ACLS Exam - A&B Versions

ECC
American Heart Association
Advanced Cardiovascular
Life Support
Written Exams
Contents:
¾ Exam Memo
¾ Student Answer Sheet
¾ Version A Exam
¾ Version A Answer Key
¾ Version A Reference Sheet
¾ Version B Exam
¾ Version B Answer Key
¾ Version B Reference Sheet
May 2011
© 2011 American Heart Association

2011 Advanced Cardiovascular Life Support
Written Exams
Introduction The 2011 ACLS Provider Course includes both skills tests and a written
exam. The written exam measures the mastery of cognitive skills. The 2011
written exam must be used with the 2011 course materials, ie, Provider
Manual, course video, and Instructor Manual.
Administering This closed-book written exam must be completed independently by each

the written student. To receive a course completion card, students must score at least
exam
84% on the written exam.
Remediation All students deserve remediation on topics in which they are not confident
and topics they have not mastered.
For guidance on remediation, refer to the Instructor Manual.
Copying and Written exams are secured items. ACLS Training Centers may distribute
distribution ACLS Providers exams only to ACLS Instructors, ACLS Training Center
Faculty, and ACLS Regional Faculty members who are aligned with the
Training Center. Written exams may be copied as needed for conducting
courses. Training Centers may distribute exams in the original and complete
PDF format via email.
Exams may not be posted on Internet or Intranet sites accessible by persons

not authorized to receive the exams.
May 2011
ANSWER SHEET
Advanced Cardiovascular Life Support
Written Exam
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ECC
Life Support
Written Exam
Version A
May 2011

Exam Version A (50 questions)
Please do not mark on this exam. Record the best answer on the separate answer sheet.
1. You find an unresponsive patient who is not breathing. After activating the emergency
response system, you determine that there is no pulse. What is your next action?
A. Open the airway with a head tilt–chin lift.

B. Administer epinephrine at a dose of 1 mg/kg.
C. Deliver 2 rescue breaths each over 1 second.
D. Start chest compressions at a rate of at least 100/min.
2. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the
heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry
reading is 97%. What assessment step is most important now?
A. PETCO2
B. Chest x-ray
C. Laboratory testing
D. Obtaining a 12-lead ECG
3. What is the preferred method of access for epinephrine administration during cardiac arrest in
most patients?
A. Intraosseous
B. Endotracheal
C. Central intravenous
D. Peripheral intravenous
4. An activated AED does not promptly analyze the rhythm. What is your next action?
A. Begin chest compressions.

B. Discontinue the resuscitation attempt.
C. Check all AED connections and reanalyze.
D. Rotate AED electrodes to an alternate position.
2
Advanced Cardiovascular Life Support Written Exam Version A
5. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm below, and
the patient has no pulse. Another member of your team resumes chest compressions, and an IV is
in place. What management step is your next priority?
A. Give 0.5 mg of atropine.

B. Insert an advanced airway.
C. Administer 1 mg of epinephrine.
D. Administer a dopamine infusion.
6. During a pause in CPR, you see this lead II ECG rhythm on the monitor. The patient has no
pulse. What is the next action?
A. Establish vascular access.

B. Obtain the patient’s history.
C. Resume chest compressions.
D. Terminate the resuscitative effort.
7. What is a common but sometimes fatal mistake in cardiac arrest management?
A. Failure to obtain vascular access

B. Prolonged periods of no ventilations
C. Failure to perform endotracheal intubation
D. Prolonged interruptions in chest compressions
8. Which action is a component of high-quality chest compressions?

A. Allowing complete chest recoil
B. Chest compressions without ventilation
C. 60 to 100 compressions per minute with a 15:2 ratio
D. Uninterrupted compressions at a depth of 1½ inches
3
9. Which action increases the chance of successful conversion of ventricular fibrillation?
A. Pausing chest compressions immediately after a defibrillation attempt

B. Administering 4 quick ventilations immediately before a defibrillation attempt
C. Using manual defibrillator paddles with light pressure against the chest
D. Providing quality compressions immediately before a defibrillation attempt
10. Which situation BEST describes pulseless electrical activity?
A. Asystole without a pulse

B. Sinus rhythm without a pulse
C. Torsades de pointes with a pulse
D. Ventricular tachycardia with a pulse
11. What is the BEST strategy for performing high-quality CPR on a patient with an advanced
airway in place?
A. Provide compressions and ventilations with a 15:2 ratio.

B. Provide compressions and ventilations with a 30:2 ratio.
C. Provide a single ventilation every 6 seconds during the compression pause.
D. Provide continuous chest compressions without pauses and 10 ventilations per minute.
12. Three minutes after witnessing a cardiac arrest, one member of your team inserts an
endotracheal tube while another performs continuous chest compressions. During subsequent
ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level
of 8 mm Hg. What is the significance of this finding?
A. Chest compressions may not be effective.

B. The endotracheal tube is no longer in the trachea.
C. The patient meets the criteria for termination of efforts.
D. The team is ventilating the patient too often (hyperventilation).
13. The use of quantitative capnography in intubated patients
A. allows for monitoring of CPR quality.

B. measures oxygen levels at the alveoli level.
C. determines inspired carbon dioxide relating to cardiac output.
D. detects electrolyte abnormalities early in code management.
4
14. For the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally
presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole,
which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is
your next treatment?
A. Apply a transcutaneous pacemaker.

B. Administer 1 mg of intravenous atropine.
C. Administer 40 units of intravenous vasopressin.
D. Consider terminating resuscitative efforts after consulting medical control.
15. Which is a safe and effective practice within the defibrillation sequence?
A. Stop chest compressions as you charge the defibrillator.

B. Be sure oxygen is not blowing over the patient’s chest during the shock.
C. Assess for the presence of a pulse immediately after the shock.
D. Commandingly announce “clear” after you deliver the defibrillation shock.
16. During your assessment, your patient suddenly loses consciousness. After calling for help
and determining that the patient is not breathing, you are unsure whether the patient has a pulse.
What is your next action?
A. Leave and get an AED.

B. Begin chest compressions.
C. Deliver 2 quick ventilations.
D. Check the patient’s mouth for the presence of a foreign body.
17. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles?
A. Hands-free pads deliver more energy than paddles.

B. Hands-free pads increase electrical arc.
C. Hands-free pads allow for a more rapid defibrillation.
D. Hands-free pads have universal adaptors that can work with any machine.
18. What action is recommended to help minimize interruptions in chest compressions during
CPR?
A. Continue CPR while charging the defibrillator.

B. Perform pulse checks immediately after defibrillation.
C. Administer IV medications only when delivering breaths.
D. Continue to use an AED even after the arrival of a manual defibrillator.
19. Which action is included in the BLS Survey?
A. Early defibrillation
B. Advanced airway management
C. Rapid medication administration
D. Preparation for therapeutic hypothermia
5
20. Which drug and dose are recommended for the management of a patient in refractory
ventricular fibrillation?
A. Atropine 2 mg
B. Amiodarone 300 mg
C. Vasopressin 1 mg/kg
D. Dopamine 2 mg/kg per minute
21. What is the appropriate interval for an interruption in chest compressions?
A. 10 seconds or less
B. 10 to 15 seconds
C. 15 to 20 seconds
D. Interruptions are never acceptable
22. Which of the following is a sign of effective CPR?
A. PETCO2 ≥10 mm Hg
B. Measured urine output of 1 mL/kg per hour
C. Patient temperature >32°C (89.6°F)
D. Diastolic intra-arterial pressure <20 mm Hg
23. What is the primary purpose of a medical emergency team (MET) or rapid response team
(RRT)?
A. Identifying and treating early clinical deterioration

B. Rapidly intervening with patients admitted through emergency department triage
C. Responding to patients during a disaster or multiple-patient situation
D. Responding to patients after activation of the emergency response system
24. Which action improves the quality of chest compressions delivered during a resuscitation
attempt?
A. Observe ECG rhythm to determine depth of compressions.

B. Do not allow the chest to fully recoil with each compression.
C. Compress the upper half of the sternum at a rate of 150 compressions per minute.
D. Switch providers about every 2 minutes or every 5 compression cycles.
25. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate
of 80/min?
A. 1 breath every 3 to 4 seconds

B. 1 breath every 5 to 6 seconds
C. 2 breaths every 5 to 6 seconds
D. 2 breaths every 6 to 8 seconds
6
26. A patient presents to the emergency department with new onset of dizziness and fatigue. On
examination, the patient’s heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory
rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication?
A. Atropine 0.5 mg
B. Oxygen 12 to 15 L/min
C. Epinephrine 0.5 mg
D. Aspirin 160 mg chewed
27. A patient presents to the emergency department with dizziness and shortness of breath with a
sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your
monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate
dose of dopamine for this patient?
A. 2 to 10 mg/min
B. 2 to 10 mcg/kg per minute
C. 10 to 15 mg/min
D. 10 to 15 mcg/kg per minute
28. A patient has sudden onset of dizziness. The patient’s heart rate is 180/min, blood pressure is
110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air.
The lead II ECG is shown below:
What is the next appropriate intervention?
A. Vagal maneuvers
B. Metoprolol 5 mg IV
C. Adenosine 6 mg IV
D. Normal saline 1 L bolus
7
29. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a
rate of 220/min. The patient’s blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the
pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the
patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular
tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal
maneuvers. What is the next recommended intervention?
A. Adenosine 6 mg IV push
B. Amiodarone 300 mg IV push
C. Synchronized cardioversion at 50 J
D. Synchronized cardioversion at 200 J
30. You are receiving a radio report from an EMS team en route with a patient who may be having
an acute stroke. The hospital CT scanner is not working at this time. What should you do in this
situation?
A. Contact the patient’s family to see what they would prefer.

B. Have the EMS crew choose an appropriate patient disposition.
C. Accept the report and provide care within your present capability.
D. Divert the patient to a hospital 15 minutes away with CT capabilities.
31. Choose an appropriate indication to stop or withhold resuscitative efforts.
A. Arrest not witnessed

B. Evidence of rigor mortis
C. Patient age greater than 85 years
D. No return of spontaneous circulation after 10 minutes of CPR
32. A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She
had been taking oral antacids for the past 6 hours because she thought she had heartburn. The
initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored
respiratory rate is 14 breaths/min, and the pulse oximetry reading is 96%. Which is the most
appropriate intervention to perform next?
A. Administer oxygen.
B. Obtain a 12-lead ECG.
C. Evaluate for fibrinolytic eligibility.
D. Administer sublingual nitroglycerin.
33. A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart
rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention
has the highest priority?
A. Atropine IV push
B. Epinephrine IV infusion
C. Application of a transcutaneous pacemaker
D. Simple airway maneuvers and assisted ventilation
8
34. What is the appropriate procedure for endotracheal tube suctioning after the appropriate
catheter is selected?
A. Suction during insertion but for no longer than 30 seconds.

B. Suction the mouth and nose for no longer than 30 seconds.
C. Suction during withdrawal but for no longer than 10 seconds.
D. Hyperventilate before catheter insertion, and then suction during withdrawal.
35. While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy
skin, you see this lead II ECG rhythm:
What is the most appropriate first intervention?
A. Aspirin
B. Atropine
C. Lidocaine
D. Nitroglycerin
36. A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel
measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate
of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm.
What is the most appropriate action for the EMS team to perform next?
A. 12-lead ECG assessment

B. Administration of 100% supplementary oxygen
C. Cincinnati Prehospital Stroke Scale assessment
D. Administration of a low-dose aspirin
37. EMS is transporting a patient with a positive prehospital stroke assessment. Upon arrival in
the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min,
the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead
II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention
should you perform next?
A. Head CT scan
B. Transfer to the stroke unit
C. Immediate rtPA administration
D. Administration of 100% oxygen
9
38. What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway
in place?
A. 4 to 6 breaths per minute

B. 8 to 10 breaths per minute
C. 12 to 14 breaths per minute
D. 16 to 18 breaths per minute
39. A 62-year-old man in the emergency department says that his heart is beating fast. He says he
has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is
200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What
intervention should you perform next?
A. Obtain a 12-lead ECG.

B. Give 150 mg of amiodarone.
C. Administer 160 mg of aspirin.
D. Administer 6 mg of adenosine.
40. You are evaluating a 48-year-old man with crushing substernal chest pain. The patient is pale,
diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32
mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is
unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular
wide-complex tachycardia. What intervention should you perform next?
A. Procedural sedation
B. 12-lead ECG
C. Amiodarone administration
D. Synchronized cardioversion
41. What is the initial priority for an unconscious patient with any tachycardia on the monitor?
A. Review the patient’s home medications.

B. Evaluate the breath sounds.
C. Determine whether pulses are present.
D. Administer sedative drugs.
42. Which rhythm requires synchronized cardioversion?
A. Unstable supraventricular tachycardia

B. Atrial fibrillation
C. Sinus tachycardia
D. NSR on monitor but no pulse
10
43. What is the recommended second dose of adenosine for patients in refractory but stable
narrow-complex tachycardia?
A. 3 mg
B. 6 mg
C. 9 mg
D. 12 mg
44. What is the usual post–cardiac arrest target range for PETCO2 when ventilating a patient who
achieves return of spontaneous circulation (ROSC)?
A. 30 to 35 mm Hg
B. 35 to 40 mm Hg
C. 40 to 45 mm Hg
D. 45 to 50 mm Hg
45. Which condition is a contraindication to therapeutic hypothermia during the post–cardiac

arrest period for patients who achieve return of spontaneous circulation ROSC?
A. Initial rhythm of asystole

B. Responding to verbal commands
D. Desire to provide coronary reperfusion (eg, PCI)
46. What is the potential danger of using ties that pass circumferentially around the patient’s neck
when securing an advanced airway?
A. May interfere with effective ventilation

B. Places the patient’s cervical spine at risk
C. Obstruction of venous return from the brain
D. Does not adequately secure the airway device
47. What is the most reliable method of confirming and monitoring correct placement of an
endotracheal tube?
A. 5-point auscultation
B. Colorimetric capnography
C. Continuous waveform capnography
D. Use of esophageal detection devices
48. What is the recommended IV fluid (normal saline or Ringer’s lactate) bolus dose for a patient
who achieves ROSC but is hypotensive during the post–cardiac arrest period?
A. 250 to 500 mL
B. 500 to 1000 mL
C. 1 to 2 L
D. 2 to 3 L
11
49. What is the minimum systolic blood pressure one should attempt to achieve with fluid,
inotropic, or vasopressor administration in a hypotensive post–cardiac arrest patient who
achieves ROSC?
A. 90 mm Hg
B. 85 mm Hg
C. 80 mm Hg
D. 75 mm Hg
50. What is the first treatment priority for a patient who achieves ROSC?
A. Coronary reperfusion
B. Therapeutic hypothermia
C. Maintaining blood glucose <185 mg/dL
D. Optimizing ventilation and oxygenation
12
2011 WRITTEN EXAM A
Answer Key
Question Answer
1. A B C ●
2. A B C ●
3. A B C ●
4. ● B C D
5. A B ● D
6. A B ● D
7. A B C ●
8. ● B C D
9. A B C ●
10. A ● C D
11. A B C ●
12. ● B C D
13. ● B C D
14. A B C ●
15. A ● C D
16. A ● C D
17. A B ● D
18. ● B C D
19. ● B C D
20. A ● C D
21. ● B C D
22. ● B C D
23. ● B C D
24. A B C ●
25. A ● C D

26. ● B C D
27 A ● C D
28 ● B C D
29 ● B C D
30. A B C ●
31. A ● C D
32. A ● C D
33. A B C ●
34. A B ● D
35. A ● C D
36. A B ● D
37. ● B C D
38. A ● C D
39. ● B C D
40 A B C ●
41. A B ● D
42. ● B C D
43. A B C ●
44. A ● C D
45. A ● C D
46. A B ● D
47. A B ● D
48. A B ● D
49. ● B C D
50. A B C ●

2011 WRITTEN EXAM A
Reference Sheet
Page Number in ACLS

Question Provider Manual Answer
1. 52 A B C ●
2. 96 A B C ●
3. 71 A B C ●
4. 57 ● B C D
5. 81 A B ● D
6. 81 A B ● D
7. 62 A B C ●
8. 14 ● B C D
9. 57 A B C ●
10. 78 A ● C D
11. 48 A B C ●
12. 67 ● B C D
13. 75 ● B C D
14. 90 A B C ●
15. 64 A ● C D
16. 50 A ● C D
17. 64 A B ● D
18. 63 ● B C D
19. 35 ● B C D
20. 66 A ● C D
21. 14 ● B C D
22. 37 ● B C D
23. 26 ● B C D
24. 14 A B C ●
25. 47 A ● C D

26. 110 ● B C D
27. 110 A ● C D
28. 129 ● B C D
29. 129 ● B C D
30. 139 A B C ●
31. 87 A ● C D
32. 96 A ● C D
33. 110 A B C ●
34. 46 A B ● D
35. 110 A ● C D
36. 136 A B ● D
37. 140 ● B C D
38. 36 A ● C D
39. 119 ● B C D
40. 119 A B C ●
41. 116 A B ● D
42. 116 ● B C D
43. 129 A B C ●
44. 67 A ● C D
45. 76 A ● C D
46. 75 A B ● D
47. 76 A B ● D
48. 76 A B ● D
49. 76 ● B C D
50. 74 A B C ●

ECC
Life Support
Written Exam
Version B
May 2011

Exam Version B (50 questions)
Please do not mark on this exam. Record the best answer on the separate answer sheet.
1. What should be done to minimize interruptions in chest compressions during CPR?
A. Perform pulse checks only after defibrillation.

B. Continue CPR while the defibrillator is charging.
C. Administer IV medications only when breaths are given.
D. Continue to use AED even after the arrival of a manual defibrillator.
2. Which condition is an indication to stop or withhold resuscitative efforts?
A. Unwitnessed arrest
B. Safety threat to providers
D. No return of spontaneous circulation after 10 minutes of CPR
3. After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The
patient’s lead II ECG appears below. What is your next action?
A. IV or IO access
B. Endotracheal tube placement
C. Consultation with cardiology for possible PCI
D. Application of a transcutaneous pacemaker
4. After verifying unresponsiveness and abnormal breathing, you activate the emergency
response team. What is your next action?
A. Retrieve an AED.
B. Check for a pulse.
C. Deliver 2 rescue breaths.
D. Administer a precordial thump.
2
Advanced Cardiovascular Life Support Written Exam Version B
5. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac
arrest?
A. Not recommended for routine use

B. Recommended during every resuscitation attempt
C. Recommended when the patient is vomiting
D. Recommended only for supraglottic airway insertion
6. What survival advantages does CPR provide to a patient in ventricular fibrillation?
A. Increases the defibrillation threshold

B. Directly restores an organized rhythm
C. Opposes the harmful effects of epinephrine
D. Produces a small amount of blood flow to the heart
7. What is the recommended compression rate for performing CPR?
A. 60 to 80 per minute
B. 80 to 100 per minute
C. About 100 per minute
D. At least 100 per minute
8. EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After
attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most
important early intervention?
A. Defibrillation
B. Endotracheal intubation
C. Epinephrine administration
D. Antiarrhythmic administration
9. A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR.
The next intervention is to
A. administer amiodarone.
B. administer a second shock.
C. administer epinephrine.
D. insert an advanced airway.
3
10. What is the recommended next step after a defibrillation attempt?
A. Open the patient’s airway.

B. Determine if a carotid pulse is present.
C. Check the ECG for evidence of a rhythm.
D. Begin CPR, starting with chest compressions.
11. Which of the following is the recommended first choice for establishing intravenous access
during the attempted resuscitation of a patient in cardiac arrest?
A. Subclavian vein
B. Antecubital vein
C. Intraosseous line
D. Internal jugular vein
12. What is the recommended first intravenous dose of amiodarone for a patient with refractory
ventricular fibrillation?
A. 1 mg
B. 1 mg/kg
C. 1 mEq/kg
D. 300 mg
13. IV/IO drug administration during CPR should be
A. given rapidly during compressions.

B. administered slowly during the pause for a pulse check.
C. given by infusion.
D. given before any defibrillation attempts.
14. How often should the team leader switch chest compressors during a resuscitation attempt?
A. Every minute
B. Every 2 minutes
C. Every 3 minutes
D. Every 4 minutes
15. Which finding is a sign of ineffective CPR?
A. PETCO2 <10 mm Hg
B. Patient temperature >32°C (89.6°F)
C. Diastolic intra-arterial pressure ≥20 mm Hg
D. Measured patient urine output of 1 mL/kg per hour
4
16. A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when
the medication is administered. What element of effective resuscitation team dynamics does this
represent?
A. Clear messages
B. Knowing one’s limitations
C. Closed-loop communication
D. Clear roles and responsibilities
17. How long should it take to perform a pulse check during the BLS Survey?
A. 1 to 5 seconds
B. 5 to 10 seconds
C. 10 to 15 seconds
D. 15 to 20 seconds
18. Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine
that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your
assessment and management of this patient?
A. Apply the AED.

B. Check the patient’s pulse.
C. Open the patient’s airway.
D. Check for the presence of breathing.
19. Which treatment or medication is appropriate for the treatment of a patient in asystole?
A. Atropine
B. Epinephrine
C. Defibrillation
D. Transcutaneous pacing
20. An AED advises a shock for a pulseless patient lying in snow. What is the next action?
A. Place a backboard beneath the patient and administer the shock.

B. Move the patient off the snow to bare ground and deliver the shock.
C. Remove any snow beneath the patient and then administer the shock.
D. Administer the shock immediately and continue as directed by the AED.
21. What is the minimum depth of chest compressions for an adult in cardiac arrest?
A. 1 inch
B. 1½ inches
C. 2 inches
D. 2½ inches
5
22. A patient with pulseless ventricular tachycardia is defibrillated. What is the next action?
A. Check for a pulse.

B. Administer an IV antiarrhythmic.
C. Start chest compressions at a rate of at least 100/min.
D. Repeat the unsynchronized shock, increasing to 200 J.
23. You have completed your first 2-minute period of CPR. You see an organized, nonshockable
rhythm on the ECG monitor. What is the next action?
A. Administer normal saline at 20 mL/kg.

B. Administer epinephrine at 1 mg/kg IV.
C. Obtain a blood pressure and oxygen saturation.
D. Have a team member attempt to palpate a carotid pulse.
24. Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac
arrest. What is the next most preferred route for drug administration?
A. Intraosseous (IO)
B. Endotracheal (ET)
C. Intramuscular (IM)
D. Central venous access
25. What is the appropriate rate of chest compressions for an adult in cardiac arrest?
A. At least 150/min
B. At least 100/min
C. Approximately 100/min
D. Approximately 120/min
26. You are receiving a radio report from an EMS team en route with a patient who may be having
an acute stroke. The hospital CT scanner is not working at this time. What should you do in this
situation?
A. Contact the patient’s family to see what they would prefer.

B. Have the EMS crew choose an appropriate patient disposition.
C. Accept the report and provide care within your present capability.
D. Divert the patient to a hospital 15 minutes away with CT capabilities.
6
27. A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient’s
blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min,
and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV
is in place. What is the next action?
A. Acquisition of a 12-lead ECG

B. Vagal maneuvers
C. Procedural sedation
D. Immediate defibrillation
28. A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is
diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart
rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The
patient’s 12-lead ECG shows ST-segment elevation in the anterior leads. First responders
administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8
on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action?
A. Administer an additional dose of aspirin.

B. Administer an additional nitroglycerin tablet.
C. Administer high-flow oxygen via an oxygen mask.
D. Administer 2 to 4 mg of morphine by slow IV bolus.
29. A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing.
The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12
breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex
tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG?
A. Administration of IV epinephrine
B. Seeking expert consultation
C. Procedural sedation
30. A postoperative patient in the ICU reports new chest pain. What actions have the highest
priority?
A. Administer an IV fluid bolus and obtain arterial blood gas.

B. Start dopamine at 2 mcg/kg per minute and obtain a chest x-ray.
C. Send blood to the laboratory for chemistry and cardiac enzymes.
D. Obtain a 12-lead ECG and administer aspirin if not contraindicated.
7
31. An 80-year-old woman presents to the emergency department with dizziness. She now states
she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and
oriented. Her lead II ECG is below. After you start an IV, what is the next action?
A. Give an IV fluid bolus.

B. Give atropine and monitor for changes in mental status.
C. Start an epinephrine infusion and titrate to patient response.
D. Conduct a problem-focused history and physical examination.
32. What is the recommended oral dose of aspirin for patients suspected of having one of the
acute coronary syndromes?
A. 2 to 4 mg
B. 80 to 120 mg
C. 160 to 325 mg
D. 400 to 600 mg
33. 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 below.
Which of the following terms best describes this patient?
A. Sinus tachycardia
B. Perfusing ventricular tachycardia
C. Stable supraventricular tachycardia
D. Unstable supraventricular tachycardia
8
34. What is the most appropriate intervention for a rapidly deteriorating patient who has this lead
II ECG?
A. Valsalva maneuver
B. Synchronized cardioversion
C. Intravenous administration of adenosine
D. Immediate unsynchronized countershock
35. What is the purpose of a medical emergency team (MET) or rapid response team (RRT)?
A. Providing online consultation to EMS personnel in the field

B. Providing diagnostic consultation to emergency department patients
C. Improving care for deteriorating patients admitted to critical care units
D. Improving patient outcomes by identifying and treating early clinical deterioration
36. What is the recommended assisted ventilation rate for patients in respiratory arrest with a
perfusing rhythm?
A. 4 to 6 breaths per minute

B. 10 to 12 breaths per minute
C. 14 to 16 breaths per minute
D. 16 to 18 breaths per minute
37. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the
heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry
reading is 97%. What assessment step is most important now?
A. PETCO2
B. Chest x-ray
C. Laboratory testing
D. Obtaining a 12-lead ECG
38. Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious
and in respiratory arrest. What is the recommended initial airway management technique?
A. Placing a nasopharyngeal airway

B. Using an advanced airway device
C. Performing a head tilt–chin lift maneuver
D. Performing a jaw thrust without head extension
9
39. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the
following lead II ECG rhythm:
What is the appropriate next intervention?
A. Defibrillation
B. Amiodarone 150 mg IV
C. Adenosine 6 mg IV push
40. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm:
What is the appropriate next intervention?
A. Defibrillation
B. Adenosine 6 mg IV push
C. Epinephrine 1 mg IV push
41. What is the recommended energy dose for biphasic synchronized cardioversion of atrial
fibrillation?
A. 50 to 75 J
B. 75 to 100 J
C. 120 to 200 J
D. 200 to 300 J
10
42. Which of the following is an acceptable method of selecting an appropriately sized
oropharyngeal airway (OPA)?
A. Estimate by using the size of the patient’s thumb.

B. Estimate by using the formula Weight (kg)/8 + 2.
C. Measure from the thyroid cartilage to the angle of the mandible.
D. Measure from the corner of the mouth to the angle of the mandible.
43. Which is a contraindication to nitroglycerin administration in the management of acute

coronary syndromes?
A. Heart rate greater than 80/min

B. Right ventricular infarction and dysfunction
C. Phosphodiesterase inhibitor use more than 72 hours ago
D. Systolic blood pressure greater than 100 mm Hg
44. What is the recommended initial intervention for managing hypotension in the immediate
period after return of spontaneous circulation (ROSC)?
A. Atropine bolus
B. Administration of IV or IO fluid bolus
C. Placement of a central line to monitor pulmonary wedge pressure
D. Phenylephrine hydrochloride titrated to keep systolic blood pressure >100 mm Hg
45. Which is an appropriate and important intervention to perform for a patient who achieves
ROSC during an out-of-hospital resuscitation?
A. Initiate an antiarrhythmic infusion.

B. Transport the patient to a facility capable of performing PCI.
C. Replace any supraglottic airway with an endotracheal tube.
D. Place a central venous catheter for hemodynamic monitoring.
46. What is the immediate danger of excessive ventilation during the post–cardiac arrest period
for patients who achieve ROSC?
A. Oxygen toxicity
B. Pulmonary hypertension
C. Decreased cerebral blood flow
D. Ventilation/perfusion mismatch
47. What is the recommended target temperature range for achieving therapeutic hypothermia
after cardiac arrest?
A. 26°C to 28°C
B. 29°C to 31°C
C. 32°C to 34°C
D. 35°C to 37°C
11
48. What is the recommended duration of therapeutic hypothermia after reaching the target
temperature?
A. 0 to 12 hours
B. 12 to 24 hours
C. 24 to 36 hours
D. 36 to 48 hours
49. What is the danger of routinely administering high concentrations of oxygen during the post–
cardiac arrest period for patients who achieve ROSC?
A. Potential oxygen toxicity

B. Adverse hemodynamic effects
C. Decrease in cerebral blood flow
D. Increased intrathoracic pressure
50. What is the recommended dose of epinephrine for the treatment of hypotension in a post–
cardiac arrest patient who achieves ROSC?
A. 2 to 10 mg/min IV infusion
B. 0.1 to 0.5 mcg/kg per minute IV infusion
C. 1 mg IV push every 3 to 5 minutes
D. 10 mg IV push every 3 to 5 minutes
12
2011 WRITTEN EXAM B
Answer Key
Question Answer
1. A ● C D
2. A ● C D
3. ● B C D
4. A ● C D
5. ● B C D
6. A B C ●
7. A B C ●
8. ● B C D
9. A ● C D
10. A B C ●
11. A ● C D
12. A B C ●
13. ● B C D
14. A ● C D
15. ● B C D
16. A B ● D
17. A ● C D
18. A ● C D
19. A ● C D
20. A B C ●
21. A B ● D
22. A B ● D
23. A B C ●
24. ● B C D
25. A ● C D

26. A B C ●
27. A ● C D
28. A B C ●
29. A ● C D
30. A B C ●
31. A B C ●
32. A B ● D
33. A B C ●
34. A ● C D
35. A B C ●
36. A ● C D
37. A B C ●
38. A B ● D
39. A B C ●
40. ● B C D
41. A B ● D
42. A B C ●
43. A ● C D
44. A ● C D
45. A ● C D
46. A B ● D
47. A B ● D
48. A ● C D
49. ● B C D
50. A ● C D

2011 WRITTEN EXAM B
Reference Sheet
Page Number in ACLS

Question Provider Manual Answer
1. 63 A ● C D
2. 87 A ● C D
3. 81 ● B C D
4. 13 A ● C D
5. 48 ● B C D
6. 54 A B C ●
7. 35 A B C ●
8. 54 ● B C D
9. 61 A ● C D
10. 13 A B C ●
11. 70 A ● C D
12. 66 A B C ●
13. 70 ● B C D
14. 35 A ● C D
15. 67 ● B C D
16. 19 A B ● D
17. 13 A ● C D
18. 13 A ● C D
19. 88 A ● C D
20. 58 A B C ●
21. 51 A B ● D
22. 63 A B ● D
23. 64 A B C ●
24. 69 ● B C D
25. 51 A ● C D

26. 139 A B C ●
27. 129 A ● C D
28. 97 A B C ●
29. 129 A ● C D
30. 96 A B C ●
31. 110 A B C ●
32. 97 A B ● D
33. 115 A B C ●
34. 116 A ● C D
35. 26 A B C ●
36. 36 A ● C D
37. 96 A B C ●
38. 40 A B ● D
39. 116 A B C ●
40. 121 ● B C D
41. 122 A B ● D
42. 43 A B C ●
43. 97 A ● C D
44. 76 A ● C D
45. 28 A ● C D
46. 75 A B ● D
47. 77 A B ● D
48. 77 A ● C D
49. 74 ● B C D
50. 76 A ● C D


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ECC

American Heart Association

© 2011 American Heart Association

Administering This closed-book written exam must be completed independently by each

For guidance on remediation, refer to the Instructor Manual.

Exams may not be posted on Internet or Intranet sites accessible by persons

American Heart Association

© 2011 American Heart Association

A. Open the airway with a head tilt–chin lift.

A. Begin chest compressions.

A. Give 0.5 mg of atropine.

A. Establish vascular access.

7. What is a common but sometimes fatal mistake in cardiac arrest management?

A. Failure to obtain vascular access

8. Which action is a component of high-quality chest compressions?

A. Pausing chest compressions immediately after a defibrillation attempt

10. Which situation BEST describes pulseless electrical activity?

A. Asystole without a pulse

A. Provide compressions and ventilations with a 15:2 ratio.

A. Chest compressions may not be effective.

13. The use of quantitative capnography in intubated patients

A. allows for monitoring of CPR quality.

A. Apply a transcutaneous pacemaker.

A. Stop chest compressions as you charge the defibrillator.

A. Leave and get an AED.

A. Hands-free pads deliver more energy than paddles.

A. Continue CPR while charging the defibrillator.

19. Which action is included in the BLS Survey?

21. What is the appropriate interval for an interruption in chest compressions?

22. Which of the following is a sign of effective CPR?

A. Identifying and treating early clinical deterioration

A. Observe ECG rhythm to determine depth of compressions.

A. 1 breath every 3 to 4 seconds

What is the next appropriate intervention?

A. Contact the patient’s family to see what they would prefer.

31. Choose an appropriate indication to stop or withhold resuscitative efforts.

A. Arrest not witnessed

A. Suction during insertion but for no longer than 30 seconds.

What is the most appropriate first intervention?

A. 12-lead ECG assessment

A. 4 to 6 breaths per minute

A. Obtain a 12-lead ECG.

A. Review the patient’s home medications.

42. Which rhythm requires synchronized cardioversion?

A. Unstable supraventricular tachycardia

45. Which condition is a contraindication to therapeutic hypothermia during the post–cardiac

A. Initial rhythm of asystole

A. May interfere with effective ventilation

Advanced Cardiovascular Life Support Written Exam Version A

Advanced Cardiovascular Life Support Written Exam Version A

Page Number in ACLS

Advanced Cardiovascular Life Support Written Exam Version A

Advanced Cardiovascular Life Support Written Exam Version A

American Heart Association

© 2011 American Heart Association

1. What should be done to minimize interruptions in chest compressions during CPR?

A. Perform pulse checks only after defibrillation.

2. Which condition is an indication to stop or withhold resuscitative efforts?

A. Not recommended for routine use

6. What survival advantages does CPR provide to a patient in ventricular fibrillation?

A. Increases the defibrillation threshold

7. What is the recommended compression rate for performing CPR?

A. Open the patient’s airway.

13. IV/IO drug administration during CPR should be

ACLS Exam - A&B Versions

ACLS Exam - A&B Versions