PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION (PALS) QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALE | LATEST VERSION PDF
Section One: Questions 1–100
A 4-year-old child presents with a heart rate of 45/min and signs of poor perfusion despite
oxygenation and ventilation. What is the first-line pharmacologic intervention?
A. Amiodarone
B. Epinephrine
C. Atropine
D. Adenosine
🟢 B. Epinephrine
🔴 RATIONALE: Epinephrine is the first-line medication for symptomatic bradycardia in pediatric
patients when ventilation and oxygenation fail to improve the heart rate and perfusion.
During a cardiac arrest in an infant, what is the recommended chest compression depth?
A. At least one-third of the anterior-posterior diameter of the chest
B. Exactly 1 inch
C. Exactly 2 inches
D. At least one-half of the chest width
🟢 A. At least one-third of the anterior-posterior diameter of the chest
🔴 RATIONALE: PALS guidelines specify compressing at least one-third of the AP diameter of the
chest for infants and children to ensure adequate perfusion.
Which of the following is a sign of compensated shock in a child?
A. Hypotension
B. Altered mental status
C. Tachycardia with preserved blood pressure
D. Absence of peripheral pulses
,🟢 C. Tachycardia with preserved blood pressure
🔴 RATIONALE: Compensated shock is characterized by the body's ability to maintain perfusion to
vital organs through compensatory mechanisms, most notably tachycardia, despite systemic
stress.
When performing bag-mask ventilation, what is the mnemonic used to troubleshoot ineffective
ventilation?
A. SOAP
B. DOPE
C. SAMPLE
D. AVPU
🟢 B. DOPE
🔴 RATIONALE: The DOPE mnemonic (Dislodgement, Obstruction, Pneumothorax, Equipment
failure) is used to systematically evaluate and correct causes of ventilation failure.
A 2-year-old in supraventricular tachycardia (SVT) is hemodynamically unstable. What is the most
appropriate next step?
A. Vagal maneuvers
B. Synchronized cardioversion
C. Adenosine 0.1 mg/kg IV
D. Amiodarone 5 mg/kg IV
🟢 B. Synchronized cardioversion
🔴 RATIONALE: For unstable SVT, immediate synchronized cardioversion is the recommended
treatment to restore normal sinus rhythm.
What is the appropriate energy dose for the first attempt at defibrillation in a pediatric patient?
A. 1 J/kg
,B. 2 J/kg
C. 4 J/kg
D. 10 J/kg
🟢 B. 2 J/kg
🔴 RATIONALE: The recommended initial dose for pediatric defibrillation is 2 J/kg, followed by 4
J/kg for subsequent shocks.
Which fluid is preferred for initial bolus resuscitation in a child with hypovolemic shock?
A. 5% Dextrose in water
B. 0.45% Sodium Chloride
C. Isotonic crystalloid
D. Albumin
🟢 C. Isotonic crystalloid
🔴 RATIONALE: Isotonic crystalloids (such as normal saline or lactated Ringer's) are the preferred
fluids for initial resuscitation to restore intravascular volume.
In a child with suspected raised intracranial pressure, what is the primary goal of ventilation?
A. Maintain hyperventilation to induce hypocapnia
B. Ensure normocapnia
C. Allow permissive hypercapnia
D. Maintain high PEEP
🟢 B. Ensure normocapnia
🔴 RATIONALE: Maintaining normocapnia is essential in cases of elevated intracranial pressure to
prevent secondary ischemic injury; hyperventilation should only be used as a temporary bridge.
What is the correct ratio of compressions to ventilations for a lone rescuer in a pediatric patient?
A. 30:2
, B. 15:2
C. 5:1
D. 10:2
🟢 A. 30:2
🔴 RATIONALE: For a single rescuer, the compression-to-ventilation ratio for all pediatric patients
is 30:2.
Which of the following is a common early sign of respiratory distress in an infant?
A. Bradypnea
B. Nasal flaring
C. Hypotension
D. Bradycardia
🟢 B. Nasal flaring
🔴 RATIONALE: Nasal flaring, along with grunting and retractions, are classic early physical
findings of increased work of breathing in infants.
You are managing a child with septic shock. Fluid resuscitation has been initiated, but the child
remains hypotensive. What is the next priority?
A. Start a dopamine infusion
B. Start an epinephrine infusion
C. Administer a second fluid bolus
D. Intubate immediately
🟢 B. Start an epinephrine infusion
🔴 RATIONALE: In fluid-refractory septic shock, vasoactive support (specifically epinephrine for
cold shock or norepinephrine for warm shock) is indicated.
ANSWERS WITH DETAILED RATIONALE | LATEST VERSION PDF
Section One: Questions 1–100
A 4-year-old child presents with a heart rate of 45/min and signs of poor perfusion despite
oxygenation and ventilation. What is the first-line pharmacologic intervention?
A. Amiodarone
B. Epinephrine
C. Atropine
D. Adenosine
🟢 B. Epinephrine
🔴 RATIONALE: Epinephrine is the first-line medication for symptomatic bradycardia in pediatric
patients when ventilation and oxygenation fail to improve the heart rate and perfusion.
During a cardiac arrest in an infant, what is the recommended chest compression depth?
A. At least one-third of the anterior-posterior diameter of the chest
B. Exactly 1 inch
C. Exactly 2 inches
D. At least one-half of the chest width
🟢 A. At least one-third of the anterior-posterior diameter of the chest
🔴 RATIONALE: PALS guidelines specify compressing at least one-third of the AP diameter of the
chest for infants and children to ensure adequate perfusion.
Which of the following is a sign of compensated shock in a child?
A. Hypotension
B. Altered mental status
C. Tachycardia with preserved blood pressure
D. Absence of peripheral pulses
,🟢 C. Tachycardia with preserved blood pressure
🔴 RATIONALE: Compensated shock is characterized by the body's ability to maintain perfusion to
vital organs through compensatory mechanisms, most notably tachycardia, despite systemic
stress.
When performing bag-mask ventilation, what is the mnemonic used to troubleshoot ineffective
ventilation?
A. SOAP
B. DOPE
C. SAMPLE
D. AVPU
🟢 B. DOPE
🔴 RATIONALE: The DOPE mnemonic (Dislodgement, Obstruction, Pneumothorax, Equipment
failure) is used to systematically evaluate and correct causes of ventilation failure.
A 2-year-old in supraventricular tachycardia (SVT) is hemodynamically unstable. What is the most
appropriate next step?
A. Vagal maneuvers
B. Synchronized cardioversion
C. Adenosine 0.1 mg/kg IV
D. Amiodarone 5 mg/kg IV
🟢 B. Synchronized cardioversion
🔴 RATIONALE: For unstable SVT, immediate synchronized cardioversion is the recommended
treatment to restore normal sinus rhythm.
What is the appropriate energy dose for the first attempt at defibrillation in a pediatric patient?
A. 1 J/kg
,B. 2 J/kg
C. 4 J/kg
D. 10 J/kg
🟢 B. 2 J/kg
🔴 RATIONALE: The recommended initial dose for pediatric defibrillation is 2 J/kg, followed by 4
J/kg for subsequent shocks.
Which fluid is preferred for initial bolus resuscitation in a child with hypovolemic shock?
A. 5% Dextrose in water
B. 0.45% Sodium Chloride
C. Isotonic crystalloid
D. Albumin
🟢 C. Isotonic crystalloid
🔴 RATIONALE: Isotonic crystalloids (such as normal saline or lactated Ringer's) are the preferred
fluids for initial resuscitation to restore intravascular volume.
In a child with suspected raised intracranial pressure, what is the primary goal of ventilation?
A. Maintain hyperventilation to induce hypocapnia
B. Ensure normocapnia
C. Allow permissive hypercapnia
D. Maintain high PEEP
🟢 B. Ensure normocapnia
🔴 RATIONALE: Maintaining normocapnia is essential in cases of elevated intracranial pressure to
prevent secondary ischemic injury; hyperventilation should only be used as a temporary bridge.
What is the correct ratio of compressions to ventilations for a lone rescuer in a pediatric patient?
A. 30:2
, B. 15:2
C. 5:1
D. 10:2
🟢 A. 30:2
🔴 RATIONALE: For a single rescuer, the compression-to-ventilation ratio for all pediatric patients
is 30:2.
Which of the following is a common early sign of respiratory distress in an infant?
A. Bradypnea
B. Nasal flaring
C. Hypotension
D. Bradycardia
🟢 B. Nasal flaring
🔴 RATIONALE: Nasal flaring, along with grunting and retractions, are classic early physical
findings of increased work of breathing in infants.
You are managing a child with septic shock. Fluid resuscitation has been initiated, but the child
remains hypotensive. What is the next priority?
A. Start a dopamine infusion
B. Start an epinephrine infusion
C. Administer a second fluid bolus
D. Intubate immediately
🟢 B. Start an epinephrine infusion
🔴 RATIONALE: In fluid-refractory septic shock, vasoactive support (specifically epinephrine for
cold shock or norepinephrine for warm shock) is indicated.
