ACLS Pretest Tips: How to Prepare Without Cramming

ACLS Cards · Updated November 3, 2026 · Adult · 2025 guidelines · Clinical review pending

Most ACLS courses ask you to complete a precourse self-assessment (often called the "pretest") before class, and finish with a written test and a skills check. The pretest is there to show you what to review. Here's how to use it well. We don't publish or reproduce exam questions; this page is about how to study.

The three areas that matter

Rhythm recognition. If you can't name the rhythm, you can't pick the algorithm. Practice until VF, pulseless VT, asystole, PEA, sinus brady, the AV blocks, narrow-complex tachycardia, AF, flutter, monomorphic VT and torsades are instant.
Pharmacology. Which drug, which dose, which rhythm, and when not to give it.
Algorithm flow. The decision points in order: pulse or no pulse, shockable or not, stable or unstable, narrow or wide.

A 7-day plan

Day	Focus
1	Take the pretest cold. Don't look anything up. Write down every topic you guessed on.
2	High-quality CPR and the cardiac arrest algorithm. Say the 2-minute cycle out loud.
3	Rhythm strips: 20 minutes of mixed practice, then just your weak rhythms.
4	Bradycardia and tachycardia algorithms. Draw each from memory, then check.
5	Drugs: make your own flashcards from the numbers below.
6	Post-arrest care, ACS and stroke basics. Re-read your Day 1 weak list.
7	Mock megacode with a friend: one runs the case, one leads. Swap.

Numbers worth memorizing

CPR: 100–120 compressions/min^{pending review, ref C1}, at least 2 in (5 cm) deep, no more than 2.4 in (6 cm)^{pending review, ref C2}, pauses of 10 s or less^{pending review, ref C5}.
Epinephrine in arrest: 1 mg IV/IO every 3–5 min^{pending review, ref A1}.
Amiodarone in VF/pVT: 300 mg, then 150 mg^{pending review, ref A4}.
Atropine in bradycardia: 1 mg every 3–5 min, max 3 mg^{pending review, ref B2}.
Adenosine: 6 mg, then 12 mg^{pending review, ref T3}.
Post-arrest: SpO₂ 90–98%^{pending review, ref P1}, MAP 65 mm Hg or higher^{pending review, ref P3}.

Check that your study materials use these 2025 numbers. See what changed in 2025.

Common traps

Checking a pulse right after a shock. Current teaching: resume CPR immediately after a shock^{pending review, ref A9}.
Endotracheal drugs. No longer part of the guidelines^{pending review, ref A11}.
Synchronized vs unsynchronized. Pulseless rhythms and polymorphic VT get unsynchronized shocks.
Vasopressin. Not recommended in arrest^{pending review, ref A12}.
Atropine in asystole/PEA. It's a bradycardia drug, not an arrest drug.
Old numbers. A sheet that says 92–98%^{pending review, ref P1} for post-arrest SpO₂ is teaching the 2020 target.

On the day

In the megacode, talk out loud: name the rhythm, the algorithm and the next step. Use closed-loop communication with your team.
Assign roles early: compressor, airway, monitor/defibrillator, IV/drugs, recorder.
When stuck, go back to basics: is there a pulse, and is CPR good?
Name a reversible cause (the H's and T's) in every arrest case.

A cheat sheet is a study tool, not a substitute for the course: an ACLS provider card requires an approved course with hands-on skills testing.

Source: 2025 Guidelines for CPR and Emergency Cardiovascular Care (Circulation, October 2025), as summarized in the pack's source checklist. Original wording and layout; no guideline figures reproduced.