ACLS Post Test 2026
Questions and Answers
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50 Questions | Aligned with Current AHA Guidelines
Section 1: BLS, CPR, and Airway Management
High-Quality CPR, Compression Depth/Rate, Ventilation, Airway Adjuncts, and Team Dynamics (Q1-Q12)
Q1: A 56-year-old male collapses in the emergency department. The monitor shows ventricular
fibrillation. Which of the following is the MOST critical component of high-quality CPR during the
initial resuscitation?
A. Administering epinephrine as soon as possible
B. Providing chest compressions at a rate of 100-120 per minute with a depth of at least 2 inches (5 cm)
and allowing full chest recoil between compressions
C. Intubating the patient immediately before beginning compressions
D. Performing synchronized cardioversion at 200 J biphasic
Correct Answer: B
Rationale: The foundation of high-quality CPR is delivering chest compressions at a rate of 100-120/min with a depth
of at least 2 inches (5 cm), ensuring complete chest recoil between compressions, and minimizing interruptions to less
than 10 seconds per the AHA 2025 guidelines. Epinephrine is administered after the first shock and during CPR, not
before compressions. Immediate intubation is not the priority over starting compressions. Synchronized cardioversion is
not indicated for VF; defibrillation (unsynchronized shock) is the correct treatment for VF/pVT.
Q2: You are performing bag-mask ventilation on an apneic patient. Which technique BEST ensures
adequate ventilation and minimizes gastric inflation?
A. Deliver each breath over 1 second with just enough volume to produce visible chest rise, using a C-E
clamp technique to maintain a tight mask seal
B. Deliver rapid, forceful breaths to maximize oxygenation and hyperventilate the patient
C. Perform the head tilt-chin lift maneuver even if cervical spine injury is suspected
D. Ventilate at a rate of 20 breaths per minute during ongoing chest compressions
Correct Answer: A
Rationale: Each ventilation should be delivered over 1 second with sufficient tidal volume to produce visible chest rise,
typically 400-600 mL in an adult. The C-E clamp technique (thumb and index finger forming a C on the mask,
remaining fingers lifting the jaw in an E shape) provides an optimal seal. Hyperventilation increases intrathoracic
pressure, decreases venous return, and can cause gastric inflation leading to aspiration. For patients with suspected
spinal injury, the jaw-thrust maneuver without head tilt is preferred. During CPR with an advanced airway, the rate is
1 breath every 5-6 seconds (10-12/min), not 20 per minute.
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Q3: After placing an endotracheal tube, which of the following is the GOLD STANDARD for
confirming correct endotracheal tube placement?
A. Auscultation of bilateral breath sounds and observation of chest wall rise
B. Waveform capnography showing a persistent quantitative capnographic waveform with a PETCO2
value consistent with the patient condition
C. Observation of condensation (fogging) in the endotracheal tube
D. Use of a bulb-style esophageal detector device
Correct Answer: B
Rationale: Waveform capnography is the gold standard for continuous confirmation of endotracheal tube placement
according to the AHA guidelines. A persistent, quantitative capnographic waveform with an appropriate PETCO2
value confirms both initial and ongoing correct tube position. Auscultation, fogging, and color-change devices can be
unreliable and are considered supplementary methods. Clinical assessment alone (breath sounds, chest rise) has been
shown to miss esophageal intubations. Continuous waveform capnography also provides real-time monitoring for tube
displacement during patient movement or transport.
Q4: A patient has been successfully intubated, but during the rhythm check, you notice absent breath
sounds over the left lung, gurgling over the epigastrium, and the SpO2 is dropping rapidly. The
capnography waveform is absent. What is the MOST likely diagnosis?
A. Right mainstem bronchus intubation
B. Tension pneumothorax
C. Inadvertent esophageal intubation
D. Pulmonary embolism
Correct Answer: C
Rationale: The combination of absent breath sounds, gurgling over the epigastrium, decreasing SpO2, and absence of
capnography waveform are the classic signs of inadvertent esophageal intubation. This is a critical, immediately
life-threatening event requiring prompt recognition and correction. Right mainstem intubation would typically present
with absent breath sounds on the left but would still show a capnography waveform and no epigastric gurgling.
Tension pneumothorax presents with absent breath sounds on the affected side, tracheal deviation, and hypotension,
but would not cause gurgling or loss of capnography. Immediate removal of the tube and re-establishment of
ventilation via bag-mask is required.
Q5: A rescuer states, "I am going to administer epinephrine 1 mg IV push." The team leader responds,
"That is correct, go ahead." Which communication technique does this represent?
A. SBAR (Situation, Background, Assessment, Recommendation)
B. Closed-loop communication
C. CUS (Concerned, Uncomfortable, Safety issue)
D. Debriefing
Correct Answer: B
Rationale: Closed-loop communication is a structured team communication technique in which the sender gives a clear
message or order, the receiver repeats back the message to confirm understanding, and the sender confirms that the
message was received correctly. This technique reduces errors during high-stress resuscitation events and is a core
element of AHA team dynamics training. The correct format is: sender gives order, receiver repeats order ("I have an
order to give 1 mg epinephrine IV push. Is this correct?"), and the team leader confirms. SBAR is used for patient
Page 2
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handoffs, CUS is used for escalating safety concerns, and debriefing occurs after the resuscitation event.
Q6: During a cardiac arrest resuscitation, the team leader notices that chest compressions are being
interrupted for rhythm checks lasting more than 15 seconds. What is the MAXIMUM recommended
interruption time for chest compressions during a rhythm check?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Correct Answer: B
Rationale: The AHA guidelines recommend that interruptions to chest compressions be minimized to less than 10
seconds. Prolonged interruptions significantly reduce coronary perfusion pressure and decrease the likelihood of
successful defibrillation. The rhythm check should be performed efficiently during the 2-minute CPR cycle, with the
team prepared to immediately resume compressions if a non-shockable rhythm is identified or immediately after a
shock is delivered for a shockable rhythm. Every second without compressions decreases the chance of ROSC.
Q7: Which airway maneuver is MOST appropriate for a patient with a suspected cervical spine injury
who requires airway opening?
A. Head tilt-chin lift
B. Jaw-thrust maneuver without head tilt
C. Oropharyngeal airway insertion only
D. Extension of the neck to maximize airway patency
Correct Answer: B
Rationale: The jaw-thrust maneuver without head tilt is the recommended airway opening technique for patients with
suspected cervical spine injury, as it opens the airway by displacing the mandible forward without extending the neck.
The head tilt-chin lift maneuver and neck extension are contraindicated in suspected spinal injury as they may worsen
a cervical spine fracture and cause spinal cord injury. An oropharyngeal airway can be used as an adjunct but does
not replace the need for a proper airway-opening maneuver. If the jaw-thrust is unsuccessful, the head tilt-chin lift
may be used as a last resort.
Q8: After an advanced airway is placed during cardiac arrest, what is the CORRECT ventilation rate
during ongoing CPR?
A. 1 breath every 3-4 seconds (15-20 per minute)
B. 1 breath every 5-6 seconds (10-12 per minute)
C. 2 breaths every 10 seconds (12 per minute)
D. 1 breath every 8-10 seconds (6-8 per minute)
Correct Answer: B
Rationale: Once an advanced airway (endotracheal tube or supraglottic airway) is in place, the AHA guideline
ventilation rate is 1 breath every 5-6 seconds (10-12 breaths per minute), delivered asynchronously with chest
compressions. This is a change from the previous recommendation of compressions paused for ventilations. The
asynchronous delivery means compressions continue without pausing for breaths, which maximizes coronary perfusion
pressure. Ventilating at 15-20 breaths per minute would cause excessive positive intrathoracic pressure and decrease
cardiac output. The old 30:2 ratio applies only before advanced airway placement.
Page 3
Questions and Answers
Verified Answers by Expert
50 Questions | Aligned with Current AHA Guidelines
Section 1: BLS, CPR, and Airway Management
High-Quality CPR, Compression Depth/Rate, Ventilation, Airway Adjuncts, and Team Dynamics (Q1-Q12)
Q1: A 56-year-old male collapses in the emergency department. The monitor shows ventricular
fibrillation. Which of the following is the MOST critical component of high-quality CPR during the
initial resuscitation?
A. Administering epinephrine as soon as possible
B. Providing chest compressions at a rate of 100-120 per minute with a depth of at least 2 inches (5 cm)
and allowing full chest recoil between compressions
C. Intubating the patient immediately before beginning compressions
D. Performing synchronized cardioversion at 200 J biphasic
Correct Answer: B
Rationale: The foundation of high-quality CPR is delivering chest compressions at a rate of 100-120/min with a depth
of at least 2 inches (5 cm), ensuring complete chest recoil between compressions, and minimizing interruptions to less
than 10 seconds per the AHA 2025 guidelines. Epinephrine is administered after the first shock and during CPR, not
before compressions. Immediate intubation is not the priority over starting compressions. Synchronized cardioversion is
not indicated for VF; defibrillation (unsynchronized shock) is the correct treatment for VF/pVT.
Q2: You are performing bag-mask ventilation on an apneic patient. Which technique BEST ensures
adequate ventilation and minimizes gastric inflation?
A. Deliver each breath over 1 second with just enough volume to produce visible chest rise, using a C-E
clamp technique to maintain a tight mask seal
B. Deliver rapid, forceful breaths to maximize oxygenation and hyperventilate the patient
C. Perform the head tilt-chin lift maneuver even if cervical spine injury is suspected
D. Ventilate at a rate of 20 breaths per minute during ongoing chest compressions
Correct Answer: A
Rationale: Each ventilation should be delivered over 1 second with sufficient tidal volume to produce visible chest rise,
typically 400-600 mL in an adult. The C-E clamp technique (thumb and index finger forming a C on the mask,
remaining fingers lifting the jaw in an E shape) provides an optimal seal. Hyperventilation increases intrathoracic
pressure, decreases venous return, and can cause gastric inflation leading to aspiration. For patients with suspected
spinal injury, the jaw-thrust maneuver without head tilt is preferred. During CPR with an advanced airway, the rate is
1 breath every 5-6 seconds (10-12/min), not 20 per minute.
,ACLS Post Test | Verified Answers by Expert
Q3: After placing an endotracheal tube, which of the following is the GOLD STANDARD for
confirming correct endotracheal tube placement?
A. Auscultation of bilateral breath sounds and observation of chest wall rise
B. Waveform capnography showing a persistent quantitative capnographic waveform with a PETCO2
value consistent with the patient condition
C. Observation of condensation (fogging) in the endotracheal tube
D. Use of a bulb-style esophageal detector device
Correct Answer: B
Rationale: Waveform capnography is the gold standard for continuous confirmation of endotracheal tube placement
according to the AHA guidelines. A persistent, quantitative capnographic waveform with an appropriate PETCO2
value confirms both initial and ongoing correct tube position. Auscultation, fogging, and color-change devices can be
unreliable and are considered supplementary methods. Clinical assessment alone (breath sounds, chest rise) has been
shown to miss esophageal intubations. Continuous waveform capnography also provides real-time monitoring for tube
displacement during patient movement or transport.
Q4: A patient has been successfully intubated, but during the rhythm check, you notice absent breath
sounds over the left lung, gurgling over the epigastrium, and the SpO2 is dropping rapidly. The
capnography waveform is absent. What is the MOST likely diagnosis?
A. Right mainstem bronchus intubation
B. Tension pneumothorax
C. Inadvertent esophageal intubation
D. Pulmonary embolism
Correct Answer: C
Rationale: The combination of absent breath sounds, gurgling over the epigastrium, decreasing SpO2, and absence of
capnography waveform are the classic signs of inadvertent esophageal intubation. This is a critical, immediately
life-threatening event requiring prompt recognition and correction. Right mainstem intubation would typically present
with absent breath sounds on the left but would still show a capnography waveform and no epigastric gurgling.
Tension pneumothorax presents with absent breath sounds on the affected side, tracheal deviation, and hypotension,
but would not cause gurgling or loss of capnography. Immediate removal of the tube and re-establishment of
ventilation via bag-mask is required.
Q5: A rescuer states, "I am going to administer epinephrine 1 mg IV push." The team leader responds,
"That is correct, go ahead." Which communication technique does this represent?
A. SBAR (Situation, Background, Assessment, Recommendation)
B. Closed-loop communication
C. CUS (Concerned, Uncomfortable, Safety issue)
D. Debriefing
Correct Answer: B
Rationale: Closed-loop communication is a structured team communication technique in which the sender gives a clear
message or order, the receiver repeats back the message to confirm understanding, and the sender confirms that the
message was received correctly. This technique reduces errors during high-stress resuscitation events and is a core
element of AHA team dynamics training. The correct format is: sender gives order, receiver repeats order ("I have an
order to give 1 mg epinephrine IV push. Is this correct?"), and the team leader confirms. SBAR is used for patient
Page 2
, ACLS Post Test | Verified Answers by Expert
handoffs, CUS is used for escalating safety concerns, and debriefing occurs after the resuscitation event.
Q6: During a cardiac arrest resuscitation, the team leader notices that chest compressions are being
interrupted for rhythm checks lasting more than 15 seconds. What is the MAXIMUM recommended
interruption time for chest compressions during a rhythm check?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Correct Answer: B
Rationale: The AHA guidelines recommend that interruptions to chest compressions be minimized to less than 10
seconds. Prolonged interruptions significantly reduce coronary perfusion pressure and decrease the likelihood of
successful defibrillation. The rhythm check should be performed efficiently during the 2-minute CPR cycle, with the
team prepared to immediately resume compressions if a non-shockable rhythm is identified or immediately after a
shock is delivered for a shockable rhythm. Every second without compressions decreases the chance of ROSC.
Q7: Which airway maneuver is MOST appropriate for a patient with a suspected cervical spine injury
who requires airway opening?
A. Head tilt-chin lift
B. Jaw-thrust maneuver without head tilt
C. Oropharyngeal airway insertion only
D. Extension of the neck to maximize airway patency
Correct Answer: B
Rationale: The jaw-thrust maneuver without head tilt is the recommended airway opening technique for patients with
suspected cervical spine injury, as it opens the airway by displacing the mandible forward without extending the neck.
The head tilt-chin lift maneuver and neck extension are contraindicated in suspected spinal injury as they may worsen
a cervical spine fracture and cause spinal cord injury. An oropharyngeal airway can be used as an adjunct but does
not replace the need for a proper airway-opening maneuver. If the jaw-thrust is unsuccessful, the head tilt-chin lift
may be used as a last resort.
Q8: After an advanced airway is placed during cardiac arrest, what is the CORRECT ventilation rate
during ongoing CPR?
A. 1 breath every 3-4 seconds (15-20 per minute)
B. 1 breath every 5-6 seconds (10-12 per minute)
C. 2 breaths every 10 seconds (12 per minute)
D. 1 breath every 8-10 seconds (6-8 per minute)
Correct Answer: B
Rationale: Once an advanced airway (endotracheal tube or supraglottic airway) is in place, the AHA guideline
ventilation rate is 1 breath every 5-6 seconds (10-12 breaths per minute), delivered asynchronously with chest
compressions. This is a change from the previous recommendation of compressions paused for ventilations. The
asynchronous delivery means compressions continue without pausing for breaths, which maximizes coronary perfusion
pressure. Ventilating at 15-20 breaths per minute would cause excessive positive intrathoracic pressure and decrease
cardiac output. The old 30:2 ratio applies only before advanced airway placement.
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