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WorksheetsACLS Test E Questions
Total questions: 50
Worksheet time: 50mins
An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action?
Give an IV fluid bolus.
Give atropine and monitor for changes in mental status.
Conduct a problem-focused history and physical examination.
Start an epinephrine infusion and titrate to patient response.
A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next?
Give 150 mg of amiodarone.
Obtain a 12-lead ECG.
Administer 160 mg of aspirin.
Administer 6 mg of adenosine.
A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next?
12-lead ECG assessment
Administration of 100% supplementary oxygen
Administration of a low-dose aspirin
Cincinnati Prehospital Stroke Scale assessment
What action is recommended to help minimize interruptions in chest compressions during CPR?
Perform pulse checks immediately after defibrillation.
Continue CPR while charging the defibrillator.
Administer IV medications only when delivering breaths.
Continue to use an AED even after the arrival of a manual defibrillator.
What is the minimum depth of chest compressions for an adult in cardiac arrest?
1 inch
1 1/2 inches
2 1/2 inches
2 inches
What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC?
2 to 10 mg/min IV infusion
0.1 to 0.5 mcg/kg per min IV infusion
1 mg IV push every 3 to 5 minutes
10 mg IV push every 3 to 5 minutes
Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest?
Subclavian vein
Intraosseous Line
Antecubital vein
Internal jugular vein
What is the appropriate rate of chest compressions for an adult in cardiac arrest?
80 to 100/min
130 to 150/min
110 to 130/min
100 to 120/min
Which finding is a sign of ineffective CPR?
Patient temperature >32 degrees Celsius (89.6 degrees F)
Diastolic intra-arterial pressure > 20 mm Hg
Measured patient urine output of 1 ml/kg per hour
PETCO2 <10 mm Hg
The use of quantitative capnography in intubated patients
allows for monitoring of CPR quality
measures oxygen levels at the alveoli level
determines inspired carbon dioxide relating to cardiac output
detects electrolyte abnormalities early in code management
Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient?
Check patient's pulse.
Apply the AED.
Open the patient's airway.
Check for the presence of breathing.
Which action is included in the BLS Survey?
Advanced airway management
Rapid medication administration
Preparation for therapeutic hypothermia
Early defibrillation
What is the first treatment priority for a patient who achieves ROSC?
Coronary reperfusion
Optimizing ventilation and oxygenation
Therapeutic hypothermia
Maintaining blood glucose <185 mg/dL
What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
Identifying and treating early clinical deterioration
Rapidly intervening with patients admitted through emergency department triage
Responding to patients during a disaster or multiple-patient situation
Responding to patients after activation of the emergency response system
A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient’s blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal
maneuvers. What is the next recommended intervention?
Amiodarone 300 mg IV push
Adenosine 6 mg IV push
Synchronized cardioversion at 50 J
Synchronized cardioversion at 200 J
While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:
What is the most appropriate first intervention?
Aspirin
Atropine
Lidocaine
Nitroglycerin
What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm?
4 to 6 breaths per minute
14 to 16 breaths per minute
10 to 12 breaths per minute
16 to 18 breaths per minute
An AED advises a shock for a pulseless patient lying in snow. What is the next action?
Administer the shock immediately and continue as directed by the AED.
Place a backboard beneath the patient and administer the shock.
Move the patient off the snow to bare ground and deliver the shock.
Remove any snow beneath the patient and then administer the shock.
What is the BEST strategy for performing high-quality CPR on a patient with an advanced
airway in place?
Provide compressions and ventilations with a 15:2 ratio.
Provide continuous chest compressions without pauses and 10 ventilations per minute.
Provide compressions and ventilations with a 30:2 ratio.
Provide a single ventilation every 6 seconds during the compression pause.
What is a common but sometimes fatal mistake in cardiac arrest management?
Failure to obtain vascular access
Prolonged interruptions in chest compressions
Prolonged periods of no ventilations
Failure to perform endotracheal intubation
How often should the team leader switch chest compressors during a resuscitation attempt?
Every minute
Every 2 minutes
Every 3 minutes
Every 4 minutes
A postoperative patient in the ICU reports new chest pain. What actions have the highest priority?
Administer an IV fluid bolus and obtain arterial blood gas.
Start dopamine at 2 mcg/kg per minute and obtain a chest x-ray.
Obtain a 12-lead ECG and administer aspirin if not contraindicated.
Send blood to the laboratory for chemistry and cardiac enzymes.
You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm below, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What management step is your next priority?
Give 0.5 mg of atropine.
Administer 1 mg of epinephrine.
Insert an advanced airway.
Administer a dopamine infusion.
You are evaluating a 48-year-old man with crushing substernal chest pain. The patient is pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular wide-complex tachycardia. What intervention should you perform next?
Synchronized cardioversion
Procedural sedation
12-lead ECG
Amiodarone administration
Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique?
Placing a nasopharyngeal airway
Using an advanced airway device
Performing a jaw thrust without head extension
Performing a head tilt–chin lift maneuver
Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding?
The patient meets the criteria for termination of efforts.
The endotracheal tube is no longer in the trachea.
Chest compressions may not be effective.
The team is ventilating the patient too often (hyperventilation).
What is the recommended duration of therapeutic hypothermia after reaching the target temperature?
0 to 12 hours
12 to 24 hours
24 to 36 hours
36 to 48 hours
You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now?
Obtaining a 12-lead ECG
PETCO2
Chest x-ray
Laboratory testing
A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to
administer amiodarone.
administer epinephrine.
administer a second shock.
insert an advanced airway.
Choose an appropriate indication to stop or withhold resuscitative efforts.
Evidence of rigor mortis
Arrest not witnessed
Patient age greater than 85 years
No return of spontaneous circulation after 10 minutes of CPR
Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation?
Atropine 2 mg
Vasopressin 1mg/kg
Dopamine 2 mg/kg per minute
Amiodarone 300 mg
EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most important early intervention?
Defibrillation
Endotracheal intubation
Epinephrine administration
Anti arrhythmic administration
Which situation BEST describes pulseless electrical activity?
Asystole without a pulse
Torsades de pointes with a pulse
Ventricular tachycardia with a pulse
Sinus rhythm without a pulse
What is the initial priority for an unconscious patient with any tachycardia on the monitor?
Review the patient’s home medications.
Determine whether pulses are present.
Evaluate the breath sounds.
Administer sedative drugs.
A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient’s blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action?
Vagal maneuvers
Acquisition of a 12-lead ECG
Procedural sedation
Immediate defibrillation
What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation?
50 to 75 J
75 to 100 J
120 to 200 J
200 to 300 J
You find an unresponsive patient who is not breathing. After activating the emergency response system, you determine that there is no pulse. What is your next action?
Open the airway with a head tilt–chin lift.
Administer epinephrine at a dose of 1 mg/kg.
Deliver 2 rescue breaths each over 1 second.
Start chest compressions at a rate of at least 100/min.
Which is a safe and effective practice within the defibrillation sequence?
Stop chest compressions as you charge the defibrillator.
Be sure oxygen is not blowing over the patient’s chest during the shock.
Assess for the presence of a pulse immediately after the shock.
Commandingly announce “clear” after you deliver the defibrillation shock.
You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation?
Contact the patient’s family to see what they would prefer.
Have the EMS crew choose an appropriate patient disposition.
Divert the patient to a hospital 15 minutes away with CT capabilities.
Accept the report and provide care within your present capability.
A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient’s 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action?
Administer 2 to 4 mg of morphine by slow IV bolus.
Administer an additional dose of aspirin.
Administer an additional nitroglycerin tablet.
Administer high-flow oxygen via an oxygen mask.
What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG?
Valsalva maneuver
Intravenous administration of adenosine
Immediate unsynchronized countershock
Synchronized cardioversion
Which action increases the chance of successful conversion of ventricular fibrillation?
Pausing chest compressions immediately after a defibrillation attempt
Administering 4 quick ventilations immediately before a defibrillation attempt
Providing quality compressions immediately before a defibrillation attempt
Using manual defibrillator paddles with light pressure against the chest
Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration?
Intraosseous (IO)
Endotracheal (ET)
Intramuscular (IM)
Central venous access
Which action is a component of high-quality chest compressions?
Chest compressions without ventilation
60 to 100 compressions per minute with a 15:2 ratio
Allowing complete chest recoil
Uninterrupted compressions at a depth of 1½ inches
What is the immediate danger of excessive ventilation during the post–cardiac arrest period for patients who achieve ROSC?
Oxygen toxicity
Decreased cerebral blood flow
Pulmonary hypertension
Ventilation/perfusion mismatch
What is the recommended IV fluid (normal saline or Ringer’s lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post–cardiac arrest period?
250 to 500 mL
1 to 2 L
500 to 1000 mL
2 to 3 L
What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected?
Suction during insertion but for no longer than 30 seconds.
Suction the mouth and nose for no longer than 30 seconds.
Suction during withdrawal but for no longer than 10 seconds.
Hyperventilate before catheter insertion, and then suction during withdrawal.
A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this
represent?
Clear messages
Closed-loop communication
Knowing one’s limitations
Clear roles and responsibilities
Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes?
Right ventricular infarction and dysfunction
Heart rate greater than 80/min
Phosphodiesterase inhibitor use more than 72 hours ago
Systolic blood pressure greater than 100 mm Hg
What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest?
Recommended during every resuscitation attempt
Not recommended for routine use
Recommended when the patient is vomiting
Recommended only for supraglottic airway insertion
