ACLS Pretest

Sinus Bradycardia

Please identify the rhythm by selecting the best single answer.

Reentry supraventricular tachycardia

Please identify the rhythm by selecting the best single answer.

Second-degree AV block (Mobitz II block)

Please identify the rhythm by selecting the best single answer.

Agonal rhythm/asystole

Please identify the rhythm by selecting the best single answer.

Third-Degree AV block

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Monomorphic Ventricular Tachycardia

Please identify the rhythm by selecting the best single answer.

Sinus Tachycardia

Please identify the rhythm by selecting the best single answer.

Sinus Bradycardia

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Atrial Fibrillation

Please identify the rhythm by selecting the best single answer.

Course Ventricular Fibrillation

Please identify the rhythm by selecting the best single answer.

Polymorphic Ventricular Tachycardia

Please identify the rhythm by selecting the best single answer.

Second-degree AV block (Mobitz I Wenchebach)

Please identify the rhythm by selecting the best single answer.

Normal Sinus Rhythm

Please identify the rhythm by selecting the best single answer.

Pulseless electrical activity

Please identify the rhythm by selecting the best single answer.

Course Ventricular Fibrillation

Please identify the rhythm by selecting the best single answer.

Reentry supraventricular tachycardia

Please identify the rhythm by selecting the best single answer.

Fine Ventricular Fibrillation

Please identify the rhythm by selecting the best single answer.

Atrial Flutter

Please identify the rhythm by selecting the best single answer.

Second-degree AV block (Mobitz II block)

Please identify the rhythm by selecting the best single answer.

Reentry supraventricular tachycardia

Please identify the rhythm by selecting the best single answer.

Perform immediate electrical cardioversion

A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm Hg. The next action is to:

Give normal Saline 250 mL to 500 ml fluid bolus

A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 sublingual nitroglycerin tablets. There are no contraindications, and 4 mg of morphine sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest discomfort. You should:

Amiodarone 300 mg

A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which is the next drug/dose to anticipate administering?

150 mg IV push

A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amidarone IV. The patient is intubated. A second does of amiodarone is now called for. The recommended second dose of amiodarone is

Adenosine 6 mg

A 35-year-old woman has palpitations, light-headiness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminated the rhythm. An IV has been established. What drug should be administered IV?

Seeking expert consultation

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. Which of the following actions is recommended?

Use of phosphodiesterase inhibitor within 12 hours.

A patient with possible ST-segment elevation MI has ongoing chest discomfort. Which of the following would be a contraindication to the administration of nitrates?

Start epinephrine 2 to 10 mcg/min

A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm Hg. Which of the following is now indicated?

Epinephrine 1 mg

A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Of the following, which drug and dose should be administered first by the IV/IO route?

Gain IV or IO access

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 finds asystole. After resuming high-quality compressions, your next action is to:

Give Aspirin 160 to 325 mg chewed immediately.

A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. Aspirin was taken by the patient because he had a history of gastritis treated 5 years ago. Your next action is?

Chest pain or shortness of breath is present

Bradycardia requires treatment when:

Magnesium is indicated for VF/pulseless VT associated with torsades de pointes.

Which of the following statements about the use of magnesium in cardiac arrest is most accurate?

Epinephrine 1 mg or vasopressin 40 units IV or IO

A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated, and an IV has been started. The rhythm is asystole. Which is the first drug/dose to administer?

0.5 mg

A patient has sinus bradycardia with a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?

Second dose of epinephrine 1 mg

A patient is in refractory ventricular fibrillation. High-quality CPR is in progress, and shocks have been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. What drug should the team leader request to be prepared for administration next?

Do not give aspirin for at least 24 hours if rtPA is administered

A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He was brought to the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy?

The correct dose of vasopressin is 40 units administered IV or IO.

Which of the following statements is most accurate regarding the administration of vasopressin during cardiac arrest?

IV or IO

A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR?

Lidocaine, epinephrine, vasopressin

Your patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route?

Give atropine 0.5 mg IV.

The patient suddenly becomes unconscious and has a weak carotid pulse. Cardiac monitoring, supplementary oxygen, and an IV have been initiated. The code cart with all the drugs and a transcutaneous pacer are immediately available. Next you would?

Give epinephrine 1 mg IV.

You arrive on the scene to find CPR in progress. Nursing staff report that the patient was recovering from a pulmonary embolism and suddenly collapsed. There is no pulse or spontaneous respirations. High-quality CPR and effective bag-mask ventilation are being provided. An IV has been initiated. What would you do now?

Seek expert consultation

Following resuscitation with CPR and a single shock, you observe this rhythm while preparing the patient for transport. Your patient is stable, and blood pressure is 120/80 mg Hg. She is apprehensive but has no symptoms other than palpitations. At this time you would?

Prepare to give epinephrine 1 mg IV.

Following imitation of CPR and 1 shock for VF, this rhythm is present on the next rhythm check. A second shock is give, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next order?

Continue monitoring and seek expert consultation.

A patient presents with the above rhythm and reports an irregular heartbeat. She has no other symptoms. Her medical history is significant for a myocardial infarction 7 years ago. Blood pressure is 110/70 mm Hg. What would you do at this time

Give a single shock.

You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action?

1 to 2 L of normal saline

A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is intubated and is receiving 100% oxygen. Blood pressure is 80/60 mm Hg. During the resuscitation, she received 2 doses of epinephrine 1 mg and 1 dose of aminodarone 300 mg IV. You now observe the above rhythm on the cardiac monitor. The rhythm abnormality is becoming more frequent and increasing in number. You should order:

Atropine 0.5 mg IV

You arrive on the scene to find a 56-year-old diabetic woman with dizziness. She is pale and diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm above. She is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. Your next order is:

Continue monitoring the patient and seek expert consultation.

You are evaluating a patient with chest discomfort lasting 15 minutes during transportation to the emergency department. He is receiving oxygen, and 2 sublingual nitroglycerin tablets have relieved his chest discomfort. He reports no other symptoms but appears anxious. Blood pressure is 130/70 mg Hg. You observe the above rhythm on the monitor. What is your next action?

Repeat adenosine 12 mg IV.

A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown above without conversion of the rhythm. She is now extremely apprehensive. Blood pressure is 108/70 mm Hg. What is the next appropriate intervention?

Resume high-quality chest compressions.

A patient was in refractory ventricular fibrillation. A shock has just been administered. Your team looks to you for instructions. Your immediate next order is:

Sublingual nitroglycerin 0.4 mg

A patient in the emergency department develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitored rhythm becomes irregular as seen above. Oxygen is being administered by nasal cannula at 4 L/min, and an IV line is in place. Blood pressure is 160/96 mm Hg. There are no allergies or contraindications to any medication. You would first order:

Administer adenosine 6 mg; seek expert consultation

You are monitoring a patient. He suddenly has the above persistent rhythm. You ask about symptoms, and he reports that he has mild palpitations, but otherwise he is clinically stable with unchanged vital signs. What is your next action?

Give an immediate unsynchronized high-energy shock (defibrillation dose).

This patient has been resuscitated from cardiac arrest. During the resuscitation, amiodarone 300 mg was administered. The patient developed severe chest discomfort with diaphoresis. He is now unresponsive. What is the next indicated action?

Reperfusion therapy

A patient’s 12-lead ECG was transmitted by the paramedics and showed an acute MI. The above findings are seen on a rhythm strip when a monitor is placed in the emergency department. The patient had resolution of moderate (5/10) chest pain with 3 does of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention below is most important, reducing in-hospital and 30-day mortality?

Perform vagal maneuvers

A 35-year-old woman presents to the emergency department with a chief complaint of palpations. She has no chest discomfort, shortness of breath, or light-headedness. Which of the following is indicated first?

Begin CPR, starting with high-quality chest compressions.

A patient becomes unresponsive. You are uncertain if a faint pulse is present with the above rhythm. What is your next action?

Administer epinephrine 1 mg.

You are the code team leader and arrive to find a patient with the above rhythm and CPR in progress. Team members report that the patient was well but reported chest pain and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, high-quality CPR is in progress, and an IV has been established. What would be your next order?

Give magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 5 to 20 minutes.

A patient was admitted to the general medical ward with a history of alcoholism. A code in progress, and he has recurrent episodes of the rhythm. You review his chart. Notes about the 12-lead ECG say that his baseline QT interval is high normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg and 1 dose of aminodarone 300 mg IV so far. What would you order for his next medication?

Give atropine 0.5 mg IV

You are monitoring the patient and note the above rhythm on the cardiac monitor. She has dizziness, and her blood pressure is 80/40 mm Hg. She has an IV in place. What is your next action?