LATEST UPDATE 2026/2027 – PALS Pre-Course Self-
Assessment (Verified A+ Answers Included)
Question 1
A 3-month-old infant presents with a heart rate of 65/min. Which rhythm is most likely?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: C) Sinus bradycardia
Rationale: The normal resting heart rate for a 3-month-old infant is typically between
100-160/min. A heart rate of 65/min is abnormally low, indicating sinus bradycardia. In
infants, bradycardia is often associated with hypoxia or respiratory distress and should
be evaluated as part of the systematic approach .
Question 2
Clinical clue: heart rate 214/min. Identify the rhythm.
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: D) Supraventricular tachycardia (SVT)
Rationale: A heart rate of 214/min, especially in an infant or child, is consistent with
SVT. SVT rates typically exceed 180-220/min in infants and 180-200/min in children, with
abrupt onset and termination. This rhythm is often narrow-complex and regular .
Question 3
,A 7-year-old child is unresponsive with no detectable pulses. The cardiac monitor shows
a wide-complex tachycardia at 200/min. Which rhythm is this?
A) Sinus tachycardia
B) Supraventricular tachycardia (SVT)
C) Ventricular tachycardia (monomorphic)
D) Ventricular fibrillation
Answer: C) Ventricular tachycardia (monomorphic)
Rationale: A wide-complex tachycardia with no detectable pulses is presumed to be
pulseless ventricular tachycardia. This is a shockable rhythm requiring immediate
defibrillation. The wide QRS complex (>0.09 seconds in children) distinguishes it from
narrow-complex SVT .
Question 4
A patient has no detectable pulses. The monitor shows a rhythm with organized
electrical activity but no mechanical contraction. What is this rhythm called?
A) Asystole
B) Pulseless electrical activity (PEA)
C) Ventricular fibrillation
D) Normal sinus rhythm
Answer: B) Pulseless electrical activity (PEA)
Rationale: PEA is characterized by organized cardiac electrical activity on the monitor
without corresponding palpable pulses. It indicates electromechanical dissociation,
where the heart's electrical system is functioning but the mechanical pump is not.
Common causes include hypovolemia, hypoxia, tension pneumothorax, and cardiac
tamponade .
Question 5
Clinical clue: initial rhythm associated with no detectable pulses. The monitor shows a
chaotic, disorganized waveform with no identifiable QRS complexes. Identify the rhythm.
,A) Ventricular fibrillation (VF)
B) Asystole
C) Pulseless electrical activity
D) Torsades de pointes
Answer: A) Ventricular fibrillation (VF)
Rationale: VF presents as a chaotic, disorganized waveform with no identifiable QRS
complexes. It is a life-threatening arrhythmia requiring immediate defibrillation. VF is
characterized by rapid, irregular ventricular contractions with no effective cardiac
output .
Question 6
A febrile infant has a heart rate of 188/min. Which rhythm is most likely?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: B) Sinus tachycardia
Rationale: The presence of fever suggests a physiological cause for the tachycardia.
Sinus tachycardia is a compensatory response to increased metabolic demand, fever,
pain, or hypovolemia. The rate is usually less than 220/min in infants and less than
180/min in children. Treatment focuses on the underlying cause .
Question 7
A 7-year-old child has a heart rate of 78/min. Which rhythm is most likely?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: A) Normal sinus rhythm
, Rationale: A heart rate of 78/min is within the normal range for a 7-year-old child
(approximately 70-110/min). Normal sinus rhythm demonstrates a P wave before each
QRS complex with a consistent PR interval .
Question 8
A 1-year-old child has a heart rate of 44/min with no detectable pulses. Which rhythm is
most likely?
A) Sinus tachycardia
B) Sinus bradycardia
C) Supraventricular tachycardia (SVT)
D) Asystole
Answer: B) Sinus bradycardia with pulselessness
Rationale: A heart rate of 44/min in a 1-year-old represents severe bradycardia. In the
presence of no detectable pulses, this is a critical finding requiring immediate
intervention. Pulseless bradycardia is treated with CPR, epinephrine, and treatment of
reversible causes .
Question 9
A patient's monitor shows a rhythm with a heart rate of 300/min. Which rhythm is most
likely?
A) Sinus tachycardia
B) Supraventricular tachycardia (SVT)
C) Ventricular fibrillation
D) Atrial flutter
Answer: B) Supraventricular tachycardia (SVT)
Rationale: Rates of 300/min in infants or children are most consistent with SVT. This
rhythm has a sudden onset and termination, with a regular, narrow-complex QRS. Vagal
maneuvers or adenosine may be used to convert the rhythm .
Assessment (Verified A+ Answers Included)
Question 1
A 3-month-old infant presents with a heart rate of 65/min. Which rhythm is most likely?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: C) Sinus bradycardia
Rationale: The normal resting heart rate for a 3-month-old infant is typically between
100-160/min. A heart rate of 65/min is abnormally low, indicating sinus bradycardia. In
infants, bradycardia is often associated with hypoxia or respiratory distress and should
be evaluated as part of the systematic approach .
Question 2
Clinical clue: heart rate 214/min. Identify the rhythm.
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: D) Supraventricular tachycardia (SVT)
Rationale: A heart rate of 214/min, especially in an infant or child, is consistent with
SVT. SVT rates typically exceed 180-220/min in infants and 180-200/min in children, with
abrupt onset and termination. This rhythm is often narrow-complex and regular .
Question 3
,A 7-year-old child is unresponsive with no detectable pulses. The cardiac monitor shows
a wide-complex tachycardia at 200/min. Which rhythm is this?
A) Sinus tachycardia
B) Supraventricular tachycardia (SVT)
C) Ventricular tachycardia (monomorphic)
D) Ventricular fibrillation
Answer: C) Ventricular tachycardia (monomorphic)
Rationale: A wide-complex tachycardia with no detectable pulses is presumed to be
pulseless ventricular tachycardia. This is a shockable rhythm requiring immediate
defibrillation. The wide QRS complex (>0.09 seconds in children) distinguishes it from
narrow-complex SVT .
Question 4
A patient has no detectable pulses. The monitor shows a rhythm with organized
electrical activity but no mechanical contraction. What is this rhythm called?
A) Asystole
B) Pulseless electrical activity (PEA)
C) Ventricular fibrillation
D) Normal sinus rhythm
Answer: B) Pulseless electrical activity (PEA)
Rationale: PEA is characterized by organized cardiac electrical activity on the monitor
without corresponding palpable pulses. It indicates electromechanical dissociation,
where the heart's electrical system is functioning but the mechanical pump is not.
Common causes include hypovolemia, hypoxia, tension pneumothorax, and cardiac
tamponade .
Question 5
Clinical clue: initial rhythm associated with no detectable pulses. The monitor shows a
chaotic, disorganized waveform with no identifiable QRS complexes. Identify the rhythm.
,A) Ventricular fibrillation (VF)
B) Asystole
C) Pulseless electrical activity
D) Torsades de pointes
Answer: A) Ventricular fibrillation (VF)
Rationale: VF presents as a chaotic, disorganized waveform with no identifiable QRS
complexes. It is a life-threatening arrhythmia requiring immediate defibrillation. VF is
characterized by rapid, irregular ventricular contractions with no effective cardiac
output .
Question 6
A febrile infant has a heart rate of 188/min. Which rhythm is most likely?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: B) Sinus tachycardia
Rationale: The presence of fever suggests a physiological cause for the tachycardia.
Sinus tachycardia is a compensatory response to increased metabolic demand, fever,
pain, or hypovolemia. The rate is usually less than 220/min in infants and less than
180/min in children. Treatment focuses on the underlying cause .
Question 7
A 7-year-old child has a heart rate of 78/min. Which rhythm is most likely?
A) Normal sinus rhythm
B) Sinus tachycardia
C) Sinus bradycardia
D) Supraventricular tachycardia (SVT)
Answer: A) Normal sinus rhythm
, Rationale: A heart rate of 78/min is within the normal range for a 7-year-old child
(approximately 70-110/min). Normal sinus rhythm demonstrates a P wave before each
QRS complex with a consistent PR interval .
Question 8
A 1-year-old child has a heart rate of 44/min with no detectable pulses. Which rhythm is
most likely?
A) Sinus tachycardia
B) Sinus bradycardia
C) Supraventricular tachycardia (SVT)
D) Asystole
Answer: B) Sinus bradycardia with pulselessness
Rationale: A heart rate of 44/min in a 1-year-old represents severe bradycardia. In the
presence of no detectable pulses, this is a critical finding requiring immediate
intervention. Pulseless bradycardia is treated with CPR, epinephrine, and treatment of
reversible causes .
Question 9
A patient's monitor shows a rhythm with a heart rate of 300/min. Which rhythm is most
likely?
A) Sinus tachycardia
B) Supraventricular tachycardia (SVT)
C) Ventricular fibrillation
D) Atrial flutter
Answer: B) Supraventricular tachycardia (SVT)
Rationale: Rates of 300/min in infants or children are most consistent with SVT. This
rhythm has a sudden onset and termination, with a regular, narrow-complex QRS. Vagal
maneuvers or adenosine may be used to convert the rhythm .
