1
AHA ACLS ADVANCED PRACTICE EXAM ACTUAL
EXAM 2026/2027 | COMPLETE COURSE REVIEW |
100 VERIFIED Q&A | COMPLETE RATIONALES |
PASS GUARANTEED - A+ GRADED
QUESTION 1
A 62-year-old male presents with chest pain, diaphoresis, and nausea. ECG shows ST-segment elevation in
leads V1-V4. What is the most appropriate immediate intervention?
A. Administer sublingual nitroglycerin
B. Activate the STEMI protocol and prepare for emergent PCI
C. Administer morphine sulfate
D. Administer aspirin and wait for cardiology consultation
Rationale: This patient is presenting with an acute STEMI (ST-segment elevation myocardial infarction) as
evidenced by chest pain and ST elevation in leads V1-V4 (anterior wall MI). The most appropriate immediate
intervention is to activate the STEMI protocol and prepare for emergent percutaneous coronary intervention
(PCI). Time to reperfusion is critical, and door-to-balloon time should be less than 90 minutes.
QUESTION 2
During a code blue, the monitor shows ventricular fibrillation. The patient has received 2 shocks and 1 dose of
epinephrine. What is the next medication to administer?
A. Lidocaine 1 mg/kg IV push
B. Amiodarone 300 mg IV push
C. Atropine 1 mg IV push
D. Vasopressin 40 units IV push
Rationale: For refractory VF/pVT after 2 shocks and epinephrine, amiodarone 300 mg IV push is the next
medication. Amiodarone is an antiarrhythmic that stabilizes the cardiac membrane and increases the success
of defibrillation. It can be repeated with 150 mg if VF/pVT persists.
QUESTION 3
A 55-year-old female presents with palpitations, shortness of breath, and a heart rate of 150 bpm. ECG shows
narrow-complex tachycardia at 150 bpm. She is hypotensive with a blood pressure of 85/60 mmHg. What is
the most appropriate intervention?
,2
A. Administer adenosine 6 mg IV push
B. Perform synchronized cardioversion at 120-200 J
C. Administer diltiazem 20 mg IV push
D. Administer amiodarone 150 mg IV push
Rationale: This patient is unstable with narrow-complex tachycardia and hypotension. Unstable patients
require immediate synchronized cardioversion. The energy dose for biphasic cardioversion is 120-200 J.
Adenosine is used for stable narrow-complex tachycardia, not unstable patients.
QUESTION 4
A 45-year-old male is found unresponsive with no pulse. The monitor shows asystole. What is the first
priority in managing this patient?
A. Administer atropine 1 mg IV push
B. Start high-quality CPR and administer epinephrine 1 mg IV push
C. Perform transcutaneous pacing
D. Administer amiodarone 300 mg IV push
Rationale: Asystole is a non-shockable rhythm. The first priority is high-quality CPR and epinephrine 1 mg
IV push every 3-5 minutes. Atropine is no longer recommended for asystole. Transcutaneous pacing is not
recommended for asystole.
QUESTION 5
A 70-year-old male with a history of heart failure presents with bradycardia at 40 bpm, hypotension, and
confusion. What is the most appropriate initial intervention?
A. Administer dopamine 5 mcg/kg/min IV infusion
B. Administer atropine 0.5 mg IV push
C. Perform transcutaneous pacing
D. Administer epinephrine 2-10 mcg/min IV infusion
Rationale: Symptomatic bradycardia with hemodynamic compromise should be treated with atropine 0.5 mg
IV push every 3-5 minutes (maximum 3 mg). Atropine blocks vagal tone and increases heart rate.
Transcutaneous pacing and vasopressors are used if atropine is ineffective.
QUESTION 6
A 48-year-old female with a history of opioid use disorder is found unresponsive with slow, shallow
respirations and a pulse. What is the most appropriate initial intervention?
A. Administer flumazenil 0.2 mg IV
B. Administer naloxone 2 mg IN
,3
C. Start CPR
D. Administer oxygen at 15 L/min
Rationale: This patient is showing signs of opioid overdose with respiratory depression. Naloxone 2 mg IN
(intranasal) or 0.4-2 mg IV/IM is the appropriate initial intervention. Naloxone rapidly reverses opioid-
induced respiratory depression.
QUESTION 7
A 60-year-old male is in cardiac arrest. The monitor shows pulseless electrical activity (PEA). Which of the
following should be considered as a reversible cause?
A. Ventricular fibrillation
B. Hypovolemia
C. Tachycardia
D. Bradycardia
Rationale: PEA has many reversible causes, often remembered as the "H's and T's." Hypovolemia is one of the
most common reversible causes of PEA. Other reversible causes include hypoxia, hypothermia, tension
pneumothorax, cardiac tamponade, and hyperkalemia.
QUESTION 8
A 52-year-old male presents with acute onset of severe headache, nausea, and right-sided weakness. The FAST
exam reveals facial droop, arm drift, and speech difficulty. What is the most appropriate immediate
intervention?
A. Administer IV alteplase (tPA)
B. Activate the stroke team and obtain a STAT CT head scan
C. Administer aspirin 324 mg chewed
D. Administer heparin 60 units/kg IV bolus
Rationale: This patient is presenting with an acute stroke. The immediate priority is to activate the stroke
team and obtain a STAT CT head scan to differentiate between ischemic and hemorrhagic stroke. IV alteplase
(tPA) is given only for ischemic stroke within 4.5 hours and after CT confirmation.
QUESTION 9
A 65-year-old female presents with chest pain, shortness of breath, and hypotension. ECG shows ST-segment
depression in leads II, III, and aVF. What is the most appropriate diagnosis?
A. STEMI
B. NSTEMI
, 4
C. Unstable angina
D. Aortic dissection
Rationale: ST-segment depression with chest pain and hypotension suggests NSTEMI (non-ST-elevation
myocardial infarction). NSTEMI is diagnosed by ST depression and elevated troponin levels. Treatment
includes antiplatelet therapy, anticoagulation, and consideration of PCI.
QUESTION 10
A 55-year-old male is in cardiac arrest. The monitor shows VF. The patient has received 3 shocks, 1 mg
epinephrine, and 300 mg amiodarone. VF persists. What is the next step?
A. Administer lidocaine 1-1.5 mg/kg IV push
B. Continue CPR, administer epinephrine 1 mg IV push, and consider additional amiodarone 150 mg
IV push
C. Administer atropine 1 mg IV push
D. Perform transcutaneous pacing
Rationale: For refractory VF, continue high-quality CPR, administer epinephrine every 3-5 minutes, and
consider a repeat dose of amiodarone 150 mg IV push. Lidocaine is an alternative to amiodarone but is not the
first-line treatment.
QUESTION 11
A 60-year-old male with a history of COPD presents with respiratory distress, confusion, and a respiratory
rate of 8/min. What is the most appropriate immediate intervention?
A. Administer albuterol nebulizer
B. Provide bag-valve-mask ventilation with 100% oxygen
C. Administer methylprednisolone 125 mg IV push
D. Administer morphine sulfate 2 mg IV push
Rationale: This patient is in respiratory failure with a respiratory rate of 8/min, confusion, and signs of
hypoxia. Bag-valve-mask ventilation with 100% oxygen is the most appropriate immediate intervention to
provide ventilatory support and oxygenation while the underlying cause is addressed.
QUESTION 12
A 68-year-old female presents with palpitations, chest discomfort, and a heart rate of 180 bpm. ECG shows
wide-complex tachycardia at 180 bpm. She is stable with a blood pressure of 110/70 mmHg. What is the most
appropriate intervention?
A. Perform synchronized cardioversion at 100 J
B. Administer amiodarone 150 mg IV over 10 minutes
AHA ACLS ADVANCED PRACTICE EXAM ACTUAL
EXAM 2026/2027 | COMPLETE COURSE REVIEW |
100 VERIFIED Q&A | COMPLETE RATIONALES |
PASS GUARANTEED - A+ GRADED
QUESTION 1
A 62-year-old male presents with chest pain, diaphoresis, and nausea. ECG shows ST-segment elevation in
leads V1-V4. What is the most appropriate immediate intervention?
A. Administer sublingual nitroglycerin
B. Activate the STEMI protocol and prepare for emergent PCI
C. Administer morphine sulfate
D. Administer aspirin and wait for cardiology consultation
Rationale: This patient is presenting with an acute STEMI (ST-segment elevation myocardial infarction) as
evidenced by chest pain and ST elevation in leads V1-V4 (anterior wall MI). The most appropriate immediate
intervention is to activate the STEMI protocol and prepare for emergent percutaneous coronary intervention
(PCI). Time to reperfusion is critical, and door-to-balloon time should be less than 90 minutes.
QUESTION 2
During a code blue, the monitor shows ventricular fibrillation. The patient has received 2 shocks and 1 dose of
epinephrine. What is the next medication to administer?
A. Lidocaine 1 mg/kg IV push
B. Amiodarone 300 mg IV push
C. Atropine 1 mg IV push
D. Vasopressin 40 units IV push
Rationale: For refractory VF/pVT after 2 shocks and epinephrine, amiodarone 300 mg IV push is the next
medication. Amiodarone is an antiarrhythmic that stabilizes the cardiac membrane and increases the success
of defibrillation. It can be repeated with 150 mg if VF/pVT persists.
QUESTION 3
A 55-year-old female presents with palpitations, shortness of breath, and a heart rate of 150 bpm. ECG shows
narrow-complex tachycardia at 150 bpm. She is hypotensive with a blood pressure of 85/60 mmHg. What is
the most appropriate intervention?
,2
A. Administer adenosine 6 mg IV push
B. Perform synchronized cardioversion at 120-200 J
C. Administer diltiazem 20 mg IV push
D. Administer amiodarone 150 mg IV push
Rationale: This patient is unstable with narrow-complex tachycardia and hypotension. Unstable patients
require immediate synchronized cardioversion. The energy dose for biphasic cardioversion is 120-200 J.
Adenosine is used for stable narrow-complex tachycardia, not unstable patients.
QUESTION 4
A 45-year-old male is found unresponsive with no pulse. The monitor shows asystole. What is the first
priority in managing this patient?
A. Administer atropine 1 mg IV push
B. Start high-quality CPR and administer epinephrine 1 mg IV push
C. Perform transcutaneous pacing
D. Administer amiodarone 300 mg IV push
Rationale: Asystole is a non-shockable rhythm. The first priority is high-quality CPR and epinephrine 1 mg
IV push every 3-5 minutes. Atropine is no longer recommended for asystole. Transcutaneous pacing is not
recommended for asystole.
QUESTION 5
A 70-year-old male with a history of heart failure presents with bradycardia at 40 bpm, hypotension, and
confusion. What is the most appropriate initial intervention?
A. Administer dopamine 5 mcg/kg/min IV infusion
B. Administer atropine 0.5 mg IV push
C. Perform transcutaneous pacing
D. Administer epinephrine 2-10 mcg/min IV infusion
Rationale: Symptomatic bradycardia with hemodynamic compromise should be treated with atropine 0.5 mg
IV push every 3-5 minutes (maximum 3 mg). Atropine blocks vagal tone and increases heart rate.
Transcutaneous pacing and vasopressors are used if atropine is ineffective.
QUESTION 6
A 48-year-old female with a history of opioid use disorder is found unresponsive with slow, shallow
respirations and a pulse. What is the most appropriate initial intervention?
A. Administer flumazenil 0.2 mg IV
B. Administer naloxone 2 mg IN
,3
C. Start CPR
D. Administer oxygen at 15 L/min
Rationale: This patient is showing signs of opioid overdose with respiratory depression. Naloxone 2 mg IN
(intranasal) or 0.4-2 mg IV/IM is the appropriate initial intervention. Naloxone rapidly reverses opioid-
induced respiratory depression.
QUESTION 7
A 60-year-old male is in cardiac arrest. The monitor shows pulseless electrical activity (PEA). Which of the
following should be considered as a reversible cause?
A. Ventricular fibrillation
B. Hypovolemia
C. Tachycardia
D. Bradycardia
Rationale: PEA has many reversible causes, often remembered as the "H's and T's." Hypovolemia is one of the
most common reversible causes of PEA. Other reversible causes include hypoxia, hypothermia, tension
pneumothorax, cardiac tamponade, and hyperkalemia.
QUESTION 8
A 52-year-old male presents with acute onset of severe headache, nausea, and right-sided weakness. The FAST
exam reveals facial droop, arm drift, and speech difficulty. What is the most appropriate immediate
intervention?
A. Administer IV alteplase (tPA)
B. Activate the stroke team and obtain a STAT CT head scan
C. Administer aspirin 324 mg chewed
D. Administer heparin 60 units/kg IV bolus
Rationale: This patient is presenting with an acute stroke. The immediate priority is to activate the stroke
team and obtain a STAT CT head scan to differentiate between ischemic and hemorrhagic stroke. IV alteplase
(tPA) is given only for ischemic stroke within 4.5 hours and after CT confirmation.
QUESTION 9
A 65-year-old female presents with chest pain, shortness of breath, and hypotension. ECG shows ST-segment
depression in leads II, III, and aVF. What is the most appropriate diagnosis?
A. STEMI
B. NSTEMI
, 4
C. Unstable angina
D. Aortic dissection
Rationale: ST-segment depression with chest pain and hypotension suggests NSTEMI (non-ST-elevation
myocardial infarction). NSTEMI is diagnosed by ST depression and elevated troponin levels. Treatment
includes antiplatelet therapy, anticoagulation, and consideration of PCI.
QUESTION 10
A 55-year-old male is in cardiac arrest. The monitor shows VF. The patient has received 3 shocks, 1 mg
epinephrine, and 300 mg amiodarone. VF persists. What is the next step?
A. Administer lidocaine 1-1.5 mg/kg IV push
B. Continue CPR, administer epinephrine 1 mg IV push, and consider additional amiodarone 150 mg
IV push
C. Administer atropine 1 mg IV push
D. Perform transcutaneous pacing
Rationale: For refractory VF, continue high-quality CPR, administer epinephrine every 3-5 minutes, and
consider a repeat dose of amiodarone 150 mg IV push. Lidocaine is an alternative to amiodarone but is not the
first-line treatment.
QUESTION 11
A 60-year-old male with a history of COPD presents with respiratory distress, confusion, and a respiratory
rate of 8/min. What is the most appropriate immediate intervention?
A. Administer albuterol nebulizer
B. Provide bag-valve-mask ventilation with 100% oxygen
C. Administer methylprednisolone 125 mg IV push
D. Administer morphine sulfate 2 mg IV push
Rationale: This patient is in respiratory failure with a respiratory rate of 8/min, confusion, and signs of
hypoxia. Bag-valve-mask ventilation with 100% oxygen is the most appropriate immediate intervention to
provide ventilatory support and oxygenation while the underlying cause is addressed.
QUESTION 12
A 68-year-old female presents with palpitations, chest discomfort, and a heart rate of 180 bpm. ECG shows
wide-complex tachycardia at 180 bpm. She is stable with a blood pressure of 110/70 mmHg. What is the most
appropriate intervention?
A. Perform synchronized cardioversion at 100 J
B. Administer amiodarone 150 mg IV over 10 minutes
