ACS Exam Questions With Complete Solutions
____________ is a form of arteriosclerosis in which the
thickening and hardening of the vessel walls are caused by an
accumulation of fibrofatty deposits in the intimal lining of large
and middle-sized muscular arteries. Correct Answers
atherosclerosis
____________ is chest discomfort or other related symptoms
caused by myocardial ischemia. Correct Answers Angina
pectoris
A 35-year-old male is complaining of a headache, blurred
vision, nausea, and vomiting. He has a history of hypertension
but is noncompliant with his medications. His pupils are equal
and reactive, his skin is warm and dry, and his breath sounds are
clear and equal bilaterally. HR = 72, BP = 192/138, RR = 12,
SaO2 = 99%. In addition to monitoring his cardiac rhythm,
administering oxygen, and starting an IV at a KVO rate, which
of the following is most appropriate?
a. Labetalol, IV
b. Diazepam, IV
c. Nitroglycerin, SL
d. Morphine, IV Correct Answers a. Labetalol, IV
A 45-year-old male is alert and oriented, complaining of chest
pain. He describes a two-day history of worsening pain
manifesting as a burning sensation below his left breast that
radiates across his chest. He states that the pain seems to get
better right after eating but then worsens again. Medical history
,includes myocardial infarction, hypertension, and type II
diabetes. His medications include Inderal, Vasotech, Glucotrol,
and Lopid. Physical examination reveals cool, dry skin; clear
lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86,
RR = 12, SaO2 = 98%. The patient is on oxygen by nasal
cannula at 4 liters per minute. Which of the following should be
done next?
a. 81 mg aspirin by mouth
b. Precautionary IV of normal saline and transport
c. 0.4 mg nitroglycerin sublingually
d. 12-lead ECG Correct Answers d. 12-lead ECG
A 48-year-old male is complaining of chest pain that he
describes as dull, located substernally, but radiating to his neck.
He rates the pain a 6 on a scale of 1 to 10 and complains of
nausea and lightheadedness. His skin is cool and diaphoretic.
HR = 96, BP = 124/82, RR = 14, SaO2 = 97%. The 12-lead
ECG is nondiagnostic. In addition to oxygen, an IV of normal
saline at a keep open rate, and transport to the emergency
department, which of the following would be most appropriate?
a. Nitroglycerin, morphine, and furosemide
b. Reassurance that likely his condition is not cardiac in nature
c. Nitroglycerin
d. Aspirin, nitroglycerin, and morphine Correct Answers d.
Aspirin, nitroglycerin, and morphine
A 48-year-old male is sitting upright in bed in respiratory
distress. He describes an acute onset of difficulty breathing and
chest pain during the night that has been worsening for the past
,3 hours. He also complains of nausea. Pain is described as a
substernal pressure radiating to his left shoulder. Physical
examination reveals cool, diaphoretic skin and rales on
auscultation bilaterally. Medical history includes two prior
myocardial infarctions. Medications include Zestril and
metoprolol. HR = 132, BP = 140/100, RR = 25, SaO2? = 92%.
Which of the following is NOT indicated?
a. Adenosine
b. Enalapril
c. Morphine
d. Nitroglycerin Correct Answers a. Adenosine
A 55-year-old female has arrived in the emergency department
complaining of severe chest pain. Her blood pressure is 126/72,
pulse 138, and respirations 14. The cardiac monitor shows a
sinus tachycardia without ectopy. Management of this patient
should include oxygen, IV access, and:
a. Nitroglycerin, morphine (if pain is not relieved with
nitroglycerin), and aspirin.
b. Nitroglycerin, morphine, lidocaine, and aspirin.
c. Vagal maneuvers and adenosine 6 mg rapid IV push.
d. Nitroglycerin, aspirin, and procainamide. Correct Answers
a. Nitroglycerin, morphine (if pain is not relieved with
nitroglycerin), and aspirin.
A 56-year-old male is alert and oriented and complaining of
severe, tearing pain in his abdomen that radiates to his back, as
well as numbness in his legs. He has a history of hypertension
and type II diabetes. His skin is cool and diaphoretic. HR = 110,
, BP = 108/82, RR = 20, SaO2 = 98%. Which of the following
does the patient most need right now?
a. High-flow oxygen
b. Determination of the presence or absence of a pulsating
abdominal mass
c. Two large-bore IVs of isotonic crystalloid solution
d. Transport Correct Answers d. Transport
A 58-year-old man is complaining of chest pain. Select the
question that best evaluates the quality of the patient's pain.
a. "When did the pain begin?"
b. "How would you describe your pain?"
c. "Does anything make the pain better or worse?"
d. "Where is your discomfort?" Correct Answers b. "How
would you describe your pain?"
A 62-year-old male is complaining of excruciating chest pain
radiating to his left arm and jaw. He states that the pain has been
present for the past hour and is unrelieved with rest. His blood
pressure is 134/62, with a respiratory rate of 16. He is warm,
diaphoretic, and anxious. The cardiac monitor shows a sinus
tachycardia at 120 beats/minute without ectopy. An IV has been
established. Which of the following most correctly reflects the
recommended treatment sequence for this patient?
a. Oxygen, morphine, and a dopamine infusion at 5 to 20
mcg/kg/min
b. Oxygen, medications for pain relief, aspirin, fibrinolytic
therapy, and beta-blockers if no reason for exclusion
____________ is a form of arteriosclerosis in which the
thickening and hardening of the vessel walls are caused by an
accumulation of fibrofatty deposits in the intimal lining of large
and middle-sized muscular arteries. Correct Answers
atherosclerosis
____________ is chest discomfort or other related symptoms
caused by myocardial ischemia. Correct Answers Angina
pectoris
A 35-year-old male is complaining of a headache, blurred
vision, nausea, and vomiting. He has a history of hypertension
but is noncompliant with his medications. His pupils are equal
and reactive, his skin is warm and dry, and his breath sounds are
clear and equal bilaterally. HR = 72, BP = 192/138, RR = 12,
SaO2 = 99%. In addition to monitoring his cardiac rhythm,
administering oxygen, and starting an IV at a KVO rate, which
of the following is most appropriate?
a. Labetalol, IV
b. Diazepam, IV
c. Nitroglycerin, SL
d. Morphine, IV Correct Answers a. Labetalol, IV
A 45-year-old male is alert and oriented, complaining of chest
pain. He describes a two-day history of worsening pain
manifesting as a burning sensation below his left breast that
radiates across his chest. He states that the pain seems to get
better right after eating but then worsens again. Medical history
,includes myocardial infarction, hypertension, and type II
diabetes. His medications include Inderal, Vasotech, Glucotrol,
and Lopid. Physical examination reveals cool, dry skin; clear
lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86,
RR = 12, SaO2 = 98%. The patient is on oxygen by nasal
cannula at 4 liters per minute. Which of the following should be
done next?
a. 81 mg aspirin by mouth
b. Precautionary IV of normal saline and transport
c. 0.4 mg nitroglycerin sublingually
d. 12-lead ECG Correct Answers d. 12-lead ECG
A 48-year-old male is complaining of chest pain that he
describes as dull, located substernally, but radiating to his neck.
He rates the pain a 6 on a scale of 1 to 10 and complains of
nausea and lightheadedness. His skin is cool and diaphoretic.
HR = 96, BP = 124/82, RR = 14, SaO2 = 97%. The 12-lead
ECG is nondiagnostic. In addition to oxygen, an IV of normal
saline at a keep open rate, and transport to the emergency
department, which of the following would be most appropriate?
a. Nitroglycerin, morphine, and furosemide
b. Reassurance that likely his condition is not cardiac in nature
c. Nitroglycerin
d. Aspirin, nitroglycerin, and morphine Correct Answers d.
Aspirin, nitroglycerin, and morphine
A 48-year-old male is sitting upright in bed in respiratory
distress. He describes an acute onset of difficulty breathing and
chest pain during the night that has been worsening for the past
,3 hours. He also complains of nausea. Pain is described as a
substernal pressure radiating to his left shoulder. Physical
examination reveals cool, diaphoretic skin and rales on
auscultation bilaterally. Medical history includes two prior
myocardial infarctions. Medications include Zestril and
metoprolol. HR = 132, BP = 140/100, RR = 25, SaO2? = 92%.
Which of the following is NOT indicated?
a. Adenosine
b. Enalapril
c. Morphine
d. Nitroglycerin Correct Answers a. Adenosine
A 55-year-old female has arrived in the emergency department
complaining of severe chest pain. Her blood pressure is 126/72,
pulse 138, and respirations 14. The cardiac monitor shows a
sinus tachycardia without ectopy. Management of this patient
should include oxygen, IV access, and:
a. Nitroglycerin, morphine (if pain is not relieved with
nitroglycerin), and aspirin.
b. Nitroglycerin, morphine, lidocaine, and aspirin.
c. Vagal maneuvers and adenosine 6 mg rapid IV push.
d. Nitroglycerin, aspirin, and procainamide. Correct Answers
a. Nitroglycerin, morphine (if pain is not relieved with
nitroglycerin), and aspirin.
A 56-year-old male is alert and oriented and complaining of
severe, tearing pain in his abdomen that radiates to his back, as
well as numbness in his legs. He has a history of hypertension
and type II diabetes. His skin is cool and diaphoretic. HR = 110,
, BP = 108/82, RR = 20, SaO2 = 98%. Which of the following
does the patient most need right now?
a. High-flow oxygen
b. Determination of the presence or absence of a pulsating
abdominal mass
c. Two large-bore IVs of isotonic crystalloid solution
d. Transport Correct Answers d. Transport
A 58-year-old man is complaining of chest pain. Select the
question that best evaluates the quality of the patient's pain.
a. "When did the pain begin?"
b. "How would you describe your pain?"
c. "Does anything make the pain better or worse?"
d. "Where is your discomfort?" Correct Answers b. "How
would you describe your pain?"
A 62-year-old male is complaining of excruciating chest pain
radiating to his left arm and jaw. He states that the pain has been
present for the past hour and is unrelieved with rest. His blood
pressure is 134/62, with a respiratory rate of 16. He is warm,
diaphoretic, and anxious. The cardiac monitor shows a sinus
tachycardia at 120 beats/minute without ectopy. An IV has been
established. Which of the following most correctly reflects the
recommended treatment sequence for this patient?
a. Oxygen, morphine, and a dopamine infusion at 5 to 20
mcg/kg/min
b. Oxygen, medications for pain relief, aspirin, fibrinolytic
therapy, and beta-blockers if no reason for exclusion
