2026 Advanced Cardiovascular Life
Support (ACLS) Provider
Recertification Examination Questions
Practice Answers with Quality
Rationales
Question 1
A 58-year-old patient suddenly collapses in the emergency
department. The patient is unresponsive, has abnormal
gasping respirations, and no definite pulse is detected after a
brief assessment. What is the most appropriate immediate
action?
A. Obtain a 12-lead ECG
B. Administer atropine
C. Begin high-quality CPR and activate the resuscitation
response
D. Establish a peripheral IV before beginning compressions
Rationale: Agonal gasping is not normal breathing. In an
unresponsive adult without a definite pulse, cardiac arrest
should be presumed and CPR should begin immediately.
Question 2
During adult CPR, which compression rate is recommended?
,A. 60–80/min
B. 80–100/min
C. 100–120/min
D. 130–150/min
Rationale: Chest compressions should generally be delivered
at 100–120 compressions per minute.
Question 3
What is the recommended adult chest-compression depth
during CPR?
A. Approximately 2 cm
B. Approximately 3 cm
C. At least 5 cm (2 inches), while avoiding excessive depth
D. At least 7 cm
Rationale: Adult compressions should be at least 5 cm deep
while avoiding excessive depth that can increase injury
without improving outcomes.
Question 4
A patient in cardiac arrest has a shockable rhythm. Which
intervention has the highest priority after recognizing
ventricular fibrillation?
A. Atropine
B. Amiodarone
C. Immediate defibrillation when a defibrillator is available
D. Sodium bicarbonate
,Rationale: Early defibrillation is the definitive treatment for
ventricular fibrillation and pulseless ventricular tachycardia.
Question 5
Which finding most strongly indicates that CPR compressions
are being performed effectively?
A. Increasing oxygen saturation
B. Increasing blood pressure measured intermittently
C. An appropriate end-tidal carbon dioxide level or
improving ETCO₂ during CPR
D. Increasing respiratory rate
Rationale: ETCO₂ provides a useful physiologic indicator of
pulmonary blood flow during CPR. A sudden sustained
increase may indicate return of spontaneous circulation.
Question 6
A patient is receiving CPR and an advanced airway has been
placed. How should ventilation generally be provided?
A. Two breaths after every 30 compressions
B. 20 breaths/min
C. One breath every 6 seconds with continuous chest
compressions
D. One breath every 2 seconds
Rationale: With an advanced airway, continuous
compressions are performed while approximately one breath
is delivered every 6 seconds.
, Question 7
Which action best minimizes interruptions in chest
compressions?
A. Pause after every medication
B. Stop compressions whenever an ECG rhythm is displayed
C. Limit pauses to only those necessary for rhythm analysis,
shock delivery, and other essential interventions
D. Stop compressions during IV placement
Rationale: Minimizing interruptions preserves coronary and
cerebral perfusion during resuscitation.
Question 8
A patient remains in ventricular fibrillation after an initial
shock. What should the resuscitation team do next?
A. Immediately administer atropine
B. Check the pulse for 30 seconds
C. Resume CPR immediately for approximately 2 minutes
D. Perform synchronized cardioversion
Rationale: After defibrillation, CPR should be resumed
immediately, beginning with chest compressions, rather than
delaying for a prolonged pulse or rhythm assessment.
Question 9
Support (ACLS) Provider
Recertification Examination Questions
Practice Answers with Quality
Rationales
Question 1
A 58-year-old patient suddenly collapses in the emergency
department. The patient is unresponsive, has abnormal
gasping respirations, and no definite pulse is detected after a
brief assessment. What is the most appropriate immediate
action?
A. Obtain a 12-lead ECG
B. Administer atropine
C. Begin high-quality CPR and activate the resuscitation
response
D. Establish a peripheral IV before beginning compressions
Rationale: Agonal gasping is not normal breathing. In an
unresponsive adult without a definite pulse, cardiac arrest
should be presumed and CPR should begin immediately.
Question 2
During adult CPR, which compression rate is recommended?
,A. 60–80/min
B. 80–100/min
C. 100–120/min
D. 130–150/min
Rationale: Chest compressions should generally be delivered
at 100–120 compressions per minute.
Question 3
What is the recommended adult chest-compression depth
during CPR?
A. Approximately 2 cm
B. Approximately 3 cm
C. At least 5 cm (2 inches), while avoiding excessive depth
D. At least 7 cm
Rationale: Adult compressions should be at least 5 cm deep
while avoiding excessive depth that can increase injury
without improving outcomes.
Question 4
A patient in cardiac arrest has a shockable rhythm. Which
intervention has the highest priority after recognizing
ventricular fibrillation?
A. Atropine
B. Amiodarone
C. Immediate defibrillation when a defibrillator is available
D. Sodium bicarbonate
,Rationale: Early defibrillation is the definitive treatment for
ventricular fibrillation and pulseless ventricular tachycardia.
Question 5
Which finding most strongly indicates that CPR compressions
are being performed effectively?
A. Increasing oxygen saturation
B. Increasing blood pressure measured intermittently
C. An appropriate end-tidal carbon dioxide level or
improving ETCO₂ during CPR
D. Increasing respiratory rate
Rationale: ETCO₂ provides a useful physiologic indicator of
pulmonary blood flow during CPR. A sudden sustained
increase may indicate return of spontaneous circulation.
Question 6
A patient is receiving CPR and an advanced airway has been
placed. How should ventilation generally be provided?
A. Two breaths after every 30 compressions
B. 20 breaths/min
C. One breath every 6 seconds with continuous chest
compressions
D. One breath every 2 seconds
Rationale: With an advanced airway, continuous
compressions are performed while approximately one breath
is delivered every 6 seconds.
, Question 7
Which action best minimizes interruptions in chest
compressions?
A. Pause after every medication
B. Stop compressions whenever an ECG rhythm is displayed
C. Limit pauses to only those necessary for rhythm analysis,
shock delivery, and other essential interventions
D. Stop compressions during IV placement
Rationale: Minimizing interruptions preserves coronary and
cerebral perfusion during resuscitation.
Question 8
A patient remains in ventricular fibrillation after an initial
shock. What should the resuscitation team do next?
A. Immediately administer atropine
B. Check the pulse for 30 seconds
C. Resume CPR immediately for approximately 2 minutes
D. Perform synchronized cardioversion
Rationale: After defibrillation, CPR should be resumed
immediately, beginning with chest compressions, rather than
delaying for a prolonged pulse or rhythm assessment.
Question 9
