2026 OHIO ACLS INSTRUCTOR PRACTICE EXAM –
QUESTIONS WITH ANSWERS & RATIONALES
Question 1: According to the 2025 AHA ACLS guidelines, which medication
has been downgraded to a recommendation of "no benefit" for routine use
in adult cardiac arrest?
A) Epinephrine
B) Amiodarone
C) Vasopressin
D) Lidocaine
Correct Answer: C) Vasopressin
Rationale: The 2025 AHA guidelines state that vasopressin alone or in
combination with epinephrine offers no advantage as a substitute for
epinephrine in adult cardiac arrest. Epinephrine (A) remains the primary
vasopressor. Amiodarone (B) and lidocaine (D) remain options for refractory
VF/pVT.
Question 2: Which of the following is a key change in the 2025 AHA ACLS
guidelines regarding calcium administration?
A) Calcium is now recommended for all cardiac arrest patients
B) Routine calcium administration during cardiac arrest is no longer advised
C) Calcium is now recommended only for shockable rhythms
D) Calcium dose has been increased to 2 g IV
Correct Answer: B) Routine calcium administration during cardiac
arrest is no longer advised
,Rationale: The 2025 guidelines explicitly state that routine administration of
calcium for cardiac arrest treatment is no longer advised. Calcium may still
be used in specific situations such as hyperkalemia, hypocalcemia, or calcium
channel blocker toxicity, but is not recommended routinely.
Question 3: According to the 2025 ACLS guidelines, what is the
recommended initial energy dose for synchronized cardioversion of
unstable atrial fibrillation or atrial flutter?
A) 50 J
B) 120 J
C) 200 J or more
D) 360 J
Correct Answer: C) 200 J or more
Rationale: The 2025 guidelines recommend higher initial energy levels (200
joules or more, rather than 120 joules) for cardioversion of unstable atrial
fibrillation and flutter, because lower initial shocks were associated with
lower success rates and a higher risk of degeneration into ventricular
fibrillation.
Question 4: According to the 2025 AHA ACLS guidelines, which of the
following antiarrhythmics has been REMOVED from recommended
infusions for stable wide-complex tachycardia?
A) Amiodarone
B) Procainamide
C) Sotalol
D) Lidocaine
,Correct Answer: C) Sotalol
Rationale: Sotalol has been removed from recommended antiarrhythmic
infusions for stable wide-complex tachycardia. Evidence demonstrated no
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 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
Correct Answer: B) VF or pulseless VT that continues after three or
more defibrillation attempts
Rationale: The 2025 guidelines emphasize the concept of "persistent VF,"
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) Standard anterior-lateral pad placement only
B) Vector change (switching pads to anterior-posterior position)
C) Immediate amiodarone administration before defibrillation
D) Routine use of double sequential external defibrillation
, Correct Answer: B) Vector change (switching pads to anterior-posterior
position)
Rationale: For refractory VF, emerging data suggest potential benefit from
defibrillation strategies beyond standard anterior-lateral pad placement,
including vector change (switching pads to an anterior-posterior position)
and dual sequential external defibrillation. The AHA categorized these as
Class IIb recommendations due to limited data. They may be considered in
experienced settings once standard measures are optimized.
Question 7: According to the 2025 AHA guidelines, which of the following
is the recommended temperature management range for adults who do
not follow commands after ROSC?
A) 32°C to 34°C (strict hypothermia)
B) 32°C to 37.5°C
C) 36°C to 37.5°C
D) No temperature management is recommended
Correct Answer: B) 32°C to 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, regardless of arrest location or presenting rhythm.
This represents an expansion from the previous narrow target range.
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
QUESTIONS WITH ANSWERS & RATIONALES
Question 1: According to the 2025 AHA ACLS guidelines, which medication
has been downgraded to a recommendation of "no benefit" for routine use
in adult cardiac arrest?
A) Epinephrine
B) Amiodarone
C) Vasopressin
D) Lidocaine
Correct Answer: C) Vasopressin
Rationale: The 2025 AHA guidelines state that vasopressin alone or in
combination with epinephrine offers no advantage as a substitute for
epinephrine in adult cardiac arrest. Epinephrine (A) remains the primary
vasopressor. Amiodarone (B) and lidocaine (D) remain options for refractory
VF/pVT.
Question 2: Which of the following is a key change in the 2025 AHA ACLS
guidelines regarding calcium administration?
A) Calcium is now recommended for all cardiac arrest patients
B) Routine calcium administration during cardiac arrest is no longer advised
C) Calcium is now recommended only for shockable rhythms
D) Calcium dose has been increased to 2 g IV
Correct Answer: B) Routine calcium administration during cardiac
arrest is no longer advised
,Rationale: The 2025 guidelines explicitly state that routine administration of
calcium for cardiac arrest treatment is no longer advised. Calcium may still
be used in specific situations such as hyperkalemia, hypocalcemia, or calcium
channel blocker toxicity, but is not recommended routinely.
Question 3: According to the 2025 ACLS guidelines, what is the
recommended initial energy dose for synchronized cardioversion of
unstable atrial fibrillation or atrial flutter?
A) 50 J
B) 120 J
C) 200 J or more
D) 360 J
Correct Answer: C) 200 J or more
Rationale: The 2025 guidelines recommend higher initial energy levels (200
joules or more, rather than 120 joules) for cardioversion of unstable atrial
fibrillation and flutter, because lower initial shocks were associated with
lower success rates and a higher risk of degeneration into ventricular
fibrillation.
Question 4: According to the 2025 AHA ACLS guidelines, which of the
following antiarrhythmics has been REMOVED from recommended
infusions for stable wide-complex tachycardia?
A) Amiodarone
B) Procainamide
C) Sotalol
D) Lidocaine
,Correct Answer: C) Sotalol
Rationale: Sotalol has been removed from recommended antiarrhythmic
infusions for stable wide-complex tachycardia. Evidence demonstrated no
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 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
Correct Answer: B) VF or pulseless VT that continues after three or
more defibrillation attempts
Rationale: The 2025 guidelines emphasize the concept of "persistent VF,"
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) Standard anterior-lateral pad placement only
B) Vector change (switching pads to anterior-posterior position)
C) Immediate amiodarone administration before defibrillation
D) Routine use of double sequential external defibrillation
, Correct Answer: B) Vector change (switching pads to anterior-posterior
position)
Rationale: For refractory VF, emerging data suggest potential benefit from
defibrillation strategies beyond standard anterior-lateral pad placement,
including vector change (switching pads to an anterior-posterior position)
and dual sequential external defibrillation. The AHA categorized these as
Class IIb recommendations due to limited data. They may be considered in
experienced settings once standard measures are optimized.
Question 7: According to the 2025 AHA guidelines, which of the following
is the recommended temperature management range for adults who do
not follow commands after ROSC?
A) 32°C to 34°C (strict hypothermia)
B) 32°C to 37.5°C
C) 36°C to 37.5°C
D) No temperature management is recommended
Correct Answer: B) 32°C to 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, regardless of arrest location or presenting rhythm.
This represents an expansion from the previous narrow target range.
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
