ACLS Final Exam 2026/2027 | Q&A with Expert Verified
Explanations - 90 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Advanced Cardiovascular Life Support (ACLS)
Description This exam assesses mastery of the most current AHA ACLS guidelines (2025
update), including advanced cardiac arrest management, peri-arrest arrhythmias,
post-cardiac arrest care, and acute coronary syndromes. It emphasizes
evidence-based decision-making, pharmacology, and team leadership.
Expected Grade A+
Total Questions 90
Duration 3 hours
Learning Outcomes 1. Integrate pathophysiologic principles to guide resuscitation interventions
2. Differentiate subtle ECG patterns and select appropriate management
3. Apply updated post-arrest care bundles to improve neurological outcomes
4. Demonstrate proficiency in drug dosing, routes, and contraindications
Accreditation Meets AHA ACLS course requirements and US university graduate-level
standards
Page 1
,1. A patient with STEMI and cardiogenic shock presents 90 minutes after symptom
onset. Despite fluid resuscitation and norepinephrine, mean arterial pressure
remains 55 mmHg. Which intervention is most likely to improve survival?
A. Intra-aortic balloon pump (IABP) placement before PCI
B. Immediate PCI with microaxial left ventricular assist device (Impella) support
C. Thrombolytic therapy with tenecteplase
D. Initiation of veno-arterial ECMO and transfer to tertiary center
Answer: B. Immediate PCI with microaxial left ventricular assist device (Impella)
support
In STEMI with refractory cardiogenic shock, the AHA 2025 guidelines recommend
immediate PCI with mechanical circulatory support (MCS) such as Impella, as it
reduces afterload and augments cardiac output. IABP has not shown mortality benefit
in shock. Thrombolysis is contraindicated with cardiogenic shock, and VA-ECMO is
reserved for patients not responding to PCI+MCS.
2. During a code, the monitor shows polymorphic ventricular tachycardia with a
prolonged QT interval. The patient has no pulse. What is the appropriate first-line
antiarrhythmic?
A. Amiodarone 300 mg IV push
B. Lidocaine 1.5 mg/kg IV push
C. Magnesium sulfate 2 g IV push
D. Procainamide 20 mg/min IV infusion
Answer: C. Magnesium sulfate 2 g IV push
Polymorphic VT with prolonged QT interval (torsades de pointes) in cardiac arrest is
best treated with magnesium sulfate, which stabilizes the cardiac membrane.
Amiodarone may paradoxically prolong QT further. Lidocaine and procainamide are
not first-line for torsades.
Page 2
,3. A patient achieves ROSC after 12 minutes of CPR. They are comatose with no eye
opening to pain. Vital signs: BP 90/60 mmHg, HR 110 bpm, SpO2 94% on 100%
FiO2. Which intervention should be initiated immediately?
A. Initiate targeted temperature management at 33°C for 24 hours
B. Administer vasopressors to maintain MAP >65 mmHg, then begin hypothermia
C. Obtain emergent head CT before any cooling
D. Start therapeutic hypothermia at 36°C for 48 hours
Answer: B. Administer vasopressors to maintain MAP >65 mmHg, then begin
hypothermia
Current guidelines prioritize hemodynamic stability (MAP >65 mmHg) before
initiating targeted temperature management (TTM). Hypothermia can worsen
hypotension. TTM at 33°C or 36°C is acceptable, but the immediate priority is
correcting shock. Head CT is indicated but should not delay TTM.
4. Which of the following best explains the rationale for using capnography to assess
CPR quality during cardiac arrest?
A. ETCO2 levels correlate directly with pulmonary blood flow and cardiac output
B. ETCO2 levels reflect arterial PaCO2 and ventilatory status
C. ETCO2 values >20 mmHg indicate adequate chest compression depth
D. A sudden rise in ETCO2 during CPR signals return of spontaneous circulation
Answer: A. ETCO2 levels correlate directly with pulmonary blood flow and
cardiac output
ETCO2 during CPR reflects the amount of CO2 delivered to the lungs, which depends
on cardiac output. Low ETCO2 (<10 mmHg) suggests poor compression quality. While
a sudden rise can indicate ROSC, the primary utility is real-time feedback on
compression effectiveness. ETCO2 does not directly measure depth.
Page 3
, 5. A patient with acute coronary syndrome develops wide-complex tachycardia at
180 bpm. ECG shows a regular tachycardia with QRS duration 0.16 sec, no
discernible P waves, and a northwest axis. Which intervention is contraindicated?
A. Synchronized cardioversion at 100 J
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV over 10 minutes
D. Lidocaine 1.5 mg/kg IV push
Answer: B. Adenosine 6 mg rapid IV push
Adenosine can cause degeneration of ventricular tachycardia (VT) into ventricular
fibrillation or prolonged asystole. In this scenario, the wide-complex tachycardia is
likely VT. Synchronized cardioversion is the treatment of choice if unstable.
Amiodarone and lidocaine are acceptable antiarrhythmics for stable VT.
6. Which finding on a 12-lead ECG is most specific for acute occlusion myocardial
infarction (OMI) in the setting of inferior ST elevation?
A. ST depression in leads V1-V3
B. ST elevation in lead III greater than in lead II
C. Presence of a Q wave in lead III
D. ST segment elevation in lead aVL
Answer: A. ST depression in leads V1-V3
ST depression in V1-V3 with inferior STEMI suggests posterior wall involvement (OMI
of the circumflex artery). This is a high-risk feature. ST elevation in III > II is typical
but not specific. Q waves indicate necrosis but are not acute. ST elevation in aVL is
reciprocal to inferior injury.
Page 4
Explanations - 90 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Advanced Cardiovascular Life Support (ACLS)
Description This exam assesses mastery of the most current AHA ACLS guidelines (2025
update), including advanced cardiac arrest management, peri-arrest arrhythmias,
post-cardiac arrest care, and acute coronary syndromes. It emphasizes
evidence-based decision-making, pharmacology, and team leadership.
Expected Grade A+
Total Questions 90
Duration 3 hours
Learning Outcomes 1. Integrate pathophysiologic principles to guide resuscitation interventions
2. Differentiate subtle ECG patterns and select appropriate management
3. Apply updated post-arrest care bundles to improve neurological outcomes
4. Demonstrate proficiency in drug dosing, routes, and contraindications
Accreditation Meets AHA ACLS course requirements and US university graduate-level
standards
Page 1
,1. A patient with STEMI and cardiogenic shock presents 90 minutes after symptom
onset. Despite fluid resuscitation and norepinephrine, mean arterial pressure
remains 55 mmHg. Which intervention is most likely to improve survival?
A. Intra-aortic balloon pump (IABP) placement before PCI
B. Immediate PCI with microaxial left ventricular assist device (Impella) support
C. Thrombolytic therapy with tenecteplase
D. Initiation of veno-arterial ECMO and transfer to tertiary center
Answer: B. Immediate PCI with microaxial left ventricular assist device (Impella)
support
In STEMI with refractory cardiogenic shock, the AHA 2025 guidelines recommend
immediate PCI with mechanical circulatory support (MCS) such as Impella, as it
reduces afterload and augments cardiac output. IABP has not shown mortality benefit
in shock. Thrombolysis is contraindicated with cardiogenic shock, and VA-ECMO is
reserved for patients not responding to PCI+MCS.
2. During a code, the monitor shows polymorphic ventricular tachycardia with a
prolonged QT interval. The patient has no pulse. What is the appropriate first-line
antiarrhythmic?
A. Amiodarone 300 mg IV push
B. Lidocaine 1.5 mg/kg IV push
C. Magnesium sulfate 2 g IV push
D. Procainamide 20 mg/min IV infusion
Answer: C. Magnesium sulfate 2 g IV push
Polymorphic VT with prolonged QT interval (torsades de pointes) in cardiac arrest is
best treated with magnesium sulfate, which stabilizes the cardiac membrane.
Amiodarone may paradoxically prolong QT further. Lidocaine and procainamide are
not first-line for torsades.
Page 2
,3. A patient achieves ROSC after 12 minutes of CPR. They are comatose with no eye
opening to pain. Vital signs: BP 90/60 mmHg, HR 110 bpm, SpO2 94% on 100%
FiO2. Which intervention should be initiated immediately?
A. Initiate targeted temperature management at 33°C for 24 hours
B. Administer vasopressors to maintain MAP >65 mmHg, then begin hypothermia
C. Obtain emergent head CT before any cooling
D. Start therapeutic hypothermia at 36°C for 48 hours
Answer: B. Administer vasopressors to maintain MAP >65 mmHg, then begin
hypothermia
Current guidelines prioritize hemodynamic stability (MAP >65 mmHg) before
initiating targeted temperature management (TTM). Hypothermia can worsen
hypotension. TTM at 33°C or 36°C is acceptable, but the immediate priority is
correcting shock. Head CT is indicated but should not delay TTM.
4. Which of the following best explains the rationale for using capnography to assess
CPR quality during cardiac arrest?
A. ETCO2 levels correlate directly with pulmonary blood flow and cardiac output
B. ETCO2 levels reflect arterial PaCO2 and ventilatory status
C. ETCO2 values >20 mmHg indicate adequate chest compression depth
D. A sudden rise in ETCO2 during CPR signals return of spontaneous circulation
Answer: A. ETCO2 levels correlate directly with pulmonary blood flow and
cardiac output
ETCO2 during CPR reflects the amount of CO2 delivered to the lungs, which depends
on cardiac output. Low ETCO2 (<10 mmHg) suggests poor compression quality. While
a sudden rise can indicate ROSC, the primary utility is real-time feedback on
compression effectiveness. ETCO2 does not directly measure depth.
Page 3
, 5. A patient with acute coronary syndrome develops wide-complex tachycardia at
180 bpm. ECG shows a regular tachycardia with QRS duration 0.16 sec, no
discernible P waves, and a northwest axis. Which intervention is contraindicated?
A. Synchronized cardioversion at 100 J
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV over 10 minutes
D. Lidocaine 1.5 mg/kg IV push
Answer: B. Adenosine 6 mg rapid IV push
Adenosine can cause degeneration of ventricular tachycardia (VT) into ventricular
fibrillation or prolonged asystole. In this scenario, the wide-complex tachycardia is
likely VT. Synchronized cardioversion is the treatment of choice if unstable.
Amiodarone and lidocaine are acceptable antiarrhythmics for stable VT.
6. Which finding on a 12-lead ECG is most specific for acute occlusion myocardial
infarction (OMI) in the setting of inferior ST elevation?
A. ST depression in leads V1-V3
B. ST elevation in lead III greater than in lead II
C. Presence of a Q wave in lead III
D. ST segment elevation in lead aVL
Answer: A. ST depression in leads V1-V3
ST depression in V1-V3 with inferior STEMI suggests posterior wall involvement (OMI
of the circumflex artery). This is a high-risk feature. ST elevation in III > II is typical
but not specific. Q waves indicate necrosis but are not acute. ST elevation in aVL is
reciprocal to inferior injury.
Page 4
