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AHA Advanced Cardiovascular Life Support
(ACLS) Final Exam 2026/2027 | Latest Verified
Questions and Detailed Answers
OVERVIEW DESCRIPTION:
This comprehensive set of multiple choice questions is designed for the Advanced
Cardiovascular Life Support (ACLS) Final Exam, a rigorous, scenario-based assessment that
evaluates healthcare providers’ ability to manage cardiovascular emergencies according to the
latest American Heart Association (AHA) guidelines. The exam assesses systematic approach,
algorithm implementation, and pharmacology for resuscitation, covering core cases from cardiac
arrest management (VF/pVT, PEA, asystole), bradycardia and tachycardia algorithms, acute
coronary syndromes, stroke, post-cardiac arrest care, rhythm recognition, high-quality CPR,
team dynamics, and the identification and treatment of reversible causes (Hs and Ts). It is
administered by the American Heart Association (AHA).
QUESTION 1
A 68-year-old man collapses in the emergency department with witnessed ventricular
fibrillation on the monitor. High-quality CPR is in progress. What is the immediate next
step?
A. Administer epinephrine 1 mg IV
B. Defibrillate with 200 J biphasic
C. Insert an endotracheal tube
D. Give amiodarone 300 mg IV
CORRECT ANSWER: B
EXPERT RATIONALE: In witnessed VF/pVT, defibrillation is the priority intervention. CPR
should be performed until the defibrillator is ready, then a shock delivered without
delay.
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QUESTION 2
A 55-year-old patient in the ICU develops pulseless ventricular tachycardia. After the
first shock and 2 minutes of CPR, the rhythm remains VT with no pulse. What medication
should be administered now?
A. Atropine 1 mg IV
B. Amiodarone 300 mg IV
C. Epinephrine 1 mg IV
D. Adenosine 6 mg IV
CORRECT ANSWER: C
EXPERT RATIONALE: Epinephrine 1 mg IV/IO is given as soon as possible after the first
shock. Amiodarone is reserved for after the second shock in shock-refractory VF/pVT.
QUESTION 3
A patient with symptomatic bradycardia has a heart rate of 34 bpm, blood pressure
78/48 mmHg, and is confused. The rhythm shows sinus bradycardia. What is the first-
line drug?
A. Dopamine infusion 10 mcg/kg/min
B. Atropine 0.5 mg IV
C. Epinephrine infusion 1 mcg/min
D. Transcutaneous pacing
CORRECT ANSWER: B
EXPERT RATIONALE: Atropine 0.5 mg IV every 3-5 minutes (max 3 mg) is the initial drug
for symptomatic bradycardia. Pacing is used if atropine fails or if the patient has high-
degree AV block.
QUESTION 4
A 72-year-old presents with chest pain and an ECG showing ST-segment elevation in
leads II, III, and aVF. Vital signs are stable. What is the most appropriate immediate
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intervention?
A. Start a nitroglycerin infusion
B. Administer morphine 4 mg IV
C. Activate the cardiac catheterization laboratory for primary PCI
D. Perform synchronized cardioversion
CORRECT ANSWER: C
EXPERT RATIONALE: STEMI with stable vitals requires immediate reperfusion via primary
PCI or fibrinolysis if PCI is not available within 120 minutes. Early cath lab activation is
critical.
QUESTION 5
During a cardiac arrest, a team member is ventilating with a bag-mask device. The end-
tidal CO₂ (ETCO₂) value is consistently 8 mmHg despite high-quality compressions. What
does this finding most likely indicate?
A. Severe hyperventilation
B. Effective compressions generating high cardiac output
C. Poor-quality chest compressions or inadequate cardiac output
D. Return of spontaneous circulation
CORRECT ANSWER: C
EXPERT RATIONALE: Low ETCO₂ (<10 mmHg) during CPR suggests poor cardiac output
due to inadequate compressions or a non-shockable rhythm. ROSC typically causes a
rapid rise in ETCO₂.
QUESTION 6
A 45-year-old woman in the cardiac care unit suddenly becomes unresponsive. The
monitor shows a regular wide-complex tachycardia at 200 bpm. She has a faint pulse
and blood pressure of 70 mmHg systolic. She is diaphoretic. What is the immediate
management?
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A. Amiodarone 150 mg IV over 10 minutes
B. Synchronized cardioversion
C. Adenosine 6 mg rapid IV push
D. Defibrillation
CORRECT ANSWER: B
EXPERT RATIONALE: Unstable tachycardia with a pulse (hypotension, altered
consciousness, shock) requires immediate synchronized cardioversion. Defibrillation is
only for pulseless VT/VF.
QUESTION 7
A patient with pulseless electrical activity (PEA) is being resuscitated. CPR is ongoing,
and an IV has been established. After identifying the rhythm as PEA, what is the most
appropriate next step?
A. Administer epinephrine 1 mg IV immediately
B. Search for reversible causes (Hs and Ts)
C. Shock with 200 J
D. Insert an advanced airway
CORRECT ANSWER: A
EXPERT RATIONALE: In PEA/asystole, epinephrine 1 mg IV/IO is given as soon as
possible after rhythm check while simultaneously addressing reversible causes. No shock
is indicated.
QUESTION 8
A patient in cardiac arrest has an initial rhythm of asystole. After 2 minutes of CPR and
epinephrine, the monitor now shows fine ventricular fibrillation. What should you do?
A. Continue CPR and give amiodarone
B. Deliver a shock
C. Administer atropine 0.5 mg
AHA Advanced Cardiovascular Life Support
(ACLS) Final Exam 2026/2027 | Latest Verified
Questions and Detailed Answers
OVERVIEW DESCRIPTION:
This comprehensive set of multiple choice questions is designed for the Advanced
Cardiovascular Life Support (ACLS) Final Exam, a rigorous, scenario-based assessment that
evaluates healthcare providers’ ability to manage cardiovascular emergencies according to the
latest American Heart Association (AHA) guidelines. The exam assesses systematic approach,
algorithm implementation, and pharmacology for resuscitation, covering core cases from cardiac
arrest management (VF/pVT, PEA, asystole), bradycardia and tachycardia algorithms, acute
coronary syndromes, stroke, post-cardiac arrest care, rhythm recognition, high-quality CPR,
team dynamics, and the identification and treatment of reversible causes (Hs and Ts). It is
administered by the American Heart Association (AHA).
QUESTION 1
A 68-year-old man collapses in the emergency department with witnessed ventricular
fibrillation on the monitor. High-quality CPR is in progress. What is the immediate next
step?
A. Administer epinephrine 1 mg IV
B. Defibrillate with 200 J biphasic
C. Insert an endotracheal tube
D. Give amiodarone 300 mg IV
CORRECT ANSWER: B
EXPERT RATIONALE: In witnessed VF/pVT, defibrillation is the priority intervention. CPR
should be performed until the defibrillator is ready, then a shock delivered without
delay.
,2|Page
QUESTION 2
A 55-year-old patient in the ICU develops pulseless ventricular tachycardia. After the
first shock and 2 minutes of CPR, the rhythm remains VT with no pulse. What medication
should be administered now?
A. Atropine 1 mg IV
B. Amiodarone 300 mg IV
C. Epinephrine 1 mg IV
D. Adenosine 6 mg IV
CORRECT ANSWER: C
EXPERT RATIONALE: Epinephrine 1 mg IV/IO is given as soon as possible after the first
shock. Amiodarone is reserved for after the second shock in shock-refractory VF/pVT.
QUESTION 3
A patient with symptomatic bradycardia has a heart rate of 34 bpm, blood pressure
78/48 mmHg, and is confused. The rhythm shows sinus bradycardia. What is the first-
line drug?
A. Dopamine infusion 10 mcg/kg/min
B. Atropine 0.5 mg IV
C. Epinephrine infusion 1 mcg/min
D. Transcutaneous pacing
CORRECT ANSWER: B
EXPERT RATIONALE: Atropine 0.5 mg IV every 3-5 minutes (max 3 mg) is the initial drug
for symptomatic bradycardia. Pacing is used if atropine fails or if the patient has high-
degree AV block.
QUESTION 4
A 72-year-old presents with chest pain and an ECG showing ST-segment elevation in
leads II, III, and aVF. Vital signs are stable. What is the most appropriate immediate
,3|Page
intervention?
A. Start a nitroglycerin infusion
B. Administer morphine 4 mg IV
C. Activate the cardiac catheterization laboratory for primary PCI
D. Perform synchronized cardioversion
CORRECT ANSWER: C
EXPERT RATIONALE: STEMI with stable vitals requires immediate reperfusion via primary
PCI or fibrinolysis if PCI is not available within 120 minutes. Early cath lab activation is
critical.
QUESTION 5
During a cardiac arrest, a team member is ventilating with a bag-mask device. The end-
tidal CO₂ (ETCO₂) value is consistently 8 mmHg despite high-quality compressions. What
does this finding most likely indicate?
A. Severe hyperventilation
B. Effective compressions generating high cardiac output
C. Poor-quality chest compressions or inadequate cardiac output
D. Return of spontaneous circulation
CORRECT ANSWER: C
EXPERT RATIONALE: Low ETCO₂ (<10 mmHg) during CPR suggests poor cardiac output
due to inadequate compressions or a non-shockable rhythm. ROSC typically causes a
rapid rise in ETCO₂.
QUESTION 6
A 45-year-old woman in the cardiac care unit suddenly becomes unresponsive. The
monitor shows a regular wide-complex tachycardia at 200 bpm. She has a faint pulse
and blood pressure of 70 mmHg systolic. She is diaphoretic. What is the immediate
management?
, 4|Page
A. Amiodarone 150 mg IV over 10 minutes
B. Synchronized cardioversion
C. Adenosine 6 mg rapid IV push
D. Defibrillation
CORRECT ANSWER: B
EXPERT RATIONALE: Unstable tachycardia with a pulse (hypotension, altered
consciousness, shock) requires immediate synchronized cardioversion. Defibrillation is
only for pulseless VT/VF.
QUESTION 7
A patient with pulseless electrical activity (PEA) is being resuscitated. CPR is ongoing,
and an IV has been established. After identifying the rhythm as PEA, what is the most
appropriate next step?
A. Administer epinephrine 1 mg IV immediately
B. Search for reversible causes (Hs and Ts)
C. Shock with 200 J
D. Insert an advanced airway
CORRECT ANSWER: A
EXPERT RATIONALE: In PEA/asystole, epinephrine 1 mg IV/IO is given as soon as
possible after rhythm check while simultaneously addressing reversible causes. No shock
is indicated.
QUESTION 8
A patient in cardiac arrest has an initial rhythm of asystole. After 2 minutes of CPR and
epinephrine, the monitor now shows fine ventricular fibrillation. What should you do?
A. Continue CPR and give amiodarone
B. Deliver a shock
C. Administer atropine 0.5 mg
