AHA ACLs
Final Exam
LATEST EDITION
100% Verified • Aligned with AHA ACLS 2020 Guidelines + 2025 Updates
HOW TO USE THIS GUIDE
• Cover all 11 sections, organized by ACLS topic domain.
• Each question includes a 4–6 sentence explanation with rationale.
• Passing score on AHA ACLS exam: ~84% (50-question exam).
• Algorithm quick-reference appendix included at end of guide.
• Review explanations even for correct answers — reinforces algorithm reasoning.
, AHA ACLS Final Exam — 180 Q&A with Explanations | 2026/2027 Edition
Section 1: BLS & High-Quality CPR (Q1–Q20)
This section covers Basic Life Support (BLS) foundations and high-quality CPR metrics, which
underpin every ACLS intervention. Mastery of compression rate, depth, recoil, and minimizing
interruptions is essential because high-quality CPR is the single greatest modifiable factor affecting
survival from cardiac arrest. Questions here also address AED operation, pulse checks, ventilation,
and the critical transition between BLS and ACLS roles.
Q1. What is the recommended chest compression rate for adult high-quality CPR according to the
AHA?
A. 60–80 per minute
B. 100–120 per minute
C. 120–140 per minute
D. 80–100 per minute
Correct Answer: B
Explanation: The AHA recommends a compression rate of 100–120 compressions per minute for
adults. Rates below 100 fail to generate adequate cardiac output, while rates above 120 reduce
ventricular filling and coronary perfusion. This range optimizes both forward blood flow and
myocardial perfusion. Use of a metronome or feedback device helps maintain the target rate.
Consistent rate control is one of the five pillars of high-quality CPR.
Q2. What is the recommended chest compression depth for an adult arrest victim?
A. At least 1 inch (2.5 cm)
B. At least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm)
C. 3 inches (7.5 cm)
D. 1.5 inches (4 cm)
Correct Answer: B
Explanation: Adult compression depth should be at least 2 inches (5 cm) but not exceed 2.4 inches
(6 cm). Depths below 2 inches produce insufficient cardiac output and coronary perfusion, while
depths beyond 2.4 inches increase the risk of internal injury (rib fractures, liver/spleen laceration)
without improving outcomes. Use of a feedback device is recommended to ensure proper depth. The
depth applies to adult patients only; children require about 2 inches and infants about 1.5 inches.
AHA ACLS Final Exam Study Guide | Page 2
, AHA ACLS Final Exam — 180 Q&A with Explanations | 2026/2027 Edition
Q3. After placing an AED on an adult cardiac arrest victim, what should rescuers do while the AED
is analyzing the rhythm?
A. Continue chest compressions to avoid no-flow time
B. Stop all movement and contact with the patient
C. Provide 2 rescue breaths
D. Check the carotid pulse
Correct Answer: B
Explanation: Everyone must stop CPR and avoid touching the patient during AED rhythm analysis.
Any movement generates electrical artifact that can mimic VF, leading to inappropriate shocks or
failure to detect a shockable rhythm. This brief pause is mandatory even though it adds no-flow time.
To minimize interruptions, resume compressions immediately after the shock decision is announced.
Modern AEDs have short analysis times (typically 5–15 seconds) to limit no-flow intervals.
Q4. What is the maximum interval allowed for a pulse check in an unresponsive adult patient?
A. 5 seconds
B. 10 seconds
C. 20 seconds
D. 30 seconds
Correct Answer: B
Explanation: Pulse checks must be limited to a maximum of 10 seconds. If a pulse is not definitely
felt within 10 seconds, rescuers should assume cardiac arrest and begin CPR. Prolonged pulse checks
extend no-flow time and worsen outcomes. Healthcare providers may use simultaneous carotid and
femoral pulse palpation to improve accuracy. In ambiguous cases, err on the side of starting CPR —
harm from unnecessary compressions in a perfusing patient is far less than delay in true arrest.
Q5. Which sequence is currently recommended by the AHA for adult BLS?
A. Airway-Breathing-Compressions (ABC)
B. Compressions-Airway-Breathing (CAB)
C. Airway-Compressions-Breathing (ACB)
D. Breathing-Compressions-Airway (BCA)
Correct Answer: B
Explanation: The CAB sequence (Compressions-Airway-Breathing) is recommended for adult BLS.
Starting with compressions reduces delay to first compression and improves coronary perfusion more
rapidly. ABC remains appropriate for pediatric and drowning arrests where respiratory failure is the
predominant cause. The CAB sequence also simplifies lay-rescuer training and emphasizes
AHA ACLS Final Exam Study Guide | Page 3
, AHA ACLS Final Exam — 180 Q&A with Explanations | 2026/2027 Edition
immediate action. Begin 30 compressions within 10 seconds of recognition, then open the airway
and deliver 2 breaths.
Q6. What is the recommended compression-to-ventilation ratio for single-rescuer adult CPR?
A. 15:2
B. 30:2
C. 15:1
D. 30:1
Correct Answer: B
Explanation: A 30:2 compression-to-ventilation ratio is recommended for single-rescuer adult CPR.
This ratio balances the need for adequate circulation with oxygenation while minimizing
interruptions. The 15:2 ratio is reserved for two-rescuer pediatric CPR. For adult CPR with an
advanced airway in place, continuous compressions at 100–120/min are recommended with one
breath every 6 seconds (10 breaths/min).
Q7. When performing bag-mask ventilation on an adult apneic patient, what tidal volume and rate
are recommended?
A. Large tidal volume, 12–15 breaths/min
B. Just enough to produce visible chest rise, 1 breath every 6 seconds
C. 500 mL per breath, 20 breaths/min
D. 1 L per breath, 8 breaths/min
Correct Answer: B
Explanation: Bag-mask ventilation should deliver just enough volume to produce visible chest rise
over 1 second, at a rate of 1 breath every 6 seconds (10 breaths/min). Excessive volumes or rapid
rates cause gastric insufflation, regurgitation, aspiration, and increased intrathoracic pressure that
reduces cardiac output. Hyperventilation is a common error that worsens outcomes in cardiac arrest.
Proper mask seal, head tilt, and jaw thrust are essential for effective ventilation.
Q8. Which maneuver is preferred to open the airway in an unresponsive patient with a suspected
cervical spine injury?
A. Head tilt–chin lift
B. Jaw-thrust maneuver without head extension
C. Heimlich maneuver
D. Nasopharyngeal airway insertion only
Correct Answer: B
Explanation: The jaw-thrust maneuver without head extension is preferred when cervical spine injury
is suspected. Head tilt–chin lift can exacerbate spinal cord damage. If the jaw-thrust alone does not
AHA ACLS Final Exam Study Guide | Page 4
Final Exam
LATEST EDITION
100% Verified • Aligned with AHA ACLS 2020 Guidelines + 2025 Updates
HOW TO USE THIS GUIDE
• Cover all 11 sections, organized by ACLS topic domain.
• Each question includes a 4–6 sentence explanation with rationale.
• Passing score on AHA ACLS exam: ~84% (50-question exam).
• Algorithm quick-reference appendix included at end of guide.
• Review explanations even for correct answers — reinforces algorithm reasoning.
, AHA ACLS Final Exam — 180 Q&A with Explanations | 2026/2027 Edition
Section 1: BLS & High-Quality CPR (Q1–Q20)
This section covers Basic Life Support (BLS) foundations and high-quality CPR metrics, which
underpin every ACLS intervention. Mastery of compression rate, depth, recoil, and minimizing
interruptions is essential because high-quality CPR is the single greatest modifiable factor affecting
survival from cardiac arrest. Questions here also address AED operation, pulse checks, ventilation,
and the critical transition between BLS and ACLS roles.
Q1. What is the recommended chest compression rate for adult high-quality CPR according to the
AHA?
A. 60–80 per minute
B. 100–120 per minute
C. 120–140 per minute
D. 80–100 per minute
Correct Answer: B
Explanation: The AHA recommends a compression rate of 100–120 compressions per minute for
adults. Rates below 100 fail to generate adequate cardiac output, while rates above 120 reduce
ventricular filling and coronary perfusion. This range optimizes both forward blood flow and
myocardial perfusion. Use of a metronome or feedback device helps maintain the target rate.
Consistent rate control is one of the five pillars of high-quality CPR.
Q2. What is the recommended chest compression depth for an adult arrest victim?
A. At least 1 inch (2.5 cm)
B. At least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm)
C. 3 inches (7.5 cm)
D. 1.5 inches (4 cm)
Correct Answer: B
Explanation: Adult compression depth should be at least 2 inches (5 cm) but not exceed 2.4 inches
(6 cm). Depths below 2 inches produce insufficient cardiac output and coronary perfusion, while
depths beyond 2.4 inches increase the risk of internal injury (rib fractures, liver/spleen laceration)
without improving outcomes. Use of a feedback device is recommended to ensure proper depth. The
depth applies to adult patients only; children require about 2 inches and infants about 1.5 inches.
AHA ACLS Final Exam Study Guide | Page 2
, AHA ACLS Final Exam — 180 Q&A with Explanations | 2026/2027 Edition
Q3. After placing an AED on an adult cardiac arrest victim, what should rescuers do while the AED
is analyzing the rhythm?
A. Continue chest compressions to avoid no-flow time
B. Stop all movement and contact with the patient
C. Provide 2 rescue breaths
D. Check the carotid pulse
Correct Answer: B
Explanation: Everyone must stop CPR and avoid touching the patient during AED rhythm analysis.
Any movement generates electrical artifact that can mimic VF, leading to inappropriate shocks or
failure to detect a shockable rhythm. This brief pause is mandatory even though it adds no-flow time.
To minimize interruptions, resume compressions immediately after the shock decision is announced.
Modern AEDs have short analysis times (typically 5–15 seconds) to limit no-flow intervals.
Q4. What is the maximum interval allowed for a pulse check in an unresponsive adult patient?
A. 5 seconds
B. 10 seconds
C. 20 seconds
D. 30 seconds
Correct Answer: B
Explanation: Pulse checks must be limited to a maximum of 10 seconds. If a pulse is not definitely
felt within 10 seconds, rescuers should assume cardiac arrest and begin CPR. Prolonged pulse checks
extend no-flow time and worsen outcomes. Healthcare providers may use simultaneous carotid and
femoral pulse palpation to improve accuracy. In ambiguous cases, err on the side of starting CPR —
harm from unnecessary compressions in a perfusing patient is far less than delay in true arrest.
Q5. Which sequence is currently recommended by the AHA for adult BLS?
A. Airway-Breathing-Compressions (ABC)
B. Compressions-Airway-Breathing (CAB)
C. Airway-Compressions-Breathing (ACB)
D. Breathing-Compressions-Airway (BCA)
Correct Answer: B
Explanation: The CAB sequence (Compressions-Airway-Breathing) is recommended for adult BLS.
Starting with compressions reduces delay to first compression and improves coronary perfusion more
rapidly. ABC remains appropriate for pediatric and drowning arrests where respiratory failure is the
predominant cause. The CAB sequence also simplifies lay-rescuer training and emphasizes
AHA ACLS Final Exam Study Guide | Page 3
, AHA ACLS Final Exam — 180 Q&A with Explanations | 2026/2027 Edition
immediate action. Begin 30 compressions within 10 seconds of recognition, then open the airway
and deliver 2 breaths.
Q6. What is the recommended compression-to-ventilation ratio for single-rescuer adult CPR?
A. 15:2
B. 30:2
C. 15:1
D. 30:1
Correct Answer: B
Explanation: A 30:2 compression-to-ventilation ratio is recommended for single-rescuer adult CPR.
This ratio balances the need for adequate circulation with oxygenation while minimizing
interruptions. The 15:2 ratio is reserved for two-rescuer pediatric CPR. For adult CPR with an
advanced airway in place, continuous compressions at 100–120/min are recommended with one
breath every 6 seconds (10 breaths/min).
Q7. When performing bag-mask ventilation on an adult apneic patient, what tidal volume and rate
are recommended?
A. Large tidal volume, 12–15 breaths/min
B. Just enough to produce visible chest rise, 1 breath every 6 seconds
C. 500 mL per breath, 20 breaths/min
D. 1 L per breath, 8 breaths/min
Correct Answer: B
Explanation: Bag-mask ventilation should deliver just enough volume to produce visible chest rise
over 1 second, at a rate of 1 breath every 6 seconds (10 breaths/min). Excessive volumes or rapid
rates cause gastric insufflation, regurgitation, aspiration, and increased intrathoracic pressure that
reduces cardiac output. Hyperventilation is a common error that worsens outcomes in cardiac arrest.
Proper mask seal, head tilt, and jaw thrust are essential for effective ventilation.
Q8. Which maneuver is preferred to open the airway in an unresponsive patient with a suspected
cervical spine injury?
A. Head tilt–chin lift
B. Jaw-thrust maneuver without head extension
C. Heimlich maneuver
D. Nasopharyngeal airway insertion only
Correct Answer: B
Explanation: The jaw-thrust maneuver without head extension is preferred when cervical spine injury
is suspected. Head tilt–chin lift can exacerbate spinal cord damage. If the jaw-thrust alone does not
AHA ACLS Final Exam Study Guide | Page 4
