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ACLS Practice Test 1 1.
You auscultate the chest after endotracheal intubation. No breath sounds are heard. The endotracheal tube is most likely a. in the left mainstem bronchus. b. in the right mainstem bronchus. c. wedged against the carina. d. in the esophagus.
2.
What What is the the usu usual al targ target et range range for for end endt tid idal al !"2 #$%T!"2& when 'entilating a patient following card(ac arrest and return of spontaneous circulation #)"*!&+ a. ,- to , mm g b. , to 0- mm g c. 0- to 0 mm g d. 0 to - mm g
,.
Which Which of the rhythm rhythmss below below reui reuires res emerg emergency ency synchr synchroni onied ed cardi cardio'e o'ersi rsion+ on+ a. N*) on the monitor but no pulse. b. *table atrial fibrillation. fibrillation. c. *inus tachycardia. d. 3nst 3nstab able le sup supra ra'e 'ent ntri ricu cula larr tach tachy ycard cardia ia..
0.
Which of the following is in'ol'ed in the treatment of $%4+ a. 4ssessing for and treating the underlying causes. b. 5mmediate defibrillation. c. 4dmi dminis nistrat tratio ion n of atr atropi opine. ne. d. Transc nscutaneous pacing.
.
4 patien patientt experi experienc ences es sudde sudden n onset onset of of light lighthea headedn dedness ess and palp palpita itatio tions. ns. 6$ is 1--/ 1--/7-8 7-8 respirations 2- breaths/min8 and pulse oximetry 97: on room air. air. ;ead 55 %!< is shown below. below. What next inter'ention would be most appropriate+
a. b. c. d.
Normal sa saline bo bolus. 4denosine 7 mg 5= push followed immediately by a rapid normal saline saline flush. >etoprolol mg 5= o'er 1 minute. ?itiaem 2- mg 5= o'er 2 minutes. 1
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7.
5n the the defibr defibrill illati ation on seuen seuence8 ce8 which which of of the foll followi owing ng is a safe safe and and effec effecti' ti'ee practic practice+ e+ a. Anno Announ unce ce cle clear ar aft after er you you del deliv iver er the the ele elect ctri ricc shoc shock. k. b. Asse Assess ss for for a pul pulse se imme immedi diat atel ely y aft after er the the sho shock ck.. c. Ensure Ensure the there re is no no oxygen oxygen bei being ng blown blown ove overr he patie patient' nt'ss chest chest durin during g the shoc shock. k. d. Stop Stop che chest st com compre pressi ssions ons while while char chargi ging ng the the defi defibri brilla llato torr.
@.
Which Which of the the follow following ing is is an indic indicati ation on for for gastri gastricc la'age la'age in pati patient entss who ha'e ha'e inges ingested ted a toxi toxin n or who ha'e o'erdosed on drugs+ a. !omatose patients. b. "'erdose of opioids taken 2 hours ago. c. 4ny 4ny let letha hall dose dose rega regard rdle less ss of elap elapse sed d tim time. e. d. Within 1 hour of in inges gestion.
A.
)egardi )egarding ng defib defibril rillat lation ion88 which which actio action n incre increase asess the the likel likeliho ihood od of succes success+ s+ a. $ro'iding uality chest compressions immediately before defibrillation. b. 3sing paddles with light pressure against the chest. c. 4dmi 4dmini nist ster erin ing g 'enti 'entila lati tions ons Bus Bustt prio priorr to defi defibr bril illa lati tion on.. d. $ausing chest compressions right after defibrillation.
9.
*upport *upporti'e i'e therapy therapy for all suspect suspected ed stroke stroke patien patients ts includ includesC esC a. 4dministration of antihypertensi'es. b. >aintenance of airway and adeuate oxygenation. c. Dibrinolytic the therapy. d. *ur *urgica gicall cli clipp ppin ing g of of an an ane aneur ury ysm. sm.
1-.
4fter about minutes minutes of of !$)8 the %!< %!< monitor monitor shows shows the the rhythm rhythm below below.. No pulse pulse is detectable. detectable. 5= access has been established and bagmask 'e ntilation is being performed with 1--: oxygen. Which of the following should be the next step+
a. b. c. d.
Nore Norepi pine neph phri rine ne -.-.-2 2 to to -.2 -.2 mcg/ mcg/kg kg/m /min in 5= infu infusi sion on.. %pinephrine 1 mg 5= push. 5nsert ert an an ad ad'anced ai airway. ay. 4tropine -. -. mg mg 5= 5= push.
11. 11. 6;* includ includes es whic which h of the follow following ing++ a. Therapeutic hypothermia. b. 4dministration of 'asopressors. c. 4d'anced airway. d. %arly def defibrillation.
2
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12.
4n acti'at acti'ated ed 4%? does not promptly promptly analye analye the rhythm. rhythm. What is your next action+ action+ a. Turn the 4%? off wait ,- seconds then turn the 4%? on again. b. 4wait the arri'al of emergency medical ser'ices. c. !heck all 4%? connections and reanalye. d. )otate 4%? electrodes to an alternate position.
1,.
4 patient patient presents presents with with shortnes shortnesss of breath8 breath8 lighth lightheadedne eadedness8 ss8 and sinus sinus bradycar bradycardia dia at 02 beats/minute. 4n initial dose of atropine -. mg 5= was ineffecti'e. ineffecti'e. You do not ha'e transcutaneous pacing capability. capability. Which of the following is a reasonable next step+ a. %pi %pineph nephrrine ine 2 to 11- mcg mcg/m /min in 5=. b. 4miodarone 1- mg 5=. 5=. c. >g*"0 2 g 5=. d. 4denosine 7 mg 5=.
10.
What is is the recommended recommended second second dose dose of adenosine adenosine for patients patients in in refractory refractory but stable stable narrow narrow complex tachycardia+ a. , mg b. 7 mg c. 9 mg d. 12 mg
1.
4 pregnan pregnantt pati patient ent in cardia cardiacc arres arrestt shoul shouldC dC a. be slightly tilted to the left or ha'e her uterus displaced to the left8 or both. b. ha'e her head raised ,- degrees. c. not be defibrillated. d. be kept kept supi supine ne dur durin ing g che chest st com compres pressi sion ons. s.
17.
Dor a patien patientt experienci experiencing ng =D or pulseles pulselesss =T8 =T8 an alterna alternati'e ti'e drug drug to epinephr epinephrine ine isC isC a. lidocaine b. amiodarone. c. 'asopressin. d. atropine.
1@.
Which one of the followi following ng stateme statements nts regardi regarding ng bagmas bagmask k 'entilati 'entilation on is false+ false+ a. 5n adult adults8 s8 bagm bagmask ask de'ic de'ices es usual usually ly pro'i pro'ide de less less 'enti 'entilat latory ory 'olum 'olumee than mout mouthto htom mask ask 'entilation. b. 5deal features of a bagmask de'ice include a selfexpanding bag8 popoff 'al'e8 and transparent mask. c. Two peopl peoplee operati operating ng the the bagm bagmask ask de'i de'ice8 ce8 one one to hold hold the the mask mask to the the patie patientE ntEss face face and the other to sueee the bag8 is likely more effecti'e than one person op erating the de'ice. d. 4 bagmas bagmask k de'ice de'ice may be be used used with with a mask8 mask8 endo endotra trachea cheall tube8 tube8 or or any any other other ad'ance ad'anced d airway.
,
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1A.
4n unresponsi'e8 unresponsi'e8 pulseless patient is recei'ing effecti'e chest compressions and bagmask bagmask 'entilations. ?efibrillator pads are applied and the rhythm below is displayed. The next step should beC
a. b. c. d.
star startt an an 5= 5= and and gi'e gi'e epin epinep ephr hrin inee 1 mg mg 5= 5=. start an 5= and gi'e amiodarone ,-- mg 5=. 5=. synchronous cardio'ersion starting at 1-- B. defi defibr briillati lation on at 2-2-- B bi biphas phasiic.
19.
The correct seuence of actions in 6;* isC a. !heck for unresponsi'eness8 open airway8 airway8 gi'e 2 breaths8 check for pulse8 start !$). b. !heck for unresponsi'eness8 acti'ate emergency ser'ices8 get 4%?8 check pulse for to 1seconds8 if no definite pulse start chest compressions8 gi'e 2 ' entilations after e'ery ,compressions8 utilie 4%? as soon as possible. c. !heck !heck for for unresp unresponsi onsi'en 'eness ess88 open open airway airway88 gi'e 2 brea breaths ths88 check check for for pulse8 pulse8 star startt !$) checking for pulse e'ery minute. d. !heck !heck for for unresp unresponsi onsi'en 'eness ess88 acti'a acti'ate te emer emergenc gency y ser'ic ser'ices8 es8 check check puls pulsee for ,,- seconds seconds88 if no definite pulse start chest compressions8 gi'e 2 'entilations after e'ery ,- compressions.
2-.
4 7yearol 7yearold d woman woman presents presents with se'ere se'ere chest pain8 shortn shortness ess of breath8 breath8 nausea8 nausea8 and diaphoresis. *he smoked 1 pack/day for the last last 0- years. *he took 4*4 ,2 mg at home. home. You are gi'ing her oxygen and her saturation is 9A:. 4 cardiac cardiac monitor is attached and an 5= started. er 6$ is 1-/908 pulse 928 respirations respirations 20. Which of the following is most appropriate at this time+ a. "btain a 12lead %!< to confirm the diagnosis before gi'ing any medications. b.
21.
4ll of of the foll followi owing ng are indi indicat cators ors of effec effecti ti'e 'e !$)8 !$)8 except exceptCC a. endtidal !"2 #$%T!"2& F 1- mm g. b. diastolic 6$ F 2- mm g. c. chest chest comp compres ressio sions ns G cm #2 #2 inche inches&8 s&8 allowi allowing ng for for compl complete ete ches chestt recoi recoil8 l8 and and at a rate rate of A- compressions/min. d. minim minimii iing ng the the number number of of inter interrup ruptio tions ns in !$)8 !$)8 with with each inte interru rrupti ption on H 1- seco seconds nds..
0
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22.
What is is the minim minimum um systolic systolic blood blood pressure pressure one one should should attempt attempt to achie'e achie'e with with fluid8 fluid8 inotropes inotropes88 or 'asopressors in a postcardiac arrest patient who achie'es )"*!+ a. 9- mm g b. A mm g c. A- mm g d. @ mm g
2,.
What is is the recomme recommended nded 5= fluid fluid #normal #normal saline saline or )ingerE )ingerEss lactate& lactate& bolus bolus dose for for a patient patient who achie'es )"*! but is hypotensi'e during the postcardiac arrest period+ a. 2- to -- m; b. -- to 18--- m; c. 1 to 2 ; d. 2 to , ;
20.
What is is the most reliable reliable method method of confirmi confirming ng and monitor monitoring ing correct correct placem placement ent of an endotracheal tube+ a. point auscultation b. !olorimetric capnography c. !ontinuous wa'eform capnography d. 3se of esophageal detection de'ices
2.
What is is the potentia potentiall danger of using using ties that pass pass circumfe circumferenti rentially ally around around the patien patientEs tEs neck neck when securing an ad'anced airway+ a. >ay >ay int inter erfe fere re wit with h effe effect cti' i'ee 'ent 'entil ilat atio ion n b. $laces the patientEs cer'ical spine at risk c. "bst "bstru ruct ctio ion n of 'eno 'enous us retu return rn fro from m the the bra brain in d. ?oes ?oes not not ade adeua uate tely ly sec secur uree the the airw airway ay de' de'ic icee
27.
Which conditi condition on is a contrai contraindicat ndication ion to therapeu therapeutic tic hypother hypothermia mia during during the post postcardi cardiac ac arrest arrest period for patients who achie'e return of spontaneous circulation #)"*!&+ a. 5nit nitial rhy rhytthm of of as asystole ole b. )esponding to 'erbal commands c. $ati $atien entt age age grea greate terr tha than n 77- yea yearrs d. ?esi ?esire re to pro' pro'id idee cor corona onary ry repe reperf rfus usio ion n #e. #e.g. g. $!5& $!5&
2@.
Which Which rhyt rhythm hm reui reuires res synchr synchroni onied ed card cardio' io'ers ersion ion++ a. 3nst 3nstab able le supr supra' a'en entr tric icul ular ar tach tachy ycard cardia ia b. 4trial fibrillation fibrillation c *inus tachycardia d. N*) on monitor but no puls ulse
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2A.
What is is the initial initial priority priority for an an unconscious unconscious patient patient with with any type type of tachycardia tachycardia on on the monitor+ a. )e'iew the patientEs home medications. b. %'aluate the breath sounds. c. ?ete ?eterm rmin inee whe wheth ther er puls pulses es are are pres presen ent. t. d. 4dminister sedati'e drugs.
29.
You are e'aluating e'aluating a 0Ayearol 0Ayearold d man with with crushi crushing ng subster substernal nal chest chest pain. pain. The patient patient is is pale8 pale8 diaphoretic8 cool to the touch8 and slow to respond to your uestions. The blood pressure is A/,2 mm g8 the heart hea rt rate is 19-/min8 the respiratory rate is 1A breaths/min8 and the pulse oximeter is unable to obtain a reading because there is no radial radial pulse. The lead 55 %!< displays displays a regular widecomplex tachycardia. What inter'ention should you perform next+ a. $rocedural *edation b. 12lead %!< c. 4mi 4miodar odaron onee 11- mg 5= 5= o'e o'err 11- min minut utes es d. *ync *ynchr hron oniied ed card cardiio'er o'ersi sion on
,-.
What is is the proper proper 'entila 'entilation tion rate rate for a patient patient in cardiac cardiac arrest arrest who has an ad'anced ad'anced airway airway in place+ a. 0 to 7 breaths per minute b. A to 1- breaths per minute c. 12 to 10 breaths per per minut nute d. 17 to 1A br breaths per per minut nute
,1.
%>* is transporti transporting ng a patient patient with with a positi positi'e 'e prehospit prehospital al stroke stroke assess assessment. ment. 3pon arri'al arri'al in the the emergency department8 the initial blood pressure is 1,A/@A mm g8 the pulse rate is A-/min8 the respiratory rate is 12 breaths/min8 and the pulse oximetry reading is 9: on room air. air. The lead 55 %!< displays sinus sinus rhythm. The blood glucose le'el le'el is within within normal limits. limits. What inter'ention should you perform next+ a. ead !T scan b. Transfer to to the stroke unit c. 5mmedi mediat atee t$4 t$4 adm admiinist nistra rati tion on d. 4dmi dminis nistrat tratio ion n of of 1--: 1--: oxy oxygen gen
,2.
!hoose an appropriate indication to stop or withhold resuscitati'e efforts. a. 4rrest no not wi witnessed b. %'idence of rigor mortis c. $ati $atien entt age age grea greate terr tha than n A A yea yearrs d. No ret retur urn n of spon sponta tane neou ouss circ circul ulat atio ion n afte afterr 1- min minut utes es of of !$) !$)
7
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,,.
While treating treating a patient patient with with diiness diinessII a blood blood pressure pressure of 7A/,- mm mm gI and cool8 cool8 clammy clammy skinI skinI you see this lead 55 %!< rhythmC
What is the most appropriate first inter'ention+ a. 4spirin b. 4tropine c. 4miodarone d. Nitroglycerin ,0.
What is is the appropri appropriate ate procedure procedure for endotrac endotracheal heal tube tube suctioning suctioning after after the the appropriat appropriatee catheter catheter is selected+ a. *uct *uctio ion n duri during ng ins inser erti tion on but but for for no long longer er tha than n ,- seco second nds. s. b. *uction the mouth and nose for no longer than ,- seconds. c. *uct *uctio ion n duri during ng wit withd hdra rawa wall but but for for no lon longe gerr than than 11- seco seconds nds.. d. yper' yper'ent entila ilate te befor beforee cathet catheter er inser insertio tion8 n8 and then then sucti suction on during during with withdra drawal wal..
,.
The a. b. c. d.
,7.
Dor the the past 2 minutes8 minutes8 an %>* crew has has attempt attempted ed resuscit resuscitation ation of a patient patient who origina originally lly presented in 'entricular fibrillation. 4fter the first shock8 the %!< screen displayed displayed asystole8 which has persisted despite despite 2 doses of epinephrine8 a fluid fluid bolus8 and highuality !$). What is your next treatment+ a. 4pply pply a tr transc anscut utan aneo eous us pac pacem emak aker er.. b. 4dminister -. mg of intra'enous atropine. c. 4dmi 4dmini nist ster er ,-,-- mg mg of int intra ra'e 'eno nous us ami amiod odar aron one. e. d. !onsi !onsider der term termina inatin ting g resusci resuscitat tati'e i'e effor efforts ts after after cons consult ulting ing medi medical cal contr control. ol.
,@.
What is is the preferr preferred ed method method of access access for for epinephrin epinephrinee administr administration ation during during cardiac cardiac arres arrestt in most patients+ a. 5ntraosseous b. %ndotracheal c. !entral in intra'enous d. $eripheral intra'enous
use use of uantitati uantitati'e 'e capnography capnography in intubat intubated ed patients patients who are are undergoi undergoing ng !$) !$) allo allows ws for for mon monit itor orin ing g of of !$) !$) ual ualit ity y. measures oxygen le'els at the al'eoli le'el. dete determ rmin ines es insp inspir ired ed carb carbon on diox dioxid idee relat relatin ing g to cardi cardiac ac outp output ut.. dete detect ctss elect electro roly lyte te abno abnorm rmal alit itie iess early early in cod codee manage manageme ment nt..
@
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,A.
You are e'aluating a Ayearold man with with chest pain. The blood blood pressure is 92/- mm g8 the heart rate is 92/min8 the respiratory rate is 10 breaths/min and nonlabored8 and the pulse oximetry reading is 9@: on room air. air. What assessment step is most most important now+ a. $%T!"2 b. !hest xray c. ;aboratory testing d. 12lead %!<
,9.
Which action increases the chance of successful con'ersion of 'entricular fibrillation+ a. $ausin $ausing g chest chest compres compressio sions ns immedi immediate ately ly after after a defib defibril rillat lation ion attemp attemptt b. 4dministering 0 uick 'entilations immediately before a defibrillation defibrillation attempt c. 3sing 3sing manua manuall defib defibril rillat lator or paddl paddles es wit with h light light pressu pressure re agai against nst the chest chest d. $ro'id $ro'iding ing uality uality compre compressi ssions ons imm immedia ediatel tely y befor beforee a defi defibri brilla llati tion on attem attempt pt
0-.
4 patient patient in respirator respiratory y failure failure becomes becomes apneic apneic but continues continues to to ha'e a strong strong pulse. The heart heart rate is dropping rapidly and now shows a sinus bradycardia bradycardia at a rate of ,-/min. ,-/min. What inter'ention has the highest priority+ a. 4tropine 5= -. mg mg 5= b. *imple airway maneu'ers and assisted 'entilation c. 4ppl 4pplic icat atio ion n of a tra trans nscu cuta tane neou ouss pac pacem emak aker er d. %pinephrine 1 mg 5=
01.
What is is the primar primary y purpose purpose of a medical medical emer emergency gency team team #>%T& #>%T& or rapid rapid response response team team #))T&+ #))T&+ a. 5den 5denti tify fyin ing g and and tre treat atin ing g earl early y cli clini nica call det deter erio iora rati tion on b. )apidly inter'ening with patients admitted through emergency department triage c. )esp )espon ondi ding ng to to pat patie ient ntss duri during ng a disa disast ster er or mult multip iple lepa pati tien entt sit situa uati tion on d. )esp )espon ondi ding ng to to pati patien ents ts aft after er acti acti'at 'atio ion n of the the emer emerge gency ncy resp respons onsee syst system em
02.
Which sign indicat indicates es the need for for intubati intubation on in a patient patient ha'ing ha'ing an asthmat asthmatic ic attack+ attack+ a. Wheeing b. !onfusion c. ?ecreased $a $a!"2 d. Tachycardia
0,.
4 yearol yearold d woman8 woman8 with a histo history ry of depress depression8 ion8 is is brought brought to the the %? by her her husband husband because because of sudden onset of lightheadedness. *he is alert and oriented and denies chest pain. *he admits to taking Jtoo muchK of her tricyclic tricyclic antidepressant. er carotid pulse is about 1- beats/min and weak. 6$ is is 92/7,. 4 cardiac monitor shows the rhythm below. below. Which pharmacotherapy should should be administered immediately+
A
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a. b. c. d.
>g *"0 1 to 2 g 5= bolus >g *"0 1 to 2 g 5= o'er to 7- minutes 4mi 4miodar odaron onee 11- mg 5= 5= o'e o'err 11- mi minut nutes %pin %pinep ephr hrin inee 1 mg 5= e'er e'ery y , to min minut utes es
00.
Which Which rhyt rhythm hm may may be be misd misdiag iagnos nosed ed as as asy asysto stole+ le+ a. !omplete 4= block b. *inus bradycardia c. Dine =D d. $%4
0.
6efore 6efore deciding deciding to administ administer er fibrinoly fibrinolytic tic therapy therapy to a patien patientt with chest chest pain8 pain8 what what should should the %!< show+ a. Twa'e in in'ersion b. *Tsegment *Tsegment depression c. *Tsegment el ele'ation d. )ight bundl ndlebra branch bl block
07.
"ne respons responsibi ibilit lity y of the 4!;* 4!;* team team leader leader isC a. moni onitori toring ng the ual ualiity of !$). !$). b. establishing an ad'anced airway. airway. c. cont contac actting ing the the pat patiientE entEss fam famil ily y. d. adm adminis nisteri ering medic edicat atiions ons.
0@.
5n $%48 $%48 the %!< %!< may may show show any any rhyt rhythm hm except except when when there there isC a. =D b. Normal sinus rhythm c. $ulseless =T d. 6oth a and c.
0A.
4 stroke stroke patient patient is being treated treated in the the emergency emergency department. department. 5n assessin assessing g and recordi recording ng the neurologic status8 which of the following scales would pro'ide the most useful clinical information for diagnosis and ongoing management+ a. N5 *troke *cale b.
09.
4 patient patient presents presents with shortness shortness of breath8 breath8 palpit palpitation ations8 s8 and lighthe lightheadednes adedness. s. 6$ is 11/A, 11/A, and pulse oximetry is 9: on room air. air. ;ead 55 %!< is shown below. below. Which of the following would not be administered+
9
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a. b. c. d. -.
4den 4denos osin inee 7 mg mg 5= push push88 if if nece necess ssar ary y repe repeat at with with 12 12 mg mg ?iltiaem 2- mg 5= o'er 2 minutes8 if necessary repeat with with 2 mg in 1 minutes >etopr >etoprolo ololl mg 5=8 5=8 if necess necessary ary repeat repeat e'ery e'ery minu minutes tes for 2 more more doses doses ?igox ?igoxin in -. -. mg mg 5=8 5=8 then then -.2 -.2 mg 5= 5= e'er e'ery y 7 hour hourss for for 2 dose dosess
?uring a code8 you you attempt attempt synchroni synchronied ed cardio'ersi cardio'ersion on for 'entri 'entricular cular tachycar tachycardia dia with with pulse in an unstable patient. *uddenly there is no pulse and the rhythm is 'entricular fibrillation. fibrillation. The defibrillator fails to deli'er another shock. Which of the following is the most likely cause+ a. %uipment ma malfunction b. The defibrillator did not sense the 'entricular fibrillation fibrillation rhythm c. The The defi defibr bril illa lato torr is in Jsy Jsync nchr hron oni ied edKK mode mode d. "ne of the pads has come of off
1-
