5 Sample Questions for ACLS

1. The key clinical question when determining steps to take for the patient with symptomatic
bradycardia is:

A. Is the bradycardia reversible?

B. Does the patient respond to medications?
C. Are the symptoms caused by bradycardia or some other illness?
D. Is the patient a DNR?

2. The treatment sequence for bradycardia with poor perfusion is:

A. prepare for transcutaneous pacing, consider atropine while preparing TCP,

use epinephrine or dopamine while awaiting pacemaker or if pacing is
ineffective.
B. give epinephrine, if ineffective give atropine, if atropine is ineffective start
transcutaneous pacing
C. start IV drip of dopamine or epinephrine, if ineffective begin transcutaneous
pacing, and if this is not effective, give atropine
D. begin cpr, give epinephrine, give atropine, defibrillate, repeat epinephrine if
needed.

3. Transcutaneous pacing should be started immediately if:

A. there is no response to atropine

B. atropine is unlikely to be effective or if IV access cannot be quickly established
C. the patient is severely symptomatic
D. all of the above

4. If transcutaneous pacing is ineffective for symptomatic bradycardia, the next step would be
to prepare for:

A. prepare for transvenous pacing

B. give repeat doses of atropine
C. prepare for pacemaker placement
D. begin CPR

5. Atropine doses of less than 0.5mg may paradoxically result in further slowing of the heart
rate.
A. True
B. False

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 5 Sample Questions for ACLS

Answers
1. C. Are the symptoms caused by bradycardia or some other illness?. Treatment of
bradycardia with the bradycardia algorithm should be based on whether the symptoms
are being caused by the bradycardia or if they are being caused by some other illness
or disorder. Once it is determined that the slow heart rate is causing the symptoms
then the patient should be treated with the bradycardia algorithm.

2. A. prepare for transcutaneous pacing, consider atropine while preparing TCP, use
epinephrine or dopamine while awaiting pacemaker or if pacing is ineffective. In the
case of bradycardia with poor perfusion, TCP is indicated. Atropine can and should be
give if it does not delay TCP. Also if TCP is not available, epinephrine and dopamine
(chemical pacing) are considered equally effective to TCP.

3. D. all of the above. All of the above are indications for immediate transcutaneous
pacing.

4. A. prepare for transvenous pacing. Transvenous pacing is the next step in the
sequence of actions if TCP fails.

5. A. True. Also, atropine crosses into the CNS stimulating the vagus nerve causing
bradycardia at low doses. At higher doses the muscarinic blocking effects of Atropine
out weigh the CNS effects, causing tachycardia.

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