ACLS Practice Quiz I

2.

Your patient has unstable vital signs and is in the following rhythm. What would be the next appropriate intervention?

Synchronized Cardioversion
Unsynchronized Defibrillation

Correct Answer

A. Unsynchronized Defibrillation

Explanation

In an unstable patient in whom you are not sure if the Ventricular Tachycardia
is monomorphic or polymorphic, assume it is polymorphic and defibrillate.

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3.

A patient presents to an Emergency Department unable to speak or to move her right arm. Her symptoms began approximately 6 hours ago. This patient is an appropriate candidate for tPA.

True
False

Correct Answer

A. False

Explanation

tPA should be given as treatment for an acute CVA when the
patient presents within 3 hours of the onset of symptoms,
and there are no contraindications. In some circumstances,
with input from neurology, the window may be pushed back
to 4.5 hours.
Outside of this 4.5 hour window, there is no literature to show
that the benefits outweigh the risks of treating a CVA with
tPA and it should not be done.

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4.

Which of the following is not part of the Cincinnati Prehospital Stroke Scale?

Facial Droop (Is the face symmetrical? Have the patient smile)
Arm Weakness (Have the patient close his eyes and hold out both hands, palms up)
Abnormal Speech (Have the patient say, "You can't teach an old dog new tricks")
Poor Balance (Have the patient stand on one foot.)

Correct Answer

A. Poor Balance (Have the patient stand on one foot.)

Explanation

The Cincinnati Prehospital Stroke Scale is a tool to detect stroke
in the prehospital setting. If any one of its three components are
positive, the pt has a 72% likelihood of having an acute CVA.
If all three are positive, there is an 85% likelihood of the patient
having an acute CVA.

Remember, Face/Arm/Speech. Balance is not tested.

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1

5.

An advanced airways is imperative, as per most recent ACLS guidelines.

True
False

Correct Answer

A. False

Explanation

An advanced airway, i.e. and ET tube, is NOT necessary, as per ACLS
guidelines. As long as the patient is being ventilated adequately, any method
is acceptable.

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6.

Hyperventilation during resuscitation can cause and increase in intrathorasic pressure and a decrease in cardiac output.

True
False

Correct Answer

A. True

Explanation

Hyperventilation during resuscitation can cause an increase in intrathoracic pressure and a decrease in cardiac output. When a person hyperventilates, they breathe rapidly and shallowly, leading to excessive elimination of carbon dioxide from the body. This causes a decrease in blood carbon dioxide levels, leading to vasoconstriction and a decrease in blood flow to vital organs, including the heart. Additionally, the increased intrathoracic pressure can impede venous return to the heart, further reducing cardiac output. Therefore, it is true that hyperventilation during resuscitation can cause an increase in intrathoracic pressure and a decrease in cardiac output.

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7.

The oro-pharyngeal airway (OPA) does trigger the gag reflex. Is it more appropriately using in conscious or unconscious patients.

Conscious and semi-conscious patients
Unconscious

Correct Answer

A. Unconscious

Explanation

The OPA sits in the posterior oropharynx, excites and gag reflex,
and if used in an conscious patient will likely lead to vomiting and aspiration.

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8.

In defibrillating VT/VF, in a biphasic defibrillator, the initial shock should be between 120 J and 200 J, each subsequent shock at the same or greater energy. In an monophasic defibrillator, the initial shock should be ______.

100 J
200 J
300 J
360 J

Correct Answer

A. 360 J

Explanation

In a monophasic defibrillator, the initial shock should be 360 J. This is because monophasic defibrillators deliver a single pulse of electrical current during each shock. The higher energy level of 360 J is necessary to effectively restore normal heart rhythm in cases of ventricular tachycardia (VT) or ventricular fibrillation (VF).

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1

9.

Identify this rhythm.

First Degree Heart Block
Second Degree Heart Block, Mobitz 1 (Wenckebach)
Second Degree Heart Block, Mobitz 2
Third Degree Heart Block

Correct Answer

A. First Degree Heart Block

Explanation

This is first degree heart block.
Conduction has been slowed through the AV node so the
PR interval>0.2 seconds (one large box).

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10.

Identify this rhythm.

First Degree Heart Block
Second Degree Heart Block, Mobitz 1 (Wenckebach)
Second Degree Heart Block, Mobitz 2
Third Degree Heart Block

Correct Answer

A. Third Degree Heart Block

Explanation

This is Third Degree Heart Block.
Notice the complete dissociation between the
P-waves and the QRS complexes.
If you measure the distance between each
P-wave it will be fixed.
If you measure the distance between each QRS
complex it will be fixed.
Since there is no relationship between the P-Wave and
the QRS complex, the PR interval will be entirely varied.

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2

11.

Identify this ryhthm.

Atrial Fibrillation
Atrial Flutter
SVT
Ventricular Tachycardia
Ventricular Fibrillation
Ventricular Tachycardia (Torsades de Points)

Correct Answer

A. SVT

Explanation

This is SVT.
Notice that this is a narrow-complex, rapid, regular rhythm.
There are no discernible P-waves.

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12.

Identify this ryhthm.

Atrial Fibrillation
Atrial Flutter
SVT
Ventricular Tachycardia
Ventricular Fibrillation
Ventricular Tachycardia (Torsades de Points)

Correct Answer

A. Ventricular Tachycardia (Torsades de Points)

Explanation

This is VVentricular Tachycardia (Torsades de Points).
Notice the sinusoidal nature of this rhythm. This is generated
as the axis of depolarization revolves around a point.
This rhythm needs to be recognized because treatment is
Magnesium Sulfate.

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1

13.

Your patient is very lightheaded. Her Blood pressure = 62/40 mmHg. HR=38 BPM Her rhythm is below: While awaiting cardiology to place a pacemaker, appropriate interventions include

Transcutaneous Pacing
Dopamine 2-10 mcg/kg/minute
Epinephrine 2-10 mcg/minute
Atropine 1 mg

Correct Answer(s)

A. Transcutaneous Pacing
A. Dopamine 2-10 mcg/kg/minute
A. Epinephrine 2-10 mcg/minute

Explanation

Atropine does not have a role in complete heart block.

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14.

A patient arrests near a pool and is partially submerged in water, the AED may be safely and effectively discharged with moving the patient.

True
False

Correct Answer

A. False

Explanation

If a patient is in a puddle or in the snow, he does not need to
be moved. If he is submerged, he should be moved to drier ground.

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1

ACLS Practice Quiz I

Which of the following is most likely the result of an untreated arrhythmia?

Quiz Preview

Your patient has unstable vital signs and is in the following rhythm. What would be the next appropriate intervention?

A patient presents to an Emergency Department unable to speak or to move her right arm. Her symptoms began approximately 6 hours ago. This patient is an appropriate candidate for tPA.

Which of the following is not part of the Cincinnati Prehospital Stroke Scale?

An advanced airways is imperative, as per most recent ACLS guidelines.

Hyperventilation during resuscitation can cause and increase in intrathorasic pressure and a decrease in cardiac output.

The oro-pharyngeal airway (OPA) does trigger the gag reflex. Is it more appropriately using in conscious or unconscious patients.

In defibrillating VT/VF, in a biphasic defibrillator, the initial shock should be between 120 J and 200 J, each subsequent shock at the same or greater energy. In an monophasic defibrillator, the initial shock should be ______.

Identify this rhythm.

Identify this rhythm.

Identify this ryhthm.

Identify this ryhthm.

Your patient is very lightheaded. Her Blood pressure = 62/40 mmHg. HR=38 BPM Her rhythm is below: While awaiting cardiology to place a pacemaker, appropriate interventions include

A patient arrests near a pool and is partially submerged in water, the AED may be safely and effectively discharged with moving the patient.