ACLS precourse self-assessment: practice all three sections

1. Card 01 / 18Rhythm recognition

   In a ventricular tachycardia, what is the relationship of the QRS complex to the preceding electrical activity?

   1. AThe PR interval is shortened, and beats are conducted rapidly to the ventricles.
   2. BNo QRS complexes are observed, only P waves.
   3. CQRS complexes are normal in width and consistently follow the P waves.
   4. DThe QRS complexes are wide and occur independently of the P waves.

   Explanation

   Keyed answerD. The QRS complexes are wide and occur independently of the P waves.

   Your pickA. The PR interval is shortened, and beats are conducted rapidly to the ventricles. ww

   In a ventricular tachycardia, the QRS complexes are typically wide and occur independently of the P waves. In this condition, the ventricles contract at a rapid rate due to autonomously active ectopic foci in the ventricles, leading to a disruption in the normal rhythm. This differs from conditions like atrial fibrillation, where the QRS duration is normal but rhythm irregularity is high.

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2. Card 02 / 18Rhythm recognition

   What is a characteristic feature that helps distinguish atrial flutter from atrial fibrillation on an EKG?

   1. AIn atrial flutter, P waves are completely absent.
   2. BIn atrial flutter, the ventricular rate is extremely rapid and irregular.
   3. CAtrial flutter exhibits irregularly irregular RR intervals.
   4. DAtrial flutter shows a 'sawtooth' pattern of atrial activity.

   Explanation

   Keyed answerD. Atrial flutter shows a 'sawtooth' pattern of atrial activity.

   Your pickB. In atrial flutter, the ventricular rate is extremely rapid and irregular. ww

   In atrial flutter, the atria beat at a rapid but regular rate typically creating a distinctive 'sawtooth' pattern on the EKG. This is the primary difference from atrial fibrillation, where the atria beat irregularly, leading to an irregularly irregular ventricular rhythm without a characteristic 'sawtooth' pattern.

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3. Card 03 / 18Rhythm recognition

   In an EKG reading, if the atrial rate is measured at 75 bpm and the ventricular rate is recorded at 45 bpm, what condition is likely present?

   1. AAtrial fibrillation
   2. BSinus tachycardia
   3. CAV block
   4. DVentricular fibrillation

   Explanation

   Keyed answerC. AV block

   Your pickD. Ventricular fibrillation ww

   An AV block occurs when there is a delay or complete block in the conduction between the atria and ventricles. This results in the atria and ventricles beating independently, with the ventricular rate usually being slower than the atrial rate.

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4. Card 04 / 18Rhythm recognition

   Which of the following is true regarding ventricular pacing?

   1. AWhen the pacemaker fires, the QRS complex is replaced by a sharp spike.
   2. BWhen the pacemaker fires, a spike will be recorded preceding the QRS complex.
   3. CWhen the pacemaker fires, a spike will be recorded following the QRS complex.
   4. DWhen the pacemaker fires, a spike will be recorded following the P wave.

   Explanation

   Keyed answerB. When the pacemaker fires, a spike will be recorded preceding the QRS complex.

   Your pickC. When the pacemaker fires, a spike will be recorded following the QRS complex. ww

   A ventricular pacemaker sends a signal to the ventricles to help maintain a regular heart rate. When the pacemaker fires, a sharp spike will appear before the QRS complex. With an atrial pacemaker, a sharp spike will precede the P wave.

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5. Card 05 / 18Rhythm recognition

   Which of the following statements is true about the presentation of a first-degree heart block?

   1. APR intervals are prolonged
   2. BFlutter waves are regular
   3. CQRS intervals are significantly wider
   4. DIt is characterized by rapid and irregular heart rhythms

   Explanation

   Keyed answerA. PR intervals are prolonged

   Your pickD. It is characterized by rapid and irregular heart rhythms ww

   In a first-degree heart block, the PR interval is consistently longer than 0.20 seconds. The QRS interval typically remains less than 0.12 seconds, and the rhythm remains regular. Unlike flutter waves or irregular rhythms seen in other conditions, first-degree heart block has distinct characteristics.

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6. Card 06 / 18Rhythm recognition

   What is the intrinsic rate of ventricular escape rhythm?

   1. A30-50 bpm
   2. B60-80 bpm
   3. C40-60 bpm
   4. D20-40 bpm

   Explanation

   Keyed answerD. 20-40 bpm

   Your pickA. 30-50 bpm ww

   A ventricular escape rhythm, also known as an idioventricular rhythm, typically has an intrinsic rate of 20-40 bpm.

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7. Card 07 / 18Pharmacology

   Which medication used in the management of tachyarrhythmias carries a significant risk of causing torsades de pointes?

   1. ADiltiazem
   2. BMetoprolol
   3. CAdenosine
   4. DSotalol

   Explanation

   Keyed answerD. Sotalol

   Your pickB. Metoprolol ww

   Sotalol, a class III antiarrhythmic, carries a significant risk of QT prolongation and torsades de pointes, particularly at higher doses or in patients with electrolyte abnormalities, renal dysfunction, or other risk factors for QT prolongation.

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8. Card 08 / 18Pharmacology

   What is the correct dose of amiodarone for treating stable wide-complex ventricular tachycardia?

   1. A300 mg IV push
   2. B450 mg IV over 10 minutes
   3. C150 mg IV over 10 minutes
   4. D150 mg IV push

   Explanation

   Keyed answerC. 150 mg IV over 10 minutes

   Your pickB. 450 mg IV over 10 minutes ww

   For stable ventricular tachycardia, amiodarone is administered at 150 mg IV over 10 minutes, which can be repeated as needed, followed by an infusion of 1 mg/min for 6 hours.

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9. Card 09 / 18Pharmacology

   Which key pharmacologic property makes epinephrine the first‐line vasopressor in ACLS protocols?

   1. AIts beta-1 effect that reduces myocardial oxygen consumption while lowering coronary vascular resistance.
   2. BIts alpha-adrenergic mediated vasoconstriction that improves coronary perfusion.
   3. CIts exclusive beta-blocking effects on the myocardium.
   4. DIts long-lasting duration which prevents re-dosing.

   Explanation

   Keyed answerB. Its alpha-adrenergic mediated vasoconstriction that improves coronary perfusion.

   Your pickA. Its beta-1 effect that reduces myocardial oxygen consumption while lowering coronary vascular resistance. ww

   Epinephrine's potent alpha-adrenergic effects cause peripheral vasoconstriction, increasing coronary and cerebral perfusion during CPR.

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10. Card 10 / 18Pharmacology

    Which of the following best describes the mechanism of action of adenosine in terminating AVNRT (AV nodal reentrant tachycardia)?

    1. ASustained increase in sinus node discharge rate
    2. BLong-term suppression of ventricular automaticity
    3. CTemporary AV nodal blockade that interrupts the reentry circuit
    4. DPermanent destruction of accessory pathways

    Explanation

    Keyed answerC. Temporary AV nodal blockade that interrupts the reentry circuit

    Your pickB. Long-term suppression of ventricular automaticity ww

    Adenosine works by temporarily blocking the AV node, which interrupts the reentry circuit in AVNRT. Its ultra-short half-life (less than 10 seconds) makes it effective for acute termination with minimal prolonged side effects.

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11. Card 11 / 18Pharmacology

    After administration of IV adenosine, why is a rapid saline flush recommended?

    1. ATo improve renal clearance of adenosine
    2. BTo rapidly deliver the drug to the heart because of its short half-life
    3. CTo slow its metabolism deliberately
    4. DTo dilute the drug in the vein and decrease flushing, chest tightness and other side effects

    Explanation

    Keyed answerB. To rapidly deliver the drug to the heart because of its short half-life

    Your pickD. To dilute the drug in the vein and decrease flushing, chest tightness and other side effects ww

    Adenosine has an extremely short half-life, so a rapid saline flush ensures the drug quickly reaches the heart before it is metabolized, maximizing its efficacy.

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12. Card 12 / 18Pharmacology

    Which of the following pharmacological interventions is correctly matched with its primary function in ACLS?

    1. AAmiodarone - Antiarrhythmic for ventricular arrhythmias
    2. BCalcium chloride - Routine administration in asystole
    3. CSodium bicarbonate - First-line treatment for metabolic acidosis during cardiac arrest
    4. DAtropine - First-line vasopressor for cardiac arrest

    Explanation

    Keyed answerA. Amiodarone - Antiarrhythmic for ventricular arrhythmias

    Your pickC. Sodium bicarbonate - First-line treatment for metabolic acidosis during cardiac arrest ww

    Amiodarone's primary function in ACLS is as an antiarrhythmic agent for ventricular arrhythmias. It is used for ventricular fibrillation or pulseless ventricular tachycardia that is refractory to defibrillation, CPR, and vasopressor therapy.

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13. Card 13 / 18Practical application

    Why is early recognition of agonal breathing critical during a BLS assessment?

    1. AIt means the airway is partially open.
    2. BIt is a normal breathing variant in unconscious patients and does not require immediate CPR.
    3. CIt is a sign of cardiac arrest that necessitates immediate initiation of CPR.
    4. DIt indicates the patient is beginning to recover.

    Explanation

    Keyed answerC. It is a sign of cardiac arrest that necessitates immediate initiation of CPR.

    Your pickB. It is a normal breathing variant in unconscious patients and does not require immediate CPR. ww

    Agonal breathing is an abnormal and ineffective respiratory pattern that indicates cardiac arrest; prompt recognition ensures that CPR is initiated immediately.

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14. Card 14 / 18Practical application

    What is the recommended approach for treating hypotension in a post-cardiac arrest patient?

    1. AImmediate administration of high-dose vasopressors
    2. BIV fluid administration followed by vasopressors if needed
    3. CAdministration of calcium channel blockers
    4. DAdministration of beta-blockers

    Explanation

    Keyed answerB. IV fluid administration followed by vasopressors if needed

    Your pickA. Immediate administration of high-dose vasopressors ww

    The recommended approach for treating hypotension in a post-cardiac arrest patient is to administer IV fluids first, followed by vasopressors if needed. This two-step approach addresses potential hypovolemia first before adding pharmacological support for vascular tone.

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15. Card 15 / 18Practical application

    What potential complication in the post-resuscitation phase is most directly linked to hyperventilation after ROSC?

    1. AExacerbation of pulmonary edema
    2. BCerebral vasoconstriction leading to reduced cerebral perfusion
    3. CAugmentation of metabolic acidosis through excessive carbon dioxide retention
    4. DIncreased myocardial oxygen consumption

    Explanation

    Keyed answerB. Cerebral vasoconstriction leading to reduced cerebral perfusion

    Your pickC. Augmentation of metabolic acidosis through excessive carbon dioxide retention ww

    Excessive ventilation can lead to a decrease in CO2, which causes cerebral vasoconstriction and subsequently reduces cerebral perfusion.

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16. Card 16 / 18Practical application

    When a resuscitation team transitions from one algorithm to another (e.g., VF to PEA), what is the most important team dynamic to maintain?

    1. AClear, explicit communication about the new rhythm and algorithm change
    2. BAllowing only the team leader to announce treatment changes
    3. CPausing all interventions while everyone reviews the new algorithm
    4. DMaintaining the same team roles despite the new algorithm

    Explanation

    Keyed answerA. Clear, explicit communication about the new rhythm and algorithm change

    Your pickC. Pausing all interventions while everyone reviews the new algorithm ww

    Clear, explicit communication about the new rhythm and algorithm change ensures all team members simultaneously shift their focus and actions appropriately. This prevents some team members from continuing with the previous algorithm while others move to the new one.

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17. Card 17 / 18Practical application

    For a COPD patient with stable narrow‐complex tachycardia refractory to adenosine, what alternative rate control strategy should be considered?

    1. AConsider using a calcium channel blocker while carefully monitoring hemodynamics
    2. BProceed directly to electrical cardioversion
    3. CUse a non-selective beta-blocker
    4. DAdminister a higher 18 mg dose of adenosine and repeat it until the rhythm finally converts

    Explanation

    Keyed answerA. Consider using a calcium channel blocker while carefully monitoring hemodynamics

    Your pickD. Administer a higher 18 mg dose of adenosine and repeat it until the rhythm finally converts ww

    Non-selective beta-blockers are avoided in COPD due to bronchoconstriction risks; hence, a calcium channel blocker or alternative agent with minimal pulmonary effects is preferred.

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18. Card 18 / 18Practical application

    A patient presents with new-onset left-sided weakness and facial droop. The last known normal time was 2 hours ago. What is the first step in evaluation?

    1. APerform a rapid neurological assessment using a validated stroke scale
    2. BOrder an MRI with diffusion-weighted imaging
    3. CConsult neurosurgery before any other steps
    4. DAdminister aspirin 325 mg immediately, before any imaging or neurological assessment

    Explanation

    Keyed answerA. Perform a rapid neurological assessment using a validated stroke scale

    Your pickD. Administer aspirin 325 mg immediately, before any imaging or neurological assessment ww

    For patients presenting with acute stroke symptoms, the first step is to perform a rapid neurological assessment using a validated stroke scale like FAST, CPSS, or NIHSS to confirm the clinical suspicion of stroke before proceeding to neuroimaging and other interventions.

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19. Score card

    0%

    Answer a few cards and come back to this one.

    • Rhythm recognitionnot yet
    • Pharmacologynot yet
    • Practical applicationnot yet

    The thin line on each bar marks 70%, the line the AHA precourse self-assessment asks you to clear before class.

    Shuffle back to card 1

Pick an answer and the card turns over to the explanation. Keys: A to D or 1 to 4, arrows to move, F to turn the card.