ACLS Exam Questions & Answers 2026 (11–20)

Question 1

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?

TheoryPractice · Accepted Answer

Persistent ETCO2 below 10 mmHg after 20 minutes of ALS is associated with very poor prognosis and can inform (though not alone determine) the decision to terminate efforts.. 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.

Question 2

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?

TheoryPractice · Accepted Answer

Direct a compressor swap and charge the defibrillator simultaneously to minimize the pre-shock pause at the 2-minute mark.. 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.

Question 3

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?

TheoryPractice · Accepted Answer

Titrate O2 to maintain SpO2 92-98% to avoid hyperoxia-induced reperfusion injury.. 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.

Question 4

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?

TheoryPractice · Accepted Answer

Team leader states the order clearly; nurse repeats it back; team leader confirms; nurse administers and announces completion.. 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.

Question 5

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?

TheoryPractice · Accepted Answer

The bag-mask rate may be too high causing air trapping, or mask seal is causing passive chest movement; reassess ventilation rate and technique targeting 1 breath every 6 seconds once an advanced airway is placed.. 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.

Question 6

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?

TheoryPractice · Accepted Answer

Amiodarone 300 mg IV push, with a second dose of 150 mg if VF persists. 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.

Question 7

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?

TheoryPractice · Accepted Answer

Defibrillation at maximum biphasic energy. 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.

Question 8

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:

TheoryPractice · Accepted Answer

Resume CPR and treat as PEA, searching for reversible causes. 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.

Question 9

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:

TheoryPractice · Accepted Answer

Spontaneous return of circulation has occurred. 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.

Question 10

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?

TheoryPractice · Accepted Answer

Tension pneumothorax. 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.

ACLS Exam Questions & Answers 2026 (11–20)

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