AHA ACLS Practice Test Complete Graded A 2024

True or False? VF and Pulseless VT are shockable rhythms TRUE VF and Pulseless VT represent shockable rhythms. The left side of the Adult Cardiac Arrest Algorithm should be followed to treat. AHA Advanced Cardiovascular Life Support Provider Manual, p. 94 If the initial shock terminates VF but the arrhythmia recurs later in the resuscitation: A) Deliver subsequent shocks at the maximum energy dose B) Deliver subsequent shocks at the previously successful energy level C) Do not deliver any subsequent shocks and continue CPR D) Begin cardioversion B) Deliver subsequent shocks at the previously successful energy level AHA Advanced Cardiovascular Life Support Provider Manual, p. 96 For every minute that passes between collapse and defibrillation, how much does the chance of survival decrease from a witnessed VF sudden cardiac arrest if no bystander CPR is provided? A) 7% to 10% B) 3% to4% C) 25% to 30% D) 50% to 60% A) 7% to 10% For every minute that passes between collapse and defibrillation, the chance of survival from a witnessed VF sudden cardiac arrest declines by 7% to 10% per minute if no bystander CPR is provided. When bystanders perform CPR, the decline is more gradual and averages 3% to 4% per minute. CPR performed early can double or triple survival from sudden cardiac arrest at most defibrillation intervals. AHA Advanced Cardiovascular Life Support Provider Manual, p. 97 Pulse checks should: A) Performed every 50 cycles of CPR B) Be performed during rhythm analysis, only if an organized rhythm is present C) Take at least 15 seconds to ensure accuracy D) Give the rescuer enough information to treat the victim B) Be performed during rhythm analysis, only if an organized rhythm is present Rhythm checks should be performed after 5 cycles of CPR. Limit rhythm checks to less than 10 seconds to minimize interruptions in CPR. Pulse checks should be performed when a rhythm check reveals a change in the rhythm to a rhythm that is organized and could be generating a pulse. AHA Advanced Cardiovascular Life Support Provider Manual, p. 99 What is the first-line antiarrhythmic agent given in cardiac arrest? A) Magnesium sulfate B) Lidocaine C) Epinephrine D) Amiodarone D) Amiodarone Amiodarone is the first-line antiarrhythmic agent given in cardiac arrest because it has been clinically demonstrated that it improves the rate of ROSC and hospital admission in adults with refractory VF/pulseless VT. AHA Advanced Cardiovascular Life Support Provider Manual, p. 100 True or False? Defibrillation restarts the heart FALSE Defibrillation does not restart the heart. Defibrillation stuns the heart and briefly terminates all electrical activity, including VF and pVT. If the heart is still viable, its normal pacemakers may eventually resume electrical activity that ultimately results in a perfusing rhythm. AHA Advanced Cardiovascular Life Support Provider Manual, p. 96 If using a biphasic defibrillator and the recommended dosage is not known: A) Do not shock until the recommended dose has been identified B) Shock using the minimum energy dose available C) Shock using a 360 J energy dose D) Shock using the maximum energy dose available D) Shock using the maximum energy dose available If you do not know the effective dose range of a biphasic defibrillator, deliver the maximal energy dose for the first and all subsequent shocks. Most defibrillators used today are biphasic. Biphasic means that the electrical current travels from one paddle to the other paddle and then back in the other direction. The biphasic shock also requires less energy to restore normal heart rhythm and helps to reduce skin burns and cellular damage to the heart. AHA Advanced Cardiovascular Life Support Provider Manual, p. 96 The proper dosing of epinephrine for VF/pVT is: A) 1 mg IV/IO - repeated every 3 to 5 minutes B) 300 mg IV/IO bolus C) 1 to 2 g IV/IO diluted in 10 mL saline over 5 to 20 minutes D) 0.5 to 0.75 mg/kg IV/IO A) 1 mg IV/IO - repeated every 3 to 5 minutes AHA Advanced Cardiovascular Life Support Provider Manual, p. 99 Epinephrine is used during resuscitation: A) Because it causes vasoconstriction B) To stop allergic reactions causing heart failure C) As a pain reliever for the victim D) Because it is an antiarrhythmic A) Because it causes vasoconstriction Epinephrine increases arterial blood pressure and coronary perfusion during CPR via alpha-1-adrenoceptor agonist effects Vasoconstriction is important during CPR because it will help increase blood flow to the brain and heart AHA Advanced Cardiovascular Life Support Provider Manual, p. 99 The chest compression fraction should be: A) As high as possible B) At least 50% C) Lower than 25% D) Lower than 60% A) As high as possible Chest compression fraction is the proportion of time during cardiac arrest resuscitation when chest compressions are performed. CCF should be as high as possible: at least 60% and ideally greater than 80%. AHA Advanced Cardiovascular Life Support Provider Manual, p. 92 Tachycardia is defined as: A) An arrhytmia with a rate greater than 150/min B) An arrhytmia with a rate greater than 100/min C) Any rhythm disorder with a heart rate less than 60/min D) An organized rhythm without a pulse B) An arrhytmia with a rate greater than 100/min AHA Advanced Cardiovascular Life Support Provider Manual, p. 130 Describe how synchronized cardioversion works Synchronized cardioversion is a LOW ENERGY SHOCK that uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex (the highest point of the R-wave). When the "sync" option is engaged on a defibrillator and the shock button pushed, there will be a delay in the shock. During this delay, the machine reads and synchronizes with the patients ECG rhythm. This occurs so that the shock can be delivered with or just after the peak of the R-wave in the patients QRS complex. Synchronization avoids the delivery of a LOW ENERGY shock during cardiac repolarization (t-wave). If the shock occurs on the t-wave (during repolarization), there is a high likelihood that the shock can precipitate VF (Ventricular Fibrillation). Explain the difference between monophasic and biphasic synchronisation Monophasic uses direct current which passes in one direction from one paddle to the next. Biphasic defibrillation, alternates the direction of the pulses and requires less energy for the same effect. Most biphasic defibrillators have a first shock success rate that is significantly higher than monophasic defibrillators. Roughly 20% higher success with biphasic. Biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation, decreasing the risk of burns and myocardial damage. Synchronized cardioversion is recommended for: A) Monomorphic VT in a stable patient B) Pulseless rhythms C) Unstable SVT D) Polymorphic VT C) Unstable SVT Synchronized shocks are recommended for patients with: - Unstable SVT - Unstable atrial fibrillation - Unstable atrial flutter - Unstable regular monomorphic tachycardia with a pulse AHA Advanced Cardiovascular Life Support Provider Manual, p. 137 What is the correct energy dose for unstable atrial fibrillation when delivering monophasic synchronized shocks? A) 50 to 100 J B) 100 J C) Treat with high-energy shocks (defibrillation doses) D) 200 J` D) 200 J AHA Advanced Cardiovascular Life Support Provider Manual, p. 138 AV nodal blocking agents should be avoided in: A) Patients with a regular SVT B) Patients with a regular VT C) Patients with an irregular wide-complex tachycardia D) All of the above C) Patients with an irregular wide-complex tachycardia Avoid AV nodal blocking agents such as adenosine, calcium channel blockers, digoxin, and possible beta-blockers in patients with pre-excitation atrial fibrillation, because these drugs may cause a paradoxical increase in the ventricular response. AHA Advanced Cardiovascular Life Support Provider Manual, p. 142 Which drug is the preferred intervention for terminating narrow-complex tachycardias that are symptomatic (but stable) and supraventricular in origin (SVT)? A) Epinephrine B) Amiodarone C) Atropine D) Adenosine D) Adenosine Vagal maneuvers and Adenosine are the preferred intervention for terminating narrow-complex tachycardias that are symptomatic (but stable) and supraventricular in origin (SVT). AHA Advanced Cardiovascular Life Support Provider Manual, p. 142-143 Narrow QRS complex tachycardia (NCT) represents an umbrella term for any rapid cardiac rhythm greater than 100 beats per minute (bpm) with a QRS duration of less than 120 milliseconds (ms). A narrow QRS complex (<120 milliseconds) reflects rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the His bundle (ie, a supraventricular tachycardia). The site of origin may be in the sinus node, the atria, the atrioventricular (AV) node, the His bundle, or some combination of these sites. Adenosine should not be given to: A) Patients with asthma B) Pregnant women C) Patients with SVT D) Patients with a narrow QRS with regular rhythm A) Patients with asthma Adenosine may cause bronchospasm; therefore, adenosine should generally not be given to patients with asthma or chronic obstructive pulmonary disease. AHA Advanced Cardiovascular Life Support Provider Manual, p. 143 If SVT does not respond to vagal maneuvers, how much adenosine do you give: A) 20mL rapid IV push B) 12 mg rapid IV push C) 6 mg IV push over 10 seconds D) 6mg rapid IV push over 1 second D) 6mg rapid IV push over 1 second Give adenosine 6 mg as a rapid IV push in a large (eg, antecubital) vein over 1 second. Follow with a 20 mL saline flush and elevate the arm immediately. AHA Advanced Cardiovascular Life Support Provider Manual, p. 143 Which of the following statements is not true? A) Sinus tachycardia is a heart rate that is greater than 100/min and is generated by sinus node discharge B) Sinus tachycardia is caused by cardiac conditions C) In sinus tachycardia, the goal is to identify and treat the underlying systemic cause. D) Cardioversion is contraindicated in Sinus Tachycardia B) Sinus tachycardia is caused by cardiac conditions Sinus tachycardia is caused by external influences on the heart. These are systemic conditions, not cardiac conditions. AHA Advanced Cardiovascular Life Support Provider Manual, p. 131, 134 Vagal maneuvers alone will terminate about what percentage of SVTs? A) 25% B) 90% C) 75% D) 50% A) 25% Vagal maneuvers alone (Valsalva maneuver or carotid sinus massage) will terminate about 25% of SVTs. Adenosine is required for the remainder. AHA Advanced Cardiovascular Life Support Provider Manual, p. 143 End points for the administration of procainamide include: A) Hypotension B) Duration of QRS increases by 25% C) Maximum dose of 7 mg/kg is reached D) Increase in heart rate by 30 points A) Hypotension Procainamide can be administered to suppress wide-complex tachycardias except in patients displaying hypotension, a QRS increase of 50%, or the maximum dose of 17 mg/kg is met. AHA Advanced Cardiovascular Life Support Provider Manual, p. 133, 168 What are the 2 most common causes of Pulseless Electrical Activity? A) Hypothermia and hypoxia B) Hypovolemia and hypoxia C) Hypovolemia and hyperkalemia D) Hypoxia and hyperkalemia B) Hypovolemia and hypoxia Hypovolemia and hypoxia are the 2 most common underlying and potentially reversible causes of PEA. Be sure to look for evidence of these problems as you assess the patient. AHA Advanced Cardiovascular Life Support Provider Manual, p. 113 What is the correct dosing regimen of epinephrine to treat PEA or Asystole? A) 300 mg bolus B) 1 mg IV/IO - repeated every 8 to 10 minutes C) 1 mg IV/IO - repeated every 3 to 5 minutes D) .5 mg IV/IO - repeated every 8 to 10 minutes C) 1 mg IV/IO - repeated every 3 to 5 minutes AHA Advanced Cardiovascular Life Support Provider Manual, p. 111 Pulseless Electrical Activity is defined as: A) No electrical activity present on an ECG B) A perfusing rhythm without spontaneous respirations C) Ventricular Fibrillation D) Any organized rhythm without a pulse D) Any organized rhythm without a pulse Any organized rhythm without a pulse is defined as PEA. An organized rhythm consists of QRS complexes that are similar in appearance from beat to beat (ie, each has a uniform QRS configuration). Organized rhythms may have narrow or wide QRS complexes, they may occur at rapid or slow rates, they may be regular or irregular, and they may or may not produce a pulse. AHA Advanced Cardiovascular Life Support Provider Manual, p. 110 Possible causes of an isoelectric ECG (Flat line) include: A) Loose leads or leads not connected to the patient or defibrillator/monitor B) No power to the monitor C) Gain or amplitude too low D) All of the above D) All of the above AHA Advanced Cardiovascular Life Support Provider Manual, p. 114-115 Which of the following is not a reason to stop or withhold resuscitative efforts? A) Rigor mortis B) Indicators of do-not-attempt-resuscitation (DNAR) status C) Threat to safety of providers D) Resuscitation effort have been unsuccessful for 20 minutes or more D) Resuscitation effort have been unsuccessful for 20 minutes or more The final decision to stop resuscitative efforts can never be as simple as an isolated time interval. AHA Advanced Cardiovascular Life Support Provider Manual, p. 118 Routine insertion of an advanced airway in asystole: A) Is contraindicated in a patient in asystole B) Should take priority over gaining IV/IO access C) Should only be performed if ventilations with a BVM are ineffective D) Is necessary so the epinephrine can be given C) Should only be performed if ventilations with a BVM are ineffective If bag-mask ventilation is adequate providers may defer insertion of an advanced airway. AHA Advanced Cardiovascular Life Support Provider Manual, p. 46 The first dose of amiodarone for PEA treatment is: A) 150 mg B) 300 mg C) 100 mg D) Amiodarone is not used in PEA D) Amiodarone is not used in PEA Amiodarone is used for VF/pVT AHA Advanced Cardiovascular Life Support Provider Manual, p. 94 Which of the following statements is not true? A) CPR should not be stopped to administer drugs to PEA or Asystole patients B)Treatment of PEA is limited to interventions outlined in the algorithm C) IV/IO access is a priority over advanced airway management D) Epinephrine is a common treatment for PEA and Asystole B)Treatment of PEA is limited to interventions outlined in the algorithm Treatment of PEA is not limited to the interventions outlined in the algorithm. Healthcare providers should attempt to identify and correct an underlying cause if present. It is essential to search for and treat reversible causes for resuscitative efforts to be successful. AHA Advanced Cardiovascular Life Support Provider Manual, p. 113 Which of the following statements is true? A) There is no evidence that attempting to "defibrillate" asystole is beneficial B) The AHA recommends the use of TCP for patients with asystolic cardiac arrest C) CPR should be interrupted while establishing IV or IO access in asystole patients D) Identifying the cause of asystole is not important A) There is no evidence that attempting to "defibrillate" asystole is beneficiaL There is no evidence that attempting to "defibrillate" asystole is beneficial. In one study, the group that received shocks had a trend toward worse outcomes. If it is unclear whether the rhythm is fine VF or asystole, an initial attempt at defibrillation may be warranted. AHA Advanced Cardiovascular Life Support Provider Manual, p. 117 True or False? PEA and Asystole are shockable rhythms FALSE AHA Advanced Cardiovascular Life Support Provider Manual, p. 112