ACLS 2026/2027 COMPREHENSIVE CERTIFICATION &
RECERTIFICATION EXAM PREP BANK
1. A patient with suspected acute coronary syndrome (ACS) is placed
on a cardiac monitor and given supplemental oxygen for dyspnea. The
provider determines that oxygen therapy is effective based on which
SpO₂ target?
A. Maintain SpO₂ ≥ 90%
B. Maintain SpO₂ ≥ 92%
C. Maintain SpO₂ ≥ 94%
D. Maintain SpO₂ ≥ 96%
Rationale: For patients with suspected ACS, supplemental oxygen should
be administered to maintain an SpO₂ of at least 94%. Oxygen is not
routinely recommended for all ACS patients; it should be titrated to
achieve this target to avoid hyperoxia while ensuring adequate tissue
oxygenation.
2. During bag-valve-mask (BVM) ventilation, which complication
should raise suspicion of improper technique?
A. Gastric distention
B. Tension pneumothorax
C. Hypoxemia
D. Bronchospasm
Rationale: Delivering excessive tidal volume or ventilating too rapidly
creates excessive airway pressure that can damage the lungs and other
,organs. Excessive volume and pressure can lead to tension
pneumothorax, a life-threatening complication of improper BVM
technique.
3. A patient's assessment reveals an ETCO₂ of 55 mmHg and an SpO₂
of 88%. The provider interprets these findings as indicating which
condition?
A. Hyperventilation syndrome
B. Respiratory failure
C. Cardiac tamponade
D. Pulmonary embolism
Rationale: An SpO₂ less than 90% (corresponding to a PaO₂ less than 50
mmHg) accompanied by ETCO₂ values greater than 50 mmHg is
indicative of respiratory failure. This combination reflects inadequate
oxygenation and impaired ventilation with CO₂ retention.
4. Which ETCO₂ value confirms that ventilations are adequate?
A. 20-30 mmHg
B. 30-40 mmHg
C. 35-45 mmHg
D. 45-55 mmHg
Rationale: End-tidal carbon dioxide values in the range of 35 to 45
mmHg confirm adequacy of ventilation. Values outside this range
suggest hypo- or hyperventilation and should prompt reassessment of
ventilation rate and tidal volume.
,5. An ECG rhythm strip reveals a "sawtooth" baseline with regularly
irregular QRS complexes. The provider interprets this as which
arrhythmia?
A. Atrial fibrillation
B. Atrial flutter
C. Multifocal atrial tachycardia
D. Sinus arrhythmia
Rationale: In atrial flutter, the baseline continually rises and falls,
producing characteristic "flutter" or "sawtooth" waves. In leads II and
III, these flutter waves are often prominent. A 2:1 AV conduction ratio is
most common, though 3:1 and 4:1 ratios are also frequently seen.
6. A person suddenly collapses in a healthcare facility. What is the
FIRST assessment the healthcare provider should perform?
A. Primary assessment (ABCs)
B. Secondary assessment
C. Rapid assessment
D. Focused neurological exam
Rationale: A systematic approach begins with a rapid assessment—a
quick visual survey to ensure scene safety, form an initial impression,
and check for responsiveness, breathing, and pulse. This is followed by
the primary assessment and then secondary assessment.
, 7. In a 35-year-old female patient with suspected STEMI, what is the
minimum ST-segment elevation at the J point in leads V2 and V3 that
is considered diagnostic?
A. 0.10 mV (1.0 mm)
B. 0.15 mV (1.5 mm)
C. 0.20 mV (2.0 mm)
D. 0.25 mV (2.5 mm)
Rationale: New ST-segment elevation at the J point in leads V2 and V3 of
at least 0.15 mV (1.5 mm) in women 40 years or younger is considered
diagnostic of STEMI. For men, the threshold is different (≥0.2 mV in men
≥40 years, ≥0.25 mV in men <40 years).
8. Which two features on ECG are key to diagnosing atrial fibrillation?
A. Presence of P waves and regular QRS intervals
B. Absence of discrete P waves and irregularly irregular QRS
complexes
C. Sawtooth baseline and regular QRS intervals
D. Absence of QRS complexes and presence of flutter waves
Rationale: The two key features of atrial fibrillation on ECG are the
absence of discrete P waves and the presence of irregularly irregular
QRS complexes. The irregularity results from random conduction of
atrial impulses through the AV node.
RECERTIFICATION EXAM PREP BANK
1. A patient with suspected acute coronary syndrome (ACS) is placed
on a cardiac monitor and given supplemental oxygen for dyspnea. The
provider determines that oxygen therapy is effective based on which
SpO₂ target?
A. Maintain SpO₂ ≥ 90%
B. Maintain SpO₂ ≥ 92%
C. Maintain SpO₂ ≥ 94%
D. Maintain SpO₂ ≥ 96%
Rationale: For patients with suspected ACS, supplemental oxygen should
be administered to maintain an SpO₂ of at least 94%. Oxygen is not
routinely recommended for all ACS patients; it should be titrated to
achieve this target to avoid hyperoxia while ensuring adequate tissue
oxygenation.
2. During bag-valve-mask (BVM) ventilation, which complication
should raise suspicion of improper technique?
A. Gastric distention
B. Tension pneumothorax
C. Hypoxemia
D. Bronchospasm
Rationale: Delivering excessive tidal volume or ventilating too rapidly
creates excessive airway pressure that can damage the lungs and other
,organs. Excessive volume and pressure can lead to tension
pneumothorax, a life-threatening complication of improper BVM
technique.
3. A patient's assessment reveals an ETCO₂ of 55 mmHg and an SpO₂
of 88%. The provider interprets these findings as indicating which
condition?
A. Hyperventilation syndrome
B. Respiratory failure
C. Cardiac tamponade
D. Pulmonary embolism
Rationale: An SpO₂ less than 90% (corresponding to a PaO₂ less than 50
mmHg) accompanied by ETCO₂ values greater than 50 mmHg is
indicative of respiratory failure. This combination reflects inadequate
oxygenation and impaired ventilation with CO₂ retention.
4. Which ETCO₂ value confirms that ventilations are adequate?
A. 20-30 mmHg
B. 30-40 mmHg
C. 35-45 mmHg
D. 45-55 mmHg
Rationale: End-tidal carbon dioxide values in the range of 35 to 45
mmHg confirm adequacy of ventilation. Values outside this range
suggest hypo- or hyperventilation and should prompt reassessment of
ventilation rate and tidal volume.
,5. An ECG rhythm strip reveals a "sawtooth" baseline with regularly
irregular QRS complexes. The provider interprets this as which
arrhythmia?
A. Atrial fibrillation
B. Atrial flutter
C. Multifocal atrial tachycardia
D. Sinus arrhythmia
Rationale: In atrial flutter, the baseline continually rises and falls,
producing characteristic "flutter" or "sawtooth" waves. In leads II and
III, these flutter waves are often prominent. A 2:1 AV conduction ratio is
most common, though 3:1 and 4:1 ratios are also frequently seen.
6. A person suddenly collapses in a healthcare facility. What is the
FIRST assessment the healthcare provider should perform?
A. Primary assessment (ABCs)
B. Secondary assessment
C. Rapid assessment
D. Focused neurological exam
Rationale: A systematic approach begins with a rapid assessment—a
quick visual survey to ensure scene safety, form an initial impression,
and check for responsiveness, breathing, and pulse. This is followed by
the primary assessment and then secondary assessment.
, 7. In a 35-year-old female patient with suspected STEMI, what is the
minimum ST-segment elevation at the J point in leads V2 and V3 that
is considered diagnostic?
A. 0.10 mV (1.0 mm)
B. 0.15 mV (1.5 mm)
C. 0.20 mV (2.0 mm)
D. 0.25 mV (2.5 mm)
Rationale: New ST-segment elevation at the J point in leads V2 and V3 of
at least 0.15 mV (1.5 mm) in women 40 years or younger is considered
diagnostic of STEMI. For men, the threshold is different (≥0.2 mV in men
≥40 years, ≥0.25 mV in men <40 years).
8. Which two features on ECG are key to diagnosing atrial fibrillation?
A. Presence of P waves and regular QRS intervals
B. Absence of discrete P waves and irregularly irregular QRS
complexes
C. Sawtooth baseline and regular QRS intervals
D. Absence of QRS complexes and presence of flutter waves
Rationale: The two key features of atrial fibrillation on ECG are the
absence of discrete P waves and the presence of irregularly irregular
QRS complexes. The irregularity results from random conduction of
atrial impulses through the AV node.
