Cardiac Arrest and Resuscitation Practice Questions

31 multiple-choice questions on Cardiac arrest and resuscitation for paramedic and EMT students, from Chapter 18 (Cardiovascular Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

31 practice questions

1. According to current AHA guidelines, what is the recommended compression rate for adult CPR?

   1. A. 80 to 100 per minute
   2. B. 100 to 120 per minute
   3. C. 120 to 140 per minute
   4. D. At least 140 per minute
   Show answer

   Answer: B. 100 to 120 per minute

   AHA recommends 100 to 120 compressions per minute. Rates above 120 tend to reduce depth and allow less time for refilling.

2. What is the recommended compression depth for an average adult?

   1. A. At least 2 in (5 cm), not over 2.4 in (6 cm)
   2. B. At least 1.5 in (4 cm), not over 2 in (5 cm)
   3. C. At least 2.5 in (6 cm), not over 3 in (8 cm)
   4. D. About one-half the chest's front-to-back depth
   Show answer

   Answer: A. At least 2 in (5 cm), not over 2.4 in (6 cm)

   Adult compressions should be at least 5 cm but no more than about 6 cm deep. One-half the chest depth is far too deep for an adult; one-third is used in children and infants.

3. The family of a comatose patient resuscitated this morning asks you during an interfacility transfer whether doctors already know if he will wake up. What is the most accurate answer?

   1. A. Reliable prediction usually waits at least 72 hours
   2. B. The first hour after ROSC decides the outcome
   3. C. Fixed pupils seen on scene confirm a poor outcome for him
   4. D. He will not wake if he needed epinephrine
   Show answer

   Answer: A. Reliable prediction usually waits at least 72 hours

   Current AHA post-arrest guidance advises against early prognosis; neurologic prediction should use several tests and usually waits at least 72 hours after return to normal temperature, because sedation, temperature and shock can make findings misleading early. The first hour does not decide the outcome, early pupil findings are unreliable, and needing epinephrine does not rule out recovery.

4. A man has ROSC after a VF arrest. His 12-lead shows no ST elevation. Your system has a cardiac arrest center 15 minutes farther away than the nearest ED. What is the best destination?

   1. A. The nearest ED, since there is no ST elevation now
   2. B. The nearest clinic for stabilization first
   3. C. The closest hospital, since outcomes do not differ much
   4. D. The cardiac arrest center with PCI and critical care
   Show answer

   Answer: D. The cardiac arrest center with PCI and critical care

   AHA guidance supports regional systems that take post-arrest patients to centers able to provide emergent coronary angiography, temperature control and specialized critical care, even when the ECG does not show STEMI, as a coronary cause is still possible. A lack of ST elevation does not make the nearest ED equivalent, a clinic cannot provide post-arrest care, and outcomes do differ by center.

5. Why is hyperventilation harmful during CPR?

   1. A. It causes respiratory acidosis and lowers the pH
   2. B. It dries the airway and causes bronchospasm
   3. C. It reduces venous return to the heart
   4. D. It increases coronary flow too rapidly
   Show answer

   Answer: C. It reduces venous return to the heart

   Excessive ventilation increases intrathoracic pressure, reducing blood return to the heart and coronary perfusion. It produces respiratory alkalosis, not acidosis.

6. An intubated patient who is lying face down for a long hospital procedure goes into cardiac arrest, and turning him at once is not possible. What does AHA guidance allow?

   1. A. Waiting to start CPR until he can be turned over
   2. B. Abdominal thrusts in place of chest compressions
   3. C. Compressions over the mid-back while he stays prone
   4. D. Ventilation by itself until a supine position is safe
   Show answer

   Answer: C. Compressions over the mid-back while he stays prone

   When a patient with an advanced airway cannot be turned quickly, CPR in the prone position, with hands over the mid-thoracic spine, may be reasonable until he can be turned safely; defibrillation can also be done with pads placed on the back and side. Delaying compressions, using abdominal thrusts or giving ventilation alone would leave the patient without circulation.

7. During CPR on an intubated patient, the ETCO2 waveform, which had been reading 18 mm Hg, suddenly drops to a flat line near zero. What should you check first?

   1. A. The pads, since VF has stopped responding
   2. B. The IV line, since epinephrine is due now
   3. C. The glucose, since it may have dropped very quickly
   4. D. Tube position and the circuit for a disconnection
   Show answer

   Answer: D. Tube position and the circuit for a disconnection

   A sudden loss of the capnography waveform during CPR usually means the tube has dislodged (often into the esophagus) or the circuit has disconnected or kinked; check the tube depth and connections and reconfirm placement. ROSC raises, not removes, ETCO2. The pads, the IV line and the glucose do not explain a sudden flat capnogram.

8. A 12-year-old with a family history of sudden death faints during a soccer game; his resting ECG is normal, but exercise triggers runs of bidirectional and polymorphic VT. Which inherited condition fits?

   1. A. Catecholaminergic polymorphic VT
   2. B. Wolff-Parkinson-White preexcitation
   3. C. Benign early repolarization
   4. D. Vasovagal (reflex) syncope
   Show answer

   Answer: A. Catecholaminergic polymorphic VT

   Catecholaminergic polymorphic VT is an inherited calcium-handling disorder in which a normal resting ECG gives way to bidirectional or polymorphic VT during exercise or emotional stress, causing syncope and sudden death in children and teens. Wolff-Parkinson-White shows a short PR and delta wave at rest, early repolarization does not cause exercise-induced VT, and vasovagal syncope is not triggered by exertion with VT.

9. A 25-year-old athlete has palpitations and syncope. His ECG shows T-wave inversion in V1 to V3 and a small notch (epsilon wave) after the QRS in V1. Which condition should you report as a concern?

   1. A. Acute anterior STEMI from LAD occlusion
   2. B. Normal athletic heart with no risk
   3. C. Left ventricular hypertrophy from heavy training
   4. D. Arrhythmogenic right ventricular cardiomyopathy
   Show answer

   Answer: D. Arrhythmogenic right ventricular cardiomyopathy

   Arrhythmogenic right ventricular cardiomyopathy replaces right ventricular muscle with fat and scar, producing T-wave inversion in V1 to V3, epsilon waves and VT that can cause sudden death in young athletes. An anterior STEMI would cause ST elevation and chest pain, and a normal athletic heart or training-related hypertrophy does not produce epsilon waves with syncope.

10. Studies of out-of-hospital cardiac arrest in public places have found which disparity in bystander CPR?

    1. A. Older adults receive it more than younger ones
    2. B. Women are less likely than men to receive it
    3. C. People in rural areas receive it more often
    4. D. It is given equally to men and women
    Show answer

    Answer: B. Women are less likely than men to receive it

    Research has shown that women who arrest in public are less likely than men to receive bystander CPR, possibly because rescuers hesitate to expose or touch the chest, and rates are also lower in some low-income and minority neighborhoods. Training programs now address these barriers. Equal rates for men and women, and higher rates in older or rural patients, do not match the published findings.

11. A study of a new resuscitation drug reports survival with a Cerebral Performance Category (CPC) of 1 or 2. What does this outcome measure?

    1. A. Survival with good neurologic function
    2. B. Survival to hospital admission
    3. C. Return of a pulse, however brief it was
    4. D. Number of shocks before ROSC occurred
    Show answer

    Answer: A. Survival with good neurologic function

    The CPC scale grades brain function after arrest from 1 (good) to 5 (brain death); CPC 1 or 2 means the survivor can live independently, so it is the outcome that matters most to patients. Survival to admission, a brief return of a pulse and the number of shocks are earlier, less meaningful measures.

12. Your community starts a smartphone app that alerts nearby CPR-trained volunteers when a cardiac arrest is reported. What is the main goal of this program?

    1. A. Fewer EMS units sent to cardiac arrest calls
    2. B. Earlier EMS dispatch to the arrest
    3. C. Shorter time to bystander CPR and AED use
    4. D. Rescue breaths in every adult arrest
    Show answer

    Answer: C. Shorter time to bystander CPR and AED use

    AHA guidance supports using mobile technology to alert willing bystanders to nearby arrests, because it can increase bystander CPR and shorten the time to defibrillation before EMS arrives. It does not replace the EMS response or change when EMS is dispatched, and it is not aimed at adding rescue breaths; early compressions and AED use are the focus.

13. A 34-year-old with known Brugada syndrome has a fever of 39.5 C (103.1 F) from the flu and feels lightheaded. Why is the fever a concern?

    1. A. Fever mainly triggers atrial fibrillation
    2. B. Fever can unmask Brugada and trigger VF
    3. C. Fever prolongs the QT in Brugada
    4. D. Fever matters mainly in children with Brugada
    Show answer

    Answer: B. Fever can unmask Brugada and trigger VF

    Fever worsens the sodium channel defect in Brugada syndrome, accentuating the ECG pattern and raising the risk of polymorphic VT and VF, so these patients need monitoring, fever control and evaluation. The danger is ventricular rather than atrial fibrillation, Brugada is a sodium channel disorder rather than a long QT problem, and the risk is not limited to children.

14. A pulseless patient with a pacemaker has a monitor showing regular pacer spikes at 70/min, but no QRS complexes follow them. How should you interpret this?

    1. A. A perfusing paced rhythm that needs no CPR
    2. B. Normal pacing that confirms a pulse is present
    3. C. Cardiac arrest; the spikes are not a heart rhythm
    4. D. Pacemaker runaway that needs a magnet placed on it
    Show answer

    Answer: C. Cardiac arrest; the spikes are not a heart rhythm

    Pacer spikes show that the device is firing, not that the heart is responding. A pulseless patient with spikes and no capture is in cardiac arrest (often asystole or PEA underneath), so start CPR and follow the arrest algorithm; spikes can also hide fine VF on some leads. The spikes do not mean perfusion or a pulse, and a magnet does not treat arrest.

15. A 55-year-old survived a VF arrest. No reversible cause such as an acute MI was found. What device is he most likely to receive before discharge?

    1. A. A permanent dual-chamber pacemaker
    2. B. An implantable loop recorder
    3. C. An intra-aortic balloon pump
    4. D. An implantable defibrillator (ICD)
    Show answer

    Answer: D. An implantable defibrillator (ICD)

    Survivors of VF or VT arrest without a reversible cause have a high risk of recurrence, so an implantable defibrillator (ICD) is placed for secondary prevention. A pacemaker treats slow rhythms and cannot shock VF, a loop recorder only records the rhythm, and a balloon pump is a temporary support for shock, not a long-term device.

16. Chest compression fraction is the proportion of resuscitation time spent doing compressions. What is the AHA target?

    1. A. At least 40%, ideally 50% or more
    2. B. At least 90%, with no pauses allowed
    3. C. At least 50%, ideally about 70%
    4. D. At least 60%, ideally 80% or more
    Show answer

    Answer: D. At least 60%, ideally 80% or more

    AHA recommends a compression fraction of at least 60%, and many high-performing systems target 80% or higher by minimizing pauses.

17. You find a 54-year-old in PEA at a rate of 38. After starting CPR and giving epinephrine, what should you focus on next?

    1. A. Searching for reversible causes
    2. B. Giving atropine every 3 minutes
    3. C. Starting transcutaneous pacing
    4. D. Delivering a synchronized shock
    Show answer

    Answer: A. Searching for reversible causes

    PEA treatment is high-quality CPR, epinephrine, and identifying and treating reversible causes (Hs and Ts). Atropine and pacing are not recommended for PEA, and PEA is not shockable.

18. Which of the following is one of the reversible causes (Hs and Ts) of cardiac arrest?

    1. A. Severe hyperglycemia
    2. B. Acute hypernatremia
    3. C. Tension pneumothorax
    4. D. Severe hypertension
    Show answer

    Answer: C. Tension pneumothorax

    The Ts include tension pneumothorax, tamponade, toxins, and thrombosis (pulmonary and coronary). The Hs include hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, and hypothermia.

19. A 16-year-old with a normal resting ECG collapses in cardiac arrest at peak exertion during a basketball game. After HCM, which structural cause is a leading consideration?

    1. A. A WPW accessory pathway
    2. B. Commotio cordis from a ball
    3. C. Mitral valve prolapse with no valve leak
    4. D. An abnormally placed coronary artery
    Show answer

    Answer: D. An abnormally placed coronary artery

    An anomalous origin of a coronary artery, which can be compressed during intense exercise, is one of the leading structural causes of sudden cardiac death in young athletes after hypertrophic cardiomyopathy, and the resting ECG is often normal. WPW is an electrical pathway that usually shows a delta wave on the resting ECG, commotio cordis needs a blow to the chest, and mitral valve prolapse without regurgitation is rarely a cause.

20. A neighbor asks you the difference between a heart attack and a cardiac arrest. Which explanation is most accurate?

    1. A. In an arrest the heart stops; a heart attack is a blockage
    2. B. They are two names for exactly the same event
    3. C. A cardiac arrest is a milder kind of heart attack
    4. D. A heart attack leads to a cardiac arrest in nearly everyone
    Show answer

    Answer: A. In an arrest the heart stops; a heart attack is a blockage

    A heart attack is a circulation problem in which a blocked coronary artery damages heart muscle, usually while the person is awake and breathing; a cardiac arrest is usually an electrical problem in which the heart stops pumping and the person collapses. A heart attack can lead to arrest, but often does not. They are not the same, and arrest is not a milder event.

21. You must defibrillate a patient in VF who is lying on a metal floor in a factory. What is the correct approach?

    1. A. Move him onto a wooden surface before shocking him
    2. B. Lower the energy to half the usual setting
    3. C. Shock as usual, keeping everyone clear of contact
    4. D. Avoid shocking until he is in the ambulance
    Show answer

    Answer: C. Shock as usual, keeping everyone clear of contact

    A dry metal surface does not make defibrillation dangerous for rescuers as long as no one touches the patient and the pads do not touch each other or the metal; standing water is the real hazard. Moving him first delays the shock, lowering the energy reduces its chance of success, and waiting for the ambulance wastes critical minutes.

22. After ROSC, which blood pressure goal is recommended to avoid hypotension?

    1. A. SBP at least 90 or MAP at least 65 mm Hg
    2. B. SBP at least 70 or MAP at least 50 mm Hg
    3. C. SBP at least 140 or MAP at least 100 mm Hg
    4. D. SBP below 120 to protect the new pulse
    Show answer

    Answer: A. SBP at least 90 or MAP at least 65 mm Hg

    Post-arrest care targets a systolic pressure of at least 90 mm Hg and a MAP of at least 65 mm Hg, using fluids and vasopressors as needed. Hypotension after ROSC worsens brain injury.

23. After ROSC, what ventilation target is generally recommended?

    1. A. ETCO2 of 35 to 45 mm Hg
    2. B. ETCO2 of 20 to 25 mm Hg
    3. C. ETCO2 of 50 to 60 mm Hg
    4. D. A rate of 20 breaths per minute
    Show answer

    Answer: A. ETCO2 of 35 to 45 mm Hg

    Ventilate to normocapnia, roughly PaCO2 35 to 45 mm Hg (ETCO2 is a field estimate). Hyperventilation causes cerebral vasoconstriction and can worsen brain ischemia.

24. After ROSC, your patient's 12-lead shows ST elevation in V1 through V4. What is the most appropriate destination?

    1. A. A non-PCI ED for fibrinolytics
    2. B. A PCI-capable center
    3. C. Any emergency department
    4. D. A trauma center for ICU care
    Show answer

    Answer: B. A PCI-capable center

    Post-arrest patients with STEMI should go to a center that can perform emergency coronary angiography and PCI. Obtain a 12-lead as soon as feasible after ROSC. Fibrinolytics after an arrest carry added risk and are a fallback only when PCI cannot be reached in time, and a trauma center or a general ED cannot provide emergency angiography.

25. In cardiac arrest research using Utstein definitions, what is meant by 'sustained ROSC'?

    1. A. A pulse that lasts at least 20 minutes
    2. B. A pulse felt during one rhythm check
    3. C. A pulse that lasts until hospital discharge
    4. D. A pulse that lasts at least 10 seconds
    Show answer

    Answer: A. A pulse that lasts at least 20 minutes

    Utstein reporting defines sustained ROSC as return of circulation without further compressions for at least 20 consecutive minutes, which helps compare systems fairly. A pulse at one check or for 10 seconds is any ROSC, not sustained ROSC, and survival to discharge is a separate outcome.

26. A 15-year-old with congenital long QT syndrome faints at home the moment her loud alarm clock goes off. What best explains the event?

    1. A. She had a normal, harmless startle reaction to it
    2. B. A sudden noise triggered torsades de pointes
    3. C. A seizure caused by low blood sugar
    4. D. An anxiety attack about getting up early
    Show answer

    Answer: B. A sudden noise triggered torsades de pointes

    In some forms of congenital long QT syndrome (notably type 2), sudden loud noises or startle can trigger torsades de pointes and syncope or sudden death, so a faint linked to an alarm is a red flag. A startle reaction does not cause loss of consciousness, and hypoglycemia and anxiety do not explain an instant faint at the noise.

27. After ROSC from a 12-minute arrest, a patient's echo shows an ejection fraction of 25%, though he had normal heart function last year. What is a common explanation that may improve over days?

    1. A. A permanent old infarct from last year
    2. B. Severe aortic stenosis that appeared suddenly
    3. C. Myocardial stunning after the arrest
    4. D. A normal finding in arrest survivors
    Show answer

    Answer: C. Myocardial stunning after the arrest

    Global ischemia and reperfusion during arrest and CPR often 'stun' the heart, causing reversible pump failure that typically improves over 24 to 72 hours; it is part of post-cardiac arrest syndrome and may need vasopressor or inotropic support meanwhile. A prior infarct does not fit a normal heart last year, aortic stenosis does not appear suddenly, and severe dysfunction is not universal.

28. Which of the following meets the BLS termination of resuscitation rule for adult out-of-hospital arrest?

    1. A. Witnessed by EMS, shock delivered, and no ROSC
    2. B. Bystander CPR given, no shock, and ROSC achieved
    3. C. Unwitnessed arrest with a short initial transport time
    4. D. Not witnessed by EMS, no shock delivered, and no ROSC
    Show answer

    Answer: D. Not witnessed by EMS, no shock delivered, and no ROSC

    The BLS rule supports termination when the arrest was not witnessed by EMS, no AED shock was given, and there was no ROSC before transport. Local protocols and medical control govern its use.

29. Why is full chest recoil emphasized after each compression?

    1. A. It maximizes the force of the following compression
    2. B. It prevents gastric inflation during ventilation
    3. C. It lets the heart refill before the next compression
    4. D. It keeps the rescuer's hands from moving
    Show answer

    Answer: C. It lets the heart refill before the next compression

    Complete recoil lowers intrathoracic pressure, allowing venous return to refill the heart. Leaning on the chest reduces preload and coronary perfusion.

30. A bystander is afraid to use the AED because it might shock someone who does not need it. What is the best reassurance?

    1. A. It shocks slow heart rhythms too
    2. B. It shocks asystole to restart it
    3. C. It works on people with known heart disease
    4. D. It advises a shock only for VF or fast VT
    Show answer

    Answer: D. It advises a shock only for VF or fast VT

    An AED analyzes the rhythm and advises a shock only for VF or pulseless VT; for other rhythms it tells the rescuer to continue CPR, which is why lay rescuers can use it safely. It does not shock slow rhythms or asystole, and it works on anyone in cardiac arrest regardless of history.

31. Which statement about mechanical CPR devices reflects current AHA guidance?

    1. A. They improve survival over manual CPR in most arrests
    2. B. They are a reasonable option when manual CPR is hard to sustain
    3. C. They should replace manual CPR from the very first minute on scene
    4. D. They should be avoided because they often cause rib fractures
    Show answer

    Answer: B. They are a reasonable option when manual CPR is hard to sustain

    AHA does not recommend routine mechanical CPR, because trials have not shown better survival than high-quality manual CPR, but considers it reasonable where high-quality manual CPR is difficult or dangerous, such as during transport. It should not replace manual CPR from the first minute, and device application should minimize pauses. Rib fractures occur with both manual and mechanical CPR and are not a reason to avoid the device.