ACLS HEARTCODE EXAM–COMPLETE STUDY GUIDE | PRACTICE
QUESTIONS AND ANSWERS-RATIONALES | EXAM PREP |
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EXAM 2026-2027
1. A 58-year-old male collapses in the emergency department. The rhythm strip shows
ventricular fibrillation. What is the immediate priority intervention according to ACLS
protocols?
A. Administer amiodarone 300 mg IV push
B. Perform immediate defibrillation
C. Establish advanced airway placement
D. Administer epinephrine 1 mg IV
Answer: B
Immediate defibrillation is the primary intervention for ventricular fibrillation and pulseless
ventricular tachycardia to restore an organized cardiac rhythm.
2. During a resuscitation attempt for a patient in asystole, high-quality CPR is in progress
and IV access is established. What is the correct initial medication administration strategy?
A. Epinephrine 1 mg IV push every 3 to 5 minutes
B. Amiodarone 150 mg IV push immediately
C. Atropine 1 mg IV push every 3 to 5 minutes
D. Sodium bicarbonate 50 mEq IV push
Answer: A
Epinephrine 1 mg should be administered as soon as feasible during non-shockable rhythms
like asystole to promote coronary and cerebral perfusion.
3. A paramedic team arrives at a residence to find an unresponsive, pulseless patient. The
monitor reveals a narrow-complex rhythm at a rate of 30/min with no palpable pulse. How
should this rhythm be classified and treated?
A. Ventricular fibrillation treated with unsynchronized shocks
B. Pulseless electrical activity treated with CPR and epinephrine
C. Symptomatic bradycardia treated with transcutaneous pacing
D. Complete heart block treated with atropine
Answer: B
,Pulseless electrical activity presents with an organized rhythm without a pulse; management
focuses on high-quality CPR, identifying reversible causes, and administering epinephrine.
4. A 67-year-old female presents with acute chest pain and shortness of breath. Her blood
pressure is 80/50 mm Hg, heart rate is 140/min with a narrow complex, and skin is cool and
clammy. What is the most appropriate next step?
A. Administer synchronized cardioversion
B. Perform unsynchronized defibrillation
C. Administer adenosine 6 mg rapid IV push
D. Administer metoprolol 5 mg IV push
Answer: A
Unstable tachycardia with signs of hemodynamic compromise requires immediate
synchronized cardioversion to restore normal perfusion pressure.
5. While managing a cardiac arrest, the team leader notes that chest compression fraction
has dropped to 50 percent. What is the primary clinical goal for compression fraction in
ACLS?
A. Maintain a compression fraction of at least 60 percent, ideally greater than 80 percent
B. Keep compression fraction below 40 percent to allow frequent medication administration
C. Match the compression fraction directly to the patient's baseline heart rate
D. Eliminate interruptions only during the final two minutes of a code cycle
Answer: A
High compression fraction directly correlates with better survival rates; minimizing pauses
ensures continuous coronary and cerebral blood flow.
6. A patient achieves return of spontaneous circulation (ROSC) after cardiac arrest. Which
initial arterial blood gas parameter is a primary target during post-cardiac arrest care?
A. Normocarbia and arterial oxygen saturation between 92 and 98 percent
B. Severe hyperoxia with an oxygen saturation of 100 percent
C. Permissive hypercapnia with a target carbon dioxide above 50 mm Hg
D. Deep metabolic alkalosis using sodium bicarbonate infusions
Answer: A
Targeting normocarbia and moderate oxygen saturation prevents secondary brain injury and
avoids the detrimental oxidative stress associated with hyperoxia.
,7. A 72-year-old male is evaluated for a wide-complex tachycardia at a rate of 160/min. He
is alert, with a blood pressure of 118/76 mm Hg. What is an appropriate pharmacological
option for stable monomorphic ventricular tachycardia?
A. Amiodarone 150 mg IV infusion over 10 minutes
B. Immediate unsynchronized defibrillation at 200 joules
C. Epinephrine 1 mg IV push followed by rapid flush
D. Atropine 0.5 mg IV push up to 3 mg maximum
Answer: A
For stable wide-complex tachycardia, antiarrhythmic infusions such as amiodarone are
indicated while preparing for potential cardioversion if instability develops.
8. An adult patient in cardiac arrest is intubated with an advanced airway. What is the
recommended ventilation rate during ongoing chest compressions?
A. 1 breath every 2 to 3 seconds (20 to 30 breaths per minute) without pausing compressions
B. 1 breath every 6 seconds (10 breaths per minute) with continuous chest compressions
C. 2 breaths every 30 compressions with a 5-second pause in compressions
D. 12 to 15 breaths per minute coordinated with active compression pauses
Answer: B
Once an advanced airway is in place, providers should deliver 1 breath every 6 seconds
without pausing continuous chest compressions.
9. A patient presents with symptomatic sinus bradycardia at a rate of 38/min, dizziness,
and a blood pressure of 74/46 mm Hg. What is the first-line medication intervention?
A. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a total of 3 mg
B. Dopamine infusion titrated at 2 to 20 micrograms per kilogram per minute
C. Epinephrine infusion titrated at 2 to 10 micrograms per minute
D. Immediate transcutaneous pacing at 80 milliamperes
Answer: A
Atropine is the first-line drug for symptomatic acute bradycardia, working to increase vagal
tone and accelerate heart rate.
10. What is the recommended target temperature range for targeted temperature
management (TTM) in comatose adult patients who achieve ROSC after cardiac arrest?
A. Constant temperature between 32 and 36 degrees Celsius for at least 24 hours
B. Immediate reduction to sub-freezing body temperature for 2 hours
C. Maintenance of mild hyperthermia around 38.5 degrees Celsius
, D. Passive cooling without temperature monitoring or control devices
Answer: A
Targeted temperature management between 32 and 36 degrees Celsius improves neurological
recovery and reduces mortality after cardiac arrest.
11. During a resuscitation attempt, quantitative waveform capnography is utilized. What
does a sudden, sustained increase in end-tidal carbon dioxide (ETCO2) above 40 mm Hg
typically indicate?
A. Return of spontaneous circulation (ROSC)
B. Complete exhaustion of chest compression quality
C. Dislodgement of the endotracheal tube into the esophagus
D. Immediate cessation of cellular metabolism
Answer: A
A sharp rise in ETCO2 during CPR often signals the return of spontaneous circulation as
systemic blood flow and carbon dioxide delivery to the lungs resume.
12. A patient with acute coronary syndrome is receiving aspirin. What is the standard
recommended dose for initial emergency administration in suspected ACS?
A. 162 to 325 milligrams chewed and swallowed
B. 650 to 1000 milligrams swallowed whole with water
C. 81 milligrams taken once daily for chronic prevention only
D. 500 milligrams administered via intravenous piggyback
Answer: A
Chewing 162 to 325 mg of non-enteric coated aspirin ensures rapid buccal absorption and
immediate antiplatelet aggregation inhibition in acute coronary syndrome.
13. A 55-year-old female presents with acute onset of right-sided weakness and facial droop
starting 45 minutes ago. What is the primary diagnostic imaging required immediately
upon arrival?
A. Non-contrast computed tomography (CT) scan of the brain
B. Magnetic resonance angiography of the lower extremities
C. 12-lead electrocardiogram and cardiac enzyme panel
D. Routine upright chest radiograph
Answer: A
QUESTIONS AND ANSWERS-RATIONALES | EXAM PREP |
DOWNLOAD INSTANT PDF | GUARANTEED PASS || LATEST
EXAM 2026-2027
1. A 58-year-old male collapses in the emergency department. The rhythm strip shows
ventricular fibrillation. What is the immediate priority intervention according to ACLS
protocols?
A. Administer amiodarone 300 mg IV push
B. Perform immediate defibrillation
C. Establish advanced airway placement
D. Administer epinephrine 1 mg IV
Answer: B
Immediate defibrillation is the primary intervention for ventricular fibrillation and pulseless
ventricular tachycardia to restore an organized cardiac rhythm.
2. During a resuscitation attempt for a patient in asystole, high-quality CPR is in progress
and IV access is established. What is the correct initial medication administration strategy?
A. Epinephrine 1 mg IV push every 3 to 5 minutes
B. Amiodarone 150 mg IV push immediately
C. Atropine 1 mg IV push every 3 to 5 minutes
D. Sodium bicarbonate 50 mEq IV push
Answer: A
Epinephrine 1 mg should be administered as soon as feasible during non-shockable rhythms
like asystole to promote coronary and cerebral perfusion.
3. A paramedic team arrives at a residence to find an unresponsive, pulseless patient. The
monitor reveals a narrow-complex rhythm at a rate of 30/min with no palpable pulse. How
should this rhythm be classified and treated?
A. Ventricular fibrillation treated with unsynchronized shocks
B. Pulseless electrical activity treated with CPR and epinephrine
C. Symptomatic bradycardia treated with transcutaneous pacing
D. Complete heart block treated with atropine
Answer: B
,Pulseless electrical activity presents with an organized rhythm without a pulse; management
focuses on high-quality CPR, identifying reversible causes, and administering epinephrine.
4. A 67-year-old female presents with acute chest pain and shortness of breath. Her blood
pressure is 80/50 mm Hg, heart rate is 140/min with a narrow complex, and skin is cool and
clammy. What is the most appropriate next step?
A. Administer synchronized cardioversion
B. Perform unsynchronized defibrillation
C. Administer adenosine 6 mg rapid IV push
D. Administer metoprolol 5 mg IV push
Answer: A
Unstable tachycardia with signs of hemodynamic compromise requires immediate
synchronized cardioversion to restore normal perfusion pressure.
5. While managing a cardiac arrest, the team leader notes that chest compression fraction
has dropped to 50 percent. What is the primary clinical goal for compression fraction in
ACLS?
A. Maintain a compression fraction of at least 60 percent, ideally greater than 80 percent
B. Keep compression fraction below 40 percent to allow frequent medication administration
C. Match the compression fraction directly to the patient's baseline heart rate
D. Eliminate interruptions only during the final two minutes of a code cycle
Answer: A
High compression fraction directly correlates with better survival rates; minimizing pauses
ensures continuous coronary and cerebral blood flow.
6. A patient achieves return of spontaneous circulation (ROSC) after cardiac arrest. Which
initial arterial blood gas parameter is a primary target during post-cardiac arrest care?
A. Normocarbia and arterial oxygen saturation between 92 and 98 percent
B. Severe hyperoxia with an oxygen saturation of 100 percent
C. Permissive hypercapnia with a target carbon dioxide above 50 mm Hg
D. Deep metabolic alkalosis using sodium bicarbonate infusions
Answer: A
Targeting normocarbia and moderate oxygen saturation prevents secondary brain injury and
avoids the detrimental oxidative stress associated with hyperoxia.
,7. A 72-year-old male is evaluated for a wide-complex tachycardia at a rate of 160/min. He
is alert, with a blood pressure of 118/76 mm Hg. What is an appropriate pharmacological
option for stable monomorphic ventricular tachycardia?
A. Amiodarone 150 mg IV infusion over 10 minutes
B. Immediate unsynchronized defibrillation at 200 joules
C. Epinephrine 1 mg IV push followed by rapid flush
D. Atropine 0.5 mg IV push up to 3 mg maximum
Answer: A
For stable wide-complex tachycardia, antiarrhythmic infusions such as amiodarone are
indicated while preparing for potential cardioversion if instability develops.
8. An adult patient in cardiac arrest is intubated with an advanced airway. What is the
recommended ventilation rate during ongoing chest compressions?
A. 1 breath every 2 to 3 seconds (20 to 30 breaths per minute) without pausing compressions
B. 1 breath every 6 seconds (10 breaths per minute) with continuous chest compressions
C. 2 breaths every 30 compressions with a 5-second pause in compressions
D. 12 to 15 breaths per minute coordinated with active compression pauses
Answer: B
Once an advanced airway is in place, providers should deliver 1 breath every 6 seconds
without pausing continuous chest compressions.
9. A patient presents with symptomatic sinus bradycardia at a rate of 38/min, dizziness,
and a blood pressure of 74/46 mm Hg. What is the first-line medication intervention?
A. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a total of 3 mg
B. Dopamine infusion titrated at 2 to 20 micrograms per kilogram per minute
C. Epinephrine infusion titrated at 2 to 10 micrograms per minute
D. Immediate transcutaneous pacing at 80 milliamperes
Answer: A
Atropine is the first-line drug for symptomatic acute bradycardia, working to increase vagal
tone and accelerate heart rate.
10. What is the recommended target temperature range for targeted temperature
management (TTM) in comatose adult patients who achieve ROSC after cardiac arrest?
A. Constant temperature between 32 and 36 degrees Celsius for at least 24 hours
B. Immediate reduction to sub-freezing body temperature for 2 hours
C. Maintenance of mild hyperthermia around 38.5 degrees Celsius
, D. Passive cooling without temperature monitoring or control devices
Answer: A
Targeted temperature management between 32 and 36 degrees Celsius improves neurological
recovery and reduces mortality after cardiac arrest.
11. During a resuscitation attempt, quantitative waveform capnography is utilized. What
does a sudden, sustained increase in end-tidal carbon dioxide (ETCO2) above 40 mm Hg
typically indicate?
A. Return of spontaneous circulation (ROSC)
B. Complete exhaustion of chest compression quality
C. Dislodgement of the endotracheal tube into the esophagus
D. Immediate cessation of cellular metabolism
Answer: A
A sharp rise in ETCO2 during CPR often signals the return of spontaneous circulation as
systemic blood flow and carbon dioxide delivery to the lungs resume.
12. A patient with acute coronary syndrome is receiving aspirin. What is the standard
recommended dose for initial emergency administration in suspected ACS?
A. 162 to 325 milligrams chewed and swallowed
B. 650 to 1000 milligrams swallowed whole with water
C. 81 milligrams taken once daily for chronic prevention only
D. 500 milligrams administered via intravenous piggyback
Answer: A
Chewing 162 to 325 mg of non-enteric coated aspirin ensures rapid buccal absorption and
immediate antiplatelet aggregation inhibition in acute coronary syndrome.
13. A 55-year-old female presents with acute onset of right-sided weakness and facial droop
starting 45 minutes ago. What is the primary diagnostic imaging required immediately
upon arrival?
A. Non-contrast computed tomography (CT) scan of the brain
B. Magnetic resonance angiography of the lower extremities
C. 12-lead electrocardiogram and cardiac enzyme panel
D. Routine upright chest radiograph
Answer: A
