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Advanced Cardiovascular
Life Support
Written Exams
Contents:
Exam Memo
Student Answer Sheet
Version C Exam
Version C Answer Key
Version C Reference Sheet
Version D Exam
Version D Answer Key
Version D Reference Sheet
July 2013
Introduction The 2011 ACLS Provider Course includes both skills tests and a written
exam. The written exam measures the mastery of cognitive skills. The 2013
written exam replaces the 2011 written exam and must be used with the 2011
course materials, ie, Provider Manual, course video, and Instructor Manual.
Remediation All students deserve remediation on topics in which they are not confident
and topics they have not mastered.
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.
July 2013
ANSWER SHEET
Advanced Cardiovascular Life Support
Written Exam
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ECC
Advanced Cardiovascular
Life Support
Written Exam
Version C
July 2013
Please do not mark on this exam. Record the best answer on the separate answer sheet.
1. 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?
2. 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
A. 60 to 80 per minute
B. 80 to 100 per minute
C. About 100 per minute
D. At least 100 per minute
4. Which action improves the quality of chest compressions delivered during a resuscitation
attempt?
5. 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
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
6. What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in
place?
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
8. 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
9. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac
arrest?
10. 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
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
12. 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
13. 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
14. Which treatment or medication is appropriate for the treatment of a patient in asystole?
A. Atropine
B. Epinephrine
C. Defibrillation
D. Transcutaneous pacing
15. 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
16. 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
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
17. 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
18. 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
19. 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. Unwitnessed arrest
B. Safety threat to providers
C. Patient age greater than 85 years
D. No return of spontaneous circulation after 10 minutes of CPR
21. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles?
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
23. Which of the following is an acceptable method of selecting an appropriately sized
oropharyngeal airway (OPA)?
24. 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
25. 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.
26. What should be done to minimize interruptions in chest compressions during CPR?
27. What survival advantages does CPR provide to a patient in ventricular fibrillation?
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
28. A patient with pulseless ventricular tachycardia is defibrillated. What is the next action?
29. 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
30. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate
of 80/min?
31. 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?
32. Which is an appropriate and important intervention to perform for a patient who achieves
ROSC during an out-of-hospital resuscitation?
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
33. 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. 10 seconds or less
B. 10 to 15 seconds
C. 15 to 20 seconds
D. Interruptions are never acceptable
35. What is the danger of routinely administering high concentrations of oxygen during the post–
cardiac arrest period for patients who achieve ROSC?
37. What is the usual post–cardiac arrest target range for PETCO2 when ventilating a patient who
achieves 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
38. 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
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
39. Which rhythm requires synchronized cardioversion?
40. What is the purpose of a medical emergency team (MET) or rapid response team (RRT)?
41. An activated AED does not promptly analyze the rhythm. What is your next action?
42. 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.
43. 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
44. 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
D. Synchronized cardioversion
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
45. 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
46. A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the
following lead II ECG rhythm:
A. Defibrillation
B. Amiodarone 150 mg IV
C. Adenosine 6 mg IV push
D. Synchronized cardioversion
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
47. 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.
A. Sinus tachycardia
B. Perfusing ventricular tachycardia
C. Stable supraventricular tachycardia
D. Unstable supraventricular tachycardia
48. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm:
A. Defibrillation
B. Adenosine 6 mg IV push
C. Epinephrine 1 mg IV push
D. Synchronized cardioversion
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
49. A patient has sudden onset of dizziness. The patient’s heart rate is 160/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:
A. Vagal maneuvers
B. Metoprolol 5 mg IV
C. Adenosine 6 mg IV
D. Normal saline 1 L bolus
50. 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?
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Advanced Cardiovascular Life Support Written Exam Version C, July 2013
© 2013 American Heart Association
2013 WRITTEN EXAM C
Answer Key
Advanced Cardiovascular Life Support
Question Answer
1. A ● C D
2. A ● C D
3. A B C ●
4. A B C ●
5. A B ● D
6. A ● C D
7. ● B C D
8. A B C ●
9. ● B C D
10. A ● C D
11. A ● C D
12. A B C ●
13. A ● C D
14. A ● C D
15. A B ● D
16. A B C ●
17. A B C ●
18. ● B C D
19. A B C ●
20. A ● C D
21. A B ● D
22. A B C ●
23. A B C ●
24. ● B C D
25. A ● C D
Advanced Cardiovascular
Life Support
Written Exam
Version D
July 2013
Please do not mark on this exam. Record the best answer on the separate answer sheet.
A. Early defibrillation
B. Advanced airway management
C. Rapid medication administration
D. Preparation for therapeutic hypothermia
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. 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?
4. 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
5. What is the initial priority for an unconscious patient with any tachycardia on the monitor?
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Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
6. 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 in the left arm, 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
7. 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?
9. 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
10. An AED advises a shock for a pulseless patient lying in snow. What is the next action?
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Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
11. 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?
12. 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?
13. 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
14. What is the immediate danger of excessive ventilation during the post–cardiac arrest period
for patients who achieve return of spontaneous circulation (ROSC)?
A. Oxygen toxicity
B. Pulmonary hypertension
C. Decreased cerebral blood flow
D. Ventilation/perfusion mismatch
15. Which action increases the chance of successful conversion of ventricular fibrillation?
16. What is the BEST strategy for performing high-quality CPR on a patient with an advanced
airway in place?
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Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
17. 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?
19. What is the primary purpose of a medical emergency team (MET) or rapid response team
(RRT)?
20. 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?
21. 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?
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Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
22. What is a common but sometimes fatal mistake in cardiac arrest management?
23. 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
24. 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
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. A postoperative patient in the ICU reports new chest pain. What actions have the highest
priority?
27. What action is recommended to help minimize interruptions in chest compressions during
CPR?
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Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
28. 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
31. 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.
32. What is the recommended assisted ventilation rate for patients in respiratory arrest with a
perfusing rhythm?
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
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Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
34. Which is a safe and effective practice within the defibrillation sequence?
35. What is the appropriate procedure for endotracheal tube suctioning after the appropriate
catheter is selected?
36. 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
38. 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 - 0.5 mcg/kg per min IV infusion
C. 1 mg IV push every 3 to 5 minutes
D. 10 mg IV push every 3 to 5 minutes
39. 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
8
Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
40. 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?
41. 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
42. 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
43. 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
44. What is the recommendation on the use of cricoid pressure to prevent aspiration during
cardiac arrest?
9
Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
45. 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?
46. 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
10
Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
47. 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?
48. 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:
A. Aspirin
B. Atropine
C. Lidocaine
D. Nitroglycerin
11
Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
49. A 53-year-old man has 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?
50. 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
12
Advanced Cardiovascular Life Support Written Exam Version D, July 2013
© 2013 American Heart Association
2013 WRITTEN EXAM D
Answer Key
Advanced Cardiovascular Life Support
Question Answer
1. ● B C D
2. A B C ●
3. A B ● D
4. A B ● D
5. A B ● D
6. ● B C D
7. A B C ●
8. A ● C D
9. A ● C D
10. A B C ●
11. A B ● D
12. A B C ●
13. A B ● D
14. A B ● D
15. A B C ●
16. A B C ●
17. ● B C D
18. A ● C D
19. ● B C D
20. A B C ●
21. ● B C D
22. A B C ●
23. A B ● D
24. A ● C D
25. A ● C D