MCQ Quiz: Acute Arrhythmias

The management of acute arrhythmias and cardiac arrest represents the pinnacle of time-sensitive, high-stakes patient care. As integral members of the resuscitation team, pharmacists must have an immediate and expert command of the Advanced Cardiovascular Life Support (ACLS) algorithms and the pharmacology of emergency medications. The Patient Care VII curriculum dedicates a crucial unit to “Acute Arrhythmias, ACLS” to ensure future pharmacists can perform confidently and competently in these critical situations. This quiz will test your knowledge on the recognition and management of life-threatening arrhythmias, from symptomatic bradycardia to pulseless ventricular fibrillation.

1. A patient is found to be in pulseless ventricular tachycardia (pVT). According to the ACLS algorithm, this is considered a:

• a) Non-shockable rhythm
• b) Shockable rhythm
• c) Stable rhythm
• d) Benign rhythm Answer: b) Shockable rhythm

2. What is the immediate priority after initiating CPR for a patient in ventricular fibrillation (VF)?

• a) Administering epinephrine
• b) Establishing IV access
• c) Defibrillation
• d) Intubation Answer: c) Defibrillation

3. As per the ACLS cardiac arrest algorithm, what is the standard dose and frequency of epinephrine for an adult in asystole?

• a) 0.5 mg every 1-2 minutes
• b) 1 mg every 3-5 minutes
• c) 3 mg as a single dose
• d) 5 mg every 5-10 minutes Answer: b) 1 mg every 3-5 minutes

4. A patient with a regular, narrow-complex tachycardia at a rate of 180 bpm becomes hypotensive and acutely altered. What is the indicated treatment?

• a) Vagal maneuvers
• b) Administration of adenosine
• c) Immediate synchronized cardioversion
• d) Administration of a beta-blocker Answer: c) Immediate synchronized cardioversion

5. What is the first-line drug for the management of symptomatic bradycardia?

• a) Amiodarone
• b) Atropine
• c) Epinephrine
• d) Adenosine Answer: b) Atropine

6. For a patient in refractory ventricular fibrillation after two shocks and a dose of epinephrine, what is the recommended first dose of amiodarone?

• a) 150 mg IV push
• b) 300 mg IV push
• c) 1 mg/min infusion
• d) 1 mg IV push Answer: b) 300 mg IV push

7. Adenosine is used to treat stable supraventricular tachycardia (SVT). Due to its extremely short half-life, how must it be administered?

• a) As a slow IV infusion over 10 minutes
• b) As a rapid IV push followed immediately by a saline flush
• c) As an intramuscular injection
• d) As a sublingual tablet Answer: b) As a rapid IV push followed immediately by a saline flush

8. Which of the following are considered non-shockable rhythms in a pulseless patient?

• a) Ventricular Fibrillation and Ventricular Tachycardia
• b) Atrial Fibrillation and Atrial Flutter
• c) Asystole and Pulseless Electrical Activity (PEA)
• d) Sinus Bradycardia and Sinus Tachycardia Answer: c) Asystole and Pulselse Electrical Activity (PEA)

9. The primary goal of managing a stable patient with atrial fibrillation with rapid ventricular response (RVR) is:

• a) Immediate cardioversion
• b) Curing the atrial fibrillation
• c) Rate control
• d) Anticoagulation only Answer: c) Rate control

10. Which of the following is one of the “H’s” in the “H’s and T’s” mnemonic for reversible causes of cardiac arrest?

• a) Hypertension
• b) Hypoxia
• c) Hyperglycemia
• d) Hyperthermia Answer: b) Hypoxia

11. Which of the following is one of the “T’s” in the “H’s and T’s” mnemonic for reversible causes of cardiac arrest?

• a) Tachycardia
• b) Trauma
• c) Tamponade (cardiac)
• d) Temperature Answer: c) Tamponade (cardiac)

12. If amiodarone is not available for a patient in refractory VF/pVT, what is the alternative antiarrhythmic and its initial dose?

• a) Lidocaine 1-1.5 mg/kg
• b) Atropine 1 mg
• c) Adenosine 6 mg
• d) Magnesium 1-2 g Answer: a) Lidocaine 1-1.5 mg/kg

13. A patient with symptomatic bradycardia is unresponsive to atropine. What is a recommended second-line therapy while preparing for transcutaneous pacing?

• a) A bolus of amiodarone
• a) An infusion of dopamine or epinephrine
• c) A bolus of adenosine
• d) A bolus of lidocaine Answer: b) An infusion of dopamine or epinephrine

14. The mechanism of action of epinephrine in cardiac arrest is primarily:

• a) Its antiarrhythmic properties.
• b) Its potent vasoconstrictive (alpha-1 agonist) effects, which increase coronary and cerebral perfusion pressure.
• c) Its ability to lower the defibrillation threshold.
• d) Its negative inotropic effects. Answer: b) Its potent vasoconstrictive (alpha-1 agonist) effects, which increase coronary and cerebral perfusion pressure.

15. What is the key role of the pharmacist as a member of the “code blue” team?

• a) To lead the defibrillation attempts.
• b) To perform chest compressions.
• c) To prepare and dispense emergency medications accurately and in a timely manner.
• d) To perform the intubation. Answer: c) To prepare and dispense emergency medications accurately and in a timely manner.

16. What is the initial treatment for a stable patient with a regular, narrow-complex tachycardia (SVT)?

• a) Immediate cardioversion
• b) Amiodarone infusion
• c) Vagal maneuvers
• d) Atropine Answer: c) Vagal maneuvers

17. What is the primary treatment for Torsades de Pointes, a polymorphic ventricular tachycardia?

• a) IV calcium chloride
• b) IV sodium bicarbonate
• c) IV magnesium sulfate
• d) IV potassium chloride Answer: c) IV magnesium sulfate

18. After a Return of Spontaneous Circulation (ROSC), a key management priority is:

• a) Immediately discharging the patient.
• b) Targeted temperature management to improve neurologic outcomes.
• c) Administering a large bolus of IV fluids.
• d) Stopping all IV infusions. Answer: b) Targeted temperature management to improve neurologic outcomes.

19. A patient with hyperkalemia-induced cardiac arrest should be treated with:

• a) IV potassium
• b) IV calcium chloride or gluconate to stabilize the cardiac membrane
• c) IV magnesium
• d) IV dextrose alone Answer: b) IV calcium chloride or gluconate to stabilize the cardiac membrane

20. In the management of acute atrial fibrillation, what is a key consideration before attempting cardioversion in a patient who has been in AFib for >48 hours or an unknown duration?

• a) The patient’s blood pressure
• b) The need for anticoagulation to prevent stroke
• c) The patient’s heart rate
• d) The patient’s respiratory rate Answer: b) The need for anticoagulation to prevent stroke

21. Adenosine works by temporarily blocking AV nodal conduction. A common, transient side effect patients should be warned about is:

• a) A feeling of impending doom or chest pressure
• b) Severe hypertension
• c) Prolonged tachycardia
• d) A metallic taste Answer: a) A feeling of impending doom or chest pressure

22. Which of the following best describes Pulseless Electrical Activity (PEA)?

• a) A chaotic electrical rhythm with no pulse.
• b) A flat line on the EKG monitor.
• c) An organized electrical rhythm on the EKG monitor, but the patient has no palpable pulse.
• d) A very rapid heart rate with a pulse. Answer: c) An organized electrical rhythm on the EKG monitor, but the patient has no palpable pulse.

23. The management of any unstable tachycardia (hypotension, altered mental status, signs of shock) regardless of the rhythm is:

• a) Adenosine 6 mg IV push
• b) Amiodarone 150 mg IV over 10 minutes
• c) Atropine 1 mg IV push
• d) Immediate synchronized cardioversion Answer: d) Immediate synchronized cardioversion

24. The difference between synchronized cardioversion and defibrillation is that synchronized cardioversion:

• a) Delivers a much higher energy shock.
• b) Is only used for pulseless rhythms.
• c) Delivers the shock in synchrony with the R wave of the QRS complex.
• d) Does not require sedation. Answer: c) Delivers the shock in synchrony with the R wave of the QRS complex.

25. A patient with Wolff-Parkinson-White (WPW) syndrome develops atrial fibrillation. Which medication should be avoided as it can precipitate ventricular fibrillation?

• a) Procainamide
• b) Ibutilide
• c) An AV nodal blocking agent like diltiazem or digoxin
• d) Amiodarone Answer: c) An AV nodal blocking agent like diltiazem or digoxin

26. Which class of antiarrhythmics does amiodarone belong to?

• a) Class I (Sodium channel blocker)
• b) Class II (Beta-blocker)
• c) Class III (Potassium channel blocker)
• d) It has properties of all four classes. Answer: d) It has properties of all four classes.

27. What is the role of high-quality CPR in managing cardiac arrest?

• a) It is only done until the defibrillator arrives.
• b) It provides critical blood flow to the brain and heart.
• c) It is used to restart the heart on its own.
• d) It is only effective for PEA. Answer: b) It provides critical blood flow to the brain and heart.

28. The pharmacist’s role during a code includes keeping track of medication timing. Epinephrine should be given every:

• a) 1-2 minutes
• b) 3-5 minutes
• c) 6-8 minutes
• d) 10 minutes Answer: b) 3-5 minutes

29. The pathophysiology of arrhythmias, a topic covered in the Pathophysiology and Patient Assessment I course, involves disturbances in impulse:

• a) Formation
• b) Conduction
• c) Both formation and conduction
• d) Neither formation nor conduction Answer: c) Both formation and conduction

30. If a patient is in a stable wide-complex tachycardia, what is a reasonable first step?

• a) Immediate cardioversion
• b) Obtaining a 12-lead EKG and expert consultation
• c) Administering adenosine
• d) Administering atropine Answer: b) Obtaining a 12-lead EKG and expert consultation

31. The second dose of amiodarone for refractory VF/pVT is:

• a) 300 mg IV push
• b) 150 mg IV push
• c) 75 mg IV push
• d) Not recommended Answer: b) 150 mg IV push

32. The management of a toxin-induced cardiac arrest focuses on:

• a) Standard ACLS algorithms and administration of a specific antidote if available.
• b) Only CPR.
• c) Only defibrillation.
• d) Only the antidote. Answer: a) Standard ACLS algorithms and administration of a specific antidote if available.

33. What is the primary danger of asystole?

• a) It is a shockable rhythm with a good prognosis.
• b) It represents a complete absence of cardiac electrical activity and has a very poor prognosis.
• c) It often converts to ventricular fibrillation.
• d) It is easily treated with atropine. Answer: b) It represents a complete absence of cardiac electrical activity and has a very poor prognosis.

34. The “Stop the Bleed” training is relevant for managing which reversible cause of cardiac arrest?

• a) Hypoxia
• b) Hypovolemia
• c) Hypokalemia
• d) Tamponade Answer: b) Hypovolemia

35. A patient with a heart rate of 40 bpm is complaining of dizziness and shortness of breath. This is defined as:

• a) Stable bradycardia
• b) Asymptomatic bradycardia
• c) Symptomatic bradycardia
• d) Sinus rhythm Answer: c) Symptomatic bradycardia

36. A pharmacist notes that a patient who just had a cardiac arrest is on multiple QT-prolonging medications. This information is critical to share with the team as it may have contributed to:

• a) The patient’s hypovolemia
• b) The development of Torsades de Pointes
• c) The patient’s hyperkalemia
• d) The patient’s tension pneumothorax Answer: b) The development of Torsades de Pointes

37. Which of the following is an example of an IV beta-blocker used for acute rate control of atrial fibrillation?

• a) Metoprolol tartrate
• b) Lisinopril
• c) Amlodipine
• d) Atropine Answer: a) Metoprolol tartrate

38. The dose of adenosine should be reduced in patients who:

• a) Are taking theophylline
• b) Are taking dipyridamole or carbamazepine
• c) Have a history of asthma
• d) Are elderly Answer: b) Are taking dipyridamole or carbamazepine

39. An acute arrhythmia can precipitate what other cardiovascular emergency in a patient with underlying poor cardiac function?

• a) Septic shock
• b) Acute decompensated heart failure
• c) Hypertensive urgency
• d) Aortic dissection Answer: b) Acute decompensated heart failure

40. The main reason for using synchronized cardioversion instead of unsynchronized defibrillation for a patient with a pulse is to avoid:

• a) Delivering a shock on the T-wave, which can induce ventricular fibrillation (R-on-T phenomenon).
• b) Using too much energy.
• c) Causing pain to the patient.
• d) Damaging the cardioverter machine. Answer: a) Delivering a shock on the T-wave, which can induce ventricular fibrillation (R-on-T phenomenon).

41. The VR 360° Code video in the Patient Care VII curriculum is designed to:

• a) Provide a real-time, immersive experience of a cardiac arrest situation.
• b) Teach students how to bill for a code blue.
• c) Demonstrate proper CPR technique only.
• d) Show the layout of the hospital. Answer: a) Provide a real-time, immersive experience of a cardiac arrest situation.

42. Which electrolyte abnormality is a common reversible cause of cardiac arrest?

• a) Hypo/Hyperkalemia
• b) Hypo/Hypernatremia
• c) Hypo/Hyperchloremia
• d) Hypo/Hyperbicarbonatemia Answer: a) Hypo/Hyperkalemia

43. A pharmacist’s knowledge of antiarrhythmic drug pharmacology, such as the Vaughan-Williams classification, is essential for:

• a) Predicting potential adverse effects and drug interactions.
• b) Choosing the color of the medication label.
• c) Calculating the patient’s insurance copay.
• d) Determining the patient’s diet. Answer: a) Predicting potential adverse effects and drug interactions.

44. If a patient remains in VF/pVT after several shocks and doses of amiodarone, what is the next step?

• a) Stop resuscitation efforts.
• b) Continue high-quality CPR and consider other reversible causes.
• c) Administer a different vasopressor.
• d) Administer a large fluid bolus. Answer: b) Continue high-quality CPR and consider other reversible causes.

45. What is the pharmacist’s role after a code blue event?

• a) Their role is finished once the code ends.
• b) To help debrief, document medications used, and review the patient’s medication profile for contributing factors.
• c) To leave the unit immediately.
• d) To take the code cart back to the pharmacy. Answer: b) To help debrief, document medications used, and review the patient’s medication profile for contributing factors.

46. The management of acute arrhythmias is a core component of which Patient Care VII unit?

• a) Unit 1.3: Management of Pain, Agitation, and Delirium
• b) Unit 1.5: Management of Patients with Sepsis
• c) Unit 1.7: Acute Arrhythmias, ACLS
• d) Unit 1.2: TPN/Nutrition Answer: c) Unit 1.7: Acute Arrhythmias, ACLS

47. Which of the following is NOT a primary action during the first few minutes of managing a pulseless patient?

• a) Checking for a pulse
• b) Activating the emergency response system
• c) Starting CPR
• d) Obtaining a full family history Answer: d) Obtaining a full family history

48. Why is it important to minimize interruptions in chest compressions?

• a) It is tiring for the person doing compressions.
• b) Any interruption causes a critical drop in coronary and cerebral perfusion pressure.
• c) It makes the EKG rhythm difficult to see.
• d) It is a hospital policy with no clinical basis. Answer: b) Any interruption causes a critical drop in coronary and cerebral perfusion pressure.

49. For a patient with a known allergy to amiodarone, which antiarrhythmic would be the logical alternative in VF/pVT?

• a) Atropine
• b) Adenosine
• c) Diltiazem
• d) Lidocaine Answer: d) Lidocaine

50. The successful management of acute arrhythmias is highly dependent on:

• a) A single healthcare provider’s efforts.
• b) A well-coordinated team approach following evidence-based algorithms.
• c) The availability of the newest, most expensive drugs.
• d) Luck. Answer: b) A well-coordinated team approach following evidence-based algorithms.