AHA PALS Final Exam Version A Actual Exam With Complete Questions And
Correct Detailed Answers Plus Well Detailed Rationales (Verified Answers)
|Already Graded A+
Question 1
You are caring for a child who was resuscitated after a drowning event. The child is intubated
and ventilated with 100% oxygen with equal breath sounds and exhaled CO₂ detected. The heart
rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal
pulses are not palpable and the central pulses are weak. Intravenous access has been established.
The core temperature is 37.3°C. Based on the PALS bradycardia algorithm, which of the
following should be provided first?
A) Epinephrine IV
B) Transcutaneous pacing
C) Atropine IV
D) Dobutamine IV infusion
E) Sodium Bicarbonate IV
Correct Answer: A) Epinephrine IV
Rationale: According to the PALS Bradycardia with a Pulse Algorithm, if a child has a
heart rate < 60/min with signs of poor perfusion (mottled skin, weak pulses) that persists
despite effective ventilation and oxygenation, chest compressions should be started. If the
bradycardia persists, Epinephrine 0.01 mg/kg IV/IO is the first-line pharmacological
treatment. Atropine is generally reserved for bradycardia caused by increased vagal tone
or primary AV blocks. Dobutamine is an inotrope used in post-resuscitation care or shock,
but not as the initial drug for acute symptomatic bradycardia.
Question 2
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min).
The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not
palpable. Which of the following would be the best treatment to provide without delay?
A) Place cold packs on the distal upper and lower extremities
B) Ask the child to blow through a small straw
C) Exert light pressure on the eyes bilaterally
D) Provide synchronized cardioversion at 0.5 to 1 J/kg
E) Administer IV Amiodarone over 30 minutes
Correct Answer: D) Provide synchronized cardioversion at 0.5 to 1 J/kg
Rationale: This child is categorized as having "Unstable SVT" because of the altered mental
status (lethargy) and signs of shock (delayed capillary refill, non-palpable distal pulses).
For unstable SVT, the treatment of choice is immediate synchronized cardioversion. Vagal
maneuvers (like blowing through a straw) should only be attempted if they do not delay
definitive treatment in unstable patients. Ocular pressure (Option C) is dangerous and
contraindicated in pediatrics. Amiodarone is used for stable tachycardias or refractory
cases, not for the initial stabilization of an unstable patient.
, 2
Question 3
You are initiating treatment for a child with septic shock and hypotension. While administering
high-flow oxygen you determine that the child's respirations are adequate and SpO2 is 100%.
You have just established vascular access and obtained blood samples. Which of the following is
the next most appropriate therapy to support systemic perfusion?
A) Administer repeated fluid boluses of isotonic colloid
B) Administer repeated fluid boluses of isotonic crystalloid
C) Begin immediate dopamine infusion
D) Begin immediate dobutamine infusion
E) Administer a bolus of 50% Dextrose
Correct Answer: B) Administer repeated fluid boluses of isotonic crystalloid
Rationale: Isotonic crystalloids (such as Normal Saline or Lactated Ringer’s) are the
preferred fluids for volume resuscitation in pediatric shock. In septic shock, rapid and
repeated boluses of 20 mL/kg are used to restore intravascular volume. Colloids (Option A)
are not the first-line choice. Vasoactive infusions like dopamine or dobutamine (Options C
and D) are considered "fluid-refractory" interventions, meaning they are started only after
adequate fluid resuscitation has failed to restore blood pressure and perfusion.
Question 4
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion.
You attempted synchronized cardioversion without success. While seeking expert consultation, it
would be most appropriate to:
A) Administer a loading dose of milrinone
B) Consider possible metabolic and toxicologic causes
C) Initiate overdrive pacing transcutaneously
D) Deliver an unsynchronized shock
E) Administer IV Adenosine rapid push
Correct Answer: B) Consider possible metabolic and toxicologic causes
Rationale: In a stable patient with a tachyarrhythmia that is refractory to initial treatment,
the nurse/provider must look for underlying reversible causes (the H’s and T’s), such as
electrolyte imbalances (hyperkalemia), toxins, or hypoxia. Unsynchronized shocks (Option
D) are only for pulseless arrest (VF/pVT). Adenosine (Option E) is for SVT, not VT.
Milrinone is an inodilator used for heart failure, not as an antiarrhythmic for VT.
Question 5
You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical
ventilation. The child's heart rate suddenly drops to 40/min and his color becomes mottled. You
should respond to these changes by:
A) Increasing the ventilator rate
B) Increasing tidal volume
, 3
C) Increasing positive end-expiratory pressure (PEEP)
D) Using a resuscitation bag provide manual ventilation with 100% oxygen
E) Administering a bolus of Atropine immediately
Correct Answer: D) Using a resuscitation bag provide manual ventilation with 100% oxygen
Rationale: When an intubated patient experiences a sudden clinical deterioration, the
"DOPE" mnemonic must be used (Displacement, Obstruction, Pneumothorax,
Equipment). The first and most critical action is to disconnect the patient from the
mechanical ventilator and manually ventilate using a self-inflating bag with 100% oxygen.
This allows the clinician to feel the compliance of the lungs and confirm if the issue is with
the ventilator/equipment or the patient's airway.
Question 6
You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated high-
flow oxygen using a nonrebreathing mask about 10 minutes ago. Suddenly the infant's
respiratory rate falls to 6/min with significant intercostal retractions, and little air movement is
heard. The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the
following treatments would be best for you to provide now?
A) Administer epinephrine IV
B) Provide bag-mask ventilation
C) Administer magnesium sulfate IV
D) Intubate and ventilate
E) Perform a needle chest decompression
Correct Answer: B) Provide bag-mask ventilation
Rationale: The infant has progressed from respiratory distress to respiratory failure,
characterized by an inadequate respiratory rate (bradypnea), cyanosis, and falling heart
rate. The immediate priority is to support ventilation manually using a bag-mask device
with 100% oxygen. This must be done before more invasive procedures like intubation.
Epinephrine is not indicated unless the heart rate drops below 60/min despite ventilation.
Question 7
Which of the following is likely to be the most helpful technique to identify potentially
reversible metabolic and toxic causes during the attempted resuscitation of a young child in
cardiac arrest?
A) Obtaining a urine sample for toxicology screen
B) Obtaining chest and abdominal radiographs
C) Soliciting a history from the caregiver or family
D) Obtaining a venous blood gas
E) Performing a stat head CT
Correct Answer: C) Soliciting a history from the caregiver or family
Rationale: While labs and X-rays provide data, the history (SAMPLE history) is the most
, 4
rapid and effective way to identify the "Events leading to the injury." For example, a
parent might report the child was found near an open medicine cabinet, immediately
identifying a toxin as the cause, which would change the course of the resuscitation to
include specific antidotes.
Question 8
You are caring for a patient who developed a tension pneumothorax after several hours of
positive-pressure ventilation. Which of the following would be the most appropriate site for
needle decompression?
A) Over the third rib at the midclavicular line
B) Under the eighth rib at the midaxillary line
C) Over the fifth rib at the sternal border
D) Under the sixth rib at the midclavicular line
E) Directly into the suprasternal notch
Correct Answer: A) Over the third rib at the midclavicular line
Rationale: The standard pediatric site for needle decompression of a tension pneumothorax
is the 2nd intercostal space at the midclavicular line. This corresponds to being "over the
third rib" to avoid the neurovascular bundle that runs along the bottom of the ribs. An
alternative site is the 4th or 5th intercostal space at the anterior axillary line.
Question 9
You attempted synchronized cardioversion for an infant with supraventricular tachycardia (SVT)
and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following
should you attempt now?
A) Synchronized cardioversion at a dose of 2 J/kg
B) Synchronized cardioversion at a dose of 4 J/kg
C) Unsynchronized cardioversion at a dose of 2 J/kg
D) Unsynchronized cardioversion at a dose of 4 J/kg
E) Vagal maneuvers using ocular pressure
Correct Answer: A) Synchronized cardioversion at a dose of 2 J/kg
Rationale: If the first dose of synchronized cardioversion (0.5 to 1 J/kg) is unsuccessful, the
PALS algorithm recommends increasing the dose to 2 J/kg for the second attempt. Shocks
should remain synchronized as long as there is a detectable R-wave to avoid inducing
ventricular fibrillation. Unsynchronized shocks are only for pulseless rhythms.
Question 10
You are treating a 5-month-old with a 2-day history of vomiting and diarrhea. The patient is
listless. The respiratory rate is 52/min and unlabored. The heart rate is 170/min and pulses are
present but weak. Capillary refill is delayed. You are administering high-flow oxygen, and
intravenous access is in place. At this point the most important therapy is to:
A) Administer an epinephrine bolus
Correct Detailed Answers Plus Well Detailed Rationales (Verified Answers)
|Already Graded A+
Question 1
You are caring for a child who was resuscitated after a drowning event. The child is intubated
and ventilated with 100% oxygen with equal breath sounds and exhaled CO₂ detected. The heart
rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal
pulses are not palpable and the central pulses are weak. Intravenous access has been established.
The core temperature is 37.3°C. Based on the PALS bradycardia algorithm, which of the
following should be provided first?
A) Epinephrine IV
B) Transcutaneous pacing
C) Atropine IV
D) Dobutamine IV infusion
E) Sodium Bicarbonate IV
Correct Answer: A) Epinephrine IV
Rationale: According to the PALS Bradycardia with a Pulse Algorithm, if a child has a
heart rate < 60/min with signs of poor perfusion (mottled skin, weak pulses) that persists
despite effective ventilation and oxygenation, chest compressions should be started. If the
bradycardia persists, Epinephrine 0.01 mg/kg IV/IO is the first-line pharmacological
treatment. Atropine is generally reserved for bradycardia caused by increased vagal tone
or primary AV blocks. Dobutamine is an inotrope used in post-resuscitation care or shock,
but not as the initial drug for acute symptomatic bradycardia.
Question 2
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min).
The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not
palpable. Which of the following would be the best treatment to provide without delay?
A) Place cold packs on the distal upper and lower extremities
B) Ask the child to blow through a small straw
C) Exert light pressure on the eyes bilaterally
D) Provide synchronized cardioversion at 0.5 to 1 J/kg
E) Administer IV Amiodarone over 30 minutes
Correct Answer: D) Provide synchronized cardioversion at 0.5 to 1 J/kg
Rationale: This child is categorized as having "Unstable SVT" because of the altered mental
status (lethargy) and signs of shock (delayed capillary refill, non-palpable distal pulses).
For unstable SVT, the treatment of choice is immediate synchronized cardioversion. Vagal
maneuvers (like blowing through a straw) should only be attempted if they do not delay
definitive treatment in unstable patients. Ocular pressure (Option C) is dangerous and
contraindicated in pediatrics. Amiodarone is used for stable tachycardias or refractory
cases, not for the initial stabilization of an unstable patient.
, 2
Question 3
You are initiating treatment for a child with septic shock and hypotension. While administering
high-flow oxygen you determine that the child's respirations are adequate and SpO2 is 100%.
You have just established vascular access and obtained blood samples. Which of the following is
the next most appropriate therapy to support systemic perfusion?
A) Administer repeated fluid boluses of isotonic colloid
B) Administer repeated fluid boluses of isotonic crystalloid
C) Begin immediate dopamine infusion
D) Begin immediate dobutamine infusion
E) Administer a bolus of 50% Dextrose
Correct Answer: B) Administer repeated fluid boluses of isotonic crystalloid
Rationale: Isotonic crystalloids (such as Normal Saline or Lactated Ringer’s) are the
preferred fluids for volume resuscitation in pediatric shock. In septic shock, rapid and
repeated boluses of 20 mL/kg are used to restore intravascular volume. Colloids (Option A)
are not the first-line choice. Vasoactive infusions like dopamine or dobutamine (Options C
and D) are considered "fluid-refractory" interventions, meaning they are started only after
adequate fluid resuscitation has failed to restore blood pressure and perfusion.
Question 4
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion.
You attempted synchronized cardioversion without success. While seeking expert consultation, it
would be most appropriate to:
A) Administer a loading dose of milrinone
B) Consider possible metabolic and toxicologic causes
C) Initiate overdrive pacing transcutaneously
D) Deliver an unsynchronized shock
E) Administer IV Adenosine rapid push
Correct Answer: B) Consider possible metabolic and toxicologic causes
Rationale: In a stable patient with a tachyarrhythmia that is refractory to initial treatment,
the nurse/provider must look for underlying reversible causes (the H’s and T’s), such as
electrolyte imbalances (hyperkalemia), toxins, or hypoxia. Unsynchronized shocks (Option
D) are only for pulseless arrest (VF/pVT). Adenosine (Option E) is for SVT, not VT.
Milrinone is an inodilator used for heart failure, not as an antiarrhythmic for VT.
Question 5
You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical
ventilation. The child's heart rate suddenly drops to 40/min and his color becomes mottled. You
should respond to these changes by:
A) Increasing the ventilator rate
B) Increasing tidal volume
, 3
C) Increasing positive end-expiratory pressure (PEEP)
D) Using a resuscitation bag provide manual ventilation with 100% oxygen
E) Administering a bolus of Atropine immediately
Correct Answer: D) Using a resuscitation bag provide manual ventilation with 100% oxygen
Rationale: When an intubated patient experiences a sudden clinical deterioration, the
"DOPE" mnemonic must be used (Displacement, Obstruction, Pneumothorax,
Equipment). The first and most critical action is to disconnect the patient from the
mechanical ventilator and manually ventilate using a self-inflating bag with 100% oxygen.
This allows the clinician to feel the compliance of the lungs and confirm if the issue is with
the ventilator/equipment or the patient's airway.
Question 6
You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated high-
flow oxygen using a nonrebreathing mask about 10 minutes ago. Suddenly the infant's
respiratory rate falls to 6/min with significant intercostal retractions, and little air movement is
heard. The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the
following treatments would be best for you to provide now?
A) Administer epinephrine IV
B) Provide bag-mask ventilation
C) Administer magnesium sulfate IV
D) Intubate and ventilate
E) Perform a needle chest decompression
Correct Answer: B) Provide bag-mask ventilation
Rationale: The infant has progressed from respiratory distress to respiratory failure,
characterized by an inadequate respiratory rate (bradypnea), cyanosis, and falling heart
rate. The immediate priority is to support ventilation manually using a bag-mask device
with 100% oxygen. This must be done before more invasive procedures like intubation.
Epinephrine is not indicated unless the heart rate drops below 60/min despite ventilation.
Question 7
Which of the following is likely to be the most helpful technique to identify potentially
reversible metabolic and toxic causes during the attempted resuscitation of a young child in
cardiac arrest?
A) Obtaining a urine sample for toxicology screen
B) Obtaining chest and abdominal radiographs
C) Soliciting a history from the caregiver or family
D) Obtaining a venous blood gas
E) Performing a stat head CT
Correct Answer: C) Soliciting a history from the caregiver or family
Rationale: While labs and X-rays provide data, the history (SAMPLE history) is the most
, 4
rapid and effective way to identify the "Events leading to the injury." For example, a
parent might report the child was found near an open medicine cabinet, immediately
identifying a toxin as the cause, which would change the course of the resuscitation to
include specific antidotes.
Question 8
You are caring for a patient who developed a tension pneumothorax after several hours of
positive-pressure ventilation. Which of the following would be the most appropriate site for
needle decompression?
A) Over the third rib at the midclavicular line
B) Under the eighth rib at the midaxillary line
C) Over the fifth rib at the sternal border
D) Under the sixth rib at the midclavicular line
E) Directly into the suprasternal notch
Correct Answer: A) Over the third rib at the midclavicular line
Rationale: The standard pediatric site for needle decompression of a tension pneumothorax
is the 2nd intercostal space at the midclavicular line. This corresponds to being "over the
third rib" to avoid the neurovascular bundle that runs along the bottom of the ribs. An
alternative site is the 4th or 5th intercostal space at the anterior axillary line.
Question 9
You attempted synchronized cardioversion for an infant with supraventricular tachycardia (SVT)
and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following
should you attempt now?
A) Synchronized cardioversion at a dose of 2 J/kg
B) Synchronized cardioversion at a dose of 4 J/kg
C) Unsynchronized cardioversion at a dose of 2 J/kg
D) Unsynchronized cardioversion at a dose of 4 J/kg
E) Vagal maneuvers using ocular pressure
Correct Answer: A) Synchronized cardioversion at a dose of 2 J/kg
Rationale: If the first dose of synchronized cardioversion (0.5 to 1 J/kg) is unsuccessful, the
PALS algorithm recommends increasing the dose to 2 J/kg for the second attempt. Shocks
should remain synchronized as long as there is a detectable R-wave to avoid inducing
ventricular fibrillation. Unsynchronized shocks are only for pulseless rhythms.
Question 10
You are treating a 5-month-old with a 2-day history of vomiting and diarrhea. The patient is
listless. The respiratory rate is 52/min and unlabored. The heart rate is 170/min and pulses are
present but weak. Capillary refill is delayed. You are administering high-flow oxygen, and
intravenous access is in place. At this point the most important therapy is to:
A) Administer an epinephrine bolus
