ACLS Exam Questions & Answers 2026 (21–30)

Question 1

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?

TheoryPractice · Accepted Answer

Pause CPR, charge the defibrillator, deliver the shock, then immediately resume CPR for 2 minutes. 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.

Question 2

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?

TheoryPractice · Accepted Answer

08:07. 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.

Question 3

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?

TheoryPractice · Accepted Answer

Cardiac tamponade. 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.

Question 4

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:

TheoryPractice · Accepted Answer

Assess for signs of hemodynamic instability to determine if synchronized cardioversion is needed. 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.

Question 5

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?

TheoryPractice · Accepted Answer

A reversible cause such as severe hyperkalemia is identified and being corrected. 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.

Question 6

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?

TheoryPractice · Accepted Answer

Prevent fever by maintaining temperature at or below 37.5°C for at least 72 hours. 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.

Question 7

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?

TheoryPractice · Accepted Answer

No, routine pacing for asystole is not recommended and has not been shown to improve outcomes. 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.

Question 8

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?

TheoryPractice · Accepted Answer

Epinephrine per the standard cardiac arrest algorithm remains appropriate while digoxin toxicity is simultaneously treated as a reversible cause. 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.

Question 9

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?

TheoryPractice · Accepted Answer

Check for a pulse to confirm ROSC before proceeding with post-arrest care. 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.

Question 10

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?

TheoryPractice · Accepted Answer

Systemic thrombolysis (e.g., tPA) may be considered, understanding that CPR should continue for at least 60-90 minutes after administration. 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 Exam Questions & Answers 2026 (21–30)

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