2026 Advanced Cardiovascular Life Support ACLS
Certification Exam with All Questions from Actual
Exam, 100% Correct Answers and Rationale
ACLS Certification Exam (50 Questions)
1. You are the team leader during a cardiac arrest. The rhythm is ventricular fibrillation
(VF). After 2 minutes of CPR and 1 shock, the rhythm remains VF. What is the next
intervention?
A) Administer epinephrine 1 mg IV/IO.
B) Resume CPR for 2 minutes and give amiodarone 300 mg IV/IO.
C) Defibrillate again immediately.
D) Start chest compressions without defibrillation. Correct Answer: B) Resume CPR for
2 minutes and give amiodarone 300 mg IV/IO.
Rationale: For refractory VF, resume high-quality CPR for 2 minutes after shock, then
administer antiarrhythmic (amiodarone 300 mg first dose). AHA ACLS Cardiac Arrest
Algorithm (2020-2025 guidelines).
2. A patient in cardiac arrest has return of spontaneous circulation (ROSC). What is the
priority post-arrest care?
A) Targeted temperature management (TTM) to 32–36°C.
B) Immediate discharge.
C) Administer aspirin only.
D) No further monitoring. Correct Answer: A) Targeted temperature management (TTM)
to 32–36°C.
Rationale: TTM improves neurologic outcomes post-ROSC. AHA Post-Cardiac Arrest
Care Algorithm.
3. What is the recommended compression rate for high-quality CPR?
A) 100–120 per minute.
B) 60–80 per minute.
C) 120–140 per minute.
D) 80–100 per minute. Correct Answer: A) 100–120 per minute.
Rationale: Allows adequate cardiac output. AHA High-Quality CPR guidelines.
4. For a patient with symptomatic bradycardia (HR 40 bpm, hypotensive), what is the first-
line drug?
A) Atropine 1 mg IV.
B) Epinephrine 1 mg IV.
C) Dopamine infusion.
D) Amiodarone 300 mg IV. Correct Answer: A) Atropine 1 mg IV.
Rationale: Atropine increases heart rate by blocking vagal tone. AHA Bradycardia
Algorithm; dose is 1 mg (updated from 0.5 mg in 2020 guidelines).
5. In an adult cardiac arrest, what is the recommended defibrillation energy for biphasic
AED?
A) 120–200 J.
B) 360 J.
C) 50 J.
, D) 300 J. Correct Answer: A) 120–200 J.
Rationale: Manufacturer-recommended for biphasic devices. AHA Defibrillation
guidelines.
6. A patient has narrow-complex tachycardia (HR 150 bpm, stable). What is the initial
intervention?
A) Vagal maneuvers.
B) Synchronized cardioversion.
C) Adenosine 6 mg IV.
D) Amiodarone infusion. Correct Answer: A) Vagal maneuvers.
Rationale: Non-invasive first for stable SVT. AHA Tachycardia Algorithm.
7. What is the dose of epinephrine for anaphylaxis in adults?
A) 0.3–0.5 mg IM.
B) 1 mg IV.
C) 0.1 mg/kg IV.
D) 10 mcg/min infusion. Correct Answer: A) 0.3–0.5 mg IM.
Rationale: IM epinephrine is first-line for anaphylaxis. AHA ACLS Pharmacology.
8. During CPR, what is the recommended ventilation rate with an advanced airway?
A) 10 breaths per minute.
B) 30 breaths per minute.
C) 2 breaths every 6 seconds.
D) Continuous without pauses. Correct Answer: A) 10 breaths per minute.
Rationale: Avoids hyperventilation. AHA Airway Management guidelines.
9. For a witnessed cardiac arrest, what is the most important initial intervention?
A) Immediate defibrillation.
B) Start CPR.
C) Call for help.
D) Check pulse. Correct Answer: A) Immediate defibrillation.
Rationale: Defibrillation within 3–5 minutes doubles survival. AHA Chain of Survival.
10. A patient in VF arrest receives the first shock. What is the next dose of amiodarone if
refractory?
A) 150 mg IV.
B) 300 mg IV.
C) 1 mg/kg IV.
D) 450 mg IV. Correct Answer: A) 150 mg IV.
Rationale: Second dose is 150 mg after first 300 mg. AHA Cardiac Arrest Algorithm.
11. What is the recommended depth of chest compressions in adults?
A) 5–6 cm (2–2.4 inches).
B) 3–4 cm.
C) 6–7 cm.
D) 4–5 cm. Correct Answer: A) 5–6 cm (2–2.4 inches).
Rationale: Optimal for perfusion. AHA High-Quality CPR.
12. For stable wide-complex tachycardia, what drug is first-line?
A) Amiodarone 150 mg IV.
B) Adenosine 6 mg IV.
C) Lidocaine 1 mg/kg.
D) Procainamide. Correct Answer: A) Amiodarone 150 mg IV.
Certification Exam with All Questions from Actual
Exam, 100% Correct Answers and Rationale
ACLS Certification Exam (50 Questions)
1. You are the team leader during a cardiac arrest. The rhythm is ventricular fibrillation
(VF). After 2 minutes of CPR and 1 shock, the rhythm remains VF. What is the next
intervention?
A) Administer epinephrine 1 mg IV/IO.
B) Resume CPR for 2 minutes and give amiodarone 300 mg IV/IO.
C) Defibrillate again immediately.
D) Start chest compressions without defibrillation. Correct Answer: B) Resume CPR for
2 minutes and give amiodarone 300 mg IV/IO.
Rationale: For refractory VF, resume high-quality CPR for 2 minutes after shock, then
administer antiarrhythmic (amiodarone 300 mg first dose). AHA ACLS Cardiac Arrest
Algorithm (2020-2025 guidelines).
2. A patient in cardiac arrest has return of spontaneous circulation (ROSC). What is the
priority post-arrest care?
A) Targeted temperature management (TTM) to 32–36°C.
B) Immediate discharge.
C) Administer aspirin only.
D) No further monitoring. Correct Answer: A) Targeted temperature management (TTM)
to 32–36°C.
Rationale: TTM improves neurologic outcomes post-ROSC. AHA Post-Cardiac Arrest
Care Algorithm.
3. What is the recommended compression rate for high-quality CPR?
A) 100–120 per minute.
B) 60–80 per minute.
C) 120–140 per minute.
D) 80–100 per minute. Correct Answer: A) 100–120 per minute.
Rationale: Allows adequate cardiac output. AHA High-Quality CPR guidelines.
4. For a patient with symptomatic bradycardia (HR 40 bpm, hypotensive), what is the first-
line drug?
A) Atropine 1 mg IV.
B) Epinephrine 1 mg IV.
C) Dopamine infusion.
D) Amiodarone 300 mg IV. Correct Answer: A) Atropine 1 mg IV.
Rationale: Atropine increases heart rate by blocking vagal tone. AHA Bradycardia
Algorithm; dose is 1 mg (updated from 0.5 mg in 2020 guidelines).
5. In an adult cardiac arrest, what is the recommended defibrillation energy for biphasic
AED?
A) 120–200 J.
B) 360 J.
C) 50 J.
, D) 300 J. Correct Answer: A) 120–200 J.
Rationale: Manufacturer-recommended for biphasic devices. AHA Defibrillation
guidelines.
6. A patient has narrow-complex tachycardia (HR 150 bpm, stable). What is the initial
intervention?
A) Vagal maneuvers.
B) Synchronized cardioversion.
C) Adenosine 6 mg IV.
D) Amiodarone infusion. Correct Answer: A) Vagal maneuvers.
Rationale: Non-invasive first for stable SVT. AHA Tachycardia Algorithm.
7. What is the dose of epinephrine for anaphylaxis in adults?
A) 0.3–0.5 mg IM.
B) 1 mg IV.
C) 0.1 mg/kg IV.
D) 10 mcg/min infusion. Correct Answer: A) 0.3–0.5 mg IM.
Rationale: IM epinephrine is first-line for anaphylaxis. AHA ACLS Pharmacology.
8. During CPR, what is the recommended ventilation rate with an advanced airway?
A) 10 breaths per minute.
B) 30 breaths per minute.
C) 2 breaths every 6 seconds.
D) Continuous without pauses. Correct Answer: A) 10 breaths per minute.
Rationale: Avoids hyperventilation. AHA Airway Management guidelines.
9. For a witnessed cardiac arrest, what is the most important initial intervention?
A) Immediate defibrillation.
B) Start CPR.
C) Call for help.
D) Check pulse. Correct Answer: A) Immediate defibrillation.
Rationale: Defibrillation within 3–5 minutes doubles survival. AHA Chain of Survival.
10. A patient in VF arrest receives the first shock. What is the next dose of amiodarone if
refractory?
A) 150 mg IV.
B) 300 mg IV.
C) 1 mg/kg IV.
D) 450 mg IV. Correct Answer: A) 150 mg IV.
Rationale: Second dose is 150 mg after first 300 mg. AHA Cardiac Arrest Algorithm.
11. What is the recommended depth of chest compressions in adults?
A) 5–6 cm (2–2.4 inches).
B) 3–4 cm.
C) 6–7 cm.
D) 4–5 cm. Correct Answer: A) 5–6 cm (2–2.4 inches).
Rationale: Optimal for perfusion. AHA High-Quality CPR.
12. For stable wide-complex tachycardia, what drug is first-line?
A) Amiodarone 150 mg IV.
B) Adenosine 6 mg IV.
C) Lidocaine 1 mg/kg.
D) Procainamide. Correct Answer: A) Amiodarone 150 mg IV.
