American Heart Association

ACLS Pre-Course Self Assessment

Dec., 2006

This pre-test is exactly the same as the pretest on the

ACLS Provider manual CD. This paper version can
be completed in place of the CD version if you wish.

ECG Analysis
Name the following rhythms from the list below:
Normal Sinus Rhythm NSR
Sinus Tachycardia
Supraventricular Tachycardia SVT
Fine Ventricular Fibrillation
Monomorphic VTach
2nd degree I Block
3rd degree block
1.

2.

3.

4.

Sinus Bradycardia
Atrial Flutter
Atrial Fibrillation
Coarse Ventricular Fibrillation
Polymorphic VTach (Torsades)
2nd degree II Block
Asystole

Name the following rhythms from the list below:

Normal Sinus Rhythm NSR
Sinus Tachycardia
Supraventricular Tachycardia SVT
Fine Ventricular Fibrillation
Monomorphic VTach
2nd degree I Block
3rd degree block
5.

6.

7.

8.

9.

Sinus Bradycardia
Atrial Flutter
Atrial Fibrillation
Coarse Ventricular Fibrillation
Polymorphic VTach (Tordsades)
2nd degree II Block
Asystole

Name the following rhythms from the list below:

Normal Sinus Rhythm NSR
Sinus Tachycardia
Supraventricular Tachycardia SVT
Fine Ventricular Fibrillation
Monomorphic VTach
2nd degree I Block
3rd degree block
10.

11.

12.

13.

14.

Sinus Bradycardia
Atrial Flutter
Atrial Fibrillation
Coarse Ventricular Fibrillation
Polymorphic VTach (Torsades)
2nd degree II Block
Asystole

Name the following rhythms from the list below:

Normal Sinus Rhythm NSR
Sinus Tachycardia
Supraventricular Tachycardia SVT
Fine Ventricular Fibrillation
Monomorphic VTach
2nd degree I Block
3rd degree block
15.

16.

17.

18.

19.

20.

Sinus Bradycardia
Atrial Flutter
Atrial Fibrillation
Coarse Ventricular Fibrillation
Polymorphic VTach (Torsades)
2nd degree II Block
Asystole

Pharmacology
21.

Which of the following is most accurate regarding the administration of vasopressin during cardiac arrest?
a.
b.
c.
d.

22.

Your patient has been intubated. IV/IO access is not available. Which combination of drugs can be
administered by the endotracheal route of administration?
a.
b.
c.
d.

23.

Give an additional 2 mg of morphine sulfate

Start dopamine at 2 g/kg per minute and titrate to BP 100 systolic.
Give nitroglycerin 0.4 mg sublingually
Give normal saline 250 mL to 500 mL fluid bolus

A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138. He is asymptomatic
with a BP of 110/7-. He has a history of angina. Which of the following actions is recommended?
a.
b.
c.
d.

26.

Magnesium is indicated for VF/pulseless VT associated with torsades de pointes

Magnesium is indicated for shock-refractory monomorphic VT
Magnesium is contraindicated in VT associated with a normal QT interval
Magnesium is indicated for VF refractory to shock and amiodarone or lidocaine.

A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3
sublingual nitroglycerine tablets. There are no contraindications and 4 mg of morphine sulfate was
administered. Shortly, BP falls to 88/60 and the patient complains of increased chest discomfort. You
would:
a.
b.
c.
d.

25.

Amiodarone, lidocaine, epinephrine

Epinephrine, vasopressin, amiodarone
Lidocaine, epinephrine, vasopressin
Vasopressin, amiodarone, lidocaine

Which of the following statements about the use of magnesium in cardiac arrest is most accurate?
a.
b.
c.
d.

24.

Vasopressin is indicated for VF and pulseless VT prior to the delivery of the first shock
The correct dose of Vasopressin is 40 U administered IV or IO
Vasopressin is recommended instead of epinephrine for the treatment of asystole
Vasopressin can be administered twice during cardiac arrest

Give lidocaine 1-1.5 mg IV bolus

Immediate synchronized cardioversion
Seek expert consultation
Give adenosine 6 mg IV bolus

A 62 year-old man suddenly began to experience difficulty speaking and left-sided weakness. He is
brought to the ER. He meets initial criteria for fibrinolytic therapy and a CT scan of the brain is ordered.
Guidelines for antiplatelet and antothrombotic therapy are:
a.
b.
c.
d.

Administer heparin if CT scan is negative for hemorrhage

Give aspirin 160 mg and clopidogrel 75 mg orally
Administer aspirin 160-325 mg orally chewed, immediately
Do not give aspirin for at least 24 hours if tPA is administered

27.

A patient is in cardiac arrest. VFib has been refractory to an initial shock. Two attempts at peripheral IV
have been unsuccessful. The next recommended access route of administration for the delivery of drugs
during CPR is:
a.
b.
c.
d.

28.

A patient with an ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been
ordered. Heparin 4000 U IV bolus was administered and a heparin infusion 100 U per hour is being
administered, and Aspirin was not taken by the patient because he had a history of gastritis treated 5 years
ago. Your next action is to:
a.
b.
c.
d.

29.

Atropine 1 mg
Epinephrine 1 mg
Vasopressin 20 U
Sodium bicarbonate 50 mEq

A 35-year old woman has palpitations, lightheadedness, and a stable tachycardia. The monitor shows a
regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating
the rhythm. An IV has been established. What drug should be administered IV?
a.
b.
c.
d.

32.

Atropine 0.5 mg
Atropine 1.0 mg
Atropine 0.1 mg
Atropine 3 mg

A patient is in cardiac arrest. VFib has been refractory to an initial shock. Of the following, which drug
and dose should be administered first by IV/IO route?
a.
b.
c.
d.

31.

Substitute clopidogrel 300 mg loading dose

Give aspirin 160 325 mg chewed, immediately
Give 75 mg enteric-coated aspirin only
Give 325 mg enteric-coated aspiring rectally

A patient with possible ACS and a bradycardia of 42/min has ongoing chest discomfort. What is the initial
dose of atropine?
a.
b.
c.
d.

30.

External jugular vein

Femoral vein
Intraosseous
Endotracheal

Epinephrine 2-10 g/kg per minute

Atropine 0.5 mg
Lidocaine 1 mg/kg
Adenosine 6 mg

A patient with a possible ST-segment elevation MI has ongoing chest discomfort. Which of the following
would be a contraindication for administration of nitrates?
a.
b.
c.
d.

HR of 90/min
BP > 180 systolic
Use of phosphodiesterase inhibitor within 12 hours
Left ventricular infarct with bilateral rales

33.

A patient has sinus bradycardia with a rate of 36/min. Atropine has been administered to a total dose of 3
mg. TCP has failed to capture. The patient is confused and BP is 100/60. Which of the following is now
indicated?
a.
b.
c.
d.

34.

A patient is in pulseless VTach. Two shocks and one dose of epinephrine have been given. The next
drug/dose to anticipate to administer is:
a.
b.
c.
d.
e.

35.

place a Combitube or Laryngeal Mask Airway (LMA)

Attempt intubation with minimal CPR interruption
Call for a pulse check
Place IV or IO access

Which of the following is most accurate regarding the administration of vasopressin during cardiac arrest?
a.
b.
c.
d.

38.

0.5-0.75 mg/kg IV push

2-3 mg/kg IV push
Give endotracheal dose 2-4 mg/kg
Start infusion 1-2 mg/min
1 mg/kg IV push

You arrive on-scene with the Code Team. High-quality CPR is in progress. An AED has previously
advised no shock indicated. A rhythm now finds asystole. The next action you would take is to:
a.
b.
c.
d.

37.

Vasopressin 40U
Amiodarone 150 mg
Lidocaine 0.5 mg/kg
Epinephrine 3 mg
Amiodarone 300 mg

A patient is in refractory VFib and has received multiple appropriate defibrillations, epinephrine 1 mg IV
twice, and an initial dose of lidocaine IV. The patient is intubated. A second dose of lidocaine is now
called for. The recommended second dose of lidocaine is:
a.
b.
c.
d.
e.

36.

give additional 1mg Atropine

Give NS bolus 250 mL-500mL
Start dopamine 10-20 g/kg per minute
Start epinephrine 2-10 g/min

Vasopressin is indicated for VF and pulseless VT prior to the delivery of the first shock
Vasopressin can be administered twice during cardiac arrest
Vasopressin is recommended instead of epinephrine for the treatment of asystole
The correct dose of Vasopressin is 40 U administered IV or IO

A patient is in cardiac arrest. High-quality chest compression are being given. The patient is intubated and
an IV has been established. The rhythm is asystole. The first drug/dose to administer is:
a.
b.
c.
d.
e.

Atropine 0.5 mg IV or IO
Epinephrine 3 mg via ETT
Dopamine 2 to 20 g/kg per minute IV or IO
Atropine 1 mg IV or IO
Epinephrine 1 mg or Vasopressin 40 U IV or IO

39.

A 57 year-old woman has palpitations, chest discomfort and tachycardia. The monitor shows a regular
wide-complex QRS at a rate of 180.min. She becomes diaphoretic and BP is 80/60. The next action is to:
a.
b.
c.
d.

40.

A patient is in refractory VFib. High quality CPR is in progress and shocks have been given. One dose of
epinephrine was given after the second shock. An antiarrhythmia drug was given immediately after the
third shock. What drug should the team leader request to be prepared for administration?
a.
b.
c.
d.

41.

Obtain 12 lead ECG

Perform immediate synchronized cardioversion
Establish IV and give sedation for electrical cardioversion
Give amiodarone 300 mg IV push

Repeat the antiarrhythmic

Escalating dose epinephrine 3 mg
Second dose of epinephrine 1 mg
Sodium bicarbonate 50 mEq

A bradycardia rhythm IS treated when:

a.
b.
c.
d.

HR is < 60 with or without symptoms

BP < 100 systolic with out without symptoms
The patient has an MI on the 12-lead ECG
CP or shortness of breath is present

Practical Application
42.

You arrive on the scene to find CPR in progress. Nursing staff report that the patient was recovering from a
pulmonary embolism and suddenly collapsed. There is no pulse or spontaneous respirations. High-quality CPR
is in progress and effective ventilation is being provided with bag-mask. An IV has been initiated. You would
now:
a.
b.
c.
d.
e.

order immediate endotracheal intubation

give epinephrine 1.0 mg IV
give atropine 1 mg IV
give atropine 0.5 mg IV
initiate transcutaneous pacing

43

You are monitoring this patient after successful resuscitation. You note the above rhythm on the cardiac
monitor and document a rhythm strip for the patients chart. She has no complaints and blood pressure is
110/70 mm Hg. Now you would:
a.
b.
c.
d.
e.

prepare for transcutaneous pacing (place pacing pads, do not pace yet)
give atropine 0.5 mg IV
start dopamine 2 to 10 g/kg per minute and titrate heart rate
give atropine 1 mg IV
administer sedation and begin immediate transcutaneous pacing at 80 beats/min

44.

Following initiation of CPR and one shock for VF, this rhythm is present on the next rhythm check. A second
shock is given and chest compressions are immediately resumed. An IV is in place and no drugs have been
given. Bag-mask ventilations are producing visible chest rise. What is your next order?
a.
b.
c.
d.
e.

administer 3 sequential (stacked) shocks at 200J (biphasic defibrillator)

administer 3 sequential (stacked) shocks at 360J (monophasic defibrillator)
prepare to give amiodarone 300 mg IV
prepare to give epinephrine 1 mg IV
perform endotracheal intubation; administer 100 % oxygen

45.

You are evaluating a patient with a 15-minute duration of chest pain during transportation to the emergency
department. He is receiving oxygen, and 2 sublingual nitroglycerin tablets have relieved his chest discomfort.
He has no complaints but appears anxious. BP is 130/70 mm Hg. You observe the above rhythm on the
monitor and your next action is:
a.
b.
c.
d.
e.

start epinephrine 2 to 10 g/kg per minute and titrate

administer nitroglycerine 0.4 mg SL
continue monitoring patient, prepare for TCP
initiate transcutaneous pacing (TCP)
give atropine 0.5 mg IV

46

You arrive on-scene and find a 56 year-old diabetic woman complaining of chest discomfort. She is pale and
diaphoretic, complaining of lightheadedness. Her BP is 80/60 mm Hg. The cardiac monitor documents the
rhythm above. She is receiving oxygen at 4 L/min by Nasal Cannula, and an IV has been established.
Transcutaneous Pacing has been requested but is not yet available. Your next order is:
a.
b.
c.
d.
e.

start dopamine 2 to 10 g/kg per minute

give morphine sulfate 4 mg IV
give atropine 1 mg IV
give nitroglycerine 0.4 mg SL
give atropine 0.5 mg IV

47.

The patient was admitted to the general medical unit with a history of alcoholism. A is in progress and he has
recurrent episodes of this rhythm. You review his chart. Notes about the 12-lead ECG say that his baseline
QT-interval is top normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg and 1 dose of
amiodarone 300 mg IV so far. For his next medication you would now order:
a.
b.
c.
d.
e.

give sodium bicarb 50 mEq IV

give magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 10 -20 mins.
repeat amiodarone 300 mg IV
repeat amiodarone 150 mg IV
lidocaine 1 to 1.5 mg IV and start infusion 2 mg/minute

48

A patient becomes unresponsive and you are uncertain if a faint pulse is present with the above rhythm. Your
next action is:
a.
b.
c.
d.
e.

consider causes for pulseless electrical activity.

Start an IV and give atropine 1 mg
Start an IV and give epinephrine 1 mg IV
Order transcutaneous pacing
Begin CPR with high-quality chest compressions

49.

You are monitoring a patient. Chest discomfort has been relieved with sublingual nitro and morphine sulfate 4
mg IV. He suddenly has the above persistent rhythm. You ask about symptoms and he reports mild
palpitations, but otherwise he is clinically stable with unchanged vital signs. Your next action is:
a.
b.
c.
d.
e.

give immediate synchronized cardioversion

administer amiodarone 150 mg over 10 minutes; seek expert consultation
give sedation and perform synchronized cardioversion
give immediate unsynchronized defibrillation shock
administer magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W over 5-20 minutes

50.

A patient with an acute MI on a 12-lead ECG transmitted by the paramedics has the above findings on a rhythm
strip when a monitor is placed in the ED. The patient had resolution of moderate (5/10) chest pain with three
doses of sublingual nitroglycerine. BP is 104/70 mm Hg. Which intervention below is most important,
reducing in-hospital and 30-day mortality?
a.
b.
c.
d.
e.

atropine 0.5 mg IV, total dose 2 mg as needed

atropine 1 mg IV, total dose 3 mg as needed
reperfusion therapy
intravenous nitroglycerin for 24 hours
Temporary pacing

51.

You are the code team leader and arrive finding the above rhythm with CPR in progress. Team members report
that the patient was well but complained of chest pain and collapsed. She has no pulse or respirations. Bagmask ventilations are producing visible chest rise, high-quality CPR is in progress, and an IV has been
established. Your next order would be:
a.
b.
c.
d.
e.

administer epinephrine 1 mg
perform endotracheal intubation
administer amiodarone 300 mg
administer atropine 1 mg
start dopamine at 2 to 10 g/kg per minute

52..

A 45 year-old woman with a history of palpitations develops lightheadedness and palpitations. She has
received adenosine 6 mg IV for the rhythm shown above without conversion of the rhythm. She is now
extremely apprehensive. BP is 108/70 mm Hg. The next appropriate intervention is:
a.
b.
c.
d.
e.

repeat adenosine 3 mg IV
sedate and synchronized cardiovert
repeat adenosine 12 mg IV
perform vagal maneuvers and repeat adenosine 6 mg IV.
Perform immediate unsynchronized defibrillation

53.

A patient was in refractory VFib. A third shock has just been administered. Your immediate next order is:
a.
b.
c.
d.
e.

give atropine 1 mg IV
give amiodarone 300 mg IV
give epinephrine 1 mg IV
resume high-quality chest compressions
perform endotracheal intubation

54.

A 35 year-old woman presents the ED with a chief complaint of palpitations. She has no chest discomfort,
shortness of breath, or lightheadedness. Which of the following is indicated first?
a.
b.
c.
d.

give adenosine 3 mg IV fast

give adenosine 12 mg IV slow push (over 1-2 mins)
perform vagal maneuvers
give metoprolol 5 mg IV and repeat if necessary

55.

Following resuscitation with CPR and a single shock, you observe this rhythm while preparing the patient for
transport. Your patient is stable and BP is 120/80 mm Hg. She is apprehensive but has no complaints other
than palpitations. At this time you would:
a.
b.
c.
d.

give amiodarone 300 mg IV, start infusion

give magnesium sulfate 1-2 g over 20 minutes
give lidocaine 1-1.5 mg IV, start lidocaine infusion
seek expert consultation

56.

You are monitoring a patient with chest discomfort who becomes suddenly unresponsive. You observe the
above rhythm on the cardiac monitor. A monophasic defibrillator is present. What is your first action:
a.
b.
c.
d.
e.

give a single shock with 200 J

give a single shock with 360 J
intubate the patient and give epinephrine 2-4 mg via ET tube.
Begin CPR with chest compressions for 2 mins or about 5 cycles.
Establish an IV and give epinephrine 1 mg IV

57.

This patient suddenly collapsed and is poorly responsive. The patient has a weak carotid pulse. A cardiac
monitor, oxygen, and an IV line have been initiated. The code cart with all drugs and TCP is immediately
available. Next you would:
a.
b.
c.
d.
e.

begin TCP
initiate dopamine 2 to 10 g/kg per minute and titrate heart rate
initiate dopamine 10 to 20 g/kg per minute and titrate heart rate
initiate epinephrine 2 to 10 g per minute and titrate heart rate
give atropine 1 mg IV up to a total dose of 3 mg.

58.

This patient has been resuscitated from cardiac arrest. During the resuscitation amiodarone 300 mg was
administered. Now the patient develops severe chest discomfort, is diaphoretic, and has the above rhythm. BP
is 80/60 mm Hg. What is the next indicated action:
a.
b.
c.
d.
e.

repeat amiodarone 300 mg IV.

Perform synchronized cardioversion
Give immediate unsynchronized defibrillation
Give lidocaine 1-1.5 mg/kg IV
Repeat amiodarone 150 mg IV

59.

A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is intubated and is
receiving 100% oxygen. During the resuscitation she received 2 doses of epinephrine 1 mg, atropine 1 mg, and
lidocaine 100 mg IV. You now observe the above rhythm on the cardiac monitor. The rhythm abnormally is
becoming more frequent and increasing in number. You should order:
a.
b.
c.
d.
e.

give amiodarone 150 mg IV, start infusion

give amiodarone 300 mg IV, start infusion
give lidocaine 1- 1.5 mg IV
repeat epinephrine 1 mg IV
give lidocaine 0.5-0.75 mg/kg IV, start lidocaine infusion

60.

A patient in the ED develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitored rhythm
becomes irregular as seen above. Oxygen is being administered by NC at 4 L/min and an IV line is patent. Bp
is 160/96. There are no allergies or contraindications to any meds. You would first order:
a.
b.
c.
d.
e.

lidocaine 1 mg/kg and infusion 2 mg/min

IV nitroglycerine initiated at 10 g/min and titrated
Morphine sulfate 2-4 mg IV
Amiodarone 150 mg IV
Nitroglycerin 0.4 mg SL

61.

A patient presents with the above rhythm complaining of an irregular heart beat. She has no other complaints.
Past medical history is significant for an MI 7 years ago. BP is 110/70. At this time you would:
a.
b.
c.
d.
e.

perform elective synchronized cardioversion with presedation

administer lidocaine 1 mg/kg IV
administer nitroglycerine 0.4 mg sublinqual or spray
continue monitoring and seek expert consultation
perform emergency synchronized cardioversion

American Heart Association

ACLS Pre-Course Self Assessment

Answer Sheet

Dec., 2006

ECG Analysis
1_______________________________

11. ________________________________________

2_______________________________

12. ________________________________________

3_______________________________

13. ________________________________________

4_______________________________

14. ________________________________________

5_______________________________

15. ________________________________________

6_______________________________

16. ________________________________________

7_______________________________

17. ________________________________________

8_______________________________

18. ________________________________________

9_______________________________

19. ________________________________________

10._______________________________

20. ________________________________________
Practical Application

Pharmacology
21.

a.

b.

c.

d.

42.

a.

b.

c.

d.

e.

22.

a.

b.

c.

d.

43.

a.

b.

c.

d.

e.

23.

a.

b.

c.

d.

44.

a.

b.

c.

d.

e.

24.

a.

b.

c.

d.

45.

a.

b.

c.

d.

e.

25.

a.

b.

c.

d.

46.

a.

b.

c.

d.

e.

26.

a.

b.

c.

d.

47.

a.

b.

c.

d.

e.

27.

a.

b.

c.

d.

48.

a.

b.

c.

d.

e.

28.

a.

b.

c.

d.

49.

a.

b.

c.

d.

e.

29.

a.

b.

c.

d.

50.

a.

b.

c.

d.

e.

30.

a.

b.

c.

d.

51.

a.

b.

c.

d.

e.

31.

a.

b.

c.

d.

52.

a.

b.

c.

d.

e.

32.

a.

b.

c.

d.

53.

a.

b.

c.

d.

e.

33.

a.

b.

c.

d.

54.

a.

b.

c.

d.

34.

a.

b.

c.

d.

e.

55.

a.

b.

c.

d.

35.

a.

b.

c.

d.

e.

56.

a.

b.

c.

d.

e.

36.

a.

b.

c.

d.

57.

a.

b.

c.

d.

e.

37.

a.

b.

c.

d.

58.

a.

b.

c.

d.

e.

38.

a.

b.

c.

d.

59.

a.

b.

c.

d.

e.

39.

a.

b.

c.

d.

60.

a.

b.

c.

d.

e.

40.

a.

b.

c.

d.

61.

a.

b.

c.

d.

e.

41.

a.

b.

c.

d.

e.

American Heart Association

ACLS Pre-Course Self Assessment Answer Key

Dec., 2006

ECG Analysis
1

Supraventricular Tachycardia SVT

11. Sinus Tachycardia

Fine Ventricular Fibrillation

12.

3rd degree Block

2nd degree Type II Block

13.

2nd degree Type I Block

4 NSR

14.

Sinus Brady

5 SVT

15. Atrial Flutter

Asystole

16. Coarse VFib

Polymorphic VTach

17.

Monomorphic VTach

8 SVT

18.

3rd degree Block

19 Atrial Fibrillation

Sinus Brady
nd

10. 2 degree Type II Block

20.

Pharmacology

Fine VFib

Practical Application

21.

a.

b.

c.

d.

42.

a.

b.

c.

d.

e.

22.

a.

b.

c.

d.

43.

a.

b.

c.

d.

e.

23.

a.

b.

c.

d.

44.

a.

b.

c.

d.

e.

24.

a.

b.

c.

d.

45.

a.

b.

c.

d.

e.

25.

a.

b.

c.

d.

46.

a.

b.

c.

d.

e.

26.

a.

b.

c.

d.

47.

a.

b.

c.

d.

e.

27.

a.

b.

c.

d.

48.

a.

b.

c.

d.

e.

28.

a.

b.

c.

d.

49.

a.

b.

c.

d.

e.

29.

a.

b.

c.

d.

50.

a.

b.

c.

d.

e.

30.

a.

b.

c.

d.

51.

a.

b.

c.

d.

e.

31.

a.

b.

c.

d.

52.

a.

b.

c.

d.

e.

32.

a.

b.

c.

d.

53.

a.

b.

c.

d.

e.

33.

a.

b.

c.

d.

54.

a.

b.

c.

d.

34.

a.

b.

c.

d.

e.

55.

a.

b.

c.

d.

35.

a.

b.

c.

d.

e.

56.

a.

b.

c.

d.

e.

36.

a.

b.

c.

d.

57.

a.

b.

c.

d.

e.

37.

a.

b.

c.

d.

58.

a.

b.

c.

d.

e.

38.

a.

b.

c.

d.

59.

a.

b.

c.

d.

e.

39.

a.

b.

c.

d.

60.

a.

b.

c.

d.

e.

40.

a.

b.

c.

d.

61.

a.

b.

c.

d.

e.

41.

a.

b.

c.

d.

e.