AHA Pediatric Advanced Life Support PALS Exam Review
UPDATED ACTUAL Exam Questions and CORRECT Answers
Question 1.
What oxygen delivery system most reliably delivers a high (90% of greater)
concentration of inspired oxygen to a 7-year-old child?
Correct Answer: Nonrebreathing face mask
Question 2.
You are called to help treat an infant with severe symptomatic bradycardia (heart rate
66/min) associated with respiratory distress. Bradycardia persists despite establishment
of an effective airway, oxygenation, and ventilation. There is no heart block present.
What first drug should you administer?
Correct Answer: *Epinephrine*
Question 3.
You are part of a team attempting to resuscitate a child with ventricular fibrillation
cardiac arrest. You deliver 2 unsynchronized shocks. A team member established IO
access, so you give a dose of epinephrine, 0.01 mg/kg IO. At next rhythm check,
persistent ventricular fibrillation is present. You administer a 4-J/kg shock and resume
CPR. What drug and dose should be administered next?
Correct Answer: *Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
Question 4.
Initial impression of a 2-year-old girl shows her to be alert with mild breathing difficulty
during inspiration and pale skin color. On primary assessment, she makes high-pitched
inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her
SpO2 is 92% on room air, and she has mild inspiratory intercostal retractions. Lung
auscultation reveals transmitted upper airway sounds with adequate distal breath
sounds bilaterally. Most appropriate initial intervention for this child?
Correct Answer: *Humidified oxygen as tolerated*
Question 5.
7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing. Child is
intubated, and vascular access is established. ECG monitor shows organized rhythm
with heart rate of 45/min, but a pulse check reveals no palpable pulses. High-quality CPR
is resumed, and an initial IV dose of epinephrine is administered. What intervention
should you perform next?
Correct Answer: *Identify and treat reversible causes*
,Question 6.
You are caring for a 6-year-old patient who is receiving positive- pressure mechanical
ventilation via an endotracheal tube. Child begins to move his head and suddenly
becomes cyanotic, and his heart rate decreases. His SpO2 is 65%. You remove child
from mechanical ventilator and begin to provide manual ventilation with a bag via
endotracheal tube. During manual ventilation with 100% oxygen, child's color and heart
rate improve slightly and his BP remains adequate. Breath sounds and chest expansion
are present and adequate on right side and are present but consistently diminished on
left side. Trachea not deviated, and neck veins are not distended. Suction catheter
passes easily beyond tip of the endotracheal tube. Most likely cause of this child's acute
deterioration?
Correct Answer: *Tracheal tube displacement into right main bronchus*
‣ You are giving chest compressions for a child in cardiac arrest. What is the
proper depth of compressions for a child? -✓✓*Compress the chest at least
one third the depth of the chest, about 2 inches (5 cm)*
Question 7.
During PALS, you and another rescuers begin CPR. Your colleague begins compressions,
and you noticed that the compression rate is too slow. What should you say to offer
constructive feedback?
Correct Answer: *You need to compress at a rate of 100 to 120 per minute*
Question 8.
You are preparing to use a manual defibrillator in the pediatric setting. What best
describes when it is appropriate to use the smaller pediatric- sized paddles?
Correct Answer: *If the child weighs less than 10 kg or is less than 1 year old*
Question 9.
You need to provide rescue breaths to a child victim with a pulse. What is the
appropriate rate for delivering breaths?
Correct Answer: *1 breath every 3 to 5 seconds*
Question 10.
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You
shout for nearby help, but no one arrives. What action should you take next?
Correct Answer: *Provide CPR for about 2 minutes before leaving to activate
the emergency response system*
Question 11.
3 yo boy presents with multiple-system trauma. Child was an unrestrained passenger in
, a high-speed MVC. On primary assessment, he is unresponsive to voice or painful
stimulation. His RR is 5/min, HR and pulses are 170/min, systolic BC is 60 mmHg,
capillary refill is 5 seconds, and SpO2 is 75% on room air. What action should you take
first?
Correct Answer: *While a colleague provides spinal motion restriction, open
the airway with a jaw thrust and provide bag-mask ventilation*
Question 12.
You are assisting in the elective intubation of an average-sized 4 yo child with
respiratory failure. Colleague is retrieving the color-coded length-based tape from the
resuscitation chart. What is likely to be the estimated size of the uncuffed endotracheal
tube for this child?
Correct Answer: *5- mm tube*
Question 13.
You find a 10 yo boy to be unresponsive. You shout for help, and after finding that he is
not breathing and has no pulse, you and a colleague begin CPR. Another colleague
activates the emergency response system, brings the emergency equipment, and
places the child on a cardiac monitor/defibrillator, which reveals ventricular tachycardia.
You attempt defib at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the
second rhythm check, at which point you attempt defibrillation with 4 J/kg. A fourth
colleague arrives, starts an IV, and administers 1 dose of epinephrine 0.01 mg/kg. If v fib
or pulseless ventricular tachycardia persists after 2 minutes of CPR, you will administer
another shock. What drug and dose should be administered?
Correct Answer: *Lidocaine 1 mg/kg IV*
Question 14.
During bag-mask ventilation, how should you hold the mask to make an effective seal
between the child's face and the mask?
Correct Answer: *Position your fingers using the E-C clamp technique*
Question 15.
Age of infants
Correct Answer: <1 yo (excluding the newly born)
‣ Age of children -✓✓from 1 year of age to puberty
Question 16.
To perform a pulse check in an infant, palpate a
Correct Answer: brachial pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning
UPDATED ACTUAL Exam Questions and CORRECT Answers
Question 1.
What oxygen delivery system most reliably delivers a high (90% of greater)
concentration of inspired oxygen to a 7-year-old child?
Correct Answer: Nonrebreathing face mask
Question 2.
You are called to help treat an infant with severe symptomatic bradycardia (heart rate
66/min) associated with respiratory distress. Bradycardia persists despite establishment
of an effective airway, oxygenation, and ventilation. There is no heart block present.
What first drug should you administer?
Correct Answer: *Epinephrine*
Question 3.
You are part of a team attempting to resuscitate a child with ventricular fibrillation
cardiac arrest. You deliver 2 unsynchronized shocks. A team member established IO
access, so you give a dose of epinephrine, 0.01 mg/kg IO. At next rhythm check,
persistent ventricular fibrillation is present. You administer a 4-J/kg shock and resume
CPR. What drug and dose should be administered next?
Correct Answer: *Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
Question 4.
Initial impression of a 2-year-old girl shows her to be alert with mild breathing difficulty
during inspiration and pale skin color. On primary assessment, she makes high-pitched
inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her
SpO2 is 92% on room air, and she has mild inspiratory intercostal retractions. Lung
auscultation reveals transmitted upper airway sounds with adequate distal breath
sounds bilaterally. Most appropriate initial intervention for this child?
Correct Answer: *Humidified oxygen as tolerated*
Question 5.
7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing. Child is
intubated, and vascular access is established. ECG monitor shows organized rhythm
with heart rate of 45/min, but a pulse check reveals no palpable pulses. High-quality CPR
is resumed, and an initial IV dose of epinephrine is administered. What intervention
should you perform next?
Correct Answer: *Identify and treat reversible causes*
,Question 6.
You are caring for a 6-year-old patient who is receiving positive- pressure mechanical
ventilation via an endotracheal tube. Child begins to move his head and suddenly
becomes cyanotic, and his heart rate decreases. His SpO2 is 65%. You remove child
from mechanical ventilator and begin to provide manual ventilation with a bag via
endotracheal tube. During manual ventilation with 100% oxygen, child's color and heart
rate improve slightly and his BP remains adequate. Breath sounds and chest expansion
are present and adequate on right side and are present but consistently diminished on
left side. Trachea not deviated, and neck veins are not distended. Suction catheter
passes easily beyond tip of the endotracheal tube. Most likely cause of this child's acute
deterioration?
Correct Answer: *Tracheal tube displacement into right main bronchus*
‣ You are giving chest compressions for a child in cardiac arrest. What is the
proper depth of compressions for a child? -✓✓*Compress the chest at least
one third the depth of the chest, about 2 inches (5 cm)*
Question 7.
During PALS, you and another rescuers begin CPR. Your colleague begins compressions,
and you noticed that the compression rate is too slow. What should you say to offer
constructive feedback?
Correct Answer: *You need to compress at a rate of 100 to 120 per minute*
Question 8.
You are preparing to use a manual defibrillator in the pediatric setting. What best
describes when it is appropriate to use the smaller pediatric- sized paddles?
Correct Answer: *If the child weighs less than 10 kg or is less than 1 year old*
Question 9.
You need to provide rescue breaths to a child victim with a pulse. What is the
appropriate rate for delivering breaths?
Correct Answer: *1 breath every 3 to 5 seconds*
Question 10.
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You
shout for nearby help, but no one arrives. What action should you take next?
Correct Answer: *Provide CPR for about 2 minutes before leaving to activate
the emergency response system*
Question 11.
3 yo boy presents with multiple-system trauma. Child was an unrestrained passenger in
, a high-speed MVC. On primary assessment, he is unresponsive to voice or painful
stimulation. His RR is 5/min, HR and pulses are 170/min, systolic BC is 60 mmHg,
capillary refill is 5 seconds, and SpO2 is 75% on room air. What action should you take
first?
Correct Answer: *While a colleague provides spinal motion restriction, open
the airway with a jaw thrust and provide bag-mask ventilation*
Question 12.
You are assisting in the elective intubation of an average-sized 4 yo child with
respiratory failure. Colleague is retrieving the color-coded length-based tape from the
resuscitation chart. What is likely to be the estimated size of the uncuffed endotracheal
tube for this child?
Correct Answer: *5- mm tube*
Question 13.
You find a 10 yo boy to be unresponsive. You shout for help, and after finding that he is
not breathing and has no pulse, you and a colleague begin CPR. Another colleague
activates the emergency response system, brings the emergency equipment, and
places the child on a cardiac monitor/defibrillator, which reveals ventricular tachycardia.
You attempt defib at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the
second rhythm check, at which point you attempt defibrillation with 4 J/kg. A fourth
colleague arrives, starts an IV, and administers 1 dose of epinephrine 0.01 mg/kg. If v fib
or pulseless ventricular tachycardia persists after 2 minutes of CPR, you will administer
another shock. What drug and dose should be administered?
Correct Answer: *Lidocaine 1 mg/kg IV*
Question 14.
During bag-mask ventilation, how should you hold the mask to make an effective seal
between the child's face and the mask?
Correct Answer: *Position your fingers using the E-C clamp technique*
Question 15.
Age of infants
Correct Answer: <1 yo (excluding the newly born)
‣ Age of children -✓✓from 1 year of age to puberty
Question 16.
To perform a pulse check in an infant, palpate a
Correct Answer: brachial pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning
