ACLS practice questions, sorted by topic

1. Card 01 / 48CPR & airway

   What immediate action should be taken if a patient shows no response after initial BLS assessment prompts?

   1. AAsk multiple bystanders to recheck for responsiveness.
   2. BActivate EMS and commence chest compressions immediately.
   3. CPerform an extended pulse check before initiating CPR.
   4. DWait several moments to ensure the patient is unresponsive.

   Explanation

   Keyed answerB. Activate EMS and commence chest compressions immediately.

   Your pickD. Wait several moments to ensure the patient is unresponsive. ww

   A lack of response confirms the need to begin critical life-saving measures without delay.

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2. Card 02 / 48Cardiac arrest

   In ACLS, what is the appropriate method for distinguishing fine ventricular fibrillation from asystole?

   1. AAdminister a shock and observe the response
   2. BRely solely on automated rhythm interpretation
   3. CAdminister epinephrine 1 mg and reassess the rhythm after 2 minutes of CPR without changing leads
   4. DCheck multiple leads, ensure proper connections, increase the gain/amplitude on the monitor

   Explanation

   Keyed answerD. Check multiple leads, ensure proper connections, increase the gain/amplitude on the monitor

   Your pickC. Administer epinephrine 1 mg and reassess the rhythm after 2 minutes of CPR without changing leads ww

   The appropriate method for distinguishing fine VF from asystole is to check multiple leads/views, ensure proper lead placement and connections, increase the gain/amplitude on the monitor, and look for any organized electrical activity. This methodical approach helps prevent misidentification of potentially shockable rhythms.

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3. Card 03 / 48Brady & tachy

   Which of the following is a key characteristic that distinguishes ventricular tachycardia from supraventricular tachycardia with aberrancy on a 12-lead ECG?

   1. AAV dissociation
   2. BHeart rate above 150 bpm
   3. CPresence of P waves before each QRS complex
   4. DRegular rhythm

   Explanation

   Keyed answerA. AV dissociation

   Your pickC. Presence of P waves before each QRS complex ww

   AV dissociation is a key ECG feature that strongly suggests ventricular tachycardia rather than SVT with aberrancy. Other VT indicators include fusion beats, capture beats, and extreme axis deviation.

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4. Card 04 / 48ACS & stroke

   A 70-year-old patient presents with chest pain, diaphoresis, and ST-segment elevation on ECG. What is the recommended time window for percutaneous coronary intervention (PCI) from first medical contact?

   1. A≤3 hours
   2. B≤24 hours
   3. C≤12 hours
   4. D≤90 minutes

   Explanation

   Keyed answerD. ≤90 minutes

   Your pickB. ≤24 hours ww

   For patients with STEMI, the goal is to achieve a first medical contact-to-device (PCI) time of ≤90 minutes to minimize myocardial damage and improve outcomes.

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5. Card 05 / 48Rhythms & drugs

   How does amiodarone modify the cardiac action potential to help manage refractory ventricular arrhythmias?

   1. AIt acts only as a beta-agonist to increase contractility.
   2. BIt prolongs the action potential and refractory period.
   3. CIt shortens the refractory period to allow rapid pacing.
   4. DIt selectively enhances calcium influx into myocardial cells.

   Explanation

   Keyed answerB. It prolongs the action potential and refractory period.

   Your pickD. It selectively enhances calcium influx into myocardial cells. ww

   Amiodarone prolongs the action potential and refractory period by affecting multiple ion channels, thereby stabilizing arrhythmogenic tissue.

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6. Card 06 / 48Post-arrest care

   What is the recommended target blood pressure for a typical adult patient after return of spontaneous circulation (ROSC)?

   1. AMean arterial pressure (MAP) greater than 65 mmHg
   2. BDiastolic blood pressure less than 40 mmHg
   3. CSystolic blood pressure greater than 180 mmHg
   4. DMean arterial pressure (MAP) less than 50 mmHg

   Explanation

   Keyed answerA. Mean arterial pressure (MAP) greater than 65 mmHg

   Your pickD. Mean arterial pressure (MAP) less than 50 mmHg ww

   After return of spontaneous circulation (ROSC), the recommended target mean arterial pressure (MAP) is greater than 65 mmHg to ensure adequate organ perfusion. This typically corresponds to a systolic blood pressure of at least 90 mmHg.

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7. Card 07 / 48Team & systems

   Which of the following best demonstrates effective communication during a cardiac arrest?

   1. A"I think the patient needs medication"
   2. B"Let's try some epi soon"
   3. C"Give 1 mg epinephrine IV push now"
   4. D"Someone should probably do something about the rhythm"

   Explanation

   Keyed answerC. "Give 1 mg epinephrine IV push now"

   Your pickD. "Someone should probably do something about the rhythm" ww

   Using clear, direct language with specific doses, routes, and timing demonstrates effective communication during a cardiac arrest, eliminating ambiguity and ensuring precise actions.

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8. Card 08 / 48CPR & airway

   Why is maintaining a continuous sequence of chest compressions crucial in the management of a cardiac arrest?

   1. AIt allows ample time for pulse checks.
   2. BIt improves the comfort of the rescuer.
   3. CIt minimizes the need for rescue breaths.
   4. DIt maintains blood flow to vital organs by reducing interruptions.

   Explanation

   Keyed answerD. It maintains blood flow to vital organs by reducing interruptions.

   Your pickC. It minimizes the need for rescue breaths. ww

   Uninterrupted compressions preserve coronary and cerebral perfusion, which is essential for patient survival.

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9. Card 09 / 48Cardiac arrest

   What is the role of sodium bicarbonate in standard ACLS protocols for cardiac arrest?

   1. AMust be given prior to defibrillation to improve shock success
   2. BIs the first-line buffer therapy in all cardiac arrests
   3. CShould be administered after the first dose of epinephrine in all cases
   4. DNot routinely recommended except in specific situations

   Explanation

   Keyed answerD. Not routinely recommended except in specific situations

   Your pickC. Should be administered after the first dose of epinephrine in all cases ww

   Sodium bicarbonate is not routinely recommended in cardiac arrest according to standard ACLS protocols. It may be considered only in specific situations, including known pre-existing hyperkalemia, tricyclic antidepressant overdose, or prolonged cardiac arrest with severe acidosis.

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10. Card 10 / 48Brady & tachy

    A patient with known Wolff-Parkinson-White syndrome presents with a wide-complex tachycardia at 200 bpm. Which medication is contraindicated?

    1. AProcainamide
    2. BIbutilide
    3. CFlecainide
    4. DDiltiazem

    Explanation

    Keyed answerD. Diltiazem

    Your pickA. Procainamide ww

    Calcium channel blockers like diltiazem are contraindicated in WPW syndrome with tachycardia as they can block the AV node but not affect the accessory pathway, potentially increasing conduction through the accessory pathway and precipitating ventricular fibrillation.

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11. Card 11 / 48ACS & stroke

    A patient with acute STEMI receives fibrinolytic therapy. What is the expected timeframe for reperfusion to be considered successful?

    1. A24 hours after administration
    2. B3-4 hours after administration
    3. C15-30 minutes after administration
    4. D60-90 minutes after administration

    Explanation

    Keyed answerD. 60-90 minutes after administration

    Your pickC. 15-30 minutes after administration ww

    After fibrinolytic therapy for STEMI, successful reperfusion is indicated by >50% resolution of ST-segment elevation within 60-90 minutes of administration, along with relief of chest pain and reperfusion arrhythmias.

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12. Card 12 / 48Rhythms & drugs

    Which pharmacological agent is used both in cardiac arrest algorithms and as a chronotropic agent for symptomatic bradycardia?

    1. AEpinephrine
    2. BVasopressin
    3. CAmiodarone
    4. DSodium bicarbonate

    Explanation

    Keyed answerA. Epinephrine

    Your pickD. Sodium bicarbonate ww

    Epinephrine is used both in cardiac arrest algorithms (as a vasopressor) and can be used as a chronotropic agent for symptomatic bradycardia when atropine is ineffective. In bradycardia, it can be administered as an infusion to increase heart rate and blood pressure.

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13. Card 13 / 48Post-arrest care

    What is the recommended approach to airway management immediately after return of spontaneous circulation (ROSC)?

    1. AImmediately extubate if an advanced airway is in place
    2. BPlace an advanced airway if the patient remains unresponsive
    3. CRemove any advanced airway to allow for spontaneous breathing
    4. DProvide bag-mask ventilation only regardless of mental status

    Explanation

    Keyed answerB. Place an advanced airway if the patient remains unresponsive

    Your pickC. Remove any advanced airway to allow for spontaneous breathing ww

    After return of spontaneous circulation (ROSC), if an advanced airway was not previously placed and the patient remains unresponsive, the recommended approach is to place an advanced airway (endotracheal tube or supraglottic airway). This ensures proper ventilation and oxygenation while protecting the airway.

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14. Card 14 / 48Team & systems

    Which statement by a team leader best promotes constructive input from team members?

    1. A"I'll let you know if I need suggestions"
    2. B"We'll proceed exactly according to protocol"
    3. C"Does anyone see something we're missing?"
    4. D"I need complete silence to think"

    Explanation

    Keyed answerC. "Does anyone see something we're missing?"

    Your pickB. "We'll proceed exactly according to protocol" ww

    Asking "Does anyone see something we're missing?" explicitly invites team input and demonstrates openness to alternative perspectives, fostering a collaborative approach to patient care.

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15. Card 15 / 48CPR & airway

    What should be done when a victim with no pulse develops rigor mortis or obvious signs of death?

    1. AStart CPR and continue for at least 30 minutes
    2. BStart CPR and immediately apply AED
    3. CDo not start CPR
    4. DStart CPR but focus only on compressions

    Explanation

    Keyed answerC. Do not start CPR

    Your pickA. Start CPR and continue for at least 30 minutes ww

    When a victim with no pulse shows obvious signs of death such as rigor mortis (stiffening of the body), dependent lividity (blood pooling), or decomposition, CPR should not be started. These are signs of irreversible death where resuscitation would not be beneficial.

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16. Card 16 / 48Cardiac arrest

    What is the mechanism of action of sodium bicarbonate in treating metabolic acidosis during cardiac arrest?

    1. AIt increases oxygen delivery to tissues
    2. BIt buffers excess hydrogen ions, forming water and carbon dioxide
    3. CIt enhances the effectiveness of epinephrine
    4. DIt directly stimulates cardiac contractility

    Explanation

    Keyed answerB. It buffers excess hydrogen ions, forming water and carbon dioxide

    Your pickC. It enhances the effectiveness of epinephrine ww

    Sodium bicarbonate works by buffering excess hydrogen ions in the blood, raising the blood pH. It combines with hydrogen ions to form water and carbon dioxide (HCO3⁻ + H⁺ → H2O + CO2), thereby reducing acidosis. However, it is not routinely recommended in cardiac arrest due to potential adverse effects.

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17. Card 17 / 48Brady & tachy

    What is the most appropriate management for a patient with symptomatic sick sinus syndrome who experiences alternating bradycardia and tachycardia?

    1. ACalcium channel blocker therapy alone
    2. BPermanent pacemaker implantation
    3. CBeta-blocker therapy alone
    4. DAtropine as needed for symptomatic episodes

    Explanation

    Keyed answerB. Permanent pacemaker implantation

    Your pickD. Atropine as needed for symptomatic episodes ww

    Permanent pacemaker implantation is the definitive treatment for symptomatic sick sinus syndrome, particularly when patients experience tachy-brady syndrome (alternating slow and fast rhythms), as medications alone rarely provide adequate management.

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18. Card 18 / 48ACS & stroke

    In a patient with coronary artery disease presenting with tachycardia and chest pain, how does a rapid ventricular rate exacerbate myocardial ischemia?

    1. AIt prolongs diastolic time, overloading the myocardium
    2. BIt improves coronary blood flow through increased demand
    3. CIt shortens diastole, reducing coronary perfusion and increasing oxygen demand
    4. DIt causes direct myocardial toxicity independent of oxygen demand

    Explanation

    Keyed answerC. It shortens diastole, reducing coronary perfusion and increasing oxygen demand

    Your pickD. It causes direct myocardial toxicity independent of oxygen demand ww

    A rapid ventricular rate shortens diastolic filling time, reducing coronary perfusion and increasing myocardial oxygen demand, which can worsen ischemia in patients with coronary artery disease.

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19. Card 19 / 48Rhythms & drugs

    What is the mechanism of action of ibutilide in treating atrial fibrillation?

    1. ACompetitive blockade of beta-adrenergic receptors that slows AV nodal conduction and reduces sinus node automaticity
    2. BBlocks calcium channels in the AV node
    3. CDirect stimulation of parasympathetic activity
    4. DProlongs action potential duration and effective refractory period by affecting potassium and sodium channels

    Explanation

    Keyed answerD. Prolongs action potential duration and effective refractory period by affecting potassium and sodium channels

    Your pickA. Competitive blockade of beta-adrenergic receptors that slows AV nodal conduction and reduces sinus node automaticity ww

    Ibutilide is a Class III antiarrhythmic that prolongs action potential duration and refractory period by activating a slow inward sodium current and blocking the rapid component of the delayed rectifier potassium current. This makes it effective for acute conversion of atrial fibrillation.

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20. Card 20 / 48Post-arrest care

    Which advanced monitoring modality can provide additional prognostic information on neurological function in a patient post-cardiac arrest?

    1. AContinuous electroencephalogram (EEG) monitoring
    2. BRoutine telemetry monitoring without neuro-assessment
    3. CIntermittent auscultation of breath sounds
    4. DSerial measurements of blood pressure alone

    Explanation

    Keyed answerA. Continuous electroencephalogram (EEG) monitoring

    Your pickB. Routine telemetry monitoring without neuro-assessment ww

    Continuous EEG monitoring can help detect seizure activity and assess the severity of post-anoxic brain injury, aiding in prognostication.

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21. Card 21 / 48Team & systems

    During a cardiac arrest resuscitation, who is responsible for ensuring high-quality CPR is being performed?

    1. AEvery team member
    2. BOnly the person performing compressions
    3. COnly the most senior medical professional present
    4. DOnly the team leader

    Explanation

    Keyed answerA. Every team member

    Your pickC. Only the most senior medical professional present ww

    While the team leader oversees the entire effort, every team member shares responsibility for ensuring high-quality CPR. Any member should speak up if they notice suboptimal compressions or other issues affecting CPR quality.

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22. Card 22 / 48CPR & airway

    Which of the following is most likely to cause tension pneumothorax during CPR?

    1. AExcessive ventilation volume and pressure
    2. BProper electrode placement for defibrillation
    3. CUse of the impedance threshold device
    4. DProper chest compression depth

    Explanation

    Keyed answerA. Excessive ventilation volume and pressure

    Your pickB. Proper electrode placement for defibrillation ww

    Excessive ventilation volume and pressure during CPR is most likely to cause tension pneumothorax. Over-aggressive bag-mask ventilation or mechanical ventilation can lead to alveolar rupture, especially when combined with chest compressions.

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23. Card 23 / 48Cardiac arrest

    According to the ACLS study guides, why are identical doses used for IV and IO medication routes during resuscitation?

    1. ABecause IO doses are intentionally higher to overcome bone barriers
    2. BBecause different routes require different concentration adjustments
    3. CTo ensure consistency in therapeutic outcomes during resuscitation
    4. DBecause IV doses are reduced when administered via IO

    Explanation

    Keyed answerC. To ensure consistency in therapeutic outcomes during resuscitation

    Your pickB. Because different routes require different concentration adjustments ww

    The guidelines emphasize that standardized dosing maintains consistency in therapeutic effect regardless of the route.

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24. Card 24 / 48Brady & tachy

    Which medication is contraindicated in the treatment of narrow-complex tachycardias in patients with Wolff-Parkinson-White syndrome?

    1. AAmiodarone
    2. BProcainamide
    3. CFlecainide
    4. DVerapamil

    Explanation

    Keyed answerD. Verapamil

    Your pickB. Procainamide ww

    Non-dihydropyridine calcium channel blockers like verapamil are contraindicated in WPW with tachycardia because they block conduction through the AV node without affecting the accessory pathway. This can result in accelerated conduction through the accessory pathway, potentially leading to ventricular fibrillation.

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25. Card 25 / 48ACS & stroke

    Which of the following is a key component of the BEFAST stroke assessment tool that extends beyond the FAST assessment?

    1. ABreathing
    2. BBladder function
    3. CBlood pressure
    4. DBalance

    Explanation

    Keyed answerD. Balance

    Your pickB. Bladder function ww

    The BEFAST assessment extends the FAST (Face, Arm, Speech, Time) tool by adding Balance and Eyes (vision) assessments. Balance disturbances, particularly sudden onset of unsteadiness or coordination problems, can indicate posterior circulation strokes that might be missed by FAST alone.

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26. Card 26 / 48Rhythms & drugs

    What is the primary mechanism by which atropine increases the heart rate in patients with vagally mediated bradycardia?

    1. AIt stimulates the beta-adrenergic receptors directly
    2. BIt enhances conduction through the AV node by sodium channel blockade
    3. CIt increases calcium influx in the myocardium
    4. DIt blocks muscarinic receptors, reducing vagal effects on the SA node

    Explanation

    Keyed answerD. It blocks muscarinic receptors, reducing vagal effects on the SA node

    Your pickB. It enhances conduction through the AV node by sodium channel blockade ww

    Atropine blocks muscarinic receptors in the sinoatrial node, reducing vagal stimulation and increasing heart rate.

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27. Card 27 / 48Post-arrest care

    In a post-ROSC patient with severe myocardial dysfunction, how does the presence of myocardial failure influence the choice of pharmacologic support?

    1. AInitiate combined therapy using vasopressors with added inotropic support to improve contractility
    2. BUse vasodilators to decrease afterload without inotropic agents
    3. CRely solely on vasopressors to raise blood pressure
    4. DAdminister high-dose beta blockers to reduce myocardial oxygen consumption

    Explanation

    Keyed answerA. Initiate combined therapy using vasopressors with added inotropic support to improve contractility

    Your pickD. Administer high-dose beta blockers to reduce myocardial oxygen consumption ww

    Myocardial dysfunction necessitates not only vasopressor support to maintain blood pressure but also inotropic agents to improve contractility and cardiac output.

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28. Card 28 / 48Team & systems

    In a scenario where team members become fatigued and roles need to be reassigned, what is the most effective method for the team leader to ensure clarity and continuity in patient care?

    1. ADelay role changes until the current cycle concludes
    2. BAllow team members to self-select new roles based on fatigue
    3. CConduct a quick, clear role reassignment with confirmations
    4. DKeep the same roles to avoid disrupting established routines

    Explanation

    Keyed answerC. Conduct a quick, clear role reassignment with confirmations

    Your pickB. Allow team members to self-select new roles based on fatigue ww

    Conducting a quick role reassignment with clear, concise announcements and obtaining confirmations helps maintain high-quality care and minimizes confusion.

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29. Card 29 / 48CPR & airway

    What is the primary indication for using end-tidal CO2 monitoring during CPR?

    1. ATo calculate appropriate medication dosages
    2. BTo assess CPR quality and detect ROSC
    3. CTo measure oxygen saturation in the blood
    4. DTo determine the patient's metabolic rate

    Explanation

    Keyed answerB. To assess CPR quality and detect ROSC

    Your pickA. To calculate appropriate medication dosages ww

    End-tidal CO2 monitoring during CPR primarily serves as an indicator of CPR quality and effectiveness. Persistently low ETCO2 values (< 10 mmHg) suggest poor cardiac output from inadequate CPR, while a sudden increase can be an early indicator of return of spontaneous circulation (ROSC).

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30. Card 30 / 48Cardiac arrest

    What is the rationale behind bolus versus infusion administration of vasopressors during active resuscitation in ACLS?

    1. AInfusions are preferred during compressions because they avoid pressure spikes, while boluses are reserved for after ROSC.
    2. BBolus dosing rapidly increases pressure during CPR, while infusions are for sustained support after ROSC.
    3. COnly continuous infusions are recommended during ACLS.
    4. DBolus dosing has no effect on coronary perfusion in cardiac arrest.

    Explanation

    Keyed answerB. Bolus dosing rapidly increases pressure during CPR, while infusions are for sustained support after ROSC.

    Your pickA. Infusions are preferred during compressions because they avoid pressure spikes, while boluses are reserved for after ROSC. ww

    Bolus doses provide immediate increases in arterial pressure during compressions, whereas infusions are more suited for post-resuscitation hemodynamic support.

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31. Card 31 / 48Brady & tachy

    What would be the appropriate next step in managing a patient with symptomatic bradycardia who has received the maximum dose of atropine without improvement?

    1. APerform immediate synchronized cardioversion
    2. BAdminister additional atropine beyond the maximum dose
    3. CInitiate transcutaneous pacing
    4. DAdminister calcium channel blockers

    Explanation

    Keyed answerC. Initiate transcutaneous pacing

    Your pickB. Administer additional atropine beyond the maximum dose ww

    If a patient with symptomatic bradycardia does not respond to the maximum dose of atropine (3 mg), the next step is to initiate transcutaneous pacing. This provides electrical stimulation to maintain an adequate heart rate until more definitive therapy can be initiated.

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32. Card 32 / 48ACS & stroke

    What is the recommended non-invasive blood pressure target for a patient in the first 24 hours after receiving IV thrombolytic therapy for ischemic stroke?

    1. A<160/100 mmHg
    2. B<220/120 mmHg
    3. C<180/105 mmHg
    4. D<140/90 mmHg

    Explanation

    Keyed answerC. <180/105 mmHg

    Your pickA. <160/100 mmHg ww

    After receiving IV thrombolytic therapy for ischemic stroke, patients should maintain a blood pressure <180/105 mmHg for the first 24 hours to minimize the risk of hemorrhagic transformation. This target is lower than the pre-treatment threshold of <185/110 mmHg.

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33. Card 33 / 48Rhythms & drugs

    While reviewing a patient's 12-lead EKG, you notice a spike before the P wave. What could be the cause of this observation?

    1. AAtrial fibrillation
    2. BAtrial pacing
    3. CPremature atrial contraction
    4. DAtrial tachycardia

    Explanation

    Keyed answerB. Atrial pacing

    Your pickC. Premature atrial contraction ww

    The spike before the P wave is due to an atrial pacemaker activation.

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34. Card 34 / 48Post-arrest care

    In a comatose post-cardiac arrest patient undergoing TTM, why is controlled normocapnia preferred over mild hypercapnia?

    1. ABecause normocapnia increases the cerebral metabolic rate
    2. BBecause normocapnia avoids cerebral vasodilation and prevents increased intracranial pressure
    3. CBecause hypercapnia reduces systemic vascular resistance beneficially
    4. DBecause mild hypercapnia improves oxygenation and cerebral blood flow without raising intracranial pressure

    Explanation

    Keyed answerB. Because normocapnia avoids cerebral vasodilation and prevents increased intracranial pressure

    Your pickD. Because mild hypercapnia improves oxygenation and cerebral blood flow without raising intracranial pressure ww

    Hypercapnia can lead to cerebral vasodilation and increased intracranial pressure, which may worsen neurological injury; thus, controlled normocapnia is preferred to maintain optimal cerebral perfusion.

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35. Card 35 / 48Team & systems

    When conflicting opinions arise from multiple ACLS-trained providers regarding the next step, what should the team leader do to manage the conflict effectively?

    1. ADismiss the conflict and continue with the original plan without discussion
    2. BAllow each provider to act on their individual judgment
    3. CFacilitate a brief, collaborative discussion grounded in current guidelines
    4. DImmediately accept the opinion of the most senior provider

    Explanation

    Keyed answerC. Facilitate a brief, collaborative discussion grounded in current guidelines

    Your pickA. Dismiss the conflict and continue with the original plan without discussion ww

    The leader should facilitate a brief, collaborative discussion grounded in current guidelines, confirming a unified approach to treatment.

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36. Card 36 / 48CPR & airway

    What is the first step in the adult BLS sequence for healthcare providers?

    1. ACheck for a pulse
    2. BEnsure scene safety
    3. CGive two rescue breaths
    4. DStart chest compressions immediately

    Explanation

    Keyed answerB. Ensure scene safety

    Your pickD. Start chest compressions immediately ww

    The first step in the adult BLS sequence for healthcare providers is to check if the scene is safe. This ensures the rescuer doesn't become a victim and can safely provide care.

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37. Card 37 / 48Cardiac arrest

    During advanced CPR, a sudden rise in end-tidal CO2 is observed. What does this most likely indicate?

    1. AIt signifies over-ventilation leading to CO2 retention
    2. BIt is an artifact from a malfunctioning capnograph
    3. CIt indicates a potential return of spontaneous circulation (ROSC)
    4. DIt reflects improved chest compression depth only

    Explanation

    Keyed answerC. It indicates a potential return of spontaneous circulation (ROSC)

    Your pickA. It signifies over-ventilation leading to CO2 retention ww

    A sudden increase in ETCO2 during CPR is an early sign of return of spontaneous circulation (ROSC) because improved cardiac output brings more CO2 to the lungs.

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38. Card 38 / 48Brady & tachy

    What is the most appropriate first-line medication for rate control in atrial fibrillation with rapid ventricular response in a patient with COPD?

    1. ADiltiazem
    2. BSotalol
    3. CMetoprolol
    4. DPropranolol

    Explanation

    Keyed answerA. Diltiazem

    Your pickD. Propranolol ww

    Non-dihydropyridine calcium channel blockers like diltiazem are preferred for rate control in atrial fibrillation in patients with COPD, as they effectively slow the ventricular rate without the bronchoconstrictive effects that beta-blockers can cause in COPD patients.

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39. Card 39 / 48ACS & stroke

    Which diagnostic test is fundamental in quickly differentiating hemorrhagic from ischemic stroke in the acute setting?

    1. ANon-contrast head CT scan
    2. BCT perfusion imaging
    3. CCarotid duplex ultrasonography
    4. DMRI with diffusion-weighted imaging

    Explanation

    Keyed answerA. Non-contrast head CT scan

    Your pickD. MRI with diffusion-weighted imaging ww

    A non-contrast head CT scan is the most rapid and widely available imaging modality to identify intracranial hemorrhage, which would contraindicate thrombolytic therapy.

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40. Card 40 / 48Rhythms & drugs

    A patient with tachycardia has a 12-lead ECG showing a wide QRS complex (160 ms) with a northwest (extreme) axis. What is the most likely diagnosis?

    1. AVentricular tachycardia
    2. BSupraventricular tachycardia with left bundle branch block
    3. CSinus tachycardia with hyperkalemia
    4. DAtrial flutter with aberrant conduction

    Explanation

    Keyed answerA. Ventricular tachycardia

    Your pickB. Supraventricular tachycardia with left bundle branch block ww

    A wide QRS complex with a northwest (extreme) axis is highly suggestive of ventricular tachycardia rather than SVT with aberrancy.

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41. Card 41 / 48Post-arrest care

    Why is the timing of interventions such as coronary angiography and TTM critical in post-cardiac arrest care?

    1. ADelayed intervention minimizes short-term complications
    2. BEarly intervention maximizes myocardial recovery and neurological preservation
    3. CTiming has minimal impact on long-term outcomes
    4. DInterventions are only beneficial if ST-segment elevation is present

    Explanation

    Keyed answerB. Early intervention maximizes myocardial recovery and neurological preservation

    Your pickD. Interventions are only beneficial if ST-segment elevation is present ww

    Early intervention maximizes the likelihood of reversing myocardial injury and reducing neurological damage, thereby improving overall outcomes.

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42. Card 42 / 48Team & systems

    Which of the following statements best promotes effective team dynamics during CPR?

    1. A"These compressions are tiring me out"
    2. B"I'll need a compressor switch in 1 minute"
    3. C"I'll continue compressions as long as I can"
    4. D"Someone should take over compressions soon"

    Explanation

    Keyed answerB. "I'll need a compressor switch in 1 minute"

    Your pickC. "I'll continue compressions as long as I can" ww

    Announcing "I'll need a compressor switch in 1 minute" proactively communicates needs before fatigue affects performance, ensuring continuous high-quality compressions through planned transitions.

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43. Card 43 / 48CPR & airway

    What is the correct sequence of the ACLS Primary Survey?

    1. ACirculation, Airway, Breathing, Disability, Exposure/Environmental control
    2. BBreathing, Circulation, Airway, Disability, Exposure/Environmental control
    3. CDisability, Airway, Breathing, Circulation, Exposure/Environmental control
    4. DAirway, Breathing, Circulation, Disability, Exposure/Environmental control

    Explanation

    Keyed answerD. Airway, Breathing, Circulation, Disability, Exposure/Environmental control

    Your pickA. Circulation, Airway, Breathing, Disability, Exposure/Environmental control ww

    The ACLS Primary Survey follows the ABCDE approach: Airway assessment and management, Breathing assessment and support, Circulation assessment and support (including CPR and defibrillation if needed), Disability assessment (neurological status), and Exposure/Environmental control. This systematic approach ensures that life-threatening conditions are addressed in order of priority.

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44. Card 44 / 48CPR & airway

    Which of the following is a proper technique for giving rescue breaths to a patient with a suspected neck injury?

    1. ASkip rescue breaths and perform compression-only CPR
    2. BUse head tilt-chin lift as with any other patient
    3. CUse jaw thrust without head tilt to open the airway
    4. DRoll the patient to their side before giving breaths

    Explanation

    Keyed answerC. Use jaw thrust without head tilt to open the airway

    Your pickA. Skip rescue breaths and perform compression-only CPR ww

    When giving rescue breaths to a patient with a suspected neck injury, the jaw thrust maneuver without head tilt should be used to open the airway. This minimizes cervical spine movement while still allowing for effective ventilation.

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45. Card 45 / 48CPR & airway

    What is the correct technique for pulse check during a cardiac arrest situation?

    1. AUse a pulse oximeter to determine presence of a pulse
    2. BPalpate the radial artery for 30 seconds
    3. CPalpate the carotid or femoral artery for no more than 10 seconds
    4. DPalpate any accessible pulse point for 5-30 seconds

    Explanation

    Keyed answerC. Palpate the carotid or femoral artery for no more than 10 seconds

    Your pickA. Use a pulse oximeter to determine presence of a pulse ww

    The correct technique for pulse check during cardiac arrest is to simultaneously assess for breathing and palpate the carotid or femoral artery for no more than 10 seconds. The carotid artery is preferred for adults due to its accessibility and reliability. Checking the radial pulse is not recommended due to its unreliability during low-flow states.

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46. Card 46 / 48CPR & airway

    What is the appropriate compression depth for an adult victim of cardiac arrest?

    1. AAt least 2 inches (5 cm) but not greater than 2.4 inches (6 cm)
    2. BAt least 1 inch (2.5 cm) but not greater than 1.5 inches (4 cm)
    3. CAt least 0.5 inches (1.3 cm) but not greater than 1 inch (2.5 cm)
    4. DAt least 3 inches (7.5 cm) but not greater than 4 inches (10 cm)

    Explanation

    Keyed answerA. At least 2 inches (5 cm) but not greater than 2.4 inches (6 cm)

    Your pickC. At least 0.5 inches (1.3 cm) but not greater than 1 inch (2.5 cm) ww

    Current guidelines recommend a compression depth of at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm) for adults. This depth ensures adequate blood circulation while minimizing risk of injury.

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47. Card 47 / 48CPR & airway

    What is the correct hand placement for adult CPR?

    1. ATwo hands on the lower half of the sternum
    2. BTwo hands directly over the heart
    3. CTwo hands on the upper half of the sternum
    4. DOne hand on the lower half of the sternum

    Explanation

    Keyed answerA. Two hands on the lower half of the sternum

    Your pickC. Two hands on the upper half of the sternum ww

    The correct hand placement for adult CPR is two hands on the lower half of the sternum (breastbone). More specifically, place the heel of one hand on the center of the chest, with the other hand on top, interlocking the fingers.

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48. Card 48 / 48CPR & airway

    What is the first step a healthcare provider should take when an AED arrives for a victim in cardiac arrest?

    1. AStop CPR for at least 2 minutes
    2. BDeliver a precautionary shock immediately
    3. CCheck for a pulse before using the AED
    4. DTurn on the AED and follow the prompts

    Explanation

    Keyed answerD. Turn on the AED and follow the prompts

    Your pickB. Deliver a precautionary shock immediately ww

    When an AED arrives for a victim in cardiac arrest, the first step is to turn on the AED and follow its prompts. Modern AEDs provide step-by-step voice and visual instructions for proper use.

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49. Score card

    0%

    Answer a few cards and come back to this one.

    • CPR & airwaynot yet
    • Cardiac arrestnot yet
    • Brady & tachynot yet
    • ACS & strokenot yet
    • Rhythms & drugsnot yet
    • Post-arrest carenot yet
    • Team & systemsnot yet

    Reread a low topic: Megacode · Algorithms · Pretest

    The thin line on each bar marks 84%, the written-exam pass mark AHA Training Centers usually quote; your instructor confirms the exact rule.

    Shuffle back to card 1

Pick an answer and the card turns over to the explanation. Keys: A to D or 1 to 4, arrows to move, F to turn the card. The clock is off until you press it.