AHA ACLS Final Exam Questions and
Answers with Explanation (Latest
2026/2027
1. During CPR, which parameter best reflects optimal chest compression fraction?
A. Compression rate of 100-120/min
B. Compression depth of at least 2 inches
C. Minimizing interruptions to less than 10 seconds
D. Allowing full chest recoil after each compression
Answer: C. Minimizing interruptions to less than 10 seconds
Rationale: Chest compression fraction (CCF) is the proportion of time spent performing
compressions; a CCF >60% is targeted, achieved by minimizing pauses. Rate, depth, and
recoil are quality components but do not directly define CCF. Thus, minimizing
interruptions is the best indicator of optimal CCF.
2. Which finding on waveform capnography most reliably confirms endotracheal tube
placement?
A. Presence of a sustained waveform with each breath
B. A single large amplitude spike on insertion
C. Gradual rise in end-tidal CO2 over 30 seconds
D. Absence of any waveform after 5 breaths
Answer: A. Presence of a sustained waveform with each breath
Rationale: Continuous waveform capnography showing a sustained rectangular waveform
with each breath is the gold standard for confirming and monitoring endotracheal tube
placement. A single spike or absent waveform may indicate esophageal intubation or
dislodgement. A gradual rise may occur with ROSC but is not the primary confirmation
method.
Page 1 of 75
,3. A patient has a wide-complex tachycardia with a regular rate of 180. Which drug is
first-line if stable?
A. Adenosine 6 mg IV push
B. Amiodarone 150 mg IV over 10 minutes
C. Synchronized cardioversion at 100 J
D. Procainamide 20 mg/min IV infusion
Answer: B. Amiodarone 150 mg IV over 10 minutes
Rationale: For stable wide-complex tachycardia (possible ventricular tachycardia),
amiodarone is the preferred antiarrhythmic per ACLS. Adenosine is ineffective for most
ventricular tachycardias and may cause harm. Synchronized cardioversion is reserved for
unstable patients, and procainamide is an alternative but not first-line.
4. Which intervention is prioritized for a patient with suspected acute stroke and a
glucose level of 45 mg/dL?
A. Administer IV thrombolytic immediately
B. Correct hypoglycemia with dextrose
C. Obtain noncontrast CT head urgently
D. Start aspirin 325 mg orally
Answer: B. Correct hypoglycemia with dextrose
Rationale: Hypoglycemia can mimic stroke and must be corrected before proceeding with
thrombolysis or further stroke workup. Administering thrombolytics or antiplatelets without
correcting glucose may worsen outcomes. CT is important but secondary to immediate
glucose correction.
Page 2 of 75
,5. During a cardiac arrest, which vasopressor is recommended and at what dose?
A. Epinephrine 1 mg IV/IO every 3-5 minutes
B. Vasopressin 40 units IV once
C. Dopamine 5 mcg/kg/min infusion
D. Norepinephrine 0.1 mcg/kg/min infusion
Answer: A. Epinephrine 1 mg IV/IO every 3-5 minutes
Rationale: Epinephrine 1 mg IV/IO every 3-5 minutes is the standard vasopressor in ACLS
cardiac arrest. Vasopressin is no longer recommended as a replacement. Dopamine and
norepinephrine are not used in cardiac arrest algorithms.
6. Which rhythm is most likely to respond to unsynchronized high-energy shock?
A. Sinus tachycardia
B. Ventricular fibrillation
C. Atrial flutter
D. Monomorphic ventricular tachycardia with pulse
Answer: B. Ventricular fibrillation
Rationale: Ventricular fibrillation is a shockable rhythm treated with unsynchronized
defibrillation. Sinus tachycardia and atrial flutter are not shockable in this context.
Monomorphic VT with a pulse may be treated with synchronized cardioversion if unstable.
Page 3 of 75
, 7. What is the recommended initial energy dose for biphasic defibrillation in adult
cardiac arrest?
A. 100 J
B. 150 J
C. 200 J
D. 360 J
Answer: C. 200 J
Rationale: The AHA recommends an initial biphasic energy dose of 120-200 J, with 200 J
being a common default. Subsequent shocks should be at equivalent or higher energy. 100 J
is too low, and 360 J is typically for monophasic or subsequent shocks.
8. Which component is essential for effective team dynamics during a resuscitation?
A. Assigning roles before the event
B. Using closed-loop communication
C. Minimizing speaking to reduce noise
D. Allowing the team leader to perform all tasks
Answer: B. Using closed-loop communication
Rationale: Closed-loop communication ensures orders are acknowledged and confirmed,
reducing errors. Role assignment is helpful but not sufficient alone. Silence or a leader
doing all tasks impairs team performance.
Page 4 of 75
Answers with Explanation (Latest
2026/2027
1. During CPR, which parameter best reflects optimal chest compression fraction?
A. Compression rate of 100-120/min
B. Compression depth of at least 2 inches
C. Minimizing interruptions to less than 10 seconds
D. Allowing full chest recoil after each compression
Answer: C. Minimizing interruptions to less than 10 seconds
Rationale: Chest compression fraction (CCF) is the proportion of time spent performing
compressions; a CCF >60% is targeted, achieved by minimizing pauses. Rate, depth, and
recoil are quality components but do not directly define CCF. Thus, minimizing
interruptions is the best indicator of optimal CCF.
2. Which finding on waveform capnography most reliably confirms endotracheal tube
placement?
A. Presence of a sustained waveform with each breath
B. A single large amplitude spike on insertion
C. Gradual rise in end-tidal CO2 over 30 seconds
D. Absence of any waveform after 5 breaths
Answer: A. Presence of a sustained waveform with each breath
Rationale: Continuous waveform capnography showing a sustained rectangular waveform
with each breath is the gold standard for confirming and monitoring endotracheal tube
placement. A single spike or absent waveform may indicate esophageal intubation or
dislodgement. A gradual rise may occur with ROSC but is not the primary confirmation
method.
Page 1 of 75
,3. A patient has a wide-complex tachycardia with a regular rate of 180. Which drug is
first-line if stable?
A. Adenosine 6 mg IV push
B. Amiodarone 150 mg IV over 10 minutes
C. Synchronized cardioversion at 100 J
D. Procainamide 20 mg/min IV infusion
Answer: B. Amiodarone 150 mg IV over 10 minutes
Rationale: For stable wide-complex tachycardia (possible ventricular tachycardia),
amiodarone is the preferred antiarrhythmic per ACLS. Adenosine is ineffective for most
ventricular tachycardias and may cause harm. Synchronized cardioversion is reserved for
unstable patients, and procainamide is an alternative but not first-line.
4. Which intervention is prioritized for a patient with suspected acute stroke and a
glucose level of 45 mg/dL?
A. Administer IV thrombolytic immediately
B. Correct hypoglycemia with dextrose
C. Obtain noncontrast CT head urgently
D. Start aspirin 325 mg orally
Answer: B. Correct hypoglycemia with dextrose
Rationale: Hypoglycemia can mimic stroke and must be corrected before proceeding with
thrombolysis or further stroke workup. Administering thrombolytics or antiplatelets without
correcting glucose may worsen outcomes. CT is important but secondary to immediate
glucose correction.
Page 2 of 75
,5. During a cardiac arrest, which vasopressor is recommended and at what dose?
A. Epinephrine 1 mg IV/IO every 3-5 minutes
B. Vasopressin 40 units IV once
C. Dopamine 5 mcg/kg/min infusion
D. Norepinephrine 0.1 mcg/kg/min infusion
Answer: A. Epinephrine 1 mg IV/IO every 3-5 minutes
Rationale: Epinephrine 1 mg IV/IO every 3-5 minutes is the standard vasopressor in ACLS
cardiac arrest. Vasopressin is no longer recommended as a replacement. Dopamine and
norepinephrine are not used in cardiac arrest algorithms.
6. Which rhythm is most likely to respond to unsynchronized high-energy shock?
A. Sinus tachycardia
B. Ventricular fibrillation
C. Atrial flutter
D. Monomorphic ventricular tachycardia with pulse
Answer: B. Ventricular fibrillation
Rationale: Ventricular fibrillation is a shockable rhythm treated with unsynchronized
defibrillation. Sinus tachycardia and atrial flutter are not shockable in this context.
Monomorphic VT with a pulse may be treated with synchronized cardioversion if unstable.
Page 3 of 75
, 7. What is the recommended initial energy dose for biphasic defibrillation in adult
cardiac arrest?
A. 100 J
B. 150 J
C. 200 J
D. 360 J
Answer: C. 200 J
Rationale: The AHA recommends an initial biphasic energy dose of 120-200 J, with 200 J
being a common default. Subsequent shocks should be at equivalent or higher energy. 100 J
is too low, and 360 J is typically for monophasic or subsequent shocks.
8. Which component is essential for effective team dynamics during a resuscitation?
A. Assigning roles before the event
B. Using closed-loop communication
C. Minimizing speaking to reduce noise
D. Allowing the team leader to perform all tasks
Answer: B. Using closed-loop communication
Rationale: Closed-loop communication ensures orders are acknowledged and confirmed,
reducing errors. Role assignment is helpful but not sufficient alone. Silence or a leader
doing all tasks impairs team performance.
Page 4 of 75
