PALS TEST FINAL TEST 2026
QUESTIONS WITH CORRECT
ANSWERS GRADED A+
◍ CPR Sequence.
Answer: C-A-BCirculation-Airway-Breathing
◍ Parents of a 1-year-old female phoned EMS when they picked up their
daughter from the babysitter. Paramedics perform an initial impression
revealing an obtunded infant with irregular breathing, bruises over the
abdomen, abdominal distension, and cyanosis. Assisted bag-mask
ventilation with 100% oxygen is initiated. On primary assessment heart rate
is 36/min, peripheral pulses cannot be palpated, and central pulses are barely
palpable. Cardiac monitor shows sinus bradycardia. Chest compressions are
started at 15:2. In the ED the infant is intubated and ventilated, and IV
access is established. The heart rate is now up to 150/min, but there are
weak central pulses and no distal pulses. Systolic BP is 74. Of the following,
which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV.
Answer: C
◍ Algorithm: Pediatric Septic ShockFirst hour....
Answer: Oxygen & support ventilationEstablish IV, draw labs (glucose,
blood cultures)Begin resuscitationPush repeated 20 mL/kg isotonic
crystalloid (3-4) unless rales, resp distress, hepatomegalyCorrect
hypo-glycemia/calcemiaAdmin 1st dose antibiotics STATSTAT vasopressor
drip/stress-dose hydrocortisoneEstablish 2nd IV
,◍ You enter a room to perform an initial impression of a previously stable
10-year-old male and find him unresponsive and apneic. A code is called
and bag-mask ventilation is performed with 100% oxygen. The cardiac
monitor shows a wide-complex tachycardia. The boy has no detectable
pulses so compressions and ventilations are provided. As soon as the
defibrillator arrives you deliver an unsynchronized shock with 2 J/kg. The
rhythm check after 2 minutes of CPR reveals V
F. You then deliver a shock of 4 J/kg and resume immediate CPR beginning
with compressions. A team member has established IO access, so you give a
dose of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second
shock. At the next rhythm check, persistent VF is present. You administer
another 4 J/kg shock and resume CP
R. Based on the PALS Pulseless Arrest Algorithm, what is the next drug and
dose to administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO.
Answer: D
◍ Which of the following statements about calcium is true?
A. Calcium chloride 10% has the same bioavailability of elemental calcium
as calcium gluconate in critically ill children
B. The recommended dose is 1-2 mg/kg of calcium chloride.
C. Indications for administration of calcium include hypercalcemia,
hypokalemia, and hypomagnesemia.
D. Routine administration of calcium is not indicated during cardiac arrest..
Answer: D
◍ Initial impression of a 9-year-old male with increased work of breathing
reveals the boy to be agitated and leaning forward on the bed with obvious
respiratory distress. You administer 100% oxygen by nonrebreathing mask.
The patient is speaking in short phrases and tells you that he has asthma but
, does not carry an inhaler. He has nasal flaring, severe suprasternal and
intercostal retractions, and decreased air movement with prolonged
expiratory time and wheezing. His SpO2 is 96% (on nonrebreathing mask).
What is the next medical therapy to provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO.
Answer: C
◍ You are called to help resuscitate an infant with severe symptomatic
bradycardia associated with respiratory distress. The bradycardia persists
despite establishment of an effective airway, oxygenation, and ventilation.
There is no heart block present. Which of the following is the first drug you
should administer?
A. Dopamine
B. Adenosine
C. Atropine
D. Epinephrine.
Answer: D
◍ An infant with a history of vomiting and diarrhea arrives by ambulance.
During your primary assessment the infant responds only to painful
stimulation. The upper airway is patent, the repiratory rate is 40/min with
good bilateral breath sounds, and 100% oxygen is being administered. The
infant has cool extremities, weak pulses, and a cap refill of more than 5
seconds. The infant's BP is 85/65 mm Hg and glucose concentration is 30
mg/dL (1.65 mmol/L). Which of the following is the most appropriate
treatment to provide for this infant?
A. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over
10 to 20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a
separate infusion.
B. Establish IV or IO access and administer 20 mL/kg D50 .45% sodium
chloride bolus over 15 minutes.
, C. Establish IV or IO access and administer 20 mL/kg Lactated Ringer's
solution over 60 minutes.
D. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg
1:1,000 via the endotracheal tube..
Answer: A
◍ Algorithm: Pediatric Septic ShockFluid Responsive?.
Answer: Yes - ICUNo - Vasoactive drug & titrate for normotensionNormo:
begin dopamineHypo/warm: norepiHypo/cold: epi
◍ Adenosine (slows HR).
Answer: SVT0.1 mg/kg - dose 10.2 mg/kg - dose 2max = 6 mgRAPID push
◍ Amiodarone (antiarrythmic).
Answer: VF/VT (pulseless)5 mg/kg Bolusmax = 300 mgSVT, VT (with
pulses)5 mg/kg over 20-60 minsmax = 300 mg
◍ Which of the following statements about endotracheal drug administration is
true?
A. Endotracheal doses of resuscitation drugs in children have been well
established and are supported by evidence from clinical trials.
B. Endotracheal drug administration is the least desirable route of
administration because of this route results in unpredictable drug levels and
effects.
C. Endotracheal drug administration is the preferred route of drug
administration dring resuscitation because is results in predictable drug
levels and drug effects.
D. Intravenous drug doses for resuscitation drugs should be used whther you
give the drugs by the IV, IO, or the endotracheal route..
Answer: B
◍ Which of the following statements most accurately reflects the PALS
recommendations for the use of magnesium sulfate in the treatment of
cardiac arrest?
A. Routine use of magnesium sulfate is indicated for shock-refractory
monomorphic V
QUESTIONS WITH CORRECT
ANSWERS GRADED A+
◍ CPR Sequence.
Answer: C-A-BCirculation-Airway-Breathing
◍ Parents of a 1-year-old female phoned EMS when they picked up their
daughter from the babysitter. Paramedics perform an initial impression
revealing an obtunded infant with irregular breathing, bruises over the
abdomen, abdominal distension, and cyanosis. Assisted bag-mask
ventilation with 100% oxygen is initiated. On primary assessment heart rate
is 36/min, peripheral pulses cannot be palpated, and central pulses are barely
palpable. Cardiac monitor shows sinus bradycardia. Chest compressions are
started at 15:2. In the ED the infant is intubated and ventilated, and IV
access is established. The heart rate is now up to 150/min, but there are
weak central pulses and no distal pulses. Systolic BP is 74. Of the following,
which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV.
Answer: C
◍ Algorithm: Pediatric Septic ShockFirst hour....
Answer: Oxygen & support ventilationEstablish IV, draw labs (glucose,
blood cultures)Begin resuscitationPush repeated 20 mL/kg isotonic
crystalloid (3-4) unless rales, resp distress, hepatomegalyCorrect
hypo-glycemia/calcemiaAdmin 1st dose antibiotics STATSTAT vasopressor
drip/stress-dose hydrocortisoneEstablish 2nd IV
,◍ You enter a room to perform an initial impression of a previously stable
10-year-old male and find him unresponsive and apneic. A code is called
and bag-mask ventilation is performed with 100% oxygen. The cardiac
monitor shows a wide-complex tachycardia. The boy has no detectable
pulses so compressions and ventilations are provided. As soon as the
defibrillator arrives you deliver an unsynchronized shock with 2 J/kg. The
rhythm check after 2 minutes of CPR reveals V
F. You then deliver a shock of 4 J/kg and resume immediate CPR beginning
with compressions. A team member has established IO access, so you give a
dose of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second
shock. At the next rhythm check, persistent VF is present. You administer
another 4 J/kg shock and resume CP
R. Based on the PALS Pulseless Arrest Algorithm, what is the next drug and
dose to administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO.
Answer: D
◍ Which of the following statements about calcium is true?
A. Calcium chloride 10% has the same bioavailability of elemental calcium
as calcium gluconate in critically ill children
B. The recommended dose is 1-2 mg/kg of calcium chloride.
C. Indications for administration of calcium include hypercalcemia,
hypokalemia, and hypomagnesemia.
D. Routine administration of calcium is not indicated during cardiac arrest..
Answer: D
◍ Initial impression of a 9-year-old male with increased work of breathing
reveals the boy to be agitated and leaning forward on the bed with obvious
respiratory distress. You administer 100% oxygen by nonrebreathing mask.
The patient is speaking in short phrases and tells you that he has asthma but
, does not carry an inhaler. He has nasal flaring, severe suprasternal and
intercostal retractions, and decreased air movement with prolonged
expiratory time and wheezing. His SpO2 is 96% (on nonrebreathing mask).
What is the next medical therapy to provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO.
Answer: C
◍ You are called to help resuscitate an infant with severe symptomatic
bradycardia associated with respiratory distress. The bradycardia persists
despite establishment of an effective airway, oxygenation, and ventilation.
There is no heart block present. Which of the following is the first drug you
should administer?
A. Dopamine
B. Adenosine
C. Atropine
D. Epinephrine.
Answer: D
◍ An infant with a history of vomiting and diarrhea arrives by ambulance.
During your primary assessment the infant responds only to painful
stimulation. The upper airway is patent, the repiratory rate is 40/min with
good bilateral breath sounds, and 100% oxygen is being administered. The
infant has cool extremities, weak pulses, and a cap refill of more than 5
seconds. The infant's BP is 85/65 mm Hg and glucose concentration is 30
mg/dL (1.65 mmol/L). Which of the following is the most appropriate
treatment to provide for this infant?
A. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over
10 to 20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a
separate infusion.
B. Establish IV or IO access and administer 20 mL/kg D50 .45% sodium
chloride bolus over 15 minutes.
, C. Establish IV or IO access and administer 20 mL/kg Lactated Ringer's
solution over 60 minutes.
D. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg
1:1,000 via the endotracheal tube..
Answer: A
◍ Algorithm: Pediatric Septic ShockFluid Responsive?.
Answer: Yes - ICUNo - Vasoactive drug & titrate for normotensionNormo:
begin dopamineHypo/warm: norepiHypo/cold: epi
◍ Adenosine (slows HR).
Answer: SVT0.1 mg/kg - dose 10.2 mg/kg - dose 2max = 6 mgRAPID push
◍ Amiodarone (antiarrythmic).
Answer: VF/VT (pulseless)5 mg/kg Bolusmax = 300 mgSVT, VT (with
pulses)5 mg/kg over 20-60 minsmax = 300 mg
◍ Which of the following statements about endotracheal drug administration is
true?
A. Endotracheal doses of resuscitation drugs in children have been well
established and are supported by evidence from clinical trials.
B. Endotracheal drug administration is the least desirable route of
administration because of this route results in unpredictable drug levels and
effects.
C. Endotracheal drug administration is the preferred route of drug
administration dring resuscitation because is results in predictable drug
levels and drug effects.
D. Intravenous drug doses for resuscitation drugs should be used whther you
give the drugs by the IV, IO, or the endotracheal route..
Answer: B
◍ Which of the following statements most accurately reflects the PALS
recommendations for the use of magnesium sulfate in the treatment of
cardiac arrest?
A. Routine use of magnesium sulfate is indicated for shock-refractory
monomorphic V
