📚 ACLS Certification Exam
Correct Answers & Explanations - 26 Questions
✅ Question 1/26
A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?
Correct Answer: D 1 mg
💡 Explanation: The initial dose of atropine for symptomatic bradycardia is 1 mg IV push, repeated every 3-5 minutes to a maximum of 3 mg.
✅ Question 2/26
A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. The patient is intubated. Which best describes the recommended second dose of amiodarone for this patient?
Correct Answer: C 150 mg IV push
💡 Explanation: The second dose of amiodarone for refractory VF/pulseless VT is 150 mg IV push.
✅ Question 3/26
A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?
Correct Answer: D 1 mg
💡 Explanation: Initial atropine dose for symptomatic bradycardia is 1 mg IV.
✅ Question 4/26
A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective. Which drug should be administered?
Correct Answer: D Adenosine 6 mg
💡 Explanation: For stable narrow-complex SVT, initial treatment is adenosine 6 mg rapid IV push.
✅ Question 5/26
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?
Correct Answer: D Amiodarone 300 mg
💡 Explanation: For refractory pulseless VT/VF, give amiodarone 300 mg IV/IO after epinephrine.
✅ Question 6/26
A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. Which medication do you order next?
Correct Answer: C Epinephrine 1 mg
💡 Explanation: Continue epinephrine 1 mg every 3-5 minutes during cardiac arrest.
✅ Question 7/26
A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, BP 88/56. Which therapy is now indicated?
Correct Answer: B Epinephrine 2 to 10 mcg/min
💡 Explanation: After atropine failure, start epinephrine infusion 2-10 mcg/min for symptomatic bradycardia.
✅ Question 8/26
A 35-year-old woman has palpitations, light-headedness, and stable tachycardia. Monitor shows regular narrow-complex QRS at 180/min. Vagal maneuvers ineffective. Which drug should be administered?
Correct Answer: D Adenosine 6 mg
💡 Explanation: Adenosine 6 mg rapid IV push is first-line for stable SVT.
✅ Question 9/26
A monitored patient developed sudden onset narrow complex tachycardia at 220/min. BP 128/58, PETCO2 38, O2 sat 98%. 12-lead confirms SVT. No response to vagal maneuvers. Next action?
Correct Answer: C Administer adenosine 6 mg IV push
💡 Explanation: Stable SVT unresponsive to vagal maneuvers receives adenosine 6 mg IV push.
✅ Question 10/26
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?
Correct Answer: C Amiodarone 300 mg
💡 Explanation: Amiodarone 300 mg is the antiarrhythmic of choice for refractory VT/VF.
✅ Question 11/26
A 66-year-old man with history of intracerebral hemorrhage 2 months ago. CT negative for hemorrhage. BP 180/100. Which drug do you anticipate giving?
Correct Answer: C Aspirin
💡 Explanation: For acute ischemic stroke, aspirin 325 mg is given within 24-48 hours. rtPA is contraindicated due to recent ICH.
✅ Question 12/26
What is the indication for the use of Magnesium in cardiac arrest?
Correct Answer: A Pulseless ventricular tachycardia associated torsades de pointes
💡 Explanation: Magnesium is specifically indicated for torsades de pointes (polymorphic VT with prolonged QT).
✅ Question 13/26
A patient is in cardiac arrest. VF has been refractory to a second shock. Which drug should be administered first?
Correct Answer: C Epinephrine 1 mg IV/IO
💡 Explanation: Epinephrine 1 mg is given after the second shock in VF/pulseless VT.
✅ Question 14/26
In which situation does bradycardia require treatment?
Correct Answer: C Hypotension
💡 Explanation: Bradycardia requires treatment when it causes symptoms: hypotension, altered mental status, chest pain, or heart failure.
✅ Question 15/26
A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?
Correct Answer: C Use of a phosphodiesterase inhibitor within the previous 24 hours
💡 Explanation: Nitrates are contraindicated with PDE inhibitors (sildenafil, tadalafil, vardenafil) within 24-48 hours due to severe hypotension risk.
✅ Question 16/26
A patient is in cardiac arrest. VF has been refractory to initial shock. If no pathway for medication administration is in place, which method is preferred?
Correct Answer: C IV or IO
💡 Explanation: IV access is preferred, but IO access is an acceptable alternative if IV cannot be established.
✅ Question 17/26
A patient is in cardiac arrest. VF has been refractory to a second shock. Which drug should be administered first?
Correct Answer: C Epinephrine 1 mg IV/IO
💡 Explanation: Epinephrine 1 mg is given after the second shock in cardiac arrest.
✅ Question 18/26
Which intervention is most appropriate for the treatment of a patient in asystole?
Correct Answer: C Epinephrine
💡 Explanation: Epinephrine 1 mg every 3-5 minutes is the primary drug treatment for asystole.
✅ Question 19/26
Patient in cardiac arrest, high-quality CPR, intubated, IV started. Rhythm is asystole. What is the first drug dose to administer?
Correct Answer: C Epinephrine 1 mg IV/IO
💡 Explanation: Epinephrine 1 mg is the first-line drug for asystole.
✅ Question 20/26
You arrive on scene with code team. High-quality CPR in progress. AED advised "no shock indicated." Rhythm check finds asystole. After resuming compressions, which action next?
Correct Answer: C Establish IV or IO access
💡 Explanation: Establish vascular access for medication administration in asystole.
✅ Question 21/26
Patient with STEMI has ongoing chest discomfort. Heparin given. Patient didn't take aspirin due to gastritis history (treated 5 years ago). Next action?
Correct Answer: C Give aspirin 162 to 325 mg to chew
💡 Explanation: Aspirin is indicated for all STEMI patients unless true allergy. Remote history of gastritis is not a contraindication.
✅ Question 22/26
62-year-old man with sudden difficulty speaking and left-sided weakness. Meets criteria for fibrinolytic therapy. Guidelines for antiplatelet and fibrinolytic therapy?
Correct Answer: C Hold aspirin for at least 24 hours if rtPA is administered
💡 Explanation: Aspirin is held for 24 hours after rtPA administration to reduce bleeding risk.
✅ Question 23/26
Patient with possible STEMI has ongoing chest discomfort. Contraindication to nitrate administration?
Correct Answer: C Use of a phosphodiesterase inhibitor within the previous 24 hours
💡 Explanation: PDE inhibitors (Viagra, Cialis, Levitra) cause severe hypotension when combined with nitrates.
✅ Question 24/26
Patient has rapid irregular wide-complex tachycardia at 138/min. Asymptomatic, BP 110/70. History of angina. Next action?
Correct Answer: C Seeking expert consultation
💡 Explanation: Wide-complex tachycardia of uncertain type in stable patient warrants expert consultation.
✅ Question 25/26
Indication for the use of magnesium in cardiac arrest?
Correct Answer: C Pulseless ventricular tachycardia-associated torsades de pointes
💡 Explanation: Magnesium is indicated specifically for torsades de pointes (1-2 g IV/IO).
✅ Question 26/26
57-year-old woman with palpitations, chest discomfort, tachycardia. Regular wide-complex QRS at 180/min. Diaphoretic, BP 80/60. Next action?
Correct Answer: C Perform electrical cardioversion
💡 Explanation: Unstable tachycardia with hypotension requires immediate synchronized cardioversion.
📊 Answer Key Summary
Quick Reference:
Atropine: 1 mg | Amiodarone: 300 mg then 150 mg | Epinephrine: 1 mg | Adenosine: 6 mg | Magnesium: Torsades de pointes
✅ Pass Score: 70% (18/26 correct) | 🎯 ACLS Certified