AHA PALS (Pediatric Advanced Life Support)
Certification Exam | 190+ Practice Questions &
Verified Answers | Latest Study Guide & Exam Prep
| Pediatric Emergency, CPR, Resuscitation, ECG &
Advanced Life Support
Question 1: A 6-year-old child presents with respiratory distress, stridor, and a
barking cough. The child is sitting upright and drooling. Which of the
following is the most appropriate initial intervention?
A. Administer nebulized racemic epinephrine
B. Obtain a lateral neck radiograph
C. Prepare for immediate endotracheal intubation
D. Allow the child to remain in a position of comfort and administer humidified oxygen
CORRECT ANSWER: D. Allow the child to remain in a position of comfort and
administer humidified oxygen
Rationale: The presentation of stridor, barking cough, and respiratory distress in a child
is classic for croup (laryngotracheobronchitis). The most important initial step is to
minimize agitation, as crying and distress can worsen airway obstruction. Allowing the
child to remain in a position of comfort and providing humidified oxygen is the priority.
Nebulized racemic epinephrine is a treatment for moderate to severe croup but is not
the initial intervention before assessment. Lateral neck radiographs are not indicated for
croup and may disturb the child. Immediate intubation is reserved for impending
respiratory failure, not as an initial intervention.
Question 2: A 3-month-old infant is brought to the emergency department with
a 2-day history of poor feeding and lethargy. The infant’s heart rate is 220
bpm, blood pressure is 70/40 mmHg, and respiratory rate is 40/min. An ECG
shows narrow-complex tachycardia at 230 bpm with no visible P waves. The
infant is pale and has poor perfusion. What is the most appropriate immediate
intervention?
A. Administer adenosine 0.1 mg/kg rapid IV push
B. Perform synchronized cardioversion at 0.5 J/kg
C. Apply a vagal maneuver using ice to the face
D. Administer amiodarone 5 mg/kg IV over 20 minutes
CORRECT ANSWER: B. Perform synchronized cardioversion at 0.5 J/kg
Rationale: This infant is presenting with supraventricular tachycardia (SVT) with signs of
hemodynamic instability (poor perfusion, lethargy, hypotension). In unstable pediatric
patients with SVT, synchronized cardioversion is the treatment of choice. The initial
dose is 0.5-1 J/kg. Adenosine is used for stable SVT. Vagal maneuvers are attempted in
stable patients. Amiodarone is a second-line agent for stable, refractory SVT.
,Question 3: A 10-year-old child in the pediatric intensive care unit develops
acute respiratory distress. The child is intubated and on mechanical
ventilation. The ventilator alarm indicates high peak pressures. On
assessment, breath sounds are absent on the left side and the trachea is
deviated to the right. What is the most likely diagnosis and initial
intervention?
A. Tension pneumothorax; perform needle decompression on the left side
B. Endotracheal tube dislodgement into the right mainstem bronchus; withdraw the tube
C. Mucus plug in the left mainstem bronchus; perform suctioning
D. Pulmonary embolism; administer anticoagulation therapy
CORRECT ANSWER: A. Tension pneumothorax; perform needle decompression
on the left side
Rationale: The combination of high peak pressures, absent breath sounds on the left,
and tracheal deviation to the right is classic for a left-sided tension pneumothorax. This
is a life-threatening emergency requiring immediate needle decompression (or finger
thoracostomy) to release the trapped air. An endotracheal tube in the right mainstem
would cause absent left breath sounds but not tracheal deviation. A mucus plug would
not cause tracheal deviation. Pulmonary embolism is less likely to present with absent
breath sounds and tracheal deviation.
Question 4: A 2-year-old child with a history of a ventricular septal defect is in
cardiac arrest. The cardiac monitor shows pulseless electrical activity (PEA).
High-quality CPR is in progress. Which of the following is the most important
intervention to identify a reversible cause?
A. Administer epinephrine 0.01 mg/kg IV
B. Perform a focused bedside ultrasound
C. Obtain a 12-lead ECG
D. Administer a fluid bolus of 20 mL/kg
CORRECT ANSWER: B. Perform a focused bedside ultrasound
Rationale: In PEA, identifying reversible causes is critical. Point-of-care ultrasound
(POCUS) can rapidly identify potentially reversible causes such as cardiac tamponade,
severe hypovolemia, or a massive pulmonary embolism. While epinephrine and fluid
boluses are part of the PEA algorithm, ultrasound is the diagnostic tool of choice to
guide treatment and detect reversible etiologies. A 12-lead ECG is not feasible during
active CPR and PEA is not a shockable rhythm.
Question 5: An 8-year-old child is receiving bag-mask ventilation with 100%
oxygen. The child’s heart rate decreases from 120 bpm to 60 bpm. The cardiac
,monitor shows sinus bradycardia. The child is pale and has weak central
pulses. What is the first medication to administer?
A. Atropine 0.02 mg/kg IV
B. Epinephrine 0.01 mg/kg IV
C. Dopamine 5 mcg/kg/min IV
D. Normal saline 20 mL/kg IV
CORRECT ANSWER: B. Epinephrine 0.01 mg/kg IV
Rationale: In pediatric bradycardia with poor perfusion, epinephrine is the first-line
medication. The dose is 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO. Atropine is
used for bradycardia secondary to increased vagal tone or cholinergic toxicity, but
epinephrine is the primary drug for symptomatic bradycardia. Dopamine is a continuous
infusion for post-resuscitation care. A fluid bolus is for hypovolemia, but the primary
drug for this presentation is epinephrine.
Question 6: A 5-year-old child has a witnessed sudden collapse while playing.
The child is unresponsive, apneic, and has no palpable pulse. The cardiac
monitor reveals ventricular fibrillation (VF). High-quality CPR is in progress.
The defibrillator is charged. What is the appropriate energy dose for the first
shock?
A. 1 J/kg
B. 2 J/kg
C. 3 J/kg
D. 4 J/kg
CORRECT ANSWER: B. 2 J/kg
Rationale: The initial shock for a pediatric patient with a shockable rhythm (VF or
pulseless VT) is 2 J/kg. If the first shock is unsuccessful, subsequent shocks can be
given at 4 J/kg. The maximum adult dose is 200 J for biphasic defibrillators.
Question 7: A 1-year-old infant is in septic shock. The infant has a history of
fever, lethargy, and poor perfusion. The infant’s blood pressure is 60/35
mmHg. What is the initial fluid resuscitation volume?
A. 10 mL/kg of isotonic crystalloid
B. 20 mL/kg of isotonic crystalloid
C. 30 mL/kg of isotonic crystalloid
D. 40 mL/kg of isotonic crystalloid
CORRECT ANSWER: B. 20 mL/kg of isotonic crystalloid
, Rationale: In septic shock, fluid resuscitation is critical. The initial fluid bolus is 20
mL/kg of isotonic crystalloid (normal saline or lactated Ringer’s). This can be repeated
as needed based on clinical response. The child should be reassessed after each bolus.
Question 8: A 7-year-old child with asthma presents with severe respiratory
distress. The child is able to speak only in one- to two-word phrases. The
respiratory rate is 40/min, heart rate is 140 bpm, and oxygen saturation is 88%
on room air. The child is using accessory muscles. What is the most
appropriate initial medication?
A. Inhaled albuterol with ipratropium bromide
B. Intravenous methylprednisolone
C. Subcutaneous epinephrine
D. Heliox therapy
CORRECT ANSWER: A. Inhaled albuterol with ipratropium bromide
Rationale: This child is having a severe asthma exacerbation. The initial treatment
should be a combination of a short-acting beta-agonist (albuterol) and an anticholinergic
(ipratropium) delivered via nebulizer. Systemic corticosteroids (methylprednisolone) are
also important but should be given after or concurrently with bronchodilators, not as the
initial medication. Subcutaneous epinephrine is not the standard of care. Heliox is a
specialized therapy and not the primary intervention.
Question 9: A 4-year-old child is post-cardiac arrest and is receiving
mechanical ventilation. The child’s blood gas shows a PaCO2 of 55 mmHg and
a pH of 7.25. The child’s blood pressure is 90/60 mmHg. What is the most
appropriate ventilation strategy?
A. Hyperventilate to a PaCO2 of 30 mmHg
B. Maintain a PaCO2 of 35-40 mmHg
C. Permissive hypercapnia with a PaCO2 of 45-55 mmHg
D. Increase the respiratory rate to decrease the PaCO2 aggressively
CORRECT ANSWER: B. Maintain a PaCO2 of 35-40 mmHg
Rationale: Post-cardiac arrest care includes avoiding hypo- or hypercapnia. The target
PaCO2 should be age-appropriate (35-40 mmHg). Hyperventilation can lead to cerebral
vasoconstriction and ischemia, while severe hypercapnia can cause intracranial
hypertension. Permissive hypercapnia is not typically indicated in the immediate post-
arrest period.
Question 10: A 6-month-old infant has a heart rate of 280 bpm on the monitor.
The infant is alert, has pink color, and has strong pulses. The ECG shows a
Certification Exam | 190+ Practice Questions &
Verified Answers | Latest Study Guide & Exam Prep
| Pediatric Emergency, CPR, Resuscitation, ECG &
Advanced Life Support
Question 1: A 6-year-old child presents with respiratory distress, stridor, and a
barking cough. The child is sitting upright and drooling. Which of the
following is the most appropriate initial intervention?
A. Administer nebulized racemic epinephrine
B. Obtain a lateral neck radiograph
C. Prepare for immediate endotracheal intubation
D. Allow the child to remain in a position of comfort and administer humidified oxygen
CORRECT ANSWER: D. Allow the child to remain in a position of comfort and
administer humidified oxygen
Rationale: The presentation of stridor, barking cough, and respiratory distress in a child
is classic for croup (laryngotracheobronchitis). The most important initial step is to
minimize agitation, as crying and distress can worsen airway obstruction. Allowing the
child to remain in a position of comfort and providing humidified oxygen is the priority.
Nebulized racemic epinephrine is a treatment for moderate to severe croup but is not
the initial intervention before assessment. Lateral neck radiographs are not indicated for
croup and may disturb the child. Immediate intubation is reserved for impending
respiratory failure, not as an initial intervention.
Question 2: A 3-month-old infant is brought to the emergency department with
a 2-day history of poor feeding and lethargy. The infant’s heart rate is 220
bpm, blood pressure is 70/40 mmHg, and respiratory rate is 40/min. An ECG
shows narrow-complex tachycardia at 230 bpm with no visible P waves. The
infant is pale and has poor perfusion. What is the most appropriate immediate
intervention?
A. Administer adenosine 0.1 mg/kg rapid IV push
B. Perform synchronized cardioversion at 0.5 J/kg
C. Apply a vagal maneuver using ice to the face
D. Administer amiodarone 5 mg/kg IV over 20 minutes
CORRECT ANSWER: B. Perform synchronized cardioversion at 0.5 J/kg
Rationale: This infant is presenting with supraventricular tachycardia (SVT) with signs of
hemodynamic instability (poor perfusion, lethargy, hypotension). In unstable pediatric
patients with SVT, synchronized cardioversion is the treatment of choice. The initial
dose is 0.5-1 J/kg. Adenosine is used for stable SVT. Vagal maneuvers are attempted in
stable patients. Amiodarone is a second-line agent for stable, refractory SVT.
,Question 3: A 10-year-old child in the pediatric intensive care unit develops
acute respiratory distress. The child is intubated and on mechanical
ventilation. The ventilator alarm indicates high peak pressures. On
assessment, breath sounds are absent on the left side and the trachea is
deviated to the right. What is the most likely diagnosis and initial
intervention?
A. Tension pneumothorax; perform needle decompression on the left side
B. Endotracheal tube dislodgement into the right mainstem bronchus; withdraw the tube
C. Mucus plug in the left mainstem bronchus; perform suctioning
D. Pulmonary embolism; administer anticoagulation therapy
CORRECT ANSWER: A. Tension pneumothorax; perform needle decompression
on the left side
Rationale: The combination of high peak pressures, absent breath sounds on the left,
and tracheal deviation to the right is classic for a left-sided tension pneumothorax. This
is a life-threatening emergency requiring immediate needle decompression (or finger
thoracostomy) to release the trapped air. An endotracheal tube in the right mainstem
would cause absent left breath sounds but not tracheal deviation. A mucus plug would
not cause tracheal deviation. Pulmonary embolism is less likely to present with absent
breath sounds and tracheal deviation.
Question 4: A 2-year-old child with a history of a ventricular septal defect is in
cardiac arrest. The cardiac monitor shows pulseless electrical activity (PEA).
High-quality CPR is in progress. Which of the following is the most important
intervention to identify a reversible cause?
A. Administer epinephrine 0.01 mg/kg IV
B. Perform a focused bedside ultrasound
C. Obtain a 12-lead ECG
D. Administer a fluid bolus of 20 mL/kg
CORRECT ANSWER: B. Perform a focused bedside ultrasound
Rationale: In PEA, identifying reversible causes is critical. Point-of-care ultrasound
(POCUS) can rapidly identify potentially reversible causes such as cardiac tamponade,
severe hypovolemia, or a massive pulmonary embolism. While epinephrine and fluid
boluses are part of the PEA algorithm, ultrasound is the diagnostic tool of choice to
guide treatment and detect reversible etiologies. A 12-lead ECG is not feasible during
active CPR and PEA is not a shockable rhythm.
Question 5: An 8-year-old child is receiving bag-mask ventilation with 100%
oxygen. The child’s heart rate decreases from 120 bpm to 60 bpm. The cardiac
,monitor shows sinus bradycardia. The child is pale and has weak central
pulses. What is the first medication to administer?
A. Atropine 0.02 mg/kg IV
B. Epinephrine 0.01 mg/kg IV
C. Dopamine 5 mcg/kg/min IV
D. Normal saline 20 mL/kg IV
CORRECT ANSWER: B. Epinephrine 0.01 mg/kg IV
Rationale: In pediatric bradycardia with poor perfusion, epinephrine is the first-line
medication. The dose is 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO. Atropine is
used for bradycardia secondary to increased vagal tone or cholinergic toxicity, but
epinephrine is the primary drug for symptomatic bradycardia. Dopamine is a continuous
infusion for post-resuscitation care. A fluid bolus is for hypovolemia, but the primary
drug for this presentation is epinephrine.
Question 6: A 5-year-old child has a witnessed sudden collapse while playing.
The child is unresponsive, apneic, and has no palpable pulse. The cardiac
monitor reveals ventricular fibrillation (VF). High-quality CPR is in progress.
The defibrillator is charged. What is the appropriate energy dose for the first
shock?
A. 1 J/kg
B. 2 J/kg
C. 3 J/kg
D. 4 J/kg
CORRECT ANSWER: B. 2 J/kg
Rationale: The initial shock for a pediatric patient with a shockable rhythm (VF or
pulseless VT) is 2 J/kg. If the first shock is unsuccessful, subsequent shocks can be
given at 4 J/kg. The maximum adult dose is 200 J for biphasic defibrillators.
Question 7: A 1-year-old infant is in septic shock. The infant has a history of
fever, lethargy, and poor perfusion. The infant’s blood pressure is 60/35
mmHg. What is the initial fluid resuscitation volume?
A. 10 mL/kg of isotonic crystalloid
B. 20 mL/kg of isotonic crystalloid
C. 30 mL/kg of isotonic crystalloid
D. 40 mL/kg of isotonic crystalloid
CORRECT ANSWER: B. 20 mL/kg of isotonic crystalloid
, Rationale: In septic shock, fluid resuscitation is critical. The initial fluid bolus is 20
mL/kg of isotonic crystalloid (normal saline or lactated Ringer’s). This can be repeated
as needed based on clinical response. The child should be reassessed after each bolus.
Question 8: A 7-year-old child with asthma presents with severe respiratory
distress. The child is able to speak only in one- to two-word phrases. The
respiratory rate is 40/min, heart rate is 140 bpm, and oxygen saturation is 88%
on room air. The child is using accessory muscles. What is the most
appropriate initial medication?
A. Inhaled albuterol with ipratropium bromide
B. Intravenous methylprednisolone
C. Subcutaneous epinephrine
D. Heliox therapy
CORRECT ANSWER: A. Inhaled albuterol with ipratropium bromide
Rationale: This child is having a severe asthma exacerbation. The initial treatment
should be a combination of a short-acting beta-agonist (albuterol) and an anticholinergic
(ipratropium) delivered via nebulizer. Systemic corticosteroids (methylprednisolone) are
also important but should be given after or concurrently with bronchodilators, not as the
initial medication. Subcutaneous epinephrine is not the standard of care. Heliox is a
specialized therapy and not the primary intervention.
Question 9: A 4-year-old child is post-cardiac arrest and is receiving
mechanical ventilation. The child’s blood gas shows a PaCO2 of 55 mmHg and
a pH of 7.25. The child’s blood pressure is 90/60 mmHg. What is the most
appropriate ventilation strategy?
A. Hyperventilate to a PaCO2 of 30 mmHg
B. Maintain a PaCO2 of 35-40 mmHg
C. Permissive hypercapnia with a PaCO2 of 45-55 mmHg
D. Increase the respiratory rate to decrease the PaCO2 aggressively
CORRECT ANSWER: B. Maintain a PaCO2 of 35-40 mmHg
Rationale: Post-cardiac arrest care includes avoiding hypo- or hypercapnia. The target
PaCO2 should be age-appropriate (35-40 mmHg). Hyperventilation can lead to cerebral
vasoconstriction and ischemia, while severe hypercapnia can cause intracranial
hypertension. Permissive hypercapnia is not typically indicated in the immediate post-
arrest period.
Question 10: A 6-month-old infant has a heart rate of 280 bpm on the monitor.
The infant is alert, has pink color, and has strong pulses. The ECG shows a
