ACLS Certification Practice Exam
Versions A & B Questions And Well
Graded Solutions With Rationales
Updated 2026 2027
Master your AHA ACLS Provider Certification with this definitive study resource covering
Exam Versions A and B. Features 350 comprehensive multiple-choice questions with
verified answers and detailed rationales. Perfect for nurses, medical students, and
residents looking to pass on the first try. Covers high-quality CPR, BLS surveys, rhythm
recognition, tachy/bradycardia algorithms, acute coronary syndromes, stroke care, and
post-cardiac arrest management. Maximize your test preparation today!
Question 1: A 55-year-old male is in cardiac arrest. The monitor shows ventricular
fibrillation. After delivering a shock and resuming CPR, what is the first medication
that should be administered?
A) Amiodarone 300 mg IV
B) Atropine 1 mg IV
C) Epinephrine 1 mg IV
D) Lidocaine 100 mg IV
Rationale: Epinephrine 1 mg IV/IO should be given as soon as possible after the first
shock for non-shockable rhythms, or after the second shock for shockable rhythms
like VF/pulseless VT, and repeated every 3 to 5 minutes.
Question 2: What is the target ventilation rate for an adult patient in cardiac arrest
who has an advanced airway in place?
A) 5 to 6 breaths per minute
B) 10 breaths per minute
C) 12 to 15 breaths per minute
D) 20 breaths per minute
Rationale: Once an advanced airway is in place during cardiac arrest, asynchronous
1|Page
,ventilations should be delivered at a rate of 1 breath every 6 seconds, which equals
10 breaths per minute, while continuous chest compressions are performed.
Question 3: A patient presents with symptomatic bradycardia at a rate of 38 bpm.
The first 1 mg dose of Atropine has been administered without a change in heart
rate. What is the maximum cumulative dose of Atropine that can be given?
A) 1.5 mg
B) 2 mg
C) 3 mg
D) 5 mg
Rationale: The standard total maximum dose of atropine for symptomatic
bradycardia is 3 mg. It is administered in doses of 1 mg every 3 to 5 minutes.
Question 4: Which of the following is a primary objective of post-cardiac arrest care?
A) Inducing immediate prophylactic hypothermia to 28°C
B) Targeting a temperature between 32°C and 36°C (Targeted Temperature
Management)
C) Maintaining a blood glucose level above 200 mg/dL
D) Hyperventilating the patient to a PETCO2 of 25 mmHg
Rationale: For patients who achieve ROSC but remain unresponsive, Targeted
Temperature Management (TTM) between 32°C and 36°C should be initiated and
maintained for at least 24 hours to protect neurological function.
Question 5: A patient with a pulse develops unstable supraventricular tachycardia
(SVT). Sedation is provided, and you prepare to cardiovert. At what point in the
cardiac cycle should the shock be delivered?
A) On the descending limb of the T wave
B) On the R wave peak of the QRS complex
C) Exactly during the PR segment
D) Randomly during the cycle
Rationale: Synchronized cardioversion delivers the shock precisely on the R wave
peak to avoid shocking during the vulnerable T-wave period, which could precipitate
ventricular fibrillation.
Question 6: During CPR, the team notes a sudden, sustained rise in PETCO2 to 45
mmHg. This finding most likely indicates which of the following?
A) The advanced airway has become displaced.
B) Return of Spontaneous Circulation (ROSC) has occurred.
C) The chest compression rate is too slow.
D) The patient is experiencing severe hypercapnia.
Rationale: A sudden, sustained increase in end-tidal CO2 (PETCO2), typically above
35–40 mmHg, is a reliable indicator of ROSC due to the sudden surge in cardiac
output delivering CO2 to the lungs.
Question 7: A 65-year-old male with a history of heart disease presents with crushing
chest pain. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Which region of the heart is affected?
A) Anterior wall
B) Lateral wall
C) Inferior wall
D) Septal wall
Rationale: ST-segment elevation in leads II, III, and aVF indicates an acute
2|Page
,myocardial infarction involving the inferior wall of the heart, usually involving the right
coronary artery.
Question 8: What is the recommended first dose of Amiodarone for a patient in
refractory ventricular fibrillation?
A) 150 mg IV push
B) 300 mg IV push
C) 1 mg/min IV infusion
D) 450 mg IV push
Rationale: The initial dose of amiodarone for cardiac arrest from refractory VF or
pulseless VT is a 300 mg IV/IO bolus. A second dose of 150 mg can be given if the
rhythm persists.
Question 9: While performing chest compressions on an adult, what is the correct
recommended compression depth?
A) At least 1 inch but no more than 1.5 inches
B) At least 2 inches but no more than 2.4 inches
C) Exactly 3 inches
D) Depress the chest to one-third of the anterior-posterior diameter
Rationale: High-quality adult chest compressions must reach a depth of at least 2
inches (5 cm) but should not exceed 2.4 inches (6 cm) to avoid internal organ
injuries.
Question 10: Which rhythm is considered non-shockable during a cardiac arrest
resuscitation attempt?
A) Ventricular Fibrillation
B) Pulseless Ventricular Tachycardia
C) Asystole
D) Torsades de Pointes
Rationale: Asystole and Pulseless Electrical Activity (PEA) are non-shockable
rhythms. Defibrillation is only indicated for VF and pulseless VT.
Question 11: A patient in the emergency department goes into cardiac arrest. The
monitor shows Pulseless Electrical Activity (PEA). What is the priority intervention?
A) Deliver an immediate synchronized shock.
B) Deliver an immediate unsynchronized shock.
C) Resume high-quality CPR and administer Epinephrine 1 mg as soon as
possible.
D) Administer Amiodarone 300 mg IV.
Rationale: PEA is a non-shockable rhythm. Treatment consists of immediate high-
quality CPR and the early administration of epinephrine, alongside searching for
reversible causes.
Question 12: You are caring for a stroke patient who arrived at the hospital 1 hour
after symptom onset. A non-contrast head CT scan rules out intracranial
hemorrhage. What is the next priority treatment?
A) Administer high-dose aspirin immediately.
B) Begin an IV heparin infusion.
C) Evaluate the patient for fibrinolytic therapy (e.g., tPA).
D) Perform an emergency carotid endarterectomy.
Rationale: If an ischemic stroke is confirmed by ruling out hemorrhage via CT scan,
3|Page
, and the patient is within the eligible time window (usually up to 3 to 4.5 hours from
onset), evaluation for fibrinolytic therapy is the priority.
Question 13: What is the recommended compression rate for adult basic and
advanced life support?
A) 80 to 100 compressions per minute
B) 100 to 120 compressions per minute
C) 120 to 140 compressions per minute
D) At least 140 compressions per minute
Rationale: High-quality chest compressions must be delivered at a rate of 100 to 120
compressions per minute for all age groups during CPR.
Question 14: A patient with stable monomorphic wide-complex tachycardia presents
to the ED. The rhythm is regular. Which medication may be considered for both
diagnostic and therapeutic use?
A) Adenosine
B) Atropine
C) Epinephrine
D) Dopamine
Rationale: For a stable, regular, monomorphic wide-complex tachycardia, adenosine
(6 mg) can be considered to determine the underlying rhythm or convert it if it is a re-
entrant SVT with aberrancy.
Question 15: During a resuscitation attempt, a team member suggests giving a
medication that is outside the standard protocol guidelines. As the Team Leader,
how should you respond?
A) Administer it immediately to see if it works.
B) Ignore the suggestion completely.
C) Constructively challenge the suggestion and reassert the ACLS guideline
standard.
D) Report the team member to administration immediately.
Rationale: Clear, constructive communication is vital. The Team Leader should
address deviations from guidelines respectfully and direct the team back to
evidence-based protocols.
Question 16: What is the primary reason for ensuring complete chest recoil between
compressions?
A) It increases the ventilation volume of the lungs.
B) It allows the heart to refill completely with blood between compressions.
C) It prevents rib fractures.
D) It helps reduce the rescuer's fatigue.
Rationale: Allowing full chest wall recoil allows blood to flow back into the heart
chambers, maximizing the preload and subsequent cardiac output generated by the
next compression.
Question 17: Which of the following reversible causes of cardiac arrest corresponds
to one of the "H's"?
A) Hyperthermia
B) Hypernatremia
C) Hypovolemia
D) Hypertension
4|Page
Versions A & B Questions And Well
Graded Solutions With Rationales
Updated 2026 2027
Master your AHA ACLS Provider Certification with this definitive study resource covering
Exam Versions A and B. Features 350 comprehensive multiple-choice questions with
verified answers and detailed rationales. Perfect for nurses, medical students, and
residents looking to pass on the first try. Covers high-quality CPR, BLS surveys, rhythm
recognition, tachy/bradycardia algorithms, acute coronary syndromes, stroke care, and
post-cardiac arrest management. Maximize your test preparation today!
Question 1: A 55-year-old male is in cardiac arrest. The monitor shows ventricular
fibrillation. After delivering a shock and resuming CPR, what is the first medication
that should be administered?
A) Amiodarone 300 mg IV
B) Atropine 1 mg IV
C) Epinephrine 1 mg IV
D) Lidocaine 100 mg IV
Rationale: Epinephrine 1 mg IV/IO should be given as soon as possible after the first
shock for non-shockable rhythms, or after the second shock for shockable rhythms
like VF/pulseless VT, and repeated every 3 to 5 minutes.
Question 2: What is the target ventilation rate for an adult patient in cardiac arrest
who has an advanced airway in place?
A) 5 to 6 breaths per minute
B) 10 breaths per minute
C) 12 to 15 breaths per minute
D) 20 breaths per minute
Rationale: Once an advanced airway is in place during cardiac arrest, asynchronous
1|Page
,ventilations should be delivered at a rate of 1 breath every 6 seconds, which equals
10 breaths per minute, while continuous chest compressions are performed.
Question 3: A patient presents with symptomatic bradycardia at a rate of 38 bpm.
The first 1 mg dose of Atropine has been administered without a change in heart
rate. What is the maximum cumulative dose of Atropine that can be given?
A) 1.5 mg
B) 2 mg
C) 3 mg
D) 5 mg
Rationale: The standard total maximum dose of atropine for symptomatic
bradycardia is 3 mg. It is administered in doses of 1 mg every 3 to 5 minutes.
Question 4: Which of the following is a primary objective of post-cardiac arrest care?
A) Inducing immediate prophylactic hypothermia to 28°C
B) Targeting a temperature between 32°C and 36°C (Targeted Temperature
Management)
C) Maintaining a blood glucose level above 200 mg/dL
D) Hyperventilating the patient to a PETCO2 of 25 mmHg
Rationale: For patients who achieve ROSC but remain unresponsive, Targeted
Temperature Management (TTM) between 32°C and 36°C should be initiated and
maintained for at least 24 hours to protect neurological function.
Question 5: A patient with a pulse develops unstable supraventricular tachycardia
(SVT). Sedation is provided, and you prepare to cardiovert. At what point in the
cardiac cycle should the shock be delivered?
A) On the descending limb of the T wave
B) On the R wave peak of the QRS complex
C) Exactly during the PR segment
D) Randomly during the cycle
Rationale: Synchronized cardioversion delivers the shock precisely on the R wave
peak to avoid shocking during the vulnerable T-wave period, which could precipitate
ventricular fibrillation.
Question 6: During CPR, the team notes a sudden, sustained rise in PETCO2 to 45
mmHg. This finding most likely indicates which of the following?
A) The advanced airway has become displaced.
B) Return of Spontaneous Circulation (ROSC) has occurred.
C) The chest compression rate is too slow.
D) The patient is experiencing severe hypercapnia.
Rationale: A sudden, sustained increase in end-tidal CO2 (PETCO2), typically above
35–40 mmHg, is a reliable indicator of ROSC due to the sudden surge in cardiac
output delivering CO2 to the lungs.
Question 7: A 65-year-old male with a history of heart disease presents with crushing
chest pain. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Which region of the heart is affected?
A) Anterior wall
B) Lateral wall
C) Inferior wall
D) Septal wall
Rationale: ST-segment elevation in leads II, III, and aVF indicates an acute
2|Page
,myocardial infarction involving the inferior wall of the heart, usually involving the right
coronary artery.
Question 8: What is the recommended first dose of Amiodarone for a patient in
refractory ventricular fibrillation?
A) 150 mg IV push
B) 300 mg IV push
C) 1 mg/min IV infusion
D) 450 mg IV push
Rationale: The initial dose of amiodarone for cardiac arrest from refractory VF or
pulseless VT is a 300 mg IV/IO bolus. A second dose of 150 mg can be given if the
rhythm persists.
Question 9: While performing chest compressions on an adult, what is the correct
recommended compression depth?
A) At least 1 inch but no more than 1.5 inches
B) At least 2 inches but no more than 2.4 inches
C) Exactly 3 inches
D) Depress the chest to one-third of the anterior-posterior diameter
Rationale: High-quality adult chest compressions must reach a depth of at least 2
inches (5 cm) but should not exceed 2.4 inches (6 cm) to avoid internal organ
injuries.
Question 10: Which rhythm is considered non-shockable during a cardiac arrest
resuscitation attempt?
A) Ventricular Fibrillation
B) Pulseless Ventricular Tachycardia
C) Asystole
D) Torsades de Pointes
Rationale: Asystole and Pulseless Electrical Activity (PEA) are non-shockable
rhythms. Defibrillation is only indicated for VF and pulseless VT.
Question 11: A patient in the emergency department goes into cardiac arrest. The
monitor shows Pulseless Electrical Activity (PEA). What is the priority intervention?
A) Deliver an immediate synchronized shock.
B) Deliver an immediate unsynchronized shock.
C) Resume high-quality CPR and administer Epinephrine 1 mg as soon as
possible.
D) Administer Amiodarone 300 mg IV.
Rationale: PEA is a non-shockable rhythm. Treatment consists of immediate high-
quality CPR and the early administration of epinephrine, alongside searching for
reversible causes.
Question 12: You are caring for a stroke patient who arrived at the hospital 1 hour
after symptom onset. A non-contrast head CT scan rules out intracranial
hemorrhage. What is the next priority treatment?
A) Administer high-dose aspirin immediately.
B) Begin an IV heparin infusion.
C) Evaluate the patient for fibrinolytic therapy (e.g., tPA).
D) Perform an emergency carotid endarterectomy.
Rationale: If an ischemic stroke is confirmed by ruling out hemorrhage via CT scan,
3|Page
, and the patient is within the eligible time window (usually up to 3 to 4.5 hours from
onset), evaluation for fibrinolytic therapy is the priority.
Question 13: What is the recommended compression rate for adult basic and
advanced life support?
A) 80 to 100 compressions per minute
B) 100 to 120 compressions per minute
C) 120 to 140 compressions per minute
D) At least 140 compressions per minute
Rationale: High-quality chest compressions must be delivered at a rate of 100 to 120
compressions per minute for all age groups during CPR.
Question 14: A patient with stable monomorphic wide-complex tachycardia presents
to the ED. The rhythm is regular. Which medication may be considered for both
diagnostic and therapeutic use?
A) Adenosine
B) Atropine
C) Epinephrine
D) Dopamine
Rationale: For a stable, regular, monomorphic wide-complex tachycardia, adenosine
(6 mg) can be considered to determine the underlying rhythm or convert it if it is a re-
entrant SVT with aberrancy.
Question 15: During a resuscitation attempt, a team member suggests giving a
medication that is outside the standard protocol guidelines. As the Team Leader,
how should you respond?
A) Administer it immediately to see if it works.
B) Ignore the suggestion completely.
C) Constructively challenge the suggestion and reassert the ACLS guideline
standard.
D) Report the team member to administration immediately.
Rationale: Clear, constructive communication is vital. The Team Leader should
address deviations from guidelines respectfully and direct the team back to
evidence-based protocols.
Question 16: What is the primary reason for ensuring complete chest recoil between
compressions?
A) It increases the ventilation volume of the lungs.
B) It allows the heart to refill completely with blood between compressions.
C) It prevents rib fractures.
D) It helps reduce the rescuer's fatigue.
Rationale: Allowing full chest wall recoil allows blood to flow back into the heart
chambers, maximizing the preload and subsequent cardiac output generated by the
next compression.
Question 17: Which of the following reversible causes of cardiac arrest corresponds
to one of the "H's"?
A) Hyperthermia
B) Hypernatremia
C) Hypovolemia
D) Hypertension
4|Page
