1
Advanced Cardiovascular Life Support (ACLS):
Comprehensive Examination – 150 Multiple-
Choice Questions Comprehensive ACLS
Examination: Evidence-Based Practice,
Algorithm Mastery, and Clinical Decision-
Making in Adult Cardiovascular Emergencies
According to the 2025 AHA Guidelines a well
detailed one written and graded
A+ upgraded
SECTION 1: CARDIAC ARREST ALGORITHM – SHOCKABLE RHYTHMS (Questions 1–20)
1. A 58-year-old man collapses suddenly in the emergency department. The monitor reveals
ventricular fibrillation. What is the immediate next step after confirming the rhythm?
A) Administer epinephrine 1 mg IV
B) Perform synchronized cardioversion at 100 J
, 2
C) Defibrillate with a biphasic defibrillator at the manufacturer-recommended energy setting
D) Begin CPR for 2 minutes before defibrillating
- detailed answer 100% correct :- C
Rationale: In witnessed cardiac arrest with a shockable rhythm, immediate defibrillation is the
priority. CPR should be started immediately but defibrillation should occur as soon as the
defibrillator is available. Epinephrine is given after the second shock or later in the algorithm,
and synchronized cardioversion is not used for pulseless rhythms.
2. In refractory ventricular fibrillation, amiodarone should be administered after which event?
A) After the first defibrillation attempt
B) After the second defibrillation attempt
C) After the third defibrillation attempt
D) Immediately upon rhythm identification
- detailed answer 100% correct :- C
Rationale: Amiodarone 300 mg IV/IO is administered after the third unsuccessful defibrillation
attempt in patients with refractory VF/pVT. The first dose is given following the third shock, with
a second dose of 150 mg if needed.
3. What is the correct initial dose of epinephrine for a patient in cardiac arrest?
A) 0.5 mg IV/IO
B) 1 mg IV/IO
C) 2 mg IV/IO
D) 0.1 mg/kg IV/IO
- detailed answer 100% correct :- B
Rationale: The standard adult dose of epinephrine in cardiac arrest is 1 mg IV/IO, repeated
every 3–5 minutes. There is no maximum dose.
4. A patient with pulseless ventricular tachycardia receives defibrillation. CPR is resumed. Two
minutes later, the rhythm check reveals persistent pVT. What is the next appropriate action?
, 3
A) Administer lidocaine 1.5 mg/kg
B) Administer amiodarone 300 mg
C) Defibrillate again and resume CPR immediately
D) Administer epinephrine 1 mg
- detailed answer 100% correct :- C
Rationale: After each rhythm check showing a shockable rhythm, the patient should receive
another defibrillation shock followed by immediate CPR for 2 minutes. Antiarrhythmics are
given after the third shock.
5. Which rhythm is considered a shockable cardiac arrest rhythm?
A) Pulseless electrical activity
B) Asystole
C) Ventricular fibrillation
D) Sinus bradycardia
- detailed answer 100% correct :- C
Rationale: Ventricular fibrillation and pulseless ventricular tachycardia are the two shockable
cardiac arrest rhythms. PEA and asystole are non-shockable rhythms.
6. After defibrillation for VF, what is the immediate next step?
A) Check for a pulse
B) Analyze the rhythm
C) Resume CPR immediately
D) Administer amiodarone
- detailed answer 100% correct :- C
Rationale: After delivering a shock, CPR should be resumed immediately for 2 minutes before
reassessing the rhythm. Pulse checks should only be performed when an organized rhythm is
observed.
7. What is the recommended chest compression depth for adult CPR?
, 4
A) 4–5 cm
B) 5–6 cm
C) 6–7 cm
D) At least 7 cm
- detailed answer 100% correct :- B
Rationale: High-quality CPR requires chest compressions at a depth of 5 to 6 cm (2 to 2.4
inches). Compression rate should be 100–120 per minute with full chest recoil.
8. A patient in cardiac arrest with VF receives three shocks and one dose of amiodarone. The
rhythm remains VF. What antiarrhythmic option is appropriate next?
A) Procainamide 20 mg/min
B) Lidocaine 1–1.5 mg/kg
C) Adenosine 6 mg rapid push
D) Atropine 1 mg
- detailed answer 100% correct :- B
Rationale: Lidocaine 1–1.5 mg/kg IV/IO is the alternative to amiodarone for refractory VF/pVT,
with repeat doses of 0.5–0.75 mg/kg every 5–10 minutes up to a maximum of 3 mg/kg.
9. Which is NOT a reversible cause (H's and T's) of cardiac arrest?
A) Hypovolemia
B) Tension pneumothorax
C) Hyperthermia
D) Cardiac tamponade
- detailed answer 100% correct :- C
Rationale: The reversible causes of cardiac arrest are the 5 H's and 5 T's: hypovolemia, hypoxia,
hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade,
toxins, thrombosis (pulmonary), and thrombosis (coronary). Hyperthermia is not included.
10. How often should rhythm checks be performed during CPR?
Advanced Cardiovascular Life Support (ACLS):
Comprehensive Examination – 150 Multiple-
Choice Questions Comprehensive ACLS
Examination: Evidence-Based Practice,
Algorithm Mastery, and Clinical Decision-
Making in Adult Cardiovascular Emergencies
According to the 2025 AHA Guidelines a well
detailed one written and graded
A+ upgraded
SECTION 1: CARDIAC ARREST ALGORITHM – SHOCKABLE RHYTHMS (Questions 1–20)
1. A 58-year-old man collapses suddenly in the emergency department. The monitor reveals
ventricular fibrillation. What is the immediate next step after confirming the rhythm?
A) Administer epinephrine 1 mg IV
B) Perform synchronized cardioversion at 100 J
, 2
C) Defibrillate with a biphasic defibrillator at the manufacturer-recommended energy setting
D) Begin CPR for 2 minutes before defibrillating
- detailed answer 100% correct :- C
Rationale: In witnessed cardiac arrest with a shockable rhythm, immediate defibrillation is the
priority. CPR should be started immediately but defibrillation should occur as soon as the
defibrillator is available. Epinephrine is given after the second shock or later in the algorithm,
and synchronized cardioversion is not used for pulseless rhythms.
2. In refractory ventricular fibrillation, amiodarone should be administered after which event?
A) After the first defibrillation attempt
B) After the second defibrillation attempt
C) After the third defibrillation attempt
D) Immediately upon rhythm identification
- detailed answer 100% correct :- C
Rationale: Amiodarone 300 mg IV/IO is administered after the third unsuccessful defibrillation
attempt in patients with refractory VF/pVT. The first dose is given following the third shock, with
a second dose of 150 mg if needed.
3. What is the correct initial dose of epinephrine for a patient in cardiac arrest?
A) 0.5 mg IV/IO
B) 1 mg IV/IO
C) 2 mg IV/IO
D) 0.1 mg/kg IV/IO
- detailed answer 100% correct :- B
Rationale: The standard adult dose of epinephrine in cardiac arrest is 1 mg IV/IO, repeated
every 3–5 minutes. There is no maximum dose.
4. A patient with pulseless ventricular tachycardia receives defibrillation. CPR is resumed. Two
minutes later, the rhythm check reveals persistent pVT. What is the next appropriate action?
, 3
A) Administer lidocaine 1.5 mg/kg
B) Administer amiodarone 300 mg
C) Defibrillate again and resume CPR immediately
D) Administer epinephrine 1 mg
- detailed answer 100% correct :- C
Rationale: After each rhythm check showing a shockable rhythm, the patient should receive
another defibrillation shock followed by immediate CPR for 2 minutes. Antiarrhythmics are
given after the third shock.
5. Which rhythm is considered a shockable cardiac arrest rhythm?
A) Pulseless electrical activity
B) Asystole
C) Ventricular fibrillation
D) Sinus bradycardia
- detailed answer 100% correct :- C
Rationale: Ventricular fibrillation and pulseless ventricular tachycardia are the two shockable
cardiac arrest rhythms. PEA and asystole are non-shockable rhythms.
6. After defibrillation for VF, what is the immediate next step?
A) Check for a pulse
B) Analyze the rhythm
C) Resume CPR immediately
D) Administer amiodarone
- detailed answer 100% correct :- C
Rationale: After delivering a shock, CPR should be resumed immediately for 2 minutes before
reassessing the rhythm. Pulse checks should only be performed when an organized rhythm is
observed.
7. What is the recommended chest compression depth for adult CPR?
, 4
A) 4–5 cm
B) 5–6 cm
C) 6–7 cm
D) At least 7 cm
- detailed answer 100% correct :- B
Rationale: High-quality CPR requires chest compressions at a depth of 5 to 6 cm (2 to 2.4
inches). Compression rate should be 100–120 per minute with full chest recoil.
8. A patient in cardiac arrest with VF receives three shocks and one dose of amiodarone. The
rhythm remains VF. What antiarrhythmic option is appropriate next?
A) Procainamide 20 mg/min
B) Lidocaine 1–1.5 mg/kg
C) Adenosine 6 mg rapid push
D) Atropine 1 mg
- detailed answer 100% correct :- B
Rationale: Lidocaine 1–1.5 mg/kg IV/IO is the alternative to amiodarone for refractory VF/pVT,
with repeat doses of 0.5–0.75 mg/kg every 5–10 minutes up to a maximum of 3 mg/kg.
9. Which is NOT a reversible cause (H's and T's) of cardiac arrest?
A) Hypovolemia
B) Tension pneumothorax
C) Hyperthermia
D) Cardiac tamponade
- detailed answer 100% correct :- C
Rationale: The reversible causes of cardiac arrest are the 5 H's and 5 T's: hypovolemia, hypoxia,
hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade,
toxins, thrombosis (pulmonary), and thrombosis (coronary). Hyperthermia is not included.
10. How often should rhythm checks be performed during CPR?
