Answers to Charting and Assessment ACLS Practice Questions

1) The intrinsic pacemaker rate of ventricular cells is
        d) less than 40 beats per minute.

2) Paroxysmal atrial tachycardia is characterized by a heart rate
        c) between 150 and 250 beats per minute.

3) First degree AV block is characterized by
        c) delayed conduction, producing a prolonged PR interval.

4) A rhythm called a wandering pacemaker has
        b) changes in the p wave from one beat to the next.

5) A Wencheback rhythm has a
        b) progressively longer PRI with an eventual blocked QRS. 

6) C) Torsades do pointes is the rhythm that originates in the ventricles.

7) The pain of angina is mainly produced by c) myocardial ischemia.

8) To ensure proper delivery of the shock when performing
        synchronized cardioversion the electrical impulse cannot be
        b) discharged on the T wave. For further information
        check page 94 of the Advanced Cardiovascular Life Support
        Provider Manual by the American Heart Association (ACLSPM).

9) Cardiogenic shock is pump failure that primarily occurs as a result of
        b) left ventricular failure.

10) During CPR on an adult the chest is compressed
        c) 1 1/2 to 2 inches. For more information check
        page 4 of the BLS for Healthcare Providers Student Manual by
        the American Heart Association.

11) 5 cycles of CPR consist of
        d) 30 compressions to two breaths. For more information
        see page 120 ACLSPM.

12) The sequence in the basic life support (BLS) primary survey is:
        d) Activate EMS, check breathing, give two rescue breaths,
        check pulse, start CPR. For more information see page 20
        and 21 ACLSPM.

13) To ensure the best possible chance for your patient to survive
        an arrest the resuscitation team should ensure that
        c) interruptions in CPR are minimized. For more information
        see page 43 ACLSPM.

14) The ACLS secondary survey is composed of the following:
        b) Assess airway, assess breathing, insert an advanced
        airway if needed, confirm proper placement, assess
        rhythm, start IV, treat abnormal rhythm. For more
        information see page 22 and 23 ACLSPM.

15) The rate of rescue breathing for an adult is
        a) 1 breath every 5 to 6 seconds or 10 to 12 breaths per
        minute. For more information see page 23 ACLSPM.



16) The most common cause of airway obstruction is
        b) the tongue. For more information see page 24 ACLSPM.

17) You open the airway of a suspected neck injury patient by
        performing the b) jaw thrust maneuver. For more information
        see page 24 ACLSPM.

18)  An OPA is an a) oropharyngeal airway. For more information
        see page 22 ACLSPM.

19) A) A nasopharyngeal airway provides an airway between the nares
        and the pharynx. For more information see page 28 ACLSPM.

20) Immediately after delivering a shock you should have a team member
        c) resume CPR, beginning with chest compressions. For more
        information see page 46 ACLSPM.

21) The initial energy level for the treatment of ventricular
        tachycardia when using a biphasic defibrillator is
        b) 200 J. For more information see page 44 ACLSPM.

22) The preferred routes for drug administration are the
        a) intravenous (IV) or intraosseous (IO) routes. For more
        information see page 47 ACLSPM.

23) The statement that is true is that
        a) drugs given by the ET route need to be 2 to 2 1/2 times greater
        than the IV dose. For more information see page 48 ACLSPM.

24) C) Amiodarone cannot be given by the endotracheal route. Remember
        the neumonic NAVEL. Narcan, atropine, vasopressin, epinephrine,
        lidocaine. For more information see page 48 ACLSPM.

25) The statement about vasopressin that is not true is that
        d) the dose of vasopressin is 40 mg. For more information
        see page 49 ACLSPM.

26) The dose of Amiodarone that is given in ventricular fibrillation is
        c) 300mg IV or IO, followed by 150 mg in 3 to 5 minutes. For
        more information see page 49 ACLSPM.

27) The better treatment for ventricular fibrillation is
        a) shock, epinephrine, shock, Amiodarone, shock, magnesium.
        For more information see page 42 ACLSPM.

28) After the patient is recessitated you should
        c) start an IV infusion of the antiarrhythmic that was
        successful in converting the rhythm. For more information
        see page 50 ACLSPM.

29) The maximum 24 hour dose of Amiodarone is
        c) 2.2 g. For more information see page 50 ACLSPM.

30) The maximum dose of lidocaine is
        b) 3 mg/kg. For more information see page 51 ACLSPM.

31) When you see a flat line on the monitor you should not
        d) record the rhythm as flat line. For more information see
        page 60 ACLSPM.

32) After administering one shock and two minutes of CRP you should
        b) check the rhythm. For more information see page 46 ACLSPM.

33) The first dose of lidocaine used in the treatment of ventricular
        fibrillation is d) 1 to 1.5 mg/kg/min. For more information
        see page 51 ACLSPM.

34) The dose of magnesium for the treatment of ventricular fibrillation is
        a) 1 to 2 g in 10 ml. IV or IO over 2 minutes. For more
        information see page 50 ACLSPM.

35) The electrolyte abnormalities that often coexist with magnesium
        deficiency are a) Hypokalemia and hypocalcemia. 

36) You administer drugs for the treatment of ventricular fibrillation
        d) after the first shock and before or after the following
        shocks. For more information see page 46 ACLSPM.

37) The initial dose of atropine for the treatment of asystole is
        b) 1 mg. and repeat in 3 to 5 minutes if no response. For
        more information see page 62 ACLSPM.

38)  The better treatment for asystole is
        c) CPR, IV, epinephrine, atropine. For more information see
        page 54 ACLSPM.

39) ROSC is a) return of Spontaneous Circulation. For more information
        see page 1 ACLSPM.

40) A) Exercise is not considered a contributing factor to an arrest.
        For more information see page 56 and 57 ACLSPM.

41) The first treatment for hypotension is
        b) administer a bolus of normal saline. For more information
        see page 58 ACLSPM.

42) The signs and symptoms of an unstable patient are
        d) report of chest pain, or shortness of breath, or the patient
        has hypotension. For more information see page 82 and 88 ACLSPM.

43) The two most common causes of PEA are
        c) hypovolemia and hypoxia. For more information see page 59 ACLSPM.

44) MACE is all of the following except
        d) unstable cardiac rhythms. For more information see page 67 ACLSPM.
        
45) D) Atherosclerosis is not a potential cause of chest pain.
        For more information see page 69 ACLSPM.

46) C) Morphine does not produce arteriolar dilation. For more
        information see page 72 ACLSPM.

47) STEMI is c) ST elevation of >1mm in 2 or more leads or new LBBB.
        For more information see page 75 ACLSPM.

48)  The initial assessment of a patient with ischemic chest discomfort
        is composed of a) oxygen, monitor, vital signs. For more
        information see page 71 ACLSPM.

49) NSTEMI is b) ST segment depression of 0.5mm or greater or T wave
        inversion with discomfort. For more information see page 75 ACLSPM.

50) Unstable angina (US) is a) ST deviation <0.5 mm or T wave inversion
        of 2mm or less. For more information see page 75 ACLSPM.

51) The agents used in the medical management of ischemic chest pain are
        b) Oxygen, aspirin, nitroglycerine, morphine. For more information
        see page 74 ACLSPM.

52) The candidate for fibrolytic therapy is
        a) > 1mm ST segment elevation. For more information see
        page 76 ACLSPM.

53) You assess the pulse in the asystole algorithm
        a) Just prior to calling the arrest and after IV, epinephrine
        and atropine treatment if there is electrical activity. For more
        information see page 54 and 63 ACLSPM.

54) Resuscitation efforts are implemented for
        b) 20 minutes. For more information see page 64 ACLSPM.

55) Prolonged resuscitation efforts may be indicated for patients who
        d) Are hypothermic or overdosed on drugs. For more information
        see page 64 ACLSPM.

56) Classification of acute coronary syndromes is based on
        b) the ECG. For more information see page 73 ACLSPM.

57) Patients are instructed to chew an aspirin if
        a) they have no allergy to aspirin. For more information see
        page 71 ACLSPM.

58) Nitroglycerin can be safely administered to a patient with
        d) congestive heart failure.
        For more information see page 72 ACLSPM.

59) The infusion rate of epinephrine is
        a) 2 to 10 mcg/min. For more information see page 83 ACLSPM. 

60) The infusion rate of dopamine is a) 2 to 10 mcg/kg/min.
        For more information see page 83 ACLSPM.

61) The patient you need to be cautious of giving atropine to is
        d) A patient with Mobitz type II block. For more information
        see page 84 ACLSPM.

62) You should c) administer pain medication and sedation before you pace
        a semicontious patient. For more information see page 84 ACLSPM.

63) D) An extremely hairy chest is not considered a precaution for
        transcautaneous pacing. For more information see page 85 ACLSPM.

64) B) Oxygen is not considered an adjunctive treatment for a heart attack
        victim. For more information see page 77 ACLSPM.

65) C) Heart rate > 60 beats/min. is not considered a bradycardia rhythm.
        For more information see page 79 ACLSPM.

66) B) an occasional PVC is not a sign of an unstable patient. For more
        information see page 81 ACLSPM.

67) The better treatment for bradycardia is
        c) support airway and breathing, start IV, give atropine while
        awaiting pacemaker. For more information see page 81 ACLSPM.

68) A) A septic patient that is not tachycardic is considered to be a
        relative bradycardia. For more information see page 82 ACLSPM.

69) B) The shakes is not a sign or symptom of unstable bradycardia. For
        more information see page 82 ACLSPM.

70) Transcautaneous pacing should not be started
        a) on a patient with a 1st degree block.
        For more information see page 83 ACLSPM.

71) When pacing is still not available or a symptomatic bradycardia is
        unresponsive to atropine you should c) start a dopamine drip at
        2 to 10mcg/kg/min. For more information see page 86 ACLSPM.

72) C) The heart rate is greater than 100 beats per minute is not
        considered unstable tachycardia. For more information see
        page 88 ACLSPM.

73) The heart has to beat a) greater than 150 beats per minute to cause
        unstable tachycardia. For more information see page 88 ACLSPM.

74) The best treatment for a narrow regular tachycardia is
        b) Vagal maneuvers, adenosine. For more info. see page 91 ACLSPM.
        

75) D) Amiodarone is not an AV nodal blocking agent. For more
        information see page 91 ACLSPM.

76) When a stable tachycardic patient becomes unstable you perform
        c) immediate cardioversion. For more information see page 91 ACLSPM.

77) The best treatment for a wide tachycardia is
        a) support airway, breathing and circulation. Then give Amiodarone.
        For more information see page 91 ACLSPM.

78) If the patient has a wide-complex tachycardia and then becomes
        unstable a) assume the rhythm is ventricular tachycardia (VT)
        until proven otherwise. For more information see page 92 ACLSPM.

79) Synchronized cardioversion is where the defibrillator c) discharges
        on the QRS. For more information see page 93 ACLSPM.

80) The treatment for stable monomorphic ventricular tachycardia is
        a) an initial shock of 100 J. For more info. see page 92 ACLSPM.

81) D) Low energy shocks is not a potential problem with synchronization.
        For more information see page 93 ACLSPM.

82) C) Atrial flutter or SVT can be cardioverted at 50 J dose. For more
        information see page 95 ACLSPM.

83) D) A patient with a heart rate of 130 beats per minute at rest is not a
        patient with a compensatory tachycardia. For more information see
        page 96 and 97 ACLSPM.

84) The treatment for stable tachycardia is c) obtain IV access, get a
        12 lead ECG, consult a cardiologist. For more information see
        page 100 ACLSPM.

85) Ischemic stroke is b) caused by an arterial occlusion. For more
        information see page 104 ACLSPM.

86) The treatment for hemorrhagic stroke is
        c) support airway, breathing and circulation and consult a
        neurosurgeon. For more information see page 106 ACLSPM.

87) Arrival in the emergency department to admission into the hospital
        of 6 hours is not a goal of stroke care. For more information
        see page 105 ACLSPM.

88) D) A headache that gets better after treatment with Tylenol is not
        a sign of a stroke. For more information see page 107 ACLSPM.

89) D) Central line placement is not a contraindication to administration
        of tPA. For more information see page 107 ACLSPM.

90) Fibrinolytic therapy needs to be started within
        c) 12 hours for the MI patient and 3 hours for the stroke patient.
        For more information see page 76 and 113 ACLSPM.

91) Anticoagulants and antiplatelets may be administered to a patient who
        has received tPA for stroke b) After 24 hours. For more
        information see page 114 ACLSPM.

92) D) The Systolic blood pressure > 180 mmHg and diastolic blood
        pressure > 110 mmHg  before it is considered a contraindication
        to tPA. For more information see page 116 and 117 ACLSPM.

93) A) Labetalol, sodium nitroprusside, and nicardipine are the
        medications used to treat hypertension in the stroke patient.
        For more information see page 116 ACLSPM.

94) A) 10 mg IV over 2 minutes is the dose of Labetalol for the
        treatment of hypertension. For more information see page 117 ACLSPM.

95) The maximum dose of Labetalol is a) 300 mg. For more information
        see page 116 ACLSPM.

96) The drip rate for Labetalol is
        c) 2 to 8 mg/min. For more information see page 117 ACLSPM.

97) The IV drip range for nicardipine is a) 5 to 15 mg/hr. For more
        information see page 117 ACLSPM.

98) The sodium nitroprusside drip rate should be started at
        a) 0.5 mcg/kg/min. For more information see page 116 ACLSPM.

99) The a) valsalva maneuver or carotid sinus massage are considered
        vagal maneuvers. For more information see page 101 ACLSPM.

100) If the patient does not respond to vagal maneuvers you
        d) prepare to administer 6 mg of adenosine. For more
        information see page 101 ACLSPM.

101) State the ABCD of the ACLS secondary survey.

        Airway: Maintain a patent airway and use an advanced airway
        management if needed.
        Breathing: Give supplementary oxygen and assess adequacy of
        ventilation.
        Circulation: Obtain IV/IO access. Assess rhythm and treat
        with appropriate drugs.
        Differential diagnosis: Search for, find, and treat reversible
        causes.

        For more information see page 9 and 10 ACLSPM.

102) Name the T's in the differential diagnosis of an arrhythmia.

        Toxins
        Tamponade (cardiac)
        Tension pneumothorax
        Thrombosis (coronary or pulmonary)
        Trauma

        For more information see page 55 and 57 ACLSPM.

103) Name the H's in the differential diagnosis of an arrhythmia.

        Hypovolemia
        Hypoxia
        Hydrogen ion
        Hyer-/hypokalemia
        Hypoglycemia
        Hypothermia

        For more information see page 55 and 56 ACLSPM.

104) State the key questions in the tachycardia algorithm?

        Are symptoms present or absent?
        Is the patient stable or unstable?
        Is the QRS narrow or wide?
        Is the rhythm regular or irregular?

        For more information see page 90 ACLSPM.

105) State the links in the stroke chain of survival. 

        Rapid recognition and reaction to stroke warning signs. 
        Rapid EMS dispatch. 
        Rapid EMS system transport and prearrival notification
        to the receiving hospital.
        Rapid diagnosis and treatment in the hospital. 

        For more information see page 104 ACLSPM.

106) State the 7 D's of stroke care.

        Detection of the onset of signs and symptoms of stroke.
        Dispatch of EMS (by telephoning 911 or the
        emergency response number).
        Delivery with advanced prehospital notification to a hospital
        capable of providing acute stroke care.
        Door to ED, including arrival and urgent triage in the ED.
        Data, including computed tomography (CT) scan and interpretation
        of the scan.
        Decision regarding treatment, including fibrinolytics.
        Drug administration (as appropriate) and postadministration
        monitoring.

        For more information see page 105 ACLSPM.

107) Name the three physical findings named in the Cincinnati pre-
        hospital stroke scale 

        1) Facial droop: Have the patient smile or try to show his teeth.
        2) Arm weakness: Have the patient close his eyes and hold both
        arms out.
        3) Abnormal speech: Have the patient say "You can't teach an old
        dog new tricks".

        For more information see page 108 ACLSPM.

108) State the steps in the initial emergency department assessment
        and stabilization of the stroke patient.

        Assess ABC’s and evaluate baseline vital signs.
        Provide oxygen.
        Establish an IV access and draw blood for blood count, and
        coagulation studies.
        Check the blood glucose and promptly treat hypoglycemia.
        Perform a neurologic assessment.
        Activate the stroke team or consult a stroke expert.
        Order a CT scan of the brain.
        Obtain a 12 lead ECG.

        For more information see page 111 and 112 ACLSPM.