Advanced Cardiac Life Support (ACLS) – Algorithms & Interventions
Practice Exam Updated 2026 🩺 | Complete Study Guide with Verified
Questions and Detailed Rationales Covering ACLS Algorithms (Cardiac
Arrest, Bradycardia, Tachycardia), High-Quality CPR Integration, Airway
Management and Advanced Ventilation, ECG Rhythm Interpretation,
Pharmacology (Epinephrine, Amiodarone, Adenosine), Defibrillation and
Cardioversion, Team Dynamics and Code Leadership, Post-Cardiac
Arrest Care, Stroke and Acute Coronary Syndrome Management, and
Scenario-Based Questions for ACLS Certification Exam Success
Question 1: In adult cardiac arrest due to ventricular fibrillation, what is the
appropriate initial energy setting for a biphasic defibrillator when the
manufacturer's recommended dose is unknown?
A. 120 joules
B. 200 joules
C. 300 joules
D. 360 joules
CORRECT ANSWER: B. 200 joules
RATIONALE:When the manufacturer's recommended dose for a biphasic defibrillator is
unknown, ACLS guidelines suggest using 200 joules as the initial shock energy.
Subsequent shocks should be at the same or higher energy level. This balances efficacy
with minimizing myocardial injury while ensuring adequate current delivery for
defibrillation.
Question 2: During cardiac arrest, what is the recommended dose and route of
epinephrine for an adult patient?
A. 0.5 mg IV/IO every 5 minutes
B. 1 mg IV/IO every 3-5 minutes
C. 1 mg IV/IO every 10 minutes
D. 2 mg IV/IO every 3-5 minutes
CORRECT ANSWER: B. 1 mg IV/IO every 3-5 minutes
RATIONALE:ACLS guidelines recommend administering 1 mg of epinephrine
intravenously or intraosseously every 3-5 minutes during cardiac arrest. This dose
optimizes alpha-adrenergic effects to improve coronary and cerebral perfusion
pressure without excessive beta-adrenergic side effects that could impair myocardial
oxygen supply.
Question 3: Which rhythm is considered a "shockable" rhythm in the ACLS cardiac
arrest algorithm?
A. Asystole
B. Pulseless electrical activity (PEA)
,C. Pulseless ventricular tachycardia
D. Sinus bradycardia
CORRECT ANSWER: C. Pulseless ventricular tachycardia
RATIONALE:The ACLS algorithm identifies ventricular fibrillation (VF) and pulseless
ventricular tachycardia (pVT) as shockable rhythms because they represent organized
electrical activity that may respond to defibrillation. Asystole and PEA are non-
shockable rhythms requiring immediate CPR and epinephrine administration.
Question 4: What is the primary purpose of high-quality CPR during cardiac arrest?
A. To restore spontaneous circulation immediately
B. To maintain adequate cerebral and coronary perfusion
C. To terminate ventricular fibrillation
D. To facilitate endotracheal intubation
CORRECT ANSWER: B. To maintain adequate cerebral and coronary perfusion
RATIONALE:High-quality CPR generates artificial circulation that delivers oxygenated
blood to the brain and heart, preserving vital organ function until definitive interventions
can restore spontaneous circulation. Adequate chest compression depth (5-6 cm), rate
(100-120/min), full recoil, and minimal interruptions are critical for perfusion.
Question 5: In the bradycardia algorithm, which finding indicates the need for
immediate intervention rather than observation?
A. Heart rate of 55 bpm with no symptoms
B. Heart rate of 45 bpm with hypotension
C. Heart rate of 50 bpm during sleep
D. Heart rate of 48 bpm in a well-conditioned athlete
CORRECT ANSWER: B. Heart rate of 45 bpm with hypotension
RATIONALE:Symptomatic bradycardia, defined by inadequate perfusion signs such as
hypotension, altered mental status, shock, ischemic chest pain, or acute heart failure,
requires immediate intervention. Asymptomatic bradycardia in specific populations
may be physiological and not require treatment.
Question 6: What is the recommended initial dose of atropine for symptomatic
bradycardia in adults?
A. 0.1 mg IV
B. 0.5 mg IV
C. 1.0 mg IV
D. 2.0 mg IV
CORRECT ANSWER: B. 0.5 mg IV
RATIONALE:The ACLS bradycardia algorithm recommends an initial atropine dose of
0.5 mg IV, which may be repeated every 3-5 minutes to a maximum total dose of 3 mg.
,Doses less than 0.5 mg may paradoxically worsen bradycardia due to central vagal
stimulation.
Question 7: Which intervention is contraindicated in a patient with pulseless
electrical activity (PEA)?
A. High-quality CPR
B. Epinephrine administration
C. Defibrillation
D. Identification of reversible causes
CORRECT ANSWER: C. Defibrillation
RATIONALE:PEA is a non-shockable rhythm characterized by organized electrical
activity without mechanical cardiac output. Defibrillation is ineffective and delays
critical interventions such as CPR, epinephrine, and treatment of reversible causes (H's
and T's).
Question 8: During synchronized cardioversion for unstable atrial fibrillation, what
energy level is typically recommended as the initial dose?
A. 50-100 joules
B. 120-200 joules
C. 200-300 joules
D. 360 joules
CORRECT ANSWER: B. 120-200 joules
RATIONALE:For synchronized cardioversion of atrial fibrillation, ACLS guidelines
recommend an initial biphasic energy dose of 120-200 joules. If unsuccessful,
subsequent shocks should use higher energy levels. Synchronization prevents delivery
of shock during the T-wave, avoiding induction of ventricular fibrillation.
Question 9: What is the primary reason for minimizing interruptions in chest
compressions during CPR?
A. To reduce rescuer fatigue
B. To maintain coronary perfusion pressure
C. To facilitate rhythm analysis
D. To allow for ventilation delivery
CORRECT ANSWER: B. To maintain coronary perfusion pressure
RATIONALE:Coronary perfusion pressure (CPP) is directly proportional to the duration
of continuous chest compressions. Interruptions cause CPP to drop precipitously,
requiring multiple compressions to rebuild adequate pressure. Minimizing pauses
maximizes the likelihood of ROSC and neurological preservation.
Question 10: Which medication is first-line for stable monomorphic wide-complex
tachycardia of uncertain origin?
, A. Adenosine
B. Amiodarone
C. Verapamil
D. Procainamide
CORRECT ANSWER: B. Amiodarone
RATIONALE:For stable wide-complex tachycardia of uncertain origin, amiodarone is
preferred because it is effective for both ventricular tachycardia and supraventricular
tachycardia with aberrancy. Adenosine may be considered if SVT with aberrancy is
strongly suspected, but amiodarone provides broader coverage with lower risk of
deterioration.
Question 11: In post-cardiac arrest care, what is the target temperature range for
therapeutic hypothermia (targeted temperature management)?
A. 30-32°C
B. 32-36°C
C. 36-38°C
D. 38-40°C
CORRECT ANSWER: B. 32-36°C
RATIONALE:Current ACLS guidelines for targeted temperature management
recommend maintaining a constant temperature between 32°C and 36°C for at least 24
hours in comatose adult patients with ROSC after cardiac arrest. This range provides
neuroprotection while minimizing complications associated with deeper hypothermia.
Question 12: Which of the following is a reversible cause of cardiac arrest
categorized under the "H's and T's"?
A. Hypertension
B. Hyperglycemia
C. Hypovolemia
D. Hypernatremia
CORRECT ANSWER: C. Hypovolemia
RATIONALE:The "H's and T's" mnemonic identifies reversible causes of cardiac arrest:
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia,
Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or
coronary). Hypovolemia is addressed with fluid resuscitation.
Question 13: What is the recommended compression-to-ventilation ratio for adult
CPR with an advanced airway in place?
A. 15:2
B. 30:2
C. Continuous compressions with 1 breath every 6 seconds
D. Continuous compressions with 1 breath every 10 seconds
Practice Exam Updated 2026 🩺 | Complete Study Guide with Verified
Questions and Detailed Rationales Covering ACLS Algorithms (Cardiac
Arrest, Bradycardia, Tachycardia), High-Quality CPR Integration, Airway
Management and Advanced Ventilation, ECG Rhythm Interpretation,
Pharmacology (Epinephrine, Amiodarone, Adenosine), Defibrillation and
Cardioversion, Team Dynamics and Code Leadership, Post-Cardiac
Arrest Care, Stroke and Acute Coronary Syndrome Management, and
Scenario-Based Questions for ACLS Certification Exam Success
Question 1: In adult cardiac arrest due to ventricular fibrillation, what is the
appropriate initial energy setting for a biphasic defibrillator when the
manufacturer's recommended dose is unknown?
A. 120 joules
B. 200 joules
C. 300 joules
D. 360 joules
CORRECT ANSWER: B. 200 joules
RATIONALE:When the manufacturer's recommended dose for a biphasic defibrillator is
unknown, ACLS guidelines suggest using 200 joules as the initial shock energy.
Subsequent shocks should be at the same or higher energy level. This balances efficacy
with minimizing myocardial injury while ensuring adequate current delivery for
defibrillation.
Question 2: During cardiac arrest, what is the recommended dose and route of
epinephrine for an adult patient?
A. 0.5 mg IV/IO every 5 minutes
B. 1 mg IV/IO every 3-5 minutes
C. 1 mg IV/IO every 10 minutes
D. 2 mg IV/IO every 3-5 minutes
CORRECT ANSWER: B. 1 mg IV/IO every 3-5 minutes
RATIONALE:ACLS guidelines recommend administering 1 mg of epinephrine
intravenously or intraosseously every 3-5 minutes during cardiac arrest. This dose
optimizes alpha-adrenergic effects to improve coronary and cerebral perfusion
pressure without excessive beta-adrenergic side effects that could impair myocardial
oxygen supply.
Question 3: Which rhythm is considered a "shockable" rhythm in the ACLS cardiac
arrest algorithm?
A. Asystole
B. Pulseless electrical activity (PEA)
,C. Pulseless ventricular tachycardia
D. Sinus bradycardia
CORRECT ANSWER: C. Pulseless ventricular tachycardia
RATIONALE:The ACLS algorithm identifies ventricular fibrillation (VF) and pulseless
ventricular tachycardia (pVT) as shockable rhythms because they represent organized
electrical activity that may respond to defibrillation. Asystole and PEA are non-
shockable rhythms requiring immediate CPR and epinephrine administration.
Question 4: What is the primary purpose of high-quality CPR during cardiac arrest?
A. To restore spontaneous circulation immediately
B. To maintain adequate cerebral and coronary perfusion
C. To terminate ventricular fibrillation
D. To facilitate endotracheal intubation
CORRECT ANSWER: B. To maintain adequate cerebral and coronary perfusion
RATIONALE:High-quality CPR generates artificial circulation that delivers oxygenated
blood to the brain and heart, preserving vital organ function until definitive interventions
can restore spontaneous circulation. Adequate chest compression depth (5-6 cm), rate
(100-120/min), full recoil, and minimal interruptions are critical for perfusion.
Question 5: In the bradycardia algorithm, which finding indicates the need for
immediate intervention rather than observation?
A. Heart rate of 55 bpm with no symptoms
B. Heart rate of 45 bpm with hypotension
C. Heart rate of 50 bpm during sleep
D. Heart rate of 48 bpm in a well-conditioned athlete
CORRECT ANSWER: B. Heart rate of 45 bpm with hypotension
RATIONALE:Symptomatic bradycardia, defined by inadequate perfusion signs such as
hypotension, altered mental status, shock, ischemic chest pain, or acute heart failure,
requires immediate intervention. Asymptomatic bradycardia in specific populations
may be physiological and not require treatment.
Question 6: What is the recommended initial dose of atropine for symptomatic
bradycardia in adults?
A. 0.1 mg IV
B. 0.5 mg IV
C. 1.0 mg IV
D. 2.0 mg IV
CORRECT ANSWER: B. 0.5 mg IV
RATIONALE:The ACLS bradycardia algorithm recommends an initial atropine dose of
0.5 mg IV, which may be repeated every 3-5 minutes to a maximum total dose of 3 mg.
,Doses less than 0.5 mg may paradoxically worsen bradycardia due to central vagal
stimulation.
Question 7: Which intervention is contraindicated in a patient with pulseless
electrical activity (PEA)?
A. High-quality CPR
B. Epinephrine administration
C. Defibrillation
D. Identification of reversible causes
CORRECT ANSWER: C. Defibrillation
RATIONALE:PEA is a non-shockable rhythm characterized by organized electrical
activity without mechanical cardiac output. Defibrillation is ineffective and delays
critical interventions such as CPR, epinephrine, and treatment of reversible causes (H's
and T's).
Question 8: During synchronized cardioversion for unstable atrial fibrillation, what
energy level is typically recommended as the initial dose?
A. 50-100 joules
B. 120-200 joules
C. 200-300 joules
D. 360 joules
CORRECT ANSWER: B. 120-200 joules
RATIONALE:For synchronized cardioversion of atrial fibrillation, ACLS guidelines
recommend an initial biphasic energy dose of 120-200 joules. If unsuccessful,
subsequent shocks should use higher energy levels. Synchronization prevents delivery
of shock during the T-wave, avoiding induction of ventricular fibrillation.
Question 9: What is the primary reason for minimizing interruptions in chest
compressions during CPR?
A. To reduce rescuer fatigue
B. To maintain coronary perfusion pressure
C. To facilitate rhythm analysis
D. To allow for ventilation delivery
CORRECT ANSWER: B. To maintain coronary perfusion pressure
RATIONALE:Coronary perfusion pressure (CPP) is directly proportional to the duration
of continuous chest compressions. Interruptions cause CPP to drop precipitously,
requiring multiple compressions to rebuild adequate pressure. Minimizing pauses
maximizes the likelihood of ROSC and neurological preservation.
Question 10: Which medication is first-line for stable monomorphic wide-complex
tachycardia of uncertain origin?
, A. Adenosine
B. Amiodarone
C. Verapamil
D. Procainamide
CORRECT ANSWER: B. Amiodarone
RATIONALE:For stable wide-complex tachycardia of uncertain origin, amiodarone is
preferred because it is effective for both ventricular tachycardia and supraventricular
tachycardia with aberrancy. Adenosine may be considered if SVT with aberrancy is
strongly suspected, but amiodarone provides broader coverage with lower risk of
deterioration.
Question 11: In post-cardiac arrest care, what is the target temperature range for
therapeutic hypothermia (targeted temperature management)?
A. 30-32°C
B. 32-36°C
C. 36-38°C
D. 38-40°C
CORRECT ANSWER: B. 32-36°C
RATIONALE:Current ACLS guidelines for targeted temperature management
recommend maintaining a constant temperature between 32°C and 36°C for at least 24
hours in comatose adult patients with ROSC after cardiac arrest. This range provides
neuroprotection while minimizing complications associated with deeper hypothermia.
Question 12: Which of the following is a reversible cause of cardiac arrest
categorized under the "H's and T's"?
A. Hypertension
B. Hyperglycemia
C. Hypovolemia
D. Hypernatremia
CORRECT ANSWER: C. Hypovolemia
RATIONALE:The "H's and T's" mnemonic identifies reversible causes of cardiac arrest:
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia,
Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or
coronary). Hypovolemia is addressed with fluid resuscitation.
Question 13: What is the recommended compression-to-ventilation ratio for adult
CPR with an advanced airway in place?
A. 15:2
B. 30:2
C. Continuous compressions with 1 breath every 6 seconds
D. Continuous compressions with 1 breath every 10 seconds
