ACLS PRETEST STUDY GUIDE | 60 COMPREHENSIVE QUESTIONS AND ANSWERS (NEWEST
UPDATE 2026 – 2027)
Core Domains
High-Quality BLS and CPR Foundations
Cardiac Arrest Algorithm and Defibrillation Strategy
Airway Management and Vascular Access
ACLS Pharmacology and Medication Timing
Tachyarrhythmia and Bradycardia Management
Post–Cardiac Arrest Care
Special Resuscitation Situations and Team Dynamics
Introduction
This comprehensive pretest study guide prepares healthcare professionals for the American Heart
Association ACLS written examination and megacode assessment, aligned with the 2025 AHA
Guidelines for CPR and Emergency Cardiovascular Care and reflected in 2026–2027 course
materials. It assesses high-quality CPR, defibrillation strategy, airway and vascular access decisions,
ACLS pharmacology, tachyarrhythmia and bradycardia algorithms, post–cardiac arrest care, and
special resuscitation situations. The question bank uses multiple-choice and scenario-based formats
,mirroring real code-team decision-making. Emphasis is placed on guideline-current practice, rapid
clinical reasoning, and safe, effective team-based resuscitation.
SECTION ONE: QUESTIONS 1–60
Question 1
A patient is in cardiac arrest with a nonshockable rhythm. According to current ACLS guidance,
when should epinephrine be administered?
A. Only after the third rhythm check
B. As soon as feasible
C. After 5 minutes of CPR
D. Only after an advanced airway is placed
🟢 B. As soon as feasible
🔴 RATIONALE: For nonshockable rhythms (asystole and pulseless electrical activity), epinephrine
should be given as soon as feasible. Delaying epinephrine in nonshockable arrest is associated
with worse outcomes.
Question 2
,A patient in cardiac arrest is found to be in ventricular fibrillation. The first defibrillation attempt
has failed. What is the recommended energy strategy for subsequent shocks?
A. Use identical energy for every shock
B. Consider escalating energy for subsequent shocks
C. Always reduce energy after the first shock
D. Use stacked shocks without CPR between them
🟢 B. Consider escalating energy for subsequent shocks
🔴 RATIONALE: Current guidance favors a single-shock strategy with immediate CPR. For
refractory VF, higher energy for the second and subsequent shocks may be considered, though
the optimal escalation pattern remains unsettled.
Question 3
During a cardiac arrest, the team is considering placing an advanced airway. What is the current
recommended approach?
A. Insert an endotracheal tube before starting chest compressions
B. Defer advanced airway insertion if it would interrupt chest compressions
C. Place an advanced airway after the first minute regardless of compressions
D. Avoid advanced airways entirely in ACLS
, 🟢 B. Defer advanced airway insertion if it would interrupt chest compressions
🔴 RATIONALE: Current guidance prioritizes uninterrupted high-quality compressions. If
advanced airway placement would interrupt compressions, defer insertion until initial CPR and
defibrillation attempts have been completed.
Question 4
A patient in cardiac arrest has an advanced airway in place. What ventilation rate is
recommended?
A. 1 breath every 2 seconds
B. 1 breath every 6 seconds (about 10 breaths per minute)
C. 1 breath every 10 seconds
D. Continuous positive-pressure ventilation
🟢 B. 1 breath every 6 seconds (about 10 breaths per minute)
🔴 RATIONALE: With an advanced airway, continuous compressions are delivered with
approximately 10 breaths per minute (1 breath every 6 seconds), avoiding hyperventilation.
Question 5
UPDATE 2026 – 2027)
Core Domains
High-Quality BLS and CPR Foundations
Cardiac Arrest Algorithm and Defibrillation Strategy
Airway Management and Vascular Access
ACLS Pharmacology and Medication Timing
Tachyarrhythmia and Bradycardia Management
Post–Cardiac Arrest Care
Special Resuscitation Situations and Team Dynamics
Introduction
This comprehensive pretest study guide prepares healthcare professionals for the American Heart
Association ACLS written examination and megacode assessment, aligned with the 2025 AHA
Guidelines for CPR and Emergency Cardiovascular Care and reflected in 2026–2027 course
materials. It assesses high-quality CPR, defibrillation strategy, airway and vascular access decisions,
ACLS pharmacology, tachyarrhythmia and bradycardia algorithms, post–cardiac arrest care, and
special resuscitation situations. The question bank uses multiple-choice and scenario-based formats
,mirroring real code-team decision-making. Emphasis is placed on guideline-current practice, rapid
clinical reasoning, and safe, effective team-based resuscitation.
SECTION ONE: QUESTIONS 1–60
Question 1
A patient is in cardiac arrest with a nonshockable rhythm. According to current ACLS guidance,
when should epinephrine be administered?
A. Only after the third rhythm check
B. As soon as feasible
C. After 5 minutes of CPR
D. Only after an advanced airway is placed
🟢 B. As soon as feasible
🔴 RATIONALE: For nonshockable rhythms (asystole and pulseless electrical activity), epinephrine
should be given as soon as feasible. Delaying epinephrine in nonshockable arrest is associated
with worse outcomes.
Question 2
,A patient in cardiac arrest is found to be in ventricular fibrillation. The first defibrillation attempt
has failed. What is the recommended energy strategy for subsequent shocks?
A. Use identical energy for every shock
B. Consider escalating energy for subsequent shocks
C. Always reduce energy after the first shock
D. Use stacked shocks without CPR between them
🟢 B. Consider escalating energy for subsequent shocks
🔴 RATIONALE: Current guidance favors a single-shock strategy with immediate CPR. For
refractory VF, higher energy for the second and subsequent shocks may be considered, though
the optimal escalation pattern remains unsettled.
Question 3
During a cardiac arrest, the team is considering placing an advanced airway. What is the current
recommended approach?
A. Insert an endotracheal tube before starting chest compressions
B. Defer advanced airway insertion if it would interrupt chest compressions
C. Place an advanced airway after the first minute regardless of compressions
D. Avoid advanced airways entirely in ACLS
, 🟢 B. Defer advanced airway insertion if it would interrupt chest compressions
🔴 RATIONALE: Current guidance prioritizes uninterrupted high-quality compressions. If
advanced airway placement would interrupt compressions, defer insertion until initial CPR and
defibrillation attempts have been completed.
Question 4
A patient in cardiac arrest has an advanced airway in place. What ventilation rate is
recommended?
A. 1 breath every 2 seconds
B. 1 breath every 6 seconds (about 10 breaths per minute)
C. 1 breath every 10 seconds
D. Continuous positive-pressure ventilation
🟢 B. 1 breath every 6 seconds (about 10 breaths per minute)
🔴 RATIONALE: With an advanced airway, continuous compressions are delivered with
approximately 10 breaths per minute (1 breath every 6 seconds), avoiding hyperventilation.
Question 5
