ACLS Final Test Questions and Answers | Comprehensive Exam
Review & Detailed Rationales (2026/2027)
Question 1
What is the recommended initial lipid emulsion therapy protocol for
treating Local Anesthetic Systemic Toxicity (LAST) leading to cardiac
arrest or severe cardiovascular collapse?
• A. 20% lipid emulsion bolus of 1.5 mL/kg lean body mass over 1
minute, followed by an infusion at 0.25 mL/kg/min
• B. 10% lipid emulsion bolus of 10 mL/kg over 10 minutes
• C. 50% dextrose solution 50 mL rapid push
• D. Sodium bicarbonate 2 mEq/kg over 5 minutes
Correct Answer: A. 20% lipid emulsion bolus of 1.5 mL/kg lean body
mass over 1 minute, followed by an infusion at 0.25 mL/kg/min
Detailed Rationale: Lipid emulsion therapy creates a "lipid sink" that
sequesters lipophilic local anesthetics out of cardiac and neural tissues.
The standard initial rescue dose is 1.5 mL/kg of 20% lipid emulsion.
Question 2
What is the recommended initial management when treating a patient
experiencing severe cyanide poisoning-induced cardiac arrest?
• A. Administer Hydroxocobalamin 5 grams IV infusion over 15
minutes, alongside standard ACLS protocols
• B. Administer atropine 3 mg IV push
, • C. Provide high-dose oral activated charcoal during chest
compressions
• D. Perform immediate emergency hemodialysis
Correct Answer: A. Administer Hydroxocobalamin 5 grams IV infusion
over 15 minutes, alongside standard ACLS protocols
Detailed Rationale: Hydroxocobalamin binds cyanide ions to form
cyanocobalamin (vitamin B12), which is safely excreted by the kidneys,
rapidly restoring cellular respiration during toxic arrest.
Question 3
What is the primary mechanism of action of Vasopressin when used
historically or adjunctively as a vascular smooth muscle constrictor?
• A. Direct beta-2 adrenergic agonism in bronchial smooth muscle
• B. Stimulation of peripheral V1 vascular receptors causing non-
adrenergic vasoconstriction
• C. Inhibition of the sodium-potassium ATPase pump in cardiac
myocytes
• D. Blockade of muscarinic receptors in the sinus node
Correct Answer: B. Stimulation of peripheral V1 vascular receptors
causing non-adrenergic vasoconstriction
Detailed Rationale: Vasopressin acts directly on V1 vascular receptors
to produce potent vasoconstriction independently of adrenergic
receptors, making it useful in acidotic states where catecholamines may
have reduced efficacy.
Question 4
,What is the recommended initial infusion rate for Norepinephrine when
managing post-cardiac arrest shock refractory to fluid resuscitation?
• A. 0.1 to 0.5 mcg/min (titrated upward to maintain MAP ≥ 65
mmHg)
• B. 10 mg/min fixed dose
• C. 50 mcg/kg/min rapid push
• D. 0.01 mcg/kg/hour
Correct Answer: A. 0.1 to 0.5 mcg/min (titrated upward to maintain
MAP ≥ 65 mmHg)
Detailed Rationale: Norepinephrine is titrated carefully from low initial
rates (typically 0.1 to 0.5 mcg/min up to 10-30 mcg/min or more) to
restore vascular tone and target organ perfusion pressure.
Question 5
What is the specific ECG manifestation commonly associated with
severe hypothermia, characterized by a positive deflection at the
junction between the QRS complex and the ST segment?
• A. Delta wave
• B. J wave (Osborn wave)
• C. Epsilon wave
• D. U wave
Correct Answer: B. J wave (Osborn wave)
, Detailed Rationale: Osborn waves (J waves) are distinctive late-delta or
positive deflections appearing at the QRS-ST junction, strongly
correlated with core body temperatures below 32°C (90°F).
Question 6
What is the primary hemodynamic goal when managing a patient with
acute severe aortic dissection who develops reflex tachycardia?
• A. Increase heart rate above 120/min with atropine
• B. Aggressively control heart rate (target 60-70/min) and systolic
blood pressure (100-120 mmHg) using beta-blockers before
vasodilators
• C. Administer rapid fluid boluses of 30 mL/kg
• D. Administer sublingual nitroglycerin wide open
Correct Answer: B. Aggressively control heart rate (target 60-70/min)
and systolic blood pressure (100-120 mmHg) using beta-blockers before
vasodilators
Detailed Rationale: In aortic dissection, reducing shear stress (dP/dt) on
the aortic wall is critical. Heart rate control with beta-blockers must be
established prior to vasodilator therapy to prevent reflex tachycardia
worsening dissection propagation.
Question 7
What is the recommended immediate treatment for severe
hyperkalemia-induced cardiac arrest occurring in a dialysis patient?
• A. Calcium chloride or calcium gluconate (1-2g IV), sodium
bicarbonate, regular insulin with dextrose, and high-quality CPR
Review & Detailed Rationales (2026/2027)
Question 1
What is the recommended initial lipid emulsion therapy protocol for
treating Local Anesthetic Systemic Toxicity (LAST) leading to cardiac
arrest or severe cardiovascular collapse?
• A. 20% lipid emulsion bolus of 1.5 mL/kg lean body mass over 1
minute, followed by an infusion at 0.25 mL/kg/min
• B. 10% lipid emulsion bolus of 10 mL/kg over 10 minutes
• C. 50% dextrose solution 50 mL rapid push
• D. Sodium bicarbonate 2 mEq/kg over 5 minutes
Correct Answer: A. 20% lipid emulsion bolus of 1.5 mL/kg lean body
mass over 1 minute, followed by an infusion at 0.25 mL/kg/min
Detailed Rationale: Lipid emulsion therapy creates a "lipid sink" that
sequesters lipophilic local anesthetics out of cardiac and neural tissues.
The standard initial rescue dose is 1.5 mL/kg of 20% lipid emulsion.
Question 2
What is the recommended initial management when treating a patient
experiencing severe cyanide poisoning-induced cardiac arrest?
• A. Administer Hydroxocobalamin 5 grams IV infusion over 15
minutes, alongside standard ACLS protocols
• B. Administer atropine 3 mg IV push
, • C. Provide high-dose oral activated charcoal during chest
compressions
• D. Perform immediate emergency hemodialysis
Correct Answer: A. Administer Hydroxocobalamin 5 grams IV infusion
over 15 minutes, alongside standard ACLS protocols
Detailed Rationale: Hydroxocobalamin binds cyanide ions to form
cyanocobalamin (vitamin B12), which is safely excreted by the kidneys,
rapidly restoring cellular respiration during toxic arrest.
Question 3
What is the primary mechanism of action of Vasopressin when used
historically or adjunctively as a vascular smooth muscle constrictor?
• A. Direct beta-2 adrenergic agonism in bronchial smooth muscle
• B. Stimulation of peripheral V1 vascular receptors causing non-
adrenergic vasoconstriction
• C. Inhibition of the sodium-potassium ATPase pump in cardiac
myocytes
• D. Blockade of muscarinic receptors in the sinus node
Correct Answer: B. Stimulation of peripheral V1 vascular receptors
causing non-adrenergic vasoconstriction
Detailed Rationale: Vasopressin acts directly on V1 vascular receptors
to produce potent vasoconstriction independently of adrenergic
receptors, making it useful in acidotic states where catecholamines may
have reduced efficacy.
Question 4
,What is the recommended initial infusion rate for Norepinephrine when
managing post-cardiac arrest shock refractory to fluid resuscitation?
• A. 0.1 to 0.5 mcg/min (titrated upward to maintain MAP ≥ 65
mmHg)
• B. 10 mg/min fixed dose
• C. 50 mcg/kg/min rapid push
• D. 0.01 mcg/kg/hour
Correct Answer: A. 0.1 to 0.5 mcg/min (titrated upward to maintain
MAP ≥ 65 mmHg)
Detailed Rationale: Norepinephrine is titrated carefully from low initial
rates (typically 0.1 to 0.5 mcg/min up to 10-30 mcg/min or more) to
restore vascular tone and target organ perfusion pressure.
Question 5
What is the specific ECG manifestation commonly associated with
severe hypothermia, characterized by a positive deflection at the
junction between the QRS complex and the ST segment?
• A. Delta wave
• B. J wave (Osborn wave)
• C. Epsilon wave
• D. U wave
Correct Answer: B. J wave (Osborn wave)
, Detailed Rationale: Osborn waves (J waves) are distinctive late-delta or
positive deflections appearing at the QRS-ST junction, strongly
correlated with core body temperatures below 32°C (90°F).
Question 6
What is the primary hemodynamic goal when managing a patient with
acute severe aortic dissection who develops reflex tachycardia?
• A. Increase heart rate above 120/min with atropine
• B. Aggressively control heart rate (target 60-70/min) and systolic
blood pressure (100-120 mmHg) using beta-blockers before
vasodilators
• C. Administer rapid fluid boluses of 30 mL/kg
• D. Administer sublingual nitroglycerin wide open
Correct Answer: B. Aggressively control heart rate (target 60-70/min)
and systolic blood pressure (100-120 mmHg) using beta-blockers before
vasodilators
Detailed Rationale: In aortic dissection, reducing shear stress (dP/dt) on
the aortic wall is critical. Heart rate control with beta-blockers must be
established prior to vasodilator therapy to prevent reflex tachycardia
worsening dissection propagation.
Question 7
What is the recommended immediate treatment for severe
hyperkalemia-induced cardiac arrest occurring in a dialysis patient?
• A. Calcium chloride or calcium gluconate (1-2g IV), sodium
bicarbonate, regular insulin with dextrose, and high-quality CPR
