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Part 1: ACLS Practice Tests
Full-length ACLS practice tests that mirror the real Advanced Cardiac Life Support (ACLS) exam.
Each answer is explained in-depth to make the principles behind it crystal clear.
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What is the ACLS Exam?
The ACLS (Advanced Cardiovascular Life Support) exam is a certification exam required for healthcare providers who need advanced skills in managing cardiac emergencies, such as registered nurses, paramedics, and doctors.
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ACLS-certified providers are trained to handle situations like cardiac arrest, stroke, and other life-threatening cardiac conditions. This includes skills in recognizing abnormal heart rhythms, providing advanced airway management, administering emergency medications, and performing high-quality CPR in a team setting.
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To become ACLS certified, candidates must pass a written exam and a practical skills test, often provided by the American Heart Association (AHA) or similar organizations. After passing the exam, healthcare providers are certified to provide ACLS-level care in emergency settings.
ACLS Exam Outline
The ACLS Exam consists of 50 multiple-choice questions that test candidates on critical emergency skills. These questions cover a range of advanced cardiovascular life support topics and require knowledge in recognizing and managing life-threatening cardiac events.
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Key content areas include Cardiac Arrest Management, where candidates are tested on high-quality CPR, defibrillation techniques, and essential post-resuscitation care. Additionally, the exam covers Acute Coronary Syndromes (ACS), focusing on recognizing and managing heart attacks, and Stroke, where candidates need to identify symptoms and understand initial management strategies.
Other topics include Airway Management, which requires knowledge of both basic and advanced airway techniques. Pharmacology is also an essential part of the exam, testing candidates on the use of emergency medications to stabilize patients. Finally, the exam evaluates Team Dynamics, assessing the candidate’s understanding of effective roles and communication within a team during emergency situations.
The typical passing score for the ACLS exam is around 84%, though this may vary by certifying body. Passing the exam certifies a healthcare provider in advanced life-saving skills necessary for handling cardiac emergencies.
ACLS Exam Topics
Updated for 2025
Team Dynamics
Pharmacology
Post-Cardiac Arrest Care
Stroke Identification and Treatment
Acute Coronary Syndromes (ACS)
Arrhythmia Recognition and Management
Cardiac Arrest Management
The ACLS exam topics, as you can see above, are:
1. Cardiac Arrest Management
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Recognition: Recognizing the signs of cardiac arrest is critical. This involves identifying the absence of a pulse and breathing in a patient, followed by initiating CPR immediately. Early recognition is key to survival.
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High-Quality CPR: This includes providing effective chest compressions (at least 2 inches deep, at a rate of 100-120 compressions per minute), ensuring full chest recoil, minimizing interruptions, and providing adequate ventilations.
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Defibrillation: Early defibrillation is vital for patients in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The use of an automated external defibrillator (AED) or manual defibrillator is required.
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Airway Management Techniques: Includes both basic and advanced techniques like ensuring a patent airway with head-tilt-chin-lift, utilizing airway adjuncts (e.g., OPA, NPA), and advanced airway management (endotracheal intubation, supraglottic devices). Proper ventilation (bag-valve-mask or mechanical ventilation) is essential.
2. Arrhythmia Recognition and Management
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Ventricular Fibrillation (VF): A rapid, erratic electrical activity in the ventricles causing the heart to quiver instead of pumping blood. It is treated with immediate defibrillation.
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Ventricular Tachycardia (VT): A fast heart rhythm originating from the ventricles. If the patient has a pulse, treatment involves antiarrhythmic drugs (e.g., amiodarone or lidocaine). If pulseless, defibrillation is required.
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Bradycardia: A slow heart rate that can cause symptoms like dizziness or fainting. If symptomatic, treatment may include atropine or pacing.
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Tachycardia: A fast heart rate that may lead to instability. Treatment involves medications like adenosine for supraventricular tachycardia (SVT) or synchronized cardioversion for unstable rhythms.
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​​3. Acute Coronary Syndromes (ACS)
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Recognition: Key symptoms include chest pain, discomfort, shortness of breath, nausea, or diaphoresis. It’s essential to identify ACS early to initiate treatment and prevent further damage.
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Treatment: Treatment includes administering aspirin, nitroglycerin (if not contraindicated), and oxygen. For STEMI (ST-segment elevation myocardial infarction), immediate reperfusion therapy (PCI or fibrinolytics) is needed.
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Differentiating ACS from other causes: Distinguishing between unstable angina, NSTEMI, and STEMI is vital in guiding appropriate treatment.
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4. Stroke Identification and Treatment
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Early Identification: Using tools like the FAST (Face, Arm, Speech, Time) assessment helps quickly identify stroke symptoms. Early recognition allows for faster intervention, which is critical for improving outcomes.
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Types of Stroke: Differentiating between ischemic and hemorrhagic strokes is crucial for proper treatment.
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Treatment: For ischemic stroke, fibrinolytic therapy (tPA) may be considered if within the appropriate window (typically within 3-4.5 hours of symptom onset). For hemorrhagic stroke, managing blood pressure and preventing further bleeding is key.
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5. Post-Cardiac Arrest Care
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Maintaining Stability: After a successful resuscitation, the goal is to stabilize the patient’s cardiovascular and respiratory status. This involves careful monitoring, including vital signs and ECG.
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Avoiding Recurrence: Post-cardiac arrest care also focuses on preventing a recurrence of cardiac arrest. This can involve therapeutic hypothermia (targeted temperature management) to reduce neurological damage.
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Neurological Assessment: Assessing and managing the patient's neurological status, including the Glasgow Coma Scale (GCS) score, is critical to guide further care and prognosis.
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6. Pharmacology
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Epinephrine: Used in cardiac arrest for its vasoconstrictive properties, it helps increase perfusion to vital organs during resuscitation. It is typically administered every 3-5 minutes during arrest.
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Amiodarone: Used to treat life-threatening arrhythmias, especially for ventricular fibrillation and pulseless ventricular tachycardia, where defibrillation fails.
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Lidocaine: An alternative to amiodarone for treating VT and VF in specific cases.
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Adenosine: Used to treat SVT by causing temporary block of AV node conduction, allowing for conversion to normal rhythm.
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Atropine: Used in symptomatic bradycardia to increase heart rate by blocking vagal effects.
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7. Team Dynamics
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Communication: Effective communication in a resuscitation scenario is critical. Clear, concise, and direct communication helps ensure roles and responsibilities are understood.
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Role Assignment: Each member of the team has a specific role, such as chest compression provider, airway manager, medication administrator, and recorder. Proper role assignment prevents confusion.
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Coordinated Response: The ability to work efficiently in a team, especially under pressure, is vital for patient survival. Team members should be aware of each other’s actions and coordinate interventions effectively.
What Score is Needed to Pass the ACLS Exam?
The passing score for the ACLS exam is generally 84%, meaning you need to answer 42 out of 50 questions correctly to pass. However, this percentage can vary slightly depending on the certifying body. The most common certifying organization, the American Heart Association (AHA), follows this standard passing score. The exam is designed to assess your knowledge and understanding of the key concepts of Advanced Cardiovascular Life Support, which includes a variety of emergency situations such as cardiac arrest management, arrhythmias, stroke, and the use of ACLS medications.
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Along with passing the written exam, the ACLS certification requires you to demonstrate competency in practical skills through a hands-on skills test. This includes performing CPR, using an AED, administering medications, and managing airways in real-life simulations. Both the written exam and skills test are critical to passing the ACLS course and earning certification.
How long is the ACLS certification valid?
ACLS certification is valid for two years from the date you complete your certification course. After this period, you will need to recertify to maintain your credentials. The recertification process involves taking a refresher course, which is typically shorter than the initial certification course. The refresher course includes a review of key ACLS concepts, new guidelines, and updated protocols that might have been introduced since your last certification.​
The recertification process generally involves:
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A written exam: Similar to the original certification exam, though shorter and less comprehensive.
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A practical skills test: You will demonstrate your competency in performing key life-saving techniques such as CPR, airway management, defibrillation, and drug administration.
It is important to keep track of your certification’s expiration date. Many healthcare employers require ACLS recertification as a condition for continued employment, especially for those in roles involving emergency medical care. Delaying or missing your recertification may result in the need to retake the full course rather than just the renewal.
Is the exam only multiple-choice, or is there a practical skills test?
The ACLS exam includes both a written multiple-choice exam and a practical skills test. The written exam is designed to assess your theoretical understanding of ACLS protocols, pharmacology, and algorithms. The multiple-choice questions cover a wide range of topics, such as managing cardiac arrest, recognizing arrhythmias, treating acute coronary syndromes, and responding to stroke situations.
The practical skills test is a hands-on evaluation where you demonstrate your ability to perform the essential life-saving techniques. This includes:
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Performing high-quality CPR: You’ll demonstrate effective chest compressions, ensuring proper depth (at least 2 inches), rate (100-120 compressions per minute), and recoil, along with correct ventilation techniques.
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Using an AED: You must show competence in assessing the patient’s rhythm and delivering a shock when necessary (e.g., during VF or pulseless VT).
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Airway management: This involves using bag-valve-mask (BVM) devices, advanced airway techniques (like intubation), or supraglottic airways, if applicable.
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Administering ACLS medications: You’ll simulate the administration of medications like epinephrine, amiodarone, or atropine, depending on the clinical scenario.
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In the skills test, you will also be evaluated on your ability to work efficiently in a team, communicate effectively, and apply the ACLS protocols in a realistic emergency setting. While the written exam assesses your knowledge, the skills test ensures you can apply that knowledge under pressure, which is critical in real-world emergency situations.
What happens if I fail the exam?
If you fail either the written portion or the practical skills test of the ACLS exam, there is typically an opportunity to retake the exam. The process for retaking the exam depends on the policies of the certifying organization, but generally, you can retake the test on the same day or at a later time, depending on the availability of resources.
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Written exam: If you fail the written exam, most organizations allow you to retake the exam after reviewing the material. It’s recommended to thoroughly study the content again and consider reviewing practice questions to identify areas of weakness. Some providers may require you to retake the exam on a different day, but many also allow you to retry immediately.
Practical skills test: If you fail the practical skills test, instructors will usually give you feedback on what areas need improvement, such as CPR techniques, defibrillator use, or airway management. You will have a chance to demonstrate your skills again and try to pass the test once you’ve had time to review and practice.
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Failing the ACLS exam is not the end of the process, and many students successfully retake the exam after additional preparation. It’s important to focus on improving the areas where you struggled and ensure that you are completely familiar with the ACLS algorithms, medications, and hands-on skills required in an emergency. Some organizations may have specific guidelines on the number of retakes allowed or the timeframe for re-taking the exam, so it's helpful to understand these policies before attempting the test again.
What medications are important to know for the exam?
A significant portion of the ACLS exam will test your knowledge of medications used during emergencies. Some key medications you should be familiar with include:
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Epinephrine: Used during cardiac arrest for its vasoconstrictive properties, which improve blood flow to vital organs. It is typically administered every 3-5 minutes during arrest situations, such as VF or pulseless VT.
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Amiodarone: This antiarrhythmic medication is used to treat life-threatening arrhythmias like VF and pulseless VT, especially when defibrillation fails.
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Lidocaine: An alternative to amiodarone for treating arrhythmias, especially in situations involving ventricular arrhythmias. It can be used to stabilize heart rhythms after a shock.
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Adenosine: Administered to treat certain types of supraventricular tachycardia (SVT) by slowing conduction through the AV node, allowing the heart to return to a normal rhythm.
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Atropine: Used in symptomatic bradycardia to increase the heart rate by blocking parasympathetic effects on the heart.
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Magnesium Sulfate: Used for certain arrhythmias like torsades de pointes (a type of VT) or for patients with hypomagnesemia.
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Nitroglycerin: A vasodilator used to manage chest pain or discomfort associated with ACS. It helps relieve pain and reduce the heart's oxygen demand.
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Fibrinolytics (e.g., tPA): Used in ischemic stroke or STEMI to break up blood clots, but only within specific time windows (usually 3-4.5 hours for stroke and up to 12 hours for STEMI).
What are the most critical ACLS algorithms I should focus on?
The ACLS exam and certification focus heavily on understanding and applying specific treatment algorithms. These algorithms are used to guide the management of life-threatening emergencies. Some of the most critical algorithms to focus on include:
Cardiac Arrest Algorithm: This is one of the most important and involves the recognition of cardiac arrest, performing high-quality CPR, defibrillation (when needed), and administering the appropriate medications. The algorithm also covers the management of ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
Acute Coronary Syndrome (ACS) Algorithm: This helps you recognize and treat chest pain and other symptoms related to heart attacks. You need to understand when to administer oxygen, aspirin, nitroglycerin, and morphine. Also, the algorithm covers when to activate a catheterization lab for possible percutaneous coronary intervention (PCI) or administer fibrinolytics for STEMI.
Stroke Algorithm: Focuses on quickly identifying stroke symptoms and recognizing ischemic versus hemorrhagic strokes. You will need to understand the timing for thrombolytic therapy (tPA) and when to avoid it, as well as proper post-stroke care.
Bradycardia and Tachycardia Algorithms: These algorithms guide you through the management of arrhythmias like bradycardia (slow heart rate) and tachycardia (fast heart rate). They help determine when medications like atropine, adenosine, and amiodarone should be used and when pacing or synchronized cardioversion is necessary.
Post-Cardiac Arrest Care Algorithm: After successful resuscitation, this algorithm emphasizes post-resuscitation care, such as maintaining proper oxygenation, blood pressure management, and temperature control to prevent neurological damage.
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Being comfortable with these algorithms and understanding when to apply each step is crucial for both the exam and real-life clinical situations.
What is the format of the practical skills test, and how is it evaluated?
The practical skills test in ACLS certification evaluates your ability to perform essential life-saving skills in an emergency scenario. This test is critical because it ensures you can apply the knowledge you’ve learned in a realistic, high-pressure environment. The test is usually performed with the help of an instructor and fellow students, often in a simulated emergency situation where you will be expected to demonstrate your proficiency.
Key skills assessed during the test include:
High-quality CPR: You will need to demonstrate proper chest compressions (depth of at least 2 inches, rate of 100-120 compressions per minute) and adequate ventilation techniques (e.g., mouth-to-mask or bag-valve-mask).
Defibrillation: You’ll be tested on your ability to use an AED correctly or apply manual defibrillation (depending on the training level) in cases of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
Airway management: The test will assess your ability to maintain an open airway using basic (BVM) or advanced (endotracheal intubation, supraglottic airway) techniques, depending on the scope of your certification.
Medication administration: You will be evaluated on your ability to correctly administer ACLS medications like epinephrine, amiodarone, or atropine during a simulated cardiac arrest scenario.
Evaluators will be watching for your ability to follow established ACLS algorithms, communicate effectively with your team, and take appropriate action in a timely manner. You must demonstrate your ability to prioritize life-saving interventions, stay calm under pressure, and remain organized while managing multiple tasks.
The practical test may also involve team dynamics, where you are assessed not only for your individual skills but also for your ability to collaborate and communicate with others in a code situation. Effective teamwork is critical in real-world resuscitation efforts, so your evaluators will be looking at how well you work with others to achieve optimal patient outcomes.
After completing the skills test, you will receive feedback from your instructor, and if needed, you may be given another opportunity to demonstrate your skills. If you pass the skills test, it will confirm that you have the practical knowledge and abilities to handle emergency cardiac care.
How to Study for the ACLS Exam:
A Comprehensive Guide
Preparing for the ACLS exam can be challenging, but with the right tools and mindset, you can go in confidently and succeed. In this guide, you’ll find practical study techniques, essential resources, and expert tips designed to help you master the material and pass the ACLS exam with ease.
1. Learn the Core Algorithms in Sections
Start by breaking down the main ACLS algorithms—Cardiac Arrest, Tachycardia, Bradycardia, and Post-Cardiac Arrest Care—into manageable parts. For example, within the Cardiac Arrest algorithm, focus on the sequence for V-fib, V-tach, asystole, and PEA management. In each algorithm, identify when to start interventions like CPR, defibrillation, or medication. Understanding the progression in each algorithm will make recall easier.
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Memorize key sequences using mnemonics or visual aids, like CAB (Circulation, Airway, Breathing) for Cardiac Arrest or Shockable vs. Non-Shockable Rhythms to guide actions. Visuals like charts or flow maps are especially helpful, so refer to AHA’s algorithm charts or even draw them out to reinforce the structure.
Finally, practice the algorithms in mock scenarios to simulate test conditions. Applying your knowledge in timed scenarios not only strengthens memory but also improves your speed and confidence in navigating each algorithm’s steps.
2. Gather the Right Study Materials
To ensure a comprehensive study experience, invest in high-quality study materials:
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Exam Prep Apps: Choose study guides with practice tests, clear explanations, and key ACLS topics. We recommend our ACLS Exam Prep Apps for interactive features, progress tracking, and flexible, on-the-go study. Our app’s structured approach makes mastering the material easier and review sessions more effective.
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Online Practice Tests: Many websites offer free and paid practice tests to help you get familiar with the exam’s format and timing. With our ACLS Exam Prep Apps, you can access 10 free tests for 7 days, giving you a risk-free way to practice and build confidence before the exam.
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Flashcards: Flashcards are excellent for memorizing key terms and medical abbreviations. You can create your own or use ACLS-specific flashcard sets available online.
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Video Tutorials: Watching tutorials on hands-on skills, like taking vital signs or patient transfers, helps deepen your understanding of the test's practical aspects.
3. Master Rhythm Recognition
Mastering rhythm recognition is essential for the ACLS exam, as quick identification of cardiac rhythms can be life-saving. Focus on recognizing common rhythms like ventricular fibrillation (V-fib), ventricular tachycardia (V-tach), and heart blocks, as these frequently appear in ACLS scenarios.
To build accuracy and speed, use flashcards or online rhythm simulators for consistent practice.
Flashcards help reinforce visual memory, while simulators offer real-time recognition drills that mimic clinical situations. The more familiar you are with each rhythm’s unique features, the quicker you’ll be able to respond correctly in exam scenarios.
4. Understand the "Why" Behind Each Step
Understanding the reasoning behind each step in the ACLS algorithms makes it easier to remember and apply them effectively. Instead of rote memorization, focus on why each action is critical, as this will reinforce your ability to make quick, informed decisions.
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For instance, in Cardiac Arrest, epinephrine is administered every 3-5 minutes to increase blood flow to vital organs during resuscitation. Its vasoconstrictive effects help prioritize blood supply to the brain and heart, improving chances of survival. Knowing this purpose clarifies its timing and role within the sequence of interventions.
In Tachycardia and Bradycardia algorithms, treatments like synchronized cardioversion or pacing are chosen based on the patient’s stability. For unstable tachycardia, synchronized cardioversion is used to reset the heart rhythm without risking a dangerous arrhythmia. In symptomatic bradycardia, pacing helps increase heart rate to improve perfusion. Recognizing the “why” behind these interventions will guide your choices based on patient presentation, which is crucial in both real-life situations and the exam.
5. Take Practice Exams Regularly
Practice exams are one of the most effective ways to prepare:
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Timed Practice Tests: Simulate real exam conditions by timing yourself. This can improve your pacing and manage test-day anxiety.
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Analyze Your Results: After each practice test, review your incorrect answers to identify your weaknesses. Focus on these areas in your future study sessions.
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Set Goals: Aim to improve your score with each practice test, working toward a passing score for your state.
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Start your free 7-day trial with our ACLS Exam Prep App and get 10 realistic tests to track your progress and build confidence. Practice regularly, focus on key areas, and be ready for test day! Try it now at (link)
6. Create a Study Schedule
Staying organized is essential for ACLS exam success. Develop a focused study schedule that maximizes your preparation:
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Allocate Time by Algorithm: Dedicate study sessions to specific ACLS algorithms (e.g., one for cardiac arrest protocols, another for tachycardia and bradycardia management). This helps reinforce each protocol in depth.
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Use Varied Study Methods: Alternate between reading the ACLS Provider Manual, practicing with rhythm recognition tools, and taking practice exams. This keeps sessions engaging and reinforces your knowledge from different angles.
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Schedule Breaks: Include short breaks during your sessions to maintain focus and avoid burnout, as ACLS concepts can be intensive.
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Aim to give yourself 4-6 weeks to prepare. This timeframe allows you to cover all topics thoroughly and to practice repeatedly, ensuring you feel confident on exam day.
7. Memorize the Algorithm Steps in Logical Order
The steps in each algorithm are sequenced to maximize patient outcomes. Memorize these using mnemonic devices, flashcards, or visual aids. For instance:
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CAB (Circulation, Airway, Breathing): This is the foundational approach for the Cardiac Arrest algorithm.
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Shockable vs. Non-Shockable Rhythms: Recognize when defibrillation is needed (e.g., V-fib and pulseless V-tach) and know the sequence of interventions following each shock.
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For Bradycardia and Tachycardia algorithms, the first question is often whether the patient is stable or unstable. Then, identify interventions based on the rhythm and stability.​
Take an ACLS Practice Test
Conclusion
To prepare for the ACLS exam, the best approach is a blend of studying key algorithms and practicing with realistic, exam-like questions. Regular practice with these questions helps you get comfortable with the ACLS exam format, timing, and the types of scenarios you’ll encounter, so you feel prepared and confident on test day.
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With ExamReview, you can access a wide range of ACLS practice tests that mirror the real exam’s style and difficulty. Our platform lets you track your progress, identify weak areas, and focus on improving critical skills in rhythm recognition, medication administration, and protocol steps. Practice with ExamReview and walk into your ACLS exam feeling ready for success!
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