Advanced Cardiovascular Life
Support
Precourse Written Examination
May 2001
© 2001 American Heart
Association
This bridge test has certain questions crossed out
because they do not apply anymore since the American Heart Association ACLS
Guidelines changed. We will use this bridge test until we receive the new 2006
test from the American Heart Association.
American Heart ~ Association~ ~
Fighting Heart Disease and Stroke
ACLS Provider
Course Precourse Written Examination
This
is a single-answer multiple-choice examination. There is only one correct
answer to each question. Do not write on this question sheet. Circle the
correct answer on your answer sl1eet.
1)
Which of the
following actions is done first to restore oxygenation and ventilation
to an unresponsive, breathless, near-drowning victim?
a)
force water from the victim's lungs by performing the
Heimlich maneuver
b)
force water from the victim's lungs by starting chest
compressions
c)
stabilize cervical spine with c-collar and spine board, then
start the ABCs
d)
open the airway with a jaw-thrust maneuver, provide
in-line cervical stabilization, start the ABCs
2)
Tracheal intubation has just been attempted for a victim of
respiratory arrest. During hand ventilation with a bag, you hear stomach gurgling
over the epigastrium, and oxygen saturation (per
pulse oximetry) fails to rise. Which of the following is the most likely
explanation for these findings?
a)
intubation of the hypopharyngeal area
b)
intubation ot the left main bronchus
c)
intubation of the right
main bronchus
d)
bilateral tension pneumothorax
3. Which of the following patients needs immediate intubation?
a)
an elderly woman with severe chest pain and shallow
respirations at 30 breaths/min
b)
a 55-year-old insulin-dependent diabetic with ST-segment
elevation and runs of VT
c)
an apneic patient whose chest
does not rise with bag-mask ventilations
d)
a subdued, alcohol-intoxicated college student with a
reduced gag reflex
4)
When treating a
trauma victim who is in shock and deeply comatose, which of the following is
the airway of choice?
a)
a tracheal tube
b)
the patient's own airway
c)
a nasopharyngeal airway
d)
an oropharyngeal airway
5)
Which of these
lists of CPR performance and AED operation is correct and in the right
sequence?
a)
send someone to call
911. attach AED electrode pads, open the airway, turn
on the AED. provide 2 breaths. check for a pulse
b)
wait for the AED and
barrier device to arrive, open the airway. provide 2
breaths. check for a pulse, if no pulse attach AED
electrode pads. follow AED prompts
c)
send someone to call
911 , open the airway, provide 2 breaths, check for a pulse. if
no pulse attach the AEO. follow AED prompts
d)
provide 2 breaths.
check for a pulse, if no pulse perform chest compressions for 1 minute, call
for the AEO, when the AEO arrives attach electrode pads
.. :"
11) A patient arrives in the ED. CPR continues with
ventilations provided through a tracheal tube inserted in the field. Chest
compressions produce a femoral pulse that disappears during a "stop
compressions" pause. During the pause the cardiac monitor shows narrow QRS
complexes at a rate of 65 bpm. At this point what is the next action you
should take?
a)
check for tracheal tube dislodgment and improper tube
placement
b)
start an IV, administer atropine 1 mg IV push
c)
start an IV, send blood samples for measurement of serum
electrolytes and a toxic drug screen
d)
analyze arterial blood gases to check for acidosis,
hypoxia, and hypoventilation
12) You have intubated a patient with PEA. You hear
good bilateral breath sounds, and you see obvious bilateral chest rise. Two
minutes after epinephrine 1 mg IV is given, PEA continues at 30 bpm. Which of
the following actions should be done next?
a)
administer atropine 1 mg IV
b)
initiate transcutaneous pacing at a rate of 60 bpm
c)
start dopamine IV infusion at 15 to 20 ug/kg per minute
d)
give epinephrine (1 mL of 1: 1 0 000 solution) IV bolus
13)
For which of the following PEA patients is sodium
bicarbonate therapy (1 mEq/kg) likely to be most effective?
a)
a patient with hypercarbic
acidosis due to a tension pneumothorax
b)
a patient with a brief arrest interval
c)
a patient with documented severe hyperkalemia
d)
a patient with documented severe hypokalemia
14)
A cardiac arrest patient arrives in the ED in PEA
at 30 bpm. CPR continues, proper tube placement is confirmed, and IV access is
established. Which of the following medications is most appropriate to
give next?
a)
calcium chloride 5 mL of 10% solution IV
b)
epinephrine 1 mg IV
c)
synchronized cardioversion at 200 J
d)
sodium bicarbonate 1 mEq/kg IV
15)
Which of the following drug-dose combinations is
recommended as the initial medication to give to a patient in documented
asystole?
a)
epinephrine 3 mg IV
b)
atropine 3 mg IV
c)
epinephrine 10 mL of a 1: 10,000 solution IV
d)
atropine 0.5 mg IV
16)
When a monitor attached to a person in cardiac
arrest displays a "flat line," you should execute the "flat line
protocol." Which of the following actions is included in this protocol?
a)
check monitor display for sensitivity or "gain"
b)
obtain a right-sided 12-lead ECG
c)
change LEAD SELECT control from lead /I to paddles
and back
d)
administer a lower energy (100 J) defibrillatory
shock to "bring out" possible occult VF
17) an 88 year-old man in normothermic cardiac arrest arrives in
the ED after 15 minutes of continuous asystole. Paramedics intubated him,
confirmed proper tube placement, gained IV access, and gave
epinephrine 1 mg IV x 3 and atropine 1 mg IV x 2. Which of the following
actions is most likely to have a positive therapeutic effect and is most
consistent with the recommendations in ECC
Guidelines 2000?
a)
ask the nurse to bring members of the immediate family to
a private area, where you discuss code termination and family presence at the
resuscitation
b)
stop efforts at 10 minutes if there is no response to
epinephrine 3 mg IV every 3 minutes
c)
stop efforts at 10 minutes if there is no response to
transcutaneous pacing given with CPR
d)
stop efforts if there is no response to 3 empiric defibrillatory shocks of 360 J given 3 minutes apart
18)
A 50-year-old
man has a 3-mm ST-elevation in leads V2 to V4• Severe
chest pain continues despite oxygen, aspirin, nitroglycerin SL x 6, and
morphine 10 mg IV.
BP
= 170/11D mm Hg; HR = 120 bpm. Which of the
following treatment combinations is most appropriate for this patient
at this time (assume no contraindications to any medication)?
a)
calcium channel blocker IV + heparin bolus IV
b)
ACE inhibitor IV + lidocaine infusion
c)
magnesium sulfate IV + enoxaparin (Lovenox) SO
d)
reteplase, recombinant (Retavase)+ heparin bolus IV
19) Which of the following includes the major
components of definitive therapy for a 60-year-old patient with >2mm
ST-segment elevation within 30 minutes of the onset of symptoms of acute
ischemic chest pain?
a)
fibrinolytics or PCI, aspirin, l3-blockers, heparin
b)
heparin, aspirin, glycoprotein lib/IIIa inhibitors, IV
b-blockers, nitrates
c)
serum cardiac markers, serial ECGs, perfusion scan or
stress test
d)
prophylactic lidocaine, fluid bolus, vasopressor infusion
20) Within 45 minutes of ED arrival, which of the
following evaluation sequences should be performed for a 70-year-old woman with
rapid onset of headache, garbled speech, and right arm and leg weakness?
21) history,
physical and neurologic exams, noncontrast head CT with radiologist interpretation
b)
history, physical and neurologic exams, noncontrast head
CT, start of fibrinolytic treatment if scan is positive for stroke
c)
history, physical and neurologic exams, lumbar puncture, contrast
head CT if LP is negative for blood
d)
history, physical and neurologic exams, contrast head
CT, start of fibrinolytic treatment when improvement in neurologic signs is
noted
21) Which of the following conditions most closely mimics
the signs and symptoms of an acute stroke?
a)
acute insulin-induced hypoglycemia
b)
acute hypoxia
c)
isotonic dehydration and hypovolemia
d)
acute vasovagal or orthostatic
hypotension
22) Which of the following rhythms is an appropriate
indication for transcutaneous cardiac pacing?
a)
sinus bradycardia with no symptoms
b)
normal sinus rhythm with hypotension and shock
c)
complete heart block with pulmonary edema
d)
asystole that follows 6 or more defibrillation shocks
24.
Which one of the following patients
needs immediate synchronized cardioversion?
a)
a 78-year-old woman with fever, pneumonia, chronic
congestive heart failure, and sinus tachycardia at 125 bpm
b)
a 55-year-old man with multifocal atrial tachycardia at
125 bpm, respiratory rate of 12 breaths/minute, and BP of 134/86 mm Hg
c)
a 69-year-old woman with a history of coronary artery
disease, chest pain, a 2-mm ST elevation, and sinus tachycardia at 130 bpm
d) a 62-year-old
man with a history of rheumatic mitral valve disease, obvious shortness of
breath, HR of 160 bpm, and BP of 88/70 mm Hg
25) Which one of the following patients is most likely
presenting with stable tachycardia that you should not cardiovert?
a)
a 25-year-old wheezing asthmatic woman who has pneumonia
on chest x-ray, who is taking albuteral, and who has
the following vital signs: temp = 101.2°F, HR = 140 bpm, resp = 20 breaths/min
b)
a 55-year-old man with diaphoresis, bilateral rales, and the following vital signs:
HR = 140 bpm, BP = 90/55
mm Hg, resp = 18
breaths/min, rhythm = rapid atrial flutter
c)
a 62-year-old man with a wide-complex tachycardia at a
rate of 140 bpm, chest pain, shortness of breath, and palpitations
d)
a 55-year-old woman with chest pain, shortness of breath,
extreme weakness and dizziness, BP of 88/54 mm Hg, and a narrow-complex
tachycardia at a rate of 145 bpm
26) You prepare to cardiovert
an unstable 48-year-old tachycardic woman with the
monitor/defibrillator in "synchronization" mode. She suddenly becomes
unresponsive and pulseless right when the rhythm changes to an
irregular, chaotic, VF-like pattern. You charge to 200 J and press the SHOCK
button, but the defibrillator fails to deliver a Shock. Why?
a)
the defibrillator/monitor battery failed
b)
the "sync" switch failed
c)
you cannot shock VF in "sync" mode
d)
a monitor lead has lost contact, producing the
"pseudo-VF" rhythm
27)
An 80-year-old
woman complains of palpitations and mild lightheadedness, but the findings of
her physical exam are unremarkable. The 1st ECG shows a regular, narrow-complex
tachycardia at 150 bpm. The Valsalva maneuver slows
the ventricular rate to reveal classic atrial flutter waves, but
it does not convert the atrial flutter. Which of the following interventions should you try next?
a)
IV adenosine to slow ventricular rate
b)
IV diltiazem to slow
ventricular rate
c)
urgent DC cardioversion
d)
IV dopamine to strengthen cardiac contractions
29 ) A
75-year-old man presents to the ED with 1 week of lightheadedness, irregular
palpitations, and mild exercise intolerance. The initial 12-lead ECG displays
atrial fibriUation, which continues to show on the
monitor at a HR of 120 to 150 bpm and BP =
100/70 mm Hg. Which of the following
therapies is the most appropriate next intervention?
a)
sedation, analgesia, then immediate cardioversion
b)
oxygen via nasal cannula at 2
to 6 L/min. normal saline at 60 to 120 mL/h
c)
amiodarone 300 mg IV bolus
d)
metoprolol 5 mg IV; repeat
every 5 minutes to a total dose of 15 mg
32, Which
of the following patients is most likely to present with vague signs and
unusual symptoms of an atypical AMI?
a)
a 65-year-old woman with moderate coronary artery disease
recently confirmed by
angiography
b)
a 56-year-old man who smokes 3 packs per day but has no
history of heart disease
c)
a 45-year-old woman diagnosed with type I diabetes 22
years ago
d)
a 48-year-old man in the ICU after coronary artery bypass
surgery
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