Cardiac Arrest Medications Practice Questions

74 multiple-choice questions on Cardiac arrest medications for paramedic and EMT students, from Chapter 15 (Emergency Medications). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

74 practice questions

1. The dose of epinephrine in adult cardiac arrest is:

   1. A. 0.1 mg IV/IO of 0.1 mg/mL every minute until ROSC
   2. B. 0.5 mg IV/IO of 0.1 mg/mL every 10 minutes
   3. C. 1 mg IV/IO of 0.1 mg/mL every 3 to 5 minutes
   4. D. 0.3 mg IM of the 1 mg/mL concentration, repeated in 5 minutes
   Show answer

   Answer: C. 1 mg IV/IO of 0.1 mg/mL every 3 to 5 minutes

   That concentration was formerly labeled 1:10,000. The adult arrest dose is 1 mg IV or IO of the 0.1 mg/mL concentration, repeated every 3 to 5 minutes.

2. Epinephrine helps in cardiac arrest mainly by:

   1. A. Beta-1 stimulation that directly converts VF to sinus rhythm
   2. B. Beta-2 bronchodilation that improves oxygenation during ventilation
   3. C. Alpha vasoconstriction raising perfusion pressure
   4. D. Lowering myocardial oxygen demand so the heart can recover
   Show answer

   Answer: C. Alpha vasoconstriction raising perfusion pressure

   Its alpha effects matter more than its beta effects here. The vasoconstriction improves coronary and cerebral perfusion pressure during compressions.

3. Amiodarone in adult cardiac arrest with refractory ventricular fibrillation is typically given as:

   1. A. 5 mg/kg IV/IO, repeated up to three times
   2. B. 150 mg IV/IO, then 300 mg if needed
   3. C. 300 mg IV/IO, then 150 mg if needed
   4. D. 150 mg IV over 10 minutes, repeated once
   Show answer

   Answer: C. 300 mg IV/IO, then 150 mg if needed

   It follows defibrillation and epinephrine in the ACLS sequence. The adult arrest dose is 300 mg IV or IO, followed by 150 mg if needed.

4. Lidocaine may be used in cardiac arrest as:

   1. A. A first-line antidysrhythmic before any shock, 3 mg/kg
   2. B. A replacement for epinephrine in asystole, 1.5 mg/kg
   3. C. An alternative antidysrhythmic, 1 to 1.5 mg/kg
   4. D. A first-line vasopressor given before epinephrine, 1 mg/kg
   Show answer

   Answer: C. An alternative antidysrhythmic, 1 to 1.5 mg/kg

   Repeat doses are smaller. The initial dose is typically 1 to 1.5 mg/kg IV/IO. Lidocaine is the alternative to amiodarone.

5. Magnesium sulfate in cardiac arrest is specifically indicated for:

   1. A. All VF that persists after the first shock
   2. B. Torsades de pointes or suspected hypomagnesemia
   3. C. Asystole that persists after two epinephrine doses
   4. D. PEA from suspected hyperkalemia or acidosis
   Show answer

   Answer: B. Torsades de pointes or suspected hypomagnesemia

   Typical dosing is 1 to 2 g IV or IO.

6. A 160-kg man is in pulseless VT. Your partner proposes scaling the epinephrine dose to his weight. What dose is correct?

   1. A. 16 mg IV/IO, at 0.1 mg/kg
   2. B. 1.6 mg IV/IO, at 0.01 mg/kg
   3. C. 1 mg IV/IO, the standard adult dose
   4. D. 2 mg IV/IO, doubled for his body size
   Show answer

   Answer: C. 1 mg IV/IO, the standard adult dose

   Adult arrest epinephrine is a fixed 1 mg IV/IO every 3 to 5 minutes, whatever the body weight. Doubling it for size has no supporting evidence and adds post-ROSC tachydysrhythmias. Weight-based 0.01 mg/kg dosing is for children and is capped at the 1-mg adult dose, so 1.6 mg misapplies it, and 16 mg (0.1 mg/kg) would be a massive overdose.

7. Calcium chloride during resuscitation is indicated for:

   1. A. Hyperkalemia, hypocalcemia, or CCB overdose
   2. B. Torsades de pointes with a prolonged QT interval
   3. C. Routine use in every PEA or asystole arrest after epinephrine
   4. D. Refractory VF after amiodarone has failed to convert it
   Show answer

   Answer: A. Hyperkalemia, hypocalcemia, or CCB overdose

   It should not run in the same line as sodium bicarbonate. CCB means calcium channel blocker.

8. The most important interventions in cardiac arrest are:

   1. A. High-quality compressions and early defibrillation
   2. B. Early epinephrine and amiodarone administration
   3. C. Early advanced airway placement with capnography
   4. D. Early IV or IO access and rapid medication delivery
   Show answer

   Answer: A. High-quality compressions and early defibrillation

   Medications supplement but never replace them.

9. You draw amiodarone from a glass vial for a patient in refractory VF, and the solution foams in the syringe. What best prevents this?

   1. A. Dilute it into a 100-mL bag before the push
   2. B. Shake the vial well before drawing it up
   3. C. Warm the vial in your hand for 5 minutes
   4. D. Draw it slowly through a large-bore needle
   Show answer

   Answer: D. Draw it slowly through a large-bore needle

   Amiodarone vials contain the surfactant polysorbate 80, which foams when the solution is agitated or pulled quickly through a small needle; foam leaves air in the syringe and an inaccurate dose. Shaking makes the foaming worse. Warming the vial does not stop it. Mixing the arrest dose into a 100-mL bag turns a push into a slow infusion and delays a drug meant to be given during CPR (the bag is used for the 150-mg stable-VT dose).

10. After return of spontaneous circulation, the priorities include:

    1. A. Hyperventilating at 30/min to drive the ETCO2 down to 25 mm Hg
    2. B. Keeping 100% oxygen running so the SpO2 stays at 100%
    3. C. Oxygenation, ventilation, BP support, 12-lead ECG, and TTM
    4. D. Repeated 1 mg epinephrine boluses to keep the BP elevated
    Show answer

    Answer: C. Oxygenation, ventilation, BP support, 12-lead ECG, and TTM

    Avoid hyperoxia and hyperventilation. Priorities include maintaining oxygenation and ventilation, supporting blood pressure, obtaining a 12-lead ECG, and targeted temperature management (TTM) per protocol. Hyperventilation lowers cerebral blood flow and an SpO2 of 100% signals hyperoxia, so targets are a normal ETCO2 and an SpO2 of 92% to 98%, and repeated arrest-dose epinephrine pushes are not used to support a perfusing BP.

11. A vasopressor infusion after ROSC is used to:

    1. A. Prevent recurrent VF in place of an antidysrhythmic
    2. B. Maintain perfusion pressure when hypotension persists
    3. C. Lower afterload so the heart can pump more easily
    4. D. Replace fluid boluses in a patient who is still volume-depleted
    Show answer

    Answer: B. Maintain perfusion pressure when hypotension persists

    Norepinephrine, epinephrine, and dopamine are commonly used. Vasopressors raise rather than lower afterload, they do not replace fluid in a volume-depleted patient, and they do not prevent recurrent VF the way an antidysrhythmic may.

12. Push-dose epinephrine is used to:

    1. A. Give short-term BP support in small titrated doses
    2. B. Treat bradycardia only, never isolated hypotension
    3. C. Permanently replace a vasopressor infusion in transport
    4. D. Deliver the full 1 mg arrest dose in a perfusing patient
    Show answer

    Answer: A. Give short-term BP support in small titrated doses

    Dilution errors with this practice have caused serious harm.

13. The rhythm check shows asystole, and CPR resumes. Epinephrine is due. When should it be pushed?

    1. A. During the next pause for a rhythm check
    2. B. During compressions, as CPR resumes
    3. C. After an advanced airway is secured
    4. D. After 2 more minutes of CPR
    Show answer

    Answer: B. During compressions, as CPR resumes

    Drugs are pushed while compressions are running, so the blood flow from CPR carries them to the heart and no extra pause is created. Pushing during a rhythm check gives the drug no circulation and lengthens the pause. Drugs do not have to wait for an advanced airway. Waiting another 2-minute cycle delays a dose that is already due.

14. A patient in anaphylaxis received IM epinephrine 0.5 mg four minutes ago and now becomes pulseless. An IV is in place. Which epinephrine dose is now appropriate?

    1. A. 0.1 mg IV, as a slow 5-minute push
    2. B. Wait; the IM dose is still being absorbed
    3. C. 1 mg IV, repeated every 3 to 5 minutes
    4. D. 0.5 mg IM again, into the other thigh now
    Show answer

    Answer: C. 1 mg IV, repeated every 3 to 5 minutes

    Once the patient is pulseless, anaphylaxis is managed with standard ACLS: epinephrine 1 mg IV/IO every 3 to 5 minutes along with rapid fluids. IM absorption depends on circulation, so another IM dose will not be absorbed during CPR. Small, slow IV doses are used in a perfusing patient, not in arrest. Waiting on the earlier IM dose wastes time when circulation has stopped.

15. The pediatric cardiac arrest dose of epinephrine is:

    1. A. 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) IV/IO
    2. B. 1 mg IV/IO regardless of body weight
    3. C. 0.001 mg/kg (0.01 mL/kg of 0.1 mg/mL) IV/IO
    4. D. 0.1 mg/kg (0.1 mL/kg of 1 mg/mL) IV/IO
    Show answer

    Answer: A. 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) IV/IO

    Pediatric dose is 0.01 mg/kg, max 1 mg.

16. Amiodarone is indicated in cardiac arrest for:

    1. A. PEA with a narrow complex and slow rate
    2. B. Bradycardic arrest unresponsive to atropine
    3. C. Asystole that persists after epinephrine
    4. D. Shock-refractory VF or pulseless VT
    Show answer

    Answer: D. Shock-refractory VF or pulseless VT

    Amiodarone is given after the third shock in refractory VF/pVT.

17. A 34-year-old who had surgery last week has sudden dyspnea and then arrests in PEA. Massive pulmonary embolism is strongly suspected. Which drug therapy may the hospital team consider during CPR?

    1. A. Calcium chloride 1 g IV/IO
    2. B. Amiodarone 300 mg IV/IO
    3. C. A fibrinolytic such as alteplase
    4. D. Sodium bicarbonate 1 mEq/kg IV/IO
    Show answer

    Answer: C. A fibrinolytic such as alteplase

    AHA guidance says fibrinolysis is reasonable for confirmed pulmonary embolism causing arrest and may be considered when it is suspected, because it treats the cause (the clot). Amiodarone is for shock-refractory VF/pVT, not PEA. Routine bicarbonate and calcium do not help an obstructive arrest and are not recommended without a specific indication.

18. Twenty minutes after ROSC, an intubated patient has a generalized tonic-clonic seizure. The BP is 118/70. What is the most appropriate drug therapy?

    1. A. Midazolam, titrated, watching the BP
    2. B. Epinephrine 1 mg IV to support perfusion
    3. C. Rocuronium alone to stop the movement
    4. D. Amiodarone 150 mg over 10 minutes
    Show answer

    Answer: A. Midazolam, titrated, watching the BP

    Post-arrest guidelines recommend treating clinically apparent seizures; a titrated benzodiazepine is the usual first drug, with close BP monitoring because it can cause hypotension. Amiodarone is an antidysrhythmic, not an anticonvulsant. An arrest-dose epinephrine bolus in a perfusing patient causes severe hypertension and dysrhythmias. A paralytic alone hides the movement while the brain keeps seizing, and it leaves the patient unsedated.

19. Right after ROSC, a patient's BP is 68/40, and the norepinephrine infusion is still being set up. Per many protocols, which bridging dose is appropriate?

    1. A. Epinephrine 1 mg IV push every 3–5 min
    2. B. Epinephrine 0.5 mg IM in the thigh
    3. C. Epinephrine 10–20 mcg IV every 2–5 min
    4. D. Phenylephrine 10 mg undiluted IV push
    Show answer

    Answer: C. Epinephrine 10–20 mcg IV every 2–5 min

    Push-dose epinephrine (10 mcg/mL) given as 10 to 20 mcg every 2 to 5 minutes is commonly used to bridge severe hypotension until an infusion runs. A 1-mg push is the arrest dose and can cause extreme hypertension and VF in a perfusing patient. IM absorption is unreliable in shock and cannot be titrated minute to minute. Push-dose phenylephrine is 50 to 200 mcg of a diluted solution, so 10 mg undiluted is a gross overdose.

20. Pediatric amiodarone dose in VF/pVT arrest is:

    1. A. 1 mg/kg IV/IO bolus
    2. B. 300 mg IV/IO bolus
    3. C. 10 mg/kg IV/IO bolus
    4. D. 5 mg/kg IV/IO bolus
    Show answer

    Answer: D. 5 mg/kg IV/IO bolus

    5 mg/kg, may repeat up to 2 more times.

21. Atropine is no longer recommended for:

    1. A. Vagal pediatric bradycardia
    2. B. Asystole and PEA rhythms
    3. C. Organophosphate poisoning
    4. D. Symptomatic bradycardia
    Show answer

    Answer: B. Asystole and PEA rhythms

    Guidelines removed atropine from asystole/PEA algorithms due to lack of benefit.

22. Under current AHA guidance, what is the role of vasopressin in adult cardiac arrest?

    1. A. It is dosed at 1 unit/kg every 3 to 5 minutes
    2. B. It replaces epinephrine after two doses
    3. C. It adds no benefit over epinephrine alone
    4. D. It is the preferred first vasopressor
    Show answer

    Answer: C. It adds no benefit over epinephrine alone

    AHA adult guidelines state that vasopressin, alone or combined with epinephrine, offers no advantage over epinephrine alone, so epinephrine 1 mg every 3 to 5 minutes remains the vasopressor in the arrest algorithm. Vasopressin does not take over after any number of epinephrine doses, it is not preferred, and 1 unit/kg is not an arrest dose (the old single adult dose was 40 units).

23. After sodium bicarbonate 100 mEq is pushed during CPR, ETCO2 rises from 18 to 30 mm Hg for about a minute, and the monitor still shows PEA. What explains this?

    1. A. The tube has moved into the esophagus
    2. B. Compressions have suddenly become deeper
    3. C. Bicarbonate generates CO2 that is exhaled
    4. D. The rise confirms ROSC; stop compressions
    Show answer

    Answer: C. Bicarbonate generates CO2 that is exhaled

    Bicarbonate buffers acid by forming carbonic acid, which breaks down to CO2 and water, so ETCO2 rises briefly after a bolus. A rise from ROSC is sustained and is confirmed with a pulse check at the next rhythm check, not by stopping CPR on the number alone. An esophageal tube makes ETCO2 fall toward zero. Deeper compressions raise ETCO2 gradually rather than causing a sudden spike after a drug.

24. The dose of sodium bicarbonate is:

    1. A. 10 mEq/kg IV/IO
    2. B. 0.1 mEq/kg IV/IO
    3. C. 1 mEq/kg IV/IO
    4. D. 5 mEq/kg IV/IO
    Show answer

    Answer: C. 1 mEq/kg IV/IO

    1 mEq/kg of 8.4% (1 mEq/mL).

25. During an acute MI, a patient with a normal QT goes into pulseless polymorphic VT. After shocks and epinephrine, which antidysrhythmic is most appropriate?

    1. A. Adenosine 12 mg rapid IV/IO
    2. B. Magnesium sulfate 2 g IV/IO
    3. C. Procainamide 17 mg/kg IV/IO
    4. D. Amiodarone 300 mg IV/IO
    Show answer

    Answer: D. Amiodarone 300 mg IV/IO

    Polymorphic VT without a long QT (often ischemic) is treated like VF: shocks, epinephrine, then amiodarone or lidocaine, plus reperfusion. Magnesium is not routinely recommended in VF/pVT; it is for torsades de pointes with a prolonged QT. Procainamide needs a slow infusion and is not used in pulseless arrest. Adenosine has no role in a pulseless rhythm.

26. The adult dose of calcium chloride 10% is:

    1. A. 100 mg (1 mL) IV/IO rapid push
    2. B. 5 g (50 mL) IV/IO over 1 minute
    3. C. 10 mg/kg (0.1 mL/kg) IV/IO slowly
    4. D. 500–1,000 mg (5–10 mL) IV/IO
    Show answer

    Answer: D. 500–1,000 mg (5–10 mL) IV/IO

    Give slowly; extravasation causes necrosis. The 500 to 1,000 mg dose is pushed slowly.

27. Your agency stocks both amiodarone and lidocaine. Which statement about choosing between them for shock-refractory VF is correct?

    1. A. Either may be used per local protocol
    2. B. Lidocaine must be given before amiodarone
    3. C. Both are given together as the first drug
    4. D. Neither is given until ROSC is achieved
    Show answer

    Answer: A. Either may be used per local protocol

    AHA guidance says amiodarone or lidocaine may be considered for VF/pVT that does not respond to defibrillation; in the ALPS trial neither improved survival to discharge over placebo overall, and neither is preferred. There is no required order between them, they are not given together as a first drug, and they are given during the arrest, not held until after ROSC.

28. A 3-year-old is found in asystole. CPR began 2 minutes ago, and an IO line has just been placed. When should epinephrine be given?

    1. A. After 10 minutes, if asystole persists
    2. B. After atropine 0.02 mg/kg is given
    3. C. Now; aim for within 5 min of CPR start
    4. D. After an advanced airway has been placed
    Show answer

    Answer: C. Now; aim for within 5 min of CPR start

    For pediatric nonshockable arrest, PALS recommends giving epinephrine early, ideally within 5 minutes of starting compressions, because earlier dosing is linked to better survival. Waiting 10 minutes loses that benefit. Atropine is not used for asystole. Drug delivery does not wait for an advanced airway.

29. An adult collapses in witnessed VF. The defibrillator is charged, and your partner has epinephrine ready in a working IV. What comes first?

    1. A. Push the epinephrine, then deliver the shock
    2. B. Deliver the shock, then resume CPR at once
    3. C. Give amiodarone 300 mg, then the shock
    4. D. Give atropine 1 mg, then the shock
    Show answer

    Answer: B. Deliver the shock, then resume CPR at once

    Early defibrillation is the treatment that converts VF, so the shock is delivered without delay and CPR resumes right away. In shockable rhythms, epinephrine is given after initial shocks fail, and amiodarone after the third shock; neither should delay a ready shock. Atropine has no role in VF.

30. A 3-kg newborn's heart rate stays below 60/min despite effective ventilation and compressions, and the umbilical line is still being placed. Using 0.1 mg/kg, what endotracheal epinephrine dose may be given while access is obtained?

    1. A. 0.3 mg (3 mL of 0.1 mg/mL)
    2. B. 3 mg (3 mL of 1 mg/mL)
    3. C. 0.06 mg (0.6 mL of 0.1 mg/mL)
    4. D. 0.03 mg (0.3 mL of 0.1 mg/mL)
    Show answer

    Answer: A. 0.3 mg (3 mL of 0.1 mg/mL)

    NRP allows endotracheal epinephrine at 0.05 to 0.1 mg/kg of the 0.1 mg/mL concentration while IV access is obtained; 3 kg x 0.1 mg/kg = 0.3 mg, which is 3 mL. Then an IV/IO dose follows once the line is in. 0.03 mg is a tenfold underdose. 3 mg is a tenfold overdose and uses the 1 mg/mL concentration, which is not used in newborns. 0.06 mg is the IV dose (0.02 mg/kg), which is too low for the poorly absorbed tracheal route.

31. A 3-kg newborn delivered after a placental abruption is pale with weak pulses, and the heart rate stays low despite ventilation, compressions, and epinephrine. Which volume dose is appropriate?

    1. A. 60 mL of NS pushed as fast as possible
    2. B. 3 mL of NS over 1 minute
    3. C. 150 mL of D10 over 10 minutes
    4. D. 30 mL of NS over 5 to 10 minutes
    Show answer

    Answer: D. 30 mL of NS over 5 to 10 minutes

    NRP gives 10 mL/kg of isotonic crystalloid (or O-negative blood) over 5 to 10 minutes for suspected blood loss; 3 kg x 10 mL/kg = 30 mL. A 20-mL/kg rapid push doubles the dose and, given fast, raises the risk of intraventricular hemorrhage. 3 mL is only 1 mL/kg. D10 treats hypoglycemia at 2 mL/kg, not volume loss, and 150 mL would be 50 mL/kg.

32. During a code, your partner wants to give the next epinephrine 90 seconds after the last dose because the patient is still in asystole. What is the best response?

    1. A. Agree; in asystole it is given every 90 seconds
    2. B. Give a double dose now to save time
    3. C. Wait; repeat it every 3 to 5 minutes
    4. D. Switch to vasopressin 40 units now
    Show answer

    Answer: C. Wait; repeat it every 3 to 5 minutes

    Adult arrest epinephrine is repeated every 3 to 5 minutes (many teams give it every other 2-minute cycle). Closer dosing has no proven benefit and adds myocardial oxygen demand and post-ROSC dysrhythmias. High-dose epinephrine is not recommended for routine use, and vasopressin offers no advantage over epinephrine (2025 AHA).

33. The 'Hs and Ts' are:

    1. A. Reversible causes of cardiac arrest
    2. B. Vital sign targets in post-ROSC care
    3. C. Energy settings for defibrillation
    4. D. Drugs used in the ACLS algorithms
    Show answer

    Answer: A. Reversible causes of cardiac arrest

    Identifying reversible causes guides specific drug and procedure choices. They include hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, and thrombosis.

34. Dextrose in cardiac arrest is:

    1. A. Contraindicated even with hypoglycemia
    2. B. Given every cycle to support brain metabolism
    3. C. Given only for documented hypoglycemia
    4. D. Given routinely with the first epinephrine
    Show answer

    Answer: C. Given only for documented hypoglycemia

    Hyperglycemia worsens neurologic outcomes; treat only confirmed hypoglycemia.

35. In hyperkalemic arrest, the drug sequence commonly includes:

    1. A. Atropine and adenosine, followed by magnesium sulfate
    2. B. Magnesium, potassium chloride, and dextrose
    3. C. Calcium, bicarbonate, insulin/dextrose
    4. D. Lidocaine and amiodarone, followed by procainamide
    Show answer

    Answer: C. Calcium, bicarbonate, insulin/dextrose

    Calcium stabilizes membranes; bicarbonate and insulin shift potassium into cells. Albuterol may also be considered.

36. Epinephrine 1 mg/mL (1:1,000) given IV in cardiac arrest:

    1. A. Should be given IM instead to avoid IV toxicity
    2. B. Should be cut to 0.1 mg because it is ten times stronger
    3. C. Should be diluted to 0.1 mg/mL; the dose stays 1 mg
    4. D. Is the preferred concentration for IV push in arrest
    Show answer

    Answer: C. Should be diluted to 0.1 mg/mL; the dose stays 1 mg

    In arrest the dose is what matters; in a perfusing patient, concentrated IV epinephrine is dangerous. It must be diluted or the 0.1 mg/mL concentration used; concentration errors cause problems in perfusing patients. The IM route is unreliable in arrest, and the mass dose stays 1 mg whatever the concentration, so cutting it to 0.1 mg would give a tenth of the dose.

37. Post-ROSC, epinephrine may be continued as:

    1. A. A titrated 2–10 mcg/min infusion for hypotension
    2. B. Nothing, because it is never given after ROSC
    3. C. IM injections of 0.5 mg every 5 to 15 minutes
    4. D. Repeated 1 mg IV pushes every 3 to 5 minutes as needed
    Show answer

    Answer: A. A titrated 2–10 mcg/min infusion for hypotension

    Vasopressor infusions support post-arrest blood pressure.

38. Amiodarone after ROSC may be given as:

    1. A. A 150 mg rapid IV push every 10 minutes
    2. B. Another 300 mg IV bolus right after ROSC
    3. C. Oral tablets once the patient can swallow
    4. D. A 1 mg/min maintenance infusion for 6 hours
    Show answer

    Answer: D. A 1 mg/min maintenance infusion for 6 hours

    Maintenance infusion prevents recurrence of VF/VT. The maintenance infusion is given per protocol.

39. After ROSC, a 20-kg child remains hypotensive despite a 20-mL/kg fluid bolus. Which infusion is appropriate?

    1. A. Epinephrine 0.01 mg/kg every 3–5 min
    2. B. Dopamine 50–100 mcg/kg/min
    3. C. Epinephrine 0.1–1 mcg/kg/min
    4. D. Epinephrine 2–10 mcg/kg/min
    Show answer

    Answer: C. Epinephrine 0.1–1 mcg/kg/min

    Pediatric post-arrest hypotension after fluids is treated with a titrated vasoactive infusion such as epinephrine 0.1 to 1 mcg/kg/min. A rate of 2 to 10 mcg/kg/min confuses the adult range (2 to 10 mcg/min, not per kg) and would be a large overdose. Repeated arrest-dose boluses in a perfusing child cause severe hypertension and dysrhythmias. The dopamine range is about 2 to 20 mcg/kg/min, so 50 to 100 is far too high.

40. The maximum single dose of epinephrine in pediatric arrest is:

    1. A. 10 mg
    2. B. 0.5 mg
    3. C. 1 mg
    4. D. 0.1 mg
    Show answer

    Answer: C. 1 mg

    Pediatric epinephrine is capped at the adult dose of 1 mg.

41. A 100-kg adult remains in VF after the third shock, and the agency carries lidocaine instead of amiodarone. What first dose range is appropriate?

    1. A. 1,000 to 1,500 mg IV/IO
    2. B. 100 to 150 mg IV/IO
    3. C. 10 to 15 mg IV/IO
    4. D. 300 mg IV/IO
    Show answer

    Answer: B. 100 to 150 mg IV/IO

    The first lidocaine dose in VF/pVT is 1 to 1.5 mg/kg, so 100 kg gives 100 to 150 mg. 10 to 15 mg is a tenfold underdose. 300 mg is the amiodarone dose and already reaches lidocaine's 3-mg/kg cumulative maximum in one push. 1,000 to 1,500 mg is a tenfold overdose that would cause seizures and cardiovascular collapse.

42. Lidocaine's mechanism in VF/pVT is:

    1. A. Calcium channel blockade (Class IV)
    2. B. Potassium channel blockade (Class III)
    3. C. Beta-adrenergic blockade (Class II)
    4. D. Sodium channel blockade (Class IB)
    Show answer

    Answer: D. Sodium channel blockade (Class IB)

    Lidocaine suppresses ventricular ectopy. Sodium channel blockade decreases ventricular automaticity.

43. A 62-year-old man is in ventricular fibrillation. The second shock has just been delivered, CPR has resumed, and an IV is now in place. Which drug is most appropriate at this point?

    1. A. Amiodarone 150 mg IV infused over 10 minutes
    2. B. Vasopressin 40 units IV in place of epinephrine
    3. C. Atropine 1 mg IV repeated every 3 to 5 minutes
    4. D. Epinephrine 1 mg IV of the 0.1 mg/mL concentration
    Show answer

    Answer: D. Epinephrine 1 mg IV of the 0.1 mg/mL concentration

    In shockable rhythms epinephrine is given after initial defibrillation attempts fail, commonly after the second shock; amiodarone typically follows the third shock.

44. An adult in refractory VF has had three shocks and two doses of epinephrine. Which antidysrhythmic regimen is most appropriate now?

    1. A. Amiodarone 150 mg IV over 10 minutes
    2. B. Magnesium sulfate 2 g IV/IO push
    3. C. Procainamide 20 mg/min IV infusion
    4. D. Amiodarone 300 mg IV/IO push
    Show answer

    Answer: D. Amiodarone 300 mg IV/IO push

    The first arrest dose of amiodarone is 300 mg rapid push; 150 mg over 10 minutes is the dose for stable VT with a pulse.

45. An adult in persistent VF received lidocaine 1.5 mg/kg as the first antidysrhythmic. VF continues. Which subsequent lidocaine dosing is appropriate?

    1. A. 1.5 mg/kg every 3 minutes with no maximum total dose
    2. B. 0.1 mg/kg every minute until ROSC is achieved
    3. C. A single 3 mg/kg bolus followed by no further doses
    4. D. 0.5 to 0.75 mg/kg every 5 to 10 minutes, to a maximum of 3 mg/kg
    Show answer

    Answer: D. 0.5 to 0.75 mg/kg every 5 to 10 minutes, to a maximum of 3 mg/kg

    Repeat lidocaine doses are 0.5 to 0.75 mg/kg, with a cumulative maximum of 3 mg/kg.

46. A 70-year-old woman is found in asystole. An IO line is placed two minutes into CPR. When should the first dose of epinephrine be given?

    1. A. Only after amiodarone has been given first
    2. B. Only after three unsuccessful defibrillation attempts
    3. C. As soon as feasible now that access is established
    4. D. Only after 10 minutes of persistent asystole
    Show answer

    Answer: C. As soon as feasible now that access is established

    For nonshockable rhythms, early epinephrine is associated with better outcomes, so it is given as soon as feasible.

47. A dialysis patient who missed two sessions arrests. The monitor shows a wide, sine-wave rhythm. Along with CPR and epinephrine, which drug is most appropriate?

    1. A. Amiodarone 300 mg IV/IO
    2. B. Lidocaine 1.5 mg/kg IV/IO
    3. C. Atropine 1 mg IV/IO
    4. D. Calcium chloride 1 g IV/IO
    Show answer

    Answer: D. Calcium chloride 1 g IV/IO

    Suspected hyperkalemia is treated with calcium to stabilize the myocardial membrane, often followed by sodium bicarbonate.

48. A patient with a known prolonged QT interval goes into pulseless polymorphic VT with a twisting pattern around the baseline. Which drug is specifically indicated after defibrillation?

    1. A. Calcium chloride 1 g IV/IO
    2. B. Procainamide 17 mg/kg IV/IO
    3. C. Magnesium sulfate 1 to 2 g IV/IO
    4. D. Adenosine 6 mg rapid IV/IO push
    Show answer

    Answer: C. Magnesium sulfate 1 to 2 g IV/IO

    Torsades de pointes is treated with magnesium; procainamide further prolongs the QT and should be avoided.

49. A 24-year-old who ingested a large amount of amitriptyline arrests with a wide-complex PEA. Which adjunct is specifically indicated?

    1. A. Calcium chloride 1 g slow IV/IO
    2. B. Sodium bicarbonate 1–2 mEq/kg
    3. C. Atropine 1 mg IV/IO every 3 min
    4. D. Lidocaine 1.5 mg/kg IV/IO bolus
    Show answer

    Answer: B. Sodium bicarbonate 1–2 mEq/kg

    Sodium bicarbonate counters the sodium channel blockade of tricyclic antidepressants and is a recognized special-circumstance therapy. It is given IV/IO.

50. During CPR for bupivacaine toxicity with 20% lipid emulsion running, how does the ASRA checklist adjust epinephrine?

    1. A. Hold epinephrine until lipid is infused
    2. B. Double each dose to 2 mg IV
    3. C. Use small doses of 1 mcg/kg or less
    4. D. Use vasopressin 40 units instead
    Show answer

    Answer: C. Use small doses of 1 mcg/kg or less

    The ASRA checklist for local anesthetic systemic toxicity reduces individual epinephrine doses to 1 mcg/kg or less, because large doses can worsen dysrhythmias and impair the lipid rescue. It says to avoid vasopressin, calcium channel blockers, beta blockers, and further local anesthetics. Epinephrine is not withheld while waiting for lipid; both are given.

51. Two hours after ROSC, a comatose patient's temperature is 38.6 C. Under 2025 AHA guidance, what is the goal?

    1. A. Allow it; fever aids neurologic recovery
    2. B. Actively keep it at 37.5 C or lower
    3. C. Run 2 L of cold saline rapidly en route
    4. D. Rewarm to 39 C to protect perfusion
    Show answer

    Answer: B. Actively keep it at 37.5 C or lower

    Post-arrest patients who do not follow commands should receive deliberate temperature control between 32 and 37.5 C for at least 36 hours, which includes preventing fever, because fever is linked to worse brain outcomes. Fever does not aid recovery. Routine prehospital rapid infusion of cold IV fluid is not recommended, since it caused pulmonary edema and re-arrest in trials. Warming to 39 C creates fever.

52. A 25-kg child is in refractory pulseless VT, and the agency carries lidocaine instead of amiodarone. What is the initial lidocaine dose?

    1. A. 75 mg IV/IO (3 mg/kg)
    2. B. 2.5 mg IV/IO (0.1 mg/kg)
    3. C. 25 mg IV/IO (1 mg/kg)
    4. D. 125 mg IV/IO (5 mg/kg)
    Show answer

    Answer: C. 25 mg IV/IO (1 mg/kg)

    PALS lidocaine for shock-refractory VF/pVT is a 1 mg/kg IV/IO loading dose.

53. A 3-kg newborn has a heart rate of 40/min despite 30 seconds of effective ventilation and 60 seconds of coordinated compressions with 100% oxygen. What IV epinephrine dose is appropriate?

    1. A. 0.6 mg (0.6 mL of 1 mg/mL)
    2. B. 0.006 mg (0.06 mL of 0.1 mg/mL)
    3. C. 0.06 mg (0.6 mL of 0.1 mg/mL)
    4. D. 0.3 mg IM of the 1 mg/mL concentration
    Show answer

    Answer: C. 0.06 mg (0.6 mL of 0.1 mg/mL)

    Neonatal IV/IO epinephrine is 0.01 to 0.03 mg/kg of the 0.1 mg/mL concentration; 0.02 mg/kg x 3 kg = 0.06 mg.

54. During CPR on an intubated adult, ETCO2 abruptly rises from 14 to 42 mm Hg just before a scheduled epinephrine dose. What is the best action?

    1. A. Hyperventilate the patient to bring the ETCO2 back down
    2. B. Give the epinephrine immediately to maintain the 3-minute schedule
    3. C. Check for a pulse, suspecting ROSC, before giving more epinephrine
    4. D. Give amiodarone because the rise signals refibrillation
    Show answer

    Answer: C. Check for a pulse, suspecting ROSC, before giving more epinephrine

    A sudden sustained rise in ETCO2 is an early sign of ROSC; giving an arrest-dose epinephrine bolus to a perfusing patient can cause severe hypertension and dysrhythmias.

55. After ROSC, a 65-year-old has a BP of 74/40 despite a 1-L fluid bolus. Which is the most appropriate next medication step?

    1. A. Give amiodarone 150 mg IV to stabilize the rhythm first
    2. B. Give another 1 mg epinephrine IV push every 3 to 5 minutes
    3. C. Give nitroglycerin to reduce myocardial oxygen demand
    4. D. Start a titrated norepinephrine or epinephrine infusion
    Show answer

    Answer: D. Start a titrated norepinephrine or epinephrine infusion

    Post-arrest care targets SBP of at least 90 mm Hg and MAP of at least 65 mm Hg using fluids and vasopressor infusions, not arrest-dose boluses.

56. A ventilated post-ROSC patient has an SpO2 of 100% on 100% oxygen. What is the most appropriate oxygen adjustment?

    1. A. Remove oxygen until the SpO2 falls below 90%
    2. B. Titrate the FiO2 down to keep SpO2 at 92% to 98%
    3. C. Keep 100% oxygen for at least the first 24 hours
    4. D. Increase ventilations to 30/min to improve oxygenation
    Show answer

    Answer: B. Titrate the FiO2 down to keep SpO2 at 92% to 98%

    AHA post-arrest guidance avoids both hypoxemia and hyperoxia by targeting an SpO2 of 92% to 98%.

57. A 30-year-old is found pulseless and apneic beside a syringe. Which approach to naloxone is correct?

    1. A. Start high-quality CPR and ventilation; naloxone is secondary
    2. B. Give naloxone every 2 minutes as the primary arrest therapy
    3. C. Delay compressions until naloxone has had time to work
    4. D. Give naloxone 4 mg IN before starting compressions
    Show answer

    Answer: A. Start high-quality CPR and ventilation; naloxone is secondary

    In opioid-associated cardiac arrest, standard resuscitation takes priority; naloxone has no proven benefit once the patient is pulseless.

58. An intubated adult in cardiac arrest has two failed IV attempts. Your partner suggests giving epinephrine down the endotracheal tube. Under 2025 AHA guidance, what is best?

    1. A. Hold epinephrine until an IV works
    2. B. Place an IO line and give 1 mg IO
    3. C. Give 1 mg undiluted down the tube
    4. D. Give 2.5 mg diluted down the tube
    Show answer

    Answer: B. Place an IO line and give 1 mg IO

    The 2025 AHA adult guidelines put IV access first and IO access next if IV attempts are unsuccessful or not feasible; giving drugs through an in-place endotracheal tube was removed because absorption is unpredictable and blood levels are low. The 2 to 2.5-mg tracheal dose is outdated teaching. Holding drugs for more IV attempts delays epinephrine. An undiluted 1-mg tracheal dose is absorbed even less.

59. An intubated 10-kg infant in cardiac arrest has no vascular access. What endotracheal epinephrine dose is appropriate?

    1. A. 1 mg (1 mL of the 1 mg/mL concentration)
    2. B. 0.01 mg (0.1 mL of the 0.1 mg/mL concentration)
    3. C. 0.1 mg (1 mL of the 0.1 mg/mL concentration)
    4. D. 10 mg (10 mL of the 1 mg/mL concentration)
    Show answer

    Answer: A. 1 mg (1 mL of the 1 mg/mL concentration)

    The pediatric ET epinephrine dose is 0.1 mg/kg of the 1 mg/mL concentration, ten times the IV/IO dose.

60. A patient in anaphylaxis goes into cardiac arrest. Besides CPR and epinephrine, which therapy is especially important?

    1. A. Calcium chloride 1 g IV/IO
    2. B. Rapid, large-volume IV fluid
    3. C. Diphenhydramine 50 mg IV first
    4. D. Methylprednisolone before epinephrine
    Show answer

    Answer: B. Rapid, large-volume IV fluid

    Anaphylactic arrest is driven by massive vasodilation and capillary leak, so rapid, large-volume isotonic fluid is given along with standard ACLS epinephrine. Antihistamines and steroids do not restore circulation and must not delay epinephrine. Calcium has no role without hyperkalemia, hypocalcemia, or calcium channel blocker toxicity.

61. An 18-kg child is in VF. CPR has resumed after the second shock (4 J/kg), and an IO is in place. Which drug is given now?

    1. A. Atropine 0.36 mg IO push
    2. B. Epinephrine 0.18 mg IO
    3. C. Adenosine 1.8 mg IO
    4. D. Amiodarone 90 mg IO bolus
    Show answer

    Answer: B. Epinephrine 0.18 mg IO

    In the PALS shockable sequence, epinephrine 0.01 mg/kg (0.18 mg for 18 kg) every 3 to 5 minutes begins after the second shock; amiodarone 5 mg/kg or lidocaine 1 mg/kg follows the third shock. Atropine has no role in VF. Adenosine treats SVT in a child with a pulse.

62. A 55-year-old has been in PEA for 15 minutes with no known acidosis, hyperkalemia, or overdose. Your partner suggests sodium bicarbonate. The best response is:

    1. A. Give it before each epinephrine dose to improve its effect
    2. B. Give 50 mEq every 5 minutes until ROSC is achieved
    3. C. Routine bicarbonate is not recommended without a specific indication
    4. D. Give 1 mEq/kg now because the arrest has exceeded 10 minutes
    Show answer

    Answer: C. Routine bicarbonate is not recommended without a specific indication

    Routine sodium bicarbonate does not improve outcomes; it is reserved for conditions such as hyperkalemia or tricyclic overdose.

63. A woman who is 34 weeks pregnant goes into cardiac arrest. Regarding ACLS medications, which statement is correct?

    1. A. All drug doses are halved to protect the fetus
    2. B. Epinephrine is withheld to protect uterine blood flow
    3. C. Standard ACLS drugs and doses are used without modification
    4. D. Amiodarone is contraindicated during pregnancy arrest
    Show answer

    Answer: C. Standard ACLS drugs and doses are used without modification

    Resuscitating the mother is the best fetal therapy, so usual drugs and doses are given along with manual left uterine displacement.

64. A preeclamptic patient receiving a magnesium infusion becomes apneic and pulseless. In addition to stopping the infusion and starting CPR, which drug is indicated?

    1. A. Atropine 1 mg IV/IO every 3 minutes
    2. B. Calcium chloride 1 g IV/IO
    3. C. Magnesium sulfate 2 g IV/IO push
    4. D. Naloxone 2 mg IV/IO, repeated
    Show answer

    Answer: B. Calcium chloride 1 g IV/IO

    Magnesium toxicity is reversed with IV calcium, which AHA lists for arrest associated with magnesium therapy in pregnancy. Calcium gluconate 3 g is an alternative.

65. A patient goes into cardiac arrest shortly after receiving a large dose of bupivacaine for a nerve block. Which therapy is specifically indicated?

    1. A. Vasopressin 40 units IV in place of epinephrine
    2. B. Sodium bicarbonate 1 mEq/kg every 3 minutes
    3. C. Lidocaine 1.5 mg/kg IV as the antidysrhythmic
    4. D. 20% lipid emulsion, about 1.5 mL/kg IV bolus
    Show answer

    Answer: D. 20% lipid emulsion, about 1.5 mL/kg IV bolus

    Lipid emulsion is the specific therapy for local anesthetic systemic toxicity; adding lidocaine, another local anesthetic, would worsen toxicity.

66. After ROSC following four doses of epinephrine, the patient has sinus tachycardia at 140/min with frequent PVCs. The most likely contributing cause is:

    1. A. Hypothermia from the cold IV fluids given during CPR
    2. B. Residual beta-1 stimulation from the epinephrine
    3. C. Alpha-1 receptor blockade caused by epinephrine
    4. D. A delayed vagolytic effect of amiodarone
    Show answer

    Answer: B. Residual beta-1 stimulation from the epinephrine

    Epinephrine's beta-1 effects increase heart rate and myocardial irritability, which can persist briefly after ROSC. Hypothermia slows the heart rather than speeding it.

67. A 7-kg infant has a heart rate of 50/min with poor perfusion despite effective oxygenation and ventilation, and CPR has been started. Which drug and dose come first?

    1. A. Epinephrine 0.7 mg IV/IO (0.7 mL of 1 mg/mL)
    2. B. Adenosine 0.7 mg rapid IV/IO with a saline flush
    3. C. Epinephrine 0.07 mg IV/IO (0.7 mL of 0.1 mg/mL)
    4. D. Atropine 0.7 mg IV/IO given as a rapid push
    Show answer

    Answer: C. Epinephrine 0.07 mg IV/IO (0.7 mL of 0.1 mg/mL)

    Pediatric bradycardia with poor perfusion despite ventilation is treated with CPR and epinephrine 0.01 mg/kg of the 0.1 mg/mL concentration.

68. A 2-year-old is in asystole, and your partner draws up atropine as the first drug. Which statement is correct?

    1. A. Atropine is not indicated for pediatric asystole
    2. B. Atropine 0.02 mg/kg is given before epinephrine
    3. C. Atropine and epinephrine alternate every 3 minutes
    4. D. Atropine 0.5 mg is the preferred first drug
    Show answer

    Answer: A. Atropine is not indicated for pediatric asystole

    Pediatric asystole is treated with CPR and epinephrine; atropine is used only for bradycardia from increased vagal tone or primary AV block.

69. During resuscitation of a 1-year-old in cardiac arrest, the glucose is 30 mg/dL. Which treatment is appropriate?

    1. A. D10 at 5 to 10 mL/kg IV/IO (0.5 to 1 g/kg)
    2. B. D50 at 1 mL/kg, undiluted, by IO push
    3. C. Withhold dextrose until ROSC is achieved
    4. D. Glucagon 1 mg IM during ongoing compressions
    Show answer

    Answer: A. D10 at 5 to 10 mL/kg IV/IO (0.5 to 1 g/kg)

    Documented hypoglycemia should be corrected during pediatric resuscitation; dilute dextrose such as D10 is preferred in young children.

70. An adult in VF received epinephrine at minutes 4 and 8. At the 12-minute rhythm check, VF persists. Should another dose be given now?

    1. A. No; only two doses are allowed in shockable rhythms
    2. B. Yes; epinephrine may be repeated every 3 to 5 minutes
    3. C. No; switch to vasopressin after two epinephrine doses
    4. D. Only if two doses of amiodarone have already been given
    Show answer

    Answer: B. Yes; epinephrine may be repeated every 3 to 5 minutes

    There is no fixed maximum number of epinephrine doses in adult arrest; it is repeated every 3 to 5 minutes.

71. Compared with IV administration, drugs given by the IO route during cardiac arrest are:

    1. A. Limited to crystalloid fluids only
    2. B. Diluted tenfold before each push
    3. C. Given in the same drugs and doses
    4. D. Given at double the dose
    Show answer

    Answer: C. Given in the same drugs and doses

    The IO space drains into the central circulation, so IO drugs and doses are the same as IV.

72. A patient who ingested a large amount of verapamil goes into cardiac arrest. Which drug is a reasonable specific adjunct?

    1. A. Calcium chloride 1 g IV/IO
    2. B. Diltiazem 0.25 mg/kg IV/IO
    3. C. Adenosine 12 mg rapid IV/IO
    4. D. Procainamide 17 mg/kg IV/IO
    Show answer

    Answer: A. Calcium chloride 1 g IV/IO

    Calcium partly overcomes calcium channel blockade and is used in calcium channel blocker toxicity.

73. A term newborn is apneic after drying and stimulation, and positive-pressure ventilation is started. Per NRP, what oxygen concentration is used at first?

    1. A. 50% from a blender
    2. B. 21% (room air)
    3. C. 100%, weaned after 1 hour
    4. D. 100% from the first breath
    Show answer

    Answer: B. 21% (room air)

    For newborns at 35 weeks or more, NRP starts positive-pressure ventilation with 21% oxygen and adjusts it to the preductal SpO2 targets; preterm infants start at 21% to 30%. Starting term newborns on 100% is linked to higher mortality and is not recommended. Oxygen is raised to 100% when chest compressions begin, not routinely at the start.

74. Which adverse effect of amiodarone is most important to watch for immediately after ROSC?

    1. A. Seizures and hyperthermia
    2. B. Bronchospasm and wheezing
    3. C. Hypotension and bradycardia
    4. D. Hyperglycemia and polyuria
    Show answer

    Answer: C. Hypotension and bradycardia

    Amiodarone causes vasodilation and slows conduction, so a perfusing patient can become hypotensive and bradycardic.