Advanced Cardiovascular Life Support (ACLS) Certification
Exam Version 3– Emergency Cardiac Care and
Resuscitation Updated and Latest Questions and Correct
Answers with Rationale
1. A 62-year-old male is in pulseless ventricular tachycardia. After the first shock and two
minutes of CPR, the rhythm remains unchanged. What is the next priority intervention
according to the ACLS Cardiac Arrest Algorithm?
A. Provide a second shock immediately.
B. Administer Epinephrine 1mg IV/IO.
C. Perform a pulse check for 10 seconds.
D. Administer Amiodarone 300mg IV/IO bolus.
Ans: A
Rationale: In the management of shockable rhythms like pulseless Ventricular Tachycardia, the priority
is to deliver a shock as soon as the rhythm is recognized. After the first shock is delivered, CPR should be
performed for 2 minutes before the next rhythm check. If the rhythm remains shockable after the check, a
second shock must be delivered promptly. Epinephrine should only be administered after the second
shock has failed to convert the rhythm. Amiodarone is typically reserved until after the third shock in the
persistent VF/pVT sequence. Maintaining high-quality chest compressions throughout this process is
vital for perfusion. Pulse checks should only be performed if a non-shockable, organized rhythm is seen
on the monitor. The focus remains on rapid defibrillation and minimizing interruptions in compressions
to improve survival outcomes.
,2. Which of the following is the most reliable indicator of Return of Spontaneous Circulation
(ROSC) during continuous waveform capnography?
A. A gradual decrease in PETCO2 below 10 mmHg.
B. A sudden increase in PETCO2 to 40 mmHg or higher.
C. A persistent PETCO2 reading of 15-20 mmHg.
D. An abrupt disappearance of the capnography waveform.
Ans: B
Rationale: Waveform capnography is the gold standard for monitoring the effectiveness of chest
compressions and detecting ROSC. A sudden, significant rise in End-Tidal CO2 (PETCO2), usually to levels
of 35-40 mmHg or higher, indicates that the heart has resumed pumping blood through the lungs. This
surge in CO2 delivery to the lungs occurs because circulation is no longer dependent on manual
compressions. During CPR, a PETCO2 level below 10 mmHg generally indicates poor compression quality
or a very low chance of survival. Conversely, maintaining a PETCO2 between 10-20 mmHg suggests that
the compressions being provided are adequate. When a sudden spike is observed, providers should
complete the current cycle of CPR and then check for a pulse. This objective data helps avoid unnecessary
interruptions in compressions for pulse checks when ROSC hasn’t occurred. It also provides immediate
feedback on the physiological state of the patient during resuscitation.
,3. A patient with symptomatic bradycardia and a heart rate of 35 bpm has failed to respond
to Atropine 1mg. What is the next most appropriate pharmacological or mechanical
intervention?
A. Initiate Transcutaneous Pacing (TCP).
B. Administer Adenosine 6mg rapid IV push.
C. Start a Lidocaine infusion at 2mg/min.
D. Repeat Atropine at a dose of 3mg.
Ans: A
Rationale: When a patient presents with symptomatic bradycardia, the first-line drug intervention is
Atropine. If the initial dose of Atropine is ineffective, the ACLS guidelines recommend several second-line
options based on the clinical situation. Transcutaneous Pacing (TCP) is a critical next step, especially if
the patient is unstable or showing signs of poor perfusion. Alternatively, an infusion of Dopamine or
Epinephrine may be considered to increase heart rate and blood pressure. Adenosine is contraindicated
in this scenario as it is used for tachycardias, not bradycardias. Repeating Atropine is an option, but not at
a single dose of 3mg; the cumulative max is 3mg given in 1mg increments. TCP should not be delayed if
the patient’s condition is deteriorating rapidly. Proper sedation should be considered for conscious
patients undergoing pacing due to the discomfort of the electrical stimulus.
, 4. In the Tachycardia with a Pulse Algorithm, what is the first action for a patient with a
heart rate of 160 bpm, hypotension, and altered mental status?
A. Perform Vagal Maneuvers.
B. Administer Adenosine 6mg IV push.
C. Immediate Synchronized Cardioversion.
D. Initiate an Amiodarone infusion at 150mg over 10 minutes.
Ans: C
Rationale: The primary decision point in the ACLS Tachycardia Algorithm is determining whether the
patient is stable or unstable. Signs of instability include hypotension, acutely altered mental status, signs
of shock, ischemic chest discomfort, or acute heart failure. For any unstable tachycardia, immediate
synchronized cardioversion is the treatment of choice to restore hemodynamic stability. Vagal
maneuvers and Adenosine are typically reserved for stable patients with regular, narrow-complex SVT.
Using medications first in an unstable patient may lead to a delay in definitive treatment and further
clinical decline. Before cardioversion, if the patient is conscious, sedation should be provided if possible,
though it should not delay the procedure. The synchronizer must be turned on to ensure the shock is
delivered on the R-wave to avoid inducing ventricular fibrillation. Following the procedure, the patient’s
rhythm and blood pressure must be reassessed immediately.
Exam Version 3– Emergency Cardiac Care and
Resuscitation Updated and Latest Questions and Correct
Answers with Rationale
1. A 62-year-old male is in pulseless ventricular tachycardia. After the first shock and two
minutes of CPR, the rhythm remains unchanged. What is the next priority intervention
according to the ACLS Cardiac Arrest Algorithm?
A. Provide a second shock immediately.
B. Administer Epinephrine 1mg IV/IO.
C. Perform a pulse check for 10 seconds.
D. Administer Amiodarone 300mg IV/IO bolus.
Ans: A
Rationale: In the management of shockable rhythms like pulseless Ventricular Tachycardia, the priority
is to deliver a shock as soon as the rhythm is recognized. After the first shock is delivered, CPR should be
performed for 2 minutes before the next rhythm check. If the rhythm remains shockable after the check, a
second shock must be delivered promptly. Epinephrine should only be administered after the second
shock has failed to convert the rhythm. Amiodarone is typically reserved until after the third shock in the
persistent VF/pVT sequence. Maintaining high-quality chest compressions throughout this process is
vital for perfusion. Pulse checks should only be performed if a non-shockable, organized rhythm is seen
on the monitor. The focus remains on rapid defibrillation and minimizing interruptions in compressions
to improve survival outcomes.
,2. Which of the following is the most reliable indicator of Return of Spontaneous Circulation
(ROSC) during continuous waveform capnography?
A. A gradual decrease in PETCO2 below 10 mmHg.
B. A sudden increase in PETCO2 to 40 mmHg or higher.
C. A persistent PETCO2 reading of 15-20 mmHg.
D. An abrupt disappearance of the capnography waveform.
Ans: B
Rationale: Waveform capnography is the gold standard for monitoring the effectiveness of chest
compressions and detecting ROSC. A sudden, significant rise in End-Tidal CO2 (PETCO2), usually to levels
of 35-40 mmHg or higher, indicates that the heart has resumed pumping blood through the lungs. This
surge in CO2 delivery to the lungs occurs because circulation is no longer dependent on manual
compressions. During CPR, a PETCO2 level below 10 mmHg generally indicates poor compression quality
or a very low chance of survival. Conversely, maintaining a PETCO2 between 10-20 mmHg suggests that
the compressions being provided are adequate. When a sudden spike is observed, providers should
complete the current cycle of CPR and then check for a pulse. This objective data helps avoid unnecessary
interruptions in compressions for pulse checks when ROSC hasn’t occurred. It also provides immediate
feedback on the physiological state of the patient during resuscitation.
,3. A patient with symptomatic bradycardia and a heart rate of 35 bpm has failed to respond
to Atropine 1mg. What is the next most appropriate pharmacological or mechanical
intervention?
A. Initiate Transcutaneous Pacing (TCP).
B. Administer Adenosine 6mg rapid IV push.
C. Start a Lidocaine infusion at 2mg/min.
D. Repeat Atropine at a dose of 3mg.
Ans: A
Rationale: When a patient presents with symptomatic bradycardia, the first-line drug intervention is
Atropine. If the initial dose of Atropine is ineffective, the ACLS guidelines recommend several second-line
options based on the clinical situation. Transcutaneous Pacing (TCP) is a critical next step, especially if
the patient is unstable or showing signs of poor perfusion. Alternatively, an infusion of Dopamine or
Epinephrine may be considered to increase heart rate and blood pressure. Adenosine is contraindicated
in this scenario as it is used for tachycardias, not bradycardias. Repeating Atropine is an option, but not at
a single dose of 3mg; the cumulative max is 3mg given in 1mg increments. TCP should not be delayed if
the patient’s condition is deteriorating rapidly. Proper sedation should be considered for conscious
patients undergoing pacing due to the discomfort of the electrical stimulus.
, 4. In the Tachycardia with a Pulse Algorithm, what is the first action for a patient with a
heart rate of 160 bpm, hypotension, and altered mental status?
A. Perform Vagal Maneuvers.
B. Administer Adenosine 6mg IV push.
C. Immediate Synchronized Cardioversion.
D. Initiate an Amiodarone infusion at 150mg over 10 minutes.
Ans: C
Rationale: The primary decision point in the ACLS Tachycardia Algorithm is determining whether the
patient is stable or unstable. Signs of instability include hypotension, acutely altered mental status, signs
of shock, ischemic chest discomfort, or acute heart failure. For any unstable tachycardia, immediate
synchronized cardioversion is the treatment of choice to restore hemodynamic stability. Vagal
maneuvers and Adenosine are typically reserved for stable patients with regular, narrow-complex SVT.
Using medications first in an unstable patient may lead to a delay in definitive treatment and further
clinical decline. Before cardioversion, if the patient is conscious, sedation should be provided if possible,
though it should not delay the procedure. The synchronizer must be turned on to ensure the shock is
delivered on the R-wave to avoid inducing ventricular fibrillation. Following the procedure, the patient’s
rhythm and blood pressure must be reassessed immediately.
