AHA PALS EXAM - AMERICAN HEART ASSOCIATION / AAP - SCENARIO-BASED
2026/2027 EDITION | 230 QUESTIONS | CLINICAL APPLICATION | NEWEST EXAM
PALS
AHA / AAP
2026/2027
AHA PALS Exam
American Heart Association / AAP
2026/2027 Edition | 230 Questions with Answers
Scenario-Based Clinical Application | Newest Exam
230Q VERIFIED NEWEST EXAM CLINICAL APP
SCENARIOS 2026/2027 SCENARIOS
INCLUDES:
• Pediatric Assessment, BLS, PALS Algorithms, Respiratory Emergencies, Shock
• Arrhythmias, Cardiac Arrest, Post-Resuscitation, IO Access, Pharmacology
• 230 Questions + Answers + Scenario-Based Clinical Application + Rationales
• AHA 2020/2025 Guidelines | Professional Study Guide | Borders + Page Numbers
AHA PALS Exam Preparation | AHA / American Academy of Pediatrics | Not affiliated with AHA
Confidential Study Guide - Educational Purposes Only | 2026/2027 Edition
,Pediatric Assessment and BLS
Description: Pediatric assessment triangle appearance mental status muscle tone work of breathing nasal flaring retractions grunting abnormal sounds stridor wheezing
circulation pallor mottling cyanosis, primary assessment airway breathing circulation disability exposure, secondary assessment SAMPLE history focused exam, BLS
high-quality CPR 100-120/min depth 1/3 chest 2 inches child 1.5 inches infant 30:2 single rescuer 15:2 two rescuer, AED use child pads 8 years or less.
Respiratory Emergencies PALS
Description: Respiratory distress increased work nasal flaring retractions tachypnea tachycardia wheezing stridor, respiratory failure inadequate compensation decreased
LOC bradypnea irregular agonal bradycardia cyanosis, respiratory arrest apnea unresponsive, upper airway obstruction croup epiglottitis foreign body, lower airway
obstruction bronchiolitis asthma, lung tissue disease pneumonia pulmonary edema, disordered control CNS depression, interventions position airway suction oxygen
high-flow albuterol epinephrine nebulizer CPAP intubation.
Shock Recognition and Management
Description: Shock types hypovolemic blood loss vomiting diarrhea cool clammy delayed cap refill tachycardia hypotension late fluid bolus 20 mL/kg isotonic crystalloid
repeat blood if hemorrhagic, distributive septic anaphylactic neurogenic warm early flushed bounding pulses cool late hypotension fluids vasopressors epinephrine
norepinephrine, cardiogenic myocardial dysfunction edema JVD hepatomegaly rales fluid cautious inotropes epinephrine dopamine, obstructive tamponade tension
pneumothorax ductal dependent lesion pericardiocentesis needle decompression prostaglandin.
Arrhythmias PALS Algorithms
Description: Bradycardia HR less than 60 with poor perfusion despite oxygen ventilation epinephrine 0.01 mg/kg IV/IO 0.1 mL/kg 1:10,000 atropine 0.02 mg/kg if vagal
increased vagal tone consider pacing, tachycardia SVT HR greater than 220 infant greater than 180 child narrow QRS history abrupt onset vagal maneuvers adenosine 0.1
mg/kg max 6 mg then 0.2 mg/kg max 12 mg rapid push saline flush synchronized cardioversion 0.5-1 J/kg then 2 J/kg, VT with pulse wide QRS cardioversion 0.5-1 J/kg
amiodarone 5 mg/kg lidocaine 1 mg/kg, pulseless VT/VF defibrillation 2 J/kg then 4 J/kg max 10 J/kg CPR epinephrine 0.01 mg/kg q3-5 min amiodarone 5 mg/kg or
lidocaine 1 mg/kg, asystole PEA CPR epinephrine q3-5 min no defibrillation reversible causes H's and T's.
Cardiac Arrest Post-Resuscitation Pharmacology
Description: Cardiac arrest pulseless algorithm high-quality CPR push hard fast allow recoil minimize interruptions, defibrillation doses 2 J/kg first 4 J/kg subsequent max
10, epinephrine IV/IO 0.01 mg/kg 0.1 mL/kg 1:10,000 q3-5 min, amiodarone 5 mg/kg bolus max 300 mg or lidocaine 1 mg/kg, magnesium 25-50 mg/kg max 2 g torsades
hypomagnesemia, reversible causes H's Hypoxia Hypovolemia Hydrogen ion acidosis Hypo/Hyperkalemia Hypoglycemia Hypothermia T's Tension pneumothorax
Tamponade Toxins Thrombosis pulmonary coronary, post-resuscitation optimize oxygenation avoid hyperoxia SpO2 94-99, ventilation PaCO2 35-45, hemodynamics
normotension fluids inotropes vasopressors, glucose normoglycemia 60-180, temperature control avoid fever treat fever, monitor for recurrence, IO access when IV not in
90 sec critically ill proximal tibia anteromedial flat surface 1-2 cm below tibial tuberosity distal femur proximal humerus all fluids meds blood IO, pharmacology epinephrine
dosing anaphylaxis IM 0.01 mg/kg max 0.5 mg bradycardia hypotension IV/IO 0.01 mg/kg infusion 0.1-1 mcg/kg/min, atropine 0.02 mg/kg min 0.1 mg max 0.5 mg child 1
mg adolescent, adenosine 0.1 mg/kg max 6 mg then 0.2 mg/kg max 12 mg rapid IV push, amiodarone 5 mg/kg max 300 mg.
Page 2 - AHA PALS 230Q 2026/2027
,Question 1: Q1: Scenario: 4-year-old with respiratory distress, wheezing, SpO2 88%, HR 150, RR 40. Best next action?
A. High-flow oxygen, albuterol nebulizer, assess response, prepare for escalating respiratory support per PALS respiratory distress algorithm
B. No oxygen needed
C. Immediate intubation without oxygen trial
D. Only chest compressions
CORRECT ANSWER: A. High-flow oxygen, albuterol nebulizer, assess response, prepare for escalating respiratory support per PALS
respiratory distress algorithm
RATIONALE:
Scenario-Based Clinical Application: High-flow oxygen, albuterol nebulizer, assess response, prepare for escalating respiratory support per PALS respiratory distress
algorithm. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance
work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 2: Q2: Pediatric bradycardia HR 45 with hypotension, poor perfusion unresponsive to oxygen and ventilation. Next?
A. Only atropine always first
B. No epinephrine
C. Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000), consider atropine if vagal, prepare transcutaneous pacing if IV/IO delayed
D. Defibrillation 2 J/kg
CORRECT ANSWER: C. Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000), consider atropine if vagal, prepare transcutaneous pacing if IV/IO
delayed
RATIONALE:
Scenario-Based Clinical Application: Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000), consider atropine if vagal, prepare transcutaneous pacing if IV/IO delayed.
Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of
breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 3: Q3: Pediatric tachycardia SVT HR 220 infant, no hypotension, vagal maneuvers failed. Treatment?
A. Cardioversion 0.5 J/kg first
B. Adenosine 1 mg/kg
C. Defibrillation 2 J/kg
D. Adenosine 0.1 mg/kg rapid IV push (max 6 mg first dose) then 0.2 mg/kg (max 12 mg) with saline flush
CORRECT ANSWER: D. Adenosine 0.1 mg/kg rapid IV push (max 6 mg first dose) then 0.2 mg/kg (max 12 mg) with saline flush
RATIONALE:
Scenario-Based Clinical Application: Adenosine 0.1 mg/kg rapid IV push (max 6 mg first dose) then 0.2 mg/kg (max 12 mg) with saline flush. Evidence-based per AHA
PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of breathing circulation, primary
secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis,
Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 4: Q4: Pediatric pulseless VT/VF - defibrillation dose and CPR?
A. Defibrillation 10 J/kg first
B. Defibrillation 2 J/kg first dose then 4 J/kg, CPR 100-120/min, epinephrine 0.01 mg/kg q3-5 min, amiodarone 5 mg/kg or lidocaine 1 mg/kg
C. No CPR needed
D. Only epinephrine no defib
CORRECT ANSWER: B. Defibrillation 2 J/kg first dose then 4 J/kg, CPR 100-120/min, epinephrine 0.01 mg/kg q3-5 min, amiodarone 5 mg/kg or
lidocaine 1 mg/kg
RATIONALE:
Scenario-Based Clinical Application: Defibrillation 2 J/kg first dose then 4 J/kg, CPR 100-120/min, epinephrine 0.01 mg/kg q3-5 min, amiodarone 5 mg/kg or lidocaine 1
mg/kg. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of
breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 5: Q5: Pediatric asystole/PEA algorithm?
A. High-quality CPR, epinephrine 0.01 mg/kg q3-5 min, identify reversible causes H's and T's, no defibrillation for asystole/PEA
B. Defibrillation for asystole
C. No epinephrine for PEA
D. Only defibrillation
CORRECT ANSWER: A. High-quality CPR, epinephrine 0.01 mg/kg q3-5 min, identify reversible causes H's and T's, no defibrillation for
asystole/PEA
RATIONALE:
Scenario-Based Clinical Application: High-quality CPR, epinephrine 0.01 mg/kg q3-5 min, identify reversible causes H's and T's, no defibrillation for asystole/PEA.
Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of
breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 6: Q6: Respiratory failure vs distress vs arrest differentiation?
A. No difference
B. All same
C. Distress increased work, failure inadequate compensation, arrest apnea bradycardia unresponsive - interventions escalate oxygen to ventilation to
CPR
D. Only distress matters
CORRECT ANSWER: C. Distress increased work, failure inadequate compensation, arrest apnea bradycardia unresponsive - interventions
escalate oxygen to ventilation to CPR
Page 3 - AHA PALS 230Q 2026/2027
, RATIONALE:
Scenario-Based Clinical Application: Distress increased work, failure inadequate compensation, arrest apnea bradycardia unresponsive - interventions escalate oxygen to
ventilation to CPR. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle
appearance work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and
T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis
pulmonary coronary).
Question 7: Q7: Shock types - hypovolemic, distributive, cardiogenic, obstructive - signs and treatment?
A. Only fluids for all shock
B. All shock same treatment
C. No shock types
D. Hypovolemic: cool clammy delayed cap refill fluids 20 mL/kg bolus; Distributive: warm early cool late fluids vasopressors; Cardiogenic: edema JVD
inotropes; Obstructive: tamponade tension pneumo
CORRECT ANSWER: D. Hypovolemic: cool clammy delayed cap refill fluids 20 mL/kg bolus; Distributive: warm early cool late fluids
vasopressors; Cardiogenic: edema JVD inotropes; Obstructive: tamponade tension pneumo
RATIONALE:
Scenario-Based Clinical Application: Hypovolemic: cool clammy delayed cap refill fluids 20 mL/kg bolus; Distributive: warm early cool late fluids vasopressors;
Cardiogenic: edema JVD inotropes; Obstructive: tamponade tension pneumo. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using
evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of breathing circulation, primary secondary assessment, PALS algorithms for
respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia,
Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 8: Q8: IO access indications and sites?
A. IO never indicated
B. IO when IV not accessible in 90 sec critically ill/injured child: proximal tibia anteromedial, distal femur, proximal humerus, all fluids meds blood can go
IO
C. Only IV always
D. Only oral fluids
CORRECT ANSWER: B. IO when IV not accessible in 90 sec critically ill/injured child: proximal tibia anteromedial, distal femur, proximal
humerus, all fluids meds blood can go IO
RATIONALE:
Scenario-Based Clinical Application: IO when IV not accessible in 90 sec critically ill/injured child: proximal tibia anteromedial, distal femur, proximal humerus, all fluids
meds blood can go IO. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle
appearance work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and
T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis
pulmonary coronary).
Question 9: Q9: PALS pharmacology - epinephrine dosing?
A. Anaphylaxis IM 0.01 mg/kg (max 0.5 mg), bradycardia/hypotension IV/IO 0.01 mg/kg (0.1 mL/kg 1:10,000), infusion 0.1-1 mcg/kg/min
B. IM 1 mg/kg
C. IV 1 mg/kg
D. No dosing
CORRECT ANSWER: A. Anaphylaxis IM 0.01 mg/kg (max 0.5 mg), bradycardia/hypotension IV/IO 0.01 mg/kg (0.1 mL/kg 1:10,000), infusion 0.1-1
mcg/kg/min
RATIONALE:
Scenario-Based Clinical Application: Anaphylaxis IM 0.01 mg/kg (max 0.5 mg), bradycardia/hypotension IV/IO 0.01 mg/kg (0.1 mL/kg 1:10,000), infusion 0.1-1
mcg/kg/min. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance
work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 10: Q10: Post-resuscitation care - goals?
A. Only oxygen
B. No goals
C. Optimize oxygenation ventilation avoid hyperoxia, normotension, target PaCO2 35-45, glucose control, fever prevention, monitor for recurrence
D. Only fluids
CORRECT ANSWER: C. Optimize oxygenation ventilation avoid hyperoxia, normotension, target PaCO2 35-45, glucose control, fever
prevention, monitor for recurrence
RATIONALE:
Scenario-Based Clinical Application: Optimize oxygenation ventilation avoid hyperoxia, normotension, target PaCO2 35-45, glucose control, fever prevention, monitor for
recurrence. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance
work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Page 4 - AHA PALS 230Q 2026/2027
2026/2027 EDITION | 230 QUESTIONS | CLINICAL APPLICATION | NEWEST EXAM
PALS
AHA / AAP
2026/2027
AHA PALS Exam
American Heart Association / AAP
2026/2027 Edition | 230 Questions with Answers
Scenario-Based Clinical Application | Newest Exam
230Q VERIFIED NEWEST EXAM CLINICAL APP
SCENARIOS 2026/2027 SCENARIOS
INCLUDES:
• Pediatric Assessment, BLS, PALS Algorithms, Respiratory Emergencies, Shock
• Arrhythmias, Cardiac Arrest, Post-Resuscitation, IO Access, Pharmacology
• 230 Questions + Answers + Scenario-Based Clinical Application + Rationales
• AHA 2020/2025 Guidelines | Professional Study Guide | Borders + Page Numbers
AHA PALS Exam Preparation | AHA / American Academy of Pediatrics | Not affiliated with AHA
Confidential Study Guide - Educational Purposes Only | 2026/2027 Edition
,Pediatric Assessment and BLS
Description: Pediatric assessment triangle appearance mental status muscle tone work of breathing nasal flaring retractions grunting abnormal sounds stridor wheezing
circulation pallor mottling cyanosis, primary assessment airway breathing circulation disability exposure, secondary assessment SAMPLE history focused exam, BLS
high-quality CPR 100-120/min depth 1/3 chest 2 inches child 1.5 inches infant 30:2 single rescuer 15:2 two rescuer, AED use child pads 8 years or less.
Respiratory Emergencies PALS
Description: Respiratory distress increased work nasal flaring retractions tachypnea tachycardia wheezing stridor, respiratory failure inadequate compensation decreased
LOC bradypnea irregular agonal bradycardia cyanosis, respiratory arrest apnea unresponsive, upper airway obstruction croup epiglottitis foreign body, lower airway
obstruction bronchiolitis asthma, lung tissue disease pneumonia pulmonary edema, disordered control CNS depression, interventions position airway suction oxygen
high-flow albuterol epinephrine nebulizer CPAP intubation.
Shock Recognition and Management
Description: Shock types hypovolemic blood loss vomiting diarrhea cool clammy delayed cap refill tachycardia hypotension late fluid bolus 20 mL/kg isotonic crystalloid
repeat blood if hemorrhagic, distributive septic anaphylactic neurogenic warm early flushed bounding pulses cool late hypotension fluids vasopressors epinephrine
norepinephrine, cardiogenic myocardial dysfunction edema JVD hepatomegaly rales fluid cautious inotropes epinephrine dopamine, obstructive tamponade tension
pneumothorax ductal dependent lesion pericardiocentesis needle decompression prostaglandin.
Arrhythmias PALS Algorithms
Description: Bradycardia HR less than 60 with poor perfusion despite oxygen ventilation epinephrine 0.01 mg/kg IV/IO 0.1 mL/kg 1:10,000 atropine 0.02 mg/kg if vagal
increased vagal tone consider pacing, tachycardia SVT HR greater than 220 infant greater than 180 child narrow QRS history abrupt onset vagal maneuvers adenosine 0.1
mg/kg max 6 mg then 0.2 mg/kg max 12 mg rapid push saline flush synchronized cardioversion 0.5-1 J/kg then 2 J/kg, VT with pulse wide QRS cardioversion 0.5-1 J/kg
amiodarone 5 mg/kg lidocaine 1 mg/kg, pulseless VT/VF defibrillation 2 J/kg then 4 J/kg max 10 J/kg CPR epinephrine 0.01 mg/kg q3-5 min amiodarone 5 mg/kg or
lidocaine 1 mg/kg, asystole PEA CPR epinephrine q3-5 min no defibrillation reversible causes H's and T's.
Cardiac Arrest Post-Resuscitation Pharmacology
Description: Cardiac arrest pulseless algorithm high-quality CPR push hard fast allow recoil minimize interruptions, defibrillation doses 2 J/kg first 4 J/kg subsequent max
10, epinephrine IV/IO 0.01 mg/kg 0.1 mL/kg 1:10,000 q3-5 min, amiodarone 5 mg/kg bolus max 300 mg or lidocaine 1 mg/kg, magnesium 25-50 mg/kg max 2 g torsades
hypomagnesemia, reversible causes H's Hypoxia Hypovolemia Hydrogen ion acidosis Hypo/Hyperkalemia Hypoglycemia Hypothermia T's Tension pneumothorax
Tamponade Toxins Thrombosis pulmonary coronary, post-resuscitation optimize oxygenation avoid hyperoxia SpO2 94-99, ventilation PaCO2 35-45, hemodynamics
normotension fluids inotropes vasopressors, glucose normoglycemia 60-180, temperature control avoid fever treat fever, monitor for recurrence, IO access when IV not in
90 sec critically ill proximal tibia anteromedial flat surface 1-2 cm below tibial tuberosity distal femur proximal humerus all fluids meds blood IO, pharmacology epinephrine
dosing anaphylaxis IM 0.01 mg/kg max 0.5 mg bradycardia hypotension IV/IO 0.01 mg/kg infusion 0.1-1 mcg/kg/min, atropine 0.02 mg/kg min 0.1 mg max 0.5 mg child 1
mg adolescent, adenosine 0.1 mg/kg max 6 mg then 0.2 mg/kg max 12 mg rapid IV push, amiodarone 5 mg/kg max 300 mg.
Page 2 - AHA PALS 230Q 2026/2027
,Question 1: Q1: Scenario: 4-year-old with respiratory distress, wheezing, SpO2 88%, HR 150, RR 40. Best next action?
A. High-flow oxygen, albuterol nebulizer, assess response, prepare for escalating respiratory support per PALS respiratory distress algorithm
B. No oxygen needed
C. Immediate intubation without oxygen trial
D. Only chest compressions
CORRECT ANSWER: A. High-flow oxygen, albuterol nebulizer, assess response, prepare for escalating respiratory support per PALS
respiratory distress algorithm
RATIONALE:
Scenario-Based Clinical Application: High-flow oxygen, albuterol nebulizer, assess response, prepare for escalating respiratory support per PALS respiratory distress
algorithm. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance
work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 2: Q2: Pediatric bradycardia HR 45 with hypotension, poor perfusion unresponsive to oxygen and ventilation. Next?
A. Only atropine always first
B. No epinephrine
C. Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000), consider atropine if vagal, prepare transcutaneous pacing if IV/IO delayed
D. Defibrillation 2 J/kg
CORRECT ANSWER: C. Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000), consider atropine if vagal, prepare transcutaneous pacing if IV/IO
delayed
RATIONALE:
Scenario-Based Clinical Application: Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000), consider atropine if vagal, prepare transcutaneous pacing if IV/IO delayed.
Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of
breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 3: Q3: Pediatric tachycardia SVT HR 220 infant, no hypotension, vagal maneuvers failed. Treatment?
A. Cardioversion 0.5 J/kg first
B. Adenosine 1 mg/kg
C. Defibrillation 2 J/kg
D. Adenosine 0.1 mg/kg rapid IV push (max 6 mg first dose) then 0.2 mg/kg (max 12 mg) with saline flush
CORRECT ANSWER: D. Adenosine 0.1 mg/kg rapid IV push (max 6 mg first dose) then 0.2 mg/kg (max 12 mg) with saline flush
RATIONALE:
Scenario-Based Clinical Application: Adenosine 0.1 mg/kg rapid IV push (max 6 mg first dose) then 0.2 mg/kg (max 12 mg) with saline flush. Evidence-based per AHA
PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of breathing circulation, primary
secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis,
Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 4: Q4: Pediatric pulseless VT/VF - defibrillation dose and CPR?
A. Defibrillation 10 J/kg first
B. Defibrillation 2 J/kg first dose then 4 J/kg, CPR 100-120/min, epinephrine 0.01 mg/kg q3-5 min, amiodarone 5 mg/kg or lidocaine 1 mg/kg
C. No CPR needed
D. Only epinephrine no defib
CORRECT ANSWER: B. Defibrillation 2 J/kg first dose then 4 J/kg, CPR 100-120/min, epinephrine 0.01 mg/kg q3-5 min, amiodarone 5 mg/kg or
lidocaine 1 mg/kg
RATIONALE:
Scenario-Based Clinical Application: Defibrillation 2 J/kg first dose then 4 J/kg, CPR 100-120/min, epinephrine 0.01 mg/kg q3-5 min, amiodarone 5 mg/kg or lidocaine 1
mg/kg. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of
breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 5: Q5: Pediatric asystole/PEA algorithm?
A. High-quality CPR, epinephrine 0.01 mg/kg q3-5 min, identify reversible causes H's and T's, no defibrillation for asystole/PEA
B. Defibrillation for asystole
C. No epinephrine for PEA
D. Only defibrillation
CORRECT ANSWER: A. High-quality CPR, epinephrine 0.01 mg/kg q3-5 min, identify reversible causes H's and T's, no defibrillation for
asystole/PEA
RATIONALE:
Scenario-Based Clinical Application: High-quality CPR, epinephrine 0.01 mg/kg q3-5 min, identify reversible causes H's and T's, no defibrillation for asystole/PEA.
Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of
breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 6: Q6: Respiratory failure vs distress vs arrest differentiation?
A. No difference
B. All same
C. Distress increased work, failure inadequate compensation, arrest apnea bradycardia unresponsive - interventions escalate oxygen to ventilation to
CPR
D. Only distress matters
CORRECT ANSWER: C. Distress increased work, failure inadequate compensation, arrest apnea bradycardia unresponsive - interventions
escalate oxygen to ventilation to CPR
Page 3 - AHA PALS 230Q 2026/2027
, RATIONALE:
Scenario-Based Clinical Application: Distress increased work, failure inadequate compensation, arrest apnea bradycardia unresponsive - interventions escalate oxygen to
ventilation to CPR. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle
appearance work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and
T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis
pulmonary coronary).
Question 7: Q7: Shock types - hypovolemic, distributive, cardiogenic, obstructive - signs and treatment?
A. Only fluids for all shock
B. All shock same treatment
C. No shock types
D. Hypovolemic: cool clammy delayed cap refill fluids 20 mL/kg bolus; Distributive: warm early cool late fluids vasopressors; Cardiogenic: edema JVD
inotropes; Obstructive: tamponade tension pneumo
CORRECT ANSWER: D. Hypovolemic: cool clammy delayed cap refill fluids 20 mL/kg bolus; Distributive: warm early cool late fluids
vasopressors; Cardiogenic: edema JVD inotropes; Obstructive: tamponade tension pneumo
RATIONALE:
Scenario-Based Clinical Application: Hypovolemic: cool clammy delayed cap refill fluids 20 mL/kg bolus; Distributive: warm early cool late fluids vasopressors;
Cardiogenic: edema JVD inotropes; Obstructive: tamponade tension pneumo. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using
evaluate-identify-intervene sequence, pediatric assessment triangle appearance work of breathing circulation, primary secondary assessment, PALS algorithms for
respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia,
Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 8: Q8: IO access indications and sites?
A. IO never indicated
B. IO when IV not accessible in 90 sec critically ill/injured child: proximal tibia anteromedial, distal femur, proximal humerus, all fluids meds blood can go
IO
C. Only IV always
D. Only oral fluids
CORRECT ANSWER: B. IO when IV not accessible in 90 sec critically ill/injured child: proximal tibia anteromedial, distal femur, proximal
humerus, all fluids meds blood can go IO
RATIONALE:
Scenario-Based Clinical Application: IO when IV not accessible in 90 sec critically ill/injured child: proximal tibia anteromedial, distal femur, proximal humerus, all fluids
meds blood can go IO. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle
appearance work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and
T's (Hypoxia, Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis
pulmonary coronary).
Question 9: Q9: PALS pharmacology - epinephrine dosing?
A. Anaphylaxis IM 0.01 mg/kg (max 0.5 mg), bradycardia/hypotension IV/IO 0.01 mg/kg (0.1 mL/kg 1:10,000), infusion 0.1-1 mcg/kg/min
B. IM 1 mg/kg
C. IV 1 mg/kg
D. No dosing
CORRECT ANSWER: A. Anaphylaxis IM 0.01 mg/kg (max 0.5 mg), bradycardia/hypotension IV/IO 0.01 mg/kg (0.1 mL/kg 1:10,000), infusion 0.1-1
mcg/kg/min
RATIONALE:
Scenario-Based Clinical Application: Anaphylaxis IM 0.01 mg/kg (max 0.5 mg), bradycardia/hypotension IV/IO 0.01 mg/kg (0.1 mL/kg 1:10,000), infusion 0.1-1
mcg/kg/min. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance
work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Question 10: Q10: Post-resuscitation care - goals?
A. Only oxygen
B. No goals
C. Optimize oxygenation ventilation avoid hyperoxia, normotension, target PaCO2 35-45, glucose control, fever prevention, monitor for recurrence
D. Only fluids
CORRECT ANSWER: C. Optimize oxygenation ventilation avoid hyperoxia, normotension, target PaCO2 35-45, glucose control, fever
prevention, monitor for recurrence
RATIONALE:
Scenario-Based Clinical Application: Optimize oxygenation ventilation avoid hyperoxia, normotension, target PaCO2 35-45, glucose control, fever prevention, monitor for
recurrence. Evidence-based per AHA PALS 2020/2025 Guidelines: assessment using evaluate-identify-intervene sequence, pediatric assessment triangle appearance
work of breathing circulation, primary secondary assessment, PALS algorithms for respiratory, shock, arrhythmia, cardiac arrest, reversible causes H's and T's (Hypoxia,
Hypovolemia, Hydrogen ion acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary coronary).
Page 4 - AHA PALS 230Q 2026/2027
