American Heart Association

Advanced Cardiovascular
Life Support
Precourse Written
Examination

May 2001

© 2001 American Heart Association

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 sheet.

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 of 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

ACLS Provider Course Precourse Exam 2

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 AED, follow AED prompts
d. provide 2 breaths, check for a pulse, if no pulse perform chest compressions for 1
minute, call for the AED, when the AED arrives attach electrode pads

6. You are operating an AED in an attempted resuscitation of a man who collapsed in

the airport. After delivery of 3 successive shocks, your pulse check indicates he still
lacks a pulse. What is the next thing you do?

a. reanalyze the victim’s rhythm

b. perform CPR until EMS personnel arrive
c. perform CPR for 1 minute, then reanalyze the victim's rhythm
d. leave the AED attached and start transport to the nearest ED, stopping every 3 minutes
for the AED to reanalyze

7. A patient remains in VF cardiac arrest after 3 stacked shocks, tracheal intubation,

epinephrine 1 mg IV, and a 4th shock. Which of the following drug-dose combina-
tions should this patient receive next?

a. amiodarone 150 mg IV given over 10 minutes

b. lidocaine 1 to 1.5 mg/kg IV push
c. procainamide 50 mg/min, up to a total dose of 17 mg/kg
d. magnesium 1 to 2 g, appropriately diluted, IV push

8. A patient in VF cardiac arrest has failed to respond to 3 shocks, epinephrine 1 mg IV,

and a 4th shock. You give the medication nurse a “standing order” to administer
epinephrine every 3 minutes as long as the resuscitation continues. Which of the
following dose regimens is recommended?

a. epinephrine 1 mg, 3 mg, 5 mg, and 7 mg (escalating regimen)

b. epinephrine 0.2 mg/kg per dose (high-dose regimen)
c. epinephrine 1 mg IV push, repeated every 3 minutes
d. epinephrine 1 mg IV push, followed in 3 minutes by vasopressin 40 U IV

ACLS Provider Course Precourse Exam 3

9. EMTs arrive at the side of a 55-year-old man in cardiac arrest. The first AED analysis
registers “shock indicated.” But before the shock can be delivered, the EMTs learn
that the man has gone 12 minutes without any bystander CPR. What actions should
the EMTs take next?

a. resume CPR, supplement with 100% O2, continue until paramedics arrive
b. allow the AED to charge and shock
c. resume CPR, supplement with 100% O2 for 3 minutes, reanalyze, shock if indicated
d. resume CPR, contact medical control, request permission to stop resuscitative efforts

10. While treating a patient in persistent VF arrest after 3 shocks, you consider using
vasopressin. Which of the following guidelines for use of vasopressin is true?

a. give vasopressin 40 U every 3 to 5 minutes

b. give vasopressin for better vasoconstriction and β-adrenergic stimulation than provided
by epinephrine
c. give vasopressin as an alternative to epinephrine in shock-refractory VF
d. give vasopressin as the first-line pressor agent for clinical shock caused by
hypovolemia

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 a dopamine IV infusion at 15 to 20 µg/kg per minute
d. give epinephrine (1 mL of 1:10 000 solution) IV bolus

ACLS Provider Course Precourse Exam 4

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 II to paddles and back
d. administer a lower energy (100 J) defibrillatory shock to “bring out” possible occult VF

ACLS Provider Course Precourse Exam 5

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 place-
ment, gained IV access, and gave epinephrine 1 mg IV × 3 and atropine 1 mg IV × 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 × 6, and morphine 10 mg IV.
BP = 170/110 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) SQ
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, β-blockers, heparin

b. heparin, aspirin, glycoprotein IIb/IIIa inhibitors, IV β-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?

a. 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

ACLS Provider Course Precourse Exam 6

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

23. A patient with a HR of 30 to 40 bpm complains of dizziness, cool, clammy extremi-

ties, and dyspnea with minimal exercise. What is the first drug to give to this
patient?

a. atropine 0.5 to 1 mg
b. epinephrine 1 mg IV push
c. isoproterenol infusion 2 to 10 µg/min
d. adenosine 6 mg rapid IV push

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

ACLS Provider Course Precourse Exam 7

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 albuterol, 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 unrespon-
sive 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 ven-
tricular 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

28. A previously healthy 50-year-old man complains of chest tightness, palpitations, and
dizziness. HR is 170 bpm, BP is 90/60 mm Hg, and the ECG shows a narrow-complex
tachycardia. You decide that the rhythm is multifocal atrial tachycardia. He failed to
respond to initial vagal maneuvers and 2 rounds of adenosine. As your next action,
which of the following treatments is inappropriate ?

a. IV amiodarone
b. IV metoprolol
c. IV diltiazem
d. DC cardioversion

ACLS Provider Course Precourse Exam 8

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
fibrillation, 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

30. A 66-year-old, malnourished, chronic alcoholic presents with polymorphic ven-

tricular tachycardia that resembles torsades de pointes. His HR is irregular at 120 to
160 bpm, and his BP is 95/65 mm Hg. He has no related symptoms and no signs of
impaired heart function. Which of the following treatments is most appropriate at
this time?

a. IV amiodarone
b. IV magnesium
c. IV lidocaine
d. IV procainamide

31. You are performing CPR on a man in cardiac arrest when a technician arrives
and attaches an AED. With the first rhythm analysis a shock is “indicated” and
delivered, but the next rhythm analysis signals "no shock advised." What is the
most appropriate next action?

a. check for a pulse

b. press the manual OVERRIDE button and operate the AED as a manual defibrillator
c. insert an oropharyngeal airway and start 100% oxygen at 6 L/min
d. support breathing and place the patient in the recovery position until the hospital code
team arrives

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

ACLS Provider Course Precourse Exam 9

33. A 60-year-old man (weight = 50 kg) with a history of recurrent VF has converted
from VF to a wide-complex perfusing rhythm after epinephrine 1 mg IV and a 4th
shock (HR = 60 bpm, BP = 90/60 mm Hg). Which of the following drug regimens is
most appropriate to give next?

a. amiodarone 300 mg IV push

b. adenosine 6 mg rapid IV push
c. magnesium 3 g IV push, diluted in 10 mL of D5W
d. procainamide 20 to 50 mg/min, up to a maximum dose of 17 mg/kg

ACLS Provider Course Precourse Exam 10