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ACLS : Advanced Cardiac Life Support - 2025 Exam

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ACLS


Advanced Cardiac Life Support - 2025


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Question #342


A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is incubated and is receiving 100% oxygen. During the resuscitation she received 2 doses of epinephrine 1 mg, atropine 1 mg, and lidocaine 100 mg IV. You now observe the above rhythm on the cardiac monitor. The rhythm abnormality is becoming more frequent and increasing in number.

You should order:


  • Give amiodarone 300 mg IV, start infusion

    Give lidocaine 1 to 1.5 mg IV

    Repeat epinephrine 1 mg IV

    Give lidocaine 0.5 to 0.75 mg/kg IV, start lidocaine infusion

    Give amiodarone 150 mg IV, start infusion


    • Answer: D Question #343

    A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks at you for instruction. Your immediate next order is:


  • Give atropine 1 mg IV

    Resume high-quality chest compressions

    Give amiodarone 300 mg IV

    Perform endotracheal intubation

    Give epinephrine 1 mg IV


    • Answer: B Question #344

    A patient presents with the above rhythm complaining of an irregular heartbeat. She has no other complaints. Past medical history is significant for a myocardial infarction 7 years ago. Blood pressure is 110/70 mmHg. At this time you would

  • Continue monitoring and seek expert consultation

    Administer nitroglycerin 0.4 mg sublingual or spray

    Perform emergency synchronized cardioversion

    Administer lidocaine 1 mo/kg IV

    Perform elective synchronized cardioversion with presedation


    • Answer: A Question #345

    You arrive on-scene to find CPR in progress. Nursing staff report that the patient was recovering from a pulmonary embolism and suddenly collapsed. There is no pulse or spontaneous respirations. High-quality CPR is in progress, and effective ventilation is being provided with bag-mask. An IV has been initiated. You would now


  • Initiate transcutaneous pacing

    Give epinephrine 1.0 mg IV

    Order immediate endotracheal intubation

    Give atropine 0.5 mg IV

    Give atropine 1 mg IV


    • Answer: B Question #346

    A 45-year-old woman with a history of palpitations develops lightheadedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown above without conversion of the rhythm. She is now extremely apprehensive. Blood pressure is 108/70 mmHg. The next appropriate intervention is


  • Perform vagal maneuvers and repeat adenosine 6 mg IV

    Perform immediate unsynchronized cardioversion

    Repeat adenosine 12 mg IV

    Repeat adenosine 3 mg IV

    Sedate and perform synchronized cardioversion


    • Answer: C Question #347

    You arrive on-scene and find a 56-year-old diabetic woman complaining of chest discomfort. She is pale and diaphoretic, complaining

    of lightheadedness. Her blood pressure is 80/60 mmHg. The cardiac monitor documents the rhythm above. She is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. Transcutaneous pacing has been requested but is not yet available.


    Your next order is -


  • Give morphine sulfate 4 mg IV

    Start dopamine at 2 to 10 ug/kg per minute

    Give atropine 0.5 mg IV

    Give atropine 1 mg IV

    Give nitroglycerin 0.4 mg SL


    • Answer: C Question #348

    You are evaluating a patient with 15-minute duration of chest pain during transportation to the emergency department. He is receiving oxygen, and 2 sublingual nitroglycerin tablets have relieved his chest discomfort. He has no complaints but appears anxious. Blood pressure is 130/70 mmHg. You observe the above rhythm on the monitor and your next action is


  • Give atropine 0.5 mg IV

    Initiate transcutaneous pacing (TCP)

    Continue monitoring patient, prepare for TCP

    Administer nitroglycerin 0.4 mg SL

    Start epinephrine 2 to 10 ug/min and titrate


    • Answer: C Question #349

    Following resuscitation with CPR and a single shock, you observe this rhythm while preparing the patient for transport. Your patient is stable and blood pressure is

    120/80 mmHg. She is apprehensive but has no complaints other than palpitations. At this time you would


  • Give magnesium sulfate 1 to 2 g over 20 minutes

    Seek expert consultation

    Give amiodarone 300 mg IV, start infusion

    Give lidocaine 1 to 1.5 mg IV, start lidocaine infusion


    • Answer: B Question #350

    A patient in the ED develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitored rhythm becomes irregular as seen

    above. Oxygen is being administered by nasal cannula at 4 L/min and an intravenous line is patent. Blood pressure is 160/96 mmHg. There are no allergies or contraindications to any medication. You would first order


  • Lidocaine 1 mg/kg IV and infusion 2 mg/min

    Morphine sulfate 2 to 4 mg IV

    Nitroglycerin 0.4 mg SL

    Amiodarone 150 mg IV

    Intravenous nitroglycerin initiated at 10 ug/min and titrated


    • Answer: C Question #351

    This patient was admitted to the general medical ward with a history of alcoholism. A code is in progress and he has recurrent episodes of this rhythm. You review his chart. Notes about the 12- lead ECG say that his baseline QT-interval is top normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg and 1 dose of amiodarone 300 mg IV so far. For his next medication you would now order


  • Repeat amiodarone 150 mg IV

    Lidocaine 1 to 1.5 mg IV and start infusion 2 mg/minute

    Repeat amiodarone 300 mg IV

    Give magnesium sulfate 1 to 2 g IV diluted in 10 ml_ D5W given over 5 to 20 minutes

    Give sodium bicarbonate 50 mEq IV


    • Answer: D Question #352

    This patient suddenly collapsed and is poorly responsive. The patient has a weak carotid pulse. A cardiac monitor, oxygen, and an intravenous line have been initiated. The code cart with all drugs and pF transcutaneous pacer is immediately available. Next you would


  • Initiate dopamine at 10 to 20 ug/kg per minute and titrate heart rate

    Give atropine 1 mg IV up to a total dose of 3 mg

    Initiate epinephrine at 2 to 10 ug per minute and titrate heart rate

    Initiate dopamine at 2 to 10 ug/kg per minute and titrate heart rate

    Begin transcutaneous pacing


    • Answer: E Question #353

    Following initiation of CPR and one shock for VF, this rhythm is present on the next rhythm check. A second shock is given and chest compressions are immediately resumed. An IV is in place and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next order?


  • Prepare to give amiodarone 300 mg IV

    Administer 3 sequential (stacked) shocks at 360 Joules (monophasic defibrillator)

    Perform endotracheal intubation; administer 100% oxygen

    Administer 3 sequential (stacked) shocks at 200 Joules (biphasic defibrillator)

    Prepare to give epinephrine 1 mg IV


    • Answer: E Question #354

    A patient with an acute Ml on a 12-lead ECG transmitted by the paramedics has the above findings on a rhythm strip when a monitor is placed in the ED. The patient had resolution of moderate (5/10) chest pain with three doses of sublingual nitroglycerin. Blood pressure is 104/70 mmHg. Which intervention below is most important, reducing in-hospital and 30-day mortality?


  • Atropine 1 mg IV, total dose 3 mg as needed

    Intravenous nitroglycerin for 24 hours

    Reperfusion therapy

    Atropine 0.5 mg IV, total dose 2 mg as needed

    Temporary pacing


    • Answer: C


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