ACLS Practice Test
This pretest is designed to prepare you for the ACLS certification and re-certification exams.
After you have answered the questions and read the comments on each, you will be more than prepared to take and pass the ACLS exams.
- 1.
Which of the following is most likely the result of an untreated arrhythmia?
- A.
Embolic CVA
- B.
Thrombotic CVA
- C.
Hemorrhagic CVA
- D.
Pulmonary Embolus
Correct Answer
A. Embolic CVAExplanation
The patient with atrial fibrillation is at increased risk
of an embolic stroke unless they are appropriately
anticoagulated.Rate this question:
-
- 2.
Which of the following is not in the differential for causing this rhythm?
- A.
Fever
- B.
Anemia
- C.
Anxiety
- D.
Dehydration
- E.
Hypoxia
- F.
Pulmonary Embolus
- G.
Response to Medications
- H.
All are in the Differential
Correct Answer
H. All are in the DifferentialExplanation
The above rhythm is Sinus Tachycardia.
Of note, had the rhythm been over 150 bpm,
the P waves would have been harder to see,
merging with the preceding T wave, and
other rhythms would need to be considered,
such as SVT or Atrial flutter with 2:1 block.
The first four items on the above differential
are unlikely to cause a Sinus Tachycardia
above 150 bpm.Rate this question:
-
- 3.
Your patient has unstable vital signs and is in the following rhythm. What would be the next appropriate intervention?
- A.
Adenosine 6 mg
- B.
Synchronized Cardioversion
- C.
Agressive Hydration
- D.
A or B
Correct Answer
D. A or BExplanation
This patient is in an SVT.
Because his vital are unstable,
he needs to be returned to sinus
rhythm immediately. Either Adenosine or
Electrical Synchronized cardioversion would
be appropriate.Rate this question:
-
- 4.
Your patient has unstable vital signs and is in the following rhythm. What would be the next appropriate intervention?
- A.
Synchronized Cardioversion
- B.
Unsynchronized Defibrillation
Correct Answer
B. Unsynchronized DefibrillationExplanation
In an unstable patient in whom you are not sure if the Ventricular Tachycardia
is monomorphic or polymorphic, assume it is polymorphic and defibrillate.Rate this question:
-
- 5.
Your patient is in the following rhythm and has no pulse.
- A.
Treat with synchronized Cardioversion
- B.
Treat with unsynchronized Defibrillation
Correct Answer
B. Treat with unsynchronized DefibrillationExplanation
This is a wide complex tachycardia and is most likely Ventricular
tachycardia. While it appears monomorphic, since the patient is
pulseless, it should be defibrillated.
In synchronized cardioversion, a lower energy is used and it is
timed to the QRS. In unsynchronized defibrillation, a higher
energy is used and the shock is applied immediately, without
being timed to the QRS complex.Rate this question:
-
- 6.
Your patient has stable vitals and is in the following rhythm.
- A.
Ask the patient to Valsalva.
- B.
Attempt Carotid Massage
- C.
Treat with Adenosine 6mg Fast IV push
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
This pt is stable, in SVT. Treatment with vagal maneuvers, as well
as adenosine are appropriate interventions.Rate this question:
-
- 7.
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.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
-
- 8.
A patient presents within 60 minutes of an acute neurologic event. A CT of her brain reveals an acute hemorrhagic CVA. Is the patient a candidate for tPA?
- A.
Yes
- B.
No
Correct Answer
B. NoExplanation
80% of acute strokes are ischemic.
The above patient had a hemorrhagic stroke.
This is an absolute contraindication to tPA.Rate this question:
-
- 9.
In a potential stroke patient, what is the NINDS recommendation for the length of time from ED presentation to performing a CT?
- A.
5 Minutes
- B.
25 Minutes
- C.
1 Hour
- D.
As quickly as possible
Correct Answer
B. 25 Minutes -
- 10.
Which of the following is not part of the Cincinnati Prehospital Stroke Scale?
- A.
Facial Droop (Is the face symmetrical? Have the patient smile)
- B.
Arm Weakness (Have the patient close his eyes and hold out both hands, palms up)
- C.
Abnormal Speech (Have the patient say, "You can't teach an old dog new tricks")
- D.
Poor Balance (Have the patient stand on one foot.)
Correct Answer
D. 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.Rate this question:
-
- 11.
In a patient who presents with new neurologic symptoms, which would not be an absolute contraindication to tPA?
- A.
A history of a GI bleed in the distant past.
- B.
Patient presented with a seizure.
- C.
Patient awakened with symptoms.
- D.
Minor, resolving symptoms.
Correct Answer
A. A history of a GI bleed in the distant past.Explanation
Treatment with tPA comes with a real risk of bleeding and
it should only be given where appropriate.
If the patient presents with a seizure, it is not possible to
differentiate between an Acute CVA and a Todd's Paralysis.
If the patient awakened with symptoms, the time of onset
cannot be established.
If the symptoms are minor and quickly resolving, the risks of
tPA will exceed its benefits.
A distant history of GI is not a contraindication.Rate this question:
-
- 12.
As per most recent BLS guidelines, what is the appropriate order of intervention in an adult victim?
- A.
Airway-Breathing-Chest Compressions (ABC's)
- B.
Chest Compressions-Airway-Breathing (CAB's)
Correct Answer
B. Chest Compressions-Airway-Breathing (CAB's)Explanation
This is a HUGE change in BLS.
Since adults have approximately 5 minutes of oxygen reserve,
newer recommendations are to begin chest compressions and
restore circulation before addressing oxygenation.Rate this question:
-
- 13.
An advanced airways is imperative, as per most recent ACLS guidelines.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
-
- 14.
What is the recommended ratio of chest compressions to breaths in CPR?
- A.
30:2
- B.
It depends on the age of the victim.
- C.
It depends on the size of the victim.
- D.
It depends on the sex of the victim.
Correct Answer
A. 30:2Explanation
To avoid confusion, the universal ratio of chest compression to
CPR is 30:2, regardless.Rate this question:
-
- 15.
In post cardiac arrest care, the oxygen saturation should be kept at 100%.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
An oxygen saturation of 100% is unnecessary and potentially harmful. Supplemental oxygen should be given until the oxygen saturation is approximately 94%.Rate this question:
-
- 16.
Hyperventilation during resuscitation can cause and increase in intrathorasic pressure and a decrease in cardiac output.
- A.
True
- B.
False
Correct Answer
A. True -
- 17.
During CPR, the rate of chest compressions should be approximately 100/minute
- A.
True
- B.
False
Correct Answer
A. True -
- 18.
The naso-pharyngeal airway (NPA) does not active the gag reflex so it does not cause vomiting. Is it more appropriately used in the conscious or unconscious patient?
- A.
Conscious or semi-conscious
- B.
Unconscious
Correct Answer
A. Conscious or semi-conscious -
- 19.
The oro-pharyngeal airway (OPA) does trigger the gag reflex. Is it more appropriately using in conscious or unconscious patients.
- A.
Conscious and semi-conscious patients
- B.
Unconscious
Correct Answer
B. UnconsciousExplanation
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.Rate this question:
-
- 20.
Bystander CPR has not been shown to change outcome.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
For every minute that passes between a witnessed VF arrest
and defibrillation, the chance of survival decreased by 7-10%.
With bystander CPR, the decline is more gradual and falls by 3-4% per minute.
CPR saves lives.Rate this question:
-
- 21.
CPR should be begun while the AED is readied for use.
- A.
True
- B.
False
Correct Answer
A. True -
- 22.
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 ______.
- A.
100 J
- B.
200 J
- C.
300 J
- D.
360 J
Correct Answer
D. 360 J -
- 23.
Which of the following does not appear in the algorithm for ventricular fibrillation?
- A.
Epinephrine 1 mg
- B.
Atropine 1 mg
- C.
Defibrillation
- D.
Vasopressin 40 units
- E.
All appear
Correct Answer
B. Atropine 1 mg -
- 24.
In which rhythm is escalating doses of epinephrine (1 mg, followed by 3 mg, followed but 5 mg q 5 minutes) indicated?
- A.
Pulseless VT
- B.
VF
- C.
Asystole
- D.
None of the above.
Correct Answer
D. None of the above.Explanation
There is no indication of escalating or high dose epinephrine.Rate this question:
-
- 25.
Identify this rhythm.
- A.
First Degree Heart Block
- B.
Second Degree Heart Block, Mobitz 1 (Wenckebach)
- C.
Second Degree Heart Block, Mobitz 2
- D.
Third Degree Heart Block
Correct Answer
A. First Degree Heart BlockExplanation
This is first degree heart block.
Conduction has been slowed through the AV node so the
PR interval>0.2 seconds (one large box).Rate this question:
-
- 26.
Identify this rhythm.
- A.
First Degree Heart Block
- B.
Second Degree Heart Block, Mobitz 1 (Wenckebach)
- C.
Second Degree Heart Block, Mobitz 2
- D.
Third Degree Heart Block
Correct Answer
B. Second Degree Heart Block, Mobitz 1 (Wenckebach)Explanation
This is Second Degree Heart Block, Type 1 (Wenckebach).
Notice the PR interval lengthens with each subsequent beat
until a P wave is not followed by a QRS. After this dropped beat,
the PR interval shortens again.Rate this question:
-
- 27.
Identify this rhythm.
- A.
First Degree Heart Block
- B.
Second Degree Heart Block, Mobitz 1 (Wenckebach)
- C.
Second Degree Heart Block, Mobitz 2
- D.
Third Degree Heart Block
Correct Answer
C. Second Degree Heart Block, Mobitz 2Explanation
This is Second Degree Heart Block, Mobitz 2.
Notice that the PR interval is fixed, and that many
P waves are not conducted so they are not followed
by a QRS complex. In this example, every third P-wave
is conductedRate this question:
-
- 28.
Identify this rhythm.
- A.
First Degree Heart Block
- B.
Second Degree Heart Block, Mobitz 1 (Wenckebach)
- C.
Second Degree Heart Block, Mobitz 2
- D.
Third Degree Heart Block
Correct Answer
D. Third Degree Heart BlockExplanation
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.Rate this question:
-
- 29.
Identify this ryhthm.
- A.
Atrial Fibrillation
- B.
Atrial Flutter
- C.
SVT
- D.
Ventricular Tachycardia
- E.
Ventricular Fibrillation
- F.
Ventricular Tachycardia (Torsades de Points)
Correct Answer
A. Atrial FibrillationExplanation
This is Atrial Fibrillation.
Notice that there are no discernible P-waves and that the interval
between each QRS varies, beat-to-beat.Rate this question:
-
- 30.
Identify this ryhthm.
- A.
Atrial Fibrillation
- B.
Atrial Flutter
- C.
SVT
- D.
Ventricular Tachycardia
- E.
Ventricular Fibrillation
- F.
Ventricular Tachycardia (Torsades de Points)
Correct Answer
B. Atrial FlutterExplanation
This is Atrial Flutter.
Notice the flutter give the telltale 'sawtooth' pattern.
the rate of the flutter waves is 300 BPM, and in this example
every 3rd or every 4th flutter wave is conducted.Rate this question:
-
- 31.
Identify this ryhthm.
- A.
Atrial Fibrillation
- B.
Atrial Flutter
- C.
SVT
- D.
Ventricular Tachycardia
- E.
Ventricular Fibrillation
- F.
Ventricular Tachycardia (Torsades de Points)
Correct Answer
C. SVTExplanation
This is SVT.
Notice that this is a narrow-complex, rapid, regular rhythm.
There are no discernible P-waves.Rate this question:
-
- 32.
Identify this ryhthm.
- A.
Atrial Fibrillation
- B.
Atrial Flutter
- C.
SVT
- D.
Ventricular Tachycardia
- E.
Ventricular Fibrillation
- F.
Ventricular Tachycardia (Torsades de Points)
Correct Answer
D. Ventricular TachycardiaExplanation
This is VT.
Notice that this is a wide-complex, rapid, regular rhythm.
There are no discernible P-waves.Rate this question:
-
- 33.
Identify this ryhthm.
- A.
Atrial Fibrillation
- B.
Atrial Flutter
- C.
SVT
- D.
Ventricular Tachycardia
- E.
Ventricular Fibrillation
- F.
Ventricular Tachycardia (Torsades de Points)
Correct Answer
E. Ventricular FibrillationExplanation
This is Ventricular Fibrillation.
Notice that this is wide-complex and irregular.
This rhythm will not generate any mechanical systoles.Rate this question:
-
- 34.
Identify this ryhthm.
- A.
Atrial Fibrillation
- B.
Atrial Flutter
- C.
SVT
- D.
Ventricular Tachycardia
- E.
Ventricular Fibrillation
- F.
Ventricular Tachycardia (Torsades de Points)
Correct Answer
F. 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.Rate this question:
-
- 35.
Your patient is in the following rhythm but has no pulse. Which are possible causes for this Pulseless Electrical Activity?
- A.
HyperKalemia
- B.
Hypoxia
- C.
Hypothermia
- D.
Hydrogen Ions (Acidosis)
- E.
Hypothermia
- F.
Hypoglycemia
- G.
Tamponade
- H.
Tension Pneumothorax
- I.
Thrombosis (PE)
- J.
Thrombosis (MI)
- K.
Toxins
- L.
Trauma
Correct Answer(s)
A. HyperKalemia
B. Hypoxia
C. Hypothermia
D. Hydrogen Ions (Acidosis)
E. Hypothermia
F. Hypoglycemia
G. Tamponade
H. Tension Pneumothorax
I. Thrombosis (PE)
J. Thrombosis (MI)
K. Toxins
L. TraumaExplanation
These are the H's and T's of PEA.
Know them.Rate this question:
-
- 36.
The recommended length of time for a Rhythm Check is <10 seconds.
- A.
True
- B.
False
Correct Answer
A. True -
- 37.
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.
Transcutaneous Pacing
- B.
Dopamine 2-10 mcg/kg/minute
- C.
Epinephrine 2-10 mcg/minute
- D.
Atropine 1 mg
Correct Answer(s)
A. Transcutaneous Pacing
B. Dopamine 2-10 mcg/kg/minute
C. Epinephrine 2-10 mcg/minuteExplanation
Atropine does not have a role in complete heart block.Rate this question:
-
- 38.
In a patient with a suspected C-spine injury, the recommended technique for airway opening is the chin-lift/head-tilt
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
When a c-spine injury is suspected, open the airway
with the jaw thrust maneuverRate this question:
-
- 39.
During a resuscitation, with an ET tube in place, chest compressions should be paused to give a breath?
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Chest compressions should not be withheld.
The respiratory rate should be approximately
one breath every 6-8 seconds.Rate this question:
-
- 40.
A patient arrests near a pool and is partially submerged in water, the AED may be safely and effectively discharged with moving the patient.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
-
- 41.
During CPR, chest compressions should NOT be interrupted for _____.
- A.
Ventilation
- B.
To intubate a patient who is being ventilated by BVM.
- C.
Rhythm checks in an unchanged rhythm.
- D.
Charging the defibrillator.
- E.
Defibrillation
Correct Answer(s)
A. Ventilation
B. To intubate a patient who is being ventilated by BVM.
C. Rhythm checks in an unchanged rhythm.
D. Charging the defibrillator. -
- 42.
Following defibrillation, when should chest compressions resume?
- A.
Following a pulse check.
- B.
After a 10 second pulse check, and giving 2 breaths.
- C.
After evaluating the post-defibrillation rhythm.
- D.
Immediately.
Correct Answer
D. Immediately.Explanation
A pulse check is appropriate after about 2 minutes of
CPR following defibrillation.Rate this question:
-
.jpg "Your patient is in the following rhythm and has no pulse.")
.jpg "Identify this rhythm.")
.jpg "Identify this rhythm.")
.jpg "Identify this ryhthm.")
.jpg "Identify this ryhthm.")
.jpg "Identify this ryhthm.")
Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
-
Current Version
-
Jun 19, 2019Quiz Edited by
ProProfs Editorial Team -
Sep 27, 2015Quiz Created by
Haitham Zraigat
Back to top