Advanced Cardiac Life Support Nursing
Competency Exam — Code: NUR-ACLS-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A patient develops ventricular fibrillation (VF) and is found pulseless. The
defibrillator is charged. What is the nurse's priority immediately before
delivering the shock?
A. Begin chest compressions
B. Administer epinephrine
C. Ensure everyone is clear of the patient
D. Administer amiodarone
Answer: C. Ensure everyone is clear of the patient
,Rationale: Before defibrillation, the resuscitation team must confirm that
nobody is touching the patient, bed, or equipment connected to the patient. This
prevents accidental electrical injury and allows the shock to be delivered safely.
2. During high-quality CPR, which finding best indicates that chest
compressions are being performed effectively?
A. End-tidal CO₂ of 8 mmHg
B. End-tidal CO₂ of 15 mmHg
C. End-tidal CO₂ of 22 mmHg
D. Oxygen saturation of 100%
Answer: C. End-tidal CO₂ of 22 mmHg
Rationale: During CPR, a persistently low ETCO₂ can indicate inadequate
perfusion or ineffective compressions. An ETCO₂ above approximately 10 mmHg
is generally associated with better-quality compressions, although trends and
the clinical context are important.
3. A patient with symptomatic bradycardia has a heart rate of 34/min,
hypotension, altered mental status, and signs of shock. Atropine is
administered but produces no improvement. What is the most appropriate
next intervention?
A. Observe for another 10 minutes
B. Initiate transcutaneous pacing
C. Administer adenosine
D. Perform synchronized cardioversion
Answer: B. Initiate transcutaneous pacing
Rationale: Unstable symptomatic bradycardia that does not respond to atropine
requires escalation. Transcutaneous pacing is an appropriate immediate
intervention while preparing for transvenous pacing or considering chronotropic
infusions such as dopamine or epinephrine.
, 4. A patient in cardiac arrest has an organized rhythm on the monitor but no
palpable pulse. Which rhythm is most consistent with this presentation?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Pulseless electrical activity
D. Sinus tachycardia
Answer: C. Pulseless electrical activity
Rationale: PEA occurs when electrical activity appears organized or otherwise
present on the monitor but the patient has no detectable pulse. Management
focuses on high-quality CPR, epinephrine, and rapid identification and treatment
of reversible causes.
5. Which medication is administered during the initial treatment of adult
cardiac arrest associated with VF or pulseless VT?
A. Adenosine
B. Epinephrine
C. Atropine
D. Diltiazem
Answer: B. Epinephrine
Rationale: Epinephrine is administered during cardiac arrest at 1 mg IV/IO every
3–5 minutes. In shockable arrest, defibrillation should not be delayed while
waiting for medication administration.
6. A patient remains in VF after an initial defibrillation attempt and CPR.
Which medication is commonly used for refractory VF/pulseless VT?
A. Amiodarone
B. Verapamil
C. Atropine
D. Digoxin
Answer: A. Amiodarone
, Rationale: Amiodarone is an antiarrhythmic used for refractory VF or pulseless
VT after defibrillation and CPR. Lidocaine is an alternative antiarrhythmic in this
setting.
7. During CPR, the monitor suddenly shows a narrow-complex organized
rhythm. The nurse checks for a pulse and finds none. What should the team
do?
A. Deliver an immediate synchronized shock
B. Continue CPR and treat PEA
C. Administer adenosine
D. Stop resuscitation because an organized rhythm has returned
Answer: B. Continue CPR and treat PEA
Rationale: An organized rhythm does not equal return of spontaneous
circulation (ROSC). If no pulse is present, the patient remains in cardiac arrest
and CPR should continue while reversible causes are addressed.
8. Which intervention is most appropriate for a patient with stable regular
narrow-complex supraventricular tachycardia (SVT)?
A. Immediate unsynchronized defibrillation
B. Vagal maneuvers followed by adenosine if appropriate
C. Immediate transcutaneous pacing
D. IV atropine
Answer: B. Vagal maneuvers followed by adenosine if appropriate
Rationale: Stable regular narrow-complex SVT can initially be treated with vagal
maneuvers. If unsuccessful, adenosine is appropriate for a regular rhythm when
contraindications are absent.
9. A patient with tachycardia has hypotension, acute pulmonary edema, and
altered mental status. What is the priority treatment?
A. Oral beta blocker
B. Synchronized cardioversion
Competency Exam — Code: NUR-ACLS-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A patient develops ventricular fibrillation (VF) and is found pulseless. The
defibrillator is charged. What is the nurse's priority immediately before
delivering the shock?
A. Begin chest compressions
B. Administer epinephrine
C. Ensure everyone is clear of the patient
D. Administer amiodarone
Answer: C. Ensure everyone is clear of the patient
,Rationale: Before defibrillation, the resuscitation team must confirm that
nobody is touching the patient, bed, or equipment connected to the patient. This
prevents accidental electrical injury and allows the shock to be delivered safely.
2. During high-quality CPR, which finding best indicates that chest
compressions are being performed effectively?
A. End-tidal CO₂ of 8 mmHg
B. End-tidal CO₂ of 15 mmHg
C. End-tidal CO₂ of 22 mmHg
D. Oxygen saturation of 100%
Answer: C. End-tidal CO₂ of 22 mmHg
Rationale: During CPR, a persistently low ETCO₂ can indicate inadequate
perfusion or ineffective compressions. An ETCO₂ above approximately 10 mmHg
is generally associated with better-quality compressions, although trends and
the clinical context are important.
3. A patient with symptomatic bradycardia has a heart rate of 34/min,
hypotension, altered mental status, and signs of shock. Atropine is
administered but produces no improvement. What is the most appropriate
next intervention?
A. Observe for another 10 minutes
B. Initiate transcutaneous pacing
C. Administer adenosine
D. Perform synchronized cardioversion
Answer: B. Initiate transcutaneous pacing
Rationale: Unstable symptomatic bradycardia that does not respond to atropine
requires escalation. Transcutaneous pacing is an appropriate immediate
intervention while preparing for transvenous pacing or considering chronotropic
infusions such as dopamine or epinephrine.
, 4. A patient in cardiac arrest has an organized rhythm on the monitor but no
palpable pulse. Which rhythm is most consistent with this presentation?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Pulseless electrical activity
D. Sinus tachycardia
Answer: C. Pulseless electrical activity
Rationale: PEA occurs when electrical activity appears organized or otherwise
present on the monitor but the patient has no detectable pulse. Management
focuses on high-quality CPR, epinephrine, and rapid identification and treatment
of reversible causes.
5. Which medication is administered during the initial treatment of adult
cardiac arrest associated with VF or pulseless VT?
A. Adenosine
B. Epinephrine
C. Atropine
D. Diltiazem
Answer: B. Epinephrine
Rationale: Epinephrine is administered during cardiac arrest at 1 mg IV/IO every
3–5 minutes. In shockable arrest, defibrillation should not be delayed while
waiting for medication administration.
6. A patient remains in VF after an initial defibrillation attempt and CPR.
Which medication is commonly used for refractory VF/pulseless VT?
A. Amiodarone
B. Verapamil
C. Atropine
D. Digoxin
Answer: A. Amiodarone
, Rationale: Amiodarone is an antiarrhythmic used for refractory VF or pulseless
VT after defibrillation and CPR. Lidocaine is an alternative antiarrhythmic in this
setting.
7. During CPR, the monitor suddenly shows a narrow-complex organized
rhythm. The nurse checks for a pulse and finds none. What should the team
do?
A. Deliver an immediate synchronized shock
B. Continue CPR and treat PEA
C. Administer adenosine
D. Stop resuscitation because an organized rhythm has returned
Answer: B. Continue CPR and treat PEA
Rationale: An organized rhythm does not equal return of spontaneous
circulation (ROSC). If no pulse is present, the patient remains in cardiac arrest
and CPR should continue while reversible causes are addressed.
8. Which intervention is most appropriate for a patient with stable regular
narrow-complex supraventricular tachycardia (SVT)?
A. Immediate unsynchronized defibrillation
B. Vagal maneuvers followed by adenosine if appropriate
C. Immediate transcutaneous pacing
D. IV atropine
Answer: B. Vagal maneuvers followed by adenosine if appropriate
Rationale: Stable regular narrow-complex SVT can initially be treated with vagal
maneuvers. If unsuccessful, adenosine is appropriate for a regular rhythm when
contraindications are absent.
9. A patient with tachycardia has hypotension, acute pulmonary edema, and
altered mental status. What is the priority treatment?
A. Oral beta blocker
B. Synchronized cardioversion
