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| SF) vowntoan ACLS Exam Version A é American Heart y Associations Advanced Cardiovascular Life Support Exam Version A (50 questions) Pi mark on this exam. rd the best answer on th: iv nswer sheet. SOB. gO > You find an unresponsive patient who is not breathing. After activating the emergency response system, you determine that there is no pulse. What is your next action? Open the airway with a head tilt-chin lift. Administer epinephrine at a dose of 1 mg/kg. Deliver 2 rescue breaths each over 1 second, You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step ismost important now? PETCO, Chest x-ray obtaining ae What is the preferred method of access for epinephrine administration duringcardiac arrest in most patients? Intraosseous Endotracheal Central intravenous 4. Anactivated AED does not promptly analyze the rhythm. Whatis your next action? gO > Discontinue the resuscitation attempt. Check all AED connections and reanalyze. Rotate AED electrodes to an alternate position. ACLS Exam Version A é American Heart y Associatione 9. Which action increases the chance of successful conversion of ventricular fibrillation? Pausing chest compressions immediately after a defibrillation attempt Administering 4 quick ventilations immediately before a defibrillation attempt pa manual defibrillator —_ with sli — a nst the chest 10. Which situation BEST describes pulseless electrical activity? SOR py Asystole withouta pulse Torsades de pointes with a pulse Ventricular tachycardia with a pulse gO > 11. What is the BEST strategy for performing high-quality CPR on a patient withan advanced airway in place? Provide compressions and ventilations with a 15:2 ratio. Provide compressions and ventilations with a 30:2 ratio. Provide a i ventilation — 6 seconds — the md vowel fone 12. Three minutes after witnessing a cardiac arrest, one member of your team insertsan gOs > endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO: level of 8 mm Hg. What is the significance of this finding? The endotracheal tube is no longer in the trachea. The patient meets the criteria for termination of efforts. The team is ventilating the patient too often (hyperventilation). gO > 13. The use of quantitative capnography in intubated patients A B. measures oxygen levels at the alveoli level. C. determines inspired carbon dioxide relating to cardiac output. D. detects electrolyte abnormalities early in code management. 14. DOR > ACLS Exam Version A i American Heart ? Associatione For the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECGscreen displayed asystole, which has persisted despite 2 doses of epinephrine,a fluid bolus, and high-quality CPR. What is your next treatment? Applya transcutaneous pacemaker. Administer 1 mg of intravenous atropine. Administer 40 units of intravenous vasopressin. 15. Which isa safe and effective practice within the defibrillation sequence? A w c D. DOn > Stop chest compressions as you charge the defibrillator. Assess for the presence of a pulse immediately after the shock. Commandingly announce “clear” after you deliver the defibrillation shock. . During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, youareunsurewhether the patient hasa pulse. What is your next action? Leave and get an AED, Deliver 2 quick ventilations. Check the patient’s mouth for the presence of a foreign body. 17. What is an advantage of using hands-free detibrillation pads instead of detibrillationpaddles? A poe C. Hands-free pads deliver more energy than paddles. Hands-free = increase electrical arc. Hands-free pads have universal adaptors that can work with any machine. . What action is recommended to help minimize interruptions in chestcompressions during CPR? Perform pulse checks immediately after defibrillation. Administer 1V medications only when delivering breaths. Continue to use an AED even after the arrival of a manual defibrillator, 19. Which action is included in the BLS Survey? A gos > ACLS Exam Version A é American Heart y Associatione . Which drug and dose are recommended for the management of a_patientin refractory ventricular fibrillation? Atropine 2 mg Vasopressin 1 mg/kg Dopamine 2 mg/kg per minute 21, Whats theappropriate interval for an interruption in chest compressions? gO > 10 to 15 seconds 15 to 20 seconds Interruptions are never acceptable 22. Which of the following isa sign of effective CPR? gos } Soe > gos > A Measured urine output of 1 ml/kg per hour Patient temperature >32°C (89.6°F) Diastolic intra-arterial pressure <20 mm Hg . What is the primary purpose of a medical emergency team (MET) or rapidresponse team (RRT)? Rapidly intervening with patients admitted through emergency department triage Responding to patients during a disaster or multiple-patient situation Responding to patients after activation of the emergency response system . Which action improves the quality of chest compressions delivered during aresuscitation attempt? Observe ECG rhythm to determine depth of compressions. Do not allow the chest to fully recoil with each compression. Compress the upper half of the sternum at a rate of 150 compressions per minute. . What is the appropriate ventilation strategy for an adult in respiratory arrest witha pulse rate of 80/min? 1 breath every 3 to 4 seconds ACLS Exam Version A 26. SOF} gO > ACLS Exam Version A Ae American - Heart Associatione A patient present to the emergency department with new onset of dizziness and fatigue. On examination, the patient’s heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is95%. What is the appropriate first medication? Oxygen 12 to 15 L/min Epinephrine 0.5 mg Aspirin 160 mg chewed . A patient present to the emergency department with dizziness and shortness ofbreath with a sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneouspacemaker, What is the appropriate dose of dopamine for this patient? 2 to 10 mg/min 10 to 15 mg/min 10 to 15 meg/kg per minute . A patient has sudden onset of dizziness. The patient’s heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead I ECG is shown below: What is the next appropriate intervention? gos > Metoprolol 5 mg IV Adenosine 6 mg IV Normal saline 1 1. bolus 29. SOR py DOS ACLS Exam Version A é American Heart Association. A monitored patient in the ICU developed a sudden onset of narrow- complex tachycardia at a rate of 220/min. The patient’s blood pressure is 128/58 mm Hg,the PETCO:> is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction, The heart rate has not responded to vagal maneuvers. What is the next recommended intervention? Amiodarone 300 mg 1V push Synchronized cardioversion at 50 J Synchronized cardioversion at 200 J . You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at thistime. What should you do in this situation? Contact the patient’s family to see what they would prefer. Have the EMS crew choose an appropriate patient disposition ? Accept the ven and provide care within _ present ap si 31. Choose an appropriate indication to stop or withhold resuscitative efforts. A Sof Dow > Arrest not witnessed Patient age greater than 85 years No return of spontaneous circulation after 10 minutes of CPR . A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min,and the pulse oximetry reading is 96%. Which is the most appropriate interventionto perform next? Administer oxygen Evaluate for fibrinolytic eligibility. Administer sublingual nitroglycerin. . A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? ACLS Exam Version A a American Heart Associations 34. What is the appropriate procedure for endotracheal tube suctioning after theappropriate catheter is selected? Suction during insertion but for no longer than 30 seconds. suction the mouth and nose for no ana than 30 secon Hyperventilate before catheter insertion, and then suction during withdrawal. 35. While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, andcool, clammy skin, you see this lead 11 ECG rhythm: What is the most appropriate first intervention? A. Aspirin B. Atropine C, Lidocaine D. Nitroglycerin 36. A 68-year-old woman experienced a sudden onset of right arm weakness, EMSpersonnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, anonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading 0f97%. The lead 11 ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next? 12-lead EC! Administration of 100% su — san Administration of a low-dose aspirin a assessment. gos > 37. EMS is transporting a patient with a positive prehospital stroke assessment. Uponarrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air, The lead TI ECG displays sinus rhythm, The blood glucose level is within normal limits. What intervention should you perform next? 3. Head Cr san B. Transfer to the stroke unit ACLS Exam Version A Cc, Immediate rtPA administration D. Administration of 100% oxygen ACLS Exam Version A C. Sinus tachycardia D. NSRon monitor but no pulse ACLS Exam Version A a American Heart Associations 43. What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia? 3 mg 6mg 9 = 44, What is the usual post—cardiac arrest target range for PETCO2 when ventilatinga gos > patient who achieves return of spontaneous circulation (ROSC)? 30 to 35 mm Hg 40 to 45 mm Hg 45 to 50 mm Hg DOn > 45. Which condition is a contraindication to therapeutic hypothermia during the post— cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? Tnitial rhythm of asystole Patient age greater than 60 years Desire to provide coronary reperfusion (eg, PCT) goon > 46. What is the potential danger of using ties that pass circumferentially around thepatient’s neck when securing an advanced airway? A. May interfere with effective ventilation B. Places the patient’s cervical spine at risk Cc. Obstruction of venous revarn frova the brain D. Does not adequately secure the airway device 47. What is the most reliable method of confirming and monitoring correctplacement of an endotracheal tube? 5-pointauscultation Colorimetric sat ho Use of esophageal detection devices gos p 48. What is the recommended IV fluid (normal saline or Ringer’s lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period? ACLS Exam Version A é American Heart Associatione 49. What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? §. 90mm Bg B. 85mm Hg C. 80mm Hg D, 75mm Hg 50. Whatis the first treatment priority fora patient who achieves ROSC? Coronary reperfusion Therapeutic hypothermia oS Maintaining blood glucose <185 mg/dL 9 ACLS Exam Version A 
