If you’re prepping for the ACLS final test, two things are probably true:
One, you’re tired.
Two, your brain is stuffed with algorithms, drug names, and rhythms that look like alien codes.
Don’t sweat. Been there. That last-minute cramming, the deep sigh after misreading a strip, the caffeine-powered all-nighter — yep, welcome to the club.
But let’s flip it. This isn’t about panic. This is your cheat sheet, your final pre-game huddle, your deep breath before go-time.
We’re breaking down the ACLS final test questions and answers — not just the what, but the why, and in a way that sticks.
Let’s run it like a code.
1. Communication is Life (Literally)
You tell your teammate, “Give 1 mg Atropine IV.”
What should they say? “I’ll draw up 1 mg of Atropine.” Closed-loop. Done.
Why? Because clear talk avoids dead talk. That feedback loop prevents screwups. No assumptions, no “I thought you meant…” situations. Just clarity. It saves lives in real codes and points on your test.
2. Know What Kills… and What Helps
Too much ventilation? Bad news. It drops cardiac output.
Think of it like overfilling a tire. More isn’t always better.
Interruptions in chest compressions? Max allowed? 10 seconds. That’s it.
And want a hack? Charge the defibrillator while still doing CPR. Don’t stop until you have to. That rhythm is precious.
3. Know the Rhythms Like You Know Your Netflix Password
Monomorphic VTach? Easy — all those QRSs look the same.
Third-degree block? P waves and QRSs are doing their own thing, not talking.
Second-degree Type I vs Type II?
- Type I = gets slower then drops.
- Type II = constant PR intervals, but some P waves don’t get through.
And if you see ventricular fibrillation? Shock it. If it doesn’t go away, give epinephrine 1 mg, then amiodarone 300 mg if it still doesn’t fix it.
Simple rule: Fast and unstable? Cardioversion. Pulseless? Defibrillation.
4. Stroke? Time is Brain.
You’ve got 25 minutes from hospital arrival to do a noncontrast CT scan. That scan rules out bleeding before you give meds.
If it’s ischemic and no contraindications? Start fibrinolytic therapy ASAP. Every minute matters — 2 million neurons die every 60 seconds during a stroke. Let that sink in.
5. Chest Pain? Think Fast. Move Faster.
A patient shows up with chest pain — maybe sweaty, pale, pressure in the chest. Don’t wait around.
- First step? 12-lead ECG.
- Goal? Door-to-balloon in 90 minutes max for PCI.
And yes, give aspirin: 160 to 325 mg orally. That’s standard. Unless they’re allergic, it’s going down.
6. Leadership Isn’t Optional
In the middle of a code, someone messes up? Call it out immediately — respectfully but clearly. That hesitation could cost time or worse.
And if someone’s assigned something out of their scope? They speak up. They ask for a new role. That’s solid teamwork.
Switch up compressors every 2 minutes. CPR is brutal work. Fresh arms = better compressions = better chances.
7. Airway and Breathing Basics Still Matter
Don’t overthink OPA sizing: corner of the mouth to the angle of the jaw.
Bagging a patient with a pulse? Go slow — 1 breath every 5 to 6 seconds.
Want to confirm your tube’s in? Best bet: waveform capnography. That square wave is gold. Plus, PETCO2 tells you how good compressions are. If it’s under 10 mmHg, you need better compressions.
8. The Post-Code Game
ROSC? Congrats. You made it through the storm — but you’re not done.
- If they can’t follow commands: Targeted Temperature Management (TTM).
Keep it at 32–36°C, for at least 24 hours. - Keep systolic BP at or above 90 mmHg.
- Keep oxygen sat above 94% — apply O₂ if it’s lower.
And always send them to a coronary reperfusion-capable center.
9. Tachy Stuff and When to Zap
- Stable narrow-complex tachycardia and adenosine didn’t work? Go up to 12 mg next.
- Unstable SVT? Cardioversion.
- Super fast heart (like 190 bpm) + low BP? Assume unstable SVT — time to zap, synchronized.
10. One More Thing — BLS is Always the Foundation
In a noisy room, double-check all verbal orders.
You think you heard “500 mg of amiodarone”? Confirm it. Don’t guess.
Pulse check? 5 to 10 seconds, max. No more standing around like you’re waiting for a sign from the heavens.
And remember: if your patient becomes pulseless and apneic, and the rhythm looks shockable? Defibrillation comes first.
Quick-Fire Recap (Because That’s How We Learn)
- Closed-loop communication saves lives and test scores.
- Don’t over-ventilate — it kills output.
- CPR interruptions? Max 10 sec.
- STEMI? Door-to-balloon ≤90 min.
- Stroke? CT in ≤25 min, start fibrinolytics ASAP.
- VFib? Shock → Epi 1mg → Amio 300mg.
- Waveform capnography = your friend.
- ROSC but unresponsive? Start TTM.
- Don’t let adrenaline ruin technique.