American Heart Association

ECC American Heart Association

ACLS Provider Written Examinations

Contents: ¾ Examination Memo ¾ Version A Answer Sheet ¾ Version A Exam ¾ Version A Answer Key ¾ Version A Annotations ¾ Version B Answer Sheet ¾ Version B Exam ¾ Version B Answer Key ¾ Version B Annotations

August 2006

© 2006 American Heart Association

2006 ACLS Provider Written Test

Introduction

The 2006 ACLS Provider Course includes both skills tests and written tests. The written test measures the mastery of cognitive skills. The 2006 written test must be used with the 2006 course materials, ie, student manuals, course videos, and instructor manuals.

Administering the written tests

This closed-book test must be completed individually by each student. To receive a course completion card, students must score at least 84% on the written test.

Remediation

All students deserve remediation on topics in which they are not confident or have not mastered. For guidance on remediation, refer to the instructor manual.

Copying and distribution

Written tests are secured items. ACLS Training Centers may distribute ACLS Provider exams only to ACLS Instructors, ACLS Training Center Faculty, and ACLS Regional Faculty members who are aligned with the TC. Written tests may be copied as needed for conducting courses. Training Centers may distribute exams in the original and complete Adobe PDF format via electronic communications, ie, email. Tests may not be posted on Internet or Intranet sites accessible by persons not authorized to receive the tests.

August 2006

ACLS Provider Course Written Exam Version A Answer Sheet Name _________________________________

Date_____________________

Circle the correct answers. Question

Answer

1.

a

b

c

d

2.

a

b

c

d

3.

a

b

c

d

4.

a

b

c

d

5.

a

b

c

d

6.

a

b

c

d

7.

a

b

c

d

8.

a

b

c

d

9.

a

b

c

d

10.

a

b

c

d

11.

a

b

c

d

12.

a

b

c

d

13.

a

b

c

d

14.

a

b

c

d

15.

a

b

c

d

16.

a

b

c

d

17.

a

b

c

d


For questions 18 through 22, select the best single answer to match the name of the rhythm on the list to the rhythm strip. A. B. C. D. E. F. G. H. I. 18. 19. 20. 21. 22.

Normal sinus rhythm Sinus tachycardia Sinus bradycardia Ventricular tachycardia Ventricular fibrillation Atrial fibrillation Third-degree AV block Agonal rhythm/asystole Atrial flutter A A A A A

B B B B B

C C C C C

D D D D D

E E E E E

F F F F F

G G G G G

H H H H H

I I I I I

For questions 23 through 25, indicate if the following rhythm is appropriate to defibrillate. Check “Yes” if the rhythm is appropriate to defibrillate. Check “No” if the rhythm is not appropriate to defibrillate. 23. Yes ____

No ____

24. Yes ____

No ____

25. Yes ____

No ____



Advanced Cardiovascular Life Support

Written Examination Version A

August 2006


ACLS Provider Course Written Exam Version A Please do not mark on this examination. Record the best answer on the separate answer sheet.

1. The goal of an intervention for a patient in respiratory or cardiac arrest is to A. B. C. D.

Identify those patients at risk for acute myocardial infarction Give the provider a comprehensive picture of patient history Restore effective oxygenation, ventilation, and circulation Ensure prompt return of verbal responsiveness

2. Which one of the following actions is included in the BLS Primary Survey? A. B. C. D.

Obtain IV/IO access Place an advanced airway device Give appropriate drugs to manage rhythm Perform high-quality CPR until an AED arrives

3. Which one of the following statements correctly describes how to ventilate a cardiac arrest patient with a confirmed advanced airway in place? A. Deliver each ventilation over 1 second at a rate of 30 to 35 per minute, watching closely for visible chest rise B. Deliver ventilations over 1 second, every 6 to 8 seconds C. Deliver ventilations every 10 to 15 seconds; increase as needed to produce visible chest rise D. Deliver 1 ventilation after each set of 30 compressions, watching closely for visible chest rise

4.

You have begun CPR on an unresponsive 56-year-old woman who collapsed in cardiac arrest in the hospital ED waiting room. A nurse arrives and quickly attaches the AED. The first rhythm analysis indicates “no shock advised.” What is the most appropriate action to perform next? A. Place the patient in the recovery position, ensuring a clear airway B. Establish IV/IO access and administer 1 mg epinephrine C. Resume CPR, beginning with chest compressions; continue for 2 minutes or 5 cycles of compressions and ventilations D. Check for the presence of a carotid pulse

ACLS Provider Course Exam Version A © 2006 American Heart Association

2

5. The role of a team member in resuscitation includes A. B. C. D.

Being proficient in skills according to your scope of practice Refraining from pointing out mistakes until the debriefing that follows the code Following directions from the team leader without hesitation or questions Being in charge of all decisions to reduce any confusion about who is responsible for the outcome

6. Which one of the following is the most critical component for successful resuscitation of a patient in cardiac arrest? A. B. C. D.

Performing high-quality CPR Providing advanced interventions immediately upon recognition of cardiac arrest Providing time for critical advanced procedures despite prolonged interruptions in CPR Obtaining a 12-lead ECG to identify the location and extent of a possible acute myocardial infarction

7. The following patients were diagnosed with acute ischemic stroke. Which one of these patients is most likely to be a candidate for IV fibrinolytic therapy? A. A 65-year-old man who lives alone and was found unresponsive by a neighbor B. An 85-year-old woman who called EMS approximately 5 hours after onset of left-sided weakness C. A 60-year-old man with confusion and right-sided weakness who was described as being normal 90 minutes ago D. A 58-year-old woman who was diagnosed with bleeding ulcers 1 week ago

8. A team member tells the team leader “I think the next drug in the algorithm is epinephrine and not amiodarone. Do you concur?” This is an example of the key element of a working team called A. B. C. D.

Constructive interventions Reevaluation and summarizing Knowing one’s limitations Mutual respect

9. Which one of the following identifies, in the correct order, the 4 “universal steps” required to operate an AED? A. B. C. D.

Power on AED, attach AED pads, analyze rhythm, clear patient and deliver shock if indicated Attach AED pads, power on AED, analyze rhythm, clear patient and deliver shock if indicated Attach AED pads, power on AED, check pulse, analyze rhythm, and deliver shock if indicated Power on AED, attach AED pads, clear patient and shock if indicated, check pulse and analyze rhythm

10. Which one of the following offers the best chance of success in patients with PEA? A. B. C. D.

Rapid assessment and identification of an immediately correctable cause Perform early transcutaneous pacing Perform rapid defibrillation Give antiarrhythmic therapy


3

11. A cardiac arrest patient is in PEA at 30 beats per minute. CPR is in progress, proper advanced airway placement is confirmed, and IV access has been established. Which one of the following classes of medications should be administered first? A. B. C. D.

Electrolyte preparation, such as calcium chloride Vasopressor, such as epinephrine Antiarrhythmic, such as amiodarone Alkalinizing agent, such as sodium bicarbonate

12. Which one of the following doses is the recommended initial dose of epinephrine for an adult patient in asystole? A. B. C. D.

3 mg 1:1000 IV 0.3 mg 1:1000 SC 1 mg 1:10 000 IV 0.5 mg 1:10 000 ET

13. Which one of the following treatment protocols is used in the early management of a patient with ACS? A. B. C. D.

Lidocaine bolus followed by a continuous infusion of lidocaine Oxygen, aspirin, sublingual or spray nitroglycerin, and possibly morphine Bolus of amiodarone followed by an oral ACE inhibitor Calcium channel blocker plus intravenous furosemide

14. For which of the following should atropine be considered while waiting for the pacer? A. B. C. D.

A patient who is normotensive with a heart rate of 52 A patient with signs of poor perfusion with altered mental status and a heart rate of 88 A patient in VF who fails to respond to the initial dose of epinephrine A patient with signs of poor perfusion with a heart rate of 40

15. Which one of the following terms best describes the condition of a 34-year-old woman who presents to the ED with palpitations but no other symptoms? Her exam is normal except for a radial pulse rate of 184; the ECG and monitor display a narrow-complex, regular tachycardia. A. B. C. D.

Stable supraventricular tachycardia Unstable supraventricular tachycardia Sinus tachycardia Perfusing ventricular tachycardia

16. An important principle in managing sinus tachycardia is A. B. C. D.

Performing vagal maneuvers Giving adenosine 6 mg IV push Giving 500 mL NS rapid fluid bolus Identifying the cause


4

17. Fibrinolytics are used to treat which one of the following? A. B. C. D.

Intracerebral hemorrhage Subarachnoid hemorrhage Ischemic stroke Transient ischemic attack

For questions 18 through 22, select the best single answer to match the name of the rhythm on the list to the rhythm strip below. A. B. C. D. E. F. G. H. I.

Normal sinus rhythm Sinus tachycardia Sinus bradycardia Ventricular tachycardia Ventricular fibrillation Atrial fibrillation Third-degree AV block Agonal rhythm/asystole Atrial flutter

18.

A {

B {

C {

D {

E {

F {

G {

H {

I {

B {

C {

D {

E {

F {

G {

H {

I {

19.

A {


5

20.

A {

B {

C {

D {

E {

F {

G {

H {

I {

B {

C {

D {

E {

F {

G {

H {

I {

B {

C {

D {

E {

F {

G {

H {

I {

21.

A {

22.

A {


6

For questions 23 through 25, indicate if the following rhythm is appropriate to defibrillate. Check “Yes” if the rhythm is appropriate to defibrillate. Check “No” if the rhythm is not appropriate to defibrillate. 23. Is this rhythm appropriate to defibrillate? Yes____

No____

24. Is this rhythm appropriate to defibrillate? Yes____

No____

25. Is this rhythm appropriate to defibrillate? Yes____

No____


7

ACLS Provider Course Written Exam Version A Answer Key

Question

Answer

1.

a

b

n

d

2.

a

b

c

n

3.

a

n

c

d

4.

a

b

n

d

5.

n

b

c

d

6.

n

b

c

d

7.

a

b

n

d

8.

n

b

c

d

9.

n

b

c

d

10.

n

b

c

d

11.

a

n

c

d

12.

a

b

n

d

13.

a

n

c

d

14.

a

b

c

n

15.

n

b

c

d

16.

a

b

c

n

17.

a

b

n

d


For questions 18 through 22, select the best single answer to match the name of the rhythm on the list to the rhythm strip. A. B. C. D. E. F. G. H. I. 18. 19. 20. 21. 22.

Normal sinus rhythm Sinus tachycardia Sinus bradycardia Ventricular tachycardia Ventricular fibrillation Atrial fibrillation Third-degree AV block Agonal rhythm/asystole Atrial flutter A A z A A

B B B B B

z C C C C

D D D D z

E E E z E

F F F F F

G G G G G

H z H H H

I I I I I


No _X__

24. Yes _X__

No ____

25. Yes ____

No _X__

ACLS Provider Course Exam A Answer Key © 2006 American Heart Association


Advanced Cardiovascular Life Support

Written Examination Annotated Answer Key Version A August 2006


ACLS Provider Course Written Exam Version A Annotated Answer Key Please do not mark on this examination. Record the best answer on the separate answer sheet. 1. The goal of an intervention for a patient in respiratory or cardiac arrest is to A. B. C. D.

Identify those patients at risk for acute myocardial infarction Give the provider a comprehensive picture of patient history Restore effective oxygenation, ventilation, and circulation Ensure prompt return of verbal responsiveness

The correct answer is C. Interventions aimed at restoring effective oxygenation, ventilation, and circulation must be the primary goal when caring for the patient in cardiac arrest. These actions also improve the patient’s chance of surviving with return of intact neurologic function. For the patient in respiratory arrest, restoration of effective oxygenation and ventilation reduce the patient’s risk of progressing to cardiac arrest. Injury to the myocardium, patient history, and responsiveness are not of much importance when the patient is in cardiac arrest. (ACLS PM page 7) 2. Which one of the following actions is included in the BLS Primary Survey? A. B. C. D.


The correct answer is D. The BLS Primary Survey includes assessing whether the airway is open, determining if the patient is breathing, if respirations are adequate, and if a pulse is present, and checking for a shockable rhythm when the patient has no pulse. The results of the BLS Primary Survey determine the actions to be taken without requiring advanced equipment or actions. Highquality CPR can easily be performed without any advanced equipment. Beginning high-quality CPR as early as possible has been demonstrated to improve the patient’s chance for return of spontaneous circulation. (ACLS PM pages 7-8) 3. Which one of the following statements correctly describes how to ventilate a cardiac arrest patient with a confirmed advanced airway in place? A. Deliver each ventilation over 1 second at a rate of 30 to 35 per minute, watching closely for visible chest rise B. Deliver ventilations over 1 second, every 6 to 8 seconds C. Deliver ventilations every 10 to 15 seconds; increase as needed to produce visible chest rise D. Deliver 1 ventilation after each set of 30 compressions, watching closely for visible chest rise The correct answer is B. Once an advanced airway is placed and the location confirmed in the cardiac arrest patient, deliver ventilations once every 6 to 8 seconds (approximately 8 to 10 breaths per minute). This results in no interruptions in chest compressions. It also provides adequate ventilation and oxygenation considering the needs of the cardiac arrest patient. (ACLS PM page 32) ACLS Provider Course Annotated Exam Version A © 2006 American Heart Association

2

4. You have begun CPR on an unresponsive 56-year-old woman who collapsed in cardiac arrest in the hospital ED waiting room. A nurse arrives and quickly attaches the AED. The first rhythm analysis indicates “no shock advised.” What is the most appropriate action to perform next? A. Place the patient in the recovery position, ensuring a clear airway B. Establish IV/IO access and administer 1 mg epinephrine C. Resume CPR, beginning with chest compressions; continue for 2 minutes or 5 cycles of compressions and ventilations D. Check for the presence of a carotid pulse The correct answer is C. This patient was determined to be in cardiac arrest. Once an AED analyzes the rhythm and determines no shock is needed, immediate CPR is indicated. The AED should prompt the provider to start CPR beginning with compressions once a rhythm analysis results in a “no shock advised” message. Providing other advanced therapies and checking for a pulse will only result in delays to chest compressions. Remember, minimize interruptions in chest compressions. (ACLS PM page 38) 5. The role of a team member in resuscitation includes A. B. C. D.

Being proficient in skills according to your scope of practice Refraining from pointing out mistakes until the debriefing that follows the code Following directions from the team leader without hesitation or questions Being in charge of all decisions to reduce any confusion about who is responsible for the outcome

The correct answer is A. Team members must be proficient in the skills they are trained and authorized to perform within their scope of practice. To be successful, team members must be clear about role assignments, prepared to fulfill role responsibilities, well practiced in resuscitation skills, knowledgeable about the algorithms, and committed to success. (ACLS PM page 12) 6. Which one of the following is the most critical component for successful resuscitation of a patient in cardiac arrest? A. B. C. D.


The correct answer is A. Successful resuscitation of a patient in cardiac arrest depends greatly on the performance of actions in the BLS Primary Survey. CPR is a critical action in the BLS Primary Survey. ACLS providers must make every effort to minimize any interruptions in chest compressions. CPR can double or triple survival from witnessed sudden cardiac arrest. (ACLS PM pages 7, 8 and 35) 7. The following patients were diagnosed with acute ischemic stroke. Which one of these patients is most likely to be a candidate for IV fibrinolytic therapy? A. A 65-year-old man who lives alone and was found unresponsive by a neighbor B. An 85-year-old woman who called EMS approximately 5 hours after onset of left-sided weakness C. A 60-year-old man with confusion and right-sided weakness who was described as being normal 90 minutes ago D. A 58-year-old woman who was diagnosed with bleeding ulcers 1 week ago

ACLS Provider Course Annotated Exam Version A © 2006 American Heart Association

3

The correct answer is C. This 60-year-old patient has evidence of a stroke. Additionally, since his symptoms began less than 3 hours ago and no contraindications are noted, he is a candidate for IV fibrinolytic therapy. An unknown time of symptom onset, onset of symptoms greater than 3 hours before treatment, history of active internal bleeding, or recent GI hemorrhage are contraindications to IV fibrinolytic therapy. (ACLS PM page 115) 8. A team member tells the team leader “I think the next drug in the algorithm is epinephrine and not amiodarone. Do you concur?” This is an example of the key element of a working team called A. B. C. D.

Constructive interventions Reevaluation and summarizing Knowing one’s limitations Mutual respect

The correct answer is A. A team member may be required to intervene if an action that is about to occur is inappropriate at the time. Constructive intervention is an important element of effective resuscitation team dynamics. When constructive intervention is necessary, it must be done tactfully. (ACLS PM page 16) 9. Which one of the following identifies, in the correct order, the 4 “universal steps” required to operate an AED? A. Power on AED, attach AED pads, analyze rhythm, clear patient and deliver shock if indicated B. Attach AED pads, power on AED, analyze rhythm, clear patient and deliver shock if indicated C. Attach AED pads, power on AED, check pulse, analyze rhythm, and deliver shock if indicated D. Power on AED, attach AED pads, clear patient and shock if indicated, check pulse and analyze rhythm The correct answer is A. The AED must first be powered on. This allows the device to begin providing prompts to the AED operator. Once the AED is powered on, the defibrillation pads must then be attached. Attachment of the pads will create the necessary circuit and then allow the AED to progress to the next step. The AED will then either begin analyzing the rhythm or will do so after the AED operator presses an “analyze” button. If a shock is indicated, the AED will advise the operator to clear the patient in order to avoid delivering an accidental shock to another provider or bystander. Once the patient is cleared, the shock may be delivered (if indicated). (ACLS PM pages 36-37) 10. Which one of the following offers the best chance of success in patients with PEA? A. B. C. D.

Rapid assessment and identification of an immediately correctable cause Perform early transcutaneous pacing Perform rapid defibrillation Give antiarrhythmic therapy

The correct answer is A. The ability to achieve a good resuscitation outcome, with return of a perfusing rhythm and spontaneous respirations, depends on the ability of the resuscitation team to provide effective CPR and to identify and correct a cause of PEA if present. If you can quickly identify a specific condition that has caused or is contributing to PEA and correct it, you may achieve return of spontaneous circulation. (ACLS PM pages 52 and 56-57)


4


Electrolyte preparation, such as calcium chloride Vasopressor, such as epinephrine Antiarrhythmic, such as amiodarone Alkalinizing agent, such as sodium bicarbonate

The correct answer is B. No vasopressor has been shown to increase survival from PEA. Because vasopressors (epinephrine and vasopressin) can improve aortic diastolic blood pressure and coronary artery perfusion pressure, they continue to be recommended. (ACLS PM page 53) 12. Which one of the following doses is the recommended initial dose of epinephrine for an adult patient in asystole? A. B. C. D.

3 mg 1:1000 IV 0.3 mg 1:1000 SC 1 mg 1:10 000 IV 0.5 mg 1:10 000 ET

The correct answer is C. The standard epinephrine dose for adult cardiac arrest is 1 mg IV/IO every 3 to 5 minutes. High-dose epinephrine is not routinely recommended. The IV/IO routes for medication administration are the preferred routes for drug and fluid administration. They are preferable to the endotracheal route. (ACLS PM pages 48 and 53) 13. Which one of the following treatment protocols is used in the early management of a patient with ACS? A. B. C. D.


The correct answer is B. Secondary goals in the treatment of ACS are relief of ischemic chest pain, prevention of major adverse cardiac events, and treatment of acute, life-threatening complications of ACS. Initial management should include oxygen, aspirin, sublingual or spray dose nitroglycerin, and possibly IV morphine (if chest discomfort is unresponsive to nitrates). Lidocaine, amiodarone, and furosemide may be indicated in specific patients but are not generally part of the early management of the ACS patient. (ACLS PM pages 71-72) 14. For which of the following should atropine be considered while waiting for the pacer? A. B. C. D.



5

The correct answer is D. Since this patient has signs of poor perfusion, the treatment should include preparing for transcutaneous pacing. Atropine 0.5 mg IV may be considered while awaiting the pacer. If perfusion is adequate, the patient is observed and monitored. In VF arrest, atropine is not indicated since the ventricular rate is actually very fast (fibrillation). When treating the patient with bradycardia and signs of poor perfusion, consider atropine while awaiting the pacer. (ACLS PM pages 82-84) 15. Which one of the following terms best describes the condition of a 34-year-old woman who presents to the ED with palpitations but no other symptoms? Her exam is normal except for a radial pulse rate of 184; the ECG and monitor display a narrow-complex, regular tachycardia. A. B. C. D.


The correct answer is A. Since this patient has no signs of unstable tachycardia (no altered mental status, ongoing chest discomfort or pain, hypotension or other signs of shock), this patient has a stable arrhythmia. The question states the rhythm is narrow, thus ventricular tachycardia can be ruled out. At rest, sinus tachycardia usually does not exceed 120 to 130 beats per minute. It generally does not exceed 180 beats per minute with exercise except in a young person during strenuous physical exercise. This patient at rest in the ED with a rate of 184 is most likely experiencing a stable reentry supraventricular tachycardia. (ACLS PM pages 98 and 101) 16. An important principle in managing sinus tachycardia is A. B. C. D.


The correct answer is D. In sinus tachycardia, the goal is to identify and treat the underlying systemic cause. Vagal maneuvers may slow sinus tachycardia, though this is usually transient. While a fluid bolus may be appropriate, identification of the cause must first be determined. (ACLS PM page 97) 17. Fibrinolytics are used to treat which one of the following? A. B. C. D.


The correct answer is C. Community and professional education has been successful in increasing the proportion of eligible stroke patient treated with fibrinolytics. The sixth “D” is the decision regarding treatment, including fibrinolytics. Fibrinolytics are contraindicated in hemorrhagic strokes. For this reason, the CT scan is critical to the decision. To be eligible for fibrinolytics, the patient should have a clinical diagnosis of ischemic stroke with a measurable neurologic deficit. Therefore, a diagnosis of transient ischemic attack would not provide the indication for fibrinolytics. (ACLS PM pages 104-106 and 113-115)


6


Normal sinus rhythm Sinus tachycardia Sinus bradycardia Ventricular tachycardia Ventricular fibrillation Atrial fibrillation Third-degree AV block Agonal rhythm/asystole Atrial flutter

18.

A {

B {

C n

D {

E {

F {

G {

H {

I {

The correct answer is C, sinus bradycardia. This is a sinus mechanism rhythm since every QRS complex is preceded by a normal appearing P wave, the complexes are narrow and regular, and each P wave appears to result in a ventricular complex. Since the rate is less than 60 beats per minute, this is sinus bradycardia.

19.

A {

B {

C {

D {

E {

F {

G {

H n

I {

The correct answer is H, agonal rhythm/asystole. This rhythm has no discernible, organized electrical activity. Assuming you have ruled out other causes for this lack of electrical activity, you must conclude this rhythm is asystole. A single ventricular beat of an agonal rhythm is seen in the left hand portion of the tracing.


7

20.

A n

B {

C {

D {

E {

F {

G {

H {

I {

The correct answer is A, normal sinus rhythm. This rhythm has narrow complexes, each preceded by a normal appearing P wave at a rate (about 75 beats per minute) between 60 and 100 beats per minute. Because there are no rhythm abnormalities identified, this rhythm is normal sinus rhythm.

21.

A {

B {

C {

D {

E n

F {

G {

H {

I {

The correct answer is E, ventricular fibrillation. This chaotic fractionated rhythm has broad, rapid, irregular, and abnormal complexes. There are no definite P waves, QRS complexes, or T waves. The extremely irregular and rapid rate of activity indicates fibrillation. These findings indicate the rhythm originates in the ventricles.


8

22.

A {

B {

C {

D n

E {

F {

G {

H {

I {

The correct answer is D, ventricular tachycardia. This wide complex rhythm has a rate greater than 100 beats per minute and is regular. P waves are not identified and there are no fusion complexes, so the rhythm appears to originate in the ventricles.

For questions 23 through 25, indicate if the following rhythm is appropriate to defibrillate. Check “Yes” if the rhythm is appropriate to defibrillate. Check “No” if the rhythm is not appropriate to defibrillate.

23. Is this rhythm appropriate to defibrillate? Yes____ No____

No. This rhythm is not appropriate to defibrillate. Defibrillation should only be performed when the rhythm is ventricular fibrillation, pulseless ventricular tachycardia, or polymorphic ventricular tachycardia. This rhythm is organized and slow. Therefore, defibrillation is not appropriate.


9


Yes. This rhythm is chaotic, rapid with wide complexes. Defibrillation should only be performed when the rhythm is ventricular fibrillation, pulseless ventricular tachycardia, or polymorphic ventricular tachycardia. This is ventricular fibrillation. Therefore, defibrillation is appropriate.


No. This rhythm is not appropriate to defibrillate. Defibrillation should only be performed when the rhythm is ventricular fibrillation, pulseless ventricular tachycardia, or polymorphic ventricular tachycardia. This rhythm has no organized electrical activity. It is an agonal rhythm or asystole. Therefore, defibrillation is not appropriate.


10

ACLS Provider Course Written Exam Version B Answer Sheet Name _________________________________

Date_____________________

Circle the correct answers. Question

Answer

1.

a

b

c

d

2.

a

b

c

d

3.

a

b

c

d

4.

a

b

c

d

5.

a

b

c

d

6.

a

b

c

d

7.

a

b

c

d

8.

a

b

c

d

9.

a

b

c

d

10.

a

b

c

d

11.

a

b

c

d

12.

a

b

c

d

13.

a

b

c

d

14.

a

b

c

d

15.

a

b

c

d

16.

a

b

c

d

17.

a

b

c

d


For questions 18 through 21, select the best single answer to match the name of the rhythm on the list to the rhythm strip. A. B. C. D. E. F. G. H. I. 18. 19. 20. 21.

Mobitz I AV block Atrial fibrillation Ventricular fibrillation Third-degree AV block Supraventricular tachycardia Ventricular tachycardia Torsades de pointes Normal sinus rhythm Mobitz II AV block A A A A

B B B B

C C C C

D D D D

E E E E

F F F F

G G G G

H H H H

I I I I


No ____

23. Yes ____

No ____

24. Yes ____

No ____

25. Yes ____

No ____



Advanced Cardiovascular Life Support Written Examination Version B

August 2006


ACLS Provider Course Written Exam Version B Please do not mark on this examination. Record the best answer on the separate answer sheet. 1. Which one of the following statements correctly describes how to ventilate a cardiac arrest patient with a confirmed advanced airway in place? A. Deliver each ventilation over 1 second at a rate of 30 to 35 per minute, watching closely for visible chest rise B. Deliver ventilations over 1 second, every 6 to 8 seconds C. Deliver ventilations every 10 to 15 seconds; increase as needed to produce visible chest rise D. Deliver 1 ventilation after each set of 30 compressions, watching closely for visible chest rise

2. The goal of an intervention for a patient in respiratory or cardiac arrest is to A. B. C. D.

Restore effective oxygenation, ventilation, and circulation Ensure prompt return of verbal responsiveness Identify those patients at risk for acute myocardial infarction Give the provider a comprehensive picture of patient history

3. For which of the following should atropine be considered while waiting for the pacer? A. B. C. D.


4. You have begun CPR on an unresponsive 56-year-old woman who collapsed in cardiac arrest in the hospital ED waiting room. A nurse arrives and quickly attaches the AED. The first rhythm analysis indicates “no shock advised.” What is the most appropriate action to perform next? A. Establish IV/IO access and administer 1 mg epinephrine B. Resume CPR, beginning with chest compressions; continue for 2 minutes or 5 cycles of compressions and ventilations C. Check for the presence of a carotid pulse D. Place the patient in the recovery position, ensuring a clear airway

ACLS Provider Course Exam Version B © 2006 American Heart Association

2

5. Which one of the following identifies, in the correct order, the 4 “universal steps” required to operate an AED? A. B. C. D.

Power on AED, attach AED pads, analyze rhythm, clear patient, and deliver shock if indicated Attach AED pads, power on AED, analyze rhythm, clear patient and deliver shock if indicated Attach AED pads, power on AED, check pulse, analyze rhythm, and deliver shock if indicated Power on AED, attach AED pads, clear patient and shock if indicated, check pulse and analyze rhythm

6. Which one of the following actions is included in the BLS Primary Survey? A. B. C. D.


7. When the team member informs the team leader that “the IV is in,” this is an example of the key element of a working team called A. B. C. D.

Closed-loop communication A fixation error Knowing one’s limitations Challenging decision making

8. Which one of the following offers the best chance of success in patients with PEA? A. B. C. D.

Perform early transcutaneous pacing Perform rapid defibrillation Rapid assessment and identification of an immediately correctable cause Give antiarrhythmic therapy


Alkalinizing agent, such as sodium bicarbonate Antiarrhythmic, such as amiodarone Vasopressor, such as epinephrine Electrolyte preparation, such as calcium chloride

10. Which one of the following doses is the recommended initial dose of epinephrine for an adult patient in asystole? A. B. C. D.

0.3 mg 1:1000 SC 1 mg 1:10 000 IV 0.5 mg 1:10 000 ET 3 mg 1:1000 IV


3



12. Which one of the following terms best describes the condition of a 34-year-old woman who presents to the ED with palpitations but no other symptoms? Her exam is normal except for a radial pulse rate of 184; the ECG and monitor display a narrow-complex, regular tachycardia. A. B. C. D.


13. Fibrinolytics are used to treat which one of the following? A. B. C. D.


14. A team member tells the team leader “I am uncomfortable with placing the endotracheal tube in a patient who is this obese. Can you help?” This is an example of the key element of a working team called A. B. C. D.

Constructive interventions Clear roles and responsibilities Knowing one’s limitations Knowledge sharing

15. Which of the following actions, in addition to others, should you take to assess whether an ET tube is properly placed? A. B. C. D.

Make sure that compressions are not interrupted Secure the tube Listen for bilateral breath sounds Check for adequate capillary refill

16. Which one of the following treatment protocols is used in the early management of a patient with ACS? A. B. C. D.



4

17. Which one of the following is the most critical component for successful resuscitation of a patient in cardiac arrest? A. B. C. D.



Mobitz I AV block Atrial fibrillation Ventricular fibrillation Third-degree AV block Supraventricular tachycardia Ventricular tachycardia Torsades de pointes Normal sinus rhythm Mobitz II AV block

18.

A {

B {

C {

D {

E {

F {

G {

H {

I {

B {

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D {

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I {

19.

A {


5

20.

A {

B {

C {

D {

E {

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B {

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21.

A {




6





7

ACLS Provider Course Written Exam Version B Answer Key

Question

Answer

1.

a

n

c

d

2.

n

b

c

d

3.

a

b

c

n

4.

a

n

c

d

5.

n

b

c

d

6.

a

b

c

n

7.

n

b

c

d

8.

a

b

n

d

9.

a

b

n

d

10.

a

n

c

d

11.

a

b

c

n

12.

n

b

c

d

13.

a

b

n

d

14.

a

b

n

d

15.

a

b

n

d

16.

a

n

c

d

17.

n

b

c

d


For questions 18 through 21, select the best single answer to match the name of the rhythm on the list to the rhythm strip below. A. B. C. D. E. F. G. H. I. 18. 19. 20. 21.

Mobitz I AV block Atrial fibrillation Ventricular fibrillation Third-degree AV block Supraventricular tachycardia Ventricular tachycardia Torsades de pointes Normal sinus rhythm Mobitz II AV block A A A A

z B B B

C C n C

D n D D

E E E n

F F F F

G G G G

H H H H

I I I I

For questions 22 through 25, indicate if the following rhythm is appropriate to defibrillate. Check “Yes” if the rhythm is appropriate to defibrillate. Check “No” if the rhythm is not appropriate to defibrillate. 22. Yes _X___ 23. Yes____ 24. Yes ___ 25. Yes___

No ____ No _X__ No _X__ No _X___

ACLS Provider Course Exam B Answer Key © 2006 American Heart Association


Advanced Cardiovascular Life Support Written Examination Annotated Answer Key Version B

August 2006


ACLS Provider Course Written Exam Version B Annotated Answer Key Please do not mark on this examination. Record the best answer on the separate answer sheet. 1. Which one of the following statements correctly describes how to ventilate a cardiac arrest patient with a confirmed advanced airway in place? A. Deliver each ventilation over 1 second at a rate of 30 to 35 per minute, watching closely for visible chest rise B. Deliver ventilations over 1 second, every 6 to 8 seconds C. Deliver ventilations every 10 to 15 seconds; increase as needed to produce visible chest rise D. Deliver 1 ventilation after each set of 30 compressions, watching closely for visible chest rise The correct answer is B. Once an advanced airway is placed and the location confirmed in the cardiac arrest patient, deliver ventilations once every 6 to 8 seconds (approximately 8 to 10 breaths per minute). This results in no interruptions in chest compressions. It also provides adequate ventilation and oxygenation considering the needs of the cardiac arrest patient. (ACLS PM page 32) 2. The goal of an intervention for a patient in respiratory or cardiac arrest is to A. B. C. D.

Restore effective oxygenation, ventilation, and circulation Ensure prompt return of verbal responsiveness Identify those patients at risk for acute myocardial infarction Give the provider a comprehensive picture of patient history

The correct answer is A. Interventions aimed at restoring effective oxygenation, ventilation, and circulation must be the primary goal when caring for the patient in cardiac arrest. These actions also improve the patient’s chance of surviving with return of intact neurologic function. For the patient in respiratory arrest, restoration of effective oxygenation and ventilation reduce the patient’s risk of progressing to cardiac arrest. Injury to the myocardium, patient history, and responsiveness are not of much importance when the patient is in cardiac arrest. (ACLS PM page 7) 3. For which of the following should atropine be considered while waiting for the pacer? A. B. C. D.


The correct answer is D. Because this patient has signs of poor perfusion, the treatment should include preparing for transcutaneous pacing. Atropine 0.5 mg IV may be considered while awaiting the pacer. If perfusion is adequate, the patient is observed and monitored. In VF arrest, atropine is not indicated since the ventricular rate is actually very fast (fibrillation). When treating the patient with bradycardia and signs of poor perfusion, consider atropine while awaiting the pacer. (ACLS PM pages 82-84).

ACLS Provider Course Annotated Exam Version B © 2006 American Heart Association

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4. You have begun CPR on an unresponsive 56-year-old woman who collapsed in cardiac arrest in the hospital ED waiting room. A nurse arrives and quickly attaches the AED. The first rhythm analysis indicates “no shock advised.” What is the most appropriate action to perform next? A. Establish IV/IO access and administer 1 mg epinephrine B. Resume CPR, beginning with chest compressions; continue for 2 minutes or 5 cycles of compressions and ventilations C. Check for the presence of a carotid pulse D. Place the patient in the recovery position, ensuring a clear airway The correct answer is B. This patient was determined to be in cardiac arrest. Once an AED analyzes the rhythm and determines no shock is needed, immediate CPR is indicated. The AED should prompt the provider to start CPR beginning with compressions once a rhythm analysis results in a “no shock advised” message. Providing other advanced therapies and checking for a pulse will only result in delays to chest compressions. Remember, minimize interruptions in chest compressions. (ACLS PM page 38) 5. Which one of the following identifies, in the correct order, the 4 “universal steps” required to operate an AED? A. Power on AED, attach AED pads, analyze rhythm, clear patient, and deliver shock if indicated B. Attach AED pads, power on AED, analyze rhythm, clear patient and deliver shock if indicated C. Attach AED pads, power on AED, check pulse, analyze rhythm, and deliver shock if indicated D. Power on AED, attach AED pads, clear patient and shock if indicated, check pulse and analyze rhythm The correct answer is A. The AED must first be powered on. This allows the device to begin providing prompts to the AED operator. Once the AED is powered on, the defibrillation pads must then be attached. Attachment of the pads will create the necessary circuit and then allow the AED to progress to the next step. The AED will then either begin analyzing the rhythm or will do so after the AED operator presses an “analyze” button. If a shock is indicated, the AED will advise the operator to clear the patient in order to avoid delivering an accidental shock to another provider or bystander. Once the patient is cleared, the shock may be delivered (if indicated). (ACLS PM pages 36-37) 6. Which one of the following actions is included in the BLS Primary Survey? A. B. C. D.


The correct answer is D. The BLS Primary Survey includes assessing whether the airway is open, determining if the patient is breathing, if respirations are adequate, and if a pulse is present, and checking for a shockable rhythm when the patient has no pulse. The results of the BLS Primary Survey determine the actions to be taken without requiring advanced equipment or actions. Highquality CPR can easily be performed without any advanced equipment. Beginning high-quality CPR as early as possible has been demonstrated to improve the patient’s chance for return of spontaneous circulation. (ACLS PM pages 7-8)


3

7. When the team member informs the team leader that “the IV is in,” this is an example of the key element of a working team called A. B. C. D.

Closed-loop communication A fixation error Knowing one’s limitations Challenging decision making

The correct answer is A. Closed-loop communications involves three key elements. The team leader first gives a message or order to a team member. The team leader then confirms the message was heard and understood by receiving a clear response and good eye contact with the team member. The team leader then listens for confirmation from the team member that the task was performed. (ACLS PM page 13) 8. Which one of the following offers the best chance of success in patients with PEA? A. B. C. D.

Perform early transcutaneous pacing Perform rapid defibrillation Rapid assessment and identification of an immediately correctable cause Give antiarrhythmic therapy

The correct answer is C. The ability to achieve a good resuscitation outcome, with return of a perfusing rhythm and spontaneous respirations, depends on the ability of the resuscitation team to provide effective CPR and to identify and correct a cause of PEA if present. If you can quickly identify a specific condition that has caused or is contributing to PEA and correct it, you may achieve return of spontaneous circulation. (ACLS PM pages 52 and 56-57) 9. A cardiac arrest patient is in PEA at 30 beats per minute. CPR is in progress, proper advanced airway placement is confirmed, and IV access has been established. Which one of the following classes of medications should be administered first? A. B. C. D.

Alkalinizing agent, such as sodium bicarbonate Antiarrhythmic, such as amiodarone Vasopressor, such as epinephrine Electrolyte preparation, such as calcium chloride

The correct answer is C. No vasopressor has been shown to increase survival from PEA. Because vasopressors (epinephrine and vasopressin) can improve aortic diastolic blood pressure and coronary artery perfusion pressure, they continue to be recommended. (ACLS PM page 53) 10. Which one of the following doses is the recommended initial dose of epinephrine for an adult patient in asystole? A. B. C. D.

0.3 mg 1:1000 SC 1 mg 1:10 000 IV 0.5 mg 1:10 000 ET 3 mg 1:1000 IV

The correct answer is B. The standard epinephrine dose for adult cardiac arrest is 1 mg IV/IO every 3 to 5 minutes. High-dose epinephrine is not routinely recommended. The IV/IO routes for medication administration are the preferred routes for drug and fluid administration. They are preferable to the endotracheal route. (ACLS PM pages 48 and 53)


4



The correct answer is D. In sinus tachycardia, the goal is to identify and treat the underlying systemic cause. Vagal maneuvers may slow sinus tachycardia though this is usually transient. While a fluid bolus may be appropriate, identification of the cause must first be determined. (ACLS PM page 98) 12. Which one of the following terms best describes the condition of a 34-year-old woman who presents to the ED with palpitations but no other symptoms? Her exam is normal except for a radial pulse rate of 184; the ECG and monitor display a narrow-complex, regular tachycardia. A. B. C. D.


The correct answer is A. Since this patient has no signs of unstable tachycardia (no altered mental status, ongoing chest discomfort or pain, hypotension or other signs of shock), this patient has a stable arrhythmia. The question states the rhythm is narrow, thus ventricular tachycardia can be ruled out. At rest sinus tachycardia usually does not exceed 120 to 130 beats per minute. It generally does not exceed 180 beats per minute with exercise except in a young person during strenuous physical exercise. This patient at rest in the ED with a rate of 184 is most likely experiencing a stable reentry supraventricular tachycardia. (ACLS PM pages 98 and 101) 13. Fibrinolytics are used to treat which one of the following? A. B. C. D.


The correct answer is C. Community and professional education has been successful in increasing the proportion of eligible stroke patients treated with fibrinolytics. The sixth “D” is the decision regarding treatment, including fibrinolytics. Fibrinolytics are contraindicated in hemorrhagic strokes. For this reason, the CT scan is critical to the decision. To be eligible for fibrinolytics, the patient should have a clinical diagnosis of ischemic stroke with a measurable neurologic deficit. Therefore, a diagnosis of transient ischemic attack would not provide the indication for fibrinolytics. (ACLS PM pages 104-106 and 113-115) 14. A team member tells the team leader “I am uncomfortable with placing the endotracheal tube in a patient who is this obese. Can you help?” This is an example of the key element of a working team called A. B. C. D.

Constructive interventions Clear roles and responsibilities Knowing one’s limitations Knowledge sharing


5

The correct answer is C. Everyone on the team should know his or her own limitations and capabilities. Team members should anticipate situations in which they might require assistance. Team members should inform the team leader when assistance is required. (ACLS PM page 14) 15. Which of the following actions, in addition to others, should you take to assess whether an ET tube is properly placed? A. B. C. D.

Make sure that compressions are not interrupted Secure the tube Listen for bilateral breath sounds Check for adequate capillary refill

The correct answer is C. Placement of the endotracheal tube must be confirmed by physical exam and a confirmation device (eg, exhaled CO2 detector, esophageal detector device). Once the tube placement is confirmed, the tube is secured in place. Physical exam may include a variety of methods, including listening for breath sounds. Compression interruption does not have any effect on the confirmation of the ET tube placement. Capillary refill is not a useful method in confirming endotracheal tube placement. (ACLS PM pages 22 and 31) 16. Which one of the following treatment protocols is used in the early management of a patient with ACS? A. B. C. D.


The correct answer is B. Secondary goals in the treatment of ACS are relief of ischemic chest pain, prevention of major adverse cardiac events, and treatment of acute, life-threatening complications of ACS. Initial management should include oxygen, aspirin, sublingual or spray dose nitroglycerin, and possibly IV morphine (if chest discomfort is unresponsive to nitrates). Lidocaine, amiodarone, and furosemide may be indicated in specific patients but are not generally part of the early management of the ACS patient. (ACLS PM pages 71-72) 17. Which one of the following is the most critical component for successful resuscitation of a patient in cardiac arrest? A. B. C. D.


The correct answer is A. Performance of the actions in the BLS Primary Survey substantially improves a patient’s chances for survival and a good (or better) neurologic outcome. The success of any resuscitation attempt is built on a strong base of high quality CPR and defibrillation when required by the patient’s ECG rhythm. (ACLS PM pages 7, 43, and 47)


6


Mobitz I AV block Atrial fibrillation Ventricular fibrillation Third-degree AV block Supraventricular tachycardia Ventricular tachycardia Torsades de pointes Normal sinus rhythm Mobitz II AV block

18.

A {

B n

C {

D {

E {

F {

G {

H {

I {

The correct answer is B, atrial fibrillation. This rhythm is irregular and has no pattern to it. There are no normal P waves appearing before each ventricular complex. The complexes are narrow indicating the pacemaker for this rhythm is not ventricular. These characteristics are those of atrial fibrillation.

19.

A {

B {

C {

D n

E {

F {

G {

H {

I {

The correct answer is D, third-degree AV block. While there are P waves, there is not a P wave immediately preceding each ventricular complex. Some P waves do not result in ventricular complexes. As a result, the atrial rate is greater than the ventricular rate. This dissociation is common with thirddegree AV block.


7

20.

A {

B {

C n

D {

E {

F {

G {

H {

I {

The correct answer is C, ventricular fibrillation. This chaotic fractionated rhythm has broad, rapid, irregular, and abnormal complexes. There are no definite P waves, QRS complexes, or T waves. The extremely irregular and rapid rate of activity indicates fibrillation. These findings indicate the rhythm originates in the ventricles.

21.

A {

B {

C {

D {

E n

F {

G {

H {

I {

The correct answer is E, supraventricular tachycardia. This rhythm is regular and has narrow complexes. This indicates the pacemaker for the rhythm is supraventricular (above the ventricles). There are no obvious P waves preceding each complex, so this does not appear to be a sinus rhythm. The rate is definitely greater than 100. These characteristics are those of supraventricular tachycardia.


8



Yes. This is ventricular fibrillation. This rhythm is chaotic, rapid with wide complexes. Defibrillation should only be performed when the rhythm is ventricular fibrillation, pulseless ventricular tachycardia, or polymorphic ventricular tachycardia. This is ventricular fibrillation. Therefore, defibrillation is appropriate.


No. This appears to be a supraventricular rhythm that has two PVCs. The rhythms that should be defibrillated are ventricular fibrillation, ventricular tachycardia without a pulse, and polymorphic ventricular tachycardia.


9


No. This rhythm is a supraventricular tachycardia. If the patient with this rhythm was unstable, it would be appropriate to provide synchronized cardioversion. However, it is not appropriate to defibrillate this rhythm. The rhythms that should be defibrillated are ventricular fibrillation, ventricular tachycardia without a pulse, and polymorphic ventricular tachycardia.


No. This rhythm is not appropriate to defibrillate. Defibrillation should only be performed when the rhythm is ventricular fibrillation, pulseless ventricular tachycardia, or polymorphic ventricular tachycardia. This rhythm has no organized electrical activity. It is an agonal rhythm or asystole. Therefore, defibrillation is not appropriate.


10

American Heart Association

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