ACLS practice test, ACLS pretest questions, ACLS practice questions and the 2025 ACLS algorithms

These are two different tests taken weeks apart, and confusing them is the most common preparation mistake in ACLS. The first is the Precourse Self-Assessment, which the AHA requires you to complete before you are allowed to attend an ACLS course at all. It is an online assessment delivered through the AHA eLearning platform, it is scored, and you need at least 70% to pass. There is no limit on attempts, so you take it until you clear it, then print the certificate of completion and bring it to class or send it to your training center in advance. It covers three defined sections: rhythm recognition, pharmacology, and practical application. One genuinely useful change arrived with the 2025 Guidelines: the AHA made the ACLS Precourse Self-Assessment free and open to everyone, so you can now work through it as a study tool whether or not you have booked a course. The second test is the ACLS Provider written exam, sat at the end of the course. That one is 50 multiple-choice questions and the passing score is 84%, which on 50 questions means you can miss eight and pass, and missing nine fails you. It is an open-resource exam. Neither of these is the part that actually fails people, though. The Megacode is the in-person skills test where you lead a simulated resuscitation, and it is judged on performance rather than a percentage.

Eighty-four percent on the ACLS Provider written exam, and 70% on the Precourse Self-Assessment. Those two numbers are not interchangeable and it is worth fixing them separately in your head, because the tighter one comes second. On a 50-question exam, 84% is 42 correct. You have eight wrong answers of margin, not fifteen. That is a narrow band for a test that spans rhythm interpretation, drug doses, defibrillation energy, airway management and post-arrest care, and it is the reason the open-resource rule exists rather than being a generosity. All AHA exams are now open resource, meaning you may use the ACLS Provider Manual, the course handouts and your personal notes during the written exam. Read that as a signal about what the exam is testing. An open-resource exam cannot reward memorization, so it stops asking what the dose of amiodarone is and starts asking which drug this patient needs, in what sequence, and at what point in the algorithm. Candidates who prepare by making a flashcard deck of doses and then discover they may bring the manual anyway have usually prepared for the wrong exam. Build the reference you will actually use instead: a single page with the cardiac arrest, bradycardia and tachycardia algorithms and the doses attached to each branch, tabbed so you can find it in ten seconds under time pressure.

The 2025 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care were published in Circulation on October 22, 2025, and the AHA launched updated BLS, ACLS and PALS courses the same day. The deadline that matters to you has already passed: since March 1, 2026, every AHA Training Center and instructor has been required to teach from the updated materials. If you are sitting an ACLS course now, you are sitting the 2025 course, and any practice question written against the 2020 Guidelines is testing a syllabus that is no longer current. Several changes are worth knowing by name. The AHA replaced the separate adult and pediatric, in-hospital and out-of-hospital chains with a single unified Chain of Survival, so there is now one model rather than four. The adult choking sequence is stated as cycles of 5 back blows followed by 5 abdominal thrusts, continued until the obstruction is relieved or the patient becomes unresponsive. Naloxone now appears explicitly in the algorithm for suspected opioid overdose in respiratory or cardiac arrest, which reflects how much of the out-of-hospital arrest population that now describes. And the guidelines add a recommendation for safety huddles on high-risk hospitalized patients, on the evidence that improving team awareness of a deteriorating patient prevents arrests rather than treating them. The core resuscitation mechanics did not change: compressions at least 2 inches deep at 100 to 120 per minute, interruptions under 10 seconds, and a compressor change every 2 minutes.

Most of what the ACLS written exam and the Megacode ask you is a variation on one question: given this rhythm and this patient, what do you do next. That is why memorizing the algorithm posters as pictures does not survive contact with a scenario. Learn them as a small number of decisions instead. In cardiac arrest, the first fork is whether the rhythm is shockable. Only two rhythms in cardiac arrest are: ventricular fibrillation and pulseless ventricular tachycardia. Everything else is asystole or PEA, where PEA is defined as any organized rhythm without a pulse that is not VF or pVT. That single definition answers a surprising share of rhythm questions. On the shockable branch you shock, resume compressions immediately, give epinephrine 1 mg every 3 to 5 minutes, and add amiodarone at 300 mg for the first dose and 150 mg for the second, with lidocaine as the alternative. On the non-shockable branch you give epinephrine 1 mg every 3 to 5 minutes and hunt reversible causes. For a patient with a pulse the fork is different and simpler: stable or unstable. Unstable means poor blood pressure and poor mentation, and it moves you to electricity. Unstable tachycardia gets immediate synchronized cardioversion. Symptomatic bradycardia gets atropine 1 mg every 3 to 5 minutes to a maximum total of 3 mg, then pacing or an infusion if atropine fails. Stable means you have time, so you get a 12-lead and expert consultation, and stable narrow-complex tachycardia gets adenosine, 6 mg first and 12 mg second.

One of the three sections of the Precourse Self-Assessment is rhythm recognition, and it is the section people fail. The reason is that reading a rhythm strip is a pattern skill built by volume, not a fact you can revise the night before. The list you are responsible for is finite and short, which is the good news. On the tachycardia side: sinus tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, monomorphic ventricular tachycardia and polymorphic ventricular tachycardia. On the bradycardia side: sinus bradycardia, first degree heart block, second degree heart block type 1, second degree type 2, and third degree block. In cardiac arrest: ventricular fibrillation, pulseless VT, asystole and PEA. That is roughly fifteen patterns. Work them as pairs that are easy to confuse rather than as a list. Atrial fibrillation against atrial flutter is irregularly irregular with no discernible P waves against the sawtooth pattern with a regular ventricular response. SVT against sinus tachycardia is usually a rate question at the extremes and a P wave question in the middle. Second degree type 1 against type 2 is the PR interval lengthening progressively before a dropped beat, against a fixed PR interval with beats dropped without warning. Third degree is the one where the P waves and the QRS complexes are each regular but have nothing to do with each other. Get those four pairs right and the rest of the list falls out.

Fifty multiple-choice questions on the ACLS Provider written exam, with 42 correct required. The honest answer on difficulty is that the written exam is not the hard part for most candidates, and treating it as the hard part is what causes trouble. It is open resource, the question style is direct, and a nurse or paramedic who works the algorithms for a few hours passes it comfortably. What catches people is the Megacode, the in-person skills test where you take the team leader role through a simulated resuscitation and are assessed on whether you actually ran it: whether you assigned roles, whether compressions started fast and stayed deep enough with short interruptions, whether you called for the right drug at the right point, whether you used closed-loop communication, and whether you identified the reversible cause. The AHA describes the effective team behaviors explicitly and they are testable: clear roles and responsibilities, knowing your own limitations, constructive intervention when someone is about to make an error, knowledge sharing, summarizing and re-evaluating, closed-loop communication where the order is repeated back, and mutual respect. The team roles are named too: team leader, compressor, airway, medications, monitor and defibrillator, recorder and timer, and the CPR coach whose specific job is keeping compression quality high. Practice saying the algorithm out loud, as instructions to other people, rather than reading it silently. That is the actual skill being assessed.

Usually yes, and increasingly so, but this is the one question you should confirm with your own employer before you pay for anything. There are two national providers of advanced resuscitation training in the United States. The American Heart Association calls its course Advanced Cardiovascular Life Support, or ACLS. The American Red Cross calls its equivalent Advanced Life Support, or ALS, and states plainly on its own page that ALS is often used interchangeably with the term ACLS, describing its program as scientifically equivalent to and educationally superior to the alternative. Both issue a two-year certification. Both require BLS proficiency as the only hard prerequisite. Both are delivered as classroom or blended learning, where an online course is followed by an in-person skills session with a certified instructor. The differences that matter in practice are structural rather than clinical. Red Cross builds adaptive learning into its online component, so a provider who demonstrates competency can test out of individual sessions and finish faster. It also splits renewal into two named routes: a Recertification Option with a brief in-person skills review before testing, and a Challenge Option that takes an experienced provider straight to the skills test. The AHA equivalent for experienced providers is the separate ACLS for Experienced Providers course, which covers cardiovascular, respiratory and metabolic, and toxicology emergencies plus post-cardiac arrest care. Where employers still specify AHA, it is usually contractual language written years ago rather than a clinical judgment, but it binds you all the same. Ask before you book.

The AHA publishes the content list, and it is short enough to use as a study checklist. The ACLS course covers the systematic approach to assessment, high-quality BLS, airway management, rhythm recognition, defibrillation, intravenous and intraosseous access as information only rather than a tested skill, use of medications, cardioversion, transcutaneous pacing, and high-performance teams. Read the IV and IO line carefully, because it settles a common worry: you are not going to be assessed on cannulating anything, so a candidate who is out of practice at access does not need to solve that before the course. What you are assessed on is knowing which drug, when, and by what route. The course is built explicitly on top of BLS rather than repeating it, which is why BLS proficiency is a prerequisite and why compression quality still shows up in the Megacode assessment. Two ACLS course paths exist. The standard ACLS Provider course is written for healthcare professionals who direct or participate in the management of cardiac arrest, stroke and other cardiopulmonary emergencies, which the AHA lists as emergency response, emergency medicine, critical care and intensive care, and surgery personnel, along with anyone who needs the card for a job requirement. ACLS for Experienced Providers is a different course for people already proficient in ACLS skills, ECG interpretation and ACLS pharmacology who regularly lead resuscitations, and it goes deeper into cardiovascular, respiratory, metabolic and toxicology emergencies and post-cardiac arrest care.

ACLS is not only cardiac arrest, and the sections that are not arrest tend to be tested with a specific number attached, which makes them cheap marks. For acute coronary syndrome, the presentation to know is a pale, cool, diaphoretic patient with chest pain, dyspnea, anxiety, hypotension and poor perfusion. Aspirin is 162 to 325 mg. The reperfusion target is percutaneous coronary intervention within 90 minutes of arrival at the emergency department. For suspected stroke, the number is a noncontrast head CT within 20 minutes of hospital arrival, and the purpose of getting it early is to rule out hemorrhagic stroke, because the treatments diverge completely from that point: ischemic stroke gets fibrinolytic therapy as soon as possible if there are no contraindications, while hemorrhagic stroke gets a neurosurgical consult. Notifying the receiving hospital in advance is part of the answer to a lot of stroke scenario questions, not an optional courtesy. After return of spontaneous circulation, the post-arrest sequence has four steps in order: optimize ventilation and oxygenation, treat hypotension where systolic blood pressure is under 90 mmHg, go to the cath lab if there is a STEMI, and begin targeted temperature management at 32 to 36 degrees Celsius for at least 24 hours if the patient cannot follow commands. That last condition is the one candidates drop. Targeted temperature management is indicated for the patient who does not follow commands after ROSC, not for every resuscitated patient.

A handful of monitoring facts come up repeatedly in both the written exam and the Megacode debrief, and they are the ones that separate a candidate who has memorized an algorithm from one who can run a code. Waveform capnography is the most reliable method of confirming and monitoring endotracheal tube placement, and it does double duty: an end-tidal CO2 under 10 mmHg in an intubated patient indicates that compressions are not effective, so it is a real-time quality measure rather than just an airway check. Compression standard is at least 2 inches deep at 100 to 120 per minute with full recoil between compressions, interruptions kept under 10 seconds, and compressors swapped every 2 minutes because quality falls off measurably before fatigue is felt. Ventilation without an advanced airway runs at 30 compressions to 2 breaths; once an endotracheal tube is in, compressions become continuous and you give one breath every 6 seconds. Rescue breathing for a patient who has a pulse but is not breathing adequately is also one breath every 6 seconds, each delivered gently over 1 second to visible chest rise. Excessive ventilation is a genuine harm rather than a technicality, because it raises intrathoracic pressure and reduces cardiac output. Two defibrillation habits are worth building deliberately: continue compressions while the defibrillator charges, and charge before the rhythm check rather than after it. Pre-charging roughly 15 seconds before a planned rhythm check measurably raises the chest compression fraction, which is the single number most closely tied to survival.

Practice questions in ACLS have a specific job, and it is not predicting your score. On the Precourse Self-Assessment you can retake until you pass, so the score is close to meaningless as a target; what the assessment is genuinely good for is telling you which of the three sections is weak. If you clear pharmacology and practical application easily and scrape rhythm recognition, you have learned the most useful thing the test can tell you, and the correct response is a week of strip reading rather than another pass through the drug list. Grade yourself honestly on method, not just outcome. A question you answered correctly by eliminating two options and guessing between the remaining pair is not knowledge, and it will not survive a rephrased item. Mark it wrong in your own review and come back to it. Practice under the constraint you will actually face, which for the written exam means with the manual available. If you never practice with the reference, you will not have built the index you need to use it quickly, and hunting for a dose in a manual you have not tabbed costs more time than the eight-question margin allows. Finally, rehearse out loud. The Megacode assesses whether you can direct a team, and reading an algorithm silently trains a different skill from saying the words in the right order to another person under pressure. Practice questions build the knowledge, but only spoken rehearsal builds the performance the skills test measures.