ACLS Recertification Exam Practice Questions and
Answers (AHA)
Q1. You find an unresponsive patient with no pulse. What is the first step?
Answer: Start chest compressions
Rationale: High-quality CPR is the immediate priority in ACLS cardiac arrest
management.
Q2. Which rhythm requires immediate defibrillation?
Answer: Ventricular fibrillation
Rationale: VF is a shockable rhythm; defibrillation is the first-line treatment.
Q3. Recommended compression rate during CPR?
Answer: 100–120/min
Rationale: This rate optimizes perfusion and survival outcomes.
Q4. First drug for pulseless VT/VF after CPR and defibrillation?
Answer: Epinephrine
Rationale: Administer every 3–5 minutes; it increases coronary and cerebral perfusion.
Q5. Which drug is used for refractory VF/VT?
Answer: Amiodarone
Rationale: First-line antiarrhythmic for persistent VF/VT.
Q6. Target oxygen saturation post–cardiac arrest?
Answer: 94–99%
Rationale: Avoid hyperoxia; maintain recommended range for optimal outcomes.
Q7. Compression-to-ventilation ratio without advanced airway?
Answer: 30:2
Rationale: Standard ratio for adult resuscitation.
Q8. Which rhythm is not shockable?
Answer: Asystole
Rationale: Managed with CPR + epinephrine, not defibrillation.
Q9. Best way to confirm endotracheal tube placement?
Answer: Continuous waveform capnography
Rationale: Gold standard for confirming airway placement.
Q10. Which drug is not recommended in ACLS cardiac arrest?
Answer: Atropine
Rationale: Removed from ACLS cardiac arrest algorithm.
, Q11. Initial joules for biphasic defibrillation?
Answer: 200 J
Rationale: Recommended starting dose for biphasic defibrillators.
Q12. Which rhythm requires synchronized cardioversion?
Answer: Unstable atrial fibrillation
Rationale: Cardioversion is indicated for unstable tachyarrhythmias.
Q13. Which drug is used for stable supraventricular tachycardia (SVT)?
Answer: Adenosine
Rationale: First-line drug for stable SVT.
Q14. Which rhythm requires immediate pacing?
Answer: Symptomatic bradycardia
Rationale: Transcutaneous pacing indicated when unstable.
Q15. Which drug is first-line for symptomatic bradycardia?
Answer: Atropine
Rationale: 1 mg IV every 3–5 minutes; first-line intervention.
Q16. Which rhythm is treated with magnesium sulfate?
Answer: Torsades de pointes
Rationale: Magnesium stabilizes rhythm in torsades.
Q17. Most reliable indicator of CPR quality?
Answer: End-tidal CO₂ >10 mmHg
Rationale: Reflects effective perfusion during compressions.
Q18. Which rhythm requires immediate defibrillation?
Answer: Pulseless VT
Rationale: Shockable rhythm; defibrillation is priority.
Q19. Which drug is used for unstable VT with a pulse?
Answer: Amiodarone
Rationale: Antiarrhythmic for ventricular tachycardia.
Q20. Which rhythm requires CPR + epinephrine, not defibrillation?
Answer: Pulseless electrical activity (PEA)
Rationale: Non-shockable rhythm; managed with CPR + meds.
Q21. Which rhythm requires immediate defibrillation?
Answer: Ventricular fibrillation
Rationale: VF is shockable; defibrillation is essential.
Q22. Which drug is used for refractory VF after epinephrine?
Answer: Amiodarone
Answers (AHA)
Q1. You find an unresponsive patient with no pulse. What is the first step?
Answer: Start chest compressions
Rationale: High-quality CPR is the immediate priority in ACLS cardiac arrest
management.
Q2. Which rhythm requires immediate defibrillation?
Answer: Ventricular fibrillation
Rationale: VF is a shockable rhythm; defibrillation is the first-line treatment.
Q3. Recommended compression rate during CPR?
Answer: 100–120/min
Rationale: This rate optimizes perfusion and survival outcomes.
Q4. First drug for pulseless VT/VF after CPR and defibrillation?
Answer: Epinephrine
Rationale: Administer every 3–5 minutes; it increases coronary and cerebral perfusion.
Q5. Which drug is used for refractory VF/VT?
Answer: Amiodarone
Rationale: First-line antiarrhythmic for persistent VF/VT.
Q6. Target oxygen saturation post–cardiac arrest?
Answer: 94–99%
Rationale: Avoid hyperoxia; maintain recommended range for optimal outcomes.
Q7. Compression-to-ventilation ratio without advanced airway?
Answer: 30:2
Rationale: Standard ratio for adult resuscitation.
Q8. Which rhythm is not shockable?
Answer: Asystole
Rationale: Managed with CPR + epinephrine, not defibrillation.
Q9. Best way to confirm endotracheal tube placement?
Answer: Continuous waveform capnography
Rationale: Gold standard for confirming airway placement.
Q10. Which drug is not recommended in ACLS cardiac arrest?
Answer: Atropine
Rationale: Removed from ACLS cardiac arrest algorithm.
, Q11. Initial joules for biphasic defibrillation?
Answer: 200 J
Rationale: Recommended starting dose for biphasic defibrillators.
Q12. Which rhythm requires synchronized cardioversion?
Answer: Unstable atrial fibrillation
Rationale: Cardioversion is indicated for unstable tachyarrhythmias.
Q13. Which drug is used for stable supraventricular tachycardia (SVT)?
Answer: Adenosine
Rationale: First-line drug for stable SVT.
Q14. Which rhythm requires immediate pacing?
Answer: Symptomatic bradycardia
Rationale: Transcutaneous pacing indicated when unstable.
Q15. Which drug is first-line for symptomatic bradycardia?
Answer: Atropine
Rationale: 1 mg IV every 3–5 minutes; first-line intervention.
Q16. Which rhythm is treated with magnesium sulfate?
Answer: Torsades de pointes
Rationale: Magnesium stabilizes rhythm in torsades.
Q17. Most reliable indicator of CPR quality?
Answer: End-tidal CO₂ >10 mmHg
Rationale: Reflects effective perfusion during compressions.
Q18. Which rhythm requires immediate defibrillation?
Answer: Pulseless VT
Rationale: Shockable rhythm; defibrillation is priority.
Q19. Which drug is used for unstable VT with a pulse?
Answer: Amiodarone
Rationale: Antiarrhythmic for ventricular tachycardia.
Q20. Which rhythm requires CPR + epinephrine, not defibrillation?
Answer: Pulseless electrical activity (PEA)
Rationale: Non-shockable rhythm; managed with CPR + meds.
Q21. Which rhythm requires immediate defibrillation?
Answer: Ventricular fibrillation
Rationale: VF is shockable; defibrillation is essential.
Q22. Which drug is used for refractory VF after epinephrine?
Answer: Amiodarone
