AHA PALS EXAM 2024 ACTUAL EXAM 50 QUESTIONS AND
ANSWERS WITH RATIONALES
Identify and treat reversible causes - A 7yo boy is found unresponsive, apneic, and
pulseless. CPR is ongoing. The child is intubated, and vascular access is established.
The ECG monitor shows an organized rhythm with a heart rate of 45/min, but a pulse
check reveals no palpable pulses. High quality CPR is resumed, and an initial IV dose
of epinephrine is administered. Which intervention should you perform next?
Lidocaine 1 mg/kg IV - You find a 10yo boy to be unresponsive. You shout for help, and
after finding that he is not breathing and has no pulse, you and a colleague begin CPR.
Another colleague activates the emergency response system, brings the emergency
equipment, and places the child on a cardiac monitor/defibrillator, which reveals the
rhythm shown here. You attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The
rhythm persists at the second rhythm check, at which point you attempt defibrillation
with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of
epinephrine 0.01 mg/kg. If ventricular fibrillation or pulseless ventricular tachycardia
persists after 2 minutes of CPR, you will administer another shock. Which drug and
dose should be administered next?
While a colleague provides spinal motion restriction, open the airway with a jaw thrust
and provide bag-mask ventilation - A 3yo boy presents with multiple-system trauma.
The child was an unrestrained passenger in a high-speed MVC. On primary
assessment, he is unresponsive to voice or painful stimulation. His respiratory rate is
5/min, heart rate and pulses are 170/min, systolic BP is 60 mmHg, capillary refill is 5
seconds, and spO2 is 75% on room air. Which action should you take first?
Open the airway with a head tilt-chin lift maneuver and give 2 breaths - You are alone
and witness a child suddenly collapse. There is no suspected head or neck injury. A
colleague responded to your shout for help and is activating the emergency response
system and is retrieving the resuscitation equipment, including a defibrillator. After
delivering 30 compressions, what would be your next action?
"You need to compress at a rate of 100-120 per minute." - You and another rescuer
begin CPR. Your colleague begins compressions, and you notice that the compression
rate is too slow. What should you say to offer constructive feedback?
Tracheal tube displacement into the right main bronchus - You are caring for a 6yo
patient who is receiving positive-pressure mechanical ventilation via an endotracheal
tube. The child begins to move his head and suddenly becomes cyanotic, and his heart
rate decreases. His spO2 is 65%. You remove the child from the mechanical ventilator
, and begin to provide manual ventilation with a bag via the endotracheal tube. During
manual ventilation with 100% oxygen, the child's color and heart rate improve slightly
and his BP remains adequate. Breath sounds and chest expansion are present and
adequate on the right side and are present but consistently diminished on the left side.
The trachea is not deviated, and the neck veins are not distended. a suction catheter
passes easily beyond the tip of the endotracheal tube. Which of hte following is the
most likely cause of this child's acute deterioration?
Compress the chest at least one third the depth of the chest, about 2 inches (5 cm) -
You are giving chest compressions for a child in cardiac arrest? What is the proper
depth of compressions for a child?
- SVT converting to sinus rhythm after adenosine administration
- Sinus bradycardia
- Sinus bradycardia - version 2
- Normal sinus rhythm
- Asystole
- Wide complex tachycardia
- Wide complex tachycardia - version 2
- Torsades de pointes
- Supraventricular tachycardia
- VF with successful defib and resumption of organized rhythm
- Pulseless electrical activity
- Ventricular fibrillation
- Sinus tachycardia
Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give
D25W 2-4 ml/kg IV - A previously healthy infant with a history of vomiting and diarrhea
is brought to the emergency department by her parents. During your assessment, you
find that the infant responds only to painful stimulation. The infant's respiratory rate is 40
breaths per minute, and central pulses are rapid and weak. The infant has good bilateral
breath sounds, cool extremities, and a capillary refill time of more than 5 seconds. The
infant's blood pressure is 85/65 mmHg, and glucose is 30 mg/dL (1.65 mmol/L). You
ANSWERS WITH RATIONALES
Identify and treat reversible causes - A 7yo boy is found unresponsive, apneic, and
pulseless. CPR is ongoing. The child is intubated, and vascular access is established.
The ECG monitor shows an organized rhythm with a heart rate of 45/min, but a pulse
check reveals no palpable pulses. High quality CPR is resumed, and an initial IV dose
of epinephrine is administered. Which intervention should you perform next?
Lidocaine 1 mg/kg IV - You find a 10yo boy to be unresponsive. You shout for help, and
after finding that he is not breathing and has no pulse, you and a colleague begin CPR.
Another colleague activates the emergency response system, brings the emergency
equipment, and places the child on a cardiac monitor/defibrillator, which reveals the
rhythm shown here. You attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The
rhythm persists at the second rhythm check, at which point you attempt defibrillation
with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of
epinephrine 0.01 mg/kg. If ventricular fibrillation or pulseless ventricular tachycardia
persists after 2 minutes of CPR, you will administer another shock. Which drug and
dose should be administered next?
While a colleague provides spinal motion restriction, open the airway with a jaw thrust
and provide bag-mask ventilation - A 3yo boy presents with multiple-system trauma.
The child was an unrestrained passenger in a high-speed MVC. On primary
assessment, he is unresponsive to voice or painful stimulation. His respiratory rate is
5/min, heart rate and pulses are 170/min, systolic BP is 60 mmHg, capillary refill is 5
seconds, and spO2 is 75% on room air. Which action should you take first?
Open the airway with a head tilt-chin lift maneuver and give 2 breaths - You are alone
and witness a child suddenly collapse. There is no suspected head or neck injury. A
colleague responded to your shout for help and is activating the emergency response
system and is retrieving the resuscitation equipment, including a defibrillator. After
delivering 30 compressions, what would be your next action?
"You need to compress at a rate of 100-120 per minute." - You and another rescuer
begin CPR. Your colleague begins compressions, and you notice that the compression
rate is too slow. What should you say to offer constructive feedback?
Tracheal tube displacement into the right main bronchus - You are caring for a 6yo
patient who is receiving positive-pressure mechanical ventilation via an endotracheal
tube. The child begins to move his head and suddenly becomes cyanotic, and his heart
rate decreases. His spO2 is 65%. You remove the child from the mechanical ventilator
, and begin to provide manual ventilation with a bag via the endotracheal tube. During
manual ventilation with 100% oxygen, the child's color and heart rate improve slightly
and his BP remains adequate. Breath sounds and chest expansion are present and
adequate on the right side and are present but consistently diminished on the left side.
The trachea is not deviated, and the neck veins are not distended. a suction catheter
passes easily beyond the tip of the endotracheal tube. Which of hte following is the
most likely cause of this child's acute deterioration?
Compress the chest at least one third the depth of the chest, about 2 inches (5 cm) -
You are giving chest compressions for a child in cardiac arrest? What is the proper
depth of compressions for a child?
- SVT converting to sinus rhythm after adenosine administration
- Sinus bradycardia
- Sinus bradycardia - version 2
- Normal sinus rhythm
- Asystole
- Wide complex tachycardia
- Wide complex tachycardia - version 2
- Torsades de pointes
- Supraventricular tachycardia
- VF with successful defib and resumption of organized rhythm
- Pulseless electrical activity
- Ventricular fibrillation
- Sinus tachycardia
Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give
D25W 2-4 ml/kg IV - A previously healthy infant with a history of vomiting and diarrhea
is brought to the emergency department by her parents. During your assessment, you
find that the infant responds only to painful stimulation. The infant's respiratory rate is 40
breaths per minute, and central pulses are rapid and weak. The infant has good bilateral
breath sounds, cool extremities, and a capillary refill time of more than 5 seconds. The
infant's blood pressure is 85/65 mmHg, and glucose is 30 mg/dL (1.65 mmol/L). You
