ACLS questions and answers, Exams of Cardiology

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A C L S P R E - T E S T

A N N O T A T E D A N S W E R K E Y

June, 2011

Question 1:

Please identify the rhythm by selecting the best single answer

Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm X Third-degree AV block Polymorphic ventricular tachycardia

Question 2:

There is no pulse with this rhythm. Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole X Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 3:

Please identify the rhythm by selecting the best single answer

Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) X Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block X Polymorphic ventricular tachycardia

Question 7:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation X Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 8:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation X Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 9:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation X Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 10:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation X Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 11:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia X Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter X Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 15:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia X Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 16:

Please identify the rhythm by selecting the best single answer X Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 17:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity X Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 18:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia Monomorphic ventricular tachycardia X Sinus tachycardia Normal sinus rhythm Third-degree AV block Polymorphic ventricular tachycardia

Question 19:

Please identify the rhythm by selecting the best single answer Agonal rhythm/asystole Pulseless electrical activity Atrial fibrillation Reentry supraventricular tachycardia Atrial flutter X Second-degree AC block (Mobitz I Wenckebach) Coarse ventricular fibrillation Second-degree AV block (Mobitz II block) Fine ventricular fibrillation Sinus bradycardia

Question 24: A 62-year-old man suddenly experienced difficulty speaking and left-side weakness. He was brought to the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy>

X Do not give aspirin for at least 24 hours if rtPA is administered.

Give aspirin 160 mg and clopidogrel 75 mg orally.

Administer heparin if CT scan is negative for hemorrhage.

Administer aspirin 160 to 325 mg chewed immediately.

Question 25: A patient with possible ST-segment elevation MI has ongoing chest discomfort. Which of the following would be a contraindication to the administration of nitrates?

Heart rate 90/min.

Left ventricular infarct with bilateral rales.

Blood pressure greater than 180 mm Hg. X Use of a phosphodiesterase inhibitor within 12 hours

Question 26: A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Of the following, which drug and dose should be administered first by the IV/IO route?

X Epinephrine 1 mg

Vasopressin 20 units

Sodium bicarbonate 50 mEq

Atropine 1 mg

Question 27: A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. What drug should be administered IV?

Lidocaine 1mg/kg X Adenosine 6 mg

Epinephrine 2 to 10 mcg/kg per minute

Atropine 0.5 mg

Question 28: A patient with sinus bradycardia and heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?

0.1mg

3 mg

1 mg X 0.5 mg

Question 29: A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommended second dose of amiodarone is:

An endotracheal dose of 2 to 4 mg/kg.

300 mg IV push.

1 mg/kg IV push.

An infusion of 1 to 2 mg/min. X 150 mg IV push.

Question 30: A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 sublingual nitroglycerin tablets. There are no contraindications, and 4 mg of morphine sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest discomfort. You should:

X Give normal saline 250 mL to 500 mL fluid bolus.

Give an additional 2 mg of morphine sulfate.

Give sublingual nitroglycerin 0.4 mg.

Start dopamine at 2 mcg/kg per minute and titrate to a systolic blood pressure reading of 100 mm Hg.

Question 31: A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. Which of the following actions is recommended?

Giving adenosine 6 mg IV bolus. X Seeking expert consultation.

Giving lidocaine 1 to 1.5 mg IV bolus.

Immediate synchronized cardioversion.

Question 32: You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised “no shock indicated.” A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to:

X Gain IV or IO access.

Place an esophageal-tracheal tube or laryngeal mask airway.

Attempt endotracheal intubation with minimal interruptions in CPR.

Call for a pulse check.

Question 33: A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which is the next drug/dose to anticipate to administer?

X Amiodarone 300 mg

Amiodarone 150 mg

Vasopressin 40 units

Epinephrine 3 mg

Lidocaine 0.5 mg/kg

Question 34: Your patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route?

Vasopressin, amiodarone, lidocaine

Amiodarone, lidocaine, epinephrine

Epinephrine, vasopressin, amiodarone X Lidocaine, epinephrine, vasopressin

Question 35: A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR?

Femoral vein X IV or IO

Central line

Endotracheal

Repeat adenosine 3 mg IV.

Perform immediate unsynchronized cardioversion.

Sedate and perform synchronized cardioversion. X Repeat adenosine 12 mg IV.

Perform vagal maneuvers and repeat adenosine 6 mg IV.

Question 42: A patient in the emergency department develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitored rhythm becomes irregular as seen above. Oxygen is being administered by nasal cannula at 4 L/min, and an IV line is in place. Blood pressure is 160/96 mm Hg. There are no allergies or contraindications to any medication. You would first order:

X Sublingual nitroglycerin 0.4 mg.

Morphine sulfate 2 to 4 mg IV.

Lidocaine 1 mg/kg IV and infusion 2 mg/min.

Amiodarone 150 mg IV.

IV nitroglycerin initiated at 10 mcg/min and titrated to patient response.

Question 43: Following initiation of CPR and 1 shock for VF, this rhythm is present on the next rhythm check. A second shock is given and chest compressions are resumed immediately. An IV is in place and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next order?

Administer 3 sequential (stacked) shocks at 360 J (monophasic defibrillator).

Prepare to give amiodarone 300 mg IV.

Administer 3 sequential (stacked) shocks at 200 J (biphasic defibrillator).

Perform endotracheal intubation; administer 100% oxygen. X Prepare to give epinephrine 1 mg IV.

Question 44: You arrive on the scene to find a 56-year-old diabetic woman with dizziness. She is pale and diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm below. She is receiving oxygen at 4 L/min by nasal cannula and an IV has been established. Your next order is:

Dopamine at 2 to 10 mcg/kg per minute.

Sublingual nitroglycerin 0.4 mg.

Morphine sulfate 4 mg IV. X Atropine 0.5 mg IV.

Atropine 1 mg IV.

Question 45: A patient becomes unresponsive. You are uncertain if a faint pulse is present with the rhythm below. What is your next action?

Order transcutaneous pacing. X Begin CPR, starting with high-quality chest compressions.

Start an IV and give epinephrine 1 mg IV.

Consider causes of pulseless electrical activity.

Start an IV and give atropine 1 mg.

Question 46: This patient has been resuscitated from cardiac arrest. During the resuscitation, amiodarone 300 mg was administered. The patient developed severe chest discomfort with diaphoresis. He is now unresponsive. What is the next indicated action?

Perform immediate synchronized cardioversion.

Repeat amiodarone 150 mg IV. X Give an immediate unsynchronized high-energy shock (defibrillation dose).

Repeat amiodarone 300 mg IV.

Give lidocaine 1 to 1.5 mg/kg IV.

Question 47: You are monitoring the patient and note the rhythm below on the cardiac monitor. She has dizziness and her blood pressure is 80/40 mm Hg. She has an IV in place. What is your next action?

Give an immediate synchronized shock.

Give sedation and perform synchronized cardioversion.

Administer magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 5 to 20 minutes.

Give an immediate unsynchronized shock. X Administer adenosine 6 mg; seek expert consultation.

Question 51: The patient suddenly becomes unconscious and has a weak carotid pulse. Cardiac monitoring, supplementary oxygen, and an IV have been initiated. The code cart with all the drugs and transcutaneous pacer are immediately available. Next you would:

Begin transcutaneous pacing.

Initiate dopamine at 10 to 20 mcg/kg per minute and to patient response.

Initiate dopamine at 2 to 10 mcg/kg per minute and titrate to patient response. X Give atropine 0.5 mg IV.

Initiate epinephrine at 2 to 10 mcg/kg per minute.

Question 52: A patient’s 12-lead ECG was transmitted by the paramedics and showed an acute MI. The above findings are seen on rhythm strip when a monitor is placed in emergency department. The patient had resolution of moderate (5.10) chest pain with 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention below is most important, reducing in-hospital and 30-day mortality?

X Reperfusion therapy.

IV nitroglycerin for 24 hours.

Temporary pacing.

Atropine 0.5 mg IV, total dose 2 mg as needed.

Atropine 1 mg IV, total dose 3 mg as needed.

Question 53: This patient was admitted to the general medical ward with a history of alcoholism. A code is in progress and he has recurrent episodes of this rhythm. You review his chart. Notes about the 12-lead ECG say

that his baseline QT interval is high normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg and 1 dose of amiodarone 300 mg IV so far. What would you order for his next medication?

Lidocaine 1 to 1.5 mg IV and start infusion 2 mg/min.

Repeat amiodarone 300 mg IV.

Repeat amiodarone 150 mg IV.

Give sodium bicarbonate 50 mEq IV. X Give magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 5 to 20 minutes

Question 54: You are the code team leader and arrive to find a patient with above rhythm and CPR in progress. Team members report that the patient was well but reported chest pain and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, high-quality CPR is in progress, and an IV has been established. What would be your next order?

Administer atropine 1 mg.

Perform endotracheal intubation.

Start dopamine at 10 to 20 mcg/kg per minute. X Administer epinephrine 1 mg.

Administer amiodarone 300 mg.

Question 55: A patient presents with the rhythm below and reports an irregular heartbeat. She has no other symptoms. Her medical history is significant for a myocardial infarction 7 years ago. Blood pressure is 110/ mm Hg. What would you do at this time?

Perform elective synchronized cardioversion with presedation. X Continue monitoring and seek expert consultation.

Administer nitroglycerin 0.4 sublingual or spray.

Administer lidocaine 1mg/kg IV.

Perform emergency synchronized cardioversion

Question 59: You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action?

Intubate the patient and give epinephrine 2 to 4 mg via the endotracheal tube.

Being CPR with chest compressions for 2 minutes or about 5 cycles of compressions and ventilations.

Establish an IV and give epinephrine 1 mg.

Establish and IV and give vasopressin 40 units. X Give a single shock.

Question 60: A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is intubated and is receiving 100% oxygen. Blood pressure is 80/60 mm Hg. During the resuscitation, she received 2 doses of epinephrine 1 mg and 1 does of amiodarone 300 mg IV. You now observe this rhythm on the cardiac monitor. The rhythm abnormality is becoming more frequent and increasing in number. You should order:

Amiodarone 150 mg IV bolus; start infusion.

A repeat dose of epinephrine 1 mg IV.

Lidocaine 1 to 1.5 mg IV; star infusion. X 1 to 2 L of normal saline.

Amiodarone 300 mg IV.