PALS Precourse Test
1. Parents of a 1-year-old female phoned EMS when they C
picked up their daughter from the babysitter. Para-
medics perform an initial impression revealing an ob-
tunded infant with irregular breathing, bruises over
the abdomen, abdominal distension, and cyanosis. As-
sisted bag-mask ventilation with 100% oxygen is initi-
ated. On primary assessment heart rate is 36/min, pe-
ripheral pulses cannot be palpated, and central puls-
es are barely palpable. Cardiac monitor shows sinus
bradycardia. Chest compressions are started at 15:2.
In the ED the infant is intubated and ventilated, and
IV access is established. The heart rate is now up to
150/min, but there are weak central pulses and no
distal pulses. Systolic BP is 74. Of the following, which
would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilu-
tion) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV
2. You enter a room to perform an initial impression of D
a previously stable 10-year-old male and find him un-
responsive and apneic. A code is called and bag-mask
ventilation is performed with 100% oxygen. The car-
diac monitor shows a wide-complex tachycardia. The
boy has no detectable pulses so compressions and
ventilations are provided. As soon as the defibrillator
arrives you deliver an unsynchronized shock with 2
J/kg. The rhythm check after 2 minutes of CPR reveals
VF. You then deliver a shock of 4 J/kg and resume
, PALS Precourse Test
immediate CPR beginning with compressions. A team
member has established IO access, so you give a dose
of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO
after second shock. At the next rhythm check, per-
sistent VF is present. You administer another 4 J/kg
shock and resume CPR. Based on the PALS Pulseless
Arrest Algorithm, what is the next drug and dose to
administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO
3. Which of the following statements about calcium is D
true?
A. Calcium chloride 10% has the same bioavailability of
elemental calcium as calcium gluconate in critically ill
children
B. The recommended dose is 1-2 mg/kg of calcium
chloride.
C. Indications for administration of calcium include
hypercalcemia, hypokalemia, and hypomagnesemia.
D. Routine administration of calcium is not indicated
during cardiac arrest.
4. C
, PALS Precourse Test
Initial impression of a 9-year-old male with increased
work of breathing reveals the boy to be agitated and
leaning forward on the bed with obvious respiratory
distress. You administer 100% oxygen by nonrebreath-
ing mask. The patient is speaking in short phrases
and tells you that he has asthma but does not carry
an inhaler. He has nasal flaring, severe suprasternal
and intercostal retractions, and decreased air move-
ment with prolonged expiratory time and wheezing.
His SpO2 is 96% (on nonrebreathing mask). What is the
next medical therapy to provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO
5. You are called to help resuscitate an infant with severe D
symptomatic bradycardia associated with respiratory
distress. The bradycardia persists despite establish-
ment of an effective airway, oxygenation, and venti-
lation. There is no heart block present. Which of the
following is the first drug you should administer?
A. Dopamine
B. Adenosine
C. Atropine
1. Parents of a 1-year-old female phoned EMS when they C
picked up their daughter from the babysitter. Para-
medics perform an initial impression revealing an ob-
tunded infant with irregular breathing, bruises over
the abdomen, abdominal distension, and cyanosis. As-
sisted bag-mask ventilation with 100% oxygen is initi-
ated. On primary assessment heart rate is 36/min, pe-
ripheral pulses cannot be palpated, and central puls-
es are barely palpable. Cardiac monitor shows sinus
bradycardia. Chest compressions are started at 15:2.
In the ED the infant is intubated and ventilated, and
IV access is established. The heart rate is now up to
150/min, but there are weak central pulses and no
distal pulses. Systolic BP is 74. Of the following, which
would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilu-
tion) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV
2. You enter a room to perform an initial impression of D
a previously stable 10-year-old male and find him un-
responsive and apneic. A code is called and bag-mask
ventilation is performed with 100% oxygen. The car-
diac monitor shows a wide-complex tachycardia. The
boy has no detectable pulses so compressions and
ventilations are provided. As soon as the defibrillator
arrives you deliver an unsynchronized shock with 2
J/kg. The rhythm check after 2 minutes of CPR reveals
VF. You then deliver a shock of 4 J/kg and resume
, PALS Precourse Test
immediate CPR beginning with compressions. A team
member has established IO access, so you give a dose
of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO
after second shock. At the next rhythm check, per-
sistent VF is present. You administer another 4 J/kg
shock and resume CPR. Based on the PALS Pulseless
Arrest Algorithm, what is the next drug and dose to
administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO
3. Which of the following statements about calcium is D
true?
A. Calcium chloride 10% has the same bioavailability of
elemental calcium as calcium gluconate in critically ill
children
B. The recommended dose is 1-2 mg/kg of calcium
chloride.
C. Indications for administration of calcium include
hypercalcemia, hypokalemia, and hypomagnesemia.
D. Routine administration of calcium is not indicated
during cardiac arrest.
4. C
, PALS Precourse Test
Initial impression of a 9-year-old male with increased
work of breathing reveals the boy to be agitated and
leaning forward on the bed with obvious respiratory
distress. You administer 100% oxygen by nonrebreath-
ing mask. The patient is speaking in short phrases
and tells you that he has asthma but does not carry
an inhaler. He has nasal flaring, severe suprasternal
and intercostal retractions, and decreased air move-
ment with prolonged expiratory time and wheezing.
His SpO2 is 96% (on nonrebreathing mask). What is the
next medical therapy to provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO
5. You are called to help resuscitate an infant with severe D
symptomatic bradycardia associated with respiratory
distress. The bradycardia persists despite establish-
ment of an effective airway, oxygenation, and venti-
lation. There is no heart block present. Which of the
following is the first drug you should administer?
A. Dopamine
B. Adenosine
C. Atropine
