Deck 37: Emergency Cardiovascular Life Support

Question 1

What is the first step in basic life support?

A) Open the airway.
B) Activate the EMS system.
C) Determine unresponsiveness.
D) Restore circulation.

Answer 1

C
Explanation: Check for lack of movement or response and no normal breathing or only gasping.

Question 2

After two attempts at securing the airway and ventilating an infant in respiratory arrest, you still cannot confirm adequate air movement. At this point, what should you do?

A) Provide external cardiac compressions.
B) Apply 6 to 10 strong abdominal thrusts.
C) Apply back blows, followed by chest thrusts.
D) Try to ventilate again with smaller puffs.

Answer 2

C
Explanation: If a second attempt at ventilation fails, the victim may have a foreign body airway obstruction, so proceed with the methods described on p. 797.

Question 3

What is the proper rate of external chest compressions for adults?

A) 40/min
B) 60/min
C) 80/min
D) 100/min

Answer 3

D
Explanation: Compress the sternum 2 in (5.0 cm) at a rate of 100/min.

Question 4

You enter a man's room and find him collapsed on the floor in a prone position. He is totally unresponsive, and there is no breathing. To properly institute procedures to secure his airway, what must you do first?

A) Employ the log-roll technique to obtain a proper position.
B) Try to lift the patient and place him back on the bed.
C) Go to the nursing station and get an oral intubation tray.
D) Wait for the crash cart and cardiac arrest team to arrive.

Question 5

You enter an adult woman's room and find her collapsed on the floor near the bed. When you shake her shoulder and shout, "Are you OK?" there is no response. What should your next, immediate step be?

A) Open her airway.
B) Call for help (call a code).
C) Begin chest compressions.
D) Determine pulselessness.

Question 6

Should the initial attempt to ventilate fail, which of the following actions would you suggest?

A) Reposition the victim's head and repeat the effort.
B) Place a handkerchief over the victim's mouth and continue.
C) Use the jaw thrust maneuver instead of the head-tilt and chin-lift.
D) Immediately perform the Heimlich maneuver (abdominal thrusts).

Question 7

What is the most common cause of airway obstruction in unconscious patients?

A) Foreign body lodged in the upper airway
B) Oral or nasal secretions blocking the pharynx
C) Tongue falling back into the pharynx
D) Severe spasm of the laryngeal musculature

Question 8

If an infant patient has a pulse but is not breathing, ventilation must be started immediately at what rate?

A) 5 to 6 breaths/min
B) 10 to 12 breaths/min
C) 6 to 8 breaths/min
D) 20 breaths/min

Question 9

What is the leading cause of death among adults over the age of 40 in the United States?

A) Chronic pulmonary disease
B) Sudden cardiac arrest
C) Motor vehicle trauma
D) Airway obstruction

Question 10

During properly performed external chest compression on an adult, how should the heel of the hand be positioned?

A) Three finger widths above the xiphoid tip, middle of sternum
B) Two finger widths below the manubrium, upper sternum
C) One finger width below the intermammary line, midsternal line
D) Two finger widths above the xiphoid tip, lower half of sternum

Question 11

After confirming respiratory arrest and securing the airway in a 1-year-old infant, at which of the following rates would you provide rescue breathing?

A) 12 to 20 breaths/min
B) 20 to 30 breaths/min
C) 30 to 40 breaths/min
D) 40 to 60 breaths/min

Question 12

How long should the health care provider assess for a pulse on an unresponsive patient?

A) 5 sec
B) 10 sec
C) 15 sec
D) 30 sec

Question 13

Which of the following arteries should be palpated in pulseless infants?

A) Brachial
B) Radial
C) Carotid
D) Femoral

Question 14

After successful initiation of mouth-to-mouth ventilation on an adult in respiratory arrest, you confirm the presence of a good pulse. At this point you would continue ventilation at what rate?

A) 8 to 10 breaths/min
B) 10 to 12 breaths/min
C) 12 to 15 breaths/min
D) 15 to 20 breaths/min

Question 15

When properly performed, mouth-to-mouth (expired air) ventilation provides approximately how much oxygen (O₂)?

A) 20%
B) 16%
C) 12%
D) 30%

Question 16

Which of the following statements is true about adult external cardiac compression?

A) Compressions should displace the sternum at least 3 to 4 in.
B) Compressions should occur at a rate of 60 to 80/min.
C) Compression time should at least equal the upstroke phase.
D) Compressions can be safely interrupted for up to 50 sec.

Question 17

For chest compressions to be effective, in what position must the patient be placed?

A) Horizontal prone, on a firm surface
B) Horizontal supine, on a firm surface
C) Horizontal supine, on a soft surface
D) Sitting, with the neck fully extended

Question 18

Which of the following arteries should be palpated in pulseless adults and children older than 1 year of age?

A) Brachial
B) Radial
C) Carotid
D) Femoral

Question 19

A patient with suspected spinal trauma is admitted to the emergency department and subsequently goes into respiratory arrest. Which of the following would be the appropriate action to initially secure an open airway in this patient?

A) Insert an esophageal obturator airway.
B) Apply the jaw thrust maneuver.
C) Apply the head-tilt and chin-lift method.
D) Employ the log-roll technique.

Question 20

When coming upon an accident victim outside the hospital setting who appears unconscious, what should a practitioner immediately do?

A) Tilt the head and lift the chin to open the airway.
B) Begin external cardiac (chest) compressions.
C) Look for any obvious head or neck injuries.
D) Move the victim to a flat, hard surface.

Question 21

To help open the airway of a conscious adult with complete airway obstruction, what would you do?

A) Apply back blows, followed by chest thrusts.
B) Try to ventilate the victim at a high rate.
C) Decompress the stomach with epigastric pressure.
D) Apply repeated strong abdominal thrusts.

Question 22

During single-rescuer adult CPR, what is the proper ratio of compressions to ventilation?

A) 30 compressions for every breath
B) 30 compressions for every two breaths
C) 5 compressions for every breath
D) 5 compressions for every two breaths

Question 23

What is the best way to increase CPR survival rates in the field?

A) Provide early defibrillation.
B) Start intravenous access immediately.
C) Get the patient to a hospital.
D) Immediately intubate the patient.

Question 24

During properly performed external chest compression on infants, how should the middle and index fingers be positioned?

A) One finger width above the tip of the xiphoid
B) 1.0 to 1.5 in above the tip of the xiphoid
C) 1.0 to 1.5 in below the tip of the manubrium
D) Placed just below nipple line in center of chest

Question 25

After successful resuscitation, the heart rate of neonate being ventilated with 100% O₂ drops to 50/min. What should you do now?

A) Assess the infant's peripheral pulses.
B) Begin external chest compressions at 100 or more per minute.
C) Continue to observe the infant for signs of shock.
D) Begin external chest compressions at 50/min.

Question 26

During CPR, how can you judge if ventilation is effective?

A) Observing the patient's chest rise and fall
B) Seeing the patient's pupils constrict with light
C) Feeling the return of a palpable carotid pulse
D) Hearing gurgling sounds over the epigastrium

Question 27

What is the proper ratio of external chest compressions to ventilation for a newborn?

A) 5:1
B) 3:1
C) 15:2
D) 30:5

Question 28

The automatic external defibrillator will indicate that a shock is needed if it detects which of the following rhythms?
1) Bradycardia
2) Atrial fibrillation
3) Ventricular fibrillation
4) Ventricular tachycardia

A)1 only
B)1 and 2 only
C)3 and 4 only
D)1, 2, and 3 only

Question 29

During properly performed external chest compression on infants, how much should the sternum be compressed?

A) 0.5 in
B) 1.0 in
C) 1.5 in
D) 2.0 in

Question 30

During properly performed external chest compression on children under 8 years old or on large toddlers, how much should the sternum be compressed?

A) 0.5 in
B) 1.0 in
C) 2.0 in
D) 3.0 in

Question 31

During single-rescuer CPR applied to infants or children, what is the proper ratio of compressions to ventilation?

A) 30 compressions for every breath
B) 5 compressions for every two breaths
C) 30 compressions for every two breaths
D) 5 compressions for every breath

Question 32

What is the proper rate of external chest compressions for infants?

A) 80/min
B) 100/min
C) 120/min
D) 140/min

Question 33

After successive abdominal thrusts, the patient becomes unconscious and the airway still appears obstructed. What is the next appropriate action?

A) Rescuer should move the patient to the ground, activate EMS system, and begin CPR.
B) Halt efforts to clear the airway and decompress the stomach.
C) Try to remove the obstructing material manually (finger sweep).
D) Immediately apply a series of strong back blows to the patient.

Question 34

Which of the following are major hazards associated with abdominal thrusts?
1) Rupture of abdominal viscera
2) Laceration of abdominal viscera
3) Rupture of thoracic viscera
4) Increased intracranial pressure

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 35

What is the major complication associated with manual removal of foreign material from the airway?

A) Forcing the object deeper into the airway
B) Lacerating upper airway structures
C) Causing gagging and reflex bradycardia
D) Increasing the possibility of infection

Question 36

What is the proper rate of external chest compressions for children up to puberty?

A) 80/min
B) 100/min
C) 120/min
D) 140/min

Question 37

During two-person CPR applied to an adult, what is the proper ratio of compressions to ventilation?

A) 5 compressions for every two breaths
B) 30 compressions for every breath
C) 5 compressions for every breath
D) 30 compressions for every two breaths

Question 38

Which of the following are legitimate reasons for discontinuing basic life-support measures?
1) If spontaneous breathing and a palpable pulse return
2) If a physician pronounces the arrest victim dead
3) If advanced life-support measures become available

A)2 and 3 only
B)1 and 2 only
C)1, 2, and 3
D)1 and 3 only

Question 39

How long will the apneic patient take to die without intervention?

A) 1 min
B) 3 to 5 min
C) 4 to 6 min
D) 10 to 20 min

Question 40

What is the best way to avoid gastric distention during artificial ventilation?

A) Hyperextend the neck before each artificial breath.
B) Use inspiratory breaths with low to moderate flows.
C) Apply pressure over the cricoid during inspiration.
D) Apply constant pressure to the lower abdomen.

Question 41

A patient is having frequent premature ventricular contractions and runs of ventricular tachycardia. Which of the following drugs would be considered for this patient?
1) Procainamide
2) Epinephrine HCl
3) Atropine
4) Amiodarone

A)1 and 3 only
B)2 only
C)1 and 4 only
D)2, 3, and 4 only

Question 42

Which of the following statements is true about the use of O₂ during advanced cardiac life support (ACLS)?

A) Expired air ventilation is sufficient during provision of ACLS.
B) The highest possible FiO₂ should be applied as quickly as possible.
C) Lack of O₂ (hypoxia) has little effect on other ACLS procedures.
D) An FiO₂ of 0.5 is most optimal for avoiding toxicity.

Question 43

Which of the following is the drug of choice for a patient with stable ventricular tachycardia?

A) Sodium bicarbonate
B) Amiodarone
C) Atropine
D) Epinephrine

Question 44

During CPR, a properly positioned endotracheal tube can do which of the following?
1) Isolate and protect the lower airway from aspiration.
2) Permit suctioning of the trachea and main stem bronchi.
3) Facilitate positive-pressure ventilation and oxygenation.
4) Provide a route for administration of selected drug agents.

A)1, 2, and 3 only
B)3 and 4 only
C)1, 2, 3, and 4
D)1 and 4 only

Question 45

Which of the following reasons explains why abdominal thrusts are not recommended for infants younger than 1 year?

A) Their unprotected abdomens and large livers
B) Their abdominal breathing pattern
C) Esophageal pressure less than in adults
D) Vena cava obstructed by the abdominal thrust

Question 46

What is the preferred method of securing a patent airway during CPR?

A) Oropharyngeal airway
B) Endotracheal tube
C) Tracheostomy tube
D) Nasopharyngeal airway

Question 47

When are nasopharyngeal airways contraindicated?
1) When foreign body obstruction already exists
2) In neonatal/pediatric patients
3) In cases of trauma to the nasal region
4) When the jaws of a patient cannot be separated

A)2 and 4 only
B)2 and 3 only
C)2, 3, and 4 only
D)1, 2, and 3 only

Question 48

On inspection of an electrocardiographic rhythm strip, you note the following occurring in sustained "bursts" over 2 to 3 min: a rate of 195; regular rhythm; P waves and PR intervals not easily discernible; normal QRS complexes (a few are widened). What is most likely the problem?

A) Ventricular tachycardia
B) Premature ventricular contractions
C) Atrial fibrillation
D) Supraventricular tachycardia (SVT)

Question 49

Which of the following best describes the position of a correctly sized and properly inserted oropharyngeal airway?

A) Distal tip at the base of tongue, flange inside anterior teeth
B) Distal tip at level of uvula, flange extending outside the teeth
C) Distal tip at the base of tongue, flange outside the teeth
D) Distal below the epiglottis, flange extending outside the teeth

Question 50

A patient in the emergency department exhibits signs of acute upper airway obstruction and is concurrently having severe seizures that make it impossible to open the mouth. In this case, what would be the adjunct airway of choice?

A) Oropharyngeal airway
B) Oral endotracheal tube
C) Nasopharyngeal airway
D) Tracheostomy tube

Question 51

Which of the following is false about oropharyngeal airways?

A) Incorrect placement can worsen airway obstruction.
B) They all consist of a flange, body, and channel(s).
C) They should only be used by trained personnel.
D) They are contraindicated in children and infants.

Question 52

How would you estimate the appropriate length for a nasopharyngeal airway?

A) Subtract twice the diameter of the tube from its length.
B) Measure the distance from the earlobe to the Adam's apple.
C) Apply the estimating formula: length (cm) = 15 + (age ÷ 2).
D) Measure the distance from the earlobe to the tip of the nose.

Question 53

Most sudden deaths of cardiac origin are due to which of the following?

A) Cardiac tamponade
B) Ventricular aneurysm
C) Mitral stenosis
D) Cardiac arrhythmias

Question 54

When used as an airway adjunct for CPR, an ideal mask should have which of the following characteristics?
1) Constructed of opaque material
2) Include an inlet for supplemental O₂
3) Capable of a tight seal against the face
4) Standard 15/22 mm connection

A)2 and 4 only
B)1 and 3 only
C)2, 3, and 4 only
D)1, 3, and 4 only

Question 55

How do oropharyngeal and nasopharyngeal airways help to restore airway patency?

A) Isolating or protecting the lower airway from aspiration
B) Displacing the soft palate and uvula posteriorly
C) Lifting and displacing the epiglottis anteriorly
D) Separating the tongue from the posterior pharyngeal wall

Question 56

What is the recommended upper time limit for any intubation attempt performed during CPR?

A) 10 sec
B) 30 sec
C) 60 sec
D) 90 sec

Question 57

When are oropharyngeal airways contraindicated?
1) When foreign body obstruction already exists
2) In patients who are unconscious or comatose
3) In cases of oromaxillary or mandibular trauma

A)1, 2, and 3
B)1 and 3 only
C)3 only
D)1 and 2 only

Question 58

What is the most common problem with the use of bag-valve-mask resuscitators?

A) Equipment failure
B) Nosocomial infection
C) Pulmonary barotrauma
D) Pulmonary hemorrhage

Question 59

During an attempt to insert a nasopharyngeal airway in a patient, you encounter an obstruction to further movement. What is the most appropriate action at this time?

A) Use a stylet to force the nasopharyngeal airway in place.
B) Attempt to pass the airway through the opposite naris.
C) Use a tongue depressor to push the airway posteriorly.
D) Use Magill forceps to help guide the airway in place.

Question 60

A patient with supraventricular tachycardia (SVT) at a rate of 195/min is developing symptoms of shock and unconsciousness. At this time, what would you recommend?

A) Vagal stimulation through carotid sinus massage
B) Administration of a strong beta-adrenergic agent
C) Synchronous electrical shock (cardioversion)
D) Administration of a bolus of intravenous lidocaine

Question 61

What is the primary drug agent used to treat symptomatic bradycardias?

A) Sodium nitroprusside
B) Procainamide HCl
C) Dopamine HCl
D) Atropine sulfate

Question 62

For which of the following arrhythmias is an electronic pacemaker indicated?

A) Third-degree heart block
B) Sinus tachycardia
C) First-degree heart block
D) Ventricular fibrillation

Question 63

What is the ideal route for the administration of most drugs used in emergency life-support situations?

A) Peripheral intravenous line
B) Intramuscular injection
C) Direct intracardiac injection
D) Endotracheal tube

Question 64

What is the maximum energy level for defibrillation of children and infants?

A) 1 J/kg
B) 2 J/kg
C) 3 J/kg
D) 4 J/kg

Question 65

Which of the following are differences between cardioversion and defibrillation?
1) In cardioversion, the countershock is synchronized with the R wave.
2) In defibrillation, more energy is applied.
3) In cardioversion, the countershock is synchronized with the R wave.
4) In defibrillation, more energy is applied.

A)1 only
B)1 and 2 only
C)2 only
D)3 and 4 only

Question 66

What is the initial energy level for a biphasic defibrillation of an adult patient?

A) 120 to 200 J
B) 200 to 300 J
C) 300 to 360 J
D) 400 J

Question 67

During ACLS for a 4-year-old child in ventricular fibrillation, a shockable rhythm persists after five cycles of CPR. At this time, what would you recommend?

A) Switch to synchronous countershock (cardioversion).
B) Apply one shock (4 J/kg) and resume compressions immediately.
C) Immediately deliver three to five precordial thumps.
D) Get larger paddles and apply more electrolyte gel.

Question 68

What is the primary indication for dopamine in advanced cardiac life support?

A) Ventricular tachycardia
B) Ventricular fibrillation
C) Hypotension with signs and symptoms of shock
D) Cardiogenic shock with CHF

Question 69

Causes of ventricular fibrillation include which of the following?
1) Damage to the sinoatrial node
2) Digitalis overdose
3) Severe hypoxia
4) Myocardial infarction (MI)

A)2 and 4 only
B)1, 2, and 3 only
C)2, 3, and 4 only
D)1, 3, and 4 only

Question 70

Which of the following drugs can be administered through an endotracheal tube during emergency life support?
1) Lidocaine HCl
2) Atropine sulfate
3) Epinephrine HCl
4) Dopamine HCl

A)2 and 4 only
B)1, 3, and 4 only
C)1, 2, and 3 only
D)2 and 3 only