PALS ALL QUESTIONS AND ANSWERS
WELL ILLUSTRATED.
You are caring for a child who was resuscitated after a drowning event. The child is
intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2
detected. The heart rate is slow and the monitor shows sinus bradycardia. The skin is
cool, mottled, and moist; distal pulses are not palpable and the central pulses are weak.
Intravenous access has been established. The core temperature is 37.3oC. Based on
the PALS bradycardia algorithm, which of the following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion - correct answer. Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate =
220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill.
Distal pulses are not palpable. Which of the following would be the best treatment to
provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg - correct answer. Provide
synchronized cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While
administering high-flow oxygen you determine that the child's respirations are adequate
and SpO2 is 100%. You have just established vascular access and obtained blood
samples. Which of the following is the next most appropriate therapy to support
systemic perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
, Begin immediate dobutamine infusion - correct answer. Administer repeated fluid
boluses of isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate
perfusion. You attempted synchronized cardioversion without success. While seeking
expert consultation, it would be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock - correct answer. Consider possible metabolic and
toxicologic causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving
mechanical ventilation. The child's heart rate suddenly drops to 40/min and his color
becomes mottled. You should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen - correct
answer. Using a resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You
initiated high-flow oxygen using a nonrebreathing mask about 10 minutes ago and
established intravenous access. Initially the infant's heart rate was in the 150/min range
with strong pulses. Suddenly the infant's respiratory rate falls to 6/min with significant
intercostals retractions, and little air movement is heard. The infant becomes cyanotic
and the heart rate decreases to 95/min. Which of the following treatments would be best
for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate - correct answer. Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify potentially
reversible metabolic and toxic causes during the attempted resuscitation of a young
child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas - correct answer. Soliciting a history from the caregiver
or family
WELL ILLUSTRATED.
You are caring for a child who was resuscitated after a drowning event. The child is
intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2
detected. The heart rate is slow and the monitor shows sinus bradycardia. The skin is
cool, mottled, and moist; distal pulses are not palpable and the central pulses are weak.
Intravenous access has been established. The core temperature is 37.3oC. Based on
the PALS bradycardia algorithm, which of the following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion - correct answer. Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate =
220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill.
Distal pulses are not palpable. Which of the following would be the best treatment to
provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg - correct answer. Provide
synchronized cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While
administering high-flow oxygen you determine that the child's respirations are adequate
and SpO2 is 100%. You have just established vascular access and obtained blood
samples. Which of the following is the next most appropriate therapy to support
systemic perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
, Begin immediate dobutamine infusion - correct answer. Administer repeated fluid
boluses of isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate
perfusion. You attempted synchronized cardioversion without success. While seeking
expert consultation, it would be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock - correct answer. Consider possible metabolic and
toxicologic causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving
mechanical ventilation. The child's heart rate suddenly drops to 40/min and his color
becomes mottled. You should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen - correct
answer. Using a resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You
initiated high-flow oxygen using a nonrebreathing mask about 10 minutes ago and
established intravenous access. Initially the infant's heart rate was in the 150/min range
with strong pulses. Suddenly the infant's respiratory rate falls to 6/min with significant
intercostals retractions, and little air movement is heard. The infant becomes cyanotic
and the heart rate decreases to 95/min. Which of the following treatments would be best
for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate - correct answer. Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify potentially
reversible metabolic and toxic causes during the attempted resuscitation of a young
child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas - correct answer. Soliciting a history from the caregiver
or family
