AHA ACLS Final Exam Question Bank (Latest 2026/2027
Edition) – 100% Correct Questions, Answers & Detailed
Rationales
Q1
A 68-year-old male collapses in the hospital cafeteria. You arrive to find him
unresponsive, apneic, and pulseless. The monitor shows ventricular fibrillation. What is
the first action you should take?
A) Deliver a precordial thump
B) Begin immediate high-quality CPR
C) Defibrillate with 120-200 J biphasic
D) Administer 1 mg epinephrine IV/IO
Answer: C
Rationales:
● A: A precordial thump is no longer recommended in the ACLS algorithm for
witnessed VF/pulseless VT and has been removed from routine practice due to
ineffectiveness and potential harm.
● B: While CPR is critical, for witnessed ventricular fibrillation with a defibrillator
immediately available, defibrillation takes precedence over chest compressions
per the shock-first approach.
● C: Immediate defibrillation with 120-200 J (biphasic) or 360 J (monophasic) is
the priority intervention for witnessed VF to maximize survival and neurological
outcomes.
● D: Epinephrine is administered after the first shock and 2 minutes of CPR if VF
persists, not as the initial intervention.
,Q2
During CPR on an adult patient, what is the recommended compression-to-ventilation
ratio when an advanced airway is NOT in place?
A) 15:2
B) 30:2
C) 20:2
D) 40:2
Answer: B
Rationales:
● A: A 15:2 ratio is used for two-rescuer CPR in infants and children, not for adult
patients.
● B: The 30:2 ratio for adult CPR optimizes coronary and cerebral perfusion while
minimizing interruptions in chest compressions.
● C: A 20:2 ratio is not a recognized compression-to-ventilation ratio in any AHA
ACLS protocol.
● D: A 40:2 ratio would provide inadequate ventilation and is not supported by any
resuscitation guidelines.
Q3
You are managing a patient in pulseless electrical activity (PEA). The rhythm is
organized with a rate of 40 bpm, but there is no palpable pulse. What is the most
appropriate initial pharmacological intervention?
A) 1 mg atropine IV/IO
B) 1 mg epinephrine IV/IO every 3-5 minutes
C) 40 units vasopressin IV/IO
,D) 300 mg amiodarone IV/IO
Answer: B
Rationales:
● A: Atropine is no longer recommended for PEA or asystole in the ACLS algorithm
as it has not demonstrated improved outcomes in non-shockable rhythms.
● B: Epinephrine 1 mg IV/IO every 3-5 minutes is the standard vasopressor for PEA
to improve coronary and cerebral perfusion pressure during CPR.
● C: Vasopressin was removed from the ACLS cardiac arrest algorithm in 2015
updates due to lack of proven benefit over epinephrine.
● D: Amiodarone is indicated for refractory ventricular fibrillation or pulseless
ventricular tachycardia, not for PEA.
Q4
A 72-year-old woman presents with acute onset of shortness of breath, hypotension (BP
82/48), tachycardia (HR 128), and jugular venous distension. Her ECG shows sinus
tachycardia with right axis deviation and S1Q3T3 pattern. What is the most likely
diagnosis?
A) Acute myocardial infarction
B) Tension pneumothorax
C) Massive pulmonary embolism
D) Cardiac tamponade
Answer: C
Rationales:
● A: While MI can cause hypotension and tachycardia, the S1Q3T3 pattern and
acute hemodynamic collapse with JVD are not classic for isolated MI.
, ● B: Tension pneumothorax presents with unilateral absent breath sounds, tracheal
deviation, and hyperresonance, not typically with S1Q3T3 pattern.
● C: Massive pulmonary embolism classically presents with acute hypotension,
tachycardia, JVD, and ECG findings of right heart strain including S1Q3T3 pattern.
● D: Cardiac tamponade presents with Beck's triad (hypotension, JVD, muffled
heart sounds) and electrical alternans, not S1Q3T3 pattern.
Q5
During resuscitation of a patient in ventricular fibrillation, you have delivered two shocks
and performed 2 minutes of CPR. The rhythm persists as VF. What is your next
pharmacological intervention?
A) 1 mg atropine IV/IO
B) 1 mg epinephrine IV/IO
C) 300 mg amiodarone IV/IO
D) 50 mg lidocaine IV/IO
Answer: B
Rationales:
● A: Atropine is not indicated for VF/pulseless VT as it is used for symptomatic
bradycardia, not shockable rhythms.
● B: Epinephrine 1 mg IV/IO is administered after the second shock in the
VF/pulseless VT algorithm to improve myocardial and cerebral perfusion.
● C: Amiodarone 300 mg is administered after the third shock if VF persists, not
after the second shock.
● D: Lidocaine is an alternative antiarrhythmic but is not the first-line agent and
would be considered only if amiodarone is unavailable.
Q6
Edition) – 100% Correct Questions, Answers & Detailed
Rationales
Q1
A 68-year-old male collapses in the hospital cafeteria. You arrive to find him
unresponsive, apneic, and pulseless. The monitor shows ventricular fibrillation. What is
the first action you should take?
A) Deliver a precordial thump
B) Begin immediate high-quality CPR
C) Defibrillate with 120-200 J biphasic
D) Administer 1 mg epinephrine IV/IO
Answer: C
Rationales:
● A: A precordial thump is no longer recommended in the ACLS algorithm for
witnessed VF/pulseless VT and has been removed from routine practice due to
ineffectiveness and potential harm.
● B: While CPR is critical, for witnessed ventricular fibrillation with a defibrillator
immediately available, defibrillation takes precedence over chest compressions
per the shock-first approach.
● C: Immediate defibrillation with 120-200 J (biphasic) or 360 J (monophasic) is
the priority intervention for witnessed VF to maximize survival and neurological
outcomes.
● D: Epinephrine is administered after the first shock and 2 minutes of CPR if VF
persists, not as the initial intervention.
,Q2
During CPR on an adult patient, what is the recommended compression-to-ventilation
ratio when an advanced airway is NOT in place?
A) 15:2
B) 30:2
C) 20:2
D) 40:2
Answer: B
Rationales:
● A: A 15:2 ratio is used for two-rescuer CPR in infants and children, not for adult
patients.
● B: The 30:2 ratio for adult CPR optimizes coronary and cerebral perfusion while
minimizing interruptions in chest compressions.
● C: A 20:2 ratio is not a recognized compression-to-ventilation ratio in any AHA
ACLS protocol.
● D: A 40:2 ratio would provide inadequate ventilation and is not supported by any
resuscitation guidelines.
Q3
You are managing a patient in pulseless electrical activity (PEA). The rhythm is
organized with a rate of 40 bpm, but there is no palpable pulse. What is the most
appropriate initial pharmacological intervention?
A) 1 mg atropine IV/IO
B) 1 mg epinephrine IV/IO every 3-5 minutes
C) 40 units vasopressin IV/IO
,D) 300 mg amiodarone IV/IO
Answer: B
Rationales:
● A: Atropine is no longer recommended for PEA or asystole in the ACLS algorithm
as it has not demonstrated improved outcomes in non-shockable rhythms.
● B: Epinephrine 1 mg IV/IO every 3-5 minutes is the standard vasopressor for PEA
to improve coronary and cerebral perfusion pressure during CPR.
● C: Vasopressin was removed from the ACLS cardiac arrest algorithm in 2015
updates due to lack of proven benefit over epinephrine.
● D: Amiodarone is indicated for refractory ventricular fibrillation or pulseless
ventricular tachycardia, not for PEA.
Q4
A 72-year-old woman presents with acute onset of shortness of breath, hypotension (BP
82/48), tachycardia (HR 128), and jugular venous distension. Her ECG shows sinus
tachycardia with right axis deviation and S1Q3T3 pattern. What is the most likely
diagnosis?
A) Acute myocardial infarction
B) Tension pneumothorax
C) Massive pulmonary embolism
D) Cardiac tamponade
Answer: C
Rationales:
● A: While MI can cause hypotension and tachycardia, the S1Q3T3 pattern and
acute hemodynamic collapse with JVD are not classic for isolated MI.
, ● B: Tension pneumothorax presents with unilateral absent breath sounds, tracheal
deviation, and hyperresonance, not typically with S1Q3T3 pattern.
● C: Massive pulmonary embolism classically presents with acute hypotension,
tachycardia, JVD, and ECG findings of right heart strain including S1Q3T3 pattern.
● D: Cardiac tamponade presents with Beck's triad (hypotension, JVD, muffled
heart sounds) and electrical alternans, not S1Q3T3 pattern.
Q5
During resuscitation of a patient in ventricular fibrillation, you have delivered two shocks
and performed 2 minutes of CPR. The rhythm persists as VF. What is your next
pharmacological intervention?
A) 1 mg atropine IV/IO
B) 1 mg epinephrine IV/IO
C) 300 mg amiodarone IV/IO
D) 50 mg lidocaine IV/IO
Answer: B
Rationales:
● A: Atropine is not indicated for VF/pulseless VT as it is used for symptomatic
bradycardia, not shockable rhythms.
● B: Epinephrine 1 mg IV/IO is administered after the second shock in the
VF/pulseless VT algorithm to improve myocardial and cerebral perfusion.
● C: Amiodarone 300 mg is administered after the third shock if VF persists, not
after the second shock.
● D: Lidocaine is an alternative antiarrhythmic but is not the first-line agent and
would be considered only if amiodarone is unavailable.
Q6
