ACLS Provider Certification Practice
Exam Questions And Well Graded
Solutions With Rationales Updated 2026
2027
Comprehensive study bank featuring 350 practice questions and answers for the
ACLS Provider Certification Exam (Versions A-H). This guide features accurate
formatting with bold answers and rationales. Covers all key algorithms: BLS,
Bradycardia, Tachycardia, and Post-Cardiac Arrest Care. Includes advanced
pharmacology (Amiodarone, Epinephrine, Adenosine), reversible causes (H's & T's),
and Megacode dynamics. Perfect for nursing, medical, and EMS students seeking
first-time pass success.
Which of the following describes the correct chest compression depth for an adult
victim?
A) At least 1 inch
B) At least 2 inches (5 cm) but not more than 2.4 inches (6 cm)
C) Exactly 3 inches
D) Between 1.5 and 2 inches
Rationale: Standard guidelines state that adult compressions must go deep enough
to effectively pump blood but not so deep that they cause excessive structural
damage.
1|Page
,What is the primary action of Epinephrine when administered during cardiac arrest?
A) Vasoconstriction to improve coronary and cerebral perfusion
B) Vasodilation to increase peripheral blood flow
C) Beta-blockade to slow down tachyarrhythmias
D) Parasympathetic stimulation to increase heart rate
Rationale: Epinephrine acts primarily as an alpha-1 adrenergic agonist during
cardiac arrest, constricting peripheral blood vessels to shunt blood toward the heart
and brain.
A patient has an advanced airway in place during CPR. What is the correct
ventilation rate for an adult?
A) 1 breath every 3 seconds
B) 1 breath every 6 seconds (10 breaths per minute)
C) 2 breaths after every 30 compressions
D) 1 breath every 10 seconds
Rationale: Once an advanced airway is inserted, compressions are continuous, and
ventilations are given asynchronously at a steady rate of 1 breath every 6 seconds.
For which of the following cardiac arrest rhythms is a synchronization feature turned
ON during energy delivery?
A) Ventricular Fibrillation
B) Pulseless Ventricular Tachycardia
C) Asystole
D) Monomorphic Tachycardia with a pulse
Rationale: Synchronization is only used for patients with a pulse who are
experiencing unstable tachyarrhythmias to avoid delivering a shock during the
vulnerable T-wave.
What is the first drug choice for a patient with stable narrow-complex
supraventricular tachycardia (SVT) after vagal maneuvers fail?
A) Adenosine
B) Atropine
C) Amiodarone
D) Epinephrine
Rationale: Adenosine is highly effective at slowing conduction through the AV node
and terminating stable narrow-complex SVT.
A patient is in asystole. Which of the following actions should be prioritized?
A) Immediate defibrillation at 200 Joules
B) High-quality CPR and early Epinephrine
C) Administration of a 300 mg Amiodarone bolus
D) Endotracheal intubation before beginning chest compressions
Rationale: Asystole is a non-shockable rhythm. Treatment relies entirely on high-
quality chest compressions and administering Epinephrine as soon as possible.
What is the maximum total dose of Atropine that can be given for symptomatic
bradycardia?
A) 1 mg
B) 2 mg
C) 3 mg
D) 5 mg
2|Page
,Rationale: Atropine is dosed at 1 mg every 3 to 5 minutes, up to a maximum total
dose of 3 mg for bradycardia.
During post-cardiac arrest care, what is the recommended minimum systolic blood
pressure target?
A) 80 mmHg
B) 90 mmHg
C) 100 mmHg
D) 120 mmHg
Rationale: Maintaining a systolic blood pressure of at least 90 mmHg (or a mean
arterial pressure of at least 65 mmHg) ensures adequate perfusion to vital organs.
Which reversible cause of cardiac arrest is most likely associated with a patient
presenting with flat neck veins, rapid heart rate prior to arrest, and trauma?
A) Hypovolemia
B) Tension Pneumothorax
C) Cardiac Tamponade
D) Hyperkalemia
Rationale: Severe blood loss causes hypovolemia, resulting in empty vascular
structures and collapsed neck veins.
What is the correct second dose of Amiodarone for a patient in refractory Ventricular
Fibrillation?
A) 300 mg
B) 150 mg
C) 100 mg
D) 50 mg
Rationale: The initial dose of Amiodarone for pulseless cardiac arrest is 300 mg
IV/IO, followed by a single second dose of 150 mg if the rhythm persists.
A patient presents with a high-degree AV block and symptomatic bradycardia. Vagal
maneuvers and Atropine have failed. What is the next immediate intervention?
A) Give 150 mg Amiodarone
B) Transcutaneous pacing (TCP)
C) Administer a 2-liter fluid bolus
D) Deliver a synchronized cardioversion
Rationale: Transcutaneous pacing is the primary intervention for unstable
bradycardia when first-line drug therapy is ineffective.
Which of the following is an absolute contraindication to fibrinolytic therapy in an
acute ischemic stroke patient?
A) Active internal bleeding or a history of recent intracranial hemorrhage
B) Age older than 65 years
C) Blood pressure of 140/90 mmHg
D) Symptoms starting 2 hours ago
Rationale: Fibrinolytics degrade clots and can turn an ischemic stroke into a fatal
hemorrhagic event if active bleeding or past intracranial bleeding exists.
What is the role of the team leader during a resuscitation attempt?
A) Perform all physical interventions manually
B) Monitor performance, guide decisions, and maintain situational awareness
C) Remain completely silent until the code is over
D) Delegate tasks without confirming closed-loop communication
3|Page
, Rationale: The team leader steps back to maintain an objective view of the situation,
tracking protocols and coordinating roles.
How often should chest compressors switch roles during an adult resuscitation?
A) Every 1 minute
B) Every 2 minutes (or after 5 cycles of CPR)
C) Every 5 minutes
D) Only when the compressor feels exhausted
Rationale: Fatigue diminishes compression quality quickly. Switching every 2
minutes keeps compressions effective and matches rhythm checks.
Which of the following represents a key element of comprehensive post-cardiac
arrest care?
A) Routine hyperventilation to lower carbon dioxide levels
B) Targeted Temperature Management (TTM)
C) Immediate administration of high-dose beta-blockers
D) Prophylactic administration of Atropine
Rationale: TTM protects neurological function in patients who remain unresponsive
after achieving return of spontaneous circulation (ROSC).
What does a sudden, sharp rise in end-tidal CO2 (ETCO2) during CPR typically
indicate?
A) The endotracheal tube has become dislodged
B) The patient is developing a tension pneumothorax
C) Return of Spontaneous Circulation (ROSC)
D) Safe transition into asystole
Rationale: A sudden surge in exhaled carbon dioxide reflects a dramatic increase in
blood flow back to the lungs due to the heart restarting.
A patient with a acute coronary syndrome (ACS) complains of chest tightness.
Nitroglycerin should be avoided if the systolic blood pressure drops below what
level?
A) 90 mmHg
B) 100 mmHg
C) 110 mmHg
D) 120 mmHg
Rationale: Nitroglycerin is a potent vasodilator and can cause severe hypotension if
given to an already hypotensive patient.
What is the first choice of IV fluid for volume resuscitation in a post-cardiac arrest
patient?
A) Sterile water
B) Dextrose 5% in water (D5W)
C) Normal Saline or Lactated Ringer's
D) 3% Hypertonic Saline
Rationale: Isotonic crystalloids like Normal Saline or Lactated Ringer's expand the
intravascular volume without shifting fluid inappropriately.
Which rhythm exhibits a totally irregular rhythm with no discernible P waves and a
narrow QRS complex?
A) Ventricular Tachycardia
B) Atrial Fibrillation
C) First-Degree AV Block
4|Page
Exam Questions And Well Graded
Solutions With Rationales Updated 2026
2027
Comprehensive study bank featuring 350 practice questions and answers for the
ACLS Provider Certification Exam (Versions A-H). This guide features accurate
formatting with bold answers and rationales. Covers all key algorithms: BLS,
Bradycardia, Tachycardia, and Post-Cardiac Arrest Care. Includes advanced
pharmacology (Amiodarone, Epinephrine, Adenosine), reversible causes (H's & T's),
and Megacode dynamics. Perfect for nursing, medical, and EMS students seeking
first-time pass success.
Which of the following describes the correct chest compression depth for an adult
victim?
A) At least 1 inch
B) At least 2 inches (5 cm) but not more than 2.4 inches (6 cm)
C) Exactly 3 inches
D) Between 1.5 and 2 inches
Rationale: Standard guidelines state that adult compressions must go deep enough
to effectively pump blood but not so deep that they cause excessive structural
damage.
1|Page
,What is the primary action of Epinephrine when administered during cardiac arrest?
A) Vasoconstriction to improve coronary and cerebral perfusion
B) Vasodilation to increase peripheral blood flow
C) Beta-blockade to slow down tachyarrhythmias
D) Parasympathetic stimulation to increase heart rate
Rationale: Epinephrine acts primarily as an alpha-1 adrenergic agonist during
cardiac arrest, constricting peripheral blood vessels to shunt blood toward the heart
and brain.
A patient has an advanced airway in place during CPR. What is the correct
ventilation rate for an adult?
A) 1 breath every 3 seconds
B) 1 breath every 6 seconds (10 breaths per minute)
C) 2 breaths after every 30 compressions
D) 1 breath every 10 seconds
Rationale: Once an advanced airway is inserted, compressions are continuous, and
ventilations are given asynchronously at a steady rate of 1 breath every 6 seconds.
For which of the following cardiac arrest rhythms is a synchronization feature turned
ON during energy delivery?
A) Ventricular Fibrillation
B) Pulseless Ventricular Tachycardia
C) Asystole
D) Monomorphic Tachycardia with a pulse
Rationale: Synchronization is only used for patients with a pulse who are
experiencing unstable tachyarrhythmias to avoid delivering a shock during the
vulnerable T-wave.
What is the first drug choice for a patient with stable narrow-complex
supraventricular tachycardia (SVT) after vagal maneuvers fail?
A) Adenosine
B) Atropine
C) Amiodarone
D) Epinephrine
Rationale: Adenosine is highly effective at slowing conduction through the AV node
and terminating stable narrow-complex SVT.
A patient is in asystole. Which of the following actions should be prioritized?
A) Immediate defibrillation at 200 Joules
B) High-quality CPR and early Epinephrine
C) Administration of a 300 mg Amiodarone bolus
D) Endotracheal intubation before beginning chest compressions
Rationale: Asystole is a non-shockable rhythm. Treatment relies entirely on high-
quality chest compressions and administering Epinephrine as soon as possible.
What is the maximum total dose of Atropine that can be given for symptomatic
bradycardia?
A) 1 mg
B) 2 mg
C) 3 mg
D) 5 mg
2|Page
,Rationale: Atropine is dosed at 1 mg every 3 to 5 minutes, up to a maximum total
dose of 3 mg for bradycardia.
During post-cardiac arrest care, what is the recommended minimum systolic blood
pressure target?
A) 80 mmHg
B) 90 mmHg
C) 100 mmHg
D) 120 mmHg
Rationale: Maintaining a systolic blood pressure of at least 90 mmHg (or a mean
arterial pressure of at least 65 mmHg) ensures adequate perfusion to vital organs.
Which reversible cause of cardiac arrest is most likely associated with a patient
presenting with flat neck veins, rapid heart rate prior to arrest, and trauma?
A) Hypovolemia
B) Tension Pneumothorax
C) Cardiac Tamponade
D) Hyperkalemia
Rationale: Severe blood loss causes hypovolemia, resulting in empty vascular
structures and collapsed neck veins.
What is the correct second dose of Amiodarone for a patient in refractory Ventricular
Fibrillation?
A) 300 mg
B) 150 mg
C) 100 mg
D) 50 mg
Rationale: The initial dose of Amiodarone for pulseless cardiac arrest is 300 mg
IV/IO, followed by a single second dose of 150 mg if the rhythm persists.
A patient presents with a high-degree AV block and symptomatic bradycardia. Vagal
maneuvers and Atropine have failed. What is the next immediate intervention?
A) Give 150 mg Amiodarone
B) Transcutaneous pacing (TCP)
C) Administer a 2-liter fluid bolus
D) Deliver a synchronized cardioversion
Rationale: Transcutaneous pacing is the primary intervention for unstable
bradycardia when first-line drug therapy is ineffective.
Which of the following is an absolute contraindication to fibrinolytic therapy in an
acute ischemic stroke patient?
A) Active internal bleeding or a history of recent intracranial hemorrhage
B) Age older than 65 years
C) Blood pressure of 140/90 mmHg
D) Symptoms starting 2 hours ago
Rationale: Fibrinolytics degrade clots and can turn an ischemic stroke into a fatal
hemorrhagic event if active bleeding or past intracranial bleeding exists.
What is the role of the team leader during a resuscitation attempt?
A) Perform all physical interventions manually
B) Monitor performance, guide decisions, and maintain situational awareness
C) Remain completely silent until the code is over
D) Delegate tasks without confirming closed-loop communication
3|Page
, Rationale: The team leader steps back to maintain an objective view of the situation,
tracking protocols and coordinating roles.
How often should chest compressors switch roles during an adult resuscitation?
A) Every 1 minute
B) Every 2 minutes (or after 5 cycles of CPR)
C) Every 5 minutes
D) Only when the compressor feels exhausted
Rationale: Fatigue diminishes compression quality quickly. Switching every 2
minutes keeps compressions effective and matches rhythm checks.
Which of the following represents a key element of comprehensive post-cardiac
arrest care?
A) Routine hyperventilation to lower carbon dioxide levels
B) Targeted Temperature Management (TTM)
C) Immediate administration of high-dose beta-blockers
D) Prophylactic administration of Atropine
Rationale: TTM protects neurological function in patients who remain unresponsive
after achieving return of spontaneous circulation (ROSC).
What does a sudden, sharp rise in end-tidal CO2 (ETCO2) during CPR typically
indicate?
A) The endotracheal tube has become dislodged
B) The patient is developing a tension pneumothorax
C) Return of Spontaneous Circulation (ROSC)
D) Safe transition into asystole
Rationale: A sudden surge in exhaled carbon dioxide reflects a dramatic increase in
blood flow back to the lungs due to the heart restarting.
A patient with a acute coronary syndrome (ACS) complains of chest tightness.
Nitroglycerin should be avoided if the systolic blood pressure drops below what
level?
A) 90 mmHg
B) 100 mmHg
C) 110 mmHg
D) 120 mmHg
Rationale: Nitroglycerin is a potent vasodilator and can cause severe hypotension if
given to an already hypotensive patient.
What is the first choice of IV fluid for volume resuscitation in a post-cardiac arrest
patient?
A) Sterile water
B) Dextrose 5% in water (D5W)
C) Normal Saline or Lactated Ringer's
D) 3% Hypertonic Saline
Rationale: Isotonic crystalloids like Normal Saline or Lactated Ringer's expand the
intravascular volume without shifting fluid inappropriately.
Which rhythm exhibits a totally irregular rhythm with no discernible P waves and a
narrow QRS complex?
A) Ventricular Tachycardia
B) Atrial Fibrillation
C) First-Degree AV Block
4|Page
