PALS CERTIFICATION SCRIPT 2026
COMPLETE QUESTIONS AND CORRECT
ANSWERS
◉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?
Over the third rib at the midclavicular line
Under the eighth rib at the midaxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line Answer: Over the third
rib at the midclavicular line
◉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?
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 J/kg
,Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg Answer:
Synchronized cardioversion at a dose of 2 J/kg
◉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:
Administer an epinephrine bolus
Begin bag-mask ventilation
Provide a rapid 20 ml/kg isotonic crystalloid fluid bolus
Administer a bolus of 0.5 g/kg of dextrose Answer: Provide a rapid
20 ml/kg isotonic crystalloid fluid bolus
◉Which of the following groups of clinical findings would be most
consistent with categorizing a patient with compensated shock?
Normal systolic blood pressure, decreased level of consciousness,
cool extremities with delayed capillary refill, and faint or
nonpalpable distal pulses
Decreased level of consciousness, extensor posturing in response to
pain, hypertension, and apnea
, Normal blood pressure, normal level of consciousness, bounding
distal pulses, hypercarbia, hypoxemia, and normal urine output
Unresponsiveness, normal breathing, and good distal pulses
Answer: Normal systolic blood pressure, decreased level of
consciousness, cool extremities with delayed capillary refill, and
faint or nonpalpable distal pulses
◉You are treating a 10-year-old patient after a motor vehicle crash.
The patient is unresponsive and flexes his arms at the elbow in
response to a painful stimulus. An endotracheal tube is in place with
position confirmed. You are ventilating using a resuscitation bag
with oxygen, and the child has an SPO2 of 95% and good chest
excursion bilaterally. The blood pressure is 130/70 mm Hg, and the
heart rate is 90/min with good perfusion. You have established
intravenous access. Which of the following actions would be most
appropriate at this time?
Obtain a CT scan of the head and neck
Begin manual hyperventilation
Provide continuous positive airway pressure
Give an intravenous bolus of mannitol Answer: Obtain a CT scan of
the head and neck
◉You arrive on the scene of a 12-year-old child who suddenly
collapsed on the playground. The child is unresponsive, apneic, and
pulseless and CPR is in progress. A lay rescuer just brought the
COMPLETE QUESTIONS AND CORRECT
ANSWERS
◉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?
Over the third rib at the midclavicular line
Under the eighth rib at the midaxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line Answer: Over the third
rib at the midclavicular line
◉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?
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 J/kg
,Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg Answer:
Synchronized cardioversion at a dose of 2 J/kg
◉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:
Administer an epinephrine bolus
Begin bag-mask ventilation
Provide a rapid 20 ml/kg isotonic crystalloid fluid bolus
Administer a bolus of 0.5 g/kg of dextrose Answer: Provide a rapid
20 ml/kg isotonic crystalloid fluid bolus
◉Which of the following groups of clinical findings would be most
consistent with categorizing a patient with compensated shock?
Normal systolic blood pressure, decreased level of consciousness,
cool extremities with delayed capillary refill, and faint or
nonpalpable distal pulses
Decreased level of consciousness, extensor posturing in response to
pain, hypertension, and apnea
, Normal blood pressure, normal level of consciousness, bounding
distal pulses, hypercarbia, hypoxemia, and normal urine output
Unresponsiveness, normal breathing, and good distal pulses
Answer: Normal systolic blood pressure, decreased level of
consciousness, cool extremities with delayed capillary refill, and
faint or nonpalpable distal pulses
◉You are treating a 10-year-old patient after a motor vehicle crash.
The patient is unresponsive and flexes his arms at the elbow in
response to a painful stimulus. An endotracheal tube is in place with
position confirmed. You are ventilating using a resuscitation bag
with oxygen, and the child has an SPO2 of 95% and good chest
excursion bilaterally. The blood pressure is 130/70 mm Hg, and the
heart rate is 90/min with good perfusion. You have established
intravenous access. Which of the following actions would be most
appropriate at this time?
Obtain a CT scan of the head and neck
Begin manual hyperventilation
Provide continuous positive airway pressure
Give an intravenous bolus of mannitol Answer: Obtain a CT scan of
the head and neck
◉You arrive on the scene of a 12-year-old child who suddenly
collapsed on the playground. The child is unresponsive, apneic, and
pulseless and CPR is in progress. A lay rescuer just brought the
