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ACLS FINAL EXAM 2026 COMPLETE (150)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
EXPLANATIONS|GUARANTEED PASS.
ACLS
Ace the ACLS Final Exam with practice questions covering advanced
cardiovascular life support, cardiac arrest management, ECG rhythm
interpretation, airway management, emergency medications, and
resuscitation protocols. This study guide helps reinforce critical
emergency care concepts and supports effective certification exam
preparation. Designed to improve clinical decision-making and boost
confidence in life-saving situations. Suitable for nursing, paramedic,
and healthcare professionals.
MULTIPLE CHOICE.
Section 1: The Systematic Approach s High-Quality CPR (Questions 1-20)
Q1. You arrive on scene to find a patient in cardiac arrest. You confirm unresponsiveness
and agonal breathing. What is your next action?
A) Check for a pulse for up to 20 seconds
B) Attach the AED immediately
C) Begin high-quality chest compressions
D) Open the airway with a head tilt-chin lift
Correct Answer: C) Begin high-quality chest compressions
Rationale: The 2020 AHA guidelines emphasize starting CPR immediately if the patient is
unresponsive with abnormal breathing. Pulse check should be brief (5-10 seconds). High-
quality compressions are the priority to perfuse the brain and heart.
Q2. What is the correct compression-to-ventilation ratio for a single rescuer in adult
cardiac arrest?
A) 15:2
B) 30:2
C) 30:1
D) Continuous compressions with no breaths
Correct Answer: B) 30:2
Rationale: For a single rescuer (adult), the ratio is 30 compressions to 2 ventilations. For
two rescuers in the adult setting, it remains 30:2 (unlike infants/children where it is 15:2).
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Q3. You are performing CPR. How deep should you compress the adult chest?
A) 1 inch (2.5 cm)
B) 1.5 inches (4 cm)
C) At least 2 inches (5 cm)
D) At least 3 inches (7.5 cm)
Correct Answer: C) At least 2 inches (5 cm)
Rationale: The AHA recommends a compression depth of 2 to 2.4 inches (5 to 6 cm) for
adults. Depth greater than 2.4 inches increases risk of injury without proven benefit.
Q4. What is the recommended chest compression rate?
A) 60-80 per minute
B) 80-100 per minute
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C) 100-120 per minute
D) 120-140 per minute
Correct Answer: C) 100-120 per minute
Rationale: Studies show that rates exceeding 120/min reduce compression depth, and
rates below 100/min reduce coronary perfusion pressure.
Q5. You see an organized rhythm on the monitor. You check for a pulse and do not feel one.
What rhythm is this considered?
A) Sinus Tachycardia
B) Pulseless Electrical Activity (PEA)
C) Ventricular Tachycardia
D) Asystole
Correct Answer: B) Pulseless Electrical Activity (PEA)
Rationale: PEA is defined as any organized rhythm (excluding VT/VF) on the monitor in the
absence of a palpable pulse. Treat the patient, not the monitor.
Q6. How often should epinephrine be administered during cardiac arrest?
A) Every 1-2 minutes
B) Every 3-5 minutes
C) Every 10 minutes
D) Only once
Correct Answer: B) Every 3-5 minutes
Rationale: The standard dose of 1 mg IV/IO epinephrine is repeated every 3-5 minutes
during ACLS for shockable and non-shockable rhythms.
Q7. What is the maximum interval for rhythm checks during CPR?
A) 30 seconds
B) 1 minute
C) 2 minutes
D) 4 minutes
Correct Answer: C) 2 minutes
Rationale: Rhythm checks should occur every 2 minutes, coinciding with the rescuer swap
or compressor fatigue. Pauses should be less than 10 seconds.
Q8. A patient in V-Fib receives a shock. What should the team do immediately after the
shock is delivered?
A) Check for a pulse
B) Analyze the rhythm
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C) Resume CPR starting with chest compressions
D) Give epinephrine
Correct Answer: C) Resume CPR starting with chest compressions
Rationale: Post-shock, the rhythm is often organized but non-perfusing. Guidelines strongly
advise resuming CPR immediately (starting with compressions) for 2 minutes before
rechecking the rhythm.
QG. Your patient has a known opioid overdose and is apneic but has a pulse. What is the
priority?
A) High-quality CPR
B) Naloxone (Narcan) IM
C) Rescue breathing (1 breath every 5-6 seconds)
D) Defibrillation
Correct Answer: C) Rescue breathing (1 breath every 5-6 seconds)
Rationale: This patient is in respiratory arrest (pulse present). Rescue breathing is required.
Naloxone is important but should not delay ventilation.
Q10. Which best describes "complete chest recoil"?
A) Leaning on the chest between compressions
B) Allowing the chest to return to its normal position
C) Compressing the sternum 1 inch
D) Lifting hands entirely off the chest
Correct Answer: B) Allowing the chest to return to its normal position
Rationale: Allowing complete recoil increases venous return and coronary perfusion
pressure. Leaning decreases filling and reduces cardiac output.
Q11. After administering a shock with a biphasic defibrillator for V-Fib, the monitor shows
organized electrical activity. You check a carotid pulse and it is weak (40 bpm). What is your
next action?
A) Deliver another shock immediately
B) Start a dopamine drip
C) Resume CPR for 2 minutes
D) Give Atropine 1 mg
Correct Answer: C) Resume CPR for 2 minutes
Rationale: Even with a weak pulse post-shock, the patient may be in "post-resuscitation
myocardial dysfunction." Resume CPR to support perfusion while preparing for
transcutaneous pacing if the pulse is truly slow.
ACLS FINAL EXAM 2026 COMPLETE (150)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
EXPLANATIONS|GUARANTEED PASS.
ACLS
Ace the ACLS Final Exam with practice questions covering advanced
cardiovascular life support, cardiac arrest management, ECG rhythm
interpretation, airway management, emergency medications, and
resuscitation protocols. This study guide helps reinforce critical
emergency care concepts and supports effective certification exam
preparation. Designed to improve clinical decision-making and boost
confidence in life-saving situations. Suitable for nursing, paramedic,
and healthcare professionals.
MULTIPLE CHOICE.
Section 1: The Systematic Approach s High-Quality CPR (Questions 1-20)
Q1. You arrive on scene to find a patient in cardiac arrest. You confirm unresponsiveness
and agonal breathing. What is your next action?
A) Check for a pulse for up to 20 seconds
B) Attach the AED immediately
C) Begin high-quality chest compressions
D) Open the airway with a head tilt-chin lift
Correct Answer: C) Begin high-quality chest compressions
Rationale: The 2020 AHA guidelines emphasize starting CPR immediately if the patient is
unresponsive with abnormal breathing. Pulse check should be brief (5-10 seconds). High-
quality compressions are the priority to perfuse the brain and heart.
Q2. What is the correct compression-to-ventilation ratio for a single rescuer in adult
cardiac arrest?
A) 15:2
B) 30:2
C) 30:1
D) Continuous compressions with no breaths
Correct Answer: B) 30:2
Rationale: For a single rescuer (adult), the ratio is 30 compressions to 2 ventilations. For
two rescuers in the adult setting, it remains 30:2 (unlike infants/children where it is 15:2).
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Q3. You are performing CPR. How deep should you compress the adult chest?
A) 1 inch (2.5 cm)
B) 1.5 inches (4 cm)
C) At least 2 inches (5 cm)
D) At least 3 inches (7.5 cm)
Correct Answer: C) At least 2 inches (5 cm)
Rationale: The AHA recommends a compression depth of 2 to 2.4 inches (5 to 6 cm) for
adults. Depth greater than 2.4 inches increases risk of injury without proven benefit.
Q4. What is the recommended chest compression rate?
A) 60-80 per minute
B) 80-100 per minute
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C) 100-120 per minute
D) 120-140 per minute
Correct Answer: C) 100-120 per minute
Rationale: Studies show that rates exceeding 120/min reduce compression depth, and
rates below 100/min reduce coronary perfusion pressure.
Q5. You see an organized rhythm on the monitor. You check for a pulse and do not feel one.
What rhythm is this considered?
A) Sinus Tachycardia
B) Pulseless Electrical Activity (PEA)
C) Ventricular Tachycardia
D) Asystole
Correct Answer: B) Pulseless Electrical Activity (PEA)
Rationale: PEA is defined as any organized rhythm (excluding VT/VF) on the monitor in the
absence of a palpable pulse. Treat the patient, not the monitor.
Q6. How often should epinephrine be administered during cardiac arrest?
A) Every 1-2 minutes
B) Every 3-5 minutes
C) Every 10 minutes
D) Only once
Correct Answer: B) Every 3-5 minutes
Rationale: The standard dose of 1 mg IV/IO epinephrine is repeated every 3-5 minutes
during ACLS for shockable and non-shockable rhythms.
Q7. What is the maximum interval for rhythm checks during CPR?
A) 30 seconds
B) 1 minute
C) 2 minutes
D) 4 minutes
Correct Answer: C) 2 minutes
Rationale: Rhythm checks should occur every 2 minutes, coinciding with the rescuer swap
or compressor fatigue. Pauses should be less than 10 seconds.
Q8. A patient in V-Fib receives a shock. What should the team do immediately after the
shock is delivered?
A) Check for a pulse
B) Analyze the rhythm
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C) Resume CPR starting with chest compressions
D) Give epinephrine
Correct Answer: C) Resume CPR starting with chest compressions
Rationale: Post-shock, the rhythm is often organized but non-perfusing. Guidelines strongly
advise resuming CPR immediately (starting with compressions) for 2 minutes before
rechecking the rhythm.
QG. Your patient has a known opioid overdose and is apneic but has a pulse. What is the
priority?
A) High-quality CPR
B) Naloxone (Narcan) IM
C) Rescue breathing (1 breath every 5-6 seconds)
D) Defibrillation
Correct Answer: C) Rescue breathing (1 breath every 5-6 seconds)
Rationale: This patient is in respiratory arrest (pulse present). Rescue breathing is required.
Naloxone is important but should not delay ventilation.
Q10. Which best describes "complete chest recoil"?
A) Leaning on the chest between compressions
B) Allowing the chest to return to its normal position
C) Compressing the sternum 1 inch
D) Lifting hands entirely off the chest
Correct Answer: B) Allowing the chest to return to its normal position
Rationale: Allowing complete recoil increases venous return and coronary perfusion
pressure. Leaning decreases filling and reduces cardiac output.
Q11. After administering a shock with a biphasic defibrillator for V-Fib, the monitor shows
organized electrical activity. You check a carotid pulse and it is weak (40 bpm). What is your
next action?
A) Deliver another shock immediately
B) Start a dopamine drip
C) Resume CPR for 2 minutes
D) Give Atropine 1 mg
Correct Answer: C) Resume CPR for 2 minutes
Rationale: Even with a weak pulse post-shock, the patient may be in "post-resuscitation
myocardial dysfunction." Resume CPR to support perfusion while preparing for
transcutaneous pacing if the pulse is truly slow.
