ACLS FINAL EXAM QUESTIONS AND
ANSWERS
1. A patient with suspected acute coronary syndromes (ACS) is placed
on a car- diac monitor. The patient is complaining of dyspnea and is
given supplemental oxygen. The provider determines that the oxygen
is effective based on which SaO2 level?
Answer When a patient presents with potential ACS, the patient should have oxygen administered to
maintain an SaO2 of at least 94%.
2. A patient experiences cardiac arrest, and the resuscitation team
initiates ventilations using a bag-valve-mask (BVM) resuscitator. The
development of which condition during the provision of care would
lead the team to suspect that improper BVM technique is being used?
Answer Complications can occur with the use of a BVM resuscitator due to improper
technique. Delivering excessive volume or ventilating too fast creates excessive pressure that can
damage the airways, lungs and other organs. Excessive volume can lead to tension pneumothorax.
3. Assessment of a patient reveals an ETCO2 level of 55 mmHg and
an arterial oxygen saturation (SaO2) level of 88%. The provider
would interpret these findings as indicative of which condition?
Answer An SaO2 level of less than 90% (PaO2 of less than 50 mmHg) accompanied by
ETCO2 values greater than 50 mmHg is indicative of respiratory failure.
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,4. A healthcare provider initiates ventilations to ensure adequate
breathing and oxygenation. While ventilations are being performed,
capnography is estab- lished to evaluate the adequacy of the
ventilations. The healthcare provider determines that ventilations are
adequate based on which end-tidal carbon dioxide (ETCO2) value?
Answer End-tidal carbon dioxide values in the range of 35 to 45 mmHg confirm adequacy of
ventilation.
5. A patient comes to the emergency department complaining of
palpitations and "some shortness of breath." Cardiac monitoring is
initiated and reveals the following ECG rhythm strip. The provider
interprets this strip as indicating which arrhythmia?
Answer In atrial flutter, atrial contraction occurs at such a rapid rate that discrete P waves separated
by a flat baseline cannot be seen on the strip. Instead, the baseline continually rises and falls, producing
the "flutter" waves. In leads II and III, the flutter waves may be quite prominent, creating a "sawtooth"
pattern. Because of the volume of atrial impulses, the AV node allows only some of the impulses to
pass through to the ventricles. In atrial flutter, a 2:1 ratio is the most common (i.e., for every two flutter
waves, only one impulse passes through the AV node to generate a QRS complex). Ratios of 3:1 and 4:1
are also frequently seen.
6. A person suddenly collapses while sitting in the sunroom of a
healthcare
facility. A healthcare provider observes the event and hurries over to
assess the
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, situation. The healthcare provider performs which assessment first?
Answer A systematic approach to assessment is necessary. The healthcare provider should first
perform a rapid assessment. A rapid assessment is a quick visual survey to ensure safety, to form an
initial impression about the patient's condition, and to check for responsiveness, breathing and a pulse if
the patient appears to be unresponsive. This would be followed by a primary assessment and then a
secondary assessment.
7. A 35-year-old female patient's ECG is consistent with STEMI. The ECG
reveals a new ST-segment elevation at the J point in leads V2 and V3
of at least which size?
Answer New ST-segment elevation at the J point in leads V2 and V3 of at least 0.15 mV (1.5 mm) in
women 40 years or younger is considered diagnostic of STEMI.
8. An ECG strip of a patient in the emergency department reveals the
following rhythm. Which feature would the healthcare provider
interpret as indicating atrial fibrillation?
Answer The two key features of atrial fibrillation on ECG are the absence of discrete P waves
and the presence of irregularly irregular QRS complexes.
9. A patient presents to the emergency department with mild to
moderate recurrent chest pain, without any nausea or vomiting. A 12-
lead ECG is obtained and shows ST-segment depression with transient
T-wave elevation indicative of NSTE-ACS. Cardiac enzyme levels are
obtained and are not elevated. These find- ings suggest which condition?
Answer A patient who presents with ECG findings consistent with NSTE-ACS and does not
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ANSWERS
1. A patient with suspected acute coronary syndromes (ACS) is placed
on a car- diac monitor. The patient is complaining of dyspnea and is
given supplemental oxygen. The provider determines that the oxygen
is effective based on which SaO2 level?
Answer When a patient presents with potential ACS, the patient should have oxygen administered to
maintain an SaO2 of at least 94%.
2. A patient experiences cardiac arrest, and the resuscitation team
initiates ventilations using a bag-valve-mask (BVM) resuscitator. The
development of which condition during the provision of care would
lead the team to suspect that improper BVM technique is being used?
Answer Complications can occur with the use of a BVM resuscitator due to improper
technique. Delivering excessive volume or ventilating too fast creates excessive pressure that can
damage the airways, lungs and other organs. Excessive volume can lead to tension pneumothorax.
3. Assessment of a patient reveals an ETCO2 level of 55 mmHg and
an arterial oxygen saturation (SaO2) level of 88%. The provider
would interpret these findings as indicative of which condition?
Answer An SaO2 level of less than 90% (PaO2 of less than 50 mmHg) accompanied by
ETCO2 values greater than 50 mmHg is indicative of respiratory failure.
1/
18
,4. A healthcare provider initiates ventilations to ensure adequate
breathing and oxygenation. While ventilations are being performed,
capnography is estab- lished to evaluate the adequacy of the
ventilations. The healthcare provider determines that ventilations are
adequate based on which end-tidal carbon dioxide (ETCO2) value?
Answer End-tidal carbon dioxide values in the range of 35 to 45 mmHg confirm adequacy of
ventilation.
5. A patient comes to the emergency department complaining of
palpitations and "some shortness of breath." Cardiac monitoring is
initiated and reveals the following ECG rhythm strip. The provider
interprets this strip as indicating which arrhythmia?
Answer In atrial flutter, atrial contraction occurs at such a rapid rate that discrete P waves separated
by a flat baseline cannot be seen on the strip. Instead, the baseline continually rises and falls, producing
the "flutter" waves. In leads II and III, the flutter waves may be quite prominent, creating a "sawtooth"
pattern. Because of the volume of atrial impulses, the AV node allows only some of the impulses to
pass through to the ventricles. In atrial flutter, a 2:1 ratio is the most common (i.e., for every two flutter
waves, only one impulse passes through the AV node to generate a QRS complex). Ratios of 3:1 and 4:1
are also frequently seen.
6. A person suddenly collapses while sitting in the sunroom of a
healthcare
facility. A healthcare provider observes the event and hurries over to
assess the
2/
18
, situation. The healthcare provider performs which assessment first?
Answer A systematic approach to assessment is necessary. The healthcare provider should first
perform a rapid assessment. A rapid assessment is a quick visual survey to ensure safety, to form an
initial impression about the patient's condition, and to check for responsiveness, breathing and a pulse if
the patient appears to be unresponsive. This would be followed by a primary assessment and then a
secondary assessment.
7. A 35-year-old female patient's ECG is consistent with STEMI. The ECG
reveals a new ST-segment elevation at the J point in leads V2 and V3
of at least which size?
Answer New ST-segment elevation at the J point in leads V2 and V3 of at least 0.15 mV (1.5 mm) in
women 40 years or younger is considered diagnostic of STEMI.
8. An ECG strip of a patient in the emergency department reveals the
following rhythm. Which feature would the healthcare provider
interpret as indicating atrial fibrillation?
Answer The two key features of atrial fibrillation on ECG are the absence of discrete P waves
and the presence of irregularly irregular QRS complexes.
9. A patient presents to the emergency department with mild to
moderate recurrent chest pain, without any nausea or vomiting. A 12-
lead ECG is obtained and shows ST-segment depression with transient
T-wave elevation indicative of NSTE-ACS. Cardiac enzyme levels are
obtained and are not elevated. These find- ings suggest which condition?
Answer A patient who presents with ECG findings consistent with NSTE-ACS and does not
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