ALS/ACLS - Red Cross Final Exam [2023]
__ Questions With Solutions
Section 1: Cardiac Arrest & Defibrillation (Questions 1-25)
1. A 58-year-old male is found unresponsive, pulseless, and apneic. The cardiac
monitor shows a chaotic, irregular waveform with no identifiable QRS
complexes. What is the first priority intervention?
A. Establish IV access and administer epinephrine 1 mg
B. Perform immediate defibrillation
C. Initiate transcutaneous pacing
D. Administer amiodarone 300 mg IV push
Correct Answer: B
Rationale: This patient presents with ventricular fibrillation (VF), a shockable
rhythm requiring immediate defibrillation. The ALS algorithm prioritizes early
defibrillation for VF/pulseless VT, as survival decreases by 7-10% for every minute
defibrillation is delayed. Defibrillation interrupts the chaotic electrical activity,
allowing the heart's natural pacemaker to potentially resume organized electrical
activity .
2. During cardiac arrest resuscitation, what is the correct compression-to-
ventilation ratio for a single rescuer providing CPR without an advanced airway?
A. 15 compressions to 2 ventilations
B. 30 compressions to 2 ventilations
C. 30 compressions to 1 ventilation
D. 15 compressions to 1 ventilation
Correct Answer: B
,Rationale: For adult cardiac arrest, the compression-to-ventilation ratio is 30:2 for
single rescuers and two-rescuer CPR. This ratio maximizes coronary and cerebral
perfusion by minimizing interruptions in chest compressions while providing
adequate oxygenation and ventilation. Compressions should be at least 2 inches
deep at 100-120 per minute with full recoil .
3. A patient in pulseless electrical activity (PEA) has a heart rate of 40 bpm on
the monitor but no palpable pulse. What is the appropriate management?
A. Immediate defibrillation
B. CPR, epinephrine 1 mg IV/IO every 3-5 minutes, and search for reversible
causes
C. Atropine 1 mg IV every 3 minutes to maximum 3 mg
D. Synchronized cardioversion at 100 joules
Correct Answer: B
Rationale: PEA is a non-shockable rhythm requiring high-quality CPR and
epinephrine administration while identifying and treating reversible causes.
Defibrillation is contraindicated for PEA, and atropine is not recommended for
PEA/asystole in current guidelines. The team must systematically evaluate the H's
and T's to identify the underlying cause .
4. What is the recommended initial energy setting for biphasic defibrillation in
an adult patient with ventricular fibrillation?
A. 50-100 joules
B. 100-150 joules
C. Manufacturer's recommendation (typically 120-200 joules)
D. 360 joules
Correct Answer: C
,Rationale: For biphasic defibrillators, the recommended initial energy is the
manufacturer's recommendation, which is typically 120-200 joules. If the
manufacturer's recommendation is unknown, use the maximum available energy
setting. Monophasic defibrillators should use 360 joules. Biphasic waveforms are
more effective at lower energy levels than monophasic .
5. A patient with suspected acute coronary syndromes (ACS) is placed on a
cardiac monitor. The patient is complaining of dyspnea and is given
supplemental oxygen. The provider determines that the oxygen is effective
based on which SpO2 level?
A. 88%
B. 90%
C. 95%
D. 100%
Correct Answer: C
Rationale: For patients with ACS, supplemental oxygen is titrated to maintain an
oxygen saturation of at least 90%, with a target of 90% to 98%. The 2025
guidelines emphasize avoiding hyperoxia. A SpO2 of 95% indicates effective
oxygenation within the target range .
6. A 45-year-old female presents to the resuscitation room in polymorphic
ventricular tachycardia (Torsades de Pointes). She is conscious, but her blood
pressure is 88/52 mmHg. What is the immediate intravenous pharmacologic
agent of choice?
A. Amiodarone 150 mg IV push
B. Magnesium sulfate 1 to 2 grams IV diluted over 5 to 20 minutes
C. Lidocaine 1.5 mg/kg IV push
D. Adenosine 6 mg rapid IV push
Correct Answer: B
, Rationale: Magnesium sulfate (1 to 2 grams IV) is the drug of choice for treating
Torsades de Pointes, regardless of whether the patient is in cardiac arrest or
presents with a pulse. It suppresses early afterdepolarizations that trigger this
polymorphic arrhythmia. Amiodarone and lidocaine are not first-line for Torsades,
and adenosine is contraindicated in polymorphic VT .
7. During CPR with an advanced airway in place, what is the correct ventilation
rate?
A. 1 breath every 3 seconds (20 breaths/min)
B. 1 breath every 6 seconds (10 breaths/min)
C. 2 breaths after every 30 compressions
D. 1 breath every 10 seconds (6 breaths/min)
Correct Answer: B
Rationale: Once an advanced airway (endotracheal tube or supraglottic device) is
placed during CPR, continuous chest compressions are delivered at 100-120 per
minute without pausing for ventilations. The recommended ventilation rate is 1
breath every 6 seconds (10 breaths per minute). This avoids hyperventilation,
which can increase intrathoracic pressure and decrease venous return .
8. A patient in cardiac arrest has received one shock for VF, and CPR has been
resumed. The rhythm check reveals persistent VF. What is the next appropriate
intervention?
A. Administer 1 mg epinephrine IV/IO
B. Administer amiodarone 300 mg IV/IO
C. Defibrillate again immediately
D. Check for a pulse for 30 seconds
Correct Answer: C
__ Questions With Solutions
Section 1: Cardiac Arrest & Defibrillation (Questions 1-25)
1. A 58-year-old male is found unresponsive, pulseless, and apneic. The cardiac
monitor shows a chaotic, irregular waveform with no identifiable QRS
complexes. What is the first priority intervention?
A. Establish IV access and administer epinephrine 1 mg
B. Perform immediate defibrillation
C. Initiate transcutaneous pacing
D. Administer amiodarone 300 mg IV push
Correct Answer: B
Rationale: This patient presents with ventricular fibrillation (VF), a shockable
rhythm requiring immediate defibrillation. The ALS algorithm prioritizes early
defibrillation for VF/pulseless VT, as survival decreases by 7-10% for every minute
defibrillation is delayed. Defibrillation interrupts the chaotic electrical activity,
allowing the heart's natural pacemaker to potentially resume organized electrical
activity .
2. During cardiac arrest resuscitation, what is the correct compression-to-
ventilation ratio for a single rescuer providing CPR without an advanced airway?
A. 15 compressions to 2 ventilations
B. 30 compressions to 2 ventilations
C. 30 compressions to 1 ventilation
D. 15 compressions to 1 ventilation
Correct Answer: B
,Rationale: For adult cardiac arrest, the compression-to-ventilation ratio is 30:2 for
single rescuers and two-rescuer CPR. This ratio maximizes coronary and cerebral
perfusion by minimizing interruptions in chest compressions while providing
adequate oxygenation and ventilation. Compressions should be at least 2 inches
deep at 100-120 per minute with full recoil .
3. A patient in pulseless electrical activity (PEA) has a heart rate of 40 bpm on
the monitor but no palpable pulse. What is the appropriate management?
A. Immediate defibrillation
B. CPR, epinephrine 1 mg IV/IO every 3-5 minutes, and search for reversible
causes
C. Atropine 1 mg IV every 3 minutes to maximum 3 mg
D. Synchronized cardioversion at 100 joules
Correct Answer: B
Rationale: PEA is a non-shockable rhythm requiring high-quality CPR and
epinephrine administration while identifying and treating reversible causes.
Defibrillation is contraindicated for PEA, and atropine is not recommended for
PEA/asystole in current guidelines. The team must systematically evaluate the H's
and T's to identify the underlying cause .
4. What is the recommended initial energy setting for biphasic defibrillation in
an adult patient with ventricular fibrillation?
A. 50-100 joules
B. 100-150 joules
C. Manufacturer's recommendation (typically 120-200 joules)
D. 360 joules
Correct Answer: C
,Rationale: For biphasic defibrillators, the recommended initial energy is the
manufacturer's recommendation, which is typically 120-200 joules. If the
manufacturer's recommendation is unknown, use the maximum available energy
setting. Monophasic defibrillators should use 360 joules. Biphasic waveforms are
more effective at lower energy levels than monophasic .
5. A patient with suspected acute coronary syndromes (ACS) is placed on a
cardiac monitor. The patient is complaining of dyspnea and is given
supplemental oxygen. The provider determines that the oxygen is effective
based on which SpO2 level?
A. 88%
B. 90%
C. 95%
D. 100%
Correct Answer: C
Rationale: For patients with ACS, supplemental oxygen is titrated to maintain an
oxygen saturation of at least 90%, with a target of 90% to 98%. The 2025
guidelines emphasize avoiding hyperoxia. A SpO2 of 95% indicates effective
oxygenation within the target range .
6. A 45-year-old female presents to the resuscitation room in polymorphic
ventricular tachycardia (Torsades de Pointes). She is conscious, but her blood
pressure is 88/52 mmHg. What is the immediate intravenous pharmacologic
agent of choice?
A. Amiodarone 150 mg IV push
B. Magnesium sulfate 1 to 2 grams IV diluted over 5 to 20 minutes
C. Lidocaine 1.5 mg/kg IV push
D. Adenosine 6 mg rapid IV push
Correct Answer: B
, Rationale: Magnesium sulfate (1 to 2 grams IV) is the drug of choice for treating
Torsades de Pointes, regardless of whether the patient is in cardiac arrest or
presents with a pulse. It suppresses early afterdepolarizations that trigger this
polymorphic arrhythmia. Amiodarone and lidocaine are not first-line for Torsades,
and adenosine is contraindicated in polymorphic VT .
7. During CPR with an advanced airway in place, what is the correct ventilation
rate?
A. 1 breath every 3 seconds (20 breaths/min)
B. 1 breath every 6 seconds (10 breaths/min)
C. 2 breaths after every 30 compressions
D. 1 breath every 10 seconds (6 breaths/min)
Correct Answer: B
Rationale: Once an advanced airway (endotracheal tube or supraglottic device) is
placed during CPR, continuous chest compressions are delivered at 100-120 per
minute without pausing for ventilations. The recommended ventilation rate is 1
breath every 6 seconds (10 breaths per minute). This avoids hyperventilation,
which can increase intrathoracic pressure and decrease venous return .
8. A patient in cardiac arrest has received one shock for VF, and CPR has been
resumed. The rhythm check reveals persistent VF. What is the next appropriate
intervention?
A. Administer 1 mg epinephrine IV/IO
B. Administer amiodarone 300 mg IV/IO
C. Defibrillate again immediately
D. Check for a pulse for 30 seconds
Correct Answer: C
