[Advanced Cardiac Life Support (ACLS)] COMPLETE EXAM
QUESTIONS AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED RATIONALES |
FULL STUDY GUIDE | EXAM PREP | PRACTICE TEST |
CERTIFICATION PREPARATION
1. You are leading a code blue team responding to a 68-year-old male in the ICU who is found
unresponsive and pulseless. High-quality CPR is in progress. The cardiac monitor reveals
ventricular fibrillation (VF). What is the priority intervention immediately following the first
defibrillation attempt?
A. Administer a 300 mg bolus of Amiodarone
B. Resume CPR immediately for 2 minutes
C. Check for a palpable carotid pulse
D. Insert an advanced airway device
Correct Answer: B. Resume CPR immediately for 2 minutes
Rationale: Following any defibrillation attempt, chest compressions should be resumed immediately
for 2 minutes (or 5 cycles) without a pulse check. This ensures continuous coronary perfusion and
maximizes the chance of successful return of spontaneous circulation (ROSC). A pulse check is not
performed until the 2-minute cycle is complete. Amiodarone, while indicated for VF/pulseless VT, is
administered after the second shock, not the first, and advanced airway placement should not
interrupt high-quality CPR.
2. A 55-year-old patient presents to the emergency department with acute onset of chest pain and
diaphoresis. The 12-lead ECG shows 2-mm ST-segment elevation in leads V2, V3, and V4. The
patient is hemodynamically stable. What is the most appropriate initial therapeutic intervention
for this patient?
A. Administer sublingual nitroglycerin and monitor for pain relief
B. Administer a loading dose of aspirin and clopidogrel
C. Activate the catheterization lab for immediate percutaneous coronary intervention (PCI)
D. Begin a heparin infusion and admit to the telemetry unit
Correct Answer: C. Activate the catheterization lab for immediate percutaneous coronary
intervention (PCI)
Rationale: This patient is exhibiting classic signs of an ST-segment elevation myocardial infarction
(STEMI). The definitive treatment is emergent reperfusion therapy, with PCI being the gold standard if
it can be performed within 90 minutes of first medical contact. While aspirin, nitroglycerin, and
heparin are all important components of care, they are temporizing measures. The priority is to
activate the cath lab for immediate mechanical reperfusion.
3. A 72-year-old patient with a history of heart failure is admitted with bradycardia. The patient is
lethargic and complaining of lightheadedness. Blood pressure is 80/50 mmHg, and the heart rate is
38 bpm. Atropine 0.5 mg is administered intravenously with minimal effect. Which of the following
is the most appropriate next step?
A. Administer a second dose of Atropine 0.5 mg
B. Initiate an epinephrine infusion at 2-10 mcg/min
,C. Start transcutaneous pacing
D. Administer a 500 mL normal saline fluid bolus
Correct Answer: C. Start transcutaneous pacing
Rationale: In a patient with symptomatic bradycardia (hypotension, altered mental status) who is
unresponsive to atropine, transcutaneous pacing (TCP) is the next indicated intervention. The
maximum dose of atropine for bradycardia is 3 mg; however, if a 0.5 mg dose is ineffective, pacing
should be initiated promptly rather than repeating the same dose. While a fluid bolus may be
considered for hypovolemia, it is not the primary treatment for bradycardia, and an epinephrine
infusion is a second-line therapy for unstable bradycardia if TCP is unavailable or ineffective.
4. You are providing CPR to a 48-year-old female in cardiac arrest. High-quality CPR is being
performed, with compressions at 2 inches deep and a rate of 100/min. The patient has a
supraglottic airway in place. What is the proper ventilation rate for this patient?
A. 1 breath every 6 seconds (10 breaths/min)
B. 2 breaths every 30 compressions (30:2 ratio)
C. 1 breath every 3 seconds (20 breaths/min)
D. 2 breaths every 15 compressions (15:2 ratio)
Correct Answer: A. 1 breath every 6 seconds (10 breaths/min)
Rationale: In adult cardiac arrest, once an advanced airway (e.g., supraglottic airway or endotracheal
tube) is in place, the compression-to-ventilation ratio is no longer used. Instead, continuous chest
compressions are performed at a rate of 100-120/min while delivering one breath every 6 seconds
(10 breaths/min). This minimizes interruptions and maintains adequate oxygenation and ventilation.
5. A 60-year-old patient in the postoperative unit suddenly complains of shortness of breath and
chest pain. The patient is restless and anxious. On assessment, the patient's blood pressure is
85/55 mmHg, heart rate is 125 bpm, and oxygen saturation is 88% on 4 L/min nasal cannula. The
clinical presentation is most consistent with which of the following conditions?
A. Acute myocardial infarction
B. Anaphylactic reaction
C. Pulmonary embolism
D. Hypovolemic shock
Correct Answer: C. Pulmonary embolism
Rationale: The classic presentation of a massive pulmonary embolism (PE) includes acute onset of
dyspnea, chest pain, tachycardia, and hypotension, often accompanied by hypoxia and signs of shock.
This presentation can mimic an MI, but the combination of sudden respiratory distress and
hemodynamic instability in a postoperative patient (who is at high risk for thromboembolism) makes
PE the most likely diagnosis. Anaphylaxis typically involves bronchospasm and skin changes, and
hypovolemic shock usually presents with a history of fluid loss.
6. A 58-year-old male is in cardiac arrest. High-quality CPR is ongoing. The monitor shows pulseless
ventricular tachycardia (VT). The team leader calls for defibrillation and delivers a shock. After the
shock, the rhythm converts to asystole. What is the immediate next action?
A. Administer a 1 mg dose of epinephrine
B. Check for a pulse for 10 seconds
C. Resume chest compressions immediately
D. Deliver another shock to convert the new rhythm
,Correct Answer: C. Resume chest compressions immediately
Rationale: Regardless of the post-shock rhythm, the immediate action is to resume CPR starting with
chest compressions. In this scenario, the rhythm has changed from a shockable rhythm to a non-
shockable rhythm (asystole). The team should continue CPR and follow the algorithm for asystole,
which includes administering epinephrine and re-checking the rhythm after 2 minutes. A pulse check
is not recommended immediately after a shock; high-quality CPR should be performed for 2 minutes
before reassessing rhythm and pulse.
7. A 47-year-old patient is admitted to the cardiac care unit with acute decompensated heart
failure. The patient is in respiratory distress, with crackles halfway up the lung fields and jugular
venous distention. Which medication is most appropriate for immediate preload reduction in this
scenario?
A. IV Furosemide
B. IV Nitroglycerin
C. IV Morphine
D. IV Dobutamine
Correct Answer: B. IV Nitroglycerin
Rationale: IV nitroglycerin is a potent venodilator that rapidly reduces preload (venous return to the
heart) and is the most appropriate agent for immediate preload reduction in severe pulmonary
edema. While furosemide is a mainstay of CHF treatment and does reduce preload by promoting
diuresis, its onset of action is delayed. Morphine (vasodilator) and dobutamine (inotrope) are used in
specific situations but are not the primary agents for acute preload reduction.
8. What is the maximum amount of time a pulse check should take during a cardiac arrest
resuscitation?
A. 15 seconds
B. 10 seconds
C. 5 seconds
D. 20 seconds
Correct Answer: B. 10 seconds
Rationale: During CPR, interruptions must be minimized to maintain adequate cerebral and coronary
perfusion. The current ACLS guidelines recommend that a pulse check should not exceed 10 seconds.
Prolonged pulse checks lead to a significant drop in perfusion pressure and reduce the likelihood of
ROSC.
9. A patient in the emergency department is experiencing a witnessed, sudden cardiac arrest. The
monitor shows ventricular fibrillation (VF). The defibrillator is attached and charged. What is the
recommended energy level for the initial biphasic defibrillation attempt?
A. 360 Joules
B. 200 Joules
C. 100 Joules
D. 120-200 Joules (or manufacturer's recommendation)
Correct Answer: D. 120-200 Joules (or manufacturer's recommendation)
Rationale: For biphasic defibrillators, the initial energy dose for treating VF/pulseless VT is typically
120-200 Joules, or as per the manufacturer's recommendations on the device. Monophasic
, defibrillators use a standard dose of 360 Joules. It is critical for the team leader to be familiar with the
specific defibrillator being used.
10. A 67-year-old female presents with a wide-complex tachycardia of 150 bpm. Her blood
pressure is 110/75 mmHg, and she is asymptomatic except for mild palpitations. Which of the
following is the most appropriate initial management step?
A. Immediate synchronized cardioversion
B. IV administration of Amiodarone
C. Vagal maneuvers
D. IV administration of Adenosine
Correct Answer: C. Vagal maneuvers
Rationale: In a stable patient with a regular, wide-complex tachycardia, vagal maneuvers are a safe
and appropriate first-line intervention to attempt to terminate the rhythm, particularly if the rhythm
is supraventricular in origin (SVT with aberrancy). If vagal maneuvers are ineffective, adenosine is a
common diagnostic and therapeutic agent. Synchronized cardioversion is reserved for unstable
patients, and amiodarone is used in stable VT after other interventions are considered.
11. A 72-year-old patient is intubated and on a mechanical ventilator in the ICU. The high-pressure
alarm sounds. On assessment, the patient is cyanotic, has absent breath sounds on the left side,
and tracheal deviation to the right. What is the most likely cause of this sudden deterioration?
A. Displacement of the endotracheal tube into the right mainstem bronchus
B. Tension pneumothorax on the left side
C. Pulmonary embolism
D. Acute asthma exacerbation
Correct Answer: B. Tension pneumothorax on the left side
Rationale: This patient is exhibiting classic signs of a tension pneumothorax: severe respiratory
distress, cyanosis, absent breath sounds on the affected side, and tracheal deviation away from the
affected side (in this case, to the right). This is a life-threatening emergency. A right mainstem
intubation would cause decreased breath sounds on the left but not tracheal deviation away from the
right side. Pulmonary embolism does not typically cause absent breath sounds or tracheal deviation.
12. You are treating a patient with symptomatic bradycardia. The patient is in a monitored bed and
has an IV line established. Atropine has been administered without improvement in the patient's
condition. You decide to initiate transcutaneous pacing (TCP). Which of the following represents
the correct sequence for TCP?
A. Set rate to 80 bpm, increase current (mA) until electrical capture is observed, then check for
mechanical capture
B. Sedate the patient, set current to 40 mA, then set rate to 60 bpm
C. Set rate to 60 bpm, set current to 20 mA, then activate pacing
D. Activate the pacing mode, then adjust the rate and current based on the patient's blood pressure
Correct Answer: A. Set rate to 80 bpm, increase current (mA) until electrical capture is observed,
then check for mechanical capture
Rationale: The correct sequence for initiating TCP is to set the rate to the desired target (typically 60-
80 bpm), then increase the current (mA) output from zero until electrical capture is seen on the
monitor (a wide QRS complex with a T-wave). After achieving electrical capture, it is crucial to assess
QUESTIONS AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED RATIONALES |
FULL STUDY GUIDE | EXAM PREP | PRACTICE TEST |
CERTIFICATION PREPARATION
1. You are leading a code blue team responding to a 68-year-old male in the ICU who is found
unresponsive and pulseless. High-quality CPR is in progress. The cardiac monitor reveals
ventricular fibrillation (VF). What is the priority intervention immediately following the first
defibrillation attempt?
A. Administer a 300 mg bolus of Amiodarone
B. Resume CPR immediately for 2 minutes
C. Check for a palpable carotid pulse
D. Insert an advanced airway device
Correct Answer: B. Resume CPR immediately for 2 minutes
Rationale: Following any defibrillation attempt, chest compressions should be resumed immediately
for 2 minutes (or 5 cycles) without a pulse check. This ensures continuous coronary perfusion and
maximizes the chance of successful return of spontaneous circulation (ROSC). A pulse check is not
performed until the 2-minute cycle is complete. Amiodarone, while indicated for VF/pulseless VT, is
administered after the second shock, not the first, and advanced airway placement should not
interrupt high-quality CPR.
2. A 55-year-old patient presents to the emergency department with acute onset of chest pain and
diaphoresis. The 12-lead ECG shows 2-mm ST-segment elevation in leads V2, V3, and V4. The
patient is hemodynamically stable. What is the most appropriate initial therapeutic intervention
for this patient?
A. Administer sublingual nitroglycerin and monitor for pain relief
B. Administer a loading dose of aspirin and clopidogrel
C. Activate the catheterization lab for immediate percutaneous coronary intervention (PCI)
D. Begin a heparin infusion and admit to the telemetry unit
Correct Answer: C. Activate the catheterization lab for immediate percutaneous coronary
intervention (PCI)
Rationale: This patient is exhibiting classic signs of an ST-segment elevation myocardial infarction
(STEMI). The definitive treatment is emergent reperfusion therapy, with PCI being the gold standard if
it can be performed within 90 minutes of first medical contact. While aspirin, nitroglycerin, and
heparin are all important components of care, they are temporizing measures. The priority is to
activate the cath lab for immediate mechanical reperfusion.
3. A 72-year-old patient with a history of heart failure is admitted with bradycardia. The patient is
lethargic and complaining of lightheadedness. Blood pressure is 80/50 mmHg, and the heart rate is
38 bpm. Atropine 0.5 mg is administered intravenously with minimal effect. Which of the following
is the most appropriate next step?
A. Administer a second dose of Atropine 0.5 mg
B. Initiate an epinephrine infusion at 2-10 mcg/min
,C. Start transcutaneous pacing
D. Administer a 500 mL normal saline fluid bolus
Correct Answer: C. Start transcutaneous pacing
Rationale: In a patient with symptomatic bradycardia (hypotension, altered mental status) who is
unresponsive to atropine, transcutaneous pacing (TCP) is the next indicated intervention. The
maximum dose of atropine for bradycardia is 3 mg; however, if a 0.5 mg dose is ineffective, pacing
should be initiated promptly rather than repeating the same dose. While a fluid bolus may be
considered for hypovolemia, it is not the primary treatment for bradycardia, and an epinephrine
infusion is a second-line therapy for unstable bradycardia if TCP is unavailable or ineffective.
4. You are providing CPR to a 48-year-old female in cardiac arrest. High-quality CPR is being
performed, with compressions at 2 inches deep and a rate of 100/min. The patient has a
supraglottic airway in place. What is the proper ventilation rate for this patient?
A. 1 breath every 6 seconds (10 breaths/min)
B. 2 breaths every 30 compressions (30:2 ratio)
C. 1 breath every 3 seconds (20 breaths/min)
D. 2 breaths every 15 compressions (15:2 ratio)
Correct Answer: A. 1 breath every 6 seconds (10 breaths/min)
Rationale: In adult cardiac arrest, once an advanced airway (e.g., supraglottic airway or endotracheal
tube) is in place, the compression-to-ventilation ratio is no longer used. Instead, continuous chest
compressions are performed at a rate of 100-120/min while delivering one breath every 6 seconds
(10 breaths/min). This minimizes interruptions and maintains adequate oxygenation and ventilation.
5. A 60-year-old patient in the postoperative unit suddenly complains of shortness of breath and
chest pain. The patient is restless and anxious. On assessment, the patient's blood pressure is
85/55 mmHg, heart rate is 125 bpm, and oxygen saturation is 88% on 4 L/min nasal cannula. The
clinical presentation is most consistent with which of the following conditions?
A. Acute myocardial infarction
B. Anaphylactic reaction
C. Pulmonary embolism
D. Hypovolemic shock
Correct Answer: C. Pulmonary embolism
Rationale: The classic presentation of a massive pulmonary embolism (PE) includes acute onset of
dyspnea, chest pain, tachycardia, and hypotension, often accompanied by hypoxia and signs of shock.
This presentation can mimic an MI, but the combination of sudden respiratory distress and
hemodynamic instability in a postoperative patient (who is at high risk for thromboembolism) makes
PE the most likely diagnosis. Anaphylaxis typically involves bronchospasm and skin changes, and
hypovolemic shock usually presents with a history of fluid loss.
6. A 58-year-old male is in cardiac arrest. High-quality CPR is ongoing. The monitor shows pulseless
ventricular tachycardia (VT). The team leader calls for defibrillation and delivers a shock. After the
shock, the rhythm converts to asystole. What is the immediate next action?
A. Administer a 1 mg dose of epinephrine
B. Check for a pulse for 10 seconds
C. Resume chest compressions immediately
D. Deliver another shock to convert the new rhythm
,Correct Answer: C. Resume chest compressions immediately
Rationale: Regardless of the post-shock rhythm, the immediate action is to resume CPR starting with
chest compressions. In this scenario, the rhythm has changed from a shockable rhythm to a non-
shockable rhythm (asystole). The team should continue CPR and follow the algorithm for asystole,
which includes administering epinephrine and re-checking the rhythm after 2 minutes. A pulse check
is not recommended immediately after a shock; high-quality CPR should be performed for 2 minutes
before reassessing rhythm and pulse.
7. A 47-year-old patient is admitted to the cardiac care unit with acute decompensated heart
failure. The patient is in respiratory distress, with crackles halfway up the lung fields and jugular
venous distention. Which medication is most appropriate for immediate preload reduction in this
scenario?
A. IV Furosemide
B. IV Nitroglycerin
C. IV Morphine
D. IV Dobutamine
Correct Answer: B. IV Nitroglycerin
Rationale: IV nitroglycerin is a potent venodilator that rapidly reduces preload (venous return to the
heart) and is the most appropriate agent for immediate preload reduction in severe pulmonary
edema. While furosemide is a mainstay of CHF treatment and does reduce preload by promoting
diuresis, its onset of action is delayed. Morphine (vasodilator) and dobutamine (inotrope) are used in
specific situations but are not the primary agents for acute preload reduction.
8. What is the maximum amount of time a pulse check should take during a cardiac arrest
resuscitation?
A. 15 seconds
B. 10 seconds
C. 5 seconds
D. 20 seconds
Correct Answer: B. 10 seconds
Rationale: During CPR, interruptions must be minimized to maintain adequate cerebral and coronary
perfusion. The current ACLS guidelines recommend that a pulse check should not exceed 10 seconds.
Prolonged pulse checks lead to a significant drop in perfusion pressure and reduce the likelihood of
ROSC.
9. A patient in the emergency department is experiencing a witnessed, sudden cardiac arrest. The
monitor shows ventricular fibrillation (VF). The defibrillator is attached and charged. What is the
recommended energy level for the initial biphasic defibrillation attempt?
A. 360 Joules
B. 200 Joules
C. 100 Joules
D. 120-200 Joules (or manufacturer's recommendation)
Correct Answer: D. 120-200 Joules (or manufacturer's recommendation)
Rationale: For biphasic defibrillators, the initial energy dose for treating VF/pulseless VT is typically
120-200 Joules, or as per the manufacturer's recommendations on the device. Monophasic
, defibrillators use a standard dose of 360 Joules. It is critical for the team leader to be familiar with the
specific defibrillator being used.
10. A 67-year-old female presents with a wide-complex tachycardia of 150 bpm. Her blood
pressure is 110/75 mmHg, and she is asymptomatic except for mild palpitations. Which of the
following is the most appropriate initial management step?
A. Immediate synchronized cardioversion
B. IV administration of Amiodarone
C. Vagal maneuvers
D. IV administration of Adenosine
Correct Answer: C. Vagal maneuvers
Rationale: In a stable patient with a regular, wide-complex tachycardia, vagal maneuvers are a safe
and appropriate first-line intervention to attempt to terminate the rhythm, particularly if the rhythm
is supraventricular in origin (SVT with aberrancy). If vagal maneuvers are ineffective, adenosine is a
common diagnostic and therapeutic agent. Synchronized cardioversion is reserved for unstable
patients, and amiodarone is used in stable VT after other interventions are considered.
11. A 72-year-old patient is intubated and on a mechanical ventilator in the ICU. The high-pressure
alarm sounds. On assessment, the patient is cyanotic, has absent breath sounds on the left side,
and tracheal deviation to the right. What is the most likely cause of this sudden deterioration?
A. Displacement of the endotracheal tube into the right mainstem bronchus
B. Tension pneumothorax on the left side
C. Pulmonary embolism
D. Acute asthma exacerbation
Correct Answer: B. Tension pneumothorax on the left side
Rationale: This patient is exhibiting classic signs of a tension pneumothorax: severe respiratory
distress, cyanosis, absent breath sounds on the affected side, and tracheal deviation away from the
affected side (in this case, to the right). This is a life-threatening emergency. A right mainstem
intubation would cause decreased breath sounds on the left but not tracheal deviation away from the
right side. Pulmonary embolism does not typically cause absent breath sounds or tracheal deviation.
12. You are treating a patient with symptomatic bradycardia. The patient is in a monitored bed and
has an IV line established. Atropine has been administered without improvement in the patient's
condition. You decide to initiate transcutaneous pacing (TCP). Which of the following represents
the correct sequence for TCP?
A. Set rate to 80 bpm, increase current (mA) until electrical capture is observed, then check for
mechanical capture
B. Sedate the patient, set current to 40 mA, then set rate to 60 bpm
C. Set rate to 60 bpm, set current to 20 mA, then activate pacing
D. Activate the pacing mode, then adjust the rate and current based on the patient's blood pressure
Correct Answer: A. Set rate to 80 bpm, increase current (mA) until electrical capture is observed,
then check for mechanical capture
Rationale: The correct sequence for initiating TCP is to set the rate to the desired target (typically 60-
80 bpm), then increase the current (mA) output from zero until electrical capture is seen on the
monitor (a wide QRS complex with a T-wave). After achieving electrical capture, it is crucial to assess
