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AHA PALS Practice Exam Questions with Complete Solution
1. 1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary
assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry?
A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be administered
C. Unreliable; no supplementary oxygen is indicated
D. Unreliable; supplementary oxygen should be administered: Unreliable; sup- plementary oxygen should be
administered
2. 2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy. The
child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child's most likely condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
D. Cardiogenic shock: Septic shock
3. 3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is 55/40 mm Hg.
What term describes this infant's blood pressure?
A. Hypotensive
B. Normal
C. Hypertensive
D. Compensated: Hypotensive
4. 4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mg/kg to be
given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug: Respectfully ask the team leader to clarify the dose
5. 5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds: Inadequate oxygenation and/or ventilation
6. 6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction: Lower airway obstruction
intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consul-
tation with an oncologist to determine the chemotherapeutic regimen: Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. 11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an
unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. Two providers may attempt peripheral vascular access twice each B. Three providers may attempt peripheral vascular access once each C. Place a central venous line D. Place an intraosseous line: Place an intraosseous line
12. 12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock with
adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
C. 20 mL/kg normal saline
D. 10 mL/kg lactated Ringer's: 20 mL/kg normal saline
13. 13. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's
color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector: Administer nebulized epinephrine
14. 14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has the following vital
signs: heart rate 168/min, respiratory rate 15/min, blood pressure 9060 mm Hg, and temperature 98.6°F (37°C). The child's capillary refill time is 4 seconds. After 2 IV boluses of normal saline (20 mL/kg each), the child's vital signs are now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94/62 mm Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child's urine output is 1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or information should be obtained first?
A. Arterial blood gas
B. Serum potassium concentration
C. Glucose
D. A 12-lead ECG: Glucose
15. 15. A 15-year-old boy presents with acute onset of severe respiratory distress, with retractions and an
oxygen saturation of 85%. His trachea is deviated to the right, and there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is 84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate intervention?
A. Obtain a chest x-ray
B. Perform needle decompression on the left chest C. Insert a chest tube on the left side
D. Insert an IV and administer 20 mL/kg of normal saline: Perform needle decompression on the left chest
D. 94% to 100%: 94% to 99%
19. 19. A 3-month-old infant with bronchiolitis is suctioned to remove upper airway secretions. The infant's
heart rate decreases from 155/min to 65/min as shown below. The infant remains alert, with easily palpable pulses. Capillary refill time is 1 second. What is the most appropriate initial intervention?
A. Administer oxygen and ensure adequate ventilation; be prepared to inter-
vene further if heart rate does not increase
B. Establish IV/IO access and administer epinephrine 0.01 mg/kg IV
C. Establish IV/IO access and administer atropine 0.02 mg/kg IV
D. Call for help and prepare to provide transthoracic pacing/transvenous pac- ing: Administer oxygen and ensure
adequate ventilation; be prepared to intervene further if heart rate
20. 20. A 3-month-old infant with bronchiolitis is intubated for management of respiratory failure. During
transport, the infant develops bradycardia with a heart rate of 60/min, and the infant's oxygen saturation decreases to 75%. There are breath sounds on the right side, but no air entry is heard on the left side. What is the most appropriate initial intervention?
A. Administer epinephrine 0.01 mg/kg IV
B. Place a chest tube on the left
C. Verify the endotracheal tube position
D. Aggressively suction the endotracheal tube: Verify the endotracheal tube position
21. 21. For a 6-month-old infant with supraventricular tachycardia and ade- quate perfusion, which of the
following is the preferred vagal maneuver?
A. Ocular pressure
B. Carotid pressure
C. Valsalva maneuver
D. Ice to the face: Ice to the face
22. 22. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10
minutes after eating peanuts. What is the most appropriate initial medication for this child?
A. Nebulized albuterol
B. Epinephrine IM
C. Isotonic crystalloid IV
D. Methylprednisolone: Epinephrine IM
23. 23. A 2-year-old child was found submerged in a swimming pool. She is unresponsive, not breathing,
and pulseless. In addition to performing high-quality CPR and establishing vascular access, which of the following is the most appropriate intervention?
A. Give atropine 0.02 mg/kg lIO/IV
B. Apply cricoid pressure
C. Give epinephrine 0.01 mg/kg IO/IV
D. Provide transthoracic pacing: Give epinephrine 0.01 mg/kg IO/IV
24. 24. A 3-year-old child is unresponsive, not breathing, and pulseless.
High-quality CPR is in progress. A cardiac monitor is applied, and the rhythm below is noted. What is the next appropriate intervention?
A. Attempt defibrillation with a 2 J/kg shock
D. Cardiac apex: C. Brachial
28. 28. A 7-year-old child presents in pulseless arrest. The child's ECG shows the rhythm below. Which of the
following describes the patient's condition?
A. Ventricular escape rhythm
B. Ventricular tachycardia
C. Pulseless electrical activity
D. Sinus bradycardia: Pulseless electrical activity
29. 30. A 12-year-old child suddenly collapses while playing sports. He is unre- sponsive and not breathing.
Emergency response is activated. The child has no pulse, and CPR is initiated. An AED arrives. What is the most appropriate next intervention?
A. Contact the child's family
B. Provide CPR for 2 minutes
C. Drive the child to the hospital
D. Use the AED: Use the AED
30. 31. A 6-year-old child is found unresponsive, not breathing, and pulseless. What is the correct compression-
to-ventilation ratio when 2 or more health- care providers are present to perform CPR?: 15:
31. 32. A 5-year-old child has had severe respiratory distress for 2 days. During assessment the child's heart rate
decreases from 140/min to 90/min, and the child's respiratory rate decreases from 66/min to 8/min. What intervention is most appropriate?
A. Provide rescue breaths at a rate of 12 to 20/min B. Provide rescue breaths at a rate of 6 to 10/min
C. Initiate chest compressions at a rate of at least 100/min
D. Initiate chest compressions at a rate of 60/min: Provide rescue breaths at a rate of 12 to 20/min
32. 33. A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor
perfusion. Pulses are weak and thready. Vascu- lar access cannot be established. What is the most appropriate intervention?
A. Unsynchronized shock with 0.5 to 1 J/kg
B. Synchronized shock with 0.5 to 1 J/kg
C. Unsynchronized shock with 2 J/kg
D. Synchronized shock with 2 J/kg: Synchronized shock with 0.5 to 1 J/kg
33. 1. A 13-year-old patient with asthma just received oxygen and albuterol via a nebulizer. What is the next
most appropriate intervention?
A. Administer 0.1 mg/kg of adenosine
B. Obtain a blood sample to evaluate arterial or venous blood gases
C. Reassess breath sounds and clinical status
D. Repeat the albuterol treatment: Reassess breath sounds and clinical status
34. 2. The respiratory rate of a 1-year-old child with respiratory distress has decreased from 65/min to 30/min.
The child is more lethargic and continues to have subcostal retractions. What does this change likely indicate?
A. Respiratory distress is unchanged
B. Progression toward respiratory failure
38. 7. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes
after eating peanuts. What is the most appropri- ate initial medication for this child?
A. Nebulized albuterol
B. Epinephrine IM
C. Isotonic crystalloid IV
D. Methylprednisolone IV: Epinephrine IM
39. 8. A mother brings her 7-year-old child to the emergency department. The mother states that the child has
had a fever for the past 4 days and has had little to eat or drink during the past 24 hours. Your initial impression reveals a lethargic child with increased respiratory rate and pale color. Heart rate is 160/min, respiratory rate is 38/min, and blood pressure is 86/48 mm Hg. Capillary refill is 4 seconds. Which of the following is the most appropriate intervention for this child?
A. Fluid bolus of 10 mL/kg of isotonic crystalloid
B. Fluid bolus of 20 mL/kg of isotonic crystalloid
C. Maintenance fluid infusion of isotonic crystalloid at 10 mL/h
D. Maintenance fluid infusion of 5% dextrose and water at 20 mL/h: Fluid bolus of 20 mL/kg of isotonic crystalloid
40. 9. An intubated 5-year-old child who was in a motor vehicle collision becomes increasingly more difficult to
ventilate. The child has diminished breath sounds and chest expansion on the right side of the chest, with audible breath sounds and visible chest expansion on the left. The endotracheal tube insertion depth has not changed. What is the most appropriate intervention?
A. Deflate the cuff and pull the tube back
B. Perform needle decompression on the right chest
C. Perform needle decompression on the left chest D. Insert a gastric tube: -
Perform needle decompression on the right chest
41. 10. A 2-year-old child with a 2-day history of a barking cough presents with audible stridor on inspiration,
intercostal retractions, and agitation. What is the most appropriate intervention for this child?
A. Lay the child flat on a stretcher
B. Suction the mouth and nose
C. Administer nebulized epinephrine
D. Administer inhaled albuterol: Administer nebulized epinephrine
42. 11. Which of the following oxygen saturations indicates the need for addi- tional intervention?
A. 96% on room air
B. 95% on room air
C. 93% on 4 L of oxygen
D. 97% on 50% oxygen: 93% on 4 L of oxygen
43. 12. A 3-year-old child presents with a 2-day history of nausea and vomiting. She is alert, with no increase in
respiratory effort, and is pale in color. The child's heart rate is 160/min, respiratory rate is 40/min, and blood pressure is 100/70 mm Hg. Her extremities are cool, with sluggish capillary refill. Which term best describes this child's physiologic state?
A. Compensated shock
B. Cardiogenic shock
C. Hypotensive shock
88%. Airway and lungs are clear. Peripheral pulses are diminished. Which of the following is the most appropriate initial intervention?
A. Provide 100% oxygen via a nonrebreathing mask B. Obtain IV access
C. Administer dopamine
D. Administer an antibiotic: Provide 100% oxygen via a nonrebreathing mask
46. 16. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's
color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector: Administer nebulized epinephrine
47. 17. The initial impression of a 4-year-old child reveals a lethargic child who is diaphoretic, with no increased
work of breathing and pink color. Her heart rate is 220/min, respiratory rate is 24/min, blood pressure is 84/ mm Hg, and capillary refill time is 5 seconds. IV access has been established. The rhythm below is seen on the cardiac monitor. What is the most appropriate initial intervention?
A. Give adenosine 0.1 mg/kg rapid IV push
B. Perform carotid sinus massage
C. Perform synchronized cardioversion at 0.5 J/kg D. Attempt defibrillation at 2 J/kg: Give adenosine 0.1 mg/kg
rapid IV push
48. 18. An 8-month-old infant is being evaluated. The child's mother says the infant has not been feeding well.
The infant is alert with rapid but unlabored breathing, and the infant's color is pale. A cardiac monitor is applied, and the rhythm below is noted. Distal pulses are readily palpable.You give oxygen and establish IV access. What is the most appropriate vagal maneuver?
A. Valsalva maneuver
B. Carotid massage
C. Ocular pressure
D. Ice to the face: Ice to the face
49. 19. A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor
perfusion. Pulses are weak and thready. Vascu- lar access cannot be established. What is the most appropriate intervention?
A. Unsynchronized shock with 0.5 to 1 J/kg
B. Synchronized shock with 0.5 to 1 J/kg
C. Unsynchronized shock with 2 J/kg
D. Synchronized shock with 2 J/kg: Synchronized shock with 0.5 to 1 J/kg
50. 20. A 3-month-old infant presents with lethargy and a 3-day history of vomiting, diarrhea, and poor feeding.
The initial impression reveals lethargy, increased respiratory effort with retractions, and pale, mottled skin color. Vital signs are as follows: heart rate 210/min, respiratory rate 60/min, and blood pressure 60/40 mm Hg. Peripheral pulses are thready, and capillary refill time is 4 seconds. The cardiac monitor displays the rhythm below. After administration of oxygen and establishment of vascular access, what is the most appropriate intervention?
A. Adenosine O.1 mg/kg IV rapid push
B. Provide CPR for 2 minutes
C. Drive the child to the hospital
D. Use the AED: Use the AED
54. 24. A 3-year-old child is in cardiac arrest, and high- quality CPR is in progress. The first rhythm check
reveals the rhythm below. Defibrillation is attempted with a shock dose of 2 J/kg. After administration of the shock, what
is the most appropriate next intervention?
A. Resume CPR, beginning with chest compressions
B. Check for a pulse
C. Analyze the rhythm
D. Administer epinephrine: Resume CPR, beginning with chest compressions
55. 25. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds: Inadequate oxygenation and/or ventilation
56. 26. A 3-year-old child is in cardiac arrest, and a resuscitation attempt is in progress. The child is in
ventricular fibrillation and was given a shock at 2 J/kg, followed by immediate CPR. At the next rhythm check, ventricular fibrillation is again noted on the cardiac monitor. What is the most appropriate next intervention?
A. Attempt defibrillation with a 4 J/kg shock
B. Attempt defibrillation with a 2 J/kg shock
C. Resume CPR
D. Check for a pulse for at least 10 seconds: A. Attempt defibrillation with a 4 J/kg shock
