ACLS Practice Test

ACLS Exam at a Glance

What changed for ACLS in 2026

• Oct 25, 2026: Validity changed to 2 years (previously Two years).^[3]

What the ACLS is and how it works

According to American Heart Association, “The exam has a minimum passing score of 84%.”^[1]

ACLS (Advanced Cardiovascular Life Support) is an American Heart Association course for healthcare providers who lead or join the care of cardiac arrest and related emergencies. The written exam is part of the Provider course. It is administered online and is open resource, so you may use your materials while you answer.

The Instructor-led Provider exam has 50 questions. The minimum passing score is 84%. The AHA does not mandate a time limit, but plan on roughly 1 to 2 minutes per question.

If you score below the passing mark, the next step depends on the result. A score between 73% and 83% is handled with oral remediation: the instructor has you verbally explain each item you missed. A score below 73% leads to the alternate exam.

Before an Instructor-led course, every student must complete the Precourse Self-Assessment and score at least 70%. The HeartCode ACLS blended option costs $178 for the online portion, and the hands-on session is sold separately.

After you meet all course requirements, you receive a Provider Course Completion Card that is valid for 2 years.

Details such as scheduling, the hands-on skills session and any extra requirements can vary by training center and employer. Confirm them with your instructor or the AHA at cpr.heart.org before you book.

Worked examples: how to reason through ACLS questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: After delivering a defibrillation shock, what should be done immediately?

1. Check the pulse and rhythm before resuming CPR
2. Resume CPR immediately, starting with chest compressions
3. Administer epinephrine before resuming CPR
4. Check the rhythm for 30 seconds to assess response

Answer: B. Resume CPR immediately, starting with chest compressions

Explanation:

Resuming CPR right away, starting with chest compressions, is correct. The heart often has no effective pumping right after a shock, so compressions keep blood moving to the brain and heart.

Checking the pulse and rhythm first (A) delays compressions. Giving epinephrine before CPR (C) gets the order wrong, because drugs are given during ongoing CPR cycles and never replace compressions. Watching the rhythm for 30 seconds (D) leaves the patient without perfusion for far too long.

Rule to remember: shock, then compressions straight away. The rhythm check comes at the next scheduled pause, not immediately after the shock.

Example 2

Question: Which finding on non-contrast CT head is an absolute contraindication to IV tPA in acute ischemic stroke?

1. Hyperdense MCA sign
2. Early ischemic changes in less than 1/3 of MCA territory
3. Hemorrhagic transformation
4. Loss of gray-white differentiation in basal ganglia

Answer: C. Hemorrhagic transformation

Explanation:

Hemorrhagic transformation means there is bleeding in the brain, and any intracranial hemorrhage on the non-contrast CT rules out IV tPA. That is why C is correct.

A hyperdense MCA sign (A) points to clot in the artery, which is the target of treatment, not a bleed. Early ischemic changes in less than 1/3 of the MCA territory (B) are not an absolute barrier. Loss of gray-white differentiation in the basal ganglia (D) is an ischemic change, not a hemorrhage, so it does not carry the same automatic exclusion.

Rule to remember: the CT is read first to exclude bleeding. Ischemic signs call for judgment, but blood on the scan stops thrombolysis.

Example 3

Question: Amiodarone 300 mg IV has been given for refractory VF. If VF persists, what is the correct supplemental dose?

1. 300 mg repeat dose
2. 150 mg once
3. 150 mg up to two additional doses
4. Amiodarone should not be repeated

Answer: B. 150 mg once

Explanation:

After an initial 300 mg dose of amiodarone for refractory VF, the supplemental dose is 150 mg given once. B is correct.

Repeating 300 mg (A) uses the initial dose again, which is not the recommended follow-up. Allowing 150 mg up to two additional doses (C) permits more than the single supplemental dose the algorithm describes. Saying amiodarone should not be repeated (D) is wrong, because a reduced second dose is part of the pathway for persistent VF.

Rule to remember: the larger dose goes in first, then one smaller supplemental dose. Keep giving high-quality CPR and shocks between drugs.

For a fuller set of questions on this topic, see our acls review algorithm free resource.

For a fuller set of questions on this topic, see our acls precourse self assessment test resource.

How to use these practice tests

Start with the official material. Finish the Precourse Self-Assessment and read the algorithms in your provider manual, so the practice questions have something to attach to.

Then take a short diagnostic set to see where you stand. A good place to begin is the ACLS Practice Test. Sort your misses into topics rather than just recording a score.

Work the weak topics one at a time. For rhythms, use Cardiac Rhythm Recognition until you can name a strip and its next step without hesitating. For drugs and shocks, use Emergency Pharmacology and Electrical Therapies and Defibrillation. For the algorithms themselves, practise Pulseless and Tachycardia and Bradycardia Algorithms. Cover Post-Cardiac Arrest Care, Acute Coronary Syndromes and Acute Stroke Care before test day.

After every wrong answer, open the manual to the matching page and write the rule in a sentence. Our questions are written by us, not taken from the real exam, so use them to build recall and not to predict exact wording. In the last days, repeat a mixed set and recheck only the items you still miss.

Sources & last verified

1. American Heart Association — number of questions, time limit, passing score, retake policy (official source). “The ACLS exam consists of 50 questions.” Verified Oct 25, 2026.
2. shopcpr.heart.org — exam fee (official source). “$178.00” Verified Oct 25, 2026.
3. American Heart Association — validity (official source). “Upon completion of all course requirements, participants receive a Provider Course Completion Card which is valid for two years.” Verified Oct 25, 2026.
4. American Heart Association — eligibility (official source). “All students must complete the Precourse Self-Assessment and achieve a score of at least 70% before taking the ACLS Course.” Verified Oct 25, 2026.

How we verify: editorial & fact-checking policy. Report an error: contact us.