2026-2027 OHIO ACLS INSTRUCTOR PRACTICE
EXAM – QUESTIONS WITH ANSWERS &
RATIONALES
Question 1: According to the 2025 AHA guidelines, which of the following
statements about vasopressin is correct?
A) Vasopressin is now the preferred first-line vasopressor for cardiac arrest
B) Vasopressin alone offers no advantage over epinephrine and is not
recommended for routine use
C) Vasopressin should be used in combination with corticosteroids for all
cardiac arrests
D) Vasopressin is recommended only for shockable rhythms
Correct Answer: B) Vasopressin alone offers no advantage over
epinephrine and is not recommended for routine use
Rationale: The 2025 guidelines state that vasopressin, either alone or in
combination with epinephrine, provides no advantage over epinephrine alone
and is no longer recommended for routine use in cardiac arrest. Epinephrine
remains the primary vasopressor at 1 mg every 3–5 minutes.
Question 2: The 2025 AHA guidelines recommend against routine
administration of which medication during cardiac arrest?
A) Epinephrine
B) Amiodarone
C) Calcium
D) Lidocaine
,Correct Answer: C) Calcium
Rationale: Routine administration of calcium during cardiac arrest is no
longer advised. Calcium may still be used for specific indications such as
known or suspected hyperkalemia, hypocalcemia, or calcium channel blocker
toxicity, but is not recommended routinely.
Question 3: According to the 2025 AHA guidelines, what is the
recommended initial energy dose for synchronized cardioversion of
unstable atrial fibrillation or atrial flutter?
A) 50 J
B) 100 J
C) 120 J
D) 200 J or more
Correct Answer: D) 200 J or more
Rationale: The 2025 guidelines recommend higher initial energy levels (200
joules or more) for cardioversion of unstable atrial fibrillation and flutter.
Lower initial shocks were associated with lower success rates and a higher
risk of degeneration into ventricular fibrillation.
Question 4: Which antiarrhythmic medication has been REMOVED from
the recommended infusions for stable wide-complex tachycardia in the
2025 AHA guidelines?
A) Amiodarone
B) Procainamide
C) Lidocaine
D) Sotalol
,Correct Answer: D) Sotalol
Rationale: Sotalol has been removed from recommended antiarrhythmic
infusions for stable wide-complex tachycardia due to lack of added benefit
compared with procainamide or amiodarone, along with slower infusion
times. Procainamide and amiodarone are now the preferred agents when
expert consultation is not immediately available.
Question 5: The 2025 AHA guidelines define "persistent VF" as:
A) VF that terminates after one defibrillation shock
B) VF or pulseless VT that continues after three or more defibrillation
attempts
C) VF that occurs only in the presence of hypothermia
D) VF that responds to amiodarone within 2 minutes
Correct Answer: B) VF or pulseless VT that continues after three or
more defibrillation attempts
Rationale: Persistent VF is defined as VF or pulseless VT that continues after
three or more defibrillation attempts. This category includes refractory VF
(never terminating) and recurrent VF (briefly terminating but recurring).
Question 6: Which of the following defibrillation strategies received a Class
IIb recommendation in the 2025 AHA guidelines for persistent VF?
A) Routine use of double sequential external defibrillation
B) Vector change (switching pads to anterior-posterior position)
C) Immediate amiodarone administration before defibrillation
D) Increasing defibrillation energy to 360 J for all shocks
, Correct Answer: B) Vector change (switching pads to anterior-posterior
position)
Rationale: For persistent VF, emerging data suggest potential benefit from
vector change (switching pads to an anterior-posterior position) and dual
sequential external defibrillation. These received Class IIb recommendations
and may be considered in experienced settings once standard measures are
optimized.
Question 7: According to the 2025 AHA guidelines, what is the
recommended temperature management range for adults who do not
follow commands after ROSC?
A) Strict hypothermia at 32°C–34°C
B) 32°C–36°C
C) 32°C–37.5°C
D) 36°C–37.5°C only
Correct Answer: C) 32°C–37.5°C
Rationale: The 2025 guidelines recommend that all adults who do not follow
commands after ROSC should receive deliberate temperature control
between 32°C and 37.5°C. Temperature management has shifted from strict
hypothermia targets to a broader goal of fever prevention.
Question 8: The 2025 AHA guidelines have reversed which pandemic-era
guidance for adult resuscitation?
A) Use of mechanical CPR devices
B) Compression-only CPR instead of CPR with rescue breaths
EXAM – QUESTIONS WITH ANSWERS &
RATIONALES
Question 1: According to the 2025 AHA guidelines, which of the following
statements about vasopressin is correct?
A) Vasopressin is now the preferred first-line vasopressor for cardiac arrest
B) Vasopressin alone offers no advantage over epinephrine and is not
recommended for routine use
C) Vasopressin should be used in combination with corticosteroids for all
cardiac arrests
D) Vasopressin is recommended only for shockable rhythms
Correct Answer: B) Vasopressin alone offers no advantage over
epinephrine and is not recommended for routine use
Rationale: The 2025 guidelines state that vasopressin, either alone or in
combination with epinephrine, provides no advantage over epinephrine alone
and is no longer recommended for routine use in cardiac arrest. Epinephrine
remains the primary vasopressor at 1 mg every 3–5 minutes.
Question 2: The 2025 AHA guidelines recommend against routine
administration of which medication during cardiac arrest?
A) Epinephrine
B) Amiodarone
C) Calcium
D) Lidocaine
,Correct Answer: C) Calcium
Rationale: Routine administration of calcium during cardiac arrest is no
longer advised. Calcium may still be used for specific indications such as
known or suspected hyperkalemia, hypocalcemia, or calcium channel blocker
toxicity, but is not recommended routinely.
Question 3: According to the 2025 AHA guidelines, what is the
recommended initial energy dose for synchronized cardioversion of
unstable atrial fibrillation or atrial flutter?
A) 50 J
B) 100 J
C) 120 J
D) 200 J or more
Correct Answer: D) 200 J or more
Rationale: The 2025 guidelines recommend higher initial energy levels (200
joules or more) for cardioversion of unstable atrial fibrillation and flutter.
Lower initial shocks were associated with lower success rates and a higher
risk of degeneration into ventricular fibrillation.
Question 4: Which antiarrhythmic medication has been REMOVED from
the recommended infusions for stable wide-complex tachycardia in the
2025 AHA guidelines?
A) Amiodarone
B) Procainamide
C) Lidocaine
D) Sotalol
,Correct Answer: D) Sotalol
Rationale: Sotalol has been removed from recommended antiarrhythmic
infusions for stable wide-complex tachycardia due to lack of added benefit
compared with procainamide or amiodarone, along with slower infusion
times. Procainamide and amiodarone are now the preferred agents when
expert consultation is not immediately available.
Question 5: The 2025 AHA guidelines define "persistent VF" as:
A) VF that terminates after one defibrillation shock
B) VF or pulseless VT that continues after three or more defibrillation
attempts
C) VF that occurs only in the presence of hypothermia
D) VF that responds to amiodarone within 2 minutes
Correct Answer: B) VF or pulseless VT that continues after three or
more defibrillation attempts
Rationale: Persistent VF is defined as VF or pulseless VT that continues after
three or more defibrillation attempts. This category includes refractory VF
(never terminating) and recurrent VF (briefly terminating but recurring).
Question 6: Which of the following defibrillation strategies received a Class
IIb recommendation in the 2025 AHA guidelines for persistent VF?
A) Routine use of double sequential external defibrillation
B) Vector change (switching pads to anterior-posterior position)
C) Immediate amiodarone administration before defibrillation
D) Increasing defibrillation energy to 360 J for all shocks
, Correct Answer: B) Vector change (switching pads to anterior-posterior
position)
Rationale: For persistent VF, emerging data suggest potential benefit from
vector change (switching pads to an anterior-posterior position) and dual
sequential external defibrillation. These received Class IIb recommendations
and may be considered in experienced settings once standard measures are
optimized.
Question 7: According to the 2025 AHA guidelines, what is the
recommended temperature management range for adults who do not
follow commands after ROSC?
A) Strict hypothermia at 32°C–34°C
B) 32°C–36°C
C) 32°C–37.5°C
D) 36°C–37.5°C only
Correct Answer: C) 32°C–37.5°C
Rationale: The 2025 guidelines recommend that all adults who do not follow
commands after ROSC should receive deliberate temperature control
between 32°C and 37.5°C. Temperature management has shifted from strict
hypothermia targets to a broader goal of fever prevention.
Question 8: The 2025 AHA guidelines have reversed which pandemic-era
guidance for adult resuscitation?
A) Use of mechanical CPR devices
B) Compression-only CPR instead of CPR with rescue breaths
