ACLS Provider Certification Exam Version A
(2026)Latest Edition | American Heart Association (AHA)
Question 1
During high-quality CPR, which of the following is the most critical factor for
achieving return of spontaneous circulation (ROSC)?
A. Adequate ventilation rate
B. Minimal interruptions in chest compressions
C. Administration of epinephrine
D. Advanced airway placement
Answer: B. Minimal interruptions in chest compressions.
Rationale: Minimizing interruptions in chest compressions is the most critical factor for
achieving ROSC. Coronary perfusion pressure is maintained during compressions, and
interruptions reduce the likelihood of successful resuscitation. Studies show that chest
compression fraction should be at least 80% .
Question 2
A patient presents with pulseless ventricular tachycardia. What is the correct
sequence of actions?
A. Defibrillation → CPR → Epinephrine
B. CPR → Defibrillation → CPR → Rhythm check
C. Epinephrine → Defibrillation → CPR
D. CPR → Epinephrine → Defibrillation
Answer: B. CPR → Defibrillation → CPR → Rhythm check.
Rationale: The correct sequence is to start CPR immediately, then defibrillate as soon as
possible, resume CPR immediately after shock, and check rhythm after 2 minutes of CPR.
This minimizes interruptions and maximizes perfusion .
,Question 3
Which of the following best describes the role of the team leader during a
resuscitation attempt?
A. Performing chest compressions while directing the team
B. Standing back and observing without directing
C. Assigning roles, making clinical decisions, and facilitating communication
D. Documenting all interventions
Answer: C. Assigning roles, making clinical decisions, and facilitating
communication.
Rationale: The team leader's primary role is to assign roles, make clinical decisions, and
facilitate communication. The leader should not be performing chest compressions while
directing. Closed-loop communication is essential for team performance .
Question 4
What is the recommended dose and route for epinephrine in cardiac arrest?
A. 0.5 mg IV push every 5 minutes
B. 1 mg IV/IO push every 3-5 minutes
C. 2 mg IV push every 3 minutes
D. 0.1 mg/kg IV push every 5 minutes
Answer: B. 1 mg IV/IO push every 3-5 minutes.
Rationale: The AHA recommends epinephrine 1 mg IV/IO push every 3-5 minutes during
cardiac arrest. Higher doses are not associated with improved outcomes and may cause
harm .
Question 5
,A patient with a STEMI has a systolic blood pressure of 85 mmHg and evidence of
cardiogenic shock. Which intervention is most appropriate?
A. Nitroglycerin infusion
B. Intravenous fluid bolus and inotropic support
C. Immediate fibrinolysis
D. Observation and monitoring
Answer: B. Intravenous fluid bolus and inotropic support.
Rationale: Patients with STEMI and cardiogenic shock require hemodynamic support.
Nitroglycerin is contraindicated in hypotension. Inotropic support and fluid resuscitation
are appropriate, along with emergent PCI .
Question 6
What is the appropriate initial energy setting for biphasic synchronized
cardioversion of atrial fibrillation?
A. 50-100 J
B. 100-200 J
C. 200-300 J
D. 300-360 J
Answer: B. 100-200 J.
Rationale: The recommended initial energy for biphasic synchronized cardioversion of
atrial fibrillation is 100-200 J. For atrial flutter and SVT, 50-100 J is recommended. Higher
energies may be needed if initial shocks are unsuccessful .
Question 7
A patient in cardiac arrest has an initial rhythm of asystole. Which medication
should be administered first?
, A. Amiodarone 300 mg IV
B. Atropine 1 mg IV
C. Epinephrine 1 mg IV
D. Lidocaine 1.5 mg/kg IV
Answer: C. Epinephrine 1 mg IV.
Rationale: Epinephrine is the first-line medication for asystole and PEA. Atropine is no
longer recommended in asystole and PEA according to current AHA guidelines.
Amiodarone is used for shockable rhythms like VF/VT .
Question 8
In the Hs and Ts mnemonic for reversible causes of cardiac arrest, what does the
"T" in Tension pneumothorax represent?
A. Tension pneumothorax
B. Tamponade (cardiac)
C. Toxins
D. Thrombosis (coronary and pulmonary)
Answer: A. Tension pneumothorax.
Rationale: The Hs and Ts are: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-
/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade (cardiac), Toxins,
Thrombosis (pulmonary), Thrombosis (coronary) .
Question 9
What is the recommended initial dose of amiodarone for shock-refractory
ventricular fibrillation?
A. 150 mg IV push
B. 300 mg IV push
C. 100 mg IV push
D. 450 mg IV push
(2026)Latest Edition | American Heart Association (AHA)
Question 1
During high-quality CPR, which of the following is the most critical factor for
achieving return of spontaneous circulation (ROSC)?
A. Adequate ventilation rate
B. Minimal interruptions in chest compressions
C. Administration of epinephrine
D. Advanced airway placement
Answer: B. Minimal interruptions in chest compressions.
Rationale: Minimizing interruptions in chest compressions is the most critical factor for
achieving ROSC. Coronary perfusion pressure is maintained during compressions, and
interruptions reduce the likelihood of successful resuscitation. Studies show that chest
compression fraction should be at least 80% .
Question 2
A patient presents with pulseless ventricular tachycardia. What is the correct
sequence of actions?
A. Defibrillation → CPR → Epinephrine
B. CPR → Defibrillation → CPR → Rhythm check
C. Epinephrine → Defibrillation → CPR
D. CPR → Epinephrine → Defibrillation
Answer: B. CPR → Defibrillation → CPR → Rhythm check.
Rationale: The correct sequence is to start CPR immediately, then defibrillate as soon as
possible, resume CPR immediately after shock, and check rhythm after 2 minutes of CPR.
This minimizes interruptions and maximizes perfusion .
,Question 3
Which of the following best describes the role of the team leader during a
resuscitation attempt?
A. Performing chest compressions while directing the team
B. Standing back and observing without directing
C. Assigning roles, making clinical decisions, and facilitating communication
D. Documenting all interventions
Answer: C. Assigning roles, making clinical decisions, and facilitating
communication.
Rationale: The team leader's primary role is to assign roles, make clinical decisions, and
facilitate communication. The leader should not be performing chest compressions while
directing. Closed-loop communication is essential for team performance .
Question 4
What is the recommended dose and route for epinephrine in cardiac arrest?
A. 0.5 mg IV push every 5 minutes
B. 1 mg IV/IO push every 3-5 minutes
C. 2 mg IV push every 3 minutes
D. 0.1 mg/kg IV push every 5 minutes
Answer: B. 1 mg IV/IO push every 3-5 minutes.
Rationale: The AHA recommends epinephrine 1 mg IV/IO push every 3-5 minutes during
cardiac arrest. Higher doses are not associated with improved outcomes and may cause
harm .
Question 5
,A patient with a STEMI has a systolic blood pressure of 85 mmHg and evidence of
cardiogenic shock. Which intervention is most appropriate?
A. Nitroglycerin infusion
B. Intravenous fluid bolus and inotropic support
C. Immediate fibrinolysis
D. Observation and monitoring
Answer: B. Intravenous fluid bolus and inotropic support.
Rationale: Patients with STEMI and cardiogenic shock require hemodynamic support.
Nitroglycerin is contraindicated in hypotension. Inotropic support and fluid resuscitation
are appropriate, along with emergent PCI .
Question 6
What is the appropriate initial energy setting for biphasic synchronized
cardioversion of atrial fibrillation?
A. 50-100 J
B. 100-200 J
C. 200-300 J
D. 300-360 J
Answer: B. 100-200 J.
Rationale: The recommended initial energy for biphasic synchronized cardioversion of
atrial fibrillation is 100-200 J. For atrial flutter and SVT, 50-100 J is recommended. Higher
energies may be needed if initial shocks are unsuccessful .
Question 7
A patient in cardiac arrest has an initial rhythm of asystole. Which medication
should be administered first?
, A. Amiodarone 300 mg IV
B. Atropine 1 mg IV
C. Epinephrine 1 mg IV
D. Lidocaine 1.5 mg/kg IV
Answer: C. Epinephrine 1 mg IV.
Rationale: Epinephrine is the first-line medication for asystole and PEA. Atropine is no
longer recommended in asystole and PEA according to current AHA guidelines.
Amiodarone is used for shockable rhythms like VF/VT .
Question 8
In the Hs and Ts mnemonic for reversible causes of cardiac arrest, what does the
"T" in Tension pneumothorax represent?
A. Tension pneumothorax
B. Tamponade (cardiac)
C. Toxins
D. Thrombosis (coronary and pulmonary)
Answer: A. Tension pneumothorax.
Rationale: The Hs and Ts are: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-
/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade (cardiac), Toxins,
Thrombosis (pulmonary), Thrombosis (coronary) .
Question 9
What is the recommended initial dose of amiodarone for shock-refractory
ventricular fibrillation?
A. 150 mg IV push
B. 300 mg IV push
C. 100 mg IV push
D. 450 mg IV push
