ACLS RECERTIFICATION FINAL PAPER 2026
EXAM QUESTIONS AND SOLUTIONS
◉ What rhythm is first treated with vagal maneuvers then adenosine
6mg 20 cc fluid flush followed by 12mg adenosine if 6 not effective.
After both adenosine injxns fail to convert rhythm, will need to do
synchronized cardioversion with 50 joules? Answer:
Supraventricular tachycardia
◉ What is the drug of first choice for symptomatic bradycardia?
Answer: Atropine 0.5mg (with a max of 3mg)
◉ Which ECG rhythm is commonly associated with bradycardia?
Answer: Mobitz II (Second-degree AV block (Type 2)) can rapidly
progress to complete heart block.
◉ What is generally considered the most important and clinically
significant degree of block? Answer: Complete block is generally the
most important and clinically significant degree of block. It is also
the most likely block to cause cardiovascular collapse.
◉ Which drugs are involved in the Bradycardia Algorithm? Answer:
Atropine is an IV push medication that is used to increase heart rate.
,Epinephrine and dopamine are both used as an alternative to TCP
and are infusions.
◉ True or False? Signs of symptomatic bradycardia include
hypotension, orthostatic hypotension, diaphoresis, pulmonary
congestion, runs of PVC's or VT. Answer: True
◉ The primary decision point in the bradycardia algorithm is the
determination of Answer: Adequate perfusion
◉ After it is determined that the patient does not have adequate
perfusion your first step is to: Answer: give atropine while awaiting
transcutaneous pacer
DO NOT delay TCP if atropine is not ready
◉ The correct dose of epinephrine given in the bradycardia
algorithm is Answer: 2-10 mcg/min
◉ The correct dose of dopamine given in the bradycardia algorithm
is: Answer: 2-20 mcg/kg/min infusion
◉ The key clinical question when determining steps to take for the
patient with symptomatic bradycardia is: Answer: Are the symptoms
caused by bradycardia or some other illness?
, ◉ The treatment sequence for bradycardia with poor perfusion is:
Answer: prepare for transcutaneous pacing, consider atropine while
preparing TCP, use epinephrine or dopamine while awaiting
pacemaker or if pacing is ineffective
◉ Transcutaneous pacing should be started immediately if:
A. there is no response to atropine
B. atropine is unlikely to be effective or if IV access cannot be quickly
established
C. the patient is severely symptomatic
D. all of the above Answer: D-do not delay TCP while preparing
atropine
◉ If transcutaneous pacing is ineffective for symptomatic
bradycardia, the next step would be to prepare for: Answer: prepare
for transvenous pacing
◉ True or false? Atropine doses of less than 0.5mg may
paradoxically result in further slowing of the heart rate. Answer:
true- atropine crosses into the CNS stimulating the vagus nerve
causing bradycardia at low doses.
At higher doses the muscarinic blocking effects of Atropine out
weigh the CNS effects, causing tachycardia.
EXAM QUESTIONS AND SOLUTIONS
◉ What rhythm is first treated with vagal maneuvers then adenosine
6mg 20 cc fluid flush followed by 12mg adenosine if 6 not effective.
After both adenosine injxns fail to convert rhythm, will need to do
synchronized cardioversion with 50 joules? Answer:
Supraventricular tachycardia
◉ What is the drug of first choice for symptomatic bradycardia?
Answer: Atropine 0.5mg (with a max of 3mg)
◉ Which ECG rhythm is commonly associated with bradycardia?
Answer: Mobitz II (Second-degree AV block (Type 2)) can rapidly
progress to complete heart block.
◉ What is generally considered the most important and clinically
significant degree of block? Answer: Complete block is generally the
most important and clinically significant degree of block. It is also
the most likely block to cause cardiovascular collapse.
◉ Which drugs are involved in the Bradycardia Algorithm? Answer:
Atropine is an IV push medication that is used to increase heart rate.
,Epinephrine and dopamine are both used as an alternative to TCP
and are infusions.
◉ True or False? Signs of symptomatic bradycardia include
hypotension, orthostatic hypotension, diaphoresis, pulmonary
congestion, runs of PVC's or VT. Answer: True
◉ The primary decision point in the bradycardia algorithm is the
determination of Answer: Adequate perfusion
◉ After it is determined that the patient does not have adequate
perfusion your first step is to: Answer: give atropine while awaiting
transcutaneous pacer
DO NOT delay TCP if atropine is not ready
◉ The correct dose of epinephrine given in the bradycardia
algorithm is Answer: 2-10 mcg/min
◉ The correct dose of dopamine given in the bradycardia algorithm
is: Answer: 2-20 mcg/kg/min infusion
◉ The key clinical question when determining steps to take for the
patient with symptomatic bradycardia is: Answer: Are the symptoms
caused by bradycardia or some other illness?
, ◉ The treatment sequence for bradycardia with poor perfusion is:
Answer: prepare for transcutaneous pacing, consider atropine while
preparing TCP, use epinephrine or dopamine while awaiting
pacemaker or if pacing is ineffective
◉ Transcutaneous pacing should be started immediately if:
A. there is no response to atropine
B. atropine is unlikely to be effective or if IV access cannot be quickly
established
C. the patient is severely symptomatic
D. all of the above Answer: D-do not delay TCP while preparing
atropine
◉ If transcutaneous pacing is ineffective for symptomatic
bradycardia, the next step would be to prepare for: Answer: prepare
for transvenous pacing
◉ True or false? Atropine doses of less than 0.5mg may
paradoxically result in further slowing of the heart rate. Answer:
true- atropine crosses into the CNS stimulating the vagus nerve
causing bradycardia at low doses.
At higher doses the muscarinic blocking effects of Atropine out
weigh the CNS effects, causing tachycardia.
