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AHA PALS PRACTICE EXAM
QUESTIONS & ANSWERS
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; supplemen-
tary oxygen should be administered C. Unreliable; no supplementary oxygen is indicated D. Unreliable; supplementary oxygen should be administered ANS Unreliable; supplementary 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/ 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
ANS 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
ANS 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
ANS 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
D. Decreased respiratory effort
ANS Decreased oxygen saturation
9. 9. An alert 2-year-old child with an increased work of breathing and pink
color is being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this patient's condition? A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing
ANS Respiratory distress
10. 10. The parents of a 7-year-old child who is undergoing chemotherapy
report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the following ANS The child is dif- ficult to arouse, with pale color. The child's heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the most appropriate 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 ANS 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 mot- tled 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
ANS 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
ANS 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
C. Glucose
D. A 12-lead ECG
ANS 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 ANS Perform needle decompression on the left chest
16. 16. A 4-year-old is being treated for hypovolemic shock and has received a
single fluid bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4 seconds. What describes this patient's condition?
A. Hypotensive shock
B. Compensated shock
C. No longer in shock
D. Cardiogenic shock
ANS Compensated shock
17. 17. An 8-year-old child had a sudden onset of palpitations and light-head-
edness. At the time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted. What is the most appropriate initial intervention?
A. Provide synchronized cardioversion at 0.5 to 1 J/kg
B. Attempt vagal maneuvers
C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone
5 mg/kg over 20 minutes ANS Attempt vagal maneuvers
18. 18. A 10-year-old child had a sudden witnessed cardiac arrest and re-
ceived immediate bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous circulation. The child remains unresponsive and has an advanced airway in place. There is no history of trauma or signs of shock. What is the target range for oxygen saturation for this child? A. 92% to 100% B. 92% to 99%
ANS 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
ANS 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
ANS 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
ANS 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
B. Administer epinephrine 0.01 mg/kg
C. Consider placement of an advanced airway
D. Administer amiodarone 5 mg/kg
ANS Attempt defibrillation with a 2 J/kg shock
25. 25. A pulseless 6-week-old infant arrives in the emergency department,
and high-quality CPR is in progress. The initial rhythm strip is shown below. CPR continues, and vascular access has been established. What is the next appropriate intervention?
A. Administer atropine 0.02 mg/kg IO/IV
B. Attempt defibrillation with a 2 J/kg shock
C. Administer epinephrine 0.01 mg/kg IO/IV
D. Consider insertion of an advanced airway
ANS Administer epinephrine 0.01 mg/kg IO/IV
B. Ventricular tachycardia
C. Pulseless electrical activity
D. Sinus bradycardia
ANS Pulseless electrical activity
29. 30. A 12-year-old child suddenly collapses while playing sports. He is
unresponsive and not breathing. Emergency response is activated. The child has no pulse, and CPR is initiated. An AED arrives. What is the most appro- priate 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
ANS Use the AED
30. 31. A 6-year-old child is found unresponsive, not breathing, and pulse-
less. What is the correct compression-to-ventilation ratio when 2 or more healthcare providers are present to perform CPR? ANS 15 ANS 2
31. 32. A 5-year-old child has had severe respiratory distress for 2 days. Dur-
ing 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 ANS 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. Vascular access cannot be established. What is the most appropriate inter- vention?
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
ANS 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
ANS Reassess breath sounds and clinical status
ryngeal airway?
A. Conscious with no gag reflex
B. Unconscious with a gag reflex
C. Unconscious with no gag reflex
D. Conscious with a gag reflex
ANS Unconscious with no gag reflex
38. 7. 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 IV
ANS 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
ANS 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 endotra- cheal 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
ANS -
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
44. 13. A 3-year-old child presents with dehydration after a 2-day history of
vomiting and diarrhea. The child after has received 2 fluid boluses of 20 mL/ kg of normal saline. After the second bolus, the child is alert and interacting. Her heart rate is 110/ min, respiratory rate is 30/min, and blood pressure is 92/64 mm Hg. Her capillary refill time is 2 seconds, and oxygen saturation is 98%. What is the most appropriate next intervention for this child?
A. Administer another 20 mL/kg normal saline fluid bolus
B. Administer 10 mL/kg of packed red cells
C. Continue to monitor and reevaluate the child
D. Initiate a dopamine drip of 20 mcg/kg per minute
ANS Continue to monitor and reevaluate the child
45. 14. A 3-year-old child presents with a high fever and a petechial rash. The
child is lethargic, has no signs of increased work of breathing, and is pale in color. His heart rate is 180/min, respiratory rate is 30/min, blood pressure is 80/68 mm Hg. Capillary refill time is 4 seconds, and oxygen saturation is 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 ANS 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
ANS 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 ANS Give adenosine 0.1 mg/kg rapid IV push
