AHA ACLS FINAL WRITTEN EXAM 2024/2025 EXAM with
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Basic Life Support (BLS) and High-Quality CPR
2. ACLS Survey and Systematic Approach
3. Respiratory Arrest and Airway Management
4. Bradycardia Management
5. Tachycardia Management (Stable and Unstable)
6. Cardiac Arrest: VF/Pulseless VT
7. Cardiac Arrest: PEA and Asystole
8. Acute Coronary Syndromes (ACS)
9. Acute Stroke Management
10. Post-Cardiac Arrest Care
1. A 68-year-old patient in the ICU develops sudden onset of symptomatic bradycardia with a heart
rate of 38 bpm. The patient is hypotensive and exhibits signs of shock. After establishing an
airway and administering oxygen, what is the most appropriate next intervention?
A. Administer a bolus of 500 mL normal saline
B. Administer atropine 1 mg IV push
, C. Initiate transcutaneous pacing immediately
D. Administer epinephrine 2-10 mcg/min infusion
CORRECT ANSWER : B
Rationale: Atropine is the first-line medication for symptomatic bradycardia. Option A is
incorrect because while fluids may be used, they are not the definitive treatment for symptomatic
bradycardia. Option C is reserved for patients who fail to respond to atropine or are at high risk
for asystole. Option D is a second-line infusion for refractory cases.
2. During a cardiac arrest, the rhythm monitor shows ventricular fibrillation. After delivering the
first shock, what is the immediate next step in the ACLS cardiac arrest algorithm?
A. Reassess the rhythm for 10 seconds
B. Resume chest compressions starting with compressions
C. Check for a pulse
D. Administer 1 mg epinephrine
CORRECT ANSWER : B
Rationale: Following a shock, the immediate priority is to resume high-quality CPR to minimize
the time without blood flow. Option A is incorrect because the rhythm should not be checked
until the 2-minute cycle is complete. Option C is incorrect as pulse checks during rhythm
changes are discouraged. Option D is incorrect as the first dose of epinephrine is typically
administered after the second or third rhythm check.
3. A patient presents with a narrow-complex supraventricular tachycardia (SVT) at a rate of 170
bpm. The patient is alert and hemodynamically stable. What is the recommended initial
management strategy?
A. Synchronized cardioversion
B. Vagal maneuvers
C. Amiodarone 150 mg IV push
D. Adenosine 12 mg rapid IV push
CORRECT ANSWER : B
, Rationale: Vagal maneuvers are the first-line, non-pharmacologic intervention for stable
narrow-complex SVT. Option A is for unstable patients. Option C is not indicated for the initial
termination of SVT. Option D is correct only if vagal maneuvers fail.
4. A patient in the emergency department exhibits signs of an acute ischemic stroke. The time of
symptom onset is 2.5 hours ago. The patient is a candidate for fibrinolytic therapy. What is the
maximum time from symptom onset that qualifies a patient for IV alteplase administration in the
absence of contraindications?
A. 60 minutes
B. 180 minutes
C. 270 minutes
D. 480 minutes
CORRECT ANSWER : B
Rationale: The current standard for IV alteplase in acute ischemic stroke is within 3 hours (180
minutes) of onset, with an extended window up to 4.5 hours in strictly defined groups. Options A,
C, and D reflect incorrect timeframes that do not align with the core ACLS protocols for initial
thrombolytic eligibility.
5. A patient in asystole is receiving high-quality CPR. You have established IV/IO access. What is
the most appropriate next step in the medication administration protocol?
A. Administer 1 mg epinephrine as soon as possible
B. Administer 300 mg amiodarone
C. Prepare for transcutaneous pacing
D. Administer 1 mg atropine
CORRECT ANSWER : A
Rationale: In asystole, epinephrine should be administered as soon as feasible. Option B is
incorrect because amiodarone is only used for shock-refractory VF/pVT. Option C is incorrect
as pacing is rarely effective for asystole. Option D is incorrect as atropine has been removed
from the routine cardiac arrest algorithm.
6. During post-cardiac arrest care, a patient is comatose with a blood pressure of 80/50 mmHg.
What is the recommended strategy for hemodynamic optimization?
A. Administer a fluid bolus and consider vasopressors
, B. Initiate therapeutic hypothermia immediately
C. Administer 150 mg amiodarone
D. Maintain a systolic blood pressure of 140 mmHg
CORRECT ANSWER : A
Rationale: Hypotension is common after ROSC and must be treated to ensure organ perfusion.
Option B is outdated, as targeted temperature management is now the standard. Option C is
ineffective for post-arrest hypotension. Option D is unnecessarily high; the goal is to maintain
systolic BP >90 mmHg.
7. A patient with a wide-complex tachycardia is hemodynamically unstable. What is the treatment
of choice?
A. Adenosine 6 mg
B. Amiodarone 150 mg
C. Synchronized cardioversion
D. Procainamide 1 g
CORRECT ANSWER : C
Rationale: Any unstable tachycardia requires immediate synchronized cardioversion regardless
of the rhythm. Options A, B, and D are pharmacologic interventions reserved for stable rhythms
or as adjuncts to electrical therapy.
8. You are managing a patient with pulseless electrical activity (PEA). Which of the following
conditions is considered a reversible cause (H's and T's) for PEA?
A. Hyperglycemia
B. Hypovolemia
C. Hypertension
D. Hyperthermia
CORRECT ANSWER : B
Rationale: Hypovolemia is one of the classic "H's" of the reversible causes of cardiac arrest.
Options A, C, and D are not recognized as primary, acute reversible causes within the H's and
T's mnemonic.
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Basic Life Support (BLS) and High-Quality CPR
2. ACLS Survey and Systematic Approach
3. Respiratory Arrest and Airway Management
4. Bradycardia Management
5. Tachycardia Management (Stable and Unstable)
6. Cardiac Arrest: VF/Pulseless VT
7. Cardiac Arrest: PEA and Asystole
8. Acute Coronary Syndromes (ACS)
9. Acute Stroke Management
10. Post-Cardiac Arrest Care
1. A 68-year-old patient in the ICU develops sudden onset of symptomatic bradycardia with a heart
rate of 38 bpm. The patient is hypotensive and exhibits signs of shock. After establishing an
airway and administering oxygen, what is the most appropriate next intervention?
A. Administer a bolus of 500 mL normal saline
B. Administer atropine 1 mg IV push
, C. Initiate transcutaneous pacing immediately
D. Administer epinephrine 2-10 mcg/min infusion
CORRECT ANSWER : B
Rationale: Atropine is the first-line medication for symptomatic bradycardia. Option A is
incorrect because while fluids may be used, they are not the definitive treatment for symptomatic
bradycardia. Option C is reserved for patients who fail to respond to atropine or are at high risk
for asystole. Option D is a second-line infusion for refractory cases.
2. During a cardiac arrest, the rhythm monitor shows ventricular fibrillation. After delivering the
first shock, what is the immediate next step in the ACLS cardiac arrest algorithm?
A. Reassess the rhythm for 10 seconds
B. Resume chest compressions starting with compressions
C. Check for a pulse
D. Administer 1 mg epinephrine
CORRECT ANSWER : B
Rationale: Following a shock, the immediate priority is to resume high-quality CPR to minimize
the time without blood flow. Option A is incorrect because the rhythm should not be checked
until the 2-minute cycle is complete. Option C is incorrect as pulse checks during rhythm
changes are discouraged. Option D is incorrect as the first dose of epinephrine is typically
administered after the second or third rhythm check.
3. A patient presents with a narrow-complex supraventricular tachycardia (SVT) at a rate of 170
bpm. The patient is alert and hemodynamically stable. What is the recommended initial
management strategy?
A. Synchronized cardioversion
B. Vagal maneuvers
C. Amiodarone 150 mg IV push
D. Adenosine 12 mg rapid IV push
CORRECT ANSWER : B
, Rationale: Vagal maneuvers are the first-line, non-pharmacologic intervention for stable
narrow-complex SVT. Option A is for unstable patients. Option C is not indicated for the initial
termination of SVT. Option D is correct only if vagal maneuvers fail.
4. A patient in the emergency department exhibits signs of an acute ischemic stroke. The time of
symptom onset is 2.5 hours ago. The patient is a candidate for fibrinolytic therapy. What is the
maximum time from symptom onset that qualifies a patient for IV alteplase administration in the
absence of contraindications?
A. 60 minutes
B. 180 minutes
C. 270 minutes
D. 480 minutes
CORRECT ANSWER : B
Rationale: The current standard for IV alteplase in acute ischemic stroke is within 3 hours (180
minutes) of onset, with an extended window up to 4.5 hours in strictly defined groups. Options A,
C, and D reflect incorrect timeframes that do not align with the core ACLS protocols for initial
thrombolytic eligibility.
5. A patient in asystole is receiving high-quality CPR. You have established IV/IO access. What is
the most appropriate next step in the medication administration protocol?
A. Administer 1 mg epinephrine as soon as possible
B. Administer 300 mg amiodarone
C. Prepare for transcutaneous pacing
D. Administer 1 mg atropine
CORRECT ANSWER : A
Rationale: In asystole, epinephrine should be administered as soon as feasible. Option B is
incorrect because amiodarone is only used for shock-refractory VF/pVT. Option C is incorrect
as pacing is rarely effective for asystole. Option D is incorrect as atropine has been removed
from the routine cardiac arrest algorithm.
6. During post-cardiac arrest care, a patient is comatose with a blood pressure of 80/50 mmHg.
What is the recommended strategy for hemodynamic optimization?
A. Administer a fluid bolus and consider vasopressors
, B. Initiate therapeutic hypothermia immediately
C. Administer 150 mg amiodarone
D. Maintain a systolic blood pressure of 140 mmHg
CORRECT ANSWER : A
Rationale: Hypotension is common after ROSC and must be treated to ensure organ perfusion.
Option B is outdated, as targeted temperature management is now the standard. Option C is
ineffective for post-arrest hypotension. Option D is unnecessarily high; the goal is to maintain
systolic BP >90 mmHg.
7. A patient with a wide-complex tachycardia is hemodynamically unstable. What is the treatment
of choice?
A. Adenosine 6 mg
B. Amiodarone 150 mg
C. Synchronized cardioversion
D. Procainamide 1 g
CORRECT ANSWER : C
Rationale: Any unstable tachycardia requires immediate synchronized cardioversion regardless
of the rhythm. Options A, B, and D are pharmacologic interventions reserved for stable rhythms
or as adjuncts to electrical therapy.
8. You are managing a patient with pulseless electrical activity (PEA). Which of the following
conditions is considered a reversible cause (H's and T's) for PEA?
A. Hyperglycemia
B. Hypovolemia
C. Hypertension
D. Hyperthermia
CORRECT ANSWER : B
Rationale: Hypovolemia is one of the classic "H's" of the reversible causes of cardiac arrest.
Options A, C, and D are not recognized as primary, acute reversible causes within the H's and
T's mnemonic.
