ACLS FINAL EXAM
1. A patient is brought into the emergency department with a suspected opioid overdose.The
patient is in cardiac arrest.Which action would be the team's
priority?
Answer: Although no evidence supports any benefit to naloxone administration during
cardiac arrest, administration of naloxone during both respiratory and cardiacarrest is
recommended when opioid overdose is suspected. However, for a patientin cardiac arrest,
high-quality CPR is prioritized over the administration of naloxone.
2. A patient in the telemetry unit is receiving continuous cardiac monitoring.The patient has
a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following
figure. The provider interprets this strip as indicating which arrhythmia?
Answer: In third-degree AV block, no electrical communication occurs between the atria and
ventricles, thus no relationship between P waves and QRS complexes exists. The RR interval
is constant. The PP interval is constant or slightly irregular, as with sinus arrhythmia. If
pacemaker cells in the AVjunction simulate ventricular contraction, the QRS complexes will
be narrow (less than 120 milliseconds in duration). Impulses that originate in the ventricles
producewide, bizarre QRS complexes. This arrhythmia may result from damage caused by
myocardial infarction.
3. A patient with dyspnea and a change in mental status arrives at the
emergency department. The healthcare team completes the necessary assessments and begins
to care for the patient, including initiating cardiac monitoring, pulse oximetry, supplemental
oxygen and vascular access. The team reviews the patient's ECG rhythm strip, as shown in the
following figure.Which agent would the team most likely administer?
Answer: The ECG strip is showingbradycardia. Atropine is an anticholinergic drug that
increases sinoatrial node firingby counteracting vagus nerve action to increase the heart rate.
It is the first-line therapy for symptomatic bradycardia. A 0.5-mg bolus is given intravenously
every 3to 5 minutes, up to a maximum dose of 3 mg.
4. The ECG rhythm strip of a patient who arrived in the emergency department complaining
of dizziness, syncope and shortness of breath reveals sinusbradycardia. When reviewing the
patient's medication history, the healthcareprovider identifies which agent(s) as a potential
cause of the patient's currentcondition?
Answer: Medications associated with causing sinus bradycardia include ²-blockers such as
metoprolol and calcium channel blockers such as verapamil and digoxin.
5. The emergency department team is providing care to a patient who is experiencing
ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the
patient's current condition. Which electrolyteimbalance(s) would most likely be involved?
Answer: Although ventricular tachycardiausually occurs in the presence of heart disease or
damage, electrolyte derangements, including hypocalcemia, hypomagnesemia and
hypokalemia, can also be involved.
, 6. A patient experiencing an unstable bradyarrhythmia does not respond toatropine or
transcutaneous pacing. Which intervention would the healthcare provider use next?
Answer: Epinephrine or dopamine may be administered to patients withsymptomatic
bradycardia if atropine and transcutaneous pacing are not effective.
7. A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamicallystable and has a
heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary
assessment, which statement(s) by the patient would the team interpret as a possible
contributing cause?
Answer: If the heart rate is between 100 and 150 beats per minute, the underlying cause is
most likely a systemic one, such as anxiety, dehydration or infection.That condition is treated
first.If the heart rate is 150 beats per minute or more, the tachycardia is likely caused bya
cardiac condition, rather than a systemic one.
8. A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a
narrow-complex supraventricular tachyarrhythmia. The patientis hemodynamically stable.
Which intervention would be initiated first?
Answer: Fora patient who is hemodynamically stable and experiencing a narrow-complex
supraventricular tachyarrhythmia, vagal maneuvers are attempted first. If ineffective,adenosine
is given.
9. A patient in the telemetry unit is stable. Cardiac monitoring indicates the patient has
ventricular tachycardia with a pulse. Further assessment revealsthat the corrected QT interval
is greater than 0.46 seconds. Which treatment would be appropriate at this time?
Answer: For a patient with ventricular tachycardia whois stable, has a pulse and has a
corrected QT interval greater than 0.46 seconds, synchronized cardioversion is the
recommended treatment.
10. A patient is brought into the emergency department. The patient does not have a pulse.
The cardiac monitor shows the following rhythm. The teaminterprets this as which condition?
Answer: The cardiac monitor reveals ventricular tachy-cardia. In pulseless ventricular
tachycardia, the ventricular rate is usually greater than 180 beats per minute, and the QRS
complexes are very wide.
11. A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest,
the patient's ECG showed peaked T waves. What might becausing the patient's cardiac arrest?
Answer: Suspect hyperkalemia in all patients withacute or chronic renal failure who exhibit a
wide-complex ventricular rhythm or tall,peaked T waves on an ECG before cardiac arrest.
12. A member of the resuscitation team is preparing to defibrillate a patient in cardiac arrest
using a biphasic defibrillator. The team member would set the energy dose according to the
manufacturer's recommendations, which isusually:
Answer: When using a biphasic defibrillator, the energy dose should be set at 120to 200
joules.
13. A member of the resuscitation team is preparing to administer medications intravenously
1. A patient is brought into the emergency department with a suspected opioid overdose.The
patient is in cardiac arrest.Which action would be the team's
priority?
Answer: Although no evidence supports any benefit to naloxone administration during
cardiac arrest, administration of naloxone during both respiratory and cardiacarrest is
recommended when opioid overdose is suspected. However, for a patientin cardiac arrest,
high-quality CPR is prioritized over the administration of naloxone.
2. A patient in the telemetry unit is receiving continuous cardiac monitoring.The patient has
a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following
figure. The provider interprets this strip as indicating which arrhythmia?
Answer: In third-degree AV block, no electrical communication occurs between the atria and
ventricles, thus no relationship between P waves and QRS complexes exists. The RR interval
is constant. The PP interval is constant or slightly irregular, as with sinus arrhythmia. If
pacemaker cells in the AVjunction simulate ventricular contraction, the QRS complexes will
be narrow (less than 120 milliseconds in duration). Impulses that originate in the ventricles
producewide, bizarre QRS complexes. This arrhythmia may result from damage caused by
myocardial infarction.
3. A patient with dyspnea and a change in mental status arrives at the
emergency department. The healthcare team completes the necessary assessments and begins
to care for the patient, including initiating cardiac monitoring, pulse oximetry, supplemental
oxygen and vascular access. The team reviews the patient's ECG rhythm strip, as shown in the
following figure.Which agent would the team most likely administer?
Answer: The ECG strip is showingbradycardia. Atropine is an anticholinergic drug that
increases sinoatrial node firingby counteracting vagus nerve action to increase the heart rate.
It is the first-line therapy for symptomatic bradycardia. A 0.5-mg bolus is given intravenously
every 3to 5 minutes, up to a maximum dose of 3 mg.
4. The ECG rhythm strip of a patient who arrived in the emergency department complaining
of dizziness, syncope and shortness of breath reveals sinusbradycardia. When reviewing the
patient's medication history, the healthcareprovider identifies which agent(s) as a potential
cause of the patient's currentcondition?
Answer: Medications associated with causing sinus bradycardia include ²-blockers such as
metoprolol and calcium channel blockers such as verapamil and digoxin.
5. The emergency department team is providing care to a patient who is experiencing
ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the
patient's current condition. Which electrolyteimbalance(s) would most likely be involved?
Answer: Although ventricular tachycardiausually occurs in the presence of heart disease or
damage, electrolyte derangements, including hypocalcemia, hypomagnesemia and
hypokalemia, can also be involved.
, 6. A patient experiencing an unstable bradyarrhythmia does not respond toatropine or
transcutaneous pacing. Which intervention would the healthcare provider use next?
Answer: Epinephrine or dopamine may be administered to patients withsymptomatic
bradycardia if atropine and transcutaneous pacing are not effective.
7. A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamicallystable and has a
heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary
assessment, which statement(s) by the patient would the team interpret as a possible
contributing cause?
Answer: If the heart rate is between 100 and 150 beats per minute, the underlying cause is
most likely a systemic one, such as anxiety, dehydration or infection.That condition is treated
first.If the heart rate is 150 beats per minute or more, the tachycardia is likely caused bya
cardiac condition, rather than a systemic one.
8. A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a
narrow-complex supraventricular tachyarrhythmia. The patientis hemodynamically stable.
Which intervention would be initiated first?
Answer: Fora patient who is hemodynamically stable and experiencing a narrow-complex
supraventricular tachyarrhythmia, vagal maneuvers are attempted first. If ineffective,adenosine
is given.
9. A patient in the telemetry unit is stable. Cardiac monitoring indicates the patient has
ventricular tachycardia with a pulse. Further assessment revealsthat the corrected QT interval
is greater than 0.46 seconds. Which treatment would be appropriate at this time?
Answer: For a patient with ventricular tachycardia whois stable, has a pulse and has a
corrected QT interval greater than 0.46 seconds, synchronized cardioversion is the
recommended treatment.
10. A patient is brought into the emergency department. The patient does not have a pulse.
The cardiac monitor shows the following rhythm. The teaminterprets this as which condition?
Answer: The cardiac monitor reveals ventricular tachy-cardia. In pulseless ventricular
tachycardia, the ventricular rate is usually greater than 180 beats per minute, and the QRS
complexes are very wide.
11. A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest,
the patient's ECG showed peaked T waves. What might becausing the patient's cardiac arrest?
Answer: Suspect hyperkalemia in all patients withacute or chronic renal failure who exhibit a
wide-complex ventricular rhythm or tall,peaked T waves on an ECG before cardiac arrest.
12. A member of the resuscitation team is preparing to defibrillate a patient in cardiac arrest
using a biphasic defibrillator. The team member would set the energy dose according to the
manufacturer's recommendations, which isusually:
Answer: When using a biphasic defibrillator, the energy dose should be set at 120to 200
joules.
13. A member of the resuscitation team is preparing to administer medications intravenously
