ADVANCED CARDIAC LIFE SUPPORT NURSING EXAM – PRACTICE QUESTIONS
AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Rhythm Recognition and Interpretation
Pharmacological Interventions and Dosing
Post-Cardiac Arrest Care
Airway Management and Ventilation
Acute Coronary Syndromes
Acute Ischemic Stroke Management
Team Dynamics and High-Performance Teams
Electrical Therapy and Defibrillation
Ethical Considerations and End-of-Life Care
Introduction
This comprehensive assessment is designed to evaluate the proficiency and clinical
readiness of nursing professionals in Advanced Cardiac Life Support (ACLS). The exam
encompasses a broad spectrum of critical care competencies, ranging from fundamental
rhythm analysis to complex pharmacological management and post-resuscitation
stabilization. Through a rigorous blend of theoretical knowledge and high-fidelity
scenario-based questions, candidates are challenged to demonstrate rapid decision-
making, effective team leadership, and adherence to established clinical guidelines. The
focus remains on real-world application, ensuring that practitioners can provide high-
,quality, evidence-based intervention during cardiovascular emergencies to improve
patient outcomes and survival rates in acute care settings.
Section One: Questions 1–100
1. A patient in the ICU becomes unresponsive, pulseless, and the monitor reveals
ventricular fibrillation. After calling for help and starting CPR, what is the next
priority action?
A. Administer 1 mg of Epinephrine
B. Perform endotracheal intubation
C. Defibrillate the patient immediately
D. Establish intraosseous access
🟢 C. Defibrillate the patient immediately
🔴 RATIONALE: For a witnessed arrest with a shockable rhythm (VF/pVT), immediate
defibrillation is the priority. Early shocks are more likely to result in ROSC before
metabolic changes make the heart less responsive to electricity.
2. During a resuscitation attempt, the team leader orders 1 mg of Epinephrine IV.
How often can this dose be repeated?
A. Every 1 to 2 minutes
B. Every 3 to 5 minutes
C. Every 5 to 10 minutes
D. Only after three shocks have failed
🟢 B. Every 3 to 5 minutes
,🔴 RATIONALE: Standard ACLS protocols dictate that Epinephrine 1 mg should be
administered every 3 to 5 minutes during cardiac arrest to maintain coronary perfusion
pressure.
3. A 65-year-old male presents with crushing chest pain and ST-segment elevation
in leads II, III, and aVF. Which wall of the heart is affected?
A. Anterior
B. Lateral
C. Septal
D. Inferior
🟢 D. Inferior
🔴 RATIONALE: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, usually involving the right coronary artery.
4. Which of the following is the recommended compression-to-ventilation ratio for
an adult patient in cardiac arrest when an advanced airway is NOT in place?
A. 15:2
B. 30:2
C. 10:1
D. 5:1
🟢 B. 30:2
🔴 RATIONALE: For adult CPR without an advanced airway, the ratio is 30
compressions to 2 breaths to provide adequate cardiac output and oxygenation.
, 5. A patient has been in PEA (Pulseless Electrical Activity) for 10 minutes. The team
has ruled out hypovolemia and hypoxia. What is the next most common
reversible cause to consider?
A. Hyperkalemia
B. Hypertension
C. Hyperglycemia
D. Hypokalemia
🟢 A. Hyperkalemia
🔴 RATIONALE: Hyperkalemia is one of the "H's and T's" of reversible causes for PEA
and should be suspected, especially in patients with renal failure or metabolic acidosis.
6. What is the preferred route for drug administration during adult cardiac arrest?
A. Endotracheal
B. Intramuscular
C. Peripheral intravenous
D. Central venous line
🟢 C. Peripheral intravenous
🔴 RATIONALE: The peripheral IV route is the preferred first-line access for drug
delivery because it is quicker and easier to establish than a central line without
interrupting CPR.
7. A patient with a heart rate of 160 bpm is alert, oriented, and denies chest pain or
shortness of breath. The BP is 124/82 mmHg. What is the first-line treatment?
AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Rhythm Recognition and Interpretation
Pharmacological Interventions and Dosing
Post-Cardiac Arrest Care
Airway Management and Ventilation
Acute Coronary Syndromes
Acute Ischemic Stroke Management
Team Dynamics and High-Performance Teams
Electrical Therapy and Defibrillation
Ethical Considerations and End-of-Life Care
Introduction
This comprehensive assessment is designed to evaluate the proficiency and clinical
readiness of nursing professionals in Advanced Cardiac Life Support (ACLS). The exam
encompasses a broad spectrum of critical care competencies, ranging from fundamental
rhythm analysis to complex pharmacological management and post-resuscitation
stabilization. Through a rigorous blend of theoretical knowledge and high-fidelity
scenario-based questions, candidates are challenged to demonstrate rapid decision-
making, effective team leadership, and adherence to established clinical guidelines. The
focus remains on real-world application, ensuring that practitioners can provide high-
,quality, evidence-based intervention during cardiovascular emergencies to improve
patient outcomes and survival rates in acute care settings.
Section One: Questions 1–100
1. A patient in the ICU becomes unresponsive, pulseless, and the monitor reveals
ventricular fibrillation. After calling for help and starting CPR, what is the next
priority action?
A. Administer 1 mg of Epinephrine
B. Perform endotracheal intubation
C. Defibrillate the patient immediately
D. Establish intraosseous access
🟢 C. Defibrillate the patient immediately
🔴 RATIONALE: For a witnessed arrest with a shockable rhythm (VF/pVT), immediate
defibrillation is the priority. Early shocks are more likely to result in ROSC before
metabolic changes make the heart less responsive to electricity.
2. During a resuscitation attempt, the team leader orders 1 mg of Epinephrine IV.
How often can this dose be repeated?
A. Every 1 to 2 minutes
B. Every 3 to 5 minutes
C. Every 5 to 10 minutes
D. Only after three shocks have failed
🟢 B. Every 3 to 5 minutes
,🔴 RATIONALE: Standard ACLS protocols dictate that Epinephrine 1 mg should be
administered every 3 to 5 minutes during cardiac arrest to maintain coronary perfusion
pressure.
3. A 65-year-old male presents with crushing chest pain and ST-segment elevation
in leads II, III, and aVF. Which wall of the heart is affected?
A. Anterior
B. Lateral
C. Septal
D. Inferior
🟢 D. Inferior
🔴 RATIONALE: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, usually involving the right coronary artery.
4. Which of the following is the recommended compression-to-ventilation ratio for
an adult patient in cardiac arrest when an advanced airway is NOT in place?
A. 15:2
B. 30:2
C. 10:1
D. 5:1
🟢 B. 30:2
🔴 RATIONALE: For adult CPR without an advanced airway, the ratio is 30
compressions to 2 breaths to provide adequate cardiac output and oxygenation.
, 5. A patient has been in PEA (Pulseless Electrical Activity) for 10 minutes. The team
has ruled out hypovolemia and hypoxia. What is the next most common
reversible cause to consider?
A. Hyperkalemia
B. Hypertension
C. Hyperglycemia
D. Hypokalemia
🟢 A. Hyperkalemia
🔴 RATIONALE: Hyperkalemia is one of the "H's and T's" of reversible causes for PEA
and should be suspected, especially in patients with renal failure or metabolic acidosis.
6. What is the preferred route for drug administration during adult cardiac arrest?
A. Endotracheal
B. Intramuscular
C. Peripheral intravenous
D. Central venous line
🟢 C. Peripheral intravenous
🔴 RATIONALE: The peripheral IV route is the preferred first-line access for drug
delivery because it is quicker and easier to establish than a central line without
interrupting CPR.
7. A patient with a heart rate of 160 bpm is alert, oriented, and denies chest pain or
shortness of breath. The BP is 124/82 mmHg. What is the first-line treatment?
