1. You and your partner arrive at the scene of an unresponsive middle-aged man.

Your initial
assessment reveals that he is apneic and pulseless. Which of the following interventions will
provide the BEST chance of survival for this patient?
A) Five minutes of CPR prior to analyzing his cardiac rhythm
B) CPR at the appropriate rate and with minimal interruptions
C) Prompt insertion of an advanced airway to prevent aspiration
D) Immediate defibrillation for presumed ventricular fibrillation

2. While en route to the scene of a patient in cardiac arrest, the emergency medical dispatcher
advises you that she has the caller on the phone, but the caller refuses to do CPR on the
patient. With an estimated time of arrival at the scene of 5 minutes, you should:
A) ask the dispatcher to inform the man to do chest compressions only.
B) recall that the caller has a legal and moral duty to act in this situation.
C) have the dispatcher reassure the caller that he will not contract a disease.
D) advise the dispatcher to tell the caller that the patient will die without CPR.

3. You and your partner are off duty and are playing golf. Suddenly, you see an elderly man grab
his chest and collapse to the ground near the 9th hole. You should:
A) tell your partner to call 9-1-1 as you proceed to assess the man.
B) both proceed to the man and begin two-rescuer CPR if needed.
C) perform 2 minutes of CPR if needed and then call an ambulance.
D) tell the man's golf buddy to perform a precordial thump at once.

4. You are performing one-rescuer CPR on a 50-year-old woman in cardiac arrest. A bystander
returns with an AED. You ask the bystander to attach the pads to the patient's chest as you
continue CPR. After rhythm analysis, the AED states, “Shock advised.” You should:
A) confirm the absence of a pulse and deliver the shock.
B) perform CPR for 2 more minutes and then defibrillate.
C) defibrillate the patient and reassess for a carotid pulse.
D) deliver a single shock and immediately resume CPR.

5. After analyzing an apneic and pulseless adult's cardiac rhythm with the AED, you receive a
“no shock advised” message. You should:
A) assess for a carotid pulse and continue CPR if necessary.
B) reanalyze the patient's cardiac rhythm for confirmation.
C) resume CPR for 2 minutes and then reassess the patient.
D) continue rescue breaths at a rate of 10 to 12 breaths/min.

6. Your team is attempting resuscitation of a man in cardiac arrest. One of the team members, an
EMT-Intermediate, intubates the patient and confirms proper placement of the endotracheal
tube. Your MOST appropriate next action should be to:
A) assume that the patient is in severe metabolic acidosis and hyperventilate him for at least 2 to
3 minutes.
B) instruct the EMT-Intermediate to provide one breath every 6 to 8 seconds while chest
compressions are continuous.
C) administer 2.5 mg of epinephrine 1:10,000 via the endotracheal tube without interrupting
chest compressions.
D) defibrillate the patient with the maximum energy setting, reassess for a pulse, and continue
CPR if he remains pulseless.

7. After opening an unresponsive adult's airway, you assess his breathing and determine that he
is apneic. What should you do next?
A) Give two rescue breaths that make the chest visibly rise.
B) Assess for a carotid pulse for no longer than 10 seconds.
C) Reposition the man's airway and reassess for breathing.
D) Perform a finger sweep of his mouth to remove any debris.

8. You have been performing chest compressions and your partner has been ventilating a 60-
year-old woman in cardiac arrest. After 2 minutes, you reanalyze her cardiac rhythm and
determine that a shock is advised. After ensuring that nobody is touching the patient, you
should:
A) quickly assess for a carotid or femoral pulse and defibrillate one time at the AED's maximum
energy setting.
B) reanalyze her cardiac rhythm while simultaneously checking for a carotid pulse and
defibrillate one time if needed.
C) deliver the shock as indicated, assess for a carotid pulse for no longer than 10 seconds, and
then resume CPR.
D) deliver the shock and have your partner immediately resume chest compressions while you
assume the ventilator role.

9. You are shopping at the mall when you hear a frantic lady scream, “Please help, my baby is
not breathing!” You rush to the lady's aid, assess her 4-year-old child, and determine that he
is not breathing. After sending a bystander to call 9-1-1, you should:
A) begin chest compressions with one hand at a rate of 100 compressions/min.
B) reposition the child's airway and reassess for breathing for at least 5 seconds.
C) deliver 2 rescue breaths over 1 second each and assess for a carotid pulse.
D) deliver 2 breaths that cause visible chest rise and assess the brachial pulse.

10. Your partner returns with the AED as you are performing CPR on a 5-year-old child. As he
opens the AED, he tells you that there are no pediatric pads, only adult pads. You should:
A) use the adult AED pads, but only provide a total of two defibrillations.
B) tell him to resume one-rescuer CPR as you try to locate pediatric pads.
C) instruct him to apply the adult pads as you continue one-rescuer CPR.
D) continue two-rescuer CPR until EMS arrives and assumes patient care.

11. You and your partner have completed 5 cycles of CPR on a 3-year-old child. The AED states,
“No shock advised” and the child is still pulseless. You should:
A) continue CPR for 2 minutes using a compression to ventilation ratio of 30 to 2.
B) perform 5 cycles of 15 compressions to 2 ventilations and reassess the child.
C) check to make sure the AED pads are properly placed and push the analyze button.
D) deliver 2 effective rescue breaths and advise your partner to resume compressions.

12. You are picking your child up from daycare when one of the daycare workers discovers that
an 8-month-old girl is not breathing. She panics, and asks you to do something. Your
assessment of the infant reveals that she is unresponsive. You should:
A) tell the daycare worker to quickly call 9-1-1 as you open the infant's airway.
B) assess for a brachial or femoral pulse and begin CPR if no pulse is detected.
C) perform 2 minutes of CPR if needed and tell the daycare worker to call 9-1-1.
D) open the infant's airway and assess for breathing for no longer than 5 seconds.

13. While awaiting the arrival of EMS, you and an EMT-Basic are performing CPR on a 6-
month-old infant. Which of the following is NOT appropriate for this patient?
A) Compression to ventilation ratio of 15:2
B) Performing 100 compressions per minute
C) Switching rescuer roles every 2 minutes
D) Cardiac rhythm analysis using an AED

14. You are dispatched to a local park for an unresponsive 49-year-old man. When you arrive,
you find a group of bystanders surrounding the patient, who is not moving. One of the
bystanders tells you that they found the patient like this, and that no care was provided
before your arrival. Your initial assessment reveals that the patient is apneic and pulseless.
You should:
A) perform 5 cycles of 30 compressions and 2 ventilations as your partner applies the
defibrillator pads.
B) immediately apply the defibrillator pads, assess the patient's cardiac rhythm, and defibrillate
if indicated.
C) begin one-rescuer CPR as your partner radios for backup and makes preparations to insert an
advanced airway.
D) perform CPR for 5 minutes before assessing his cardiac rhythm because his cardiac arrest
was not witnessed by you.

15. You are dispatched to a restaurant for “CPR in progress.” When you arrive at the scene and
enter the restaurant, you observe two bystanders performing well-coordinated and high-
quality CPR on the patient, a middle-aged man. You should:
A) advise the bystanders to stop CPR as you apply the defibrillator pads and assess the patient's
cardiac rhythm.
B) ask the bystanders how long CPR has been in progress as you apply the defibrillator pads
around the compressor's hands.
C) ask the bystanders to stop CPR so you can confirm that the patient is in cardiac arrest, and
perform 2 minutes of CPR if he is.
D) allow the bystanders to continue CPR as you insert an advanced airway device while your
partner establishes vascular access.

16. After performing 2 minutes of CPR on a 5-month-old infant whose cardiac arrest was not
witnessed by you, you should:
A) attach an AED, ensure that it is equipped with pediatric pads, and analyze the infant's cardiac
rhythm.
B) assess for a brachial pulse, continue CPR if the infant is still pulseless, and establish vascular
access via IV or IO.
C) apply the proper size defibrillation pads and assess the infant's cardiac rhythm with a manual
monitor/defibrillator.
D) assess for a femoral pulse, continue CPR and insert an advanced airway device, and reassess
the infant in 2 minutes.

17. You are performing CPR on a 60-year-old woman in cardiac arrest. After 2 minutes, you
assess her cardiac rhythm and determine that she is in asystole. After instructing two of
your team members to resume CPR, you should:
A) insert an advanced airway device and then resume cycles of CPR.
B) establish IV or IO access and administer 1 mg of atropine sulfate rapidly.
C) administer 1 mg of epinephrine 1:10,000 after obtaining vascular access.
D) perform endotracheal intubation and ventilate at a rate of 15 breaths/min.

18. As you are administering 40 units of vasopressin to an adult woman in ventricular

fibrillation, your team members continue CPR. After 2 minutes, you reassess her and
determine that she is pulseless and still in ventricular fibrillation. You should:
A) instruct your team to continue CPR as the defibrillator is charging.
B) administer 300 mg of amiodarone while CPR remains uninterrupted.
C) deliver a monophasic defibrillation with 200 joules and resume CPR.
D) advise your team to stop CPR as you prepare to deliver another shock.

19. You are the team leader in the attempted resuscitation of an adult man in ventricular
fibrillation. An advanced airway device has been inserted and vascular access has been
obtained. As you observe the actions of your team members, it is MOST important to
ensure that:
A) the patient is defibrillated one time every 60 seconds as necessary.
B) the person managing the airway delivers one breath every 3 to 5 seconds.
C) epinephrine is given at least 10 minutes after administering vasopressin.
D) compressions are hard and fast, with full chest recoil between compressions.

20. Your assessment of a 68-year-old man reveals an organized cardiac rhythm at a rate of 80 per
minute and an absent carotid pulse. Appropriate treatment for this patient includes all of the
following, EXCEPT:
A) epinephrine.
B) atropine.
C) intubation.
D) IV fluid boluses

21. After approximately 6 minutes of attempted resuscitation, your patient experiences a return
of spontaneous circulation (ROSC) and is in a sinus rhythm with occasional premature
ventricular complexes (PVCs). What should you do next?
A) Begin an antiarrhythmic infusion and titrate it.
B) Reassess his airway and obtain a blood pressure.
C) Administer 1.5 mg/kg of lidocaine for the PVCs.
D) Give a 20 mL/kg bolus of an isotonic crystalloid.

22. You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After
performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is in
Torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since
you administered the last dose of epinephrine. You should next:
A) give 300 mg of amiodarone via rapid intravenous or intraosseous push.
B) give 1 to 2 g of magnesium sulfate without interrupting chest compressions.
C) push the synchronize button on the defibrillator and cardiovert with 200 joules.
D) give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes.

23. You have an impedance threshold device (ITD) attached to the endotracheal tube as you
ventilate an apneic and pulseless patient. Following defibrillation and 2 additional minutes
of CPR, it is determined that return of spontaneous circulation has occurred. However, the
patient is still apneic. You should:
A) leave the ITD attached to the endotracheal tube and continue to ventilate.
B) remove the ITD and continue ventilations at a rate of 10 to 12 breaths/min.
C) leave the ITD attached, but increase your ventilation rate to 15 breaths/min.
D) hyperventilate the patient to eliminate excess carbon dioxide from the blood.

24. You have intubated an apneic 30-year-old man who did not respond to Narcan
administration. The endotracheal tube (ETT) is secured in place and you have confirmed its
placement using the appropriate methods. After loading the patient into the ambulance, you
should:
A) perform a clinical assessment to ensure that the ETT is placed correctly.
B) continue to ventilate the patient at a rate of 8 to 10 breaths/min.
C) assess for vapor mist in the endotracheal tube when squeezing the bag.
D) mildly hyperventilate the patient for 2 minutes to facilitate oxygenation.

25. You have been attempting resuscitation of an 80-year-old woman for approximately 15
minutes. An advanced airway has been placed, ventilations have been delivered at the
appropriate rate, high-quality CPR was performed with minimal interruptions, and rhythms-
specific medications were administered. Despite your efforts, the patient remains in
asystole. Which of the following statements regarding this scenario is MOST correct?
A) Transcutaneous cardiac pacing may restore a perfusing rhythm and should therefore be
attempted immediately.
B) It would not be unreasonable to attempt a single defibrillation in case the patient was actually
in fine ventricular fibrillation.
C) You have clearly performed all the appropriate interventions and termination of resuscitative
efforts should be strongly considered.
D) Since older people are prone to hypothermia, and hypothermia protects the brain during
hypoxia, you should continue your efforts for 5 more minutes.

Answer Key - AppendixA

1. B
2. A
3. A
4. D
5. C
6. B
7. A
8. D
9. C
10. C
11. B
12. A
13. D
14. A
15. B
16. C
17. C
18. A
19. D
20. B
21. B
22. B
23. B
24. A
25. C