Advanced Cardiovascular Life Support (ACLS) Certification
Exam Version 2– Emergency Cardiac Care and
Resuscitation Updated and Latest Questions and Correct
Answers with Rationale
1. A 65-year-old patient presents in Ventricular Fibrillation (VF). After the first shock and 2
minutes of CPR, which medication should be administered first?
A. Epinephrine 1mg
B. Amiodarone 300mg
C. Lidocaine 1.5mg/kg
D. Atropine 1mg
Ans: A
Rationale: The ACLS Cardiac Arrest Algorithm prioritizes epinephrine administration after the second
shock in a shockable rhythm sequence. Epinephrine works as an alpha-adrenergic vasoconstrictor which
increases coronary and cerebral perfusion pressure during CPR. It is administered every 3 to 5 minutes
throughout the resuscitation effort to maintain vascular tone. Early administration of vasopressors is
associated with a higher likelihood of return of spontaneous circulation (ROSC). Amiodarone is typically
reserved for use after the third shock if VF or pulseless VT persists despite epinephrine. While Lidocaine
is an alternative to Amiodarone, it is also secondary to the primary vasopressor intervention. Therefore,
Epinephrine 1mg is the correct immediate pharmacological choice in this clinical scenario.
,2. Which of the following is the recommended compression depth for an adult victim during
high-quality CPR?
A. At least 1 inch (2.5 cm)
B. At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
C. Exactly 3 inches (7.5 cm)
D. Between 1.5 and 2 inches (4 to 5 cm)
Ans: B
Rationale: Effective chest compressions are the cornerstone of high-quality CPR and significantly impact
survival rates. Current guidelines suggest that compressions must be at least 2 inches deep to provide
adequate blood flow to vital organs. However, it is also advised not to exceed 2.4 inches to prevent
internal thoracic injuries. Maintaining this specific range ensures that the heart is sufficiently compressed
to eject blood into the systemic circulation. Providers should allow for full chest recoil between
compressions to permit the heart to refill with blood. Inadequate depth leads to poor perfusion and
reduces the chances of achieving ROSC in cardiac arrest patients. This specific measurement is a critical
metric monitored during ACLS training and real-life resuscitation events.
,3. A patient with a pulse has a heart rate of 35 bpm and is experiencing chest pain and low
blood pressure. What is the first-line drug treatment?
A. Dopamine infusion
B. Epinephrine infusion
C. Adenosine 6mg
D. Atropine 1mg
Ans: D
Rationale: This patient is presenting with symptomatic bradycardia which requires immediate
intervention according to the ACLS Bradycardia Algorithm. Atropine 1mg is designated as the first-line
pharmacological treatment for unstable bradycardia with a pulse. It works by blocking the vagus nerve’s
effects on the heart to increase the firing rate of the sinoatrial node. The maximum cumulative dose of
Atropine for bradycardia is 3mg in total. If Atropine is ineffective, the provider should consider
transcutaneous pacing or infusions of dopamine or epinephrine. Symptomatic signs like chest pain and
hypotension indicate that the low heart rate is causing end-organ hypoperfusion. Therefore, rapid
administration of Atropine is essential to stabilize the patient’s hemodynamic status before further
deterioration.
, 4. What is the targeted PETCO2 value that indicates high-quality chest compressions are
being performed?
A. At least 5 mmHg
B. At least 10 mmHg
C. At least 20 mmHg
D. At least 40 mmHg
Ans: B
Rationale: Quantitative waveform capnography is the most reliable method to monitor the effectiveness
of chest compressions during CPR. A PETCO2 value of at least 10 mmHg is widely accepted as an
indicator of adequate pulmonary blood flow generated by compressions. If the PETCO2 remains below 10
mmHg, the team should focus on improving compression depth and rate or reducing interruptions. A
sudden spike in PETCO2 to values between 35 and 45 mmHg often serves as a primary indicator of ROSC.
This technology allows real-time feedback and helps the team leader make decisions regarding the
quality of resuscitation efforts. It also helps in confirming and monitoring the placement of an
endotracheal tube throughout the procedure. Monitoring these levels is essential for optimizing the
physiological state of the patient during advanced life support.
Exam Version 2– Emergency Cardiac Care and
Resuscitation Updated and Latest Questions and Correct
Answers with Rationale
1. A 65-year-old patient presents in Ventricular Fibrillation (VF). After the first shock and 2
minutes of CPR, which medication should be administered first?
A. Epinephrine 1mg
B. Amiodarone 300mg
C. Lidocaine 1.5mg/kg
D. Atropine 1mg
Ans: A
Rationale: The ACLS Cardiac Arrest Algorithm prioritizes epinephrine administration after the second
shock in a shockable rhythm sequence. Epinephrine works as an alpha-adrenergic vasoconstrictor which
increases coronary and cerebral perfusion pressure during CPR. It is administered every 3 to 5 minutes
throughout the resuscitation effort to maintain vascular tone. Early administration of vasopressors is
associated with a higher likelihood of return of spontaneous circulation (ROSC). Amiodarone is typically
reserved for use after the third shock if VF or pulseless VT persists despite epinephrine. While Lidocaine
is an alternative to Amiodarone, it is also secondary to the primary vasopressor intervention. Therefore,
Epinephrine 1mg is the correct immediate pharmacological choice in this clinical scenario.
,2. Which of the following is the recommended compression depth for an adult victim during
high-quality CPR?
A. At least 1 inch (2.5 cm)
B. At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
C. Exactly 3 inches (7.5 cm)
D. Between 1.5 and 2 inches (4 to 5 cm)
Ans: B
Rationale: Effective chest compressions are the cornerstone of high-quality CPR and significantly impact
survival rates. Current guidelines suggest that compressions must be at least 2 inches deep to provide
adequate blood flow to vital organs. However, it is also advised not to exceed 2.4 inches to prevent
internal thoracic injuries. Maintaining this specific range ensures that the heart is sufficiently compressed
to eject blood into the systemic circulation. Providers should allow for full chest recoil between
compressions to permit the heart to refill with blood. Inadequate depth leads to poor perfusion and
reduces the chances of achieving ROSC in cardiac arrest patients. This specific measurement is a critical
metric monitored during ACLS training and real-life resuscitation events.
,3. A patient with a pulse has a heart rate of 35 bpm and is experiencing chest pain and low
blood pressure. What is the first-line drug treatment?
A. Dopamine infusion
B. Epinephrine infusion
C. Adenosine 6mg
D. Atropine 1mg
Ans: D
Rationale: This patient is presenting with symptomatic bradycardia which requires immediate
intervention according to the ACLS Bradycardia Algorithm. Atropine 1mg is designated as the first-line
pharmacological treatment for unstable bradycardia with a pulse. It works by blocking the vagus nerve’s
effects on the heart to increase the firing rate of the sinoatrial node. The maximum cumulative dose of
Atropine for bradycardia is 3mg in total. If Atropine is ineffective, the provider should consider
transcutaneous pacing or infusions of dopamine or epinephrine. Symptomatic signs like chest pain and
hypotension indicate that the low heart rate is causing end-organ hypoperfusion. Therefore, rapid
administration of Atropine is essential to stabilize the patient’s hemodynamic status before further
deterioration.
, 4. What is the targeted PETCO2 value that indicates high-quality chest compressions are
being performed?
A. At least 5 mmHg
B. At least 10 mmHg
C. At least 20 mmHg
D. At least 40 mmHg
Ans: B
Rationale: Quantitative waveform capnography is the most reliable method to monitor the effectiveness
of chest compressions during CPR. A PETCO2 value of at least 10 mmHg is widely accepted as an
indicator of adequate pulmonary blood flow generated by compressions. If the PETCO2 remains below 10
mmHg, the team should focus on improving compression depth and rate or reducing interruptions. A
sudden spike in PETCO2 to values between 35 and 45 mmHg often serves as a primary indicator of ROSC.
This technology allows real-time feedback and helps the team leader make decisions regarding the
quality of resuscitation efforts. It also helps in confirming and monitoring the placement of an
endotracheal tube throughout the procedure. Monitoring these levels is essential for optimizing the
physiological state of the patient during advanced life support.
