Pediatric Advanced Life Support (PALS) Provider
ExaminationDEFINED ANSWERS LATEST
ALREADY GRADED A+ (2025/2026)
1. A 4-year-old child presents with a barking cough, stridor at rest, and
suprasternal retractions. Oxygen saturation is 89% on room air. What is the most
appropriate initial intervention?
A. Administer nebulized racemic epinephrine and oral dexamethasone
B. Obtain a lateral neck X-ray to rule out epiglottitis
C. Perform immediate endotracheal intubation
D. Give inhaled albuterol and ipratropium
**Correct Answer: A**
**Rationale:** The presentation is classic for moderate to severe croup
(laryngotracheobronchitis). Nebulized epinephrine reduces mucosal edema, and
dexamethasone decreases inflammation. Intubation is reserved for severe,
refractory cases. Albuterol is not indicated for croup. Imaging may agitate the
child and worsen airway obstruction.
2. During the Pediatric Assessment Triangle (PAT), which component assesses the
child's tone, interactiveness, and consolability?
A. Work of breathing
B. Circulation to skin
C. Appearance
D. Perfusion
,**Correct Answer: C**
**Rationale:** Appearance reflects the child's neurologic status, including muscle
tone, interactivity, consolability, and gaze. It is a key indicator of oxygenation and
brain perfusion.
3. A 6-month-old infant with bronchiolitis has severe intercostal retractions, nasal
flaring, and an SpO2 of 90% despite suctioning. What is the next step?
A. Administer bronchodilators
B. Provide high-flow oxygen or CPAP
C. Order a chest X-ray
D. Start systemic corticosteroids
**Correct Answer: B**
**Rationale:** Severe bronchiolitis with hypoxia requires respiratory support.
High-flow nasal cannula or CPAP can reduce work of breathing and improve gas
exchange. Bronchodilators and corticosteroids are not routinely recommended in
bronchiolitis.
4. An 8-year-old in compensated septic shock has warm extremities, bounding
pulses, and tachycardia. Which of the following best describes this hemodynamic
state?
A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive shock
D. Obstructive shock
**Correct Answer: C**
,**Rationale:** Warm, flushed skin with bounding pulses and widened pulse
pressure indicates distributive (vasodilatory) shock, typical of early sepsis. Fluid
resuscitation is the priority.
5. A 3-year-old with a history of tetralogy of Fallot becomes cyanotic and irritable
during a diaper change. What is the most likely cause?
A. Seizure
B. Hypercyanotic "tet" spell
C. Pulmonary embolism
D. Anaphylaxis
**Correct Answer: B**
**Rationale:** Tet spells occur with increased right-to-left shunting due to crying
or straining. Management includes knee-to-chest position, oxygen, morphine, and
volume expansion.
6. A child in cardiac arrest has a rhythm of ventricular fibrillation on the monitor.
What is the initial defibrillation dose?
A. 0.5 J/kg
B. 1 J/kg
C. 2 J/kg
D. 4 J/kg
**Correct Answer: C**
**Rationale:** The first shock dose for pediatric VF/pulseless VT is 2 J/kg.
Subsequent shocks are 4 J/kg, maximum adult dose 200 J for biphasic.
, 7. During a PALS resuscitation, the team leader orders 0.01 mg/kg of epinephrine
IV/IO for a 20 kg child in asystole. The available concentration is 1:10,000 (0.1
mg/mL). How many milliliters should be administered?
A. 0.2 mL
B. 1 mL
C. 2 mL
D. 10 mL
**Correct Answer: C**
**Rationale:** Dose = 0.01 mg/kg × 20 kg = 0.2 mg. Concentration = 0.1 mg/mL.
Volume = 0.2 mg / 0.1 mg/mL = 2 mL.
8. Which of the following is a sign of respiratory failure in a child?
A. Respiratory rate of 30 breaths/min in a school-aged child
B. Grunting, bradycardia, and decreasing level of consciousness
C. Mild intercostal retractions and nasal flaring
D. Wheezing with prolonged expiration
**Correct Answer: B**
**Rationale:** Respiratory failure is indicated by inadequate
oxygenation/ventilation leading to bradycardia, altered mental status, and
reduced respiratory effort (exhaustion). Grunting signifies impending failure.
9. A 12-year-old with status asthmaticus has a peak flow of 30% of predicted after
three albuterol treatments. What adjunctive therapy is recommended?
ExaminationDEFINED ANSWERS LATEST
ALREADY GRADED A+ (2025/2026)
1. A 4-year-old child presents with a barking cough, stridor at rest, and
suprasternal retractions. Oxygen saturation is 89% on room air. What is the most
appropriate initial intervention?
A. Administer nebulized racemic epinephrine and oral dexamethasone
B. Obtain a lateral neck X-ray to rule out epiglottitis
C. Perform immediate endotracheal intubation
D. Give inhaled albuterol and ipratropium
**Correct Answer: A**
**Rationale:** The presentation is classic for moderate to severe croup
(laryngotracheobronchitis). Nebulized epinephrine reduces mucosal edema, and
dexamethasone decreases inflammation. Intubation is reserved for severe,
refractory cases. Albuterol is not indicated for croup. Imaging may agitate the
child and worsen airway obstruction.
2. During the Pediatric Assessment Triangle (PAT), which component assesses the
child's tone, interactiveness, and consolability?
A. Work of breathing
B. Circulation to skin
C. Appearance
D. Perfusion
,**Correct Answer: C**
**Rationale:** Appearance reflects the child's neurologic status, including muscle
tone, interactivity, consolability, and gaze. It is a key indicator of oxygenation and
brain perfusion.
3. A 6-month-old infant with bronchiolitis has severe intercostal retractions, nasal
flaring, and an SpO2 of 90% despite suctioning. What is the next step?
A. Administer bronchodilators
B. Provide high-flow oxygen or CPAP
C. Order a chest X-ray
D. Start systemic corticosteroids
**Correct Answer: B**
**Rationale:** Severe bronchiolitis with hypoxia requires respiratory support.
High-flow nasal cannula or CPAP can reduce work of breathing and improve gas
exchange. Bronchodilators and corticosteroids are not routinely recommended in
bronchiolitis.
4. An 8-year-old in compensated septic shock has warm extremities, bounding
pulses, and tachycardia. Which of the following best describes this hemodynamic
state?
A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive shock
D. Obstructive shock
**Correct Answer: C**
,**Rationale:** Warm, flushed skin with bounding pulses and widened pulse
pressure indicates distributive (vasodilatory) shock, typical of early sepsis. Fluid
resuscitation is the priority.
5. A 3-year-old with a history of tetralogy of Fallot becomes cyanotic and irritable
during a diaper change. What is the most likely cause?
A. Seizure
B. Hypercyanotic "tet" spell
C. Pulmonary embolism
D. Anaphylaxis
**Correct Answer: B**
**Rationale:** Tet spells occur with increased right-to-left shunting due to crying
or straining. Management includes knee-to-chest position, oxygen, morphine, and
volume expansion.
6. A child in cardiac arrest has a rhythm of ventricular fibrillation on the monitor.
What is the initial defibrillation dose?
A. 0.5 J/kg
B. 1 J/kg
C. 2 J/kg
D. 4 J/kg
**Correct Answer: C**
**Rationale:** The first shock dose for pediatric VF/pulseless VT is 2 J/kg.
Subsequent shocks are 4 J/kg, maximum adult dose 200 J for biphasic.
, 7. During a PALS resuscitation, the team leader orders 0.01 mg/kg of epinephrine
IV/IO for a 20 kg child in asystole. The available concentration is 1:10,000 (0.1
mg/mL). How many milliliters should be administered?
A. 0.2 mL
B. 1 mL
C. 2 mL
D. 10 mL
**Correct Answer: C**
**Rationale:** Dose = 0.01 mg/kg × 20 kg = 0.2 mg. Concentration = 0.1 mg/mL.
Volume = 0.2 mg / 0.1 mg/mL = 2 mL.
8. Which of the following is a sign of respiratory failure in a child?
A. Respiratory rate of 30 breaths/min in a school-aged child
B. Grunting, bradycardia, and decreasing level of consciousness
C. Mild intercostal retractions and nasal flaring
D. Wheezing with prolonged expiration
**Correct Answer: B**
**Rationale:** Respiratory failure is indicated by inadequate
oxygenation/ventilation leading to bradycardia, altered mental status, and
reduced respiratory effort (exhaustion). Grunting signifies impending failure.
9. A 12-year-old with status asthmaticus has a peak flow of 30% of predicted after
three albuterol treatments. What adjunctive therapy is recommended?
