ACLS Exam A&B: American Heart Association Nursing Topics, Exams of Nursing

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ACLS exam A&B American Heart Association

Nursing Topics (University of Minnesota Twin Cities)

American Heart Association

Advanced Cardiovascular

Life Support

Exams A and B

Contents

 Student Answer Sheet

 Exam A

 Exam A Answer Key

 Exam A Annotated Answer Key

 Exam B

 Exam B Answer Key

 Exam B Annotated Answer Key

26. A B C D

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50. A B C D

American Heart Association

Advanced Cardiovascular

Life Support

Exam A

Advanced Cardiovascular Life Support Exam A

(50 questions)

Please do not mark on this exam. Record the best answer on the separate answer sheet.

1. 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

2. 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

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

C. Order an echocardiogram before fibrinolytic administration D. Wait for the results of the MRI

9. Which best describes this rhythm?

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication?

B. Check the pulse immediately after defibrillation C. Use an AED to monitor the patient’s rhythm D. Continue CPR while the defibrillator charges

25. 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

26. 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

27. 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

28. 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

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

A. 0 to 8 hours B. At least 24 hours C. At least 36 hours D. At least 48 hours

30. 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

C. 20 mg D. 40 mg

37. 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

38. 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

39. 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. 75 mm Hg B. 80 mm Hg C. 85 mm Hg D. 90 mm Hg

40. 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

Use this scenario to answer the next 6 questions:

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?

Acute coronary syndrome Acute heart failure Acute ischemic stroke Supraventricular tachycardia with ischemic chest pain

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

Advanced airway insertion Vasoactive medication administration Chest compressions Vascular access

Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient?

Epinephrine 1 mg Amiodarone 300 mg Lidocaine 1 mg/kg Atropine 1 mg

Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next?

Epinephrine 1 mg Atropine 1 mg Magnesium sulfate 1 g Amiodarone 300 mg

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?

Initiate targeted temperature management Check the glucose level Administer epinephrine Extubate

Which would you have done first if the patient had not gone into ventricular fibrillation?

Established IV access Obtained a 12-lead ECG Given atropine 1 mg Performed synchronized cardioversion

Answer Key

Advanced Cardiovascular Life Support Exam A

Question Answer

1. A B ● D

2. ● B C D

3. A B C ●

4. A B ● D

5. A ● C D

6. A ● C D

7. A B ● D

8. A ● C D

9. A B C ●

10. A B ● D

11. A B C ●

12. A ● C D

13. A B C ●

14. ● B C D

15. A B C ●

16. A ● C D

17. A ● C D

18. A B ● D

19. ● B C D

20. A B ● D

21. ● B C D

22. A B C ●

23. ● B C D

24. A B C ●

25. A B ● D

26. ● B C D

27. A B ● D

28. A ● C D

29. A ● C D

30. ● B C D

31. A B ● D

32. ● B C D

33. A ● C D

Annotated Answer Key

Advanced Cardiovascular Life Support Exam A

Provider Manual page numbers below refer to the printed book and the eBook as viewed through the offline desktop/laptop reader, not the eBook as viewed through the mobile apps or ebooks.heart.org.

1. 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

The correct answer is C. 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]

2. 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

The correct answer is A. 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]

3. 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

The correct answer is D. 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]

4. 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

The correct answer is C. 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]

5. Which type of atrioventricular block best describes this rhythm?

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

The correct answer is B. 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]