ACLS / BLS Certification Exam Practice
Questions And Verified Correct Answers With
Detailed Rationales 2026-2027 Edition
Question 1 [BLS / Cardiac Arrest]
A 58-year-old man collapses in the emergency department. The nurse determines the
patient is unresponsive, not breathing, and has no pulse. What is the first action the
nurse should take?
1. A. Establish IV access and administer epinephrine 1 mg IV.
2. B. Begin high-quality CPR starting with chest compressions.
3. C. Deliver a shock with the defibrillator.
4. D. Insert an advanced airway and ventilate at 10 breaths/min.
Correct Answer: B
Rationale: The 2020 AHA Guidelines emphasize immediate initiation of high-quality CPR
for all unresponsive, pulseless patients. The C-A-B sequence (Compressions-Airway-
Breathing) is used. CPR should begin immediately while the defibrillator is being prepared.
Epinephrine (A) is given after 2 minutes of CPR. Defibrillation (C) is only indicated for
shockable rhythms (VF/pVT), which have not yet been identified. Advanced airway
insertion (D) is a secondary intervention.
Question 2 [BLS / CPR Technique]
During CPR on an adult, what is the recommended compression-to-ventilation ratio
for a single rescuer?
5. A. 15:2
6. B. 30:2
7. C. 5:1
8. D. 50:2
Correct Answer: B
Rationale: For adult BLS, the recommended compression-to-ventilation ratio is 30:2 for
both single-rescuer and two-rescuer CPR. For two-rescuer infant/child CPR, the ratio is 15:2
(A). The 30:2 ratio maximizes coronary and cerebral perfusion by minimizing interruptions
in chest compressions. Compressions should be at least 2 inches (5 cm) deep at a rate of
100–120/min with full chest recoil.
,Question 3 [ACLS / Defibrillation]
A patient in cardiac arrest is found to be in ventricular fibrillation (VF). The
defibrillator is charged and ready. What is the next appropriate action?
9. A. Check for a pulse before delivering the shock.
10. B. Deliver one shock and immediately resume CPR starting with compressions.
11. C. Administer epinephrine 1 mg IV before delivering the shock.
12. D. Deliver three stacked shocks in rapid succession.
Correct Answer: B
Rationale: For VF/pulseless VT, the ACLS algorithm recommends immediate defibrillation
with one shock (biphasic: 120–200 J; monophasic: 360 J), followed immediately by CPR
starting with compressions for 2 minutes before checking the rhythm or pulse. Checking the
pulse (A) wastes critical time. Epinephrine (C) is given after 2 minutes of CPR and rhythm
re-check. Stacked shocks (D) are no longer recommended — single-shock strategy with
immediate CPR is superior.
Question 4 [ACLS / Team Dynamics]
During CPR, the team leader notices that the compressor is becoming fatigued and
the compression depth has decreased. What should the team leader do?
13. A. Continue with the current compressor to maintain consistency.
14. B. Rotate compressors every 2 minutes or sooner if fatigued.
15. C. Increase the compression rate to compensate for decreased depth.
16. D. Switch to active compression-decompression CPR device.
Correct Answer: B
Rationale: Compressor fatigue is a well-documented cause of decreased compression
quality (depth and rate). The AHA recommends rotating compressors every 2 minutes
(typically synchronized with rhythm checks) or sooner if the compressor shows signs of
fatigue. This maintains high-quality CPR throughout the resuscitation. Increasing the rate
(C) does not compensate for inadequate depth. Mechanical CPR devices (D) are not the first-
line solution.
Question 5 [ACLS / Cardiac Arrest Pharmacology]
, A patient in cardiac arrest has been receiving high-quality CPR. The rhythm check
reveals pulseless electrical activity (PEA). What is the first medication the team
should administer?
17. A. Atropine 1 mg IV
18. B. Epinephrine 1 mg IV every 3–5 minutes
19. C. Amiodarone 300 mg IV
20. D. Adenosine 6 mg rapid IV push
Correct Answer: B
Rationale: Epinephrine 1 mg IV/IO is the first-line vasopressor in cardiac arrest (both
shockable and non-shockable rhythms) and should be administered every 3–5 minutes. It
increases coronary and cerebral perfusion pressure during CPR. Atropine (A) is no longer
recommended for PEA/asystole in the ACLS algorithm. Amiodarone (C) is for refractory
VF/pVT. Adenosine (D) is for stable supraventricular tachycardia, not cardiac arrest.
Question 6 [ACLS / Asystole & PEA]
A patient is in cardiac arrest with a rhythm of asystole on the monitor. The team has
been performing CPR and has given one dose of epinephrine. What is the next
priority intervention?
21. A. Defibrillate immediately.
22. B. Continue CPR and identify/treat reversible causes (H's and T's).
23. C. Administer atropine 1 mg IV.
24. D. Perform a precordial thump.
Correct Answer: B
Rationale: Asystole is a non-shockable rhythm. The ACLS algorithm for asystole/PEA
emphasizes high-quality CPR, epinephrine every 3–5 minutes, and aggressive identification
and treatment of reversible causes (the H's and T's): Hypovolemia, Hypoxia, Hydrogen ion
(acidosis), Hypo-/Hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade
(cardiac), Toxins, Thrombosis (pulmonary/coronary), Trauma. Defibrillation (A) is
contraindicated. Atropine (C) is no longer recommended. Precordial thump (D) is only for
witnessed, monitored arrest with immediate VF.
Question 7 [ACLS / Bradycardia]
A patient with a heart rate of 32 bpm is symptomatic with hypotension (BP 72/48
mmHg), altered mental status, and chest pain. The patient has a second-degree AV
block type II on the monitor. What is the first-line treatment?
Questions And Verified Correct Answers With
Detailed Rationales 2026-2027 Edition
Question 1 [BLS / Cardiac Arrest]
A 58-year-old man collapses in the emergency department. The nurse determines the
patient is unresponsive, not breathing, and has no pulse. What is the first action the
nurse should take?
1. A. Establish IV access and administer epinephrine 1 mg IV.
2. B. Begin high-quality CPR starting with chest compressions.
3. C. Deliver a shock with the defibrillator.
4. D. Insert an advanced airway and ventilate at 10 breaths/min.
Correct Answer: B
Rationale: The 2020 AHA Guidelines emphasize immediate initiation of high-quality CPR
for all unresponsive, pulseless patients. The C-A-B sequence (Compressions-Airway-
Breathing) is used. CPR should begin immediately while the defibrillator is being prepared.
Epinephrine (A) is given after 2 minutes of CPR. Defibrillation (C) is only indicated for
shockable rhythms (VF/pVT), which have not yet been identified. Advanced airway
insertion (D) is a secondary intervention.
Question 2 [BLS / CPR Technique]
During CPR on an adult, what is the recommended compression-to-ventilation ratio
for a single rescuer?
5. A. 15:2
6. B. 30:2
7. C. 5:1
8. D. 50:2
Correct Answer: B
Rationale: For adult BLS, the recommended compression-to-ventilation ratio is 30:2 for
both single-rescuer and two-rescuer CPR. For two-rescuer infant/child CPR, the ratio is 15:2
(A). The 30:2 ratio maximizes coronary and cerebral perfusion by minimizing interruptions
in chest compressions. Compressions should be at least 2 inches (5 cm) deep at a rate of
100–120/min with full chest recoil.
,Question 3 [ACLS / Defibrillation]
A patient in cardiac arrest is found to be in ventricular fibrillation (VF). The
defibrillator is charged and ready. What is the next appropriate action?
9. A. Check for a pulse before delivering the shock.
10. B. Deliver one shock and immediately resume CPR starting with compressions.
11. C. Administer epinephrine 1 mg IV before delivering the shock.
12. D. Deliver three stacked shocks in rapid succession.
Correct Answer: B
Rationale: For VF/pulseless VT, the ACLS algorithm recommends immediate defibrillation
with one shock (biphasic: 120–200 J; monophasic: 360 J), followed immediately by CPR
starting with compressions for 2 minutes before checking the rhythm or pulse. Checking the
pulse (A) wastes critical time. Epinephrine (C) is given after 2 minutes of CPR and rhythm
re-check. Stacked shocks (D) are no longer recommended — single-shock strategy with
immediate CPR is superior.
Question 4 [ACLS / Team Dynamics]
During CPR, the team leader notices that the compressor is becoming fatigued and
the compression depth has decreased. What should the team leader do?
13. A. Continue with the current compressor to maintain consistency.
14. B. Rotate compressors every 2 minutes or sooner if fatigued.
15. C. Increase the compression rate to compensate for decreased depth.
16. D. Switch to active compression-decompression CPR device.
Correct Answer: B
Rationale: Compressor fatigue is a well-documented cause of decreased compression
quality (depth and rate). The AHA recommends rotating compressors every 2 minutes
(typically synchronized with rhythm checks) or sooner if the compressor shows signs of
fatigue. This maintains high-quality CPR throughout the resuscitation. Increasing the rate
(C) does not compensate for inadequate depth. Mechanical CPR devices (D) are not the first-
line solution.
Question 5 [ACLS / Cardiac Arrest Pharmacology]
, A patient in cardiac arrest has been receiving high-quality CPR. The rhythm check
reveals pulseless electrical activity (PEA). What is the first medication the team
should administer?
17. A. Atropine 1 mg IV
18. B. Epinephrine 1 mg IV every 3–5 minutes
19. C. Amiodarone 300 mg IV
20. D. Adenosine 6 mg rapid IV push
Correct Answer: B
Rationale: Epinephrine 1 mg IV/IO is the first-line vasopressor in cardiac arrest (both
shockable and non-shockable rhythms) and should be administered every 3–5 minutes. It
increases coronary and cerebral perfusion pressure during CPR. Atropine (A) is no longer
recommended for PEA/asystole in the ACLS algorithm. Amiodarone (C) is for refractory
VF/pVT. Adenosine (D) is for stable supraventricular tachycardia, not cardiac arrest.
Question 6 [ACLS / Asystole & PEA]
A patient is in cardiac arrest with a rhythm of asystole on the monitor. The team has
been performing CPR and has given one dose of epinephrine. What is the next
priority intervention?
21. A. Defibrillate immediately.
22. B. Continue CPR and identify/treat reversible causes (H's and T's).
23. C. Administer atropine 1 mg IV.
24. D. Perform a precordial thump.
Correct Answer: B
Rationale: Asystole is a non-shockable rhythm. The ACLS algorithm for asystole/PEA
emphasizes high-quality CPR, epinephrine every 3–5 minutes, and aggressive identification
and treatment of reversible causes (the H's and T's): Hypovolemia, Hypoxia, Hydrogen ion
(acidosis), Hypo-/Hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade
(cardiac), Toxins, Thrombosis (pulmonary/coronary), Trauma. Defibrillation (A) is
contraindicated. Atropine (C) is no longer recommended. Precordial thump (D) is only for
witnessed, monitored arrest with immediate VF.
Question 7 [ACLS / Bradycardia]
A patient with a heart rate of 32 bpm is symptomatic with hypotension (BP 72/48
mmHg), altered mental status, and chest pain. The patient has a second-degree AV
block type II on the monitor. What is the first-line treatment?
