ACLS PROVIDER FINAL EXAM – QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 58-year-old man collapses in the cardiac catheterization laboratory. The monitor
displays ventricular fibrillation. CPR is initiated immediately, and a defibrillator is
brought to the bedside. What is the immediate next step in management?
A. Administer 1 mg of epinephrine IV push
B. Deliver a single asynchronous shock
C. Perform synchronized cardioversion at 100 joules
D. Insert an advanced airway prior to rhythm analysis
Answer: B
In cases of cardiac arrest caused by ventricular fibrillation or pulseless ventricular
tachycardia, the priority intervention after initiating high-quality CPR is the immediate
delivery of a single unsynchronized defibrillation shock, followed by the immediate resumption
of CPR.
2. A paramedic team responds to a 65-year-old female complaining of sudden onset central
chest pressure radiating to her left jaw. Her blood pressure is 110/70 mmHg, heart rate is
88 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is
96% on room air. A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Which intervention should be prioritized?
A. Administration of sublingual nitroglycerin regardless of blood pressure trends
B. Immediate transport to a PCI-capable facility for primary percutaneous coronary intervention
C. Initiation of an intravenous beta-blocker infusion prior to reperfusion therapy
D. Administration of routine prophylactic antiarrhythmic medications
Answer: B
Patients presenting with ST-segment elevation myocardial infarction (STEMI) require rapid
triage and transportation to a percutaneous coronary intervention (PCI)-capable hospital for
primary reperfusion therapy, ideally within a door-to-balloon time of less than 90 minutes.
3. A 45-year-old male is brought to the emergency department following an acute overdose
of tricyclic antidepressants. He is lethargic, hypotensive, and the ECG shows a wide QRS
complex of 140 milliseconds. Which pharmacologic agent is indicated to treat the widening
QRS interval?
A. Sodium bicarbonate IV bolus
,B. Calcium channel blocker infusion
C. Regular insulin with dextrose
D. Intravenous beta-blocker therapy
Answer: A
Sodium bicarbonate alkalinizes the serum and increases extracellular sodium concentration,
which helps overcome the fast sodium channel blockade induced by tricyclic antidepressants
and narrows the QRS duration.
4. During the resuscitation of a patient in cardiac arrest, the team leader notes the end-tidal
carbon dioxide (ETCO2) reading has suddenly increased from 12 mmHg to 38 mmHg.
What is the most likely clinical significance of this change?
A. Worsening hyperventilation by the bag-mask operator
B. Return of spontaneous circulation (ROSC)
C. Impending endotracheal tube dislodgement into the esophagus
D. Complete exhaustion of chest compression quality
Answer: B
A sudden and sustained increase in end-tidal carbon dioxide (ETCO2) during resuscitation—
typically to values of 35 mmHg or greater—is a primary physiological indicator of the return
of spontaneous circulation (ROSC), reflecting improved pulmonary blood flow.
5. A 72-year-old female presents with symptomatic bradycardia. Her heart rate is 34 beats
per minute, blood pressure is 78/48 mmHg, and she reports acute dizziness and shortness
of breath. Initial transcutaneous pacing is established, but she remains hemodynamically
unstable. What pharmacologic therapy should be administered next?
A. Atropine 1 mg IV push repeated every 3 to 5 minutes up to 3 mg total
B. Dopamine infusion titrated from 2 to 20 mcg/kg per minute
C. Amiodarone 150 mg IV over 10 minutes
D. Adenosine 6 mg rapid IV push
Answer: B
When transcutaneous pacing fails to stabilize a patient with symptomatic bradycardia,
continuous infusions of vasoactive medications such as dopamine or epinephrine are
indicated to support heart rate and blood pressure while identifying reversible causes.
6. An adult patient in the intensive care unit experiences sudden pulseless electrical activity
(PEA). High-quality CPR is immediately initiated, and an intravenous line is secured.
What is the correct timing for administering the first dose of epinephrine?
A. Administer immediately after rhythm confirmation, then repeat every 3 to 5 minutes
, B. Withhold epinephrine until after three unsuccessful defibrillation attempts
C. Administer only if the rhythm transitions to ventricular fibrillation
D. Delay administration until a central venous catheter is verified
Answer: A
In non-shockable rhythms such as PEA and asystole, epinephrine should be administered as
soon as vascular access is established during cardiac arrest and repeated every 3 to 5 minutes
during ongoing resuscitation.
7. A 60-year-old man is evaluated for acute dyspnea. Vital signs show blood pressure 85/50
mmHg, heart rate 145 beats per minute, respiratory rate 28 breaths per minute, and
oxygen saturation 89% on room air. The 12-lead ECG demonstrates a regular narrow-
complex tachycardia. The patient is visibly distressed and diaphoretic. What is the
definitive initial management strategy?
A. Immediate synchronized cardioversion
B. Administration of intravenous adenosine 6 mg rapid push
C. Trial of coached vagal maneuvers for 5 minutes
D. Oral beta-blocker administration
Answer: A
Unstable tachyarrhythmias characterized by hypotension, altered mental status, or signs of
shock require immediate synchronized cardioversion rather than pharmacologic trials or
delayed interventions.
8. Following successful resuscitation from cardiac arrest, a patient remains comatose. The
interprofessional team initiates targeted temperature management (TTM). What is the
recommended temperature range to maintain for at least 24 hours?
A. 32°C to 36°C (89.6°F to 96.8°F)
B. 37°C to 38°C (98.6°F to 100.4°F)
C. 30°C to 32°C (86.0°F to 89.6°F)
D. 38.5°C to 39.5°C (101.3°F to 103.1°F)
Answer: A
Targeted temperature management for comatose adult survivors of cardiac arrest involves
actively maintaining a constant core body temperature between 32°C and 36°C to optimize
neurologic recovery and reduce secondary brain injury.
9. A resuscitation team is managing an adult in cardiac arrest with ventricular fibrillation.
After two defibrillation shocks and administration of epinephrine, the rhythm persists.
Which antiarrhythmic agent is indicated next?
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 58-year-old man collapses in the cardiac catheterization laboratory. The monitor
displays ventricular fibrillation. CPR is initiated immediately, and a defibrillator is
brought to the bedside. What is the immediate next step in management?
A. Administer 1 mg of epinephrine IV push
B. Deliver a single asynchronous shock
C. Perform synchronized cardioversion at 100 joules
D. Insert an advanced airway prior to rhythm analysis
Answer: B
In cases of cardiac arrest caused by ventricular fibrillation or pulseless ventricular
tachycardia, the priority intervention after initiating high-quality CPR is the immediate
delivery of a single unsynchronized defibrillation shock, followed by the immediate resumption
of CPR.
2. A paramedic team responds to a 65-year-old female complaining of sudden onset central
chest pressure radiating to her left jaw. Her blood pressure is 110/70 mmHg, heart rate is
88 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is
96% on room air. A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF.
Which intervention should be prioritized?
A. Administration of sublingual nitroglycerin regardless of blood pressure trends
B. Immediate transport to a PCI-capable facility for primary percutaneous coronary intervention
C. Initiation of an intravenous beta-blocker infusion prior to reperfusion therapy
D. Administration of routine prophylactic antiarrhythmic medications
Answer: B
Patients presenting with ST-segment elevation myocardial infarction (STEMI) require rapid
triage and transportation to a percutaneous coronary intervention (PCI)-capable hospital for
primary reperfusion therapy, ideally within a door-to-balloon time of less than 90 minutes.
3. A 45-year-old male is brought to the emergency department following an acute overdose
of tricyclic antidepressants. He is lethargic, hypotensive, and the ECG shows a wide QRS
complex of 140 milliseconds. Which pharmacologic agent is indicated to treat the widening
QRS interval?
A. Sodium bicarbonate IV bolus
,B. Calcium channel blocker infusion
C. Regular insulin with dextrose
D. Intravenous beta-blocker therapy
Answer: A
Sodium bicarbonate alkalinizes the serum and increases extracellular sodium concentration,
which helps overcome the fast sodium channel blockade induced by tricyclic antidepressants
and narrows the QRS duration.
4. During the resuscitation of a patient in cardiac arrest, the team leader notes the end-tidal
carbon dioxide (ETCO2) reading has suddenly increased from 12 mmHg to 38 mmHg.
What is the most likely clinical significance of this change?
A. Worsening hyperventilation by the bag-mask operator
B. Return of spontaneous circulation (ROSC)
C. Impending endotracheal tube dislodgement into the esophagus
D. Complete exhaustion of chest compression quality
Answer: B
A sudden and sustained increase in end-tidal carbon dioxide (ETCO2) during resuscitation—
typically to values of 35 mmHg or greater—is a primary physiological indicator of the return
of spontaneous circulation (ROSC), reflecting improved pulmonary blood flow.
5. A 72-year-old female presents with symptomatic bradycardia. Her heart rate is 34 beats
per minute, blood pressure is 78/48 mmHg, and she reports acute dizziness and shortness
of breath. Initial transcutaneous pacing is established, but she remains hemodynamically
unstable. What pharmacologic therapy should be administered next?
A. Atropine 1 mg IV push repeated every 3 to 5 minutes up to 3 mg total
B. Dopamine infusion titrated from 2 to 20 mcg/kg per minute
C. Amiodarone 150 mg IV over 10 minutes
D. Adenosine 6 mg rapid IV push
Answer: B
When transcutaneous pacing fails to stabilize a patient with symptomatic bradycardia,
continuous infusions of vasoactive medications such as dopamine or epinephrine are
indicated to support heart rate and blood pressure while identifying reversible causes.
6. An adult patient in the intensive care unit experiences sudden pulseless electrical activity
(PEA). High-quality CPR is immediately initiated, and an intravenous line is secured.
What is the correct timing for administering the first dose of epinephrine?
A. Administer immediately after rhythm confirmation, then repeat every 3 to 5 minutes
, B. Withhold epinephrine until after three unsuccessful defibrillation attempts
C. Administer only if the rhythm transitions to ventricular fibrillation
D. Delay administration until a central venous catheter is verified
Answer: A
In non-shockable rhythms such as PEA and asystole, epinephrine should be administered as
soon as vascular access is established during cardiac arrest and repeated every 3 to 5 minutes
during ongoing resuscitation.
7. A 60-year-old man is evaluated for acute dyspnea. Vital signs show blood pressure 85/50
mmHg, heart rate 145 beats per minute, respiratory rate 28 breaths per minute, and
oxygen saturation 89% on room air. The 12-lead ECG demonstrates a regular narrow-
complex tachycardia. The patient is visibly distressed and diaphoretic. What is the
definitive initial management strategy?
A. Immediate synchronized cardioversion
B. Administration of intravenous adenosine 6 mg rapid push
C. Trial of coached vagal maneuvers for 5 minutes
D. Oral beta-blocker administration
Answer: A
Unstable tachyarrhythmias characterized by hypotension, altered mental status, or signs of
shock require immediate synchronized cardioversion rather than pharmacologic trials or
delayed interventions.
8. Following successful resuscitation from cardiac arrest, a patient remains comatose. The
interprofessional team initiates targeted temperature management (TTM). What is the
recommended temperature range to maintain for at least 24 hours?
A. 32°C to 36°C (89.6°F to 96.8°F)
B. 37°C to 38°C (98.6°F to 100.4°F)
C. 30°C to 32°C (86.0°F to 89.6°F)
D. 38.5°C to 39.5°C (101.3°F to 103.1°F)
Answer: A
Targeted temperature management for comatose adult survivors of cardiac arrest involves
actively maintaining a constant core body temperature between 32°C and 36°C to optimize
neurologic recovery and reduce secondary brain injury.
9. A resuscitation team is managing an adult in cardiac arrest with ventricular fibrillation.
After two defibrillation shocks and administration of epinephrine, the rhythm persists.
Which antiarrhythmic agent is indicated next?
