1. Your community has begun an aggressive patient education campaign to reduce
the risk of stroke. All EMS systems, hospital, and medical personnel have been
asked to participate. You want to identify patients at the highest risk for stroke to
enable you to target those most in need of intervention. As you review the list of
problems demonstrated by the patient you saw today, which of the following is
the MOST powerful modifiable risk factor for stroke?
a.
b.
c.
d.
High blood sugar
High blood potassium
High blood sodium
Untreated high blood pressure (hypertension)
2. Before giving rescue breath to an unresponsive patient, you must check for
adequate breathing. You do this by listening and feeling for airflow through the
victims nose or mouth. In addition, what other sign should you assess?
a.
b.
c.
d.
Look into the patients mouth to see if anything is blocking the airway
Gently shake the patient shoulders
Check the patient pupil and look for constructive response to light
Look to see if the patients chest rises (and falls|) when the patient breathes
3. You are participating in the attempted resuscitation of a patient in a doctors office.
You are performing mouth-to –mask breathing using a pocket mask without
oxygen until the arrival of the resuscitation team. Which of the following
describes the BEST method of delivering rescue breaths with a pocket mask but
no oxygen?
a. Reduce the volume and duration of breaths from the volume and duration
you would provide with mouth-to-mouth ventilation
b. Provide approximately the same volume as you would with mouth-tomouth ventilation (with a volume sufficient to make the chest rise) and
deliver the breaths over 2 seconds
c. Increase your air volume and duration of breaths
d. Give 3 breaths between series of compressions
4. You confirm that a responsive adult is choking. While you perform abdominal
thrust on the victim he becomes limp and unresponsive and collapses to the floor.
What should you do next?
a. Roll the person over and give 5 back blows between the shoulder blades
b. Lower the victim to the ground, open the victims airway, and provide
rapid and forceful mouth-to-mouth breathing
c. Lower the victim to the ground, give 5 abdominal thrusts, attempt rescue
breathing, and then alternate abdominal thrusts and attempts at rescue
breathing
d. Lower the victim to the ground, open the airway with a tongue-jaw lift,
perform a finger sweep, open the airway, and check for breathing. If the
victim is not breathing adequately, attempt rescue breathing.
5. Which of the following actions is MOST effective in restoring oxygenation and
ventilation to an unresponsive, breathless, near-drowning victim?
a. Force water from the victims lungs by performing the Heimlich maneuver
b. Force water from the victims lungs by starting chest compressions
c. Stabilize the 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.
6. During the “analyze” phase of AED operation, which of the following action is
indicated?
a.
b.
c.
d.
Continue chest compressions
Continue ventilations without chest compressions
Prepare the patient for transport
Avoid all contact with and movement of the patient
7. Which of the following actions is NOT performed when you “clear” a patient just
before defibrillator discharge?
a. Check the person managing the airway; body not touching bag mask or
tracheal tube, oxygen flow turned OFF
b. Check yourself; hands correctly placed on paddles, body not touching
patient or bed
c. Check monitor leads; leads disconnected to prevent shock damage to
monitor
d. Check others: no one touching patient, bed, or equipment connected to
patient
8. Which of these statements about IV administration of medications during
resuscitation is TRUE?
a. Give epinephrine via the intracardiac route if IV access is not obtained
within 3 minutes
b. Follows IV medications through peripheral veins with a fluid bolus
c. Do not follow IV medications though central veins with a fluid bolus
d. Run normal saline mixed with sodium bicarbonate (100 mEq/L) during
continuing CPR.
9. While treating a patient in persistent VF arrest after 3 shocks, you consider using
vasopressin. Which of the following guidelines for use of vasopressin in TRUE?
a. Give vasopressin 40 U every 3 to 5 minutes
b. Give vasopressin for better vasoconstriction and b-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 to pressor agent for clinical shock caused
by Hypovolemia.
10. Which of the following causes of PEA is MOST likely to respond to immediate
treatment?
a.
b.
c.
d.
Massive pulmonary embolism
Hypovolemia
Massive acute myocardial infarction
Myocardial rupture and stroke
11. Which of the following statements about treating a patient with a rapid atrial
fibrillation (HR>180 bpm) is TRUE?
a. Do not cardiovert if the tachycardia is producing serious signs and
symptoms
b. You must have an exact rhythm diagnosis before cardioversion, especially
in unstable patients
c. Calcium channel blockers help control the rate in rapid atrial fibrillation
d. Use amiodarone only for ventricular tachycardias, never for
supraventricular tachycardias.
12. Which of the following drug-dose combinations is recommended as the initial
medication to give a patient in documented Asystole?
a.
b.
c.
d.
Epinephrine 3 mg IV
Atropine 3 mg IV
Epinephrin 10 ml of a 1:10 000 solution IV
Atropine 0.5 mg IV
13. Which of the following rhythm is a proper indication for transcutaneous cardiac
pacing?
a.
b.
c.
d.
Sinus bradycardia with no symptoms
Normal sinus rhythm with hypotension and shock
Complete heart block with pulmonary edema
Asystole that follows 6 or more defibrillation shocks
14. Which of the following statements correctly describes the ventilations that should
be provided after tracheal tube insertion, cuff inflation, and position verification?
a. Delivers an average of 12 to 15 ventilations per minute with no pauses for
chest compression.
b. Deliver ventilations as rapidly as possible as long as visible chest rise
occurs with each breath
c. Deliver ventilations with a tidal volume of 3 to 5 mL/kg
d. Deliver ventilation using room air until COPD is rules out.
15. Which of the following agents used frequently in the early management of acute
cardiac ischemia?
a.
b.
c.
d.
Lidocaine bolus followed by a continuous infusion of lidocaine
Chewable aspirin, sublingual nitroglycerin, and intravenous morphine
Bolus of amiodarone followed by an oral ACE inhibitor
Calcium channel blocker plus intravenous furosemide
16. Which of the following conditions MOST closely mimics the signs and symptoms
of an acute stroke?
a.
b.
c.
d.
Acute insulin-induced hypoglycemia
Acute hypoxia
Isotonic dehydration and hypovolemia
Acute vasovagal or orthostatic hypotension
17. In proper order, what are the 4 “universal steps” required to operate an AED?
a. Power on AED, attaches AED to victim, analyze rhythm, deliver shock if
indicated
b. Attach AED to victim, power on AED, analyze rhythm, deliver shock if
indicated
c. Attach electrode pads to victim, attach electrode cables to AED, power on
AED, analyze rhythm, deliver shock if indicated
d. Power on AED, attach AED to victim, deliver first shock, analyze rhythm.
18. 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 AED, provide 2 breaths, check for a pulse
b. Wait for 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 AED, follow AED prompts
d. Provide 2 breaths, check for a pulse, if no pulse perform chest
compressions for 1 minute, call for AED, when AED arrives attach
electrode pads.
19. The drug vasopressin is a new addition to the ECC guidelines, for which of the
following arrest rhythms is vasopressin recommended?
a.
b.
c.
d.
Ventricular fibrillation
Asystole
PEA
All of the above.
20. 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.
b.
c.
d.
Check monitor displays for sensitivity or “grain”
Obtain a right-sided 12 lead ECG
Change LEAD SELECT control from lead II to paddles and back
Administer a lower energy (100 J) defibrillator shock to “bring out”
possible occult VF
21. Which of the following statements accurately describes the use of bag-mask
ventilation (BMV) during resuscitation?
a. BMV can be performed effectively with minimal training and little
practice
b. BMV will deliver nearly 100% oxygen when combined with a reservoir
and high flow rate oxygen
c. BMV cannot be performed effectively by one person during resuscitation
d. BMV should not be used if the patient has any spontaneous respiratory
effort.
22. Which of the following conditions MOST closely mimics the signs and symptoms
of an acute stroke?
a.
b.
c.
d.
Acute insulin-induced hypoglycemia
Acute hypoxia
Isotonic dehydration and Hypovolemia
Acute vasovagal or orthostatic hypotension
23. Which of the following causes of pre-hospital asystole is MOST likely to respond
to immediate treatment?
a.
b.
c.
d.
Prolonged cardiac arrest
Prolonged submsrsion in warm water
Drug overdose
Blunt multi-system trauma
24. Which of the following patient needs immediate intubation?
a. An apneic patient whose chest does not rise with bag-mask ventilations
b. An elderly woman with severe chest pain and shallow respirations at 30
breaths/min
c. A 55-year old insulin-dependent diabetic with ST-segment elevation and
runs of VT
d. A subdued, alcohol-intoxicated college student with a reduced gag reflex
25. Which of the following rhythms is an appropriate indication for transcutaneous
cardiac pacing?
a.
b.
c.
d.
Sinus bradycardia with no symptoms
Normal sinus rhythm with no hypotension and shock
Complete heart block with pulmonary edema
Asystole that follows 6 or more defibrillation shocks.
26. A person with acute heart attack pain often delays phoning the EMS system (997).
Which of the following statements provides the MOST accurate explanation for
this behavior?
a. People often deny that their symptoms might be due to a heart attack
b. Symptoms of a heart attack come and go, so it is prudent to wait for up to
an hour to avoid a “false alarm”
c. If family members are trained in CPR, the victim can wait and ask
someone in the family to provide transportation to the hospital if the signs
of heart attack persist
d. If you phone the EMS System, transport to the hospital actually takes
longer than if the victim drives to the hospital or asks a family to provide
the transportation.
27. You are caring for a 68-year old woman following surgery and have observed her
continuously. She was talking normally to you earlier but now complains of a
sudden numbness and weakness on one side of her face and “pins and needles” in
her arm. You notice that one side of her face is drooping, and she is unable to
repeat a phrase when asked. What is the MOST likely cause of these problems?
a.
b.
c.
d.
A seizure
A heart attack
Cardiac arrest
A stroke
28. An adult victim of sudden, witnessed cardiac arrest arrives in the Emergency
Department. You are thinking about these victims chances of survival. Which of
the following would give this victim the BEST chance of survival from sudden
out-of-hospital cardiac arrest?
a. Immediate CPR and defibrillation within minutes (no more than 3 to 5
minutes)
b. CPR performed by EMS personnel upon arrival at the victims side
c. Defibrillation in 10 minutes with or without CPR
d. Immediate CPR with defibrillation in 10 minutes.
29. You are providing rescue breathing for an unresponsive, non-breathing child who
has signs of circulation. How often should you provide rescue breaths for this
child?
a.
b.
c.
d.
Once every 3 seconds (20 breaths per minute)
Once every 4 seconds (15 breaths per minute)
Once every 6 seconds (10 breaths per minute)
Once every 10 seconds (6 breaths per minute)
30. You are in a physician’s office building after hours when you find a colleague
slumped over his desk. You verify that he is unresponsive, phone the emergency
response number, and get the AED. You open the man’s airway, determine that he
is only gasping, and give 2 breaths. You check for signs of circulation and find
there are none (including no pulse). You attach the AED, but the voice prompt
tells you that no shock is indicated. You begin chest compressions and perform
cycles of compressions and ventilations. What is your ratio of chest compressions
to ventilations for this man?
a.
b.
c.
d.
15 to 2
12 to 4
5 to 1
3 to 1
31. You and your colleague are providing 2-rescuers CPR for a man. You are
performing chest compressions: your colleague is performing bag-mask
ventilation. Which of the following MOST accurately represents the speed of
compressions that you should deliver to this man?
a.
b.
c.
d.
A rate of 80 to 100 times per minute
A rate of about 100 times per minute
A rate no faster than 60 times per minute
A rate of at least 120 times per minute.
32. Which statement about injuries in infants and children is TRUE?
a.
b.
c.
d.
Most fatal injuries are not preventable
Injuries are the chief cause of death in children and young adults
Bicycle helmets will not prevent death from head injuries
Scholl files are the leading cause of fatal childhood injuries.
33. It is worth the effort to quit smoking because:
a. Some cigarettes contain more tars and nicotine than others and there is no
certainty which type is being smoked
b. After a period of years the death rate of those who stopped smoking is
nearly as low as those who never smoked
c. Smoking lowers the ability of the blood carry carbon monoxide
d. Other risk factors such as high blood pressure and high blood cholesterol
cannot be controlled.
34. Advance Cardiac Life Support certification implies:
a. Successful completion of a course instruction in ACLS according to the
cognitive and performance of the International Guideline 2000 for CPR
and ECC Association
b. Licensure to perform procedures in a hospital or pre-hospital setting
c. Qualifications to perform procedures in a hospital or pre-hospital setting
d. Expertise in ACLS.
35. During the course of cardioversion, a patient suddenly develops ventricular
fibrillation. Which one of the following steps should be taken?
a.
b.
c.
d.
Begin external chest compression immediately
Inject 300 mg Amerdorone
Administer a second synchronized shock instantly
Turn off synchronizer switch and proceed with unsynchronized counter
shock.
36. It is usually medically and legally acceptable to terminate CPR when:
a. Twenty minutes have passed and the resuscitation effort has not been
successful
b. There is no papillary response to light
c. There is some question as to whether or not the brain can fully and
completely recover and response
d. The cardiovascular systems have failed to respond to effectively
performed BLS and ACLS efforts.
37. Regarding ventilation during CPR:
a.
b.
c.
d.
Large volume (800-1200 ml) is less dangerous and more beneficial
The placement of the tube must be confirmed using ETCO2
LMA has no place in case of difficult intubation
You do have to pause after the 5th compression for ventilation in case of
the patient has endotracheal tube in situ
e. Double lumen endotracheal tubes can be used.
38. Acute coronary syndromes:
a.
b.
c.
d.
Pre-hospital 12 lead ECG is not mandatory
About 10% die before reaching the hospital
It includes unstable agina factors and acute myocardial infarction
Clot busting agent has no place in the management.
39. A 57-year-old male is complaining of chest pain and dizziness. His blood pressure
is 118/64, respiratory rate 24. The cardiac monitor displays sporadic episodes of
Torsades de Pointes. Which of the following treatment measures should be
avoided in the management of this patient?
a.
b.
c.
d.
Administration of amedorone 300 mg I.V.
Administration of magnesium sulfate
Consideration of an isoprotenerol infusion
Defibrillation of any sustained episodes of torsades.
40. Which of the following statements regarding management of the suspected stroke
patients is INCORRECT:
a. Lorazepam or diazepam may be used to treat active seizures
b. 5% dextrose in water is the preferred intravenous solution for
administration to the suspected stroke patient
c. If the patient develops signs of herniation, intubation with
hyperventilation may provide a temporary means of reducing
increased intracranial pressure
d. Signs and symptoms of acute stroke include an intense or usually
severe headache of sudden onset, aphasia, incoordination and
weakness.
41. Adenosine:
a. Is pure B-adrenergic stimulator
b. Is used to suppress ventricular ectopy
c. Increases systolic blood pressure and dilates the renal and mesenteric
vasculature
d. Is a first-line agent in the management of stable paroxysmal
supraventricular tachycardia.
42. A 50-year old female is complaining of chest pain, dizziness and nausea. Her
blood pressure is 62/38, respirations 18. The cardiac monitor shows a sinus
bradycardia at 48/minute with frequent, multi-formed PVCs. Your first choice of
drug and dosage will be:
a. Sublingual nitroglycerin
b. Morphine 1-3 mg bolus
c. Atropine 0.5-10 mg IV bolus
d. Lidocaine 1-1.5 mg/kg IV bolus.
43. You have intubated a 60 year old female patient in cardiac arrest. Which of the
following would indicate inadvertent esophageal intubation:
a.
b.
c.
d.
Subcutaneous emphysema
External jugular vein distension
Gurgling sounds heard over the epigastrium
Breath sounds present on only one side of the chest.
44. Select the INCORRECT statement regarding the management of the cardiac arrest
patient in VF:
a. The patients chest should be examined for the presence of a
nitroglycerin patch prior to defibrillation and, if present, should be
removed
b. Successive shocks are more important than adjunctive drug therapy
and delays between shocks to deliver medications may be detrimental
c. When delivering the initial “stacked” shock sequence, CPR should be
performed while the defibrillator is being recharged between shocks
d. When using conventional defibrillator paddles, the paddles should be
left pressed to the chest during the delivery of the initial “stacked”
shock sequence
e. Biphasic D.C. shock using less joules have better result than
monophasic D.C. Shock.
45. Which of the following statements regarding central venous access is
INCORRECT:
a. If a femoral pulse is absent, the vein may be difficult to locate
b. Central venous lines may be successfully placed, even when peripheral
infusion is poor
c. Central venous access technique requires more training than does
peripheral venipuncture
d. Current ACLS guidelines recommend accessing the central circulation
through an internal jugular site or infraclavicular subclavain site.
46. A transient ischemic attack usually LASTS:
a. Few minutes, disappear quickly and sometime may persist for several
hours
b. 30 minutes to 1 hour
c. No more than four hours
d. Several minutes or up to 24 hours
e. It only occurs for few seconds.
47. Rescue breathing can sustain life in a non-breathing victim because:
a. The pressure resulting from each breath forces carbon dioxide out of
the victims nose or mouth
b. Each breath of air given contains approximately 16% oxygen
c. It cause the victim to exhale more oxygen
d. The high carbon dioxide content in the rescuers breath stimulates the
victims respiratory center.
48. A person using medicine prescribed to control high blood pressure:
a. Can stop using it once the blood pressure has been brought to the
normal range
b. Must continue to take medications to control the problem
c. Should have the pressure checked at least once every three years
d. No longer has to be concerned about high salt intake and high
cholesterol levels.
49. As plaque or fatty material are deposited and built on the inner surface of a blood
vessel wall:
a. The walls become stronger and better able to resist the high pressures
resulting from hypertension
b. Blood pressure decreases because the wall of the vessel becomes more
flexible
c. A persons chances of experiencing a heart attack are decreased
d. Blood pressure increases because the blood must be forced through a
smaller opening in the vessel.
50. Select the INCORRECT statement:
a. Electric shocks produce parasympathetic discharge
b. Routine shocking of asystole cannot make the rhythm any worse
c. In asystole, transcutaneous pacing should be considered early in the
arrest situation
d. Epinephrine and atropine are administered in the management of the
patient in asystole.
51. Select the INCORRECT statement regarding the use of bag-valve-mask device:
a. Ideal features include a self-expanding bag, pop-off valve and
transparent mask
b. This device may be used with mask, endotracheal tube or other
invasive airway device
c. In adults, valve-bag units usually provide less ventilatory volume than
mouth-to-mouth or mouth-to-mouth mask ventilation
d. Effective ventilation is more likely when two rescuers use the bagvalve device, one to hold the mask and one to squeeze the bag
e. It may lead to partial obstruction and stomach distension in unexpert
hands.