ACLS exam prep · 2025 Guidelines
ACLS exam prep, built on the 2025 AHA Guidelines
ACLS is the AHA Advanced Cardiovascular Life Support (ACLS) Provider Course, and passing it earns an AHA ACLS Provider course completion card (eCard) valid for 2 years. Walking in rusty is normal: turn the eight cards on this page and see which topic needs you first.
Eight cards: stroke, ACS, rhythms, drugs
In which of the following stroke patients would mechanical thrombectomy be contraindicated?
Explanation
Keyed answerC. Patient with a small vessel lacunar stroke
Your pick
Mechanical thrombectomy is indicated for large vessel occlusion strokes. A patient with a small vessel lacunar stroke would not benefit from mechanical thrombectomy as the occluded vessels are too small to be accessed with endovascular devices.
A 65-year-old patient with known atrial fibrillation presents with acute onset of right-sided weakness and aphasia. Last known well was 3 hours ago. Which medication is contraindicated in the acute management?
Explanation
Keyed answerA. Intravenous heparin
Your pick
Heparin is contraindicated in the acute management of ischemic stroke, particularly when IV thrombolytics may be administered. Anticoagulants like heparin significantly increase the risk of hemorrhagic transformation when given concurrently with or immediately after tPA.
What is the significance of ST-segment depression in leads V1-V3 with ST-segment elevation in lead aVR during an episode of chest pain?
Explanation
Keyed answerB. Suggests left main coronary artery or proximal LAD occlusion
Your pick
ST depression in V1-V3 with ST elevation in aVR during chest pain suggests left main coronary artery or proximal LAD occlusion, a critical finding indicating severe, potentially life-threatening ischemia requiring urgent intervention.
In the management of acute ischemic stroke, what is the target blood pressure before administering IV thrombolytics?
Explanation
Keyed answerD. <185/110 mmHg
Your pick
Before administering IV thrombolytics for acute ischemic stroke, the target blood pressure should be <185/110 mmHg to reduce the risk of hemorrhagic complications.
When preparing epinephrine for administration during cardiac arrest, what is the standard concentration used?
Explanation
Keyed answerB. 1:10,000 (0.1 mg/mL)
Your pick
The standard concentration of epinephrine used during cardiac arrest is 1:10,000 (0.1 mg/mL). This is typically provided in a 10 mL prefilled syringe containing 1 mg of epinephrine. Using standardized concentrations helps prevent dosing errors during resuscitation.
What is a serious adverse effect of prolonged ventricular tachycardia?
Explanation
Keyed answerC. Cardiac arrest
Your pick
Ventricular tachycardia, especially when prolonged, can lead to inadequate cardiac output and eventually result in cardiac arrest. This condition is life-threatening and requires immediate medical intervention.
A 67-year-old patient presents with syncope and is found to have a junctional rhythm at 38 bpm. Which of the following medications is most likely to cause this finding?
Explanation
Keyed answerA. Digoxin
Your pick
Digoxin toxicity is a common cause of junctional rhythm with bradycardia, especially in elderly patients. Digoxin can suppress the sinus node function and AV node conduction, leading to junctional escape rhythms. Other findings may include AV blocks and bidirectional ventricular tachycardia.
A 55-year-old patient presents with sudden onset of palpitations. ECG shows an irregular rhythm with narrow QRS complexes and no visible P waves at a rate of approximately 150 bpm. Which of the following is the most likely diagnosis?
Explanation
Keyed answerD. Atrial fibrillation
Your pick
An irregular rhythm with narrow QRS complexes and no visible P waves at a rate around 150 bpm is classic for atrial fibrillation. The irregularly irregular rhythm without discernible P waves is the hallmark ECG finding that distinguishes it from other tachyarrhythmias.
0%
Answer a few cards and come back to this one.
- ACS & strokenot yet
- Rhythms & drugsnot yet
Reread a low topic: Algorithms · Pretest
The thin line on each bar marks 84%, the written-exam pass mark AHA Training Centers usually quote; your instructor confirms the exact rule.
Pick an answer and the card turns over to the explanation. Keys: A to D or 1 to 4, arrows to move, F to turn the card.
The card
What ACLS is, and who runs it
ACLS stands for Advanced Cardiovascular Life Support: the AHA Advanced Cardiovascular Life Support (ACLS) Provider Course, written and run by the American Heart Association (AHA). It teaches a team to manage cardiac arrest and the emergencies around it, such as stroke, acute coronary syndromes and unstable heart rhythms, with one shared set of algorithms. You will also hear it called Advanced Cardiac Life Support, the course's name before 2010; the course behind both names is the same.
What you walk out with is an AHA ACLS Provider course completion card (eCard). It is a course completion card that employers and hospitals ask for, not a government license, and only an AHA Training Center or AHA instructor can issue the card. That is why searches for “AHA ACLS” or “American Heart Association ACLS” mostly lead to course listings: the card only comes from a class.
ACLS for nurses
The course is usually taken by physicians and residents, emergency, ICU, telemetry and OR nurses, paramedics, respiratory therapists, CRNAs, NPs, PAs and pharmacists. For nursing, the requirement tends to follow the unit, not the license: an ED, ICU or step-down job description names ACLS, a medical-surgical one often asks only for BLS. Nurses are often the first hands in an in-hospital code, so the parts that feel least familiar are usually the drug orders and the team-leader role in the Megacode, not the compressions. Walk through the Megacode as team leader.
3 parts
The three parts of the ACLS course
Every AHA ACLS course has the same three checkpoints: the precourse self-assessment, the skills tests (including the Megacode) and the written exam. Each one is practiced on its own page here, so you can go straight to the part that worries you.
| Part | What it checks | Practice it here |
|---|---|---|
| Precourse self-assessment | An online Precourse Self-Assessment that every student completes before class, in three sections: rhythm recognition, pharmacology and practical application. The line is 70%, and you can retake it until you reach the line. | 18-card precourse practice |
| Skills tests | A high-quality BLS (adult CPR and AED) skills test, an airway management skills test and the Megacode. In the Megacode, a simulated case in which you act as team leader, the algorithm has to come out of your mouth as orders. | Megacode practice cases |
| Written exam | Usually about 50 multiple-choice questions (as AHA Training Centers report it; confirm the count with yours), mostly short clinical cases. Pass mark: 84%, the figure Training Centers usually quote (your instructor confirms the exact rule). | 60-card practice test and the exam guide |
Every AHA ACLS path ends in a hands-on skills test, so there is no fully online AHA ACLS card. The online route, HeartCode, still finishes in a skills session; the exam guide explains both paths and how renewal works.
Start
Where to start
Most people arrive here a week or two before class with one question: what first? Two answers decide it.
Start here
- Is your precourse self-assessment done?
Not yet
- Take the precourse practice cards first: rhythms, drugs, practical cases.
- Missed strips? Reread the rhythm section.
Done
- Run the 60-card practice test once, untimed.
- Reread the topic you scored lowest in, starting from the algorithm flowcharts.
- Then a daily set of practice questions until class.
Every page on this site, by what it does
- ACLS algorithms: cardiac arrest, bradycardia, tachycardia, ACS, stroke and post-arrest care, drawn as flowcharts.
- The H's and T's: the reversible causes, and how a question stem hides them.
- ACLS practice questions: 48 more cards, sorted by topic.
- The ACLS study guide: topic weights, a 7-day plan and what to do with the provider manual.
- The ACLS exam guide: the written test, the skills tests and renewal.
The deck
Why these eight cards
The eight cards at the top are not a random sample. Four are acute coronary syndrome and stroke cards, four are rhythm and drug cards, because those are the two areas people tend to remember least from their last course: the reperfusion windows and blood-pressure rules on one side, the drug concentrations and the borderline strips on the other.
2025
Taught to the 2025 Guidelines
Everything on this site follows the 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care, published on October 22, 2025. The ACLS Provider Course was updated to the 2025 Guidelines when they were released, and instructors had to switch to the new materials by March 1, 2026. Any ACLS course you take now teaches and tests the 2025 version.
For most of the course, the changes are refinements rather than a new algorithm: IV before IO for drug access, a lower post-arrest oxygen floor, temperature control held longer after ROSC, and how to think about VF that keeps coming back after several shocks. The algorithms page marks each change where it sits.
FAQ
Questions people ask
Who needs an ACLS certification?
Usually physicians and residents, emergency, ICU, telemetry and OR nurses, paramedics, respiratory therapists, CRNAs, NPs, PAs and pharmacists. It is set by employers and hospital credentialing, not by law, so the job description or your unit manager is the place to confirm it.
Can I get my American Heart Association CPR card online?
Not entirely. The AHA BLS and ACLS courses both have an online part, but every AHA ACLS path ends in a hands-on skills test, so there is no fully online AHA ACLS card, and BLS works the same way. Sites that promise an instant online card issue their own card, not the AHA’s, so check with your employer before paying for one.
Can ACLS be taken online?
The theory can: HeartCode ACLS has an online part with simulated patient cases, then a hands-on skills session with an AHA instructor or a voice-assisted manikin. The card arrives after the skills session, from the Training Center that ran it.
Is the ACLS hard?
It is manageable, and the nerves are common even among people who run codes at work. The concepts rarely trip people; the drug orders and the rhythm strips do. Ten cards a day and a reread of your weakest topic close most of that gap within a week or two.
What is the ACLS precourse self-assessment?
It is an online Precourse Self-Assessment that every student completes before class. It covers rhythm recognition, pharmacology and practical application, you need 70% to attend the class, and you can retake it until you reach the line.
Pick one card, not the whole course
You do not need to relearn ACLS in one sitting. Start with the topic your eight cards flagged, give it twenty minutes, then come back for a fresh set.