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ACLS Exam Version B Exam 2026-2027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% Latest Already Graded A+
1. A 57-year-old male presents with acute onset of substernal chest
pressure radiating to his left arm. He is diaphoretic and nauseated. His
initial blood pressure is 90/60 mm Hg, heart rate is 110 bpm, and
respiratory rate is 22/min. The cardiac monitor shows sinus tachycardia
with frequent premature ventricular contractions (PVCs). Which of the
following is the most appropriate initial intervention?
A) Immediate synchronized cardioversion
B) Administration of amiodarone 150 mg IV push
C) Oxygen administration and aspirin 324 mg chewed
D) Immediate transcutaneous pacing
Answer: C
Explanation: The patient is presenting with symptoms highly suggestive
of an acute coronary syndrome (ACS). The initial management for all
patients with suspected ACS includes supplemental oxygen if hypoxemic
(SpO2 < 90%) and aspirin. Aspirin reduces mortality in ACS by inhibiting
platelet aggregation. Option A is incorrect because synchronized
cardioversion is for unstable tachyarrhythmias with a pulse, not for the
primary management of ACS. Option B is incorrect because amiodarone
is an antiarrhythmic used for ventricular arrhythmias or atrial
fibrillation, not a first-line agent for ACS without a specific arrhythmia
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indication. Option D is incorrect because transcutaneous pacing is for
symptomatic bradycardia, not for this presentation.
2. In the context of acute ischemic stroke, which of the following blood
pressure parameters would absolutely contraindicate the
administration of intravenous alteplase (tPA)?
A) Systolic blood pressure > 140 mm Hg or diastolic > 90 mm Hg
B) Systolic blood pressure > 160 mm Hg or diastolic > 95 mm Hg
C) Systolic blood pressure > 180 mm Hg or diastolic > 110 mm Hg
D) Systolic blood pressure > 200 mm Hg or diastolic > 120 mm Hg
Answer: C
Explanation: For patients who are candidates for intravenous alteplase,
the blood pressure must be rigorously controlled to reduce the risk of
intracranial hemorrhage. The specific exclusion criteria include a systolic
blood pressure greater than 185 mm Hg or a diastolic blood pressure
greater than 110 mm Hg at the time of treatment initiation. If the blood
pressure cannot be lowered to below these thresholds with
antihypertensive agents, tPA is contraindicated. Options A and B are
below the established threshold and would not be absolute
contraindications. Option D, while elevated, is beyond the threshold, but
the specific cutoff in the guidelines is 185/110, making option C the
correct and precise answer.
3. A patient in the intensive care unit develops pulseless ventricular
tachycardia. High-quality CPR is in progress, and the patient has been
defibrillated once with 120 J for a biphasic defibrillator. The rhythm
remains refractory. Which medication should be administered next?
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A) Epinephrine 1 mg IV/IO
B) Amiodarone 300 mg IV/IO push
C) Lidocaine 1 mg/kg IV/IO
D) Magnesium sulfate 2 g IV/IO
Answer: B
Explanation: In the management of pulseless ventricular tachycardia
(VT) or ventricular fibrillation (VF), the first treatment is defibrillation.
After the first shock, if the rhythm persists, the next step is to administer
epinephrine or an antiarrhythmic. However, the current American Heart
Association (AHA) guidelines recommend amiodarone or lidocaine for
refractory VF/pulseless VT after the initial defibrillation attempts.
Amiodarone 300 mg IV/IO push is the preferred antiarrhythmic. Option
A, epinephrine, is given after the second shock or if the rhythm is
asystole/PEA, but antiarrhythmics are the primary pharmacological
intervention for shockable rhythms. Option C, lidocaine, is an alternative
but not the first-line recommended agent. Option D, magnesium, is
specifically indicated for torsades de pointes, not for routine refractory
VT/VF.
4. During a resuscitation effort, you are unable to obtain intravenous
access in a patient with cardiac arrest. Which of the following routes of
drug administration is the most appropriate alternative?
A) Subcutaneous injection
B) Intramuscular injection
C) Intraosseous (IO) access
D) Endotracheal tube administration
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Answer: C
Explanation: In cardiac arrest, when IV access is not readily achievable,
the intraosseous (IO) route is the preferred alternative. The IO route
provides a reliable and rapid pathway into the systemic circulation via
the bone marrow, and the doses for all medications are the same as
those for IV administration. While endotracheal tube (ET)
administration is possible, it is less reliable, requires higher doses, and is
only used for specific drugs (e.g., epinephrine, atropine, lidocaine,
naloxone). The AHA guidelines recommend IO access over ET
administration due to its superior pharmacokinetics and ease of
placement. Subcutaneous and intramuscular routes are not acceptable
for emergency drugs during cardiac arrest due to poor and
unpredictable absorption.
5. A 72-year-old female presents to the emergency department with a
heart rate of 38 bpm, blood pressure of 85/50 mm Hg, and confusion.
Her ECG reveals a third-degree atrioventricular (AV) block with a wide
QRS escape rhythm. Which of the following is the definitive treatment
for this patient?
A) Atropine 0.5 mg IV push
B) Dopamine infusion at 5 mcg/kg/min
C) Transcutaneous pacing
D) Transvenous pacing
Answer: D
Explanation: The patient is exhibiting symptomatic bradycardia with
hemodynamic instability (hypotension and altered mental status) due to
a third-degree AV block. The definitive treatment for symptomatic
ACLS Exam Version B Exam 2026-2027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% Latest Already Graded A+
1. A 57-year-old male presents with acute onset of substernal chest
pressure radiating to his left arm. He is diaphoretic and nauseated. His
initial blood pressure is 90/60 mm Hg, heart rate is 110 bpm, and
respiratory rate is 22/min. The cardiac monitor shows sinus tachycardia
with frequent premature ventricular contractions (PVCs). Which of the
following is the most appropriate initial intervention?
A) Immediate synchronized cardioversion
B) Administration of amiodarone 150 mg IV push
C) Oxygen administration and aspirin 324 mg chewed
D) Immediate transcutaneous pacing
Answer: C
Explanation: The patient is presenting with symptoms highly suggestive
of an acute coronary syndrome (ACS). The initial management for all
patients with suspected ACS includes supplemental oxygen if hypoxemic
(SpO2 < 90%) and aspirin. Aspirin reduces mortality in ACS by inhibiting
platelet aggregation. Option A is incorrect because synchronized
cardioversion is for unstable tachyarrhythmias with a pulse, not for the
primary management of ACS. Option B is incorrect because amiodarone
is an antiarrhythmic used for ventricular arrhythmias or atrial
fibrillation, not a first-line agent for ACS without a specific arrhythmia
,2|Page
indication. Option D is incorrect because transcutaneous pacing is for
symptomatic bradycardia, not for this presentation.
2. In the context of acute ischemic stroke, which of the following blood
pressure parameters would absolutely contraindicate the
administration of intravenous alteplase (tPA)?
A) Systolic blood pressure > 140 mm Hg or diastolic > 90 mm Hg
B) Systolic blood pressure > 160 mm Hg or diastolic > 95 mm Hg
C) Systolic blood pressure > 180 mm Hg or diastolic > 110 mm Hg
D) Systolic blood pressure > 200 mm Hg or diastolic > 120 mm Hg
Answer: C
Explanation: For patients who are candidates for intravenous alteplase,
the blood pressure must be rigorously controlled to reduce the risk of
intracranial hemorrhage. The specific exclusion criteria include a systolic
blood pressure greater than 185 mm Hg or a diastolic blood pressure
greater than 110 mm Hg at the time of treatment initiation. If the blood
pressure cannot be lowered to below these thresholds with
antihypertensive agents, tPA is contraindicated. Options A and B are
below the established threshold and would not be absolute
contraindications. Option D, while elevated, is beyond the threshold, but
the specific cutoff in the guidelines is 185/110, making option C the
correct and precise answer.
3. A patient in the intensive care unit develops pulseless ventricular
tachycardia. High-quality CPR is in progress, and the patient has been
defibrillated once with 120 J for a biphasic defibrillator. The rhythm
remains refractory. Which medication should be administered next?
,3|Page
A) Epinephrine 1 mg IV/IO
B) Amiodarone 300 mg IV/IO push
C) Lidocaine 1 mg/kg IV/IO
D) Magnesium sulfate 2 g IV/IO
Answer: B
Explanation: In the management of pulseless ventricular tachycardia
(VT) or ventricular fibrillation (VF), the first treatment is defibrillation.
After the first shock, if the rhythm persists, the next step is to administer
epinephrine or an antiarrhythmic. However, the current American Heart
Association (AHA) guidelines recommend amiodarone or lidocaine for
refractory VF/pulseless VT after the initial defibrillation attempts.
Amiodarone 300 mg IV/IO push is the preferred antiarrhythmic. Option
A, epinephrine, is given after the second shock or if the rhythm is
asystole/PEA, but antiarrhythmics are the primary pharmacological
intervention for shockable rhythms. Option C, lidocaine, is an alternative
but not the first-line recommended agent. Option D, magnesium, is
specifically indicated for torsades de pointes, not for routine refractory
VT/VF.
4. During a resuscitation effort, you are unable to obtain intravenous
access in a patient with cardiac arrest. Which of the following routes of
drug administration is the most appropriate alternative?
A) Subcutaneous injection
B) Intramuscular injection
C) Intraosseous (IO) access
D) Endotracheal tube administration
, 4|Page
Answer: C
Explanation: In cardiac arrest, when IV access is not readily achievable,
the intraosseous (IO) route is the preferred alternative. The IO route
provides a reliable and rapid pathway into the systemic circulation via
the bone marrow, and the doses for all medications are the same as
those for IV administration. While endotracheal tube (ET)
administration is possible, it is less reliable, requires higher doses, and is
only used for specific drugs (e.g., epinephrine, atropine, lidocaine,
naloxone). The AHA guidelines recommend IO access over ET
administration due to its superior pharmacokinetics and ease of
placement. Subcutaneous and intramuscular routes are not acceptable
for emergency drugs during cardiac arrest due to poor and
unpredictable absorption.
5. A 72-year-old female presents to the emergency department with a
heart rate of 38 bpm, blood pressure of 85/50 mm Hg, and confusion.
Her ECG reveals a third-degree atrioventricular (AV) block with a wide
QRS escape rhythm. Which of the following is the definitive treatment
for this patient?
A) Atropine 0.5 mg IV push
B) Dopamine infusion at 5 mcg/kg/min
C) Transcutaneous pacing
D) Transvenous pacing
Answer: D
Explanation: The patient is exhibiting symptomatic bradycardia with
hemodynamic instability (hypotension and altered mental status) due to
a third-degree AV block. The definitive treatment for symptomatic
