What is generally considered the most important and clinically

significant degree of block?

 1. type I (Mobitz I)

 2. type II (Mobitz II)

 3. third-degree AV block
 4. first-degree AV block
Correct
AHA ACLS Provider Manual p. 66 “Complete block is generally
the most important and clinically significant degree of block.” It is
also the most likely block to cause cardiovascular collapse.

 1. atropine, epinephrine, dopamine

 2. atropine, norepinephrine, dopamine

 3. atropine, lidocaine, adenosine

 4. atropine, epinephrine, lidocaine
Correct
AHA ACLS Provider Manual p. 69. Epinephrine and dopamine are
both used as an alternative to TCP and are infusions. Atropine is
an IV push medication that is used to increase heart rate.

Bradyarrhythmia is defined as:

 1. any rhythm disorder with a heart rate less than 40 beats per minute

 2. any rhythm disorder with a heart rate less than 60 beats per
minute

 3. any symptomatic rhythm disorder with a heart rate less than 50

beats per minute
 4. any rhythm disorder with a heart rate less than 50 beats per minute
Incorrect
 AHA ACLS Provider Manual p. 66. Any rhythm disorder with a
heart rate <60/min is classified as a bradyarrhythmia. Remember:
when the symptoms of a patient are caused by bradycardia, the
rate will usually be less than 50/min.

Symptomatic bradycardia exists when_________.

 1. the heart rate is slow

 2. the patient has symptoms

 3. the symptoms are due to a slow heart rate

 4. all of the above are needed for symptomatic bradycardia to exist.
Correct
AHA ACLS Provider Manual pg. 68. Symptomatic bradycardia
exists clinically when these 3 criteria are present.

Symptoms of bradycardia include acutely altered mental status,

signs of shock, and ischemic chest discomfort.

 1. True
 2. False
Correct
AHA ACLS Provider Manual pg. 70
All of these symptoms are related to a decrease in perfusion
caused by the slow heart rate.

Signs of symptomatic bradycardia include hypotension and acute

heart failure

 1. True
 2. False
Correct
AHA ACLS Provider Manual p. 70. Both listed are included as
signs seen with symptomatic bradycardia.
 The primary decision point in the bradycardia algorithm is the
determination of:

 1. heart rate

 2. adequate perfusion

 3. blood pressure
 4. rhythm
Correct
AHA ACLS Manual p. 70. Adequate perfusion is the primary
decision point for determining if use of the bradycardia algorithm
is necessary.

After it is determined that the patient does not have adequate

perfusion your first step is to:

 1. prepare for transcutaneous pacing

 2. observe and monitor the patient

 3. give atropine while awaiting transcutaneous pacer

 4. use defibrillator set at 200 J
Correct
AHA ACLS Manual p. 70. Per the Bradycardia algorithm, the first
step after determining inadequate perfusion is to give atropine.

What is the first-line agent for treatment of symptomatic

bradycardia?

 1. atropine

 2. lidocaine

 3. epinephrine
 4. vasopressin
Correct
 AHA ACLS Provider Manual p. 70. “Give Atropine as first-line
treatment.”

Which rhythm is most likely to be associated with symptomatic

bradycardia?

 1. PEA

 2. Mobitz II

 3. ventricular fibrillation
 4. sinus rhythm
Correct
AHA ACLS Provider Manual p. 66 lists all of the major ECG
rhythms associated with bradycardia. Mobitz II which is also
called Second-degree AV block (Type 2) is clinically significant for
ACLS because this rhythm can rapidly progress to complete heart
block.

The correct dose of dopamine given in the bradycardia algorithm

is:

 1. 5-20 mcg/kg/min infusion

 2. 2-8 mcg/kg/min infusion

 3. 5-10 mcg/kg/min infusion

 4. 1-5 mcg/kg/min infusion
Correct
AHA ACLS Provider Manual p. 69. “Begin dopamine infusion at 5-
20 mcg/kg/min and titrate to patient response.”

The key clinical question when determining steps to take for the
patient with symptomatic bradycardia is:

 1. Is the bradycardia reversible?

 2. Does the patient respond to medications?

 3. Are the symptoms caused by bradycardia or some other illness?

 4. Is the patient a DNR?
Correct
AHA ACLS Provider Manual p. 70. Treatment of bradycardia with
the bradycardia algorithm should be based on whether the
symptoms are being caused by the bradycardia or if they are
being caused by some other illness or disorder. Once it is
determined that the slow heart rate is causing the symptoms then
the patient should be treated with the bradycardia algorithm.

The treatment sequence for bradycardia with poor perfusion is:

 1. prepare for transcutaneous pacing, give atropine while preparing

TCP, use epinephrine or dopamine while awaiting pacemaker or if
pacing is ineffective.

 2. give epinephrine, if ineffective give atropine, if atropine is ineffective

start transcutaneous pacing

 3. start IV drip of dopamine or epinephrine, if ineffective begin

transcutaneous pacing, and if this is not effective, give atropine
 4. begin cpr, give epinephrine, give atropine, defibrillate, repeat
epinephrine if needed.
Correct
AHA ACLS Provider Manual p. 70-72.
In the case of bradycardia with poor perfusion, TCP is indicated.
Atropine can and should be given if it does not delay TCP. Also if
TCP is not available, epinephrine and dopamine (chemical
pacing) are considered equally effective to TCP.

Transcutaneous pacing should be started immediately if:

 1. there is no response to atropine

 2. atropine is unlikely to be effective or if IV access cannot be quickly
established

 3. the patient is severely symptomatic

 4. all of the above
Correct
AHA ACLS Provider Manual p. 71 & 74. All of the above are
indications for immediate transcutaneous pacing. From p. 74 “Do
not delay pacing for unstable patients, particularly those with high-
degree AV block.”

If transcutaneous pacing is ineffective for symptomatic

bradycardia, the next step would be to prepare for:

 1. prepare for transvenous pacing

 2. give repeat doses of atropine

 3. prepare for pacemaker placement

 4. begin CPR

 5. begin an infusion of dopamine or epinephrine

 6. both 1 and 5
Correct
AHA ACLS Provider Manual pg. 72 Transvenous pacing is the
next step in the sequence of actions if TCP fails and while
transvenous pacing is being prepared, a dopamine or epinephrine
infusion should be started.

Atropine doses of less than 0.5mg may paradoxically result in

further slowing of the heart rate.

 1. True
 2. False
Correct
 AHA ACLS Provider Manual p. 71. Also, atropine crosses into the
CNS stimulating the vagus nerve causing bradycardia at low
doses. At higher doses the muscarinic blocking effects of Atropine
outweigh the CNS effects, causing tachycardia.

For bradycardia unresponsive to atropine, what other drug should

be considered?

 1. vasopressin

 2. epinephrine

 3. magnesium sulfate
 4. all of the above
Correct
AHA ACLS Manual p. 70. Epinephrine along with dopamine can
be considered for the treatment of bradycardia within the
bradycardia algorithm.

If atropine fails, the treatment of choice for symptomatic

bradycardia with signs of poor perfusion is ____________.

 1. pacemaker placement

 2. transcutaneous pacing

 3. CPR
 4. none of the above
Correct
AHA ACLS Manual p. 74. Transcutaneous pacing should not be
delayed for patients who are unstable due to a slow heart rate. It
is non-invasive and has a high rate of success for improving the
clinical condition of patients with symptomatic bradycardia.

The correct dose of epinephrine given in the bradycardia

algorithm is:
 1. 1-5 mcg/min infusion

 2. 2-8 mcg/min infusion

 3. 2-10 mcg/min infusion

 4. 5-10 mcg/min infusion
Correct
AHA ACLS Provider Manual p. 70. Begin epinephrine infusion at
a dose of 2-10 mcg/min and titrate to patient response.

The correct dose of atropine given in the bradycardia algorithm is:

 1. 1 mg atropine, may repeat up to a total dose of 3 mg

 2. 0.5 mg atropine, may repeat up to a total dose of 2 mg

 3. 0.5 mg atropine, may repeat up to a total dose of 3 mg

 4. 1 mg atropine, may repeat up to a total dose of 4 mg
Correct
AHA ACLS Provider Manual p. 70. “For Bradycardia, give
atropine 1 mg IV every 3-5 minutes.”

For transcutaneous pacing, the current milliamperes (mA) output

should be:

 1. set at 30 mA

 2. set 2 mA above capture dose

 3. set 4 mA above capture dose

 4. set no higher than capture dose
Correct
AHA ACLS Provider Manual P. 73 “Set the current milliaperes
output 2 mA above the dose at which consistent capture is
observed.” The above capture setting will vary depending upon
what type of defibrillator monitor you are using.
 For transcutaneous pacing, the demand rate should be set at:

 1. no higher than 60/min

 2. started at 60-80/min with adjustment based on clinical response

 3. started at 80/min with adjustment based on clinical response

 4. started at 100/min and reduced to minimum for clinical response
Correct
AHA ACLS Provider Manual pg. 73 (Box at the bottom of the
page): Demand rate should be set to 60/min. This can be
adjusted up or down once pacing capture is achieved.

After initiating external pacing, you should assess the carotid

pulse to confirm mechanical capture.

 1. True
 2. False
Incorrect
AHA ACLS Provider Manual P. 73 The carotid pulse should not
be assessed to confirm mechanical capture. The electrical
stimulation causes muscular jerking that may mimic the carotid
pulse.

Preparation for transcutaneous pacing (standby pacing) should be

made for which of the following?

 1. unstable sinus bradycardia

 2. third degree AV block

 3. Mobitz type II second-degree AV block

 4. all of the above
Correct
 AHA ACLS Provider Manual P 74: All of these rhythms listed can
rapidly degenerate into more serious conditions and are an
indication to ready for immediate transcutaneous pacing.

What is the infusion rate for epinephrine in the bradycardia

algorithm?

 1. 2-5 micrograms/min

 2. 2-10 micrograms/min

 3. 0.5 mg, every 3-5 min

 4. 1 mg, every 5 min
Correct
AHA ACLS Provider Manual P. 69 An alternative to pacing if
symptomatic bradycardia is unresponsive to atropine is a
chronotropic drug infusion to stimulate the heart.” For
epinephrine, initiate at 2-10 mcg/min and titrate to patient
response.

If transcutaneous pacing and drugs fail, what would be your next

intervention?

 1. defibrillation

 2. synchronized cardioversion

 3. transvenous pacing
 4. CPR
Correct
AHA ACLS Provider Manual P. 72 (At the top of the page above
figure 28)
Transvenous pacing is the placement of a temporary intravenous
pacemaker. Using a transvenous pacemaker is more effective
than TCP because electrical impedance basically eliminated. The
 electrical current flows through a wire in the vein(s) to the pacing
electrode in the heart.

The following rhythm is complete block. Which definition of

complete block is correct.

 1. One or more (but not all) of the atrial impulses fail to conduct to the
ventricles due to impaired conduction.

 2. The impulse conducting from atria to ventricles through the AV node is

delayed and travels slower than normal PR interval is lengthened beyond 0.20
seconds

 3. The impulse generated in the SA node in the atrium does not

propagate to the ventricles and there is no apparent relationship
between P waves and QRS complexes.
 4. There is no impulse generated from the SA node in the atrium but the
ventricles contract from random locations below the AV Node.
Correct
Third degree AV block or complete heart block occurs when the
impulse generated in the SA node in the atrium does not
propagate to the ventricles and there is no apparent relationship
between P waves and QRS complexes.

Identify the following rhythm.

 1. second degree block

 2. sinus bradycardia

 3. complete block
 4. sinus rhythm
Correct
AHA ACLS Provider Manual pg. 67 You can see all of the major
bradycardia rhythms that you will encounter on pg. 67. This
rhythm strip has a consistent and normal PR interval, is regular,
and the rate is slightly slower than normal.

Which of the following is not correct?

 1. second degree AV block type 1=Wenckebach

 2. complete block=third degree AV block

 3. second degree AV block type II=Mobitz I

 4. Wenckebach=Mobitz I
Correct
AHA ACLS Provider Manual P. 66
1 degree block = PR prolongation
Wenckebach = Mobitz I = 2nd degree block type 1
Hay = Mobitz II = 2nd degree block type 2
3rd degree block = complete block

Transcutaneous pacing is contraindicated in the patient with

________________.
 1. severe hypothermia

 2. hypokalemia

 3. chest pain
 4. all of the above
Incorrect
AHA ACLS Provider Manual pg. 127: “TCP is contraindicated in
severe hypothermia and is not recommended for asystole.” There
has been some literature that has show some benefits even with
severe hypothermia but at this time it remains a contraindicatio