PALS Exam Questions & Answers 2025

1. A previously healthy infant with a history of vomiting and diarrhea is brought to the emergency department by her parents. During your assessment, you find that the infant responds only to painful stimulation. The infant has good bilateral breath sounds, cool extremities, and a capillary refill time of more than 5 seconds. The infant's blood pressure is 85/65 mmHg and glucose is 30 mg/dL. You administer 100% oxygen via face mask and start an IV. Which treatment is the most appropriate for this infant? a) Administer D50W 0.45% NaCl 20 mL/kg bolus over 15 minutes b) Administer LR solution 20 mL/kg over 60 minutes c) Administer a bolus of isotonic crystalloid 20 mL/kg over 5 to 20 minutes and also give D25W 2 to 4 mL/kg IV d) Administer D10W 20 mL/kg over 5 minutes - c) Administer a bolus of isotonic crystalloid 20 mL/kg over 5 to 20 minutes and also give D25W 2 to 4 mL/kg 2. Which statement is correct about endotracheal drug administration during resuscitative efforts for pediatric patients? a) The intravenous drug dose should be used b) It is the preferred route of drug administration c) The drug dose used is lower than the intravenous dose d) It is the least desirable route of administration - d) It is the least desirable route of administration 3. Which statement is correct about the effects of epinephrine during attempted resuscitation? a) Epi decreases peripheral vascular resistance and reduces myocardial afterload b) Epi stimulates spontaneous contractions when asystole is present c) Epi decreases myocardial oxygen consumption d) Epi is contraindicated in VFib - Epinephrine stimulates spontaneous contractions when asystole is present 4. Which oxygen delivery system most reliably delivers a high (90% or greater) concentration of inspired oxygen to a 7yo child? a) nasal cannula b) simple oxygen mask c) nonrebreather face mask d) face tent - c) nonrebreathing face mask 5. A 9-year-old boy is agitated and leaning forward on the bed in obvious respiratory distress. 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 movement with prolonged expiratory time and wheezing. You administer 100% oxygen by a nonrebreathing mask. His POx is 92%. Which medication do you prepare to give to this patient? a) Albuterol b) Adenosine c) Amiodarone d) Procainamide - a) Albuterol 6. You are part of team attempting to resuscitate a child with ventricular fibrillation cardiac arrest. You deliver 2 unsynchronized shocks. A team member established IO access, so you give a dose of epi, 0.01 mg/kg IO. At the next rhythm check, persistent ventricular fibrillation is present. You administer a 4-J/kg shock ad resume CPR. Which drug and dose should be administered next? a) Magnesium sulfate 25 to 50 mg/kg IO b) Epinephrine 0.1 mg/kg IO c) Atropine 0.02 mg/kg IO d) Amiodarone 5 mg/kg IO - d) Amiodarone 5 mg/kg IO 7. Paramedics are called to the home of a 1-year-old child. Their initial assessment reveals a child who responds only to painful stimuli and has irregular breathing, faint central pulse, bruises over the abdomen, abdominal distention, and cyanosis. Bag-mask ventilation with 100% oxygen is initiated. The child's heart rate is 36/min. Peripheral pulses cannot be palpated, and central pulses are barely palpable. The cardiac monitor shows sinus bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency department, the child is intubated and ventilated with 100% oxygen, and IV access is established. The heart rate is now 150/min with weak central pulses but no distal pulses. Systolic blood pressure is 74 mmHg. Which intervention should be provided? a) Epinephrine 0.01 mg/kg IV b) Rapid bolus of 20 mg/kg of isotonic crystalloid c) Atropine 0.02 mg/kg IV d) Amiodarone 5 mg/kg IV - b) Rapid bolus of 20 mg/kg of isotonic crystalloid 8. Initial impression of a 2yo girl shows her to be alert with mild breathing difficulty during inspiration and pale skin color. On primary assessment, she makes high- pitched inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which is the most appropriate initial intervention for this child? a) Endotracheal intubation b) IV dexamethasone c) Humidified oxygen as tolerated d) Nebulized albuterol - c) Humidified oxygen as tolerated 9. Which statement is true about the use of calcium chloride in pediatric patients? a) It has the same bioavailability of elemental calcium as calcium gluconate b) It is indicated for hypercalcemia, hypokalemia, and hypomagnesemia c) Routine administration is not indicate during cardiac arrest d) The recommended dose is 1 to 2 mg/kg - c) Routine administration is not indicated during cardiac arrest 10. You are called to help treat an infant with severe symptomatic bradycardia (HR 66/min) associated with respiratory distress. The bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. Which is the first drug you should administer? a) Adenosine b) Atropine c) Dopamine d) Epinephrine - d) Epinephrine 11. A 3-year-old boy presents with multiple-system trauma. The child was an unrestrained passenger in a high-speed motor vehicle crash. On primary assessment, he is unresponsive to voice or painful stimulation. His respiratory rate is 5/min, heart rate and pulses are 170/min, systolic blood pressure is 66 mmHg, capillary refill is 5 seconds, and SpO2 is 75% on room air. Which action should you take first? a) Provide 100% oxygen by simple face mask b) Perform immediate endotracheal intubation c) Establish immediate access d) While a colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask ventilation - d) While a colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask ventilation 12. You just assisted with the elective endotracheal intubation of a child with respiratory failure and a perfusing rhythm. Which provides a reliable, prompt assessment of correct endotracheal tube placement in the child? a) Auscultation of breath sounds over the lateral chest bilaterally plus presence of mist in the endotracheal tube b) Adequate bilateral breath sounds and chest expansion plus detection of ETCO2 with waveform capnography c) Absence of breath sounds over the abdomen during positive-pressure ventilation d) Confirmation of appropriate oxygen and carbon dioxide tensions on arterial blood gas analysis - b) Adequate bilateral breath sounds and chest expansion plus detection of ETCO2 with waveform capnography 13. Why is allowing complete chest recoil important when performing high-quality CPR?