PALS Bundled Exams Questions and Answers with Complete Solutions(All Graded A+)

PALS- Pediatric Advanced Life Support
Questions and Answers Already Passed
The PALS systemic approach algorithm begins with the initial impression. This is an assessment
of which 3 characteristics? Correct Answer-1. Consciousness

2. Breathing
3. Color
   The right branch of the systemic approach algorithm focuses on what sequence to prevent
   cardiopulmonary arrest? Correct Answer-Evaluate, Identify, Intervene
   The evaluate portion of the sequence consists of three assessment tools: Correct Answer-1.
   Primary
4. Secondary
5. Diagnostic
   What is included in the primary assessment of a patient? Correct Answer-A
   B
   C
   D
   E
   Vitals
   What is included in the secondary assessment of a patient? Correct Answer-Focused history and
   a focused physical exam
   The initial impression of the PALS systematic approach algorithm includes which of the
   following characteristics? (Choose all correct answers.)
6. Appearance
7. Breathing
8. Restlessness
9. Color
10. Pain Correct Answer-1, 2, 4
    The second box of the PALS systematic approach algorithm contains a question. (Fill in the
    blank to complete the question.)
    Is the child __ or is immediate intervention needed? Correct Answer-unresponsive
    In the PALS systematic approach algorithm, if the child is determined to be unresponsive or
    immediate intervention is needed what will be your next step?
11. Start CPR
12. Apply breathing with a bag valve mask
13. Activate emergency response
14. Check for a pulse Correct Answer-3.
    After the emergency response is activated, the next intervention is to __.
15. Lightly shake the child’s shoulders.
16. Look, listen, and feel.
17. Open the airway.
18. Check for breathing and a pulse Correct Answer-4.
    After it is determined that the child has no pulse, what should be done?
19. Call for help
20. Begin CPR
21. Provide 2 rescue breaths
22. Start an IV Correct Answer-2.
    A child is unresponsive and is not breathing. You have activated the emergency response system
    and your pulse check reveals that the child has a pulse. What should you do now?
23. Perform a brief head to toe assessment.
24. Place the child in the recovery position.
    

PALS – Written Test and Case Study
Review Material Latest Updated 2022
CPR Sequence Correct Answer-C-A-B
Circulation-Airway-Breathing
Core Case Action Order
(A,I,I) Correct Answer-Assess
Identify
Intervene
CBC
(Assessment part 1 aka initial assessment) Correct Answer-Consciousness
Breathing
Color
ABCDE
(Assessment part 2 aka primary assessment) Correct Answer-Airway
Breathing
Circulation
Disability
Exposure
SAMPLE
(Assessment part 3) Correct Answer-S/Sx
Allergies
Medications
Past medical hx
Last meal/drink
Events leading to situation

Reversible Causes of Pediatric Cardiac Arrest (H&T’s)
6 H’s
(G,K,T,V,X,DRO) Correct Answer-1. Hypo-Glycemia

2. Hypo/hyper-Kalemia
3. Hypo-Thermia
4. Hypo-Volemia
5. Hypo-Xia
6. HyDROgen ion (acidosis)
   Reversible Causes of Pediatric Cardiac Arrest (H&T’s)
   5 T’s
   (A,E,HC,HP,O) Correct Answer-1. Tamponade, cardiac
7. Tension pneumothorax
8. Thrombosis, coronary
9. Thrombosis, pulmonary
10. Toxins
    UAO: Presentation, Causes, TX Correct Answer-Stridor on inspiration, High pitched inspiration
    (Anaphylaxis, Croup, Foreign Body)
    Humid Oxygen, Neb Epi, Removal
    Croup presentation Tx Correct Answer-O2
    Racemic epinephrine (0.25mg/kg)
    Humidified epi (0.5 ml/kg/3cc’s NS
    Core Case Resp 1: UAO (Anaphylaxis) Correct Answer-Open airway
    Admin O2 100% non-rebreather, re-assess
    AED, Vitals (cardiac rhythm = sinus tachy)
    S/sx of UAO, resp distress
    TX: Epi IM, Steroids, CPAP
    

PALS RED CROSS FINAL EXAM
QUESTIONS AND ANSWERS ALREADY
PASSED
A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory
distress. The child is breathing spontaneously and receiving supplemental oxygen. Which
additional intervention is a critical component of airway management for this patient? Correct
Answer-Airway clearance (e.g., suctioning)
A child being cared for in the pediatric telemetry unit suddenly displays the following ECG
waveform. The provider prepares to intervene because the child is demonstrating which type of
arrhythmia? Correct Answer-Supraventricular tachycardia
A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of
post-cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is
experiencing a systemic response to ischemia/reperfusion. The team bases this determination on
which finding(s)? Correct Answer-Hypotension, fever, hyperglycemia
An 11-year-old soccer player is brought to the emergency department. After a quick assessment,
the team realizes this patient is experiencing a severe asthma exacerbation. Which medication
would the team administer immediately? Correct Answer-Albuterol with or without ipratropium
bromide
After ROSC, a child is experiencing post-cardiac arrest hypoperfusion. The PALS resuscitation
team would administer which element to restore intravascular volume and optimize preload?
Correct Answer-Isotonic fluid boluses
A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest.
When preparing to administer medications, which action would be appropriate for the team to
take? Correct Answer-Estimate weight using a length-based resuscitation tape.

A 4-year-old child is brought to the emergency department by the parents. Assessment reveals
that the child has only gasping respirations and the pulse rate is 65 beats per minute. Which
action would the provider initiate first? Correct Answer-Deliver 1 BVM ventilation every 2 to 3
seconds.
The PALS team leader is conducting a debriefing session with the team. Which topic(s) would
the team leader most likely address during the session? Correct Answer-Discussion of the pros
and cons of the interventions
Evaluation of the objective data gathered during the event, Summary of the event, including what
actions were taken, Identification of ways to improve
The PALS resuscitation team notes the following ECG waveform and the child does not have a
pulse. The team prepares to intervene to address which arrhythmia? Correct Answer-Torsades de
pointes
What is the correct IV/IO dose of epinephrine for a pediatric patient in cardiac arrest? Correct
Answer-0.01 mg/kg every 3 to 5 min (max single dose 1 mg)
Assessment of a 3-month-old infant admitted with respiratory distress reveals fever, grunting and
a wet, “junky” cough. The infant’s parents said the child had a recent respiratory infection with a
fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the
provider most likely suspect as the cause? Correct Answer-Bronchiolitis
A child is experiencing supraventricular tachycardia (SVT) with adequate perfusion and is to
receive treatment. Which initial treatment would the provider administer? Correct Answer-Vagal
maneuvers
A healthcare provider notices petechiae on the arms and legs while performing a rapid skin
assessment of a child with a high fever and respiratory distress. Based on this assessment, which
condition should the provider consider? Correct Answer-Life-threatening systemic infection

PALS – Red Cross Final Exam 2021
Already Passed
Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic,
tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of
oxygen delivery? Correct Answer-Lactate
A provider is forming an initial impression of a child using the Pediatric Assessment Triangle
(PAT). During which step of the PAT may the provider use the mnemonic TICLS to assess the
patient? Correct Answer-Appearance
A child being cared for in the pediatric telemetry unit suddenly displays the following ECG
waveform. The provider prepares to intervene because the child is demonstrating which type of
arrhythmia? Correct Answer-Supraventricular tachycardia
A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest.
When preparing to administer medications, which action would be appropriate for the team to
take? Correct Answer-Estimate weight using a length-based resuscitation tape.
A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory
rate and a low O2 saturation level. The provider interprets these findings as indicating which
condition? Correct Answer-Respiratory failure
A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory
distress. The child is breathing spontaneously and receiving supplemental oxygen. Which
additional intervention is a critical component of airway management for this patient? Correct
Answer-Airway clearance
An 8-year-old child being treated in the emergency department has significant respiratory
distress. The child also exhibits hives, wheezing, angioedema, tachycardia and tachypnea. The

parents state that the child, who is allergic to peanuts, had eaten some popcorn that had peanuts
in it. The team initiates care, preparing to administer which agent first? Correct AnswerEpinephrine
A 12-lead ECG is ordered for a child complaining of a “racing heart.” When placing the
electrodes on the child, at which location would the lead for V4 be placed? Correct Answer-Fifth
intercostal space at midclavicular line, left side
A 10-year-old child has collapsed in the gym of the elementary school. The school nurse arrives
and determines that the child is unresponsive. The school nurse then simultaneously checks for
breathing and a central pulse, limiting this assessment to which time frame? Correct Answer-At
least 5 seconds, but no more than 10
A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the
provider administer? Correct Answer-1. Racemic epinephrine

2. Corticosteroids
   A child is experiencing shock. The emergency response team prepares for imminent cardiac
   arrest when assessment reveals which finding(s)? Correct Answer-1. Bradycardia
3. Diminished central pulses
4. Hypotension
   A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For
   which rhythm(s) would this action be appropriate? Correct Answer-1. Ventricular fibrillation
   (VF)
5. Pulseless ventricular tachycardia (pVT)
   A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment.
   Which initial treatment would the provider administer? Correct Answer-Vagal maneuvers
   

AHA PALS Practice exam Questions and
Answers Rated A

1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The
   primary assessment reveals that the airway is open and the respiratory rate is 30/min, with
   crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min.
   The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the
   basis of this information, which of the following provides the best interpretation of the oxygen
   saturation of 95% by pulse oximetry?
   A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be
   administered
   C. Unreliable; no supplementary oxygen is indicated
   D. Unreliable; supplementary oxygen should be administered Correct Answer-Unreliable;
   supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with
   chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min,
   respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less than 2
   seconds. What is the child’s most likely condition?
   A. Septic shock
   B. Hypovolemic shock
   C. Significant bradycardia
   D. Cardiogenic shock Correct Answer-Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is
   55/40 mm Hg. What term describes this infant’s blood pressure?
   A. Hypotensive
   B. Normal
   C. Hypertensive
   D. Compensated Correct Answer-Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1
   mg/kg to be given 10. What should the team member do?
   A. Administer the drug as ordered
   B. Administer 0.01 mg/kg of epinephrine
   C. Respectfully ask the team leader to clarify the dose
   D. Refuse to administer the drug Correct Answer-Respectfully ask the team leader to clarify the
   dose
5. Which of the following is a characteristic of respiratory failure?
   A. Inadequate oxygenation and/or ventilation
   B. Hypotension
   C. An increase in serum pH (alkalosis)
   D. Abnormal respiratory sounds Correct Answer-Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
   A. Disordered control of breathing
   B. Hypovolemic shock
   C. Lower airway obstruction
   D. Upper airway obstruction Correct Answer-Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a
   few minutes ago. Which of the following most likely to be abnormal?
   A. Vascular resistance
   B. Pulse rate
   C. Lung compliance
   D. Control of breathing Correct Answer-Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory distress caused
   by lung tissue disease?
   A. Decreased oxygen saturation

B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort Correct Answer-Decreased oxygen saturation

9. An alert 2-year-old child with an increased work of breathing and pink color is being
   evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this
   patient’s condition? A. Respiratory distress
   B. Respiratory arrest
   C. Respiratory failure
   D. Disordered control of breathing Correct Answer-Respiratory distress
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has
    been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the
    following: The child is difficult to arouse, with pale color. The child’s heart rate is 160/min,
    respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds,
    and temperature is 103°F (39.4°C). What is the most appropriate intervention?
    A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
    B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
    C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an
    oncologist to determine the chemotherapeutic regimen Correct Answer-Obtain vascular access
    and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals
    an unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min,
    respiratory rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6
    seconds, and temperature is 102°F (38.9°C). What is the best method of establishing immediate
    vascular access? A. Two providers may attempt peripheral vascular access twice each
    B. Three providers may attempt peripheral vascular access once each
    C. Place a central venous line
    D. Place an intraosseous line Correct Answer-Place an intraosseous line

PALS Updated FINAL EXAM QUESTONS
AND ANSWERS WITH COMPLETE
SOLUTIONS
A 12-year-old child being evaluated in the pediatric intensive care unit displays the following
ECG waveform. The team interprets this as which arrhythmia? Correct Answer-second degree
Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic,
tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of
oxygen delivery? Correct Answer-Lactate
A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory
rate and a low O2 saturation level. The provider interprets these findings as indicating which
condition? Correct Answer-Respiratory failure
A 4-year-old child is brought to the emergency department by the parents. Assessment reveals
that the child has only gasping respirations and the pulse rate is 65 beats per minute. Which
action would the provider initiate first? Correct Answer-Deliver 1 BVM ventilation every 3 to 5
seconds.
A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with
Lyme disease 2 months ago. A rhythm strip is obtained as shown below. The provider interprets
this rhythm as indicating which arrhythmia? Correct Answer-First-degree atrioventricular (AV)
block
A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of
post-cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is
experiencing a systemic response to ischemia/reperfusion. The team bases this determination on
which finding(s)? Correct Answer-Hypotension

Fever
Hyperglycemia
A 2-year-old child arrives at the emergency department with the parents. The child is
unresponsive, is not breathing and has no pulse. Two emergency department providers begin
high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR? Correct
Answer-Allowing the chest to recoil fully after each compression
Providing ventilations that last about 1 second each
Compressing the chest about 2 inches
Giving 2 ventilations to every 15 compressions
A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For
which rhythm(s) would this action be appropriate? Correct Answer-VF and pVT are shockable
cardiac arrest rhythms.
A provider is assessing a child with suspected shock. Which statement correctly describes
hypotension and shock? Correct Answer-Hypotension is not a consistent feature of shock;
A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals
difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal
cannula with the goal of improving the child’s oxygen saturation above what percentage? Correct
Answer-Supplemental oxygen should be administered as needed to maintain an oxygen
saturation above 94%.
An 11-year-old soccer player is brought to the emergency department. After a quick assessment,
the team realizes this patient is experiencing a severe asthma exacerbation. Which medication
would the team administer first? Correct Answer-Albuterol plus ipratropium bromid

PALS Questions and Answers Latest
Updated 2022 Rated A
Ratio of compressions to ventilations for two rescuer CPR on infant or child? Correct Answer15:2
Pedi SBP HOTN formula for ages 1-10? Correct Answer-70 + (2x age in years)
Hypoglycemia infant? Correct Answer-<60 mg/dl
Hypoglycemia Neonate? Correct Answer-<45 mg/dl
HOTN SBP Infant? Correct Answer-70 mm hg
HOTN SBP Neonate? Correct Answer-60 mm hg
Uncuffed tube size formula Correct Answer-Age in years / 4+4
Possible/Probable rate issue in infants Correct Answer-220 bpm
Possible/ Probable rate issue Child Correct Answer-180 bpm
PEDI Sync Cardioversion Dosage Correct Answer-First dose 0.5 – 1 J/KG.
Subsequent dosage is 2 J/KG
PEDI Defib Dosage Correct Answer-First is 2 j/kg.
Second is 4j/kg
Subsequent dosage is 8 j/kg
Sudden deterioration in an intubate patient Correct Answer-DOPE

PALS Questions and Answers with
Complete Solutions Latest Updated
2022; Already Passed
You are caring for a child who was resuscitated after a drowning event. The child is intubated
and ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart
rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal
pulses are not palpable and the central pulses are weak. Intravenous access has been established.
The core temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the
following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion Correct Answer-Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min).
The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not
palpable. Which of the following would be the best treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg Correct Answer-Provide synchronized
cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While administering
high-flow oxygen you determine that the child’s respirations are adequate and SpO2 is 100%.
You have just established vascular access and obtained blood samples. Which of the following is
the next most appropriate therapy to support systemic perfusion?

Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion Correct Answer-Administer repeated fluid boluses of
isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion.
You attempted synchronized cardioversion without success. While seeking expert consultation, it
would be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock Correct Answer-Consider possible metabolic and toxicologic
causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical
ventilation. The child’s heart rate suddenly drops to 40/min and his color becomes mottled. You
should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen Correct Answer-Using a
resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated
high-flow oxygen using a nonrebreathing mask about 10 minutes ago and established
intravenous access. Initially the infant’s heart rate was in the 150/min range with strong pulses.
Suddenly the infant’s respiratory rate falls to 6/min with significant intercostals retractions, and

little air movement is heard. The infant becomes cyanotic and the heart rate decreases to 95/min.
Which of the following treatments would be best for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate Correct Answer-Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify potentially
reversible metabolic and toxic causes during the attempted resuscitation of a young child in
cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas Correct Answer-Soliciting a history from the caregiver or family
You are caring for a patient who developed a tension pneumothorax after several hours of
positive-pressure ventilation. Which of the following would be the most appropriate site for
needle decompression?
Over the third rib at the midclavicular line
Under the eighth rib at the midaxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line Correct Answer-Over the third rib at the
midclavicular line
You attempted synchronized cardioversion for an infant with supraventricular tachycardia (SVT)
and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following
should you attempt now?

PALS PreTest Questions and Answers
Latest Updated 2022 Graded A+
You are called to help treat an infant with severe symptomatic bradycardia (heart rate 66/min)
associated with respiratory distress. The bradycardia persists despite establishment of an
effective airway, oxygenation, and ventilation. There is no heart block present. Which is the first
drug you should administer? Correct Answer-Epinephrine
Initial impression of a 2yo girl shows her to be alert with mild breathing difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory
sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room
air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Which is the most
appropriate initial intervention for this child? Correct Answer-Humidified oxygen as tolerated
You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest.
You delivered 2 unsynchronized shocks. A team member established IO access, so you give a
dose of epinephrine, 0.01 mg/kg IO. At the next rhythm check, persistent ventricular fibrillation
is present. You administer a 4 J/kg shock and resume CPR. Which drug and dose should be
administered next? Correct Answer-Amiodarone 5 mg/kg IO
Which statement is correct about the effects of epinephrine during attempted resuscitation?
Correct Answer-Epinephrine stimulates spontaneous contractions when asystole is present
A previously healthy infant with a history of vomiting and diarrhea is brought to the emergency
department by her parents. During your assessment, you find that the infant responds only to
painful stimulation. Correct Answer-Administer a bolus of isotonic crystalloid 20 ml/kg over 5-
20 minutes, and also give D25W 2-4 ml/kg IV

Which statement is correct about endotracheal drug administration during resuscitative efforts
for pediatric patients? Correct Answer-It is the least desirable route of administration
Which statement is correct about the use of calcium chloride in pediatric patients? Correct
Answer-Routine administration is not indicated during cardiac arrest
A 9yo boy is agitated and leaning forward on the bed in obvious respiratory distress. Correct
Answer-Albuterol
Which oxygen delivery system most reliably delivers a high (90% or greater) concentration of
inspired oxygen to a 7yo child? Correct Answer-Nonrebreathing face mask
Paramedics are called to the home of a 1yo child. Their initial assessment reveals a child who
responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the
abdomen, abdominal distention, and cyanosis Correct Answer-Rapid bolus of 20ml/kg of
isotonic crystalloid
A 7yo boy is found unresponsive, apneic, and pulseless. CPR is ongoing Correct AnswerIdentify and treat reversible causes
You are preparing to use a manual defibrillator in the pediatric setting. Which best describes
when it is appropriate to use the smaller, pediatric-sized paddles? Correct Answer-If the child
weighs less than 10kg or is less than 1 year old
What compression-to-ventilation ratio should be used for 2-rescuer infant CPR? Correct Answer15 compressions to 2 breaths
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout
for nearby help, but no one arrives. What action should you take next? Correct Answer-Provide
CPR for about 2 minutes before leaving to activate the emergency response system

PALS 2021 Questions and Answers with
Complete Solutions
10 seconds Correct Answer-A 6 month old infant is unresponsive. You begin checking for
breathing at the same time you check for the infants pulse. Which is the maximum time you
should spend when trying to simultaneously check for breathing and palpate the infants pulse
before starting CPR?
Disordered Control of Breathing Correct Answer-A 4 year old child is brought to the emergency
department for seizures. The seizures stopped a few minutes ago, but the child continues to have
slow and irregular respirations. Which condition is most consistent with your assessment?
blood glucose Correct Answer-An 8 year old child is brought to the emergency department with
a 2 day history of lethargy and polyuria. The child has new onset rapid, deep, and labored
breathing. Which diagnostic test should you order first?
Reposition the patient, and insert an oral airway Correct Answer-After rectal administration of
diazepam, an 8 year old boy with a history of seizures is no unresponsive to painful stimuli. His
respirations are shallow, at a rate of 10/min. His Oxygen saturation is 94% on 2L of NC oxygen.
On examination, the child is snoring with poor chest rise and poor air entry bilaterally. What
action should you take next?
Provide bag mask ventilation Correct Answer-After rectal administration of diazepam, an 8 year
old boy with a history of seizures is no unresponsive to painful stimuli. His respirations are
shallow, at a rate of 10/min. His Oxygen saturation is 94% on 2L of NC oxygen. On
examination, the child is snoring with poor chest rise and poor air entry bilaterally. After
repositioning the patient and you insert an Oral airway, the patient continues to deteriorate. What
next step is the most appropriate?

15:2 Correct Answer-A 6 year old child is found unresponsive, not breathing, and without a
pulse. one health care worker leaves to activate the emergency response system and get the
resuscitation equipment. You and another healthcare provider immediatly begin CPR. Which
compression to ventilation ratio do you use?
94%-99% Correct Answer-In post resuscitation management after cardiac arrest, extra care
should be taken to avoid repercussion injury. what should the ideal oxygen saturation range most
likely be?
“resume compressions” Correct Answer-A 3 year old child is in cardiac arrest, and high quality
CPR is in progress. You are the team leader. The first rhythm check reveals the rhythm shown
here. Defibrillation is attempted with a shock dose of 2 J/kg. after administration of the shock,
what should you say to you team members?
2-4 J/kg Correct Answer-A 4 year old child in cardiac arrest is brought to the emergency
department by ambulance. High quality CPR is being performed. The cardiac monitor displays
the rhythm strip shown here. The estimated weight of the child is 20 kg. What dose range should
you use for the initial defibrillation?
40 Joules Correct Answer-A 4 year old child in cardiac arrest is brought to the emergency
department by ambulance. High quality CPR is being performed. The cardiac monitor displays
the rhythm strip shown here. The estimated weight of the child is 20 kg. As the team leader, how
many joules do you tell your team member to use to perform initial Defib?
Allowing complete chest wall recoil after each compression Correct Answer-You are the team
leader during a pediatric resuscitation attempt. which action is an element of high quality CPR?
blood pressure Correct Answer-You are caring for a 3 month old boy with a 2 day history of
fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is
190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and
shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he

PALS Test Questions and Answers
Latest 2022 Already Passed
Chest Compression depth: Infant Correct Answer-1.5 inch or 4 cm (1/3 AP Diameter)
Chest Compression depth: Child Correct Answer-2 inches or 5 cm (1/3 AP Diameter)
Maximum Compression depth: Infant Correct Answer-2.4 in or 6cm
Infant/children/adolescent compression rate Correct Answer-100-120 compressions a minute
Ratio for single rescuer Correct Answer-30 compressions 2 breaths
Ratio for 2 rescuer Correct Answer-15 compressions 2 breaths
Rate of rescue breathing Correct Answer-1 breath every 6-8 seconds or 8-10 breaths/min
Isotonic Crystalloids 2 examples Correct Answer-NS & Lactated Ringers
Fluid challenge is how much (in hypotension)? Correct Answer-20mL/kg (18kg gets 260 mL)
BP parameters for PALS (minimum systolic in 4 age groups) Correct Answer-0-1month old=
min 60 systolic
1 month-1 year= min 70 systolic
1 year-10 year= min 70+(2xage) systolic
over 10 years= min 90 systolic
Atropine dose pre-intubation Correct Answer-Atropine 0.02 mg/kg

PALS version A
You are caring for a child who was resuscitated after a drowning event. The child is intubated
and ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart
rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal
pulses are not palpable and the central pulses are weak. Intravenous access has been established.
The core temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the
following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion Correct Answer-Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min).
The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not
palpable. Which of the following would be the best treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg Correct Answer-Provide synchronized
cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While administering
high-flow oxygen you determine that the child’s respirations are adequate and SpO2 is 100%.
You have just established vascular access and obtained blood samples. Which of the following is
the next most appropriate therapy to support systemic perfusion?
Administer repeated fluid boluses of isotonic colloid

Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion Correct Answer-Administer repeated fluid boluses of
isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion.
You attempted synchronized cardioversion without success. While seeking expert consultation, it
would be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock Correct Answer-Consider possible metabolic and toxicologic
causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical
ventilation. The child’s heart rate suddenly drops to 40/min and his color becomes mottled. You
should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen Correct Answer-Using a
resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated
high-flow oxygen using a nonrebreathing mask about 10 minutes ago and established
intravenous access. Initially the infant’s heart rate was in the 150/min range with strong pulses.
Suddenly the infant’s respiratory rate falls to 6/min with significant intercostals retractions, and
little air movement is heard. The infant becomes cyanotic and the heart rate decreases to 95/min.
Which of the following treatments would be best for you to provide now?