1|Page
PALS - Red Cross Midterm Newest Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 4-year-old child is brought to the emergency department with a
two-day history of fever, lethargy, and a petechial rash. The child is
poorly perfused, with a weak central pulse and a heart rate of 180
beats per minute. What is the MOST appropriate initial action?
A) Administer a 20 mL/kg bolus of isotonic crystalloid over 5 to 10
minutes.
B) Begin bag-mask ventilation with 100% oxygen and prepare for
immediate endotracheal intubation.
C) Administer epinephrine 0.01 mg/kg IV/IO.
D) Apply a cardiac monitor and obtain a 12-lead ECG.
Answer: A
Explanation: The child is presenting with signs of septic shock (fever,
lethargy, petechiae, poor perfusion, tachycardia). The immediate
priority in pediatric shock, especially if there is no respiratory failure, is
to restore intravascular volume. A rapid bolus of 20 mL/kg of isotonic
crystalloid (e.g., normal saline or lactated Ringer's) is the first-line
,2|Page
treatment. This should be given rapidly, often over 5-10 minutes, and
may need to be repeated based on the child's response.
2. For a child in cardiac arrest with a shockable rhythm, what is the
appropriate energy dose for the first defibrillation attempt using a
biphasic defibrillator?
A) 2 J/kg
B) 4 J/kg
C) 6 J/kg
D) 10 J/kg
Answer: A
Explanation: The recommended initial defibrillation energy dose for a
pediatric patient with a shockable rhythm (ventricular fibrillation or
pulseless ventricular tachycardia) is 2 J/kg. If this is unsuccessful, the
dose can be increased to 4 J/kg for subsequent shocks. Using higher
doses as a starting point is not recommended and may cause
myocardial damage.
3. A 6-month-old infant is in respiratory distress with audible stridor
and subcostal retractions. Which of the following is the MOST likely
cause of this presentation?
A) Asthma
B) Bronchiolitis
C) Croup
,3|Page
D) Foreign body aspiration
Answer: C
Explanation: Stridor is a hallmark sign of upper airway obstruction. In a
6-month-old, the most common infectious cause of stridor is croup
(laryngotracheobronchitis), which causes inflammation and narrowing
of the subglottic area. Asthma and bronchiolitis are lower airway
diseases that typically present with wheezing and increased work of
breathing, not stridor. Foreign body aspiration can cause stridor but is
less common than croup as a primary diagnosis without a history of a
choking episode.
4. A 10-year-old child has a heart rate of 40 beats per minute, is pale,
and has a decreased level of consciousness. Bag-mask ventilation with
100% oxygen has been started, and the airway is patent. What is the
NEXT step in management?
A) Administer atropine 0.02 mg/kg IV/IO.
B) Administer epinephrine 0.01 mg/kg IV/IO.
C) Begin chest compressions.
D) Establish vascular access.
Answer: B
Explanation: This child has symptomatic bradycardia with poor
perfusion and altered mental status. The PALS guidelines recommend
treating symptomatic bradycardia with epinephrine (0.01 mg/kg IV/IO),
which acts as an inotrope and chronotrope to increase heart rate and
cardiac output. Atropine is not the first-line drug in pediatrics and is
, 4|Page
typically reserved for specific situations like vagal-mediated
bradycardia. Chest compressions are indicated if the heart rate is less
than 60 bpm with signs of poor perfusion, but the first step after
ensuring oxygenation and ventilation is to administer epinephrine.
5. Which of the following correctly describes the proper placement of
hands for chest compressions on a 3-year-old child?
A) Two thumbs encircling the chest over the lower half of the sternum.
B) The heel of one hand on the lower half of the sternum.
C) Two hands with fingers interlocked on the upper half of the sternum.
D) Two fingers on the lower half of the sternum.
Answer: B
Explanation: For a child (1 year to puberty), the recommended
technique for chest compressions is to use the heel of one or two hands
on the lower half of the sternum. For a small child, one hand may be
sufficient, while a larger child may require two hands. The two-thumb
technique is used for infants. Placing hands on the upper half of the
sternum is incorrect, and the two-finger technique is for infants.
6. A child is in a shockable rhythm during a cardiac arrest. After the first
shock and 2 minutes of CPR, the cardiac monitor shows a return of
organized electrical activity. What is the term for this?
A) Return of spontaneous circulation (ROSC).
B) Pulseless electrical activity (PEA).
PALS - Red Cross Midterm Newest Exam Preparation
With Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 4-year-old child is brought to the emergency department with a
two-day history of fever, lethargy, and a petechial rash. The child is
poorly perfused, with a weak central pulse and a heart rate of 180
beats per minute. What is the MOST appropriate initial action?
A) Administer a 20 mL/kg bolus of isotonic crystalloid over 5 to 10
minutes.
B) Begin bag-mask ventilation with 100% oxygen and prepare for
immediate endotracheal intubation.
C) Administer epinephrine 0.01 mg/kg IV/IO.
D) Apply a cardiac monitor and obtain a 12-lead ECG.
Answer: A
Explanation: The child is presenting with signs of septic shock (fever,
lethargy, petechiae, poor perfusion, tachycardia). The immediate
priority in pediatric shock, especially if there is no respiratory failure, is
to restore intravascular volume. A rapid bolus of 20 mL/kg of isotonic
crystalloid (e.g., normal saline or lactated Ringer's) is the first-line
,2|Page
treatment. This should be given rapidly, often over 5-10 minutes, and
may need to be repeated based on the child's response.
2. For a child in cardiac arrest with a shockable rhythm, what is the
appropriate energy dose for the first defibrillation attempt using a
biphasic defibrillator?
A) 2 J/kg
B) 4 J/kg
C) 6 J/kg
D) 10 J/kg
Answer: A
Explanation: The recommended initial defibrillation energy dose for a
pediatric patient with a shockable rhythm (ventricular fibrillation or
pulseless ventricular tachycardia) is 2 J/kg. If this is unsuccessful, the
dose can be increased to 4 J/kg for subsequent shocks. Using higher
doses as a starting point is not recommended and may cause
myocardial damage.
3. A 6-month-old infant is in respiratory distress with audible stridor
and subcostal retractions. Which of the following is the MOST likely
cause of this presentation?
A) Asthma
B) Bronchiolitis
C) Croup
,3|Page
D) Foreign body aspiration
Answer: C
Explanation: Stridor is a hallmark sign of upper airway obstruction. In a
6-month-old, the most common infectious cause of stridor is croup
(laryngotracheobronchitis), which causes inflammation and narrowing
of the subglottic area. Asthma and bronchiolitis are lower airway
diseases that typically present with wheezing and increased work of
breathing, not stridor. Foreign body aspiration can cause stridor but is
less common than croup as a primary diagnosis without a history of a
choking episode.
4. A 10-year-old child has a heart rate of 40 beats per minute, is pale,
and has a decreased level of consciousness. Bag-mask ventilation with
100% oxygen has been started, and the airway is patent. What is the
NEXT step in management?
A) Administer atropine 0.02 mg/kg IV/IO.
B) Administer epinephrine 0.01 mg/kg IV/IO.
C) Begin chest compressions.
D) Establish vascular access.
Answer: B
Explanation: This child has symptomatic bradycardia with poor
perfusion and altered mental status. The PALS guidelines recommend
treating symptomatic bradycardia with epinephrine (0.01 mg/kg IV/IO),
which acts as an inotrope and chronotrope to increase heart rate and
cardiac output. Atropine is not the first-line drug in pediatrics and is
, 4|Page
typically reserved for specific situations like vagal-mediated
bradycardia. Chest compressions are indicated if the heart rate is less
than 60 bpm with signs of poor perfusion, but the first step after
ensuring oxygenation and ventilation is to administer epinephrine.
5. Which of the following correctly describes the proper placement of
hands for chest compressions on a 3-year-old child?
A) Two thumbs encircling the chest over the lower half of the sternum.
B) The heel of one hand on the lower half of the sternum.
C) Two hands with fingers interlocked on the upper half of the sternum.
D) Two fingers on the lower half of the sternum.
Answer: B
Explanation: For a child (1 year to puberty), the recommended
technique for chest compressions is to use the heel of one or two hands
on the lower half of the sternum. For a small child, one hand may be
sufficient, while a larger child may require two hands. The two-thumb
technique is used for infants. Placing hands on the upper half of the
sternum is incorrect, and the two-finger technique is for infants.
6. A child is in a shockable rhythm during a cardiac arrest. After the first
shock and 2 minutes of CPR, the cardiac monitor shows a return of
organized electrical activity. What is the term for this?
A) Return of spontaneous circulation (ROSC).
B) Pulseless electrical activity (PEA).
