American Red Cross| Advanced Cardiovascular
Life Support (ACLS) | AHA Certification Exam:
A Comprehensive Review of 210 Real
Questions and Answers with Clinical Rationale|
Updated 2026-2027| Latest Version| Guaranteed
Pass
Table of Contents
1. High-Quality BLS & Team Dynamics (Questions 1-10)
2. Airway Management & Ventilation (Questions 11-20)
3. Acute Coronary Syndromes (ACS) (Questions 21-30)
4. Acute Stroke (Questions 31-35)
5. Adult Cardiac Arrest Algorithms (VF/pVT & Asystole/PEA) (Questions
36-45)
6. Post-Cardiac Arrest Care (Questions 46-50)
7. Bradyarrhythmia (Questions 51-55)
8. Tachyarrhythmias (Questions 56-65)
9. Tachycardia with a Pulse Algorithm & Cardioversion (Questions 66-75)
10.Special Resuscitation Situations (Hypothermia, Pregnancy, Tox,
etc.) (Questions 76-85)
11.Pharmacology and Medication Review (Questions 86-95)
12.Mega code Scenarios & Critical Thinking (Questions 96-100)
, 13.BLS & CPR Quality Refresher (Questions 101-110)
14.Advanced Airway & Ventilation Management (Questions 111-120)
15.Acute Coronary Syndromes (ACS) – Deep Dive (Questions 121-130)
16.Acute Stroke – Advanced Topics (Questions 131-135)
17.Adult Cardiac Arrest – Shockable Rhythms (Questions 136-145)
18.Adult Cardiac Arrest – Non-Shockable Rhythms (Questions 146-155)
19.Post-Cardiac Arrest Care & Prognostication (Questions 156-165)
20.Bradyarrhythmia & Pacing (Questions 166-175)
21.Tachyarrhythmias & Cardioversion (Questions 176-185)
22.Special Resuscitation Situations (Questions 186-195)
23.Pharmacology & Medication Calculations (Questions 196-200)
24.Mega code Scenarios & Team Leadership (Questions 201-210)
MULTIPLE CHOICE QUESTIONS
Section 1: High-Quality BLS & Team Dynamics (1-10)
1. A 7-year-old child presents with bradycardia, poor perfusion, and
hypotension. Despite adequate bag-mask ventilation and high-flow oxygen,
the heart rate remains 52 bpm with central pulses only palpable at a rate of 40
bpm. Which medication should be administered first?
A) Atropine 0.02 mg/kg
B) Epinephrine 0.01 mg/kg
C) Adenosine 0.1 mg/kg
D) Amiodarone 5 mg/kg
Answer: B) Epinephrine 0.01 mg/kg
Rationale: In pediatric bradycardia with poor perfusion, epinephrine is the first-
line medication. Atropine is only used if the bradycardia is due to increased vagal
tone or primary AV block.
,2. Which of the following best describes the correct compression-to-ventilation
ratio for a single rescuer performing CPR on an adult?
A) 15:2
B) 30:2
C) 15:1
D) Continuous compressions with asynchronous breaths at 10/min
Answer: B) 30:2
Rationale: For a single rescuer performing CPR on an adult, the recommended
compression-to-ventilation ratio is 30:2. This is designed to maximize the number
of compressions delivered.
3. You are leading a resuscitation team. A team member suggests a treatment
that you believe is not indicated. What is the MOST appropriate action?
A) Ignore the suggestion to avoid confusion.
B) Say, "That is a good idea, but let's follow the algorithm for now."
C) Immediately stop all interventions to discuss the new idea.
D) Ask the team member to leave the room.
Answer: B) Say, "That is a good idea, but let's follow the algorithm for now."
Rationale: Effective team dynamics involve closed-loop communication and
mutual respect. Acknowledging the suggestion while maintaining focus on the
established algorithm fosters a positive team environment without disrupting the
code.
4. You are performing CPR on an adult patient. After 2 minutes of CPR, you
check the rhythm and it remains pulseless electrical activity (PEA). What is
your next action?
A) Administer a shock.
B) Administer epinephrine.
C) Check for a pulse again in 2 minutes.
D) Resume CPR immediately.
Answer: D) Resume CPR immediately.
Rationale: After a rhythm check, immediately resume chest compressions. Do not
delay compressions for medication administration or pulse checks. Epinephrine is
given during the CPR cycle, not immediately instead of it.
, 5. What is the recommended depth of chest compressions for an adult patient
during CPR?
A) At least 1.5 inches (4 cm)
B) At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
C) At least 3 inches (7.5 cm)
D) At least 4 inches (10 cm)
Answer: B) At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
Rationale: The 2020 guidelines recommend a compression depth of at least 2
inches (5 cm) for adults, with an upper limit of 2.4 inches (6 cm) to avoid injury.
6. A "code leader" asks for the patient's rhythm. The monitor shows
Ventricular Tachycardia (VT). A team member says, "I don't think that's VT,
it looks more like SVT with aberrancy." What is the most appropriate initial
action by the code leader?
A) Tell the team member to be quiet and not question orders.
B) Immediately start synchronizing for cardioversion.
C) Stop CPR and ask everyone to look at the monitor.
D) Reassess the patient's pulse and clinical status.
Answer: D) Reassess the patient's pulse and clinical status.
Rationale: The clinical presentation is paramount. If the patient is pulseless, treat
as VT/V-Fib. If the patient has a pulse but is unstable, synchronized cardioversion
is the treatment, regardless of whether it's VT or SVT with aberrancy.
7. You are performing two-rescuer CPR on a child. The compressor is giving
high-quality compressions. The second rescuer should provide ventilations at
what rate?
A) 1 breath every 6 seconds (10 breaths/min)
B) 1 breath every 3 seconds (20 breaths/min)
C) 2 breaths every 30 compressions
D) 2 breaths every 15 compressions
Answer: A) 1 breath every 6 seconds (10 breaths/min)
Rationale: For the adult and pediatric patient with an advanced airway in place
during two-rescuer CPR, give 1 breath every 6 seconds (10 breaths/min). For two-
rescuer CPR without an advanced airway, the ratio is 15:2 for children.
Life Support (ACLS) | AHA Certification Exam:
A Comprehensive Review of 210 Real
Questions and Answers with Clinical Rationale|
Updated 2026-2027| Latest Version| Guaranteed
Pass
Table of Contents
1. High-Quality BLS & Team Dynamics (Questions 1-10)
2. Airway Management & Ventilation (Questions 11-20)
3. Acute Coronary Syndromes (ACS) (Questions 21-30)
4. Acute Stroke (Questions 31-35)
5. Adult Cardiac Arrest Algorithms (VF/pVT & Asystole/PEA) (Questions
36-45)
6. Post-Cardiac Arrest Care (Questions 46-50)
7. Bradyarrhythmia (Questions 51-55)
8. Tachyarrhythmias (Questions 56-65)
9. Tachycardia with a Pulse Algorithm & Cardioversion (Questions 66-75)
10.Special Resuscitation Situations (Hypothermia, Pregnancy, Tox,
etc.) (Questions 76-85)
11.Pharmacology and Medication Review (Questions 86-95)
12.Mega code Scenarios & Critical Thinking (Questions 96-100)
, 13.BLS & CPR Quality Refresher (Questions 101-110)
14.Advanced Airway & Ventilation Management (Questions 111-120)
15.Acute Coronary Syndromes (ACS) – Deep Dive (Questions 121-130)
16.Acute Stroke – Advanced Topics (Questions 131-135)
17.Adult Cardiac Arrest – Shockable Rhythms (Questions 136-145)
18.Adult Cardiac Arrest – Non-Shockable Rhythms (Questions 146-155)
19.Post-Cardiac Arrest Care & Prognostication (Questions 156-165)
20.Bradyarrhythmia & Pacing (Questions 166-175)
21.Tachyarrhythmias & Cardioversion (Questions 176-185)
22.Special Resuscitation Situations (Questions 186-195)
23.Pharmacology & Medication Calculations (Questions 196-200)
24.Mega code Scenarios & Team Leadership (Questions 201-210)
MULTIPLE CHOICE QUESTIONS
Section 1: High-Quality BLS & Team Dynamics (1-10)
1. A 7-year-old child presents with bradycardia, poor perfusion, and
hypotension. Despite adequate bag-mask ventilation and high-flow oxygen,
the heart rate remains 52 bpm with central pulses only palpable at a rate of 40
bpm. Which medication should be administered first?
A) Atropine 0.02 mg/kg
B) Epinephrine 0.01 mg/kg
C) Adenosine 0.1 mg/kg
D) Amiodarone 5 mg/kg
Answer: B) Epinephrine 0.01 mg/kg
Rationale: In pediatric bradycardia with poor perfusion, epinephrine is the first-
line medication. Atropine is only used if the bradycardia is due to increased vagal
tone or primary AV block.
,2. Which of the following best describes the correct compression-to-ventilation
ratio for a single rescuer performing CPR on an adult?
A) 15:2
B) 30:2
C) 15:1
D) Continuous compressions with asynchronous breaths at 10/min
Answer: B) 30:2
Rationale: For a single rescuer performing CPR on an adult, the recommended
compression-to-ventilation ratio is 30:2. This is designed to maximize the number
of compressions delivered.
3. You are leading a resuscitation team. A team member suggests a treatment
that you believe is not indicated. What is the MOST appropriate action?
A) Ignore the suggestion to avoid confusion.
B) Say, "That is a good idea, but let's follow the algorithm for now."
C) Immediately stop all interventions to discuss the new idea.
D) Ask the team member to leave the room.
Answer: B) Say, "That is a good idea, but let's follow the algorithm for now."
Rationale: Effective team dynamics involve closed-loop communication and
mutual respect. Acknowledging the suggestion while maintaining focus on the
established algorithm fosters a positive team environment without disrupting the
code.
4. You are performing CPR on an adult patient. After 2 minutes of CPR, you
check the rhythm and it remains pulseless electrical activity (PEA). What is
your next action?
A) Administer a shock.
B) Administer epinephrine.
C) Check for a pulse again in 2 minutes.
D) Resume CPR immediately.
Answer: D) Resume CPR immediately.
Rationale: After a rhythm check, immediately resume chest compressions. Do not
delay compressions for medication administration or pulse checks. Epinephrine is
given during the CPR cycle, not immediately instead of it.
, 5. What is the recommended depth of chest compressions for an adult patient
during CPR?
A) At least 1.5 inches (4 cm)
B) At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
C) At least 3 inches (7.5 cm)
D) At least 4 inches (10 cm)
Answer: B) At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
Rationale: The 2020 guidelines recommend a compression depth of at least 2
inches (5 cm) for adults, with an upper limit of 2.4 inches (6 cm) to avoid injury.
6. A "code leader" asks for the patient's rhythm. The monitor shows
Ventricular Tachycardia (VT). A team member says, "I don't think that's VT,
it looks more like SVT with aberrancy." What is the most appropriate initial
action by the code leader?
A) Tell the team member to be quiet and not question orders.
B) Immediately start synchronizing for cardioversion.
C) Stop CPR and ask everyone to look at the monitor.
D) Reassess the patient's pulse and clinical status.
Answer: D) Reassess the patient's pulse and clinical status.
Rationale: The clinical presentation is paramount. If the patient is pulseless, treat
as VT/V-Fib. If the patient has a pulse but is unstable, synchronized cardioversion
is the treatment, regardless of whether it's VT or SVT with aberrancy.
7. You are performing two-rescuer CPR on a child. The compressor is giving
high-quality compressions. The second rescuer should provide ventilations at
what rate?
A) 1 breath every 6 seconds (10 breaths/min)
B) 1 breath every 3 seconds (20 breaths/min)
C) 2 breaths every 30 compressions
D) 2 breaths every 15 compressions
Answer: A) 1 breath every 6 seconds (10 breaths/min)
Rationale: For the adult and pediatric patient with an advanced airway in place
during two-rescuer CPR, give 1 breath every 6 seconds (10 breaths/min). For two-
rescuer CPR without an advanced airway, the ratio is 15:2 for children.
