AHA ACLS Post Test Answer Key (American Heart Association
Guidelines) | Newest Version UP-TO-DATE EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS | Question
And VERIFIED ANSWERS - INSTANT PDF DOWNLOAD -
150 Questions
Section 1: Basic Life Support (BLS) and CPR (Questions 1-15)
1 During a witnessed in-hospital cardiac arrest, the team delivers the first shock at 2 minutes of CPR. After the
shock, the monitor shows persistent ventricular fibrillation. The team resumes CPR immediately. What is the
optimal compression-ventilation strategy to maximize coronary perfusion pressure while minimizing
interruptions?
A) Continuous chest compressions at 100-120/min with asynchronous ventilations at 10 breaths/min using a
bag-mask device
B) 30:2 compression-to-ventilation ratio with a 2-second pause for each ventilation, maintaining a compression
rate of 100/min
C) Continuous chest compressions at 120-140/min with asynchronous ventilations at 6 breaths/min via advanced
airway
D) Compression rate of 100/min with a 10-second pause every 2 minutes for rhythm check and two ventilations
Answer: A
Rationale: Current AHA guidelines recommend continuous chest compressions with asynchronous ventilations (10
breaths/min) once an advanced airway is in place, as this minimizes interruptions and maintains higher coronary
perfusion pressure. Option B is incorrect because 30:2 with pauses reduces compression fraction. Option C uses
excessive rate (120-140) and low ventilation rate. Option D introduces prolonged pauses, reducing perfusion.
2 A patient in cardiac arrest has an end-tidal carbon dioxide (ETCO2) reading of 8 mmHg after 10 minutes of
high-quality CPR. Which of the following interventions is most likely to improve this value and increase the
likelihood of return of spontaneous circulation (ROSC)?
A) Increase compression depth to at least 2.5 inches (6 cm)
B) Administer a bolus of sodium bicarbonate 1 mEq/kg
C) Switch to a mechanical compression device to ensure consistent depth
D) Optimize compression rate to 100-120/min and ensure full chest recoil
Answer: D
Rationale: Low ETCO2 (<10 mmHg) indicates poor cardiac output. Optimizing compression rate (100-120/min)
and ensuring full chest recoil improves venous return and cardiac output, thus increasing ETCO2. Excessive depth
(>2.4 inches) may cause injury without benefit. Sodium bicarbonate is not recommended for routine use.
Mechanical devices have not shown superiority over high-quality manual CPR.
3 In a cardiac arrest with an advanced airway, the team leader notes that the compression fraction is 68% over the
first 5 minutes. Which of the following is the most likely consequence of this compression fraction, and what
adjustment should be prioritized?
A) Decreased cerebral perfusion; minimize interruptions by extending rhythm checks to every 3 minutes
B) Increased intrathoracic pressure; reduce ventilation rate to 6 breaths/min
,C) Inadequate coronary perfusion; limit pauses for pulse checks to <10 seconds and resume CPR immediately
after defibrillation
D) Elevated arterial partial pressure of oxygen; decrease compression rate to 80/min
Answer: C
Rationale: A compression fraction below 80% indicates excessive pauses, reducing coronary and cerebral perfusion.
The priority is to minimize pauses, especially for pulse checks (<10 seconds) and after defibrillation. Extending
rhythm checks to 3 minutes (A) is not recommended. Reducing ventilation (B) may help but does not address
pauses. Decreasing compression rate (D) would worsen perfusion.
4 A 55-year-old man collapses in the hospital cafeteria. The first responder begins CPR. After 3 minutes, the code
team arrives and attaches the defibrillator. The rhythm is asystole. Which of the following is the most
appropriate immediate action?
A) Administer epinephrine 1 mg IV as soon as intravenous access is obtained
B) Perform defibrillation at 200 J biphasic
C) Place an advanced airway and deliver asynchronous ventilations at 10 breaths/min
D) Administer amiodarone 300 mg IV push
Answer: A
Rationale: For asystole, the priority is high-quality CPR and early epinephrine administration (1 mg IV every 3-5
minutes). Defibrillation (B) is not indicated for asystole. Advanced airway (C) is important but not the most
immediate priority. Amiodarone (D) is used for shockable rhythms (VF/pVT) not asystole.
5 A patient in cardiac arrest has a pulse check performed during CPR. The compressor pauses for 12 seconds to
palpate the carotid pulse. What is the most direct adverse effect of this prolonged pause?
A) Decreased mean arterial pressure below 30 mmHg
B) Increased risk of rib fracture
C) Reduced coronary perfusion pressure to zero
D) Impaired cerebral autoregulation
Answer: C
Rationale: Prolonged pauses in compressions cause coronary perfusion pressure (CPP) to fall to near zero within
seconds, reducing myocardial blood flow. While MAP also drops, CPP is the critical determinant of ROSC. Rib
fracture risk (B) is related to depth, not pauses. Cerebral autoregulation (D) is impaired but not the most direct
effect.
6 During CPR, the team observes that the chest compression depth is consistently 2.2 inches (5.5 cm) with a rate
of 105/min. However, the patient's ETCO2 is 12 mmHg after 8 minutes. Which of the following is the most
likely explanation for the low ETCO2 despite seemingly adequate compressions?
A) Incomplete chest recoil causing reduced venous return
B) Excessive ventilation rate of 12 breaths/min
C) Patient has severe pulmonary embolism
D) Compression rate too slow at 105/min
Answer: A
Rationale: Incomplete chest recoil prevents negative intrathoracic pressure during decompression, reducing venous
return and cardiac output, thus lowering ETCO2. The depth and rate are within guidelines. Excessive ventilation
(B) can decrease venous return but is less common. Pulmonary embolism (C) is possible but not the most likely
with adequate compressions. Rate of 105/min is acceptable.
,7 A team is performing CPR on a patient with a suspected opioid overdose. The patient is unresponsive, not
breathing, and has no pulse. Which of the following sequences is most appropriate?
A) Begin CPR immediately with 30 compressions then 2 ventilations; administer naloxone after 2 minutes of
CPR
B) Administer naloxone intranasal first, then assess breathing; if no response, start CPR
C) Start with 2 rescue breaths, then check pulse; if pulseless, begin CPR and administer naloxone
D) Begin CPR with continuous compressions and asynchronous ventilations; administer naloxone after advanced
airway placement
Answer: A
Rationale: For suspected opioid overdose with cardiac arrest, standard CPR (30:2) should be initiated immediately.
Naloxone can be administered after starting CPR but does not replace chest compressions. Option B delays CPR.
Option C delays compressions. Option D is for advanced airway, not initial management.
8 A patient in cardiac arrest receives epinephrine 1 mg IV. After 3 minutes of high-quality CPR, the rhythm
changes from asystole to pulseless electrical activity (PEA) with a rate of 40/min. What is the most appropriate
next step?
A) Administer another dose of epinephrine 1 mg IV immediately
B) Perform a focused ultrasound to identify reversible causes
C) Deliver a single shock at 200 J biphasic
D) Administer atropine 1 mg IV
Answer: A
Rationale: Epinephrine is administered every 3-5 minutes in cardiac arrest regardless of rhythm. PEA is a
non-shockable rhythm, so defibrillation (C) is not indicated. Atropine (D) is no longer recommended for PEA.
Ultrasound (B) may help identify causes but should not delay epinephrine administration.
9 A 70-year-old patient with a history of coronary artery disease collapses. Bystander CPR is initiated. The
defibrillator shows ventricular fibrillation. A shock is delivered, and CPR is resumed. After 2 minutes, the
rhythm check shows organized rhythm with a pulse of 60/min. The patient is breathing spontaneously. What is
the most appropriate immediate post-ROSC intervention?
A) Administer amiodarone 150 mg IV over 10 minutes
B) Start a lidocaine infusion at 1 mg/min
C) Obtain a 12-lead ECG to assess for ST-elevation myocardial infarction
D) Initiate targeted temperature management at 32-36°C
Answer: D
Rationale: Targeted temperature management (TTM) is recommended for all comatose patients after ROSC to
improve neurological outcomes. Amiodarone (A) or lidocaine (B) are for rhythm control but not immediate
post-ROSC. ECG (C) is important but should not delay TTM initiation.
10 During a cardiac arrest resuscitation, the team leader notices that the compressor is fatiguing after 4 minutes.
Which of the following is the most effective strategy to maintain compression quality?
A) Switch compressors every 2 minutes, limiting the switch to <5 seconds
B) Allow the current compressor to continue until the next rhythm check
C) Use a mechanical compression device immediately
D) Reduce compression rate to 80/min to conserve energy
Answer: A
Rationale: The AHA recommends switching compressors every 2 minutes to prevent fatigue, with a brief
interruption (<5 seconds) to maintain compression fraction. Continuing with a fatigued compressor (B) reduces
, quality. Mechanical devices (C) are not universally available and may cause delays. Reducing rate (D) would
decrease perfusion.
11 In a witnessed cardiac arrest in the hospital, a healthcare provider initiates CPR. After 2 minutes of high-quality
CPR, the cardiac monitor reveals ventricular fibrillation. The defibrillator is charged to 200 J biphasic. The
provider delivers the shock. Immediately after the shock, the provider should:
A) Check the rhythm on the monitor and palpate a pulse
B) Resume CPR immediately, starting with chest compressions
C) Deliver a second shock without delay
D) Administer epinephrine 1 mg IV push
Answer: B
Rationale: After defibrillation, the heart may be in a non-perfusing rhythm or may have a perfusing rhythm but with
a weak pulse. The priority is to minimize interruptions in chest compressions. Current guidelines recommend
immediate resumption of CPR (starting with compressions) for 2 minutes before checking the rhythm or pulse.
Option A delays CPR; option C is incorrect because a rhythm check should occur after 2 minutes of CPR; option D
is given during CPR, not immediately after shock.
12 During CPR on an adult, the compression-to-ventilation ratio for a single rescuer is 30:2. For two rescuers, the
ratio remains 30:2. However, once an advanced airway is in place (e.g., endotracheal tube or supraglottic
airway), what is the correct compression-to-ventilation rate?
A) Continuous compressions at 100-120/min with asynchronous ventilations at 10 breaths/min
B) Compressions at 30:2 ratio, but with a pause for two breaths every 30 compressions
C) Compressions at 15:2 ratio, with ventilations delivered during the pause
D) Compressions at 100-120/min with synchronous ventilations delivered during the upstroke of each
compression
Answer: A
Rationale: With an advanced airway in place, rescuers no longer deliver cycles of 30 compressions and 2 breaths.
Instead, they provide continuous chest compressions at a rate of 100-120/min without pauses for ventilation.
Ventilations are delivered asynchronously at a rate of 10 breaths/min (one breath every 6 seconds). This maximizes
coronary perfusion pressure. Option B describes the no-advanced-airway scenario; option C is the pediatric ratio;
option D is incorrect as synchronous ventilations are not recommended.
13 A patient is found unresponsive with agonal gasps. A lone healthcare provider begins CPR. After 30
compressions, the provider opens the airway and attempts to deliver a breath. The chest does not rise visibly.
What is the most appropriate next step?
A) Continue with chest compressions and attempt a breath again after 30 more compressions
B) Reopen the airway using the head-tilt/chin-lift maneuver and attempt a breath again
C) Administer two rescue breaths, each over 2 seconds, regardless of chest rise
D) Immediately apply a bag-mask device with 100% oxygen and squeeze the bag forcefully
Answer: B
Rationale: If the chest does not rise during the first rescue breath, the airway may be obstructed or the
head-tilt/chin-lift may be inadequate. The correct action is to reposition the airway (reopen using head-tilt/chin-lift)
and then attempt a second breath. If still unsuccessful, resume chest compressions. Option A delays ventilation
correction; option C is incorrect because breaths should be delivered over 1 second each, and if chest does not rise,
repositioning is needed; option D is premature and forceful ventilation can cause gastric inflation.
Guidelines) | Newest Version UP-TO-DATE EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS | Question
And VERIFIED ANSWERS - INSTANT PDF DOWNLOAD -
150 Questions
Section 1: Basic Life Support (BLS) and CPR (Questions 1-15)
1 During a witnessed in-hospital cardiac arrest, the team delivers the first shock at 2 minutes of CPR. After the
shock, the monitor shows persistent ventricular fibrillation. The team resumes CPR immediately. What is the
optimal compression-ventilation strategy to maximize coronary perfusion pressure while minimizing
interruptions?
A) Continuous chest compressions at 100-120/min with asynchronous ventilations at 10 breaths/min using a
bag-mask device
B) 30:2 compression-to-ventilation ratio with a 2-second pause for each ventilation, maintaining a compression
rate of 100/min
C) Continuous chest compressions at 120-140/min with asynchronous ventilations at 6 breaths/min via advanced
airway
D) Compression rate of 100/min with a 10-second pause every 2 minutes for rhythm check and two ventilations
Answer: A
Rationale: Current AHA guidelines recommend continuous chest compressions with asynchronous ventilations (10
breaths/min) once an advanced airway is in place, as this minimizes interruptions and maintains higher coronary
perfusion pressure. Option B is incorrect because 30:2 with pauses reduces compression fraction. Option C uses
excessive rate (120-140) and low ventilation rate. Option D introduces prolonged pauses, reducing perfusion.
2 A patient in cardiac arrest has an end-tidal carbon dioxide (ETCO2) reading of 8 mmHg after 10 minutes of
high-quality CPR. Which of the following interventions is most likely to improve this value and increase the
likelihood of return of spontaneous circulation (ROSC)?
A) Increase compression depth to at least 2.5 inches (6 cm)
B) Administer a bolus of sodium bicarbonate 1 mEq/kg
C) Switch to a mechanical compression device to ensure consistent depth
D) Optimize compression rate to 100-120/min and ensure full chest recoil
Answer: D
Rationale: Low ETCO2 (<10 mmHg) indicates poor cardiac output. Optimizing compression rate (100-120/min)
and ensuring full chest recoil improves venous return and cardiac output, thus increasing ETCO2. Excessive depth
(>2.4 inches) may cause injury without benefit. Sodium bicarbonate is not recommended for routine use.
Mechanical devices have not shown superiority over high-quality manual CPR.
3 In a cardiac arrest with an advanced airway, the team leader notes that the compression fraction is 68% over the
first 5 minutes. Which of the following is the most likely consequence of this compression fraction, and what
adjustment should be prioritized?
A) Decreased cerebral perfusion; minimize interruptions by extending rhythm checks to every 3 minutes
B) Increased intrathoracic pressure; reduce ventilation rate to 6 breaths/min
,C) Inadequate coronary perfusion; limit pauses for pulse checks to <10 seconds and resume CPR immediately
after defibrillation
D) Elevated arterial partial pressure of oxygen; decrease compression rate to 80/min
Answer: C
Rationale: A compression fraction below 80% indicates excessive pauses, reducing coronary and cerebral perfusion.
The priority is to minimize pauses, especially for pulse checks (<10 seconds) and after defibrillation. Extending
rhythm checks to 3 minutes (A) is not recommended. Reducing ventilation (B) may help but does not address
pauses. Decreasing compression rate (D) would worsen perfusion.
4 A 55-year-old man collapses in the hospital cafeteria. The first responder begins CPR. After 3 minutes, the code
team arrives and attaches the defibrillator. The rhythm is asystole. Which of the following is the most
appropriate immediate action?
A) Administer epinephrine 1 mg IV as soon as intravenous access is obtained
B) Perform defibrillation at 200 J biphasic
C) Place an advanced airway and deliver asynchronous ventilations at 10 breaths/min
D) Administer amiodarone 300 mg IV push
Answer: A
Rationale: For asystole, the priority is high-quality CPR and early epinephrine administration (1 mg IV every 3-5
minutes). Defibrillation (B) is not indicated for asystole. Advanced airway (C) is important but not the most
immediate priority. Amiodarone (D) is used for shockable rhythms (VF/pVT) not asystole.
5 A patient in cardiac arrest has a pulse check performed during CPR. The compressor pauses for 12 seconds to
palpate the carotid pulse. What is the most direct adverse effect of this prolonged pause?
A) Decreased mean arterial pressure below 30 mmHg
B) Increased risk of rib fracture
C) Reduced coronary perfusion pressure to zero
D) Impaired cerebral autoregulation
Answer: C
Rationale: Prolonged pauses in compressions cause coronary perfusion pressure (CPP) to fall to near zero within
seconds, reducing myocardial blood flow. While MAP also drops, CPP is the critical determinant of ROSC. Rib
fracture risk (B) is related to depth, not pauses. Cerebral autoregulation (D) is impaired but not the most direct
effect.
6 During CPR, the team observes that the chest compression depth is consistently 2.2 inches (5.5 cm) with a rate
of 105/min. However, the patient's ETCO2 is 12 mmHg after 8 minutes. Which of the following is the most
likely explanation for the low ETCO2 despite seemingly adequate compressions?
A) Incomplete chest recoil causing reduced venous return
B) Excessive ventilation rate of 12 breaths/min
C) Patient has severe pulmonary embolism
D) Compression rate too slow at 105/min
Answer: A
Rationale: Incomplete chest recoil prevents negative intrathoracic pressure during decompression, reducing venous
return and cardiac output, thus lowering ETCO2. The depth and rate are within guidelines. Excessive ventilation
(B) can decrease venous return but is less common. Pulmonary embolism (C) is possible but not the most likely
with adequate compressions. Rate of 105/min is acceptable.
,7 A team is performing CPR on a patient with a suspected opioid overdose. The patient is unresponsive, not
breathing, and has no pulse. Which of the following sequences is most appropriate?
A) Begin CPR immediately with 30 compressions then 2 ventilations; administer naloxone after 2 minutes of
CPR
B) Administer naloxone intranasal first, then assess breathing; if no response, start CPR
C) Start with 2 rescue breaths, then check pulse; if pulseless, begin CPR and administer naloxone
D) Begin CPR with continuous compressions and asynchronous ventilations; administer naloxone after advanced
airway placement
Answer: A
Rationale: For suspected opioid overdose with cardiac arrest, standard CPR (30:2) should be initiated immediately.
Naloxone can be administered after starting CPR but does not replace chest compressions. Option B delays CPR.
Option C delays compressions. Option D is for advanced airway, not initial management.
8 A patient in cardiac arrest receives epinephrine 1 mg IV. After 3 minutes of high-quality CPR, the rhythm
changes from asystole to pulseless electrical activity (PEA) with a rate of 40/min. What is the most appropriate
next step?
A) Administer another dose of epinephrine 1 mg IV immediately
B) Perform a focused ultrasound to identify reversible causes
C) Deliver a single shock at 200 J biphasic
D) Administer atropine 1 mg IV
Answer: A
Rationale: Epinephrine is administered every 3-5 minutes in cardiac arrest regardless of rhythm. PEA is a
non-shockable rhythm, so defibrillation (C) is not indicated. Atropine (D) is no longer recommended for PEA.
Ultrasound (B) may help identify causes but should not delay epinephrine administration.
9 A 70-year-old patient with a history of coronary artery disease collapses. Bystander CPR is initiated. The
defibrillator shows ventricular fibrillation. A shock is delivered, and CPR is resumed. After 2 minutes, the
rhythm check shows organized rhythm with a pulse of 60/min. The patient is breathing spontaneously. What is
the most appropriate immediate post-ROSC intervention?
A) Administer amiodarone 150 mg IV over 10 minutes
B) Start a lidocaine infusion at 1 mg/min
C) Obtain a 12-lead ECG to assess for ST-elevation myocardial infarction
D) Initiate targeted temperature management at 32-36°C
Answer: D
Rationale: Targeted temperature management (TTM) is recommended for all comatose patients after ROSC to
improve neurological outcomes. Amiodarone (A) or lidocaine (B) are for rhythm control but not immediate
post-ROSC. ECG (C) is important but should not delay TTM initiation.
10 During a cardiac arrest resuscitation, the team leader notices that the compressor is fatiguing after 4 minutes.
Which of the following is the most effective strategy to maintain compression quality?
A) Switch compressors every 2 minutes, limiting the switch to <5 seconds
B) Allow the current compressor to continue until the next rhythm check
C) Use a mechanical compression device immediately
D) Reduce compression rate to 80/min to conserve energy
Answer: A
Rationale: The AHA recommends switching compressors every 2 minutes to prevent fatigue, with a brief
interruption (<5 seconds) to maintain compression fraction. Continuing with a fatigued compressor (B) reduces
, quality. Mechanical devices (C) are not universally available and may cause delays. Reducing rate (D) would
decrease perfusion.
11 In a witnessed cardiac arrest in the hospital, a healthcare provider initiates CPR. After 2 minutes of high-quality
CPR, the cardiac monitor reveals ventricular fibrillation. The defibrillator is charged to 200 J biphasic. The
provider delivers the shock. Immediately after the shock, the provider should:
A) Check the rhythm on the monitor and palpate a pulse
B) Resume CPR immediately, starting with chest compressions
C) Deliver a second shock without delay
D) Administer epinephrine 1 mg IV push
Answer: B
Rationale: After defibrillation, the heart may be in a non-perfusing rhythm or may have a perfusing rhythm but with
a weak pulse. The priority is to minimize interruptions in chest compressions. Current guidelines recommend
immediate resumption of CPR (starting with compressions) for 2 minutes before checking the rhythm or pulse.
Option A delays CPR; option C is incorrect because a rhythm check should occur after 2 minutes of CPR; option D
is given during CPR, not immediately after shock.
12 During CPR on an adult, the compression-to-ventilation ratio for a single rescuer is 30:2. For two rescuers, the
ratio remains 30:2. However, once an advanced airway is in place (e.g., endotracheal tube or supraglottic
airway), what is the correct compression-to-ventilation rate?
A) Continuous compressions at 100-120/min with asynchronous ventilations at 10 breaths/min
B) Compressions at 30:2 ratio, but with a pause for two breaths every 30 compressions
C) Compressions at 15:2 ratio, with ventilations delivered during the pause
D) Compressions at 100-120/min with synchronous ventilations delivered during the upstroke of each
compression
Answer: A
Rationale: With an advanced airway in place, rescuers no longer deliver cycles of 30 compressions and 2 breaths.
Instead, they provide continuous chest compressions at a rate of 100-120/min without pauses for ventilation.
Ventilations are delivered asynchronously at a rate of 10 breaths/min (one breath every 6 seconds). This maximizes
coronary perfusion pressure. Option B describes the no-advanced-airway scenario; option C is the pediatric ratio;
option D is incorrect as synchronous ventilations are not recommended.
13 A patient is found unresponsive with agonal gasps. A lone healthcare provider begins CPR. After 30
compressions, the provider opens the airway and attempts to deliver a breath. The chest does not rise visibly.
What is the most appropriate next step?
A) Continue with chest compressions and attempt a breath again after 30 more compressions
B) Reopen the airway using the head-tilt/chin-lift maneuver and attempt a breath again
C) Administer two rescue breaths, each over 2 seconds, regardless of chest rise
D) Immediately apply a bag-mask device with 100% oxygen and squeeze the bag forcefully
Answer: B
Rationale: If the chest does not rise during the first rescue breath, the airway may be obstructed or the
head-tilt/chin-lift may be inadequate. The correct action is to reposition the airway (reopen using head-tilt/chin-lift)
and then attempt a second breath. If still unsuccessful, resume chest compressions. Option A delays ventilation
correction; option C is incorrect because breaths should be delivered over 1 second each, and if chest does not rise,
repositioning is needed; option D is premature and forceful ventilation can cause gastric inflation.
