[AHA PALS FINAL EXAM VERSION A EXAM] – EXAM-STYLE QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A 4-year-old child presents with a 3-day history of fever, stridor, and a
"barking" cough. The child is sitting upright and drooling. On examination, the
child is tachypneic with subcostal and intercostal retractions. Which of the
following is the most appropriate initial intervention?
A. Administer racemic epinephrine via nebulizer.
B. Obtain a lateral neck radiograph.
C. Prepare for immediate endotracheal intubation.
D. Administer a dose of dexamethasone.
Correct Answer: C. Prepare for immediate endotracheal intubation.
*Rationale: * The presentation of stridor, drooling, and tripod positioning with a
toxic appearance is classic for acute epiglottitis. This is a life-threatening airway
emergency. The most appropriate initial action is to prepare for immediate
definitive airway management (endotracheal intubation) in a controlled setting,
typically the operating room. Nebulized racemic epinephrine and corticosteroids
are treatments for croup (laryngotracheobronchitis), which is characterized by a
gradual onset and a barky cough without drooling. A lateral neck radiograph may
confirm the diagnosis but should not delay securing the airway, and should not
be performed if it causes the child distress, as this can precipitate complete
airway obstruction.
,2. A 6-month-old infant is brought to the emergency department in cardiac
arrest. High-quality CPR is in progress. The cardiac monitor reveals a wide-
complex tachycardia at a rate of 280 beats per minute with no palpable pulses.
What is the most appropriate next step in management?
A. Administer a dose of amiodarone 5 mg/kg IV/IO.
B. Perform immediate synchronized cardioversion at 1 J/kg.
C. Administer a rapid bolus of adenosine 0.1 mg/kg IV/IO.
D. Perform immediate defibrillation at 4 J/kg.
Correct Answer: B. Perform immediate synchronized cardioversion at 1 J/kg.
*Rationale: * This infant is in unstable, pulseless ventricular tachycardia (VT).
Synchronized cardioversion is the treatment of choice for a hemodynamically
unstable tachyarrhythmia with a palpable pulse. However, in the absence of a
pulse, the patient is in cardiac arrest. For pulseless VT or ventricular fibrillation
(VF), the correct immediate action is defibrillation, not synchronized
cardioversion. The initial defibrillation dose for pediatric patients is 2 J/kg, not 4
J/kg. Amiodarone is a second-line antiarrhythmic given after defibrillation
attempts for refractory VF/pulseless VT, and adenosine is for stable
supraventricular tachycardia (SVT).
3. A 2-year-old child has a heart rate of 220 beats per minute. The ECG shows a
narrow QRS complex. The child is alert, has adequate perfusion, and is
breathing comfortably. Which of the following is the most appropriate initial
management?
A. Perform vagal maneuvers.
B. Administer a rapid IV bolus of adenosine 0.1 mg/kg.
,C. Administer a rapid IV bolus of adenosine 0.2 mg/kg.
D. Prepare for immediate synchronized cardioversion.
Correct Answer: A. Perform vagal maneuvers.
*Rationale: * The patient is a stable 2-year-old with a narrow-complex
tachycardia. Stable supraventricular tachycardia (SVT) should be treated with
vagal maneuvers as the first-line intervention in a child. If vagal maneuvers are
unsuccessful, the next step is to administer adenosine IV/IO rapidly. The correct
initial dose of adenosine is 0.1 mg/kg (maximum 6 mg). If this is ineffective, a
second dose of 0.2 mg/kg (maximum 12 mg) may be given. Synchronized
cardioversion is indicated for unstable patients with a pulse or when
pharmacologic measures fail in a stable patient.
4. A 10-year-old child in cardiac arrest is being resuscitated. High-quality CPR
has been ongoing for 8 minutes. An advanced airway is in place. The cardiac
monitor shows asystole. The team has administered epinephrine every 3-5
minutes. What is the most appropriate next step?
A. Administer a dose of atropine 0.02 mg/kg.
B. Administer a fluid bolus of 20 mL/kg of normal saline.
C. Check for a pulse and consider termination of efforts.
D. Continue CPR and repeat epinephrine.
Correct Answer: D. Continue CPR and repeat epinephrine.
*Rationale: * The management of asystole continues with high-quality CPR and
epinephrine. Atropine is no longer recommended in the pediatric cardiac arrest
algorithm for asystole or pulseless electrical activity (PEA). Fluid boluses are not
, indicated for this rhythm. The decision to terminate resuscitative efforts is
complex and multifactorial; simply having asystole for 8 minutes is not alone an
indication, as survival is possible but rare. The algorithm dictates continued CPR,
rhythm checks every 2 minutes, and epinephrine administration every 3-5
minutes until the return of spontaneous circulation (ROSC) or a decision is made
to stop.
5. A 3-year-old child is unresponsive and not breathing. A single rescuer finds
the child. Which of the following sequences correctly describes the initial steps
of pediatric basic life support (BLS)?
A. Check for responsiveness, shout for help, look for breathing, and check for a
pulse for 10 seconds.
B. Shout for help, check for responsiveness, begin chest compressions, and then
open the airway.
C. Check for responsiveness, shout for help, begin chest compressions, and then
open the airway.
D. Open the airway, check for breathing, provide two rescue breaths, and then
check for a pulse.
Correct Answer: A. Check for responsiveness, shout for help, look for breathing,
and check for a pulse for 10 seconds.
*Rationale: * The correct sequence for a single rescuer is to first check for
responsiveness. If unresponsive, the rescuer should shout for help and activate
the emergency response system (or send someone if available). The rescuer
should then check for breathing and a pulse. This should be done simultaneously
if possible, but at least within 10 seconds. The current guidelines for a single
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A 4-year-old child presents with a 3-day history of fever, stridor, and a
"barking" cough. The child is sitting upright and drooling. On examination, the
child is tachypneic with subcostal and intercostal retractions. Which of the
following is the most appropriate initial intervention?
A. Administer racemic epinephrine via nebulizer.
B. Obtain a lateral neck radiograph.
C. Prepare for immediate endotracheal intubation.
D. Administer a dose of dexamethasone.
Correct Answer: C. Prepare for immediate endotracheal intubation.
*Rationale: * The presentation of stridor, drooling, and tripod positioning with a
toxic appearance is classic for acute epiglottitis. This is a life-threatening airway
emergency. The most appropriate initial action is to prepare for immediate
definitive airway management (endotracheal intubation) in a controlled setting,
typically the operating room. Nebulized racemic epinephrine and corticosteroids
are treatments for croup (laryngotracheobronchitis), which is characterized by a
gradual onset and a barky cough without drooling. A lateral neck radiograph may
confirm the diagnosis but should not delay securing the airway, and should not
be performed if it causes the child distress, as this can precipitate complete
airway obstruction.
,2. A 6-month-old infant is brought to the emergency department in cardiac
arrest. High-quality CPR is in progress. The cardiac monitor reveals a wide-
complex tachycardia at a rate of 280 beats per minute with no palpable pulses.
What is the most appropriate next step in management?
A. Administer a dose of amiodarone 5 mg/kg IV/IO.
B. Perform immediate synchronized cardioversion at 1 J/kg.
C. Administer a rapid bolus of adenosine 0.1 mg/kg IV/IO.
D. Perform immediate defibrillation at 4 J/kg.
Correct Answer: B. Perform immediate synchronized cardioversion at 1 J/kg.
*Rationale: * This infant is in unstable, pulseless ventricular tachycardia (VT).
Synchronized cardioversion is the treatment of choice for a hemodynamically
unstable tachyarrhythmia with a palpable pulse. However, in the absence of a
pulse, the patient is in cardiac arrest. For pulseless VT or ventricular fibrillation
(VF), the correct immediate action is defibrillation, not synchronized
cardioversion. The initial defibrillation dose for pediatric patients is 2 J/kg, not 4
J/kg. Amiodarone is a second-line antiarrhythmic given after defibrillation
attempts for refractory VF/pulseless VT, and adenosine is for stable
supraventricular tachycardia (SVT).
3. A 2-year-old child has a heart rate of 220 beats per minute. The ECG shows a
narrow QRS complex. The child is alert, has adequate perfusion, and is
breathing comfortably. Which of the following is the most appropriate initial
management?
A. Perform vagal maneuvers.
B. Administer a rapid IV bolus of adenosine 0.1 mg/kg.
,C. Administer a rapid IV bolus of adenosine 0.2 mg/kg.
D. Prepare for immediate synchronized cardioversion.
Correct Answer: A. Perform vagal maneuvers.
*Rationale: * The patient is a stable 2-year-old with a narrow-complex
tachycardia. Stable supraventricular tachycardia (SVT) should be treated with
vagal maneuvers as the first-line intervention in a child. If vagal maneuvers are
unsuccessful, the next step is to administer adenosine IV/IO rapidly. The correct
initial dose of adenosine is 0.1 mg/kg (maximum 6 mg). If this is ineffective, a
second dose of 0.2 mg/kg (maximum 12 mg) may be given. Synchronized
cardioversion is indicated for unstable patients with a pulse or when
pharmacologic measures fail in a stable patient.
4. A 10-year-old child in cardiac arrest is being resuscitated. High-quality CPR
has been ongoing for 8 minutes. An advanced airway is in place. The cardiac
monitor shows asystole. The team has administered epinephrine every 3-5
minutes. What is the most appropriate next step?
A. Administer a dose of atropine 0.02 mg/kg.
B. Administer a fluid bolus of 20 mL/kg of normal saline.
C. Check for a pulse and consider termination of efforts.
D. Continue CPR and repeat epinephrine.
Correct Answer: D. Continue CPR and repeat epinephrine.
*Rationale: * The management of asystole continues with high-quality CPR and
epinephrine. Atropine is no longer recommended in the pediatric cardiac arrest
algorithm for asystole or pulseless electrical activity (PEA). Fluid boluses are not
, indicated for this rhythm. The decision to terminate resuscitative efforts is
complex and multifactorial; simply having asystole for 8 minutes is not alone an
indication, as survival is possible but rare. The algorithm dictates continued CPR,
rhythm checks every 2 minutes, and epinephrine administration every 3-5
minutes until the return of spontaneous circulation (ROSC) or a decision is made
to stop.
5. A 3-year-old child is unresponsive and not breathing. A single rescuer finds
the child. Which of the following sequences correctly describes the initial steps
of pediatric basic life support (BLS)?
A. Check for responsiveness, shout for help, look for breathing, and check for a
pulse for 10 seconds.
B. Shout for help, check for responsiveness, begin chest compressions, and then
open the airway.
C. Check for responsiveness, shout for help, begin chest compressions, and then
open the airway.
D. Open the airway, check for breathing, provide two rescue breaths, and then
check for a pulse.
Correct Answer: A. Check for responsiveness, shout for help, look for breathing,
and check for a pulse for 10 seconds.
*Rationale: * The correct sequence for a single rescuer is to first check for
responsiveness. If unresponsive, the rescuer should shout for help and activate
the emergency response system (or send someone if available). The rescuer
should then check for breathing and a pulse. This should be done simultaneously
if possible, but at least within 10 seconds. The current guidelines for a single
