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ECCMultilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation. Asociación Americana del corazón Avanzado Cardiovascular Soporte vital Pruebas escritas Contenido: ¾ Nota de examen ¾ Hoja de respuestas del estudiante ¾ Versión A examen ¾ Clave de respuestas de versión A ¾ Hoja de referencia de versión A ¾ Versión B examen ¾ Clave de respuestas de la versión B ¾ Hoja de referencia versión B De mayo de 2011 Asociación del corazón © 2011 americano Multilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation. Multilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation. 2011 advanced Cardiovascular Life Support exámenes por escrito Introducción El curso de proveedor de ACLS 2011 incluye pruebas de conocimientos y un examen escrito. La prueba escrita mide el dominio de habilidades cognitivas. El examen escrito 2011 debe utilizarse con los materiales del curso 2011, es decir, Manual de proveedor, video curso y Manual del Instructor. Administración deEste examen escrito libro cerrado deberá rellenarse independientemente el escrito por cada alumno. Para recibir una tarjeta de finalización del curso, los examen alumnos deben obtener al menos el 84% en el examen escrito. Remediación de Todos los estudiantes merecen corrección sobre temas en los que no están seguros y temas que no han dominado. Para orientación sobre rehabilitación, consulte el Manual del Instructor. Copiar y distribución Pruebas escritas se fijan elementos. Centros de formación de las ACL puede distribuir exámenes ACL proveedores sólo a instructores ACL, ACL capacitación centro Facultad y ACL Regional profesores que están alineados con el centro de formación. Pruebas escritas pueden copiarse según sea necesario para la realización de cursos. Centros de formación pueden distribuir exámenes en el formato PDF original y completo por correo electrónico. Exámenes pueden no ser publicados en los sitios de Internet o Intranet accesibles por personas no autorizadas a recibir los exámenes. De mayo de 2011 Multilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation. Multilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation. HOJA DE RESPUESTAS Apoyo vital Cardiovascular avanzado Examen escrito Name___Date___Version___ Pregunta Respuesta 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. ABCD 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. ABCD 16. A B C D 17. A B C D 18. A B C D 19. A B C D 20. A B C D 21. ABCD 22. A B C D 23. A B C D 24. A B C D 25. ABCD Multilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation. B C DA36. C AD B27. C AD B50. B C DA35. 41. CD . C AD B38. C AD B28.A B26. C AD31. B C DA B A B37. C AD B39. B C AD32. B C DA B A B48. C AD B49. 30. BCD C DA45. B C AD44. B C DA47. C AD42. BCD C DA34. C AD B29. B C AD43. C AD B40. B C AD33. B C DA46. ECC American Heart Association Advanced Cardiovascular Life Support Written Exam Version A May 2011 © 2011 American Heart Association . What is your next action? A. you determine that there is no pulse. An activated AED does not promptly analyze the rhythm. P ETCO2 B. Endotracheal C. Start chest compressions at a rate of at least 100/min. 1. B. After activating the emergency response system. the heart rate is 92/min. Open the airway with a head tilt–chin lift. D. and the pulse oximetry reading is 97%. Administer epinephrine at a dose of 1 mg/kg. Laboratorytesting D. D. You are evaluating a 58-year-old man with chest pain.Advanced Cardiovascular Life Support Exam Version A (50 questions) Please do not mark on this exam. the nonlabored respiratory rate is 14 breaths/min. What assessment step is most important now? A. What is the preferred method of access for epinephrine administration during cardiac arrest in most patients? A. The blood pressure is 92/50 mm Hg. Deliver 2 rescue breaths each over 1 second. 2 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . C. Check all AED connections and reanalyze. Rotate AED electrodes to an alternate position. Obtaining a 12-lead ECG 3. C. Chestx-ray C. Peripheralintravenous 4. What is your next action? A. Begin chest compressions. B. You find an unresponsive patient who is not breathing. Discontinue the resuscitation attempt. Intraosseous B. 2. Centralintravenous D. Record the best answer on the separate answer sheet. During a pause in CPR. Failure to obtain vascular access Prolonged periods of no ventilations Failure to perform endotracheal intubation Prolonged interruptions in chest compressions 8. Obtain the patient’s history. D.5. You have completed 2 minutes of CPR. What is the next action? A. Uninterrupted compressions at a depth of 1½ inches 3 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . C. Chest compressions without ventilation C. What is a common but sometimes fatal mistake in cardiac arrest management? A. 6. you see this lead II ECG rhythm on the monitor. The patient has no pulse. Give 0. C. Establish vascular access. Allowing complete chest recoil B. B. Administer 1 mg of epinephrine. Which action is a component of high-quality chest compressions? A. 60 to 100 compressions per minute with a 15:2 ratio D. Another member of your team resumes chest compressions. 7. The ECG monitor displays the lead II rhythm below. D. and an IV is in place. C. Insert an advanced airway. B.5 mg of atropine. Administer a dopamine infusion. B. and the patient has no pulse. What management step is your next priority? A. D. Terminate the resuscitative effort. Resumechestcompressions. measures oxygen levels at the alveoli level. Provide compressions and ventilations with a 30:2 ratio. Chest compressions may not be effective. Sinus rhythm without a pulse C. Provide compressions and ventilations with a 15:2 ratio. The patient meets the criteria for termination of efforts. Asystole without a pulse B. Provide a single ventilation every 6 seconds during the compression pause. What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? A. determines inspired carbon dioxide relating to cardiac output. Torsades de pointes with a pulse D. B. 4 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . Which action increases the chance of successful conversion of ventricular fibrillation? A. 13. D. C. Three minutes after witnessing a cardiac arrest. C. B. 12. detects electrolyte abnormalities early in code management. The endotracheal tube is no longer in the trachea. C. Pausing chest compressions immediately after a defibrillation attempt Administering 4 quick ventilations immediately before a defibrillation attempt Using manual defibrillator paddles with light pressure against the chest Providing quality compressions immediately before a defibrillation attempt 10. What is the significance of this finding? A. B. one member of your team inserts an endotracheal tube while another performs continuous chest compressions. D. allows for monitoring of CPR quality. C.9. B. Ventricular tachycardia with a pulse 11. D. During subsequent ventilation. The team is ventilating the patient too often (hyperventilation). you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. The use of quantitative capnography in intubated patients A. Provide continuous chest compressions without pauses and 10 ventilations per minute. D. Which situation BEST describes pulseless electrical activity? A. Assess for the presence of a pulse immediately after the shock. Preparation for therapeutic hypothermia 5 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . 17. B. a fluid bolus. you are unsure whether the patient has a pulse. 16. C. Hands-free pads allow for a more rapid defibrillation. 19. Hands-free pads increase electrical arc. Be sure oxygen is not blowing over the patient’s chest during the shock. Begin chest compressions. Perform pulse checks immediately after defibrillation. Administer 1 mg of intravenous atropine. 18. What is your next action? A. What is your next treatment? A. Check the patient’s mouth for the presence of a foreign body. which has persisted despite 2 doses of epinephrine. and high-quality CPR. After calling for help and determining that the patient is not breathing. Commandingly announce “clear” after you deliver the defibrillation shock. an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. D. B. Which is a safe and effective practice within the defibrillation sequence? A. Earlydefibrillation B. 15. Hands-free pads have universal adaptors that can work with any machine. Rapid medication administration D. Applya transcutaneous pacemaker. Continue CPR while charging the defibrillator. your patient suddenly loses consciousness. D. B. Hands-free pads deliver more energy than paddles. What action is recommended to help minimize interruptions in chest compressions during CPR? A. C. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? A. Leave and get an AED. C. the ECG screen displayed asystole. After the first shock. Advanced airway management C. D. Deliver 2 quick ventilations. Continue to use an AED even after the arrival of a manual defibrillator. During your assessment. Consider terminating resuscitative efforts after consulting medical control. C. D. B. For the past 25 minutes. Administer 40 units of intravenous vasopressin. Administer IV medications only when delivering breaths. D. C. Stop chest compressions as you charge the defibrillator. B. Which action is included in the BLS Survey? A.14. B. What is the appropriate interval for an interruption in chest compressions? A. Compress the upper half of the sternum at a rate of 150 compressions per minute. P ETCO2 ≥10 mm Hg B. Vasopressin1mg/kg D.20. C. C. C. Which of the following is a sign of effective CPR? A. Dopamine 2 mg/kg per minute 21. 25. C. D. Amiodarone300mg C. B. Observe ECG rhythm to determine depth of compressions. B. Switch providers about every 2 minutes or every 5 compression cycles. B. D. D.6°F) D. 1 breath every 3 to 4 seconds 1 breath every 5 to 6 seconds 2 breaths every 5 to 6 seconds 2 breaths every 6 to 8 seconds 6 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . Which action improves the quality of chest compressions delivered during a resuscitation attempt? A. What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)? A. Atropine 2 mg B. Identifying and treating early clinical deterioration Rapidly intervening with patients admitted through emergency department triage Responding to patients during a disaster or multiple-patient situation Responding to patients after activation of the emergency response system 24. 10 seconds or less 10 to 15 seconds 15 to 20 seconds Interruptions are never acceptable 22. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min? A. Do not allow the chest to fully recoil with each compression. Measured urine output of 1 mL/kg per hour C. D. Diastolic intra-arterial pressure <20 mm Hg 23. Patient temperature >32°C (89. Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? A. 5mg B. A patient presents to the emergency department with new onset of dizziness and fatigue.5mg D. the blood pressure is 70/50 mm Hg. The patient’s heart rate is 180/min. D. Oxygen 12 to 15 L/min C. B. What is the appropriate first medication? A. A patient has sudden onset of dizziness. blood pressure is 110/70 mm Hg. 2 to 10 mg/min 2 to 10 mcg/kg per minute 10 to 15 mg/min 10 to 15 mcg/kg per minute 28. Epinephrine0. Atropine0. the patient’s heart rate is 35/min. On examination.26. and the oxygen saturation is 95%. and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. Adenosine 6 mg IV D. respiratory rate is 18 breaths/min. Vagalmaneuvers B. and pulse oximetry reading is 98% on room air. Normal saline 1 L bolus 7 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . Metoprolol 5 mg IV C. What is the appropriate dose of dopamine for this patient? A. The initial atropine dose was ineffective. C. the respiratory rate is 22 breaths/min. A patient presents to the emergency department with dizziness and shortness of breath with a sinus bradycardia of 40/min. Aspirin 160 mg chewed 27. The lead II ECG is shown below: What is the next appropriate intervention? A. C. What should you do in this situation? A. The heart rate has not responded to vagal maneuvers. 31. Choose an appropriate indication to stop or withhold resuscitative efforts. B. Divert the patient to a hospital 15 minutes away with CT capabilities. The hospital CT scanner is not working at this time. A. The patient’s blood pressure is 128/58 mm Hg. and the patient has not been given any vasoactive drugs. What is the next recommended intervention? A. Accept the report and provide care within your present capability. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. D. the heart rate is 92/min and regular. D. C. A patient in respiratory failure becomes apneic but continues to have a strong pulse. Contact the patient’s family to see what they would prefer. and the pulse oximetry reading is 96%. D.29. The initial blood pressure is 118/72 mm Hg. Administeroxygen. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. Obtain a 12-lead ECG. 33. D. Arrest not witnessed Evidence of rigor mortis Patient age greater than 85 years No return of spontaneous circulation after 10 minutes of CPR 32. What intervention has the highest priority? A. A 49-year-old woman arrives in the emergency department with persistent epigastric pain. Administer sublingual nitroglycerin. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. B. Which is the most appropriate intervention to perform next? A. the nonlabored respiratory rate is 14 breaths/min. B. the PETCO2 is 38 mm Hg. B. Evaluate for fibrinolytic eligibility. You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. C. C. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. Adenosine 6 mg IV push Amiodarone 300 mg IV push Synchronized cardioversion at 50 J Synchronized cardioversion at 200 J 30. Have the EMS crew choose an appropriate patient disposition. and the pulse oximetry reading is 98%. B. There is vascular access at the left internal jugular vein. C. Atropine IV push Epinephrine IV infusion Application of a transcutaneous pacemaker Simple airway maneuvers and assisted ventilation 8 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . D. While treating a patient with dizziness. the initial blood pressure is 138/78 mm Hg. B. 35. C. Suction during withdrawal but for no longer than 10 seconds. B. Nitroglycerin 36. and the pulse oximetry reading is 95% on room air. Head CT scan Transfer to the stroke unit Immediate rtPA administration Administration of 100% oxygen 9 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . Hyperventilate before catheter insertion. and cool. Suction during insertion but for no longer than 30 seconds. D. D. C. and a pulse oximetry reading of 97%. Upon arrival in the emergency department. EMS personnel measure a blood pressure of 140/90 mm Hg. Suction the mouth and nose for no longer than 30 seconds. B. What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected? A. a heart rate of 78/min. D. the pulse rate is 80/min. a nonlabored respiratory rate of 14 breaths/min. a blood pressure of 68/30 mm Hg. the respiratory rate is 12 breaths/min. What is the most appropriate action for the EMS team to perform next? A. The blood glucose level is within normal limits. and then suction during withdrawal. clammy skin. What intervention should you perform next? A. Lidocaine D. The lead II ECG displays sinus rhythm. 12-lead ECG assessment Administration of 100% supplementary oxygen Cincinnati Prehospital Stroke Scale assessment Administration of a low-dose aspirin 37. C. A 68-year-old woman experienced a sudden onset of right arm weakness. The lead II ECG displays sinus rhythm. Aspirin B. you see this lead II ECG rhythm: What is the most appropriate first intervention? A. EMS is transporting a patient with a positive prehospital stroke assessment. Atropine C.34. NSR on monitor but no pulse 10 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . the respiratory rate is 18 breaths/min. and the pulse oximeter is unable to obtain a reading because there is no radial pulse. Give 150 mg of amiodarone. The patient is pale. 42. the pulse is 200/min. Amiodaroneadministration D. 40. Administer 160 mg of aspirin. Determine whether pulses are present. and pulse oximetry is 95% on room air. Sinustachycardia D. Which rhythm requires synchronized cardioversion? A. Atrial fibrillation C. B. Unstablesupraventriculartachycardia B. C. D. and slow to respond to your questions. Synchronizedcardioversion 41. The blood pressure is 142/98 mm Hg. What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in place? A. C. Evaluate the breath sounds. He says he has no chest pain or shortness of breath. B. C. Administer 6 mg of adenosine.38. Review the patient’s home medications. cool to the touch. the heart rate is 190/min. the respiratory rate is 14 breaths/min. A 62-year-old man in the emergency department says that his heart is beating fast. 12-leadECG C. B. 4 to 6 breaths per minute 8 to 10 breaths per minute 12 to 14 breaths per minute 16 to 18 breaths per minute 39. You are evaluating a 48-year-old man with crushing substernal chest pain. What intervention should you perform next? A. What is the initial priority for an unconscious patient with any tachycardia on the monitor? A. D. Administer sedative drugs. The blood pressure is 58/32 mm Hg. The lead II ECG displays a regular wide-complex tachycardia. What intervention should you perform next? A. diaphoretic. Obtain a 12-lead ECG. Proceduralsedation B. D. B. B. May interfere with effective ventilation Places the patient’s cervical spine at risk Obstruction of venous return from the brain Does not adequately secure the airway device 47.43. What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? A. Colorimetriccapnography C. Use of esophageal detection devices 48. Continuous waveform capnography D. 12 mg 44. What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia? A. D. C. D. 250 to 500 mL 500 to 1000 mL 1 to 2 L 2 to 3 L 11 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association . What is the usual post–cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)? A. What is the potential danger of using ties that pass circumferentially around the patient’s neck when securing an advanced airway? A. 3mg B. D. Which condition is a contraindication to therapeutic hypothermia during the post–cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? A. C. 5-pointauscultation B. C. B. C. PCI) 46. 9 mg D . 6 mgC. B. What is the recommended IV fluid (normal saline or Ringer’s lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post–cardiac arrest period? A. Initial rhythm of asystole Responding to verbal commands Patient age greater than 60 years Desire to provide coronary reperfusion (eg. 30 to 35 mm Hg 35 to 40 mm Hg 40 to 45 mm Hg 45 to 50 mm Hg 45. D. B. Coronaryreperfusion B. C. 90 mm Hg 85 mm Hg 80 mm Hg 75 mm Hg 50. What is the minimum systolic blood pressure one should attempt to achieve with fluid. or vasopressor administration in a hypotensive post–cardiac arrest patient who achieves ROSC? A. Optimizing ventilation and oxygenation 12 Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association .49. D. What is the first treatment priority for a patient who achieves ROSC? A. inotropic. Maintaining blood glucose <185 mg/dL D. Therapeutichypothermia C. ABC● 10. A ●CD 16. A 11. AB●D 7. ●BCD 13. ●BCD 19. AB●D 18. ABC● 3. A ●CD 17. ABC● 15. ABC● 2. ●BCD 23. ABC● 25. AB●D 6. ●BCD 9. ●BCD 22. ●BCD 20. ●BCD 14. ●BCD 24.2011 WRITTEN EXAM A Answer Key Advanced Cardiovascular Life Support Question Answer 1. ABC● 4. ABC● 12. A 21. ABC● 8. ●BCD 5. A Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association ●CD ●CD ● CD . AB●D 42. ABC● 34. A ● CD 33. A ● CD 46. A ● CD 32. A ● CD 45. ABC● Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association ● CD ● CD ● CD . AB●D 49. AB●D 37. ●BCD 50.26. ●BCD 27 A 28 ●BCD 29 ●BCD 30. ●BCD 43. AB●D 47. AB●D 35. A 39. ●BCD 38. ABC● 31. A 36. ●BCD 40 ABC● 41. ABC● 44. AB●D 48. 26 ●BCD 24. 47 A Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association ●CD ●CD ● CD . 71 ABC● 4. 14 ●BCD 22. 14 ABC● 25. 57 ●BCD 5.2011 WRITTEN EXAM A Reference Sheet Advanced Cardiovascular Life Support Question 1. 90 ABC● 15. 62 ABC● 8. 48 ABC● 12. Page Number in ACLS Provider Manual C● B 52 A Answer 2. 96 ABC● 3. 64 AB●D 18. 57 ABC● 10. 81 AB●D 6. 63 ●BCD 19. 75 ●BCD 14. 35 ●BCD 20. 50 A ●CD 17. 37 ●BCD 23. 81 AB●D 7. 78 A 11. 66 A 21. 14 ●BCD 9. 67 ●BCD 13. 64 A ●CD 16. 76 A ● C D 46. 140 38. ●BCD B ● D116 A 41. 129 ●BCD 29. 110 A ● C D 28. C● B 67 A ● C D 45. 43. 36 A ● C D 39. C● B 119 A 116 42. B ● D 76 A 48. 110 27. 119 40. 50. 110 A ● C D 35. B ● D136 A 36. 37. B ● D 75 A 47. C● B 139 A 31.●BCD 26. B ● D 76 A 76 49. 96 A ● C D 33. C● B 110 A B ● D 46 A 34. 129 ●BCD 30. ●BCD 74 A Advanced Cardiovascular Life Support Written Exam Version A © 2011 American Heart Association ●BCD . C● B ●BCD 129 A 44. 87 A ● C D 32. ECC American Heart Association Advanced Cardiovascular Life Support Written Exam Version B May 2011 © 2011 American Heart Association . Continue CPR while the defibrillator is charging. What is your next action? A. Which condition is an indication to stop or withhold resuscitative efforts? A. No return of spontaneous circulation after 10 minutes of CPR 3. D. C. you activate the emergency response team. C. D. C. After verifying the absence of a pulse.Advanced Cardiovascular Life Support Exam Version B (50 questions) Please do not mark on this exam. B. Deliver 2 rescue breaths. What is your next action? A. 2. 2 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . B. Record the best answer on the separate answer sheet. Safety threat to providers C. Continue to use AED even after the arrival of a manual defibrillator. Administer IV medications only when breaths are given. What should be done to minimize interruptions in chest compressions during CPR? A. Retrieve an AED. The patient’s lead II ECG appears below. IV or IO access Endotracheal tube placement Consultation with cardiology for possible PCI Application of a transcutaneous pacemaker 4. D. B. After verifying unresponsiveness and abnormal breathing. Check for a pulse. Unwitnessedarrest B. you initiate CPR with adequate bag-mask ventilation. Patient age greater than 85 years D. 1. Perform pulse checks only after defibrillation. Administer a precordial thump. What is the most important early intervention? A. C. After attaching a cardiac monitor. D. Antiarrhythmicadministration 9. What survival advantages does CPR provide to a patient in ventricular fibrillation? A. Endotrachealintubation C. B. administer epinephrine. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest? A. D. D. 60 to 80 per minute 80 to 100 per minute About 100 per minute At least 100 per minute 8. Not recommended for routine use Recommended during every resuscitation attempt Recommended when the patient is vomiting Recommended only for supraglottic airway insertion 6. Defibrillation B. Epinephrineadministration D. B. C. C. The next intervention is to A. EMS personnel arrive to find a patient in cardiac arrest. insert an advanced airway. administer amiodarone. D. What is the recommended compression rate for performing CPR? A. administer a second shock.5. B. 3 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . Bystanders are performing CPR. the responder observes the following rhythm strip. C. B. A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. Increases the defibrillation threshold Directly restores an organized rhythm Opposes the harmful effects of epinephrine Produces a small amount of blood flow to the heart 7. Every 3 m inutes D. Begin CPR. Patient temperature >32°C (89. Every 4 m inutes 15. D. Internal jugula r vein 12. Check the ECG for evidence of a rhythm. 1mg/kg C. C. Subclavianvein B. B. Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? A. 1mg B. C. 14. Measured patient urine output of 1 mL/kg per hour 4 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . Intraosseous ne li D. Open the patient’s airway. given rapidly during compressions. P ETCO2 <10 mm Hg B. What is the recommended next step after a defibrillation attempt? A. How often should the team leader switch chest compressors during a resuscitation attempt? A. IV/IO drug administration during CPR should be A. D. Diastolic intra-arterial pressure ≥20 mm Hg D. 11. Determine if a carotid pulse is present. Everyminute B. Which finding is a sign of ineffective CPR? A. 1mEq/kg D. B.10. What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? A. starting with chest compressions. Every 2 m inutes C. given by infusion. Antecubitalvein C.6°F) C. 30 0 mg 13. given before any defibrillation attempts. administered slowly during the pause for a pulse check. What is the next step in your assessment and management of this patient? A. 1 to 5 seconds 5 to 10 seconds 10 to 15 seconds 15 to 20 seconds 18. Apply the AED. Administer the shock immediately and continue as directed by the AED. 19. 2nches i D. A team leader orders 1 mg of epinephrine. Move the patient off the snow to bare ground and deliver the shock. D. Check for the presence of breathing. What is the minimum depth of chest compressions for an adult in cardiac arrest? A. B. D. Clear roles and responsibilities 17. B. Defibrillation D. How long should it take to perform a pulse check during the BLS Survey? A. What element of effective resuscitation team dynamics does this represent? A. Epinephrine C. C. 21. Place a backboard beneath the patient and administer the shock. 1inch B. C. Knowing one’s limitations C. and a team member verbally acknowledges when the medication is administered. Atropine B. Check the patient’s pulse. Open the patient’s airway. An AED advises a shock for a pulseless patient lying in snow. Closed-loopcommunication D. Remove any snow beneath the patient and then administer the shock. You determine that he is unresponsive and notice that he is taking agonal breaths. Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. Clearmessages B. 1½inches C. B. C.16. What is the next action? A. 2½inches 5 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . D. Which treatment or medication is appropriate for the treatment of a patient in asystole? A. Transcutaneouspacing 20. What is the appropriate rate of chest compressions for an adult in cardiac arrest? A. Start chest compressions at a rate of at least 100/min. Central venous access 25. What is the next most preferred route for drug administration? A. Have a team member attempt to palpate a carotid pulse. B. Endotracheal(ET) C.22. C. D. At least 100/min C. What should you do in this situation? A. You have completed your first 2-minute period of CPR. The hospital CT scanner is not working at this time. 24. You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. 23. What is the next action? A. Intraosseous (IO) B. Have the EMS crew choose an appropriate patient disposition. nonshockable rhythm on the ECG monitor. What is the next action? A. At least 150/min B. Administer epinephrine at 1 mg/kg IV. C. Administer an IV antiarrhythmic. Obtain a blood pressure and oxygen saturation. Intramuscular(IM) D. Divert the patient to a hospital 15 minutes away with CT capabilities. Check for a pulse. You see an organized. 6 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. Administer normal saline at 20 mL/kg. C. Accept the report and provide care within your present capability. Approximately100/min D. D. Approximately120/min 26. B. B. Contact the patient’s family to see what they would prefer. increasing to 200 J. A patient with pulseless ventricular tachycardia is defibrillated. D. Repeat the unsynchronized shock. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. and there is a patent peripheral IV. What is the next action? A. What is the next action after establishing an IV and obtaining a 12-lead ECG?   A. and the pulse oximetry reading is 95%. the respiratory rate is 12 breaths/min. the pulse is 130/min and regular. A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. Immediatedefibrillation 28. the respiratory rate is 22 breaths/min. and the pulse oximetry reading is 96%. Acquisition of a 12-lead ECG B. The patient is diaphoretic. D. Administer 2 to 4 mg of morphine by slow IV bolus. Seeking expert consultation C. A patent peripheral IV is in place. and weakness. the respiratory rate is 16 breaths/min. Vagal maneuvers C. The lead II ECG displays a wide-complex tachycardia. Administer an IV fluid bolus and obtain arterial blood gas. A 49-year-old man has retrosternal chest pain radiating into the left arm.27. 7 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . Administer an additional nitroglycerin tablet. The blood pressure is 130/88 mm Hg. the heart rate is 110/min. with associated shortness of breath. Proceduralsedation D. C. 29. Administer an additional dose of aspirin. Start dopamine at 2 mcg/kg per minute and obtain a chest x-ray. Administer high-flow oxygen via an oxygen mask. C. A 53-year-old man has shortness of breath. and the pulse oximetry value is 95%.  Administration of IV epinephrine B. The patient’s 12-lead ECG shows ST-segment elevation in the anterior leads. B. A postoperative patient in the ICU reports new chest pain. Synchronizedcardioversion 30. What is the next action? A. the heart rate is 230/min. The lead II ECG is displayed below. Obtain a 12-lead ECG and administer aspirin if not contraindicated. B. The patient’s blood pressure is 102/59 mm Hg. Send blood to the laboratory for chemistry and cardiac enzymes. D. Proceduralsedation D. chest discomfort. First responders administered 160 mg of aspirin. The blood pressure is 132/68 mm Hg. What actions have the highest priority? A. a blood pressure of 68/50 mm Hg. Sinustachycardia B. Perfusing ventricular tachycardia C. 32. The patient’s lead II ECG is displayed below. The patient is experiencing shortness of breath. Stable supraventricular tachycardia D. She is alert and oriented. D. D. Give an IV fluid bolus. She now states she is asymptomatic after walking around. A responder is caring for a patient with a history of congestive heart failure. C. Her lead II ECG is below. what is the next action? A. Her blood pressure is 102/72 mm Hg. Conduct a problem-focused history and physical examination. B. Unstablesupraventriculartachycardia 8 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . After you start an IV. An 80-year-old woman presents to the emergency department with dizziness. Give atropine and monitor for changes in mental status. C. Start an epinephrine infusion and titrate to patient response. 2 to 4 mg 80 to 120 mg 160 to 325 mg 400 to 600 mg 33. B.31. What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? A. and a heart rate of 190/min. Which of the following terms best describes this patient? A. C. Obtaining a 12-lead ECG 38. Chest x-ray C. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg.34. P ETCO2 B. D. C. the nonlabored respiratory rate is 14 breaths/min. C. the heart rate is 92/min. What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? A. Placing a nasopharyngeal airway Using an advanced airway device Performing a head tilt–chin lift maneuver Performing a jaw thrust without head extension 9 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . Immediate unsynchronized countershock 35. Valsalvamaneuver B. B. Synchronizedcardioversion C. What is the purpose of a medical emergency team (MET) or rapid response team (RRT)? A. Intravenous administration of adenosine D. What assessment step is most important now? A. Family members found a 45-year-old woman unresponsive in bed. 4 to 6 breaths per minute 10 to 12 breaths per minute 14 to 16 breaths per minute 16 to 18 breaths per minute 37. B. What is the recommended initial airway management technique? A. What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? A. Providing online consultation to EMS personnel in the field Providing diagnostic consultation to emergency department patients Improving care for deteriorating patients admitted to critical care units Improving patient outcomes by identifying and treating early clinical deterioration 36. Laboratorytesting D. The patient is unconscious and in respiratory arrest. D. and the pulse oximetry reading is 97%. D. B. A patient has a witnessed loss of consciousness. Synchronizedcardioversion 41. Adenosine 6 mg IV push D. 50 to 75 J 75 to 100 J 120 to 200 J 200 to 300 J 10 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association .39. The lead II ECG reveals this rhythm: What is the appropriate next intervention? A. Defibrillation B. C. D. Adenosine 6 mg IV push C. Epinephrine 1 mg IV push D. Synchronizedcardioversion 40. Defibrillation B. Amiodarone 150 mg IV C. B. What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? A. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention? A. Initiate an antiarrhythmic infusion. Replace any supraglottic airway with an endotracheal tube. Place a central venous catheter for hemodynamic monitoring. 43. Heart rate greater than 80/min Right ventricular infarction and dysfunction Phosphodiesterase inhibitor use more than 72 hours ago Systolic blood pressure greater than 100 mm Hg 44. What is the immediate danger of excessive ventilation during the post–cardiac arrest period for patients who achieve ROSC? A. C. 46. Oxygentoxicity B. C. Decreased cerebral blood flow D. B. 35 C° to 37 C° 11 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . D. C. C. B. Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation? A. Atropine bolus Administration of IV or IO fluid bolus Placement of a central line to monitor pulmonary wedge pressure Phenylephrine hydrochloride titrated to keep systolic blood pressure >100 mm Hg 45. Measure from the thyroid cartilage to the angle of the mandible. Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? A.42. Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? A. B. 26 C° to 28 C° B. B. Estimate by using the size of the patient’s thumb. D. Transport the patient to a facility capable of performing PCI. What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? A. Pulmonaryhypertension C. Estimate by using the formula Weight (kg)/8 + 2. What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? A. D. D. 32 C° to 34 C° D. 29 C° to 31 C° C. Measure from the corner of the mouth to the angle of the mandible. Ventilation/perfusion mismatch 47. D. D.48.1 to 0. C. What is the recommended duration of therapeutic hypothermia after reaching the target temperature? A. 0 to 12 hours 12 to 24 hours 24 to 36 hours 36 to 48 hours 49. B. 2 to 10 mg/min IV infusion 0. C.5 mcg/kg per minute IV infusion 1 mg IV push every 3 to 5 minutes 10 mg IV push every 3 to 5 minutes 12 Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association . Potential oxygen toxicity Adverse hemodynamic effects Decrease in cerebral blood flow Increased intrathoracic pressure 50. C. What is the recommended dose of epinephrine for the treatment of hypotension in a post– cardiac arrest patient who achieves ROSC? A. B. B. What is the danger of routinely administering high concentrations of oxygen during the post– cardiac arrest period for patients who achieve ROSC? A. D. AB●D 22. A 10. ABC● 8.2011 WRITTEN EXAM B Answer Key Advanced Cardiovascular Life Support Question Answer 1. A ●CD 19. ●BCD 16. A ●CD 18. ● BCD 25. A 15. A ●CD 20. ABC● 7. ABC● 13. ●BCD 6. ●BCD 9. ABC● 21. ●BCD 14. A ●CD 3. AB●D 17. A 12. ABC● 24. ●BCD 4. A 5. ABC● 11. A ●CD 2. AB●D 23. A Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association ●CD ●CD ●CD ●CD ● CD . A 30.26. ABC● 32. ABC● 34. ABC● 31. ● BCD 50. AB●D 39. ● BCD 41. AB●D 42. A ● CD 44. A 49. ABC● 38. ABC● 43. AB●D 33. A ● CD 45. ABC● 27. A ● CD 46. AB●D 48. ABC● 29. A Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association ● CD ● CD ● CD ● CD ● CD ● CD . ABC● 40. A 35. ABC● 36. A 37. AB●D 47. A 28. 13 ABC● 11. 61 A 10. 70 ● BCD 14. 64 ABC● 24. 54 ● BCD 9. 48 ● BCD 6. 35 ABC● 8. 58 ABC● 21. 88 A ●CD 20. 13 A ●CD 19. 63 AB●D 23. 69 ●BCD 25.2011 WRITTEN EXAM B Reference Sheet Advanced Cardiovascular Life Support Question 1. 13 A ●CD 18. 70 A 12. 67 ● BCD 16. 81 ● BCD 4. 51 AB●D 22. 51 A Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association ●CD ●CD ●CD ●CD ●CD ●CD . 19 AB●D 17. 13 A 5. 54 ABC● 7. 66 ABC● 13. 35 A 15. Page Number in ACLS Provider Manual 63 A ● C D Answer 2. 87 A 3. C● B C● B C● B 116 A 121 40. ●BCD B ●122 D A 41. 77 A ● C D 49. 76 A ● C D Advanced Cardiovascular Life Support Written Exam Version B © 2011 American Heart Association ●BCD .26. 97 A ● C D 44. C● C● B B 110 A C● B 115 A 116 A ● C D 34. B ● D75 A 47. C● B 139 A 129 A ● C D 27. 76 A ● C D 45. 28. 96 A B ● D40 A 38. 96 A B ● D97 A 32. 31. 33. 74 50. 26 A 36 A ● C D 36. 42. 39. C● B 129 A ● C D 29. 35. 28 A ● C D 46. 97 A C● B 43 A 43. B ● D77 A 48. 37. 30.