TheoryACLS Study Guide
Study for the ACLS with exam topics, practice questions, a free PDF, video walkthrough and timed mock exam links.
How to study for ACLS
- Read the topic list so you know what the exam is likely to cover.
- Answer the free practice questions and read every explanation.
- Download the PDF for offline review.
- Use timed mock exams when your untimed practice feels comfortable.
Topics to review
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial and physiological integrity
- Pharmacology, infection control and patient safety
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Q1For cases of significant adult bradycardia accompanied by poor perfusion, what specific medications would you administer, and at what dosages?
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✓ Correct answer: Atropine .5 mg followed by Dopamine 2-10 mcg/kg/min or Epi 2-10 mcg/min
For cases of significant adult bradycardia accompanied by poor perfusion, the correct medications to administer are Atropine followed by either Dopamine or Epinephrine, depending on the dosage.<br/><br/>Option D (none of the above) is the wrong answer because there are specific medications that should be administered in this situation.<br/><br/>Option C (Epi 0.01 mg/kg followed by Atropine 0.5 mg or Dopamine 5-10 mcg/kg/min) is incorrect because the order of administration is incorrect. Atropine should be given first, followed by either Dopamine or Epinephrine.<br/><br/>Option B (Atropine 1 mg followed by Epi 0.01 mg/kg or Dopamine 5-10 mcg/kg/min) is also incorrect because the dosage for Atropine is higher than the recommended .5 mg. Additionally, the order of administration is incorrect.<br/><br/>In summary, the correct answer is A) Atropine .5 mg followed by Dopamine 2-10 mcg/kg/min or Epi 2-10 mcg/min. This combination and dosage will help improve perfusion in cases of significant adult bradycardia.
Q2(True or False) After initiating external pacing, you should assess the carotid pulse to confirm mechanical capture.
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✓ Correct answer: False
After initiating external pacing, you should not assess the carotid pulse to confirm mechanical capture.<br/><br/>External pacing is a method of providing electrical stimulation to pace the heart and increase the heart rate in patients with symptomatic bradycardia or heart blocks that are unresponsive to medications.<br/><br/>The electrical stimulation during external pacing may cause muscular jerking that can mimic the carotid pulse, leading to a false sense of mechanical capture.<br/><br/>Instead, the provider should monitor the patient's cardiac rhythm and the presence of electrical capture on the ECG monitor. This is confirmed by observing consistent pacing spikes on the ECG tracing, which indicate that the electrical impulse is reaching the heart and causing depolarization.
Q3A 46-year-old patient arrives with complaints of fatigue and dyspnea upon exertion. Clear lung sounds and an oxygen saturation of 94% are noted. The patient's blood pressure (BP) reads 80/42, and the heart rate (HR) is 49. In response, oxygen supplementation is initiated, intravenous access is established, and the monitor exhibits the displayed rhythm (as shown below). Despite these steps, a 12-Lead ECG does not reveal any ST elevation. <br/><br/>What action should be taken as the next intervention?
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✓ Correct answer: Administer atropine 0.5 mg IV
In this scenario, the patient presents with symptoms of fatigue, difficulty breathing during physical activity, and hemodynamic instability with a blood pressure reading of 80/42 and a heart rate of 49 beats per minute. The normal lung sounds and oxygen saturation level indicate that the issue is not primarily related to respiratory function.<br/><br/>The specific rhythm displayed on the cardiac monitor is not provided, but it is mentioned that there is no ST elevation on the 12-Lead ECG, which rules out acute myocardial infarction as the cause of the symptoms.<br/><br/>With a low blood pressure and bradycardia (slow heart rate), the most likely cause of the patient's symptoms is a symptomatic bradyarrhythmia. The most appropriate intervention for symptomatic bradycardia is the administration of atropine, which increases heart rate by inhibiting the effects of the vagus nerve on the heart.<br/><br/>Option B (Begin transcutaneous pacing) is incorrect because transcutaneous pacing is usually reserved for patients with complete heart block or other forms of bradyarrhythmias that do not respond to atropine or are temporarily unstable.<br/><br/>Option C (Start dopamine infusion) is incorrect because dopamine is a vasopressor agent that is typically used to increase blood pressure in hypotensive patients, but it does not directly increase heart rate.<br/><br/>Option D (Start epinephrine infusion) is incorrect because epinephrine is also a vasopressor agent that can increase blood pressure, but it does not specifically address the bradycardia.<br/><br/>In summary, the most appropriate intervention in this case would be to administer atropine 0.5 mg IV to increase the patient's heart rate and address the symptomatic bradycardia.
Q4During the treatment of symptomatic bradycardia in an adult patient, a second IV atropine dose of 1 mg is administered. However, the patient becomes unresponsive and stops breathing. Following this, 5 cycles of high-quality CPR and ventilations are provided, followed by a rhythm check. The monitor displays an unorganized rhythm lacking identifiable QRS complexes. A monophonic defibrillator is utilized to deliver an unsynchronized shock of 360 joules, and chest compressions are resumed. During the subsequent 2-minute rhythm check, the patient remains unconscious, and you observe the rhythm depicted below. <br/><br/>What is your initial action?
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✓ Correct answer: Check for a palpable pulse
When a patient's heart rhythm becomes unstable or stops, it is important to quickly assess their condition and take appropriate action. Option A, checking for a palpable pulse, is the correct response in this situation. By checking for a pulse, you can determine if the patient's heart is still beating and if they have a circulation.<br/><br/>Option B, preparing for immediate transcutaneous pacing, is not the correct response. Transcutaneous pacing is a procedure used to treat a slow heart rate or a heart block. In this scenario, there is no indication that the patient's heart rate is slow or that they have a heart block.<br/><br/>Option C, administering atropine 1 mg IVP (intravenous push), is also an incorrect response. Atropine is commonly used to treat symptomatic bradycardia, but in this scenario, there is no indication that the patient has a slow heart rate requiring atropine administration.<br/><br/>Option D, resuming chest compressions, is not the correct response either. Chest compressions are performed during cardiopulmonary resuscitation (CPR) when a patient does not have a palpable pulse. In this scenario, the correct first step is to assess for a palpable pulse before initiating chest compressions.<br/><br/>In conclusion, option A, checking for a palpable pulse, is the correct response to this situation. It is important to first determine if the patient has a pulse before proceeding with any further interventions or treatments.
Q5For transcutaneous pacing, it is recommended to adjust the demand rate at:
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✓ Correct answer: started at 60-80/min with adjustment based on clinical response
The initial demand rate should be established at 60/min, which can subsequently be adjusted higher or lower once pacing capture is achieved.<br/><br/>Option A suggests starting at 80/min with adjustment based on clinical response, which is incorrect. Starting at a higher rate may not be appropriate and can cause unnecessary discomfort or complications for the patient. <br/><br/>Option C suggests that the demand rate should not be higher than 60/min, which is also incorrect. While some patients may require a lower demand rate, it is not a blanket recommendation for all cases. <br/><br/>Option D suggests starting at 100/min and then reducing it to a minimum based on clinical response, which is also incorrect. Starting at a higher rate and then reducing it may not be the most appropriate approach and can lead to potential complications.
Q6(True or False)<br/><br/>PEA and Asystole are both rhythms that can be treated with electrical shock.
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✓ Correct answer: False
PEA (Pulseless Electrical Activity) and Asystole are both rhythms that are considered to be cardiac arrest rhythms. However, they cannot be treated with electrical shock. <br/><br/>Option B (True): This answer choice is incorrect. PEA and asystole cannot be treated with electrical shock, so the statement is false.
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