Advanced Cardiac Life Support (ACLS)
Certification Exam Questions and
Answers 2026 with Detailed Explanations
(35 Difficult Questions)
Question one.
A patient presents with symptomatic brady cardia, heart rate 40 bpm, hypotensive, altered mental
status. After atropene administration, total 3 mg fails to improve the patients condition. What is
the next most appropriate drug intervention?
A dopamine infusion.
B. A miodon bololis.
C. Adenosine rapid for push.
D. Epinephrine bololis.
Answer. A. Dopamine infusion.
This question tests your knowledge of the ACLS brady cardia algorithm. Specifically, when
atropene is ineffective. The keyword symptomatic bradic cardia and atropene fails indicate that
you need an alternative treatment to increase heart rate and improve profusion. After maximal
atropene, the next steps are transcutaneous pacing or continuous intravenous infusions of
chronotropic agents like dopamine or epinephrine. Dopamine is an appropriate choice as it
increases heart rate and blood pressure by stimulating alpha 1 and beta 1 receptors. For instance,
if a patient remains hypotensive and bratic after atropene, starting a dopamine infusion at 2 to 20
mcg/ kg per minute would be the correct action to support their circulation. Remember, if
atropene doesn't work for symptomatic brady cardia, think about pacing or continuous infusions
of dopamine or epinephrine.
Question two.
A patient is in refractory ventricular fibrillation VF after receiving two shocks and an initial dose
of epinephrine. What is the most appropriate first antiarithmic drug to administer in this
scenario?
A. Lidocaine 1:1 5 mg/ KG4.
B. Magnesium sulfate 1:2 G4.
C. Amiodoron 300 mg 4 bololis
D. Procanomide 20 to 50 mg/min 4.
,Answer C. Amiodoron 300 mg for bololis.
This question focuses on the management of refractory ventricular fibrillation VF in the ACLS
cardiac arrest algorithm. The keywords refractory ventricular fibrillation and two shocks and
initial epinephrine indicate that standard interventions have failed making anti-arithmics the next
critical step. Amiodaron is the preferred initial antiurythmic for VF/ pulseless VT that is
unresponsive to defibrillation given as a 300 mg forbolus which helps stabilize the heart's
electrical activity. For example, if a patient continues to be in VF despite repeated shocks and
epinephrine, amiodoron is the drug of choice to help convert the rhythm. Always remember that
amiodoron is the go-to anti-urythmic for persistent VF/Pulsless VT after initial attempts to
defibrillate and administer epinephrine.
Question three.
A patient in cardiac arrest has a known history of hypercalemia. Which medication might be
considered in addition to standard ACLS drugs?
A. Sodium bicarbonate.
B. Calcium chloride.
C. Magnesium sulfate.
D. Dextrose 50%.
Answer B. Calcium chloride.
This question tests your knowledge of specific causes of cardiac arrest that require targeted drug
therapy, especially the H's and T's. The crucial keyword is hypercalemia, which can cause
profound cardiac toxicity leading to arrest. Calcium chloride or calcium gluconate does not lower
potassium levels, but stabilizes the cardiac cell membrane, protecting the heart from the
immediate effects of high potassium. For instance, if labs confirm high potassium in a patient in
arrest, administering one gram of calcium chloride can help protect the heart. Even though other
treatments like insulin/ dextrose or sodium bicarbonate are needed to actually lower potassium,
always remember that calcium is given for hypercalemia induced cardiac instability even in
arrest to protect the heart.
Question four.
What is the initial recommended dose of adenosine for a stable patient with a narrow complex
tacocardia that is unresponsive to vagal maneuvers?
A 3 mg rapid for push.
B 6 mg rapid for push.
C. 12 mg rapid for push.
, D 18 mg rapid for push.
Answer B. 6 mg rapid for push.
This question assesses your understanding of the adenosine dosage for stable narrow complex
tacocardia. The keywords initial recommended dose and stable patient with narrow complex
tacocardia point to the standard protocol for super ventricular tacicardia SVT. Adenosine is given
as a rapid for push followed by a flush to temporarily block the AV node and terminate re-
entrant arhythmias. The initial dose for adults is 6 mg. And if the rhythm doesn't convert, a
second dose of 12 mg can be given. For example, if a patient's monitor shows SVT at 180 BPM
and vagal maneuvers fail, the first drug you would administer is 6 mg of adenosine. Always
remember the initial 6 mg dose of adenosine for SVT followed by 12 mg if needed.
Question five.
In a patient experiencing symptomatic brady cardia, which drug is contraindicated if the brady
cardia is caused by a highderee AV block, secondderee type 2 or third degree AV block?
A. Epinephrine.
B. Dopamine.
C. Atropene.
D. Norepinephrine.
Answer. C. Atropene.
This question delves into a specific contraindication for atropene in symptomatic brady cardia.
The crucial phrase contraindicated if the brady cardia is caused by a highderee AV block,
secondderee type two or thirdderee AV block highlights an important nuance in the brady cardia
algorithm. Atropene works by blocking the vagus nerves action on the SA and AV nodes, but it
is less likely to be effective and may even worsen outcomes in highderee AV blocks because the
problem lies below the AV node. For example, if an ECG shows a thirdderee AV block with a
slow ventricular escape rhythm causing symptoms, atropene is generally avoided and pacing or
other chronotropic infusions, dopamine/epinephrine are prioritized. Therefore, be cautious with
atropene in highderee AV blocks as it may not be beneficial and could potentially worsen the
block.
Question six.
A patient in cardiac arrest is found to have a prolonged QT interval on a prior ECG and then
develops torsads to points. Which medication is indicated?
A lidocaine,
B. Amiodoron,
Certification Exam Questions and
Answers 2026 with Detailed Explanations
(35 Difficult Questions)
Question one.
A patient presents with symptomatic brady cardia, heart rate 40 bpm, hypotensive, altered mental
status. After atropene administration, total 3 mg fails to improve the patients condition. What is
the next most appropriate drug intervention?
A dopamine infusion.
B. A miodon bololis.
C. Adenosine rapid for push.
D. Epinephrine bololis.
Answer. A. Dopamine infusion.
This question tests your knowledge of the ACLS brady cardia algorithm. Specifically, when
atropene is ineffective. The keyword symptomatic bradic cardia and atropene fails indicate that
you need an alternative treatment to increase heart rate and improve profusion. After maximal
atropene, the next steps are transcutaneous pacing or continuous intravenous infusions of
chronotropic agents like dopamine or epinephrine. Dopamine is an appropriate choice as it
increases heart rate and blood pressure by stimulating alpha 1 and beta 1 receptors. For instance,
if a patient remains hypotensive and bratic after atropene, starting a dopamine infusion at 2 to 20
mcg/ kg per minute would be the correct action to support their circulation. Remember, if
atropene doesn't work for symptomatic brady cardia, think about pacing or continuous infusions
of dopamine or epinephrine.
Question two.
A patient is in refractory ventricular fibrillation VF after receiving two shocks and an initial dose
of epinephrine. What is the most appropriate first antiarithmic drug to administer in this
scenario?
A. Lidocaine 1:1 5 mg/ KG4.
B. Magnesium sulfate 1:2 G4.
C. Amiodoron 300 mg 4 bololis
D. Procanomide 20 to 50 mg/min 4.
,Answer C. Amiodoron 300 mg for bololis.
This question focuses on the management of refractory ventricular fibrillation VF in the ACLS
cardiac arrest algorithm. The keywords refractory ventricular fibrillation and two shocks and
initial epinephrine indicate that standard interventions have failed making anti-arithmics the next
critical step. Amiodaron is the preferred initial antiurythmic for VF/ pulseless VT that is
unresponsive to defibrillation given as a 300 mg forbolus which helps stabilize the heart's
electrical activity. For example, if a patient continues to be in VF despite repeated shocks and
epinephrine, amiodoron is the drug of choice to help convert the rhythm. Always remember that
amiodoron is the go-to anti-urythmic for persistent VF/Pulsless VT after initial attempts to
defibrillate and administer epinephrine.
Question three.
A patient in cardiac arrest has a known history of hypercalemia. Which medication might be
considered in addition to standard ACLS drugs?
A. Sodium bicarbonate.
B. Calcium chloride.
C. Magnesium sulfate.
D. Dextrose 50%.
Answer B. Calcium chloride.
This question tests your knowledge of specific causes of cardiac arrest that require targeted drug
therapy, especially the H's and T's. The crucial keyword is hypercalemia, which can cause
profound cardiac toxicity leading to arrest. Calcium chloride or calcium gluconate does not lower
potassium levels, but stabilizes the cardiac cell membrane, protecting the heart from the
immediate effects of high potassium. For instance, if labs confirm high potassium in a patient in
arrest, administering one gram of calcium chloride can help protect the heart. Even though other
treatments like insulin/ dextrose or sodium bicarbonate are needed to actually lower potassium,
always remember that calcium is given for hypercalemia induced cardiac instability even in
arrest to protect the heart.
Question four.
What is the initial recommended dose of adenosine for a stable patient with a narrow complex
tacocardia that is unresponsive to vagal maneuvers?
A 3 mg rapid for push.
B 6 mg rapid for push.
C. 12 mg rapid for push.
, D 18 mg rapid for push.
Answer B. 6 mg rapid for push.
This question assesses your understanding of the adenosine dosage for stable narrow complex
tacocardia. The keywords initial recommended dose and stable patient with narrow complex
tacocardia point to the standard protocol for super ventricular tacicardia SVT. Adenosine is given
as a rapid for push followed by a flush to temporarily block the AV node and terminate re-
entrant arhythmias. The initial dose for adults is 6 mg. And if the rhythm doesn't convert, a
second dose of 12 mg can be given. For example, if a patient's monitor shows SVT at 180 BPM
and vagal maneuvers fail, the first drug you would administer is 6 mg of adenosine. Always
remember the initial 6 mg dose of adenosine for SVT followed by 12 mg if needed.
Question five.
In a patient experiencing symptomatic brady cardia, which drug is contraindicated if the brady
cardia is caused by a highderee AV block, secondderee type 2 or third degree AV block?
A. Epinephrine.
B. Dopamine.
C. Atropene.
D. Norepinephrine.
Answer. C. Atropene.
This question delves into a specific contraindication for atropene in symptomatic brady cardia.
The crucial phrase contraindicated if the brady cardia is caused by a highderee AV block,
secondderee type two or thirdderee AV block highlights an important nuance in the brady cardia
algorithm. Atropene works by blocking the vagus nerves action on the SA and AV nodes, but it
is less likely to be effective and may even worsen outcomes in highderee AV blocks because the
problem lies below the AV node. For example, if an ECG shows a thirdderee AV block with a
slow ventricular escape rhythm causing symptoms, atropene is generally avoided and pacing or
other chronotropic infusions, dopamine/epinephrine are prioritized. Therefore, be cautious with
atropene in highderee AV blocks as it may not be beneficial and could potentially worsen the
block.
Question six.
A patient in cardiac arrest is found to have a prolonged QT interval on a prior ECG and then
develops torsads to points. Which medication is indicated?
A lidocaine,
B. Amiodoron,
