PALS CERTIFICATION EXAM– QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. An infant presents to the emergency department with lethargy, poor feeding, and a
history of diarrhea for three days. Assessment reveals cool extremities, delayed capillary
refill of 4 seconds, and a heart rate of 180 beats per minute. Which initial fluid
resuscitation strategy is most appropriate for this pediatric client?
A. Administer a maintenance intravenous fluid bolus of 5 mL/kg over 2 hours.
B. Administer an isotonic crystalloid fluid bolus of 20 mL/kg rapidly over 5 to 20 minutes.
C. Initiate a continuous blood transfusion of packed red blood cells immediately.
D. Infuse 5% dextrose in water at twice the maintenance rate over 24 hours.
ANSWER: B. Administer an isotonic crystalloid fluid bolus of 20 mL/kg rapidly over 5 to 20
minutes.
This infant displays classic signs of compensated to decompensated hypovolemic shock.
Initial resuscitation requires rapid administration of an isotonic crystalloid, such as normal
saline or lactated Ringer's, at 20 mL/kg over 5 to 20 minutes to restore intravascular volume.
Maintenance fluids or slow infusions are inadequate for treating acute shock, and hypotonic
or pure dextrose solutions are inappropriate for initial volume resuscitation.
2. A 3-year-old child is brought in by emergency medical services following a submersion
incident in a swimming pool. The child is unresponsive, has central cyanosis, and
demonstrates agonal gasps with a heart rate of 52 beats per minute. What is the immediate
priority action?
A. Establish immediate peripheral intravenous access to draw baseline laboratory panels.
B. Initiate high-flow supplemental oxygen via a non-rebreather mask and observe.
C. Begin high-quality cardiopulmonary resuscitation and deliver rescue breaths with 100%
oxygen.
D. Prepare the client for emergency magnetic resonance imaging of the brain.
ANSWER: C. Begin high-quality cardiopulmonary resuscitation and deliver rescue breaths
with 100% oxygen.
A heart rate below 60 beats per minute with signs of poor perfusion in an infant or child
requires immediate chest compressions and rescue breathing. Waiting for intravenous access
or using simple oxygen masks is fatal when cardiac arrest or impending arrest is present due
to severe hypoxia.
,3. A pediatric nurse is evaluating a school-aged child in severe respiratory distress. The
child exhibits nasal flaring, intercostal retractions, inspiratory stridor at rest, and an
oxygen saturation of 88% on room air. Which intervention should be performed first?
A. Administer nebulized albuterol immediately.
B. Provide 100% oxygen via a non-rebreather mask and keep the child in a position of comfort.
C. Perform immediate endotracheal intubation without any preliminary measures.
D. Administer a sublingual dose of a corticosteroid and wait 30 minutes.
ANSWER: B. Provide 100% oxygen via a non-rebreather mask and keep the child in a
position of comfort.
The initial priority in acute respiratory distress is to optimize oxygenation and minimize
anxiety by administering high-flow oxygen and keeping the child in a comfortable position.
Stridor indicates upper airway obstruction where albuterol is ineffective, and aggressive
interventions like intubation should follow failed conservative measures unless immediate
arrest occurs.
4. A nurse is participating in a pediatric resuscitation code. The cardiac monitor displays
ventricular fibrillation. Following the delivery of an initial shock, what action should the
team perform next?
A. Administer a dose of calcium chloride IV push.
B. Resume high-quality chest compressions immediately for 2 minutes.
C. Check a pulse and rhythm before performing any further actions.
D. Intubate the trachea before resuming chest compressions.
ANSWER: B. Resume high-quality chest compressions immediately for 2 minutes.
Following any shock delivery for a shockable rhythm, the team must immediately resume
high-quality cardiopulmonary resuscitation starting with chest compressions for 2 minutes
before pausing to check the rhythm or pulse. Interrupting compressions reduces coronary and
cerebral perfusion pressure.
5. An 8-month-old infant is evaluated in the pediatric clinic. The infant exhibits tachypnea,
grunting, intercostal retractions, and bilateral wheezing. The parent reports a 2-day
history of clear rhinorrhea and low-grade fever. Which pathogen is the most likely cause of
this clinical presentation?
A. Group A Streptococcus
B. Respiratory syncytial virus
C. Bordetella pertussis
D. Neisseria meningitidis
ANSWER: B. Respiratory syncytial virus
, Respiratory syncytial virus is the primary causative agent of bronchiolitis in infants,
characterized by upper respiratory symptoms progressing to lower respiratory signs such as
wheezing, tachypnea, and increased work of breathing. The other pathogens present with
different clinical profiles.
6. A pediatric nurse is preparing to administer an intraosseous infusion to a severely
dehydrated toddler in circulatory collapse. Which anatomical site is the preferred primary
insertion location?
A. Proximal tibia, anteromedial surface
B. Distal femur, anterior midline
C. Proximal humerus, greater tubercle
D. Distal radius, dorsal surface
ANSWER: A. Proximal tibia, anteromedial surface
The proximal tibia just below the tibial tuberosity on the flat anteromedial surface is the
preferred and most accessible insertion site for intraosseous access in pediatric patients due to
its broad surface area and distance from growth plates.
7. A 6-year-old child is admitted with diabetic ketoacidosis. The child is lethargic,
breathing deeply and rapidly, and has dry mucous membranes. Which type of
compensatory breathing pattern is this child exhibiting?
A. Cheyne-Stokes respirations
B. Kussmaul respirations
C. Biot respirations
D. Paradoxical respirations
ANSWER: B. Kussmaul respirations
Kussmaul respirations are deep, rapid, and labored breathing patterns characteristic of
metabolic acidosis, such as diabetic ketoacidosis, where the body attempts to eliminate carbon
dioxide to reduce acid load. Cheyne-Stokes involves periods of apnea, and Biot involves
irregular groupings of breaths.
8. During pediatric advanced life support training, a nurse reviews the management of
symptomatic bradycardia in an infant. The infant has a heart rate of 50 beats per minute,
poor perfusion, and lethargy despite adequate oxygenation and ventilation. What
medication should be administered first?
A. Amiodarone
B. Epinephrine
C. Adenosine
D. Atropine
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. An infant presents to the emergency department with lethargy, poor feeding, and a
history of diarrhea for three days. Assessment reveals cool extremities, delayed capillary
refill of 4 seconds, and a heart rate of 180 beats per minute. Which initial fluid
resuscitation strategy is most appropriate for this pediatric client?
A. Administer a maintenance intravenous fluid bolus of 5 mL/kg over 2 hours.
B. Administer an isotonic crystalloid fluid bolus of 20 mL/kg rapidly over 5 to 20 minutes.
C. Initiate a continuous blood transfusion of packed red blood cells immediately.
D. Infuse 5% dextrose in water at twice the maintenance rate over 24 hours.
ANSWER: B. Administer an isotonic crystalloid fluid bolus of 20 mL/kg rapidly over 5 to 20
minutes.
This infant displays classic signs of compensated to decompensated hypovolemic shock.
Initial resuscitation requires rapid administration of an isotonic crystalloid, such as normal
saline or lactated Ringer's, at 20 mL/kg over 5 to 20 minutes to restore intravascular volume.
Maintenance fluids or slow infusions are inadequate for treating acute shock, and hypotonic
or pure dextrose solutions are inappropriate for initial volume resuscitation.
2. A 3-year-old child is brought in by emergency medical services following a submersion
incident in a swimming pool. The child is unresponsive, has central cyanosis, and
demonstrates agonal gasps with a heart rate of 52 beats per minute. What is the immediate
priority action?
A. Establish immediate peripheral intravenous access to draw baseline laboratory panels.
B. Initiate high-flow supplemental oxygen via a non-rebreather mask and observe.
C. Begin high-quality cardiopulmonary resuscitation and deliver rescue breaths with 100%
oxygen.
D. Prepare the client for emergency magnetic resonance imaging of the brain.
ANSWER: C. Begin high-quality cardiopulmonary resuscitation and deliver rescue breaths
with 100% oxygen.
A heart rate below 60 beats per minute with signs of poor perfusion in an infant or child
requires immediate chest compressions and rescue breathing. Waiting for intravenous access
or using simple oxygen masks is fatal when cardiac arrest or impending arrest is present due
to severe hypoxia.
,3. A pediatric nurse is evaluating a school-aged child in severe respiratory distress. The
child exhibits nasal flaring, intercostal retractions, inspiratory stridor at rest, and an
oxygen saturation of 88% on room air. Which intervention should be performed first?
A. Administer nebulized albuterol immediately.
B. Provide 100% oxygen via a non-rebreather mask and keep the child in a position of comfort.
C. Perform immediate endotracheal intubation without any preliminary measures.
D. Administer a sublingual dose of a corticosteroid and wait 30 minutes.
ANSWER: B. Provide 100% oxygen via a non-rebreather mask and keep the child in a
position of comfort.
The initial priority in acute respiratory distress is to optimize oxygenation and minimize
anxiety by administering high-flow oxygen and keeping the child in a comfortable position.
Stridor indicates upper airway obstruction where albuterol is ineffective, and aggressive
interventions like intubation should follow failed conservative measures unless immediate
arrest occurs.
4. A nurse is participating in a pediatric resuscitation code. The cardiac monitor displays
ventricular fibrillation. Following the delivery of an initial shock, what action should the
team perform next?
A. Administer a dose of calcium chloride IV push.
B. Resume high-quality chest compressions immediately for 2 minutes.
C. Check a pulse and rhythm before performing any further actions.
D. Intubate the trachea before resuming chest compressions.
ANSWER: B. Resume high-quality chest compressions immediately for 2 minutes.
Following any shock delivery for a shockable rhythm, the team must immediately resume
high-quality cardiopulmonary resuscitation starting with chest compressions for 2 minutes
before pausing to check the rhythm or pulse. Interrupting compressions reduces coronary and
cerebral perfusion pressure.
5. An 8-month-old infant is evaluated in the pediatric clinic. The infant exhibits tachypnea,
grunting, intercostal retractions, and bilateral wheezing. The parent reports a 2-day
history of clear rhinorrhea and low-grade fever. Which pathogen is the most likely cause of
this clinical presentation?
A. Group A Streptococcus
B. Respiratory syncytial virus
C. Bordetella pertussis
D. Neisseria meningitidis
ANSWER: B. Respiratory syncytial virus
, Respiratory syncytial virus is the primary causative agent of bronchiolitis in infants,
characterized by upper respiratory symptoms progressing to lower respiratory signs such as
wheezing, tachypnea, and increased work of breathing. The other pathogens present with
different clinical profiles.
6. A pediatric nurse is preparing to administer an intraosseous infusion to a severely
dehydrated toddler in circulatory collapse. Which anatomical site is the preferred primary
insertion location?
A. Proximal tibia, anteromedial surface
B. Distal femur, anterior midline
C. Proximal humerus, greater tubercle
D. Distal radius, dorsal surface
ANSWER: A. Proximal tibia, anteromedial surface
The proximal tibia just below the tibial tuberosity on the flat anteromedial surface is the
preferred and most accessible insertion site for intraosseous access in pediatric patients due to
its broad surface area and distance from growth plates.
7. A 6-year-old child is admitted with diabetic ketoacidosis. The child is lethargic,
breathing deeply and rapidly, and has dry mucous membranes. Which type of
compensatory breathing pattern is this child exhibiting?
A. Cheyne-Stokes respirations
B. Kussmaul respirations
C. Biot respirations
D. Paradoxical respirations
ANSWER: B. Kussmaul respirations
Kussmaul respirations are deep, rapid, and labored breathing patterns characteristic of
metabolic acidosis, such as diabetic ketoacidosis, where the body attempts to eliminate carbon
dioxide to reduce acid load. Cheyne-Stokes involves periods of apnea, and Biot involves
irregular groupings of breaths.
8. During pediatric advanced life support training, a nurse reviews the management of
symptomatic bradycardia in an infant. The infant has a heart rate of 50 beats per minute,
poor perfusion, and lethargy despite adequate oxygenation and ventilation. What
medication should be administered first?
A. Amiodarone
B. Epinephrine
C. Adenosine
D. Atropine
