Advanced Cardiovascular Life Support (ACLS) Exams A and B 2023 A+

Advanced Cardiovascular Life Support (ACLS) Exams A and B 2023 A+ l Please do not mark on this exam. Record the best answer on the separate answer sheet. 1. Which type of atrioventricular block best describes this rhythm? A. First-degree B. Second-degree type I C. Second-degree type II D. Third-degree 2. Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do? A. Monitor the patient’s PETCO2 B. Obtain a 12-lead ECG C. Check the patient’s pulse D. Obtain a chest x-ray 3. Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field? A. Comprehensive stroke care unit B. Acute rehabilitation care unit C. Acute long-term care unit D. Coronary reperfusion–capable medical center 4. Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient? A. Slow, weak pulse rate B. Cyanosis C. Agonal gasps D. Irregular, weak pulse rate 2 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 5. Which type of atrioventricular block best describes this rhythm? A. Third-degree atrioventricular block B. Second-degree atrioventricular block type I C. First-degree atrioventricular block D. Second-degree atrioventricular block type II 6. To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? A. Once every 3 to 4 seconds B. Once every 5 to 6 seconds C. Once every 10 seconds D. Once every 12 seconds 7. In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? A. Arterial blood gases B. Chest radiography C. Continuous waveform capnography D. Hemoglobin levels 8. You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient? A. Hold fibrinolytic therapy for 24 hours B. Start fibrinolytic therapy as soon as possible C. Order an echocardiogram before fibrinolytic administration D. Wait for the results of the MRI 3 9. Which best describes this rhythm? A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block 10. What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest? A. 26°C to 28°C B. 29°C to 31°C C. 32°C to 36°C D. 35°C to 37°C 11. Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? A. 100 mg B. 150 mg C. 250 mg D. 300 mg 12. Which is the primary purpose of a medical emergency team or rapid response team? A. Improving care for patients admitted to critical care units B. Improving patient outcomes by identifying and treating early clinical deterioration C. Providing diagnostic consultation to emergency department patients D. Providing online consultation to EMS personnel in the field 13. Which is the recommended next step after a defibrillation attempt? A. Check the ECG for evidence of a rhythm B. Open the patient’s airway C. Determine if a carotid pulse is present D. Resume CPR, starting with chest compressions 4 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 14. EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment? A. Alert the hospital B. Establish IV access C. Review the patient’s history D. Treat hypertension 15. A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm? A. Perfusing ventricular tachycardia B. Sinus tachycardia C. Stable supraventricular tachycardia D. Unstable supraventricular tachycardia 16. Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? A. Apply the AED B. Check the patient’s breathing and pulse C. Open the patient’s airway D. Check for a medical alert bracelet 17. Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? A. 1 to 4 seconds B. 5 to 10 seconds C. 11 to 15 seconds D. 16 to 20 seconds 18. You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication? A. “I’ll give it in a few minutes.” B. “OK.” C. “I’ll draw up 0.5 mg of atropine.” D. “Are you sure that is what you want given?” 5 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 19. What is an effect of excessive ventilation? A. Decreased cardiac output B. Decreased intrathoracic pressure C. Increased perfusion pressures D. Increased venous return 20. If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? A. Conduct a debriefing after the resuscitation attempt B. Reassign the team tasks C. Address the team member immediately D. Remove the team member from the area 21. Which best describes this rhythm? A. Monomorphic ventricular tachycardia B. Polymorphic ventricular tachycardia C. Supraventricular tachycardia D. Ventricular fibrillation 22. For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention? A. 180 minutes B. 150 minutes C. 120 minutes D. 90 minutes 23. Which is the maximum interval you should allow for an interruption in chest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25 to 30 seconds 24. Which is one way to minimize interruptions in chest compressions during CPR? A. Administer IV medications only when delivering breaths B. Check the pulse immediately after defibrillation C. Use an AED to monitor the patient’s rhythm D. Continue CPR while the defibrillator charges 6 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 25. Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to the more experienced team members B. Perform the most complicated tasks C. Clearly delegate tasks D. Assign the same tasks to more than one team member 26. Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C. Estimate by using the formula Weight (kg)/8 + 2 D. Estimate by using the size of the patient’s finger 27. You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now? A. Evaluating the PETCO2 reading B. Requesting a chest x-ray C. Obtaining a 12-lead ECG D. Requesting laboratory testing 28. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment? A. Administering adenosine 6 mg IV push B. Performing synchronized cardioversion C. Performing vagal maneuvers D. Performing defibrillation 29. During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range? A. 0 to 8 hours B. At least 24 hours C. At least 36 hours D. At least 48 hours 7 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 30. Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding? A. Chest compressions may not be effective B. The endotracheal tube is in the esophagus C. The patient meets the criteria for termination of efforts D. The team is ventilating the patient too often (hyperventilation) 31. Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? A. 40 mg B. 81 mg C. 160 to 325 mg D. 350 to 650 mg 32. A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take? A. Ask for a new task or role B. Assign it to another team member C. Do it anyway D. Seek expert advice 33. As the team leader, when do you tell the chest compressors to switch? A. Only when they tell you that they are fatigued B. About every 2 minutes C. About every 5 minutes D. About every 7 minutes 34. You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? A. Less than 80/min B. 80 to 90/min C. 100 to 120/min D. More than 120/min 35. A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? A. “OK.” B. “Are you sure?” C. “Amiodarone 500 mg IV has been given.” D. “I have an order to give 500 mg of amiodarone IV. Is this correct?” 8 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 36. A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? A. 3 mg B. 12 mg C. 20 mg D. 40 mg 37. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment? A. Administration of adenosine 6 mg IV push B. Administration of epinephrine 1 mg IV push C. Defibrillation D. Synchronized cardioversion 38. Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? A. 12-lead ECG B. Cardiac enzymes C. Coagulation studies D. Noncontrast CT scan of the head 39. What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post–cardiac arrest patient who achieves return of spontaneous circulation? A. 75 mm Hg B. 80 mm Hg C. 85 mm Hg D. 90 mm Hg 9 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 40. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next? A. Start a dopamine infusion B. Give atropine 0.5 mg C. Give epinephrine 1 mg IV D. Insert an advanced airway Use this scenario to answer the next 6 questions: A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. 41. Based on this patient’s initial presentation, which condition do you suspect led to the cardiac arrest? A. Acute coronary syndrome B. Acute heart failure C. Acute ischemic stroke D. Supraventricular tachycardia with ischemic chest pain 42. In addition to defibrillation, which intervention should be performed immediately? A. Advanced airway insertion B. Vasoactive medication administration C. Chest compressions D. Vascular access 43. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A. Epinephrine 1 mg B. Amiodarone 300 mg C. Lidocaine 1 mg/kg D. Atropine 1 mg 10 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association Use this scenario to answer the next 4 questions: A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here. 47. Based on this patient’s initial assessment, which adult ACLS algorithm should you follow? A. Acute coronary syndromes B. Tachycardia C. Suspected stroke D. Cardiac arrest 48. The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take? A. Perform bag-mask ventilation B. Intubate the patient C. Apply oxygen D. Check the pulse oximeter probe 11 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 12 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association Answer Key Advanced Cardiovascular Life Support Exam A Question Answer 1. A B ● D 2. ● B C D 3. A B C ● 4. A B ● D 5. A ● C D 6. A ● C D 7. A B ● D 8. A ● C D 9. A B C ● 10. A B ● D 11. A B C ● 12. A ● C D 13. A B C ● 14. ● B C D 15. A B C ● 16. A ● C D 17. A ● C D 18. A B ● D 19. ● B C D 20. A B ● D 21. ● B C D 22. A B C ● 23. ● B C D 24. A B C ● 25. A B ● D 1 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 26. ● B C D 27. A B ● D 28. A ● C D 29. A ● C D 30. ● B C D 31. A B ● D 32. ● B C D 33. A ● C D 34. A B ● D 35. A B C ● 36. A ● C D 37. A B ● D 38. A B C ● 39. A B C ● 40. A B ● D 41. ● B C D 42. A B ● D 43. ● B C D 44. A B C ● 45. ● B C D 46. A B C ● 47. A ● C D 48. A B ● D 49. ● B C D 50. A B C ● 2 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association Annotated Answer Key Advanced Cardiovascular Life Support Exam A Provider Manual page numbers below refer to the printed book and the eBook as viewed through the offline desktop/laptop reader, not the eBook as viewed through the mobile apps or . 1. Which type of atrioventricular block best describes this rhythm? A. First-degree B. Second-degree type I C. Second-degree type II D. Third-degree The correct answer is C. This ECG rhythm strip shows second-degree type II atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases Bradycardia Case Rhythms for Bradycardia; page 121] 2. Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do? A. Monitor the patient’s PETCO2 B. Obtain a 12-lead ECG C. Check the patient’s pulse D. Obtain a chest x-ray The correct answer is A. The AHA recommends using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway Physiologic Monitoring During CPR; page 102] 1 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 3. Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field? A. Comprehensive stroke care unit B. Acute rehabilitation care unit C. Acute long-term care unit D. Coronary reperfusion–capable medical center The correct answer is D. After return of spontaneous circulation in patients in whom coronary artery occlusion is suspected, providers should transport the patient to a facility capable of reliably providing coronary reperfusion (eg, percutaneous coronary intervention) and other goal-directed post–cardiac arrest care therapies. [ACLS Provider Manual, Part 2: Systems of Care Post–Cardiac Arrest Care Immediate Coronary Reperfusion With PCI; page 20] 4. Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient? A. Slow, weak pulse rate B. Cyanosis C. Agonal gasps D. Irregular, weak pulse rate The correct answer is C. Agonal gasps are not normal breathing. They are a sign of cardiac arrest. Agonal gasps may be present in the first minutes after sudden cardiac arrest. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Caution: Agonal Gasps; page 35] 5. Which type of atrioventricular block best describes this rhythm? A. Third-degree atrioventricular block B. Second-degree atrioventricular block type I C. First-degree atrioventricular block D. Second-degree atrioventricular block type II The correct answer is B. This ECG rhythm strip shows second-degree atrioventricular block type I. [ACLS Provider Manual, Part 5: The ACLS Cases Bradycardia Case Rhythms for Bradycardia; page 121] 2 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 6. To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? A. Once every 3 to 4 seconds B. Once every 5 to 6 seconds C. Once every 10 seconds D. Once every 12 seconds The correct answer is B. For a patient in respiratory arrest with a pulse, deliver ventilations once every 5 to 6 seconds with a bag-mask device or any advanced airway. [ACLS Provider Manual, Part 5: The ACLS Cases Respiratory Arrest Case The BLS Assessment Ventilation and Pulse Check; page 46] 7. In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? A. Arterial blood gases B. Chest radiography C. Continuous waveform capnography D. Hemoglobin levels The correct answer is C. The AHA recommends continuous waveform capnography in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube. [ACLS Provider Manual, Part 5: The ACLS Cases Respiratory Arrest Case The Primary Assessment FYI 2015 Guidelines: Correct Placement of ET Tube; page 46] 8. You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient? A. Hold fibrinolytic therapy for 24 hours B. Start fibrinolytic therapy as soon as possible C. Order an echocardiogram before fibrinolytic administration D. Wait for the results of the MRI The correct answer is B. Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. [ACLS Provider Manual, Part 5: The ACLS Cases Acute Stroke Case Approach to Stroke Care Goals of Stroke Care; page 76] 3 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 9. Which best describes this rhythm? A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block The correct answer is D. This ECG rhythm strip shows third-degree atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases Bradycardia Case Rhythms for Bradycardia; page 121] 10. What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest? A. 26°C to 28°C B. 29°C to 31°C C. 32°C to 36°C D. 35°C to 37°C The correct answer is C. For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases Immediate Post–Cardiac Arrest Care Case Application of the Immediate Post–Cardiac Arrest Care Algorithm Targeted Temperature Management; page 151] 11. Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? A. 100 mg B. 150 mg C. 250 mg D. 300 mg The correct answer is D. Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Antiarrhythmic Agents Amiodarone; page 106] 4 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 12. Which is the primary purpose of a medical emergency team or rapid response team? A. Improving care for patients admitted to critical care units B. Improving patient outcomes by identifying and treating early clinical deterioration C. Providing diagnostic consultation to emergency department patients D. Providing online consultation to EMS personnel in the field The correct answer is B. Many hospitals have implemented the use of medical emergency teams or rapid response teams. The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. [ACLS Provider Manual, Part 2: Systems of Care Cardiopulmonary Resuscitation Foundational Facts: Medical Emergency Teams and Rapid Response Teams; page 15] 13. Which is the recommended next step after a defibrillation attempt? A. Check the ECG for evidence of a rhythm B. Open the patient’s airway C. Determine if a carotid pulse is present D. Resume CPR, starting with chest compressions The correct answer is D. Follow each shock immediately with CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Overview of the BLS Assessment; page 36] 14. EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment? A. Alert the hospital B. Establish IV access C. Review the patient’s history D. Treat hypertension The correct answer is A. Prearrival notification allows the hospital to prepare to evaluate and manage the patient effectively. [ACLS Provider Manual, Part 5: The ACLS Cases Acute Stroke Case Identification of Signs of Possible Stroke Activate EMS System Immediately; page 78] 5 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 15. A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm? A. Perfusing ventricular tachycardia B. Sinus tachycardia C. Stable supraventricular tachycardia D. Unstable supraventricular tachycardia The correct answer is D. This ECG rhythm strip shows supraventricular tachycardia, and the patient is showing signs and symptoms of unstable tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Rhythms for Unstable Tachycardia; pages 129-130, and The Approach to Unstable Tachycardia Signs and Symptoms; page 131] 16. Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? A. Apply the AED B. Check the patient’s breathing and pulse C. Open the patient’s airway D. Check for a medical alert bracelet The correct answer is B. After you determine that a patient is unresponsive and activate your emergency team, a breathing check and pulse check should be performed. Ideally, these checks are done simultaneously to minimize delay in detection of cardiac arrest and initiation of CPR. After determining that a patient is not breathing and has no pulse, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Overview of the BLS Assessment; page 36] 17. Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? A. 1 to 4 seconds B. 5 to 10 seconds C. 11 to 15 seconds D. 16 to 20 seconds The correct answer is B. Check the pulse for 5 to 10 seconds. If there is no pulse within 10 seconds, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Overview of the BLS Assessment; page 36] 6 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 18. You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication? A. “I’ll give it in a few minutes.” B. “OK.” C. “I’ll draw up 0.5 mg of atropine.” D. “Are you sure that is what you want given?” The correct answer is C. When communicating with high-performance team members, the team leader should use closed-loop communication. By receiving a clear response and eye contact, the team leader confirms that the team member heard and understood the message. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics Elements of Effective High-Performance Team Dynamics How to Communicate; page 31] 19. What is an effect of excessive ventilation? A. Decreased cardiac output B. Decreased intrathoracic pressure C. Increased perfusion pressures D. Increased venous return The correct answer is A. Excessive ventilation can be harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. [ACLS Provider Manual, Part 5: The ACLS Cases Respiratory Arrest Case Management of Respiratory Arrest Critical Concepts: Avoiding Excessive Ventilation; page 47] 20. If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? A. Conduct a debriefing after the resuscitation attempt B. Reassign the team tasks C. Address the team member immediately D. Remove the team member from the area The correct answer is C. During a resuscitation attempt, the leader or a member of a high-performance team may need to intervene if an action that is about to occur may be inappropriate at the time. Team members should question a colleague who is about to make a mistake. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics Elements of Effective High-Performance Team Dynamics Roles; page 29] 7 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 21. Which best describes this rhythm? A. Monomorphic ventricular tachycardia B. Polymorphic ventricular tachycardia C. Supraventricular tachycardia D. Ventricular fibrillation The correct answer is A. This ECG rhythm strip shows a monomorphic ventricular tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Rhythms for Unstable Tachycardia; page 130] 22. For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention? A. 180 minutes B. 150 minutes C. 120 minutes D. 90 minutes The correct answer is D. For the patient with STEMI, the goals of reperfusion are to give fibrinolytics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. The goal for emergency department door–to–balloon inflation time is 90 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases: Acute Coronary Syndromes Case Immediate ED Assessment and Treatment Introduction; page 67] 23. Which is the maximum interval you should allow for an interruption in chest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25 to 30 seconds The correct answer is A. ACLS providers must make every effort to minimize any interruptions in chest compressions. Try to limit interruptions in chest compressions (eg, defibrillation and rhythm analysis) to no longer than 10 seconds. When you stop chest compressions, blood flow to the brain and heart stops. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Critical Concepts: Minimizing Interruptions; page 37] 8 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 24. Which is one way to minimize interruptions in chest compressions during CPR? A. Administer IV medications only when delivering breaths B. Check the pulse immediately after defibrillation C. Use an AED to monitor the patient’s rhythm D. Continue CPR while the defibrillator charges The correct answer is D. Shortening the interval between the last compression and the shock by even a few seconds can improve shock success (defibrillation and return of spontaneous circulation). Thus, it is reasonable for healthcare providers to practice efficient coordination between CPR and defibrillation to minimize the hands-off interval between stopping compressions and administering the shock. For example, after verifying a shockable rhythm and initiating the charging sequence on the defibrillator, another provider should resume chest compressions and continue until the defibrillator is fully charged. The defibrillator operator should deliver the shock as soon as the compressor removes his or her hands from the patient’s chest and all providers are “clear” of contact with the patient. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway Foundational Facts: Resume CPR While Manual Defibrillator Is Charging; page 96] 25. Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to the more experienced team members B. Perform the most complicated tasks C. Clearly delegate tasks D. Assign the same tasks to more than one team member The correct answer is C. To avoid inefficiencies, the team leader must clearly delegate tasks. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics Elements of Effective High- Performance Team Dynamics Roles; page 28] 26. Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C. Estimate by using the formula Weight (kg)/8 + 2 D. Estimate by using the size of the patient’s finger The correct answer is A. To select the appropriate size for an oropharyngeal airway (OPA), place the OPA against the side of the face. When the flange of the OPA is at the corner of the mouth, the tip is at the angle of the mandible. A properly sized and inserted OPA results in proper alignment with the glottic opening. [ACLS Provider Manual, Part 5: The ACLS Cases Respiratory Arrest Case Basic Airway Adjuncts: Oropharyngeal Airway Technique of OPA Insertion; page 51] 9 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 27. You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now? A. Evaluating the PETCO2 reading B. Requesting a chest x-ray C. Obtaining a 12-lead ECG D. Requesting laboratory testing The correct answer is C. The 12-lead ECG is at the center of the decision pathway in the management of ischemic chest discomfort and is the only means of identifying STEMI. [ACLS Provider Manual, Part 5: The ACLS Cases Acute Coronary Syndromes Case Immediate ED Assessment and Treatment Introduction; page 67] 28. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment? A. Administering adenosine 6 mg IV push B. Performing synchronized cardioversion C. Performing vagal maneuvers D. Performing defibrillation The correct answer is B. Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Cardioversion Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137] 29. During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range? A. 0 to 8 hours B. At least 24 hours C. At least 36 hours D. At least 48 hours The correct answer is B. For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases Immediate Post–Cardiac Arrest Care Case Application of the Immediate Post–Cardiac Arrest Care Algorithm Targeted Temperature Management; page 151] 10 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 30. Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding? A. Chest compressions may not be effective B. The endotracheal tube is in the esophagus C. The patient meets the criteria for termination of efforts D. The team is ventilating the patient too often (hyperventilation) The correct answer is A. PETCO2 values less than 10 mm Hg in intubated patients indicate that cardiac output is inadequate to achieve return of spontaneous circulation. It is reasonable to consider trying to improve quality of CPR by optimizing chest compression parameters. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway Physiologic Monitoring During CPR; page 103] 31. Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? A. 40 mg B. 81 mg C. 160 to 325 mg D. 350 to 650 mg The correct answer is C. If the patient has not taken aspirin and has no history of true aspirin allergy and no evidence of recent gastrointestinal bleeding, give the patient aspirin (160 to 325 mg) to chew. In the initial hours of an acute coronary syndrome, aspirin is absorbed better when chewed than when swallowed. [ACLS Provider Manual, Part 5: The ACLS Cases Acute Coronary Syndromes Case EMS Assessment, Care, and Hospital Preparation Administer Oxygen and Drugs; page 65] 32. A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take? A. Ask for a new task or role B. Assign it to another team member C. Do it anyway D. Seek expert advice The correct answer is A. Not only should everyone on the team know his or her own limitations and capabilities, but the team leader should also be aware of them. This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. High-performance team members should anticipate situations in which they might require assistance and inform the team leader. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics Elements of Effective High-Performance Team Dynamics Roles; page 28] 11 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 33. As the team leader, when do you tell the chest compressors to switch? A. Only when they tell you that they are fatigued B. About every 2 minutes C. About every 5 minutes D. About every 7 minutes The correct answer is B. Switch compressors about every 2 minutes, or earlier if they are fatigued. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Critical Concepts: High-Quality CPR; page 38] 34. You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? A. Less than 80/min B. 80 to 90/min C. 100 to 120/min D. More than 120/min The correct answer is C. When performing chest compressions, you should compress at a rate of 100 to 120/min. [ACLS Provider Manual, Part 4: The Systematic Approach The BLS Assessment Critical Concepts: Quality Compressions; page 37] 35. A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? A. “OK.” B. “Are you sure?” C. “Amiodarone 500 mg IV has been given.” D. “I have an order to give 500 mg of amiodarone IV. Is this correct?” The correct answer is D. Unclear communication can lead to unnecessary delays in treatment or to medication errors. Team members should question an order if the slightest doubt exists. [ACLS Provider Manual, Part 4: Effective High-Performance Team Dynamics Elements of Effective High-Performance Team Dynamics How to Communicate; page 31] 36. A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? A. 3 mg B. 12 mg C. 20 mg D. 40 mg The correct answer is B. Adenosine is indicated for most forms of stable narrow-complex supraventricular tachycardia. If the patient is not responsive to the first dose, a second dose of adenosine (12 mg rapid IV push) should be given. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Application of the Tachycardia Algorithm to the Stable Patient Narrow QRS, Regular Rhythm; page 143] 12 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 37. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment? A. Administration of adenosine 6 mg IV push B. Administration of epinephrine 1 mg IV push C. Defibrillation D. Synchronized cardioversion The correct answer is C. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway Principle of Early Defibrillation; page 97] 38. Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? A. 12-lead ECG B. Cardiac enzymes C. Coagulation studies D. Noncontrast CT scan of the head The correct answer is D. A critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a noncontrast CT scan to differentiate ischemic from hemorrhagic stroke. The CT scan should be completed within 25 minutes of the patient’s arrival in the emergency department and should be read within 45 minutes from emergency department arrival. [ACLS Provider Manual, Part 5: The ACLS Cases Acute Stroke Case CT Scan: Hemorrhage or No Hemorrhage Introduction; page 84] 13 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 39. What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post–cardiac arrest patient who achieves return of spontaneous circulation? A. 75 mm Hg B. 80 mm Hg C. 85 mm Hg D. 90 mm Hg The correct answer is D. If the patient’s volume status is adequate, infusions of vasoactive agents may be initiated and titrated to achieve a minimum systolic blood pressure of 90 mm Hg or greater or a mean arterial pressure of 65 mm Hg or more. [ACLS Provider Manual, Part 5: The ACLS Cases Immediate Post–Cardiac Arrest Care Case Overview of Post–Cardiac Arrest Care; page 146] 40. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next? A. Start a dopamine infusion B. Give atropine 0.5 mg C. Give epinephrine 1 mg IV D. Insert an advanced airway The correct answer is C. Give epinephrine as soon as IV/IO access become available. A dose of 1 mg IV/IO should be given and repeated every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: Pulseless Electrical Activity Case Managing PEA: The Adult Cardiac Arrest Algorithm Administer Epinephrine; page 111] 14 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 41. Based on this patient’s initial presentation, which condition do you suspect led to the cardiac arrest? A. Acute coronary syndrome B. Acute heart failure C. Acute ischemic stroke D. Supraventricular tachycardia with ischemic chest pain The correct answer is A. Acute life-threatening complications of acute coronary syndromes include ventricular fibrillation, pulseless ventricular tachycardia, symptomatic bradycardias, and unstable tachycardias. [ACLS Provider Manual, Part 5: The ACLS Cases Acute Coronary Syndromes Case Goals for ACS Patients; page 60] 42. In addition to defibrillation, which intervention should be performed immediately? A. Advanced airway insertion B. Vasoactive medication administration C. Chest compressions D. Vascular access The correct answer is C. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm VF/pVT (Left Side); page 93] 43. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A. Epinephrine 1 mg B. Amiodarone 300 mg C. Lidocaine 1 mg/kg D. Atropine 1 mg The correct answer is A. For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. When IV/IO access is available, give epinephrine 1 mg IV/IO during CPR after the second shock and repeat epinephrine 1 mg IV/IO every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway Shock and Vasopressors; page 99] 44. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next? A. Epinephrine 1 mg B. Atropine 1 mg C. Magnesium sulfate 1 g D. Amiodarone 300 mg The correct answer is D. Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases Cardiac Arrest: VF/Pulseless VT Case Antiarrhythmic Agents Amiodarone; page 106] 15 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 16 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 47. Based on this patient’s initial assessment, which adult ACLS algorithm should you follow? A. Acute coronary syndromes B. Tachycardia C. Suspected stroke D. Cardiac arrest The correct answer is B. This ECG rhythm strip shows ventricular tachycardia. The Adult Tachycardia With a Pulse Algorithm outlines the steps for assessment and management of a patient presenting with symptomatic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Managing Unstable Tachycardia: The Tachycardia Algorithm Overview; page 132] 48. The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take? A. Perform bag-mask ventilation B. Intubate the patient C. Apply oxygen D. Check the pulse oximeter probe The correct answer is C. In the application of the Tachycardia Algorithm to an unstable patient, identify and treat the underlying cause. Give oxygen, if indicated, and monitor oxygen saturation. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Application of the Tachycardia Algorithm to the Unstable Patient Identify and Treat the Underlying Cause; page 134] 49. After your initial assessment of this patient, which intervention should be performed next? A. Synchronized cardioversion B. Administration of amiodarone 150 mg IM C. Immediate defibrillation D. Endotracheal intubation The correct answer is A. Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases Tachycardia: Stable and Unstable Cardioversion Recommendations; page 137] 17 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association 18 Advanced Cardiovascular Life Support Exam A, March 30, 2016 © 2016 American Heart Association American Heart Association Advanced Cardiovascular Life Support Exam B March 30, 2016 © 2016 American Heart Association Advanced Cardiovascular Life Support Exam B (50 questions) Please do not mark on this exam. Record the best answer on the separate answer sheet. 1. Which best describes this rhythm? A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block 2. To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? A. Once every 10 seconds B. Once every 12 seconds C. Once every 3 to 4 seconds D. Once every 5 to 6 seconds 3. Which type of atrioventricular block best describes this rhythm? A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block 2 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 4. Which is the recommended next step after a defibrillation attempt? A. Check the ECG for evidence of a rhythm B. Determine if a carotid pulse is present C. Open the patient’s airway D. Resume CPR, starting with chest compressions 5. Which is the primary purpose of a medical emergency team or rapid response team? A. Improving patient outcomes by identifying and treating early clinical deterioration B. Improving care for patients admitted to critical care units C. Providing online consultation to EMS personnel in the field D. Providing diagnostic consultation to emergency department patients 6. You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? A. Less than 80/min B. More than 120/min C. 80 to 90/min D. 100 to 120/min 7. You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication? A. “OK.” B. “Are you sure that is what you want given?” C. “I’ll draw up 0.5 mg of atropine.” D. “I’ll give it in a few minutes.” 8. Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to the more experienced team members B. Assign the same tasks to more than one team member C. Perform the most complicated tasks D. Clearly delegate tasks 3 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 9. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next? A. Give atropine 0.5 mg B. Give epinephrine 1 mg IV C. Insert an advanced airway D. Start a dopamine infusion 10. Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field? A. Acute long-term care unit B. Acute rehabilitation care unit C. Coronary reperfusion–capable medical center D. Comprehensive stroke care unit 11. In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? A. Arterial blood gases B. Chest radiography C. Hemoglobin levels D. Continuous waveform capnography 12. As the team leader, when do you tell the chest compressors to switch? A. Only when they tell you that they are fatigued B. About every 2 minutes C. About every 5 minutes D. About every 7 minutes 4 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 13. A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm? A. Unstable supraventricular tachycardia B. Stable supraventricular tachycardia C. Perfusing ventricular tachycardia D. Sinus tachycardia 14. Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? A. Open the patient’s airway B. Apply the AED C. Check for a medical alert bracelet D. Check the patient’s breathing and pulse 15. Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient? A. Agonal gasps B. Cyanosis C. Irregular, weak pulse rate D. Slow, weak pulse rate 16. Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding? A. The endotracheal tube is in the esophagus B. The patient meets the criteria for termination of efforts C. The team is ventilating the patient too often (hyperventilation) D. Chest compressions may not be effective 17. Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? A. 12-lead ECG B. Noncontrast CT scan of the head C. Cardiac enzymes D. Coagulation studies 5 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 18. Which is one way to minimize interruptions in chest compressions during CPR? A. Administer IV medications only when delivering breaths B. Check the pulse immediately after defibrillation C. Continue CPR while the defibrillator charges D. Use an AED to monitor the patient’s rhythm 19. Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? A. 160 to 325 mg B. 350 to 650 mg C. 40 mg D. 81 mg 20. You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient? A. Wait for the results of the MRI B. Hold fibrinolytic therapy for 24 hours C. Order an echocardiogram before fibrinolytic administration D. Start fibrinolytic therapy as soon as possible 21. Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do? A. Check the patient’s pulse B. Monitor the patient’s PETCO2 C. Obtain a 12-lead ECG D. Obtain a chest x-ray 22. Which best describes this rhythm? A. Supraventricular tachycardia B. Monomorphic ventricular tachycardia C. Polymorphic ventricular tachycardia D. Ventricular fibrillation 6 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 23. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment? A. Performing vagal maneuvers B. Administering adenosine 6 mg IV push C. Performing synchronized cardioversion D. Performing defibrillation 24. Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? A. 1 to 4 seconds B. 5 to 10 seconds C. 11 to 15 seconds D. 16 to 20 seconds 25. EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment? A. Establish IV access B. Alert the hospital C. Review the patient’s history D. Treat hypertension 26. You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now? A. Obtaining a 12-lead ECG B. Evaluating the PETCO2 reading C. Requesting a chest x-ray D. Requesting laboratory testing 27. What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post–cardiac arrest patient who achieves return of spontaneous circulation? A. 75 mm Hg B. 80 mm Hg C. 85 mm Hg D. 90 mm Hg 7 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 28. A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? A. “OK.” B. “Are you sure?” C. “Amiodarone 500 mg IV has been given.” D. “I have an order to give 500 mg of amiodarone IV. Is this correct?” 29. For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention? A. 90 minutes B. 120 minutes C. 150 minutes D. 180 minutes 30. What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest? A. 26°C to 28°C B. 29°C to 31°C C. 32°C to 36°C D. 35°C to 37°C 31. During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range? A. 0 to 8 hours B. At least 24 hours C. At least 36 hours D. At least 48 hours 32. Which type of atrioventricular block best describes this rhythm? A. First-degree B. Second-degree type I C. Second-degree type II D. Third-degree 8 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 33. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment? A. Defibrillation B. Synchronized cardioversion C. Administration of adenosine 6 mg IV push D. Administration of epinephrine 1 mg IV push 34. Which is the maximum interval you should allow for an interruption in chest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25 to 30 seconds 35. What is an effect of excessive ventilation? A. Increased perfusion pressures B. Increased venous return C. Decreased cardiac output D. Decreased intrathoracic pressure 36. A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? A. 3 mg B. 12 mg C. 20 mg D. 40 mg 37. Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? A. 100 mg B. 300 mg C. 150 mg D. 250 mg 9 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 38. Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C. Estimate by using the formula Weight (kg)/8 + 2 D. Estimate by using the size of the patient’s finger 39. If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? A. Reassign the team tasks B. Address the team member immediately C. Conduct a debriefing after the resuscitation attempt D. Remove the team member from the area 40. A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take? A. Do it anyway B. Assign it to another team member C. Seek expert advice D. Ask for a new task or role 10 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 11 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 47. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A. Amiodarone 300 mg B. Atropine 1 mg C. Epinephrine 1 mg D. Lidocaine 1 mg/kg 48. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next? A. Amiodarone 300 mg B. Atropine 1 mg C. Epinephrine 1 mg D. Magnesium sulfate 1 g 49. The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post–cardiac arrest care intervention do you choose for this patient? A. Extubate B. Initiate targeted temperature management C. Check the glucose level D. Administer epinephrine 50. Which would you have done first if the patient had not gone into ventricular fibrillation? A. Established IV access B. Obtained a 12-lead ECG C. Given atropine 1 mg D. Performed synchronized cardioversion 12 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association Answer Key Advanced Cardiovascular Life Support Exam B Question Answer 1. A B C ● 2. A B C ● 3. A ● C D 4. A B C ● 5. ● B C D 6. A B C ● 7. A B ● D 8. A B C ● 9. A ● C D 10. A B ● D 11. A B C ● 12. A ● C D 13. ● B C D 14. A B C ● 15. ● B C D 16. A B C ● 17. A ● C D 18. A B ● D 19. ● B C D 20. A B C ● 21. A ● C D 22. A ● C D 23. A B ● D 24. A ● C D 25. A ● C D 1 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association 26. ● B C D 27. A B C ● 28. A B C ● 29. ● B C D 30. A B ● D 31. A ● C D 32. A B ● D 33. ● B C D 34. ● B C D 35. A B ● D 36. A ● C D 37. A ● C D 38. ● B C D 39. A ● C D 40. A B C ● 41. ● B C D 42. ● B C D 43. A ● C D 44. A B C ● 45. ● B C D 46. A ● C D 47. A B ● D 48. ● B C D 49. A ● C D 50. A B C ● 2 Advanced Cardiovascular Life Support Exam B, March 30, 2016 © 2016 American Heart Association Annotated Answer Key Advanced Cardiovascular Life Support Exam B Provider Manual page numbers below refer to the printed book and the eBook as viewed through the offline desktop/laptop reader, not the eBook as viewed through the mobile apps or . 1. Which best describes this rhythm? A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type II D. Third-degree atrioventricular block The correct answer is D. This ECG rhythm strip shows third-degree atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases Bradycardia Case Rhythms for Bradycardia; page 121] 2. To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? A. Once every 10 seconds B. Once every 12 seconds C. Once every 3 to 4 seconds D. Once every 5 to 6 seconds The correct answer is D. For a patient in respiratory arrest with a pulse, deliver ventilations once every 5 to 6 seconds with a bag-mask device or any advanced airway. [ACLS Provider Manual, Part 5: The ACLS Cases Respiratory Arrest Case The BLS Assessment Ventilation and Pulse Check; page 46] 1 Advanced Cardiovascular Life Sup