Safety Training Seminars
Safety Training Seminars
The ACLS written test can feel overwhelming. But here’s the truth: most questions follow predictable patterns. Master these 50 essential questions and answers, and you’ll walk into your exam with confidence.
Advanced Cardiovascular Life Support (ACLS) certification requires both practical skills and theoretical knowledge. The written portion tests your understanding of cardiac rhythms, pharmacology, and emergency protocols. Healthcare professionals from nurses to physicians rely on this certification to handle cardiac emergencies effectively.
This guide covers the most common ACLS test questions across all major categories. You’ll find detailed explanations that help you understand not just the correct answer, but why it’s correct. Whether you’re taking your first ACLS exam or renewing your certification, these questions mirror what you’ll encounter on test day.
Understanding cardiac rhythms forms the foundation of ACLS knowledge. These questions test your ability to identify life-threatening arrhythmias and choose appropriate interventions.
Question 1: What is the most common initial rhythm in sudden cardiac arrest?
Answer: Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). These shockable rhythms require immediate defibrillation. Studies show that early defibrillation within 3-5 minutes can improve survival rates significantly.
Question 2: How do you differentiate between ventricular tachycardia and supraventricular tachycardia with aberrancy?
Answer: VT typically shows:
Question 3: What defines bradycardia in ACLS protocols?
Answer: Heart rate less than 60 beats per minute with signs of poor perfusion. However, treatment depends on symptoms, not just the number. Athletic individuals may have resting heart rates in the 40s without adverse effects.
Question 4: Which rhythm requires synchronized cardioversion?
Answer: Unstable supraventricular tachycardia, atrial fibrillation with rapid ventricular response, atrial flutter, and stable monomorphic ventricular tachycardia. The key word is “synchronized” – the shock delivers during the QRS complex to avoid the vulnerable period.
Question 5: What characterizes torsades de pointes?
Answer: Polymorphic ventricular tachycardia with a “twisting” QRS axis around the baseline. It’s associated with prolonged QT interval and responds to magnesium sulfate, not conventional antiarrhythmics.
ACLS algorithms provide systematic approaches to cardiac emergencies. These questions test your knowledge of proper sequence and timing.
Question 6: What is the compression-to-ventilation ratio for adult CPR with an advanced airway?
Answer: Continuous chest compressions at 100-120 per minute with ventilations every 6 seconds (10 breaths per minute). No pauses for ventilations once an advanced airway is placed.
Question 7: How often should you switch chest compressors during CPR?
Answer: Every 2 minutes to prevent fatigue and maintain compression quality. Switching should take less than 5 seconds to minimize interruptions.
Question 8: When do you check for a pulse during cardiac arrest?
Answer: Only during rhythm checks every 2 minutes. Pulse checks should take no more than 10 seconds. If you’re unsure whether a pulse is present, start chest compressions.
Question 9: What is the primary survey sequence in ACLS?
Answer: Circulation, Airway, Breathing, Disability, Exposure (C-A-B-D-E). This differs from basic life support, which uses A-B-C for non-cardiac arrest situations.
Question 10: How do you treat pulseless electrical activity (PEA)?
Answer: High-quality CPR while searching for reversible causes (H’s and T’s). PEA is not a shockable rhythm. Focus on identifying and treating underlying causes like hypovolemia, hypoxia, or tension pneumothorax.
ACLS medications require precise dosing and timing. These questions cover the most commonly used emergency drugs.
Question 11: What is the correct dose of epinephrine in cardiac arrest?
Answer: 1 mg IV/IO every 3-5 minutes. This equals 10 mL of 1:10,000 concentration. Continue until return of spontaneous circulation (ROSC) or termination of resuscitation efforts.
Question 12: When is amiodarone indicated in cardiac arrest?
Answer: For shock-refractory VF/pulseless VT after the third shock. The dose is 300 mg IV/IO push, followed by 150 mg if VF/VT persists. Amiodarone can improve short-term survival to hospital admission.
Question 13: What is the vasopressin dose in ACLS?
Answer: Vasopressin is no longer recommended as a first-line treatment in the 2020 AHA guidelines. Epinephrine remains the preferred vasopressor for cardiac arrest.
Question 14: How do you calculate the adenosine dose for SVT?
Answer: First dose: 6 mg rapid IV push followed by 20 mL saline flush. If unsuccessful after 1-2 minutes, give 12 mg. Adenosine has a very short half-life (less than 10 seconds), so rapid administration is crucial.
Question 15: What is the atropine dose for symptomatic bradycardia?
Answer: 1 mg IV every 3-5 minutes, maximum total dose of 3 mg. Atropine blocks vagal stimulation but won’t work for infranodal blocks or when the problem is below the AV node.
Modern ACLS emphasizes care after ROSC. These questions cover temperature management, monitoring, and preventing rearrest.
Question 16: What is the target temperature for targeted temperature management?
Answer: 32-36°C (89.6-96.8°F) for at least 24 hours in comatose patients after cardiac arrest. Both hypothermia and normothermia are acceptable, but fever must be avoided.
Question 17: What blood pressure target is recommended post-ROSC?
Answer: Systolic blood pressure ≥90 mmHg or mean arterial pressure ≥65 mmHg. Avoid hypotension, which worsens neurological outcomes. Use vasopressors if fluid resuscitation isn’t sufficient.
Question 18: How long should you monitor for rearrest after ROSC?
Answer: Continuous monitoring for at least 12-24 hours. Most rearrests occur within the first few hours. Maintain optimal oxygenation, ventilation, and hemodynamics.
Question 19: What SpO2 target is appropriate after ROSC?
Answer: 94-99%. Avoid both hypoxemia and hyperoxemia, which can worsen neurological injury. Titrate oxygen to maintain appropriate saturation levels.
Question 20: When should you perform coronary angiography post-ROSC?
Answer: Emergent angiography for patients with STEMI or high suspicion of coronary occlusion. Consider angiography within 24 hours for other patients without obvious non-cardiac cause.
Certain situations require modifications to standard ACLS protocols. These questions test your adaptability.
Question 21: How does pregnancy change ACLS protocols?
Answer: Perform manual left uterine displacement or position the patient in left lateral tilt to relieve aortic compression. Consider perimortem cesarean delivery if no ROSC after 4 minutes of resuscitation.
Question 22: What modifications are needed for drowning victims?
Answer: Begin with rescue breathing before chest compressions (A-B-C sequence). Drowning victims often have primary respiratory arrest rather than cardiac arrest. Remove from water safely before starting resuscitation.
Question 23: How do you manage cardiac arrest from tricyclic antidepressant overdose?
Answer: Sodium bicarbonate 1-2 mEq/kg IV bolus for wide QRS complexes. The goal is to alkalinize blood and reverse sodium channel blockade. Standard ACLS drugs may be less effective.
Question 24: What’s different about pediatric ACLS dosing?
Answer: Epinephrine: 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO. Amiodarone: 5 mg/kg IV/IO bolus. Most pediatric arrests are due to respiratory causes, so focus on airway and breathing first.
Question 25: How do you handle hypothermic cardiac arrest?
Answer: Continue resuscitation until core temperature reaches 32-35°C. Hypothermic patients may appear dead but can survive with good neurological outcomes. Limit defibrillation attempts until rewarming begins.
Effective ACLS requires strong team coordination. These questions focus on leadership and communication skills.
Question 26: Who should lead an ACLS team?
Answer: The most qualified person present, typically someone with ACLS certification and experience managing cardiac arrests. Leadership can change as more qualified personnel arrive.
Question 27: How should team members communicate during resuscitation?
Answer: Use closed-loop communication: give clear orders, receive verbal confirmation, and verify completion. Example: “Give 1 mg epinephrine IV” – “1 mg epinephrine IV” – “Epinephrine given.”
Question 28: What is the role of the recorder during ACLS?
Answer: Document timing of interventions, medications given, rhythm changes, and ROSC attempts. The recorder also serves as a resource for medication dosing and timing of next interventions.
Question 29: How often should the team leader reassess the plan?
Answer: Every 2 minutes during rhythm/pulse checks. This is the time to consider differential diagnoses, evaluate intervention effectiveness, and modify the treatment plan.
Question 30: What defines effective team dynamics?
Answer: Clear role assignments, closed-loop communication, mutual respect, knowledge sharing, and constructive intervention when errors occur. Everyone should know their role and focus on it.
Proper airway management is crucial in ACLS. These questions cover both basic and advanced airway techniques.
Question 31: What’s the first-line airway management in cardiac arrest?
Answer: Bag-mask ventilation with oropharyngeal or nasopharyngeal airway. Advanced airways should only be placed by experienced providers without interrupting chest compressions.
Question 32: How do you confirm endotracheal tube placement?
Answer: Primary: End-tidal CO2 detection showing persistent waveform. Secondary: Bilateral breath sounds, chest rise, and absence of epigastric sounds. Chest X-ray confirms position but isn’t immediate.
Question 33: What’s the recommended tidal volume during CPR?
Answer: 6-7 mL/kg (approximately 500-600 mL for average adult) over 1 second. Avoid excessive ventilation, which increases intrathoracic pressure and decreases venous return.
Question 34: When should you consider a supraglottic airway?
Answer: When bag-mask ventilation is inadequate and endotracheal intubation isn’t immediately available or takes too long. Supraglottic airways are easier to insert and don’t require direct laryngoscopy.
Question 35: What indicates unsuccessful bag-mask ventilation?
Answer: No chest rise, no exhaled CO2, difficulty squeezing the bag, or persistent hypoxemia. Consider airway obstruction, poor mask seal, or need for advanced airway management.
Modern ACLS emphasizes measuring and improving resuscitation quality. These questions cover key performance indicators.
Question 36: What defines high-quality chest compressions?
Answer: Rate 100-120/minute, depth 2-2.4 inches (5-6 cm), complete recoil between compressions, minimal interruptions (<10 seconds), and compression fraction >80%.
Question 37: How do you measure compression fraction?
Answer: Total time compressions are performed divided by total resuscitation time. Target is >80%. Use defibrillator feedback or metronome to maintain quality and track performance.
Question 38: What is the maximum interruption time for pulse checks?
Answer: 10 seconds maximum. Longer interruptions decrease survival chances. If no pulse is felt within 10 seconds, resume chest compressions immediately.
Question 39: How often should you provide feedback during resuscitation?
Answer: Real-time feedback for compression depth, rate, and recoil should be continuous when available. Audio/visual prompts help maintain quality throughout the resuscitation attempt.
Question 40: What metrics should you track post-resuscitation?
Answer: Time to first compression, time to first shock, compression fraction, number of interruptions, medication timing, and time to ROSC. These metrics help identify improvement opportunities.
ACLS providers must navigate complex ethical decisions. These questions address when to start, continue, or stop resuscitation efforts.
Question 41: What are valid reasons to withhold CPR?
Answer: Valid DNR order, obvious signs of death (rigor mortis, dependent lividity, decomposition), or unsafe scene conditions. Terminal illness alone isn’t sufficient reason without proper documentation.
Question 42: How long should you continue resuscitation efforts?
Answer: No universal time limit exists. Consider reversible causes, patient factors, response to treatment, and family wishes. Some experts suggest 20 minutes for witnessed arrests without ROSC.
Question 43: What constitutes futile resuscitation?
Answer: No ROSC after adequate resuscitation, no reversible causes identified, prolonged downtime without CPR, or severe comorbidities with poor prognosis. Medical teams should discuss termination collectively.
Question 44: How do you handle family presence during resuscitation?
Answer: Allow family presence when possible with dedicated staff member support. Family presence can provide comfort and help with medical decisions. Prepare them for what they’ll see.
Question 45: What’s the role of advance directives in ACLS?
Answer: Honor valid advance directives and DNR orders. When documents are unclear or unavailable, err on the side of providing care while clarifying patient wishes with family or healthcare proxy.
ACLS care often involves multiple healthcare settings. These questions cover transitions and communication between providers.
Question 46: What information should you relay during hospital transfer?
Answer: Initial rhythm, downtime, interventions performed, medications given, patient response, and current clinical status. Use SBAR format: Situation, Background, Assessment, Recommendation.
Question 47: How do you prepare for incoming cardiac arrest patients?
Answer: Ensure defibrillator charged and ready, prepare emergency medications, assign team roles, and brief team on incoming patient information. Have backup equipment available.
Question 48: What’s the role of medical control during ACLS?
Answer: Provide guidance for complex cases, authorize deviation from protocols when indicated, and support decision-making for termination of efforts. Maintain open communication throughout.
Question 49: How do you transition care from EMS to hospital?
Answer: Provide uninterrupted chest compressions during transfer, communicate via SBAR format, transfer monitoring equipment, and continue current medications. Avoid simultaneous interventions during handoff.
Question 50: What quality metrics should EMS and hospitals share?
Answer: Response times, time to first compression, time to first shock, ROSC rates, survival to discharge, and neurological outcomes. Shared metrics help identify system-wide improvement opportunities.
Passing the ACLS written test requires more than memorizing answers. You need to understand the reasoning behind each protocol and how to apply knowledge under pressure.
The questions above represent the core concepts you’ll encounter, but every test varies slightly. Focus on understanding algorithms, drug mechanisms, and decision-making processes rather than rote memorization.
We at Safety Training Seminars understand the challenges healthcare professionals face when preparing for ACLS certification. Our comprehensive training program combines the convenience of online coursework with hands-on skills testing at over 70 California locations. As an authorized American Heart Association Training Center, we’ve helped thousands of medical professionals earn their ACLS certification with confidence.
Our approach is simple yet effective: complete the American Heart Association online course at your own pace, then demonstrate your skills during a focused 30-minute session at one of our local offices. You’ll receive your official AHA certification card the same day, backed by our commitment to excellent customer service and the lowest prices in California.
Whether you’re a nurse, physician, paramedic, or other healthcare professional, our experienced instructors provide the support you need to master both the written concepts and practical skills. We also offer PALS, BLS, and other essential certifications to keep your credentials current.
Ready to take the next step in your ACLS preparation? Contact Safety Training Seminars today to schedule your skills testing session and join the thousands of healthcare professionals who trust us for their certification needs. Your patients deserve providers who are prepared for any emergency – and we’re here to help you deliver that level of care.