AHA PALS Exam Q&A (2026 Edition)
Comprehensive Practice Examination
1. A 4-year-old child is brought to the emergency department with respiratory distress. The
child has stridor, barking cough, and fever. Which condition should the nurse suspect?
A) Asthma exacerbation
B) Epiglottitis
C) Croup (laryngotracheobronchitis)
D) Foreign body aspiration
Answer: C) Croup (laryngotracheobronchitis)
Rationale: Croup is characterized by a barking cough, stridor, and fever. It is caused by viral
infection and typically affects children aged 6 months to 3 years. Epiglottitis presents with
drooling, tripod position, and high fever. Asthma presents with wheezing. Foreign body
aspiration has a sudden onset without fever.
2. A 6-year-old child is in cardiac arrest. The team is performing CPR. Which compression-to-
ventilation ratio should be used for a single rescuer?
A) 15:2
B) 30:2
C) 15:1
D) 30:1
Answer: B) 30:2
Rationale: For a single rescuer performing CPR on a child or infant, the compression-to-
ventilation ratio is 30:2. For two rescuers, the ratio is 15:2. This is consistent with AHA guidelines
for pediatric CPR. The adult ratio is 30:2 for both single and two rescuers.
3. A child presents with bradycardia and poor perfusion. The heart rate is 52 beats/min.
Which medication should be administered first?
A) Epinephrine
B) Atropine
C) Amiodarone
D) Adenosine
Answer: A) Epinephrine
Rationale: In pediatric bradycardia with poor perfusion, epinephrine is the first-line medication.
,Atropine may be considered if bradycardia is due to increased vagal tone or primary
atrioventricular (AV) block. Amiodarone is used for shock-refractory ventricular
fibrillation/pulseless ventricular tachycardia. Adenosine is used for supraventricular tachycardia.
4. A child is in pulseless ventricular tachycardia (VT). Which defibrillation energy dose should
be used for the first shock?
A) 0.5 J/kg
B) 1 J/kg
C) 2 J/kg
D) 4 J/kg
Answer: C) 2 J/kg
Rationale: For pediatric pulseless VT or ventricular fibrillation (VF), the initial defibrillation dose
is 2 J/kg. If ineffective, the dose may be increased to 4 J/kg for subsequent shocks. The
maximum dose is 10 J/kg. Using the correct energy dose is critical for successful defibrillation
and to minimize myocardial injury.
5. A 2-year-old child is in respiratory failure with a respiratory rate of 60 breaths/min,
retractions, and nasal flaring. Which intervention should be initiated first?
A) Intubation
B) Oxygen administration
C) Chest compressions
D) Epinephrine administration
Answer: B) Oxygen administration
Rationale: The initial intervention for respiratory failure is to provide supplemental oxygen and
support ventilation. Intubation may be required if the child does not improve. Chest
compressions are not indicated if the child has a pulse. Epinephrine is not indicated for
respiratory failure without cardiac involvement.
6. A child is receiving CPR with an advanced airway in place. What is the recommended
compression rate?
A) 80-100 compressions/min
B) 100-120 compressions/min
C) 120-140 compressions/min
D) 140-160 compressions/min
Answer: B) 100-120 compressions/min
Rationale: The recommended compression rate for CPR is 100-120 compressions per minute for
,all age groups. When an advanced airway is in place, continuous compressions are provided
without pauses for ventilation. Ventilations are given at a rate of 1 breath every 2-3 seconds
(20-30 breaths/min) for children and infants.
7. A child with supraventricular tachycardia (SVT) has a heart rate of 230 beats/min and is
hemodynamically unstable. Which intervention should be performed first?
A) Adenosine administration
B) Synchronized cardioversion
C) Vagal maneuvers
D) Amiodarone administration
Answer: B) Synchronized cardioversion
Rationale: In hemodynamically unstable SVT, synchronized cardioversion is the treatment of
choice. The initial energy dose is 0.5-1 J/kg. Adenosine and vagal maneuvers are used for stable
SVT. Amiodarone is used for ventricular arrhythmias and stable SVT if adenosine fails.
8. An infant is in respiratory arrest with a heart rate of 60 beats/min. Which action should be
performed immediately?
A) Chest compressions
B) Epinephrine administration
C) Intubation
D) Ventilation with bag-mask
Answer: A) Chest compressions
Rationale: If an infant has a heart rate <60 beats/min with signs of poor perfusion, chest
compressions should be initiated immediately. The infant is essentially in cardiac arrest.
Ventilation and chest compressions should be provided simultaneously. Epinephrine may be
administered after establishing IV access.
9. A child has a heart rate of 180 beats/min, is irritable, and has poor perfusion. The rhythm is
narrow-complex tachycardia. Which medication should be administered?
A) Adenosine
B) Atropine
C) Epinephrine
D) Amiodarone
Answer: A) Adenosine
Rationale: Adenosine is the first-line medication for stable narrow-complex SVT. The initial dose
is 0.1 mg/kg IV (maximum 6 mg). If ineffective, a second dose of 0.2 mg/kg (maximum 12 mg)
, may be given. Atropine is for bradycardia. Epinephrine and amiodarone are used for ventricular
arrhythmias.
10. During resuscitation of a child, the rhythm is asystole. Which medication should be
administered?
A) Atropine
B) Epinephrine
C) Amiodarone
D) Adenosine
Answer: B) Epinephrine
Rationale: Epinephrine is the medication of choice for asystole and pulseless electrical activity
(PEA). The recommended dose is 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO every 3-5
minutes. Atropine is not recommended for asystole. Amiodarone is used for shock-refractory
VF/VT. Adenosine is used for SVT.
11. A 5-year-old child is choking and cannot cough, speak, or breathe. Which maneuver
should be performed?
A) Back blows and chest thrusts
B) Abdominal thrusts (Heimlich maneuver)
C) Finger sweep
D) Blind finger sweep
Answer: B) Abdominal thrusts (Heimlich maneuver)
Rationale: For a conscious child (age >1 year) who is choking and cannot cough, speak, or
breathe, abdominal thrusts (Heimlich maneuver) should be performed. For infants (<1 year),
back blows and chest thrusts are used. Blind finger sweeps are not recommended as they may
push the object further into the airway.
12. A child with anaphylaxis has severe respiratory distress and hypotension. Which
medication should be administered first?
A) Albuterol
B) Diphenhydramine
C) Epinephrine
D) Methylprednisolone
Answer: C) Epinephrine
Rationale: Epinephrine is the first-line medication for anaphylaxis. It reverses bronchospasm,
vasodilation, and hypotension. The dose is 0.01 mg/kg IM (maximum 0.3 mg for children, 0.5
Comprehensive Practice Examination
1. A 4-year-old child is brought to the emergency department with respiratory distress. The
child has stridor, barking cough, and fever. Which condition should the nurse suspect?
A) Asthma exacerbation
B) Epiglottitis
C) Croup (laryngotracheobronchitis)
D) Foreign body aspiration
Answer: C) Croup (laryngotracheobronchitis)
Rationale: Croup is characterized by a barking cough, stridor, and fever. It is caused by viral
infection and typically affects children aged 6 months to 3 years. Epiglottitis presents with
drooling, tripod position, and high fever. Asthma presents with wheezing. Foreign body
aspiration has a sudden onset without fever.
2. A 6-year-old child is in cardiac arrest. The team is performing CPR. Which compression-to-
ventilation ratio should be used for a single rescuer?
A) 15:2
B) 30:2
C) 15:1
D) 30:1
Answer: B) 30:2
Rationale: For a single rescuer performing CPR on a child or infant, the compression-to-
ventilation ratio is 30:2. For two rescuers, the ratio is 15:2. This is consistent with AHA guidelines
for pediatric CPR. The adult ratio is 30:2 for both single and two rescuers.
3. A child presents with bradycardia and poor perfusion. The heart rate is 52 beats/min.
Which medication should be administered first?
A) Epinephrine
B) Atropine
C) Amiodarone
D) Adenosine
Answer: A) Epinephrine
Rationale: In pediatric bradycardia with poor perfusion, epinephrine is the first-line medication.
,Atropine may be considered if bradycardia is due to increased vagal tone or primary
atrioventricular (AV) block. Amiodarone is used for shock-refractory ventricular
fibrillation/pulseless ventricular tachycardia. Adenosine is used for supraventricular tachycardia.
4. A child is in pulseless ventricular tachycardia (VT). Which defibrillation energy dose should
be used for the first shock?
A) 0.5 J/kg
B) 1 J/kg
C) 2 J/kg
D) 4 J/kg
Answer: C) 2 J/kg
Rationale: For pediatric pulseless VT or ventricular fibrillation (VF), the initial defibrillation dose
is 2 J/kg. If ineffective, the dose may be increased to 4 J/kg for subsequent shocks. The
maximum dose is 10 J/kg. Using the correct energy dose is critical for successful defibrillation
and to minimize myocardial injury.
5. A 2-year-old child is in respiratory failure with a respiratory rate of 60 breaths/min,
retractions, and nasal flaring. Which intervention should be initiated first?
A) Intubation
B) Oxygen administration
C) Chest compressions
D) Epinephrine administration
Answer: B) Oxygen administration
Rationale: The initial intervention for respiratory failure is to provide supplemental oxygen and
support ventilation. Intubation may be required if the child does not improve. Chest
compressions are not indicated if the child has a pulse. Epinephrine is not indicated for
respiratory failure without cardiac involvement.
6. A child is receiving CPR with an advanced airway in place. What is the recommended
compression rate?
A) 80-100 compressions/min
B) 100-120 compressions/min
C) 120-140 compressions/min
D) 140-160 compressions/min
Answer: B) 100-120 compressions/min
Rationale: The recommended compression rate for CPR is 100-120 compressions per minute for
,all age groups. When an advanced airway is in place, continuous compressions are provided
without pauses for ventilation. Ventilations are given at a rate of 1 breath every 2-3 seconds
(20-30 breaths/min) for children and infants.
7. A child with supraventricular tachycardia (SVT) has a heart rate of 230 beats/min and is
hemodynamically unstable. Which intervention should be performed first?
A) Adenosine administration
B) Synchronized cardioversion
C) Vagal maneuvers
D) Amiodarone administration
Answer: B) Synchronized cardioversion
Rationale: In hemodynamically unstable SVT, synchronized cardioversion is the treatment of
choice. The initial energy dose is 0.5-1 J/kg. Adenosine and vagal maneuvers are used for stable
SVT. Amiodarone is used for ventricular arrhythmias and stable SVT if adenosine fails.
8. An infant is in respiratory arrest with a heart rate of 60 beats/min. Which action should be
performed immediately?
A) Chest compressions
B) Epinephrine administration
C) Intubation
D) Ventilation with bag-mask
Answer: A) Chest compressions
Rationale: If an infant has a heart rate <60 beats/min with signs of poor perfusion, chest
compressions should be initiated immediately. The infant is essentially in cardiac arrest.
Ventilation and chest compressions should be provided simultaneously. Epinephrine may be
administered after establishing IV access.
9. A child has a heart rate of 180 beats/min, is irritable, and has poor perfusion. The rhythm is
narrow-complex tachycardia. Which medication should be administered?
A) Adenosine
B) Atropine
C) Epinephrine
D) Amiodarone
Answer: A) Adenosine
Rationale: Adenosine is the first-line medication for stable narrow-complex SVT. The initial dose
is 0.1 mg/kg IV (maximum 6 mg). If ineffective, a second dose of 0.2 mg/kg (maximum 12 mg)
, may be given. Atropine is for bradycardia. Epinephrine and amiodarone are used for ventricular
arrhythmias.
10. During resuscitation of a child, the rhythm is asystole. Which medication should be
administered?
A) Atropine
B) Epinephrine
C) Amiodarone
D) Adenosine
Answer: B) Epinephrine
Rationale: Epinephrine is the medication of choice for asystole and pulseless electrical activity
(PEA). The recommended dose is 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO every 3-5
minutes. Atropine is not recommended for asystole. Amiodarone is used for shock-refractory
VF/VT. Adenosine is used for SVT.
11. A 5-year-old child is choking and cannot cough, speak, or breathe. Which maneuver
should be performed?
A) Back blows and chest thrusts
B) Abdominal thrusts (Heimlich maneuver)
C) Finger sweep
D) Blind finger sweep
Answer: B) Abdominal thrusts (Heimlich maneuver)
Rationale: For a conscious child (age >1 year) who is choking and cannot cough, speak, or
breathe, abdominal thrusts (Heimlich maneuver) should be performed. For infants (<1 year),
back blows and chest thrusts are used. Blind finger sweeps are not recommended as they may
push the object further into the airway.
12. A child with anaphylaxis has severe respiratory distress and hypotension. Which
medication should be administered first?
A) Albuterol
B) Diphenhydramine
C) Epinephrine
D) Methylprednisolone
Answer: C) Epinephrine
Rationale: Epinephrine is the first-line medication for anaphylaxis. It reverses bronchospasm,
vasodilation, and hypotension. The dose is 0.01 mg/kg IM (maximum 0.3 mg for children, 0.5
