ACLS CERTIFICATION EXAM] – QUESTIONS AND ANSWERS | VERIFIED
AND WELL DETAILED ANSWERS PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 58-year-old male is brought to the emergency department by EMS following an acute
onset of crushing chest pain and diaphoresis. An initial 12-lead ECG reveals ST-segment
elevation in leads II, III, and aVF. Within 10 minutes of arrival, the patient becomes
unresponsive and is noted to be pulseless. The rhythm monitor shows ventricular
fibrillation. What is the immediate priority intervention?
A. Administer intravenous epinephrine 1 mg immediately
B. Perform synchronized cardioversion at 100 joules
C. Deliver an immediate unsynchronized high-energy defibrillation shock
D. Insert an advanced airway and initiate bag-valve-mask ventilation
Rationale: Ventricular fibrillation is a shockable cardiac arrest rhythm. According to ACLS
algorithms, the immediate priority for any patient in ventricular fibrillation or pulseless
ventricular tachycardia is immediate defibrillation to attempt to restore a perfusing rhythm.
Synchronized cardioversion is used for unstable tachyarrhythmias with a pulse, and
epinephrine is administered after initial defibrillation attempts if the rhythm persists.
2. A 67-year-old female in the cardiac care unit is monitored after bypass surgery and
suddenly develops a rapid, regular wide-complex tachycardia at a rate of 170 beats per
minute. She is alert, reports mild palpitations, and her blood pressure is 118/76 mmHg.
What is the most appropriate initial management step?
A. Perform synchronized cardioversion immediately
B. Administer adenosine 6 mg rapid IV push
C. Obtain a 12-lead ECG and establish expert consultation
D. Administer atropine 1 mg IV push
Rationale: This stable patient with a wide-complex tachycardia should have a 12-lead ECG
obtained to help differentiate ventricular tachycardia from supraventricular tachycardia with
aberrant conduction, and expert consultation should be sought. Immediate synchronized
cardioversion is reserved for unstable patients exhibiting signs of hemodynamic compromise
(altered mental status, shock, acute heart failure, or hypotension).
,3. During a resuscitation attempt for a patient in cardiac arrest, an intraosseous (IO) line is
established after peripheral IV access fails. Which medication can be safely administered
via the IO route during this resuscitation?
A. Amiodarone only
B. All standard cardiac arrest resuscitation medications
C. Vasopressors only
D. Crystalloid fluids without emergency drugs
Rationale: The intraosseous route provides access to a non-collapsible venous plexus and can
be used for the administration of all emergency drugs and fluids utilized during ACLS
resuscitation at the same dosing regimens as intravenous access.
4. A paramedic team arrives at a residence for a 45-year-old unresponsive female. The
rhythm monitor reveals pulseless electrical activity (PEA) at a rate of 38 beats per minute.
CPR is in progress, and an IV is established. What is the first drug administered in this
scenario?
A. Atropine 1 mg IV
B. Epinephrine 1 mg IV every 3 to 5 minutes
C. Amiodarone 300 mg IV
D. Sodium bicarbonate 50 mEq IV
Rationale: For non-shockable rhythms such as pulseless electrical activity and asystole,
epinephrine is the primary vasoactive drug and should be administered as soon as feasible
during resuscitation, repeated every 3 to 5 minutes. Atropine is no longer recommended for
routine use in PEA arrest.
5. A 72-year-old male is admitted with symptomatic bradycardia. His heart rate is 34 beats
per minute, blood pressure is 82/50 mmHg, and he appears lethargic and confused. What is
the initial pharmacological treatment of choice?
A. Dopamine infusion at 2 mcg/kg/min
B. Epinephrine infusion at 2 mg/min
C. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
D. Transcutaneous pacing initiated immediately without medication
, Rationale: Atropine is the first-line drug for symptomatic bradycardia. The initial dose is 1 mg
IV every 3 to 5 minutes up to a maximum dose of 3 mg. If atropine is ineffective,
transcutaneous pacing or an inotropic infusion should be initiated.
6. Following successful resuscitation from cardiac arrest, a patient remains comatose with a
blood pressure of 96/60 mmHg and a heart rate of 88 beats per minute. Which post-cardiac
arrest care intervention is recommended to optimize neurological recovery?
A. Induced normothermia targeting 39 degrees Celsius
B. Targeted temperature management maintaining a constant temperature between 32 and 36
degrees Celsius
C. Immediate administration of high-dose corticosteroids
D. Rapid rewarming within two hours of ROSC
Rationale: Targeted temperature management (TTM) is recommended for comatose adult
patients who achieve return of spontaneous circulation (ROSC) to improve long-term
neurological survival. Patients should maintain a targeted temperature between 32 and 36
degrees Celsius for at least 24 hours.
7. A telemetry technician notes that a patient in observation has developed atrial
fibrillation with rapid ventricular response at a rate of 145 beats per minute. The patient's
blood pressure is 130/80 mmHg and they report no chest pain or shortness of breath.
Which intervention is indicated first?
A. Immediate emergency synchronized cardioversion
B. Administration of medications to control heart rate, such as beta-blockers or calcium channel
blockers
C. Administration of IV epinephrine
D. Immediate transcutaneous pacing
Rationale: Hemodynamically stable patients with rapid atrial fibrillation are managed initially
with rate control using agents such as beta-blockers (e.g., metoprolol) or non-dihydropyridine
calcium channel blockers (e.g., diltiazem), rather than immediate electrical cardioversion.
8. A resuscitation team is performing CPR on an adult in cardiac arrest. An advanced
airway (supraglottic airway device) has been successfully placed. What is the appropriate
ventilation rate during ongoing chest compressions?
A. 8 to 10 breaths per minute without pausing compressions
B. 10 to 12 breaths per minute with a pause in compressions
AND WELL DETAILED ANSWERS PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 58-year-old male is brought to the emergency department by EMS following an acute
onset of crushing chest pain and diaphoresis. An initial 12-lead ECG reveals ST-segment
elevation in leads II, III, and aVF. Within 10 minutes of arrival, the patient becomes
unresponsive and is noted to be pulseless. The rhythm monitor shows ventricular
fibrillation. What is the immediate priority intervention?
A. Administer intravenous epinephrine 1 mg immediately
B. Perform synchronized cardioversion at 100 joules
C. Deliver an immediate unsynchronized high-energy defibrillation shock
D. Insert an advanced airway and initiate bag-valve-mask ventilation
Rationale: Ventricular fibrillation is a shockable cardiac arrest rhythm. According to ACLS
algorithms, the immediate priority for any patient in ventricular fibrillation or pulseless
ventricular tachycardia is immediate defibrillation to attempt to restore a perfusing rhythm.
Synchronized cardioversion is used for unstable tachyarrhythmias with a pulse, and
epinephrine is administered after initial defibrillation attempts if the rhythm persists.
2. A 67-year-old female in the cardiac care unit is monitored after bypass surgery and
suddenly develops a rapid, regular wide-complex tachycardia at a rate of 170 beats per
minute. She is alert, reports mild palpitations, and her blood pressure is 118/76 mmHg.
What is the most appropriate initial management step?
A. Perform synchronized cardioversion immediately
B. Administer adenosine 6 mg rapid IV push
C. Obtain a 12-lead ECG and establish expert consultation
D. Administer atropine 1 mg IV push
Rationale: This stable patient with a wide-complex tachycardia should have a 12-lead ECG
obtained to help differentiate ventricular tachycardia from supraventricular tachycardia with
aberrant conduction, and expert consultation should be sought. Immediate synchronized
cardioversion is reserved for unstable patients exhibiting signs of hemodynamic compromise
(altered mental status, shock, acute heart failure, or hypotension).
,3. During a resuscitation attempt for a patient in cardiac arrest, an intraosseous (IO) line is
established after peripheral IV access fails. Which medication can be safely administered
via the IO route during this resuscitation?
A. Amiodarone only
B. All standard cardiac arrest resuscitation medications
C. Vasopressors only
D. Crystalloid fluids without emergency drugs
Rationale: The intraosseous route provides access to a non-collapsible venous plexus and can
be used for the administration of all emergency drugs and fluids utilized during ACLS
resuscitation at the same dosing regimens as intravenous access.
4. A paramedic team arrives at a residence for a 45-year-old unresponsive female. The
rhythm monitor reveals pulseless electrical activity (PEA) at a rate of 38 beats per minute.
CPR is in progress, and an IV is established. What is the first drug administered in this
scenario?
A. Atropine 1 mg IV
B. Epinephrine 1 mg IV every 3 to 5 minutes
C. Amiodarone 300 mg IV
D. Sodium bicarbonate 50 mEq IV
Rationale: For non-shockable rhythms such as pulseless electrical activity and asystole,
epinephrine is the primary vasoactive drug and should be administered as soon as feasible
during resuscitation, repeated every 3 to 5 minutes. Atropine is no longer recommended for
routine use in PEA arrest.
5. A 72-year-old male is admitted with symptomatic bradycardia. His heart rate is 34 beats
per minute, blood pressure is 82/50 mmHg, and he appears lethargic and confused. What is
the initial pharmacological treatment of choice?
A. Dopamine infusion at 2 mcg/kg/min
B. Epinephrine infusion at 2 mg/min
C. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
D. Transcutaneous pacing initiated immediately without medication
, Rationale: Atropine is the first-line drug for symptomatic bradycardia. The initial dose is 1 mg
IV every 3 to 5 minutes up to a maximum dose of 3 mg. If atropine is ineffective,
transcutaneous pacing or an inotropic infusion should be initiated.
6. Following successful resuscitation from cardiac arrest, a patient remains comatose with a
blood pressure of 96/60 mmHg and a heart rate of 88 beats per minute. Which post-cardiac
arrest care intervention is recommended to optimize neurological recovery?
A. Induced normothermia targeting 39 degrees Celsius
B. Targeted temperature management maintaining a constant temperature between 32 and 36
degrees Celsius
C. Immediate administration of high-dose corticosteroids
D. Rapid rewarming within two hours of ROSC
Rationale: Targeted temperature management (TTM) is recommended for comatose adult
patients who achieve return of spontaneous circulation (ROSC) to improve long-term
neurological survival. Patients should maintain a targeted temperature between 32 and 36
degrees Celsius for at least 24 hours.
7. A telemetry technician notes that a patient in observation has developed atrial
fibrillation with rapid ventricular response at a rate of 145 beats per minute. The patient's
blood pressure is 130/80 mmHg and they report no chest pain or shortness of breath.
Which intervention is indicated first?
A. Immediate emergency synchronized cardioversion
B. Administration of medications to control heart rate, such as beta-blockers or calcium channel
blockers
C. Administration of IV epinephrine
D. Immediate transcutaneous pacing
Rationale: Hemodynamically stable patients with rapid atrial fibrillation are managed initially
with rate control using agents such as beta-blockers (e.g., metoprolol) or non-dihydropyridine
calcium channel blockers (e.g., diltiazem), rather than immediate electrical cardioversion.
8. A resuscitation team is performing CPR on an adult in cardiac arrest. An advanced
airway (supraglottic airway device) has been successfully placed. What is the appropriate
ventilation rate during ongoing chest compressions?
A. 8 to 10 breaths per minute without pausing compressions
B. 10 to 12 breaths per minute with a pause in compressions
