ACLS Practice Test – Comprehensive Questions & Answers

Sample Questions and Answers

Question 1.
A 62-year-old patient suddenly collapses in the hospital. He is unresponsive and has abnormal, gasping respirations. A pulse check does not detect a definite pulse. The monitor shows ventricular fibrillation. The defibrillator is immediately available. What should the resuscitation team prioritize?

A. Administer atropine before attempting defibrillation
B. Deliver an unsynchronized shock and immediately resume CPR
C. Perform synchronized cardioversion followed by a pulse check
D. Give amiodarone before starting chest compressions

Correct Answer. B

Explanation:
Ventricular fibrillation is a shockable cardiac arrest rhythm. When VF is identified, defibrillation should be performed as soon as possible, followed immediately by resumption of high-quality CPR. A synchronized shock is used for selected tachyarrhythmias with a pulse, not ventricular fibrillation during cardiac arrest. Atropine is associated with management of symptomatic bradycardia rather than VF. Although antiarrhythmic medications may be considered later in the resuscitation algorithm when VF or pulseless ventricular tachycardia persists, medication should not delay the initial shock and CPR. Rapid recognition, effective chest compressions, early defibrillation, and appropriate reassessment are central components of managing shockable cardiac arrest.

Question 2.
A patient with a pulse develops a regular narrow-complex tachycardia at 190/min. Blood pressure is 124/78 mm Hg, the patient is alert, and there is no chest pain, respiratory distress, or evidence of shock. Vagal maneuvers have not terminated the rhythm. What intervention is most appropriate next?

A. Immediate unsynchronized defibrillation
B. Intravenous adenosine
C. Intravenous atropine
D. Immediate transcutaneous pacing

Correct Answer. B

Explanation:
A regular narrow-complex tachycardia in a stable patient that has not responded to vagal maneuvers may be treated with adenosine when appropriate. Adenosine can interrupt certain reentrant supraventricular tachycardias and may also help clarify the underlying rhythm. Immediate unsynchronized defibrillation is reserved for cardiac arrest rhythms and is not the routine treatment for a stable patient with a pulse. Atropine is primarily used in symptomatic bradycardia rather than tachycardia. Transcutaneous pacing is generally considered when clinically significant bradycardia requires pacing. Before treatment, the clinician should continue assessing the patient’s stability and follow the applicable ACLS algorithm and medication administration requirements.

Question 3.
A 70-year-old patient has a heart rate of 38/min. He is confused, pale, and diaphoretic, with a blood pressure of 78/46 mm Hg. The ECG shows marked sinus bradycardia. Which finding most strongly indicates that the bradycardia requires urgent intervention?

A. The patient is 70 years old
B. The heart rate is below 40/min
C. The patient has signs of poor perfusion and hypotension
D. The ECG shows a sinus rhythm

Correct Answer. C

Explanation:
The key concern is not simply the numerical heart rate but whether the slow rate is causing clinically significant compromise. Hypotension, confusion, pallor, and diaphoresis indicate inadequate perfusion and make the bradycardia clinically significant. ACLS assessment therefore focuses on the patient’s symptoms and signs of cardiopulmonary compromise rather than treating a heart-rate number in isolation. Age alone does not determine whether intervention is required. A heart rate below 40/min can occur in some individuals without immediate instability, and sinus rhythm does not exclude clinically important bradycardia. In an unstable patient, the appropriate ACLS bradycardia pathway should be followed promptly, including preparation for pharmacologic treatment and pacing when indicated.

Question 4.
A patient arrives in the emergency department with pressure-like chest discomfort that began 45 minutes earlier. The discomfort radiates to the jaw, and the patient is diaphoretic. Which action is most important for rapidly evaluating a possible acute coronary syndrome?

A. Obtain a 12-lead ECG as soon as possible
B. Wait for cardiac biomarkers before performing an ECG
C. Perform a routine exercise stress test immediately
D. Administer a sedative before obtaining diagnostic information

Correct Answer. A

Explanation:
A 12-lead ECG is an important early assessment in a patient with symptoms suggestive of acute coronary syndrome because it can identify ischemic changes and help determine the appropriate treatment pathway. Waiting for laboratory results before obtaining the ECG can unnecessarily delay recognition of a time-sensitive cardiac emergency. An exercise stress test is not an appropriate immediate evaluation for a patient with active concerning chest symptoms. Sedation does not address the need for rapid cardiac assessment. ACLS preparation includes recognizing potentially serious cardiovascular presentations, obtaining appropriate diagnostic information promptly, and coordinating timely treatment according to the patient’s findings and current clinical protocols.

Question 5.
A patient achieves return of spontaneous circulation after cardiac arrest. The patient remains unresponsive and is receiving mechanical ventilation. The resuscitation team confirms a pulse and adequate blood pressure. What is the most appropriate next approach?

A. Stop monitoring because circulation has returned
B. Begin structured post-cardiac arrest care and continue monitoring for recurrent instability
C. Immediately remove all airway support to determine whether spontaneous breathing returns
D. Give repeated defibrillation shocks despite the presence of a pulse

Correct Answer. B

Explanation:
Return of spontaneous circulation marks the transition to post-cardiac arrest care; it does not mean that resuscitation is finished. The team should continue structured assessment and management of airway, breathing, circulation, neurologic status, temperature-related considerations, glucose, and the underlying cause of the arrest while monitoring for recurrent instability. Removing airway support solely to test spontaneous breathing can be inappropriate in an unresponsive patient who still requires ventilatory support. Defibrillation is not performed simply because the patient recently experienced cardiac arrest; treatment depends on the current rhythm and clinical condition. Effective post-arrest care is intended to stabilize the patient, identify the cause of arrest, and reduce the risk of further deterioration.