RQI 2025 ACLS Healthcare Provider
QUESTIONS WITH COMPLETE SOLUTIONS
Course
ACLS
1. Question:
A 66-year-old male collapses. You initiate CPR and attach a defibrillator, which shows
ventricular fibrillation (VF). What is your next step?
A. Deliver high-quality CPR for 2 minutes
B. Administer epinephrine 1 mg IV
C. Deliver a shock
D. Check for a pulse
Answer: C. Deliver a shock
Explanation: VF is a shockable rhythm. The first action after recognizing VF is to immediately
deliver a defibrillation shock, then resume CPR. Delaying shock reduces the chance of
survival.
2. Question:
During a cardiac arrest, the rhythm is asystole. What is the next best action?
A. Attempt defibrillation
B. Administer epinephrine
C. Perform synchronized cardioversion
D. Give amiodarone 300 mg IV
Answer: B. Administer epinephrine
Explanation: Asystole is a non-shockable rhythm. The correct treatment is CPR and
epinephrine every 3–5 minutes. Defibrillation and cardioversion are not effective in asystole.
3. Question:
A patient has a pulse but is in wide-complex tachycardia with a BP of 80/40 mmHg and altered
mental status. What is the next step?
A. Administer adenosine
B. Perform synchronized cardioversion
C. Give amiodarone 150 mg IV
D. Administer IV fluids
,Answer: B. Perform synchronized cardioversion
Explanation: This patient is unstable (hypotension, altered mental status) with a
tachyarrhythmia. Immediate synchronized cardioversion is indicated per ACLS protocol.
4. Question:
You are monitoring a patient in cardiac arrest. After 2 minutes of CPR, the ECG shows pulseless
electrical activity (PEA). What is your next step?
A. Defibrillate
B. Give epinephrine
C. Administer amiodarone
D. Deliver synchronized cardioversion
Answer: B. Give epinephrine
Explanation: PEA is non-shockable. Management includes high-quality CPR and
epinephrine every 3–5 minutes. Defibrillation and antiarrhythmics are not effective here.
5. Question:
A 45-year-old woman in cardiac arrest has just received a second shock for VF. What medication
is recommended now?
A. Lidocaine 1 mg/kg
B. Amiodarone 300 mg IV
C. Magnesium sulfate
D. Atropine 1 mg IV
Answer: B. Amiodarone 300 mg IV
Explanation: After the second shock in VF/pulseless VT, amiodarone 300 mg IV push is
recommended to help terminate the arrhythmia. Lidocaine is a second-line agent.
6. Question:
Which of the following is not a reversible cause of cardiac arrest (H’s and T’s)?
A. Hypoxia
B. Tension pneumothorax
C. Hyperglycemia
D. Tamponade
,Answer: C. Hyperglycemia
Explanation: The H’s and T’s are:
H’s: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia,
Hypothermia
T’s: Tension pneumothorax, Tamponade, Toxins, Thrombosis (cardiac/pulmonary)
Hyperglycemia is not included.
7. Question:
A patient with a heart rate of 38 bpm is hypotensive and dizzy. What is the appropriate first-line
treatment?
A. Atropine 1 mg IV
B. Transcutaneous pacing
C. Dopamine infusion
D. Epinephrine IV push
Answer: A. Atropine 1 mg IV
Explanation: In symptomatic bradycardia, the first-line drug is atropine 1 mg IV, repeat every
3–5 minutes (max 3 mg). If ineffective, consider pacing or infusions.
8. Question:
Which statement best describes high-quality CPR?
A. 60 compressions/min, 1 breath every 3 seconds
B. 120 compressions/min with minimal interruptions
C. Full chest recoil, rate of 100–120/min, depth of 2–2.4 inches
D. Shallow compressions at 90/min with frequent pauses
Answer: C. Full chest recoil, rate of 100–120/min, depth of 2–2.4 inches
Explanation: High-quality CPR includes:
Rate: 100–120/min
Depth: at least 2 inches, max 2.4 inches
Full chest recoil
Minimal interruptions
, 9. Question:
After return of spontaneous circulation (ROSC), the patient's O2 saturation is 88% on room air.
What is the next best step?
A. Begin hyperventilation
B. Give 100% oxygen until SpO₂ ≥ 94%
C. Administer amiodarone
D. Induce hypothermia immediately
Answer: B. Give 100% oxygen until SpO₂ ≥ 94%
Explanation: Post-ROSC care includes oxygenation to maintain SpO₂ ≥ 94%.
Hyperventilation is avoided. Temperature management and other interventions follow
stabilization.
10. Question:
During a code, capnography shows ETCO₂ of 8 mmHg. What does this indicate?
A. Effective CPR
B. Hyperventilation
C. Poor perfusion/ineffective CPR
D. ROSC has occurred
Answer: C. Poor perfusion/ineffective CPR
Explanation: An ETCO₂ < 10 mmHg suggests inadequate chest compressions or poor
perfusion. Aim for ETCO₂ ≥ 10–20 mmHg. A sudden rise may indicate ROSC.
11. Question:
A 58-year-old man presents with chest pain, diaphoresis, and hypotension. ECG shows ST
elevation. What is the first priority?
A. Administer aspirin
B. Give nitroglycerin
C. Perform defibrillation
D. Activate the cardiac catheterization team
Answer: A. Administer aspirin
QUESTIONS WITH COMPLETE SOLUTIONS
Course
ACLS
1. Question:
A 66-year-old male collapses. You initiate CPR and attach a defibrillator, which shows
ventricular fibrillation (VF). What is your next step?
A. Deliver high-quality CPR for 2 minutes
B. Administer epinephrine 1 mg IV
C. Deliver a shock
D. Check for a pulse
Answer: C. Deliver a shock
Explanation: VF is a shockable rhythm. The first action after recognizing VF is to immediately
deliver a defibrillation shock, then resume CPR. Delaying shock reduces the chance of
survival.
2. Question:
During a cardiac arrest, the rhythm is asystole. What is the next best action?
A. Attempt defibrillation
B. Administer epinephrine
C. Perform synchronized cardioversion
D. Give amiodarone 300 mg IV
Answer: B. Administer epinephrine
Explanation: Asystole is a non-shockable rhythm. The correct treatment is CPR and
epinephrine every 3–5 minutes. Defibrillation and cardioversion are not effective in asystole.
3. Question:
A patient has a pulse but is in wide-complex tachycardia with a BP of 80/40 mmHg and altered
mental status. What is the next step?
A. Administer adenosine
B. Perform synchronized cardioversion
C. Give amiodarone 150 mg IV
D. Administer IV fluids
,Answer: B. Perform synchronized cardioversion
Explanation: This patient is unstable (hypotension, altered mental status) with a
tachyarrhythmia. Immediate synchronized cardioversion is indicated per ACLS protocol.
4. Question:
You are monitoring a patient in cardiac arrest. After 2 minutes of CPR, the ECG shows pulseless
electrical activity (PEA). What is your next step?
A. Defibrillate
B. Give epinephrine
C. Administer amiodarone
D. Deliver synchronized cardioversion
Answer: B. Give epinephrine
Explanation: PEA is non-shockable. Management includes high-quality CPR and
epinephrine every 3–5 minutes. Defibrillation and antiarrhythmics are not effective here.
5. Question:
A 45-year-old woman in cardiac arrest has just received a second shock for VF. What medication
is recommended now?
A. Lidocaine 1 mg/kg
B. Amiodarone 300 mg IV
C. Magnesium sulfate
D. Atropine 1 mg IV
Answer: B. Amiodarone 300 mg IV
Explanation: After the second shock in VF/pulseless VT, amiodarone 300 mg IV push is
recommended to help terminate the arrhythmia. Lidocaine is a second-line agent.
6. Question:
Which of the following is not a reversible cause of cardiac arrest (H’s and T’s)?
A. Hypoxia
B. Tension pneumothorax
C. Hyperglycemia
D. Tamponade
,Answer: C. Hyperglycemia
Explanation: The H’s and T’s are:
H’s: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia,
Hypothermia
T’s: Tension pneumothorax, Tamponade, Toxins, Thrombosis (cardiac/pulmonary)
Hyperglycemia is not included.
7. Question:
A patient with a heart rate of 38 bpm is hypotensive and dizzy. What is the appropriate first-line
treatment?
A. Atropine 1 mg IV
B. Transcutaneous pacing
C. Dopamine infusion
D. Epinephrine IV push
Answer: A. Atropine 1 mg IV
Explanation: In symptomatic bradycardia, the first-line drug is atropine 1 mg IV, repeat every
3–5 minutes (max 3 mg). If ineffective, consider pacing or infusions.
8. Question:
Which statement best describes high-quality CPR?
A. 60 compressions/min, 1 breath every 3 seconds
B. 120 compressions/min with minimal interruptions
C. Full chest recoil, rate of 100–120/min, depth of 2–2.4 inches
D. Shallow compressions at 90/min with frequent pauses
Answer: C. Full chest recoil, rate of 100–120/min, depth of 2–2.4 inches
Explanation: High-quality CPR includes:
Rate: 100–120/min
Depth: at least 2 inches, max 2.4 inches
Full chest recoil
Minimal interruptions
, 9. Question:
After return of spontaneous circulation (ROSC), the patient's O2 saturation is 88% on room air.
What is the next best step?
A. Begin hyperventilation
B. Give 100% oxygen until SpO₂ ≥ 94%
C. Administer amiodarone
D. Induce hypothermia immediately
Answer: B. Give 100% oxygen until SpO₂ ≥ 94%
Explanation: Post-ROSC care includes oxygenation to maintain SpO₂ ≥ 94%.
Hyperventilation is avoided. Temperature management and other interventions follow
stabilization.
10. Question:
During a code, capnography shows ETCO₂ of 8 mmHg. What does this indicate?
A. Effective CPR
B. Hyperventilation
C. Poor perfusion/ineffective CPR
D. ROSC has occurred
Answer: C. Poor perfusion/ineffective CPR
Explanation: An ETCO₂ < 10 mmHg suggests inadequate chest compressions or poor
perfusion. Aim for ETCO₂ ≥ 10–20 mmHg. A sudden rise may indicate ROSC.
11. Question:
A 58-year-old man presents with chest pain, diaphoresis, and hypotension. ECG shows ST
elevation. What is the first priority?
A. Administer aspirin
B. Give nitroglycerin
C. Perform defibrillation
D. Activate the cardiac catheterization team
Answer: A. Administer aspirin
