ACLS EXAM QUESTIONBANK 2025
COMPLETE WITH VERIFIED
EXPLANATIONS
You respond to a patient in distress and find an unresponsive male lying on the floor
gasping for air. What step should you take next?
o Answer: C. Check pulse
o Explanation: Gasping (agonal breathing) is a sign of cardiac arrest. After
confirming unresponsiveness, the next step in the BLS survey is to check for a
pulse (carotid in adults) for 5-10 seconds to determine if CPR is needed.
Why is proper size important when using an OPA or NPA?
o Answer: D. All of the above
o Explanation: An improperly sized oropharyngeal airway (OPA) or
nasopharyngeal airway (NPA) can cause complications. Too large an OPA/NPA
may block the airway or damage tissue, while too small an airway may fail to
maintain a patent airway.
You respond to a swimming pool where a person is floating facedown and is unresponsive.
Which action do you perform first?
o Answer: None of the provided options are ideal; correct action is to remove
from water and assess.
o Explanation: The first step is to safely remove the patient from the water to a
stable surface to assess responsiveness and breathing. If pulseless, start CPR.
None of the options (A, B, C, D) directly address this initial step, but CPR (A)
would follow if no pulse is found after assessment.
Asystole is a common rhythm and should be treated with all the following EXCEPT:
o Answer: C. Defibrillation
o Explanation: Asystole is a non-shockable rhythm. Treatment includes high-
quality CPR, epinephrine (1 mg IV/IO every 3-5 minutes), and ventilations.
Defibrillation is not indicated for asystole.
You are treating a cardiac arrest patient. The AED is having problems analyzing the
rhythm. Which of the following is the correct response?
o Answer: D. Continue chest compressions
, o Explanation: If an AED cannot analyze the rhythm, continue high-quality CPR to
maintain circulation. Troubleshooting or switching devices should not interrupt
compressions.
True/False: All Acute Coronary Syndrome (ACS) patients benefit from supplemental
oxygen, and a nasal cannula should be used.
o Answer: B. False
o Explanation: Supplemental oxygen is only recommended for ACS patients with
SpO2 < 90% or respiratory distress. Routine oxygen use in normoxic patients is
not beneficial and may cause harm.
Your co-worker is acting strange. Which of the following suggests the possibility of a
stroke?
o Answer: D. All of the above
o Explanation: Slurred speech, dizziness, and arm weakness are all potential signs
of a stroke, as assessed by tools like the Cincinnati Prehospital Stroke Scale.
Which of the following are treated with synchronized shocks?
o Answer: A. Unstable atrial fibrillation
o Explanation: Synchronized cardioversion is used for unstable tachyarrhythmias
with a pulse, such as atrial fibrillation or monomorphic VT. Sinus tachycardia is
not treated with shocks, and pulseless VT or VF requires unsynchronized
defibrillation.
What is the correct dose for Procainamide?
o Answer: B. 20-50 mg/min
o Explanation: For stable monomorphic VT, procainamide is administered at 20-50
mg/min IV until the arrhythmia is suppressed, hypotension occurs, or a maximum
dose of 17 mg/kg is reached.
A male patient experiences crushing chest pain. What drug should you consider giving in
all Acute Coronary Syndrome (ACS) patients?
o Answer: B. Aspirin
o Explanation: Aspirin (162-325 mg, chewed) is recommended for all ACS
patients unless contraindicated (e.g., allergy or active bleeding), as it reduces
mortality by inhibiting platelet aggregation.
What is your priority in care for a pulseless patient?
Answer: Initiate high-quality CPR immediately.
, Explanation: For a pulseless patient, the priority is to restore circulation through high-
quality chest compressions, followed by defibrillation if the rhythm is shockable.
What is the compression to ventilation ratio for the pulseless patient without advanced
airway?
Answer: 30:2
Explanation: For adults in cardiac arrest without an advanced airway, the compression-
to-ventilation ratio is 30 compressions to 2 breaths.
How often do we switch CPR compressors?
Answer: Every 2 minutes (or every 5 cycles of 30:2).
Explanation: Switching compressors every 2 minutes prevents fatigue and ensures
consistent compression quality.
How soon should compressions be started in the pulseless patient? How long is the pulse
check?
Answer: Compressions should start immediately after confirming no pulse. Pulse check
should take 5-10 seconds.
Explanation: After confirming unresponsiveness and no pulse (checked for 5-10
seconds), start CPR immediately to minimize interruptions in circulation.
What is the maximum off chest time for the pulseless patient? A common error in CPR is…
Answer: Maximum off-chest time should be less than 10 seconds. A common error is
excessive interruptions in chest compressions.
Explanation: Interruptions should be minimized to maintain chest compression fraction
(CCF). Prolonged pauses (e.g., for pulse checks or intubation) reduce CPR effectiveness.
How much air do you use to ventilate your patient? What does excessive ventilation cause?
Answer: Use just enough air to cause visible chest rise (approximately 500-600 mL in
adults). Excessive ventilation causes increased intrathoracic pressure, decreased venous
return, and reduced cardiac output.
Explanation: Over-ventilation can impede circulation by increasing intrathoracic
pressure, reducing preload, and compromising CPR effectiveness.
What is the primary focus of the CPR Coach? What role can be combined with the CPR
Coach?
Answer: The CPR Coach focuses on ensuring high-quality CPR (adequate rate, depth,
and minimal interruptions). This role can be combined with the team leader or
monitor/defibrillator operator.
, Explanation: The CPR Coach monitors compression quality and provides real-time
feedback. Combining roles optimizes team efficiency.
What is CCF? What is the CCF goal? What action affects CCF the most? What action on
the monitor/defibrillator can increase CCF?
Answer:
o CCF (Chest Compression Fraction): The proportion of time during CPR that
compressions are performed.
o Goal: At least 60%, ideally >80%.
o Action affecting CCF most: Interruptions (e.g., pulse checks, rhythm analysis).
o Action to increase CCF: Charging the defibrillator during compressions to
minimize pause time.
Explanation: High CCF correlates with better outcomes. Minimizing interruptions and
charging the defibrillator during compressions reduces off-chest time.
How often can you defibrillate a patient? What rhythms can be defibrillated?
Answer: Defibrillate every 2 minutes if the rhythm remains shockable (VF or pulseless
VT). Only ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are
defibrillated.
Explanation: Defibrillation is performed for shockable rhythms (VF/pulseless VT) after
every 2-minute CPR cycle if the rhythm persists.
Best way to minimize interruption in chest compressions (time off chest)?
Answer: Continue CPR while charging the defibrillator, perform quick rhythm checks
(≤10 seconds), and coordinate team actions efficiently.
Explanation: Pre-charging the defibrillator and minimizing pause duration for
rhythm/pulse checks maximizes CCF.
What is the compression rate and depth?
Answer: Rate: 100-120 compressions per minute. Depth: 2-2.4 inches (5-6 cm) in adults.
Explanation: This ensures adequate circulation and coronary perfusion during CPR.
Quantitative capnography be used for what 2 things? What are PETCO2 readings
associated with each?
Answer:
o 1. Assessing CPR quality: PETCO2 >10 mmHg indicates effective CPR.
o 2. Detecting ROSC: PETCO2 ≥35-40 mmHg suggests return of spontaneous
circulation.
Explanation: Capnography measures end-tidal CO2 (PETCO2), reflecting cardiac output
and perfusion during CPR.
COMPLETE WITH VERIFIED
EXPLANATIONS
You respond to a patient in distress and find an unresponsive male lying on the floor
gasping for air. What step should you take next?
o Answer: C. Check pulse
o Explanation: Gasping (agonal breathing) is a sign of cardiac arrest. After
confirming unresponsiveness, the next step in the BLS survey is to check for a
pulse (carotid in adults) for 5-10 seconds to determine if CPR is needed.
Why is proper size important when using an OPA or NPA?
o Answer: D. All of the above
o Explanation: An improperly sized oropharyngeal airway (OPA) or
nasopharyngeal airway (NPA) can cause complications. Too large an OPA/NPA
may block the airway or damage tissue, while too small an airway may fail to
maintain a patent airway.
You respond to a swimming pool where a person is floating facedown and is unresponsive.
Which action do you perform first?
o Answer: None of the provided options are ideal; correct action is to remove
from water and assess.
o Explanation: The first step is to safely remove the patient from the water to a
stable surface to assess responsiveness and breathing. If pulseless, start CPR.
None of the options (A, B, C, D) directly address this initial step, but CPR (A)
would follow if no pulse is found after assessment.
Asystole is a common rhythm and should be treated with all the following EXCEPT:
o Answer: C. Defibrillation
o Explanation: Asystole is a non-shockable rhythm. Treatment includes high-
quality CPR, epinephrine (1 mg IV/IO every 3-5 minutes), and ventilations.
Defibrillation is not indicated for asystole.
You are treating a cardiac arrest patient. The AED is having problems analyzing the
rhythm. Which of the following is the correct response?
o Answer: D. Continue chest compressions
, o Explanation: If an AED cannot analyze the rhythm, continue high-quality CPR to
maintain circulation. Troubleshooting or switching devices should not interrupt
compressions.
True/False: All Acute Coronary Syndrome (ACS) patients benefit from supplemental
oxygen, and a nasal cannula should be used.
o Answer: B. False
o Explanation: Supplemental oxygen is only recommended for ACS patients with
SpO2 < 90% or respiratory distress. Routine oxygen use in normoxic patients is
not beneficial and may cause harm.
Your co-worker is acting strange. Which of the following suggests the possibility of a
stroke?
o Answer: D. All of the above
o Explanation: Slurred speech, dizziness, and arm weakness are all potential signs
of a stroke, as assessed by tools like the Cincinnati Prehospital Stroke Scale.
Which of the following are treated with synchronized shocks?
o Answer: A. Unstable atrial fibrillation
o Explanation: Synchronized cardioversion is used for unstable tachyarrhythmias
with a pulse, such as atrial fibrillation or monomorphic VT. Sinus tachycardia is
not treated with shocks, and pulseless VT or VF requires unsynchronized
defibrillation.
What is the correct dose for Procainamide?
o Answer: B. 20-50 mg/min
o Explanation: For stable monomorphic VT, procainamide is administered at 20-50
mg/min IV until the arrhythmia is suppressed, hypotension occurs, or a maximum
dose of 17 mg/kg is reached.
A male patient experiences crushing chest pain. What drug should you consider giving in
all Acute Coronary Syndrome (ACS) patients?
o Answer: B. Aspirin
o Explanation: Aspirin (162-325 mg, chewed) is recommended for all ACS
patients unless contraindicated (e.g., allergy or active bleeding), as it reduces
mortality by inhibiting platelet aggregation.
What is your priority in care for a pulseless patient?
Answer: Initiate high-quality CPR immediately.
, Explanation: For a pulseless patient, the priority is to restore circulation through high-
quality chest compressions, followed by defibrillation if the rhythm is shockable.
What is the compression to ventilation ratio for the pulseless patient without advanced
airway?
Answer: 30:2
Explanation: For adults in cardiac arrest without an advanced airway, the compression-
to-ventilation ratio is 30 compressions to 2 breaths.
How often do we switch CPR compressors?
Answer: Every 2 minutes (or every 5 cycles of 30:2).
Explanation: Switching compressors every 2 minutes prevents fatigue and ensures
consistent compression quality.
How soon should compressions be started in the pulseless patient? How long is the pulse
check?
Answer: Compressions should start immediately after confirming no pulse. Pulse check
should take 5-10 seconds.
Explanation: After confirming unresponsiveness and no pulse (checked for 5-10
seconds), start CPR immediately to minimize interruptions in circulation.
What is the maximum off chest time for the pulseless patient? A common error in CPR is…
Answer: Maximum off-chest time should be less than 10 seconds. A common error is
excessive interruptions in chest compressions.
Explanation: Interruptions should be minimized to maintain chest compression fraction
(CCF). Prolonged pauses (e.g., for pulse checks or intubation) reduce CPR effectiveness.
How much air do you use to ventilate your patient? What does excessive ventilation cause?
Answer: Use just enough air to cause visible chest rise (approximately 500-600 mL in
adults). Excessive ventilation causes increased intrathoracic pressure, decreased venous
return, and reduced cardiac output.
Explanation: Over-ventilation can impede circulation by increasing intrathoracic
pressure, reducing preload, and compromising CPR effectiveness.
What is the primary focus of the CPR Coach? What role can be combined with the CPR
Coach?
Answer: The CPR Coach focuses on ensuring high-quality CPR (adequate rate, depth,
and minimal interruptions). This role can be combined with the team leader or
monitor/defibrillator operator.
, Explanation: The CPR Coach monitors compression quality and provides real-time
feedback. Combining roles optimizes team efficiency.
What is CCF? What is the CCF goal? What action affects CCF the most? What action on
the monitor/defibrillator can increase CCF?
Answer:
o CCF (Chest Compression Fraction): The proportion of time during CPR that
compressions are performed.
o Goal: At least 60%, ideally >80%.
o Action affecting CCF most: Interruptions (e.g., pulse checks, rhythm analysis).
o Action to increase CCF: Charging the defibrillator during compressions to
minimize pause time.
Explanation: High CCF correlates with better outcomes. Minimizing interruptions and
charging the defibrillator during compressions reduces off-chest time.
How often can you defibrillate a patient? What rhythms can be defibrillated?
Answer: Defibrillate every 2 minutes if the rhythm remains shockable (VF or pulseless
VT). Only ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are
defibrillated.
Explanation: Defibrillation is performed for shockable rhythms (VF/pulseless VT) after
every 2-minute CPR cycle if the rhythm persists.
Best way to minimize interruption in chest compressions (time off chest)?
Answer: Continue CPR while charging the defibrillator, perform quick rhythm checks
(≤10 seconds), and coordinate team actions efficiently.
Explanation: Pre-charging the defibrillator and minimizing pause duration for
rhythm/pulse checks maximizes CCF.
What is the compression rate and depth?
Answer: Rate: 100-120 compressions per minute. Depth: 2-2.4 inches (5-6 cm) in adults.
Explanation: This ensures adequate circulation and coronary perfusion during CPR.
Quantitative capnography be used for what 2 things? What are PETCO2 readings
associated with each?
Answer:
o 1. Assessing CPR quality: PETCO2 >10 mmHg indicates effective CPR.
o 2. Detecting ROSC: PETCO2 ≥35-40 mmHg suggests return of spontaneous
circulation.
Explanation: Capnography measures end-tidal CO2 (PETCO2), reflecting cardiac output
and perfusion during CPR.
