AHA PALS Post-Test exam | Questions & Answers| Grade A| 100% Correct
(Verified Solutions)
Question 1
In which of the following clinical situations is the use of intraosseous (IO) access most
appropriate?
A) An extremity with slow capillary refill time
B) A stable child requiring routine fluid maintenance
C) When a child is alert and needs a blood draw for a CBC
D) When peripheral IV access cannot be established in an emergency
E) Only in children over the age of 8 years
Correct Answer: D) When peripheral IV access cannot be established in an emergency
Rationale: IO access is indicated in emergency situations (such as shock or cardiac arrest)
when peripheral intravenous (IV) access cannot be established quickly (typically within 90
seconds or 3 attempts). IO access allows for the rapid administration of fluids, blood
products, and medications. While slow capillary refill (Option A) indicates poor perfusion,
it is the inability to get an IV during an emergency that triggers the move to IO. It is not for
routine use or stable patients.
Question 2
A 2-week-old infant is being evaluated for irritability and poor feeding. His blood pressure is
55/40 mm Hg, and capillary refill time is 5 seconds. Which statement best describes the
assessment of this infant's blood pressure?
A) It is within the normal range for a neonate.
B) It represents compensated shock.
C) It is hypotensive.
D) It is hypertensive for this age group.
E) It is unreliable due to the infant's irritability.
Correct Answer: C) It is hypotensive.
Rationale: In a neonate (0 to 28 days old), a systolic blood pressure of less than 60 mm Hg is
defined as hypotension. This infant’s systolic pressure of 55 mm Hg, combined with a
delayed capillary refill of 5 seconds (normal is < 2 seconds), indicates decompensated
(hypotensive) shock. Immediate volume resuscitation is required to prevent cardiac arrest.
Question 3
A nurse is caring for several patients in the emergency department. Which of the following 2-
year-old children requires the most immediate intervention?
A) A child with a mild barky cough but no stridor at rest
B) A child who is grunting with each breath
C) A child with a heart rate of 110/min and pink skin
D) A child who is crying loudly for their parents
E) A child with a temperature of 101.5°F and a runny nose
, 2
Correct Answer: B) A child who is grunting
Rationale: Grunting is an ominous sign of severe respiratory distress or failure. It is
produced by exhaling against a partially closed glottis to maintain functional residual
capacity and prevent alveolar collapse (auto-PEEP). This indicates significant lung tissue
disease (parenchymal disease) or pulmonary edema and requires immediate respiratory
support and evaluation.
Question 4
A 3-year-old child is having difficulty breathing. Which of the following findings would most
likely lead a nurse to suspect an upper airway obstruction in this child?
A) Bilateral expiratory wheezing
B) Prolonged expiratory phase
C) Increased inspiratory effort with stridor and retractions
D) Productive cough with green sputum
E) Blood-streaked sputum and rales
Correct Answer: C) Increased inspiratory effort with stridor and retractions
Rationale: Upper airway obstructions (such as Croup, Epiglottitis, or foreign body
aspiration) typically interfere with the movement of air into the lungs. This results in
inspiratory stridor and increased effort during inhalation. Expiratory wheezing (Option A)
and a prolonged expiratory phase (Option B) are classic signs of lower airway obstruction,
such as asthma or bronchiolitis.
Question 5
A team member is unable to perform an assigned task during a resuscitation because it is beyond
the team member's scope of practice. What action should the team member take?
A) Attempt the task to avoid delaying the code
B) Wait until the code is over to mention the limitation
C) Ask for a new task or role immediately
D) Leave the room to find a manual for the task
E) Ask the team leader to explain the procedure while doing it
Correct Answer: C) Ask for a new task or role immediately
Rationale: Effective team dynamics include "Knowledge Sharing" and "Knowing Your
Limitations." If a task is outside a team member's scope or skill set, they must immediately
inform the Team Leader. This allows the Leader to reassign the task to a qualified person,
ensuring the patient’s safety and the efficiency of the resuscitation attempt.
Question 6
A nurse is acting as the Team Leader during a pediatric resuscitation attempt. Which action is an
essential element of high-quality CPR?
A) Compressing the chest at a rate of 80 to 90 per minute
B) Allowing complete chest wall recoil after each compression
, 3
C) Interrupting compressions for 20 seconds to check a rhythm
D) Providing as many breaths as possible per minute
E) Compressing the chest to 1/10th of the AP diameter
Correct Answer: B) Allowing complete chest wall recoil after each compression
Rationale: Complete chest recoil is vital because it allows the heart to refill with blood
(preload) between compressions. Leaning on the chest prevents this refilling and
significantly reduces the amount of blood circulated to the brain and vital organs. High-
quality CPR also requires a rate of 100-120/min, a depth of 1/3 the AP diameter, and
minimizing interruptions to less than 10 seconds.
Question 7
An 8-year-old child is brought to the emergency department with difficulty breathing. He has a
history of asthma and nut allergies and recently ate a cookie. What condition is most likely to be
present in this child?
A) Acute myocardial infarction
B) Upper airway obstruction (Anaphylaxis)
C) Diabetic ketoacidosis
D) Simple viral pneumonia
E) Tension pneumothorax
Correct Answer: B) Upper airway obstruction
Rationale: In a child with a known nut allergy, the sudden onset of respiratory distress after
eating a cookie strongly suggests an anaphylactic reaction. Anaphylaxis causes laryngeal
edema (upper airway obstruction) and bronchospasm (lower airway obstruction). While
asthma (lower airway) is in his history, the immediate threat in anaphylaxis is often the
swelling of the upper airway and tongue.
Question 8
An 8-year-old child is brought to the emergency department by ambulance after a motor vehicle
collision. Which of the following findings would suggest that immediate intervention is needed?
A) A heart rate of 95/min
B) A blood pressure of 104/65 mm Hg
C) Decreased level of consciousness
D) Minor abrasions on the extremities
E) Capillary refill of 2 seconds
Correct Answer: C) Decreased level of consciousness
Rationale: A decreased level of consciousness (assessed via AVPU or GCS) in a trauma
patient is a critical sign of potential traumatic brain injury (TBI), hypoxia, or inadequate
cerebral perfusion (shock). This requires immediate assessment of the airway to ensure the
patient can protect it and monitoring of intracranial pressure/perfusion. Options A, B, and
E represent relatively normal/stable pediatric findings.
(Verified Solutions)
Question 1
In which of the following clinical situations is the use of intraosseous (IO) access most
appropriate?
A) An extremity with slow capillary refill time
B) A stable child requiring routine fluid maintenance
C) When a child is alert and needs a blood draw for a CBC
D) When peripheral IV access cannot be established in an emergency
E) Only in children over the age of 8 years
Correct Answer: D) When peripheral IV access cannot be established in an emergency
Rationale: IO access is indicated in emergency situations (such as shock or cardiac arrest)
when peripheral intravenous (IV) access cannot be established quickly (typically within 90
seconds or 3 attempts). IO access allows for the rapid administration of fluids, blood
products, and medications. While slow capillary refill (Option A) indicates poor perfusion,
it is the inability to get an IV during an emergency that triggers the move to IO. It is not for
routine use or stable patients.
Question 2
A 2-week-old infant is being evaluated for irritability and poor feeding. His blood pressure is
55/40 mm Hg, and capillary refill time is 5 seconds. Which statement best describes the
assessment of this infant's blood pressure?
A) It is within the normal range for a neonate.
B) It represents compensated shock.
C) It is hypotensive.
D) It is hypertensive for this age group.
E) It is unreliable due to the infant's irritability.
Correct Answer: C) It is hypotensive.
Rationale: In a neonate (0 to 28 days old), a systolic blood pressure of less than 60 mm Hg is
defined as hypotension. This infant’s systolic pressure of 55 mm Hg, combined with a
delayed capillary refill of 5 seconds (normal is < 2 seconds), indicates decompensated
(hypotensive) shock. Immediate volume resuscitation is required to prevent cardiac arrest.
Question 3
A nurse is caring for several patients in the emergency department. Which of the following 2-
year-old children requires the most immediate intervention?
A) A child with a mild barky cough but no stridor at rest
B) A child who is grunting with each breath
C) A child with a heart rate of 110/min and pink skin
D) A child who is crying loudly for their parents
E) A child with a temperature of 101.5°F and a runny nose
, 2
Correct Answer: B) A child who is grunting
Rationale: Grunting is an ominous sign of severe respiratory distress or failure. It is
produced by exhaling against a partially closed glottis to maintain functional residual
capacity and prevent alveolar collapse (auto-PEEP). This indicates significant lung tissue
disease (parenchymal disease) or pulmonary edema and requires immediate respiratory
support and evaluation.
Question 4
A 3-year-old child is having difficulty breathing. Which of the following findings would most
likely lead a nurse to suspect an upper airway obstruction in this child?
A) Bilateral expiratory wheezing
B) Prolonged expiratory phase
C) Increased inspiratory effort with stridor and retractions
D) Productive cough with green sputum
E) Blood-streaked sputum and rales
Correct Answer: C) Increased inspiratory effort with stridor and retractions
Rationale: Upper airway obstructions (such as Croup, Epiglottitis, or foreign body
aspiration) typically interfere with the movement of air into the lungs. This results in
inspiratory stridor and increased effort during inhalation. Expiratory wheezing (Option A)
and a prolonged expiratory phase (Option B) are classic signs of lower airway obstruction,
such as asthma or bronchiolitis.
Question 5
A team member is unable to perform an assigned task during a resuscitation because it is beyond
the team member's scope of practice. What action should the team member take?
A) Attempt the task to avoid delaying the code
B) Wait until the code is over to mention the limitation
C) Ask for a new task or role immediately
D) Leave the room to find a manual for the task
E) Ask the team leader to explain the procedure while doing it
Correct Answer: C) Ask for a new task or role immediately
Rationale: Effective team dynamics include "Knowledge Sharing" and "Knowing Your
Limitations." If a task is outside a team member's scope or skill set, they must immediately
inform the Team Leader. This allows the Leader to reassign the task to a qualified person,
ensuring the patient’s safety and the efficiency of the resuscitation attempt.
Question 6
A nurse is acting as the Team Leader during a pediatric resuscitation attempt. Which action is an
essential element of high-quality CPR?
A) Compressing the chest at a rate of 80 to 90 per minute
B) Allowing complete chest wall recoil after each compression
, 3
C) Interrupting compressions for 20 seconds to check a rhythm
D) Providing as many breaths as possible per minute
E) Compressing the chest to 1/10th of the AP diameter
Correct Answer: B) Allowing complete chest wall recoil after each compression
Rationale: Complete chest recoil is vital because it allows the heart to refill with blood
(preload) between compressions. Leaning on the chest prevents this refilling and
significantly reduces the amount of blood circulated to the brain and vital organs. High-
quality CPR also requires a rate of 100-120/min, a depth of 1/3 the AP diameter, and
minimizing interruptions to less than 10 seconds.
Question 7
An 8-year-old child is brought to the emergency department with difficulty breathing. He has a
history of asthma and nut allergies and recently ate a cookie. What condition is most likely to be
present in this child?
A) Acute myocardial infarction
B) Upper airway obstruction (Anaphylaxis)
C) Diabetic ketoacidosis
D) Simple viral pneumonia
E) Tension pneumothorax
Correct Answer: B) Upper airway obstruction
Rationale: In a child with a known nut allergy, the sudden onset of respiratory distress after
eating a cookie strongly suggests an anaphylactic reaction. Anaphylaxis causes laryngeal
edema (upper airway obstruction) and bronchospasm (lower airway obstruction). While
asthma (lower airway) is in his history, the immediate threat in anaphylaxis is often the
swelling of the upper airway and tongue.
Question 8
An 8-year-old child is brought to the emergency department by ambulance after a motor vehicle
collision. Which of the following findings would suggest that immediate intervention is needed?
A) A heart rate of 95/min
B) A blood pressure of 104/65 mm Hg
C) Decreased level of consciousness
D) Minor abrasions on the extremities
E) Capillary refill of 2 seconds
Correct Answer: C) Decreased level of consciousness
Rationale: A decreased level of consciousness (assessed via AVPU or GCS) in a trauma
patient is a critical sign of potential traumatic brain injury (TBI), hypoxia, or inadequate
cerebral perfusion (shock). This requires immediate assessment of the airway to ensure the
patient can protect it and monitoring of intracranial pressure/perfusion. Options A, B, and
E represent relatively normal/stable pediatric findings.
