AHA ACLS Final Exam – Latest 2026/2027 Most Comprehensive
Questions & Answers with Explanation 100% Verified Prep
Guide
1. You are evaluating a 58-year-old male with chest pain. His monitor
shows a regular, narrow-QRS tachycardia at a rate of 180 bpm. His blood
pressure is 80/50 mmHg, and he is confused and diaphoretic. What is
your immediate priority intervention?
A. Administer adenosine 6 mg IV push.
B. Perform synchronized cardioversion.
C. Administer amiodarone 150 mg IV over 10 minutes.
D. Instruct the patient to bear down (vagal maneuvers).
Answer: B
Explanation: The patient is hemodynamically unstable (hypotensive,
altered mental status, diaphoresis) due to a tachyarrhythmia. According
to the ACLS algorithm, unstable tachycardia requires immediate
synchronized cardioversion. Pharmacological interventions or vagal
maneuvers are only for stable patients.
2. A patient in the ICU suddenly becomes unresponsive. The monitor
shows a bizarre, chaotic waveform with no identifiable P waves or QRS
complexes. What is the rhythm, and what is the first action?
A. Asystole; start CPR.
B. Ventricular fibrillation; defibrillate immediately.
,C. Pulseless electrical activity (PEA); start CPR.
D. Torsades de pointes; administer magnesium sulfate.
Answer: B
Explanation: A chaotic, irregular waveform with no recognizable
complexes is ventricular fibrillation (VF). Since the patient is
unresponsive and pulseless, this is a cardiac arrest. The priority action is
immediate defibrillation, followed by starting high-quality CPR.
3. During a cardiac arrest resuscitation effort, the team achieves Return
of Spontaneous Circulation (ROSC). The patient's end-tidal CO2
(PetCO2) abruptly drops from 42 mmHg to 18 mmHg. What is the most
likely cause of this sudden change?
A. The patient is waking up and hyperventilating.
B. There is a loss of ROSC, and CPR needs to be restarted.
C. The patient is developing metabolic alkalosis.
D. The endotracheal tube has migrated into the right mainstem
bronchus.
Answer: B
Explanation: A sudden, sustained drop in PetCO2 after ROSC often
indicates a loss of pulses or a significant decrease in cardiac output. The
team should immediately check for a pulse and be prepared to resume
CPR if a pulse is not felt.
, 4. A patient presents with a heart rate of 42 bpm. The rhythm is a
second-degree AV block, Type II. The patient is symptomatic with
dizziness and a blood pressure of 88/52 mmHg. After administering
atropine 1 mg IV with no improvement, what is the next best
intervention?
A. Administer a second dose of atropine 1 mg IV.
B. Initiate transcutaneous pacing (TCP).
C. Administer epinephrine 1 mg IV push.
D. Administer adenosine 6 mg IV push.
Answer: B
Explanation: Symptomatic bradycardia that does not respond to
atropine requires immediate transcutaneous pacing. Atropine is often
ineffective in second-degree Type II or third-degree blocks. Epinephrine
or dopamine infusions can be used as a bridge if pacing is delayed, but
TCP is the definitive next step.
5. Which of the following is a contraindication for the administration of
adenosine?
A. Wide-complex tachycardia of unknown origin.
B. Supraventricular tachycardia (SVT).
C. Atrial fibrillation with a rapid ventricular response.
D. Second-degree AV block, Type I.
Answer: A
Questions & Answers with Explanation 100% Verified Prep
Guide
1. You are evaluating a 58-year-old male with chest pain. His monitor
shows a regular, narrow-QRS tachycardia at a rate of 180 bpm. His blood
pressure is 80/50 mmHg, and he is confused and diaphoretic. What is
your immediate priority intervention?
A. Administer adenosine 6 mg IV push.
B. Perform synchronized cardioversion.
C. Administer amiodarone 150 mg IV over 10 minutes.
D. Instruct the patient to bear down (vagal maneuvers).
Answer: B
Explanation: The patient is hemodynamically unstable (hypotensive,
altered mental status, diaphoresis) due to a tachyarrhythmia. According
to the ACLS algorithm, unstable tachycardia requires immediate
synchronized cardioversion. Pharmacological interventions or vagal
maneuvers are only for stable patients.
2. A patient in the ICU suddenly becomes unresponsive. The monitor
shows a bizarre, chaotic waveform with no identifiable P waves or QRS
complexes. What is the rhythm, and what is the first action?
A. Asystole; start CPR.
B. Ventricular fibrillation; defibrillate immediately.
,C. Pulseless electrical activity (PEA); start CPR.
D. Torsades de pointes; administer magnesium sulfate.
Answer: B
Explanation: A chaotic, irregular waveform with no recognizable
complexes is ventricular fibrillation (VF). Since the patient is
unresponsive and pulseless, this is a cardiac arrest. The priority action is
immediate defibrillation, followed by starting high-quality CPR.
3. During a cardiac arrest resuscitation effort, the team achieves Return
of Spontaneous Circulation (ROSC). The patient's end-tidal CO2
(PetCO2) abruptly drops from 42 mmHg to 18 mmHg. What is the most
likely cause of this sudden change?
A. The patient is waking up and hyperventilating.
B. There is a loss of ROSC, and CPR needs to be restarted.
C. The patient is developing metabolic alkalosis.
D. The endotracheal tube has migrated into the right mainstem
bronchus.
Answer: B
Explanation: A sudden, sustained drop in PetCO2 after ROSC often
indicates a loss of pulses or a significant decrease in cardiac output. The
team should immediately check for a pulse and be prepared to resume
CPR if a pulse is not felt.
, 4. A patient presents with a heart rate of 42 bpm. The rhythm is a
second-degree AV block, Type II. The patient is symptomatic with
dizziness and a blood pressure of 88/52 mmHg. After administering
atropine 1 mg IV with no improvement, what is the next best
intervention?
A. Administer a second dose of atropine 1 mg IV.
B. Initiate transcutaneous pacing (TCP).
C. Administer epinephrine 1 mg IV push.
D. Administer adenosine 6 mg IV push.
Answer: B
Explanation: Symptomatic bradycardia that does not respond to
atropine requires immediate transcutaneous pacing. Atropine is often
ineffective in second-degree Type II or third-degree blocks. Epinephrine
or dopamine infusions can be used as a bridge if pacing is delayed, but
TCP is the definitive next step.
5. Which of the following is a contraindication for the administration of
adenosine?
A. Wide-complex tachycardia of unknown origin.
B. Supraventricular tachycardia (SVT).
C. Atrial fibrillation with a rapid ventricular response.
D. Second-degree AV block, Type I.
Answer: A
