Pediatric Airway Management and Resuscitation: BVM, Intubation, Cardiac Arrest, Bradycardia, and Tachycardia Practice Questions

25 multiple-choice questions on Pediatric airway management and resuscitation: BVM, intubation, cardiac arrest, bradycardia, and tachycardia for paramedic and EMT students, from Chapter 44 (Pediatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. To size an oropharyngeal airway for a child, measure from the:

   1. A. Tip of the nose to the tip of the earlobe
   2. B. Corner of the mouth to the jaw angle
   3. C. Center of the lips to the chin
   4. D. Corner of the mouth to the clavicle
   Show answer

   Answer: B. Corner of the mouth to the jaw angle

   An OPA that reaches from the corner of the mouth to the angle of the jaw fits correctly; too small pushes the tongue back, too large can obstruct the larynx. Nose-to-earlobe measurement is used to size a nasopharyngeal airway.

2. Before intubating a 3-year-old, your partner asks whether atropine should be given routinely to prevent bradycardia. PALS guidance is that atropine:

   1. A. Is not routinely needed for intubation
   2. B. Is routine for infants under 1 year
   3. C. Should be given after the tube is placed
   4. D. Requires a minimum dose of 0.1 mg
   Show answer

   Answer: A. Is not routinely needed for intubation

   AHA PALS found no evidence for routine atropine premedication in emergency pediatric intubation; it may be considered when the risk of bradycardia is higher, such as with succinylcholine. Older advice to give it routinely to every infant under 1 year has been dropped, and the former 0.1-mg minimum dose is no longer recommended. Giving it after the tube is placed does nothing to prevent bradycardia during laryngoscopy. Preoxygenation remains the main protection against hypoxic bradycardia. (AHA 2020 PALS, carried into 2025.)

3. When ventilating a 1-year-old with a bag-valve mask, you should use:

   1. A. A 250-mL neonatal bag
   2. B. A bag of at least 450 to 500 mL
   3. C. An adult bag at full squeeze
   4. D. A bag with its pop-off valve left open
   Show answer

   Answer: B. A bag of at least 450 to 500 mL

   A pediatric bag of at least 450 to 500 mL can deliver adequate tidal volume in infants and children; neonatal bags may be too small. Pop-off valves should be disabled during resuscitation because they can prevent adequate ventilation.

4. A lone rescuer without a phone finds a 5-year-old unresponsive and not breathing after an unwitnessed event. Per AHA, the rescuer should:

   1. A. Leave now to call 9-1-1 and get an AED
   2. B. Check his pulse for a full minute
   3. C. Do 2 minutes of CPR, then call 9-1-1
   4. D. Give breaths with no compressions
   Show answer

   Answer: C. Do 2 minutes of CPR, then call 9-1-1

   Most unwitnessed pediatric arrests are asphyxial, so a lone rescuer without a phone gives about 2 minutes of CPR before leaving to activate EMS and get an AED; for a witnessed sudden collapse, which suggests a cardiac cause, the rescuer gets help and an AED first. Leaving immediately is the witnessed-collapse sequence. A pulse check should take no more than 10 seconds. Breaths without compressions do not circulate blood in a pulseless child. (2025 AHA/AAP Pediatric BLS.)

5. The correct tidal volume when bagging a child is the amount that:

   1. A. Fully empties the pediatric bag
   2. B. Keeps the pop-off valve opening
   3. C. Produces audible air leak at the mask
   4. D. Just makes the chest begin to rise
   Show answer

   Answer: D. Just makes the chest begin to rise

   Give only enough volume to produce visible chest rise, over about 1 second. Larger volumes cause gastric distension, barotrauma, and reduced venous return.

6. Gastric distension during BVM ventilation of an infant is harmful mainly because it:

   1. A. Increases venous return to the heart
   2. B. Compresses the trachea from behind
   3. C. Limits diaphragm movement
   4. D. Increases lung compliance
   Show answer

   Answer: C. Limits diaphragm movement

   A distended stomach pushes up on the diaphragm, reducing lung expansion, and increases the risk of vomiting and aspiration; an orogastric tube can decompress it. It decreases rather than increases effective lung compliance, tends to impede rather than increase venous return, and does not compress the trachea.

7. Cuffed endotracheal tubes are now preferred over uncuffed tubes in children mainly because they:

   1. A. Allow a larger internal tube diameter
   2. B. Remove the risk of airway injury
   3. C. Remove the need for capnography
   4. D. Reduce air leaks and tube changes
   Show answer

   Answer: D. Reduce air leaks and tube changes

   Cuffed tubes, with attention to cuff pressure, reduce air leak, improve ventilation and capnography accuracy, and lower the need to replace a poorly fitting tube. They are a half size smaller than uncuffed tubes, not larger. They can still injure the airway if overinflated or oversized. Capnography is still required. (AHA 2020 PALS.)

8. A 6-year-old with a pulse has a regular wide-complex tachycardia at 220 beats/min with normal BP and mental status. If expert consultation advises amiodarone, it is given as:

   1. A. 5 mg/kg by rapid IV push with a flush
   2. B. 5 mg/kg IV infused over 20 to 60 min
   3. C. 300 mg IV push, the adult arrest dose
   4. D. 0.5 mg/kg IM, repeated in 5 minutes
   Show answer

   Answer: B. 5 mg/kg IV infused over 20 to 60 min

   For a perfusing child, PALS gives amiodarone 5 mg/kg slowly over 20 to 60 minutes (or procainamide, not both) after expert consultation, because a fast push can cause hypotension. Rapid push is used only in pulseless arrest. 300 mg is the adult arrest dose, far too much for a child. Amiodarone is not given IM. (AHA PALS tachycardia algorithm.)

9. Studies of prehospital pediatric airway management have shown that, for most children, BVM ventilation compared with field intubation:

   1. A. Gives similar survival outcomes
   2. B. Leads to worse neurologic outcomes
   3. C. Is ineffective in infants under 1
   4. D. Works in children over 8, not younger
   Show answer

   Answer: A. Gives similar survival outcomes

   Well-performed BVM ventilation produces survival and neurologic outcomes similar to field intubation in most children (Gausche et al., JAMA 2000), so it remains the mainstay of pediatric prehospital airway care. It did not lead to worse neurologic outcomes. It is effective in infants. It works across pediatric ages, not just over 8. (Gausche M et al. JAMA 2000;283:783-790.)

10. For an infant in cardiac arrest with a shockable rhythm, the AHA order of preference for defibrillation is:

    1. A. Standard AED, then a manual defibrillator
    2. B. Manual defibrillator, then attenuated AED
    3. C. Attenuated AED, then a manual defibrillator
    4. D. Standard AED, then an attenuated AED
    Show answer

    Answer: B. Manual defibrillator, then attenuated AED

    For infants, a manual defibrillator is preferred so the energy can be set at 2 J/kg and escalated; if none is available, an AED with a pediatric dose attenuator is next, and a standard AED is better than no shock. Putting the attenuated AED ahead of a manual device, or a standard AED ahead of either, reverses the order of preference. (2025 AHA/AAP Pediatric BLS; AHA 2020 PALS.)

11. After ROSC, a 5-year-old has a BP of 72/40 mm Hg. PALS advises keeping her systolic pressure:

    1. A. Above 70 mm Hg, as for infants
    2. B. Below the 5th percentile to rest the heart
    3. C. Above the 5th percentile for age
    4. D. Low to limit bleeding after CPR
    Show answer

    Answer: C. Above the 5th percentile for age

    After cardiac arrest in children, PALS recommends avoiding hypotension by keeping the systolic pressure above the 5th percentile for age (for a 5-year-old, at least about 80 mm Hg, from 70 + 2 x age), using fluids and vasoactive drugs as needed, because post-arrest hypotension is linked to worse survival. The infant threshold of 70 mm Hg is too low for a 5-year-old, and letting the pressure fall below the 5th percentile to rest the heart is the hypotension that worsens outcomes. Permissive hypotension is a trauma strategy, not post-arrest care. (AHA 2020 PALS post-arrest care, carried into 2025.)

12. When performing CPR on a small 2-year-old, you may compress the chest using:

    1. A. Two fingers on the lower sternum
    2. B. Two thumbs with hands encircling the chest
    3. C. A fist placed on the upper sternum
    4. D. One or two hands to reach one-third depth
    Show answer

    Answer: D. One or two hands to reach one-third depth

    For a child, use the heel of one hand or two hands, whichever reaches at least one-third of the chest depth (about 5 cm) with full recoil. Two fingers cannot reach that depth, and the 2025 AHA/AAP guidelines dropped the two-finger technique even for infants. Two-thumb encircling is an infant technique (equal to the heel of one hand) and cannot compress a toddler's chest adequately. A fist on the upper sternum is the wrong tool and the wrong spot. (2025 AHA/AAP Pediatric BLS.)

13. Pediatric CPR guidelines apply to patients from 1 year of age until:

    1. A. The onset of puberty
    2. B. The age of 8 years
    3. C. The age of 12 years
    4. D. Legal adulthood at 18
    Show answer

    Answer: A. The onset of puberty

    Child CPR recommendations apply from 1 year until signs of puberty, such as breast development in girls or axillary hair in boys; then adult guidelines are used. The age of 8 years was the old cutoff used for AED pads and dosing.

14. During CPR on an infant, compressions should be delivered:

    1. A. Directly on the xiphoid
    2. B. On the upper third of the sternum
    3. C. Left of the sternum over the heart
    4. D. Just below the nipple line
    Show answer

    Answer: D. Just below the nipple line

    Infant compressions go on the lower half of the sternum, just below the nipple line, avoiding the xiphoid process, which can be fractured and lacerate the liver. Compressing the upper sternum does not compress the heart effectively.

15. During CPR on a child after an endotracheal tube is placed, compressions and breaths should be coordinated so that:

    1. A. Compressions continue without pauses
    2. B. Compressions pause after each 15
    3. C. Compressions pause after each 30
    4. D. Breaths are given just at rhythm checks
    Show answer

    Answer: A. Compressions continue without pauses

    Once an advanced airway is in place, compressions continue without pauses for breaths, and breaths are given asynchronously at a set rate. Pausing after each 15 compressions is the two-rescuer 15:2 ratio used without an advanced airway. Pausing after each 30 is the single-rescuer ratio without an advanced airway. Breathing only at the 2-minute rhythm checks would leave the child badly underventilated. (2025 AHA/AAP Pediatric BLS and PALS.)

16. For an infant in cardiac arrest, 2025 AHA/AAP guidance on the first vascular access route is to:

    1. A. Make three IV attempts before an IO
    2. B. Choose IV or IO by what is fastest
    3. C. Give the drugs by ET tube first
    4. D. Wait for an advanced airway first
    Show answer

    Answer: B. Choose IV or IO by what is fastest

    The 2025 pediatric guidelines say to choose the initial route, IV or IO, based on availability, expertise and timeliness; IO is rapid, safe and effective in infants and children. Insisting on several IV attempts first delays drugs. IV and IO are preferred over the endotracheal route because absorption through the lungs during CPR is limited and unpredictable. Drug access should not wait for an advanced airway. (2025 AHA/AAP Part 8 PALS.)

17. In pediatric cardiac arrest, epinephrine is repeated every:

    1. A. 1 to 2 minutes
    2. B. 8 to 10 minutes
    3. C. 3 to 5 minutes
    4. D. 15 minutes
    Show answer

    Answer: C. 3 to 5 minutes

    Epinephrine is repeated every 3 to 5 minutes, and for nonshockable rhythms it should be given as soon as possible. Giving it every 1 to 2 minutes exceeds the recommended interval.

18. The most common initial rhythm in pediatric out-of-hospital cardiac arrest is:

    1. A. Ventricular fibrillation
    2. B. Pulseless ventricular tachycardia
    3. C. Asystole or PEA
    4. D. Torsades de pointes
    Show answer

    Answer: C. Asystole or PEA

    Because most pediatric arrests follow progressive hypoxia or shock, bradycardia deteriorates into PEA or asystole. Ventricular fibrillation occurs in a minority, such as in sudden collapse from a cardiac cause.

19. A 20-kg child remains in ventricular fibrillation after a 40-J shock and 2 minutes of CPR. The second shock should be dosed at:

    1. A. 1 J/kg
    2. B. 4 J/kg
    3. C. 2 J/kg
    4. D. 0.5 J/kg
    Show answer

    Answer: B. 4 J/kg

    The second shock is 4 J/kg, and later shocks are at least 4 J/kg, up to 10 J/kg or the adult dose. Repeating 2 J/kg does not follow the PALS escalation.

20. If amiodarone is unavailable for pediatric shock-refractory VF, the alternative antiarrhythmic is lidocaine at:

    1. A. 1 mg/kg IV/IO
    2. B. 5 mg/kg IV/IO
    3. C. 0.1 mg/kg IV/IO
    4. D. 10 mg/kg IV/IO
    Show answer

    Answer: A. 1 mg/kg IV/IO

    Lidocaine 1 mg/kg IV/IO is an accepted alternative to amiodarone for shock-refractory VF or pulseless VT in children. A 5 mg/kg dose is the amiodarone dose and would be toxic for lidocaine.

21. A 14-year-old cross-country runner has a resting heart rate of 52 beats/min. She is alert, with a normal blood pressure and capillary refill. You should:

    1. A. Begin chest compressions now
    2. B. Give atropine 0.02 mg/kg IV
    3. C. Give epinephrine 0.01 mg/kg IV
    4. D. Monitor and continue assessment
    Show answer

    Answer: D. Monitor and continue assessment

    Bradycardia is treated only when it causes poor perfusion; a well-perfused, conditioned adolescent athlete often has a slow resting rate. CPR and drugs are for a heart rate under 60 with signs of poor perfusion despite oxygenation and ventilation.

22. In symptomatic pediatric bradycardia, atropine is preferred over epinephrine when the cause is:

    1. A. Hypoxia from respiratory failure
    2. B. Increased vagal tone
    3. C. Hypothermia after a submersion
    4. D. Acidosis from septic shock
    Show answer

    Answer: B. Increased vagal tone

    Atropine 0.02 mg/kg blocks vagal effects and is used for vagally mediated bradycardia or primary AV block. Hypoxia is the most common cause of pediatric bradycardia and is treated with ventilation, then epinephrine.

23. A 6-month-old is irritable and pale with a heart rate of 260 beats/min that does not vary, a narrow QRS, and no visible P waves. The history is unremarkable. The rhythm is most likely:

    1. A. Sinus tachycardia from hypovolemia
    2. B. Ventricular tachycardia
    3. C. Atrial fibrillation
    4. D. Supraventricular tachycardia
    Show answer

    Answer: D. Supraventricular tachycardia

    A fixed rate above 220 beats/min in an infant with absent P waves and no history of fever or fluid loss suggests SVT. Sinus tachycardia is usually below 220, varies with activity, and has an explanatory history.

24. A bystander who is unwilling to give rescue breaths finds a 3-year-old in cardiac arrest. AHA guidance is that the bystander should:

    1. A. Give compressions without breaths
    2. B. Do nothing until a mask arrives
    3. C. Give rescue breaths with no compressions
    4. D. Check for a pulse for 30 seconds
    Show answer

    Answer: A. Give compressions without breaths

    Because most pediatric arrests are asphyxial, CPR with breaths is best, but a bystander who cannot or will not give breaths should still give chest compressions, which is far better than no CPR. Waiting for a mask leaves the child with no circulation. Breaths alone do not circulate blood in a pulseless child. Lay rescuers are not expected to check a pulse, and any check should take no more than 10 seconds. (2025 AHA/AAP Pediatric BLS.)

25. An infant in SVT has poor perfusion, and an IO line is already running. Per PALS, it is reasonable to:

    1. A. Avoid adenosine because of the IO
    2. B. Give verapamil 0.1 mg/kg IV
    3. C. Give adenosine via the IO first
    4. D. Wait for him to become pulseless
    Show answer

    Answer: C. Give adenosine via the IO first

    For unstable SVT, PALS allows a rapid dose of adenosine first if IV or IO access is already in place, as long as it does not delay synchronized cardioversion (0.5 to 1 J/kg). Adenosine works through an IO line, so the IO is not a reason to avoid it. Verapamil can cause profound hypotension and arrest in infants and is contraindicated. Waiting for pulselessness lets a treatable rhythm become an arrest. (AHA PALS tachycardia algorithm.)