PALS PROVIDER FINAL EXAM – QUESTIONS AND
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1. A 3-year-old child is brought to the emergency department by their parents with a 2-day
history of barking cough, inspiratory stridor at rest, and mild intercostal retractions. Vital
signs are HR 130/min, RR 28/min, SpO2 96% on room air, and temperature 37.8°C. What
is the most appropriate initial medical intervention to reduce upper airway edema?
A. Administer racemic epinephrine via nebulizer
B. Perform immediate endotracheal intubation
C. Administer oral or intramuscular dexamethasone
D. Initiate continuous positive airway pressure (CPAP) via face mask
Answer: C
A single dose of corticosteroid, such as dexamethasone, is the cornerstone of treatment for
moderate to severe croup to reduce laryngeal edema. Racemic epinephrine is reserved for
stridor at rest with moderate-to-severe respiratory distress, but oral/IM corticosteroids are the
primary first-line medical therapy for reducing overall hospital admission and return rates.
2. An 8-month-old infant is evaluated for lethargy and poor feeding. Physical examination
reveals mottled skin, delayed capillary refill of 4 seconds, a heart rate of 195/min, weak
peripheral pulses, and a blood pressure of 70/40 mmHg. Which form of shock is most
consistent with these clinical findings?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Distributive shock
Answer: C
Cardiogenic shock in infants is characterized by signs of inadequate tissue perfusion, marked
tachycardia out of proportion to fever, tachypnea, weak peripheral pulses, prolonged capillary
refill, and often cool, mottled extremities with normal to low blood pressure.
3. A 6-year-old child with a history of acute asthma exacerbation fails to respond to initial
inhaled beta-2 agonist therapy. The child is now drowsy, has diminished breath sounds
bilaterally with an absent wheeze, and an SpO2 of 88% on high-flow oxygen. What is the
priority physiological concern?
A. Impending respiratory arrest and severe hypercarbia
,B. Immediate upper airway foreign body obstruction
C. Development of spontaneous pneumothorax from bronchodilator toxicity
D. Severe dehydration secondary to increased work of breathing
Answer: A
A silent chest (absence of wheezing) in a deteriorating child with severe asthma indicates
dangerously low airflow and impending respiratory arrest. This requires immediate
preparation for bag-mask ventilation and potential advanced airway management.
4. A paramedic team arrives at a playground for an unresponsive 4-year-old child. The
child is apneic and pulseless. Following the initiation of high-quality CPR, the rhythm
check via AED reveals ventricular fibrillation. What is the correct initial energy dose for
manual defibrillation in this pediatric patient?
A. 1 J/kg
B. 2 J/kg
C. 4 J/kg
D. 6 J/kg
Answer: B
The initial recommended energy dose for defibrillation in pediatric cardiac arrest caused by
ventricular fibrillation or pulseless ventricular tachycardia is 2 J/kg. Subsequent shocks
should be increased to at least 4 J/kg, not to exceed the adult maximum dose.
5. A 2-year-old toddler is brought in by EMS following a witnessed ingestion of an
unknown quantity of grandparent’s antihypertensive medication. The child is lethargic,
bradycardic with a heart rate of 55/min, and hypotensive. Which drug is the specific first-
line antidote for beta-blocker or calcium channel blocker toxicity when associated with
severe hemodynamic instability?
A. Naloxone
B. Glucagon
C. Flumazenil
D. Sodium bicarbonate
Answer: B
Glucagon is the primary antidote used to reverse the cardiac depression, hypotension, and
bradycardia associated with beta-blocker toxicity by increasing intracellular cyclic AMP
independently of beta-adrenergic receptors.
6. During the resuscitation of a 5-year-old child in cardiac arrest, vascular access has not
been established after 90 seconds of attempts. What is the preferred alternative route for
administering emergency medications such as epinephrine?
, A. Endotracheal tube route
B. Intraosseous (IO) route
C. Central venous catheter via internal jugular
D. Subcutaneous injection
Answer: B
When intravenous access cannot be rapidly established during pediatric resuscitation, the
intraosseous (IO) route is the preferred and rapid alternative for fluid resuscitation and
medication administration. The endotracheal route is no longer routinely recommended for
standard drug delivery.
7. A 10-year-old patient presents with sudden-onset palpitations. The 12-lead ECG reveals
a narrow-complex tachycardia at a rate of 220/min with absent P waves. The child is alert,
with a blood pressure of 105/70 mmHg and normal capillary refill. What is the most
appropriate initial acute intervention?
A. Immediate synchronized cardioversion at 0.5 J/kg
B. Administration of intravenous adenosine via rapid push
C. Vagal maneuvers such as the ice bag to the face
D. Immediate intravenous amiodarone infusion
Answer: C
For a hemodynamically stable pediatric patient with supraventricular tachycardia (SVT), non-
pharmacological vagal maneuvers (like applying an ice pack to the face for infants or
Valsalva maneuvers for older children) should be attempted first while preparing for
pharmacological intervention.
8. An infant is brought to the clinic with severe dehydration due to acute gastroenteritis.
The infant weighs 8 kg and shows signs of compensated shock. What is the initial
recommended fluid bolus volume and type using isotonic crystalloids?
A. 80 mL of 0.45% normal saline over 10 minutes
B. 160 mL of D5W with 0.2% normal saline over 60 minutes
C. 160 mL of normal saline or lactated Ringer's over 5 to 20 minutes
D. 400 mL of normal saline rapidly over 5 minutes
Answer: C
The standard initial fluid resuscitation bolus for pediatric patients in shock is 20 mL/kg of an
isotonic crystalloid solution (such as normal saline or lactated Ringer's), administered rapidly
over 5 to 20 minutes and reassessed frequently.
9. A 7-year-old child presents with high fever, drooling, dysphagia, and severe respiratory
distress in a tripod position. Direct visualization of the oropharynx is avoided. Lateral neck
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 3-year-old child is brought to the emergency department by their parents with a 2-day
history of barking cough, inspiratory stridor at rest, and mild intercostal retractions. Vital
signs are HR 130/min, RR 28/min, SpO2 96% on room air, and temperature 37.8°C. What
is the most appropriate initial medical intervention to reduce upper airway edema?
A. Administer racemic epinephrine via nebulizer
B. Perform immediate endotracheal intubation
C. Administer oral or intramuscular dexamethasone
D. Initiate continuous positive airway pressure (CPAP) via face mask
Answer: C
A single dose of corticosteroid, such as dexamethasone, is the cornerstone of treatment for
moderate to severe croup to reduce laryngeal edema. Racemic epinephrine is reserved for
stridor at rest with moderate-to-severe respiratory distress, but oral/IM corticosteroids are the
primary first-line medical therapy for reducing overall hospital admission and return rates.
2. An 8-month-old infant is evaluated for lethargy and poor feeding. Physical examination
reveals mottled skin, delayed capillary refill of 4 seconds, a heart rate of 195/min, weak
peripheral pulses, and a blood pressure of 70/40 mmHg. Which form of shock is most
consistent with these clinical findings?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Distributive shock
Answer: C
Cardiogenic shock in infants is characterized by signs of inadequate tissue perfusion, marked
tachycardia out of proportion to fever, tachypnea, weak peripheral pulses, prolonged capillary
refill, and often cool, mottled extremities with normal to low blood pressure.
3. A 6-year-old child with a history of acute asthma exacerbation fails to respond to initial
inhaled beta-2 agonist therapy. The child is now drowsy, has diminished breath sounds
bilaterally with an absent wheeze, and an SpO2 of 88% on high-flow oxygen. What is the
priority physiological concern?
A. Impending respiratory arrest and severe hypercarbia
,B. Immediate upper airway foreign body obstruction
C. Development of spontaneous pneumothorax from bronchodilator toxicity
D. Severe dehydration secondary to increased work of breathing
Answer: A
A silent chest (absence of wheezing) in a deteriorating child with severe asthma indicates
dangerously low airflow and impending respiratory arrest. This requires immediate
preparation for bag-mask ventilation and potential advanced airway management.
4. A paramedic team arrives at a playground for an unresponsive 4-year-old child. The
child is apneic and pulseless. Following the initiation of high-quality CPR, the rhythm
check via AED reveals ventricular fibrillation. What is the correct initial energy dose for
manual defibrillation in this pediatric patient?
A. 1 J/kg
B. 2 J/kg
C. 4 J/kg
D. 6 J/kg
Answer: B
The initial recommended energy dose for defibrillation in pediatric cardiac arrest caused by
ventricular fibrillation or pulseless ventricular tachycardia is 2 J/kg. Subsequent shocks
should be increased to at least 4 J/kg, not to exceed the adult maximum dose.
5. A 2-year-old toddler is brought in by EMS following a witnessed ingestion of an
unknown quantity of grandparent’s antihypertensive medication. The child is lethargic,
bradycardic with a heart rate of 55/min, and hypotensive. Which drug is the specific first-
line antidote for beta-blocker or calcium channel blocker toxicity when associated with
severe hemodynamic instability?
A. Naloxone
B. Glucagon
C. Flumazenil
D. Sodium bicarbonate
Answer: B
Glucagon is the primary antidote used to reverse the cardiac depression, hypotension, and
bradycardia associated with beta-blocker toxicity by increasing intracellular cyclic AMP
independently of beta-adrenergic receptors.
6. During the resuscitation of a 5-year-old child in cardiac arrest, vascular access has not
been established after 90 seconds of attempts. What is the preferred alternative route for
administering emergency medications such as epinephrine?
, A. Endotracheal tube route
B. Intraosseous (IO) route
C. Central venous catheter via internal jugular
D. Subcutaneous injection
Answer: B
When intravenous access cannot be rapidly established during pediatric resuscitation, the
intraosseous (IO) route is the preferred and rapid alternative for fluid resuscitation and
medication administration. The endotracheal route is no longer routinely recommended for
standard drug delivery.
7. A 10-year-old patient presents with sudden-onset palpitations. The 12-lead ECG reveals
a narrow-complex tachycardia at a rate of 220/min with absent P waves. The child is alert,
with a blood pressure of 105/70 mmHg and normal capillary refill. What is the most
appropriate initial acute intervention?
A. Immediate synchronized cardioversion at 0.5 J/kg
B. Administration of intravenous adenosine via rapid push
C. Vagal maneuvers such as the ice bag to the face
D. Immediate intravenous amiodarone infusion
Answer: C
For a hemodynamically stable pediatric patient with supraventricular tachycardia (SVT), non-
pharmacological vagal maneuvers (like applying an ice pack to the face for infants or
Valsalva maneuvers for older children) should be attempted first while preparing for
pharmacological intervention.
8. An infant is brought to the clinic with severe dehydration due to acute gastroenteritis.
The infant weighs 8 kg and shows signs of compensated shock. What is the initial
recommended fluid bolus volume and type using isotonic crystalloids?
A. 80 mL of 0.45% normal saline over 10 minutes
B. 160 mL of D5W with 0.2% normal saline over 60 minutes
C. 160 mL of normal saline or lactated Ringer's over 5 to 20 minutes
D. 400 mL of normal saline rapidly over 5 minutes
Answer: C
The standard initial fluid resuscitation bolus for pediatric patients in shock is 20 mL/kg of an
isotonic crystalloid solution (such as normal saline or lactated Ringer's), administered rapidly
over 5 to 20 minutes and reassessed frequently.
9. A 7-year-old child presents with high fever, drooling, dysphagia, and severe respiratory
distress in a tripod position. Direct visualization of the oropharynx is avoided. Lateral neck
