PALS test
1. Clinical clues: heat rate 150/min
B. Normal sinus rhythm
E. Sinus tachycardia
F. SVT
I. Wide-complex tachycardia: I. Wide-complex tachycardia
2. Clinical clues: heart rate 200/min; no detectable pulses
C. Pulseless electrical activity
H. Torsades de pointes
I. Wide-complex tachycardia
J. Ventricular Fibrillation: H. Torsades de pointes
3. Clinical clues: febrile infant; heart rate 188/min
B. Normal sinus rhythm
E. Sinus tachycardia
F. SVT
J. Ventricular Fibrillation: E. Sinus tachycardia
4. Clinical clues: initial rhythm associated with heart rate 300/min
E. Sinus tachycardia F.SVT
G. SVT converted to NSR with adenosine
K. VFib with successful defibrillation and resumption of organized rhythm: G. SVT converted to NSR with adenosi
5. Clinical clues: age 3 months; heart rate 65/min
A. Asystole
B. Normal sinus rhythm
C. Pulseless electrical activity
D. Sinus bradycardia: D. Sinus bradycardia
6. Clinical clues: age 8 years; heart rate 78/min
A. Asystole
B. Normal sinus rhythm
C. Pulseless electrical activity
D. Sinus bradycardia: b. Normal sinus rhythm
, PALS test
7. Clinical clues: no consistent heart rate detected; no detectable pulses
H.Torsades de pointes
. Wide-complex tachycardia
J. Ventricular Fibrillation
K. VFib with successful defibrillation and resumption of organized rhythm: J. Ventricular Fibrillation
8. Clinical clues: age 7 years, heart rate 38/min
A. Asystole
B. Normal sinus rhythm
C. Pulseless electrical activity
D. Sinus bradycardia: D. Sinus bradycardia
9. Clinical signs: heart rate 214/min
E. Sinus tachycardia F.SVT
H. Torsades de pointes
. Wide-complex tachycardia
J. Ventricular Fibrillation: I. Wide-complex tachycardia
10.A previously health infant with a history of vomiting and diarrhea is brought to the emergency department
by her parents. During your assess- ment, 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 capillary refill time of more than 5 seconds. The infant's blood
pressure is 85/65 mm Hg, and glucose is 30 mg/dl (1.65 mmol/L). You administer 100% oxygen via face mask and
start an IV. Which treatment is the most appropriate for infant?
A. Administer lactated Ringer's solution 20 mL/kg over 60 minutes
B. Administer D50W 0.45% sodium chloride 20mL/kg bolus over 15 minutes
C. Administer a bolus of isotonic crystalloid 20 mL/kg over 5 to 20 minutes, and also give D25W 2 to 4 mL/kg
IV
D. Administer D10W 20 mL/kg bolus over 5 minutes: C. Administer a bolus of isotonic crystalloid 20 mL/kg over 5
to 20 minutes, and also give D25W 2 to 4 mL/kg IV
, PALS test
11.Which statement is correct about the effects of epinephrine during at- tempted resuscitation?
A. Epinephrine stimulates spontaneous contractions when asystole is present
B. Epinephrine decreases myocardial oxygen consumption
C. Epinephrine decreases peripheral vascular resistance and reduces myocar- dial afterload
D. Epinephrine is contraindicated in ventricular fibrillation: A. Epinephrine stim- ulates spontaneous contractions
when asystole is present
12.A 9-year-old boy is agitated and leaning forward on the bed in obvious respiratory distress. 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. You administer 100% oxygen by nonrebreathing mask. His SpO2 is 92%. Which medication do you
prepare to give to this patient?
A. Adenosine
B. Procainamide
C. Amiodarone
D. Albuterol: D. Albuterol
13.Which oxygen delivery system is most reliably delivers a high (90% or greater) concentration of
inspired oxygen to a 7-year-old child?
A. Nonrebreathing face mask
B. Face tent
C. Simple oxygen mask
D. Nasal cannula: A. Nonrebreathing face mask
14.Initial impression of a 2-year-old girl shows her to be alert with mild breathing and difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory sounds (mild stridor)
when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room air, and she has mild inspiratory
intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath
sounds bilater- ally. Which is the most appropriate initial intervention for this child?
A. Endotracheal intubation
B. Humidified oxygen as tolerated
, PALS test
C. Nebulized albuterol
D. IV dexamethasone: B. Humidified oxygen as tolerated
15.You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest. You
delivered 2 unsynchronized shocks. A team member established IO access, so you give a dose of epinephrine, 0.01
mg/kg IO. At the next rhythm check, persistent ventricular fibrillation is present. You administer a 4-J/kg shock
and resume CPR. Which drug and dose should be administered next?
A. Atrophine 0.02 mg/kg IO
B. Magnesium sulfate 25-50 mg/kg IO
C. Amiodarone 5 mg/kg IO
D. Epinephrine 0.1 mg/kg IO: C. Amiodarone 5 mg/kg IO
16.Paramedics are called to a home of a 1-year-old child. Their initial assess- ment reveals a child who responds
only to painful stimuli and has irregular breathing, faint central pulses, bruises over the abdomen, abdominal
disten- tion, and cyanosis. Bag-mask ventilation with 100% oxygen was initiated. The child's heart rate is 36/min.
Peripheral pulses cannot be palpated, and central pulses are barely palpable. The cardiac monitor shows sinus
bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency department, the child in intubated and
ventilated with 100% oxygen, and IV access is estab- lished. The heart rate is now 150/min with weak central
pulses but no distal pulses. Systolic blood pressure is 74 mm hg. Which intervention should be provided next?
A. Rapid bolus of 20 mL/kg of isotonic crystalloid
B. Atropine 0.02 mg/kg IV
C. Amiodarone 5 mg/kg IV
D. Epinephrine 0.01 mg/kg IV: A. Rapid bolus of 20 mL/kg of isotonic crystalloid
17.Which statement is correct about the use of calcium chloride in pediatric patients?
A. It is indicated for hypercalcemia, hypokalemia, and hypomagnesemia
B. The recommended dose is 1-2 mg/kg
C. It has the same bioavailability of elemental calcium as calcium gluconate
D. Routine administration is not indicated during cardiac arrest.: D. Routine administration is not indicated
during cardiac arrest.
18.You are called to help treat an infant with severe symptomatic bradycar- dia (heart rate 66/min) associated
with respiratory distress. The bradycardia
1. Clinical clues: heat rate 150/min
B. Normal sinus rhythm
E. Sinus tachycardia
F. SVT
I. Wide-complex tachycardia: I. Wide-complex tachycardia
2. Clinical clues: heart rate 200/min; no detectable pulses
C. Pulseless electrical activity
H. Torsades de pointes
I. Wide-complex tachycardia
J. Ventricular Fibrillation: H. Torsades de pointes
3. Clinical clues: febrile infant; heart rate 188/min
B. Normal sinus rhythm
E. Sinus tachycardia
F. SVT
J. Ventricular Fibrillation: E. Sinus tachycardia
4. Clinical clues: initial rhythm associated with heart rate 300/min
E. Sinus tachycardia F.SVT
G. SVT converted to NSR with adenosine
K. VFib with successful defibrillation and resumption of organized rhythm: G. SVT converted to NSR with adenosi
5. Clinical clues: age 3 months; heart rate 65/min
A. Asystole
B. Normal sinus rhythm
C. Pulseless electrical activity
D. Sinus bradycardia: D. Sinus bradycardia
6. Clinical clues: age 8 years; heart rate 78/min
A. Asystole
B. Normal sinus rhythm
C. Pulseless electrical activity
D. Sinus bradycardia: b. Normal sinus rhythm
, PALS test
7. Clinical clues: no consistent heart rate detected; no detectable pulses
H.Torsades de pointes
. Wide-complex tachycardia
J. Ventricular Fibrillation
K. VFib with successful defibrillation and resumption of organized rhythm: J. Ventricular Fibrillation
8. Clinical clues: age 7 years, heart rate 38/min
A. Asystole
B. Normal sinus rhythm
C. Pulseless electrical activity
D. Sinus bradycardia: D. Sinus bradycardia
9. Clinical signs: heart rate 214/min
E. Sinus tachycardia F.SVT
H. Torsades de pointes
. Wide-complex tachycardia
J. Ventricular Fibrillation: I. Wide-complex tachycardia
10.A previously health infant with a history of vomiting and diarrhea is brought to the emergency department
by her parents. During your assess- ment, 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 capillary refill time of more than 5 seconds. The infant's blood
pressure is 85/65 mm Hg, and glucose is 30 mg/dl (1.65 mmol/L). You administer 100% oxygen via face mask and
start an IV. Which treatment is the most appropriate for infant?
A. Administer lactated Ringer's solution 20 mL/kg over 60 minutes
B. Administer D50W 0.45% sodium chloride 20mL/kg bolus over 15 minutes
C. Administer a bolus of isotonic crystalloid 20 mL/kg over 5 to 20 minutes, and also give D25W 2 to 4 mL/kg
IV
D. Administer D10W 20 mL/kg bolus over 5 minutes: C. Administer a bolus of isotonic crystalloid 20 mL/kg over 5
to 20 minutes, and also give D25W 2 to 4 mL/kg IV
, PALS test
11.Which statement is correct about the effects of epinephrine during at- tempted resuscitation?
A. Epinephrine stimulates spontaneous contractions when asystole is present
B. Epinephrine decreases myocardial oxygen consumption
C. Epinephrine decreases peripheral vascular resistance and reduces myocar- dial afterload
D. Epinephrine is contraindicated in ventricular fibrillation: A. Epinephrine stim- ulates spontaneous contractions
when asystole is present
12.A 9-year-old boy is agitated and leaning forward on the bed in obvious respiratory distress. 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. You administer 100% oxygen by nonrebreathing mask. His SpO2 is 92%. Which medication do you
prepare to give to this patient?
A. Adenosine
B. Procainamide
C. Amiodarone
D. Albuterol: D. Albuterol
13.Which oxygen delivery system is most reliably delivers a high (90% or greater) concentration of
inspired oxygen to a 7-year-old child?
A. Nonrebreathing face mask
B. Face tent
C. Simple oxygen mask
D. Nasal cannula: A. Nonrebreathing face mask
14.Initial impression of a 2-year-old girl shows her to be alert with mild breathing and difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory sounds (mild stridor)
when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room air, and she has mild inspiratory
intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath
sounds bilater- ally. Which is the most appropriate initial intervention for this child?
A. Endotracheal intubation
B. Humidified oxygen as tolerated
, PALS test
C. Nebulized albuterol
D. IV dexamethasone: B. Humidified oxygen as tolerated
15.You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest. You
delivered 2 unsynchronized shocks. A team member established IO access, so you give a dose of epinephrine, 0.01
mg/kg IO. At the next rhythm check, persistent ventricular fibrillation is present. You administer a 4-J/kg shock
and resume CPR. Which drug and dose should be administered next?
A. Atrophine 0.02 mg/kg IO
B. Magnesium sulfate 25-50 mg/kg IO
C. Amiodarone 5 mg/kg IO
D. Epinephrine 0.1 mg/kg IO: C. Amiodarone 5 mg/kg IO
16.Paramedics are called to a home of a 1-year-old child. Their initial assess- ment reveals a child who responds
only to painful stimuli and has irregular breathing, faint central pulses, bruises over the abdomen, abdominal
disten- tion, and cyanosis. Bag-mask ventilation with 100% oxygen was initiated. The child's heart rate is 36/min.
Peripheral pulses cannot be palpated, and central pulses are barely palpable. The cardiac monitor shows sinus
bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency department, the child in intubated and
ventilated with 100% oxygen, and IV access is estab- lished. The heart rate is now 150/min with weak central
pulses but no distal pulses. Systolic blood pressure is 74 mm hg. Which intervention should be provided next?
A. Rapid bolus of 20 mL/kg of isotonic crystalloid
B. Atropine 0.02 mg/kg IV
C. Amiodarone 5 mg/kg IV
D. Epinephrine 0.01 mg/kg IV: A. Rapid bolus of 20 mL/kg of isotonic crystalloid
17.Which statement is correct about the use of calcium chloride in pediatric patients?
A. It is indicated for hypercalcemia, hypokalemia, and hypomagnesemia
B. The recommended dose is 1-2 mg/kg
C. It has the same bioavailability of elemental calcium as calcium gluconate
D. Routine administration is not indicated during cardiac arrest.: D. Routine administration is not indicated
during cardiac arrest.
18.You are called to help treat an infant with severe symptomatic bradycar- dia (heart rate 66/min) associated
with respiratory distress. The bradycardia
