Advanced Cardiac Life Support Test

1) During the basic life support survey you check for a pulse and then what do you do?
a ) You check for a femoral pulse and if you are unsure if there is a pulse start cardiopulmonary
resuscitation, and ask someone to call 911 and get the external defibrillator (AED).
b ) You check for a carotid pulse. If the patient has a pulse but is not breathing then start rescue
breaths.
c ) You check for a carotid pulse If there is no pulse after 10 seconds then give 2 resume breaths and
start chest compressions.
d ) You check for a carotid pulse. If there is no pulse then instruct someone to call 911 and get the
AED.
2) How do you correct an error or omission during a resuscitation event?
a ) You notice Tom about to give atropine 1 mg intravenous push for a stable bradycardia. You
inform Tom that the new advanced cardiac life support guidelines recommend 0.5 mg for a
patient having symptoms.
b ) You notice that Alex is not compressing the bag-valve mask very frequently and the patient's
pulse is only 89 %. You take over ventilating the patient so that you can increase the pulse
oximetry reading.
c ) Max is performing compressions and Susan is ventilating the patient. Sally arrives and suggests
that you take over for Max. You refuse stating that Max is doing a fine job.
d ) May walks into the room where a code has just been announced to find cardiopulmonary
resuscitation in progress but there is no crash cart. May knows that the crash cart is close, but
instead of going to get it she takes over the task of compressions.
e ) Dr. Toth is busy reviewing ABG results. You looked after this patient yesterday and remember a
history of alcoholism and renal insufficiency. You however are too shy to suggest that the
pulseless tachycardia may be related to a potassium imbalance.
3) You just stumbled onto the beach shore dragging this heavy teenage boy out of the water. You recall
during your basic life support class what the rate of adult rescue breathing is...
a ) 8 to 10 breaths per minute.
b ) 10 to 12 breaths per minute.
c ) You take a deep breath in an attempt to calm yourself and recall that the rate is 5 to 6 breaths per
minute.
d ) Then someone comes up to you and says he is only a boy. You then recall that it is 3 to 5 seconds
per breath.

4) How can you avoid excessive ventilation?

a ) Avoid excessive ventilation by monitoring the capnography reading.
b ) Avoid excessive ventilation by monitoring the pulse oximetry reading and using it as your guide.
c ) Avoid excessive ventilation by increasing the rate significantly so that you decrease the volume.
d ) Avoid excessive ventilation by slowing your rate of delivery.
5) What does pulse oximetry measure and what reading should you maintain your patient at?
a ) Pulse oximetry measures end-tidal C02 and a value of 35 to 40 mm Hg is considered normal.
b ) Pulse oximetry is invasive. It measures oxygen consumption and a value of 60% to 80% is
considered normal.
c ) Pulse oximetry measures oxygen saturation of the blood and a value of 94% or greater should be
maintained.
d ) Pulse oximetry measures intra-arterial relaxation pressure and a value of 50 mm Hg or greater
should be maintained.
6) The oropharyngeal airway device may be used under which circumstances?
a ) The conscious patient who needs suctioning and keeps biting down on the suction tube.
b ) The semiconscious patient to maintain an airway.
c ) The semiconscious patient who needs suctioning and is biting down.
d ) The unconscious patient during bag-mask ventilation to keep the tongue from obstructing the
airway.
7) You are out camping. Your neighboring campers call out for help. You rush over to find one male
lying on the ground. You are unsure that you feel a pulse. What should you do?
a ) Ask your companion to check the carotid pulse on the other side of the
body.
b ) Instruct someone to call 911, then assess the pulse again.
c ) Check the radial pulse on that side of the body after checking the carotid pulse.
d ) You remember your basic life support class and feel for a carotid pulse for only 10 seconds and
then start chest compressions.

8) You have been performing cardiopulmonary resuscitation (CPR) and recall that you conduct a
rhythm check...
a ) After 5 minutes of CPR.
b ) After 2 minutes or 5 cycles of CPR.
c ) After each shock.
d ) When instructed by the team leader.
9) You have been performing cardiopulmonary resuscitation (CPR). You recall that a pulse check is
conducted...
a ) After 2 minutes of CPR.
b ) Every few minutes.
c ) Only when an organized rhythm is seen on the monitor.
d ) When the team leader asks.
10) Which is incorrect? During an arrest, when is intravenous
access a priority?
a ) After administering the first shock.
b ) It is the first treatment for a patient demonstrating unstable tachycardia.
c ) When a patient has unstable bradycardia, asystole or pulseless electrical activity.
d ) After establishment of an advanced airway.
11) What does a vasopressor drug do?
a ) Expands the blood volume.
b ) Cause vasodilation.
c ) Cause vasoconstriction.
d ) They turn you patient's toes and fingers blue or purple.

12) What is considered the first-line antiarrhythmic drug in cardiac arrest?

a ) Amiodarone
b ) Lidocaine
c ) Sotolol.
d ) Procainamide.
13) What is the first dose of amiodarone when treating ventricular fibrillation?
a ) 150 mg
b ) 300 mg.
c ) 100 mg.
d ) 1 mg.
14) When is vasopressin administered and what is the dose?
a ) Vasopressin is administered to treat only pulseless tachycardia at a dose of 40 units.
b ) Vasopressin is given every 3 to 5 minutes during an arrest and the dose is 1mg.
c ) Vasopressin may be substituted for the first or second dose of epinephrine and the dose is 40 mg.
d ) Vasopressin may be substituted for the first or second dose of epinephrine and the dose is 40
units.
15) What drug is given to treat Torsades de points?
a ) Magnesium 0.5 mg is given to treat Torsades de points.
b ) Magnesium 1 to 2 g. over 5 to 20 minutes.
c ) Lidocaine 1 to 1.5 mg/kg.
d ) Amiodarone 300 mg.

16) When is post arrest hypothermia implemented?

a ) When the patient remains in a coma.
b ) When the patient is able to respond but has a low blood pressure and an arrhythmia.
c ) When a stroke is suspected.
d ) When the patient has had a massive heart attack.
17) In order to have a successful outcome for the patient demonstrating pulseless electrical activity the
team must do what?
a ) Give massive fluid boluses in order to increase preload of the heart.
b ) Administer high quality cardiopulmonary resuscitation and give epinephrine every 3 to 5 minutes.
c ) Make establishment of an intravascular access a priority.
d ) Perform effective CPR, determine the cause of the arrest and correct that cause.
18) Of all of the causes of pulseless electrical activity which two are considered easier to treat?
a ) Hypokalemia and hypoxia.
b ) Drug overdose and hypoxia.
c ) Hypothermia and tension pneumothorax.
d ) Hypovolemia and hypoxia.
19) You rush into a hospital room to see asystole on the monitor. What drug do you administer to treat
asystole?
a ) First you give a fluid bolus and then you determine what could have caused asystole.
b ) Amiodarone 300 mg.
c ) Atropine 0.5 mg.
d ) Epinephrine 1mg.

20) On the 12 lead electrocardiogram a STEMI is indicated by what finding?

a ) The ST segment is depressed.
b ) The ST segment is on the isoelectric line.
c ) The T wave is inverted.
d ) The ST segment is elevated.
21) How soon after arrival in the emergency department is the 12 lead electrocardiogram completed
and evaluated on a patient experiencing chest pain?
a ) Within 10 minutes of arrival in the emergency department.
b ) Within 30 minutes of arrival in the emergency department.
c ) Within 90 minutes of arrival in the emergency department.
d ) Within 5 minutes of arrival in the emergency department.
22) Acute chest pain can be caused by other conditions. Which of the following are some of those life
threatening conditions?
a ) Indigestion or a gastric ulcer.
b ) Anxiety attack.
c ) Pneumonia or bronchitis.
d ) Pericardial effusion or aortic dissection.
23) When is an aspirin not administered to a patient with chest discomfort?
a ) When sever indigestion is also suspected.
b ) When the person has asthma because often they also have an allergy to aspirin.
c ) When the person has a history of gastritis or gastrointestinal bleeding.
d ) When the person has a true aspirin allergy or recent gastrointestinal bleed.

24) Nitroglycerin is not administered to patients with which abnormal vital signs measurements?
a ) Hypoxia (<94% pulse ox), Hypotension (<90 mm Hg), or Tachycardia (>100/min.)
b ) Respirations (>34/min), Hypoxia (<94% pulse ox), or Hypotension (<90 mm Hg)
c ) Hypotension (<90 mm Hg), Tachycardia (>100/min.), or Bradycardia (<50/min.)
d ) Tachycardia (>100/min.), Bradycardia (<50/min.) or Hypoxia (<94% pulse ox)
25) It is very important that you ask your patient if he is taking medications for what condition because
it will cause hypotension if you give him nitroglycerin?
a ) Cancer because he may be taking oral morphine.
b ) Arthritis because he may be taking Advil.
c ) Erectile dysfunction because he may have taken a phosphodiesterase
inhibitor.
d ) Hypertension because he will be taking drugs that lower the blood pressure.
26) You have given your patient 3 nitroglycerin tablets each 5 minutes apart and he is still reporting
chest pain. What drug is given when nitroglycerine is ineffective?
a ) Morphine.
b ) Lidocaine.
c ) Fibrinolytic therapy.
d ) Platelet aggregate inhibitor.
27) How soon should a fibrinolytic drug be administered to a patient who has arrived in the emergency
department (ED) with a diagnosis of acute coronary syndrome (ACS)?
a ) Administered within 90 minutes of arrival in ED or within 12 hours from the time of chest
discomfort..
b ) Administered within 3 hours from time of chest discomfort or 30 minutes from arrival in ED.
c ) Administered after 24 hours from the time of chest discomfort.
d ) Administered within 30 minutes from arrival in ED or within 12 hours from the time of chest
discomfort.

28) What is symptomatic bradycardia?

a ) A slow heart rate only.
b ) A slow heart rate and difficulty arousing in the morning.
c ) A slow heart rate that causes symptoms like hypotension, shortness of breath or weakness.
d ) A slow heart rate when the person is at rest.
29) What is the initial dose of atropine and how often is it administered?
a ) The initial dose is 0.5 mg intravenous push and repeat this dose every 3 to 5 minutes.
b ) The initial dose is 1 mg intravenous push and repeat this dose every 3 to 5 minutes.
c ) The initial dose is 40 units intravenous push and repeat this dose every 3 to 5 minutes.
d ) The initial dose is 0.5 mg intravenous push and repeat this dose only once more.
30) When do you apply transcutaneous pacing (TCP)?
a ) To a patient demonstrating symptomatic bradycardia or asystole rhythm.
b ) As the primary intervention for asystole.
c ) To a patient demonstrating symptomatic bradycardia, asystole, or a third degree heart block.
d ) To a patient demonstrating symptomatic bradycardia or a third degree heart block.
31) How do you confirm electrical and mechanical capture of transcutaneous pacing (TCP)?
a ) Electrical capture is determined by seeing a pacer spike before each QRS complex and
mechanical capture by palpation of a carotid pulse.
b ) Electrical capture is determined by seeing a pacer spike before each p wave and mechanical
capture by palpation of a femoral pulse.
c ) Electrical capture is determined by seeing a wide QRS complex and mechanical capture by
palpation of a carotid pulse.
d ) Electrical capture is determined by seeing a wide QRS complex and mechanical capture by
palpation of a femoral pulse.

32) What is the starting rate of a norepinephrine infusion?

a ) From 2 to 10 mcg/kg/minute.
b ) From 2 to 10 mcg/minute.
c ) From 5 to 10 mcg/minute.
d ) From 10 to 20 mcg/kg/min.
33) The heart rate of an external pacemaker is adjusted based on what clinical response?
a ) It is not adjusted. It is set at 60 beats/minute.
b ) It is adjusted based on the occurrence of ectopic beats.
c ) It is adjusted based on the patient's symptoms, such as hypotension or chest
pain.
d ) It is adjusted based on blood pressure only.
34) You are monitoring a patient with a normal sinus rhythm. After he uses the bedside commode, you
notice that his heart rate has increased to 120 beats/minute. After 25 minutes the heart rate increases to
148 beats/minute. The patient then puts on his call light to inform you that he is short of breath and he
can feel his heart pounding. What do you do next?
a ) Assess vital signs, and continue to monitor the patient.
b ) Assess vital signs, call for assistance, and obtain the crash cart for possible immediate
cardioversion.
c ) Assess vital signs, and call the cardiologist.

35) When do you use unsynchronized shocks (defibrillaton) to treat a patient?

a ) When the patient has a pulse but is experiencing symptoms, like hypotension.
b ) When the heart rate is over 150 beats/minute.
c ) To treat any supraventricular tachycardia (SVT).
d ) Only for VF and pulseless VT.

36) Tachycardia rhythms are classified based on what features?

a ) Heart rate, width of the QRS complex and whether the rhythm is regular or irregular.
b ) Heart rate, width of the QRS complex and p wave characteristics.
c ) Heart rate, the appearance of the QRS complex, and whether the rhythm is regular or irregular.
d ) Heart rate, the appearance of the QRS complex, and the appearance of the p wave.
37) How much is the first dose of adenosine?
a ) 6mg.
b ) 12mg.
c ) 8 mg.
d ) 4 mg.
38) Adenosine is contraindicated in patients with what condition?
a ) Aspirin allergy.
b ) Bronchitis.
c ) Those taking carbamazepine (Tegretol).
d ) Asthma.
39) What is the first dose of amiodarone and how fast is it given when treating a stable wide complex
tachycardia?
a ) The first dose of amiodarone is 300 mg given over 20 minutes.
b ) The first dose of amiodarone is 150 mg given over 10 minutes.
c ) The first dose is an infusion of 1mg/min for 6 hours.
d ) The first dose of amiodarone is 150 mg given over 20 minutes.

40) How soon after arrival in the emergency department is the stroke patient expected to have a noncontrast computerized tomography (CT) performed?
a ) 30 minutes after arrival.
b ) 25 minutes after arrival.
c ) 90 minutes after arrival.
d ) 45 minutes after arrival.
41) How soon after arrival in the emergency department (ED) is the stroke patient expected to have
fibrinolytic therapy started and how long from symptom onset?
a ) 3 Hours after arriving in the ED and 3 hours from symptom onset.
b ) 3 Hours after arriving in the ED and 12 hours from symptom onset.
c ) 1 Hours after arriving in the ED and 12 hours from symptom onset.
d ) 1 Hours after arriving in the ED and 3 hours from symptom onset.
42) When should a stroke patient receive an aspirin?
a ) Within 24 hours of arrival in the emergency department.
b ) No hemorrhage on a computerized tomography (CT) scan and who is a candidate for fibrinolytic
therapy.
c ) No hemorrhage on a computerized tomography (CT) scan and who is not a candidate for
fibrinolytic therapy.
d ) Only after 24 hours from the time of fibrinolytic administration.
43) When the patient is eligible for fibrinolytic therapy what must the systolic and diastolic blood
pressure be less than?
a ) Below 185/110 mm Hg.
b ) Below 160/100 mm Hg.
c ) Below 220/120 mm Hg.
d ) Below 200/110 mm Hg.