AMLS ALS PRETEST

VERSION 1.11
 Advanced Medical Life Support
ALS Pre-Test Version 1.11

1. A 28 year old female is being evaluated for an acute onset of an alteration in mentation. She
complained of a stiff neck and persistent headache. Vital signs are P112, R22 and regular, BP
144/88, SpO2 95% and T 102.3°F (39°C). The healthcare provider should observe for which
complication?

A. Sepsis
B. Seizure
C. Cardiac arrest
D. Internal bleeding

2. A 45 year old patient is found supine on the floor of the Triage area. Healthcare providers note
pinpoint pupils, shallow respirations and vomitus in and around the mouth. What course of
action should be implemented next?

A. Initiate an IV and administer naloxone

B. Supplemental oxygen and suction
C. Obtain a blood glucose level
D. Begin bag-mask ventilation

3. Patients with a history of chronic bronchitis that present with shortness of breath are likely to
have which condition?

A. Pulmonary embolism
B. Angina pectoris
C. Angioedema
D. Hypertensive crisis

4. Acute Respiratory Distress Syndrome (ARDS) us characterized by what pathological change?

A. Excessive mucus production

B. Inflammation of the visceral pleura
C. Breakdown of the alveolar-capillary membrane
D. Accumulation of fluid between the pleural layers

5. An anxious male complains of a sore throat, fever, chills, dental pain and dyspnea. the patient
has a firm, red pronounced swelling in the sublingual anterior throat area and tongue. What
diagnosis is most likely?

A. Croup
B. Tonsillitis
C. Angioedema
D. Ludwig's angina

6. Patients on mechanical ventilation may have hypoxemia due to alveolar collapse from mucous
plugging. The best treatment for this is:
 A. Increase oxygen concentration to 100%
B. Increase tidal volume
C. Increase respiratory rate
D. Administer PEEP

7. Anaphylaxis is most associated with which physiological event?

A. Hemorrhage
B. Vasodilation
C. Bradycardia
D. Hypertension

8. An elderly patient in an assisted living facility presents with a diminished level of consciousness
and elevated white blood count. Assessment reveals pale, clammy skin and a urinary catherter
with dark colored urine. Vital signs are P132, R 38 and shallow, BP 78/46, SpO2 91% and T
100.8°F (32.8°C). What classification of shock is the patient most likely experiencing?

A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstuctive

9. Healthcare providers are assessing a patient with pronounced jugular vein distention and muffled
heart tones. Vitals are P 128, R 26, BP 74/52. What classification of shock should be
suspected?

A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstuctive

10. During compensatory shock, the renin-angiotensin-aldosterone system is activated to cause

a/an:

A. Increase in preload, afterload and re-absorption of sodium

B. Decrease in preload, afterload and re-absorption of sodium
C. Increase in myocardial contractility
D. Vasodilation and sodium retention

11. A 42 year old patient with a history of rheumatoid arthritis is taking glucocorticoids. Over the
past two weeks, she complains of chronic fatigue, weakness, and loss of appetite with weight
loss. Lab results indicate hyponatremia and hyperkalemia. What underlying diagnosis is
suspected?

A. Adrenal insuffiency
B. Diabetic ketoacidosis
C. Hypothryoidism
D. Rhabdomyolysis

12. Which condition should the healthcare provider consider to usually be a non-emergent, non-life
threatening illness?
 A. Acute coronary syndrome
B. Thoracic outlet syndrome
C. Esophageal tear
D. Aortic dissection

13. Healthcare providers should use extreme caution with nitroglycerin when ST elevation is present
in which ECG leads?

A. V1, V2
B. V3, V4
C. I, aVL
D. II, III, aVF

14. Which is a high-risk factor for intracerebral hemorrhage?

A. Marijuana
B. Coronary artery spasm
C. Bradycardia
D. Cocaine drug abuse

15. What is the initial treatment for a patient experiencing Hyperosmolar Hyperglycemic Nonketotic
Syndrome (HHNS)?

A. Crystalloid IV fluid resuscitation

B. Administration of dextrose
C. Administration of insulin
D. Fluid bolus of 5% Dextrose in Water (D5W)

16. What condition is most likely to cause respiratory acidosis?

A. Anxiety/panic attack
B. narcotic overdose
C. Methanol ingestion
D. Diabetic ketoacidosis

17. What is the most effective treatment for an unconscious patient in respiratory acidosis?

A. Assisted bag-mask ventilation

B. Sodium bicarbonate
C. Supportive care
D. IV fluid bolus

18. An autoimmune disease which produces antibodies that mimic the role of TSH and cause an
increase in thyroid hormones is:

A. Addison's disease
B. Myxedema coma
C. Grave's disease
D. Diabetic ketoacidosis
19. Glucagon may not be effective treatment for a patient with hypoglycemia if they also have which
underlying illness?

A. Alcoholism
B. Cholecystitis
C. Pancreatitis
D. Hypothyroidism

20. A 24 year old has completed a triathlon on a hot, humid day. The athlete complains of a severe
headache, muscle cramps and abdominal pain. As the patient history is obtained, the athlete
becomes lethargic. What underlying electrolyte disturbance should the healthcare provider most
likely suspect?

A. Magnesemia
B. Hyponatremia
C. Hypocalcemia
D. Hypokalemia

21. What is the sign on the ECG that will indicate a patient is experiencing hyperkalemia?

A. Flattened T waves
B. Peaked T waves
C. Narrowing of QRS complex
D. Presence of Osborne wave

22. An 82 year old alcoholic complains of nausea, non-bloody vomiting and severe epigastric and
right upper quadrant pain that radiates to the back. Palpation reveals epigastric tenderness
without peritoneal signs. What working diagnosis should be considered most likely?

A. Acute pancreatitis
B. Intestinal (bowel) obstruction
C. Peptic ulcer
D. Mallory-Weiss Syndrome

23. A 23 year old male complains of a productive cough, fever, chills and pleuritic chest pain that
has worsened over 3 days. A physical exam reveals unilateral wheezing with shallow respirations.
Vitals are P 128, R 26, BP 144/88, SpO2 90%, and T 102°F (38.8°C). What treatment should
be performed?

A. 12 Lead
B. Beta blockers
C. Initiate STEMI protocols
D. Supplemental oxygen and immediate transport

24. A patient with suspected gallbladder disease is asked to take a deep breath while the provider
presses upward into the upper right quadrant. If the patient ceases inspiration due to increase
pain while being examined, this is known as:

A. Cullen's sign
B. Rovsing's sign
C. Muphy's sign
 D. Kehr's sign

25. The patient is alert and oriented presenting with hypotension, bradycardia, normal capillary refill
and warm, dry skin. These are cardinal signs of which type of distributive shock?

A. Anaphylactic
B. Neurogenic
C. Septic
D. Toxic shock syndrome

26. During what period of the communicable disease process will antibodies begin to reach
detectable levels and the infected blood will test positive for exposure to a pathogen?

A. Communicability
B. Incubation
C. Disease
D. Latent

27. The patient presents with a history of headache, weight loss, chest discomfort, night sweats and
a persistent cough for several weeks. Which infectious disease is most likely occurring?

A. Novel H1N1 influenza

B. Meningoccal meningitis
C. Tuberculosis
D. Malaria

28. A lethargic patient presents with dilated pupils and vital signs of P 122, R 26 and BP 130/80.
He admits to excessive ingestion of diphenhydramine. What response is the cause for the
presenting signs and symptoms?

A. Sympathomimetic
B. Anticholinergic
C. Cholinergic
D. Opioid

29. Organophosphate poisoning will present with which signs and symptoms?

A. Dry mucous membranes and shock

B. Altered mental status and flushed skin
C. Euphoria and tachycardia
D. Salivation and incontinence of urine and liquid stool

30. What medication classification should be administered to an uncooperative, agitated patient?

A. Opioid
B. Nitrate
C. Benzodizepine
D. Sympathomimetic
31. A patient presents with mildly decreased mental status, slow respirations, bradycardia,
hypotension, has a blood sugar of 42mg/dl (2.3mmol). This is most likely caused from excessive
ingestion of:

A. Calcium channel blockers

B. Tricyclic antidepressants
C. Beta blockers
D. Salicylates

32. The patient complains of a deep burning discomfort diffusely throughout the epigastrium. This is
an example of which type of pain?

A. Somatic
B. Visceral
C. Referred
D. Radiating

33. A 24 year old female presents with lower right quadrant abdominal pain. Her skin is hot to the
touch and she exhibits a Psoas Sign. She complains of nausea and vomiting for 2 days. What
diagnosis is suspected?

A. Pancreatitis
B. Appendicitis
C. Gastroenteritis
D. Ectopic pregnancy

34. A known chronic alcoholic complains of the constant, severe mid-epigastric pain, nausea and
blood-streaked emesis. The patient has a temperature of 101.9°F (38.8°C) and severe
abdominal tenderness. What underlying diagnosis should be suspected?

A. Gastritis
B. Pancreatitis
C. Diverticulitis
D. Perforated gastric ulcer

35. What component of a patient's past medical history is most helpful in considering myocardial
infarction as a working diagnosis?

A. Daily intake of an aspirin

B. History of CHF
C. Recent hip surgery
D. Familial heart disease history

36. A patient describes an "aching" sensation in his chest. It occurred suddenly while resting and
radiates to the jaw. He self administered 1 nitroglycerin tablet without relief and the 12 lead
reveals a normal sinus rhythm with ST elevation in leads II, III, and aVF. What working diagnosis
is most likely?

A. Anterior wall myocardial injury

B. Inferior wall myocardial injury
C. Costochondritis
 D. Pericarditis

37. Healthcare providers are managing a patient presenting with substernal chest discomfort. They
describe the pain as "pressure-like" and it radiates to the jaw and left arm. The discomfort
subsides with rest, oxygen and administration of nitroglycerin. What is the most likely working
diagnosis?

A. Pleurisy
B. Angina pectoris
C. Myocardial infarction
D. Pulmonary embolism

38. Which infectious disease must have oxygen present to survive?

A. Tuberculosis
B. Lung abscess
C. Botulism
D. Tetanus

39. Which best practices help to prevent the spread of infectious disease?

A. Alcohol based antimicrobial equipment cleaning and handwashing

B. Goggles, gown and gloves for all patient contact
C. Facial protection and gloves for all patient contact
D. Handwashing before and after all patient contact and standard precautions.

40. Continuous positive airway pressure would be most appropriate in treating which patient?

A. 43 year old with decreased level of consciousness with respiratory difficulty

B. 22 year old with severe asthma and not responding to nebulizer treatments
C. 38 year old with carpal pedal spasms, clear lung sounds and respirations 40 times per
minute
D. 55 year old with jugular vein distention and BP 90/60

41. A patient has attempted suicide by ingesting ethylene glycol about 20 hours prior to arriving for
treatment. Lung sounds reveal bilateral crackles and respirations of 30 with symptoms of
pulmonary edema and cyanosis of the lips. The ECG reveals ventricular tachycardia. Which stage
of ethylene glycol poisoning has occurred?

A. 1
B. 2
C. 3
D. 4

42. A patient with a history of Grave's disease presents with anxiety, perfuse sweating and a
palpable goiter. Vitals are P 151, R 35 and labored, BP 84/42. Which working diagnosis is
most likely?

A. Myxedema
B. Cocaine toxicity
C. Thyrotoxicosis
 D. Diabetes insipidus

43. A patient experiences unilateral facial weakness and droop, garbled speech, altered sense of
taste and no extremity weakness. The patient has a history of Lyme's disease. What condition is
the patient likely experiencing?

A. Meningitis
B. Bell's palsy
C. Ischemic stroke
D. Hemorrhagic stroke

44. Which component of the history is most crucial when assessing a potential stroke patient?

A. Time of onset
B. Last oral intake
C. Medication allergies
D. Familial risk factors

45. The determination of a working diagnosis is dependent on the provider's assessment, critical
thinking and ____________________ __________________________ skills.

A. Patter recognition
B. Written documentation
C. Radio communication
D. Treatment intervention

46. When performing a patient assessment, what information provides the most essential
information in determining a working diagnosis?

A. Ordering and correctly interpreting all diagnostic information

B. A thorough head-to-toe examination on all patients
C. Obtaining information from bystanders
D. Medical history

47. Clinical reasoning requires the healthcare provider to:

A. Adequately communicate to peers regarding evidence-based practice

B. Order and interpret diagnostic testing results
C. Adequately perform a physical assessment
D. Process relevant information, filter out irrelevant information

48. According to the AMLS Assessment Pathway, determining whether a patient is "Sick or Not Sick"
is initially done which component of the assessment process?

A. Detailed assessment
B. First impression
C. Initial observation
D. Ongoing management
49. Select an example of a communication barrier that impairs an efficient and thorough assessment
process.

A. The patient speaks clearly and is shy

B. The patient's family is present in the home
C. You and your patient communicate fluently in the Spanish language
D. The patient can't find his hearing aid

50. Healthcare providers are treating an unresponsive patient who overdosed on lorazepam. What
intervention should be initiated?

A. Airway support
B. Administration of naloxone
C. Gather a SAMPLE history
D. Supplemental oxygen with nasal cannula