American Heart Association ACLS Provider Exam (pdf) | 2026/2027 |
Certification Q&A | Advanced Cardiac Life Support
1. A 62-year-old male presents with acute chest pain and shortness of
breath. His ECG shows ST-segment elevation in leads V1-V4. What is the
most appropriate initial therapy for this patient?
A) Administer aspirin and sublingual nitroglycerin
B) Administer aspirin and arrange for emergent percutaneous coronary
intervention (PCI)
C) Administer oxygen via non-rebreather mask and morphine
D) Administer fibrinolytic therapy
Correct Answer: Administer aspirin and arrange for emergent percutaneous
coronary intervention (PCI)
Rationale: This patient is experiencing an ST-segment elevation myocardial
infarction (STEMI). The immediate goal is reperfusion. PCI is the preferred
reperfusion strategy when it can be performed within 120 minutes of first
medical contact. Aspirin is a critical initial therapy to reduce mortality.
Oxygen should be given if SpO2 is <90%, and morphine may be used for
pain, but neither is the most appropriate initial therapy compared to
reperfusion.
2. You are leading a resuscitation attempt for a patient in pulseless
ventricular tachycardia (pVT). The rhythm is refractory to defibrillation. After
epinephrine administration, which antiarrhythmic medication is
recommended?
A) Amiodarone
B) Lidocaine
C) Magnesium sulfate
D) Procainamide
,Correct Answer: Amiodarone
Rationale: For refractory pulseless ventricular tachycardia (pVT) or
ventricular fibrillation (VF), amiodarone is the first-line antiarrhythmic
medication. The recommended initial dose is 300 mg IV/IO push, followed by
a second dose of 150 mg IV/IO if needed. Lidocaine is a second-line option.
3. A 55-year-old patient presents with a slow, irregular heart rhythm on the
monitor. The patient is symptomatic with chest pain and shortness of breath.
The heart rate is 42 bpm, and the blood pressure is 88/56 mmHg. What is the
most appropriate initial treatment?
A) Atropine 0.5 mg IV push
B) Dopamine infusion
C) Transcutaneous pacing
D) Epinephrine 1 mg IV push
Correct Answer: Transcutaneous pacing
Rationale: This patient is experiencing symptomatic bradycardia with signs of
hemodynamic instability (hypotension, chest pain). In unstable bradycardia,
transcutaneous pacing is the recommended initial treatment. Atropine may
be attempted if pacing is not immediately available, but pacing is the
definitive treatment for unstable bradycardia.
4. What is the minimum passing score required for the AHA ACLS Provider
written examination?
A) 70%
B) 75%
C) 80%
D) 84%
,Correct Answer: 84%
Rationale: To successfully complete the AHA ACLS Provider Course,
participants must achieve a minimum score of 84% on the written multiple-
choice examination.
5. Which of the following is the correct first step in the systematic approach
to a cardiopulmonary emergency?
A) Primary assessment (ABCs)
B) Activate the emergency response system
C) Perform a rapid secondary assessment
D) Check for responsiveness and breathing
Correct Answer: Check for responsiveness and breathing
Rationale: The systematic approach begins by checking for responsiveness
and breathing. If the patient is unresponsive and not breathing normally (or
only gasping), the emergency response system should be activated, and CPR
should be initiated. This is the foundational step of the BLS and ACLS
algorithms.
6. A 45-year-old man is found unresponsive with no pulse. The cardiac
monitor reveals asystole. What is the appropriate sequence of actions after
initiating high-quality CPR?
A) Administer epinephrine 1 mg IV/IO as soon as possible, then every 3-5
minutes
B) Administer atropine 1 mg IV/IO, followed by epinephrine
C) Perform a pulse check every 2 minutes and administer epinephrine only if
a rhythm change occurs
, D) Administer a single shock and then resume CPR
Correct Answer: Administer epinephrine 1 mg IV/IO as soon as possible, then
every 3-5 minutes
Rationale: In asystole, the treatment is high-quality CPR and epinephrine.
Epinephrine 1 mg IV/IO should be administered as soon as possible and
repeated every 3-5 minutes. Atropine is no longer recommended for asystole
or PEA in the ACLS algorithms.
7. You are caring for a patient with a heart rate of 150 bpm, regular, narrow
QRS complex, and a blood pressure of 100/70 mmHg. The patient is
asymptomatic. What is the most appropriate initial management?
A) Immediate synchronized cardioversion
B) Adenosine 6 mg IV rapid push
C) Vagal maneuvers
D) Observation and monitoring
Correct Answer: Vagal maneuvers
Rationale: This patient has a stable narrow-complex tachycardia (likely
supraventricular tachycardia). For stable patients, vagal maneuvers are the
first-line intervention. If vagal maneuvers are unsuccessful, adenosine may
be administered. Synchronized cardioversion is reserved for unstable
patients.
8. A patient in cardiac arrest has an advanced airway in place. Two rescuers
are performing CPR. What is the appropriate compression-to-ventilation
ratio?
A) 30:2
B) 15:2
Certification Q&A | Advanced Cardiac Life Support
1. A 62-year-old male presents with acute chest pain and shortness of
breath. His ECG shows ST-segment elevation in leads V1-V4. What is the
most appropriate initial therapy for this patient?
A) Administer aspirin and sublingual nitroglycerin
B) Administer aspirin and arrange for emergent percutaneous coronary
intervention (PCI)
C) Administer oxygen via non-rebreather mask and morphine
D) Administer fibrinolytic therapy
Correct Answer: Administer aspirin and arrange for emergent percutaneous
coronary intervention (PCI)
Rationale: This patient is experiencing an ST-segment elevation myocardial
infarction (STEMI). The immediate goal is reperfusion. PCI is the preferred
reperfusion strategy when it can be performed within 120 minutes of first
medical contact. Aspirin is a critical initial therapy to reduce mortality.
Oxygen should be given if SpO2 is <90%, and morphine may be used for
pain, but neither is the most appropriate initial therapy compared to
reperfusion.
2. You are leading a resuscitation attempt for a patient in pulseless
ventricular tachycardia (pVT). The rhythm is refractory to defibrillation. After
epinephrine administration, which antiarrhythmic medication is
recommended?
A) Amiodarone
B) Lidocaine
C) Magnesium sulfate
D) Procainamide
,Correct Answer: Amiodarone
Rationale: For refractory pulseless ventricular tachycardia (pVT) or
ventricular fibrillation (VF), amiodarone is the first-line antiarrhythmic
medication. The recommended initial dose is 300 mg IV/IO push, followed by
a second dose of 150 mg IV/IO if needed. Lidocaine is a second-line option.
3. A 55-year-old patient presents with a slow, irregular heart rhythm on the
monitor. The patient is symptomatic with chest pain and shortness of breath.
The heart rate is 42 bpm, and the blood pressure is 88/56 mmHg. What is the
most appropriate initial treatment?
A) Atropine 0.5 mg IV push
B) Dopamine infusion
C) Transcutaneous pacing
D) Epinephrine 1 mg IV push
Correct Answer: Transcutaneous pacing
Rationale: This patient is experiencing symptomatic bradycardia with signs of
hemodynamic instability (hypotension, chest pain). In unstable bradycardia,
transcutaneous pacing is the recommended initial treatment. Atropine may
be attempted if pacing is not immediately available, but pacing is the
definitive treatment for unstable bradycardia.
4. What is the minimum passing score required for the AHA ACLS Provider
written examination?
A) 70%
B) 75%
C) 80%
D) 84%
,Correct Answer: 84%
Rationale: To successfully complete the AHA ACLS Provider Course,
participants must achieve a minimum score of 84% on the written multiple-
choice examination.
5. Which of the following is the correct first step in the systematic approach
to a cardiopulmonary emergency?
A) Primary assessment (ABCs)
B) Activate the emergency response system
C) Perform a rapid secondary assessment
D) Check for responsiveness and breathing
Correct Answer: Check for responsiveness and breathing
Rationale: The systematic approach begins by checking for responsiveness
and breathing. If the patient is unresponsive and not breathing normally (or
only gasping), the emergency response system should be activated, and CPR
should be initiated. This is the foundational step of the BLS and ACLS
algorithms.
6. A 45-year-old man is found unresponsive with no pulse. The cardiac
monitor reveals asystole. What is the appropriate sequence of actions after
initiating high-quality CPR?
A) Administer epinephrine 1 mg IV/IO as soon as possible, then every 3-5
minutes
B) Administer atropine 1 mg IV/IO, followed by epinephrine
C) Perform a pulse check every 2 minutes and administer epinephrine only if
a rhythm change occurs
, D) Administer a single shock and then resume CPR
Correct Answer: Administer epinephrine 1 mg IV/IO as soon as possible, then
every 3-5 minutes
Rationale: In asystole, the treatment is high-quality CPR and epinephrine.
Epinephrine 1 mg IV/IO should be administered as soon as possible and
repeated every 3-5 minutes. Atropine is no longer recommended for asystole
or PEA in the ACLS algorithms.
7. You are caring for a patient with a heart rate of 150 bpm, regular, narrow
QRS complex, and a blood pressure of 100/70 mmHg. The patient is
asymptomatic. What is the most appropriate initial management?
A) Immediate synchronized cardioversion
B) Adenosine 6 mg IV rapid push
C) Vagal maneuvers
D) Observation and monitoring
Correct Answer: Vagal maneuvers
Rationale: This patient has a stable narrow-complex tachycardia (likely
supraventricular tachycardia). For stable patients, vagal maneuvers are the
first-line intervention. If vagal maneuvers are unsuccessful, adenosine may
be administered. Synchronized cardioversion is reserved for unstable
patients.
8. A patient in cardiac arrest has an advanced airway in place. Two rescuers
are performing CPR. What is the appropriate compression-to-ventilation
ratio?
A) 30:2
B) 15:2
