American Heart Association. Advanced Cardiovascular Life Support Exam Version A (50 questions) [Link] find an unresponsive patient who is not breathing. After activating the ‘emergency response system, you determine that there is no pulse. What is your noxt action? ‘A. Open the airway with a head tit-chin lif. B. Administer epinephrine at a dose of 1 mg/kg. . Deliver 2 rescue breaths each over 1 second. D. Start chest compressions at a rate of at least 100/min. 2. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate 44 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now? A PETCO, B. Chest xray C. Laboratory testing D. Obtaining a 12-lead ECC [Link] is the proferred method of access for epinephrine administration during cardiac arrest in most patients? A. Intraosseous B. Endotracheal . Central intravenous D. Peripheral intravenous 4,An activated AED does not promptly analyze the rhythm. What is your next action? A. Begin chest compressions. B. Discontinue the resusctation attempt . Check all AED connections and reanalyze. D. Rotate AED electrodes to an alternate position.American Heart Associations 5. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm. below, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What management step is your next priority? ‘A. Give 0.5 mg of atropine. B. Insert an advanced airway. C. Administer 1 mg of epinephrine. D. Administer a dopamine infusion. [Link] a pause in CPR, you see this lead Il ECG rhythm on the monitor. The patient has no pulse. What is the next action? A. Establish vascular access. B. Obtain the patient's history. C. Resume chest compressions. D. Terminate the resuscitative effort. [Link] is a common but sometimes fatal mistake in cardiac arrest management? Failure to obtain vascular access Prolonged periods of no ventilations Failure to perform endotracheal intubation Prolonged interruptions in chest compressions pom 8. Which action is a component of high-quality chest compressions? ‘A. Allowing complete chest recoil B. Chest compressions without ventilation C. 60 to 100 compressions per minute with a 15:2 ratio D. Uninterrupted compressions at a depth of 1% inches,a American Heart Associations 9. Which action increases the chance of successful conversion of ventricular fil illation? Pausing chest compressions immediately after a defibrillation attempt ‘Administering 4 quick ventilations immediately before a defibrillation attempt Using manual defibrillator paddles with light pressure against the chest Providing quality compressions immediately before a defibrillation attempt oom> 10. Which situation BEST describes pulseless electrical activity? Asystole without a pulse Sinus rhythm without a pulse Torsades de pointes with a pulse Ventricular tachycardia with a pulse gom> 14. What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? Provide compressions and ventilations with a 15:2 ratio. Provide compressions and ventilations with a 30:2 ratio. Provide a single ventilation every 6 seconds during the compression pause. Provide continuous chest compressions without pauses and 10 ventilations per minute. 99m> 12. Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO, level of 8 mm Hg. What is the significance of this finding? Chest compressions may not be effective. The endotracheal tube is no longer in the trachea, The patient meets the criteria for termination of efforts. The team is ventilating the patient too often (hyperventil vom> ion). 13. The use of quantitative capnography in intubated patients allows for monitoring of CPR quality. measures oxygen levels at the alveoli level. determines inspired carbon dioxide relating to cardiac output. detects electrolyte abnormalities early in code management. gom>2 american @ Heart Association. [Link] the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole, which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is your next treatment? A. Apply a transcutaneous pacemaker. B. Administer 1 mg of intravenous atropine. C. Administer 40 units of intravenous vasopressin. D. Consider terminating resuscitative efforts after consulting medical control. [Link] is a safe and effective practice within the defibrillation sequence? ‘Stop chest compressions as you charge the defibrillator. Be sure oxygen is not blowing over the patient’s chest during the shock Assess for the presence of a pulse immediately after the shock Commandingly announce "clear" after you deliver the defibrillation shock. com> 16. During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the int has a pulse. What is your next action? ‘A. Leave and get an AED. B. Begin chest compressions. C. Deliver 2 quick ventilations. D. Check the patient’s mouth for the presence of a foreign body. 17. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? Hands-free pads deliver more energy than paddies. Hands-free pads increase electrical arc. Hands-free pads allow for a more rapid defibrillation, Hands-free pads have universal adaptors that can work with any machine, pom> [Link] action is recommended to help minimize interruptions in chest compressions during CPR? A. Continue CPR while charging the defibrillator. B. Perform pulse checks immediately after defibrillation. C. Administer IV medications only when delivering breaths. D. Continue to use an AED even after the arrival of a manual defibrillator. [Link] action included in the BLS Survey? Early defibrillation Advanced airway management Rapid medication administration Preparation for therapeutic hypothermia oom>American Heart Association. [Link] drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? ‘A. Atropine 2 mg B. Amiodarone 300 mg C. Vasopressin 1 mg/kg D. Dopamine 2 mg/kg per minute [Link] is the appropriate interval for an interruption in chest compressions? ‘A. 10 seconds or less B. 10 to 15 seconds C. 15 to 20 seconds D. Interruptions are never acceptable [Link] of the following is a sign of effective CPR? A. PETCO, 210 mm Hg B. Measured urine output of 1 mL/kg per hour C. Patient temperature >32°C (89.6°F) D. Diastolic intra-arterial pressure <20 mm Hg [Link] is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)? ‘A. Identifying and treating early clinical deterioration B. Rapidly intervening with patients admitted through emergency department triage C. Responding to patients during a disaster or multiple-patient situation D. Responding to patients after activation of the emergency response system 24,Which action improves the quality of chest compressions delivered during a resuscitation attempt? A. Observe ECG rhythm to determine depth of compressions. B. Do not allow the chest to fully recoil with each compression. C. Compress the upper half of the stemum at a rate of 150 compressions per minute. D. Switch providers about every 2 minutes or every 5 compression cycles. [Link] is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min? 1 breath every 3 to 4 seconds 1 breath every 5 to 6 seconds 2 breaths every 5 to 6 seconds 2 breaths every 6 to 8 seconds voa>American Heart Association. 26. pationt presents to the emergency department with new onset of dizziness and fatigue. On examination, the pationt’s heart rate is 36/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication? A. Atropine 0.5 mg B. Oxygen 1210 15 Umin C. Epinephrine 0.5 mg D. Aspirin 160 mg chewed 2T-A patient presents to the emergency department with dizziness and shortness of breath with a sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate dose of dopamine for this patient? A. 2010 mgimin B. 2to 10 moghkg per minute C. 10to 15 mgimin D. 10to 15 moghkg per minute 28.A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry What is the next appropriate intervention? ‘A. Vagal maneuvers B. Metoprolol § mg IV C. Adenosine 6 mg IV D. Normal saline 1 L bolusAmerican Heart Association. 29. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia ata rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO, is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the le nd the patient has not been given any vasoactive drugs. A124 praventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention? A. Adenosine 6 mg IV push B, Amiodarone 300 mg IV push €. Synchronized cardioversion at 50 J D. Synchronized cardioversion at 200 J 30. You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? ‘A. Contact the patient's family to see what they would prefer. B. Have the EMS crew choose an appropriate patient disposition, . Accept the report and provide care within your present capability. D. Divert the patient to a hospital 15 minutes away with CT capabiltie. 31. Choose an appropriate indication to stop or withhold resuscitative efforts. A. Artest not witnessed B. Evidence of rigor mortis. C. Patient age greater than 85 years D. Norretum of spontaneous circulation after 10 minutes of CPR 32. 49-year-old woman arrives in the emergency department with persistent epigastric pain, She had been taking oral antacids for the past 6 hours because she thought she hhad heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and. regular, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 96%. Which is the most appropriate intervention to perform next? A. Administer oxygen. B. Obtain a 12-lead ECG. C. Evaluate for fibrinolytic eligibility. . Administer sublingual nitroglycerin. 33.A patient in respiratory failure becomes apneic but continues to have a strong pulse. ‘The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? A. Atropine IV push 8B. Epinephrine IV infusion . Application of a transcutaneous pacemaker D. Simple airway maneuvers and assisted ventilationA American @ Heart Association. [Link] is the appropriate procedure for endotracheal tube suctioning after the appropriate cathetor is solectod? ‘A. Suction during insertion but for no longer than 30 seconds. B. Suction the mouth and nose for no longer than 30 seconds. ‘C. Suction during withdrawal but for no longer than 10 seconds, D. Hyperventiate before catheter insertion, and then suction during withdrawal 35,While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm: What is the most appropriate first intervention? A. Aspirin B. Atropine ©. Lidocaine D. Nitroglycerin 36.A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nnonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. ‘The lead Il ECG displays sinus rhythm, What is the most appropriate action for the EMS team to perform next? ‘12dead ECG assessment ‘Administration of 100% supplementary oxygen Cincinnati Prehospital Stroke Scale assessment Administration of a low-dose aspirin pomp [Link] is transporting a patient with a positive prehospital stroke assessment. Upon arrival in the emergency department, the intial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry roading is 95% on room air. The lead I! ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next? Head CT scan Transfer tothe stroke unit Immediate nPA administraton ‘Administration of 100% oxygen pep>E. American Heart Association. [Link] is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in place? A. 406 breaths per minute B. 8 to 10 breaths per minute C. 12 to 14 breaths per minute D. 16 to 18 breaths per minute 39.A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is ‘95% on room air. What intervention should you perform next? ‘A. Obtain a 12-lead ECG. B. Give 150 mg of amiodarone. C. Administer 160 mg of aspirin. D. Administer 6 mg of adenosine. 40. You are evaluating a 48-year-old man with crushing substernal chest pain. The patient Pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular wide-complex tachycardia, What intervention should you perform next? A. Procedural sedation B. 124ead ECG CC. Amiodarone administration D. Synchronized cardioversion [Link] is the monitor? for an unconscious patient with any tachycardia on the ‘A. Review the patient's home medications. B. Evaluate the breath sounds C. Determine whether pulses are present. D. Administer sedative drugs. 42. Which rhythm requires synchronized cardioversion? A. Unstable supraventricular tachycardia B. Atrial fibrilation C. Sinus tachycardia D. NSR on monitor but no pulseAmerican Heart Associations [Link] is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia? A. 3mg B. 6mg Cc. 9mg D. 12mg 44, What is the usual post-cardiac arrest target range for PETC: when ventilating a Patient who achieves return of spontaneous circula 30 to 35 mm Hg 35 to 40 mm Hg 40 to. 45 mm Hg 445 to 50 mm Hg pomp [Link] condition is a contraindication to therapeutic hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? Initial rhythm of asystole Responding to verbal commands Patient age greater than 60 years Desire to provide coronary reperfusion (eg, PCI) poe> [Link] is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway? ‘A. May interfere with effective ventilation B. Places the patient's cervical spine at risk C. Obstruction of venous return from the brain D. Does not adequately secure the airway device [Link] is the most reliable method of confirming and moi placement of an endotracheal tube? A. 5-point auscultation B. Colorimetric capnography C. Continuous waveform capnography D. Use of esophageal detection devices 48. What is the recommended IV fluid (normal saline or Ringer's lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period? ‘A. 250 to 500 mL B. 500 to 1000 mL C. 102 D. 2t03LAmerican Heart Associations 49. What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? ‘A. 90mm Hg B. 85mm Hg ©. 80mm Hg D. 75mm Hg ‘50. What is the first treatment priority for a patient who achieves ROSC? A. Coronary repertusion B. Therapeutic hypothermia C. Maintaining blood glucose <185 mgidL ! Optimizing ventiation and oxygenation ‘Advanced Cardiovascular Life Support Written Exam Version A ©2011 American Heart Association