PALS CERTIFICATION EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
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1. A 4-year-old child is brought to the emergency department by parents who report
sudden onset of drooling, muffled voice, and high fever over the past 3 hours. The child is
sitting upright, leaning forward, and appears anxious. What is the most critical initial
management priority for this patient?
A. Immediately place the child supine and perform a direct visualization of the posterior
pharynx using a tongue depressor
B. Keep the child calm and comfortable in a position of comfort while preparing for immediate
pediatric subspecialty and airway support evaluation
C. Administer oral clear liquids immediately to assess for swallowing competency
D. Forcefully restrain the child to obtain an immediate peripheral intravenous line
ANSWER: B. Keep the child calm and comfortable in a position of comfort while preparing
for immediate pediatric subspecialty and airway support evaluation
Acute epiglottitis can cause sudden, complete airway obstruction if the child is agitated or
forced into a supine position; maintaining a position of comfort and avoiding unnecessary
agitation is paramount.
2. A 2-year-old child is evaluated for acute respiratory distress. Vital signs include heart
rate 145 beats per minute, respiratory rate 42 breaths per minute, and oxygen saturation
88 percent on room air. Auscultation reveals inspiratory stridor at rest, sternal retractions,
and a barking cough. What is the initial pharmacological intervention of choice in this
clinical scenario?
A. Nebulized epinephrine
B. Intravenous furosemide
C. Intravenous amiodarone
D. Subcutaneous atropine
ANSWER: A. Nebulized epinephrine
,Nebulized epinephrine causes local mucosal vasoconstriction, reducing subglottic edema in
conditions like croup, and provides rapid relief for moderate-to-severe respiratory distress with
stridor at rest.
3. An 8-month-old infant is brought in with a 2-day history of nasal congestion, low-grade
fever, and progressive tachypnea and wheezing. Physical examination shows mild
intercostal retractions and a respiratory rate of 58 breaths per minute. Which of the
following is the most likely underlying etiology?
A. Respiratory syncytial virus (RSV) bronchiolitis
B. Acute bacterial epiglottitis
C. Foreign body aspiration of a peanut
D. Hypertrophic pyloric stenosis
ANSWER: A. Respiratory syncytial virus (RSV) bronchiolitis
Bronchiolitis typically affects infants under 1 year of age, presenting with viral prodrome
followed by lower respiratory tract signs including tachypnea, wheezing, and crackles, most
commonly caused by RSV.
4. During the resuscitation of an unresponsive 3-year-old child in cardiac arrest, the
rhythm monitor displays asystole. High-quality CPR is ongoing with a bag-mask device.
What is the recommended interval for administering epinephrine during this pediatric
arrest?
A. Every 3 to 5 minutes
B. Every 30 seconds
C. Every 15 minutes
D. Only once during the entire resuscitation
ANSWER: A. Every 3 to 5 minutes
Epinephrine should be administered every 3 to 5 minutes during cardiac arrest to stimulate
alpha-adrenergic receptors, increasing coronary and cerebral perfusion pressure.
5. A 6-year-old child is assessed in the emergency department following a motor vehicle
collision. The child is lethargic, has a heart rate of 160 beats per minute, delayed capillary
refill of 4 seconds, and cool, pale extremities. Blood pressure is 70/45 mm Hg. What is the
immediate fluid resuscitation approach?
, A. Administer a rapid isotonic crystalloid bolus of 20 mL/kg over 5 to 20 minutes and reassess
perfusion
B. Restrict all fluids immediately to prevent pulmonary edema
C. Administer a hypotonic dextrose infusion at maintenance rate only
D. Infuse packed red blood cells immediately without crossmatching
ANSWER: A. Administer a rapid isotonic crystalloid bolus of 20 mL/kg over 5 to 20
minutes and reassess perfusion
Initial management of compensated or uncompensated hypovolemic shock in pediatrics
involves rapid administration of 20 mL/kg isotonic crystalloid boluses, followed by frequent
clinical reassessment.
6. A paramedic team responds to an unresponsive 5-year-old child. Assessment reveals no
breathing and no palpable pulse. High-quality chest compressions are initiated. What is the
correct compression-to-ventilation ratio for single-rescuer pediatric CPR?
A. 30 compressions to 2 breaths
B. 15 compressions to 2 breaths
C. 5 compressions to 1 breath
D. Continuous compressions with no ventilations
ANSWER: A. 30 compressions to 2 breaths
For a single rescuer performing CPR on an infant or child, the recommended compression-to-
ventilation ratio is 30:2, matching adult guidelines to maximize circulation when working
alone.
7. A 10-year-old child presents with sudden palpitations. The ECG demonstrates a narrow-
complex tachycardia at a rate of 210 beats per minute. The child is alert, with a blood
pressure of 105/70 mm Hg and normal perfusion. What is the initial non-pharmacological
intervention of choice?
A. Vagal maneuvers such as the ice bag face application or Valsalva maneuver
B. Immediate unsynchronized defibrillation at 200 joules
C. Administration of intravenous potassium chloride
D. Immediate surgical pacemaker insertion
, ANSWER: A. Vagal maneuvers such as the ice bag face application or Valsalva maneuver
In stable supraventricular tachycardia, initial management includes non-pharmacological
vagal maneuvers to increase parasympathetic tone and slow AV nodal conduction.
8. An infant is brought to the emergency department in cardiac arrest. The cardiac
monitor displays ventricular fibrillation. Following the delivery of an initial shock, high-
quality CPR is resumed. What is the recommended energy dose for the initial defibrillation
shock in pediatric patients?
A. 2 J/kg
B. 0.1 J/kg
C. 10 J/kg
D. 20 J/kg
ANSWER: A. 2 J/kg
The recommended initial energy dose for pediatric defibrillation in shockable rhythms
(VF/pVT) is 2 J/kg, which can be escalated to 4 J/kg or higher for subsequent shocks.
9. A 7-year-old child is evaluated for severe respiratory distress. Examination reveals
tachypnea, intercostal retractions, diminished breath sounds on the right side, and tracheal
deviation to the left. Blood pressure is dropping rapidly. What is the immediate life-saving
intervention?
A. Needle decompression of the right chest
B. Immediate administration of oral bronchodilators
C. Endoscopic removal of an airway foreign body
D. Placement of a central venous line
ANSWER: A. Needle decompression of the right chest
Signs of tension pneumothorax include respiratory distress, unilateral absent breath sounds,
tracheal deviation, and hemodynamic compromise, requiring immediate needle
decompression.
10. A 3-month-old infant is evaluated for lethargy, poor feeding, and a weak cry. Physical
examination reveals generalized hypotonia, large anterior fontanelle, and poor suck reflex.
Parents report honey was introduced to the diet last week. What is the most likely
diagnosis?
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 4-year-old child is brought to the emergency department by parents who report
sudden onset of drooling, muffled voice, and high fever over the past 3 hours. The child is
sitting upright, leaning forward, and appears anxious. What is the most critical initial
management priority for this patient?
A. Immediately place the child supine and perform a direct visualization of the posterior
pharynx using a tongue depressor
B. Keep the child calm and comfortable in a position of comfort while preparing for immediate
pediatric subspecialty and airway support evaluation
C. Administer oral clear liquids immediately to assess for swallowing competency
D. Forcefully restrain the child to obtain an immediate peripheral intravenous line
ANSWER: B. Keep the child calm and comfortable in a position of comfort while preparing
for immediate pediatric subspecialty and airway support evaluation
Acute epiglottitis can cause sudden, complete airway obstruction if the child is agitated or
forced into a supine position; maintaining a position of comfort and avoiding unnecessary
agitation is paramount.
2. A 2-year-old child is evaluated for acute respiratory distress. Vital signs include heart
rate 145 beats per minute, respiratory rate 42 breaths per minute, and oxygen saturation
88 percent on room air. Auscultation reveals inspiratory stridor at rest, sternal retractions,
and a barking cough. What is the initial pharmacological intervention of choice in this
clinical scenario?
A. Nebulized epinephrine
B. Intravenous furosemide
C. Intravenous amiodarone
D. Subcutaneous atropine
ANSWER: A. Nebulized epinephrine
,Nebulized epinephrine causes local mucosal vasoconstriction, reducing subglottic edema in
conditions like croup, and provides rapid relief for moderate-to-severe respiratory distress with
stridor at rest.
3. An 8-month-old infant is brought in with a 2-day history of nasal congestion, low-grade
fever, and progressive tachypnea and wheezing. Physical examination shows mild
intercostal retractions and a respiratory rate of 58 breaths per minute. Which of the
following is the most likely underlying etiology?
A. Respiratory syncytial virus (RSV) bronchiolitis
B. Acute bacterial epiglottitis
C. Foreign body aspiration of a peanut
D. Hypertrophic pyloric stenosis
ANSWER: A. Respiratory syncytial virus (RSV) bronchiolitis
Bronchiolitis typically affects infants under 1 year of age, presenting with viral prodrome
followed by lower respiratory tract signs including tachypnea, wheezing, and crackles, most
commonly caused by RSV.
4. During the resuscitation of an unresponsive 3-year-old child in cardiac arrest, the
rhythm monitor displays asystole. High-quality CPR is ongoing with a bag-mask device.
What is the recommended interval for administering epinephrine during this pediatric
arrest?
A. Every 3 to 5 minutes
B. Every 30 seconds
C. Every 15 minutes
D. Only once during the entire resuscitation
ANSWER: A. Every 3 to 5 minutes
Epinephrine should be administered every 3 to 5 minutes during cardiac arrest to stimulate
alpha-adrenergic receptors, increasing coronary and cerebral perfusion pressure.
5. A 6-year-old child is assessed in the emergency department following a motor vehicle
collision. The child is lethargic, has a heart rate of 160 beats per minute, delayed capillary
refill of 4 seconds, and cool, pale extremities. Blood pressure is 70/45 mm Hg. What is the
immediate fluid resuscitation approach?
, A. Administer a rapid isotonic crystalloid bolus of 20 mL/kg over 5 to 20 minutes and reassess
perfusion
B. Restrict all fluids immediately to prevent pulmonary edema
C. Administer a hypotonic dextrose infusion at maintenance rate only
D. Infuse packed red blood cells immediately without crossmatching
ANSWER: A. Administer a rapid isotonic crystalloid bolus of 20 mL/kg over 5 to 20
minutes and reassess perfusion
Initial management of compensated or uncompensated hypovolemic shock in pediatrics
involves rapid administration of 20 mL/kg isotonic crystalloid boluses, followed by frequent
clinical reassessment.
6. A paramedic team responds to an unresponsive 5-year-old child. Assessment reveals no
breathing and no palpable pulse. High-quality chest compressions are initiated. What is the
correct compression-to-ventilation ratio for single-rescuer pediatric CPR?
A. 30 compressions to 2 breaths
B. 15 compressions to 2 breaths
C. 5 compressions to 1 breath
D. Continuous compressions with no ventilations
ANSWER: A. 30 compressions to 2 breaths
For a single rescuer performing CPR on an infant or child, the recommended compression-to-
ventilation ratio is 30:2, matching adult guidelines to maximize circulation when working
alone.
7. A 10-year-old child presents with sudden palpitations. The ECG demonstrates a narrow-
complex tachycardia at a rate of 210 beats per minute. The child is alert, with a blood
pressure of 105/70 mm Hg and normal perfusion. What is the initial non-pharmacological
intervention of choice?
A. Vagal maneuvers such as the ice bag face application or Valsalva maneuver
B. Immediate unsynchronized defibrillation at 200 joules
C. Administration of intravenous potassium chloride
D. Immediate surgical pacemaker insertion
, ANSWER: A. Vagal maneuvers such as the ice bag face application or Valsalva maneuver
In stable supraventricular tachycardia, initial management includes non-pharmacological
vagal maneuvers to increase parasympathetic tone and slow AV nodal conduction.
8. An infant is brought to the emergency department in cardiac arrest. The cardiac
monitor displays ventricular fibrillation. Following the delivery of an initial shock, high-
quality CPR is resumed. What is the recommended energy dose for the initial defibrillation
shock in pediatric patients?
A. 2 J/kg
B. 0.1 J/kg
C. 10 J/kg
D. 20 J/kg
ANSWER: A. 2 J/kg
The recommended initial energy dose for pediatric defibrillation in shockable rhythms
(VF/pVT) is 2 J/kg, which can be escalated to 4 J/kg or higher for subsequent shocks.
9. A 7-year-old child is evaluated for severe respiratory distress. Examination reveals
tachypnea, intercostal retractions, diminished breath sounds on the right side, and tracheal
deviation to the left. Blood pressure is dropping rapidly. What is the immediate life-saving
intervention?
A. Needle decompression of the right chest
B. Immediate administration of oral bronchodilators
C. Endoscopic removal of an airway foreign body
D. Placement of a central venous line
ANSWER: A. Needle decompression of the right chest
Signs of tension pneumothorax include respiratory distress, unilateral absent breath sounds,
tracheal deviation, and hemodynamic compromise, requiring immediate needle
decompression.
10. A 3-month-old infant is evaluated for lethargy, poor feeding, and a weak cry. Physical
examination reveals generalized hypotonia, large anterior fontanelle, and poor suck reflex.
Parents report honey was introduced to the diet last week. What is the most likely
diagnosis?
