ACLS CERTIFICATION EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
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1. A 58-year-old male collapses in the workplace. A coworker finds him unresponsive,
gasping occasionally, and without a palpable carotid pulse. The emergency response team
arrives with an AED and initiates BLS protocol. What is the immediate priority
intervention upon attaching the AED pads?
A. Administer an immediate 2 mg dose of IV epinephrine before shock delivery
B. Check for a secondary pulse at the femoral artery to confirm cardiac arrest
C. Allow the AED to analyze the cardiac rhythm and deliver a shock if advised
D. Begin synchronized cardioversion immediately at 100 joules
ANSWER: C. Allow the AED to analyze the cardiac rhythm and deliver a shock if advised
Prompt rhythm analysis by the AED is the immediate priority during the initial phase of
resuscitation for an unresponsive, pulseless adult to determine if a shockable rhythm like
ventricular fibrillation is present.
2. A paramedic team arrives to find a patient in cardiac arrest. The monitor displays
ventricular fibrillation. High-quality CPR is in progress with an advanced airway in place.
After the first shock is delivered, what is the correct sequence of actions?
A. Pause CPR for 2 minutes to reassess the rhythm on the monitor
B. Resume CPR immediately for 2 minutes and prepare to administer epinephrine
C. Check a pulse immediately without resuming chest compressions
D. Administer a synchronized shock at 200 joules immediately
ANSWER: B. Resume CPR immediately for 2 minutes and prepare to administer
epinephrine
Following a defibrillation attempt, high-quality chest compressions must be resumed
immediately for 2 minutes before the next rhythm check, while simultaneously preparing
pharmacotherapy.
,3. During a resuscitation attempt for a patient in cardiac arrest, IV access is delayed. The
team leader considers alternative routes for medication administration. Which of the
following represents the preferred alternative vascular access route when IV access is
unavailable?
A. Endotracheal tube route using half the standard IV dose
B. Subclavian central line placed during active chest compressions
C. Intraosseous (IO) access route
D. Intramuscular injection into the deltoid muscle
ANSWER: C. Intraosseous (IO) access route
Intraosseous access provides rapid, reliable systemic delivery of resuscitation drugs and fluids
when peripheral IV access cannot be rapidly established during cardiac arrest.
4. A 64-year-old female presents to the emergency department complaining of acute central
chest pressure radiating to her left arm. Her blood pressure is 118/76 mm Hg, heart rate is
88 beats per minute, and oxygen saturation is 96 percent on room air. A 12-lead ECG
reveals ST-segment elevation in leads II, III, and aVF. What is the primary operational
goal for reperfusion therapy in this patient with ST-elevation myocardial infarction?
A. Door-to-balloon time of less than 90 minutes for primary PCI
B. Immediate administration of oral beta-blockers prior to ECG review
C. Initiation of maintenance anticoagulation without reperfusion therapy
D. Waiting 4 hours for serial cardiac enzyme confirmation before treatment
ANSWER: A. Door-to-balloon time of less than 90 minutes for primary PCI
For patients with STEMI, the primary goal is prompt reperfusion, aiming for a door-to-
balloon time of under 90 minutes at a PCI-capable facility or door-to-needle time under 30
minutes for fibrinolysis if PCI is unavailable.
5. A patient in the intensive care unit becomes unresponsive and is monitored via telemetry
as showing pulseless electrical activity (PEA). The team initiates CPR. What is the
standard initial pharmacological intervention and dosing regimen for PEA during cardiac
arrest?
A. Amiodarone 300 mg IV push once
B. Epinephrine 1 mg (1:10,000) IV/IO every 3 to 5 minutes
,C. Atropine 1 mg IV push every 3 minutes up to 3 mg
D. Sodium bicarbonate 50 mEq IV push every 5 minutes
ANSWER: B. Epinephrine 1 mg (1:10,000) IV/IO every 3 to 5 minutes
Epinephrine is the primary vasopressor used in non-shockable rhythms like PEA and asystole
to increase coronary and cerebral perfusion pressure, administered every 3 to 5 minutes.
6. A 72-year-old male is evaluated for sudden-onset weakness on his right side and slurred
speech starting 45 minutes ago. His blood pressure is 172/96 mm Hg. Non-contrast head
CT reveals no evidence of intracranial hemorrhage. Which of the following interventions is
indicated next?
A. Immediate administration of IV alteplase (tPA) if inclusion criteria are met
B. Immediate discharge with outpatient physical therapy referral
C. Administration of high-dose IV heparin bolus followed by maintenance infusion
D. Observation in the emergency department for 24 hours without intervention
ANSWER: A. Immediate administration of IV alteplase (tPA) if inclusion criteria are met
For acute ischemic stroke presenting within the eligible time window with no hemorrhage on
CT, intravenous thrombolytic therapy with alteplase is the standard of care to restore cerebral
blood flow.
7. An adult patient in cardiac arrest is refractory to initial defibrillation and epinephrine
administration. The rhythm is persistent ventricular fibrillation. What is the recommended
first-line antiarrhythmic medication and initial dose?
A. Lidocaine 3 mg/kg IV push
B. Procainamide 50 mg/min infusion until suppression
C. Amiodarone 300 mg IV/IO push
D. Magnesium sulfate 2 grams IV push
ANSWER: C. Amiodarone 300 mg IV/IO push
Amiodarone is the first-line antiarrhythmic agent recommended for refractory ventricular
fibrillation or pulseless ventricular tachycardia, with a second dose of 150 mg permitted if
needed.
, 8. During resuscitation of a patient in cardiac arrest, the team leader uses closed-loop
communication and clearly assigns roles. Which of the following best exemplifies effective
closed-loop communication?
A. The leader says, "Someone grab the crash cart whenever you get a chance."
B. The leader states, "John, please administer 1 mg of epinephrine now." John replies,
"Administering 1 mg of epinephrine now."
C. The team members work in silence to minimize cognitive load in the room.
D. The leader shouts instructions across the room without looking at specific team members.
ANSWER: B. The leader states, "John, please administer 1 mg of epinephrine now." John
replies, "Administering 1 mg of epinephrine now."
Closed-loop communication involves the sender addressing a specific team member, the
receiver repeating the order back to confirm comprehension, and the sender acknowledging
completion.
9. A 45-year-old female presents with symptomatic bradycardia. Her heart rate is 36 beats
per minute, blood pressure is 82/50 mm Hg, and she reports dizziness and cool, clammy
skin. What is the initial pharmacological treatment of choice?
A. Dopamine infusion at 20 mcg/kg/min
B. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
C. Epinephrine infusion starting at 10 mcg/min
D. Transcutaneous pacing without prior drug administration
ANSWER: B. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
Atropine is the first-line drug for symptomatic acute bradycardia, functioning by enhancing
sinus node automaticity and atrioventricular conduction through vagolytic action.
10. A patient presents with stable narrow-complex tachycardia at a rate of 160 beats per
minute. Vagal maneuvers are performed without success. What is the recommended initial
medication and dose to administer?
A. Adenosine 6 mg rapid IV push with a normal saline flush
B. Verapamil 10 mg slow IV push over 2 minutes
C. Metoprolol 15 mg IV push over 5 minutes
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 collapses in the workplace. A coworker finds him unresponsive,
gasping occasionally, and without a palpable carotid pulse. The emergency response team
arrives with an AED and initiates BLS protocol. What is the immediate priority
intervention upon attaching the AED pads?
A. Administer an immediate 2 mg dose of IV epinephrine before shock delivery
B. Check for a secondary pulse at the femoral artery to confirm cardiac arrest
C. Allow the AED to analyze the cardiac rhythm and deliver a shock if advised
D. Begin synchronized cardioversion immediately at 100 joules
ANSWER: C. Allow the AED to analyze the cardiac rhythm and deliver a shock if advised
Prompt rhythm analysis by the AED is the immediate priority during the initial phase of
resuscitation for an unresponsive, pulseless adult to determine if a shockable rhythm like
ventricular fibrillation is present.
2. A paramedic team arrives to find a patient in cardiac arrest. The monitor displays
ventricular fibrillation. High-quality CPR is in progress with an advanced airway in place.
After the first shock is delivered, what is the correct sequence of actions?
A. Pause CPR for 2 minutes to reassess the rhythm on the monitor
B. Resume CPR immediately for 2 minutes and prepare to administer epinephrine
C. Check a pulse immediately without resuming chest compressions
D. Administer a synchronized shock at 200 joules immediately
ANSWER: B. Resume CPR immediately for 2 minutes and prepare to administer
epinephrine
Following a defibrillation attempt, high-quality chest compressions must be resumed
immediately for 2 minutes before the next rhythm check, while simultaneously preparing
pharmacotherapy.
,3. During a resuscitation attempt for a patient in cardiac arrest, IV access is delayed. The
team leader considers alternative routes for medication administration. Which of the
following represents the preferred alternative vascular access route when IV access is
unavailable?
A. Endotracheal tube route using half the standard IV dose
B. Subclavian central line placed during active chest compressions
C. Intraosseous (IO) access route
D. Intramuscular injection into the deltoid muscle
ANSWER: C. Intraosseous (IO) access route
Intraosseous access provides rapid, reliable systemic delivery of resuscitation drugs and fluids
when peripheral IV access cannot be rapidly established during cardiac arrest.
4. A 64-year-old female presents to the emergency department complaining of acute central
chest pressure radiating to her left arm. Her blood pressure is 118/76 mm Hg, heart rate is
88 beats per minute, and oxygen saturation is 96 percent on room air. A 12-lead ECG
reveals ST-segment elevation in leads II, III, and aVF. What is the primary operational
goal for reperfusion therapy in this patient with ST-elevation myocardial infarction?
A. Door-to-balloon time of less than 90 minutes for primary PCI
B. Immediate administration of oral beta-blockers prior to ECG review
C. Initiation of maintenance anticoagulation without reperfusion therapy
D. Waiting 4 hours for serial cardiac enzyme confirmation before treatment
ANSWER: A. Door-to-balloon time of less than 90 minutes for primary PCI
For patients with STEMI, the primary goal is prompt reperfusion, aiming for a door-to-
balloon time of under 90 minutes at a PCI-capable facility or door-to-needle time under 30
minutes for fibrinolysis if PCI is unavailable.
5. A patient in the intensive care unit becomes unresponsive and is monitored via telemetry
as showing pulseless electrical activity (PEA). The team initiates CPR. What is the
standard initial pharmacological intervention and dosing regimen for PEA during cardiac
arrest?
A. Amiodarone 300 mg IV push once
B. Epinephrine 1 mg (1:10,000) IV/IO every 3 to 5 minutes
,C. Atropine 1 mg IV push every 3 minutes up to 3 mg
D. Sodium bicarbonate 50 mEq IV push every 5 minutes
ANSWER: B. Epinephrine 1 mg (1:10,000) IV/IO every 3 to 5 minutes
Epinephrine is the primary vasopressor used in non-shockable rhythms like PEA and asystole
to increase coronary and cerebral perfusion pressure, administered every 3 to 5 minutes.
6. A 72-year-old male is evaluated for sudden-onset weakness on his right side and slurred
speech starting 45 minutes ago. His blood pressure is 172/96 mm Hg. Non-contrast head
CT reveals no evidence of intracranial hemorrhage. Which of the following interventions is
indicated next?
A. Immediate administration of IV alteplase (tPA) if inclusion criteria are met
B. Immediate discharge with outpatient physical therapy referral
C. Administration of high-dose IV heparin bolus followed by maintenance infusion
D. Observation in the emergency department for 24 hours without intervention
ANSWER: A. Immediate administration of IV alteplase (tPA) if inclusion criteria are met
For acute ischemic stroke presenting within the eligible time window with no hemorrhage on
CT, intravenous thrombolytic therapy with alteplase is the standard of care to restore cerebral
blood flow.
7. An adult patient in cardiac arrest is refractory to initial defibrillation and epinephrine
administration. The rhythm is persistent ventricular fibrillation. What is the recommended
first-line antiarrhythmic medication and initial dose?
A. Lidocaine 3 mg/kg IV push
B. Procainamide 50 mg/min infusion until suppression
C. Amiodarone 300 mg IV/IO push
D. Magnesium sulfate 2 grams IV push
ANSWER: C. Amiodarone 300 mg IV/IO push
Amiodarone is the first-line antiarrhythmic agent recommended for refractory ventricular
fibrillation or pulseless ventricular tachycardia, with a second dose of 150 mg permitted if
needed.
, 8. During resuscitation of a patient in cardiac arrest, the team leader uses closed-loop
communication and clearly assigns roles. Which of the following best exemplifies effective
closed-loop communication?
A. The leader says, "Someone grab the crash cart whenever you get a chance."
B. The leader states, "John, please administer 1 mg of epinephrine now." John replies,
"Administering 1 mg of epinephrine now."
C. The team members work in silence to minimize cognitive load in the room.
D. The leader shouts instructions across the room without looking at specific team members.
ANSWER: B. The leader states, "John, please administer 1 mg of epinephrine now." John
replies, "Administering 1 mg of epinephrine now."
Closed-loop communication involves the sender addressing a specific team member, the
receiver repeating the order back to confirm comprehension, and the sender acknowledging
completion.
9. A 45-year-old female presents with symptomatic bradycardia. Her heart rate is 36 beats
per minute, blood pressure is 82/50 mm Hg, and she reports dizziness and cool, clammy
skin. What is the initial pharmacological treatment of choice?
A. Dopamine infusion at 20 mcg/kg/min
B. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
C. Epinephrine infusion starting at 10 mcg/min
D. Transcutaneous pacing without prior drug administration
ANSWER: B. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
Atropine is the first-line drug for symptomatic acute bradycardia, functioning by enhancing
sinus node automaticity and atrioventricular conduction through vagolytic action.
10. A patient presents with stable narrow-complex tachycardia at a rate of 160 beats per
minute. Vagal maneuvers are performed without success. What is the recommended initial
medication and dose to administer?
A. Adenosine 6 mg rapid IV push with a normal saline flush
B. Verapamil 10 mg slow IV push over 2 minutes
C. Metoprolol 15 mg IV push over 5 minutes
