal tube insertion, cuff inflation, and position verification?
A) deliver an average of 12 to 15 ventilations per minute with no pauses for chest compressions
B) deliver ventilations as rapidly as possible as long as visible chest rise occurs with each breath
C) deliver ventilations with a tidal volume of 3 to 5 mL/kg
D) deliver ventilations using room air until COPD is ruled out
Question 21 - Single Best Answer
Of the following statements, which one is the most accurate observation about bag-mask ventilation (BMV) during resuscitation?
A) BMV can be performed effectively with minimal training and practice
B) BMV delivers almost 100% oxygen when combined with a reservoir and high-flow-rate oxygen
C) BMV cannot be performed effectively by one person during resuscitation
D) BMV is never used when the patient has spontaneous respirations
Question 22 - Single Best Answer
An ED patient reports 35 minutes of severe, crushing, substernal chest pain. BP is 110/70 mm Hg, HR is 58 bpm, and the monitor shows regular sinus bradycardia. He has received aspirin 325 mg P0, oxygen 4 L/min via nasal cannula, and 3 sublingual nitroglycerin tablets 5 minutes apart, but his severe pain continues. Which of the following agents should be given
A) atropine 0.5 to 1 mg IV
B) furosemide 20 to 40 mg IV
C) lidocaine 1to 1.5 mg/kg
D) morphine sulfate 2 to 4 mg IV
Question 23 - Single Best Answer
Which of the following agents are used frequently in the early management of acute cardiac ischemia?
A) lidocaine bolus followed by a continuous infusion of lidocaine
B) chewable aspirin, sublingual nitroglycerin, and intravenous morphine
C) bolus of amiodarone followed by an oral ACE inhibitor
D) calcium channel blocker plus intravenous furosemide
Question 24 - Single Best Answer
Which of the following patients is most likely to have vague signs and unusual symptoms of an acute ST-elevation ACS?
A) a 65-year-old woman with angina and angiographically confirmed coronary artery disease
B) a 56-year-old man who smokes 3 packs per day but has no history of heart disease
C) a 45-year-old woman diagnosed with type I diabetes 22 years ago
D) 48-year-old man in the ICU after coronary artery bypass surgery
Question 25 - Single Best Answer
A profusely diaphoretic, hypertensive 50-year-old man complains of crushing substernal chest pain and severe shortness of breath. He chewed 2 baby aspirins at home and is now receiving oxygen. Which of the following treatment sequences is most appropriate at this time?
A) morphine then nitroglycerin, but only if morphine fails to relieve the pain
B) nitroglycerin then morphine, but only if ST elevation is >3 mm
C) nitroglycerin then morphine, but only if nitroglycerin fails to relieve the pain
D) nitroglycerin only, because the chronic hypertension contraindicates morphine
Question 26 - Single Best Answer
A 50-year-old man has 3-mm ST elevation in leads V2 to V4. Severe chest pain continues despite oxygen, aspirin, nitroglycerin SL x 6, and morphine 10 mg IV. BP = 170/110 mm Hg; HR = 120 bpm. Which of the following treatment combinations is most appropriate for this patient at this time (assume no contraindications to any medication)?
A) calcium channel blocker IV + heparin bolus IV
B) ACE inhibitor IV + lidocaine infusion
C) magnesium sulfate IV + enoxaparin (Lovenox) SQ
D) reteplase, recombinant (Retavase) + heparin bolus IV
Question 27 - Single Best Answer
A 70-year-old woman complains of a moderate headache and trouble walking. She has a facial droop, slurred speech, and difficulty raising her right arn. She takes "several medications for high blood pressure. Which of the following actions is most appropriate to take at this time?
A) call 911; tell the dispatcher you need assistance for a woman who is displaying signs and symptoms of an acute subarachnoid hemorrhage
B) call 911; tell the dispatcher you need assistance for a woman who is displaying signs and symptoms of a blocked cerebral artery
C) call 911; have the woman take 2 of each of her blood pressure medications and then have her lie down while both of you await the arrival of emergency personnel
D) call 911; get directions to the nearest Emergency Department; drive the woman to the nearby ED in your car
Question 28 - Single Best Answer
Within 45 minutes of ED arrival, which of the following evaluation sequences should be performed for a 70-year-old woman with rapid onset of headache, garbled speech, and right arm and leg weakness?
A) history, physical and neurologic exams, noncontrast head CT with radiologist interpretation
B) history, physical and neurologic exams, noncontrast head CT, start of fibrinolytic treatment if scan is positive for stroke
C) history, physical and neurologic exams, lumbar puncture, contrast head CT if LP is negative for blood
D) history, physical and neurologic exams, contrast heed CT, start fibrinolytic treatment when improvement in neurologic signs is noted
Question 29 - Single Best Answer
Which of the following conditions most closely mimics the signs and symptoms of an acute stroke?
A) acute insulin-induced hypoglycemia
B) acute hypoxia
C) isotonic dehydration and hypovolemia
D) acute vasovagal or orthostatic hypotension
Question 30 - Single Best Answer
Which at the following causes of prehospital asystole is most likely to respond to treatment?
A) prolonged cardiac arrest
B) prolonged submersion in warm water
C) drug overdose
D) blunt multisystem trauma
Question 31 - Single Best Answer
A 34-year-old woman with a history at mitral valve prolapse presents to the ED complaining of palpitations. Her vital signs areas follows: HR = 165 bpm, resp = 14 per minute, BP = 118/92, and 02 sat = 98%. Her lungs sound clear, and she reports no shortness at breath or dyspnea on exertion. The ECG and monitor display a narrow-complex, regular tachycardia. Which of the following terms best describes her condition?
A) stable tachycardia
B) unstable tachycardia
C) heart rate appropriate for clinical condition
D) tachycardia secondary to poor cardiovascular function
Question 32 - Single Best Answer
A 75-year-old man presents to the ED with 1 week of lightheadedness, irregular palpitations, and mild exercise intolerance. The initial 12-lead ECG displays atrial fibrillation, which continues to show on the monitor at a HR of 120 to 150 bpm and BP of 100/70 mm Hg. Which of the following therapies is the most appropriate next intervention?
A) sedation, analgesia, then immediate cardioversion
B) oxygen via nasal cannula at 2 to 6 L/min, normal saline at 60 to 120 mL/h
C) amiodarone 300 mg IV bolus
D) metoprolol 5 mg IV: repeat every 5 minutes to a total dose of 15 mg
Question 33 - Single Best Answer
You prepare to cardiovert an unstable 46-year-old tachycardic woman with the monitor/defibrillator in "synchronization" mode. She suddenly becomes unresponsive and pulseless as the rhythm changes to an irregular, chaotic, VF-like pattern. You charge to 200 J and press the SHOCK button, but the defibrillator fails to deliver a shock. Why?
A) the defibrillator/monitor battery failed
B) the sync switch failed
C) you cannot shock VF in "sync" mode
D) a monitor lead has lost contact, producing the "pseudo-VF" rhythm
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