TheoryACLS
Practice Test
Master ACLS algorithms, ECG rhythms, and megacodes with 500+ practice questions. Build the clinical confidence to pass your certification exam.
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ACLS exam — full Q&A walkthrough
Every question read aloud with the answer explained. Play it on your commute, then test yourself.
30 free ACLS questions
Sampled across every topic area — not just the first page. Try them as a quiz or flip them as flashcards.
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Advanced Cardiac Life Support
During a cardiac arrest resuscitation, the team leader assigns roles before CPR begins. A new nurse asks why the team leader is not doing compressions. Which response BEST explains effective team dynamics?
Correct — C. AHA ACLS guidelines designate the team leader as the coordinator who directs all actions, communicates with the team, and makes real-time decisions — a role incompatible with performing compressions, which demand full physical attention. -
Advanced Cardiac Life Support
You arrive at a patient found unresponsive. Which action is the FIRST priority in the BLS primary survey?
Correct — B. The very first step of any resuscitation is confirming that the scene is safe for rescuers, as outlined in the BLS survey; proceeding into an unsafe environment risks creating additional victims. -
Advanced Cardiac Life Support
A provider performing chest compressions on an adult patient is pushing down approximately 1.5 inches at a rate of 110/min. What correction should the team leader call out?
Correct — A. AHA guidelines specify adult compression depth of at least 2 inches (5 cm) and rate of 100-120/min; the rate of 110/min is correct, but 1.5 inches is inadequate and must be corrected. -
Advanced Cardiac Life Support
Mid-resuscitation, a team member states: 'I've pushed 1 mg of epinephrine IV.' The team leader nods without responding verbally. According to ACLS team communication principles, what problem does this represent?
Correct — A. Closed-loop communication requires that the receiver verbally acknowledges the message and the sender confirms the acknowledgment; a nod alone does not complete the loop and risks miscommunication errors. -
Advanced Cardiac Life Support
During the primary ACLS survey (ABCDE), the team has confirmed a shockable rhythm and delivered one shock. The next immediate action is:
Correct — D. Per the AHA VF/pVT algorithm, after each shock CPR is resumed immediately for 2 minutes before the next rhythm and pulse check, minimizing post-shock no-flow time. -
Advanced Cardiac Life Support
A team member who is an experienced paramedic disagrees with the team leader's decision to withhold a second dose of epinephrine. What is the MOST appropriate way for that team member to communicate concern?
Correct — C. AHA ACLS team dynamics teach 'constructive intervention': any member may calmly voice a concern to the team leader, but must still defer to the leader's final decision unless patient safety is immediately threatened. -
Advanced Cardiac Life Support
You are leading a resuscitation and observe that compressions are being interrupted for 18 seconds each time the defibrillator charges. What target metric is being violated?
Correct — A. AHA guidelines recommend minimizing all peri-shock pauses to under 10 seconds and maintaining a CPR fraction (proportion of resuscitation time with compressions) greater than 60% to optimize perfusion pressure. -
Advanced Cardiac Life Support
A resuscitation team has four members: team leader, compressor, airway provider, and IV/medication nurse. The monitor shows asystole. The airway provider spontaneously begins preparing for intubation and announces 'I'll intubate now.' What principle of team dynamics is at risk?
Correct — D. ACLS team dynamics require clearly defined roles and that significant interventions be directed by the team leader; self-initiated role expansion without instruction can create overlap, missed tasks, or unsafe actions. -
Advanced Cardiac Life Support
A 58-year-old collapses in the ICU. CPR is in progress. The monitor shows a narrow-complex organized rhythm at 70/min with no pulse. Epinephrine 1 mg has been given. Which statement BEST guides the next 2 minutes of care?
Correct — A. Pulseless electrical activity (PEA) is treated with uninterrupted high-quality CPR, epinephrine every 3-5 minutes, and aggressive search for the 6 Hs and 6 Ts; atropine is not indicated for PEA and cardioversion has no role. -
Advanced Cardiac Life Support
During handoff at shift change, the outgoing team leader states: 'We've given two rounds of epi and one dose of amiodarone 300 mg; total downtime is 14 minutes.' The incoming team leader asks what role this information plays in ACLS framework. Which answer is MOST accurate?
Correct — A. Accurate elapsed-time and medication tracking is essential for maintaining the ACLS algorithm: epinephrine recurs every 3-5 minutes, and a second amiodarone dose (150 mg) can be given for refractory VF/pVT after the initial 300 mg. -
Advanced Cardiac Life Support
You are team leader during a resuscitation. After 20 minutes, the rhythm remains asystole, no reversible causes are identified, and end-tidal CO2 is consistently below 10 mmHg despite optimal CPR. A team member asks whether resuscitation should continue. Which response BEST reflects current AHA guidance?
Correct — D. AHA guidelines acknowledge that an ETCO2 persistently below 10 mmHg after 20 minutes of ALS resuscitation is associated with extremely low survival rates and may be used — alongside clinical context — as one factor in termination-of-resuscitation discussions. -
Advanced Cardiac Life Support
A resuscitation team member assigned as the 'timer/recorder' calls out '3 minutes since last shock' while VF continues on the monitor. The compressor has been performing compressions for 2 minutes without rotation. What is the MOST important action the team leader should take NEXT?
Correct — C. To minimize CPR interruptions, AHA guidelines recommend preparing for defibrillation — including compressor rotation — while CPR continues, so the pause between stopping compressions and delivering the shock is kept under 10 seconds. -
Advanced Cardiac Life Support
During post-cardiac-arrest care following ROSC, the primary survey reveals: SpO2 88% on 100% O2, BP 78/40 mmHg, HR 118/min sinus tachycardia, GCS 6. The team leader orders a specific FiO2 target. Which order is MOST consistent with AHA post-ROSC guidelines?
Correct — B. AHA post-cardiac-arrest care guidelines recommend titrating inspired oxygen to achieve SpO2 of 92-98% (avoiding both hypoxia and hyperoxia), as excessive oxygen delivery after ROSC can worsen neurological outcomes through oxidative injury. -
Advanced Cardiac Life Support
In a megacode scenario, VF is refractory after three shocks plus epinephrine. The medication nurse announces: 'I have amiodarone ready — should I push it?' The team leader has not yet given the order. Which closed-loop communication sequence is CORRECT?
Correct — B. Closed-loop communication requires a clear verbal order from the team leader, read-back by the receiving team member, explicit confirmation by the team leader, and a completion announcement — preventing medication errors in high-stress environments. -
Advanced Cardiac Life Support
During a resuscitation, a respiratory therapist is performing bag-mask ventilation. After 2 minutes of CPR, the team leader notes visible chest rise with every compression — not just with ventilations. What does this finding MOST likely indicate, and what action is appropriate?
Correct — A. Passive chest rise with compressions during bag-mask ventilation can signal excessive ventilation rate causing dynamic hyperinflation (auto-PEEP), poor mask seal, or high airway pressure — all of which impair venous return and cardiac output; AHA guidelines target 1 breath every 6 seconds (10/min) with an advanced airway in place. -
Advanced Cardiac Life Support
During a prolonged cardiac arrest resuscitation, the team has delivered three shocks and two doses of epinephrine (1 mg each). The rhythm remains VF. Which of the following represents the correct next antiarrhythmic intervention?
Correct — B. AHA guidelines recommend amiodarone 300 mg IV/IO as the first antiarrhythmic dose for shock-refractory VF/pVT, followed by a second dose of 150 mg if VF/pVT persists; the initial dose is not 150 mg. -
Advanced Cardiac Life Support
A patient in cardiac arrest has a rhythm that shows no discernible electrical activity on the monitor. The team confirms true asystole. Which intervention is NOT recommended in the AHA cardiac arrest algorithm for asystole?
Correct — C. Defibrillation is NOT indicated for asystole; the AHA algorithm explicitly states that asystole and PEA are non-shockable rhythms, and shocking asystole does not improve outcomes and may suppress spontaneous pacemaker activity. -
Advanced Cardiac Life Support
EMS brings in a 45-year-old female found unresponsive after a witnessed collapse. The monitor shows a narrow-complex organized rhythm at 70 bpm, but the team cannot palpate a pulse after a 10-second check. The MOST appropriate immediate next step is:
Correct — A. An organized rhythm without a palpable pulse defines pulseless electrical activity (PEA), a non-shockable rhythm treated with CPR, epinephrine, and systematic H's and T's investigation rather than defibrillation or cardioversion. -
Advanced Cardiac Life Support
A 62-year-old man with known COPD is in PEA arrest. Initial ETCO2 is 12 mmHg. After 2 minutes of high-quality CPR and epinephrine, you reassess and the ETCO2 suddenly rises to 45 mmHg without any change in compression rate. The MOST likely explanation is:
Correct — A. A sudden sustained rise in ETCO2 to near-normal levels (>40 mmHg) during CPR without a change in compression mechanics is a reliable indicator of ROSC, because restored cardiac output dramatically increases CO2 delivery to the lungs. -
Advanced Cardiac Life Support
Which of the following reversible causes of cardiac arrest belongs to the 'T's' rather than the 'H's' in the H's and T's mnemonic?
Correct — D. Tension pneumothorax is one of the five T's (Tension pneumothorax, Tamponade cardiac, Toxins, Thrombosis-pulmonary, Thrombosis-coronary); the other three options all begin with 'H' and belong to the H's group. -
Advanced Cardiac Life Support
A 50-year-old woman presents in cardiac arrest. The monitor shows coarse VF. She receives one shock, 2 minutes of CPR, a second shock, 2 minutes of CPR, and epinephrine 1 mg IV. Rhythm check now shows fine VF. What is the BEST description of ideal CPR-shock cycle timing for the NEXT shock?
Correct — A. The AHA recommends minimizing the pre-shock pause (ideally under 10 seconds) by charging during CPR, pausing only to deliver the shock, then immediately resuming CPR for 2 minutes before the next rhythm check; fine VF is still a shockable rhythm. -
Advanced Cardiac Life Support
During a cardiac arrest resuscitation, the team leader asks the timekeeper to announce when epinephrine is due again. The first dose was given at 08:04. What is the EARLIEST the second dose should be administered?
Correct — B. Epinephrine is dosed every 3-5 minutes during cardiac arrest; the earliest the second dose can be given is 3 minutes after the first, which would be 08:07. -
Advanced Cardiac Life Support
A patient in PEA arrest is a 38-year-old male who was found unresponsive after a diving accident. Breath sounds are equal bilaterally, the trachea is midline, and neck veins appear distended. ETCO2 is 18 mmHg with good-quality CPR. Which reversible cause should be prioritized?
Correct — D. Distended neck veins, equal breath sounds, midline trachea, and PEA in the setting of trauma/diving point strongly to cardiac tamponade; tension pneumothorax would also cause JVD but typically shifts the trachea and abolishes breath sounds on one side. -
Advanced Cardiac Life Support
During a resuscitation attempt, a rhythm check reveals a regular wide-complex tachycardia at 180 bpm. The patient has a palpable carotid pulse. The provider suspects ventricular tachycardia with a pulse. The CORRECT next step per ACLS is:
Correct — D. A pulsed wide-complex tachycardia requires assessment for hemodynamic instability (hypotension, altered mental status, ischemic chest pain, acute heart failure); if unstable, perform synchronized cardioversion; if stable, antiarrhythmic therapy is considered — unlike pulseless VT which requires immediate defibrillation. -
Advanced Cardiac Life Support
Resuscitation has been ongoing for 20 minutes with high-quality CPR, two defibrillations, and two doses of epinephrine. ETCO2 has remained below 10 mmHg throughout. The team is considering terminating efforts. Which of the following, if present, would be the STRONGEST argument to continue resuscitation?
Correct — D. AHA guidance supports continued resuscitation when a potentially reversible cause is identified and actively being treated, as correction of the underlying etiology (e.g., hyperkalemia, hypothermia, pulmonary embolism) may restore perfusion even after prolonged arrest. -
Advanced Cardiac Life Support
A 67-year-old woman is resuscitated from VF arrest and achieves ROSC. She remains comatose and her 12-lead ECG shows ST-elevation in leads V1-V4. Blood pressure is 95/60 mmHg on a norepinephrine infusion. What is the recommended post-arrest temperature management target?
Correct — D. Current AHA/ECC post-cardiac arrest guidelines (updated 2023) recommend targeted temperature management that actively prevents fever (temperature >37.5°C) for at least 72 hours post-arrest in comatose survivors, while strict 32-34°C cooling is no longer mandated over normothermia for all patients. -
Advanced Cardiac Life Support
A team is managing a patient in asystole. One provider asks if they should consider transcutaneous pacing. What is the CORRECT response per AHA ACLS guidelines?
Correct — C. AHA guidelines do not recommend routine transcutaneous or transvenous pacing for asystolic cardiac arrest, as randomized trials have failed to demonstrate improved survival or neurological outcomes compared to CPR and medications alone. -
Advanced Cardiac Life Support
An 82-year-old man with a history of digoxin use for atrial fibrillation is brought in after a syncopal episode. His rhythm shows complete heart block with a junctional escape rate of 28 bpm and he has no pulse. Which of the following statements about medication management is MOST accurate in this scenario?
Correct — B. In cardiac arrest, the standard ACLS algorithm (CPR, epinephrine) continues regardless of the suspected cause; simultaneously, suspected toxin-mediated arrest (a 'T' in the H's and T's) is treated concurrently — in this case with Digibind — without delaying epinephrine. -
Advanced Cardiac Life Support
A patient develops VF while being monitored in the cardiac catheterization lab. The team immediately delivers a shock at 200 J (biphasic). The monitor now shows a sinus rhythm at 88 bpm. What should the team do FIRST after confirming the rhythm?
Correct — C. After any rhythm change during resuscitation, the team must confirm whether the organized rhythm correlates with a palpable pulse to distinguish ROSC from PEA before transitioning to post-arrest care or continuing resuscitation. -
Advanced Cardiac Life Support
During a cardiac arrest in a patient with known massive pulmonary embolism confirmed by prior CT, the team has completed 10 minutes of CPR without ROSC. Which intervention is MOST supported by AHA guidelines for suspected thrombus-related cardiac arrest?
Correct — B. AHA guidelines acknowledge that systemic thrombolytics (e.g., alteplase) may be considered for confirmed or strongly suspected PE-related cardiac arrest, with the caveat that CPR should be continued for at least 60-90 minutes following administration to allow the drug to work before terminating efforts.
ACLS sample questions
Tap any question below to reveal the answer and a plain-English explanation.
Advanced Cardiac Life Support A 58-year-old male collapses in the emergency department. The monitor shows completely chaotic, disorganized electrical activity with no identifiable P waves, QRS complexes, or T waves, and the baseline undulates irregularly between 150-400 cycles per minute. What rhythm is this?
A. Coarse atrial fibrillation
B. Polymorphic ventricular tachycardia
C. Ventricular fibrillation ✓
D. Artifact from patient movement
Correct — C. Ventricular fibrillation is characterized by chaotic, disorganized electrical activity with no identifiable waveforms and an irregular undulating baseline — the defining rhythm requiring immediate defibrillation per the AHA pulseless arrest algorithm.
Real Exam Practice The drug of choice for most forms of narrow-QRS tachycardia is:
A. Amiodarone
B. Atropine
C. Adenosine ✓
D. Epinephrine
Correct — C. Adenosine is the first-line drug for narrow-QRS (supraventricular) tachycardias due to its ability to transiently block AV nodal conduction.
Advanced Cardiac Life Support A rhythm strip shows a completely flat, isoelectric line with no discernible electrical activity. The patient is unresponsive and pulseless. Before diagnosing asystole, which action is most critical?
A. Administer atropine 1 mg IV immediately
B. Deliver an immediate unsynchronized shock at 200 J
C. Perform a precordial thump and reassess the rhythm
D. Confirm in at least two leads to rule out fine VF masquerading as asystole ✓
Correct — D. AHA guidelines require confirming asystole in more than one lead because fine VF can appear as a flat line in a single lead and is a shockable rhythm, making lead confirmation essential before withholding defibrillation.
Real Exam Practice Vasopressin may be used in the management of:
A. Symptomatic first-degree atrioventricular block
B. Ventricular fibrillation ✓
C. Narrow-QRS tachycardia
D. Atrial fibrillation with a rapid ventricular response
Correct — B. Vasopressin is a vasopressor used as an alternative to epinephrine in cardiac arrest, including ventricular fibrillation.
Advanced Cardiac Life Support A 67-year-old woman is found unresponsive. CPR is in progress. The monitor displays a rhythm with organized P waves, a rate of 80 bpm, and narrow QRS complexes — but no pulse is detected despite optimal CPR. Which intervention is the HIGHEST priority?
A. Deliver an immediate synchronized cardioversion at 100 J
B. Administer atropine 1 mg IV and repeat every 3-5 minutes
C. Search for and treat reversible causes (H's and T's) ✓
D. Administer amiodarone 300 mg IV bolus
Correct — C. The described rhythm is pulseless electrical activity (PEA) — an organized rhythm without a detectable pulse — and the AHA algorithm directs immediate identification and treatment of reversible causes (H's and T's), as no medication or shock corrects the underlying etiology.
Real Exam Practice Which of the following could be administered endotracheally if necessary?
A. Amiodarone, dopamine, procainamide, naloxone, and adenosine
B. Naloxone, atropine, vasopressin, epinephrine, and lidocaine ✓
C. Lidocaine, amiodarone, procainamide, vasopressin, and naloxone
D. Procainamide, epinephrine, lidocaine, adenosine, and dopamine
Correct — B. The mnemonic NAVEL covers endotracheal drugs: Naloxone, Atropine, Vasopressin, Epinephrine, and Lidocaine.
Advanced Cardiac Life Support During a resuscitation attempt, the rhythm on the monitor transitions from coarse VF to a narrow-complex organized rhythm at 90 bpm. CPR is paused to check for a pulse, and a weak carotid pulse is confirmed. What term best describes this rhythm and what is the immediate next step?
A. Accelerated idioventricular rhythm; administer lidocaine 1 mg/kg IV
B. Return of spontaneous circulation (ROSC); begin post-cardiac arrest care ✓
C. Pulseless electrical activity; resume high-quality CPR immediately
D. Pseudo-PEA; deliver a synchronized shock at 200 J
Correct — B. Detection of a palpable pulse in the setting of an organized rhythm confirms ROSC, triggering the post-cardiac arrest care bundle including targeted temperature management, hemodynamic support, and coronary angiography consideration per AHA guidelines.
Real Exam Practice The most common side effects of giving amiodarone are:
A. Nausea and asystole
B. Bradycardia and hypotension ✓
C. AV block and hypertension
D. Blurred vision and abdominal pain
Correct — B. IV amiodarone commonly causes bradycardia and hypotension, especially with rapid administration.
About the ACLS test
Study for your ACLS (Advanced Cardiovascular Life Support) exam with original practice questions written for this app from the publicly available current AHA ACLS guidelines. Every question has a clear explanation.
What you get
- The ACLS surveys and team dynamics, the adult cardiac arrest algorithm, rhythm recognition, the bradycardia and tachycardia algorithms, and post-cardiac-arrest care.
- A clear explanation for every question.
- Timed practice tests that mirror the real exam style.
Original & safe
Every question is written for this app from public study material. Nothing is copied from any real exam, test pool or third-party question bank.
You will be tested on
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial and physiological integrity
- Pharmacology, infection control and patient safety
How TheoryPractice helps you pass
- Real exam-style questions with instant, detailed explanations
- Full timed mock exams that mirror the real test format
- Flashcards & quiz modes from the same question bank
- Progress tracking so you know exactly when you're ready
Topics in this question bank
Safe and effective care environment
Health promotion and maintenance
Psychosocial and physiological integrity
Pharmacology, infection control and patient safety
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