ACLS VERSION A,B&C EXAM–COMPLETE STUDY GUIDE |
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A 58-year-old male is brought to the emergency department by paramedics following an
abrupt onset of palpitations and lightheadedness. He is alert and oriented. His initial vital
signs are heart rate 180 beats/min, respiratory rate 20 breaths/min, blood pressure 114/72
mm Hg, and oxygen saturation 98% on room air. The 12-lead ECG reveals a regular
narrow-complex tachycardia with absent distinct P waves. What is the most appropriate
initial pharmacological intervention after establishing intravenous access?
A. Amiodarone 150 mg IV push over 10 minutes
B. Adenosine 6 mg rapid IV push followed by a 20 mL normal saline flush
C. Procainamide 20 mg/min IV infusion until suppression
D. Synchronized cardioversion at 100 Joules immediately
Answer: B
Adenosine is the primary pharmacological treatment for stable, regular narrow-complex
supraventricular tachycardias unresponsive to vagal maneuvers. A rapid 6 mg IV push
followed immediately by a saline flush ensures the medication reaches the central circulation
before it is rapidly metabolized.
2. A 67-year-old female collapses in the outpatient clinic waiting room. A bystander
initiates basic life support while a nurse retrieves the automated external defibrillator and
crash cart. The monitor displays ventricular fibrillation. Following a single shock delivery,
what is the immediate next step in management according to advanced cardiovascular life
support protocols?
A. Check a carotid pulse for up to 10 seconds to assess rhythm conversion
B. Resume high-quality chest compressions immediately for 2 minutes
C. Administer epinephrine 1 mg IV push without delay
D. Obtain a 12-lead ECG to confirm termination of ventricular fibrillation
Answer: B
,Immediately following a defibrillation attempt, chest compressions must be resumed without
pausing to check for a pulse or rhythm. Minimizing interruptions in chest compressions is
vital for maintaining coronary and cerebral perfusion during cardiac arrest resuscitation.
3. Emergency medical services transport a 72-year-old male experiencing crushing
substernal chest pain radiating to the left jaw that started 45 minutes ago. He is diaphoretic
and anxious. His blood pressure is 90/60 mm Hg and heart rate is 110 beats/min.
Auscultation reveals clear lung fields and normal heart sounds. Which diagnostic modality
and subsequent intervention priority should guide immediate care?
A. Obtain an immediate 12-lead ECG and prepare for emergency reperfusion therapy if ST-
elevation myocardial infarction is present
B. Administer sublingual nitroglycerin regardless of blood pressure to relieve coronary
vasospasm
C. Delay diagnostic imaging until serial cardiac biomarker panels return from the laboratory
D. Administer intravenous beta-blockers immediately to slow the heart rate and reduce
myocardial oxygen demand
Answer: A
Prompt 12-lead ECG acquisition within 10 minutes of arrival is critical for identifying ST-
elevation myocardial infarction and expediting reperfusion via percutaneous coronary
intervention or fibrinolytic therapy. Nitroglycerin and beta-blockers must be used with caution
given his borderline hypotension.
4. A multidisciplinary resuscitation team is managing a 50-year-old male in cardiac arrest
with pulseless electrical activity. High-quality cardiopulmonary resuscitation is underway,
IV/IO access is established, and the first dose of epinephrine has been given. What is the
primary focus of the team leader during this phase?
A. Escalating defibrillation energy doses sequentially after each shock cycle
B. Identifying and treating potential reversible causes, known as the H's and T's
C. Administering prophylactic antiarrhythmic medications to prevent recurrence
D. Performing immediate endotracheal intubation regardless of bag-mask ventilation
effectiveness
Answer: B
During pulseless electrical activity, successful resuscitation hinges on systematically
identifying and treating reversible causes such as hypovolemia, hypoxia, hydrogen ions,
,hypokalemia or hyperkalemia, hypothermia, tension pneumothorax, cardiac tamponade,
toxins, and thrombosis.
5. During the resuscitation of an adult cardiac arrest patient, an advanced airway is
successfully placed via endotracheal intubation. Once placement is confirmed, how should
chest compressions and ventilation be coordinated by the rescue team?
A. Continuous chest compressions without pauses, with one rescue breath delivered every 2
seconds
B. Continuous chest compressions with positive pressure ventilation delivered at a rate of 10
breaths per minute without pausing compressions
C. Cycles of 30 chest compressions followed by 2 rescue breaths
D. Cycles of 15 chest compressions followed by 2 rescue breaths
Answer: B
Once an advanced airway is in place, rescuers no longer deliver cycles of interruptions. Chest
compressions are performed continuously at a rate of 100 to 120 per minute, while ventilations
are delivered asynchronously at a rate of 10 breaths per minute.
6. A 45-year-old male presents to the emergency department complaining of severe
dizziness. His heart rate is 38 beats/min, blood pressure is 82/50 mm Hg, and skin is pale
and diaphoteric. The monitor reveals symptomatic bradycardia with third-degree
atrioventricular block. What is the initial drug of choice and dosing schedule?
A. Epinephrine infusion titrated from 2 to 10 micrograms per minute
B. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
C. Dopamine infusion at 2 to 20 micrograms per kilogram per minute
D. Atropine 0.5 mg IV push, repeated every 3 to 5 minutes to a maximum dose of 3 mg
Answer: D
Atropine is the first-line medication for symptomatic bradycardia. The initial dose is 0.5 mg IV
push every 3 to 5 minutes, up to a maximum total dose of 3 mg. Higher initial doses or delays
can worsen heart rate or delay definitive treatment such as pacing.
7. An 81-year-old female is admitted for sepsis and develops sudden sustained
monomorphic ventricular tachycardia with a pulse. Her blood pressure is 78/44 mm Hg
and she demonstrates altered mental status. What is the immediate treatment of choice?
, A. Immediate synchronized cardioversion
B. Immediate unsynchronized defibrillation at 200 Joules
C. Amiodarone 300 mg IV push over 2 minutes
D. Immediate unassisted endotracheal intubation
Answer: A
A patient with unstable ventricular tachycardia who has a pulse requires immediate
synchronized cardioversion to restore a normal perfusion rhythm and prevent hemodynamic
collapse into ventricular fibrillation.
8. A resuscitation team is evaluating the quality of ongoing chest compressions during a
cardiac arrest call. Which quantitative metric measured via capnography indicates that
chest compressions are of high quality and being performed effectively?
A. An end-tidal carbon dioxide level consistently below 10 mm Hg
B. An end-tidal carbon dioxide level persistently greater than 10 to 20 mm Hg
C. A steady arterial oxygen saturation reading above 95%
D. A widening pulse pressure on the arterial line waveform
Answer: B
Quantitative waveform capnography reflects cardiac output during chest compressions. An
end-tidal carbon dioxide level persistently below 10 mm Hg indicates inadequate chest
compression quality, and rescuers should aim to maintain values greater than 10 to 20 mm
Hg.
9. A 60-year-old male collapses at home and emergency medical services arrive to find him
in asystole. After initiating cardiopulmonary resuscitation, establishing vascular access,
and administering epinephrine, what is the most appropriate next operational step?
A. Deliver immediate unsynchronized shocks every 2 minutes
B. Search for and treat reversible etiologies while continuing resuscitation and considering
termination criteria if appropriate
C. Administer sodium bicarbonate routinely to correct suspected metabolic acidosis
D. Perform immediate needle decompression of the bilateral chest cavities
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A 58-year-old male is brought to the emergency department by paramedics following an
abrupt onset of palpitations and lightheadedness. He is alert and oriented. His initial vital
signs are heart rate 180 beats/min, respiratory rate 20 breaths/min, blood pressure 114/72
mm Hg, and oxygen saturation 98% on room air. The 12-lead ECG reveals a regular
narrow-complex tachycardia with absent distinct P waves. What is the most appropriate
initial pharmacological intervention after establishing intravenous access?
A. Amiodarone 150 mg IV push over 10 minutes
B. Adenosine 6 mg rapid IV push followed by a 20 mL normal saline flush
C. Procainamide 20 mg/min IV infusion until suppression
D. Synchronized cardioversion at 100 Joules immediately
Answer: B
Adenosine is the primary pharmacological treatment for stable, regular narrow-complex
supraventricular tachycardias unresponsive to vagal maneuvers. A rapid 6 mg IV push
followed immediately by a saline flush ensures the medication reaches the central circulation
before it is rapidly metabolized.
2. A 67-year-old female collapses in the outpatient clinic waiting room. A bystander
initiates basic life support while a nurse retrieves the automated external defibrillator and
crash cart. The monitor displays ventricular fibrillation. Following a single shock delivery,
what is the immediate next step in management according to advanced cardiovascular life
support protocols?
A. Check a carotid pulse for up to 10 seconds to assess rhythm conversion
B. Resume high-quality chest compressions immediately for 2 minutes
C. Administer epinephrine 1 mg IV push without delay
D. Obtain a 12-lead ECG to confirm termination of ventricular fibrillation
Answer: B
,Immediately following a defibrillation attempt, chest compressions must be resumed without
pausing to check for a pulse or rhythm. Minimizing interruptions in chest compressions is
vital for maintaining coronary and cerebral perfusion during cardiac arrest resuscitation.
3. Emergency medical services transport a 72-year-old male experiencing crushing
substernal chest pain radiating to the left jaw that started 45 minutes ago. He is diaphoretic
and anxious. His blood pressure is 90/60 mm Hg and heart rate is 110 beats/min.
Auscultation reveals clear lung fields and normal heart sounds. Which diagnostic modality
and subsequent intervention priority should guide immediate care?
A. Obtain an immediate 12-lead ECG and prepare for emergency reperfusion therapy if ST-
elevation myocardial infarction is present
B. Administer sublingual nitroglycerin regardless of blood pressure to relieve coronary
vasospasm
C. Delay diagnostic imaging until serial cardiac biomarker panels return from the laboratory
D. Administer intravenous beta-blockers immediately to slow the heart rate and reduce
myocardial oxygen demand
Answer: A
Prompt 12-lead ECG acquisition within 10 minutes of arrival is critical for identifying ST-
elevation myocardial infarction and expediting reperfusion via percutaneous coronary
intervention or fibrinolytic therapy. Nitroglycerin and beta-blockers must be used with caution
given his borderline hypotension.
4. A multidisciplinary resuscitation team is managing a 50-year-old male in cardiac arrest
with pulseless electrical activity. High-quality cardiopulmonary resuscitation is underway,
IV/IO access is established, and the first dose of epinephrine has been given. What is the
primary focus of the team leader during this phase?
A. Escalating defibrillation energy doses sequentially after each shock cycle
B. Identifying and treating potential reversible causes, known as the H's and T's
C. Administering prophylactic antiarrhythmic medications to prevent recurrence
D. Performing immediate endotracheal intubation regardless of bag-mask ventilation
effectiveness
Answer: B
During pulseless electrical activity, successful resuscitation hinges on systematically
identifying and treating reversible causes such as hypovolemia, hypoxia, hydrogen ions,
,hypokalemia or hyperkalemia, hypothermia, tension pneumothorax, cardiac tamponade,
toxins, and thrombosis.
5. During the resuscitation of an adult cardiac arrest patient, an advanced airway is
successfully placed via endotracheal intubation. Once placement is confirmed, how should
chest compressions and ventilation be coordinated by the rescue team?
A. Continuous chest compressions without pauses, with one rescue breath delivered every 2
seconds
B. Continuous chest compressions with positive pressure ventilation delivered at a rate of 10
breaths per minute without pausing compressions
C. Cycles of 30 chest compressions followed by 2 rescue breaths
D. Cycles of 15 chest compressions followed by 2 rescue breaths
Answer: B
Once an advanced airway is in place, rescuers no longer deliver cycles of interruptions. Chest
compressions are performed continuously at a rate of 100 to 120 per minute, while ventilations
are delivered asynchronously at a rate of 10 breaths per minute.
6. A 45-year-old male presents to the emergency department complaining of severe
dizziness. His heart rate is 38 beats/min, blood pressure is 82/50 mm Hg, and skin is pale
and diaphoteric. The monitor reveals symptomatic bradycardia with third-degree
atrioventricular block. What is the initial drug of choice and dosing schedule?
A. Epinephrine infusion titrated from 2 to 10 micrograms per minute
B. Atropine 1 mg IV push, repeated every 3 to 5 minutes to a maximum of 3 mg
C. Dopamine infusion at 2 to 20 micrograms per kilogram per minute
D. Atropine 0.5 mg IV push, repeated every 3 to 5 minutes to a maximum dose of 3 mg
Answer: D
Atropine is the first-line medication for symptomatic bradycardia. The initial dose is 0.5 mg IV
push every 3 to 5 minutes, up to a maximum total dose of 3 mg. Higher initial doses or delays
can worsen heart rate or delay definitive treatment such as pacing.
7. An 81-year-old female is admitted for sepsis and develops sudden sustained
monomorphic ventricular tachycardia with a pulse. Her blood pressure is 78/44 mm Hg
and she demonstrates altered mental status. What is the immediate treatment of choice?
, A. Immediate synchronized cardioversion
B. Immediate unsynchronized defibrillation at 200 Joules
C. Amiodarone 300 mg IV push over 2 minutes
D. Immediate unassisted endotracheal intubation
Answer: A
A patient with unstable ventricular tachycardia who has a pulse requires immediate
synchronized cardioversion to restore a normal perfusion rhythm and prevent hemodynamic
collapse into ventricular fibrillation.
8. A resuscitation team is evaluating the quality of ongoing chest compressions during a
cardiac arrest call. Which quantitative metric measured via capnography indicates that
chest compressions are of high quality and being performed effectively?
A. An end-tidal carbon dioxide level consistently below 10 mm Hg
B. An end-tidal carbon dioxide level persistently greater than 10 to 20 mm Hg
C. A steady arterial oxygen saturation reading above 95%
D. A widening pulse pressure on the arterial line waveform
Answer: B
Quantitative waveform capnography reflects cardiac output during chest compressions. An
end-tidal carbon dioxide level persistently below 10 mm Hg indicates inadequate chest
compression quality, and rescuers should aim to maintain values greater than 10 to 20 mm
Hg.
9. A 60-year-old male collapses at home and emergency medical services arrive to find him
in asystole. After initiating cardiopulmonary resuscitation, establishing vascular access,
and administering epinephrine, what is the most appropriate next operational step?
A. Deliver immediate unsynchronized shocks every 2 minutes
B. Search for and treat reversible etiologies while continuing resuscitation and considering
termination criteria if appropriate
C. Administer sodium bicarbonate routinely to correct suspected metabolic acidosis
D. Perform immediate needle decompression of the bilateral chest cavities
