ACLS 2025 Exam Prep Test Bank(Advanced Cardiovascular Life
Support | AHA Updated) 160 Verified Questions + Full
Rationales | Evidence-Based Review
This document provides 160 expertly written ACLS exam questions with step-by-step
rationales based on AHA 2025 guidelines. Each question is written in authentic exam format to
help you practice confidently for certification or renewal. Whether you’re preparing for hospital
competency, EMS advancement, or board review, this resource will help you master every ACLS
algorithm and drug intervention with clarity and accuracy.
1. During a witnessed adult sudden collapse, what is the first action the rescuer should take?
A. Check for a pulse for up to 60 seconds
B. Activate emergency response system and begin CPR
C. Give two rescue breaths before compressions
D. Attach defibrillator pads immediately
Rationale: In a witnessed collapse, immediate activation of emergency response and starting
high-quality CPR maximize perfusion and survival. Current ACLS emphasizes no delay for
pulse checks beyond a quick assessment; early compressions are critical. Early defibrillation
follows if an AED/semi-automated defibrillator is immediately available and indicates a
shockable rhythm. Initiating CPR first reduces time to perfusion and preserves brain and
coronary blood flow. Rapid team activation enables advanced interventions to follow without
compromising compressions.
2. What is the recommended compression rate for adult CPR?
A. 80–100 compressions/min
B. 90–110 compressions/min
C. 100–120 compressions/min
D. 120–140 compressions/min
Rationale: ACLS guidelines recommend 100–120 compressions per minute to optimize
coronary perfusion pressure and cardiac output during CPR. Rates below 100 may provide
inadequate perfusion; rates above 120 may compromise chest recoil and reduce venous return.
Emphasis is also on adequate depth (at least 2 inches / 5 cm in adults), full recoil, and
minimizing interruptions. Combined, these factors improve chances of ROSC and better
neurologic outcomes.
,3. What is the recommended depth for adult chest compressions?
A. At least 3 cm (1.2 in)
B. At least 5 cm (2.0 in)
C. At least 6 cm (2.4 in)
D. Exactly 4 cm (1.6 in)
Rationale: ACLS instructs compressing the adult chest at least 5 cm (2 inches) but not
exceeding about 6 cm to balance effective perfusion and minimize injury. Adequate depth helps
generate forward blood flow while avoiding excessive force that could cause trauma. Full chest
recoil between compressions is equally important to permit venous return. Combine depth with
correct rate and minimal pauses for optimal CPR quality.
4. For a shockable rhythm (VF/pulseless VT), what is the initial recommended biphasic
defibrillation energy?
A. 0.5 J/kg
B. 2 J/kg (or manufacturer-recommended adult dose for adults)
C. 4 J/kg
D. 10 J/kg
Rationale: For pediatric patients the initial biphasic dose is 2 J/kg, but in adults use the
manufacturer-recommended adult dose (commonly 150–200 J). Early defibrillation for
VF/pulseless VT is essential — do not delay shocks unduly. After a shock, immediately resume
CPR for 2 minutes before rhythm reassessment. Escalate energy on subsequent shocks if initial
efforts fail.
5. Which rhythm is considered non-shockable and requires immediate high-quality CPR and
epinephrine?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Monomorphic VT with pulse
Rationale: Asystole is a non-shockable rhythm; defibrillation is not indicated. Management
focuses on high-quality CPR, identifying and treating reversible causes (H’s and T’s), and
administration of epinephrine (1 mg IV/IO every 3–5 minutes in adults). Quick identification
prevents delay in pharmacological and supportive measures. Prognosis is poor, but organized,
guideline-driven resuscitation is still required.
6. During adult cardiac arrest with VF unresponsive to two shocks, what medication should be
given next?
A. Sodium bicarbonate 1 mEq/kg
B. Epinephrine 1 mg IV/IO
C. Adenosine 6 mg IV push
,D. Atropine 0.5 mg IV
Rationale: After initial defibrillation attempts, epinephrine 1 mg IV/IO every 3–5 minutes is
administered to increase coronary and cerebral perfusion pressure via alpha-adrenergic
vasoconstriction. Epinephrine is a cornerstone of ACLS after defibrillation attempts and ongoing
CPR. Antiarrhythmic agents (e.g., amiodarone) are considered after defibrillation and
epinephrine per algorithm.
7. What is the recommended adult dose of amiodarone for refractory VF/pulseless VT?
A. 150 mg IV bolus only
B. 300 mg IV bolus initial, then 150 mg if needed
C. 50 mg IV bolus every 2 minutes
D. 500 mg bolus only
Rationale: For refractory VF/pulseless VT, amiodarone 300 mg IV/IO bolus is recommended,
followed by 150 mg if a second dose is needed. Amiodarone can stabilize electrical activity and
improve conversion to a perfusing rhythm. Use alongside continued CPR and defibrillation;
monitor for hypotension and prolonged QT as side effects.
8. What is the preferred vascular access route when IV access cannot be rapidly obtained during
cardiac arrest?
A. Intra-arterial line
B. Subcutaneous route
C. Intraosseous (IO) access
D. Oral route
Rationale: Intraosseous (IO) access provides rapid, reliable vascular access for fluids and
medications when IV access is delayed in cardiac arrest. IO delivers drugs into the
noncollapsible venous plexus of bone marrow, achieving systemic circulation quickly. It is
recommended early in ACLS when peripheral IV access is not promptly available.
9. Which reversible cause of cardiac arrest is characterized by pericardial tamponade?
A. Hypovolemia
B. Hypoxia
C. Toxins
D. Cardiac tamponade (a “T” of H’s and T’s)
Rationale: Cardiac tamponade — accumulation of fluid in the pericardial sac — is one of the
T’s (tension pneumothorax, tamponade, thrombosis, toxins) of reversible causes. It produces
decreased preload and obstructive shock. Rapid recognition (JVD, muffled heart sounds,
hypotension) and emergent pericardiocentesis or surgical intervention are critical to reverse
arrest.
, 10. During CPR, what is the maximum recommended pause length for pulse and rhythm checks?
A. 20 seconds
B. 15 seconds
C. 10 seconds
D. 5 seconds
Rationale: Interruptions in chest compressions should be minimized — pulse and rhythm
checks should not exceed 10 seconds. Frequent or prolonged pauses reduce coronary perfusion
pressure and worsen outcomes. Plan actions (defib, intubation, medication delivery) to limit
interruptions and maintain high-quality compressions.
11. For an adult with symptomatic bradycardia unresponsive to atropine, what is the next
recommended step?
A. Give a second higher dose of atropine
B. Start high-dose epinephrine infusion only
C. Prepare for transcutaneous pacing
D. Immediate cardioversion
Rationale: If atropine (0.5 mg IV, repeat to 3 mg max) is ineffective and bradycardia causes
instability, transcutaneous pacing is indicated while preparing for more definitive pacing or
infusion (epinephrine or dopamine). Pacing provides mechanical heart rate support when
pharmacologic measures fail.
12. What is the initial ACLS management for unstable narrow-complex SVT?
A. IV amiodarone
B. Adenosine 6 mg immediately IV push without precautions
C. Synchronized cardioversion if hemodynamically unstable
D. Vagal maneuvers only
Rationale: For hemodynamically unstable SVT, synchronized cardioversion (starting at 50–
100 J biphasic or manufacturer guidance) is recommended immediately. If stable, vagal
maneuvers and adenosine are appropriate, but instability requires cardioversion to rapidly restore
perfusion.
13. A patient receives 1 mg epinephrine IV during arrest. How often may this dose be repeated?
A. Every 10 minutes
B. Every 3–5 minutes
C. Every 1–2 minutes
D. Only once more
Rationale: Epinephrine 1 mg IV/IO during adult cardiac arrest is recommended every 3–5
minutes to maintain vasoconstriction and support coronary perfusion. Frequent dosing within
this window balances benefit against excessive adrenergic effects.
Support | AHA Updated) 160 Verified Questions + Full
Rationales | Evidence-Based Review
This document provides 160 expertly written ACLS exam questions with step-by-step
rationales based on AHA 2025 guidelines. Each question is written in authentic exam format to
help you practice confidently for certification or renewal. Whether you’re preparing for hospital
competency, EMS advancement, or board review, this resource will help you master every ACLS
algorithm and drug intervention with clarity and accuracy.
1. During a witnessed adult sudden collapse, what is the first action the rescuer should take?
A. Check for a pulse for up to 60 seconds
B. Activate emergency response system and begin CPR
C. Give two rescue breaths before compressions
D. Attach defibrillator pads immediately
Rationale: In a witnessed collapse, immediate activation of emergency response and starting
high-quality CPR maximize perfusion and survival. Current ACLS emphasizes no delay for
pulse checks beyond a quick assessment; early compressions are critical. Early defibrillation
follows if an AED/semi-automated defibrillator is immediately available and indicates a
shockable rhythm. Initiating CPR first reduces time to perfusion and preserves brain and
coronary blood flow. Rapid team activation enables advanced interventions to follow without
compromising compressions.
2. What is the recommended compression rate for adult CPR?
A. 80–100 compressions/min
B. 90–110 compressions/min
C. 100–120 compressions/min
D. 120–140 compressions/min
Rationale: ACLS guidelines recommend 100–120 compressions per minute to optimize
coronary perfusion pressure and cardiac output during CPR. Rates below 100 may provide
inadequate perfusion; rates above 120 may compromise chest recoil and reduce venous return.
Emphasis is also on adequate depth (at least 2 inches / 5 cm in adults), full recoil, and
minimizing interruptions. Combined, these factors improve chances of ROSC and better
neurologic outcomes.
,3. What is the recommended depth for adult chest compressions?
A. At least 3 cm (1.2 in)
B. At least 5 cm (2.0 in)
C. At least 6 cm (2.4 in)
D. Exactly 4 cm (1.6 in)
Rationale: ACLS instructs compressing the adult chest at least 5 cm (2 inches) but not
exceeding about 6 cm to balance effective perfusion and minimize injury. Adequate depth helps
generate forward blood flow while avoiding excessive force that could cause trauma. Full chest
recoil between compressions is equally important to permit venous return. Combine depth with
correct rate and minimal pauses for optimal CPR quality.
4. For a shockable rhythm (VF/pulseless VT), what is the initial recommended biphasic
defibrillation energy?
A. 0.5 J/kg
B. 2 J/kg (or manufacturer-recommended adult dose for adults)
C. 4 J/kg
D. 10 J/kg
Rationale: For pediatric patients the initial biphasic dose is 2 J/kg, but in adults use the
manufacturer-recommended adult dose (commonly 150–200 J). Early defibrillation for
VF/pulseless VT is essential — do not delay shocks unduly. After a shock, immediately resume
CPR for 2 minutes before rhythm reassessment. Escalate energy on subsequent shocks if initial
efforts fail.
5. Which rhythm is considered non-shockable and requires immediate high-quality CPR and
epinephrine?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Monomorphic VT with pulse
Rationale: Asystole is a non-shockable rhythm; defibrillation is not indicated. Management
focuses on high-quality CPR, identifying and treating reversible causes (H’s and T’s), and
administration of epinephrine (1 mg IV/IO every 3–5 minutes in adults). Quick identification
prevents delay in pharmacological and supportive measures. Prognosis is poor, but organized,
guideline-driven resuscitation is still required.
6. During adult cardiac arrest with VF unresponsive to two shocks, what medication should be
given next?
A. Sodium bicarbonate 1 mEq/kg
B. Epinephrine 1 mg IV/IO
C. Adenosine 6 mg IV push
,D. Atropine 0.5 mg IV
Rationale: After initial defibrillation attempts, epinephrine 1 mg IV/IO every 3–5 minutes is
administered to increase coronary and cerebral perfusion pressure via alpha-adrenergic
vasoconstriction. Epinephrine is a cornerstone of ACLS after defibrillation attempts and ongoing
CPR. Antiarrhythmic agents (e.g., amiodarone) are considered after defibrillation and
epinephrine per algorithm.
7. What is the recommended adult dose of amiodarone for refractory VF/pulseless VT?
A. 150 mg IV bolus only
B. 300 mg IV bolus initial, then 150 mg if needed
C. 50 mg IV bolus every 2 minutes
D. 500 mg bolus only
Rationale: For refractory VF/pulseless VT, amiodarone 300 mg IV/IO bolus is recommended,
followed by 150 mg if a second dose is needed. Amiodarone can stabilize electrical activity and
improve conversion to a perfusing rhythm. Use alongside continued CPR and defibrillation;
monitor for hypotension and prolonged QT as side effects.
8. What is the preferred vascular access route when IV access cannot be rapidly obtained during
cardiac arrest?
A. Intra-arterial line
B. Subcutaneous route
C. Intraosseous (IO) access
D. Oral route
Rationale: Intraosseous (IO) access provides rapid, reliable vascular access for fluids and
medications when IV access is delayed in cardiac arrest. IO delivers drugs into the
noncollapsible venous plexus of bone marrow, achieving systemic circulation quickly. It is
recommended early in ACLS when peripheral IV access is not promptly available.
9. Which reversible cause of cardiac arrest is characterized by pericardial tamponade?
A. Hypovolemia
B. Hypoxia
C. Toxins
D. Cardiac tamponade (a “T” of H’s and T’s)
Rationale: Cardiac tamponade — accumulation of fluid in the pericardial sac — is one of the
T’s (tension pneumothorax, tamponade, thrombosis, toxins) of reversible causes. It produces
decreased preload and obstructive shock. Rapid recognition (JVD, muffled heart sounds,
hypotension) and emergent pericardiocentesis or surgical intervention are critical to reverse
arrest.
, 10. During CPR, what is the maximum recommended pause length for pulse and rhythm checks?
A. 20 seconds
B. 15 seconds
C. 10 seconds
D. 5 seconds
Rationale: Interruptions in chest compressions should be minimized — pulse and rhythm
checks should not exceed 10 seconds. Frequent or prolonged pauses reduce coronary perfusion
pressure and worsen outcomes. Plan actions (defib, intubation, medication delivery) to limit
interruptions and maintain high-quality compressions.
11. For an adult with symptomatic bradycardia unresponsive to atropine, what is the next
recommended step?
A. Give a second higher dose of atropine
B. Start high-dose epinephrine infusion only
C. Prepare for transcutaneous pacing
D. Immediate cardioversion
Rationale: If atropine (0.5 mg IV, repeat to 3 mg max) is ineffective and bradycardia causes
instability, transcutaneous pacing is indicated while preparing for more definitive pacing or
infusion (epinephrine or dopamine). Pacing provides mechanical heart rate support when
pharmacologic measures fail.
12. What is the initial ACLS management for unstable narrow-complex SVT?
A. IV amiodarone
B. Adenosine 6 mg immediately IV push without precautions
C. Synchronized cardioversion if hemodynamically unstable
D. Vagal maneuvers only
Rationale: For hemodynamically unstable SVT, synchronized cardioversion (starting at 50–
100 J biphasic or manufacturer guidance) is recommended immediately. If stable, vagal
maneuvers and adenosine are appropriate, but instability requires cardioversion to rapidly restore
perfusion.
13. A patient receives 1 mg epinephrine IV during arrest. How often may this dose be repeated?
A. Every 10 minutes
B. Every 3–5 minutes
C. Every 1–2 minutes
D. Only once more
Rationale: Epinephrine 1 mg IV/IO during adult cardiac arrest is recommended every 3–5
minutes to maintain vasoconstriction and support coronary perfusion. Frequent dosing within
this window balances benefit against excessive adrenergic effects.
