Advanced Cardiovascular Life Support Provider Exam

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Welcome to the Advanced Cardiovascular Life Support written exam!

The AHA has authorized RCHS to store and administer this exam due to the COVID-19 pandemic. You must score an 84% or greater to pass. You may retake the exam if you do not pass. Per American Heart Association Guidelines, you may use your Provider Manual to assist you during this exam. Please do not close this window until exam is complete.

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The exam you are about to take is copyrighted content from the American Heart Association. RC Health Services has obtained special permission to administer the exam this way through the “Interim Guidance: Virtual Training Options during COVID-19 Outbreak” memo from the American Heart Association Training Network. This exam is to be kept confidential. You may not share the content, answers, questions, or any other material to anyone through any means.

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1. A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm?*

Sinus tachycardia

Perfusing ventricular tachycardia

Unstable supraventricular tachycardia

Stable supraventricular tachycardia

2. EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment?*

Provide prehospital notification

Review the patient’s history

Establish IV access

Treat hypertension

3. For STEMI patients, which best describes the recommended maximum goal time for first medical contact–to–balloon inflation time for percutaneous coronary intervention?*

150 minutes

120 minutes

180 minutes

90 minutes

4. Which best describes the length of time it should take to perform a pulse check during the BLS Assessment?*

5 to 10 seconds

11 to 15 seconds

16 to 20 seconds

1 to 4 seconds

5. You instruct a team member to give 1 mg atropine IV. Which response is an example of closed-loop communication?*

“Are you sure that is what you want given?”

“I’ll draw up 1 mg of atropine.”

“OK.”

“I’ll give it in a few minutes.”

6. What should be the primary focus of the CPR Coach on a resuscitation team?*

To convey positive feedback

To ensure high-quality CPR

To document CPR outcomes

To resolve team arguments

7. Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome?*

162 to 325 mg

81 mg

40 mg

350 to 650 mg

8. A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next?*

3 mg

40 mg

20 mg

12 mg

9. In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube?*

Continuous waveform capnography

Chest radiography

Hemoglobin levels

Arterial blood gases

10. How can you increase chest compression fraction during a code?*

Initiate intravenous or intraosseous access during the 2-minute cycle

Interchange the Ventilator and Compressor during a rhythm check

Administer epinephrine during the 2-minute cycle

Charge the defibrillator 15 seconds before conducting a rhythm check

11. Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient?*

Check the patient’s breathing and pulse

Check for a medical alert bracelet

Apply the AED

Open the patient’s airway

12. Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient?*

Cyanosis

Agonal gasps

Slow, weak pulse rate

Irregular, weak pulse rate

13. Which best describes this rhythm?*

Monomorphic ventricular tachycardia

Polymorphic ventricular tachycardia

Supraventricular tachycardia

Ventricular fibrillation

Use this scenario to answer the next 6 questions:

A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.

14. On the basis of this patient’s initial presentation, which condition do you suspect led to the cardiac arrest?*

Supraventricular tachycardia with ischemic chest pain

Acute heart failure

Acute ischemic stroke

Acute coronary syndrome

15. In addition to defibrillation, which intervention should be performed immediately?*

Vasoactive medication administration

Chest compressions

Vascular access

Advanced airway insertion

16. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient?*

Epinephrine 1 mg

Lidocaine 1 mg/kg

Atropine 1 mg

Amiodarone 300 mg

17. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next?*

Magnesium sulfate 1 g

Lidocaine 1 to 1.5 mg/kg

Epinephrine 1 mg

Atropine 1 mg

18. The patient has return of spontaneous circulation and is not able to follow commands. Which post–cardiac arrest care intervention do you choose for this patient?*

Check the glucose level

Extubate

Initiate targeted temperature management

Administer epinephrine

19. Which would you have done first if the patient had not gone into ventricular fibrillation?*

Performed synchronized cardioversion

Given atropine 1 mg

Established IV access

Obtained a 12-lead ECG

20. What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest?*

29°C to 31°C

32°C to 36°C

26°C to 28°C

35°C to 37°C

21. To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag?*

Once every 12 seconds

Once every 6 seconds

Once every 3 seconds

Once every 10 seconds

22. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment?*

Administration of adenosine 6 mg IV push

Administration of epinephrine 1 mg IV push

Defibrillation

Synchronized cardioversion

23. What is an effect of excessive ventilation?*

Increased perfusion pressures

Decreased cardiac output

Decreased intrathoracic pressure

Increased venous return

Use this scenario to answer the next 4 questions:

A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but appearing ill, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.

24. On the basis of this patient’s initial assessment, which ACLS algorithm should you follow?*

Acute Coronary Syndromes

Adult Tachycardia With a Pulse

Adult Suspected Stroke

Adult Cardiac Arrest

25. The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take?*

Give oxygen

Perform bag-mask ventilation

Intubate the patient

Check the pulse oximeter probe

26. After your initial assessment of this patient, which intervention should be performed next?*

Immediate defibrillation

Endotracheal intubation

Administration of amiodarone 150 mg IM

Synchronized cardioversion

27. If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority?*

Administer amiodarone 300 mg

Administer atropine 0.5 mg

Insert an advanced airway

Perform defibrillation

28. What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post–cardiac arrest patient who achieves return of spontaneous circulation?*

90 mm Hg

75 mm Hg

85 mm Hg

80 mm Hg

29. Which is the primary purpose of a medical emergency team or rapid response team?*

Improving care for patients admitted to critical care units

Improving patient outcomes by identifying and treating early clinical deterioration

Providing online consultation to EMS personnel in the field

Providing diagnostic consultation to emergency department patients

30. Which best describes this rhythm?*

First-degree atrioventricular block

Second-degree atrioventricular block type I

Second-degree atrioventricular block type II

Third-degree atrioventricular block

31. A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take?*

Seek expert advice

Assign it to another team member

Ask for a new task or role

Do it anyway

32. During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range?*

At least 48 hours

At least 36 hours

At least 8 hours

At least 24 hours

33. Which is the recommended next step after a defibrillation attempt?*

Open the patient’s airway

Determine if a carotid pulse is present

Resume CPR, starting with chest compressions

Check the ECG for evidence of a rhythm

34. Which of these tests should be performed for a patient with suspected stroke as early as possible but no more than 20 minutes after hospital arrival?*

Coagulation studies

Cardiac enzymes

12-lead ECG

Noncontrast CT scan of the head

35. Which is an acceptable method of selecting an appropriately sized oropharyngeal airway?*

Estimate by using the formula Weight (kg)/8 + 2

Estimate by using the size of the patient’s finger

Measure from the corner of the mouth to the angle of the mandible

Measure from the thyroid cartilage to the bottom of the earlobe

36. You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths per minute, and his pulse oximetry reading is 97%. Which assessment step is most important now?*

Evaluating the PETCO2 reading

Requesting laboratory testing

Requesting a chest x-ray

Obtaining a 12-lead ECG

37. Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding?*

The patient meets the criteria for termination of efforts

The endotracheal tube is in the esophagus

The team is ventilating the patient too often (hyperventilation)

Chest compressions may not be effective

38. Which type of atrioventricular block best describes this rhythm?*

First-degree

Second-degree type I

Second-degree type II

Third-degree

39. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next?*

Start a dopamine infusion

Give atropine 0.5 mg

Give epinephrine 1 mg IV

Insert an advanced airway

40. Which best describes an action taken by the Team Leader to avoid inefficiencies during a resuscitation attempt?*

Assign most tasks to the more experienced team members

Perform the most complicated tasks

Clearly delegate tasks

Assign the same tasks to more than one team member

41. Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?*

150 mg

250 mg

100 mg

300 mg

42. Which is the maximum interval you should allow for an interruption in chest compressions?*

20 seconds

25 seconds

15 seconds

10 seconds

43. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment?*

Administering adenosine 6 mg IV push

Performing synchronized cardioversion

Performing vagal maneuvers

Performing defibrillation

44. You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient?*

Hold fibrinolytic therapy for 24 hours

Give fibrinolytic therapy as soon as possible and consider endovascular therapy

Wait for the results of the MRI

Order an echocardiogram before fibrinolytic administration

45. Which type of atrioventricular block best describes this rhythm?*

Third-degree atrioventricular block

Second-degree atrioventricular block type I

First-degree atrioventricular block

Second-degree atrioventricular block type II

46. Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do?*

Obtain a 12-lead ECG

Monitor the patient’s PETCO2

Check the patient’s pulse

Obtain a chest x-ray

47. If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take?*

Conduct a debriefing after the resuscitation attempt

Address the team member immediately

Reassign the team tasks

Remove the team member from the area

48. A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member?*

“I have an order to give 500 mg of amiodarone IV. Is this correct?”

“Amiodarone 500 mg IV has been given.”

“OK.”

“Are you sure?”

49. You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions?*

More than 120/min

Less than 80/min

100 to 120/min

80 to 90/min

50. Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field?*

Coronary reperfusion–capable medical center

Acute long-term care unit

Comprehensive stroke care unit

Acute rehabilitation care unit

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