American Heart Association (AHA)
,Advanced Cardiovascular Life Support (ACLS)
Comprehensive Final Examination & Practice
Question Bank
This document contains 200 high-yield, multiple-choice practice questions meticulously formulated to reflect
current AHA ACLS guidelines, cardiac arrest algorithms, post-cardiac arrest care, pharmacology, and ECG
rhythm analysis. Detailed rationales and core clinical pearls are provided for every question to support mastery.
QUESTION 1
A 62-year-old male collapses in the emergency department waiting room. Monitors display
Ventricular Fibrillation (VF). High-quality CPR is in progress. What is the immediate priority
action?
[A] Administer IV Epinephrine 1 mg immediately
[B] Deliver an immediate unsynchronized shock (120–200 J biphasic)
[C] Perform endotracheal intubation
[D] Administer IV Amiodarone 300 mg
CORRECT ANSWER: Option B — Deliver an immediate unsynchronized shock (120–200 J biphasic)
Detailed Clinical Rationale: The primary treatment for VF or pulseless Ventricular Tachycardia (pVT) is immediate
unsynchronized defibrillation. CPR should continue until the defibrillator is charged, followed immediately by shock
delivery.
ACLS Clinical Pearl: Early defibrillation combined with high-quality CPR is the single most critical determinant of
survival in shockable cardiac arrest.
QUESTION 2
During CPR for a patient in cardiac arrest, high-quality chest compressions are defined by which
of the following rate and depth standards in adults?
[A] Rate of 80–100/min, depth of at least 1 inch (2.5 cm)
[B] Rate of 100–120/min, depth of 2 to 2.4 inches (5–6 cm)
[C] Rate of 120–140/min, depth of at least 3 inches (7.5 cm)
[D] Rate of 100/min with complete chest recoil forbidden between compressions
CORRECT ANSWER: Option B — Rate of 100–120/min, depth of 2 to 2.4 inches (5–6 cm)
Detailed Clinical Rationale: High-quality CPR parameters for adults include: compression rate of 100–120/min,
compression depth of 2 to 2.4 inches (5–6 cm), allowing complete chest recoil after each compression, minimizing
interruptions in compressions (< 10 seconds), and avoiding excessive ventilation.
ACLS Clinical Pearl: Chest compression fraction (CCF) should be kept as high as possible, with a target of at
least 60% and ideally > 80%.
QUESTION 3
,A patient in refractory VF has received 2 shocks, 2 minutes of CPR, and 1 mg Epinephrine IV. VF
persists at the 3rd rhythm check. What medication and dose should be administered next?
[A] Amiodarone 300 mg IV/IO push
[B] Lidocaine 0.5 mg/kg IV/IO push
[C] Atropine 1 mg IV push
[D] Amiodarone 150 mg IV/IO push
CORRECT ANSWER: Option A — Amiodarone 300 mg IV/IO push
Detailed Clinical Rationale: After the third shock for VF/pVT, the first dose of antiarrhythmic therapy is indicated.
Amiodarone 300 mg IV/IO bolus (or Lidocaine 1–1.5 mg/kg IV/IO) is administered during high-quality CPR.
ACLS Clinical Pearl: Amiodarone first dose = 300 mg bolus; second dose = 150 mg IV/IO. Lidocaine second dose
= 0.5–0.75 mg/kg.
QUESTION 4
A 58-year-old patient presents with symptomatic bradycardia (HR 36 bpm, BP 74/42 mmHg,
altered mental status). Atropine 1 mg IV was administered without response. What is the
immediate next step?
[A] Administer a second dose of Atropine 1 mg
[B] Initiate Transcutaneous Pacing (TCP) or start Epinephrine IV infusion (2–10 mcg/min)
[C] Administer Adenosine 6 mg rapid IV push
[D] Deliver an unsynchronized 200 J shock
CORRECT ANSWER: Option B — Initiate Transcutaneous Pacing (TCP) or start Epinephrine IV
infusion (2–10 mcg/min)
Detailed Clinical Rationale: If Atropine fails to restore an adequate heart rate in symptomatic bradycardia,
second-line treatments include Transcutaneous Pacing (TCP) or chronotropic drug infusions such as Epinephrine
(2–10 mcg/min) or Dopamine (5–20 mcg/kg/min).
ACLS Clinical Pearl: Do not delay transcutaneous pacing in patients with severe symptoms or second-degree
Mobitz II / third-degree heart blocks.
QUESTION 5
A 45-year-old female presents to the ED with a narrow-complex regular tachycardia at a rate of
210 bpm. She is alert, oriented, with BP 118/76 mmHg. Vagal maneuvers fail. What is the first-line
medication?
[A] Adenosine 6 mg rapid IV push followed immediately by a 20 mL saline flush
[B] Amiodarone 150 mg IV over 10 minutes
[C] Metoprolol 5 mg slow IV push over 5 minutes
[D] Diltiazem 0.25 mg/kg IV push over 2 minutes
CORRECT ANSWER: Option A — Adenosine 6 mg rapid IV push followed immediately by a 20 mL
saline flush
, Detailed Clinical Rationale: For stable narrow-complex supraventricular tachycardia (SVT), Adenosine 6 mg rapid
IV push is the first-line pharmacologic agent. It must be administered rapidly followed immediately by a 20 mL
saline flush due to its extremely short half-life (< 10 seconds).
ACLS Clinical Pearl: Always instruct the patient that Adenosine may cause a brief feeling of chest tightness,
flushing, or lightheadedness.
QUESTION 6
Which quantitative continuous monitoring technique is recommended during cardiac arrest to
confirm ETT placement and monitor CPR quality?
[A] Pulse oximetry (SpO2)
[B] Waveform Capnography (PetCO2)
[C] Arterial blood gas (ABG) analysis
[D] Central venous pressure (CVP) monitoring
CORRECT ANSWER: Option B — Waveform Capnography (PetCO2)
Detailed Clinical Rationale: Continuous waveform capnography is recommended in cardiac arrest to confirm
correct ETT placement, monitor CPR quality (a PetCO2 < 10 mmHg indicates inadequate compressions), and
detect Return of Spontaneous Circulation (ROSC).
ACLS Clinical Pearl: A sudden, persistent rise in PetCO2 to 35–40 mmHg or greater is a primary indicator of
ROSC during CPR.
QUESTION 7
A patient in cardiac arrest has a initial rhythm of Pulseless Electrical Activity (PEA). What is the
primary management strategy for PEA?
[A] Immediate defibrillation at maximum joules
[B] High-quality CPR, early Epinephrine 1 mg IV/IO, and identifying/correcting H's and T's
[C] Transcutaneous pacing at 80 bpm
[D] Administration of IV Calcium Chloride 1 g and Sodium Bicarbonate 50 mEq
CORRECT ANSWER: Option B — High-quality CPR, early Epinephrine 1 mg IV/IO, and
identifying/correcting H's and T's
Detailed Clinical Rationale: PEA is a non-shockable rhythm. Defibrillation is ineffective and contraindicated.
Treatment relies on continuous CPR, Epinephrine 1 mg IV/IO as soon as possible (repeated every 3–5 minutes),
and aggressive identification/treatment of reversible causes (H's and T's).
ACLS Clinical Pearl: The 5 H's: Hypovolemia, Hypoxia, Hydrogen ion (Acidosis), Hypo/Hyperkalemia,
Hypothermia. The 5 T's: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary),
Thrombosis (coronary).
QUESTION 8
Post-cardiac arrest care for a patient who achieves ROSC but remains unresponsive includes
,Advanced Cardiovascular Life Support (ACLS)
Comprehensive Final Examination & Practice
Question Bank
This document contains 200 high-yield, multiple-choice practice questions meticulously formulated to reflect
current AHA ACLS guidelines, cardiac arrest algorithms, post-cardiac arrest care, pharmacology, and ECG
rhythm analysis. Detailed rationales and core clinical pearls are provided for every question to support mastery.
QUESTION 1
A 62-year-old male collapses in the emergency department waiting room. Monitors display
Ventricular Fibrillation (VF). High-quality CPR is in progress. What is the immediate priority
action?
[A] Administer IV Epinephrine 1 mg immediately
[B] Deliver an immediate unsynchronized shock (120–200 J biphasic)
[C] Perform endotracheal intubation
[D] Administer IV Amiodarone 300 mg
CORRECT ANSWER: Option B — Deliver an immediate unsynchronized shock (120–200 J biphasic)
Detailed Clinical Rationale: The primary treatment for VF or pulseless Ventricular Tachycardia (pVT) is immediate
unsynchronized defibrillation. CPR should continue until the defibrillator is charged, followed immediately by shock
delivery.
ACLS Clinical Pearl: Early defibrillation combined with high-quality CPR is the single most critical determinant of
survival in shockable cardiac arrest.
QUESTION 2
During CPR for a patient in cardiac arrest, high-quality chest compressions are defined by which
of the following rate and depth standards in adults?
[A] Rate of 80–100/min, depth of at least 1 inch (2.5 cm)
[B] Rate of 100–120/min, depth of 2 to 2.4 inches (5–6 cm)
[C] Rate of 120–140/min, depth of at least 3 inches (7.5 cm)
[D] Rate of 100/min with complete chest recoil forbidden between compressions
CORRECT ANSWER: Option B — Rate of 100–120/min, depth of 2 to 2.4 inches (5–6 cm)
Detailed Clinical Rationale: High-quality CPR parameters for adults include: compression rate of 100–120/min,
compression depth of 2 to 2.4 inches (5–6 cm), allowing complete chest recoil after each compression, minimizing
interruptions in compressions (< 10 seconds), and avoiding excessive ventilation.
ACLS Clinical Pearl: Chest compression fraction (CCF) should be kept as high as possible, with a target of at
least 60% and ideally > 80%.
QUESTION 3
,A patient in refractory VF has received 2 shocks, 2 minutes of CPR, and 1 mg Epinephrine IV. VF
persists at the 3rd rhythm check. What medication and dose should be administered next?
[A] Amiodarone 300 mg IV/IO push
[B] Lidocaine 0.5 mg/kg IV/IO push
[C] Atropine 1 mg IV push
[D] Amiodarone 150 mg IV/IO push
CORRECT ANSWER: Option A — Amiodarone 300 mg IV/IO push
Detailed Clinical Rationale: After the third shock for VF/pVT, the first dose of antiarrhythmic therapy is indicated.
Amiodarone 300 mg IV/IO bolus (or Lidocaine 1–1.5 mg/kg IV/IO) is administered during high-quality CPR.
ACLS Clinical Pearl: Amiodarone first dose = 300 mg bolus; second dose = 150 mg IV/IO. Lidocaine second dose
= 0.5–0.75 mg/kg.
QUESTION 4
A 58-year-old patient presents with symptomatic bradycardia (HR 36 bpm, BP 74/42 mmHg,
altered mental status). Atropine 1 mg IV was administered without response. What is the
immediate next step?
[A] Administer a second dose of Atropine 1 mg
[B] Initiate Transcutaneous Pacing (TCP) or start Epinephrine IV infusion (2–10 mcg/min)
[C] Administer Adenosine 6 mg rapid IV push
[D] Deliver an unsynchronized 200 J shock
CORRECT ANSWER: Option B — Initiate Transcutaneous Pacing (TCP) or start Epinephrine IV
infusion (2–10 mcg/min)
Detailed Clinical Rationale: If Atropine fails to restore an adequate heart rate in symptomatic bradycardia,
second-line treatments include Transcutaneous Pacing (TCP) or chronotropic drug infusions such as Epinephrine
(2–10 mcg/min) or Dopamine (5–20 mcg/kg/min).
ACLS Clinical Pearl: Do not delay transcutaneous pacing in patients with severe symptoms or second-degree
Mobitz II / third-degree heart blocks.
QUESTION 5
A 45-year-old female presents to the ED with a narrow-complex regular tachycardia at a rate of
210 bpm. She is alert, oriented, with BP 118/76 mmHg. Vagal maneuvers fail. What is the first-line
medication?
[A] Adenosine 6 mg rapid IV push followed immediately by a 20 mL saline flush
[B] Amiodarone 150 mg IV over 10 minutes
[C] Metoprolol 5 mg slow IV push over 5 minutes
[D] Diltiazem 0.25 mg/kg IV push over 2 minutes
CORRECT ANSWER: Option A — Adenosine 6 mg rapid IV push followed immediately by a 20 mL
saline flush
, Detailed Clinical Rationale: For stable narrow-complex supraventricular tachycardia (SVT), Adenosine 6 mg rapid
IV push is the first-line pharmacologic agent. It must be administered rapidly followed immediately by a 20 mL
saline flush due to its extremely short half-life (< 10 seconds).
ACLS Clinical Pearl: Always instruct the patient that Adenosine may cause a brief feeling of chest tightness,
flushing, or lightheadedness.
QUESTION 6
Which quantitative continuous monitoring technique is recommended during cardiac arrest to
confirm ETT placement and monitor CPR quality?
[A] Pulse oximetry (SpO2)
[B] Waveform Capnography (PetCO2)
[C] Arterial blood gas (ABG) analysis
[D] Central venous pressure (CVP) monitoring
CORRECT ANSWER: Option B — Waveform Capnography (PetCO2)
Detailed Clinical Rationale: Continuous waveform capnography is recommended in cardiac arrest to confirm
correct ETT placement, monitor CPR quality (a PetCO2 < 10 mmHg indicates inadequate compressions), and
detect Return of Spontaneous Circulation (ROSC).
ACLS Clinical Pearl: A sudden, persistent rise in PetCO2 to 35–40 mmHg or greater is a primary indicator of
ROSC during CPR.
QUESTION 7
A patient in cardiac arrest has a initial rhythm of Pulseless Electrical Activity (PEA). What is the
primary management strategy for PEA?
[A] Immediate defibrillation at maximum joules
[B] High-quality CPR, early Epinephrine 1 mg IV/IO, and identifying/correcting H's and T's
[C] Transcutaneous pacing at 80 bpm
[D] Administration of IV Calcium Chloride 1 g and Sodium Bicarbonate 50 mEq
CORRECT ANSWER: Option B — High-quality CPR, early Epinephrine 1 mg IV/IO, and
identifying/correcting H's and T's
Detailed Clinical Rationale: PEA is a non-shockable rhythm. Defibrillation is ineffective and contraindicated.
Treatment relies on continuous CPR, Epinephrine 1 mg IV/IO as soon as possible (repeated every 3–5 minutes),
and aggressive identification/treatment of reversible causes (H's and T's).
ACLS Clinical Pearl: The 5 H's: Hypovolemia, Hypoxia, Hydrogen ion (Acidosis), Hypo/Hyperkalemia,
Hypothermia. The 5 T's: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary),
Thrombosis (coronary).
QUESTION 8
Post-cardiac arrest care for a patient who achieves ROSC but remains unresponsive includes
