ACLS Pre Test Answers

Section 1: Rhythm Identification

Answers
For section 1, identify the rhythm by selecting the
single best answer.
Choose the correct option and select submit.

Sinus bradycardia

Answer: Sinus bradycardia.

Sinus tachycardia

Answer: Sinus tachycardia.

Atrial flutter

Answer: Atrial flutter.

Polymorphic ventricular tachycardia

Answer: Polymorphic ventricular tachycardia.

Supraventricular tachycardia

Answer: Supraventricular tachycardia.

Third-degree atrioventricular block
Se
cond-degree atrioventricular block (Mobitz I
Answer: Third-degree atrioventricular block.
Wenckebach)

Answer: Second-degree atrioventricular block

(Mobitz I Wenckebach).

Ventricular fibrillation

Answer: Ventricular fibrillation.

Monomorphic ventricular tachycardia

Answer: Monomorphic ventricular tachycardia.

Second-degree atrioventricular block (Mobitz II

block)
Pulseless electrical activity
Answer: Second-degree atrioventricular block
(Mobitz II block). Answer: Pulseless electrical activity.
 Agonal rhythm/asystole
Atrial fibrillation
Answer: Agonal rhythm/asystole.
Answer: Atrial fibrillation.

Sinus bradycardia Second-degree atrioventricular block (Mobitz I

Wenckebach)
Answer: Sinus bradycardia.
Answer: Second-degree atrioventricular block
(Mobitz I Wenckebach).

Ventricular fibrillation
Ve
Answer: Ventricular fibrillation. ntricular fibrillation

Answer: Ventricular fibrillation.

 Section 2: Pharmacology Answers
You are caring for a 66-year-old man with a history
of a large intracerebral hemorrhage 2 months ago.
He is being evaluated for another acute stroke. The
CT scan is negative for hemorrhage. The patient is
receiving oxygen via nasal cannula at 2 L/min, and
an IV has been established. His blood pressure is
180/100 mm Hg. Which drug do you anticipate
giving to this patient?

Supraventricular tachycardia Choose the correct option and select submit.

A. Nicardipine
Answer: Supraventricular tachycardia. B. rtPA
C. Glucose (D50)
D. Aspirin (Correct)

A patient has a rapid irregular wide-complex

tachycardia. The ventricular rate is 138/min. He is
asymptomatic, with a blood pressure of 110/70 mm
Hg. He has a history of angina. What action is
recommended next?

Choose the correct option and select submit.

A. Giving adenosine 6 mg IV bolus
B. Performing synchronized cardioversion
Second-degree atrioventricular block (Mobitz II C. Seeking expert consultation (Correct)
block) D. Giving lidocaine 1 to 1.5 mg IV bolus
Answer: Second-degree atrioventricular block.

A patient with STEMI has ongoing chest

discomfort. Heparin 4000 units IV bolus and a
heparin infusion of 1000 units per hour are being
administered. The patient did not take aspirin
because he has a history of gastritis, which was
treated 5 years ago. What is your next action?

Choose the correct option and select submit.

A. Give aspirin 162 to 325 mg to chew (Correct)
B. Give enteric-coated aspirin 75 mg orally
C. Give enteric-coated aspirin 325 mg rectally
Normal sinus rhythm D. Give clopidogrel 300 mg orally

Answer: Normal sinus rhythm.

What is the indication for the use of magnesium in Which intervention is most appropriate for the
cardiac arrest? treatment of a patient in asystole?

Choose the correct option and select submit. Choose the correct option and select submit.
A. Ventricular tachycardia associated with a normal A. Epinephrine (Correct)
QT interval B. Defibrillation
B. Shock-refractory ventricular fibrillation C. Transcutaneous pacing
C. Shock-refractory monomorphic ventricular D. Atropine
tachycardia
D. Pulseless ventricular tachycardia-associated
torsades de pointed (correct)
You arrive on the scene with the code team. High-
quality CPR is in progress. An AED has previously
advised “no shock indicated.” A rhythm check now
In which situation does bradycardia require finds asystole. After resuming high-quality
treatment? compressions, which action do you take next?

Choose the correct option and select submit. Choose the correct option and select submit.
A. Hypotension (Correct) A. Perform endotracheal intubation
B. Systolic blood pressure greater than 100 mm Hg B. Call for a pulse check
C. Diastolic blood pressure greater than 90 mm Hg C. Insert a laryngeal airway
D. 12-lead ECG showing a normal sinus rhythm D. Establish IV or IO access (Correct)

A patient is in cardiac arrest. High-quality chest A patient is in refractory ventricular fibrillation and
compressions are being given. The patient is has received multiple appropriate defibrillation
intubated, and an IV has been started. The rhythm is shocks, epinephrine 1 mg IV twice, and an initial
asystole. What is the first drug/dose to administer? dose of amiodarone 300 mg IV. The patient is
intubated. Which best describes the recommended
Choose the correct option and select submit. second dose of amiodarone for this patient?
A. Epinephrine 1 mg IV/IO (Correct)
B. Atropine 1 mg IV/IO Choose the correct option and select submit.
C. Atropine 0.5 mg IV/IO A. 1 mg/kg IV push
D. Dopamine 2 to 20 mcg/kg per minute IV/IO B. 300 mg IV push
C. 1 to 2 mg/min infusion
D. 150 mg IV push (Correct)

A patient with sinus bradycardia and a heart rate of

42/min has diaphoresis and a blood pressure of
80/60 mm Hg. What is the initial dose of atropine? A patient with possible STEMI has ongoing chest
discomfort. What is a contraindication to nitrate
Choose the correct option and select submit. administration?
A. 0.1 mg
B. 3 mg Choose the correct option and select submit.
C. 1 mg (Correct) A. Systolic blood pressure greater than 180 mm Hg
D. 0.5 mg B. Anterior wall myocardial infarction
C. Use of a phosphodiesterase inhibitor within
the previous 24 hours (Correct)
D. Heart rate less than 90/min
 C. Epinephrine 1 mg IV/IO (Correct)
D. Lidocaine 1 mg/kg IV/IO
A patient is in pulseless ventricular tachycardia.
Two shocks and 1 dose of epinephrine have been
given. Which drug should be given next?
A 62-year-old man suddenly experienced difficulty
Choose the correct option and select submit. speaking and left-sided weakness. He meets initial
A. Lidocaine 0.5 mg/kg criteria for fibrinolytic therapy, and a CT scan of the
B. Epinephrine 3 mg brain is ordered. Which best describes the
C. Adenosine 6 mg guidelines for antiplatelet and fibrinolytic therapy?
D. Amiodarone 300 mg
Choose the correct option and select submit.
A. Hold aspirin for at least 24 hours if rtPA is
administered (Correct)
A patient has sinus bradycardia with a heart rate of B. Give aspirin 162 to 325 mg to be chewed
36/min. Atropine has been administered to a total immediately
dose of 3 mg. A transcutaneous pacemaker has C. Give heparin if the CT scan is negative for
failed to capture. The patient is confused, and her hemorrhage
blood pressure is 88/56 mm Hg. Which therapy is D. Give aspirin 120 mg and clopidogrel 75 mg
now indicated? orally

Choose the correct option and select submit.

A. Normal saline 250 mL to 500 mL bolus
B. Atropine 1 mg A 57-year-old woman has palpitations, chest
C. Epinephrine 2 to 10 mcg/min (Correct) discomfort, and tachycardia. The monitor shows a
D. Adenosine 6 mg regular wide-complex QRS at a rate of 180/min.
She becomes diaphoretic, and her blood pressure is
80/60 mm Hg. Which action do you take next?

A 35-year-old woman has palpitations, light- Choose the correct option and select submit.
headedness, and a stable tachycardia. The monitor A. Perform electrical cardioversion (Correct)
shows a regular narrow-complex QRS at a rate of B. Obtain a 12-lead ECG
180/min. Vagal maneuvers have not been effective C. Seek expert consultation
in terminating the rhythm. An IV has been D. Establish IV access
established. Which drug should be administered?

Choose the correct option and select submit.

A. Epinephrine 2 to 10 mcg/kg per minute A patient is in cardiac arrest. Ventricular fibrillation
B. Atropine 0.5 mg has been refractory to an initial shock. If no
C. Lidocaine 1 mg/kg pathway for medication administration is in place,
D. Adenosine 6 mg (Correct) which method is preferred?

Choose the correct option and select submit.

A. Endotracheal tube
A patient is in cardiac arrest. Ventricular fibrillation B. External jugular vein
has been refractory to a second shock. Which drug C. IV or IO (Correct)
should be administered first? D. Central line

Choose the correct option and select submit.

A. Sodium bicarbonate 50 mEq IV/IO
B. Atropine 1 mg IV/IO
A monitored patient in the ICU developed a sudden Which action should you take immediately after
onset of narrow-complex tachycardia at a rate of providing an AED shock?
220/min. The patient’s blood pressure is 128/58 mm
Hg, the PETCO2 is 38 mm Hg, and the pulse Choose the correct option and select submit.
oximetry reading is 98%. There is vascular access in A. Start rescue breathing
the left arm, and the patient has not been given any B. Prepare to deliver a second shock
vasoactive drugs. A 12-lead ECG confirms a C. Check the pulse rate
supraventricular tachycardia with no evidence of D. Resume chest compressions (Correct)
ischemia or infarction. The heart rate has not
responded to vagal maneuvers. What is your next
action?
What is the maximum interval for pausing chest
Choose the correct option and select submit. compressions?
A. Administer amiodarone 300 mg IV push
B. Perform synchronized cardioversion at 50 J Choose the correct option and select submit.
C. Administer adenosine 6 mg IV push (Correct) A. 25 seconds
D. Perform synchronized cardioversion at 200 J B. 10 seconds (Correct)
C. 20 seconds
D. 15 seconds

A patient is in refractory ventricular fibrillation.

High-quality CPR is in progress. One dose of
epinephrine was given after the second shock. An You are providing bag-mask ventilations to a
antiarrhythmic drug was given immediately after patient in respiratory arrest. How often should you
the third shock. You are the team leader. Which provide ventilations?
medication do you order next?
Choose the correct option and select submit.
Choose the correct option and select submit. A. Every 6 seconds (Correct)
A. Epinephrine 3 mg B. Every 10 seconds
B. Epinephrine 1 mg (Correct) C. Every 14 seconds
C. Sodium bicarbonate 50 mEq D. Every 12 seconds
D. A second dose of the antiarrhythmic drug

Section 3: Practical Application

Answers What is the recommended depth of chest
compressions for an adult victim?
After initiation of CPR and 1 shock for ventricular
fibrillation, this rhythm is present on the next Choose the correct option and select submit.
rhythm check. A second shock is given, and chest A. At least 2 inches (Correct)
compressions are resumed immediately. An IV is in B. At least 1.5 inches
place, and no drugs have been given. Bag-mask C. At least 2.5 inches
ventilations are producing visible chest rise. What is D. At least 3 inches
your next intervention?

What is the recommended compression rate for

high-quality CPR?

Choose the correct option and select submit.

Answer: Give epinephrine 1 mg IV/IO.
A. 90 to 100 compression per minute
B. 100 to 120 compressions per minute (Correct)
C. 70 to 80 compressions per minute C. Reduces the risk of rib fractures
D. 50 to 20 compressions per minute D. Increases the rate of chest compressions

How often should you switch chest compressors to A patient has been resuscitated from cardiac arrest.
avoid fatigue? During post-ROSC treatment, the patient becomes
unresponsive, with the rhythm shown here. Which
Choose the correct option and select submit. action is indicated next?
A. About every 2 minutes (Correct)
B. About every 5 minutes
C. About every 4 minutes
D. About every 3 minutes

A patient’s 12-lead ECG is transmitted by the

paramedics and shows a STEMI. When the patient Answer: Give an immediate unsynchronized high-
arrives in the emergency department, the rhythm energy shock (defibrillation does).
shown here is seen on the cardiac monitor. The
patient has resolution of moderate (5/10) chest pain
after 3 doses of sublingual nitroglycerin. Blood
pressure is 104/70 mm Hg. Which intervention is A patient was in refractory ventricular fibrillation.
most important in reducing this patient’s in-hospital A third shock has just been administered. Your team
and 30-day mortality rate? looks to you for instructions. What is your next
action?

Answer: Reperfusion therapy.

Your patient is not responsive and is not breathing. Answer: Resume high-quality chest compressions
You can palpate a carotid pulse. Which action do
you take next?
You are the code team leader and arrive to find a
Choose the correct option and select submit. patient with CPR in progress. On the next rhythm
A. Apply an AED check, you see the rhythm shown here. Team
B. Start rescue breathing (Correct) members tell you that the patient was well but
C. Obtain a 12-lead ECG reported chest discomfort and then collapsed. She
D. Start an IV has no pulse or respirations. Bag-mask ventilations
are producing visible chest rise, and IO access has
been established. Which intervention would be your
How does complete chest recoil contribute to next action?
effective CPR?

Choose the correct option and select submit.

A. Reduces rescuer fatigue
B. Allows maximum blood return to the heart Answer: Epinephrine 1 mg.
(Correct)
A 35-year-old woman presents with a chief What action minimizes the risk of air entering the
complaint of palpitations. She has no chest victim’s stomach during bag-mask ventilation?
discomfort, shortness of breath, or light-headedness.
Her blood pressure is 120/78 mm Hg. Which Choose the correct option and select submit.
intervention is indicated first? A. Ventilating until you see the chest rise
(Correct)
B. Delivering the largest breath you can
C. Ventilating as quickly as you can
D. Squeezing the bag with both hands

Answer: Vagal maneuvers.
Which action is likely to cause air to enter the
victim’s stomach (gastric inflation) during bag-
mask ventilation?
You arrive on the scene to find CPR in progress.
Nursing staff report the patient was recovering from Choose the correct option and select submit.
a pulmonary embolism and suddenly collapsed. A. Giving breaths over 1 second
Two shocks have been delivered, and an IV has B. Ventilating too quickly (Correct)
been initiated. What do you administer now? C. Providing just enough volume for the chest to
rise
D. Providing a good seal between the face and the
mask

A 45-year-old woman with a history of palpitations

develops light-headedness and palpitations. She has
Answer: Epinephrine 1 mg IV. received adenosine 6 mg IV for the rhythm shown
here, without conversion of the rhythm. She is now
extremely apprehensive. Her blood pressure is
128/70 mm Hg. What is the next appropriate
Your patient is a 56-year-old woman with a history intervention?
of type 2 diabetes who reports feeling dizzy. She is
pale and diaphoretic. Her blood pressure is 80/60
mm Hg. The cardiac monitor documents the rhythm
shown here. She is receiving oxygen at 4 L/min by
nasal cannula, and an IV has been established. What
do you administer next?
Answer: Administer adenosine 12 mg IV.

A patient becomes unresponsive. You are uncertain

if a faint pulse is present. The rhythm shown here is
Answer: Atropine 1 mg IV. seen on the cardiac monitor. An IV is in place.
Which action do you take next?
Answer: Start high-quality CPR.