ACLS Test Questions 2026: Pass Faster With 2025 AHA Updates
The ACLS test questions you will see mostly check three skills: reading the rhythm, choosing the correct algorithm, and giving the right drug at the right moment. If a rhythm strip makes your stomach drop, you are not alone. This guide, aligned with the 2025 AHA guidelines, walks you through practice questions, rationales, and megacode logic.
Healthcare providers, from nurses to paramedics, lose confidence in ventricular fibrillation, PEA, and pharmacology details, so we focus on shockable rhythms, epinephrine timing, and post-cardiac arrest care. Use these practice questions as study support, not as leaked exam content, and confirm answers against your provider manual.
ACLS Test Questions – Why ACLS Candidates Fail: They Know the Algorithms but Not the Rhythms
Many candidates memorize the cardiac arrest algorithm perfectly, then freeze when a rhythm strip appears on the screen. That moment is stressful and very common. Misreading ventricular fibrillation as asystole can send the whole answer in the wrong direction, so rhythm recognition has to come first.
Think of the strip as the question behind the question. Decide whether the patient has a pulse, then decide whether the rhythm is shockable. Practice with real-looking ECG strips, not only text, because the written exam rewards fast pattern recognition and calm clinical judgment.
ACLS Test Questions – Cardiac Rhythms and ECG Interpretation
Rhythm questions usually ask you to name the strip and choose the next action. Know sinus bradycardia, narrow-complex tachycardia, ventricular tachycardia, ventricular fibrillation, PEA, and asystole cold. Pair each rhythm with one decision: shock, cardiovert, give a drug, or treat the cause.
Remember that the 2025 guidelines now say narrow-complex tachycardia instead of SVT in the algorithm, and they list initial synchronized cardioversion doses of 100 J for narrow-complex tachycardia and monomorphic VT, and 200 J for atrial fibrillation and flutter. Polymorphic VT gets an unsynchronized defibrillation dose.
How to Identify Each Rhythm
Look for organization before rate. VF is chaotic with no recognizable complexes, pulseless VT is wide, fast, and regular, PEA can look organized yet has no pulse, and asystole is flat. Always confirm a flat line in a second lead before calling it.
| Rhythm | Strip clue | Shockable? |
| Ventricular fibrillation | Chaotic, no distinct P, QRS or T | Yes |
| Pulseless VT | Wide, fast, regular; no pulse | Yes |
| PEA | Organized rhythm, no pulse | No |
| Asystole | Flat line; confirm in a second lead | No |
ACLS Test Questions – The Rhythm Recognition Framework: Shockable vs Non-Shockable
Every pulseless rhythm falls into one of two groups. Ventricular fibrillation and pulseless ventricular tachycardia are shockable, so defibrillation is the priority and CPR bridges to the next shock. PEA and asystole are non-shockable, which means high-quality CPR, epinephrine, and a search for reversible causes.
Here is where candidates trip: fine VF can look almost flat. When you are unsure between fine VF and asystole, check another lead and electrode placement before withholding a shock. A common exam theme is that an organized rhythm without a pulse is PEA, not a reason to shock.
| Practice question | Answer | Why |
| Pulseless patient, chaotic waveform, no complexes. Next action? | Defibrillate | This is VF, a shockable rhythm |
| A shock was just delivered. What now? | Resume compressions at once; recheck rhythm after 2 minutes | Do not stop for a pulse check |
ACLS Test Questions – ACLS Algorithms and Treatment Protocols
Algorithm questions test sequence and timing. In cardiac arrest, deliver high-quality CPR at 100 to 120 compressions per minute, rotate compressors about every two minutes, and keep pauses short. Check rhythm every two minutes, and resume compressions immediately after each shock without stopping to feel for a pulse.
For rhythms with a pulse, match the algorithm to stability. Symptomatic bradycardia gets atropine, then pacing or an infusion. Stable narrow-complex tachycardia may get adenosine, while unstable tachycardia needs synchronized cardioversion without delay. Wide-complex questions reward caution, because adenosine can worsen a ventricular rhythm.
| Situation | First moves |
| VF or pVT | Shock, 2 minutes of CPR, recheck; epinephrine if initial shocks fail; amiodarone or lidocaine if refractory |
| PEA or asystole | CPR, epinephrine as soon as feasible, treat Hs and Ts |
| Symptomatic bradycardia | Atropine 1 mg, then pacing or infusion |
| Unstable tachycardia | Synchronized cardioversion |
ACLS Test Questions – Pharmacology and Drug Administration
Drug questions often hinge on one number or one timing rule. Epinephrine is 1 mg IV or IO every 3 to 5 minutes. In PEA or asystole, give it as soon as feasible; in VF or pulseless VT, the 2025 guidelines say after initial defibrillation attempts fail.
For refractory VF or pulseless VT, amiodarone 300 mg then 150 mg, or lidocaine, may be considered. Vasopressin offers no advantage over epinephrine. Atropine for bradycardia is now 1 mg, up to 3 mg total, and adenosine is 6 mg rapid push, then 12 mg.
| Drug | Adult dose | Exam trap |
| Epinephrine | 1 mg IV/IO every 3–5 min | In VF/pVT, timing is after initial shocks fail |
| Amiodarone | 300 mg, then 150 mg | Refractory VF/pVT only |
| Lidocaine | 1–1.5 mg/kg, then 0.5–0.75 mg/kg | Alternative to amiodarone |
| Atropine | 1 mg every 3–5 min, max 3 mg | Older sheets still say 0.5 mg |
| Adenosine | 6 mg rapid push, then 12 mg | Follow each dose with a saline flush |
| Vasopressin | Not recommended as a substitute | No advantage over epinephrine |
ACLS Test Questions – The Hs and Ts: Reversible Causes of Cardiac Arrest
When the rhythm is PEA or asystole, the Hs and Ts become your treatment plan. Hypovolemia, hypoxia, hydrogen ion, potassium abnormalities, and hypothermia make up the Hs. Tension pneumothorax, tamponade, toxins, and pulmonary or coronary thrombosis make up the Ts.
Scenario clues point to the cause. A dialysis patient with peaked T waves suggests hyperkalemia, while a recent long-bone fracture with sudden arrest raises pulmonary embolism. Treat the cause while compressions continue, because a fast, specific fix is often the difference between a stalled code and return of spontaneous circulation.
| Practice question | Answer |
| PEA in a dialysis patient; peaked T waves beforehand | Hyperkalemia; give calcium while continuing CPR |
| PEA after a long-bone fracture, no other cause evident | Consider pulmonary embolism |
ACLS Test Questions – Post-Cardiac Arrest Care
After return of spontaneous circulation, the exam shifts to protecting the brain and heart. The 2025 guidelines target an oxygen saturation of 90% to 98%, a mean arterial pressure of at least 65 mm Hg, and a 12-lead ECG right away to look for a coronary cause.
Temperature control now means choosing one temperature between 32 and 37.5 °C and holding it for at least 36 hours, with fever prevention as the minimum goal. Older materials quote 32 to 36 °C for 24 hours and an SpO2 of 92% to 98%, so confirm your edition.
| Topic | Older (2020) | 2025 |
| Oxygen saturation | 92–98% | 90–98% |
| Hypotension target | Avoid SBP below 90 | MAP of at least 65 mm Hg |
| Temperature | 32–36 °C for 24 h | 32–37.5 °C for at least 36 h |
ACLS Test Questions – Team Dynamics and Communication
Written exams also test leadership. Closed-loop communication means the leader gives a clear order, the team member repeats it back, and then confirms when it is done. For example: “Give amiodarone 300 mg IV.” “Amiodarone 300 mg IV.” “Amiodarone given.”
Strong teams assign roles early: compressor, airway, monitor or defibrillator, medication, and recorder. Rotate compressors about every two minutes, speak up respectfully when you see an error, and let the leader reassess the plan during each rhythm check. Calm, specific language protects both the patient and the team.
ACLS Test Questions – Airway Management and Ventilation
Once an advanced airway is in place, compressions become continuous and one breath is given every six seconds, about ten breaths per minute. Do not pause compressions for each breath. Avoid over-ventilation, because excess pressure in the chest can reduce venous return and blood flow.
Questions about airway adjuncts usually reward the simplest safe choice: bag-mask ventilation with an oropharyngeal or nasopharyngeal airway before anything advanced. To confirm and monitor an advanced airway, use continuous waveform capnography. A persistent waveform confirms placement, and a low or falling value during CPR can signal poor compressions.
| Practice question | Answer |
| Ventilation rate with an advanced airway during CPR? | One breath every 6 seconds, compressions continuous |
| Best tool to confirm tube placement and monitor CPR quality? | Continuous waveform capnography |
ACLS Test Questions – Megacode Structure
The megacode stitches algorithms together. A patient may arrest, flip from VF to PEA, regain a pulse, then deteriorate again. Evaluators watch for immediate rhythm identification, correct shock or drug decisions, minimal pauses, and a systematic search for reversible causes during non-shockable rhythms.
Practice out loud. Say the rhythm, the pulse status, the next action, and who does it. Talking through two-minute cycles builds the same habit your instructor will score, and it makes written scenario questions feel like a replay of something you have already rehearsed.
ACLS Test Questions – Build Your Rhythm Recognition Speed
The best way to handle ACLS test questions is repetition on rhythm strips, then drug and timing drills, then full scenarios. Aim for dozens of strips before test day, and review every miss until you can explain why the wrong options fail.
Finally, study from your provider manual and your training center’s current materials, since AHA courses moved to the 2025 Guidelines. This article is educational practice, not official exam content or medical advice. Verify doses against the current AHA algorithm cards before using them at the bedside.
Conclusion
Preparing with ACLS test questions can make the exam feel more familiar and manageable. Reviewing practice questions helps you strengthen your understanding of cardiac rhythms, emergency medications, treatment algorithms, and appropriate responses during critical situations. It is also useful to focus on why an answer is correct rather than simply memorizing it. Combine question practice with a careful review of current ACLS guidelines and hands-on skills for more complete preparation.
If you encounter difficult questions, use them as opportunities to identify topics that need additional study. With consistent preparation and a clear understanding of the core concepts, you can approach the ACLS exam with greater confidence and be better prepared to apply your knowledge when it matters most.
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