AMERICAN RED CROSS - ACLS - FINAL EXAM –
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
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Question 1
A 62-year-old male presents with crushing chest pain radiating to his left arm. He is
diaphoretic and nauseous. His blood pressure is 88/52 mmHg, heart rate is 42 bpm, and
respiratory rate is 16/min. The cardiac monitor shows third-degree AV block with a wide
QRS escape rhythm. Which of the following is the most appropriate immediate
intervention?
A. Atropine 0.5 mg IV push
B. Dopamine infusion at 5 mcg/kg/min
C. Transcutaneous pacing
D. Amiodarone 300 mg IV bolus
🟢 C. Transcutaneous pacing
🔴 Explanation: Transcutaneous pacing is the treatment of choice for symptomatic
bradycardia with third-degree AV block and hemodynamic instability. Atropine is unlikely
to be effective in infranodal blocks, and dopamine would be inappropriate as primary
therapy. Amiodarone is indicated for arrhythmias such as ventricular tachycardia or
fibrillation.
Question 2
During a resuscitation effort, the team leader notices that chest compressions are being
performed at a depth of only 4 cm. According to current guidelines, what is the
recommended compression depth for adult patients?
A. At least 2 inches (5 cm)
B. At least 2.4 inches (6 cm)
C. Between 1.5 and 2 inches (4–5 cm)
D. Exactly 2.5 inches (6.4 cm)
🟢 A. At least 2 inches (5 cm)
🔴 Explanation: Current guidelines recommend chest compression depth of at least 2
,inches (5 cm) but not exceeding 2.4 inches (6 cm) for adult patients. Option A is correct as
it reflects the minimum depth requirement, with emphasis on adequate compression depth
to generate sufficient perfusion.
Question 3
A 55-year-old female in the emergency department develops ventricular fibrillation.
Defibrillation is performed at 200 J biphasic. After the shock, the rhythm converts to
pulseless electrical activity (PEA). What is the next appropriate action?
A. Administer amiodarone 300 mg IV
B. Resume CPR immediately for 2 minutes
C. Administer epinephrine 1 mg IV
D. Perform synchronized cardioversion
🟢 B. Resume CPR immediately for 2 minutes
🔴 Explanation: Following defibrillation, CPR should be resumed immediately for 2 minutes
without pausing to check for a pulse or rhythm. This ensures continuous coronary
perfusion and maximizes the chance of return of spontaneous circulation.
Question 4
Which of the following ECG findings is most consistent with hyperkalemia?
A. Prolonged PR interval and widened QRS complex
B. Peaked T waves and widened QRS complex
C. ST-segment depression and T-wave inversion
D. U waves and prolonged QT interval
🟢 B. Peaked T waves and widened QRS complex
🔴 Explanation: Hyperkalemia classically presents with peaked, narrow-based T waves,
followed by PR prolongation, QRS widening, and eventual sine-wave pattern as potassium
levels rise. Option B correctly identifies these hallmark ECG changes.
,Question 5
A patient with a history of heart failure presents with acute pulmonary edema. His blood
pressure is 160/90 mmHg, heart rate is 110 bpm, and oxygen saturation is 89% on room
air. Which of the following medications is most appropriate as first-line therapy?
A. Furosemide 40 mg IV
B. Nitroglycerin 0.4 mg sublingual
C. Morphine sulfate 2 mg IV
D. Dobutamine infusion 5 mcg/kg/min
🟢 A. Furosemide 40 mg IV
🔴 Explanation: Intravenous furosemide is first-line therapy for acute pulmonary edema to
reduce preload through diuresis. While nitroglycerin may be used for afterload reduction,
furosemide addresses the volume overload that is the primary driver of symptoms in this
presentation.
Question 6
During a code, the team member responsible for chest compressions becomes fatigued
after 2 minutes. What is the appropriate action?
A. Continue compressions until the 2-minute rhythm check
B. Switch compressors during the next pulse check
C. Have another team member take over compressions immediately
D. Pause compressions to allow for rest
🟢 C. Have another team member take over compressions immediately
🔴 Explanation: To maintain high-quality CPR, compressor fatigue should be addressed
immediately by rotating the compressor every 2 minutes or sooner if fatigue is noted.
Pausing compressions or delaying the switch compromises patient outcomes.
Question 7
A 68-year-old male with a history of myocardial infarction presents with palpitations. His
ECG shows a regular, narrow-complex tachycardia at 180 bpm. He is hemodynamically
stable. Which of the following is the initial intervention?
, A. Adenosine 6 mg IV rapid push
B. Synchronized cardioversion at 100 J
C. Amiodarone 150 mg IV over 10 minutes
D. Vagal maneuvers
🟢 D. Vagal maneuvers
🔴 Explanation: In hemodynamically stable patients with regular, narrow-complex
tachycardia, vagal maneuvers are the first-line intervention. Adenosine is administered
only if vagal maneuvers fail, while cardioversion and amiodarone are indicated for
unstable patients or specific arrhythmias.
Question 8
Which of the following is the correct compression-to-ventilation ratio for a single
rescuer performing CPR on an adult?
A. 15:2
B. 30:2
C. 30:1
D. 15:1
🟢 B. 30:2
🔴 Explanation: For a single rescuer performing CPR on an adult, the compression-to-
ventilation ratio is 30:2. This ratio is designed to maximize the number of compressions
delivered while providing adequate ventilation.
Question 9
A patient is in cardiac arrest secondary to asystole. The team has administered 1 mg of
epinephrine and performed CPR for 2 minutes. The rhythm remains asystole. What is the
next step?
A. Administer atropine 1 mg IV
B. Administer a second dose of epinephrine 1 mg IV
C. Perform transcutaneous pacing
D. Administer sodium bicarbonate 50 mEq IV
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Question 1
A 62-year-old male presents with crushing chest pain radiating to his left arm. He is
diaphoretic and nauseous. His blood pressure is 88/52 mmHg, heart rate is 42 bpm, and
respiratory rate is 16/min. The cardiac monitor shows third-degree AV block with a wide
QRS escape rhythm. Which of the following is the most appropriate immediate
intervention?
A. Atropine 0.5 mg IV push
B. Dopamine infusion at 5 mcg/kg/min
C. Transcutaneous pacing
D. Amiodarone 300 mg IV bolus
🟢 C. Transcutaneous pacing
🔴 Explanation: Transcutaneous pacing is the treatment of choice for symptomatic
bradycardia with third-degree AV block and hemodynamic instability. Atropine is unlikely
to be effective in infranodal blocks, and dopamine would be inappropriate as primary
therapy. Amiodarone is indicated for arrhythmias such as ventricular tachycardia or
fibrillation.
Question 2
During a resuscitation effort, the team leader notices that chest compressions are being
performed at a depth of only 4 cm. According to current guidelines, what is the
recommended compression depth for adult patients?
A. At least 2 inches (5 cm)
B. At least 2.4 inches (6 cm)
C. Between 1.5 and 2 inches (4–5 cm)
D. Exactly 2.5 inches (6.4 cm)
🟢 A. At least 2 inches (5 cm)
🔴 Explanation: Current guidelines recommend chest compression depth of at least 2
,inches (5 cm) but not exceeding 2.4 inches (6 cm) for adult patients. Option A is correct as
it reflects the minimum depth requirement, with emphasis on adequate compression depth
to generate sufficient perfusion.
Question 3
A 55-year-old female in the emergency department develops ventricular fibrillation.
Defibrillation is performed at 200 J biphasic. After the shock, the rhythm converts to
pulseless electrical activity (PEA). What is the next appropriate action?
A. Administer amiodarone 300 mg IV
B. Resume CPR immediately for 2 minutes
C. Administer epinephrine 1 mg IV
D. Perform synchronized cardioversion
🟢 B. Resume CPR immediately for 2 minutes
🔴 Explanation: Following defibrillation, CPR should be resumed immediately for 2 minutes
without pausing to check for a pulse or rhythm. This ensures continuous coronary
perfusion and maximizes the chance of return of spontaneous circulation.
Question 4
Which of the following ECG findings is most consistent with hyperkalemia?
A. Prolonged PR interval and widened QRS complex
B. Peaked T waves and widened QRS complex
C. ST-segment depression and T-wave inversion
D. U waves and prolonged QT interval
🟢 B. Peaked T waves and widened QRS complex
🔴 Explanation: Hyperkalemia classically presents with peaked, narrow-based T waves,
followed by PR prolongation, QRS widening, and eventual sine-wave pattern as potassium
levels rise. Option B correctly identifies these hallmark ECG changes.
,Question 5
A patient with a history of heart failure presents with acute pulmonary edema. His blood
pressure is 160/90 mmHg, heart rate is 110 bpm, and oxygen saturation is 89% on room
air. Which of the following medications is most appropriate as first-line therapy?
A. Furosemide 40 mg IV
B. Nitroglycerin 0.4 mg sublingual
C. Morphine sulfate 2 mg IV
D. Dobutamine infusion 5 mcg/kg/min
🟢 A. Furosemide 40 mg IV
🔴 Explanation: Intravenous furosemide is first-line therapy for acute pulmonary edema to
reduce preload through diuresis. While nitroglycerin may be used for afterload reduction,
furosemide addresses the volume overload that is the primary driver of symptoms in this
presentation.
Question 6
During a code, the team member responsible for chest compressions becomes fatigued
after 2 minutes. What is the appropriate action?
A. Continue compressions until the 2-minute rhythm check
B. Switch compressors during the next pulse check
C. Have another team member take over compressions immediately
D. Pause compressions to allow for rest
🟢 C. Have another team member take over compressions immediately
🔴 Explanation: To maintain high-quality CPR, compressor fatigue should be addressed
immediately by rotating the compressor every 2 minutes or sooner if fatigue is noted.
Pausing compressions or delaying the switch compromises patient outcomes.
Question 7
A 68-year-old male with a history of myocardial infarction presents with palpitations. His
ECG shows a regular, narrow-complex tachycardia at 180 bpm. He is hemodynamically
stable. Which of the following is the initial intervention?
, A. Adenosine 6 mg IV rapid push
B. Synchronized cardioversion at 100 J
C. Amiodarone 150 mg IV over 10 minutes
D. Vagal maneuvers
🟢 D. Vagal maneuvers
🔴 Explanation: In hemodynamically stable patients with regular, narrow-complex
tachycardia, vagal maneuvers are the first-line intervention. Adenosine is administered
only if vagal maneuvers fail, while cardioversion and amiodarone are indicated for
unstable patients or specific arrhythmias.
Question 8
Which of the following is the correct compression-to-ventilation ratio for a single
rescuer performing CPR on an adult?
A. 15:2
B. 30:2
C. 30:1
D. 15:1
🟢 B. 30:2
🔴 Explanation: For a single rescuer performing CPR on an adult, the compression-to-
ventilation ratio is 30:2. This ratio is designed to maximize the number of compressions
delivered while providing adequate ventilation.
Question 9
A patient is in cardiac arrest secondary to asystole. The team has administered 1 mg of
epinephrine and performed CPR for 2 minutes. The rhythm remains asystole. What is the
next step?
A. Administer atropine 1 mg IV
B. Administer a second dose of epinephrine 1 mg IV
C. Perform transcutaneous pacing
D. Administer sodium bicarbonate 50 mEq IV
