PALS Questions And Answers
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 37.3ºC. 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: a) Epinephrine IV
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: d) Provide synchronized
cardioversion at 0.5 to 1 J/kg
3. You are initiating treatment for a child with septic shock and hypotension.
While administering high-flow oxygen you determine that the child's respi-
rations 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: b) Administer repeated fluid boluses of
isotonic crystalloid
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
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, PALS Questions And Answers
c) Initiate overdrive pacing transcutaneously
d) Deliver an unsynchronized shock: b) Consider possible metabolic and toxico-
logic causes
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
c) Increasing positive end-expiratory pressure (PEEP)
d) Using a resuscitation bag provide manual ventilation with 100% oxygen: d)
Using a resuscitation bag provide manual ventilation with 100% oxygen
6. You are caring for a 9-month-old patient with pronounced respiratory dis-
tress. 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 respi-
ratory rate falls to 6/min with significant intercostals 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: b) Provide bag-mask ventilation
7. Which of the following is likely to be the most helpful technique to identify
potentially reversible metabolic and toxic causes during the attempted resus-
citation 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: c) Soliciting a history from the caregiver or family
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
2/8
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 37.3ºC. 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: a) Epinephrine IV
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: d) Provide synchronized
cardioversion at 0.5 to 1 J/kg
3. You are initiating treatment for a child with septic shock and hypotension.
While administering high-flow oxygen you determine that the child's respi-
rations 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: b) Administer repeated fluid boluses of
isotonic crystalloid
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
1/8
, PALS Questions And Answers
c) Initiate overdrive pacing transcutaneously
d) Deliver an unsynchronized shock: b) Consider possible metabolic and toxico-
logic causes
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
c) Increasing positive end-expiratory pressure (PEEP)
d) Using a resuscitation bag provide manual ventilation with 100% oxygen: d)
Using a resuscitation bag provide manual ventilation with 100% oxygen
6. You are caring for a 9-month-old patient with pronounced respiratory dis-
tress. 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 respi-
ratory rate falls to 6/min with significant intercostals 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: b) Provide bag-mask ventilation
7. Which of the following is likely to be the most helpful technique to identify
potentially reversible metabolic and toxic causes during the attempted resus-
citation 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: c) Soliciting a history from the caregiver or family
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
2/8
