PALS RENEWAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1
A 3-year-old child presents with sudden onset of cyanosis and difficulty breathing
after choking on a small toy. The child is conscious, coughing weakly, and able to
make sounds. What is the first action you should take?
A. Perform abdominal thrusts immediately
B. Encourage the child to continue coughing
C. Attempt blind finger sweep of the airway
D. Call for advanced airway support
Answer: B. Encourage the child to continue coughing
Rationale: A conscious child who can cough weakly should be encouraged to
cough, as this is the most effective way to clear the airway. Abdominal thrusts are
indicated if the child cannot cough, cry, or breathe. Blind finger sweeps are
dangerous and can worsen obstruction.
Question 2
A 6-year-old child in the emergency department shows signs of shock: tachycardia,
delayed capillary refill, and cool extremities. BP is normal. What is the priority
intervention?
A. Administer oxygen
B. Establish IV/IO access and begin fluid resuscitation
C. Place the child in Trendelenburg position
D. Obtain chest X-ray before intervention
Answer: B. Establish IV/IO access and begin fluid resuscitation
,Rationale: Early recognition and treatment of compensated shock (tachycardia,
delayed cap refill, cool extremities, normal BP) is critical. Rapid fluid resuscitation
through IV/IO access is the priority. Oxygen is supportive but not definitive.
Trendelenburg is not recommended.
Question 3
A 2-year-old patient has a heart rate of 38/min, is unresponsive, and has gasping
respirations. You have a bag-mask device ready. What is the first action?
A. Begin CPR immediately
B. Give a rapid IV push of epinephrine
C. Perform tracheal intubation
D. Place the child in recovery position
Answer: A. Begin CPR immediately
Rationale: A bradycardic, unresponsive child with gasping respirations is in
cardiac arrest, and CPR should be initiated immediately. Epinephrine may follow
according to algorithm.
Question 4
During resuscitation of a 5-year-old in ventricular fibrillation, the team prepares to
defibrillate. What is the recommended initial energy dose?
A. 1 J/kg
B. 2 J/kg
C. 4 J/kg
D. 10 J/kg
Answer: B. 2 J/kg
Rationale: The recommended initial defibrillation energy for pediatric ventricular
fibrillation or pulseless ventricular tachycardia is 2 J/kg. If subsequent shocks are
required, increase to 4 J/kg.
,Question 5
A 7-year-old child presents with severe asthma and respiratory failure. Despite
oxygen and albuterol, the child is tiring, has bradycardia, and decreased level of
consciousness. What is the next step?
A. Continue high-flow oxygen and monitor
B. Prepare for advanced airway management and ventilation
C. Give IV fluids
D. Administer nebulized epinephrine
Answer: B. Prepare for advanced airway management and ventilation
Rationale: Signs of fatigue, bradycardia, and altered consciousness indicate
impending respiratory arrest. Advanced airway management and assisted
ventilation are required.
Question 6
A neonate is born with a heart rate of 40 bpm and poor respiratory effort. What is
the immediate next step?
A. Provide positive-pressure ventilation
B. Begin chest compressions
C. Administer epinephrine
D. Suction the airway aggressively
Answer: A. Provide positive-pressure ventilation
Rationale: In neonates, HR <60 bpm with inadequate respiration requires
immediate ventilation. Chest compressions are indicated if HR remains <60 bpm
despite effective ventilation.
, Question 7
During a resuscitation, a child remains pulseless and in asystole. Epinephrine has
been given. What is the next priority action?
A. Defibrillation
B. High-quality CPR and identification of reversible causes
C. Administer amiodarone immediately
D. Hyperventilate the child
Answer: B. High-quality CPR and identification of reversible causes
Rationale: Asystole is not shockable. Continue CPR, give epinephrine every 3–5
minutes, and identify reversible causes (Hs and Ts).
Question 8
Which of the following is a reversible cause of pediatric cardiac arrest?
A. Ventricular fibrillation
B. Hypovolemia
C. Pulseless electrical activity
D. Sinus bradycardia
Answer: B. Hypovolemia
Rationale: Reversible causes of cardiac arrest in children include Hs
(hypovolemia, hypoxia, hydrogen ion acidosis, hypo-/hyperkalemia, hypothermia)
and Ts (tension pneumothorax, tamponade, toxins, thrombosis).
Question 9
A child with congenital heart disease develops sudden pallor, lethargy, and
hypotension. Which type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstructive
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1
A 3-year-old child presents with sudden onset of cyanosis and difficulty breathing
after choking on a small toy. The child is conscious, coughing weakly, and able to
make sounds. What is the first action you should take?
A. Perform abdominal thrusts immediately
B. Encourage the child to continue coughing
C. Attempt blind finger sweep of the airway
D. Call for advanced airway support
Answer: B. Encourage the child to continue coughing
Rationale: A conscious child who can cough weakly should be encouraged to
cough, as this is the most effective way to clear the airway. Abdominal thrusts are
indicated if the child cannot cough, cry, or breathe. Blind finger sweeps are
dangerous and can worsen obstruction.
Question 2
A 6-year-old child in the emergency department shows signs of shock: tachycardia,
delayed capillary refill, and cool extremities. BP is normal. What is the priority
intervention?
A. Administer oxygen
B. Establish IV/IO access and begin fluid resuscitation
C. Place the child in Trendelenburg position
D. Obtain chest X-ray before intervention
Answer: B. Establish IV/IO access and begin fluid resuscitation
,Rationale: Early recognition and treatment of compensated shock (tachycardia,
delayed cap refill, cool extremities, normal BP) is critical. Rapid fluid resuscitation
through IV/IO access is the priority. Oxygen is supportive but not definitive.
Trendelenburg is not recommended.
Question 3
A 2-year-old patient has a heart rate of 38/min, is unresponsive, and has gasping
respirations. You have a bag-mask device ready. What is the first action?
A. Begin CPR immediately
B. Give a rapid IV push of epinephrine
C. Perform tracheal intubation
D. Place the child in recovery position
Answer: A. Begin CPR immediately
Rationale: A bradycardic, unresponsive child with gasping respirations is in
cardiac arrest, and CPR should be initiated immediately. Epinephrine may follow
according to algorithm.
Question 4
During resuscitation of a 5-year-old in ventricular fibrillation, the team prepares to
defibrillate. What is the recommended initial energy dose?
A. 1 J/kg
B. 2 J/kg
C. 4 J/kg
D. 10 J/kg
Answer: B. 2 J/kg
Rationale: The recommended initial defibrillation energy for pediatric ventricular
fibrillation or pulseless ventricular tachycardia is 2 J/kg. If subsequent shocks are
required, increase to 4 J/kg.
,Question 5
A 7-year-old child presents with severe asthma and respiratory failure. Despite
oxygen and albuterol, the child is tiring, has bradycardia, and decreased level of
consciousness. What is the next step?
A. Continue high-flow oxygen and monitor
B. Prepare for advanced airway management and ventilation
C. Give IV fluids
D. Administer nebulized epinephrine
Answer: B. Prepare for advanced airway management and ventilation
Rationale: Signs of fatigue, bradycardia, and altered consciousness indicate
impending respiratory arrest. Advanced airway management and assisted
ventilation are required.
Question 6
A neonate is born with a heart rate of 40 bpm and poor respiratory effort. What is
the immediate next step?
A. Provide positive-pressure ventilation
B. Begin chest compressions
C. Administer epinephrine
D. Suction the airway aggressively
Answer: A. Provide positive-pressure ventilation
Rationale: In neonates, HR <60 bpm with inadequate respiration requires
immediate ventilation. Chest compressions are indicated if HR remains <60 bpm
despite effective ventilation.
, Question 7
During a resuscitation, a child remains pulseless and in asystole. Epinephrine has
been given. What is the next priority action?
A. Defibrillation
B. High-quality CPR and identification of reversible causes
C. Administer amiodarone immediately
D. Hyperventilate the child
Answer: B. High-quality CPR and identification of reversible causes
Rationale: Asystole is not shockable. Continue CPR, give epinephrine every 3–5
minutes, and identify reversible causes (Hs and Ts).
Question 8
Which of the following is a reversible cause of pediatric cardiac arrest?
A. Ventricular fibrillation
B. Hypovolemia
C. Pulseless electrical activity
D. Sinus bradycardia
Answer: B. Hypovolemia
Rationale: Reversible causes of cardiac arrest in children include Hs
(hypovolemia, hypoxia, hydrogen ion acidosis, hypo-/hyperkalemia, hypothermia)
and Ts (tension pneumothorax, tamponade, toxins, thrombosis).
Question 9
A child with congenital heart disease develops sudden pallor, lethargy, and
hypotension. Which type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstructive
