PALS Exam 2026 Question and Answer |
Ultimate Prep Bundle | A+ Verified
• 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 -✓✓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 -✓✓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 -✓✓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
-✓✓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 -✓✓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 -✓✓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 -✓✓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?
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 J/kg
Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg -✓✓Synchronized
cardioversion at a dose of 2 J/kg
• You are treating a 5-month-old with a 2-day history of vomiting and
diarrhea. The patient is listless. The respiratory rate is 52/min and
unlabored. The heart rate is 170/min and pulses are present but weak.
Capillary refill is delayed. You are administering high-flow oxygen, and
intravenous access is in place. At this point the most important therapy is
to:
Ultimate Prep Bundle | A+ Verified
• 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 -✓✓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 -✓✓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 -✓✓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
-✓✓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 -✓✓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 -✓✓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 -✓✓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?
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 J/kg
Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg -✓✓Synchronized
cardioversion at a dose of 2 J/kg
• You are treating a 5-month-old with a 2-day history of vomiting and
diarrhea. The patient is listless. The respiratory rate is 52/min and
unlabored. The heart rate is 170/min and pulses are present but weak.
Capillary refill is delayed. You are administering high-flow oxygen, and
intravenous access is in place. At this point the most important therapy is
to:
