Basic Arrhythmia Recognition & Treatment (BART) Exam
| Practice Questions, Clinical Scenarios & Detailed
Rationale 2026/2027
QUESTION 1 What is the first-line pharmacological treatment for an
adult patient presenting with symptomatic sinus bradycardia (heart rate
< 50 beats per minute with signs of hemodynamic instability)?
A. Atropine 1 mg IV push
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV infusion
D. Epinephrine 2 mg IV push
Correct Answer: A. Atropine 1 mg IV push
Detailed Rationale: According to ACLS guidelines, Atropine is the first-
line medication for symptomatic bradycardia, administered at a dose of
1 mg IV every 3 to 5 minutes up to a maximum dose of 3 mg.
QUESTION 2 If Atropine is ineffective in treating symptomatic
bradycardia, what is the next immediate intervention recommended by
resuscitation guidelines?
A. Transcutaneous pacing, dopamine infusion, or epinephrine infusion
B. Immediate unsynchronized defibrillation at 200 Joules
C. Synchronized cardioversion at 50 Joules
D. Administration of calcium channel blockers
,Correct Answer: A. Transcutaneous pacing, dopamine infusion, or
epinephrine infusion
Detailed Rationale: When atropine fails or is contraindicated in
unstable bradycardia, second-line therapies include transcutaneous
pacing or continuous infusions of chronotropic agents like dopamine or
epinephrine.
QUESTION 3 What defines hemodynamic instability in the presence of a
tachyarrhythmia requiring immediate electrical intervention?
A. Hypotension, acutely altered mental status, signs of shock, ischemic
chest pain, or acute heart failure
B. A heart rate exceeding 100 beats per minute without any symptoms
C. Mild fatigue and anxiety during exercise
D. A regular narrow-complex rhythm at 110 beats per minute
Correct Answer: A. Hypotension, acutely altered mental status, signs of
shock, ischemic chest pain, or acute heart failure
Detailed Rationale: Hemodynamic instability indicates that the heart
rate is compromising vital organ perfusion, necessitating urgent
treatment such as synchronized cardioversion rather than medical rate
control alone.
QUESTION 4 What is the initial recommended energy dose for
synchronized cardioversion of unstable Supraventricular Tachycardia
(SVT) or Atrial Fibrillation using a biphasic defibrillator?
A. 50 to 100 Joules
B. 200 Joules fixed
,C. 10 to 20 Joules
D. 360 Joules monophasic equivalent
Correct Answer: A. 50 to 100 Joules
Detailed Rationale: Initial biphasic energy recommendations for
synchronized cardioversion of atrial fibrillation are typically 120–200 J,
while regular narrow-complex tachycardias (SVT/AFlutter) often
successfully convert at lower initial energies of 50–100 J.
QUESTION 5 What is the initial acute management step for a patient
presenting with stable, regular Narrow Complex Tachycardia (SVT)?
A. Vagal maneuvers (such as the Valsalva maneuver or carotid sinus
massage)
B. Immediate unsynchronized defibrillation
C. Transcutaneous pacing at 80 beats per minute
D. Administering a 500 mL normal saline fluid bolus alone
Correct Answer: A. Vagal maneuvers (such as the Valsalva maneuver or
carotid sinus massage)
Detailed Rationale: In stable SVT, non-pharmacological vagal
maneuvers are the initial first-line intervention to increase
parasympathetic tone and attempt to block the reentrant circuit.
QUESTION 6 What is the recommended initial dose and administration
technique for Adenosine when treating stable SVT unresponsive to
vagal maneuvers?
A. 6 mg rapid IV push followed immediately by a 20 mL normal saline
flush through a large peripheral IV site
, B. 12 mg slow IV push over 2 minutes without a flush
C. 150 mg IV infusion over 10 minutes
D. 1 mg IV push every 3 minutes
Correct Answer: A. 6 mg rapid IV push followed immediately by a 20 mL
normal saline flush through a large peripheral IV site
Detailed Rationale: Adenosine has an extremely short half-life (<10
seconds) and must be given as a rapid IV bolus directly into a proximal
site, followed immediately by a rapid saline flush to ensure it reaches
the central circulation before degrading.
QUESTION 7 If the initial 6 mg dose of Adenosine fails to convert a
stable SVT, what is the recommended second dose?
A. 12 mg rapid IV push
B. 6 mg rapid IV push repeated
C. 20 mg rapid IV push
D. 150 mg IV infusion
Correct Answer: A. 12 mg rapid IV push
Detailed Rationale: If the initial 6 mg dose of adenosine does not
terminate the SVT within 1–2 minutes, a higher dose of 12 mg rapid IV
push is administered.
QUESTION 8 What is the primary intervention for a patient in
Ventricular Fibrillation (VFib) or pulseless Ventricular Tachycardia (pVT)?
A. Immediate high-quality CPR and unsynchronized defibrillation
B. Synchronized cardioversion at 50 Joules
| Practice Questions, Clinical Scenarios & Detailed
Rationale 2026/2027
QUESTION 1 What is the first-line pharmacological treatment for an
adult patient presenting with symptomatic sinus bradycardia (heart rate
< 50 beats per minute with signs of hemodynamic instability)?
A. Atropine 1 mg IV push
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV infusion
D. Epinephrine 2 mg IV push
Correct Answer: A. Atropine 1 mg IV push
Detailed Rationale: According to ACLS guidelines, Atropine is the first-
line medication for symptomatic bradycardia, administered at a dose of
1 mg IV every 3 to 5 minutes up to a maximum dose of 3 mg.
QUESTION 2 If Atropine is ineffective in treating symptomatic
bradycardia, what is the next immediate intervention recommended by
resuscitation guidelines?
A. Transcutaneous pacing, dopamine infusion, or epinephrine infusion
B. Immediate unsynchronized defibrillation at 200 Joules
C. Synchronized cardioversion at 50 Joules
D. Administration of calcium channel blockers
,Correct Answer: A. Transcutaneous pacing, dopamine infusion, or
epinephrine infusion
Detailed Rationale: When atropine fails or is contraindicated in
unstable bradycardia, second-line therapies include transcutaneous
pacing or continuous infusions of chronotropic agents like dopamine or
epinephrine.
QUESTION 3 What defines hemodynamic instability in the presence of a
tachyarrhythmia requiring immediate electrical intervention?
A. Hypotension, acutely altered mental status, signs of shock, ischemic
chest pain, or acute heart failure
B. A heart rate exceeding 100 beats per minute without any symptoms
C. Mild fatigue and anxiety during exercise
D. A regular narrow-complex rhythm at 110 beats per minute
Correct Answer: A. Hypotension, acutely altered mental status, signs of
shock, ischemic chest pain, or acute heart failure
Detailed Rationale: Hemodynamic instability indicates that the heart
rate is compromising vital organ perfusion, necessitating urgent
treatment such as synchronized cardioversion rather than medical rate
control alone.
QUESTION 4 What is the initial recommended energy dose for
synchronized cardioversion of unstable Supraventricular Tachycardia
(SVT) or Atrial Fibrillation using a biphasic defibrillator?
A. 50 to 100 Joules
B. 200 Joules fixed
,C. 10 to 20 Joules
D. 360 Joules monophasic equivalent
Correct Answer: A. 50 to 100 Joules
Detailed Rationale: Initial biphasic energy recommendations for
synchronized cardioversion of atrial fibrillation are typically 120–200 J,
while regular narrow-complex tachycardias (SVT/AFlutter) often
successfully convert at lower initial energies of 50–100 J.
QUESTION 5 What is the initial acute management step for a patient
presenting with stable, regular Narrow Complex Tachycardia (SVT)?
A. Vagal maneuvers (such as the Valsalva maneuver or carotid sinus
massage)
B. Immediate unsynchronized defibrillation
C. Transcutaneous pacing at 80 beats per minute
D. Administering a 500 mL normal saline fluid bolus alone
Correct Answer: A. Vagal maneuvers (such as the Valsalva maneuver or
carotid sinus massage)
Detailed Rationale: In stable SVT, non-pharmacological vagal
maneuvers are the initial first-line intervention to increase
parasympathetic tone and attempt to block the reentrant circuit.
QUESTION 6 What is the recommended initial dose and administration
technique for Adenosine when treating stable SVT unresponsive to
vagal maneuvers?
A. 6 mg rapid IV push followed immediately by a 20 mL normal saline
flush through a large peripheral IV site
, B. 12 mg slow IV push over 2 minutes without a flush
C. 150 mg IV infusion over 10 minutes
D. 1 mg IV push every 3 minutes
Correct Answer: A. 6 mg rapid IV push followed immediately by a 20 mL
normal saline flush through a large peripheral IV site
Detailed Rationale: Adenosine has an extremely short half-life (<10
seconds) and must be given as a rapid IV bolus directly into a proximal
site, followed immediately by a rapid saline flush to ensure it reaches
the central circulation before degrading.
QUESTION 7 If the initial 6 mg dose of Adenosine fails to convert a
stable SVT, what is the recommended second dose?
A. 12 mg rapid IV push
B. 6 mg rapid IV push repeated
C. 20 mg rapid IV push
D. 150 mg IV infusion
Correct Answer: A. 12 mg rapid IV push
Detailed Rationale: If the initial 6 mg dose of adenosine does not
terminate the SVT within 1–2 minutes, a higher dose of 12 mg rapid IV
push is administered.
QUESTION 8 What is the primary intervention for a patient in
Ventricular Fibrillation (VFib) or pulseless Ventricular Tachycardia (pVT)?
A. Immediate high-quality CPR and unsynchronized defibrillation
B. Synchronized cardioversion at 50 Joules
