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American Heart Association



    Heartsaver CPR
   Written Examination
   Adult and Pediatric Modules

                 Pretest

   ANNOTATED ANSWER KEY

           February 2001




      © 2001 American Heart Association
Annotated Answer Key
Heartsaver CPR
Adult and Pediatric Pretest


1.   You respond to someone who has just collapsed (you witnessed the collapse). After you
     make sure that the scene is safe, what is the next thing you should do?

     a.   Check for unresponsiveness; if the victim is unresponsive, phone 911
     b.   Phone 911; wait outside to direct the emergency responders
     c.   Do 2 finger sweeps; check if food is blocking the airway
     d.   Perform CPR for 1 minute; then phone911

     The correct answer is a.

     Your first action after determining that the scene is safe is to check if the victim is unresponsive. If
     the victim is unresponsive, you should phone (or send someone to phone) the emergency medical
     services (EMS) system.
     Answer b is incorrect because you should not phone 911 until you have checked responsiveness.
     When you have determined that the victim is unresponsive and you phone 911, you should return to
     the victim and begin CPR.
     Answer c is incorrect because you should not perform finger sweeps or check the victim’s mouth
     unless you strongly suspect that an obstruction is blocking the airway or there is evidence of
     something in the victim's mouth.
     Answer d is incorrect because for adult victims of sudden cardiac arrest you should phone 911 as
     soon as you determine that the victim is unresponsive. You do not begin CPR before phoning 911
     because you must be sure emergency help (including a defibrillator) is on the way.

     Heartsaver CPR manual: pages 7 to 9 (Chain of Survival) and page 24


2.   Your tennis partner, a healthy 42-year-old woman, began to complain of vague "pressure" in
     the middle of her chest 30 minutes ago. Now the pain is worse and has moved down her left
     arm and to her back. She feels nauseated, dizzy, and sweaty. What should you do?

     a.   Give her 1 aspirin, then have her rest for an hour
     b.   Have her lie down, then call her private physician
     c.   Let her walk outside to breathe fresh air
     d.   Have her lie down or recline, then phone 911 immediately

     The correct answer is d.

     These signs and symptoms are consistent with signs of a heart attack (myocardial infarction). The
     most common sign of heart attack is chest pain or pressure that may radiate to the neck or jaw or
     down the left arm and may even be felt in the back, between the shoulder blades. However, women,
     persons with diabetes, and the elderly frequently demonstrate more vague signs, including more
     diffuse pain or pressure, and may complain that they feel lightheaded, faint, short of breath, or

 Heartsaver CPR Adult and Pediatric Pretest                                                                     2
nauseated. This answer is the only one that contains a phone call to 911, the most important action
     you can take, so this is the only possible correct answer.
     Answer a is incorrect for 2 reasons. EMS personnel or the Emergency Department may prescribe an
     aspirin, but it is not necessary for you to administer the aspirin. It is more important for you to phone
     the EMS system. The answer is also incorrect because it would delay the phone call to 911 by an
     hour. During the first hour of a heart attack the victim is at highest risk of sudden death from
     ventricular fibrillation.
     Answer b is incorrect because the call to the private physician will only delay the phone call to the
     EMS system and delay arrival of EMS personnel and transport of the victim to a medical facility.
     Answer c is incorrect because the victim of a heart attack is at highest risk of death from ventricular
     fibrillation during the first hour after the onset of symptoms. You must phone 911 immediately.

     Heartsaver CPR manual: page 10


3.   Your doctor tells you that you have several risk factors for stroke. Which of the following
     stroke risk factors can be controlled?

     a.   Prior history of stroke
     b.   Heredity (family history)
     c.   Gender
     d.   Untreated high blood pressure (hypertension)

     The correct answer is d.

     Hypertension and cigarette smoke are 2 of the major controllable risk factors for heart attack and
     stroke. If you have high blood pressure, you should be under the care of a doctor and you should
     take your prescribed medications exactly as directed.
     Answer a is incorrect because you cannot change your medical history.
     Answer b is incorrect because you cannot control or change your heredity or a family history of
     stroke or risk factors for stroke.
     Answer c is incorrect because you cannot change your gender.

     Heartsaver CPR manual: pages 16 to 17


4.   You are at work when a 60-year-old customer begins to complain of a sudden numbness and
     weakness on one side of his face and in one arm. He also has trouble speaking. What
     problem do you think he has?

     a.   An epileptic seizure
     b.   A heart attack
     c.   A stroke
     d.   Diabetic coma

     The correct answer is c.

     The most common signs of stroke are the sudden onset of a severe headache; sudden trouble
     seeing out of one or both eyes; sudden numbness or weakness on one side of the body or face;
     sudden confusion or trouble speaking or understanding; sudden dizziness, trouble walking, or loss of
     balance or coordination. If you see any of these signs you should suspect a stroke and phone 911
     immediately.
     Answer a is incorrect because these signs are not consistent with a seizure.



 Heartsaver CPR Adult and Pediatric Pretest                                                                    3
Answer b is incorrect because the victim has reported no pain or pressure or even vague signs of a
     heart attack, such as dizziness, shortness of breath, or nausea (see question 3 for signs of a heart
     attack).
     Answer d is incorrect because a diabetic coma will cause the victim to be unresponsive.

     Heartsaver CPR manual: page 13


5.   You are alone, and you have just pulled a submerged child from a swimming pool. The child
     is unresponsive and you shout for help. No one has responded to your shout. What should
     you do about phoning 911?

     a.   Check for signs of circulation, and if there are no signs phone 911
     b.   Phone 911 immediately, then continue the ABCs of CPR
     c.   Give 2 rescue breaths, then phone 911
     d.   Perform the ABCs of CPR and then phone 911 after about 1 minute of rescue support

     The correct answer is d.

     Whenever you find an unresponsive child, you should begin the steps of CPR immediately. Children
     who suffer cardiac arrest are most often hypoxic (in need of oxygen), so you should perform about 1
     minute of CPR before activating the EMS system. This allows you to initiate rescue breathing and
     restore delivery of oxygen to the brain and heart as quickly as possible. Submersion victims also
     need immediate rescue breathing before you phone 911.
     Answer a is incorrect because you should not check for signs of circulation until after you have
     opened the airway, checked for breathing, and (if normal breathing is absent) delivered 2 effective
     breaths. Submersion victims most frequently require rescue breathing, so you should not skip that
     (or any) part of the CPR sequence.
     Answer b is incorrect because for the submersion victim of any age you should begin CPR and
     phone 911 after approximately 1 minute.
     Answer c is incorrect because you should perform the assessment and skills steps of CPR for
     approximately 1 minute before leaving the child to phone 911.

     Heartsaver CPR manual: page 50 (Special Resuscitation Situations—[adult] Submersion), pages 72
     to 75 (Infant and Child Chain of Survival, and pages 101 to 107 (steps of CPR)


6.   Every year hundreds of thousands of adults die of sudden cardiac arrest. Which of the
     following interventions will have the greatest impact on improving survival from sudden
     cardiac arrest?

     a.   CPR by EMS personnel
     b.   Immediate bystander CPR and early (within 5 minutes or less) defibrillation
     c.   Defibrillation in 10 minutes without CPR
     d.   Immediate CPR with defibrillation in 10 minutes

     The correct answer is b.

     Immediate bystander CPR nearly doubles survival from cardiac arrest. Most sudden cardiac arrest is
     caused by a sudden arrhythmia called ventricular fibrillation (VF). The treatment for VF cardiac arrest
     is defibrillation—the sooner defibrillation occurs, the greater the victim's chances of survival.
     Answer a is incorrect. Although CPR improves survival, if it is not performed until EMS personnel
     arrive, the victim's chances of survival are reduced dramatically because the brain and heart have
     already experienced a severe loss of oxygen for many minutes.



 Heartsaver CPR Adult and Pediatric Pretest                                                                 4
Answer c is incorrect because survival from sudden cardiac arrest decreases by about 7% to 10%
     for every minute defibrillation is delayed if no bystander CPR is performed. Therefore, if bystander
     CPR is not provided, within 10 minutes a victim's chance of survival is very, very low.
     Answer d is incorrect because even if CPR is performed immediately, defibrillation within 5 minutes
     would result in much greater survival (answer b) than defibrillation within 10 minutes. For every
     minute defibrillation is delayed, even when CPR is provided, the victim's chance of survival falls.

     Heartsaver CPR manual: pages 6 to 9 (Chain of Survival), particularly page 8


7.   You are starting to provide CPR for an unresponsive victim. Which of the following describes
     the best way to open the airway in an unresponsive victim of any age who has no sign of
     head or neck injury?

     a.   Give 5 back blows and then sweep out the mouth
     b.   Tilt the head and lift the chin
     c.   Wait until a mask or other barrier device is available to open the airway
     d.   Grab and lift the lower chin

     The correct answer is b.

     The head tilt–chin lift technique is the method you will use most commonly. This technique lifts the
     jaw away from the back of the throat to open the airway. You should also be prepared to perform the
     jaw thrust if you suspect head or neck injury.
     Answer a is incorrect for several reasons. First, back blows are an alternative method of relieving
     severe or complete foreign-body airway obstruction in the responsive adult, and back blows are most
     often used for infants. These measures are not appropriate for a lay rescuer when a victim is
     unresponsive and has no signs of airway obstruction.
     Answer c is incorrect because you do not need a mask or other barrier device to open the airway for
     an unresponsive victim. Opening the airway may be the only intervention needed for an
     unresponsive victim, and it should not be delayed for lack of a barrier device.
     Answer d is incorrect because you do not need to grab and lift the lower chin.

     Heartsaver CPR manual: pages 24 to 25


8.   You have entered an office and find a colleague unresponsive. You have phoned 911 and you
     are beginning CPR for the victim. You have opened the airway and must check for breathing.
     You do this by listening and feeling for airflow through the victim's nose or mouth. What
     other things should you assess to determine if a victim is breathing normally?

     a.   Look into the victim's mouth to see if anything is blocking his airway
     b.   Shake the victim to see if there is any response
     c.   Check for signs of circulation
     d.   Look to see if the victim's chest rises and falls, signaling that the victim is breathing

     The correct answer is d.

     If the victim is not breathing or is breathing very shallowly or very slowly, he is not breathing
     normally, which means that you must deliver rescue breaths.
     Answer a is incorrect because you should not look in the victim's mouth—you need to see if the
     victim is breathing.
     Answer b is incorrect because you already shook the victim and attempted to stimulate the victim
     when you found that he was unresponsive.


 Heartsaver CPR Adult and Pediatric Pretest                                                                 5
Answer c is incorrect because there is no need to check for signs of circulation until after you have
     checked for breathing and (if the victim is not breathing normally) delivered 2 effective breaths. Then
     you should check for signs of circulation.

     Heartsaver CPR manual: pages 23 to 26


9.   You are delivering rescue breaths with a mask to an unresponsive, nonbreathing teenager in
     a movie theater. Which of the following best describes the volume of air you should provide
     during mouth-to-mask ventilations?

     a. Reduce your air volume and duration of breaths from what you would provide during mouth-to-
        mouth ventilation
     b. Deliver air over 2 seconds until the chest rises, just as you would for mouth-to-mouth
        breathing
     c. Increase your air volume but shorten the duration of breaths
     d. Give 3 breaths over 10 seconds

     The correct answer is b.

     The only way to know if you are delivering a sufficient volume of air effectively is if you see the
     victim's chest rise. If the chest does not rise, you are not delivering effective rescue breaths: you
     either have not opened the airway sufficiently or have not delivered enough air.
     Answer a is incorrect because there is no reason to reduce the air volume and duration of breaths
     from that delivered during mouth-to-mouth ventilation. You should always provide sufficient air to
     make the chest rise.
     Answer c is incorrect because there is no evidence that you need to increase the air volume, and
     you should not shorten the duration of breaths.
     Answer d is incorrect because you should not provide 3 breaths over 10 seconds.

     Heartsaver CPR manual: pages 26 to 27 and 30 to 31


10. A 24-year-old woman in your apartment building has taken an overdose of strong sleeping
    pills, and her daughter has called you to help her until EMS personnel arrive (911 has been
    called). The woman is unresponsive but is breathing normally, moaning, and moving. What
    should you do next?

     a.   Start mouth-to-mouth breathing
     b.   Start CPR
     c.   Place the victim in the recovery position
     d.   Perform CPR for 1 minute but with chest compressions only

     The correct answer is c.

     If the victim is breathing normally and injury is not suspected, you should place the victim in the
     recovery position and continue to monitor her breathing.
     Answer a is incorrect because it is not necessary to provide mouth-to-mouth breathing if the victim is
     breathing normally.
     Answer b is incorrect because you do not need to start CPR because you have opened the airway,
     checked for breathing, and found that the victim is breathing normally.
     Answer d is incorrect because you will not need to continue the ABCs of CPR if the victim is
     breathing normally.



 Heartsaver CPR Adult and Pediatric Pretest                                                                  6
Heartsaver CPR manual: pages 24 to 29 (the recovery position is presented on pages
    28 to 29)


11. You confirm that a responsive young man in a cafeteria has severe or complete foreign-body
    airway obstruction. He is not coughing or talking, and he is clutching his throat with his
    hands. When you ask if he is choking, he nods yes. When you ask if he can speak, he shakes
    his head no. Which is the best way to relieve his obstruction?

    a.   Give him several back blows between the shoulder blades
    b.   Give him abdominal thrusts (the Heimlich maneuver)
    c.   Give some water to drink
    d.   Give him fast and forceful mouth-to-mouth breathing

    The correct answer is b.

    This maneuver is recommended in the Heartsaver CPR course.
    Answer a is incorrect because although back blows are used in Europe and are an alternative
    technique, they are not the preferred technique taught in this course.
    Answer c is incorrect because you should not provide water to the victim of severe or complete
    foreign-body airway obstruction.
    Answer d is incorrect because you should not provide mouth-to-mouth breathing to the responsive
    victim, and you should never provide fast, forceful mouth-to-mouth breathing.

    Heartsaver CPR manual: page 15 (signs of severe or complete foreign-body airway obstruction) and
    pages 31 to 33 (choking)


12. A 2-year-old child playing on the floor at a daycare center suddenly begins to cough weakly.
    She makes high-pitched noises when she inhales and seems to be in respiratory distress and
    has bluish skin. What is the likeliest cause of these symptoms?

    a. Loss of responsiveness and airway obstruction from a relaxed tongue falling back to block the
       airway
    b. Severe foreign-body airway obstruction with inadequate air exchange
    c. Infected and swollen airway passages
    d. A seizure from a possible head injury

    The correct answer is b.

    These signs are consistent with incomplete foreign-body airway obstruction with inadequate air
    exchange. The poor, weak cough; high-pitched noises; respiratory distress; and bluish color are all
    consistent with severe foreign-body airway obstruction.
    Answer a is incorrect because the child is responsive (not unresponsive).
    Answer c is incorrect because the child developed the signs of respiratory distress suddenly. Signs
    of infection are more likely to produce a gradual onset of symptoms or other signs of infection such
    as fever. Asthma is unlikely to produce acute (sudden) signs of respiratory distress.
    Answer d is incorrect because these signs are more consistent with severe or complete foreign-body
    airway obstruction.

    Heartsaver CPR manual: pages 109 to 112




 Heartsaver CPR Adult and Pediatric Pretest                                                                7
13. You are delivering rescue breaths to a 6-year-old child who was submerged in a swimming
    pool. The child is unresponsive, and when you open the airway the child is not breathing.
    Which of the following statements best describes the amount of air (ventilation volume) you
    should provide during rescue breathing for this child?

    a.   Half the amount you give an adult
    b.   Twice the amount you give a 3-year-old
    c.   Enough to see the child’s chest rise slowly and gently
    d.   Based on the child's weight

    The correct answer is c.

    Whether you provide rescue breathing with mouth-to-mouth ventilation or a barrier device, you
    should provide enough air to see the chest rise.
    Answer a is incorrect because it is impossible to estimate the volume you should provide for an adult
    or a child. The correct volume of rescue breaths for any victim is the volume that makes that victim's
    chest rise.
    Answer b is incorrect because it is impossible to estimate the volume that you should provide for a 3-
    year-old or a 6-year-old. The correct volume of rescue breaths for any victim is the volume that
    makes that victim's chest rise.
    Answer d is incorrect because even if you know the child's weight and could estimate the precise
    volume of each breath, it would be impossible for you to estimate the volume that you are delivering
    to the child.

    Heartsaver CPR manual: pages 103 to 108


14. You are performing rescue breathing for a nonbreathing 7-year-old child who demonstrates
    signs of circulation. How often should you ventilate the child?

    a.   Approximately 20 breaths per minute (1 breath every 3 seconds)
    b.   Approximately 15 breaths per minute (1 breath every 4 seconds)
    c.   Approximately 10 to 12 breaths per minute (1 breath every 5 seconds)
    d.   Approximately 6 breaths per minute (1 breath every 10 seconds)

    The correct answer is a.

    This is the correct number of rescue breaths to deliver for infants and children 1 to 8 years of age.
    Answer b is incorrect because it is too slow for infants and children.
    Answer c is incorrect because this rescue breathing rate is appropriate for the adult victim or the
    child 8 years of age or older, but it is not appropriate for an infant or a child less than 8 years of age.
    Answer d is incorrect because it would provide too few rescue breaths for the victim of any age.

    Heartsaver CPR manual: pages 105 and 107




 Heartsaver CPR Adult and Pediatric Pretest                                                                       8
15. You are performing CPR on a middle-aged man who collapsed in your presence. Which of the
    following best describes your technique for delivery of 2 rescue breaths after every group of
    15 chest compressions?

    a. You should deliver the breaths slowly (over 2 seconds each) with a volume sufficient to
       make the chest rise
    b. You should deliver the second breath before the air has escaped from the first rescue breath to
       "stack" breaths and increase effectiveness of the ventilation
    c. You should deliver the breaths as quickly as possible to minimize the interruptions in chest
       compressions
    d. You should deliver the breaths slowly (over 5 seconds each)

    The correct answer is a.

    When you deliver breaths slowly, you reduce the likelihood that you will generate high pressures and
    force air into the stomach instead of the lungs. When you see the chest rise, you know that the
    breaths were effective.
    Answer b is incorrect because "stacking" of breaths will increase the likelihood that you will force air
    into the stomach instead of the lungs. Gastric inflation (filling of the stomach with air) is not good
    because it can interfere with good inflation of the lungs and can lead to other complications such as
    vomiting and aspiration.
    Answer c is incorrect because rapid, forceful delivery of breaths is more likely to cause gastric
    inflation and its complications.
    Answer d is incorrect because although you should deliver the breaths slowly, you should take only
    about 2 seconds to deliver each breath.

    Heartsaver CPR manual: pages 26 to 27


16. A 40-year-old man collapses at the fitness center after a workout, with no evidence of injury.
    He is unresponsive, and someone has phoned 911 and has gone to get the AED. You open
    the airway and find that the victim is not breathing. After you provide 2 effective rescue
    breaths, you should check for signs of circulation to determine if the victim is in cardiac
    arrest. How do you check for signs of circulation?

    a. Call out the man’s name several times to see if he responds
    b. Push on the man’s chest several times to see if he responds
    c. Open the airway and look, listen, and feel for normal breathing or coughing while you
       scan the man for any signs of movement
    d. Shake the man several times

    The correct answer is c.

    You should take no more than 10 seconds for this assessment. If there are no signs of circulation,
    begin chest compressions and then cycles of compressions and ventilations until the arrival of the
    AED.
    Answer a is incorrect because you called the man's name and stimulated him several times to
    determine unresponsiveness. You have proceeded well beyond that point in the assessment and
    skill steps of CPR.
    Answer b is incorrect because there is no evidence that pushing on the man's chest will produce a
    response that stimulation and 2 rescue breaths did not.
    Answer d is also incorrect because this method is used to check for responsiveness.

    Heartsaver CPR manual: page 26


 Heartsaver CPR Adult and Pediatric Pretest                                                                    9
17. You are performing chest compressions and ventilations on an adult victim of sudden
    cardiac arrest. What is the appropriate compression rate to use during adult CPR?

     a.   A rate of about 60 times per minute
     b.   A rate of about 80 times per minute
     c.   A rate of about 100 times per minute
     d.   A rate of about 120 times per minute

     The correct answer is c.

     This compression rate, which allows for interruptions for rescue breathing, will result in the delivery of
     fewer than 100 compressions per minute. But this rate should be sufficient to maintain blood flow to
     the heart and brain until defibrillation can be performed.
     Answers a and b are incorrect because these compression rates are too slow to support vital oxygen
     delivery.
     Answer d is incorrect because it is more rapid than needed for the adult victim of cardiac arrest.

     Heartsaver CPR manual: page 28


18. What is the ratio of compressions to ventilations for 1- or 2-rescuer adult CPR?

     a.   15 compressions to 1 ventilation
     b.   15 compressions to 2 ventilations
     c.   5 compressions to 1 ventilation
     d.   5 compressions to 2 ventilations

     The correct answer is b.

     This ratio is appropriate for either 1 or 2 lay rescuers.
     Answer a is incorrect because this ratio does not provide enough ventilations.
     Answer c is incorrect because this is the appropriate compression-ventilation ratio for infants and
     children.
     Answer d is incorrect because it would interrupt chest compressions for too long a time.

     Heartsaver CPR manual: page 28


19. You are providing chest compressions and ventilations for a child who was found
    unresponsive. You open the airway and check for breathing and find that the child has only
    occasional gasping respirations. After you deliver 2 rescue breaths you check for signs of
    circulation and find none. Which of the following best describes the delivery of chest
    compressions for a child?

     a.   Compress at a rate of about 100 times per minute
     b.   Make sure to push the breastbone down at least 2 inches
     c.   Use 2 fingers to compress the center of the sternum
     d.   Compress 15 times and then give 3 quick breaths

     The correct answer is a.

     This will deliver fewer than 100 compressions per minute because the compressions are interrupted
     to provide rescue breaths.
     Answer b is incorrect because you should compress the child approximately 1/3 to 1/2 the depth of


Heartsaver CPR Adult and Pediatric Pretest                                                                  10
the child's chest.
     Answer c is incorrect because you use 2 fingers to compress the infant's chest, but you use the heel
     of one hand to compress the child's chest.
     Answer d is incorrect because you use a 5:1 ratio for cycles of compressions and ventilations for the
     infant or child.

     Heartsaver CPR manual: pages 105 to 107

20. A neighbor runs to you with his limp 5-month-old infant. You determine that the child is
    unresponsive and send the neighbor to phone 911. You open the child's airway and find that
    the child is not breathing. After you deliver 2 effective rescue breaths, you determine that
    there are no signs of circulation. How should you do chest compressions on this infant?

     a. Use both hands, one on top of the other
     b. Use the tips of 2 fingers and press on the breastbone 1 finger's width below the nipple
        line
     c. Use the heel of one hand over the lower half of the breastbone
     d. Use the palm and fingers of one hand

     The correct answer is b.

     This will provide chest compressions over the lower half of the sternum (breastbone). You will deliver
     chest compressions at a rate of at least 100 per minute, and you should be careful to avoid the
     bottom of the breastbone.
     Answer a is incorrect, because you use 2 hands to provide chest compressions for an adult. Two-
     handed compressions produce too much force for use in a child.
     Answer c is incorrect because the technique describes the proper technique for chest compressions
     in a child 1 to 8 years of age.
     Answer d is incorrect because if you use the palm and the fingers, you will likely press over too large
     an area of the chest and may break the victim's ribs.

     Heartsaver CPR manual: pages 105 to 107


21. The first link in the AHA Chain of Survival for infants and children is prevention of cardiac
    arrest. What is the most common condition or typical cause of cardiac arrest in children?

     a. An inherited form of cardiac rhythm problem
     b. Lack of oxygen to the heart muscle and brain caused by breathing emergencies,
        respiratory arrest, or shock
     c. Electric shock from appliances
     d. A heart attack

     The correct answer is b.

     If these emergencies are not treated, the infant or child can develop cardiac arrest.
     Answer a is incorrect. Although inherited arrhythmias can contribute to risk of cardiac arrest in
     children, these conditions are not the most common cause of cardiac arrest.
     Answer c is incorrect because electric shock is not an extremely common form of cardiac arrest.
     Answer d is incorrect because although heart attacks can occur in infants and small children, they
     are an unusual cause of cardiac arrest in this age group.

     Heartsaver CPR manual: pages 76 to 78 and 102


Heartsaver CPR Adult and Pediatric Pretest                                                                11
22. What is the correct ratio of compressions to ventilations for infant and child CPR?

     a.   10 to 2
     b.   12 to 2
     c.   5 to 1
     d.   15 to 2

     The correct answer is c.

     The 5:1 compression-ventilation ratio is correct for infant or child CPR for 1 or 2 rescuers.
     Answers a and b are incorrect because these are incorrect ratios of compressions to ventilations for
     victims of any age.
     Answer d is incorrect because although it is the correct ratio of compressions and ventilations for an
     adult victim, it is incorrect for the infant or child victim.

     Heartsaver CPR manual: pages 105 to 107


23. You are alone and performing CPR on an adult cardiac arrest victim. You have just checked
    for signs of circulation after delivering the initial 2 rescue breaths. You find no signs of
    circulation, so you begin cycles of 15 compressions and 2 ventilations. When should you
    check for signs of circulation again?

     a.   After 4 cycles of 15 and 2 and every few minutes thereafter
     b.   After 5 minutes of CPR, then every 5 minutes thereafter
     c.   Do not check for circulation again until EMS personnel arrive to assess the victim
     d.   Do not check for circulation again until the patient begins to breathe

     The correct answer is a.

     You should check only after the first minute (about 4 cycles) and then every few minutes until EMS
     personnel arrive.
     Answer b is incorrect because a 5-minute wait is too long to check for signs of circulation after you
     have begun compressions.
     Answer c is incorrect because you should check for return of signs of circulation before EMS
     personnel arrive.
     Answer d is incorrect because the victim may resume signs of circulation before he or she recovers
     and begins breathing normally.

     Heartsaver CPR manual: page 28
.

24. When you perform CPR, how do your chest compressions and rescue breathing help the
    victim?

     a.   They decrease the need for coronary artery bypass
     b.   They force the heart in VF back to a normal heart rhythm
     c.   They constrict the pupils to help preserve vision
     d.   They provide a flow of oxygen to the heart and brain

     The correct answer is d.




Heartsaver CPR Adult and Pediatric Pretest                                                                   12
CPR buys time. When you perform chest compressions and rescue breathing, you are providing
     oxygen to the heart and brain. Blood is circulated to the lungs, heart, and brain by chest
     compressions. This blood will likely receive enough oxygen in the lungs to keep the heart and brain
     viable at least for a time.
     Answer a is incorrect because CPR is performed for victims of cardiac arrest and there is no relation
     between CPR and a reduced need for coronary bypass surgery.
     Answer b is incorrect because CPR does not force the heart into a normal heart rhythm. If VF is
     present, a defibrillator is needed.
     Answer c is incorrect because CPR does not constrict pupils, and pupil constriction will not preserve
     vision.

     Heartsaver CPR manual: pages 8 to 9


25. A 6-year-old is hit by a car and thrown several feet. Someone has phoned 911, and you rush
    to the child's side. He is not responsive and you know you need to open his airway. Which of
    the following best describes the technique you should use to open the airway of this child?

     a. Tilt his head and lift his chin with cervical spine immobilization
     b. Do not touch him at all because he might have a broken neck
     c. Sweep out his mouth and pull forward on his tongue
     d. Use the jaw thrust without tilting the head or moving the neck

     The correct answer is d.

     Head and neck injuries should be suspected in any pedestrian hit by a car, particularly an
     unresponsive child who was struck and thrown. The jaw-thrust technique without head tilt is the
     safest approach to opening the airway of the victim with suspected neck injury to avoid moving the
     head and neck.
     Answer a is incorrect because doing the head tilt–chin lift will move the neck and may cause or
     worsen a spinal cord injury.
     Answer b is incorrect because the airway of an unconscious victim must be open (patent) or the
     victim will develop hypoxia (inadequate oxygen supply to the heart and brain and other vital organs).
     If you suspect a head or neck injury is present, you should open the airway without moving the head
     or neck.
     Answer c is incorrect because the finger sweep is done only in cases of airway obstruction in the
     unresponsive child when you see something in the child's mouth.

     Heartsaver CPR manual: pages 102 to 103




Heartsaver CPR Adult and Pediatric Pretest                                                                13

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Heartsaver cpr pretest_with_annotated_answer_key

  • 1. American Heart Association Heartsaver CPR Written Examination Adult and Pediatric Modules Pretest ANNOTATED ANSWER KEY February 2001 © 2001 American Heart Association
  • 2. Annotated Answer Key Heartsaver CPR Adult and Pediatric Pretest 1. You respond to someone who has just collapsed (you witnessed the collapse). After you make sure that the scene is safe, what is the next thing you should do? a. Check for unresponsiveness; if the victim is unresponsive, phone 911 b. Phone 911; wait outside to direct the emergency responders c. Do 2 finger sweeps; check if food is blocking the airway d. Perform CPR for 1 minute; then phone911 The correct answer is a. Your first action after determining that the scene is safe is to check if the victim is unresponsive. If the victim is unresponsive, you should phone (or send someone to phone) the emergency medical services (EMS) system. Answer b is incorrect because you should not phone 911 until you have checked responsiveness. When you have determined that the victim is unresponsive and you phone 911, you should return to the victim and begin CPR. Answer c is incorrect because you should not perform finger sweeps or check the victim’s mouth unless you strongly suspect that an obstruction is blocking the airway or there is evidence of something in the victim's mouth. Answer d is incorrect because for adult victims of sudden cardiac arrest you should phone 911 as soon as you determine that the victim is unresponsive. You do not begin CPR before phoning 911 because you must be sure emergency help (including a defibrillator) is on the way. Heartsaver CPR manual: pages 7 to 9 (Chain of Survival) and page 24 2. Your tennis partner, a healthy 42-year-old woman, began to complain of vague "pressure" in the middle of her chest 30 minutes ago. Now the pain is worse and has moved down her left arm and to her back. She feels nauseated, dizzy, and sweaty. What should you do? a. Give her 1 aspirin, then have her rest for an hour b. Have her lie down, then call her private physician c. Let her walk outside to breathe fresh air d. Have her lie down or recline, then phone 911 immediately The correct answer is d. These signs and symptoms are consistent with signs of a heart attack (myocardial infarction). The most common sign of heart attack is chest pain or pressure that may radiate to the neck or jaw or down the left arm and may even be felt in the back, between the shoulder blades. However, women, persons with diabetes, and the elderly frequently demonstrate more vague signs, including more diffuse pain or pressure, and may complain that they feel lightheaded, faint, short of breath, or Heartsaver CPR Adult and Pediatric Pretest 2
  • 3. nauseated. This answer is the only one that contains a phone call to 911, the most important action you can take, so this is the only possible correct answer. Answer a is incorrect for 2 reasons. EMS personnel or the Emergency Department may prescribe an aspirin, but it is not necessary for you to administer the aspirin. It is more important for you to phone the EMS system. The answer is also incorrect because it would delay the phone call to 911 by an hour. During the first hour of a heart attack the victim is at highest risk of sudden death from ventricular fibrillation. Answer b is incorrect because the call to the private physician will only delay the phone call to the EMS system and delay arrival of EMS personnel and transport of the victim to a medical facility. Answer c is incorrect because the victim of a heart attack is at highest risk of death from ventricular fibrillation during the first hour after the onset of symptoms. You must phone 911 immediately. Heartsaver CPR manual: page 10 3. Your doctor tells you that you have several risk factors for stroke. Which of the following stroke risk factors can be controlled? a. Prior history of stroke b. Heredity (family history) c. Gender d. Untreated high blood pressure (hypertension) The correct answer is d. Hypertension and cigarette smoke are 2 of the major controllable risk factors for heart attack and stroke. If you have high blood pressure, you should be under the care of a doctor and you should take your prescribed medications exactly as directed. Answer a is incorrect because you cannot change your medical history. Answer b is incorrect because you cannot control or change your heredity or a family history of stroke or risk factors for stroke. Answer c is incorrect because you cannot change your gender. Heartsaver CPR manual: pages 16 to 17 4. You are at work when a 60-year-old customer begins to complain of a sudden numbness and weakness on one side of his face and in one arm. He also has trouble speaking. What problem do you think he has? a. An epileptic seizure b. A heart attack c. A stroke d. Diabetic coma The correct answer is c. The most common signs of stroke are the sudden onset of a severe headache; sudden trouble seeing out of one or both eyes; sudden numbness or weakness on one side of the body or face; sudden confusion or trouble speaking or understanding; sudden dizziness, trouble walking, or loss of balance or coordination. If you see any of these signs you should suspect a stroke and phone 911 immediately. Answer a is incorrect because these signs are not consistent with a seizure. Heartsaver CPR Adult and Pediatric Pretest 3
  • 4. Answer b is incorrect because the victim has reported no pain or pressure or even vague signs of a heart attack, such as dizziness, shortness of breath, or nausea (see question 3 for signs of a heart attack). Answer d is incorrect because a diabetic coma will cause the victim to be unresponsive. Heartsaver CPR manual: page 13 5. You are alone, and you have just pulled a submerged child from a swimming pool. The child is unresponsive and you shout for help. No one has responded to your shout. What should you do about phoning 911? a. Check for signs of circulation, and if there are no signs phone 911 b. Phone 911 immediately, then continue the ABCs of CPR c. Give 2 rescue breaths, then phone 911 d. Perform the ABCs of CPR and then phone 911 after about 1 minute of rescue support The correct answer is d. Whenever you find an unresponsive child, you should begin the steps of CPR immediately. Children who suffer cardiac arrest are most often hypoxic (in need of oxygen), so you should perform about 1 minute of CPR before activating the EMS system. This allows you to initiate rescue breathing and restore delivery of oxygen to the brain and heart as quickly as possible. Submersion victims also need immediate rescue breathing before you phone 911. Answer a is incorrect because you should not check for signs of circulation until after you have opened the airway, checked for breathing, and (if normal breathing is absent) delivered 2 effective breaths. Submersion victims most frequently require rescue breathing, so you should not skip that (or any) part of the CPR sequence. Answer b is incorrect because for the submersion victim of any age you should begin CPR and phone 911 after approximately 1 minute. Answer c is incorrect because you should perform the assessment and skills steps of CPR for approximately 1 minute before leaving the child to phone 911. Heartsaver CPR manual: page 50 (Special Resuscitation Situations—[adult] Submersion), pages 72 to 75 (Infant and Child Chain of Survival, and pages 101 to 107 (steps of CPR) 6. Every year hundreds of thousands of adults die of sudden cardiac arrest. Which of the following interventions will have the greatest impact on improving survival from sudden cardiac arrest? a. CPR by EMS personnel b. Immediate bystander CPR and early (within 5 minutes or less) defibrillation c. Defibrillation in 10 minutes without CPR d. Immediate CPR with defibrillation in 10 minutes The correct answer is b. Immediate bystander CPR nearly doubles survival from cardiac arrest. Most sudden cardiac arrest is caused by a sudden arrhythmia called ventricular fibrillation (VF). The treatment for VF cardiac arrest is defibrillation—the sooner defibrillation occurs, the greater the victim's chances of survival. Answer a is incorrect. Although CPR improves survival, if it is not performed until EMS personnel arrive, the victim's chances of survival are reduced dramatically because the brain and heart have already experienced a severe loss of oxygen for many minutes. Heartsaver CPR Adult and Pediatric Pretest 4
  • 5. Answer c is incorrect because survival from sudden cardiac arrest decreases by about 7% to 10% for every minute defibrillation is delayed if no bystander CPR is performed. Therefore, if bystander CPR is not provided, within 10 minutes a victim's chance of survival is very, very low. Answer d is incorrect because even if CPR is performed immediately, defibrillation within 5 minutes would result in much greater survival (answer b) than defibrillation within 10 minutes. For every minute defibrillation is delayed, even when CPR is provided, the victim's chance of survival falls. Heartsaver CPR manual: pages 6 to 9 (Chain of Survival), particularly page 8 7. You are starting to provide CPR for an unresponsive victim. Which of the following describes the best way to open the airway in an unresponsive victim of any age who has no sign of head or neck injury? a. Give 5 back blows and then sweep out the mouth b. Tilt the head and lift the chin c. Wait until a mask or other barrier device is available to open the airway d. Grab and lift the lower chin The correct answer is b. The head tilt–chin lift technique is the method you will use most commonly. This technique lifts the jaw away from the back of the throat to open the airway. You should also be prepared to perform the jaw thrust if you suspect head or neck injury. Answer a is incorrect for several reasons. First, back blows are an alternative method of relieving severe or complete foreign-body airway obstruction in the responsive adult, and back blows are most often used for infants. These measures are not appropriate for a lay rescuer when a victim is unresponsive and has no signs of airway obstruction. Answer c is incorrect because you do not need a mask or other barrier device to open the airway for an unresponsive victim. Opening the airway may be the only intervention needed for an unresponsive victim, and it should not be delayed for lack of a barrier device. Answer d is incorrect because you do not need to grab and lift the lower chin. Heartsaver CPR manual: pages 24 to 25 8. You have entered an office and find a colleague unresponsive. You have phoned 911 and you are beginning CPR for the victim. You have opened the airway and must check for breathing. You do this by listening and feeling for airflow through the victim's nose or mouth. What other things should you assess to determine if a victim is breathing normally? a. Look into the victim's mouth to see if anything is blocking his airway b. Shake the victim to see if there is any response c. Check for signs of circulation d. Look to see if the victim's chest rises and falls, signaling that the victim is breathing The correct answer is d. If the victim is not breathing or is breathing very shallowly or very slowly, he is not breathing normally, which means that you must deliver rescue breaths. Answer a is incorrect because you should not look in the victim's mouth—you need to see if the victim is breathing. Answer b is incorrect because you already shook the victim and attempted to stimulate the victim when you found that he was unresponsive. Heartsaver CPR Adult and Pediatric Pretest 5
  • 6. Answer c is incorrect because there is no need to check for signs of circulation until after you have checked for breathing and (if the victim is not breathing normally) delivered 2 effective breaths. Then you should check for signs of circulation. Heartsaver CPR manual: pages 23 to 26 9. You are delivering rescue breaths with a mask to an unresponsive, nonbreathing teenager in a movie theater. Which of the following best describes the volume of air you should provide during mouth-to-mask ventilations? a. Reduce your air volume and duration of breaths from what you would provide during mouth-to- mouth ventilation b. Deliver air over 2 seconds until the chest rises, just as you would for mouth-to-mouth breathing c. Increase your air volume but shorten the duration of breaths d. Give 3 breaths over 10 seconds The correct answer is b. The only way to know if you are delivering a sufficient volume of air effectively is if you see the victim's chest rise. If the chest does not rise, you are not delivering effective rescue breaths: you either have not opened the airway sufficiently or have not delivered enough air. Answer a is incorrect because there is no reason to reduce the air volume and duration of breaths from that delivered during mouth-to-mouth ventilation. You should always provide sufficient air to make the chest rise. Answer c is incorrect because there is no evidence that you need to increase the air volume, and you should not shorten the duration of breaths. Answer d is incorrect because you should not provide 3 breaths over 10 seconds. Heartsaver CPR manual: pages 26 to 27 and 30 to 31 10. A 24-year-old woman in your apartment building has taken an overdose of strong sleeping pills, and her daughter has called you to help her until EMS personnel arrive (911 has been called). The woman is unresponsive but is breathing normally, moaning, and moving. What should you do next? a. Start mouth-to-mouth breathing b. Start CPR c. Place the victim in the recovery position d. Perform CPR for 1 minute but with chest compressions only The correct answer is c. If the victim is breathing normally and injury is not suspected, you should place the victim in the recovery position and continue to monitor her breathing. Answer a is incorrect because it is not necessary to provide mouth-to-mouth breathing if the victim is breathing normally. Answer b is incorrect because you do not need to start CPR because you have opened the airway, checked for breathing, and found that the victim is breathing normally. Answer d is incorrect because you will not need to continue the ABCs of CPR if the victim is breathing normally. Heartsaver CPR Adult and Pediatric Pretest 6
  • 7. Heartsaver CPR manual: pages 24 to 29 (the recovery position is presented on pages 28 to 29) 11. You confirm that a responsive young man in a cafeteria has severe or complete foreign-body airway obstruction. He is not coughing or talking, and he is clutching his throat with his hands. When you ask if he is choking, he nods yes. When you ask if he can speak, he shakes his head no. Which is the best way to relieve his obstruction? a. Give him several back blows between the shoulder blades b. Give him abdominal thrusts (the Heimlich maneuver) c. Give some water to drink d. Give him fast and forceful mouth-to-mouth breathing The correct answer is b. This maneuver is recommended in the Heartsaver CPR course. Answer a is incorrect because although back blows are used in Europe and are an alternative technique, they are not the preferred technique taught in this course. Answer c is incorrect because you should not provide water to the victim of severe or complete foreign-body airway obstruction. Answer d is incorrect because you should not provide mouth-to-mouth breathing to the responsive victim, and you should never provide fast, forceful mouth-to-mouth breathing. Heartsaver CPR manual: page 15 (signs of severe or complete foreign-body airway obstruction) and pages 31 to 33 (choking) 12. A 2-year-old child playing on the floor at a daycare center suddenly begins to cough weakly. She makes high-pitched noises when she inhales and seems to be in respiratory distress and has bluish skin. What is the likeliest cause of these symptoms? a. Loss of responsiveness and airway obstruction from a relaxed tongue falling back to block the airway b. Severe foreign-body airway obstruction with inadequate air exchange c. Infected and swollen airway passages d. A seizure from a possible head injury The correct answer is b. These signs are consistent with incomplete foreign-body airway obstruction with inadequate air exchange. The poor, weak cough; high-pitched noises; respiratory distress; and bluish color are all consistent with severe foreign-body airway obstruction. Answer a is incorrect because the child is responsive (not unresponsive). Answer c is incorrect because the child developed the signs of respiratory distress suddenly. Signs of infection are more likely to produce a gradual onset of symptoms or other signs of infection such as fever. Asthma is unlikely to produce acute (sudden) signs of respiratory distress. Answer d is incorrect because these signs are more consistent with severe or complete foreign-body airway obstruction. Heartsaver CPR manual: pages 109 to 112 Heartsaver CPR Adult and Pediatric Pretest 7
  • 8. 13. You are delivering rescue breaths to a 6-year-old child who was submerged in a swimming pool. The child is unresponsive, and when you open the airway the child is not breathing. Which of the following statements best describes the amount of air (ventilation volume) you should provide during rescue breathing for this child? a. Half the amount you give an adult b. Twice the amount you give a 3-year-old c. Enough to see the child’s chest rise slowly and gently d. Based on the child's weight The correct answer is c. Whether you provide rescue breathing with mouth-to-mouth ventilation or a barrier device, you should provide enough air to see the chest rise. Answer a is incorrect because it is impossible to estimate the volume you should provide for an adult or a child. The correct volume of rescue breaths for any victim is the volume that makes that victim's chest rise. Answer b is incorrect because it is impossible to estimate the volume that you should provide for a 3- year-old or a 6-year-old. The correct volume of rescue breaths for any victim is the volume that makes that victim's chest rise. Answer d is incorrect because even if you know the child's weight and could estimate the precise volume of each breath, it would be impossible for you to estimate the volume that you are delivering to the child. Heartsaver CPR manual: pages 103 to 108 14. You are performing rescue breathing for a nonbreathing 7-year-old child who demonstrates signs of circulation. How often should you ventilate the child? a. Approximately 20 breaths per minute (1 breath every 3 seconds) b. Approximately 15 breaths per minute (1 breath every 4 seconds) c. Approximately 10 to 12 breaths per minute (1 breath every 5 seconds) d. Approximately 6 breaths per minute (1 breath every 10 seconds) The correct answer is a. This is the correct number of rescue breaths to deliver for infants and children 1 to 8 years of age. Answer b is incorrect because it is too slow for infants and children. Answer c is incorrect because this rescue breathing rate is appropriate for the adult victim or the child 8 years of age or older, but it is not appropriate for an infant or a child less than 8 years of age. Answer d is incorrect because it would provide too few rescue breaths for the victim of any age. Heartsaver CPR manual: pages 105 and 107 Heartsaver CPR Adult and Pediatric Pretest 8
  • 9. 15. You are performing CPR on a middle-aged man who collapsed in your presence. Which of the following best describes your technique for delivery of 2 rescue breaths after every group of 15 chest compressions? a. You should deliver the breaths slowly (over 2 seconds each) with a volume sufficient to make the chest rise b. You should deliver the second breath before the air has escaped from the first rescue breath to "stack" breaths and increase effectiveness of the ventilation c. You should deliver the breaths as quickly as possible to minimize the interruptions in chest compressions d. You should deliver the breaths slowly (over 5 seconds each) The correct answer is a. When you deliver breaths slowly, you reduce the likelihood that you will generate high pressures and force air into the stomach instead of the lungs. When you see the chest rise, you know that the breaths were effective. Answer b is incorrect because "stacking" of breaths will increase the likelihood that you will force air into the stomach instead of the lungs. Gastric inflation (filling of the stomach with air) is not good because it can interfere with good inflation of the lungs and can lead to other complications such as vomiting and aspiration. Answer c is incorrect because rapid, forceful delivery of breaths is more likely to cause gastric inflation and its complications. Answer d is incorrect because although you should deliver the breaths slowly, you should take only about 2 seconds to deliver each breath. Heartsaver CPR manual: pages 26 to 27 16. A 40-year-old man collapses at the fitness center after a workout, with no evidence of injury. He is unresponsive, and someone has phoned 911 and has gone to get the AED. You open the airway and find that the victim is not breathing. After you provide 2 effective rescue breaths, you should check for signs of circulation to determine if the victim is in cardiac arrest. How do you check for signs of circulation? a. Call out the man’s name several times to see if he responds b. Push on the man’s chest several times to see if he responds c. Open the airway and look, listen, and feel for normal breathing or coughing while you scan the man for any signs of movement d. Shake the man several times The correct answer is c. You should take no more than 10 seconds for this assessment. If there are no signs of circulation, begin chest compressions and then cycles of compressions and ventilations until the arrival of the AED. Answer a is incorrect because you called the man's name and stimulated him several times to determine unresponsiveness. You have proceeded well beyond that point in the assessment and skill steps of CPR. Answer b is incorrect because there is no evidence that pushing on the man's chest will produce a response that stimulation and 2 rescue breaths did not. Answer d is also incorrect because this method is used to check for responsiveness. Heartsaver CPR manual: page 26 Heartsaver CPR Adult and Pediatric Pretest 9
  • 10. 17. You are performing chest compressions and ventilations on an adult victim of sudden cardiac arrest. What is the appropriate compression rate to use during adult CPR? a. A rate of about 60 times per minute b. A rate of about 80 times per minute c. A rate of about 100 times per minute d. A rate of about 120 times per minute The correct answer is c. This compression rate, which allows for interruptions for rescue breathing, will result in the delivery of fewer than 100 compressions per minute. But this rate should be sufficient to maintain blood flow to the heart and brain until defibrillation can be performed. Answers a and b are incorrect because these compression rates are too slow to support vital oxygen delivery. Answer d is incorrect because it is more rapid than needed for the adult victim of cardiac arrest. Heartsaver CPR manual: page 28 18. What is the ratio of compressions to ventilations for 1- or 2-rescuer adult CPR? a. 15 compressions to 1 ventilation b. 15 compressions to 2 ventilations c. 5 compressions to 1 ventilation d. 5 compressions to 2 ventilations The correct answer is b. This ratio is appropriate for either 1 or 2 lay rescuers. Answer a is incorrect because this ratio does not provide enough ventilations. Answer c is incorrect because this is the appropriate compression-ventilation ratio for infants and children. Answer d is incorrect because it would interrupt chest compressions for too long a time. Heartsaver CPR manual: page 28 19. You are providing chest compressions and ventilations for a child who was found unresponsive. You open the airway and check for breathing and find that the child has only occasional gasping respirations. After you deliver 2 rescue breaths you check for signs of circulation and find none. Which of the following best describes the delivery of chest compressions for a child? a. Compress at a rate of about 100 times per minute b. Make sure to push the breastbone down at least 2 inches c. Use 2 fingers to compress the center of the sternum d. Compress 15 times and then give 3 quick breaths The correct answer is a. This will deliver fewer than 100 compressions per minute because the compressions are interrupted to provide rescue breaths. Answer b is incorrect because you should compress the child approximately 1/3 to 1/2 the depth of Heartsaver CPR Adult and Pediatric Pretest 10
  • 11. the child's chest. Answer c is incorrect because you use 2 fingers to compress the infant's chest, but you use the heel of one hand to compress the child's chest. Answer d is incorrect because you use a 5:1 ratio for cycles of compressions and ventilations for the infant or child. Heartsaver CPR manual: pages 105 to 107 20. A neighbor runs to you with his limp 5-month-old infant. You determine that the child is unresponsive and send the neighbor to phone 911. You open the child's airway and find that the child is not breathing. After you deliver 2 effective rescue breaths, you determine that there are no signs of circulation. How should you do chest compressions on this infant? a. Use both hands, one on top of the other b. Use the tips of 2 fingers and press on the breastbone 1 finger's width below the nipple line c. Use the heel of one hand over the lower half of the breastbone d. Use the palm and fingers of one hand The correct answer is b. This will provide chest compressions over the lower half of the sternum (breastbone). You will deliver chest compressions at a rate of at least 100 per minute, and you should be careful to avoid the bottom of the breastbone. Answer a is incorrect, because you use 2 hands to provide chest compressions for an adult. Two- handed compressions produce too much force for use in a child. Answer c is incorrect because the technique describes the proper technique for chest compressions in a child 1 to 8 years of age. Answer d is incorrect because if you use the palm and the fingers, you will likely press over too large an area of the chest and may break the victim's ribs. Heartsaver CPR manual: pages 105 to 107 21. The first link in the AHA Chain of Survival for infants and children is prevention of cardiac arrest. What is the most common condition or typical cause of cardiac arrest in children? a. An inherited form of cardiac rhythm problem b. Lack of oxygen to the heart muscle and brain caused by breathing emergencies, respiratory arrest, or shock c. Electric shock from appliances d. A heart attack The correct answer is b. If these emergencies are not treated, the infant or child can develop cardiac arrest. Answer a is incorrect. Although inherited arrhythmias can contribute to risk of cardiac arrest in children, these conditions are not the most common cause of cardiac arrest. Answer c is incorrect because electric shock is not an extremely common form of cardiac arrest. Answer d is incorrect because although heart attacks can occur in infants and small children, they are an unusual cause of cardiac arrest in this age group. Heartsaver CPR manual: pages 76 to 78 and 102 Heartsaver CPR Adult and Pediatric Pretest 11
  • 12. 22. What is the correct ratio of compressions to ventilations for infant and child CPR? a. 10 to 2 b. 12 to 2 c. 5 to 1 d. 15 to 2 The correct answer is c. The 5:1 compression-ventilation ratio is correct for infant or child CPR for 1 or 2 rescuers. Answers a and b are incorrect because these are incorrect ratios of compressions to ventilations for victims of any age. Answer d is incorrect because although it is the correct ratio of compressions and ventilations for an adult victim, it is incorrect for the infant or child victim. Heartsaver CPR manual: pages 105 to 107 23. You are alone and performing CPR on an adult cardiac arrest victim. You have just checked for signs of circulation after delivering the initial 2 rescue breaths. You find no signs of circulation, so you begin cycles of 15 compressions and 2 ventilations. When should you check for signs of circulation again? a. After 4 cycles of 15 and 2 and every few minutes thereafter b. After 5 minutes of CPR, then every 5 minutes thereafter c. Do not check for circulation again until EMS personnel arrive to assess the victim d. Do not check for circulation again until the patient begins to breathe The correct answer is a. You should check only after the first minute (about 4 cycles) and then every few minutes until EMS personnel arrive. Answer b is incorrect because a 5-minute wait is too long to check for signs of circulation after you have begun compressions. Answer c is incorrect because you should check for return of signs of circulation before EMS personnel arrive. Answer d is incorrect because the victim may resume signs of circulation before he or she recovers and begins breathing normally. Heartsaver CPR manual: page 28 . 24. When you perform CPR, how do your chest compressions and rescue breathing help the victim? a. They decrease the need for coronary artery bypass b. They force the heart in VF back to a normal heart rhythm c. They constrict the pupils to help preserve vision d. They provide a flow of oxygen to the heart and brain The correct answer is d. Heartsaver CPR Adult and Pediatric Pretest 12
  • 13. CPR buys time. When you perform chest compressions and rescue breathing, you are providing oxygen to the heart and brain. Blood is circulated to the lungs, heart, and brain by chest compressions. This blood will likely receive enough oxygen in the lungs to keep the heart and brain viable at least for a time. Answer a is incorrect because CPR is performed for victims of cardiac arrest and there is no relation between CPR and a reduced need for coronary bypass surgery. Answer b is incorrect because CPR does not force the heart into a normal heart rhythm. If VF is present, a defibrillator is needed. Answer c is incorrect because CPR does not constrict pupils, and pupil constriction will not preserve vision. Heartsaver CPR manual: pages 8 to 9 25. A 6-year-old is hit by a car and thrown several feet. Someone has phoned 911, and you rush to the child's side. He is not responsive and you know you need to open his airway. Which of the following best describes the technique you should use to open the airway of this child? a. Tilt his head and lift his chin with cervical spine immobilization b. Do not touch him at all because he might have a broken neck c. Sweep out his mouth and pull forward on his tongue d. Use the jaw thrust without tilting the head or moving the neck The correct answer is d. Head and neck injuries should be suspected in any pedestrian hit by a car, particularly an unresponsive child who was struck and thrown. The jaw-thrust technique without head tilt is the safest approach to opening the airway of the victim with suspected neck injury to avoid moving the head and neck. Answer a is incorrect because doing the head tilt–chin lift will move the neck and may cause or worsen a spinal cord injury. Answer b is incorrect because the airway of an unconscious victim must be open (patent) or the victim will develop hypoxia (inadequate oxygen supply to the heart and brain and other vital organs). If you suspect a head or neck injury is present, you should open the airway without moving the head or neck. Answer c is incorrect because the finger sweep is done only in cases of airway obstruction in the unresponsive child when you see something in the child's mouth. Heartsaver CPR manual: pages 102 to 103 Heartsaver CPR Adult and Pediatric Pretest 13