AHA ACLS Written Test — 50 Questions (100% Scored) 2026/2027 Updated | Provider Manual Aligned
AHA ACLS Written Test — 50 out of 50 (100% Scored)
2026/2027 UPDATED | Comprehensive 50-Question Exam
Aligned with the AHA ACLS Provider Manual and Current Guidelines
Exam Specifications: Exactly 50 questions across 8 sections | 35% recall (drug doses, energy levels, rates, algorithm
steps), 45% application (scenario-based algorithm decisions, rhythm interpretation, drug administration), 20%
analysis (special situations, reversible causes, post-arrest care) | 65% scenario-based, 35% direct recall. Each item
includes four options (A–D), one correct answer marked [CORRECT], and a detailed rationale with AHA Guidelines
reasoning and ACLS algorithm requirements.
Section 1: ACLS Overview and Systems of Care
Questions Q1–Q6 | Focus: Chain of Survival, Team Dynamics, and Systems of Care
Q1: Which sequence represents the correct order of the AHA Out-of-Hospital Chain of Survival for an adult?
A. Activated dispatch → High-quality CPR → Rapid defibrillation → Advanced life support →
Integrated post-cardiac arrest care [CORRECT]
B. Rapid defibrillation → Activated dispatch → High-quality CPR → Advanced life support → Integrated
post-cardiac arrest care
C. High-quality CPR → Activated dispatch → Advanced life support → Rapid defibrillation → Integrated
post-cardiac arrest care
D. Advanced life support → High-quality CPR → Activated dispatch → Rapid defibrillation → Integrated
post-cardiac arrest care
Correct Answer: A
Rationale: The AHA adult out-of-hospital Chain of Survival begins with activation of the emergency response system
(dispatch), followed by high-quality CPR, rapid defibrillation, advanced life support, and integrated post-cardiac arrest care.
The 2020/2026 AHA Guidelines reinforced surveillance and prevention as an additional link preceding dispatch. Any other
sequence disrupts the evidence-based chain that maximimates survival.
Q2: Which component is the MOST critical to the in-hospital cardiac arrest Chain of Survival and is the
foundation of all subsequent ACLS interventions?
A. High-quality CPR with minimal interruptions and adequate rate/depth [CORRECT]
B. Early administration of epinephrine
C. Early placement of an advanced airway
D. Rapid transport to a cardiac catheterization laboratory
Correct Answer: A
Rationale: Per the AHA Guidelines, high-quality CPR is the cornerstone of all resuscitation and must be performed with
minimal interruptions, adequate rate (100–120/min), and adequate depth (at least 2 inches). Without high-quality CPR,
defibrillation, epinephrine, and advanced airways are less effective. The other interventions are important but depend on a
foundation of effective compressions.
Q3: A resuscitation team is responding to a cardiac arrest. Which team role is responsible for coordinating all
team members, ensuring algorithm adherence, and making global decisions?
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,AHA ACLS Written Test — 50 Questions (100% Scored) 2026/2027 Updated | Provider Manual Aligned
A. Team Leader [CORRECT]
B. Compressor
C. Airway Manager
D. Recorder/Documenter
Correct Answer: A
Rationale: The Team Leader oversees the entire resuscitation, ensures algorithm adherence, assigns roles, and makes global
decisions. The compressor performs CPR, the airway manager manages ventilation, and the recorder documents events. The
Team Leader remains hands-off to maintain situational awareness, a key AHA team-dynamics principle.
Q4: Which behavior BEST demonstrates closed-loop communication during a cardiac arrest?
A. Team Leader says, "Give 1 mg epinephrine IV push." Team member repeats, "I'm giving 1 mg
epinephrine IV push," administers it, and then reports, "1 mg epinephrine IV push given." [CORRECT]
B. Team Leader says, "Give epinephrine," and the team member nods silently.
C. Team member administers epinephrine without confirming the order.
D. Team Leader gives multiple medication orders at once and walks away.
Correct Answer: A
Rationale: Closed-loop communication requires the receiver to repeat the order back, execute it, and then confirm
completion. This prevents medication errors and missed doses. Silent acknowledgment, unconfirmed administration, and
stacked orders all violate the AHA team-dynamics principles and increase the risk of error during resuscitation.
Q5: Which statement BEST reflects a system of care approach to improving cardiac arrest outcomes?
A. Hospitals should establish standardized cardiac arrest response teams, measure performance metrics
(e.g., CPR quality, defibrillation time, ROSC rates), and provide structured debriefing after each event.
[CORRECT]
B. Hospitals should rely on individual clinician skill without standardized protocols.
C. Each clinician should select whichever algorithm they prefer for each arrest.
D. Post-arrest debriefing is optional and not linked to outcomes.
Correct Answer: A
Rationale: Systems of care require standardized teams, performance measurement, and structured debriefing — all linked
by the AHA to improved survival. Relying on individual preference, omitting protocols, or treating debriefing as optional
contradicts evidence that team training and continuous quality improvement directly improve outcomes.
Q6: During a resuscitation, a team member states, "I think we should defibrillate now, the rhythm is VF."
Which concept of team dynamics does this BEST illustrate?
A. Constructive intervention — offering an observation that may improve patient care while preserving
team function. [CORRECT]
B. Undermining the Team Leader's authority.
C. Closed-loop communication.
D. Hierarchical command structure.
Correct Answer: A
Rationale: AHA team-dynamics principles encourage all team members to provide constructive intervention when they
observe a clinically important issue, while still respecting the Team Leader's role. This is not undermining, nor is it
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, AHA ACLS Written Test — 50 Questions (100% Scored) 2026/2027 Updated | Provider Manual Aligned
closed-loop communication (which is order verification) or a rigid hierarchy. Constructive intervention reduces medical
errors.
Section 2: High-Quality BLS and CPR Quality
Questions Q7–Q12 | Focus: Compression Metrics, Feedback Devices, and Team-Based CPR
Q7: Which set of adult high-quality CPR metrics matches current AHA Guidelines?
A. Compression rate 100–120/min, depth at least 2 inches (5 cm), full chest recoil between compressions,
chest compression fraction ≥80%, minimizing interruptions. [CORRECT]
B. Compression rate 80–100/min, depth 1 inch, partial recoil, no limit on interruptions.
C. Compression rate 120–140/min, depth 3 inches, full recoil, no chest compression fraction target.
D. Compression rate 60–80/min, depth 1.5 inches, full recoil, interruptions every 2 minutes.
Correct Answer: A
Rationale: Current AHA Guidelines specify adult compression rate of 100–120/min, depth of at least 2 inches (5 cm) but no
more than 2.4 inches (6 cm), full chest recoil, and a chest compression fraction of at least 80% with minimal interruptions.
Other options contain wrong rates, inadequate depth, or excessive interruption parameters.
Q8: A patient in cardiac arrest has a measured ETCO2 of 8 mmHg during CPR. After 5 minutes of optimized
high-quality CPR, the ETCO2 rises to 18 mmHg. What does this change most likely indicate?
A. Improved CPR quality and/or improved perfusion; ROSC may be developing and the team should
assess for signs of ROSC. [CORRECT]
B. The endotracheal tube is in the esophagus.
C. The patient has severe metabolic acidosis.
D. The patient has a tension pneumothorax.
Correct Answer: A
Rationale: ETCO2 during CPR reflects pulmonary blood flow and cardiac output. A rising ETCO2 (toward or above 20
mmHg) suggests improved CPR quality or developing ROSC, prompting assessment for pulses and signs of perfusion.
Esophageal intubation produces very low or absent ETCO2, while acidosis and tension pneumothorax do not explain a rising
trend.
Q9: Which statement about chest compression fraction (CCF) is correct?
A. CCF should be at least 80%, meaning at least 80% of the resuscitation time is spent actively
compressing the chest. [CORRECT]
B. CCF should be ≤60% to allow time for medication administration.
C. CCF is the percentage of time compressions are paused for pulse checks.
D. CCF is the ratio of compressions to ventilations.
Correct Answer: A
Rationale: Chest compression fraction is the proportion of arrest time during which chest compressions are performed, and
the AHA recommends at least 80% to maximize perfusion. CCF is not the pause percentage, the compression-to-ventilation
ratio, or a target for reduced compressions.
AHA ACLS Written Exam | 50 of 50 Page 3
AHA ACLS Written Test — 50 out of 50 (100% Scored)
2026/2027 UPDATED | Comprehensive 50-Question Exam
Aligned with the AHA ACLS Provider Manual and Current Guidelines
Exam Specifications: Exactly 50 questions across 8 sections | 35% recall (drug doses, energy levels, rates, algorithm
steps), 45% application (scenario-based algorithm decisions, rhythm interpretation, drug administration), 20%
analysis (special situations, reversible causes, post-arrest care) | 65% scenario-based, 35% direct recall. Each item
includes four options (A–D), one correct answer marked [CORRECT], and a detailed rationale with AHA Guidelines
reasoning and ACLS algorithm requirements.
Section 1: ACLS Overview and Systems of Care
Questions Q1–Q6 | Focus: Chain of Survival, Team Dynamics, and Systems of Care
Q1: Which sequence represents the correct order of the AHA Out-of-Hospital Chain of Survival for an adult?
A. Activated dispatch → High-quality CPR → Rapid defibrillation → Advanced life support →
Integrated post-cardiac arrest care [CORRECT]
B. Rapid defibrillation → Activated dispatch → High-quality CPR → Advanced life support → Integrated
post-cardiac arrest care
C. High-quality CPR → Activated dispatch → Advanced life support → Rapid defibrillation → Integrated
post-cardiac arrest care
D. Advanced life support → High-quality CPR → Activated dispatch → Rapid defibrillation → Integrated
post-cardiac arrest care
Correct Answer: A
Rationale: The AHA adult out-of-hospital Chain of Survival begins with activation of the emergency response system
(dispatch), followed by high-quality CPR, rapid defibrillation, advanced life support, and integrated post-cardiac arrest care.
The 2020/2026 AHA Guidelines reinforced surveillance and prevention as an additional link preceding dispatch. Any other
sequence disrupts the evidence-based chain that maximimates survival.
Q2: Which component is the MOST critical to the in-hospital cardiac arrest Chain of Survival and is the
foundation of all subsequent ACLS interventions?
A. High-quality CPR with minimal interruptions and adequate rate/depth [CORRECT]
B. Early administration of epinephrine
C. Early placement of an advanced airway
D. Rapid transport to a cardiac catheterization laboratory
Correct Answer: A
Rationale: Per the AHA Guidelines, high-quality CPR is the cornerstone of all resuscitation and must be performed with
minimal interruptions, adequate rate (100–120/min), and adequate depth (at least 2 inches). Without high-quality CPR,
defibrillation, epinephrine, and advanced airways are less effective. The other interventions are important but depend on a
foundation of effective compressions.
Q3: A resuscitation team is responding to a cardiac arrest. Which team role is responsible for coordinating all
team members, ensuring algorithm adherence, and making global decisions?
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,AHA ACLS Written Test — 50 Questions (100% Scored) 2026/2027 Updated | Provider Manual Aligned
A. Team Leader [CORRECT]
B. Compressor
C. Airway Manager
D. Recorder/Documenter
Correct Answer: A
Rationale: The Team Leader oversees the entire resuscitation, ensures algorithm adherence, assigns roles, and makes global
decisions. The compressor performs CPR, the airway manager manages ventilation, and the recorder documents events. The
Team Leader remains hands-off to maintain situational awareness, a key AHA team-dynamics principle.
Q4: Which behavior BEST demonstrates closed-loop communication during a cardiac arrest?
A. Team Leader says, "Give 1 mg epinephrine IV push." Team member repeats, "I'm giving 1 mg
epinephrine IV push," administers it, and then reports, "1 mg epinephrine IV push given." [CORRECT]
B. Team Leader says, "Give epinephrine," and the team member nods silently.
C. Team member administers epinephrine without confirming the order.
D. Team Leader gives multiple medication orders at once and walks away.
Correct Answer: A
Rationale: Closed-loop communication requires the receiver to repeat the order back, execute it, and then confirm
completion. This prevents medication errors and missed doses. Silent acknowledgment, unconfirmed administration, and
stacked orders all violate the AHA team-dynamics principles and increase the risk of error during resuscitation.
Q5: Which statement BEST reflects a system of care approach to improving cardiac arrest outcomes?
A. Hospitals should establish standardized cardiac arrest response teams, measure performance metrics
(e.g., CPR quality, defibrillation time, ROSC rates), and provide structured debriefing after each event.
[CORRECT]
B. Hospitals should rely on individual clinician skill without standardized protocols.
C. Each clinician should select whichever algorithm they prefer for each arrest.
D. Post-arrest debriefing is optional and not linked to outcomes.
Correct Answer: A
Rationale: Systems of care require standardized teams, performance measurement, and structured debriefing — all linked
by the AHA to improved survival. Relying on individual preference, omitting protocols, or treating debriefing as optional
contradicts evidence that team training and continuous quality improvement directly improve outcomes.
Q6: During a resuscitation, a team member states, "I think we should defibrillate now, the rhythm is VF."
Which concept of team dynamics does this BEST illustrate?
A. Constructive intervention — offering an observation that may improve patient care while preserving
team function. [CORRECT]
B. Undermining the Team Leader's authority.
C. Closed-loop communication.
D. Hierarchical command structure.
Correct Answer: A
Rationale: AHA team-dynamics principles encourage all team members to provide constructive intervention when they
observe a clinically important issue, while still respecting the Team Leader's role. This is not undermining, nor is it
AHA ACLS Written Exam | 50 of 50 Page 2
, AHA ACLS Written Test — 50 Questions (100% Scored) 2026/2027 Updated | Provider Manual Aligned
closed-loop communication (which is order verification) or a rigid hierarchy. Constructive intervention reduces medical
errors.
Section 2: High-Quality BLS and CPR Quality
Questions Q7–Q12 | Focus: Compression Metrics, Feedback Devices, and Team-Based CPR
Q7: Which set of adult high-quality CPR metrics matches current AHA Guidelines?
A. Compression rate 100–120/min, depth at least 2 inches (5 cm), full chest recoil between compressions,
chest compression fraction ≥80%, minimizing interruptions. [CORRECT]
B. Compression rate 80–100/min, depth 1 inch, partial recoil, no limit on interruptions.
C. Compression rate 120–140/min, depth 3 inches, full recoil, no chest compression fraction target.
D. Compression rate 60–80/min, depth 1.5 inches, full recoil, interruptions every 2 minutes.
Correct Answer: A
Rationale: Current AHA Guidelines specify adult compression rate of 100–120/min, depth of at least 2 inches (5 cm) but no
more than 2.4 inches (6 cm), full chest recoil, and a chest compression fraction of at least 80% with minimal interruptions.
Other options contain wrong rates, inadequate depth, or excessive interruption parameters.
Q8: A patient in cardiac arrest has a measured ETCO2 of 8 mmHg during CPR. After 5 minutes of optimized
high-quality CPR, the ETCO2 rises to 18 mmHg. What does this change most likely indicate?
A. Improved CPR quality and/or improved perfusion; ROSC may be developing and the team should
assess for signs of ROSC. [CORRECT]
B. The endotracheal tube is in the esophagus.
C. The patient has severe metabolic acidosis.
D. The patient has a tension pneumothorax.
Correct Answer: A
Rationale: ETCO2 during CPR reflects pulmonary blood flow and cardiac output. A rising ETCO2 (toward or above 20
mmHg) suggests improved CPR quality or developing ROSC, prompting assessment for pulses and signs of perfusion.
Esophageal intubation produces very low or absent ETCO2, while acidosis and tension pneumothorax do not explain a rising
trend.
Q9: Which statement about chest compression fraction (CCF) is correct?
A. CCF should be at least 80%, meaning at least 80% of the resuscitation time is spent actively
compressing the chest. [CORRECT]
B. CCF should be ≤60% to allow time for medication administration.
C. CCF is the percentage of time compressions are paused for pulse checks.
D. CCF is the ratio of compressions to ventilations.
Correct Answer: A
Rationale: Chest compression fraction is the proportion of arrest time during which chest compressions are performed, and
the AHA recommends at least 80% to maximize perfusion. CCF is not the pause percentage, the compression-to-ventilation
ratio, or a target for reduced compressions.
AHA ACLS Written Exam | 50 of 50 Page 3
