AHA ACLS FINAL EXAM ACTUAL TEST
PREP (100 Q&AS WITH RATIONALES
INSIDE QUESTIONS) – LATEST
2026/2027 EDITION
AHA ACLS Final Exam Practice Prep 2026/2027
1. A 62-year-old male is brought to the emergency
department experiencing crushing substernal chest
pain. The initial 12-lead electrocardiogram (ECG)
reveals ST-segment elevation in leads II, III, and aVF.
Which of the following immediate interventions
should the nurse prioritize to improve coronary
perfusion?
A. Administer a high-dose intravenous bolus of amiodarone to
prevent potential ventricular arrhythmias.
B. Correct Answer: Administer chewable aspirin
162 to 325 mg immediately if not contraindicated and
coordinate rapid reperfusion therapy. Rationale:
Aspirin inhibits platelet aggregation and reduces thrombus
formation in acute coronary syndromes, making it a critical
early intervention alongside rapid reperfusion for ST-
elevation myocardial infarction (STEMI).
C. Prepare for immediate transcutaneous pacing to manage
potential high-degree atrioventricular blocks.
D. Administer a 2-liter intravenous fluid bolus of normal saline
to treat suspected right ventricular infarction before reviewing
vital signs.
2. During a cardiac arrest resuscitation attempt, the
team leader notes ventricular fibrillation on the
cardiac monitor. The team delivers a high-energy
,unsynchronized shock. What is the immediate next
operational step the team must take?
A. Correct Answer: Resume high-quality chest
compressions immediately for 2 minutes starting with
chest compressions before checking the rhythm or
pulse. Rationale: Delivering a shock does not instantly
restore a perfusing rhythm; performing immediate CPR
minimizes coronary perfusion pressure decay and optimizes
the chances of ROSC after shock delivery.
B. Pause all interventions to check the carotid pulse and assess
for spontaneous respirations for up to 10 seconds.
C. Administer an immediate intravenous bolus of epinephrine 1
mg combined with a rapid saline flush.
D. Analyze the cardiac rhythm again to evaluate if the
defibrillation successfully terminated the ventricular
fibrillation.
3. A client presents to the emergency department with
a sudden onset of regular narrow-complex tachycardia
at a rate of 180 beats per minute. The client is alert,
oriented, and denies chest pain or shortness of breath,
with a blood pressure of 118/76 mmHg. Which of the
following initial interventions is most appropriate?
A. Administer a rapid intravenous bolus of adenosine 12 mg
through a central venous access device.
B. Prepare for immediate synchronized cardioversion starting
at a high energy level of 200 Joules.
C. Correct Answer: Instruct the client to perform a
vagal maneuver, such as blowing through a modified
syringe or bearing down against a closed glottis.
Rationale: In stable supraventricular tachycardia (SVT),
vagal maneuvers are the first-line, non-invasive intervention
to increase vagal tone and slow conduction through the AV
node before chemical interventions are introduced.
,D. Initiate an intravenous infusion of diltiazem at a high
maintenance rate without establishing telemetry monitoring.
4. A resuscitation team is managing a client in
pulseless electrical activity (PEA). The nurse has
established intravenous access and administered the
first dose of epinephrine. How often should the nurse
administer subsequent epinephrine doses during the
arrest?
A. Every 60 seconds continuously to maintain a high circulating
systemic vascular resistance.
B. Every 2 minutes immediately preceding every single rhythm
analysis check throughout the code.
C. Correct Answer: Every 3 to 5 minutes throughout
the duration of the resuscitation attempt. Rationale:
The AHA ACLS guidelines mandate administering epinephrine
1 mg IV/IO every 3 to 5 minutes for non-shockable rhythms
(PEA/Asystole) to optimize coronary and cerebral perfusion.
D. Only after a minimum of three distinct shocks have failed to
convert the rhythm into a shockable state.
5. A 55-year-old female client is experiencing
symptomatic bradycardia with a heart rate of 38 beats
per minute. The client is diaphoretic, reports severe
dizziness, and has a blood pressure of 82/44 mmHg.
Which of the following first-line medications should
the nurse administer?
A. Correct Answer: Atropine sulfate 1 mg via rapid
intravenous push, repeatable up to a total maximum
dose of 3 mg. Rationale: Atropine reverses vagal-mediated
bradycardia by blocking acetylcholine receptors; current
ACLS guidelines specify a starting dose of 1 mg IV, repeatable
every 3 to 5 minutes up to a 3 mg maximum for symptomatic
bradycardia.
B. Epinephrine 1 mg via direct, undiluted rapid intravenous
, injection every 3 minutes.
C. Adenosine 6 mg via rapid intravenous push followed
immediately by a twenty-milliliter fluid flush.
D. Amiodarone 300 mg diluted in dextrose solutions
administered over a continuous fifteen-minute window.
6. A client in the intensive care unit becomes
unresponsive and displays a wide-complex
polymorphic ventricular tachycardia on the monitor.
The nurse checks for a pulse and finds it is absent.
Which of the following actions is required
immediately?
A. Deliver a synchronized cardioversion shock matching the
energy level precisely to the R-wave peak.
B. Correct Answer: Activate the emergency
response system, begin high-quality CPR, and deliver
an unsynchronized defibrillation shock immediately.
Rationale: Pulseless polymorphic ventricular tachycardia
(torsades de pointes) cannot be reliably synchronized by a
monitor; it must be treated immediately as an unsynchronized
shock (defibrillation) to prevent permanent biological death.
C. Initiate a continuous intravenous infusion of lidocaine at a
standardized weight-based maintenance rate.
D. Attempt a series of prolonged precordial thumps while
waiting for the advanced code team to arrive.
7. A paramedic team is transporting a stroke client to a
designated comprehensive stroke center. The
symptoms began approximately two hours ago. Which
of the following absolute time windows represents the
standard threshold for administering intravenous
alteplase (tPA) from symptom onset?
A. Within a maximum window of 60 minutes from the time the
client arrived at the emergency department triage desk.
B. Correct Answer: Within 3 to 4.5 hours from the
well-documented onset of acute neurological
PREP (100 Q&AS WITH RATIONALES
INSIDE QUESTIONS) – LATEST
2026/2027 EDITION
AHA ACLS Final Exam Practice Prep 2026/2027
1. A 62-year-old male is brought to the emergency
department experiencing crushing substernal chest
pain. The initial 12-lead electrocardiogram (ECG)
reveals ST-segment elevation in leads II, III, and aVF.
Which of the following immediate interventions
should the nurse prioritize to improve coronary
perfusion?
A. Administer a high-dose intravenous bolus of amiodarone to
prevent potential ventricular arrhythmias.
B. Correct Answer: Administer chewable aspirin
162 to 325 mg immediately if not contraindicated and
coordinate rapid reperfusion therapy. Rationale:
Aspirin inhibits platelet aggregation and reduces thrombus
formation in acute coronary syndromes, making it a critical
early intervention alongside rapid reperfusion for ST-
elevation myocardial infarction (STEMI).
C. Prepare for immediate transcutaneous pacing to manage
potential high-degree atrioventricular blocks.
D. Administer a 2-liter intravenous fluid bolus of normal saline
to treat suspected right ventricular infarction before reviewing
vital signs.
2. During a cardiac arrest resuscitation attempt, the
team leader notes ventricular fibrillation on the
cardiac monitor. The team delivers a high-energy
,unsynchronized shock. What is the immediate next
operational step the team must take?
A. Correct Answer: Resume high-quality chest
compressions immediately for 2 minutes starting with
chest compressions before checking the rhythm or
pulse. Rationale: Delivering a shock does not instantly
restore a perfusing rhythm; performing immediate CPR
minimizes coronary perfusion pressure decay and optimizes
the chances of ROSC after shock delivery.
B. Pause all interventions to check the carotid pulse and assess
for spontaneous respirations for up to 10 seconds.
C. Administer an immediate intravenous bolus of epinephrine 1
mg combined with a rapid saline flush.
D. Analyze the cardiac rhythm again to evaluate if the
defibrillation successfully terminated the ventricular
fibrillation.
3. A client presents to the emergency department with
a sudden onset of regular narrow-complex tachycardia
at a rate of 180 beats per minute. The client is alert,
oriented, and denies chest pain or shortness of breath,
with a blood pressure of 118/76 mmHg. Which of the
following initial interventions is most appropriate?
A. Administer a rapid intravenous bolus of adenosine 12 mg
through a central venous access device.
B. Prepare for immediate synchronized cardioversion starting
at a high energy level of 200 Joules.
C. Correct Answer: Instruct the client to perform a
vagal maneuver, such as blowing through a modified
syringe or bearing down against a closed glottis.
Rationale: In stable supraventricular tachycardia (SVT),
vagal maneuvers are the first-line, non-invasive intervention
to increase vagal tone and slow conduction through the AV
node before chemical interventions are introduced.
,D. Initiate an intravenous infusion of diltiazem at a high
maintenance rate without establishing telemetry monitoring.
4. A resuscitation team is managing a client in
pulseless electrical activity (PEA). The nurse has
established intravenous access and administered the
first dose of epinephrine. How often should the nurse
administer subsequent epinephrine doses during the
arrest?
A. Every 60 seconds continuously to maintain a high circulating
systemic vascular resistance.
B. Every 2 minutes immediately preceding every single rhythm
analysis check throughout the code.
C. Correct Answer: Every 3 to 5 minutes throughout
the duration of the resuscitation attempt. Rationale:
The AHA ACLS guidelines mandate administering epinephrine
1 mg IV/IO every 3 to 5 minutes for non-shockable rhythms
(PEA/Asystole) to optimize coronary and cerebral perfusion.
D. Only after a minimum of three distinct shocks have failed to
convert the rhythm into a shockable state.
5. A 55-year-old female client is experiencing
symptomatic bradycardia with a heart rate of 38 beats
per minute. The client is diaphoretic, reports severe
dizziness, and has a blood pressure of 82/44 mmHg.
Which of the following first-line medications should
the nurse administer?
A. Correct Answer: Atropine sulfate 1 mg via rapid
intravenous push, repeatable up to a total maximum
dose of 3 mg. Rationale: Atropine reverses vagal-mediated
bradycardia by blocking acetylcholine receptors; current
ACLS guidelines specify a starting dose of 1 mg IV, repeatable
every 3 to 5 minutes up to a 3 mg maximum for symptomatic
bradycardia.
B. Epinephrine 1 mg via direct, undiluted rapid intravenous
, injection every 3 minutes.
C. Adenosine 6 mg via rapid intravenous push followed
immediately by a twenty-milliliter fluid flush.
D. Amiodarone 300 mg diluted in dextrose solutions
administered over a continuous fifteen-minute window.
6. A client in the intensive care unit becomes
unresponsive and displays a wide-complex
polymorphic ventricular tachycardia on the monitor.
The nurse checks for a pulse and finds it is absent.
Which of the following actions is required
immediately?
A. Deliver a synchronized cardioversion shock matching the
energy level precisely to the R-wave peak.
B. Correct Answer: Activate the emergency
response system, begin high-quality CPR, and deliver
an unsynchronized defibrillation shock immediately.
Rationale: Pulseless polymorphic ventricular tachycardia
(torsades de pointes) cannot be reliably synchronized by a
monitor; it must be treated immediately as an unsynchronized
shock (defibrillation) to prevent permanent biological death.
C. Initiate a continuous intravenous infusion of lidocaine at a
standardized weight-based maintenance rate.
D. Attempt a series of prolonged precordial thumps while
waiting for the advanced code team to arrive.
7. A paramedic team is transporting a stroke client to a
designated comprehensive stroke center. The
symptoms began approximately two hours ago. Which
of the following absolute time windows represents the
standard threshold for administering intravenous
alteplase (tPA) from symptom onset?
A. Within a maximum window of 60 minutes from the time the
client arrived at the emergency department triage desk.
B. Correct Answer: Within 3 to 4.5 hours from the
well-documented onset of acute neurological
