High-quality CPR, Mechanical CPR, and Pit-crew Teamwork Practice Questions

25 multiple-choice questions on High-quality CPR, mechanical CPR, and pit-crew teamwork for paramedic and EMT students, from Chapter 40 (Responding to the Field Code). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. During excellent mechanical CPR, the patient in cardiac arrest begins to move his arms and groan but has no pulse at the rhythm check. This most likely represents:

   1. A. Return of a normal pulse
   2. B. CPR-induced consciousness
   3. C. A seizure needing a shock
   4. D. A sign to stop CPR now
   Show answer

   Answer: B. CPR-induced consciousness

   High-quality compressions can perfuse the brain enough to cause movement or awareness without return of circulation. Continue CPR, check for ROSC at rhythm checks, and consider sedation or analgesia per protocol if the movement interferes with care. It is not a reason to stop compressions.

2. Feedback shows that a large paramedic's compressions are reaching 7 cm (2.8 in) at 110 per minute with full recoil. You should:

   1. A. Coach him to ease off to 5 to 6 cm
   2. B. Let him go on, since 7 cm is within range
   3. C. Have him speed up to 130 to cut depth
   4. D. Have him go to 4 cm to limit rib injury
   Show answer

   Answer: A. Coach him to ease off to 5 to 6 cm

   Adult compressions should be at least 5 cm (2 in) but not more than about 6 cm (2.4 in); depths above 6 cm are linked to more injuries without added benefit. The rate and recoil are already correct, so only depth needs adjusting. At 7 cm he is above the upper limit, so the depth is not within range. Dropping to 4 cm would overcorrect below the 5-cm minimum and reduce blood flow. Speeding up to 130 would reduce depth only by breaking the rate limit, which shortens filling time. (2025 AHA adult BLS; Stiell 2014.)

3. While responding to a reported cardiac arrest, a crew can best reduce hands-off time in the first minutes by:

   1. A. Deciding on roles once the rhythm is known
   2. B. Letting each member choose a task on arrival at the door
   3. C. Assigning each role before reaching the patient
   4. D. Waiting for the supervisor to assign roles
   Show answer

   Answer: C. Assigning each role before reaching the patient

   Pit-crew systems assign positions, such as compressor, airway, and defibrillator or leader, before the crew reaches the patient, so compressions and pads start within seconds and tasks are not duplicated or missed. Waiting until the rhythm is known delays the first compressions and pads, which are needed whatever the rhythm is. Letting people choose tasks on arrival leads to two people doing the same thing while another job waits. Waiting for a supervisor wastes the minutes when CPR and defibrillation matter most. (Hopkins 2016 pit-crew implementation; AHA 2025 systems of care.)

4. CPR feedback data show the compressor is leaning on the chest and not releasing fully between compressions. This most directly reduces:

   1. A. Peak compression depth
   2. B. Venous return to the heart
   3. C. Arterial oxygen content
   4. D. Compression rate accuracy
   Show answer

   Answer: B. Venous return to the heart

   Incomplete recoil keeps intrathoracic pressure high, which limits venous return, coronary perfusion pressure, and cardiac output. Depth and rate can still look correct on the monitor while leaning silently reduces blood flow.

5. A code review finds long pauses in compressions. The most common sources of avoidable hands-off time during EMS resuscitations are:

   1. A. Drug doses given during compressions
   2. B. Charging during ongoing compressions
   3. C. Changing the compressor during rhythm checks
   4. D. Airway placement, rhythm checks, and moves
   Show answer

   Answer: D. Airway placement, rhythm checks, and moves

   Most interruptions come from advanced airway attempts, prolonged rhythm or pulse checks, and moving the patient. Planning roles, limiting pauses to under 10 seconds, intubating during compressions, and delaying moves reduce hands-off time. Drug administration and charging should happen without pausing.

6. A neighboring agency promotes head-up (elevated head and chest) CPR. Under 2025 AHA guidance, head-up CPR in adult cardiac arrest is:

   1. A. Not recommended outside clinical trials
   2. B. Recommended for every adult arrest
   3. C. Recommended only with a mechanical CPR device
   4. D. Required when the ETCO2 is below 10
   Show answer

   Answer: A. Not recommended outside clinical trials

   The 2025 AHA adult ALS guidelines state that head-up CPR is not recommended except in the setting of clinical trials, because the evidence so far comes from observational data and bundled care that cannot show a benefit of the position itself. It is therefore not recommended for every adult arrest. Using it with a mechanical device or an impedance threshold device is part of the bundles being studied, not a recommended standard. No guideline makes head-up CPR a response to a low ETCO2; a low ETCO2 calls for better compressions and a look for the cause. (2025 AHA Part 9.)

7. At a rhythm check you see VF, but the defibrillator displays a pad contact error. You should:

   1. A. Stop CPR until the error clears
   2. B. Shock anyway through the bad pads
   3. C. Resume CPR while fixing the pads
   4. D. Check for a pulse every 10 seconds
   Show answer

   Answer: C. Resume CPR while fixing the pads

   Compressions should continue while you press the pads firmly, dry or shave the skin, or replace them. Shocking through poorly adherent pads risks burns and failure, and stopping CPR while troubleshooting leaves the brain and heart without blood flow.

8. Immediately after you deliver a shock for VF, the monitor shows an organized rhythm. You should:

   1. A. Check a carotid pulse for 10 seconds
   2. B. Deliver a second shock at higher energy
   3. C. Resume compressions for 2 minutes
   4. D. Start post-ROSC ventilations at 10/min
   Show answer

   Answer: C. Resume compressions for 2 minutes

   Most patients do not have an effective pulse immediately after a shock, even with an organized rhythm, so CPR resumes at once and the pulse is checked at the next rhythm check. Stopping to feel for a pulse right after the shock extends the pause when the heart most needs perfusion.

9. Your partner is ready to intubate an adult during CPR. To limit the pause in compressions, the best plan is to:

   1. A. Stop CPR until the tube is secured
   2. B. Do laryngoscopy while compressions go on
   3. C. Intubate only after the first epinephrine
   4. D. Pause CPR for 30 seconds each attempt
   Show answer

   Answer: B. Do laryngoscopy while compressions go on

   Laryngoscopy can usually be done while compressions continue, with any pause kept to the few seconds needed to pass the tube (under 10 seconds), because every interruption lowers coronary perfusion pressure. Stopping CPR until the tube is secured creates a long, harmful pause. Airway placement does not depend on the timing of epinephrine and should not be tied to it. A 30-second pause per attempt is three times the recommended maximum. (2025 AHA adult ALS; NAEMSP airway position statement.)

10. Compressions should be delivered with the heel of the hand on the:

    1. A. Lower half of the sternum
    2. B. Upper third of the sternum
    3. C. Xiphoid process
    4. D. Left chest over the apex
    Show answer

    Answer: A. Lower half of the sternum

    Hands go in the center of the chest on the lower half of the sternum, roughly between the nipples. Compressing over the xiphoid process risks liver and gastric injury and moves less blood.

11. You find an adult in cardiac arrest lying on a soft mattress in a bedroom. You should:

    1. A. Begin CPR on the bed to avoid moving him
    2. B. Elevate his legs to improve venous return
    3. C. Compress at about 140 per minute instead
    4. D. Move him to the floor or a firm board
    Show answer

    Answer: D. Move him to the floor or a firm board

    A soft mattress absorbs much of each compression, so CPR should be done on a firm surface, usually the floor. Leg elevation is not recommended, and faster rates reduce depth and filling time.

12. After a stair carry, you notice that the piston of a mechanical CPR device has slid down toward the upper abdomen. You should:

    1. A. Keep going, since position is not critical
    2. B. Pause briefly and recenter it on the sternum
    3. C. Remove it and switch to manual CPR for good now
    4. D. Raise the depth setting to make up for it
    Show answer

    Answer: B. Pause briefly and recenter it on the sternum

    A mechanical device works only if the piston or band stays centered on the lower half of the sternum; after any move the position should be checked, and a migrated piston should be recentered in a brief pause. Compressing over the upper abdomen moves less blood and can injure the liver and stomach, so position is critical. Abandoning the device is not necessary when a quick repositioning fixes the problem and the patient still has to be moved. Increasing the depth would only push harder on the abdomen. (2025 AHA adult BLS on mechanical CPR; manufacturer instructions for use.)

13. Your crew must carry an adult in refractory VF down three flights of stairs and then drive 25 minutes to an ECPR center. The best way to maintain compressions is:

    1. A. Manual CPR on a stair chair
    2. B. Pausing CPR until in the ambulance
    3. C. One-rescuer manual compressions
    4. D. A mechanical CPR device
    Show answer

    Answer: D. A mechanical CPR device

    Manual compressions during stair carries and in a moving ambulance are shallow and frequently interrupted, and they put the crew at risk. A mechanical device keeps compressions consistent during movement, which is exactly the situation AHA describes as reasonable for its use.

14. When applying a mechanical CPR device during a resuscitation, the crew should:

    1. A. Apply it in steps with only brief pauses
    2. B. Stop CPR fully until the device is running
    3. C. Apply it before the first rhythm analysis
    4. D. Delay it until the advanced airway is placed
    Show answer

    Answer: A. Apply it in steps with only brief pauses

    Device application is a common source of long pauses, so teams practice placing the backplate and arm with interruptions of only a few seconds each. Mechanical CPR should never delay the first defibrillation attempt.

15. Two minutes into good-quality CPR on an 80-year-old woman, you feel her ribs crack under your hands. You should:

    1. A. Reduce the depth to about 3 cm (1.2 in)
    2. B. Slow the rate to 80/min to protect the ribs
    3. C. Check hand position and keep the same depth
    4. D. Pause CPR to check for a flail segment
    Show answer

    Answer: C. Check hand position and keep the same depth

    Rib and sternal fractures are common during CPR, especially in older adults, and are not a reason to change technique; confirm your hands are on the lower half of the sternum and continue at least 5 cm deep. Reducing the depth to 3 cm makes compressions ineffective, and the patient will die without circulation. Slowing to 80 per minute drops below the 100 to 120 range and reduces flow without protecting the ribs. Pausing to examine the chest for a flail segment interrupts perfusion and changes nothing about care during the arrest. (2025 AHA adult BLS; ch40 CPR quality section.)

16. You arrive as a bystander's AED announces 'No shock advised.' The patient is unresponsive and not breathing normally. You should:

    1. A. Check a pulse for a full 30 seconds
    2. B. Swap to your monitor before any CPR
    3. C. Reanalyze with the AED right away
    4. D. Resume compressions right away
    Show answer

    Answer: D. Resume compressions right away

    A 'no shock advised' prompt means the rhythm is not shockable at that moment, which in an unresponsive patient who is not breathing normally is usually asystole or PEA, so compressions should resume at once for 2 minutes. A 30-second pulse check is three times longer than the 10-second maximum and leaves the patient without flow. Switching to your monitor can wait until the next planned rhythm check, so it does not add a pause. Pressing analyze again right away only adds another hands-off pause; the rhythm is reassessed at the next 2-minute check. (2025 AHA adult BLS and ALS.)

17. Real-time CPR feedback devices are useful mainly because they:

    1. A. Diagnose the arrest rhythm during CPR
    2. B. Help keep rate and depth on target
    3. C. Remove the need to rotate compressors
    4. D. Measure the patient's blood pressure
    Show answer

    Answer: B. Help keep rate and depth on target

    Rescuers are poor judges of their own compression quality, and feedback devices correct rate, depth, and recoil in real time. They do not reduce fatigue, so compressors should still switch every 2 minutes.

18. Before an advanced airway is placed, which ventilation strategy during adult CPR is also acceptable for EMS crews?

    1. A. Continuous compressions with 1 breath every 6 s
    2. B. Continuous compressions with 1 breath every 2 s
    3. C. 15 compressions to 2 breaths, as for children
    4. D. Breaths only during each 2-minute rhythm check
    Show answer

    Answer: A. Continuous compressions with 1 breath every 6 s

    Since 2017, AHA has said it may be reasonable for EMS providers to give continuous compressions with asynchronous breaths at 10 per minute (1 every 6 seconds) before an advanced airway, as an alternative to 30:2; the large ROC trial found similar survival with the two methods. One breath every 2 seconds is 30 per minute and would cause hyperventilation in an adult. A 15:2 ratio is for two-rescuer CPR in infants and children. Ventilating only at rhythm checks would leave long periods with no ventilation. (Kleinman 2018 focused update; Nichol 2015; AHA 2020 and 2025 BLS.)

19. A 70-year-old woman is in cardiac arrest, wedged between a toilet and a bathtub. You should first:

    1. A. Begin compressions where she lies
    2. B. Place an IO before moving her
    3. C. Quickly drag her to open floor space
    4. D. Apply pads in the AP position as she lies
    Show answer

    Answer: C. Quickly drag her to open floor space

    A cramped position prevents effective compressions, airway management, and defibrillation, so a rapid move of a few seconds to open space pays off. Starting CPR in the wedged position produces poor compressions for the whole resuscitation.

20. Why do even short pauses in chest compressions matter?

    1. A. Each pause makes VF quickly degrade into asystole
    2. B. Each pause sharply raises intrathoracic pressure
    3. C. Each pause worsens existing rib fractures
    4. D. Perfusion pressure falls fast, rebuilds slowly
    Show answer

    Answer: D. Perfusion pressure falls fast, rebuilds slowly

    Coronary perfusion pressure drops within seconds of stopping compressions and takes many compressions to recover, so frequent pauses keep the heart underperfused. VF does deteriorate with time, but not with each brief pause.

21. Ninety seconds into a CPR cycle, the feedback device shows the compressor's depth is falling to 1.5 in (4 cm). The best action is to:

    1. A. Swap compressors now, in under 5 seconds
    2. B. Wait for the 2-minute check to swap
    3. C. Have him slow to 80/min to save energy
    4. D. Switch to a 15:2 ratio to reduce workload
    Show answer

    Answer: A. Swap compressors now, in under 5 seconds

    The 2-minute rotation is a minimum, not a rule to wait out; a fatigued compressor should be replaced right away with a quick, choreographed swap. Slowing the rate or changing the ratio reduces blood flow further.

22. Routine use of an impedance threshold device with conventional CPR in adult cardiac arrest is:

    1. A. Recommended for all adults
    2. B. Not recommended
    3. C. Required with mechanical CPR
    4. D. Recommended in pediatric arrest
    Show answer

    Answer: B. Not recommended

    The large ROC PRIMED trial found no survival benefit from adding an impedance threshold device to conventional CPR, so AHA does not recommend routine use. Some systems use it in bundled care, such as with active compression-decompression CPR, per local protocol.

23. In most EMS systems, adult cardiac arrest resuscitation is best performed:

    1. A. En route, to shorten time to the hospital
    2. B. At the hospital after a rapid scoop-and-run
    3. C. On scene, until ROSC or a decision to stop
    4. D. In the ambulance after the first shock
    Show answer

    Answer: C. On scene, until ROSC or a decision to stop

    Manual CPR in a moving ambulance is poor quality and unsafe, and most hospital care can be delivered on scene, so systems usually work the arrest where it is found. Early transport is reserved for specific situations, such as ECPR candidates or causes that need hospital treatment.

24. Well-performed manual chest compressions in an adult generate roughly what share of normal cardiac output?

    1. A. About 25% to 33%
    2. B. About 5% to 10%
    3. C. About 60% to 70%
    4. D. About 90% to 100%
    Show answer

    Answer: A. About 25% to 33%

    Even ideal compressions produce only about one-quarter to one-third of normal cardiac output, which is why quality and continuity matter so much. Assuming CPR comes close to normal output underestimates the harm of every pause.

25. A paramedic is monitoring CPR quality during a code. Which finding should prompt an immediate correction?

    1. A. Compression fraction of 85%
    2. B. Compressor swaps every 2 minutes
    3. C. Compressions at 135 per minute
    4. D. Pre-shock pause of 4 seconds
    Show answer

    Answer: C. Compressions at 135 per minute

    A rate of 135 exceeds the 120 upper limit, which reduces depth and diastolic filling time. A compression fraction of 85%, 2-minute swaps, and a 4-second pre-shock pause all meet or beat AHA targets.