ACLS Exam Questions & Answers 2026 (11–20)

✓ Correct answer: D. Evaluate the quantitative waveform capnography measurement and obtain a chest x-ray when possible.

When confirming the correct placement of an endotracheal (ET) tube, it is crucial to use reliable methods. Option D provides the appropriate methods to verify the accurate position of the ET tube.<br/><br/>By evaluating the quantitative waveform capnography measurement, healthcare providers can assess the levels of carbon dioxide (CO2) in the patient's exhaled breath. This measurement serves as a reliable indicator of correct tube placement. An ET tube that is properly positioned within the trachea will yield a waveform with a distinct shape known as the "capnographic waveform."<br/><br/>Additionally, obtaining a chest x-ray when possible further ensures accurate tube placement. This imaging technique provides a visual confirmation of the ET tube's position, allowing healthcare providers to confirm that it is correctly situated within the trachea.<br/><br/>By utilizing both quantitative waveform capnography measurement and obtaining a chest x-ray, healthcare providers can confidently verify the accurate placement of the ET tube, ensuring that the patient receives optimal ventilation and oxygenation.<br/><br/>Now, let's analyze the incorrect answer options:<br/><br/>Option A suggests visually assessing the rise and fall of the chest to confirm a patent airway and adequate ventilation. While this method may provide some indication of ventilation, it is not an accurate or reliable method for confirming the accurate placement of an ET tube. The rise and fall of the chest can occur even with improper tube placement, such as in the esophagus. Therefore, this method should not be solely relied upon for verification.<br/><br/>Option B recommends gently tugging on the end of the endotracheal tube to ensure proper positioning. This action, known as "tube position confirmation by palpation," is an outdated and unreliable method. Tugging on the tube does not offer definitive confirmation of correct placement and may even cause harm or dislodgement. Therefore, this method should be avoided.<br/><br/>Option C suggests monitoring pulse oximetry continuously for 15 minutes after placement of the advanced airway. While pulse oximetry is valuable in assessing oxygenation, it does not provide direct information about the placement of the ET tube. Relying solely on pulse oximetry may lead to delayed recognition of improper tube position and potentially compromise the patient's ventilation and oxygenation.<br/><br/>In summary, the appropriate methods to verify the accurate position of an ET tube include evaluating the quantitative waveform capnography measurement and obtaining a chest x-ray when possible. These methods provide reliable and objective confirmation, ensuring optimal care for the patient undergoing resuscitation.

✓ Correct answer: C. Detects return of spontaneous circulation (ROSC)

Capnography assists in evaluating the quality of CPR, monitoring tube placement, and identifying the return of spontaneous circulation.<br/><br/>Quantitative waveform capnography indirectly offers insights into cardiac output by tracking the amount of CO₂ exhaled from circulation. Adequate PETCO₂ levels are indicative of effective CPR and guide providers in optimizing compression techniques. If PETCO₂ falls below 10 mm Hg, efforts are made to enhance CPR quality.<br/><br/>Capnography serves as a valuable complement to advanced airways. Exhaled CO₂ values and the presence of a continuous waveform help in tracking endotracheal tube position and identifying potential deterioration, obstructions, or displacement.<br/><br/>ROSC can be confirmed by a sudden rise in PETCO₂ to normal levels (35 to 40 mm Hg) or by observable spontaneous movement. This confirmation can be useful when an organized rhythm is detected during a rhythm check.<br/><br/>Capnography does not influence drug distribution within the central circulation.<br/><br/>Tidal volume and inflation duration are not measurable through capnography at present, thus they cannot aid in resuscitation efforts.

✓ Correct answer: D. Mobitz II

In cases of bradycardia, the typical ECG rhythm that is seen is Mobitz II. Mobitz II is a type of second-degree atrioventricular (AV) block characterized by intermittent failure of the atrial electrical impulses to conduct to the ventricles. This results in a prolonged PR interval followed by a dropped QRS complex. Mobitz II can be a serious rhythm disturbance and may require medical intervention.<br/><br/>Option A (sinus rhythm) is incorrect because sinus rhythm refers to the normal rhythm of the heart, where electrical impulses are generated by the sinus node in the right atrium. Sinus rhythm is not typically seen in cases of bradycardia.<br/><br/>Option B (PEA) is incorrect because PEA, or pulseless electrical activity, is a situation where there is electrical activity on the ECG but no corresponding mechanical activity of the heart. It is a form of cardiac arrest and is not specific to bradycardia.<br/><br/>Option D (ventricular fibrillation) is incorrect because ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic and disorganized electrical activity in the ventricles. It is not typically associated with bradycardia.<br/><br/>Therefore, the correct answer for the ECG rhythm typically seen in cases of bradycardia is C) Mobitz II.

✓ Correct answer: A. New left bundle branch block (LBBB)

The following conditions warrant consideration and preparation for transcutaneous pacing in the context of acute myocardial infarction (MI):<br/><br/>1. New Left Bundle Branch Block (LBBB)<br/>2. Hypotension<br/>3. Mobitz Type II AV Block<br/><br/>In the presence of high-risk conduction disturbances, providers should be prepared for transcutaneous pacing. This pertains to patients with conditions characterized by hemodynamically unstable bradycardia, including those stemming from slow heart rates (such as hypotension, heart failure, or shock), rhythms prone to deterioration or arising from ischemia (like LBBB or AV blocks), and bradycardia with ventricular escape rhythms that lead to symptomatic manifestations.<br/><br/>It is important to recognize that acute coronary syndromes (ACS), particularly affecting circulation to the SA node through the right coronary artery, particularly in the context of inferior AMI. This can result in the slowing of the impulse originating at the SA node due to ischemia or infarction.<br/><br/>However, if diastolic blood pressure exceeds 90 mm Hg in the setting of AMI, this does not typically indicate symptomatic bradycardia and would not necessitate pacing.<br/><br/>Asymptomatic bradycardia, even within the context of ACS, generally does not call for immediate treatment.<br/><br/>Source: AHA Advanced Cardiovascular Life Support Provider Manual, 2015.

✓ Correct answer: C. 1 positive pressure breath every 6 seconds with no interruptions in chest compressions

When providing ventilations with an advanced airway during a code, the correct method is to administer 1 positive pressure breath every 6 seconds with no interruptions in chest compressions. This ensures that oxygen is provided to the patient while maintaining the effectiveness of chest compressions in circulation.<br/><br/>Option A (1 positive pressure breath every 5-6 seconds with no interruptions in chest compressions) is incorrect. While the timing is similar to the correct answer, it is important to stick to consistently providing breaths every 6 seconds to maintain the proper balance between ventilation and chest compressions.<br/><br/>Option C (2 breaths for every 30 compressions) is incorrect. This method is typically used for basic life support (BLS) and not recommended when an advanced airway is in place. With an advanced airway, continuous chest compressions are prioritized over providing a specific ratio of compressions to breaths.<br/><br/>Option D (1 breath every 10-12 seconds) is also incorrect. The interval between breaths should be closer to 6 seconds, as stated in the correct answer. Waiting 10-12 seconds between breaths may lead to insufficient oxygenation of the patient.<br/><br/>In summary, option B provides the most accurate and appropriate method for providing ventilations with an advanced airway during a code.

✓ Correct answer: C. early defibrillation

Early defibrillation is the intervention that holds the utmost significance when dealing with witnessed sudden cardiac arrest. Sudden cardiac arrest occurs when the heart suddenly stops beating effectively, leading to a loss of blood flow to the brain and other vital organs. Defibrillation is the process of delivering an electric shock to the heart to restore its normal rhythm. When sudden cardiac arrest is witnessed, early defibrillation is crucial as it gives the highest chances of survival. <br/><br/>Option A) early activation of EMS. While activating emergency medical services (EMS) is an important step in the management of sudden cardiac arrest, it is not the intervention that holds the utmost significance. Early defibrillation takes precedence as it directly addresses the disrupted heart rhythm.<br/><br/>Option B) rapid use of resuscitation drugs. Although the administration of resuscitation drugs may be a part of advanced life support interventions for cardiac arrest, it is not the primary intervention of utmost significance. Early defibrillation is vital to rapidly restore the heart's normal rhythm.<br/><br/>Option C) effective chest compressions. Effective chest compressions are a critical component of cardiopulmonary resuscitation (CPR) during sudden cardiac arrest. However, while they help maintain blood circulation, they are not the intervention that holds the utmost significance. Early defibrillation remains the priority for increasing the chances of survival.<br/><br/>In summary, while early activation of EMS, rapid use of resuscitation drugs, and effective chest compressions are all important in the management of sudden cardiac arrest, the intervention that holds the utmost significance is D) early defibrillation.

✓ Correct answer: B. Central venous access can be established through the subclavian, femoral, or jugular veins.

Central venous access is an important method for obtaining large-bore intravenous access during resuscitation efforts. It allows for the administration of fluids, medications, and blood products more rapidly and efficiently.<br/><br/>Central venous access can be obtained through various routes, including the subclavian, femoral, or jugular veins (correct answer). Each route has its advantages and disadvantages, and the choice of site depends on the clinical scenario and the skill and experience of the healthcare provider.<br/><br/>Options A, C, and D are incorrect statements. While central venous access is a valuable tool in resuscitation, it may not always be the preferred method, especially in critically ill patients or during life-threatening emergencies. It is typically reserved for patients with difficult peripheral venous access or when large volumes of fluid or blood products are needed. Patients with heart failure may benefit from central venous access to monitor their central venous pressure and guide fluid management during resuscitation.

✓ Correct answer: D. Third-degree atrioventricular (AV) block

Third-degree atrioventricular (AV) block, also known as complete heart block, is the most likely cause of the persistent hypotension in this scenario. In third-degree AV block, there is complete dissociation between the atrial and ventricular rhythms. The atria and ventricles contract independently of each other, resulting in a slow ventricular rate that is typically below the patient's normal intrinsic rate. External pacing is initiated to support the heart rate and maintain cardiac output in these patients. However, despite pacing at an adjusted rate of 75/minute, the patient's hypotension persists because the ventricles are not responding adequately to the external pacing.

✓ Correct answer: C. Hyperventilation should be avoided to optimize cardiac output, and to reduce the risk for gastric inflation, and vomiting.

The correct approach to advanced airway management during cardiac arrest is to avoid hyperventilation. Hyperventilation refers to providing excessive ventilation or breathing at a rate that is faster than normal. In the context of advanced airway management during cardiac arrest, hyperventilation should be avoided to optimize cardiac output.<br/><br/>During cardiac arrest, the primary goal is to maintain adequate blood flow to vital organs, including the heart and the brain. Hyperventilation can actually decrease cardiac output by causing a decrease in the amount of blood returning to the heart. This is because hyperventilation leads to a decrease in the amount of carbon dioxide in the blood, which in turn causes blood vessels to constrict and impedes blood flow.<br/><br/>Furthermore, hyperventilation can also lead to gastric inflation and vomiting. During advanced airway management, if excessive breaths are delivered too forcefully, they can cause air to enter the stomach instead of the lungs. This can lead to gastric inflation, which can result in regurgitation and vomiting. Regurgitation and vomiting can further complicate the management of the airway and potentially cause aspiration, where stomach contents enter the lungs. Aspiration can lead to further complications and compromise the patient's respiratory status.<br/><br/>Therefore, the correct approach to advanced airway management during cardiac arrest is to avoid hyperventilation. This helps optimize cardiac output and reduces the risk for gastric inflation, regurgitation, and vomiting. By maintaining a normal respiratory rate and avoiding excessive breaths, healthcare providers can effectively manage the airway during cardiac arrest while minimizing potential complications. <br/><br/>Now let's analyze the wrong answers:<br/><br/>Option A states that ventilations should be provided at a rate of 1 breath every 6 seconds, and coordinated with chest compressions. This approach is incorrect because it promotes a slower respiratory rate than what is recommended during cardiac arrest. The current guidelines recommend delivering ventilations at a rate of 10 breaths per minute, so the correct approach is not to provide 1 breath every 6 seconds. Additionally, chest compressions and ventilations should be coordinated in a specific ratio (e.g., 30:2) rather than simply providing ventilations in coordination with chest compressions.<br/><br/>Option B states that advanced airways eliminate the risk for aspiration and should be a priority during the Primary Assessment. This approach is incorrect because it overstates the benefits of advanced airways and does not prioritize the primary assessment correctly. While advanced airways can help secure the airway and assist with ventilation, they do not completely eliminate the risk for aspiration. Additionally, during the primary assessment, the focus is primarily on identifying and treating immediately life-threatening conditions, such as ensuring effective chest compressions and providing timely defibrillation, rather than solely prioritizing advanced airways.<br/><br/>Option D states that maintaining oxygen at 100% will increase cardiac output. This approach is incorrect because it oversimplifies the relationship between oxygenation and cardiac output. While maintaining adequate oxygenation is crucial during cardiac arrest, aiming for 100% oxygen saturation is not recommended. Excessive oxygen administration can lead to oxygen toxicity and potential harm to the patient. The current guidelines recommend titrating oxygen administration to achieve an oxygen saturation level of 94-98%.<br/><br/>In conclusion, the correct approach to advanced airway management during cardiac arrest is to avoid hyperventilation. This helps optimize cardiac output and reduces the risk for gastric inflation, regurgitation, and vomiting. Option A, which suggests providing ventilations at a rate of 1 breath every 6 seconds, and coordinated with chest compressions, is incorrect. Option B, which states that advanced airways eliminate the risk for aspiration and should be a priority during the Primary Assessment, is incorrect. Option D, which claims that maintaining oxygen at 100% will increase cardiac output, is also incorrect.

✓ Correct answer: D. Attempt intraosseous (IO) access

Intraosseous (IO) access is the next appropriate step when peripheral intravenous (IV) access cannot be established during cardiac arrest with ongoing high-quality compressions and an advanced airway in place (correct answer).<br/><br/>IO access involves inserting a needle directly into the bone marrow cavity, allowing for the administration of fluids and medications when intravenous access is not possible. While medications can be administered through the advanced airway (option A), IO access is preferred for delivering fluids and drugs directly into the circulation during cardiac arrest situations.<br/><br/>Continuing high-quality chest compressions without fluids or medications (option B) is not ideal, as prompt administration of medications is crucial for optimizing the chances of return of spontaneous circulation (ROSC). Administering medications via intramuscular injection (option C) is not recommended during cardiac arrest due to slow absorption and uncertainty of reaching therapeutic levels quickly.