PALS version A questions and answers 2026\2027
A+ Grade
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 37.3oC. Based on the PALS bradycardia algorithm, which of the following should be
provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
- correct answer Epinephrine IV
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?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
- correct answer Provide synchronized cardioversion at 0.5 to 1 J/kg
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?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
- correct answer Administer repeated fluid boluses of isotonic crystalloid
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:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock
- correct answer Consider possible metabolic and toxicologic causes
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:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
- correct answer Using a resuscitation bag provide manual ventilation with 100% oxygen
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 and established intravenous access. Initially
the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's respiratory
rate falls to 6/min with significant intercostals retractions, and little air movement is heard. The infant
A+ Grade
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 37.3oC. Based on the PALS bradycardia algorithm, which of the following should be
provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
- correct answer Epinephrine IV
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?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
- correct answer Provide synchronized cardioversion at 0.5 to 1 J/kg
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?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
- correct answer Administer repeated fluid boluses of isotonic crystalloid
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:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock
- correct answer Consider possible metabolic and toxicologic causes
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:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
- correct answer Using a resuscitation bag provide manual ventilation with 100% oxygen
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 and established intravenous access. Initially
the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's respiratory
rate falls to 6/min with significant intercostals retractions, and little air movement is heard. The infant
