Advanced Cardiac Life Support &
Emergency Neurological Care Exam
2026/2027 | 120 ACLS Practice Questions
with Answers & Explanations for Critical
Care, Emergency Medicine, and Nursing
Certification
Description:
Master ACLS rhythms, shock management, stroke care, and critical care emergencies
with this comprehensive 2026/2027 exam bank. 120 multiple-choice questions with
evidence-based answers and detailed explanations. Updated to latest AHA guidelines.
Download the 2026/2027 edition — pass your certification with confidence.
ACLS & Critical Care Exam 2026/2027
,Section 1: Tachyarrhythmias & Emergency Treatment
Question 1
A patient is found pulseless and apneic. The cardiac monitor reveals a wide-complex regular
tachycardia without discernible P waves. Following immediate high-quality CPR and
defibrillation, which medication is administered as the first-line antiarrhythmic?
A. Epinephrine
B. Amiodarone
C. Lidocaine
D. Atropine
Answer: B
Explanation: For ventricular tachycardia (VTach) without a pulse, the ACLS algorithm
prioritizes defibrillation. After defibrillation, amiodarone is the first-line antiarrhythmic to
stabilize the myocardial membrane and prevent recurrence. Epinephrine is given after
amiodarone to improve coronary perfusion.
Question 2
A patient’s cardiac monitor shows a chaotic, disorganized waveform with no recognizable
QRS complexes or T waves. There is no palpable pulse. What is the correct sequence of
interventions?
A. Epinephrine, Amiodarone, Defibrillation, CPR
B. CPR, Defibrillation, Epinephrine, Amiodarone
C. Defibrillation, Amiodarone, CPR, Epinephrine
D. Amiodarone, CPR, Defibrillation, Epinephrine
Answer: B
Explanation: This rhythm is ventricular fibrillation (VF). The immediate priority is high-
quality CPR while preparing for defibrillation. After the first shock and resuming CPR,
epinephrine is given, followed by amiodarone for refractory VF/pulseless VTach.
Question 3
What percentage of cardiac output is typically lost when a patient develops new-onset atrial
fibrillation due to the loss of the “atrial kick”?
,A. 10-15%
B. 20-25%
C. 30-40%
D. 45-50%
Answer: B
Explanation: The atrial contraction contributes approximately 20-25% of ventricular filling,
known as the atrial kick. Its loss in atrial fibrillation can significantly reduce cardiac output,
especially in patients with diastolic dysfunction or reduced ventricular compliance.
Question 4
A patient with known atrial fibrillation presents with a heart rate of 150 bpm, hypotension,
and altered mental status. What is the immediate treatment?
A. Oral anticoagulation and rate control with diltiazem
B. Chemical cardioversion with amiodarone
C. Synchronized cardioversion
D. Immediate defibrillation
Answer: C
Explanation: The patient has unstable atrial fibrillation with rapid ventricular response
(RVR). Unstable signs (hypotension, altered mental status) require immediate synchronized
cardioversion to restore a perfusing rhythm. Defibrillation is unsynchronized and used for
pulseless rhythms.
Question 5
A stable patient presents with atrial fibrillation and a heart rate of 110 bpm. Which
medication is appropriate for acute rate control and acts as a calcium channel blocker to
decrease both blood pressure and heart rate?
A. Amiodarone
B. Metoprolol
C. Diltiazem
D. Digoxin
Answer: C
, Explanation: Diltiazem (Cardizem) is a non-dihydropyridine calcium channel blocker
indicated for acute rate control in stable atrial fibrillation. It slows AV nodal conduction,
reducing ventricular rate. Beta-blockers are also used, but diltiazem is specifically known for
this dual effect.
Question 6
Why is unsynchronized defibrillation avoided in the treatment of a stable patient with atrial
fibrillation?
A. It is less effective than synchronized cardioversion for AFib.
B. It can induce ventricular fibrillation if a shock falls on the T wave.
C. It causes more severe post-procedural myocardial stunning.
D. It requires higher energy levels which increase the risk of stroke.
Answer: D
Explanation: In atrial fibrillation, there is a risk of left atrial appendage thrombus.
Unsynchronized defibrillation (or even synchronized cardioversion without adequate
anticoagulation) can dislodge a clot, causing an embolic stroke or pulmonary embolism.
Therefore, stable AFib is rate-controlled and anticoagulated, not acutely shocked.
Section 2: Pulseless Rhythms & Cardiac Arrest Management
Question 7
Asystole is confirmed on the monitor. What is the most critical initial step before proceeding
with the ACLS algorithm?
A. Administer atropine 1 mg IV push.
B. Confirm asystole in at least two leads.
C. Immediately defibrillate with 360 J.
D. Establish an advanced airway.
Answer: B
Explanation: Asystole must be confirmed in two orthogonal leads (e.g., leads II and V). Fine
ventricular fibrillation can mimic asystole on a single lead. Defibrillation is not indicated for
true asystole; the treatment is high-quality CPR and epinephrine.
Emergency Neurological Care Exam
2026/2027 | 120 ACLS Practice Questions
with Answers & Explanations for Critical
Care, Emergency Medicine, and Nursing
Certification
Description:
Master ACLS rhythms, shock management, stroke care, and critical care emergencies
with this comprehensive 2026/2027 exam bank. 120 multiple-choice questions with
evidence-based answers and detailed explanations. Updated to latest AHA guidelines.
Download the 2026/2027 edition — pass your certification with confidence.
ACLS & Critical Care Exam 2026/2027
,Section 1: Tachyarrhythmias & Emergency Treatment
Question 1
A patient is found pulseless and apneic. The cardiac monitor reveals a wide-complex regular
tachycardia without discernible P waves. Following immediate high-quality CPR and
defibrillation, which medication is administered as the first-line antiarrhythmic?
A. Epinephrine
B. Amiodarone
C. Lidocaine
D. Atropine
Answer: B
Explanation: For ventricular tachycardia (VTach) without a pulse, the ACLS algorithm
prioritizes defibrillation. After defibrillation, amiodarone is the first-line antiarrhythmic to
stabilize the myocardial membrane and prevent recurrence. Epinephrine is given after
amiodarone to improve coronary perfusion.
Question 2
A patient’s cardiac monitor shows a chaotic, disorganized waveform with no recognizable
QRS complexes or T waves. There is no palpable pulse. What is the correct sequence of
interventions?
A. Epinephrine, Amiodarone, Defibrillation, CPR
B. CPR, Defibrillation, Epinephrine, Amiodarone
C. Defibrillation, Amiodarone, CPR, Epinephrine
D. Amiodarone, CPR, Defibrillation, Epinephrine
Answer: B
Explanation: This rhythm is ventricular fibrillation (VF). The immediate priority is high-
quality CPR while preparing for defibrillation. After the first shock and resuming CPR,
epinephrine is given, followed by amiodarone for refractory VF/pulseless VTach.
Question 3
What percentage of cardiac output is typically lost when a patient develops new-onset atrial
fibrillation due to the loss of the “atrial kick”?
,A. 10-15%
B. 20-25%
C. 30-40%
D. 45-50%
Answer: B
Explanation: The atrial contraction contributes approximately 20-25% of ventricular filling,
known as the atrial kick. Its loss in atrial fibrillation can significantly reduce cardiac output,
especially in patients with diastolic dysfunction or reduced ventricular compliance.
Question 4
A patient with known atrial fibrillation presents with a heart rate of 150 bpm, hypotension,
and altered mental status. What is the immediate treatment?
A. Oral anticoagulation and rate control with diltiazem
B. Chemical cardioversion with amiodarone
C. Synchronized cardioversion
D. Immediate defibrillation
Answer: C
Explanation: The patient has unstable atrial fibrillation with rapid ventricular response
(RVR). Unstable signs (hypotension, altered mental status) require immediate synchronized
cardioversion to restore a perfusing rhythm. Defibrillation is unsynchronized and used for
pulseless rhythms.
Question 5
A stable patient presents with atrial fibrillation and a heart rate of 110 bpm. Which
medication is appropriate for acute rate control and acts as a calcium channel blocker to
decrease both blood pressure and heart rate?
A. Amiodarone
B. Metoprolol
C. Diltiazem
D. Digoxin
Answer: C
, Explanation: Diltiazem (Cardizem) is a non-dihydropyridine calcium channel blocker
indicated for acute rate control in stable atrial fibrillation. It slows AV nodal conduction,
reducing ventricular rate. Beta-blockers are also used, but diltiazem is specifically known for
this dual effect.
Question 6
Why is unsynchronized defibrillation avoided in the treatment of a stable patient with atrial
fibrillation?
A. It is less effective than synchronized cardioversion for AFib.
B. It can induce ventricular fibrillation if a shock falls on the T wave.
C. It causes more severe post-procedural myocardial stunning.
D. It requires higher energy levels which increase the risk of stroke.
Answer: D
Explanation: In atrial fibrillation, there is a risk of left atrial appendage thrombus.
Unsynchronized defibrillation (or even synchronized cardioversion without adequate
anticoagulation) can dislodge a clot, causing an embolic stroke or pulmonary embolism.
Therefore, stable AFib is rate-controlled and anticoagulated, not acutely shocked.
Section 2: Pulseless Rhythms & Cardiac Arrest Management
Question 7
Asystole is confirmed on the monitor. What is the most critical initial step before proceeding
with the ACLS algorithm?
A. Administer atropine 1 mg IV push.
B. Confirm asystole in at least two leads.
C. Immediately defibrillate with 360 J.
D. Establish an advanced airway.
Answer: B
Explanation: Asystole must be confirmed in two orthogonal leads (e.g., leads II and V). Fine
ventricular fibrillation can mimic asystole on a single lead. Defibrillation is not indicated for
true asystole; the treatment is high-quality CPR and epinephrine.
