AHA PALS GUIDANCE (ALGORITHMS, DRUG DOSES, AND
TEAM ROLES) QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED SOLUTIONS) |
GRADED A+|
1. A 6-year-old (20 kg) is unresponsive and not breathing normally. You start CPR.
What is the first medication you should consider if an advanced airway is placed and
IV/IO access achieved during pulseless arrest?
A. Amiodarone
B. Epinephrine 0.01 mg/kg IV/IO
C. Atropine 0.02 mg/kg
D. Adenosine
Answer: B. Epinephrine 0.01 mg/kg IV/IO.
Rationale: Epinephrine (0.01 mg/kg, 1:10,000) is recommended as the first drug for
pediatric cardiac arrest once IV/IO access is available to support coronary and
cerebral perfusion. Repeat every 3–5 minutes per PALS algorithm. (cpr.heart.org)
2. During defibrillation for a shockable pediatric arrest, what is the recommended initial
energy dose?
A. 0.5 J/kg
B. 1 J/kg
C. 2 J/kg
D. 5 J/kg
Answer: C. 2 J/kg.
Rationale: The PALS recommendation is an initial biphasic energy of 2 J/kg for
pediatric defibrillation; subsequent shocks can be 4 J/kg (max single shock often ~10
J/kg or adult dose). (cpr.heart.org)
3. A 3-year-old (15 kg) with bradycardia and poor perfusion despite adequate
oxygenation and ventilation: next drug and dose?
A. Epinephrine 0.01 mg/kg IV/IO
B. Dopamine infusion 5 mcg/kg/min
C. Atropine 0.02 mg/kg IV/IO
D. Amiodarone 5 mg/kg IV/IO
Answer: A. Epinephrine 0.01 mg/kg IV/IO.
Rationale: If bradycardia with poor perfusion persists despite optimized
oxygenation and ventilation, give epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of
1:10,000). Atropine was historically used for vagal causes but epinephrine is preferred
for symptomatic bradycardia with poor perfusion. (cpr.heart.org)
4. Which is the most appropriate initial fluid bolus for a child in presumed hypovolemic
shock (unless cardiogenic)?
A. 5 mL/kg isotonic crystalloid
B. 10 mL/kg isotonic crystalloid
C. 20 mL/kg isotonic crystalloid
D. 40 mL/kg isotonic crystalloid
Answer: C. 20 mL/kg isotonic crystalloid.
Rationale: For pediatric septic/hypovolemic shock, initial isotonic crystalloid bolus
, is typically 20 mL/kg, reassess frequently. In resource-limited settings and if concern
for cardiac dysfunction, bolus strategy may be adjusted. (cpr.heart.org)
5. A 10-kg infant in respiratory arrest is intubated and an advanced airway is in place.
What ventilation rate is recommended during pediatric cardiac arrest?
A. 8–10 breaths/min
B. 10–12 breaths/min
C. 20–30 breaths/min
D. 6–8 breaths/min
Answer: B. 10–12 breaths/min.
Rationale: With an advanced airway in pediatric arrest, deliver 1 breath every 6–8
seconds (about 8–10 breaths/min) historically; more recent guidance often suggests 10
breaths/min (1 every 6 seconds) — generally 10–12/min is acceptable to ensure
oxygenation without excessive ventilation. Check specific local algorithm updates.
(PMC)
6. For a child with ventricular fibrillation (VF) refractory to 2 shocks, what is the next
medication recommended?
A. Lidocaine 1 mg/kg IV/IO
B. Calcium chloride 20 mg/kg
C. Epinephrine only
D. Amiodarone 5 mg/kg IV/IO
Answer: D. Amiodarone 5 mg/kg IV/IO.
Rationale: For refractory VF/pulseless VT, after epinephrine and repeated
defibrillation attempts, give amiodarone 5 mg/kg IV/IO (max single dose frequently
300 mg depending on age/weight; may repeat as indicated). Lidocaine is an
alternative if amiodarone unavailable. (cpr.heart.org)
7. Which of the following is the correct dose of epinephrine for an infant (3 kg) in
ROSC with ongoing hypotension requiring bolus?
A. 0.01 mg/kg IV/IO (0.03 mg)
B. 0.1 mg/kg IV/IO (0.3 mg)
C. 1 mg IV
D. 0.5 mg IV
Answer: A. 0.01 mg/kg IV/IO (0.03 mg).
Rationale: Standard epinephrine dosing is 0.01 mg/kg IV/IO (1:10,000) for
resuscitation; for a 3-kg infant that equals 0.03 mg (0.3 mL of 1:10,000).
(cpr.heart.org)
8. What is the recommended DOSE of adenosine for a child with stable SVT?
A. 0.05 mg/kg rapid IV push (first dose)
B. 0.1 mg/kg rapid IV push (first dose)
C. 0.01 mg/kg slow IV push
D. 0.3 mg/kg slow IV push
Answer: B. 0.1 mg/kg rapid IV push (first dose).
Rationale: Adenosine is given as a rapid IV bolus for SVT: initial dose 0.1 mg/kg
(max 6 mg), then 0.2 mg/kg (max 12 mg) if required. Always give rapidly and follow
with saline flush. (cpr.heart.org)
9. A 7-year-old with a pulse of 40 bpm, signs of poor perfusion and apnea. After
opening airway and giving oxygen, bradycardia persists. What is the immediate next
intervention?
A. IV atropine 0.02 mg/kg
B. Start chest compressions and give epinephrine
, C. Give a fluid bolus 20 mL/kg
D. Start amiodarone infusion
Answer: B. Start chest compressions and give epinephrine.
Rationale: If bradycardia with poor perfusion or cardiac arrest, begin CPR
(compressions) and treat with epinephrine. Optimize oxygenation/ventilation first;
atropine may be used for certain causes but epinephrine is recommended for severe
symptomatic bradycardia. (cpr.heart.org)
10. Which rhythm is considered a “shockable” rhythm in PALS?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation (VF)
D. Sinus bradycardia
Answer: C. Ventricular fibrillation (VF).
Rationale: Shockable rhythms: VF and pulseless ventricular tachycardia (pVT).
Asystole and PEA are non-shockable and management focuses on CPR and
epinephrine. (cpr.heart.org)
11. In pediatric septic shock, if initial fluid boluses fail and patient remains hypotensive,
which medication is recommended as first-line vasoactive agent in many PALS
contexts?
A. Dopamine infusion
B. Epinephrine infusion
C. Norepinephrine infusion
D. Dobutamine infusion
Answer: B. Epinephrine infusion.
Rationale: Current PALS guidance favors epinephrine over dopamine for many
pediatric septic shock cases; in some contexts norepinephrine is used for vasodilatory
shock. Local practice and patient response guide choice. (cpr.heart.org)
12. What is the maximum joules/kg commonly recommended for a single pediatric
defibrillation shock (practical maximum)?
A. 2 J/kg
B. 4 J/kg
C. 10 J/kg or adult dose (whichever lower)
D. 20 J/kg
Answer: C. 10 J/kg or adult dose (whichever lower).
Rationale: Many sources indicate practical upper-limit single energy around 10
J/kg or the adult dose; follow device and resource guidance. (cpr.heart.org)
13. A child with narrow-complex tachycardia and poor perfusion needs immediate
synchronized cardioversion. What is the initial energy?
A. 0.5 J/kg
B. 1 J/kg
C. 0.5–1 J/kg then 2 J/kg if needed
D. 5 J/kg
Answer: C. 0.5–1 J/kg then 2 J/kg if needed.
Rationale: For unstable tachyarrhythmias with a pulse, synchronized cardioversion
is recommended starting at 0.5–1 J/kg; if ineffective escalate to 2 J/kg. (cpr.heart.org)
14. Which of the following is the recommended route if IV access is delayed during
pediatric cardiac arrest?
A. Subcutaneous injection
TEAM ROLES) QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED SOLUTIONS) |
GRADED A+|
1. A 6-year-old (20 kg) is unresponsive and not breathing normally. You start CPR.
What is the first medication you should consider if an advanced airway is placed and
IV/IO access achieved during pulseless arrest?
A. Amiodarone
B. Epinephrine 0.01 mg/kg IV/IO
C. Atropine 0.02 mg/kg
D. Adenosine
Answer: B. Epinephrine 0.01 mg/kg IV/IO.
Rationale: Epinephrine (0.01 mg/kg, 1:10,000) is recommended as the first drug for
pediatric cardiac arrest once IV/IO access is available to support coronary and
cerebral perfusion. Repeat every 3–5 minutes per PALS algorithm. (cpr.heart.org)
2. During defibrillation for a shockable pediatric arrest, what is the recommended initial
energy dose?
A. 0.5 J/kg
B. 1 J/kg
C. 2 J/kg
D. 5 J/kg
Answer: C. 2 J/kg.
Rationale: The PALS recommendation is an initial biphasic energy of 2 J/kg for
pediatric defibrillation; subsequent shocks can be 4 J/kg (max single shock often ~10
J/kg or adult dose). (cpr.heart.org)
3. A 3-year-old (15 kg) with bradycardia and poor perfusion despite adequate
oxygenation and ventilation: next drug and dose?
A. Epinephrine 0.01 mg/kg IV/IO
B. Dopamine infusion 5 mcg/kg/min
C. Atropine 0.02 mg/kg IV/IO
D. Amiodarone 5 mg/kg IV/IO
Answer: A. Epinephrine 0.01 mg/kg IV/IO.
Rationale: If bradycardia with poor perfusion persists despite optimized
oxygenation and ventilation, give epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of
1:10,000). Atropine was historically used for vagal causes but epinephrine is preferred
for symptomatic bradycardia with poor perfusion. (cpr.heart.org)
4. Which is the most appropriate initial fluid bolus for a child in presumed hypovolemic
shock (unless cardiogenic)?
A. 5 mL/kg isotonic crystalloid
B. 10 mL/kg isotonic crystalloid
C. 20 mL/kg isotonic crystalloid
D. 40 mL/kg isotonic crystalloid
Answer: C. 20 mL/kg isotonic crystalloid.
Rationale: For pediatric septic/hypovolemic shock, initial isotonic crystalloid bolus
, is typically 20 mL/kg, reassess frequently. In resource-limited settings and if concern
for cardiac dysfunction, bolus strategy may be adjusted. (cpr.heart.org)
5. A 10-kg infant in respiratory arrest is intubated and an advanced airway is in place.
What ventilation rate is recommended during pediatric cardiac arrest?
A. 8–10 breaths/min
B. 10–12 breaths/min
C. 20–30 breaths/min
D. 6–8 breaths/min
Answer: B. 10–12 breaths/min.
Rationale: With an advanced airway in pediatric arrest, deliver 1 breath every 6–8
seconds (about 8–10 breaths/min) historically; more recent guidance often suggests 10
breaths/min (1 every 6 seconds) — generally 10–12/min is acceptable to ensure
oxygenation without excessive ventilation. Check specific local algorithm updates.
(PMC)
6. For a child with ventricular fibrillation (VF) refractory to 2 shocks, what is the next
medication recommended?
A. Lidocaine 1 mg/kg IV/IO
B. Calcium chloride 20 mg/kg
C. Epinephrine only
D. Amiodarone 5 mg/kg IV/IO
Answer: D. Amiodarone 5 mg/kg IV/IO.
Rationale: For refractory VF/pulseless VT, after epinephrine and repeated
defibrillation attempts, give amiodarone 5 mg/kg IV/IO (max single dose frequently
300 mg depending on age/weight; may repeat as indicated). Lidocaine is an
alternative if amiodarone unavailable. (cpr.heart.org)
7. Which of the following is the correct dose of epinephrine for an infant (3 kg) in
ROSC with ongoing hypotension requiring bolus?
A. 0.01 mg/kg IV/IO (0.03 mg)
B. 0.1 mg/kg IV/IO (0.3 mg)
C. 1 mg IV
D. 0.5 mg IV
Answer: A. 0.01 mg/kg IV/IO (0.03 mg).
Rationale: Standard epinephrine dosing is 0.01 mg/kg IV/IO (1:10,000) for
resuscitation; for a 3-kg infant that equals 0.03 mg (0.3 mL of 1:10,000).
(cpr.heart.org)
8. What is the recommended DOSE of adenosine for a child with stable SVT?
A. 0.05 mg/kg rapid IV push (first dose)
B. 0.1 mg/kg rapid IV push (first dose)
C. 0.01 mg/kg slow IV push
D. 0.3 mg/kg slow IV push
Answer: B. 0.1 mg/kg rapid IV push (first dose).
Rationale: Adenosine is given as a rapid IV bolus for SVT: initial dose 0.1 mg/kg
(max 6 mg), then 0.2 mg/kg (max 12 mg) if required. Always give rapidly and follow
with saline flush. (cpr.heart.org)
9. A 7-year-old with a pulse of 40 bpm, signs of poor perfusion and apnea. After
opening airway and giving oxygen, bradycardia persists. What is the immediate next
intervention?
A. IV atropine 0.02 mg/kg
B. Start chest compressions and give epinephrine
, C. Give a fluid bolus 20 mL/kg
D. Start amiodarone infusion
Answer: B. Start chest compressions and give epinephrine.
Rationale: If bradycardia with poor perfusion or cardiac arrest, begin CPR
(compressions) and treat with epinephrine. Optimize oxygenation/ventilation first;
atropine may be used for certain causes but epinephrine is recommended for severe
symptomatic bradycardia. (cpr.heart.org)
10. Which rhythm is considered a “shockable” rhythm in PALS?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation (VF)
D. Sinus bradycardia
Answer: C. Ventricular fibrillation (VF).
Rationale: Shockable rhythms: VF and pulseless ventricular tachycardia (pVT).
Asystole and PEA are non-shockable and management focuses on CPR and
epinephrine. (cpr.heart.org)
11. In pediatric septic shock, if initial fluid boluses fail and patient remains hypotensive,
which medication is recommended as first-line vasoactive agent in many PALS
contexts?
A. Dopamine infusion
B. Epinephrine infusion
C. Norepinephrine infusion
D. Dobutamine infusion
Answer: B. Epinephrine infusion.
Rationale: Current PALS guidance favors epinephrine over dopamine for many
pediatric septic shock cases; in some contexts norepinephrine is used for vasodilatory
shock. Local practice and patient response guide choice. (cpr.heart.org)
12. What is the maximum joules/kg commonly recommended for a single pediatric
defibrillation shock (practical maximum)?
A. 2 J/kg
B. 4 J/kg
C. 10 J/kg or adult dose (whichever lower)
D. 20 J/kg
Answer: C. 10 J/kg or adult dose (whichever lower).
Rationale: Many sources indicate practical upper-limit single energy around 10
J/kg or the adult dose; follow device and resource guidance. (cpr.heart.org)
13. A child with narrow-complex tachycardia and poor perfusion needs immediate
synchronized cardioversion. What is the initial energy?
A. 0.5 J/kg
B. 1 J/kg
C. 0.5–1 J/kg then 2 J/kg if needed
D. 5 J/kg
Answer: C. 0.5–1 J/kg then 2 J/kg if needed.
Rationale: For unstable tachyarrhythmias with a pulse, synchronized cardioversion
is recommended starting at 0.5–1 J/kg; if ineffective escalate to 2 J/kg. (cpr.heart.org)
14. Which of the following is the recommended route if IV access is delayed during
pediatric cardiac arrest?
A. Subcutaneous injection
