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Combination of ACLS Test Prep & ACLS
Competency Quiz Sets
A 5-year-old child in supraventricular tachycardia has adequate pulses with the rhythm. Supplemental oxygen is in place and vital signs are stable except for the elevated heart rate. The most appropriate next intervention for this child is: - โ๏ธ Vagal Maneuvers Rationale: Vagal maneuvers are a reasonable first intervention for supraventricular tachycardia in a hemodynamically stable patient, as this child is. A child has an advanced airway in place during cardiac arrest. How frequently should ventilations be given? - โ๏ธ Every 6-8 Seconds 8-10 BPM Rationale: The latest AHA guidelines recommend one ventilation every six seconds, or 10 per minute, when an advanced airway is in place. You are using a bag-valve mask to resuscitate an infant, while another rescuer is performing chest compressions. What is the correct ratio of chest compressions to ventilations? - โ๏ธ 15 chest compressions to 2 ventilations Rationale: The AHA suggests that during a pediatric resuscitation with two or more rescuers present, the correct ratio of chest compressions to ventilations is 15:2. You are alone performing infant CPR. What is the correct ratio of chest compressions to ventilations? - โ๏ธ 30 chest compressions to 2 ventilations Rationale: The AHA suggests that during a pediatric resuscitation with only one rescuer present, the correct ratio of chest compressions to ventilations is 30:2. A 7 month old appears to be unconscious and not breathing. You check for a pulse at the ________ artery. - โ๏ธ Brachial Rationale: Rescuers should use the brachial artery in the upper arm to check for a pulse. The artery is easily palpable in infants and young children. A clear sign of upper airway obstruction is: - โ๏ธ A "whistling" sound during breathing Rationale: A "whistling" sound during breathing usually indicates stridor. Crying suggests full lung function, as does breath sounds in all lung fields. Decreased inspiratory effort is a non-specific sign, but may reflect a central process (i.e. consequence of head trauma).
In children, which of the following is the most common form of arrest? - โ๏ธ Respiratory arrest Rationale: Respiratory distress, failure, and arrest are the most common conditions prompting PALS care. In fact, most cases of pediatric cardiac arrest are preceded by respiratory issues. In small children, a rescue breath should be given: - โ๏ธ Over one second Rationale: Rescue breaths and ventilations should be delivered over one second, regardless of the patient's age. What is the normal range of heart rates for an 8-year-old child? - โ๏ธ Answer: 60-140 per minute (The ACLS test I took says this. This is most likely a older ACLS test. According to 2015 Handbook of Emergency Cardiovascular Care it says for a school-age child the rate is 75-118.) Rationale: Normal vital sign values change as children age. It is important to know what "normal" is for the age of your patient. The child you are caring for is very pale. You know that this pallor can be caused by all of the following EXCEPT: A) Anemia B) Heat C) Shock D) Albinism - โ๏ธ Heat Rationale: Heat generally causes skin flushing and capillary dilation, which makes the skin red/pink. The other conditions result in pale skin. Anemia and shock are due to decreased blood flow through skin capillaries. Albinism is due to a congenital lack of skin pigment. Clinical signs of respiratory distress may include all of the following EXCEPT: A) Rapid respiratory rate B) Grunting respirations C) Warm, pink skin D) Diminished level of consciousness - โ๏ธ Warm, pink skin Rationale: Grunting respirations, rapid respiratory rate, and a diminished level of consciousness are signs of respiratory compromise. Warm, pink skin would not normally occur during the course of respiratory distress. Late and ominous signs of respiratory failure include all of the following EXCEPT: A) Rapid respiratory rate B) Cyanosis
Rationale: These are all important goals of shock management in children. Untreated shock may lead to cardiopulmonary failure, decreased blood perfusion, decreased oxygen delivery to the tissues, and organ damage. When evaluating a child's bradycardia, it is important to consider the child's: A) Baseline rate B) Level of activity C) Clinical condition D) All of the above - โ๏ธ All of the above Rationale: An abnormally slow heart rate must be evaluated in the context of the child's current condition. Is the child sleeping? What is her normal heart rate, i.e., is this slow for her? Most importantly, is the bradycardia causing symptoms or is it likely to cause symptoms imminently? For asystole, the team should do CPR until IV or IO access is achieved. The drug of choice for asystole is: - โ๏ธ Epinephrine Rationale: Epinephrine is the drug of choice for the treatment of asystole. In school age children and infants, the two most common initial rhythms seen in pediatric cardiac arrest are: - โ๏ธ Asystole and PEA Rationale: While cardiac arrest in children is usually preceded by respiratory distress and failure, the two most common, immediate causes of cardiac arrest in children are asystole and PEA. What is the correct depth of chest compressions in an adult? - โ๏ธ Between 2 and 2.4 inches Rationale: Previous guidelines had recommended a depth of at least 2 inches. This was based on the concept that rescuers tend to be too shallow, rather than too deep with their compressions. However, pressing too deeply is not good, either. So the recommendation is 2 to 2.4 inches or 5 to 6 centimeters. A victim probably has a neck injury. What is the correct way to open the airway? - โ๏ธ Jaw thrust Rationale: A head tilt-chin lift is effective in opening the patient's airway, but may put stress on an unstable cervical spine. In a suspected neck injury, a jaw thrust without bending the victim's neck is preferable. How long should a pulse check last? - โ๏ธ No more than 10 seconds
Rationale: If you cannot feel a pulse, how long do you spend making sure you didn't just miss it? The AHA provides an answer: 10 seconds. If you haven't felt a pulse in 10 seconds, stop searching and start rescuing. Where should you check for a pulse in an adult? - โ๏ธ Carotid artery Rationale: The most reliable and AHA-recommended place to check for a pulse in an adult is the carotid artery. Where should you check for a pulse in an infant? - โ๏ธ Brachial Artery Rationale: The most efficient and AHA-recommended place to check for a pulse in an infant is the brachial artery. A child is gasping for breath but has a pulse rate of 100 per minute. The rescuers should: - โ๏ธ Give 1 breath every 3 to 5 seconds Rationale: This child needs rescue breathing, not chest compressions. The correct rate for pediatric rescue breathing is 1 ventilation every 3 to 5 seconds. This equates to 12-20 breaths per minute. A child is not breathing but has a pulse rate of 50 per minute. The rescuers should: - โ๏ธ Start CPR beginning with compressions Rationale: A pulse rate <60 bpm is consistent with cardiac arrest in children. Therefore, CPR is required, starting with chest compressions. A 50-year-old man who has been eating steak in a restaurant abruptly stands up and grabs his neck. The rescuer determines that the victim is choking. The best response is to: - โ๏ธ Use abdominal thrusts Rationale: Abdominal thrusts, also known as the Heimlich maneuver, are the preferred way to dislodge a foreign object from an adult's airway. An infant who had been choking becomes unresponsive. The rescuer should: - โ๏ธ Begin CPR Rationale: Back blows, chest thrusts, or abdominal thrusts are not to be used if the chocking victim becomes unconscious. Instead, CPR should begin immediately. Efforts to relieve choking should be stopped when: A) The obstruction is removed B) The victim becomes unresponsive C) The victim begins breathing normally D) Any of the above occurs - โ๏ธ Any of the above occurs
C) Central venous oxygen saturation D) All of the above - โ๏ธ All of the above Rationale: All of these measures can inform providers about the quality of CPR. The quantitative waveform capnography goal is at least 10 mm Hg during CPR. Arterial diastolic blood pressure should be at least 20 mm Hg during CPR. Central venous oxygen saturation as measured by a Swan-Ganz catheter or equivalent should be at least 30%. Narrow-complex supraventricular tachycardia is best treated with: - โ๏ธ Adenosine Rationale: The main drug treatment for narrow QRS complex SVT is adenosine. The other drugs are used in ACLS under different circumstances. Pulseless electrical activity is treated with _______? - โ๏ธ Epinephrine Rationale: Epinephrine is the standard treatment for PEA. Unsynchronized cardioversion is not recommended because PEA is not considered a "shockable" rhythm. The correct sequence for basic life support is: - โ๏ธ CAB - Compressions, Airway, Breathing. Rationale: While ABC is easier to remember, the proper sequence for basic life support is now CAB; Compressions (circulation), Airway, Breathing. Which of the following is the correct initial dose of adenosine for the treatment of supraventricular tachycardia? - โ๏ธ 6 mg IV Rationale: The first dosage of adenosine is 6 mg IV. If 6 mg fails to achieve an effect, the subsequent dosage is 12 mg IV. At what heart rate does tachycardia usually become symptomatic? - โ๏ธ 150 BPM Rationale: While it depends on the patient, a useful rule of thumb is tachycardia starts to become symptomatic at 150 bpm. The textbook definition of tachycardia is a heart rate >100 bpm. Sinus bradycardia Rationale: There is a P wave at an appropriate length of time before a normal QRS complex during each heartbeat. The only apparent anomaly is that the rate is very slow. - โ๏ธ You are the paramedic on an ambulance transporting a 65-year-old female. The patient is connected to the monitor and you see this rhythm; she has a palpable pulse. What is the rhythm? True or False: Pulse checks should be done for at least 10 seconds. - โ๏ธ False
Rationale: They should be done for no more than 10 seconds. True or False: The initial recommended dosage of atropine for symptomatic bradycardia is 0.5 mg IV. - โ๏ธ True Rationale: Dosages less than 0.5 mg may cause a paradoxical slowing of the heart rate. During cardiopulmonary resuscitation, deliver oxygen at: - โ๏ธ 100% Rationale: CPR is performed during cardiac arrest and 100% oxygen should be administered during cardiac arrest. The goal for initiation of fibrinolytic therapy in appropriate stroke patients is: - โ๏ธ Within 1 hour of arrival to the ED. Rationale: All diagnostic testing and checklists should be performed so that a fibrinolytic drug can be infused within 1 hour of arriving to the emergency department. The window from symptom onset is different (3 hours in most, 4.5 hours in some). The most common reversible causes of PEA are called the "H's and T's" and include all of the following EXCEPT: A) Hypovolemia B) Hypoxia C) Hypocalcemia D) Tamponade - โ๏ธ Hypocalcemia Rationale: Hypocalcemia is not a common cause of PEA, nor is it part of the H's and T's mnemonic. An EMT discovers STEMI on a 12-lead ECG in the ambulance. The best option is to: - โ๏ธ Take the patient to a hospital capable of providing PCI, 15 minutes away. Rationale: PCI is the preferred treatment for STEMI. So much so, patients should be preferentially taken to hospitals that offer the procedure, even if it takes a slightly longer time. During travel time, the accepting hospital should activate the cardiac catheterization team. Which of the following signs is NOT part of the Cincinnati Prehospital Stroke Scale? A) Facial droop B) Arm drift C) Speech abnormality D) Confusion or disorientation - โ๏ธ Confusion or disorientation Rationale: The Cincinnati Prehospital Stroke Scale can be remembered by the acronym FAST: Facial droop, Arm drift, Speech abnormality (slurring, usually), and Time. Time is not a symptom.
If you are using a biphasic defibrillator, but are unsure of the appropriate starting energy setting, you should set the defibrillator to: - โ๏ธ 200 J. Treatment for a patient with bradycardia and significantly compromised cardiac output includes - โ๏ธ transcutaneous cardiac pacing. You and your partner arrive at the scene of an unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patient's wife tells you that he collapsed about 10 minutes ago. You should: - โ๏ธ initiate CPR as your partner applies the defibrillator pads. You have applied the cardiac monitor to your 66-year-old male cardiac arrest patient and see what appears to be asystole. You should: - โ๏ธ assess another lead or increase the gain sensitivity. The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is: - โ๏ธ transcutaneous pacing. Common causes of cardiac arrest include all of the following, EXCEPT: - โ๏ธ hyperglycemia. Think H & Ts A 56-year-old man presents with an acute onset of chest pressure and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should:
- โ๏ธ administer supplemental oxygen. A patient is considered a potential candidate for fibrinolytic therapy if he or she has experienced chest discomfort for: - โ๏ธ less than 12 hours. You receive a call to a skilled nursing facility for an elderly man with generalized weakness. The patient's nurse tells you that he has not eaten anything in the past 18 hours. She presents you with his chart, which states that he has a history of atrial fibrillation, congestive heart failure, and hypertension. His medications include Vasotec, digoxin, and warfarin. As you apply the cardiac monitor, your partner takes the patient's vital signs, which reveal a blood pressure of 136/76 mm Hg, a rapid and irregular pulse, and respirations of 22 breaths/min. The ECG reveals atrial fibrillation with a variable rate between 110 and 130 beats/min, and a 12-lead ECG tracing reveals the same. After applying supplemental oxygen, you should: - โ๏ธ start an IV line set to keep the vein open, administer diltiazem, and transport. Regardless of the patient's presenting cardiac arrest rhythm, the first IV or IO drug that should be given is: - โ๏ธ a vasopressor. Which of the following actions should NOT occur while CPR is in progress? - โ๏ธ Cardiac rhythm assessment
A 70-year-old woman remains in asystole following 10 minutes of well-coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to: - โ๏ธ seriously consider ceasing resuscitative efforts. After administering 40 units of vasopressin to an elderly woman in bradycardic pulseless electrical activity, you should: - โ๏ธ continue CPR and flush the IV line with 20 mL of normal saline. Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia? - โ๏ธ Aberrant conduction. QRS Width. Myocardial ischemia occurs when the heart muscle: - โ๏ธ is deprived of oxygen because of a blocked artery. The preferred antiarrhythmic medication and initial dose for a patient with refractory ventricular fibrillation or pulseless ventricular tachycardia is: - โ๏ธ amiodarone, 300 mg. You and an EMT are performing CPR on an elderly woman in cardiac arrest and your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should: - โ๏ธ perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min. A 33-year-old woman presents with an acute onset of "fluttering" in her chest. She is conscious and alert but is somewhat anxious. She denies any significant medical problems but states that she has been under a lot of stress at work. You apply the cardiac monitor, which reveals a narrow QRS complex tachycardia at a rate of 170 beats/min. The patient's blood pressure is 140/90 mm Hg, and she is breathing without difficulty. The MOST appropriate treatment for this patient involves: - โ๏ธ oxygen, IV access, vagal maneuvers, and 6 mg of adenosine. Which of the following pulseless rhythms is NOT treated as pulseless electrical activity? - โ๏ธ Ventricular tachycardia You have just performed synchronized cardioversion on a patient with unstable ventricular tachycardia. Upon reassessment, you note that the patient is unresponsive, apneic, and pulseless. You should: - โ๏ธ ensure that the synchronizer is off, defibrillate, and immediately begin CPR. When assessing an anxious patient who presents with tachycardia, you must: - โ๏ธ determine if the tachycardia is causing hemodynamic instability. You are performing CPR on an 80-year-old woman whose cardiac arrest was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a bag-mask device are producing adequate chest rise. IV access has been obtained and 1 mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rate of 70 beats/min. According to the patient's husband, she has had numerous episodes of diarrhea over the
- Active peptic ulcer
- Current use of anticoagulants: the higher the INR, the higher the risk of bleeding. Source: 2015 handbook of emergency cardiovascular care You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to: - โ๏ธ resume CPR at once. A 68-year-old woman presents with an acute onset of confusion, shortness of breath, and diaphoresis. Her blood pressure is 72/50 mm Hg, her heart rate is slow and weak, and her respirations are increased and shallow. The ECG reveals a third-degree heart block at a rate of 38 beats/min. After placing the patient on high-flow oxygen, you should: - โ๏ธ immediately attempt transcutaneous pacing. A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient? - โ๏ธ Adenosine This is still in a Sinus Tachycardia range. What is the approximate maximum dose of lidocaine for a 200-pound patient? - โ๏ธ 275 mg. Max dose for Lidocaine is 3mg/kg. 200 lbs convert to kg is roughly 91 kg. 91ร3 is 273. Assuming this answer was rounded up. If a patient remains comatose following return of spontaneous circulation, you should: - โ๏ธ provide mild hyperventilation.
