ACLS Precourse 2021

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Rhythm Identification
A. Agnoal rhythm/asystole
H. Second-degree atrioventricular block (Mobitz I

Wenckebach)
B. Atrial fibrillation
G. Pulseless electrical activity
N. Ventricular fibrillation
K. Sinus tachycardia
J. Sinus bradycardia
J. Sinus bradycardia
M. Third-degree atrioventricular block
C. Atrial flutter
I. Second-degree atrioventricular block (Mobitz II block)
F. Polymorphic ventricular tachycardia
E. Normal sinus rhythm
I. Second-degree atrioventricular block (Mobitz II block)
L. Supraventricular tachycardia
L. Supraventricular tachycardia
D. Monomorphic ventricular tachycardia
H. Second-degree atrioventricular block (Mobitz I

Wenckebach)
Pharmacology
1. You are caring for a 66-year-old man with a history of a large intracerebral hemorrhage 2 months ago. He is being
evaluated for another acute stroke. The CT scan is negative for hemorrhage. The patient is receiving oxygen via
nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do
you anticipate giving to this patient? aspirin
2. A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What
is the initial dose of atropine? 1 mg
3. A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 unit per
hour are being administered. The patient did not take aspirin because he has a history of gastritis, which was treated 5
years ago. What is your next action? give aspirin 160 to 325 mg to chew
4. A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug
should be given next? amiodarone 300 mg
5. What is the indication for the use of magnesium in cardiac arrest? pulseless VT-associated torsades de pointes
6. In which situation does bradycardia require treatment? hypotension
7. You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock
indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next?
establish IV or IO access
8. A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a
blood pressure of 110/70 mm Hg. He has a history of angina. What action is recommended next?
seeking expert consultation
9. A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One dose of epinephrine was given after
the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which
medication do you order next? epinephrine 1 mg
10. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The
patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is
vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a
supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has no responded to vagal
maneuvers. What is your next action? administer adenosine 6 mg IV push
11. A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. he meets initial criteria for
fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and
fibrinolytic therapy? hold aspirin for at least 24 hours if rtPA is administered
12. A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor show a regular narrow-
complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has ben
established. Which drug should be administered? adenosine 6 mg
13. Which intervention is most appropriate for the treatment of a patient in asystole? epinephrine
14. A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated, and an IV has
been started. The rhythm is asystole. What is the first drug/dose to administer? epinephrine 1 mg IV / IO
15. A patient is in cardiac arrest. Ventricular fibrillation has been refractory to second shock. Which drug should be
administered first? epinephrine 1 mg IV / IO
16. A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A
transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which
therapy is now indicated? epinephrine 2 to 10 mcg/min
17. A 57 year-old-woman has palpitations, chest discomfort, and tachycardia. The monitor show a regular wide-complex QRS
at a rate of 180/min. she becomes diaphoretic, and her blood pressure is 80/60 mm Hg. Which action do you take next?
perform electrical cardioversion
18. A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication
administration is in place, which method is preferred? IV or IO
19. A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?
use of a phosphodiesterase inhibitor within the previous 24 hours
20. A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1
mg IV twice, and an initial dose of amiodarone 300 mg IV. The patient is intubated. Which best describe the
recommended second dose of amiodarone for this patient? 150 mg IV push
Practical Application
1. You are providing bag-mask ventilations to a patient in respiratory arrest. How often should you provide ventilations?
every 6 seconds
2. A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for
instructions. What is your next action?
resume high-quality chest compressions
3. What is the recommended depth of chest compression for an adult victim? at least 2 inches
4. A patient’s 12-lead ECG is transmitted by the paramedics and shows a STEMI. When the patient arrives in the emergency
department, the rhythm shown here is seen on the cardiac monitor. The patient has resolution of moderate (5/10) chest
pain after 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention is most important in
reducing this patient’s in-hospital and 30-day mortality rate?
reperfusion therapy
5. You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see the
rhythm shown here (looks like normal sinus rhythm). Team members tell you that the patient was well but reported
chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest
rise, and IO access has been established. which intervention would be your next action?
epinephrine 1 mg
6. What is the recommended compression rate for high-quality CPR? 100 to 120 compressions per minute
7. A patient becomes unresponsive. You are uncertain if a faint pulse is present. The rhythm shown here is seen on the
cardiac monitor. An IV is in place. Which action do you take next?
start high-quality CPR
8. You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary
embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you
administer now?
epinephrine 1 mg IV
9. Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next?
start rescue breathing
10. A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received
adenosine 6 mg IV for the rhythm shown here (SVT), without conversion of the rhythm. She is now extremely
apprehensive. Her blood pressure is 128/70 mm Hg. What is the next appropriate intervention?
administer adenosine 12 mg IV
11. A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive,
with the rhythm shown here (polymorphic ventricular tachycardia). which action is indicated next?
give an immediate unsynchronized high-energy shock (defibrillation dose)
12. What is the maximum interval for pausing chest compressions? 10 seconds
13. How often should you switch chest compressors to avoid fatigue? about every 2 minutes
14. Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation?
ventilation too quickly
15. Which action should you take immediately after providing an AED shock? resume chest compressions
16. What action minimizes the risk of air entering the victim's stomach during bag-mask ventilation?
ventilating until you see the chest rise
17. After initiation of CPR and 1 shock for ventricular fibrillation, this rhythm (ventricular fibrillation) is present on the next
rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs
have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?
give epinephrine 1 mg IV / IO
18. A 35-year-old woman presents with a chief complaint of palpitations. She has no chest discomfort, shortness of breath,
or light-headedness. Her blood pressure is 120/78 mm Hg. Which intervention is indicated first?
vagal maneuvers
19. How does complete chest recoil contribute to effective CPR?

allows maximum blood return to the heart
20. Your patient is a 56-year-old woman with a history of type 2 diabetes who reports feeling dizzy. She is pale ad
diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm shown here (sinus
bradycardia). she is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. What so you
administer next?
atropine 1 mg IV
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H. Second-degree atrioventricular block (Mobitz I

G. Pulseless electrical activity

M. Third-degree atrioventricular block

I. Second-degree atrioventricular block (Mobitz II block)

F. Polymorphic ventricular tachycardia

E. Normal sinus rhythm

I. Second-degree atrioventricular block (Mobitz II block)

D. Monomorphic ventricular tachycardia

H. Second-degree atrioventricular block (Mobitz I

6. In which situation does bradycardia require treatment? hypotension

resume high-quality chest compressions

start high-quality CPR

give an immediate unsynchronized high-energy shock (defibrillation dose)

19. How does complete chest recoil contribute to effective CPR?

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