ACLS Practice Test: Video 1 Answers (25 Questions) — Questions and Answers

Question 1: When eligible stroke patients are treated with fibrinolytics, the following objectives are pursued:

Within 6 hours of arrival to the ED
Within 4 hours of arrival to the ED
Within 1 hour of arrival to the ED (Correct answer)
Within 3 hours of arrival to the ED

Correct answer: Within 1 hour of arrival to the ED

For eligible acute ischemic stroke patients, the objective for administering intravenous fibrinolytics (thrombolytics) is within 1 hour of arrival to the emergency department (door-to-needle time). This rapid treatment is critical to dissolve the clot and restore blood flow to the brain, thereby minimizing neurological damage and improving patient outcomes.

Question 2: Following a cardiac arrest, hypotension is not treated with:

IV dopamine infusion
IV calcium infusion (Correct answer)
IV Ringer’s lactate or IV normal saline
IV epinephrine infusion

Correct answer: IV calcium infusion

Following a cardiac arrest, hypotension is typically treated with intravenous fluids (such as Ringer’s lactate or normal saline) and vasopressor infusions like dopamine or epinephrine to support blood pressure and organ perfusion. Intravenous calcium infusion is not a standard treatment for post-cardiac arrest hypotension, although it may be used in specific circumstances like hyperkalemia or calcium channel blocker overdose.

Question 3: A post-cardiac arrest patient is being prepared for targeted temperature management. Which complication should be closely monitored?

Respiratory alkalosis
Hyperthermia rebound
Coagulopathy and shivering (Correct answer)
Hypertension and bradycardia only

Correct answer: Coagulopathy and shivering

TTM can cause coagulopathy, shivering (which raises temperature and metabolic demand), bradycardia, and electrolyte shifts requiring monitoring.

Question 4: The best method for treating narrow-complex supraventricular tachycardia is:

Amiodarone
Atropine
Adenosine (Correct answer)
Epinephrine

Correct answer: Adenosine

Adenosine is the first-line pharmacologic treatment for stable narrow-complex supraventricular tachycardia (SVT) that does not respond to vagal maneuvers. It works by transiently blocking AV nodal conduction, which often terminates the re-entrant pathway responsible for SVT. Its rapid onset and short duration of action make it ideal for this condition.

Question 5: A patient develops torsades de pointes. Which treatment is specifically indicated for this arrhythmia?

Atropine 0.5 mg IV
Adenosine 6 mg IV push
Magnesium sulfate 1–2 g IV (Correct answer)
Amiodarone 300 mg IV

Correct answer: Magnesium sulfate 1–2 g IV

Magnesium sulfate is the treatment of choice for torsades de pointes, which is often associated with hypomagnesemia or QT prolongation.

Question 6: A 58-year-old patient has a heart rate of 190 bpm with a wide QRS complex and is pulseless. What is the correct action?

Synchronized cardioversion at 120 J
Defibrillation and CPR per VF/pVT algorithm (Correct answer)
Adenosine 6 mg IV push
Amiodarone 300 mg IV bolus

Correct answer: Defibrillation and CPR per VF/pVT algorithm

A pulseless wide-complex tachycardia is treated as ventricular fibrillation/pulseless VT — defibrillation and CPR per cardiac arrest algorithm.

Question 7: In the ACLS tachycardia algorithm, which condition requires treatment regardless of symptoms due to inherent risk?

Sinus tachycardia at 105 bpm
Ventricular tachycardia at 200 bpm even if stable (Correct answer)
Atrial fibrillation with ventricular rate of 90 bpm
Junctional rhythm at 55 bpm

Correct answer: Ventricular tachycardia at 200 bpm even if stable

Ventricular tachycardia at high rates carries risk of deterioration to VF and warrants prompt treatment even in stable patients.

Question 8: A patient has sinus bradycardia at 48 bpm but is awake, alert, with BP 118/76 and no symptoms. What is the correct ACLS management?

Transcutaneous pacing
Atropine 0.5 mg IV immediately
Dopamine infusion at 5 mcg/kg/min
Observation — no treatment required (Correct answer)

Correct answer: Observation — no treatment required

Asymptomatic bradycardia without hemodynamic compromise does not require intervention in the ACLS algorithm.

Question 9: Which energy setting is recommended for synchronized cardioversion of atrial flutter?

360 J
200 J
120–200 J
50–100 J (Correct answer)

Correct answer: 50–100 J

Atrial flutter typically responds to lower energy levels (50–100 J) for synchronized cardioversion compared to atrial fibrillation.

Question 10: What is the recommended initial dose of dopamine infusion for hemodynamically significant bradycardia when atropine fails?

15–20 mcg/kg/min
0.1–0.5 mcg/kg/min
2–10 mcg/kg/min (Correct answer)
1–2 mcg/kg/min

Correct answer: 2–10 mcg/kg/min

Dopamine is initiated at 2–10 mcg/kg/min as a chronotropic agent for symptomatic bradycardia refractory to atropine.

Question 11: Which electrolyte abnormality is most commonly associated with recurrent ventricular fibrillation after ROSC?

Hypomagnesemia (Correct answer)
Hypernatremia
Hypercalcemia
Hyperphosphatemia

Correct answer: Hypomagnesemia

Hypomagnesemia lowers the threshold for ventricular fibrillation and should be corrected in post-arrest patients.

Question 12: When should neurological prognostication be performed after targeted temperature management in a post-cardiac arrest patient?

Immediately after ROSC
After 48 hours of normothermia if sedation is minimal
At least 72 hours after return to normothermia (Correct answer)
Within 24 hours of ROSC

Correct answer: At least 72 hours after return to normothermia

Prognostication should be deferred until at least 72 hours after normothermia to allow sedation and TTM effects to clear.

Question 13: Which vasopressor is considered first-line for refractory hypotension (MAP <65 mmHg) in post-cardiac arrest syndrome?

Norepinephrine (Correct answer)
Epinephrine alone
Dopamine
Vasopressin alone

Correct answer: Norepinephrine

Norepinephrine is the preferred vasopressor for post-arrest hemodynamic support due to its alpha-adrenergic potency with less tachycardia than dopamine.

Question 14: A post-arrest patient undergoes CT brain showing diffuse cerebral edema with loss of gray-white differentiation. This finding suggests:

Severe anoxic brain injury with poor prognosis (Correct answer)
Reversible cerebral vasospasm
Hypertensive encephalopathy responding to treatment
Normal appearance in the setting of hypothermia

Correct answer: Severe anoxic brain injury with poor prognosis

Diffuse cerebral edema with gray-white matter blurring on CT indicates severe anoxic injury and portends a poor neurological outcome.

Question 15: Which clinical sign at 72 hours post-arrest, when combined with other predictors, is associated with poor neurological prognosis?

Eye opening to voice
Presence of cough reflex
Localizing motor response to pain
Absent pupillary light reflex bilaterally (Correct answer)

Correct answer: Absent pupillary light reflex bilaterally

Bilaterally absent pupillary light reflexes at 72 hours are a strong multimodal indicator of poor neurological prognosis after cardiac arrest.

Question 16: What is the maximum single dose of aspirin recommended for initial ACS treatment in the prehospital or ED setting?

650 mg
500 mg
162–325 mg (Correct answer)
81 mg

Correct answer: 162–325 mg

The recommended initial aspirin dose for suspected ACS is 162–325 mg (non-enteric coated) chewed as soon as possible.

Question 17: Which of the following is the preferred reperfusion strategy for STEMI if PCI can be performed within 90 minutes of first medical contact?

Coronary artery bypass grafting
Fibrinolytic therapy
Primary percutaneous coronary intervention (Correct answer)
Intravenous nitroglycerin infusion

Correct answer: Primary percutaneous coronary intervention

Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed within 90 minutes of first medical contact at a PCI-capable center.

Question 18: A patient presents with ACS and is found to have a history of prior intracranial hemorrhage. Which antiplatelet agent should be AVOIDED?

Aspirin 81 mg
Ticagrelor
Prasugrel (Correct answer)
Clopidogrel

Correct answer: Prasugrel

Prasugrel is contraindicated in patients with a history of stroke or TIA due to significantly increased risk of intracranial hemorrhage.

Question 19: A patient with STEMI develops cardiogenic shock. Which intervention has the strongest evidence for improving mortality?

Immediate surgical revascularization
Intra-aortic balloon pump placement
Emergency primary PCI (Correct answer)
High-dose vasopressor infusion alone

Correct answer: Emergency primary PCI

Emergency revascularization with primary PCI is the only intervention shown to reduce mortality in STEMI complicated by cardiogenic shock.

Question 20: Which of the following is an absolute contraindication to fibrinolytic therapy in STEMI?

Prior ischemic stroke more than 3 months ago
Age over 75 years
Active internal bleeding or bleeding diathesis (Correct answer)
Uncontrolled hypertension treated with medication

Correct answer: Active internal bleeding or bleeding diathesis

Active internal bleeding or bleeding diathesis is an absolute contraindication to fibrinolytic therapy due to the risk of life-threatening hemorrhage.

Question 21: How long should a child be suctioned for in order to prevent hypoxia?

12-15 seconds
10 - 15 seconds
5-10 seconds (Correct answer)
8-10 seconds

Correct answer: 5-10 seconds

Suctioning removes oxygen from the airway along with secretions, which can quickly lead to hypoxia, especially in children who have smaller lung volumes. To minimize the risk of desaturation and adverse effects, each suctioning attempt in a child should be limited to a brief duration, typically 5-10 seconds.

Question 22: Which of the following lung sounds is/are most likely to be audible while auscultating the lung(s) in areas of a tension pneumothorax?

Absent or decreased breath sounds. (Correct answer)
Wheezing and cracking.
High-pitched whistle.
Labored breath sounds.

Correct answer: Absent or decreased breath sounds.

In a tension pneumothorax, air accumulates in the pleural space, causing the lung on the affected side to collapse and preventing air movement. When auscultating the chest, this lack of air movement results in absent or significantly decreased breath sounds over the affected lung field. While the patient will exhibit labored breathing, the sounds directly from the lung itself will be diminished.

Question 23: What are the reflections of preload, cardiac contractility, and afterload?

Heart volume
Blood volume
Stroke count
Stroke volume (Correct answer)

Correct answer: Stroke volume

Stroke volume is the amount of blood ejected by the ventricle with each heartbeat, and it is a direct reflection of the heart's pumping efficiency. It is determined by three key factors: preload (the stretch on the heart muscle before contraction), cardiac contractility (the force of the contraction), and afterload (the resistance the heart must overcome to eject blood).

Question 24: Peripheral edema is a sign of heart issues in a patient. What kind of congestion would you expect to see?

Low blood pressure
Congestion outside the systemic venous circulation
High blood pressure
Congestion in the systemic venous circulation (Correct answer)

Correct answer: Congestion in the systemic venous circulation

Peripheral edema, especially in the lower extremities, is a classic sign of right-sided heart failure. When the right ventricle fails to pump blood effectively, blood backs up into the systemic venous circulation. This increased pressure in the veins forces fluid out of the capillaries and into the surrounding tissues, causing visible swelling.

Question 25: When should 50% dextrose be avoided absent a diagnosis of hypoglycemia?

Both A and B (Correct answer)
Stroke
Head Trauma
Neither A nor B

Correct answer: Both A and B

Administering hypertonic dextrose (D50) to patients with suspected stroke or head trauma, in the absence of confirmed hypoglycemia, can be detrimental. The dextrose can exacerbate cerebral edema and increase intracranial pressure, potentially worsening neurological injury. Therefore, D50 should only be given in these specific situations if hypoglycemia is definitively diagnosed.

ACLS Practice Test: Video 1 Answers (25 Questions)

When eligible stroke patients are treated with fibrinolytics, the following objectives are pursued:

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