ACLS practice test: a full mock of the written exam

1. Card 01 / 60Cardiac arrest

   What is the appropriate response when a previously shockable rhythm changes to a non-shockable rhythm during cardiac arrest resuscitation?

   1. AImmediately administer amiodarone regardless of the new rhythm
   2. BImmediately deliver another shock at a higher energy level
   3. CStop CPR to reassess the patient for a pulse
   4. DComplete the current CPR cycle, then transition to the non-shockable rhythm algorithm

   Explanation

   Keyed answerD. Complete the current CPR cycle, then transition to the non-shockable rhythm algorithm

   Your pickA. Immediately administer amiodarone regardless of the new rhythm ww

   When a previously shockable rhythm changes to a non-shockable rhythm during resuscitation, the appropriate response is to complete the current CPR cycle, then transition to the non-shockable rhythm algorithm. This would typically involve continuing high-quality CPR, administering epinephrine every 3-5 minutes, and identifying and treating reversible causes.

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2. Card 02 / 60Brady & tachy

   What is the pathophysiological mechanism behind bradycardia developing as a complication of inferior wall myocardial infarction?

   1. AVentricular remodeling causing mechanical compression of the AV node
   2. BIncreased vagal tone and/or ischemia of the SA node due to right coronary artery involvement
   3. CDamage to the left bundle branch
   4. DExcessive sympathetic stimulation

   Explanation

   Keyed answerB. Increased vagal tone and/or ischemia of the SA node due to right coronary artery involvement

   Your pickA. Ventricular remodeling causing mechanical compression of the AV node ww

   In inferior wall MI, there is often increased vagal tone due to stimulation of cardiac receptors (Bezold-Jarisch reflex). Additionally, the right coronary artery, which is typically involved in inferior MI, supplies the SA node in approximately 60% of people, potentially causing direct ischemic damage to the node.

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3. Card 03 / 60CPR & airway

   What is the maximum interval that chest compressions should be interrupted during ACLS resuscitation efforts?

   1. A10 seconds
   2. B15 seconds
   3. C30 seconds
   4. D5 seconds

   Explanation

   Keyed answerA. 10 seconds

   Your pickB. 15 seconds ww

   The maximum interval that chest compressions should be interrupted during ACLS resuscitation is 10 seconds. This applies to critical interventions such as intubation, rhythm checks, and defibrillation. Minimizing interruptions in chest compressions is essential for maintaining coronary and cerebral perfusion.

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4. Card 04 / 60ACS & stroke

   Which of the following best describes the Cincinnati Prehospital Stroke Scale?

   1. AAssessment of facial droop, arm drift, and speech abnormalities
   2. BGlasgow Coma Scale score, pupillary reaction, and motor response
   3. CFacial symmetry, leg strength, and language
   4. DBlood pressure, pupils, and level of consciousness

   Explanation

   Keyed answerA. Assessment of facial droop, arm drift, and speech abnormalities

   Your pickB. Glasgow Coma Scale score, pupillary reaction, and motor response ww

   The Cincinnati Prehospital Stroke Scale assesses three physical findings: facial droop, arm drift, and speech abnormalities. It's a simple tool designed for rapid stroke assessment in the field, with high sensitivity for anterior circulation strokes.

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5. Card 05 / 60Rhythms & drugs

   In patients treated with IV tPA, what dynamic ECG changes may indicate reperfusion arrhythmias post-therapy?

   1. ATransient accelerated idioventricular rhythms may signify reperfusion
   2. BNew onset atrial fibrillation indicates reperfusion injury
   3. CPersistent ventricular fibrillation post-tPA indicates successful reperfusion
   4. DStable sinus rhythm immediately post-tPA is diagnostic of reperfusion

   Explanation

   Keyed answerA. Transient accelerated idioventricular rhythms may signify reperfusion

   Your pickC. Persistent ventricular fibrillation post-tPA indicates successful reperfusion ww

   Reperfusion often leads to transient arrhythmias such as accelerated idioventricular rhythms, which are indicators of successful reperfusion.

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6. Card 06 / 60Post-arrest care

   What is the underlying goal of targeted temperature management in the post-cardiac arrest period regarding neuroprotection?

   1. ATo increase myocardial contractility
   2. BTo accelerate the return to normothermia
   3. CTo reduce cerebral metabolism and limit reperfusion injury
   4. DTo stimulate an immune response

   Explanation

   Keyed answerC. To reduce cerebral metabolism and limit reperfusion injury

   Your pickB. To accelerate the return to normothermia ww

   TTM reduces the cerebral metabolic rate and limits reperfusion injury to vulnerable brain tissues, thus improving neurological outcomes.

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7. Card 07 / 60Team & systems

   Which of the following represents the most effective initial approach to team leadership in a cardiac arrest?

   1. AQuietly taking control without announcement
   2. BWaiting to see if someone else takes charge
   3. CFocusing on performing interventions rather than coordinating
   4. DClearly announcing "I am leading this code"

   Explanation

   Keyed answerD. Clearly announcing "I am leading this code"

   Your pickC. Focusing on performing interventions rather than coordinating ww

   Clearly announcing "I am leading this code" eliminates ambiguity about leadership, allowing for clear direction and coordination from the beginning of the resuscitation effort.

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8. Card 08 / 60Cardiac arrest

   In which of the following situations would double sequential defibrillation be considered?

   1. APulseless electrical activity (PEA) to stimulate electrical activity
   2. BRefractory ventricular fibrillation unresponsive to multiple standard defibrillation attempts
   3. CFirst-time ventricular fibrillation to ensure conversion
   4. DAsystole to attempt to generate an electrical impulse

   Explanation

   Keyed answerB. Refractory ventricular fibrillation unresponsive to multiple standard defibrillation attempts

   Your pickA. Pulseless electrical activity (PEA) to stimulate electrical activity ww

   Double sequential defibrillation (using two defibrillators to deliver shocks in rapid succession) may be considered for refractory ventricular fibrillation that persists despite multiple standard defibrillation attempts, antiarrhythmic medications, and correction of reversible causes. It is not part of the standard algorithm; evidence remains limited and the 2025 Guidelines say its usefulness is not established.

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9. Card 09 / 60Brady & tachy

   Which ECG finding would suggest that a wide-complex tachycardia is more likely ventricular tachycardia rather than supraventricular tachycardia with aberrancy?

   1. AQRS duration <120 ms
   2. BPresence of a P wave before each QRS complex
   3. CConcordance across precordial leads
   4. DRS pattern in at least one precordial lead

   Explanation

   Keyed answerC. Concordance across precordial leads

   Your pickB. Presence of a P wave before each QRS complex ww

   Concordance refers to all precordial leads showing either positive or negative deflections. Positive concordance (all R waves) or negative concordance (all QS complexes) across precordial leads strongly suggests ventricular tachycardia rather than SVT with aberrancy.

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10. Card 10 / 60CPR & airway

    How should a healthcare provider check for responsiveness in an adult?

    1. ABegin chest compressions immediately
    2. BTap and shout, 'Are you okay?'
    3. CCheck for a carotid pulse first
    4. DPlace in recovery position and monitor

    Explanation

    Keyed answerB. Tap and shout, 'Are you okay?'

    Your pickD. Place in recovery position and monitor ww

    To check for responsiveness, a healthcare provider should tap the person's shoulders and shout, 'Are you okay?' This helps determine if the person is conscious and responsive.

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11. Card 11 / 60ACS & stroke

    What is the recommended time window for administering IV alteplase (tPA) to eligible patients with acute ischemic stroke?

    1. AWithin 4.5 hours from symptom onset
    2. BWithin 12 hours from symptom onset
    3. CWithin 1 hour from arrival to emergency department
    4. DWithin 24 hours from symptom onset

    Explanation

    Keyed answerA. Within 4.5 hours from symptom onset

    Your pickC. Within 1 hour from arrival to emergency department ww

    The AHA guidelines recommend administering IV alteplase within 4.5 hours from symptom onset for eligible patients with acute ischemic stroke, with earlier administration associated with better outcomes.

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12. Card 12 / 60Cardiac arrest

    What is the recommended initial energy level for defibrillation of ventricular fibrillation in adults using a biphasic defibrillator?

    1. A200-300 joules
    2. B300-360 joules
    3. C50-100 joules
    4. D120-200 joules

    Explanation

    Keyed answerD. 120-200 joules

    Your pickA. 200-300 joules ww

    The recommended initial energy level for defibrillation of ventricular fibrillation in adults using a biphasic defibrillator is 120-200 joules, depending on the manufacturer's recommendations. If unknown, the maximum available energy should be used.

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13. Card 13 / 60Rhythms & drugs

    What is a significant clinical risk associated with a prolonged QT interval in the context of tachyarrhythmias?

    1. AIt indicates a benign variation with no risk
    2. BIt decreases the risk of ventricular fibrillation
    3. CIt predisposes the patient to torsades de pointes
    4. DIt enhances the effectiveness of beta-blockers

    Explanation

    Keyed answerC. It predisposes the patient to torsades de pointes

    Your pickB. It decreases the risk of ventricular fibrillation ww

    A prolonged QT interval predisposes patients to torsades de pointes, a potentially life-threatening form of polymorphic ventricular tachycardia.

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14. Card 14 / 60Brady & tachy

    Which of the following is a specific ECG finding that can help distinguish ventricular tachycardia from supraventricular tachycardia with aberrancy?

    1. ARegular R-R intervals
    2. BQRS duration of 120-140 ms
    3. CPresence of capture beats
    4. DRate above 150 bpm

    Explanation

    Keyed answerC. Presence of capture beats

    Your pickB. QRS duration of 120-140 ms ww

    Capture beats occur when a supraventricular impulse conducts to the ventricles during ventricular tachycardia, resulting in a normal (narrow) QRS complex amidst the wide QRS complexes of VT. This finding is specific for VT and doesn't occur in SVT with aberrancy, where all beats conduct with the same aberrant pattern.

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15. Card 15 / 60CPR & airway

    What is the correct compression rate for adult CPR according to current ACLS guidelines?

    1. A100-120 compressions per minute
    2. B120-140 compressions per minute
    3. C80-100 compressions per minute
    4. D60-80 compressions per minute

    Explanation

    Keyed answerA. 100-120 compressions per minute

    Your pickB. 120-140 compressions per minute ww

    Current ACLS guidelines recommend a chest compression rate of 100-120 compressions per minute for adult CPR. This rate optimizes cardiac output during resuscitation.

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16. Card 16 / 60Post-arrest care

    What is the recommended approach for managing seizures in post-cardiac arrest patients?

    1. AObserve without intervention for 30 minutes
    2. BDecrease targeted temperature management to 30°C
    3. CIncrease targeted temperature management to 38°C
    4. DTreat promptly with anticonvulsant medications

    Explanation

    Keyed answerD. Treat promptly with anticonvulsant medications

    Your pickB. Decrease targeted temperature management to 30°C ww

    The recommended approach for managing seizures in post-cardiac arrest patients is to treat them promptly with anticonvulsant medications. Seizures increase cerebral oxygen consumption and can worsen neurological outcomes if not quickly controlled.

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17. Card 17 / 60Team & systems

    Which practice best supports effective team dynamics during the initial minutes of a resuscitation?

    1. ASpeaking in abbreviated forms to save time
    2. BUsing standardized terminology from ACLS protocols
    3. CUsing technical medical jargon to sound professional
    4. DCreating facility-specific code terminology

    Explanation

    Keyed answerB. Using standardized terminology from ACLS protocols

    Your pickC. Using technical medical jargon to sound professional ww

    Using standardized terminology from ACLS protocols ensures all team members understand communications in the same way, preventing misinterpretation and ensuring coordinated actions during the critical initial minutes.

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18. Card 18 / 60Cardiac arrest

    Which of the following statements about vasopressin in cardiac arrest is correct according to current ACLS guidelines?

    1. AVasopressin should be given with every other dose of epinephrine
    2. BVasopressin is the preferred first-line vasopressor
    3. CVasopressin is given as 40 units IV push every 4 minutes
    4. DVasopressin is no longer recommended as a routine alternative to epinephrine

    Explanation

    Keyed answerD. Vasopressin is no longer recommended as a routine alternative to epinephrine

    Your pickA. Vasopressin should be given with every other dose of epinephrine ww

    In current ACLS guidelines, vasopressin is no longer recommended as a routine alternative to epinephrine in cardiac arrest algorithms due to a lack of proven benefit over epinephrine alone.

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19. Card 19 / 60ACS & stroke

    Which of the following is a relative contraindication for thrombolytic therapy in acute ischemic stroke?

    1. AMajor surgery within the past 14 days
    2. BIntracranial neoplasm
    3. CCurrent active internal bleeding
    4. DArterial puncture at a non-compressible site within 7 days

    Explanation

    Keyed answerA. Major surgery within the past 14 days

    Your pickD. Arterial puncture at a non-compressible site within 7 days ww

    Major surgery within the past 14 days is considered a relative contraindication for thrombolytic therapy in acute ischemic stroke due to increased bleeding risk, though in some cases the benefit may outweigh the risk.

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20. Card 20 / 60Brady & tachy

    A patient presents with a sinus bradycardia at 45 bpm but is asymptomatic with a blood pressure of 110/70 mmHg. What is the most appropriate management?

    1. ADopamine infusion
    2. BTranscutaneous pacing
    3. CObservation and monitoring
    4. DImmediate atropine administration

    Explanation

    Keyed answerC. Observation and monitoring

    Your pickD. Immediate atropine administration ww

    For asymptomatic bradycardia with stable vital signs, observation and monitoring are appropriate as intervention is not necessary unless the patient develops symptoms or becomes hemodynamically unstable.

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21. Card 21 / 60CPR & airway

    What is the recommended approach for ventilation during CPR once an advanced airway is placed?

    1. A15 compressions followed by 2 breaths
    2. B1 breath every 3 seconds (20 breaths per minute) with continuous compressions
    3. C1 breath every 6 seconds (10 breaths per minute) with continuous compressions
    4. D30 compressions followed by 2 breaths

    Explanation

    Keyed answerC. 1 breath every 6 seconds (10 breaths per minute) with continuous compressions

    Your pickB. 1 breath every 3 seconds (20 breaths per minute) with continuous compressions ww

    Once an advanced airway is placed during CPR, the recommendation is to provide 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are performed without pauses for ventilation. This maximizes blood flow while maintaining adequate oxygenation.

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22. Card 22 / 60Rhythms & drugs

    What is the correct dose of adenosine for a second administration if the first 6 mg dose fails to convert supraventricular tachycardia?

    1. A12 mg IV push
    2. B18 mg IV push
    3. C6 mg IV push repeated
    4. D9 mg IV push

    Explanation

    Keyed answerA. 12 mg IV push

    Your pickC. 6 mg IV push repeated ww

    If the initial 6 mg rapid IV push of adenosine fails to convert SVT, the next appropriate dose is 12 mg given as a rapid IV push, followed by a saline flush. This higher dose may be successful in terminating the arrhythmia if the initial dose was insufficient.

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23. Card 23 / 60Cardiac arrest

    During cardiac arrest, when should the first dose of epinephrine be administered for a patient with pulseless electrical activity (PEA)?

    1. AAs soon as possible after rhythm identification
    2. BAfter a second rhythm check
    3. CAfter 2 minutes of CPR
    4. DAfter attempted defibrillation

    Explanation

    Keyed answerA. As soon as possible after rhythm identification

    Your pickD. After attempted defibrillation ww

    For a patient with pulseless electrical activity (PEA), the first dose of epinephrine should be administered as soon as possible after rhythm identification. Since defibrillation is not indicated for PEA, medication administration should take priority.

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24. Card 24 / 60Brady & tachy

    What is the appropriate treatment for polymorphic ventricular tachycardia (Torsades de Pointes) in a patient with a prolonged QT interval?

    1. AIV magnesium sulfate 1-2 g
    2. BIV amiodarone 150 mg
    3. CIV procainamide 20-50 mg/min
    4. DIV lidocaine 1-1.5 mg/kg

    Explanation

    Keyed answerA. IV magnesium sulfate 1-2 g

    Your pickC. IV procainamide 20-50 mg/min ww

    For Torsades de Pointes with prolonged QT interval, IV magnesium sulfate (1-2 g) is the first-line treatment. Magnesium stabilizes cardiac cell membranes and can terminate this specific type of polymorphic VT. Additionally, correcting any electrolyte abnormalities and removing offending QT-prolonging medications is essential.

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25. Card 25 / 60Post-arrest care

    Which simultaneous monitoring techniques should be employed during post-resuscitation care to optimize both neurological and hemodynamic outcomes?

    1. ASerial neurological exams without hemodynamic monitoring
    2. BContinuous ECG monitoring alone
    3. CContinuous capnography combined with invasive arterial blood pressure monitoring
    4. DIntermittent non-invasive blood pressure monitoring and pulse oximetry

    Explanation

    Keyed answerC. Continuous capnography combined with invasive arterial blood pressure monitoring

    Your pickD. Intermittent non-invasive blood pressure monitoring and pulse oximetry ww

    The integration of continuous capnography and invasive arterial blood pressure monitoring allows for real-time adjustments in ventilation and perfusion, ensuring both cerebral and systemic circulation are optimized.

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26. Card 26 / 60Team & systems

    Which approach to knowledge sharing during a resuscitation effort is most effective?

    1. ASharing all possible information regardless of relevance
    2. BSharing critical observations with suggested actions
    3. CKeeping observations to yourself unless directly asked
    4. DSharing information only with the team leader, not the whole team

    Explanation

    Keyed answerB. Sharing critical observations with suggested actions

    Your pickD. Sharing information only with the team leader, not the whole team ww

    Sharing critical observations with suggested actions provides both the information and its potential implications, allowing the team to incorporate the knowledge effectively into the resuscitation effort.

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27. Card 27 / 60ACS & stroke

    A 72-year-old patient presents with facial droop, slurred speech, and right arm weakness that began 2.5 hours ago. What is the most appropriate initial imaging study?

    1. ANon-contrast CT of the head
    2. BCarotid duplex ultrasound
    3. CMRI with diffusion-weighted imaging
    4. DCT angiography of the head and neck

    Explanation

    Keyed answerA. Non-contrast CT of the head

    Your pickC. MRI with diffusion-weighted imaging ww

    Non-contrast CT of the head is the initial imaging study of choice for suspected acute stroke. It can quickly rule out hemorrhagic stroke and other contraindications to thrombolytic therapy, allowing for rapid decision-making regarding IV tPA administration within the critical time window.

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28. Card 28 / 60CPR & airway

    Which of the following techniques is recommended for opening the airway in an unconscious adult with no suspected cervical spine injury?

    1. AChin lift without head tilt
    2. BHead tilt only without chin lift
    3. CHead tilt-chin lift
    4. DJaw thrust only without head tilt

    Explanation

    Keyed answerC. Head tilt-chin lift

    Your pickD. Jaw thrust only without head tilt ww

    The head tilt-chin lift maneuver is the recommended technique for opening the airway in an unconscious adult with no suspected cervical spine injury. This maneuver helps move the tongue away from the posterior pharynx, clearing the airway.

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29. Card 29 / 60Cardiac arrest

    When should the rhythm be reassessed during CPR?

    1. AApproximately every 1 minute
    2. BApproximately every 2 minutes
    3. CAfter each defibrillation attempt
    4. DApproximately every 5 minutes

    Explanation

    Keyed answerB. Approximately every 2 minutes

    Your pickC. After each defibrillation attempt ww

    During CPR, the rhythm should be reassessed approximately every 2 minutes. This typically coincides with the time to switch compressors to minimize fatigue and maintain high-quality CPR. Rhythm assessment allows for appropriate changes in the resuscitation approach.

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30. Card 30 / 60Brady & tachy

    What is the most appropriate initial intervention for a patient with a regular narrow-complex tachycardia at 160 bpm who has chest pain and hypotension?

    1. AVagal maneuvers followed by adenosine
    2. BIV metoprolol
    3. CIV diltiazem
    4. DImmediate synchronized cardioversion

    Explanation

    Keyed answerD. Immediate synchronized cardioversion

    Your pickA. Vagal maneuvers followed by adenosine ww

    A patient with narrow-complex tachycardia who is hemodynamically unstable (hypotension, chest pain) should receive immediate synchronized cardioversion rather than medications, as per ACLS guidelines. This provides rapid rhythm control to restore hemodynamic stability.

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31. Card 31 / 60Rhythms & drugs

    Which medication is the first-line vasopressor recommended in the ACLS cardiac arrest algorithm?

    1. AVasopressin
    2. BEpinephrine
    3. CDopamine
    4. DNorepinephrine

    Explanation

    Keyed answerB. Epinephrine

    Your pickD. Norepinephrine ww

    Epinephrine is the first-line vasopressor in the ACLS cardiac arrest algorithm. It's recommended for all cardiac arrest rhythms (VF, pVT, PEA, and asystole) to improve coronary and cerebral perfusion during CPR by increasing vasoconstriction.

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32. Card 32 / 60Cardiac arrest

    What is the correct dose of lidocaine for persistent VF/pulseless VT after defibrillation and epinephrine?

    1. A0.5 mg/kg IV/IO
    2. B1-1.5 mg/kg IV/IO
    3. C2-2.5 mg/kg IV/IO
    4. D5 mg/kg IV/IO

    Explanation

    Keyed answerB. 1-1.5 mg/kg IV/IO

    Your pickC. 2-2.5 mg/kg IV/IO ww

    The initial dose of lidocaine for persistent VF/pulseless VT is 1-1.5 mg/kg IV/IO. An additional dose of 0.5-0.75 mg/kg may be given after 5-10 minutes to a maximum total dose of 3 mg/kg.

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33. Card 33 / 60CPR & airway

    What is the recommended approach for chest compressions in terms of chest recoil?

    1. AMaintain slight pressure on the chest between compressions
    2. BOnly allow partial recoil to maintain compression rhythm
    3. CAllow complete chest recoil after each compression
    4. DAlternate between complete and partial recoil

    Explanation

    Keyed answerC. Allow complete chest recoil after each compression

    Your pickA. Maintain slight pressure on the chest between compressions ww

    For effective chest compressions, rescuers should allow complete chest recoil (return to normal position) after each compression. This allows the heart to refill with blood between compressions, improving CPR effectiveness.

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34. Card 34 / 60ACS & stroke

    Which of the following statements about the "time is brain" concept in stroke management is correct?

    1. ACollateral circulation prevents any permanent damage for the first 6 hours
    2. BThrombolytic therapy is equally effective regardless of when it is administered within the first 24 hours
    3. CNeural tissue death occurs only after 12 hours of ischemia
    4. DApproximately 1.9 million neurons are lost each minute during an untreated stroke

    Explanation

    Keyed answerD. Approximately 1.9 million neurons are lost each minute during an untreated stroke

    Your pickB. Thrombolytic therapy is equally effective regardless of when it is administered within the first 24 hours ww

    The "time is brain" concept emphasizes that neural tissue is rapidly lost during stroke, with approximately 1.9 million neurons lost each minute until reperfusion occurs. This underscores the critical importance of rapid recognition and treatment to minimize brain damage.

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35. Card 35 / 60Post-arrest care

    In refractory shock after ROSC, what is the recommended strategy to stabilize the patient’s hemodynamics?

    1. AUse exclusively high-dose vasopressors without fluids
    2. BRely solely on inotropic agents without addressing volume status
    3. CAdminister only fluid therapy until blood pressure normalizes
    4. DEmploy a combined strategy of fluids, vasopressors, and inotropes guided by invasive hemodynamic measurements

    Explanation

    Keyed answerD. Employ a combined strategy of fluids, vasopressors, and inotropes guided by invasive hemodynamic measurements

    Your pickB. Rely solely on inotropic agents without addressing volume status ww

    A mixed approach using volume resuscitation, vasopressors, and inotropic agents—selected based on invasive hemodynamic monitoring—optimizes perfusion and addresses both preload and contractility issues.

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36. Card 36 / 60Brady & tachy

    What is the recommended initial energy level for biphasic synchronized cardioversion of unstable monomorphic ventricular tachycardia?

    1. A200 J
    2. B50 J
    3. C360 J
    4. D100 J

    Explanation

    Keyed answerD. 100 J

    Your pickA. 200 J ww

    The recommended initial energy level for biphasic synchronized cardioversion of unstable monomorphic VT is 100 J, which provides a balance between efficacy and minimizing myocardial damage. Energy levels can be escalated if the initial shock is unsuccessful.

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37. Card 37 / 60Team & systems

    During an ACLS code, if a team member fails to repeat the team leader’s instruction, what action should the leader take to maintain effective closed‐loop communication?

    1. AIgnore the lapse if the intervention is already underway
    2. BRepeat the instruction louder without checking for acknowledgment
    3. CAssume other team members will clarify the missed communication
    4. DPrompt for repetition and reiterate the instruction clearly

    Explanation

    Keyed answerD. Prompt for repetition and reiterate the instruction clearly

    Your pickB. Repeat the instruction louder without checking for acknowledgment ww

    It is essential that instructions are confirmed; therefore, the leader should immediately prompt for repetition and reiterate the instruction in a clear manner.

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38. Card 38 / 60Cardiac arrest

    What is the preferred method for establishing vascular access when IV access cannot be established in a cardiac arrest situation?

    1. AIntraosseous (IO) access
    2. BCentral venous access
    3. CIntramuscular injection
    4. DEndotracheal administration

    Explanation

    Keyed answerA. Intraosseous (IO) access

    Your pickD. Endotracheal administration ww

    When IV access cannot be established in cardiac arrest, intraosseous (IO) access is the preferred alternative. It provides rapid access to the vascular system and allows for administration of all resuscitation medications.

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39. Card 39 / 60Rhythms & drugs

    Which of the following is the appropriate treatment for a patient with a junctional escape rhythm at 35 bpm who is asymptomatic with normal blood pressure?

    1. ATranscutaneous pacing
    2. BObservation and monitoring
    3. CIsoproterenol infusion
    4. DImmediate atropine administration

    Explanation

    Keyed answerB. Observation and monitoring

    Your pickD. Immediate atropine administration ww

    For an asymptomatic patient with a junctional escape rhythm and normal blood pressure, observation and monitoring are appropriate, as intervention is unnecessary in the absence of symptoms or hemodynamic compromise.

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40. Card 40 / 60CPR & airway

    What is the recommended concentration of oxygen to be delivered during CPR?

    1. A70-80% oxygen
    2. B100% oxygen
    3. C21% oxygen (room air)
    4. D40-60% oxygen

    Explanation

    Keyed answerB. 100% oxygen

    Your pickC. 21% oxygen (room air) ww

    During CPR, oxygen should be delivered at the highest possible concentration (100%) to maximize oxygen delivery to tissues during periods of low perfusion.

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41. Card 41 / 60Brady & tachy

    What is the primary indication for administering atropine during ACLS?

    1. AVentricular fibrillation
    2. BPulseless electrical activity
    3. CAsystole (as a first-line medication)
    4. DSymptomatic bradycardia

    Explanation

    Keyed answerD. Symptomatic bradycardia

    Your pickC. Asystole (as a first-line medication) ww

    The primary indication for administering atropine during ACLS is symptomatic bradycardia, particularly when the slow heart rate is causing hypotension, altered mental status, chest pain, or other signs of instability. Atropine blocks vagal influences on the SA and AV nodes, potentially increasing heart rate.

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42. Card 42 / 60ACS & stroke

    Which pharmacological agent is used in ACLS for its vasodilatory properties in acute heart failure?

    1. AEpinephrine
    2. BNorepinephrine
    3. CNitroglycerin
    4. DDopamine

    Explanation

    Keyed answerC. Nitroglycerin

    Your pickB. Norepinephrine ww

    Nitroglycerin is used in ACLS for its vasodilatory properties in acute heart failure. It primarily causes venodilation, reducing preload, and at higher doses causes arterial dilation, reducing afterload, which can improve cardiac output in heart failure patients.

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43. Card 43 / 60Cardiac arrest

    What is the recommended initial dose of epinephrine for cardiac arrest in an adult patient?

    1. A1 mg IV/IO every 10 minutes
    2. B1 mg IV/IO every 3-5 minutes
    3. C2 mg IV/IO every 3-5 minutes
    4. D0.5 mg IV/IO every 3-5 minutes

    Explanation

    Keyed answerB. 1 mg IV/IO every 3-5 minutes

    Your pickD. 0.5 mg IV/IO every 3-5 minutes ww

    The recommended initial dose of epinephrine for adult cardiac arrest is 1 mg IV/IO every 3-5 minutes. This dosage is indicated for all cardiac arrest rhythms according to current ACLS guidelines.

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44. Card 44 / 60Post-arrest care

    For a post-cardiac arrest patient experiencing recurrent ventricular arrhythmias, what is the most appropriate immediate intervention?

    1. ARestart the full CPR protocol
    2. BDiscontinue TTM to focus solely on arrhythmia management
    3. CSwitch immediately to high-dose beta-blockers
    4. DInitiate antiarrhythmic therapy (e.g., amiodarone) while maintaining TTM

    Explanation

    Keyed answerD. Initiate antiarrhythmic therapy (e.g., amiodarone) while maintaining TTM

    Your pickB. Discontinue TTM to focus solely on arrhythmia management ww

    Using antiarrhythmic medications such as amiodarone in conjunction with continued TTM is indicated to stabilize the rhythm while protecting the brain.

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45. Card 45 / 60CPR & airway

    What is the appropriate method to determine if a collapsed adult needs CPR?

    1. ACheck for unresponsiveness, no normal breathing, and no pulse
    2. BCheck for any movement and begin CPR if the person is completely still
    3. CCheck for a pulse only; if absent, begin CPR
    4. DCheck for unresponsiveness and no breathing only

    Explanation

    Keyed answerA. Check for unresponsiveness, no normal breathing, and no pulse

    Your pickB. Check for any movement and begin CPR if the person is completely still ww

    To determine if a collapsed adult needs CPR, check for responsiveness by tapping and shouting, look for no breathing or only gasping, and check for no pulse within 10 seconds. If the person is unresponsive, not breathing normally, and has no definite pulse, begin CPR.

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46. Card 46 / 60Team & systems

    Which approach best supports effective CPR team rotation?

    1. APlanning compressor switches during scheduled rhythm checks
    2. BAssigning one person to perform all compressions
    3. CHaving each team member perform exactly 5 minutes of compressions
    4. DSwitching compressors whenever someone feels tired

    Explanation

    Keyed answerA. Planning compressor switches during scheduled rhythm checks

    Your pickC. Having each team member perform exactly 5 minutes of compressions ww

    Planning compressor switches during scheduled rhythm checks minimizes interruptions to chest compressions while ensuring regular rotation to prevent fatigue and maintain high-quality CPR.

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47. Card 47 / 60Brady & tachy

    What is the best indicator of hemodynamic instability in a patient with tachycardia that would warrant immediate synchronized cardioversion?

    1. AHeart rate >150 bpm regardless of other symptoms
    2. BNon-specific ST changes on ECG
    3. CHypotension with systolic BP <90 mmHg
    4. DMild anxiety and palpitations

    Explanation

    Keyed answerC. Hypotension with systolic BP <90 mmHg

    Your pickA. Heart rate >150 bpm regardless of other symptoms ww

    Hypotension (systolic BP <90 mmHg) is a key indicator of hemodynamic instability in tachycardia that warrants immediate synchronized cardioversion. Other signs include altered mental status, ongoing chest pain, acute heart failure, and shock. These signs indicate the tachycardia is causing end-organ hypoperfusion requiring immediate intervention.

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48. Card 48 / 60Cardiac arrest

    When establishing IV access during a cardiac arrest, which site is generally preferred?

    1. AExternal jugular vein
    2. BAntecubital vein
    3. CDorsal hand vein
    4. DFemoral vein

    Explanation

    Keyed answerB. Antecubital vein

    Your pickA. External jugular vein ww

    Antecubital veins are generally preferred for IV access during cardiac arrest because they provide reliable access to central circulation and allow for rapid drug delivery compared to more distal sites.

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49. Card 49 / 60Rhythms & drugs

    What is the distinguishing ECG feature of accelerated idioventricular rhythm compared to ventricular tachycardia?

    1. ARate between 50-110 bpm
    2. BPresence of P waves before each QRS
    3. CQRS duration <120 ms
    4. DAbsence of AV dissociation

    Explanation

    Keyed answerA. Rate between 50-110 bpm

    Your pickB. Presence of P waves before each QRS ww

    Accelerated idioventricular rhythm (AIVR) has a rate of 50-110 bpm, whereas ventricular tachycardia is defined as a ventricular rhythm at a rate >100 bpm (typically >120 bpm). AIVR is often seen during reperfusion after myocardial infarction and typically doesn't require specific treatment.

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50. Card 50 / 60ACS & stroke

    A 60-year-old patient presents with sudden onset confusion, right-sided weakness, and aphasia. The last known well time was 2 hours ago. Vital signs are stable. What is the initial step in management?

    1. AStart IV heparin
    2. BAdminister aspirin 325 mg
    3. CObtain MRI with diffusion-weighted imaging
    4. DActivate the stroke team or protocol

    Explanation

    Keyed answerD. Activate the stroke team or protocol

    Your pickC. Obtain MRI with diffusion-weighted imaging ww

    For a patient with stroke symptoms within the treatment window, the first step is to activate the stroke team or protocol, which will expedite all subsequent evaluations, including rapid neurological assessment, laboratory tests, and imaging studies to determine eligibility for reperfusion therapy.

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51. Card 51 / 60CPR & airway

    During CPR for an adult in cardiac arrest, what is the recommended compression to ventilation ratio when no advanced airway is in place?

    1. A15:1
    2. B30:1
    3. C15:2
    4. D30:2

    Explanation

    Keyed answerD. 30:2

    Your pickA. 15:1 ww

    When no advanced airway is in place during adult CPR, the recommended compression to ventilation ratio is 30:2. This ratio balances the need for circulation with the need for oxygenation.

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52. Card 52 / 60Brady & tachy

    What is the most appropriate management for a patient with a ventricular rate of 150 bpm who has atrial flutter with 2:1 conduction on ECG and is hemodynamically stable?

    1. AAdminister digoxin IV push
    2. BAdminister IV diltiazem for rate control
    3. CImmediate synchronized cardioversion
    4. DAdminister adenosine to convert to normal sinus rhythm

    Explanation

    Keyed answerB. Administer IV diltiazem for rate control

    Your pickD. Administer adenosine to convert to normal sinus rhythm ww

    For hemodynamically stable atrial flutter with rapid ventricular response, rate control with an AV nodal blocking agent like diltiazem is appropriate initial management. This slows the ventricular rate by increasing the degree of AV block while the underlying flutter continues, improving symptoms and hemodynamics.

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53. Card 53 / 60Cardiac arrest

    Which of the following is the most likely cause of PEA in a trauma patient?

    1. AAcidosis
    2. BHyperkalemia
    3. CHypovolemia
    4. DToxins

    Explanation

    Keyed answerC. Hypovolemia

    Your pickB. Hyperkalemia ww

    In a trauma patient, hypovolemia from blood loss is the most likely cause of pulseless electrical activity (PEA). Other potential causes in trauma include tension pneumothorax, cardiac tamponade, and hypothermia.

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54. Card 54 / 60Post-arrest care

    Which laboratory marker, when trended in the post-resuscitation period, is most useful for assessing the adequacy of tissue perfusion?

    1. ALactate clearance
    2. BWhite blood cell count
    3. CSerum sodium concentration
    4. DPlatelet count

    Explanation

    Keyed answerA. Lactate clearance

    Your pickC. Serum sodium concentration ww

    Lactate clearance reflects how well tissues are being perfused and can indicate the effectiveness of post-cardiac arrest management.

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55. Card 55 / 60Team & systems

    If a junior team member points out a potential error during resuscitation, what response best upholds mutual respect and effective team dynamics?

    1. ADismiss the concern to avoid interrupting procedures
    2. BPrivately disregard the comment without explanation
    3. CAcknowledge the concern openly and invite a brief discussion
    4. DAsk the junior member to report their observation after the code

    Explanation

    Keyed answerC. Acknowledge the concern openly and invite a brief discussion

    Your pickD. Ask the junior member to report their observation after the code ww

    A respectful approach involves openly acknowledging the concern and briefly discussing it while ensuring patient care continues uninterrupted.

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56. Card 56 / 60Rhythms & drugs

    While analyzing an EKG of a patient, you notice a spike immediately preceding the QRS complex. What is the most likely cause of this finding?

    1. AVentricular fibrillation
    2. BVentricular pacing
    3. CWandering atrial pacemaker
    4. DAtrial fibrillation

    Explanation

    Keyed answerB. Ventricular pacing

    Your pickC. Wandering atrial pacemaker ww

    A vertical spike preceding the QRS complex indicates the presence of a ventricular pacemaker. The goal of a pacemaker is to ensure the heart maintains an appropriate rate and rhythm. Atrial fibrillation, ventricular fibrillation, and wandering atrial pacemaker are arrhythmias that do not typically present this way on an EKG.

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57. Card 57 / 60ACS & stroke

    What concern does an excessively rapid ventricular rate in atrial fibrillation create in stroke patients regarding cerebral perfusion?

    1. AIt improves overall cardiac output with no perfusion compromise
    2. BIt increases diastolic blood pressure, protecting the brain
    3. CIt reduces diastolic time, compromising cerebral perfusion
    4. DIt only affects renal perfusion, not cerebral

    Explanation

    Keyed answerC. It reduces diastolic time, compromising cerebral perfusion

    Your pickA. It improves overall cardiac output with no perfusion compromise ww

    A very fast ventricular rate shortens diastolic filling, so stroke volume and cardiac output fall and cerebral perfusion falls with them. Coronary perfusion, which happens mainly in diastole, drops too, which can worsen ischemia.

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58. Card 58 / 60CPR & airway

    What is the appropriate action if a rescuer notices the victim has dentures during CPR?

    1. ARemove dentures only before delivering rescue breaths
    2. BPush dentures firmly into place regardless of fit
    3. CAlways remove all dentures before beginning CPR
    4. DLeave well-fitted dentures in place

    Explanation

    Keyed answerD. Leave well-fitted dentures in place

    Your pickA. Remove dentures only before delivering rescue breaths ww

    If a victim has dentures that appear well-fitted, they should be left in place during CPR, as they help maintain facial structure and create a better seal for rescue breaths. Only remove them if they become loose or interfere with airway management.

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59. Card 59 / 60Brady & tachy

    What is the correct initial dose of adenosine for a patient with stable supraventricular tachycardia?

    1. A150 mg IV over 10 minutes
    2. B12 mg IV push
    3. C6 mg IV push
    4. D3 mg IV push

    Explanation

    Keyed answerC. 6 mg IV push

    Your pickA. 150 mg IV over 10 minutes ww

    The initial dose of adenosine for stable SVT is 6 mg administered as a rapid IV push, followed by a saline flush. If unsuccessful, a second dose of 12 mg can be given.

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60. Card 60 / 60Cardiac arrest

    What is the primary treatment for pulseless ventricular tachycardia?

    1. AImmediate administration of atropine
    2. BImmediate defibrillation
    3. CImmediate administration of amiodarone
    4. DImmediate administration of epinephrine

    Explanation

    Keyed answerB. Immediate defibrillation

    Your pickD. Immediate administration of epinephrine ww

    The primary treatment for pulseless ventricular tachycardia is immediate defibrillation. A defibrillatory shock is the most effective way to terminate this lethal arrhythmia and restore organized electrical activity.

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61. Score card

    0%

    Answer a few cards and come back to this one.

    • Cardiac arrestnot yet
    • Brady & tachynot yet
    • CPR & airwaynot yet
    • ACS & strokenot yet
    • Rhythms & drugsnot yet
    • Post-arrest carenot yet
    • Team & systemsnot yet

    Reread a low topic: Algorithms · Megacode · Pretest

    The thin line on each bar marks 84%, the written-exam pass mark AHA Training Centers usually quote; your instructor confirms the exact rule.

    Shuffle back to card 1

Pick an answer and the card turns over to the explanation. Keys: A to D or 1 to 4, arrows to move, F to turn the card. The clock is off until you press it.