2025 ACLS Provider Written Exam –
50 Actual Questions with Verified
Correct Answers & AHA-Based
Explanations | A+ Graded
Cardiac Arrest Management (Questions 1–10)
Question 1
You find an unresponsive patient who is not breathing. After activating the emergency
response system, you determine there is no pulse. What is your next action?
A. Administer epinephrine
B. Start chest compressions at 100–120 per minute
C. Perform defibrillation
D. Insert an advanced airway
Answer: B
Rationale: For an unresponsive patient with no pulse or breathing, start high-quality chest
compressions at 100–120 per minute immediately after activating the emergency response
system. This is per the AHA ACLS algorithm for pulseless rhythms. Epinephrine (A) is given
after CPR initiation, defibrillation (C) is for shockable rhythms, and airway management (D) is
secondary.
AHA Guideline: Prioritize high-quality CPR in cardiac arrest.
Question 2
What is a common but sometimes fatal mistake in cardiac arrest management?
A. Administering oxygen too early
B. Prolonged interruptions in chest compressions
C. Using an AED without training
D. Giving epinephrine too soon
Answer: B
Rationale: Prolonged interruptions in chest compressions reduce coronary perfusion pressure
and decrease the chance of return of spontaneous circulation (ROSC). Minimizing pauses is
critical in ACLS. Oxygen (A), AED use (C), and epinephrine timing (D) are less critical errors.
AHA Guideline: Minimize compression interruptions to <10 seconds.
Question 3
,Which action is a component of high-quality chest compressions?
A. Compressing at a depth of 3–4 cm
B. Allowing complete chest recoil
C. Compressing at a rate of 80–100 per minute
D. Pausing every minute for ventilation
Answer: B
Rationale: High-quality CPR includes allowing complete chest recoil to ensure adequate venous
return and cardiac filling. Depth should be 5–6 cm (A incorrect), rate should be 100–120 per
minute (C incorrect), and pauses should be minimized (D incorrect).
AHA Guideline: Ensure full chest recoil during CPR.
Question 4
What is the recommended interval for interruptions in chest compressions during CPR?
A. 20 seconds or less
B. 10 seconds or less
C. 30 seconds or less
D. 5 seconds or less
Answer: B
Rationale: Interruptions in chest compressions should be limited to 10 seconds or less to
maintain perfusion, per AHA guidelines. Longer intervals (A, C) reduce CPR effectiveness, and
5 seconds (D) is overly restrictive.
AHA Guideline: Limit interruptions to ≤10 seconds.
Question 5
You have completed 2 minutes of CPR. The ECG shows pulseless electrical activity (PEA),
and an IV is in place. What is your next priority?
A. Administer 1 mg epinephrine
B. Defibrillate immediately
C. Insert an advanced airway
D. Administer amiodarone 300 mg
Answer: A
Rationale: For PEA, administer 1 mg epinephrine IV/IO every 3–5 minutes after initiating CPR,
per AHA ACLS guidelines. Defibrillation (B) is for shockable rhythms, airway insertion (C) is
secondary, and amiodarone (D) is for ventricular fibrillation/pulseless ventricular tachycardia
(VF/pVT).
AHA Guideline: Epinephrine is the first drug for PEA.
Question 6
What is the best strategy for high-quality CPR with an advanced airway in place?
A. Pause compressions for ventilations
, B. Provide continuous chest compressions and 10 ventilations per minute
C. Ventilate every 3 seconds
D. Compress at 80 per minute
Answer: B
Rationale: With an advanced airway, provide continuous chest compressions without pauses and
ventilate at 10 breaths per minute (1 breath every 6 seconds). Pausing compressions (A), frequent
ventilation (C), or slow compression rate (D) reduces CPR quality.
AHA Guideline: Continuous compressions with 10 breaths/min for advanced airway.
Question 7
An AED does not promptly analyze a rhythm. What is your next step?
A. Administer epinephrine
B. Begin chest compressions
C. Check electrode placement
D. Defibrillate manually
Answer: B
Rationale: If an AED fails to analyze, resume chest compressions immediately to avoid delays
in CPR. Checking electrodes (C) is secondary, epinephrine (A) follows CPR, and manual
defibrillation (D) requires a manual defibrillator.
AHA Guideline: Prioritize CPR if AED malfunctions.
Question 8
During CPR, you notice a PETCO2 of 8 mm Hg on capnography with an advanced airway.
What does this indicate?
A. Effective chest compressions
B. Inadequate chest compressions
C. Proper airway placement
D. Return of spontaneous circulation
Answer: B
Rationale: A PETCO2 <10 mm Hg during CPR with an advanced airway suggests inadequate
chest compressions, as effective CPR typically yields PETCO2 ≥10 mm Hg. Airway placement
(C) is confirmed by waveform presence, and ROSC (D) typically shows higher PETCO2 (35–40
mm Hg).
AHA Guideline: Use capnography to monitor CPR quality.
Question 9
What is the priority intervention for a patient in asystole, in addition to high-quality CPR?
A. Defibrillation
B. Administer epinephrine as early as possible
50 Actual Questions with Verified
Correct Answers & AHA-Based
Explanations | A+ Graded
Cardiac Arrest Management (Questions 1–10)
Question 1
You find an unresponsive patient who is not breathing. After activating the emergency
response system, you determine there is no pulse. What is your next action?
A. Administer epinephrine
B. Start chest compressions at 100–120 per minute
C. Perform defibrillation
D. Insert an advanced airway
Answer: B
Rationale: For an unresponsive patient with no pulse or breathing, start high-quality chest
compressions at 100–120 per minute immediately after activating the emergency response
system. This is per the AHA ACLS algorithm for pulseless rhythms. Epinephrine (A) is given
after CPR initiation, defibrillation (C) is for shockable rhythms, and airway management (D) is
secondary.
AHA Guideline: Prioritize high-quality CPR in cardiac arrest.
Question 2
What is a common but sometimes fatal mistake in cardiac arrest management?
A. Administering oxygen too early
B. Prolonged interruptions in chest compressions
C. Using an AED without training
D. Giving epinephrine too soon
Answer: B
Rationale: Prolonged interruptions in chest compressions reduce coronary perfusion pressure
and decrease the chance of return of spontaneous circulation (ROSC). Minimizing pauses is
critical in ACLS. Oxygen (A), AED use (C), and epinephrine timing (D) are less critical errors.
AHA Guideline: Minimize compression interruptions to <10 seconds.
Question 3
,Which action is a component of high-quality chest compressions?
A. Compressing at a depth of 3–4 cm
B. Allowing complete chest recoil
C. Compressing at a rate of 80–100 per minute
D. Pausing every minute for ventilation
Answer: B
Rationale: High-quality CPR includes allowing complete chest recoil to ensure adequate venous
return and cardiac filling. Depth should be 5–6 cm (A incorrect), rate should be 100–120 per
minute (C incorrect), and pauses should be minimized (D incorrect).
AHA Guideline: Ensure full chest recoil during CPR.
Question 4
What is the recommended interval for interruptions in chest compressions during CPR?
A. 20 seconds or less
B. 10 seconds or less
C. 30 seconds or less
D. 5 seconds or less
Answer: B
Rationale: Interruptions in chest compressions should be limited to 10 seconds or less to
maintain perfusion, per AHA guidelines. Longer intervals (A, C) reduce CPR effectiveness, and
5 seconds (D) is overly restrictive.
AHA Guideline: Limit interruptions to ≤10 seconds.
Question 5
You have completed 2 minutes of CPR. The ECG shows pulseless electrical activity (PEA),
and an IV is in place. What is your next priority?
A. Administer 1 mg epinephrine
B. Defibrillate immediately
C. Insert an advanced airway
D. Administer amiodarone 300 mg
Answer: A
Rationale: For PEA, administer 1 mg epinephrine IV/IO every 3–5 minutes after initiating CPR,
per AHA ACLS guidelines. Defibrillation (B) is for shockable rhythms, airway insertion (C) is
secondary, and amiodarone (D) is for ventricular fibrillation/pulseless ventricular tachycardia
(VF/pVT).
AHA Guideline: Epinephrine is the first drug for PEA.
Question 6
What is the best strategy for high-quality CPR with an advanced airway in place?
A. Pause compressions for ventilations
, B. Provide continuous chest compressions and 10 ventilations per minute
C. Ventilate every 3 seconds
D. Compress at 80 per minute
Answer: B
Rationale: With an advanced airway, provide continuous chest compressions without pauses and
ventilate at 10 breaths per minute (1 breath every 6 seconds). Pausing compressions (A), frequent
ventilation (C), or slow compression rate (D) reduces CPR quality.
AHA Guideline: Continuous compressions with 10 breaths/min for advanced airway.
Question 7
An AED does not promptly analyze a rhythm. What is your next step?
A. Administer epinephrine
B. Begin chest compressions
C. Check electrode placement
D. Defibrillate manually
Answer: B
Rationale: If an AED fails to analyze, resume chest compressions immediately to avoid delays
in CPR. Checking electrodes (C) is secondary, epinephrine (A) follows CPR, and manual
defibrillation (D) requires a manual defibrillator.
AHA Guideline: Prioritize CPR if AED malfunctions.
Question 8
During CPR, you notice a PETCO2 of 8 mm Hg on capnography with an advanced airway.
What does this indicate?
A. Effective chest compressions
B. Inadequate chest compressions
C. Proper airway placement
D. Return of spontaneous circulation
Answer: B
Rationale: A PETCO2 <10 mm Hg during CPR with an advanced airway suggests inadequate
chest compressions, as effective CPR typically yields PETCO2 ≥10 mm Hg. Airway placement
(C) is confirmed by waveform presence, and ROSC (D) typically shows higher PETCO2 (35–40
mm Hg).
AHA Guideline: Use capnography to monitor CPR quality.
Question 9
What is the priority intervention for a patient in asystole, in addition to high-quality CPR?
A. Defibrillation
B. Administer epinephrine as early as possible
