ACLS FINAL EXAM ACTUAL EXAM 2026 | ADVANCED CARDIOVASCULAR LIFE
SUPPORT EXAM ALL QUESTIONS AND CORRECT ANSWERS VERIFIED ANSWERS
Question 1
An ECG shows a rhythm with a constant PR interval, but some P waves are not followed by a
QRS complex. Which type of atrioventricular block best describes this rhythm?
A) First-degree AV block
B) Second-degree type I (Wenckebach)
C) Second-degree type II
D) Third-degree AV block
E) Sinus bradycardia
Correct Answer: C) Second-degree type II
Rationale: In Second-degree type II block, the PR interval remains constant, but there are
intermittent "dropped" QRS complexes. This is more dangerous than Type I because it is
more likely to progress to complete heart block.
Question 2
Your patient is in cardiac arrest and has been intubated. To assess the quality of chest
compressions in real-time, which of the following should you do?
A) Monitor the patient's PETCO2
B) Check for a carotid pulse every 30 seconds
C) Perform an ABG every 5 minutes
D) Monitor the patient's blood pressure
E) Assess the patient's pupillary response
Correct Answer: A) Monitor the patient's PETCO2
Rationale: Quantitative waveform capnography is the most reliable way to monitor CPR
quality. A PETCO2 level below 10 mmHg indicates that chest compressions are not
effective and need to be improved.
Question 3
Which facility is the most appropriate EMS destination for a patient who suffered a sudden
cardiac arrest and achieved return of spontaneous circulation (ROSC) in the field?
A) The nearest urgent care center
B) A community hospital without specialized labs
C) A psychiatric facility for evaluation
D) Coronary reperfusion-capable medical center
E) A rehabilitation hospital
Correct Answer: D) Coronary reperfusion-capable medical center
Rationale: Patients who achieve ROSC after cardiac arrest often require immediate
coronary angiography and percutaneous coronary intervention (PCI) to address
underlying causes like myocardial infarction.
, 2
Question 4
Which of the following respiratory signs is a likely indicator of cardiac arrest in an unresponsive
patient?
A) Tachypnea
B) Wheezing
C) Agonal gasps
D) Deep, rapid Kussmaul breathing
E) Stridor
Correct Answer: C) Agonal gasps
Rationale: Agonal gasps are not effective breathing. They are a sign of brainstem reflex
during cardiac arrest and should be treated as a sign of pulselessness and a need for
immediate CPR.
Question 5
An ECG shows a rhythm where the PR interval progressively lengthens until a QRS complex is
dropped. Which block is this?
A) First-degree AV block
B) Second-degree atrioventricular block type I
C) Second-degree atrioventricular block type II
D) Third-degree AV block
E) High-grade AV block
Correct Answer: B) Second-degree atrioventricular block type I
Rationale: Second-degree type I (also known as Wenckebach) is characterized by the
"longer, longer, longer, drop" pattern of the PR interval.
Question 6
To properly ventilate an adult patient in respiratory arrest who has a perfusing rhythm (a pulse),
how often should you squeeze the bag?
A) Once every 3 to 4 seconds
B) Once every 5 to 6 seconds
C) Once every 10 seconds
D) Twice every 30 seconds
E) Continuous rapid ventilation
Correct Answer: B) Once every 5 to 6 seconds.
Rationale: For an adult with a pulse but not breathing effectively, the recommended
ventilation rate is 10 to 12 breaths per minute, which equates to one breath every 5 to 6
seconds.
Question 7
In addition to clinical assessment, which is the most reliable method to confirm and monitor the
correct placement of an endotracheal tube?
, 3
A) Auscultation of breath sounds
B) Visualizing chest rise
C) Continuous waveform capnography
D) Observing moisture in the tube
E) Measuring the distance of the tube at the teeth
Correct Answer: C) Continuous waveform capnography
Rationale: Waveform capnography provides objective evidence of CO2 being exhaled from
the lungs, confirming that the tube is in the trachea rather than the esophagus.
Question 8
You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The
CT scan shows no signs of hemorrhage. The patient has no contraindications to fibrinolytic
therapy. What is the best treatment?
A) Wait for an MRI to confirm the diagnosis
B) Start fibrinolytic therapy as soon as possible
C) Administer 325 mg of aspirin and discharge
D) Perform an immediate carotid endarterectomy
E) Administer heparin bolus
Correct Answer: B) Start fibrinolytic therapy as soon as possible.
Rationale: Fibrinolytic therapy (e.g., Alteplase or Tenecteplase) is time-sensitive and should
be administered within the established window (typically 3 to 4.5 hours) for ischemic stroke
if hemorrhage is ruled out.
Question 9
An ECG shows P waves and QRS complexes that occur independently of each other with no
relationship between them. Which best describes this rhythm?
A) First-degree block
B) Second-degree type II
C) Sinus rhythm with PVCs
D) Third-degree atrioventricular block.
E) Ventricular fibrillation
Correct Answer: D) Third-degree atrioventricular block.
Rationale: In Third-degree (complete) AV block, the atria and ventricles are electrically
dissociated. The P waves "march through" the QRS complexes without any correlation.
Question 10
What is the recommended range from which a temperature should be selected and maintained to
achieve targeted temperature management (TTM) after cardiac arrest?
A) 28 to 30 Degrees Celsius
B) 30 to 32 Degrees Celsius
C) 32 to 36 Degrees Celsius
, 4
D) 37 to 38 Degrees Celsius
E) 38 to 40 Degrees Celsius
Correct Answer: C) 32 to 36 Degrees Celsius
Rationale: TTM is used to improve neurological outcomes in post-cardiac arrest patients
who do not follow commands. The target range is 32°C to 36°C for at least 24 hours.
Question 11
Which is the recommended first intravenous dose of amiodarone for a patient with refractory
ventricular fibrillation (VF)?
A) 1 mg
B) 6 mg
C) 150 mg
D) 300 mg
E) 500 mg
Correct Answer: D) 300 mg
Rationale: The first dose of amiodarone in the cardiac arrest algorithm for shockable
rhythms is 300 mg IV/IO bolus, followed by a second dose of 150 mg if needed.
Question 12
What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
A) To manage the hospital's billing for emergencies
B) Improving patient outcomes by identifying and treating early clinical deterioration.
C) To perform the final autopsy on patients
D) To replace the primary nurse for the entire shift
E) To assist the family with discharge paperwork
Correct Answer: B) Improving patient outcomes by identifying and treating early clinical
deterioration.
Rationale: RRTs are designed to intervene when a patient's condition begins to decline,
ideally preventing a cardiac arrest from occurring.
Question 13
What is the recommended next step immediately after a defibrillation attempt?
A) Check the monitor for a rhythm change
B) Perform a pulse check for 10 seconds
C) Check for spontaneous respirations
D) Resume CPR, starting with chest compressions
E) Administer a dose of epinephrine
Correct Answer: D) Resume CPR, starting with chest compressions
Rationale: To minimize interruptions in perfusion, CPR should be resumed immediately
after the shock. The rhythm check occurs only after 2 minutes of CPR.
SUPPORT EXAM ALL QUESTIONS AND CORRECT ANSWERS VERIFIED ANSWERS
Question 1
An ECG shows a rhythm with a constant PR interval, but some P waves are not followed by a
QRS complex. Which type of atrioventricular block best describes this rhythm?
A) First-degree AV block
B) Second-degree type I (Wenckebach)
C) Second-degree type II
D) Third-degree AV block
E) Sinus bradycardia
Correct Answer: C) Second-degree type II
Rationale: In Second-degree type II block, the PR interval remains constant, but there are
intermittent "dropped" QRS complexes. This is more dangerous than Type I because it is
more likely to progress to complete heart block.
Question 2
Your patient is in cardiac arrest and has been intubated. To assess the quality of chest
compressions in real-time, which of the following should you do?
A) Monitor the patient's PETCO2
B) Check for a carotid pulse every 30 seconds
C) Perform an ABG every 5 minutes
D) Monitor the patient's blood pressure
E) Assess the patient's pupillary response
Correct Answer: A) Monitor the patient's PETCO2
Rationale: Quantitative waveform capnography is the most reliable way to monitor CPR
quality. A PETCO2 level below 10 mmHg indicates that chest compressions are not
effective and need to be improved.
Question 3
Which facility is the most appropriate EMS destination for a patient who suffered a sudden
cardiac arrest and achieved return of spontaneous circulation (ROSC) in the field?
A) The nearest urgent care center
B) A community hospital without specialized labs
C) A psychiatric facility for evaluation
D) Coronary reperfusion-capable medical center
E) A rehabilitation hospital
Correct Answer: D) Coronary reperfusion-capable medical center
Rationale: Patients who achieve ROSC after cardiac arrest often require immediate
coronary angiography and percutaneous coronary intervention (PCI) to address
underlying causes like myocardial infarction.
, 2
Question 4
Which of the following respiratory signs is a likely indicator of cardiac arrest in an unresponsive
patient?
A) Tachypnea
B) Wheezing
C) Agonal gasps
D) Deep, rapid Kussmaul breathing
E) Stridor
Correct Answer: C) Agonal gasps
Rationale: Agonal gasps are not effective breathing. They are a sign of brainstem reflex
during cardiac arrest and should be treated as a sign of pulselessness and a need for
immediate CPR.
Question 5
An ECG shows a rhythm where the PR interval progressively lengthens until a QRS complex is
dropped. Which block is this?
A) First-degree AV block
B) Second-degree atrioventricular block type I
C) Second-degree atrioventricular block type II
D) Third-degree AV block
E) High-grade AV block
Correct Answer: B) Second-degree atrioventricular block type I
Rationale: Second-degree type I (also known as Wenckebach) is characterized by the
"longer, longer, longer, drop" pattern of the PR interval.
Question 6
To properly ventilate an adult patient in respiratory arrest who has a perfusing rhythm (a pulse),
how often should you squeeze the bag?
A) Once every 3 to 4 seconds
B) Once every 5 to 6 seconds
C) Once every 10 seconds
D) Twice every 30 seconds
E) Continuous rapid ventilation
Correct Answer: B) Once every 5 to 6 seconds.
Rationale: For an adult with a pulse but not breathing effectively, the recommended
ventilation rate is 10 to 12 breaths per minute, which equates to one breath every 5 to 6
seconds.
Question 7
In addition to clinical assessment, which is the most reliable method to confirm and monitor the
correct placement of an endotracheal tube?
, 3
A) Auscultation of breath sounds
B) Visualizing chest rise
C) Continuous waveform capnography
D) Observing moisture in the tube
E) Measuring the distance of the tube at the teeth
Correct Answer: C) Continuous waveform capnography
Rationale: Waveform capnography provides objective evidence of CO2 being exhaled from
the lungs, confirming that the tube is in the trachea rather than the esophagus.
Question 8
You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The
CT scan shows no signs of hemorrhage. The patient has no contraindications to fibrinolytic
therapy. What is the best treatment?
A) Wait for an MRI to confirm the diagnosis
B) Start fibrinolytic therapy as soon as possible
C) Administer 325 mg of aspirin and discharge
D) Perform an immediate carotid endarterectomy
E) Administer heparin bolus
Correct Answer: B) Start fibrinolytic therapy as soon as possible.
Rationale: Fibrinolytic therapy (e.g., Alteplase or Tenecteplase) is time-sensitive and should
be administered within the established window (typically 3 to 4.5 hours) for ischemic stroke
if hemorrhage is ruled out.
Question 9
An ECG shows P waves and QRS complexes that occur independently of each other with no
relationship between them. Which best describes this rhythm?
A) First-degree block
B) Second-degree type II
C) Sinus rhythm with PVCs
D) Third-degree atrioventricular block.
E) Ventricular fibrillation
Correct Answer: D) Third-degree atrioventricular block.
Rationale: In Third-degree (complete) AV block, the atria and ventricles are electrically
dissociated. The P waves "march through" the QRS complexes without any correlation.
Question 10
What is the recommended range from which a temperature should be selected and maintained to
achieve targeted temperature management (TTM) after cardiac arrest?
A) 28 to 30 Degrees Celsius
B) 30 to 32 Degrees Celsius
C) 32 to 36 Degrees Celsius
, 4
D) 37 to 38 Degrees Celsius
E) 38 to 40 Degrees Celsius
Correct Answer: C) 32 to 36 Degrees Celsius
Rationale: TTM is used to improve neurological outcomes in post-cardiac arrest patients
who do not follow commands. The target range is 32°C to 36°C for at least 24 hours.
Question 11
Which is the recommended first intravenous dose of amiodarone for a patient with refractory
ventricular fibrillation (VF)?
A) 1 mg
B) 6 mg
C) 150 mg
D) 300 mg
E) 500 mg
Correct Answer: D) 300 mg
Rationale: The first dose of amiodarone in the cardiac arrest algorithm for shockable
rhythms is 300 mg IV/IO bolus, followed by a second dose of 150 mg if needed.
Question 12
What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
A) To manage the hospital's billing for emergencies
B) Improving patient outcomes by identifying and treating early clinical deterioration.
C) To perform the final autopsy on patients
D) To replace the primary nurse for the entire shift
E) To assist the family with discharge paperwork
Correct Answer: B) Improving patient outcomes by identifying and treating early clinical
deterioration.
Rationale: RRTs are designed to intervene when a patient's condition begins to decline,
ideally preventing a cardiac arrest from occurring.
Question 13
What is the recommended next step immediately after a defibrillation attempt?
A) Check the monitor for a rhythm change
B) Perform a pulse check for 10 seconds
C) Check for spontaneous respirations
D) Resume CPR, starting with chest compressions
E) Administer a dose of epinephrine
Correct Answer: D) Resume CPR, starting with chest compressions
Rationale: To minimize interruptions in perfusion, CPR should be resumed immediately
after the shock. The rhythm check occurs only after 2 minutes of CPR.
