AHA PALS All Questions With
100% Correct Verified Answers And
Rationale (2024/2025) A+
Multiple Choice
1. 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 37.3°C. Based On The PALS Bradycardia Algorithm, Which Of
The Following Should Be Provided First?
A) Epinephrine IV
B) Transcutaneous Pacing
C) Atropine IV
D) Dobutamine IV Infusion
Correct Ans: A)
In The PALS Bradycardia Algorithm, When A Child Is Bradycardic And Showing
Signs Of Poor Perfusion, The First-Line Treatment Is Epinephrine (0.01 Mg/Kg
IV/IO). This Is The Most Appropriate Intervention To Improve The Heart Rate And
Systemic Perfusion. Atropine May Be Considered In Some Situations, Especially
With Evidence Of Vagal-Induced Bradycardia, But It Is Not The First Choice In
Cases Of Poor Perfusion Or Where The Heart Rate Is Slow But Not Due To Increased
Vagal Tone. Transcutaneous Pacing May Be Used If The Child Is Unstable And
Epinephrine Is Ineffective. However, Epinephrine Is Typically Used First.
Dobutamine Is Generally Used For Shock Management But Does Not Address The
Underlying Bradycardia.
,2. 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?
A) Place Cold Packs On The Distal Upper And Lower Extremities
B) Ask The Child To Blow Through A Small Straw
C) Exert Light Pressure On The Eyes Bilaterally
D) Provide Synchronized Cardioversion At 0.5 To 1 J/Kg
Correct Ans: D)
When A Child With Supraventricular Tachycardia (SVT) Presents With Signs Of
Poor Perfusion (Such As Lethargy, Cool Skin, And Absent Distal Pulses), The First-
Line Treatment Is Synchronized Cardioversion. This Is Used To Correct The
Arrhythmia And Restore Normal Heart Function. Vagal Maneuvers (Like Having The
Child Blow Through A Straw Or Exerting Pressure On The Eyes) Can Sometimes Be
Helpful, But They Are Typically Not Effective In Such A Critically Ill Child And
Should Not Delay More Definitive Treatments Like Synchronized Cardioversion.
Cold Packs And Vagal Maneuvers Are Generally Not Recommended In These
Situations.
3. 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?
A) Administer Repeated Fluid Boluses Of Isotonic Colloid
B) Administer Repeated Fluid Boluses Of Isotonic Crystalloid
C) Begin Immediate Dopamine Infusion
D) Begin Immediate Dobutamine Infusion
Correct Ans: B)
, In Pediatric Septic Shock, The Initial Management Step Is To Provide Fluid
Resuscitation. Isotonic Crystalloid (E.G., Normal Saline Or Lactated Ringer's) Is
Typically Given In Repeated Boluses (20 Ml/Kg) To Restore Circulation Volume
And Improve Systemic Perfusion. Isotonic Colloid May Be Used In Certain Cases,
But Crystalloid Is Typically The First Choice. Vasopressors Like Dopamine Or
Dobutamine Are Generally Used After Fluid Resuscitation If Hypotension Persists.
Immediate Use Of Vasopressors Before Adequate Fluid Resuscitation Can Lead To
Inadequate Tissue Perfusion.
4. 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:
A) Administer A Loading Dose Of Milrinone
B) Consider Possible Metabolic And Toxicologic Causes
C) Initiate Overdrive Pacing Transcutaneously
D) Deliver An Unsynchronized Shock
Correct Ans: B)
If The Child With Ventricular Tachycardia (VT) Is Stable With Pulses And Perfusion,
It Is Important To Rule Out Possible Metabolic Or Toxicologic Causes That May Be
Contributing To The Arrhythmia. This Includes Checking Electrolyte Levels,
Considering Medication Or Drug Toxicity, And Other Underlying Conditions. If The
VT Persists Despite Synchronized Cardioversion, Further Diagnostic Work-Up Is
Essential. Overdrive Pacing Or Unsynchronized Shocks May Be Considered In The
Case Of Unstable VT Or In An Emergency Setting, But They Are Not The First Step
In A Stable Child.
5. 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:
A) Increasing The Ventilator Rate
100% Correct Verified Answers And
Rationale (2024/2025) A+
Multiple Choice
1. 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 37.3°C. Based On The PALS Bradycardia Algorithm, Which Of
The Following Should Be Provided First?
A) Epinephrine IV
B) Transcutaneous Pacing
C) Atropine IV
D) Dobutamine IV Infusion
Correct Ans: A)
In The PALS Bradycardia Algorithm, When A Child Is Bradycardic And Showing
Signs Of Poor Perfusion, The First-Line Treatment Is Epinephrine (0.01 Mg/Kg
IV/IO). This Is The Most Appropriate Intervention To Improve The Heart Rate And
Systemic Perfusion. Atropine May Be Considered In Some Situations, Especially
With Evidence Of Vagal-Induced Bradycardia, But It Is Not The First Choice In
Cases Of Poor Perfusion Or Where The Heart Rate Is Slow But Not Due To Increased
Vagal Tone. Transcutaneous Pacing May Be Used If The Child Is Unstable And
Epinephrine Is Ineffective. However, Epinephrine Is Typically Used First.
Dobutamine Is Generally Used For Shock Management But Does Not Address The
Underlying Bradycardia.
,2. 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?
A) Place Cold Packs On The Distal Upper And Lower Extremities
B) Ask The Child To Blow Through A Small Straw
C) Exert Light Pressure On The Eyes Bilaterally
D) Provide Synchronized Cardioversion At 0.5 To 1 J/Kg
Correct Ans: D)
When A Child With Supraventricular Tachycardia (SVT) Presents With Signs Of
Poor Perfusion (Such As Lethargy, Cool Skin, And Absent Distal Pulses), The First-
Line Treatment Is Synchronized Cardioversion. This Is Used To Correct The
Arrhythmia And Restore Normal Heart Function. Vagal Maneuvers (Like Having The
Child Blow Through A Straw Or Exerting Pressure On The Eyes) Can Sometimes Be
Helpful, But They Are Typically Not Effective In Such A Critically Ill Child And
Should Not Delay More Definitive Treatments Like Synchronized Cardioversion.
Cold Packs And Vagal Maneuvers Are Generally Not Recommended In These
Situations.
3. 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?
A) Administer Repeated Fluid Boluses Of Isotonic Colloid
B) Administer Repeated Fluid Boluses Of Isotonic Crystalloid
C) Begin Immediate Dopamine Infusion
D) Begin Immediate Dobutamine Infusion
Correct Ans: B)
, In Pediatric Septic Shock, The Initial Management Step Is To Provide Fluid
Resuscitation. Isotonic Crystalloid (E.G., Normal Saline Or Lactated Ringer's) Is
Typically Given In Repeated Boluses (20 Ml/Kg) To Restore Circulation Volume
And Improve Systemic Perfusion. Isotonic Colloid May Be Used In Certain Cases,
But Crystalloid Is Typically The First Choice. Vasopressors Like Dopamine Or
Dobutamine Are Generally Used After Fluid Resuscitation If Hypotension Persists.
Immediate Use Of Vasopressors Before Adequate Fluid Resuscitation Can Lead To
Inadequate Tissue Perfusion.
4. 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:
A) Administer A Loading Dose Of Milrinone
B) Consider Possible Metabolic And Toxicologic Causes
C) Initiate Overdrive Pacing Transcutaneously
D) Deliver An Unsynchronized Shock
Correct Ans: B)
If The Child With Ventricular Tachycardia (VT) Is Stable With Pulses And Perfusion,
It Is Important To Rule Out Possible Metabolic Or Toxicologic Causes That May Be
Contributing To The Arrhythmia. This Includes Checking Electrolyte Levels,
Considering Medication Or Drug Toxicity, And Other Underlying Conditions. If The
VT Persists Despite Synchronized Cardioversion, Further Diagnostic Work-Up Is
Essential. Overdrive Pacing Or Unsynchronized Shocks May Be Considered In The
Case Of Unstable VT Or In An Emergency Setting, But They Are Not The First Step
In A Stable Child.
5. 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:
A) Increasing The Ventilator Rate
