ACLS Practice Exam PDF 2026 Certification
Prep | Advanced Cardiovascular Life Support
Questions & Answers Study Guide (AHA-
Style Review)
ACLS PRACTICE EXAM 2026 - CERTIFICATION PREP
Advanced Cardiovascular Life Support (AHA-Style Review)
DOCUMENT OVERVIEW:
• This comprehensive study guide contains 200 high-quality ACLS practice questions
designed to prepare you for the American Heart Association Advanced
Cardiovascular Life Support certification exam, covering all major domains
including BLS foundations, cardiac arrhythmias, medications, resuscitation
protocols, and special scenarios.
• Study systematically by reviewing each question carefully, understanding the
EXPERT RATIONALE for the correct answer, and using this material to identify
knowledge gaps before taking your official certification examination.
QUESTION 1
A 58-year-old male is found unresponsive and not breathing normally. You
initiate CPR. After 2 minutes, the AED arrives and indicates a shockable
rhythm. After delivering one shock, what is the next immediate action?
A) Reassess the rhythm immediately
B) Continue CPR for another 5 minutes before checking rhythm
C) Resume CPR immediately for 2 minutes, then reassess rhythm
D) Administer epinephrine IV/IO before continuing CPR
E) Obtain a 12-lead ECG to confirm the rhythm
✓ C) Resume CPR immediately for 2 minutes, then reassess rhythm
,EXPERT RATIONALE: According to AHA ACLS guidelines, after delivering a shock for
a shockable rhythm, you must immediately resume CPR for 2 minutes (about 5
cycles) before pausing to reassess the rhythm. This approach maximizes perfusion
pressure and cerebral blood flow during resuscitation.
QUESTION 2
What is the recommended compression-to-ventilation ratio for single-rescuer
CPR in an adult?
A) 15:2
B) 30:1
C) 30:2
D) 100:2
E) 50:5
✓ C) 30:2
EXPERT RATIONALE: The current AHA guideline for single-rescuer CPR in adults is a
30:2 compression-to-ventilation ratio. This means 30 chest compressions followed
by 2 rescue breaths, which maintains adequate perfusion and oxygenation.
QUESTION 3
A patient is in cardiac arrest with a presenting rhythm of asystole. What
medication should be administered first?
A) Amiodarone 300 mg IV/IO
B) Epinephrine 1 mg IV/IO
C) Atropine 0.5-1 mg IV/IO
D) Sodium bicarbonate 1 mEq/kg
E) Procainamide 10-15 mg/kg
,✓ B) Epinephrine 1 mg IV/IO
EXPERT RATIONALE: Epinephrine is the first-line medication for asystole and
should be administered as soon as vascular access is obtained. The standard dose
is 1 mg IV/IO every 3-5 minutes during ongoing resuscitation.
QUESTION 4
Which of the following is NOT a sign of effective CPR?
A) Palpable pulse with each compression
B) Chest rise with ventilation
C) Pupil constriction
D) Return of spontaneous circulation
E) Skin color improvement
✓ C) Pupil constriction
EXPERT RATIONALE: Pupil constriction is not a reliable sign of effective CPR and
should not be used to assess CPR quality. Instead, assess for a palpable pulse,
adequate chest rise with ventilation, and ultimately return of spontaneous
circulation (ROSC).
QUESTION 5
A 72-year-old woman collapses and is found unresponsive. You do not detect a
pulse within 10 seconds. What is the appropriate action?
A) Continue checking for a pulse for another 20 seconds
B) Activate the emergency response system and begin CPR immediately
C) Call for an AED first before beginning CPR
D) Verify unresponsiveness by shouting and tapping her shoulder again
E) Wait for professional help to arrive before beginning CPR
, ✓ B) Activate the emergency response system and begin CPR immediately
EXPERT RATIONALE: If an unresponsive patient is not breathing normally and you
cannot detect a pulse within 10 seconds, you should activate the emergency
response system and begin CPR immediately. Delays in initiating CPR significantly
reduce survival chances.
QUESTION 6
What is the current recommended depth for chest compressions in adult CPR?
A) 1-1.5 inches (2.5-4 cm)
B) 1.5-2 inches (4-5 cm)
C) 2-2.4 inches (5-6 cm)
D) 2.4-3 inches (6-7.5 cm)
E) At least 3.5 inches (9 cm)
✓ C) 2-2.4 inches (5-6 cm)
EXPERT RATIONALE: The current AHA ACLS guideline recommends chest
compression depth of at least 2 inches but not greater than 2.4 inches (5-6 cm) for
adults. Compressions that are too shallow or too deep can both be ineffective and
harmful.
QUESTION 7
A patient experiences sudden chest pain and dyspnea. The 12-lead ECG shows
ST elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
Prep | Advanced Cardiovascular Life Support
Questions & Answers Study Guide (AHA-
Style Review)
ACLS PRACTICE EXAM 2026 - CERTIFICATION PREP
Advanced Cardiovascular Life Support (AHA-Style Review)
DOCUMENT OVERVIEW:
• This comprehensive study guide contains 200 high-quality ACLS practice questions
designed to prepare you for the American Heart Association Advanced
Cardiovascular Life Support certification exam, covering all major domains
including BLS foundations, cardiac arrhythmias, medications, resuscitation
protocols, and special scenarios.
• Study systematically by reviewing each question carefully, understanding the
EXPERT RATIONALE for the correct answer, and using this material to identify
knowledge gaps before taking your official certification examination.
QUESTION 1
A 58-year-old male is found unresponsive and not breathing normally. You
initiate CPR. After 2 minutes, the AED arrives and indicates a shockable
rhythm. After delivering one shock, what is the next immediate action?
A) Reassess the rhythm immediately
B) Continue CPR for another 5 minutes before checking rhythm
C) Resume CPR immediately for 2 minutes, then reassess rhythm
D) Administer epinephrine IV/IO before continuing CPR
E) Obtain a 12-lead ECG to confirm the rhythm
✓ C) Resume CPR immediately for 2 minutes, then reassess rhythm
,EXPERT RATIONALE: According to AHA ACLS guidelines, after delivering a shock for
a shockable rhythm, you must immediately resume CPR for 2 minutes (about 5
cycles) before pausing to reassess the rhythm. This approach maximizes perfusion
pressure and cerebral blood flow during resuscitation.
QUESTION 2
What is the recommended compression-to-ventilation ratio for single-rescuer
CPR in an adult?
A) 15:2
B) 30:1
C) 30:2
D) 100:2
E) 50:5
✓ C) 30:2
EXPERT RATIONALE: The current AHA guideline for single-rescuer CPR in adults is a
30:2 compression-to-ventilation ratio. This means 30 chest compressions followed
by 2 rescue breaths, which maintains adequate perfusion and oxygenation.
QUESTION 3
A patient is in cardiac arrest with a presenting rhythm of asystole. What
medication should be administered first?
A) Amiodarone 300 mg IV/IO
B) Epinephrine 1 mg IV/IO
C) Atropine 0.5-1 mg IV/IO
D) Sodium bicarbonate 1 mEq/kg
E) Procainamide 10-15 mg/kg
,✓ B) Epinephrine 1 mg IV/IO
EXPERT RATIONALE: Epinephrine is the first-line medication for asystole and
should be administered as soon as vascular access is obtained. The standard dose
is 1 mg IV/IO every 3-5 minutes during ongoing resuscitation.
QUESTION 4
Which of the following is NOT a sign of effective CPR?
A) Palpable pulse with each compression
B) Chest rise with ventilation
C) Pupil constriction
D) Return of spontaneous circulation
E) Skin color improvement
✓ C) Pupil constriction
EXPERT RATIONALE: Pupil constriction is not a reliable sign of effective CPR and
should not be used to assess CPR quality. Instead, assess for a palpable pulse,
adequate chest rise with ventilation, and ultimately return of spontaneous
circulation (ROSC).
QUESTION 5
A 72-year-old woman collapses and is found unresponsive. You do not detect a
pulse within 10 seconds. What is the appropriate action?
A) Continue checking for a pulse for another 20 seconds
B) Activate the emergency response system and begin CPR immediately
C) Call for an AED first before beginning CPR
D) Verify unresponsiveness by shouting and tapping her shoulder again
E) Wait for professional help to arrive before beginning CPR
, ✓ B) Activate the emergency response system and begin CPR immediately
EXPERT RATIONALE: If an unresponsive patient is not breathing normally and you
cannot detect a pulse within 10 seconds, you should activate the emergency
response system and begin CPR immediately. Delays in initiating CPR significantly
reduce survival chances.
QUESTION 6
What is the current recommended depth for chest compressions in adult CPR?
A) 1-1.5 inches (2.5-4 cm)
B) 1.5-2 inches (4-5 cm)
C) 2-2.4 inches (5-6 cm)
D) 2.4-3 inches (6-7.5 cm)
E) At least 3.5 inches (9 cm)
✓ C) 2-2.4 inches (5-6 cm)
EXPERT RATIONALE: The current AHA ACLS guideline recommends chest
compression depth of at least 2 inches but not greater than 2.4 inches (5-6 cm) for
adults. Compressions that are too shallow or too deep can both be ineffective and
harmful.
QUESTION 7
A patient experiences sudden chest pain and dyspnea. The 12-lead ECG shows
ST elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
