1|Page
AHA PALS PEDIATRIC EMERGENCY CARE EXAM 2025 | 120
VERIFIED QUESTIONS & ANSWERS WITH RATIONALES, 100%
CORRECT, ALREADY GRADED A+
Q1 — Scene & initial check
You arrive to find a 4-year-old unresponsive on the floor after a witnessed
collapse. Bystanders report they suddenly went limp and are not breathing
normally. The room is safe. What is your first two actions in the pediatric
BLS sequence?
Answer: Check responsiveness (tap/shout), shout for nearby help and send
someone to activate the emergency response system and fetch an AED, then
open airway and check breathing.
Rationale: Always verify scene safety and patient responsiveness before
intervening. Early activation of the emergency response system and early
defibrillation (when indicated) improve survival. Initial assessment and
prompt escalation follow standard BLS algorithms. cpr.heart.org
,2|Page
Q2 — Bradycardia with poor perfusion
A 7-year-old (approx. 25 kg) in the ED has a heart rate of 50/min, becomes
pale, and has weak peripheral pulses after a period of prolonged hypoxia.
Oxygen and effective ventilations are being provided, but perfusion remains
poor and the rate is <60/min. What is the immediate next step?
Answer: Begin high-quality chest compressions immediately (treat as
cardiac arrest), while continuing oxygenation and preparing for epinephrine.
Rationale: In children, severe bradycardia with signs of poor perfusion
despite adequate oxygenation/ventilation is treated like cardiac arrest — start
CPR promptly and give epinephrine as soon as IV/IO access is available.
cpr.heart.org+1
Q3 — Single-rescuer compression:ventilation ratio
You are a lone rescuer performing CPR on an unresponsive 6-year-old with
no advanced airway. What compression:ventilation ratio should you use?
Answer: 30 compressions : 2 ventilations.
Rationale: For single rescuers (healthcare or lay) performing pediatric CPR
without an advanced airway, 30:2 provides the best balance of circulatory
compressions and ventilations until additional help arrives. cpr.heart.org
,3|Page
Q4 — Two-rescuer pediatric CPR ratio
Two rescuers are providing CPR for an 18-month-old child (no advanced
airway). What ratio should they use?
Answer: 15 compressions : 2 ventilations.
Rationale: Two-rescuer pediatric CPR uses 15:2 to increase hands-on
compression fraction while ensuring adequate ventilations for children.
cpr.heart.org
Q5 — Compression depth — child
A 9-year-old (pre-pubertal) requires chest compressions. What compression
depth should you target?
Answer: Approximately one-third the anterior-posterior chest diameter —
roughly 2 inches (≈5 cm).
Rationale: Pediatric compressions should depress the chest at least one-third
of the AP diameter; in children this approximates 2 inches to optimize
perfusion without excessive injury. cpr.heart.org
Q6 — Compression depth — infant
An 8-month-old infant needs high-quality CPR. What depth do you aim for?
Answer: About one-third of chest depth — ≈1.5 inches (≈4 cm).
, 4|Page
Rationale: Infants require proportionally less depth; the one-third-AP rule is
recommended to balance perfusion and risk of injury. cpr.heart.org
Q7 — First drug in pediatric pulseless arrest
A 3-year-old in cardiac arrest (pulseless) is being resuscitated with adequate
compressions and ventilation; IV access obtained. What is the first
recommended IV/IO medication and dose?
Answer: Epinephrine 0.01 mg/kg IV/IO of the 1:10,000 concentration (0.1
mL/kg of 0.1 mg/mL), repeat every 3–5 minutes as needed.
Rationale: Epinephrine is first-line vasopressor in pediatric cardiac arrest to
support coronary and cerebral perfusion; standard PALS dosing is 0.01
mg/kg IV/IO (max 1 mg adult dose). cpr.heart.org+1
Q8 — Pediatric defibrillation energy
A 6-year-old (approx. 20 kg) is in witnessed VF. What initial shock energy
should you deliver with a manual defibrillator?
Answer: Use an initial energy of 2 J/kg (can consider 2–4 J/kg as
acceptable); if first shock unsuccessful, increase to 4 J/kg for subsequent
shocks (do not routinely exceed 10 J/kg or the adult dose).
Rationale: Pediatric defibrillation is weight-based. AHA/PALS guidance
supports an initial shock around 2 J/kg and escalating to 4 J/kg for refractory
AHA PALS PEDIATRIC EMERGENCY CARE EXAM 2025 | 120
VERIFIED QUESTIONS & ANSWERS WITH RATIONALES, 100%
CORRECT, ALREADY GRADED A+
Q1 — Scene & initial check
You arrive to find a 4-year-old unresponsive on the floor after a witnessed
collapse. Bystanders report they suddenly went limp and are not breathing
normally. The room is safe. What is your first two actions in the pediatric
BLS sequence?
Answer: Check responsiveness (tap/shout), shout for nearby help and send
someone to activate the emergency response system and fetch an AED, then
open airway and check breathing.
Rationale: Always verify scene safety and patient responsiveness before
intervening. Early activation of the emergency response system and early
defibrillation (when indicated) improve survival. Initial assessment and
prompt escalation follow standard BLS algorithms. cpr.heart.org
,2|Page
Q2 — Bradycardia with poor perfusion
A 7-year-old (approx. 25 kg) in the ED has a heart rate of 50/min, becomes
pale, and has weak peripheral pulses after a period of prolonged hypoxia.
Oxygen and effective ventilations are being provided, but perfusion remains
poor and the rate is <60/min. What is the immediate next step?
Answer: Begin high-quality chest compressions immediately (treat as
cardiac arrest), while continuing oxygenation and preparing for epinephrine.
Rationale: In children, severe bradycardia with signs of poor perfusion
despite adequate oxygenation/ventilation is treated like cardiac arrest — start
CPR promptly and give epinephrine as soon as IV/IO access is available.
cpr.heart.org+1
Q3 — Single-rescuer compression:ventilation ratio
You are a lone rescuer performing CPR on an unresponsive 6-year-old with
no advanced airway. What compression:ventilation ratio should you use?
Answer: 30 compressions : 2 ventilations.
Rationale: For single rescuers (healthcare or lay) performing pediatric CPR
without an advanced airway, 30:2 provides the best balance of circulatory
compressions and ventilations until additional help arrives. cpr.heart.org
,3|Page
Q4 — Two-rescuer pediatric CPR ratio
Two rescuers are providing CPR for an 18-month-old child (no advanced
airway). What ratio should they use?
Answer: 15 compressions : 2 ventilations.
Rationale: Two-rescuer pediatric CPR uses 15:2 to increase hands-on
compression fraction while ensuring adequate ventilations for children.
cpr.heart.org
Q5 — Compression depth — child
A 9-year-old (pre-pubertal) requires chest compressions. What compression
depth should you target?
Answer: Approximately one-third the anterior-posterior chest diameter —
roughly 2 inches (≈5 cm).
Rationale: Pediatric compressions should depress the chest at least one-third
of the AP diameter; in children this approximates 2 inches to optimize
perfusion without excessive injury. cpr.heart.org
Q6 — Compression depth — infant
An 8-month-old infant needs high-quality CPR. What depth do you aim for?
Answer: About one-third of chest depth — ≈1.5 inches (≈4 cm).
, 4|Page
Rationale: Infants require proportionally less depth; the one-third-AP rule is
recommended to balance perfusion and risk of injury. cpr.heart.org
Q7 — First drug in pediatric pulseless arrest
A 3-year-old in cardiac arrest (pulseless) is being resuscitated with adequate
compressions and ventilation; IV access obtained. What is the first
recommended IV/IO medication and dose?
Answer: Epinephrine 0.01 mg/kg IV/IO of the 1:10,000 concentration (0.1
mL/kg of 0.1 mg/mL), repeat every 3–5 minutes as needed.
Rationale: Epinephrine is first-line vasopressor in pediatric cardiac arrest to
support coronary and cerebral perfusion; standard PALS dosing is 0.01
mg/kg IV/IO (max 1 mg adult dose). cpr.heart.org+1
Q8 — Pediatric defibrillation energy
A 6-year-old (approx. 20 kg) is in witnessed VF. What initial shock energy
should you deliver with a manual defibrillator?
Answer: Use an initial energy of 2 J/kg (can consider 2–4 J/kg as
acceptable); if first shock unsuccessful, increase to 4 J/kg for subsequent
shocks (do not routinely exceed 10 J/kg or the adult dose).
Rationale: Pediatric defibrillation is weight-based. AHA/PALS guidance
supports an initial shock around 2 J/kg and escalating to 4 J/kg for refractory
