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PALS Red Cross Final Exam: 150 Practice Questions with Multiple Answers, Correct Responses, and Detailed Explanations Based on the Most Current AHA/Red Cross Pediatric Advanced Life Support Guidelines
Questions 1–150 (Master Version – Combined
Best)
Section 1: Pediatric Assessment Triangle (PAT) &
Initial Assessment
- A 2-year-old presents with lethargy, abnormal breathing, and pale skin. Which components of the Pediatric Assessment Triangle (PAT) are abnormal? (Select all that apply) A) Appearance B) Work of breathing C) Circulation to skin D) Blood pressure Correct Answers: A, B, C Explanation: PAT assesses appearance (lethargy), work of breathing (abnormal breathing), and circulation to skin (pale). Blood pressure is not part of PAT.
- During the primary assessment (ABCDE), what does the “D” stand for? A) Defibrillation
B) Disability C) Drugs D) Drainage Correct Answer: B Explanation: ABCDE = Airway, Breathing, Circulation, Disability, Exposure.
- A child is unresponsive, not breathing, and has no pulse. What is the first action? A) Give 2 rescue breaths B) Start chest compressions C) Attach AED D) Open airway Correct Answer: B Explanation: Immediately begin chest compressions (C-A-B sequence).
- How long should a pulse check take during rapid assessment? A) 5 to 10 seconds B) 15 to 20 seconds C) 30 seconds D) 1 minute Correct Answer: A Explanation: Pulse check should be no more than 5–10 seconds to avoid delaying CPR.
- A child has an oxygen saturation of 89% on room air. After administering oxygen, what is the target SpO2 range? A) 100% B) 94–99% C) 90–92%
A) Nebulized epinephrine (racemic or L-epinephrine) B) Dexamethasone 0.6 mg/kg PO/IM C) Albuterol D) Antibiotics Correct Answers: A, B Explanation: Nebulized epinephrine for acute relief; steroids for inflammation. Albuterol is not effective for croup.
- A child with suspected epiglottitis presents with fever, drooling, tripod positioning, and stridor. What should you avoid? A) Oxygen by mask B) Visualizing the airway with a tongue depressor C) Transport D) Humidified air Correct Answer: B Explanation: Never examine the throat in suspected epiglottitis; may cause complete obstruction. Prepare for controlled intubation. 1 0. A 2-year-old has sudden choking, coughing, and stridor while eating. The child is conscious with poor air exchange. What is the appropriate intervention? A) Back blows and chest thrusts (infant) B) Abdominal thrusts (Heimlich) C) Blind finger sweep D) Encourage coughing Correct Answer: B Explanation: For severe FBAO in a conscious child >1 year, perform abdominal thrusts.
Section 3: Respiratory Failure & Advanced Airway
1 1. Which findings are consistent with respiratory failure? (Select all that apply) A) Diminished breath sounds B) Bradycardia C) Normal mental status D) Slowed or gasping respiratory rate Correct Answers: A, B, D Explanation: Respiratory failure includes inadequate ventilation/oxygenation, leading to bradycardia, decreased breath sounds, and altered mental status (not normal). 1 2. A child with status asthmaticus receives continuous albuterol, ipratropium, and IV magnesium. The child becomes drowsy, has a silent chest, and PCO2 is 58 mm Hg. What is the next step? A) Increase albuterol frequency B) Intubate and mechanically ventilate C) Give another dose of magnesium D) Discharge home Correct Answer: B Explanation: Drowsiness, silent chest, and hypercapnia indicate impending respiratory failure requiring intubation. 1 3. A 10 kg intubated child needs mechanical ventilation. What initial settings are appropriate? A) Tidal volume 10 mL/kg, rate 10 B) Tidal volume 6–8 mL/kg, rate 20– C) Tidal volume 15 mL/kg, rate 15 D) Tidal volume 4 mL/kg, rate 40 Correct Answer: B
2 Explanation: Lung-protective ventilation: 6–8 mL/kg; rates: infant 0–30, child 12–20, adolescent 10–15.*
1 7. A child has Beck’s triad: hypotension, jugular venous distension, and muffled heart tones. What is the diagnosis? A) Tension pneumothorax B) Cardiac tamponade C) Hypovolemic shock D) Septic shock Correct Answer: B Explanation: Beck’s triad is classic for cardiac tamponade; treatment is pericardiocentesis. 1 8. A child with tension pneumothorax after chest trauma has absent breath sounds on the right, tracheal deviation to the left, and hypotension. What is the immediate intervention? A) Chest tube insertion B) Needle decompression (2nd intercostal space, midclavicular line) C) Pericardiocentesis D) IV fluids only Correct Answer: B Explanation: Needle decompression relieves tension; chest tube follows. 1 9. Which statement about hypotension in pediatric shock is true? A) Hypotension is an early sign B) Hypotension is a late and ominous sign C) Children maintain blood pressure longer than adults D) Both B and C Correct Answer: D Explanation: Children compensate well; hypotension indicates decompensated shock.
2 0. Which findings are consistent with cardiogenic shock? (Select all that apply) A) Hepatomegaly B) Jugular venous distension C) Gallop rhythm D) Dry mucous membranes Correct Answers: A, B, C Explanation: Cardiogenic shock shows signs of fluid overload (JVD, hepatomegaly, gallop). Dry mucous membranes suggest hypovolemia.
Section 5: Shock Management – Fluids &
Vasoactives
2 1. What is the recommended initial fluid bolus dose for pediatric shock? A) 10 mL/kg B) 20 mL/kg C) 30 mL/kg D) 5 mL/kg Correct Answer: B
- Explanation: 20 mL/kg isotonic crystalloid (NS or LR) over 5– minutes; repeat as needed.* 2 2. A child with septic shock has received three fluid boluses ( mL/kg total) and remains hypotensive with cool extremities. What is the next step? A) Fourth fluid bolus B) Start epinephrine infusion (cold shock) C) Administer corticosteroids
Correct Answers: A, B, C Explanation: Refractory anaphylaxis requires repeat epinephrine, IV epinephrine drip, and aggressive fluids.
Section 6: CPR & Compressions
2 6. Compression-to-ventilation ratio for single rescuer in a child (1 year to puberty)? A) 15: B) 30: C) 3: D) 15: Correct Answer: B Explanation: Single rescuer uses 30:2 for all ages except newborns (3:1). Two rescuers use 15:2 for children. 2 7. Compression depth for a 5-year-old child? A) 1.5 inches (4 cm) B) 2 inches (5 cm) C) 2.4 inches (6 cm) D) 2.5 inches (6.4 cm) Correct Answer: B Explanation: Child compressions should be at least 1/3 anterior- posterior chest depth, about 2 inches (5 cm). 2 8. For an infant (single rescuer), where should compressions be performed? A) Two fingers on the lower half of sternum (just below nipple line) B) One hand on the upper sternum C) Two thumbs encircling the chest (two-rescuer technique)
D) Heel of one hand Correct Answer: A Explanation: Single rescuer infant CPR: two fingers; two rescuer: two thumb-encircling technique. 2 9. How often should chest compressions be interrupted for rhythm checks? A) Every 30 seconds B) Every 2 minutes (5 cycles) C) Every 5 minutes D) Never Correct Answer: B Explanation: Compressions are paused every 2 minutes for rhythm check unless ROSC suspected. 3 0. Which of the following can monitor CPR quality during cardiac arrest? (Select all that apply) A) ETCO2 (target ≥15–20 mm Hg) B) Arterial diastolic pressure (target ≥20–25 mm Hg in children) C) Central venous oxygen saturation (ScvO2) D) Patient’s skin color Correct Answers: A, B, C Explanation: ETCO2, invasive BP, and ScvO2 are objective measures; skin color is unreliable.
Section 7: Defibrillation & Cardioversion
3 1. Initial defibrillation dose for pediatric VF/pVT? A) 1 J/kg B) 2 J/kg
D) Place pads in anterior-posterior position for small children Correct Answers: A, B, D Explanation: Pediatric system preferred (attenuated energy ~50– J); adult AED acceptable if not available. 3 5. After defibrillation, what should the team do immediately? A) Check pulse for 10 seconds B) Resume CPR for 2 minutes (5 cycles) C) Give epinephrine D) Analyze rhythm Correct Answer: B
- Explanation: Immediately resume CPR for 2 minutes before rhythm/pulse check.*
Section 8: Medications – Core Drugs
3 6. What is the correct IV/IO dose of epinephrine for pediatric cardiac arrest? A) 0.001 mg/kg B) 0.01 mg/kg (0.1 mL/kg of 1:10,000) C) 0.1 mg/kg D) 1 mg/kg Correct Answer: B
- Explanation: Epinephrine 0.01 mg/kg every 3–5 minutes. Maximum single dose 1 mg.* 3 7. Amiodarone dose for pediatric pulseless VT/VF is? A) 1 mg/kg B) 5 mg/kg (max 300 mg) C) 10 mg/kg (max 450 mg total for two doses)
D) Both B and C Correct Answers: B, C
- Explanation: First dose 5 mg/kg (max 300 mg); second dose 5 mg/kg (max 450 mg cumulative).* 3 8. A child with stable SVT (adequate perfusion, HR 240) receives adenosine. What is the correct administration technique? A) Slow IV push over 5 minutes B) Rapid IV push followed by rapid saline flush C) Intramuscular injection D) Subcutaneous injection Correct Answer: B Explanation: Adenosine has a very short half-life; give rapid push with immediate saline flush. 3 9. Which medication is first-line for Torsades de pointes with a pulse? A) Amiodarone B) Magnesium sulfate (25–50 mg/kg IV, max 2 g) C) Lidocaine D) Epinephrine Correct Answer: B Explanation: Magnesium is specific for Torsades due to prolonged QT. 4 0. What is the maximum single dose of epinephrine 1:10,000 IV in a child? A) 0.5 mg B) 1 mg C) 2 mg D) 5 mg
D) 0.5 mg Correct Answer: C Explanation: Minimum dose 0.1 mg (even for infants). 4 4. A child with complete heart block and poor perfusion does not respond to CPR and epinephrine. What is the next intervention? A) Repeat epinephrine B) Transcutaneous pacing C) High-dose atropine D) Amiodarone Correct Answer: B Explanation: Symptomatic complete heart block requires pacing. 4 5. Atropine is most effective for bradycardia caused by which condition? A) Hypoxia B) Increased vagal tone C) Hyperkalemia D) Complete heart block Correct Answer: B Explanation: Atropine blocks vagal tone; it will not help hypoxic bradycardia or complete heart block.
Section 10: Tachycardia Algorithm
4 6. A child has narrow-complex tachycardia, HR 230, and adequate perfusion. What is the first intervention? A) Synchronized cardioversion B) Vagal maneuvers (ice to face, Valsalva if age-appropriate)
C) Adenosine D) Amiodarone Correct Answer: B Explanation: For stable SVT with adequate perfusion, start with vagal maneuvers. 4 7. Which vagal maneuver is appropriate for a 2-month-old infant with stable SVT? A) Ice to the face (with caution) B) Carotid sinus massage C) Ocular pressure D) Valsalva maneuver Correct Answer: A Explanation: Ice to the face (applying ice-cold water or bag to face) is safe for infants; avoid carotid or ocular pressure. 4 8. What is the correct first dose of adenosine for a child with SVT? A) 0.01 mg/kg (max 0.6 mg) B) 0.1 mg/kg (max 6 mg) C) 0.2 mg/kg (max 12 mg) D) 1 mg/kg (max 6 mg) Correct Answer: B Explanation: First dose: 0.1 mg/kg (max 6 mg); second dose: 0. mg/kg (max 12 mg). 4 9. A child has stable wide-complex tachycardia. What is the most likely rhythm? A) Sinus tachycardia B) Ventricular tachycardia (until proven otherwise) C) Atrial fibrillation
C) Treat seizures aggressively D) Induce hypothermia to 32°C for all patients Correct Answers: A, B, C Explanation: Current guidelines recommend TTM at 34–36°C or normothermia (36–37.5°C), not routine 32°C. 5 3. A child after ROSC has a temperature of 39°C. What should be done? A) No intervention B) Administer antipyretics and cooling to maintain ≤37.5°C C) Induce hypothermia to 32°C D) Allow fever for neuroprotection Correct Answer: B Explanation: Fever worsens neurologic outcome; maintain normothermia (36–37.5°C). 5 4. What is the target blood glucose range after pediatric cardiac arrest? A) 40–60 mg/dL B) 80–180 mg/dL C) 200–300 mg/dL D) 300–400 mg/dL Correct Answer: B Explanation: Avoid both hypoglycemia and severe hyperglycemia (>200–250 mg/dL). 5 5. Which test is most useful to assess tissue perfusion and oxygen delivery after ROSC? A) Complete blood count B) Serum lactate C) Liver function tests
D) B-type natriuretic peptide Correct Answer: B Explanation: Lactate levels reflect adequacy of perfusion and ongoing ischemia.
Section 12: Arrhythmia Recognition &
Management
5 6. Which ECG findings are consistent with supraventricular tachycardia (SVT)? (Select all that apply) A) Heart rate >220 bpm in infant, >180 bpm in child B) Narrow QRS (<0.09 seconds) C) Absent or abnormal P waves D) Irregularly irregular rhythm Correct Answers: A, B, C Explanation: SVT is regular, narrow-complex (unless aberrancy), very fast, with no discernible P waves. 5 7. A child has torsades de pointes with a pulse. What is the first medication? A) Amiodarone B) Magnesium sulfate (25–50 mg/kg IV, max 2 g) C) Lidocaine D) Epinephrine Correct Answer: B Explanation: Magnesium is first-line for Torsades de pointes. 5 8. Which conditions predispose to torsades de pointes? (Select all that apply) A) Hypomagnesemia
