ACLS POST TEST 1, 2 & 3 Actual Questions and Answers With
Expert Explanation (2026/2027 Update) | Complete A+ Guide -
180 Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Advanced Cardiovascular Life Support (ACLS)
Description This exam assesses mastery of ACLS algorithms, pharmacology, rhythm
recognition, and team dynamics per the 2025 American Heart Association
guidelines. It covers post-resuscitation care, acute coronary syndromes, stroke,
and special resuscitation scenarios.
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Integrate hemodynamic monitoring data to optimize post-cardiac arrest care.
2. Differentiate between shockable and non-shockable rhythms and select
appropriate interventions.
3. Apply evidence-based pharmacology for peri-arrest dysrhythmias.
4. Interpret capnography waveforms to guide CPR quality and ROSC detection.
5. Manage team dynamics during simulated resuscitation scenarios.
Accreditation Conforms to American Heart Association ACLS course standards and USMLE
Step 2 CK / NBME content outlines.
Page 1
,1. A patient in the intensive care unit develops pulseless electrical activity (PEA)
after a witnessed collapse. The monitor shows a narrow-complex rhythm at 40/min.
Which of the following is the MOST likely reversible cause in this scenario?
A. Severe hypothermia
B. Tension pneumothorax
C. Hyperkalemia
D. Acute coronary thrombosis
Answer: B. Tension pneumothorax
Narrow-complex PEA suggests preserved ventricular conduction, often due to
mechanical obstruction or hypovolemia. Tension pneumothorax compresses the heart
and great vessels, causing obstructive shock and narrow-complex PEA. Hyperkalemia
typically produces wide-complex rhythms. Acute coronary thrombosis usually presents
with ventricular fibrillation or wide-complex PEA. Severe hypothermia may cause
bradycardia but not typically narrow-complex PEA.
2. During a resuscitation, capnography shows an end-tidal CO2 (ETCO2) of 8
mmHg after 10 minutes of high-quality CPR. The waveform is flat. Which of the
following is the MOST appropriate interpretation?
A. Return of spontaneous circulation (ROSC) is imminent
B. CPR is being performed with excessive ventilation
C. Cardiac output is severely inadequate and reversible causes should be addressed
D. The endotracheal tube is likely misplaced in the esophagus
Answer: C. Cardiac output is severely inadequate and reversible causes should be
addressed
An ETCO2 persistently <10 mmHg during CPR indicates very low cardiac output and
poor CPR quality or reversible causes (e.g., tension pneumothorax, tamponade). While
esophageal intubation would produce no CO2, a flat waveform at 8 mmHg suggests
some CO2 but critically low. Excessive ventilation would cause a gradual decline but
not such a low plateau. ROSC typically shows a sudden rise to >40 mmHg.
Page 2
,3. A patient presents with unstable bradycardia and a heart rate of 30/min. The
monitor shows third-degree AV block with a narrow QRS escape rhythm. Blood
pressure is 70/40 mmHg. After atropine 0.5 mg IV, the heart rate increases to 45/min
but the patient remains hypotensive. Which of the following is the MOST
appropriate next step?
A. Administer a second dose of atropine 1 mg IV
B. Initiate transcutaneous pacing (TCP)
C. Start dopamine infusion at 5 mcg/kg/min
D. Prepare for transvenous pacing
Answer: B. Initiate transcutaneous pacing (TCP)
In unstable bradycardia refractory to atropine, transcutaneous pacing is the
recommended next step per ACLS guidelines. Atropine can be repeated up to 3 mg, but
when hypotension persists after the first dose, TCP should be initiated without delay.
Dopamine is an alternative if TCP is unavailable, but TCP is preferred. Transvenous
pacing is definitive but not immediately available in most settings.
4. Which of the following drug-dose combinations is CORRECT for the management
of stable monomorphic ventricular tachycardia with preserved ejection fraction?
A. Amiodarone 150 mg IV over 10 minutes, repeated once if needed
B. Lidocaine 1-1.5 mg/kg IV push, followed by infusion
C. Procainamide 20 mg/min IV up to 17 mg/kg
D. Synchronized cardioversion at 100 J biphasic
Answer: C. Procainamide 20 mg/min IV up to 17 mg/kg
For stable monomorphic VT, procainamide (20 mg/min up to 17 mg/kg) is a first-line
antiarrhythmic. Amiodarone 150 mg over 10 minutes is used for unstable VT or when
procainamide is contraindicated. Lidocaine is less effective and reserved for specific
scenarios. Synchronized cardioversion is indicated if the patient becomes unstable, not
for stable VT.
Page 3
, 5. A patient with suspected acute coronary syndrome develops ventricular
fibrillation. Defibrillation is performed at 200 J biphasic, and CPR is resumed. After
2 minutes, the rhythm check shows organized rhythm with a pulse. The patient is
now unconscious and breathing agonal respirations. Which of the following is the
HIGHEST priority intervention?
A. Administer amiodarone 300 mg IV push
B. Obtain a 12-lead ECG
C. Initiate targeted temperature management (TTM)
D. Prepare for emergent coronary angiography
Answer: C. Initiate targeted temperature management (TTM)
After ROSC, the unconscious patient without purposeful response should receive
targeted temperature management (TTM) to improve neurological outcomes. While
obtaining a 12-lead ECG and preparing for angiography are important, TTM is the
immediate priority to prevent brain injury. Amiodarone is not indicated after ROSC
unless recurrent arrhythmias occur.
6. During a code, a team member states, 'I think we should give another dose of
epinephrine.' The team leader responds, 'Let's check the rhythm first.' This
exchange BEST exemplifies which team dynamic principle?
A. Closed-loop communication
B. Constructive intervention
C. Shared mental model
D. Clear roles and responsibilities
Answer: B. Constructive intervention
Constructive intervention occurs when a team member questions an action and the
leader provides a rationale or alternative, promoting patient safety. Closed-loop
communication requires the sender to confirm receipt. Shared mental model is the
overall team understanding. Clear roles are about designated tasks, not this specific
interaction.
Page 4
Expert Explanation (2026/2027 Update) | Complete A+ Guide -
180 Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Advanced Cardiovascular Life Support (ACLS)
Description This exam assesses mastery of ACLS algorithms, pharmacology, rhythm
recognition, and team dynamics per the 2025 American Heart Association
guidelines. It covers post-resuscitation care, acute coronary syndromes, stroke,
and special resuscitation scenarios.
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Integrate hemodynamic monitoring data to optimize post-cardiac arrest care.
2. Differentiate between shockable and non-shockable rhythms and select
appropriate interventions.
3. Apply evidence-based pharmacology for peri-arrest dysrhythmias.
4. Interpret capnography waveforms to guide CPR quality and ROSC detection.
5. Manage team dynamics during simulated resuscitation scenarios.
Accreditation Conforms to American Heart Association ACLS course standards and USMLE
Step 2 CK / NBME content outlines.
Page 1
,1. A patient in the intensive care unit develops pulseless electrical activity (PEA)
after a witnessed collapse. The monitor shows a narrow-complex rhythm at 40/min.
Which of the following is the MOST likely reversible cause in this scenario?
A. Severe hypothermia
B. Tension pneumothorax
C. Hyperkalemia
D. Acute coronary thrombosis
Answer: B. Tension pneumothorax
Narrow-complex PEA suggests preserved ventricular conduction, often due to
mechanical obstruction or hypovolemia. Tension pneumothorax compresses the heart
and great vessels, causing obstructive shock and narrow-complex PEA. Hyperkalemia
typically produces wide-complex rhythms. Acute coronary thrombosis usually presents
with ventricular fibrillation or wide-complex PEA. Severe hypothermia may cause
bradycardia but not typically narrow-complex PEA.
2. During a resuscitation, capnography shows an end-tidal CO2 (ETCO2) of 8
mmHg after 10 minutes of high-quality CPR. The waveform is flat. Which of the
following is the MOST appropriate interpretation?
A. Return of spontaneous circulation (ROSC) is imminent
B. CPR is being performed with excessive ventilation
C. Cardiac output is severely inadequate and reversible causes should be addressed
D. The endotracheal tube is likely misplaced in the esophagus
Answer: C. Cardiac output is severely inadequate and reversible causes should be
addressed
An ETCO2 persistently <10 mmHg during CPR indicates very low cardiac output and
poor CPR quality or reversible causes (e.g., tension pneumothorax, tamponade). While
esophageal intubation would produce no CO2, a flat waveform at 8 mmHg suggests
some CO2 but critically low. Excessive ventilation would cause a gradual decline but
not such a low plateau. ROSC typically shows a sudden rise to >40 mmHg.
Page 2
,3. A patient presents with unstable bradycardia and a heart rate of 30/min. The
monitor shows third-degree AV block with a narrow QRS escape rhythm. Blood
pressure is 70/40 mmHg. After atropine 0.5 mg IV, the heart rate increases to 45/min
but the patient remains hypotensive. Which of the following is the MOST
appropriate next step?
A. Administer a second dose of atropine 1 mg IV
B. Initiate transcutaneous pacing (TCP)
C. Start dopamine infusion at 5 mcg/kg/min
D. Prepare for transvenous pacing
Answer: B. Initiate transcutaneous pacing (TCP)
In unstable bradycardia refractory to atropine, transcutaneous pacing is the
recommended next step per ACLS guidelines. Atropine can be repeated up to 3 mg, but
when hypotension persists after the first dose, TCP should be initiated without delay.
Dopamine is an alternative if TCP is unavailable, but TCP is preferred. Transvenous
pacing is definitive but not immediately available in most settings.
4. Which of the following drug-dose combinations is CORRECT for the management
of stable monomorphic ventricular tachycardia with preserved ejection fraction?
A. Amiodarone 150 mg IV over 10 minutes, repeated once if needed
B. Lidocaine 1-1.5 mg/kg IV push, followed by infusion
C. Procainamide 20 mg/min IV up to 17 mg/kg
D. Synchronized cardioversion at 100 J biphasic
Answer: C. Procainamide 20 mg/min IV up to 17 mg/kg
For stable monomorphic VT, procainamide (20 mg/min up to 17 mg/kg) is a first-line
antiarrhythmic. Amiodarone 150 mg over 10 minutes is used for unstable VT or when
procainamide is contraindicated. Lidocaine is less effective and reserved for specific
scenarios. Synchronized cardioversion is indicated if the patient becomes unstable, not
for stable VT.
Page 3
, 5. A patient with suspected acute coronary syndrome develops ventricular
fibrillation. Defibrillation is performed at 200 J biphasic, and CPR is resumed. After
2 minutes, the rhythm check shows organized rhythm with a pulse. The patient is
now unconscious and breathing agonal respirations. Which of the following is the
HIGHEST priority intervention?
A. Administer amiodarone 300 mg IV push
B. Obtain a 12-lead ECG
C. Initiate targeted temperature management (TTM)
D. Prepare for emergent coronary angiography
Answer: C. Initiate targeted temperature management (TTM)
After ROSC, the unconscious patient without purposeful response should receive
targeted temperature management (TTM) to improve neurological outcomes. While
obtaining a 12-lead ECG and preparing for angiography are important, TTM is the
immediate priority to prevent brain injury. Amiodarone is not indicated after ROSC
unless recurrent arrhythmias occur.
6. During a code, a team member states, 'I think we should give another dose of
epinephrine.' The team leader responds, 'Let's check the rhythm first.' This
exchange BEST exemplifies which team dynamic principle?
A. Closed-loop communication
B. Constructive intervention
C. Shared mental model
D. Clear roles and responsibilities
Answer: B. Constructive intervention
Constructive intervention occurs when a team member questions an action and the
leader provides a rationale or alternative, promoting patient safety. Closed-loop
communication requires the sender to confirm receipt. Shared mental model is the
overall team understanding. Clear roles are about designated tasks, not this specific
interaction.
Page 4
