ACLS Written Exam ACTUAL EXAM
2026/2027 | ACLS Written | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: BLS Review & High-Quality CPR (Q1–Q6)
Q1: You arrive to find an unresponsive 72-year-old male. You confirm unresponsiveness, activate the
emergency response system, and check for breathing and pulse simultaneously. The patient is not
breathing normally and has no palpable carotid pulse. What is the correct compression-to-ventilation
ratio for adult BLS when performed by a single rescuer without an advanced airway?
A. 15 compressions to 2 ventilations
B. 30 compressions to 2 ventilations [CORRECT]
C. Continuous compressions with 1 ventilation every 6 seconds
D. 15 compressions to 1 ventilation
Correct Answer: B
Rationale: The 2020 AHA Guidelines specify a 30:2 compression-to-ventilation ratio for adult BLS when
performed by a single rescuer or two rescuers without an advanced airway. This ratio maximizes
coronary perfusion pressure while providing adequate oxygenation. Once an advanced airway is placed,
compressions continue uninterrupted with 1 breath every 6 seconds (10 breaths/minute).
Q2: During CPR on an adult patient, which compression depth is consistent with current AHA guidelines?
A. At least 1.5 inches (4 cm)
B. 2 to 2.4 inches (5 to 6 cm) [CORRECT]
C. Greater than 2.4 inches (6 cm)
D. 1 to 1.5 inches (2.5 to 4 cm)
Correct Answer: B
Rationale: AHA guidelines recommend compressing the adult chest at least 2 inches (5 cm) but not
greater than 2.4 inches (6 cm). Depths less than 2 inches are insufficient to generate adequate cardiac
output, while depths greater than 2.4 inches may cause injury (rib fractures, cardiac contusion) without
additional survival benefit.
,Q3: You are performing CPR with an advanced airway in place (endotracheal tube). What is the correct
ventilation rate?
A. 1 breath every 3 seconds (20 breaths/min)
B. 1 breath every 6 seconds (10 breaths/min) [CORRECT]
C. 2 breaths every 30 compressions
D. 1 breath every 10 seconds (6 breaths/min)
Correct Answer: B
Rationale: With an advanced airway in place, compressions continue uninterrupted at 100–120/min
while ventilations are delivered asynchronously at 1 breath every 6 seconds (10 breaths/min). This
avoids hyperventilation, which increases intrathoracic pressure and reduces venous return, coronary
perfusion, and cerebral perfusion.
Q4: During a code, the team leader notices compression pauses lasting 15–20 seconds during rhythm
checks and pulse checks. What is the recommended maximum interruption time for compressions?
A. Less than 5 seconds
B. Less than 10 seconds [CORRECT]
C. Less than 20 seconds
D. Up to 30 seconds is acceptable
Correct Answer: B
Rationale: Compressions should be interrupted for no more than 10 seconds for rhythm checks, pulse
checks, or advanced airway placement. Longer interruptions cause rapid decay of coronary perfusion
pressure, requiring multiple compressions to rebuild adequate pressure. Minimizing interruptions is
critical for maintaining myocardial and cerebral perfusion.
Q5: What is the target compression fraction (percentage of time during arrest that chest compressions
are performed) according to AHA guidelines?
A. Greater than 40%
B. Greater than 60%, ideally greater than 80% [CORRECT]
C. Greater than 90%
D. Compression fraction is not a measured quality indicator
Correct Answer: B
Rationale: AHA guidelines recommend a compression fraction greater than 60%, with a goal of greater
than 80%. Higher compression fractions correlate with improved survival. This is achieved by minimizing
pauses for rhythm analysis, pulse checks, intubation, defibrillation charging, and team transitions. Real-
time feedback devices help monitor this metric.
, Q6: During CPR, you notice the chest does not fully recoil between compressions. What is the clinical
significance of inadequate chest recoil?
A. Improved coronary perfusion
B. Reduced venous return, decreased coronary perfusion pressure, and decreased cardiac output
[CORRECT]
C. Increased risk of rib fractures only
D. No significant clinical impact
Correct Answer: B
Rationale: Full chest recoil allows the thoracic cavity to expand, creating negative intrathoracic pressure
that draws venous blood back to the heart (venous return). Incomplete recoil increases intrathoracic
pressure, reducing venous return, coronary perfusion pressure, and cardiac output. Rescuers must avoid
leaning on the chest between compressions.
SECTION 2: Cardiac Arrest Algorithms (Q7–Q16)
Q7: You arrive to find an unresponsive 68-year-old male. The cardiac monitor shows chaotic, irregular
electrical activity with no discernible waves or complexes. The patient has no pulse. What is your
immediate action?
A. Administer epinephrine 1 mg IV immediately
B. Defibrillate with 200 J biphasic and begin CPR [CORRECT]
C. Perform synchronized cardioversion at 100 J
D. Administer amiodarone 300 mg IV immediately
Correct Answer: B
Rationale: The described rhythm is ventricular fibrillation (VFib), a shockable rhythm. Immediate
defibrillation (200 J biphasic or equivalent monophasic dose) followed immediately by CPR is the
priority. Defibrillation stops the chaotic electrical activity, allowing the heart's natural pacemaker to
resume an organized rhythm. Epinephrine and amiodarone are administered later in the algorithm.
Q8: A patient in cardiac arrest has been in VFib. You have delivered 2 shocks and performed 2 minutes
of CPR. What is the next medication to administer?
A. Atropine 1 mg IV
B. Epinephrine 1 mg IV/IO push [CORRECT]
C. Adenosine 6 mg rapid IV push
D. Sodium bicarbonate 50 mEq IV
2026/2027 | ACLS Written | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: BLS Review & High-Quality CPR (Q1–Q6)
Q1: You arrive to find an unresponsive 72-year-old male. You confirm unresponsiveness, activate the
emergency response system, and check for breathing and pulse simultaneously. The patient is not
breathing normally and has no palpable carotid pulse. What is the correct compression-to-ventilation
ratio for adult BLS when performed by a single rescuer without an advanced airway?
A. 15 compressions to 2 ventilations
B. 30 compressions to 2 ventilations [CORRECT]
C. Continuous compressions with 1 ventilation every 6 seconds
D. 15 compressions to 1 ventilation
Correct Answer: B
Rationale: The 2020 AHA Guidelines specify a 30:2 compression-to-ventilation ratio for adult BLS when
performed by a single rescuer or two rescuers without an advanced airway. This ratio maximizes
coronary perfusion pressure while providing adequate oxygenation. Once an advanced airway is placed,
compressions continue uninterrupted with 1 breath every 6 seconds (10 breaths/minute).
Q2: During CPR on an adult patient, which compression depth is consistent with current AHA guidelines?
A. At least 1.5 inches (4 cm)
B. 2 to 2.4 inches (5 to 6 cm) [CORRECT]
C. Greater than 2.4 inches (6 cm)
D. 1 to 1.5 inches (2.5 to 4 cm)
Correct Answer: B
Rationale: AHA guidelines recommend compressing the adult chest at least 2 inches (5 cm) but not
greater than 2.4 inches (6 cm). Depths less than 2 inches are insufficient to generate adequate cardiac
output, while depths greater than 2.4 inches may cause injury (rib fractures, cardiac contusion) without
additional survival benefit.
,Q3: You are performing CPR with an advanced airway in place (endotracheal tube). What is the correct
ventilation rate?
A. 1 breath every 3 seconds (20 breaths/min)
B. 1 breath every 6 seconds (10 breaths/min) [CORRECT]
C. 2 breaths every 30 compressions
D. 1 breath every 10 seconds (6 breaths/min)
Correct Answer: B
Rationale: With an advanced airway in place, compressions continue uninterrupted at 100–120/min
while ventilations are delivered asynchronously at 1 breath every 6 seconds (10 breaths/min). This
avoids hyperventilation, which increases intrathoracic pressure and reduces venous return, coronary
perfusion, and cerebral perfusion.
Q4: During a code, the team leader notices compression pauses lasting 15–20 seconds during rhythm
checks and pulse checks. What is the recommended maximum interruption time for compressions?
A. Less than 5 seconds
B. Less than 10 seconds [CORRECT]
C. Less than 20 seconds
D. Up to 30 seconds is acceptable
Correct Answer: B
Rationale: Compressions should be interrupted for no more than 10 seconds for rhythm checks, pulse
checks, or advanced airway placement. Longer interruptions cause rapid decay of coronary perfusion
pressure, requiring multiple compressions to rebuild adequate pressure. Minimizing interruptions is
critical for maintaining myocardial and cerebral perfusion.
Q5: What is the target compression fraction (percentage of time during arrest that chest compressions
are performed) according to AHA guidelines?
A. Greater than 40%
B. Greater than 60%, ideally greater than 80% [CORRECT]
C. Greater than 90%
D. Compression fraction is not a measured quality indicator
Correct Answer: B
Rationale: AHA guidelines recommend a compression fraction greater than 60%, with a goal of greater
than 80%. Higher compression fractions correlate with improved survival. This is achieved by minimizing
pauses for rhythm analysis, pulse checks, intubation, defibrillation charging, and team transitions. Real-
time feedback devices help monitor this metric.
, Q6: During CPR, you notice the chest does not fully recoil between compressions. What is the clinical
significance of inadequate chest recoil?
A. Improved coronary perfusion
B. Reduced venous return, decreased coronary perfusion pressure, and decreased cardiac output
[CORRECT]
C. Increased risk of rib fractures only
D. No significant clinical impact
Correct Answer: B
Rationale: Full chest recoil allows the thoracic cavity to expand, creating negative intrathoracic pressure
that draws venous blood back to the heart (venous return). Incomplete recoil increases intrathoracic
pressure, reducing venous return, coronary perfusion pressure, and cardiac output. Rescuers must avoid
leaning on the chest between compressions.
SECTION 2: Cardiac Arrest Algorithms (Q7–Q16)
Q7: You arrive to find an unresponsive 68-year-old male. The cardiac monitor shows chaotic, irregular
electrical activity with no discernible waves or complexes. The patient has no pulse. What is your
immediate action?
A. Administer epinephrine 1 mg IV immediately
B. Defibrillate with 200 J biphasic and begin CPR [CORRECT]
C. Perform synchronized cardioversion at 100 J
D. Administer amiodarone 300 mg IV immediately
Correct Answer: B
Rationale: The described rhythm is ventricular fibrillation (VFib), a shockable rhythm. Immediate
defibrillation (200 J biphasic or equivalent monophasic dose) followed immediately by CPR is the
priority. Defibrillation stops the chaotic electrical activity, allowing the heart's natural pacemaker to
resume an organized rhythm. Epinephrine and amiodarone are administered later in the algorithm.
Q8: A patient in cardiac arrest has been in VFib. You have delivered 2 shocks and performed 2 minutes
of CPR. What is the next medication to administer?
A. Atropine 1 mg IV
B. Epinephrine 1 mg IV/IO push [CORRECT]
C. Adenosine 6 mg rapid IV push
D. Sodium bicarbonate 50 mEq IV
