PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
PALS Pediatric Emergency Resuscitation – Final Exam
(2025/2026) | Updated Questions & Verified Answers
1. The most common cause of pediatric cardiac arrest is:
A) Arrhythmia
B) Respiratory failure
C) Myocardial infarction
D) Hypothermia
Answer: B) Respiratory failure
Rationale: In children, cardiac arrest is usually secondary to respiratory failure or
shock, unlike adults where arrhythmia is common.
2. When performing high-quality chest compressions on a child, the depth
should be:
A) At least 1 inch
B) At least one-third the chest diameter (~2 inches or 5 cm)
C) 4 inches
D) Light compressions until chest rises
Answer: B) At least one-third the chest diameter (~2 inches or 5 cm)
Rationale: Pediatric compressions require adequate depth, approximately one-
third of the chest’s anterior-posterior diameter.
3. The first drug of choice for pediatric pulseless arrest is:
A) Amiodarone
B) Epinephrine
C) Lidocaine
D) Atropine
Answer: B) Epinephrine
Rationale: Epinephrine 0.01 mg/kg IV/IO is given every 3–5 minutes during
pulseless arrest to improve coronary and cerebral perfusion.
, PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
4. A 4-year-old is in respiratory distress with stridor and drooling. The most
likely diagnosis is:
A) Asthma
B) Croup
C) Epiglottitis
D) Bronchiolitis
Answer: C) Epiglottitis
Rationale: Classic signs include drooling, tripod position, and stridor. Airway
management must be carefully prepared to avoid sudden obstruction.
5. During pediatric CPR with two rescuers, the compression-to-ventilation ratio
is:
A) 30:2
B) 20:2
C) 15:2
D) 10:1
Answer: C) 15:2
Rationale: With two rescuers, the ratio is 15:2 in children and infants, improving
oxygen delivery compared to the adult 30:2 ratio.
6. Which rhythm is shockable in pediatric cardiac arrest?
A) Asystole
B) Pulseless electrical activity
C) Ventricular fibrillation
D) Sinus tachycardia
Answer: C) Ventricular fibrillation
Rationale: VF and pulseless VT are shockable rhythms; asystole and PEA require
CPR and medications, not shocks.
7. The most reliable method to confirm endotracheal tube placement in a child
is:
A) Chest rise observation
B) Fog in the tube
, PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
C) Capnography waveform (ETCO₂)
D) Auscultation alone
Answer: C) Capnography waveform (ETCO₂)
Rationale: Continuous capnography is the gold standard for confirming tube
placement and monitoring CPR effectiveness.
8. A 2-year-old in septic shock remains hypotensive after fluids. The next best
step is:
A) Additional fluids
B) Epinephrine or norepinephrine infusion
C) Atropine
D) Oxygen alone
Answer: B) Epinephrine or norepinephrine infusion
Rationale: Fluid-refractory septic shock requires vasoactive support, commonly
epinephrine or norepinephrine depending on presentation.
9. The first intervention for a child with a foreign body airway obstruction who
becomes unresponsive is:
A) Blind finger sweep
B) Begin CPR, starting with chest compressions
C) Rescue breaths only
D) Heimlich maneuver
Answer: B) Begin CPR, starting with chest compressions
Rationale: Once the child becomes unresponsive, chest compressions are started to
dislodge the object. Finger sweeps are not done unless the object is visible.
10. The most effective way to improve survival in pediatric cardiac arrest is:
A) Early drug administration
B) Early airway placement
C) High-quality CPR and early defibrillation
D) Post-resuscitation care only
, PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
Answer: C) High-quality CPR and early defibrillation
Rationale: The “Chain of Survival” emphasizes immediate CPR and rapid
defibrillation as the top priorities.
11. A normal systolic blood pressure for a 5-year-old is approximately:
A) 60 mmHg
B) 70 mmHg
C) 90 mmHg
D) 110 mmHg
Answer: C) 90 mmHg
Rationale: Normal pediatric systolic BP is roughly 70 + (2 × age in years). For
age 5 → 70 + 10 = 80–90 mmHg.
12. What is the recommended dose of amiodarone in pediatric pulseless VT/VF?
A) 1 mg/kg
B) 5 mg/kg IV/IO
C) 0.01 mg/kg IV
D) 2 mg/kg IM
Answer: B) 5 mg/kg IV/IO
Rationale: Amiodarone 5 mg/kg IV/IO bolus (max 300 mg) can be repeated up to
two times for refractory VF/pulseless VT.
13. What is the most common initial shock energy dose for pediatric
defibrillation?
A) 1 J/kg
B) 2 J/kg
C) 5 J/kg
D) 10 J/kg
Answer: B) 2 J/kg
Rationale: First shock is 2 J/kg; subsequent shocks may be increased to 4 J/kg and
higher as needed.
PALS Pediatric Emergency Resuscitation – Final Exam
(2025/2026) | Updated Questions & Verified Answers
1. The most common cause of pediatric cardiac arrest is:
A) Arrhythmia
B) Respiratory failure
C) Myocardial infarction
D) Hypothermia
Answer: B) Respiratory failure
Rationale: In children, cardiac arrest is usually secondary to respiratory failure or
shock, unlike adults where arrhythmia is common.
2. When performing high-quality chest compressions on a child, the depth
should be:
A) At least 1 inch
B) At least one-third the chest diameter (~2 inches or 5 cm)
C) 4 inches
D) Light compressions until chest rises
Answer: B) At least one-third the chest diameter (~2 inches or 5 cm)
Rationale: Pediatric compressions require adequate depth, approximately one-
third of the chest’s anterior-posterior diameter.
3. The first drug of choice for pediatric pulseless arrest is:
A) Amiodarone
B) Epinephrine
C) Lidocaine
D) Atropine
Answer: B) Epinephrine
Rationale: Epinephrine 0.01 mg/kg IV/IO is given every 3–5 minutes during
pulseless arrest to improve coronary and cerebral perfusion.
, PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
4. A 4-year-old is in respiratory distress with stridor and drooling. The most
likely diagnosis is:
A) Asthma
B) Croup
C) Epiglottitis
D) Bronchiolitis
Answer: C) Epiglottitis
Rationale: Classic signs include drooling, tripod position, and stridor. Airway
management must be carefully prepared to avoid sudden obstruction.
5. During pediatric CPR with two rescuers, the compression-to-ventilation ratio
is:
A) 30:2
B) 20:2
C) 15:2
D) 10:1
Answer: C) 15:2
Rationale: With two rescuers, the ratio is 15:2 in children and infants, improving
oxygen delivery compared to the adult 30:2 ratio.
6. Which rhythm is shockable in pediatric cardiac arrest?
A) Asystole
B) Pulseless electrical activity
C) Ventricular fibrillation
D) Sinus tachycardia
Answer: C) Ventricular fibrillation
Rationale: VF and pulseless VT are shockable rhythms; asystole and PEA require
CPR and medications, not shocks.
7. The most reliable method to confirm endotracheal tube placement in a child
is:
A) Chest rise observation
B) Fog in the tube
, PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
C) Capnography waveform (ETCO₂)
D) Auscultation alone
Answer: C) Capnography waveform (ETCO₂)
Rationale: Continuous capnography is the gold standard for confirming tube
placement and monitoring CPR effectiveness.
8. A 2-year-old in septic shock remains hypotensive after fluids. The next best
step is:
A) Additional fluids
B) Epinephrine or norepinephrine infusion
C) Atropine
D) Oxygen alone
Answer: B) Epinephrine or norepinephrine infusion
Rationale: Fluid-refractory septic shock requires vasoactive support, commonly
epinephrine or norepinephrine depending on presentation.
9. The first intervention for a child with a foreign body airway obstruction who
becomes unresponsive is:
A) Blind finger sweep
B) Begin CPR, starting with chest compressions
C) Rescue breaths only
D) Heimlich maneuver
Answer: B) Begin CPR, starting with chest compressions
Rationale: Once the child becomes unresponsive, chest compressions are started to
dislodge the object. Finger sweeps are not done unless the object is visible.
10. The most effective way to improve survival in pediatric cardiac arrest is:
A) Early drug administration
B) Early airway placement
C) High-quality CPR and early defibrillation
D) Post-resuscitation care only
, PALS Pediatric Emergency Resuscitation – Final Exam 2025/2026
Answer: C) High-quality CPR and early defibrillation
Rationale: The “Chain of Survival” emphasizes immediate CPR and rapid
defibrillation as the top priorities.
11. A normal systolic blood pressure for a 5-year-old is approximately:
A) 60 mmHg
B) 70 mmHg
C) 90 mmHg
D) 110 mmHg
Answer: C) 90 mmHg
Rationale: Normal pediatric systolic BP is roughly 70 + (2 × age in years). For
age 5 → 70 + 10 = 80–90 mmHg.
12. What is the recommended dose of amiodarone in pediatric pulseless VT/VF?
A) 1 mg/kg
B) 5 mg/kg IV/IO
C) 0.01 mg/kg IV
D) 2 mg/kg IM
Answer: B) 5 mg/kg IV/IO
Rationale: Amiodarone 5 mg/kg IV/IO bolus (max 300 mg) can be repeated up to
two times for refractory VF/pulseless VT.
13. What is the most common initial shock energy dose for pediatric
defibrillation?
A) 1 J/kg
B) 2 J/kg
C) 5 J/kg
D) 10 J/kg
Answer: B) 2 J/kg
Rationale: First shock is 2 J/kg; subsequent shocks may be increased to 4 J/kg and
higher as needed.
