Final Exam ACLS 2025-2026 latest updated version with expert solutions

A patient experiences cardiac arrest, and the resuscitation team initiates ventilations using a bag-valve-mask (BVM) resuscitator. The development of which condition during the provision of care would lead the team to suspect that improper BVM technique is being used?

Select the correct answer to this question.

Rib fracture

Esophageal injury

Pneumothorax

Hypertension

Pneumothorax

1 A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member follows each medication administration with a bolus of fluid. How much would the team member give?

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5 to 10 mL

10 to 20 mL

20 to 30 mL

30 to 40 mL

When administering medications during a cardiac arrest, all medications administrated through the IV or intraosseous infusion route should be followed by a 10- to 20-mL fluid bolus.

The resuscitation team suspects that hyperkalemia is the cause of cardiac arrest in a patient brought to the emergency department. Which finding on a 12-lead ECG would confirm this suspicion?

Wide-complex ventricular rhythm and tall, peaked T waves

ST-segment changes, T-wave inversion

Flat T waves, prominent U waves and possibly prolonged QT intervals

Narrow-complex ventricular tachycardia

Wide-complex ventricular rhythm and tall, peaked T waves

In hyperkalemia the patient's 12-lead ECG rhythm strip will show wide-complex ventricular rhythm and tall, peaked T waves.

A patient with an ischemic stroke arrives at the emergency department at 2 a.m. The patient's symptoms started about 12:30 a.m. After completing the necessary assessments, the healthcare team diagnoses an ischemic stroke, and the patient is determined to be a candidate for fibrinolytic therapy. To achieve the best outcomes, the team should initiate therapy for this patient no later than by which time?

Select the correct answer to this question.

3:00 a.m.

5:30 a.m.

6:00 a.m.

8:30 a.m.

1

3:00 a.m.

A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced cardiac life support was initiated. The patient required the placement of an advanced airway to maintain airway patency. Which statement indicates that the team performed high-quality CPR?

Select the correct answer to this question.

"We kept the rate of chest compressions to around 100 per minute but adjusted their depth to 1.5 inches while giving 1 ventilation every 3 seconds."

"We delivered chest compressions at a rate of 80 to 100 per minute to a depth of at least 2 inches and gave 1 ventilation every 6 seconds."

"We initiated chest compressions at a rate of 100 to 110 per minute to a depth of 2.4 inches and then gave 1 ventilation every 10 seconds."

"We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute."

4

"We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute."

A patient with a suspected stroke arrives at the emergency department at 7:10 p.m. The stroke team ensures that a comprehensive neurologic assessment using the National Institutes of Health Stroke Scale (NIHSS) is completed and that brain imaging is performed by which time?

7:20 p.m.

7:30 p.m.

7:40 p.m.

7:50 p.m.

2

Within 20 minutes of the patient's arrival, a comprehensive neurologic assessment should be completed and brain imaging should be performed. That would be 7:30 p.m. for this patient.

The emergency department team is providing care to a patient who is experiencing ventricular tachycardia. The patient's serum electrolyte levels are a contributing cause of the patient's current condition. Which electrolyte imbalance(s) would most likely be involved?

Select all correct options that apply.

Hyperkalemia

Hypochloremia

Hypernatremia

Hypomagnesemia

Hypocalcemia

Hypomagnesemia

Hypocalcemia

A 30-year-old patient has been brought to the emergency department in cardiac arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm would suggest which of the following as a possible precipitating factor?

The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation include electrocution, myocardial ischemia or infarction, shock, stimulant overdose and ventricular tachycardia.

electrocution

A patient enters the emergency department in respiratory compromise. The team is monitoring the patient using capnography and identifies that ETCO2 levels are initially 33 mmHg and later 40 mmHg. From these readings, the team identifies that the patient is progressing in what stage of respiratory compromise?

Respiratory acidosis

Respiratory failure

Respiratory distress

Respiratory arrest

3

Capnography can objectively assess the severity of a patient's respiratory distress. Early on, the patient will often hyperventilate, leading to hypocapnia that is reflected by a low ETCO2 value (less than 35 mmHg). As respiratory distress increases, and the patient begins to tire, the ETCO2 value may return to the normal range (35 to 45 mmHg). However, if the patient progresses to respiratory failure, the ETCO2 level will increase to greater than 45 mmHg, which indicates hypoventilation.

A patient comes to the emergency department complaining of palpitations and "some shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm strip. The provider interprets this strip as indicating which arrhythmia?

Atrial fibrillation

Ventricular tachycardia

Ventricular fibrillation

Atrial flutter

Atrial flutter

A patient is experiencing respiratory distress secondary to an exacerbation of chronic obstructive pulmonary disease. The patient begins to exhibit signs and symptoms of worsening respiratory function and experiences respiratory arrest. The team intervenes, delivering ventilations via BVM resuscitator. The team would deliver 1 ventilation at which interval?

Every 3 to 4 seconds

Every 5 to 6 seconds

Every 7 to 8 seconds

Every 8 to 9 seconds

The team would deliver 1 ventilation every 5 to 6 seconds. Each ventilation should last about 1 second and make the chest begin to rise.

Assessment of a patient in the emergency department reveals that the patient is experiencing respiratory compromise. From the assessment, the team identifies that the patient is in the earliest stage of this condition. Which stage would this be?

Select the correct answer to this question.

Respiratory distress

Respiratory arrest

Respiratory acidosis

Respiratory failure

Respiratory distress

Respiratory compromise occurs along a continuum, beginning with respiratory distress, progressing to respiratory failure and then to respiratory arrest

After cardiac arrest and successful resuscitation, the patient has a return of spontaneous circulation. The patient is unable to follow verbal commands. Targeted temperature management is initiated. Which method(s) would be appropriate for the resuscitation team to use?

Giving an ice-cold IV fluid bolus

Applying cooling blankets to the patient's body

Administering cool-mist oxygen therapy

Applying a cool compress to the patient's forehead

Using an endovascular catheter

Giving an ice-cold IV fluid bolus

Applying cooling blankets to the patient's body

Using an endovascular catheter

A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. The history reveals that before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause?

Select the correct answer to this question.

Tension pneumothorax

Cardiac tamponade

Acidosis

Hypothermia

Tension pneumothorax

Prearrest signs of tension pneumothorax in the advanced stage include jugular venous distension, cyanosis, apnea and hyperresonance on percussion. Difficulty ventilating the patient may also be a sign of tension pneumothorax.

A 40-year-old patient in the waiting room of the primary care provider's office approaches a staff member and says, "I'm having really severe, crushing chest pain that is moving to both my arms." The patient is diaphoretic and dyspneic. Which action would be appropriate for the staff member to take?

Activate the emergency medical services system.

Take the patient to an exam room immediately.

Give the patient an aspirin.

Obtain a 12-lead ECG.

Activate the emergency medical services system.

A patient with dyspnea and a change in mental status arrives at the emergency department. The healthcare team completes the necessary assessments and begins to care for the patient, including initiating cardiac monitoring and pulse oximetry; providing supplemental oxygen and ensuring adequate ventilation; and obtaining vascular access. The team reviews the patient's ECG rhythm strip, as shown in the following figure. Which agent would the team most likely administer?

Amiodarone 150 mg over 10 minutes

Atropine 0.5 mg every 3 to 5 minutes

Dopamine 5 to 10 mcg/min

Epinephrine 2 to 10 mcg/min

Atropine 0.5 mg every 3 to 5 minutes

A patient is brought to the emergency department by their spouse. The spouse says, "I think it's a stroke." The stroke team assesses the patient using the National Institutes of Health Stroke Scale (NIHSS). Which area(s) would the team include in this assessment?

Select all correct options that apply.

Facial palsy

Level of consciousness

Language deficits

Visual function

Cranial nerve function

Level of consciousness

Language deficits

Visual function

A patient is brought into the emergency department with a suspected opioid overdose. The patient is in cardiac arrest. Which action would be the team's priority?

Select the correct answer to this question.

Giving naloxone intravenously (IV)

Obtaining a 12-lead electrocardiogram (ECG)

Administering supplemental oxygen

Initiating high-quality CPR

Initiating high-quality CPR

Although no evidence supports any benefit to naloxone administration during cardiac arrest, administration of naloxone during both respiratory and cardiac arrest is recommended when opioid overdose is suspected. However, for a patient in cardiac arrest, high-quality CPR is prioritized over the administration of naloxone.

A patient with a diagnosis of ACS is experiencing cardiogenic shock. Which adjuvant therapy would be contraindicated?

Select the correct answer to this question.

Direct thrombin inhibitor

β-Blockers

Glycoprotein IIb/IIIa inhibitors

Heparin

β-Blockers

The use of β-blockers is contraindicated in patients who are at risk for cardiogenic shock, low cardiac output and acute heart failure.

A member of the resuscitation team is preparing to defibrillate a patient in cardiac arrest using a biphasic defibrillator. The team member would set the energy dose according to the manufacturer's recommendations, which is usually:

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100 to 150 joules

120 to 200 joules

300 joules

360 joules

120 to 200 joules

When using a biphasic defibrillator, the energy dose should be set at 120 to 200 joules

A patient in cardiac arrest experiences return of spontaneous circulation. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation. Which finding(s) would indicate the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation?

Select all correct options that apply.

PaCO2 35 mmHg

SaO2 96%

SaO2 92%

ETCO2 50 mmHg

ETCO2 40 mmHg

PaCO2 35 mmHg

SaO2 92%

ETCO2 50 mmHg

A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow-complex supraventricular tachyarrhythmia. The patient is hemodynamically stable. Which intervention would be initiated first?

Select the correct answer to this question.

Adenosine administration

Sedation

Vagal maneuvers

Synchronized cardioversion

Vagal maneuvers

A patient experiencing an unstable bradyarrhythmia does not respond to atropine. Which interventions could the healthcare provider use next?

Select all correct options that apply.

Carotid massage

Epinephrine or dopamine infusio

Transcutaneous pacing

Synchronized cardioversion

Epinephrine or dopamine infusio

Transcutaneous pacing

A patient is brought into the emergency department. The patient does not have a pulse. The cardiac monitor shows the following rhythm. The team interprets this as which condition?

ventricular tachycardia

A patient with suspected acute coronary syndromes (ACS) is placed on a cardiac monitor. The patient is complaining of dyspnea and is given supplemental oxygen. The provider determines that the supplemental oxygen dose is correct based on which SaO2 level?

Select the correct answer to this question.

87%

91%

93%

95%

95%

A healthcare provider is establishing cardiac monitoring using a five-electrode system. The healthcare provider demonstrates proper use of the system by placing the green electrode in which location?

Select the correct answer to this question.

At the fourth intercostal space, right sternal border

On the lower right abdomen

On the lower left abdomen

Under the left clavicle, at the midclavicular line

On the lower right abdomen

A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest, the patient's ECG showed peaked T waves. What might be causing the patient's cardiac arrest?

Select the correct answer to this question.

Acidosis

Hyperkalemia

Hypoxia

Hypothermia

Hyperkalemia

Suspect hyperkalemia in all patients with acute or chronic renal failure who exhibit a wide-complex ventricular rhythm or tall, peaked T waves on an ECG before cardiac arrest.

The ECG rhythm strip of a patient who arrived in the emergency department complaining of dizziness, syncope and shortness of breath reveals sinus bradycardia. When reviewing the patient's medication history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition?

Select all correct options that apply.

Quinapril

Verapamil

Digoxin

Metoprolol

Losartan

Verapamil

Digoxin

Metoprolol

Medications associated with causing sinus bradycardia include β-blockers such as metoprolol and calcium channel blockers such as verapamil and digoxin.

A patient with STEMI is experiencing chest pain that is refractory to sublingual nitroglycerin. Intravenous nitroglycerin is prescribed. When administering this medication, it would be titrated to maintain which systolic blood pressure?

Select the correct answer to this question.

60 mmHg

70 mmHg

80 mmHg

90 mmHg

90 mmHg

In patients with STEMI, IV nitroglycerin may be used when chest pain or discomfort is recurrent or refractory to nitroglycerin administered sublingually or by spray. The IV nitroglycerin should be titrated to maintain a systolic blood pressure of 90 mmHg or more.

Cardiac monitoring indicates that a patient has a ventricular tachyarrhythmia. The patient has a pulse and is not showing any signs of hemodynamic compromise. A 12-lead ECG reveals an irregular rhythm with QRS complexes greater than 0.12 second in duration. Which action would be appropriate at this time?

Select the correct answer to this question.

Synchronized cardioversion

Atropine

Defibrillation

Consider an antiarrhythmic infusion and expert consultation

Consider an antiarrhythmic infusion and expert consultation

A patient experiencing STEMI comes to the emergency department of a large medical center at 9:30 p.m. The patient states that the symptoms started about 8 p.m. After confirming the diagnosis and initiating care, the healthcare team schedules the patient for percutaneous coronary intervention (PCI). The facility is capable of administering PCI. To achieve the best outcomes, therapy should be administered to this patient by which time?

Select the correct answer to this question.

11:00 p.m.

12:00 a.m.

1:00 a.m.

1:30 a.m.

11:00 p.m.

Reperfusion therapy should be administered within 1 hour, 30 minutes of the patient's first medical contact if the patient does not need to be transferred to another facility. The patient arrived at 9:30 p.m., so the latest the therapy should be administered would be 11 p.m.

Assessment of a patient reveals an ETCO2 level of 55 mmHg and an arterial oxygen saturation (SaO2) level of 88%. The provider would interpret these findings as indicative of which condition?

Select the correct answer to this question.

Respiratory distress

Cardiac arrest

Respiratory failure

Respiratory arrest

Respiratory failure

A patient in the telemetry unit is receiving continuous cardiac monitoring. The patient has a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following figure. The provider interprets this strip as indicating which arrhythmia?

Second-degree AV block

First-degree atrioventricular (AV) block

Sinus tachycardia

Third-degree AV block

Third-degree AV block

A patient is being treated in the emergency department and is determined to have NSTE-ACS. Invasive management is planned based on which finding?

Select the correct answer to this question.

Atrial tachycardia

Ventricular tachycardia

Atrial fibrillation

Ventricular fibrillation

Ventricular tachycardia

An early invasive strategy should be considered for patients with high-risk NSTE-ACS, which would be indicated by ventricular tachycardia.

A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of chronic obstructive pulmonary disease. Assessment reveals respiratory failure. Which action would be the initial priority?

Delivery of supplemental oxygen via nasal cannula

Initiation of capnography

Establishment of vascular access

Assisted ventilation with BVM resuscitator

Assisted ventilation with BVM resuscitator

Patients who cannot ventilate adequately despite an open airway or who have insufficient respiratory effort require assisted ventilation initially provided via a BVM resuscitator.

A healthcare provider initiates ventilations to ensure adequate breathing and oxygenation. While ventilations are being performed, capnography is established to evaluate the adequacy of the ventilations. The healthcare provider determines that ventilations are adequate based on which end-tidal carbon dioxide (ETCO2) value?

elect the correct answer to this question.

10 to 15 mmHg

20 to 25 mmHg

25 to 30 mmHg

35 to 45 mmHg

35 to 45 mmHg

A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamically stable and has a heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary assessment, which statement(s) by the patient would the team interpret as a possible contributing cause?

Select all correct options that apply.

"I've had a terrible cold with a horrible cough and fever the past week."

"I've been so anxious lately because I just lost my job."

"I had an aortic valve replacement several years ago."

"I've had a history of heart disease for the past 3 years."

"I've been vomiting for the past 2 days from a gastrointestinal bug."

"I've had a terrible cold with a horrible cough and fever the past week."

"I've been so anxious lately because I just lost my job."

"I've been vomiting for the past 2 days from a gastrointestinal bug."

A patient presents to the emergency department with suspected ACS. Electrocardiogram and cardiac biomarkers show the patient has ST-segment elevation myocardial infarction (STEMI). Physical examination reveals signs of left ventricular dysfunction. Which finding(s) would support this?

Select all correct options that apply.

Weak peripheral pulses

Chest pain

Cool, clammy skin

Crackles

Hypotension

Weak peripheral pulses

Hypotension

Crackles

A 20-year-old man with respiratory depression is brought to the emergency department by his parents. The parents state that "[They] found him at home with various needles and syringes around him, but [they] have no idea what he took." Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 p.m. The patient does not respond to this initial dose. The team would expect to administer a second dose after how many minutes?

Select the correct answer to this question.

2 minutes

4 minutes

6 minutes

8 minutes

4 minutes

A person suddenly collapses while sitting in the sunroom of a healthcare facility. A healthcare provider observes the event and hurries over to assess the situation. The healthcare provider performs which assessment first?

Select the correct answer to this question.

Rapid assessment

Secondary assessment

Primary assessment

Basic life support assessment

Rapid assessment

The stroke team is assessing a patient with a suspected stroke. The patient is alert and able to carry on a conversation, although the patient has difficulty getting the words out. Testing confirms that the patient has had an ischemic stroke. Based on the patient's medical history, a history of which arrhythmia would alert the team to the patient's increased risk for stroke?

Select the correct answer to this question.

Ventricular fibrillation

Atrial fibrillation

Atrial tachycardia

Bradycardia

atrial fibrillation

An ECG strip of a patient in the emergency department reveals the following rhythm. Which feature would the healthcare provider interpret as indicating atrial fibrillation?

Narrow QRS complex with PP interval constant or slightly irregular

Presence of wide QRS complexes that are bizarrely and consistently shaped

Presence of flutter waves and sawtooth patterns

Absence of discrete P waves and presence of irregularly irregular QRS complexes

Absence of discrete P waves and presence of irregularly irregular QRS complexes

A 35-year-old female patient's ECG is consistent with STEMI. The ECG reveals a new ST-segment elevation at the J point in leads V2 and V3 of at least which size?

Select the correct answer to this question.

0.10 mV

0.15 mV

0.2 mV

0.25 mV

0.15 mV

A patient presents to the emergency department with mild to moderate recurrent chest pain, without any nausea or vomiting. A 12-lead ECG is obtained and shows ST-segment depression with transient T-wave elevation indicative of NSTE-ACS. Cardiac serum markers are obtained and are not elevated. The patient's risk-stratification score indicates low risk. These findings suggest which condition?

Select the correct answer to this question.

Non-STEMI

Myocardial infarction

STEMI

Unstable angina

Unstable angina

The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured?

D

A patient's capnogram reveals the following waveform. Which segment would the healthcare provider interpret as reflecting the beginning of exhalation?

A-B

Cardiac monitoring of a patient in cardiac arrest reveals ventricular fibrillation. What intervention would the team perform next?

Initiate capnography.

Administer 1 shock.

Provide post-cardiac arrest care.

Insert an advanced airway.

Administer 1 shock

A patient comes to the emergency department with a suspected stroke. The patient is alert and oriented and accompanied by a family member. The family member says, "I noticed he was slurring his words and had trouble walking, like his leg was numb." Which finding would suggest that the patient is experiencing a condition that mimics a stroke?

Hyperkalemia

Hypoglycemia

Hyperglycemia

Hypokalemia

Hypoglycemia