2026/2027
ACLS Advanced Cardiovascular
Life Support Test 2026/2027:
Certification Review with Exam-
Style Questions
Question 1:
A healthcare provider sees an adult collapse near exposed electrical wiring. The
patient appears unresponsive. Which action should the provider take first?
A. Check the patient’s carotid pulse
B. Begin chest compressions immediately
C. Ensure that the scene is safe before approaching
D. Ask a bystander to retrieve an AED
Correct Answer: C. Ensure that the scene is safe before approaching
Rationale: Scene safety must be verified before patient contact because an electrical
or environmental hazard could injure the rescuer and create additional victims. Pulse
assessment, chest compressions, and AED retrieval are important only after the
provider can safely approach. Effective resuscitation cannot occur when rescuers or
team members remain exposed to an uncontrolled hazard.
Question 2:
After confirming scene safety, a provider finds an adult unresponsive. Emergency
assistance has been activated. Which assessment should be performed next?
A. Measure blood pressure before determining respiratory status
B. Check breathing and pulse simultaneously for no more than 10 seconds
C. Listen for breath sounds for approximately 30 seconds
D. Obtain a complete medical history from bystanders
Correct Answer: B. Check breathing and pulse simultaneously for no more than
10 seconds
Rationale: Breathing and pulse are assessed simultaneously to minimize the delay in
identifying cardiac arrest. The assessment should take no longer than 10 seconds.
Blood-pressure measurement, detailed auscultation, and history collection may
provide useful information later, but they must not delay CPR when an unresponsive
patient has absent or abnormal breathing and no definite pulse.
,2026/2027
Question 3:
An unresponsive adult has occasional irregular gasps, and the provider cannot identify
a carotid pulse within 10 seconds. How should the gasping be interpreted?
A. As adequate spontaneous breathing
B. As a sign that rescue breathing alone is needed
C. As agonal respiration consistent with cardiac arrest
D. As evidence that circulation remains adequate
Correct Answer: C. As agonal respiration consistent with cardiac arrest
Rationale: Agonal gasps are abnormal, ineffective respiratory efforts commonly seen
during cardiac arrest. They must not be mistaken for normal breathing. Because the
patient also has no definite pulse, CPR should begin immediately. Rescue breathing
alone is appropriate only when a pulse is present. Gasping does not demonstrate
adequate ventilation, oxygenation, or circulation.
Question 4:
A patient is unresponsive, has no normal breathing, and has no palpable pulse. Which
intervention has the highest immediate priority?
A. Obtain a 12-lead ECG
B. Begin high-quality chest compressions
C. Insert an advanced airway
D. Establish intravenous access
Correct Answer: B. Begin high-quality chest compressions
Rationale: Immediate high-quality CPR provides temporary blood flow to the heart
and brain while an AED or advanced resuscitation resources are obtained. ECG
acquisition, advanced airway placement, and vascular access may become necessary,
but none should delay the initiation of compressions. Prolonged absence of circulation
rapidly produces irreversible cerebral and myocardial injury.
Question 5:
During adult CPR, which compression technique best meets current high-quality CPR
recommendations?
A. 80–100 compressions/min at a depth of 3 cm
B. 100–120 compressions/min at a depth of at least 5 cm but not more than 6 cm
C. 120–140 compressions/min at a depth greater than 7 cm
D. 60–80 compressions/min at a depth of exactly 5 cm
,2026/2027
Correct Answer: B. 100–120 compressions/min at a depth of at least 5 cm but not
more than 6 cm
Rationale: Adult compressions should be delivered at 100–120 per minute to a depth
of at least 2 inches or 5 cm while avoiding depths greater than 2.4 inches or 6 cm.
Slower or shallower compressions provide inadequate perfusion. Excessively rapid or
deep compressions may reduce effectiveness and increase injury without improving
survival.
Question 6:
A feedback device shows that a rescuer is maintaining correct compression rate and
depth but is leaning on the patient’s chest between compressions. What is the most
important consequence?
A. Increased pulmonary ventilation
B. Reduced venous return and cardiac filling
C. Increased coronary blood flow
D. Shortened time to rhythm analysis
Correct Answer: B. Reduced venous return and cardiac filling
Rationale: Leaning prevents complete chest recoil. Full recoil permits the chest to re-
expand, lowers intrathoracic pressure, and promotes venous return to the heart.
Incomplete recoil reduces cardiac filling and coronary perfusion. It does not improve
ventilation or coronary blood flow. The rescuer should release all pressure between
compressions without removing the hands from position.
Question 7:
During a resuscitation, compressions are stopped for 25 seconds while the team
prepares intubation equipment. Why is this practice harmful?
A. It causes the AED battery to discharge
B. It decreases coronary and cerebral perfusion pressure
C. It prevents epinephrine from entering the circulation
D. It increases the likelihood of excessive chest recoil
Correct Answer: B. It decreases coronary and cerebral perfusion pressure
Rationale: Blood flow generated by CPR falls rapidly whenever compressions stop
and requires several subsequent compressions to rebuild. A prolonged airway-related
pause therefore reduces perfusion of the myocardium and brain. Advanced airway
preparation should occur without interrupting compressions whenever possible. The
pause does not directly discharge the AED, block medication entry, or cause
excessive recoil.
, 2026/2027
Question 8:
After approximately two minutes of continuous chest compressions, a rescuer’s depth
begins to decrease. What should the team leader do?
A. Increase the ventilation rate to compensate
B. Continue with the same rescuer until a pulse returns
C. Rotate compressors during the next planned brief pause
D. Stop CPR and evaluate the rescuer’s physical condition
Correct Answer: C. Rotate compressors during the next planned brief pause
Rationale: Compression depth commonly deteriorates as fatigue develops, even when
the rescuer does not recognize it. Rotating approximately every two minutes, or
sooner when fatigue is evident, helps maintain compression quality. The exchange
should occur during a planned rhythm-analysis pause and take only a few seconds.
Increasing ventilation cannot compensate for inadequate circulatory support.
Question 9:
Two healthcare providers are performing CPR on an adult in cardiac arrest. No
advanced airway is present. Which compression-to-ventilation ratio should they use?
A. 15 compressions to 2 breaths
B. 20 compressions to 2 breaths
C. 30 compressions to 2 breaths
D. Continuous compressions with 20 breaths per minute
Correct Answer: C. 30 compressions to 2 breaths
Rationale: Adult CPR without an advanced airway uses cycles of 30 compressions
and 2 breaths. The ratio applies whether one or multiple rescuers are present. A 15:2
ratio is associated with two-rescuer pediatric CPR, not routine adult CPR. Continuous
compressions with asynchronous ventilation begin only after an advanced airway has
been placed.
Question 10:
An adult is apneic but has a definite carotid pulse. Which intervention is most
appropriate?
A. Begin cycles of 30 compressions and 2 breaths
B. Provide one breath every 6 seconds and reassess the pulse every 2 minutes
C. Deliver immediate defibrillation
D. Withhold treatment until the patient loses a pulse
ACLS Advanced Cardiovascular
Life Support Test 2026/2027:
Certification Review with Exam-
Style Questions
Question 1:
A healthcare provider sees an adult collapse near exposed electrical wiring. The
patient appears unresponsive. Which action should the provider take first?
A. Check the patient’s carotid pulse
B. Begin chest compressions immediately
C. Ensure that the scene is safe before approaching
D. Ask a bystander to retrieve an AED
Correct Answer: C. Ensure that the scene is safe before approaching
Rationale: Scene safety must be verified before patient contact because an electrical
or environmental hazard could injure the rescuer and create additional victims. Pulse
assessment, chest compressions, and AED retrieval are important only after the
provider can safely approach. Effective resuscitation cannot occur when rescuers or
team members remain exposed to an uncontrolled hazard.
Question 2:
After confirming scene safety, a provider finds an adult unresponsive. Emergency
assistance has been activated. Which assessment should be performed next?
A. Measure blood pressure before determining respiratory status
B. Check breathing and pulse simultaneously for no more than 10 seconds
C. Listen for breath sounds for approximately 30 seconds
D. Obtain a complete medical history from bystanders
Correct Answer: B. Check breathing and pulse simultaneously for no more than
10 seconds
Rationale: Breathing and pulse are assessed simultaneously to minimize the delay in
identifying cardiac arrest. The assessment should take no longer than 10 seconds.
Blood-pressure measurement, detailed auscultation, and history collection may
provide useful information later, but they must not delay CPR when an unresponsive
patient has absent or abnormal breathing and no definite pulse.
,2026/2027
Question 3:
An unresponsive adult has occasional irregular gasps, and the provider cannot identify
a carotid pulse within 10 seconds. How should the gasping be interpreted?
A. As adequate spontaneous breathing
B. As a sign that rescue breathing alone is needed
C. As agonal respiration consistent with cardiac arrest
D. As evidence that circulation remains adequate
Correct Answer: C. As agonal respiration consistent with cardiac arrest
Rationale: Agonal gasps are abnormal, ineffective respiratory efforts commonly seen
during cardiac arrest. They must not be mistaken for normal breathing. Because the
patient also has no definite pulse, CPR should begin immediately. Rescue breathing
alone is appropriate only when a pulse is present. Gasping does not demonstrate
adequate ventilation, oxygenation, or circulation.
Question 4:
A patient is unresponsive, has no normal breathing, and has no palpable pulse. Which
intervention has the highest immediate priority?
A. Obtain a 12-lead ECG
B. Begin high-quality chest compressions
C. Insert an advanced airway
D. Establish intravenous access
Correct Answer: B. Begin high-quality chest compressions
Rationale: Immediate high-quality CPR provides temporary blood flow to the heart
and brain while an AED or advanced resuscitation resources are obtained. ECG
acquisition, advanced airway placement, and vascular access may become necessary,
but none should delay the initiation of compressions. Prolonged absence of circulation
rapidly produces irreversible cerebral and myocardial injury.
Question 5:
During adult CPR, which compression technique best meets current high-quality CPR
recommendations?
A. 80–100 compressions/min at a depth of 3 cm
B. 100–120 compressions/min at a depth of at least 5 cm but not more than 6 cm
C. 120–140 compressions/min at a depth greater than 7 cm
D. 60–80 compressions/min at a depth of exactly 5 cm
,2026/2027
Correct Answer: B. 100–120 compressions/min at a depth of at least 5 cm but not
more than 6 cm
Rationale: Adult compressions should be delivered at 100–120 per minute to a depth
of at least 2 inches or 5 cm while avoiding depths greater than 2.4 inches or 6 cm.
Slower or shallower compressions provide inadequate perfusion. Excessively rapid or
deep compressions may reduce effectiveness and increase injury without improving
survival.
Question 6:
A feedback device shows that a rescuer is maintaining correct compression rate and
depth but is leaning on the patient’s chest between compressions. What is the most
important consequence?
A. Increased pulmonary ventilation
B. Reduced venous return and cardiac filling
C. Increased coronary blood flow
D. Shortened time to rhythm analysis
Correct Answer: B. Reduced venous return and cardiac filling
Rationale: Leaning prevents complete chest recoil. Full recoil permits the chest to re-
expand, lowers intrathoracic pressure, and promotes venous return to the heart.
Incomplete recoil reduces cardiac filling and coronary perfusion. It does not improve
ventilation or coronary blood flow. The rescuer should release all pressure between
compressions without removing the hands from position.
Question 7:
During a resuscitation, compressions are stopped for 25 seconds while the team
prepares intubation equipment. Why is this practice harmful?
A. It causes the AED battery to discharge
B. It decreases coronary and cerebral perfusion pressure
C. It prevents epinephrine from entering the circulation
D. It increases the likelihood of excessive chest recoil
Correct Answer: B. It decreases coronary and cerebral perfusion pressure
Rationale: Blood flow generated by CPR falls rapidly whenever compressions stop
and requires several subsequent compressions to rebuild. A prolonged airway-related
pause therefore reduces perfusion of the myocardium and brain. Advanced airway
preparation should occur without interrupting compressions whenever possible. The
pause does not directly discharge the AED, block medication entry, or cause
excessive recoil.
, 2026/2027
Question 8:
After approximately two minutes of continuous chest compressions, a rescuer’s depth
begins to decrease. What should the team leader do?
A. Increase the ventilation rate to compensate
B. Continue with the same rescuer until a pulse returns
C. Rotate compressors during the next planned brief pause
D. Stop CPR and evaluate the rescuer’s physical condition
Correct Answer: C. Rotate compressors during the next planned brief pause
Rationale: Compression depth commonly deteriorates as fatigue develops, even when
the rescuer does not recognize it. Rotating approximately every two minutes, or
sooner when fatigue is evident, helps maintain compression quality. The exchange
should occur during a planned rhythm-analysis pause and take only a few seconds.
Increasing ventilation cannot compensate for inadequate circulatory support.
Question 9:
Two healthcare providers are performing CPR on an adult in cardiac arrest. No
advanced airway is present. Which compression-to-ventilation ratio should they use?
A. 15 compressions to 2 breaths
B. 20 compressions to 2 breaths
C. 30 compressions to 2 breaths
D. Continuous compressions with 20 breaths per minute
Correct Answer: C. 30 compressions to 2 breaths
Rationale: Adult CPR without an advanced airway uses cycles of 30 compressions
and 2 breaths. The ratio applies whether one or multiple rescuers are present. A 15:2
ratio is associated with two-rescuer pediatric CPR, not routine adult CPR. Continuous
compressions with asynchronous ventilation begin only after an advanced airway has
been placed.
Question 10:
An adult is apneic but has a definite carotid pulse. Which intervention is most
appropriate?
A. Begin cycles of 30 compressions and 2 breaths
B. Provide one breath every 6 seconds and reassess the pulse every 2 minutes
C. Deliver immediate defibrillation
D. Withhold treatment until the patient loses a pulse
