PALS Certification Exam — Questions and Answers

Question 1: A 3-year-old presents with HR 170, BP 60/40, cool mottled extremities, and altered mental status after a bee sting. Which type of shock is most likely?

Cardiogenic shock
Distributive (anaphylactic) shock (Correct answer)
Hypovolemic shock
Obstructive shock

Correct answer: Distributive (anaphylactic) shock

Anaphylactic shock is a form of distributive shock triggered by allergen exposure, causing massive vasodilation and hypotension.

Question 2: Sodium bicarbonate may be considered in pediatric arrest for which specific condition?

Hyperkalemia-induced cardiac arrest (Correct answer)
Tension pneumothorax
Hypoglycemia
Hypovolemia

Correct answer: Hyperkalemia-induced cardiac arrest

Sodium bicarbonate is considered in cardiac arrest associated with hyperkalemia or sodium-channel blocker toxicity.

Question 3: Which of the following arrhythmias would be indicated by typical sawtooth P-wave activity on the ECG monitor, using the ILCOR PALS Provider Manual?

Sinus tachycardia
Atrial flutter (Correct answer)
Atrial fibrillation
Supraventricular tachycardia

Correct answer: Atrial flutter

The characteristic 'sawtooth' pattern of P-waves on an ECG, particularly in leads II, III, and aVF, is a hallmark finding of atrial flutter. This pattern represents rapid and regular atrial depolarization, typically at a rate of 250-350 bpm. This distinct ECG finding helps differentiate atrial flutter from other arrhythmias like atrial fibrillation or sinus tachycardia.

Question 4: The team leader asks a nurse to establish IV access. The nurse is already performing chest compressions. What should the nurse do?

Stop compressions immediately and start the IV
Attempt to do both tasks simultaneously
Ignore the request and continue compressions
Communicate to the team leader that compressions are ongoing and ask for reassignment (Correct answer)

Correct answer: Communicate to the team leader that compressions are ongoing and ask for reassignment

Team members should communicate workload conflicts so the leader can reassign tasks and maintain care priorities.

Question 5: You are performing bag-mask ventilation on a 6-month-old infant who has a pulse but is in respiratory arrest. What is the correct ventilation rate according to the most recent PALS guidelines?

1 breath every 2 to 3 seconds (20-30 breaths/min) (Correct answer)
1 breath every 6 to 8 seconds (8-10 breaths/min)
1 breath every 5 to 6 seconds (10-12 breaths/min)
As fast as possible to raise oxygen saturation

Correct answer: 1 breath every 2 to 3 seconds (20-30 breaths/min)

For rescue breathing in an infant or child with a pulse but inadequate respiratory effort, the correct rate is 1 breath every 2 to 3 seconds, which equals 20-30 breaths per minute. This rate ensures adequate ventilation without compromising hemodynamic stability by causing excessive intrathoracic pressure.

Question 6: When performing bag-mask ventilation on a child with a pulse but absent respirations, what is the recommended ventilation rate?

30–40 breaths per minute
8–10 breaths per minute
12–20 breaths per minute (Correct answer)
20–30 breaths per minute

Correct answer: 12–20 breaths per minute

For a child with a pulse, deliver 1 breath every 3–5 seconds (12–20 breaths per minute) to support oxygenation without causing hyperventilation.

Question 7: Which auscultatory finding during the primary assessment indicates air trapping and lower airway obstruction in a pediatric patient?

Inspiratory stridor
Expiratory wheezing (Correct answer)
Absence of breath sounds unilaterally
Inspiratory crackles

Correct answer: Expiratory wheezing

Expiratory wheezing indicates lower airway obstruction with air trapping, as in bronchospasm or asthma.

Question 8: When using a bag-mask device in a child, which ventilation rate is correct for a child with a pulse but absent respirations?

30-40 breaths/min
20-30 breaths/min
12-20 breaths/min (Correct answer)
8-10 breaths/min

Correct answer: 12-20 breaths/min

PALS guidelines recommend 12–20 breaths/min for rescue breathing in a child with a perfusing rhythm but no spontaneous respirations.

Question 9: Which presentation rhythm is most frequently seen in kids going into cardiac arrest?

Ventricular fibrillation
PEA/asystole (Correct answer)
Pulseless ventricular tachycardia
Third-degree AV block

Correct answer: PEA/asystole

Unlike adults, where ventricular fibrillation is a common initial rhythm in cardiac arrest, children most frequently present with pulseless electrical activity (PEA) or asystole. This is because pediatric cardiac arrest is typically secondary to respiratory failure or shock, leading to progressive bradycardia and then asystole, rather than a primary cardiac event.

Question 10: Which of the following BEST describes allowing full chest recoil during CPR?

Reducing compression depth on alternate compressions
Pausing for 1 second between each compression
Releasing pressure so the chest returns to its natural position without leaning (Correct answer)
Lifting hands completely off the chest between compressions

Correct answer: Releasing pressure so the chest returns to its natural position without leaning

Full recoil means releasing all pressure so the chest fully expands without the rescuer leaning, which allows the heart to refill between compressions.

Question 11: What is the primary indicator of adequate ventilation during bag-mask ventilation in a pediatric patient?

Visible, gentle chest rise with each delivered breath (Correct answer)
Symmetric breath sounds heard on auscultation of the axillae
A respiratory rate of 20 breaths per minute is achieved
Heart rate increases by at least 10 bpm after ventilation

Correct answer: Visible, gentle chest rise with each delivered breath

Visible, gentle chest rise with each breath confirms that the tidal volume is being effectively delivered to the lungs.

Question 12: In a child with wide-complex tachycardia and a pulse who is hemodynamically stable, which drug is preferred?

Adenosine 0.1 mg/kg IV rapid push
Epinephrine 0.01 mg/kg IV
Lidocaine 1 mg/kg IV bolus
Amiodarone 5 mg/kg IV over 20–60 minutes (Correct answer)

Correct answer: Amiodarone 5 mg/kg IV over 20–60 minutes

Amiodarone is the preferred antiarrhythmic for stable wide-complex tachycardia in pediatric patients per PALS guidelines.

Question 13: In a pediatric patient with septic shock, what is the recommended initial fluid bolus dose per PALS guidelines?

10 mL/kg isotonic crystalloid
20 mL/kg isotonic crystalloid (Correct answer)
40 mL/kg isotonic crystalloid
5 mL/kg isotonic crystalloid

Correct answer: 20 mL/kg isotonic crystalloid

PALS recommends 20 mL/kg of isotonic crystalloid as the initial fluid bolus for septic shock, repeated as needed up to 60 mL/kg.

Question 14: Which finding best indicates that a fluid bolus has been successful in a child with hypovolemic shock?

Increase in respiratory rate
Decrease in urine output
Rise in temperature
Improved capillary refill, improved mental status, and normalization of heart rate (Correct answer)

Correct answer: Improved capillary refill, improved mental status, and normalization of heart rate

Successful fluid resuscitation is indicated by improved perfusion signs: better capillary refill, improved mentation, and normalization of heart rate.

Question 15: Which action by the team leader BEST promotes situational awareness during a pediatric code?

Speaking only when a new intervention is ordered
Regularly summarizing the patient's status, interventions given, and next steps aloud (Correct answer)
Delegating all communication to the recorder
Performing compressions to model proper technique

Correct answer: Regularly summarizing the patient's status, interventions given, and next steps aloud

Periodic summaries by the team leader keep all members informed and aligned on the patient's status and care plan.

Question 16: Which of the following is a contraindication to IO placement at a specific site?

Intact skin over the insertion site
Fracture of the bone proximal to the intended site (Correct answer)
Use of a manual IO needle
Age under 1 year

Correct answer: Fracture of the bone proximal to the intended site

A fracture proximal to the IO site is a contraindication because fluids and medications can extravasate through the fracture site into surrounding tissue.

Question 17: A 6-month-old has HR 210, CRT 4 sec, cool extremities, and normal BP. This presentation is best classified as:

Decompensated shock
Neurogenic shock
Irreversible shock
Compensated shock (Correct answer)

Correct answer: Compensated shock

Compensated shock maintains normal blood pressure through physiologic compensation; decompensated shock is defined by hypotension.

Question 18: When evaluating a pediatric patient's blood pressure, which formula approximates the lower limit of normal systolic BP for children aged 1–10 years?

70 + (age in years × 3) mmHg
70 + (age in years × 2) mmHg (Correct answer)
60 + (age in years × 2) mmHg
80 + (age in years × 2) mmHg

Correct answer: 70 + (age in years × 2) mmHg

The PALS formula for the lower limit of normal systolic BP is 70 + (2 × age in years) mmHg for children aged 1–10 years.

Question 19: What is the correct IO flush volume to confirm placement and ensure patency before drug administration?

0.5 mL of normal saline
50 mL of D5W
5–10 mL of normal saline (Correct answer)
1 mL of heparinized saline

Correct answer: 5–10 mL of normal saline

A 5–10 mL saline flush is used to confirm IO placement and patency, and should be given before medications.

Question 20: What is the correct energy dose for synchronized cardioversion in a child with unstable SVT?

2 J/kg initial dose
0.5–1 J/kg, may increase to 2 J/kg (Correct answer)
1–2 J/kg for all arrhythmias
4 J/kg initial dose

Correct answer: 0.5–1 J/kg, may increase to 2 J/kg

Synchronized cardioversion for unstable SVT or VT with a pulse starts at 0.5–1 J/kg and can be increased to 2 J/kg if needed.

Question 21: Which of the following findings best differentiates respiratory failure from respiratory distress in a child?

Oxygen saturation of 95% on room air
Audible wheezing or stridor
Presence of tachypnea and retractions
Altered mental status and cyanosis despite oxygen (Correct answer)

Correct answer: Altered mental status and cyanosis despite oxygen

Respiratory distress is a state of increased work of breathing where the body is still compensating. Respiratory failure occurs when these compensatory mechanisms fail, leading to inadequate oxygenation and/or ventilation. Hallmarks of respiratory failure include a significant change in mental status (lethargy, unresponsiveness), poor air movement, and persistent cyanosis despite supplemental oxygen, often accompanied by a slowing respiratory rate or bradycardia.

Question 22: In a child with obstructive shock from tension pneumothorax, what is the definitive treatment?

Synchronized cardioversion
Endotracheal intubation alone
Needle decompression followed by chest tube thoracostomy (Correct answer)
IV fluid bolus of 20 mL/kg

Correct answer: Needle decompression followed by chest tube thoracostomy

Tension pneumothorax causing obstructive shock requires immediate needle decompression followed by chest tube placement to relieve the obstruction.

Question 23: Which of the following rhythms requires immediate defibrillation rather than synchronized cardioversion?

Unstable SVT with a pulse
Stable monomorphic VT
Atrial flutter with hemodynamic compromise
Pulseless ventricular fibrillation (Correct answer)

Correct answer: Pulseless ventricular fibrillation

VF is a disorganized rhythm with no defined QRS, requiring asynchronous defibrillation because the device cannot synchronize to a QRS complex.

Question 24: An 8-month-old infant is found apneic with a brachial pulse of 45/min and signs of poor perfusion. Despite effective bag-mask ventilation with 100% oxygen, the heart rate remains 45/min and perfusion is poor. What is the most appropriate immediate action?

Administer IV epinephrine 0.01 mg/kg.
Begin high-quality chest compressions and continue assisted ventilations. (Correct answer)
Provide rescue breaths only and recheck the pulse in 2 minutes.
Attach an AED and wait for rhythm analysis.

Correct answer: Begin high-quality chest compressions and continue assisted ventilations.

The PALS algorithm states that if a child has a heart rate less than 60/min with signs of poor perfusion despite adequate oxygenation and ventilation, CPR should be initiated. This infant's heart rate is 45/min with poor perfusion, meeting the criteria to start chest compressions along with ventilations.

Question 25: During systematic assessment of a 4-year-old with suspected increased intracranial pressure, which pupillary finding is most concerning?

Unilateral fixed and dilated pupil (Correct answer)
Sluggish bilateral pupil response
Pinpoint pupils bilaterally
Equal and reactive pupils bilaterally

Correct answer: Unilateral fixed and dilated pupil

A unilateral fixed and dilated pupil (blown pupil) suggests uncal herniation from unilateral mass effect or severe ICP elevation.

Question 26: During resuscitation, the team leader becomes overwhelmed and stops directing the team. What is the BEST next step?

Stop all interventions until leadership is restored
All team members act independently based on their own judgment
The most senior team member should assume leadership (Correct answer)
Continue without a leader until the code is complete

Correct answer: The most senior team member should assume leadership

If the team leader is unable to lead, the most senior or experienced available member should assume that role to restore direction.

Question 27: A 10-year-old with diabetic ketoacidosis has deep, rapid, unlabored breathing. How should this breathing pattern be classified in the PAT?

Increased work of breathing
Obstructive pattern
Agonal breathing
Normal work of breathing despite abnormal rate (Correct answer)

Correct answer: Normal work of breathing despite abnormal rate

Kussmaul breathing is deep and rapid but unlabored (no accessory muscle use or retractions), so work of breathing in the PAT is normal.

Question 28: A 4-year-old child in the pediatric intensive care unit develops sudden, severe bradycardia. According to the PALS algorithm, what is the most common underlying cause of bradycardia in children?

Hypoxia (Correct answer)
Primary cardiac conduction defect
Hypoglycemia
Hyperthermia

Correct answer: Hypoxia

Unlike adults, bradycardia in children is most often a secondary event, not a primary cardiac problem. The most common cause of pediatric bradycardia is hypoxia resulting from respiratory distress or failure. Therefore, the initial management steps in the PALS bradycardia algorithm focus on assessing and supporting the airway and breathing to ensure adequate oxygenation.

Question 29: A 3-year-old presents with a heart rate of 220 bpm, poor perfusion, and altered mental status. The rhythm is narrow-complex and regular. What is the most appropriate next intervention?

Defibrillation at 2 J/kg
Amiodarone 5 mg/kg IV
Adenosine 0.1 mg/kg IV
Synchronized cardioversion at 1 J/kg (Correct answer)

Correct answer: Synchronized cardioversion at 1 J/kg

Unstable SVT with signs of poor perfusion requires immediate synchronized cardioversion starting at 1 J/kg.

Question 30: A 6-year-old with symptomatic bradycardia does not respond to oxygenation and ventilation. What is the first medication given?

Amiodarone
Atropine (Correct answer)
Lidocaine
Adenosine

Correct answer: Atropine

Atropine 0.02 mg/kg IV/IO is the first-line drug for symptomatic bradycardia after oxygenation/ventilation fails.

Question 31: In a child who is not responding, where on the body is the best place to feel their pulse?

Brachial
Radial
Carotid (Correct answer)
Pedal

Correct answer: Carotid

In an unresponsive child, the carotid pulse is the most reliable and easily accessible central pulse to palpate. It is located in the neck, lateral to the trachea, and provides a strong indication of central circulation. Assessing this pulse is crucial for quickly evaluating cardiac output during resuscitation efforts.

Question 32: Which of the following best describes second-degree AV block Mobitz type II?

No relationship between P waves and QRS complexes
Consistent PR interval with sudden dropped QRS complexes (Correct answer)
Alternating wide and narrow QRS complexes
Progressively lengthening PR interval before a dropped beat

Correct answer: Consistent PR interval with sudden dropped QRS complexes

Mobitz type II is characterized by a fixed PR interval with sudden non-conducted P waves (dropped QRS), indicating infranodal block.

Question 33: A wide-complex tachycardia at 180 bpm with a pulse is seen in a child with mild symptoms. What should be done first to differentiate VT from SVT with aberrancy?

Administer amiodarone
Perform synchronized cardioversion
Obtain a 12-lead ECG and assess clinical history (Correct answer)
Administer adenosine immediately

Correct answer: Obtain a 12-lead ECG and assess clinical history

A 12-lead ECG combined with clinical context helps differentiate VT from SVT with aberrant conduction before pharmacologic intervention.

Question 34: Which of the following Hs and Ts should always be taken into account in pediatric crises where cardiac arrest or altered mental status is recorded, per the ILCOR ACLS Provider Manual?

Hydrogen ion (acidosis)
Tension pneumothorax
Hypoglycemia (Correct answer)
Toxins

Correct answer: Hypoglycemia

Hypoglycemia is a critical and reversible cause of altered mental status and can contribute to cardiac arrest in pediatric patients. It is one of the 'Hs' (Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia, Hypoglycemia) that must always be considered and addressed promptly during pediatric resuscitation due to its potential for rapid deterioration.

Question 35: When peripheral IV access cannot be established quickly in a critically ill child, what is the recommended alternative route for emergency medication administration?

Central venous catheter
Endotracheal tube
Intraosseous (IO) access (Correct answer)
Subcutaneous injection

Correct answer: Intraosseous (IO) access

IO access is recommended by PALS guidelines when IV access cannot be established rapidly, as it provides reliable vascular access in emergencies.

Question 36: What is the correct IV/IO dose of atropine for a pediatric patient with symptomatic bradycardia according to the PALS guidelines?

0.1 mg/kg, with no minimum dose
0.5 mg fixed dose, may repeat once
0.02 mg/kg, with a maximum single dose of 0.5 mg (Correct answer)
0.01 mg/kg, with a maximum total dose of 1 mg

Correct answer: 0.02 mg/kg, with a maximum single dose of 0.5 mg

The correct IV/IO dose for atropine in the PALS bradycardia algorithm is 0.02 mg/kg. It's important to also remember the minimum dose (0.1 mg) and the maximum single dose (0.5 mg), which can be repeated once.

Question 37: A 7-year-old child in the PICU develops an unstable narrow-complex tachycardia. You are preparing for synchronized cardioversion. What is the recommended initial energy dose?

0.5 to 1 J/kg (Correct answer)
4 J/kg
10 J/kg
20 J/kg

Correct answer: 0.5 to 1 J/kg

For unstable tachycardia requiring synchronized cardioversion, the initial recommended energy dose is 0.5 to 1 J/kg. If the first shock is unsuccessful, the dose may be increased to 2 J/kg for a subsequent attempt. Higher energy doses are used for defibrillation in cardiac arrest.

Question 38: Which of the following is a core responsibility of the PALS team leader during a resuscitation event?

Performing chest compressions for the first two minutes.
Personally establishing IV or IO access.
Serving as the dedicated timekeeper and recorder.
Monitoring team performance and providing real-time direction. (Correct answer)

Correct answer: Monitoring team performance and providing real-time direction.

The team leader's primary role is to maintain a global perspective of the resuscitation. This includes assigning roles, making treatment decisions, monitoring the quality of interventions (like CPR), and guiding the team, rather than being absorbed in a single task.

Question 39: A child has been successfully resuscitated and is being managed in the post-cardiac arrest phase. The team is aiming for normocapnia. Which of the following is the most reliable method for continuous monitoring of ventilation status?

Arterial blood gas analysis every 4 hours
Waveform capnography (Correct answer)
Serial chest X-rays
Pulse oximetry

Correct answer: Waveform capnography

Waveform capnography provides a continuous, real-time measurement of end-tidal CO2 (ETCO2), which reflects the partial pressure of CO2 in arterial blood (PaCO2). [2, 3] This allows for precise titration of mechanical ventilation to achieve normocapnia (avoiding both hypocapnia and hypercapnia), which is crucial for maintaining stable cerebral blood flow. [3, 8] While ABGs are the gold standard for measurement, they are intermittent, whereas capnography is continuous. [1]

Question 40: A 2-year-old presents with labored breathing, nasal flaring, and audible wheezing. According to the Pediatric Assessment Triangle (PAT), which of the three sides is most clearly abnormal based on these findings?

Neurological Status
Appearance
Work of Breathing (Correct answer)
Circulation to the Skin

Correct answer: Work of Breathing

The Pediatric Assessment Triangle (PAT) evaluates three components: Appearance, Work of Breathing, and Circulation to the Skin. Findings such as labored breathing, nasal flaring, and audible wheezing are all direct indicators of increased respiratory effort and fall under the 'Work of Breathing' side of the triangle.

Question 41: A 15 kg child is in asystolic cardiac arrest. You are preparing the first dose of epinephrine. What is the correct volume of epinephrine to administer IV/IO, using the standard 1:10,000 concentration?

0.75 mL
15 mL
1.5 mL (Correct answer)
0.15 mL

Correct answer: 1.5 mL

The PALS dose for IV/IO epinephrine in cardiac arrest is 0.01 mg/kg. For a 15 kg child, this is 0.15 mg (15 kg x 0.01 mg/kg). The standard 1:10,000 concentration contains 1 mg in 10 mL, which is equivalent to 0.1 mg per mL. Therefore, the correct volume is 0.15 mg divided by 0.1 mg/mL, which equals 1.5 mL.

Question 42: What condition usually results in pediatric cardiac arrest, secondary to shock or respiratory failure?

Hypovolemia
Coronary occlusion
Pulmonary embolism
Tissue hypoxia (Correct answer)

Correct answer: Tissue hypoxia

In pediatric patients, cardiac arrest is most commonly secondary to progressive respiratory failure or shock, which ultimately leads to severe tissue hypoxia. Prolonged lack of oxygen to the body's tissues and organs causes cellular dysfunction. This cascade of events eventually leads to cardiac arrest, often presenting as bradycardia progressing to asystole or PEA.

Question 43: Which arrhythmias below have a QRS complex lasting longer than 0.09 seconds?

Atrial flutter
Sinus tachycardia
Supraventricular tachycardia
Supraventricular tachycardia with aberrant intraventricular conduction (Correct answer)

Correct answer: Supraventricular tachycardia with aberrant intraventricular conduction

A QRS complex lasting longer than 0.09 seconds indicates a delay in ventricular depolarization. While typical supraventricular tachycardia (SVT) has a narrow QRS, SVT with aberrant intraventricular conduction means the supraventricular impulse is conducted abnormally through the ventricles. This mimics a wide QRS complex, making it challenging to distinguish from ventricular tachycardia.

Question 44: Which of the following clinical signs is considered a hallmark of upper airway obstruction in a pediatric patient?

Rales and crackles
Expiratory wheezing
Inspiratory stridor (Correct answer)
Productive cough

Correct answer: Inspiratory stridor

Inspiratory stridor, a high-pitched sound heard during inspiration, is the characteristic sign of upper airway obstruction. It indicates turbulent airflow through a narrowed portion of the airway above the thoracic inlet, such as the larynx or trachea. Expiratory wheezing is typical of lower airway obstruction, while rales and crackles suggest fluid in the alveoli (lung tissue disease).

Question 45: Which ECG finding is characteristic of ventricular fibrillation (VF) in a child?

Chaotic, irregular waveforms with no identifiable P waves or QRS complexes (Correct answer)
Regular narrow-complex rhythm with rate >220 bpm
Sawtooth flutter waves at 300 bpm
Wide-complex tachycardia with identifiable P waves

Correct answer: Chaotic, irregular waveforms with no identifiable P waves or QRS complexes

VF is characterized by chaotic, disorganized electrical activity with no discernible P waves or QRS complexes on ECG.

Question 46: A 5-year-old boy with a known severe peanut allergy accidentally ingested a cookie containing peanuts. He is now anxious, has diffuse urticaria, wheezing, and a blood pressure of 70/40 mmHg. What is the immediate, first-line medication for managing his condition?

Intramuscular epinephrine (Correct answer)
A rapid 20 mL/kg bolus of normal saline
Intravenous diphenhydramine
Intravenous hydrocortisone

Correct answer: Intramuscular epinephrine

This patient is presenting with anaphylactic shock, a type of distributive shock. The immediate and most critical treatment is intramuscular epinephrine. Epinephrine addresses the life-threatening symptoms by causing vasoconstriction, bronchodilation, and decreasing capillary permeability. While fluids, antihistamines, and corticosteroids are also part of the management, epinephrine is the first-line and life-saving intervention.

Question 47: A 5-year-old child collapses in the hospital playroom. You find them unresponsive, apneic, and pulseless. The monitor shows ventricular fibrillation. High-quality CPR is initiated. According to the PALS Cardiac Arrest Algorithm, what is the correct energy dose for the initial defibrillation attempt?

0.5 J/kg
4 J/kg
2 J/kg (Correct answer)
10 J/kg

Correct answer: 2 J/kg

The PALS guidelines recommend an initial energy dose of 2 J/kg for the first defibrillation attempt in a pediatric patient with a shockable rhythm like ventricular fibrillation. Subsequent shocks may be given at higher energy levels, typically starting at 4 J/kg.

Question 48: Which of the following does not usually result in a youngster experiencing a sudden cardiac arrest?

Drug intoxication (Correct answer)
Long QT syndrome
Myocarditis
Hypertrophic cardiomyopathy

Correct answer: Drug intoxication

While drug intoxication can cause various cardiac issues, it is not considered one of the usual primary causes of sudden cardiac arrest in youngsters compared to underlying structural or electrical heart conditions. Myocarditis, hypertrophic cardiomyopathy, and long QT syndrome are well-established, common causes of sudden cardiac death in otherwise healthy-appearing children and adolescents.

Question 49: When performing synchronized cardioversion for unstable SVT in a child, which energy level is used for the second attempt if the first is unsuccessful?

4 J/kg
0.5 J/kg
2 J/kg (Correct answer)
3 J/kg

Correct answer: 2 J/kg

If the initial synchronized cardioversion at 1 J/kg fails, the second attempt uses 2 J/kg.

Question 50: In a child with hemorrhagic shock, which fluid is preferred over isotonic crystalloid once available?

Packed red blood cells (pRBCs) (Correct answer)
5% albumin
Lactated Ringer's solution
Hypertonic saline

Correct answer: Packed red blood cells (pRBCs)

In hemorrhagic shock, packed red blood cells restore oxygen-carrying capacity along with volume, making them superior to crystalloid alone.

Question 51: Which vasopressor is considered first-line for anaphylaxis in the pediatric patient?

Norepinephrine
Vasopressin
Epinephrine (Correct answer)
Dopamine

Correct answer: Epinephrine

Epinephrine (IM into anterolateral thigh) is the first-line treatment for anaphylaxis in all age groups.

PALS Certification Exam

The AHA Pediatric Advanced Life Support (PALS) exam evaluates healthcare providers on systematic assessment, resuscitation algorithms, pharmacology, and team dynamics for critically ill pediatric patients.

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Sources & references

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