Failed ACLS written exam twice - what am I missing in the algorithm sections?
So I've bombed the ACLS written component twice now. I scored a 72% both times, and passing is 84%, so I keep tripping on the H's and T's, drug dosing sequences for VF/VT, and when to switch between rhythms. I study about 2 hours a night for 3 weeks before each attempt and clearly that's not cutting it.
I've been an RN for 6 years on med-surg, so I don't run codes often and the algorithms don't stick the way they do for ICU nurses. I bought the AHA provider manual but reading it straight through feels useless. I retain maybe 40% of what I read without doing practice scenarios alongside it.
I've been using resources aligned with the acl 2025 format which helped with rhythm identification, but I'm still weak on pharmacology — epinephrine timing, amiodarone vs lidocaine, the whole push-and-resume sequence during CPR.
I have 5 weeks until my next attempt and I'm willing to put in 3 hours a day. Did you drill algorithms separately from pharmacology, or mix everything together?
Printed every AHA flowchart and taped them to my bathroom mirror for 3 weeks. By test day I could walk through pulseless VT vs VF without thinking. For pharmacology I made flashcards with exact dose and timing — 1mg epi every 3-5 min, 300mg amiodarone first dose. Don't try to memorize the full manual, just the decision points.
Failed the first attempt at 78% and passed the second at 91%. The difference was doing megacode scenarios out loud even when alone — verbalizing “checking pulse, no pulse, beginning CPR, charging to 200J” wired the sequence into my head. Also don't skip the BLS refresher beforehand thinking you already know the CPR ratios.
Med-surg background here and I passed first try studying 90 minutes every day for 6 weeks straight. The key was understanding WHY each drug is given at that point in the algorithm, not just memorizing the sequence. Once you understand mechanism it's way harder to forget under pressure during the megacode.
The rhythm strip section is where most people bleed points. Get a separate EKG rhythm app and do 20 strips a day for two weeks. By the time I sat the written exam I could identify SVT vs VT vs afib in under 5 seconds, which probably bumped my score 8-10%.