ACLS Practice Questions 1) What is the intrinsic pacemaker rate of ventricular cells? a) Greater than 80 beats per minute. b) 60 to 80 beats per minute. c) 40 to 60 beats per minute. d) Less than 40 beats per minute. 2) Paroxysmal atrial tachycardia is characterized by a heart rate of. a) Of 100 beats per minute. b) Between 100 and 150 beats per minute. c) Between 150 and 250 beats per minute. d) Greater than 250 beats per minute. 3) First degree AV block is characterized by a) A variable heart rate usually less than 60 beats per minute. b) An irregular rhythm. c) Delayed conduction, producing a prolonged PR interval. d) P waves hidden within the QRS complex. 4) What is a wandering pacemaker? a) An ectopic beat that originates in the atria. b) There are changes in the p wave from one beat to the next. c) There can be no change in the PRI interval. d) Conduction through the ventricles is abnormal. 5) Which statement about Wenckebach is true? a) The R to R interval is regular. b) Progressively longer PRI with eventual blocked QRS. c) The PRI is constant with an eventual blocked QRS. d) There is not a discernable pattern to the rhythm. 6) Which of the following rhythms originate in the ventricles? a) Atrial flutter. b) Junctional tachycardia. c) Torsades de pointes. d) Wandering pacemaker. 7) The pain of angina pectoris is primarily produced by a) Coronary vasoconstriction. b) Movement of thromboemboli. c) Myocardial ischemia. d) The presence of atheromas. 8) To ensure proper delivery of the shock when performing synchronized cardioversion you should do all of the following except. a) Announce to the team members: “Charging defibrillator, stand clear”. b) The electrical impulse should be discharged on the T wave. c) You need to press the synch button and look for markers on the R wave. d) You will need to reactivate the synch mode after delivery of each synchronized shock if you intend to deliver another synchronized shock. 9) Cardiogenic shock is pump failure that primarily occurs as a result of a) Coronary artery stenosis b) Left ventricular failure. c) Myocardial ischemia. d) Right atrial fibrillation. 10) During CPR on an adult the chest is compressed. a) 2 inches. b) 2 to 2 1/2 inches. c) 1 1/2 to 2 inches. d) 1 1/2 to 2 1/2 inches. 11) What does 5 cycles of CPR consist of? a) 15 compressions to two breaths. b) 15 compressions to one breath. c) 30 compressions to one breath. d) 30 compressions to two breaths. 12) What is the sequence in the basic life support (BLS) primary survey? a) Check pulse, start CPR, assess reparations, start rescue breathing and activate EMS. b) Open the airway, start rescue breathing, check heart rhythm, provide shocks as indicated. c) Open the airway, assess breathing, give rescue breaths, check pulse, start CPR. d) Activate EMS, check breathing, give two rescue breaths, check pulse, start CPR. 13) To ensure the best possible chance for your patient to survive an arrest the resuscitation team should ensure that: a) Family members are not present during the resuscitation effort. b) Every attempt is made to check for signs of life. c) Interruptions in CPR are minimized. d) The team follows the ACLS guidelines perfectly. 14) What is the ACLS secondary survey composed of? a) Assess airway, assess oxygenation, confirm circulation, start an IV. b) Assess airway, assess breathing, insert an advanced airway if needed, confirm proper placement, assess rhythm, start IV, treat abnormal rhythm. c) Assess airway, assess pulse, treat arrhythmia, confirm proper placement of an advanced airway, start IV, give fluids if needed. d) Assess airway, intubate, insert a central line, shock patient. 15) What is the rate of rescue breathing for an adult? a) 1 breath every 5 to 6 seconds or 10 to 12 breaths per minute. b) 2 breaths to every 30 compressions. c) 1 breath every 6 seconds or 14 breaths per minute. d) 12 to 16 breaths per minute. 16) What is the most common cause of airway obstruction? a) Food getting stuck in the esophagus. b) The tongue. c) People trying to swallow objects. d) Eating to fast and talking at the same time. 17) How do you open the airway of a suspected neck injury patient? a) Head tilt-chin lift. b) Jaw thrust maneuver. c) You do not open the airway because it will damage the spinal cord. d) You ventilate the nose instead. 18) What is an OPA? a) Oropharyngeal airway. b) Oraesphageal airway. c) Oral pharyngeal airway. d) Oral patient airway. 19) Which statement about a nasopharyngeal airway is correct? a) Provides an airway between the nares and the pharynx. b) It is called a trumpet and it is used for frequent suctioning. c) Cannot be used on a patient with an intact cough and gag reflex. d) Will not cause laryngospasm and vomiting. 20) Immediately after delivering a shock you should have a team member. a) Deliver another shock if the rhythm is still ventricular fibrillation. b) Assess the pulse. c) Resume CPR, beginning with chest compressions. d) Give appropriate drug indicated in the ACLS guidelines. 21) What is the initial energy level for the treatment of ventricular tachycardia when using a biphasic defibrillator? a) 350 J. b) 200 J. c) 120 J. d) 150 J. 22) What is the preferred route for drug administration? a) Intravenous (IV) or intraosseous (IO). b) Central line. c) Peripheral line in the anticubital space. d) IV or endotracheal (ET). 23) Which of the following statements is true? a) Drugs given by the ET route need to be 2 to 2 1/2 times greater than the IV dose. b) The ET route is preferred over the IO route for drug administration. c) Drugs do not need to be diluted when given during a cardiac arrest. d) IO access is only recommended for pediatric patients. 24) Which of the following drugs cannot be given by the endotracheal route? a) Narcan, epinephrine. b) Atropine, lidocaine. c) Amiodarone. d) Vasopressin, epinephrine. 25) Which statement about vasopressin is not true? a) Vasopressin is a nonadrenergic peripheral vasoconstrictor. b) A single dose of vasopressin may replace either the first or second dose of epinephrine. c) Vasopressors like vasopressin optimize cardiac output and blood pressure in cardiac arrest. d) The dose of vasopressin is 40 mg. 256 What is the dose of Amiodarone that is given in ventricular fibrillation? a) 150 mg IV or IO, then 300 mg in 3 to 5 minutes. b) 300 mg IV or IO, then another dose in 3 to 5 minutes. c) 300 mg IV or IO, followed by 150 mg in 3 to 5 minutes. d) 150 mg IV or IO, followed by another 150 mg in 3 to 5 minutes. 27) Which of the following is the better treatment for ventricular fibrillation? a) Shock, shock, epinephrine, lidocaine, magnesium. b) Shock, epinephrine, shock, Amiodarone, shock, magnesium. c) Shock, vasopressin, magnesium, Amiodarone. d) Shock, start IV, intubate, insert foley catheter, epinephrine. 28) After the patient is recessitated you should do this first. a) Inform the family. b) Order a wet-stat chest radiograph to confirm endotracheal tube placement. c) Start an IV infusion of the antiarrhythmic that was successful in converting the rhythm. d) Clean up the room and chart. 29) What is considered the maximum 24 hour dose of Amiodarone? a) 2 g. b) 1.5 g. c) 2.2 g. d) 2.5 g. 30) What is the maximum dose for lidocaine? a) 2 mg/kg. b) 3 mg/kg. c) 4 mg/kg d) 1.5 mg/kg. 31) When you see a flat line on the monitor you should do all of the following except: a) Change leads to validate asystole. b) Check that all the leads are in their proper place. c) Check that the amplitude is not turned down. d) Record the rhythm as flat line. 32) What do you do after administering one shock and two minutes of CRP? a) Check the pulse. b) Check the rhythm. c) Check for breathing d) Check that CPR is performed correctly. 33) What is the first dose of lidocaine used in the treatment of ventricular fibrillation? a) 0.5 to 0.75 mg/kg/min. b) 2 mg/kg/min. c) 1 to 2 g. d) 1 to 1.5 mg/kg/min. 34) What is the dose of magnesium for the treatment of ventricular fibrillation? a) 1 to 2 g in 10 ml. IV or IO over 2 minutes. b) 1 to 2 g in 10 ml. IV or IO over 20 minutes. c) 1 to 2 g in 50 ml. IV over 30 minutes. d) 1 to 2 g in 10 ml. IV or IO every 3 to 5 minutes. 35) What electrolyte abnormalities often coexist with magnesium deficiency? a) Hypokalemia and hypocalcemia. b) Hyperkalemia and hyponatremia. c) Hypercalcemia and hyperkalemia. d) Hypocalcemia and hypernatremia. 36) When do you administer drugs for the treatment of ventricular fibrillation? a) After the second shock. b) After each shock. c) Before you shock the patient. d) After the first shock and before or after the following shocks. 37) What is the initial dose of atropine for the treatment of asystole? a) 3 mg. b) 1 mg. And repeat in 3 to 5 minutes if no response. c) 0.5 mg. d) 1 to 2 mg. 38) Which is the better treatment for asystole? a) CPR, IV, intubate, epinephrine, pace. b) CPR, IV, epinephrine or vasopressin, pace. c) CPR, IV, epinephrine, atropine. d) CPR, IO, intubate, epinephrine, defibrillate or pace. 39) What is ROSC? a) Return of Spontaneous Circulation. b) Review of Stroke Scale. c) Reevaluation of Sudden Confusion. d) Report of Observance of Standards and Codes. 40) Which of the following is not a contributing factor to an arrest. a) Exercise. b) Taking doubling the prescription dose. c) Developing a pneumothorax. d) Being the passenger in a motor vehicle accident. 41) What is considered the first treatment for hypotension? a) Start a low dose dopamine infusion. b) Administer a bolus of normal saline. c) Administer a vasoconstrictor by the IV route. d) Stop all blood pressure medication. 42) What are the signs and symptoms of an unstable patient? a) A patient who complains all of the time. b) A patient who demonstrates tachycardia, fever, and sweats. c) A patient who reports pain. d) A patient who reports chest pain, or shortness of breath, or has hypotension. 43) What are the two most common causes of PEA? a) Hypothermia and hypoxia. b) Hypovolemia and thrombosis. c) Hypovolemia and hypoxia. d) Hypothermia and aneurysm. 44) MACE is all of the following except. a) Death or nonfatal MI. b) Urgent revascularization. c) Major adverse cardiac events. d) Unstable cardiac rhythms. 45) Which of the following is not a potential cause of chest pain? a) Aortic dissection. b) Pulmonary embolism. c) Pericardial effusion. d) Atherosclerosis. 46) All of the following are effects of morphine except. a) Decreases catecholamine release. b) Produces venodilation. c) Produces arteriolar dilation. d) Decreases systemic vascular resistance. 47) What is STEMI? a) ST deviation <0.5 mm or T wave inversion of 2mm or less. b) ST segment depression of 0.5mm or greater or T wave inversion with discomfort. c) ST elevation of >1mm in 2 or more leads or new LBBB. d) ST elevation of 20 minutes or less. 48) What is the initial assessment of a patient with ischemic chest discomfort composed of? a) Oxygen, monitor, vital signs. b) Morphine, nitroglycerine, aspirin, and oxygen. c) Vital signs, oxygen, IV. d) Vital signs, complete history, call physician. 49) What is NSTEMI? a) ST deviation <0.5 mm or T wave inversion of 2mm or less. b) ST segment depression of 0.5mm or greater or T wave inversion with discomfort. c) ST elevation of >1mm in 2 or more leads or new LBBB. d) ST elevation of 20 minutes or less. 50) What is unstable angina (US)? a) ST deviation <0.5 mm or T wave inversion of 2mm or less. b) ST segment depression of 0.5mm or greater or T wave inversion with discomfort. c) ST elevation of >1mm in 2 or more leads or new LBBB. d) ST elevation of 20 minutes or less. 51) What are the agents used in the medical management of ischemic chest pain? a) Stop and make the patient rest. b) Oxygen, aspirin, nitroglycerine, morphine. c) Serial ECG, CPK and troponin. d) Reperfusion therapy. 52) Of the following, who is a candidate for fibrolytic therapy? a) > 1mm ST segment elevation. b) Onset of symptoms was 14 hours ago. c) Onset of symptoms was yesterday. d) Inferior MI. 53) When do 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. b) Just prior to calling the arrest and after each drug. c) Just prior to calling the arrest and after placing the IV and intubating, and then after each drug. d) Just prior to calling the arrest and each time after you give epinephrine. 54) How long should the team implement resuscitation efforts? a) 30 minutes. b) 20 minutes. c) One hour. d) Until they are exhausted. 55) Prolonged resuscitation efforts may be indicated for patients who a) Have a diagnosis of terminal cancer. b) Suffered a massive MI. c) Drowned. d) Are hypothermic or overdosed on drugs. 56) Classification of acute coronary syndromes is based on a) ECG and cardiac enzymes. b) ECG. c) History. d) History and ECG. 57) Patients are instructed to chew an aspirin if a) They have no allergy to aspirin. b) They have a recent gastrointestinal bleed. c) History of gastritis or peptic ulcer. d) They are not having a heart attack. 58) Nitroglycerin can be safely administered to a patient with a) An inferior MI with RV involvement. b) Recent consumption of Viagra, Cialis or Levetra. c) Systolic blood pressure < 90 mmHg. d) Congestive heart failure. 59) What is the infusion rate of epinephrine? a) 2 to 10 mcg/min. b) 2 to 10 mcg/kg/min. c) 2 to 10 mg/min. d) 2 to 10 units/min. 60) What is the infusion rate of dopamine? a) 2 to 10 mcg/kg/min. b) 2 to 10 mg/min. c) 2 to 10 units/min. d) 2 to 10 mcg/min. 61) Which patient do you need to be cautious of giving atropine to? a) The patient who was just given benadryl. b) A patient with a second degree block. c) A patient with a pacemaker. d) A patient with Mobitz type II block. 62) What should you do before you pace a semicontious patient? a) Ensure proper placement of the pacing patches. b) Consult a cardiologist. c) Administer pain medication and sedation. d) Let the monitor technician know that you are going to pace the patient. 63) Which of the following is not a precaution for transcautaneous pacing? a) It is contraindicated in severe hypothermia. b) It is not recommended for asystole. c) Assess only the carotid pulse when confirming mechanical capture. d) An extremely hairy chest. 64) Which of the following is not considered an adjunctive treatment for a heart attack victim? a) Nitroglycerine. b) Oxygen. c) Beta-blockers. d) Angiotensin-converting enzyme inhibitors (ACE). 65) Which of the following is not considered a bradycardia rhythm? a) Second degree heart block. b) Sinus bradycardia. c) Heart rate > 60 beats/min. d) Third degree heart block. 66) Which of the following is not a sign of an unstable patient? a) Pulmonary congestion. b) Occasional PVC. c) Hypotension. d) Syncope. 67) What is the better treatment for bradycardia? a) CPR, IV, atropine, and observe the patient. b) Support airway, breathing and circulation. c) Support airway and breathing, start IV, give atropine while awaiting pacemaker. d) CPR, fluid bolus, dopamine drip, pacemaker. 68) Which of the following is considered to be a relative bradycardia? a) A septic patient that is not tachycardic. b) A patient who has had a recent MI. c) An athlete. d) A patient with a third degree heart block. 69) Which of the following is not a sign or symptom of unstable bradycardia? a) Chest pain, shortness of breath. b) The shakes. c) Weakness, fatigue. d) Decreased level of consciousness. 70) Transcautaneous pacing should be started immediately in all of the following except: a) When there is no response to atropine. b) The patient is severely symptomatic. c) The unstable patient has a 2nd degree block or 3rd degree block. d) On a patient with a 1st degree block. 71) When pacing is still not available or a symptomatic bradycardia is unresponsive to atropine you should: a) Start a dopamine drip at 10 to 20mcg/kg/min. b) Start an epinephrine drip at 2 to 20mcg/min. c) Start a dopamine drip at 2 to 10mcg/kg/min. d) Start an epinephrine drip at 5mcg/min. 72) Which of the following is not considered unstable tachycardia? a) The heart is beating so fast that the cardiac output is reduced. b) Patient reports chest pain, and shortness of breath. c) Heart rate is greater than 100 beats per minute. d) The heart is beating ineffectively. 73) How fast does the heart have to beat to cause unstable tachycardia? a) Greater than 150 beats per minute. b) Greater than 100 beats per minute. c) Greater than 200 beats per minute. d) Depends on the speed of the atria. 74) Of the following, what is the best treatment for a narrow regular tachycardia? a) Diltiazem drip. b) Vagal maneuvers, adenosine. c) Amiodarone bolus and then start a drip. d) Loading doses of digoxin. 75) Which of the following is not an AV nodal blocking agent? a) Adenosine. b) Digoxin. c) Diltiazem. d) Amiodarone. 76) What do you do if a stable tachycardic patient becomes unstable? a) Obtain a 12 lead ECG. b) Consult a cardiologist. c) Immediate cardioversion. d) Get consent for cardioversion. 77) Of the following, what is the best treatment for a wide tachycardia? a) Support airway, breathing and circulation. Then give Amiodarone. b) Immediate cardioversion. c) Support airway, breathing and circulation. Then give adenosine. d) Loading dose of 1g magnesium then a magnesium drip. 78) What should you do if the patient has a wide-complex tachycardia and is unstable? a) Assume the rhythm is ventricular tachycardia (VT) until proven otherwise. b) Check for a pulse. c) Get a second opinion. d) Recheck the pulse and blood pressure. 79) What is synchronized cardioversion? a) Electrical shock is delivered when the shock button is pressed. b) A higher energy is used. c) Discharges on the QRS. d) Discharges on the T wave. 80) What is the treatment for stable monomorphic ventricular tachycardia? a) Initial shock of 100 J. b) Initial shock of 200 J. c) Synchronized shock of 350 J. d) Unsynchronized shock of 350 J. 81) Which of the following is not a potential problem with synchronization? a) The monitor sensor may be unable to identify the R wave peak. b) No synchronization available through the quick look paddles. c) Synchronization may take extra time. d) Low energy shocks are only delivered. 82) Which of the following can be cardioverted at 50 J dose? a) VT or VF. b) Stable VT. c) Atrial flutter or SVT. d) Atrial fibrillation. 83) Which of the following is not a compensatory tachycardia? a) A patient with a fever. b) A recovery room patient. c) A patient who is NPO and has diarrhea. d) A patient with a heart rate of 130 beats per minute at rest. 84) What is the treatment for stable tachycardia? a) Immediate cardioversion. b) Lidocaine 0.5 mg/kg bolus then start an infusion at 2mg/min. c) Obtain IV access, get a 12 lead ECG, consult a cardiologist. d) Give an Amiodarone 150mg bolus and start an infusion. 85) What is ischemic stroke? a) Caused by an aneurysm. b) Caused by an arterial occlusion. c) Caused by a burst blood vessel in the brain. d) Caused by medical treatment. 86) What is the treatment for hemorrhagic stroke? a) Heparin bolus and then infusion. b) Obtain a stat CT scan. c) Support airway, breathing and circulation and consult a neurosurgeon. d) Evaluation for possible fibrinolytic therapy. 87) Which of the following is not a goal of stroke care? a) General assessment within 10 minutes of arrival in the emergency department. b) CT scan performed within 25 minutes of arrival in the emergency department. c) Initiation of fibrinolytic therapy within 1 hour of arrival in the emergency department. d) Arrival in the emergency department to admission into the hospital of 6 hours. 88) Which of the following is not a sign of a stroke? a) Trouble speaking or understanding. b) Loss of balance or coordination. c) Sudden weakness or numbness. d) Headache that gets better after treatment with Tylenol. 89) Which of the following is not a contraindication to administration of tPA? a) Witnessed seizure. b) History of arteriovenous malformation. c) Platelet count <100 000/mm. d) Central line placement. 90) Fibrinolytic therapy needs to be started within what time frame? a) Within 6 hours for the MI patient and 3 hours for the stroke patient. b) Within 3 hours for the MI patient and 12 hours for the stroke patient. c) Within 12 hours for the MI patient and 3 hours for the stroke patient. d) Within 6 hours for the MI patient and 3 hours for the stroke patient. 91) When may anticoagulants or antiplatelets be administered to a patient who has received tPA for stroke treatment? a) Within one hour of administration of tPA. b) After 24 hours. c) Never. d) Within 5 hours of administration of tPA. 92) How high does the blood pressure go before it is considered a contraindication to tPA? a) Systolic blood pressure > 200 mmHg and diastolic blood pressure > 110mmHg. b) Systolic blood pressure > 210 mmHg and diastolic blood pressure > 110mmHg. c) Systolic blood pressure > 180 mmHg and diastolic blood pressure > 90mmHg. d) Systolic blood pressure > 180 mmHg and diastolic blood pressure > 110mmHg. 93) What medications are used to treat hypertension in the stroke patient? a) Labetalol, sodium nitroprusside, nicardipine. b) Beta-blockers, ACE inhibitors, nitroglycerine. c) Nitroglycerine, Labetalol, calcium channel blockers. d) ACE inhibitors, angiotensin II receptor antagonists, beta-blockers. 94) What is the dose of Labetalol for the treatment of hypertension? a) 10 mg IV over 2 minutes. b) 5 to 10 mg over 10 minutes. c) 2 mg over 2 minutes. d) 10 to 15 mg over two minutes. 95) What is the maximum dose of Labetalol? a) 300 mg. b) 500 mg. c) 200mg. d) 150 mg. 96) What is the drip rate for Labetalol? a) 5 units/hr. b) 10 mg/min. c) 2 to 8 mg/min. d) 5 to 10 mg/min. 97) What is the IV drip range for nicardipine? a) 5 to 15 mg/hr. b) 5 to 20 mg/hr. c) 2 to 10 mg/hr. d) 10 to 20 mg/hr. 98) What should the sodium nitroprusside drip rate be started at? a) 0.5 mcg/kg/min. b) 1 mcg/kg/min. c) 1.5 mcg/kg/min. d) 0.2 mcg/kg/min. 99) Which of the following are considered vagal maneuvers? a) Valsalva maneuver or carotid sinus massage. b) Valsalva maneuver. c) Carotid sinus massage. d) A deep breath. 100) What do you do if the patient does not respond to vagal maneuvers? a) Bolus with cardizem and start a cardizem drip. b) Consult a cardiologist. c) Prepare to administer 12 mg of adenosine. d) Prepare to administer 6 mg of adenosine. 101) State the ABCD of the ACLS secondary survey. A) ____________________________________________. B) ____________________________________________. C) ____________________________________________. D) ____________________________________________. 102) Name the T’s in the differential diagnosis of an arrhythmia. 1) ___________________________________________. 2) ___________________________________________. 3) ___________________________________________. 4) ___________________________________________. 5) ___________________________________________. 103) Name the H’s in the differential diagnosis of an arrhythmia. 1) _____________________________________________. 2) _____________________________________________. 3) _____________________________________________. 4) _____________________________________________. 5) _____________________________________________. 6) _____________________________________________. 104) State the key questions in the tachycardia algorithm? 1) ________________________________________. 2) ________________________________________. 3) ________________________________________. 4) ________________________________________. 105) State the links in the stroke chain of survival. 1) __________________________________. 2) __________________________________. 3) __________________________________. 4) __________________________________. 106) State the 7 D’s of stroke care. 1) _____________________. 2) _____________________. 3) _____________________. 4) _____________________. 5) _____________________. 6) _____________________. 7) _____________________. 107) Name the three physical findings named in the Cincinnati prehospital stroke scale. 1) _______________________________________________. 2) _______________________________________________. 3) _______________________________________________. 108) State the steps in the initial emergency department assessment and stabilization. 1) _____________________________________________________________. 2) _____________________________________________________________. 3) _____________________________________________________________. 4) _____________________________________________________________. 5) _____________________________________________________________. 6) _____________________________________________________________. 7) _____________________________________________________________. 8) _____________________________________________________________.