ADVANCED LIFE SUPPORT ALS 2025/2026 –
PRACTICE QUESTIONS WITH 100% SOLVED
ANSWERS!!
What oxygen delivery system most reliably delivers a high (90% of greater) concentration
of inspired oxygen to a 7-year-old child?
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?
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?
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?
Humidified oxygen as tolerated
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?
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?
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)
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?
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?
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?
1 breath every 3 to 5 seconds
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?
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?
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?
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?
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?
Position your fingers using the E-C clamp technique
Age of infants
<1 yo (excluding the newly born)
Age of children
PRACTICE QUESTIONS WITH 100% SOLVED
ANSWERS!!
What oxygen delivery system most reliably delivers a high (90% of greater) concentration
of inspired oxygen to a 7-year-old child?
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?
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?
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?
Humidified oxygen as tolerated
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?
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?
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)
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?
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?
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?
1 breath every 3 to 5 seconds
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?
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?
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?
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?
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?
Position your fingers using the E-C clamp technique
Age of infants
<1 yo (excluding the newly born)
Age of children
