Pediatric Advanced Life Support. Exam 2025
Questions and Answers
What oxygen delivery system most reliably delivers a high (90% of greater) concentration of
inspired oxygen to a 7-year-old child? - ANS Nonrebreathing face mask
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? - ANS *Epinephrine*
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? - ANS *Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
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? - ANS *Humidified oxygen as tolerated*
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,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? -
ANS *Identify and treat reversible causes*
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? - ANS *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? - ANS *Compress the chest at least one third the depth of the
chest, about 2 inches (5 cm)*
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? - ANS *You need to compress at a rate of 100 to 120 per minute*
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? - ANS *If the child weighs
less than 10 kg or is less than 1 year old*
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate
for delivering breaths? - ANS *1 breath every 3 to 5 seconds*
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, 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? - ANS *Provide CPR
for about 2 minutes before leaving to activate the emergency response system*
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? - ANS *While a colleague
provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask
ventilation*
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? -
ANS *5-mm tube*
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? - ANS *Lidocaine 1 mg/kg IV*
During bag-mask ventilation, how should you hold the mask to make an effective seal between
the child's face and the mask? - ANS *Position your fingers using the E-C clamp technique*
Age of infants - ANS <1 yo (excluding the newly born)
Age of children - ANS from 1 year of age to puberty
Pg. 3 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
Questions and Answers
What oxygen delivery system most reliably delivers a high (90% of greater) concentration of
inspired oxygen to a 7-year-old child? - ANS Nonrebreathing face mask
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? - ANS *Epinephrine*
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? - ANS *Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
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? - ANS *Humidified oxygen as tolerated*
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
,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? -
ANS *Identify and treat reversible causes*
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? - ANS *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? - ANS *Compress the chest at least one third the depth of the
chest, about 2 inches (5 cm)*
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? - ANS *You need to compress at a rate of 100 to 120 per minute*
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? - ANS *If the child weighs
less than 10 kg or is less than 1 year old*
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate
for delivering breaths? - ANS *1 breath every 3 to 5 seconds*
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, 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? - ANS *Provide CPR
for about 2 minutes before leaving to activate the emergency response system*
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? - ANS *While a colleague
provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask
ventilation*
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? -
ANS *5-mm tube*
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? - ANS *Lidocaine 1 mg/kg IV*
During bag-mask ventilation, how should you hold the mask to make an effective seal between
the child's face and the mask? - ANS *Position your fingers using the E-C clamp technique*
Age of infants - ANS <1 yo (excluding the newly born)
Age of children - ANS from 1 year of age to puberty
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