PALS version B questions and answers 2026\2027
A+ Grade
You are treating an 8-year-old with ventricular tachycardia (VT) 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
Initiate overdrive pacing transcutaneously
Consider possible metabolic and toxicologic causes
Deliver an unsynchronized shock
- correct answer Consider possible metabolic and toxicologic causes
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 (ie, second intercostal space) at the mid-clavicular 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 (ie, second intercostal space) at the mid-clavicular line
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 colloidge
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 caring for a 5-year-old patient with supraventricular tachycardia (SVT) (heart rate is 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?
Provide synchronized cardioversion at 0.5 to 1 J/kg
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
- correct answer Provide synchronized cardioversion at 0.5 to 1 J/kg
You attempted synchronized cardioversion for an infant with SVT and poor perfusion. The SVT persists
after the initial shock of 1 J/kg. Which of the following should you attempt now?
Synchronized cardioversion at a dose of 4 J/kg
Synchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg
- correct answer Synchronized cardioversion at a dose of 2 J/kg
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
Using a resuscitation bag to provide manual ventilation with 100% oxygen
Increasing tidal volume
A+ Grade
You are treating an 8-year-old with ventricular tachycardia (VT) 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
Initiate overdrive pacing transcutaneously
Consider possible metabolic and toxicologic causes
Deliver an unsynchronized shock
- correct answer Consider possible metabolic and toxicologic causes
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 (ie, second intercostal space) at the mid-clavicular 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 (ie, second intercostal space) at the mid-clavicular line
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 colloidge
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 caring for a 5-year-old patient with supraventricular tachycardia (SVT) (heart rate is 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?
Provide synchronized cardioversion at 0.5 to 1 J/kg
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
- correct answer Provide synchronized cardioversion at 0.5 to 1 J/kg
You attempted synchronized cardioversion for an infant with SVT and poor perfusion. The SVT persists
after the initial shock of 1 J/kg. Which of the following should you attempt now?
Synchronized cardioversion at a dose of 4 J/kg
Synchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg
- correct answer Synchronized cardioversion at a dose of 2 J/kg
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
Using a resuscitation bag to provide manual ventilation with 100% oxygen
Increasing tidal volume
