PALS Pre-course Test, (answered & Updated
2021/2022)
1. Parents of a 1-year-old female phoned EMS when they picked up their daughter from the
babysitter. Paramedics perform an initial impression revealing an obtunded infant with
irregular breathing, bruises over the abdomen, abdominal distension, and cyanosis. Assisted
bag-mask ventilation with 100% oxygen is initiated. On primary assessment heart rate is
36/min, peripheral pulses cannot be palpated, and central pulses are barely palpable. Cardiac
monitor shows sinus bradycardia. Chest compressions are started at 15:2. In the ED the infant
is intubated and ventilated, and IV access is established. The heart rate is now up to 150/min,
but there are weak central pulses and no distal pulses. Systolic BP is 74. Of the following,
which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV - C
2. You enter a room to perform an initial impression of a previously stable 10-year-old male and
find him unresponsive and apneic. A code is called and bag-mask ventilation is performed
with 100% oxygen. The cardiac monitor shows a wide-complex tachycardia. The boy has no
detectable pulses so compressions and ventilations are provided. As soon as the defibrillator
arrives you deliver an unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of
CPR reveals VF. You then deliver a shock of 4 J/kg and resume immediate CPR beginning
with compressions. A team member has established IO access, so you give a dose of epi, 0.01
mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second shock. At the next rhythm check,
persistent VF is present. You administer another 4 J/kg shock and resume CPR. Based on the
PALS Pulseless Arrest Algorithm, what is the next drug and dose to administer when CPR is
restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO - D
3. Which of the following statements about calcium is true?
, A. Calcium chloride 10% has the same bioavailability of elemental calcium as calcium
gluconate in critically ill children
B. The recommended dose is 1-2 mg/kg of calcium chloride.
C. Indications for administration of calcium include hypercalcemia, hypokalemia, and
hypomagnesemia.
D. Routine administration of calcium is not indicated during cardiac arrest. - D
4. Initial impression of a 9-year-old male with increased work of breathing reveals the boy to be
agitated and leaning forward on the bed with obvious respiratory distress. You administer
100% oxygen by nonrebreathing mask. The patient is speaking in short phrases and tells you
that he has asthma but does not carry an inhaler. He has nasal flaring, severe suprasternal and
intercostal retractions, and decreased air movement with prolonged expiratory time and
wheezing. His SpO2 is 96% (on nonrebreathing mask). What is the next medical therapy to
provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO - C
5. You are called to help resuscitate an infant with severe symptomatic bradycardia associated
with respiratory distress. The bradycardia persists despite establishment of an effective
airway, oxygenation, and ventilation. There is no heart block present. Which of the following
is the first drug you should administer?
A. Dopamine
B. Adenosine
C. Atropine
D. Epinephrine - D
6. An infant with a history of vomiting and diarrhea arrives by ambulance. During your primary
assessment the infant responds only to painful stimulation. The upper airway is patent, the
repiratory rate is 40/min with good bilateral breath sounds, and 100% oxygen is being
administered. The infant has cool extremities, weak pulses, and a cap refill of more than 5
2021/2022)
1. Parents of a 1-year-old female phoned EMS when they picked up their daughter from the
babysitter. Paramedics perform an initial impression revealing an obtunded infant with
irregular breathing, bruises over the abdomen, abdominal distension, and cyanosis. Assisted
bag-mask ventilation with 100% oxygen is initiated. On primary assessment heart rate is
36/min, peripheral pulses cannot be palpated, and central pulses are barely palpable. Cardiac
monitor shows sinus bradycardia. Chest compressions are started at 15:2. In the ED the infant
is intubated and ventilated, and IV access is established. The heart rate is now up to 150/min,
but there are weak central pulses and no distal pulses. Systolic BP is 74. Of the following,
which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV - C
2. You enter a room to perform an initial impression of a previously stable 10-year-old male and
find him unresponsive and apneic. A code is called and bag-mask ventilation is performed
with 100% oxygen. The cardiac monitor shows a wide-complex tachycardia. The boy has no
detectable pulses so compressions and ventilations are provided. As soon as the defibrillator
arrives you deliver an unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of
CPR reveals VF. You then deliver a shock of 4 J/kg and resume immediate CPR beginning
with compressions. A team member has established IO access, so you give a dose of epi, 0.01
mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second shock. At the next rhythm check,
persistent VF is present. You administer another 4 J/kg shock and resume CPR. Based on the
PALS Pulseless Arrest Algorithm, what is the next drug and dose to administer when CPR is
restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO - D
3. Which of the following statements about calcium is true?
, A. Calcium chloride 10% has the same bioavailability of elemental calcium as calcium
gluconate in critically ill children
B. The recommended dose is 1-2 mg/kg of calcium chloride.
C. Indications for administration of calcium include hypercalcemia, hypokalemia, and
hypomagnesemia.
D. Routine administration of calcium is not indicated during cardiac arrest. - D
4. Initial impression of a 9-year-old male with increased work of breathing reveals the boy to be
agitated and leaning forward on the bed with obvious respiratory distress. You administer
100% oxygen by nonrebreathing mask. The patient is speaking in short phrases and tells you
that he has asthma but does not carry an inhaler. He has nasal flaring, severe suprasternal and
intercostal retractions, and decreased air movement with prolonged expiratory time and
wheezing. His SpO2 is 96% (on nonrebreathing mask). What is the next medical therapy to
provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO - C
5. You are called to help resuscitate an infant with severe symptomatic bradycardia associated
with respiratory distress. The bradycardia persists despite establishment of an effective
airway, oxygenation, and ventilation. There is no heart block present. Which of the following
is the first drug you should administer?
A. Dopamine
B. Adenosine
C. Atropine
D. Epinephrine - D
6. An infant with a history of vomiting and diarrhea arrives by ambulance. During your primary
assessment the infant responds only to painful stimulation. The upper airway is patent, the
repiratory rate is 40/min with good bilateral breath sounds, and 100% oxygen is being
administered. The infant has cool extremities, weak pulses, and a cap refill of more than 5
