AHA ACLS Exam 2025 – Real Exam & Practice Bank with Pre-Test & Post-Test

AHA ACLS Exam 2025 – Real Exam &
Practice Bank with Pre-Test & Post-Test
This final certification exam for AHA ACLS (2025 edition) features 100 scenario-based
questions aligned with current guidelines. Each question presents a clinical scenario, followed
immediately by the correct answer in RED and a detailed rationale including AHA references,
pharmacology, and key teaching points.

Question 1: You arrive at the scene of a 55-year-old male who collapsed at work. He is
unresponsive, not breathing, and has no pulse. Coworks confirm the collapse was witnessed
2 minutes ago. What is your immediate first action in this out-of-hospital cardiac arrest
situation?
Activate the emergency response system, retrieve an AED, and start CPR with chest
compressions
Rationale: AHA chain of survival emphasizes early activation and defibrillation for witnessed
arrest; CPR (30:2 ratio) until AED arrives minimizes time to shock in potential VF.



Question 2: During resuscitation of an adult in ventricular fibrillation, the team has
delivered one shock and completed 2 minutes of CPR. The patient remains in VF. What is
the next medication and dose to administer intravenously?
Epinephrine 1 mg IV/IO push
Rationale: AHA algorithm: Epinephrine after second shock in shockable rhythm enhances
perfusion; repeat every 3-5 minutes.



Question 3: A 65-year-old female presents to the ER with chest pain and is found to have
symptomatic bradycardia with a heart rate of 35 bpm and hypotension. Atropine 1 mg IV
has been given without response. What is the most appropriate next intervention?
Initiate transcutaneous pacing at a rate of 60-70 bpm
Rationale: AHA bradycardia algorithm: Pacing indicated when pharmacological therapy fails in
symptomatic patients; prepare for dopamine infusion if pacing unavailable.



Question 4: In the management of a patient with narrow-complex supraventricular
tachycardia who is stable but symptomatic, vagal maneuvers have failed. What is the initial
dose of medication to administer?
Adenosine 6 mg rapid IV push followed by saline flush
Rationale: Adenosine interrupts reentry at AV node; AHA requires rapid push due to short half-
life (<10 seconds); monitor for asystole pause.

,Question 5: A patient in cardiac arrest receives high-quality CPR and defibrillation for VF.
The rhythm check shows asystole. What is the correct sequence of actions for this non-
shockable rhythm?
Continue CPR, administer epinephrine 1 mg IV every 3-5 minutes, and search for
reversible causes using the Hs and Ts mnemonic
Rationale: AHA non-shockable algorithm prioritizes CPR quality and etiology identification; no
defibrillation for asystole.



Question 6: During post-cardiac arrest care for a patient who achieved ROSC after out-of-
hospital arrest, what is the recommended target temperature range for targeted
temperature management?
Maintain body temperature between 32°C and 36°C for at least 24 hours
Rationale: AHA post-arrest bundle: TTM reduces neurologic damage; avoid fever >37.7°C.



Question 7: A 45-year-old male with known coronary disease presents with unstable wide-
complex tachycardia at 180 bpm. He is hypotensive and confused. What is the immediate
treatment of choice?
Perform synchronized cardioversion starting at 100 J biphasic
Rationale: AHA tachycardia algorithm: Unstable patients require immediate cardioversion;
sedation if time permits.



Question 8: In a patient experiencing an acute ischemic stroke within the thrombolytic
window, what blood pressure parameter must be controlled before administering tPA?
Systolic blood pressure less than 185 mmHg and diastolic less than 110 mmHg
Rationale: AHA stroke guidelines: Hypertension increases hemorrhage risk; use labetalol or
nicardipine to lower BP.



Question 9: A resuscitation team is using waveform capnography during CPR. What end-
tidal CO2 value suggests that return of spontaneous circulation may be imminent?
A sudden increase in EtCO2 to greater than 40 mmHg
Rationale: Rising EtCO2 indicates improved cardiac output; AHA uses this as a ROSC
predictor.

, Question 10: For a patient in refractory ventricular fibrillation after three shocks,
epinephrine, and amiodarone, what alternative antiarrhythmic can be considered?
Lidocaine 1 to 1.5 mg/kg IV bolus
Rationale: AHA allows lidocaine when amiodarone unavailable; class Ib agent suppresses
ventricular ectopy.



Question 11: A pregnant woman at 22 weeks gestation is in cardiac arrest. What
modification to standard CPR technique is required to improve venous return?
Perform manual left uterine displacement or tilt the backboard 15-30 degrees to the left
Rationale: AHA obstetric considerations: Relieves aortocaval compression; consider
perimortem cesarean if no ROSC in 4-5 minutes.



Question 12: During ACLS team resuscitation, what is the primary responsibility of the
team leader in ensuring high-performance team dynamics?
Maintain situational awareness, assign clear roles, and facilitate closed-loop
communication
Rationale: AHA emphasizes leadership to reduce errors; use SBAR for handoffs.



Question 13: A patient with suspected opioid overdose is apneic and cyanotic. What is the
initial dose and route of naloxone administration in this emergency?
Naloxone 2 mg intranasally or intramuscularly, repeated as needed
Rationale: AHA supports naloxone for lay rescuers; reverses respiratory depression while
supporting ventilation.



Question 14: In the ACLS algorithm for pulseless electrical activity, what diagnostic tool
can rapidly identify cardiac tamponade as a reversible cause?
Bedside ultrasound showing pericardial effusion
Rationale: Point-of-care ultrasound integrates into Hs/Ts assessment; pericardiocentesis if
confirmed.



Question 15: What is the recommended compression-to-ventilation ratio for adult CPR
when an advanced airway is in place during two-rescuer resuscitation?
Continuous compressions at 100-120/min with 10 ventilations per minute
Rationale: AHA: Asynchronous CPR maximizes perfusion; avoid hyperventilation.