2025 AHA PALS Exam A – 200 Practice Questions with Verified
Answers & Explanations
Question 1
What is the first step in the systematic approach to assessing a seriously ill or injured child?
A) Begin CPR immediately
B) Assess the child's level of consciousness
C) Perform the initial impression (look, listen, and feel)
D) Check for a pulse
Correct Answer: C
Rationale: The systematic approach begins with the initial impression, using look, listen, and feel to form
a general sense of the child's condition before proceeding to a more detailed assessment.
Question 2
A 4yearold child presents with respiratory distress, pallor, and cool extremities. The heart rate is
180/min, respiratory rate is 40/min, and blood pressure is 80/45 mmHg. What is the most appropriate
next step?
A) Administer a fluid bolus
B) Begin chest compressions
C) Prepare for intubation
D) Obtain a chest xray
Correct Answer: A
Rationale: The child is in compensated shock, as evidenced by tachycardia, pallor, cool extremities, and
hypotension threshold approaching. A fluid bolus of 20 mL/kg isotonic crystalloid is indicated.
,Question 3
During the initial assessment of a pediatric patient, you identify grunting, nasal flaring, and retractions.
These findings are most consistent with which condition?
A) Compensated shock
B) Respiratory distress
C) Hypotension
D) Normal breathing
Correct Answer: B
Rationale: Grunting, nasal flaring, and retractions are signs of increased work of breathing, indicating
respiratory distress. These findings represent the body's attempt to compensate for inadequate
ventilation or oxygenation.
Question 4
Which assessment finding indicates the child is in respiratory failure rather than respiratory distress?
A) Nasal flaring
B) Intercostal retractions
C) Oxygen saturation of 72% on room air
D) Tachypnea
Correct Answer: C
Rationale: Respiratory failure is defined by inadequate ventilation and/or oxygenation. An SpO₂ of 72%
on room air indicates severe hypoxemia and respiratory failure. Respiratory distress is characterized by
increased work of breathing with adequate compensation.
,Question 5
A team member is unable to perform an assigned task because it is beyond their scope of practice.
Which action should the team member take?
A) Ask for a new task or role
B) Refuse to perform the task without explanation
C) Perform the task anyway
D) Seek expert consultation
Correct Answer: A
Rationale: In highperformance team dynamics, a team member who cannot perform an assigned task
should ask for a new task or role. This maintains team efficiency and patient safety while respecting
scope of practice.
Question 6
A 5yearold child presents with lethargy, increased work of breathing, and pale color. The primary
assessment reveals the airway is open and respiratory rate is 30/min with crackles on auscul tation. The
cardiac monitor shows sinus tachycardia at 165/min. The pulse oximeter displays an SpO₂ of 95% and a
pulse rate of 93/min. 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
Correct Answer: D
Rationale: The pulse oximeter displays a pulse rate of 93/min, but the cardiac monitor shows sinus
tachycardia at 165/min. This discrepancy indicates the SpO₂ reading is unreliable. Supplementary oxygen
should be administered while evaluating the cause of the desaturation.
, Question 7
An 8yearold child with a history of asthma and nut allergies is brought to the ED for difficulty breathing.
His mother reports he recently ate a cookie at a picnic. The most likely condition is:
A) Disordered control of breathing
B) Hypovolemic shock
C) Lung tissue disease
D) Anaphylaxis/Upper airway obstruction
Correct Answer: D
Rationale: The history of nut allergy plus recent ingestion of a cookie plus acute respiratory distress
strongly suggests anaphylaxis. Anaphylaxis can cause upper airway edema (angioedema),
bronchospasm, and hypotension. This is a lifethreatening emergency requiring immediate epinephrine.
Question 8
A 13yearold 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
Correct Answer: C
Rationale: After administering a treatment, the patient's response must be reassessed. Reassessment of
breath sounds and clinical status guides further management decisions.
Answers & Explanations
Question 1
What is the first step in the systematic approach to assessing a seriously ill or injured child?
A) Begin CPR immediately
B) Assess the child's level of consciousness
C) Perform the initial impression (look, listen, and feel)
D) Check for a pulse
Correct Answer: C
Rationale: The systematic approach begins with the initial impression, using look, listen, and feel to form
a general sense of the child's condition before proceeding to a more detailed assessment.
Question 2
A 4yearold child presents with respiratory distress, pallor, and cool extremities. The heart rate is
180/min, respiratory rate is 40/min, and blood pressure is 80/45 mmHg. What is the most appropriate
next step?
A) Administer a fluid bolus
B) Begin chest compressions
C) Prepare for intubation
D) Obtain a chest xray
Correct Answer: A
Rationale: The child is in compensated shock, as evidenced by tachycardia, pallor, cool extremities, and
hypotension threshold approaching. A fluid bolus of 20 mL/kg isotonic crystalloid is indicated.
,Question 3
During the initial assessment of a pediatric patient, you identify grunting, nasal flaring, and retractions.
These findings are most consistent with which condition?
A) Compensated shock
B) Respiratory distress
C) Hypotension
D) Normal breathing
Correct Answer: B
Rationale: Grunting, nasal flaring, and retractions are signs of increased work of breathing, indicating
respiratory distress. These findings represent the body's attempt to compensate for inadequate
ventilation or oxygenation.
Question 4
Which assessment finding indicates the child is in respiratory failure rather than respiratory distress?
A) Nasal flaring
B) Intercostal retractions
C) Oxygen saturation of 72% on room air
D) Tachypnea
Correct Answer: C
Rationale: Respiratory failure is defined by inadequate ventilation and/or oxygenation. An SpO₂ of 72%
on room air indicates severe hypoxemia and respiratory failure. Respiratory distress is characterized by
increased work of breathing with adequate compensation.
,Question 5
A team member is unable to perform an assigned task because it is beyond their scope of practice.
Which action should the team member take?
A) Ask for a new task or role
B) Refuse to perform the task without explanation
C) Perform the task anyway
D) Seek expert consultation
Correct Answer: A
Rationale: In highperformance team dynamics, a team member who cannot perform an assigned task
should ask for a new task or role. This maintains team efficiency and patient safety while respecting
scope of practice.
Question 6
A 5yearold child presents with lethargy, increased work of breathing, and pale color. The primary
assessment reveals the airway is open and respiratory rate is 30/min with crackles on auscul tation. The
cardiac monitor shows sinus tachycardia at 165/min. The pulse oximeter displays an SpO₂ of 95% and a
pulse rate of 93/min. 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
Correct Answer: D
Rationale: The pulse oximeter displays a pulse rate of 93/min, but the cardiac monitor shows sinus
tachycardia at 165/min. This discrepancy indicates the SpO₂ reading is unreliable. Supplementary oxygen
should be administered while evaluating the cause of the desaturation.
, Question 7
An 8yearold child with a history of asthma and nut allergies is brought to the ED for difficulty breathing.
His mother reports he recently ate a cookie at a picnic. The most likely condition is:
A) Disordered control of breathing
B) Hypovolemic shock
C) Lung tissue disease
D) Anaphylaxis/Upper airway obstruction
Correct Answer: D
Rationale: The history of nut allergy plus recent ingestion of a cookie plus acute respiratory distress
strongly suggests anaphylaxis. Anaphylaxis can cause upper airway edema (angioedema),
bronchospasm, and hypotension. This is a lifethreatening emergency requiring immediate epinephrine.
Question 8
A 13yearold 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
Correct Answer: C
Rationale: After administering a treatment, the patient's response must be reassessed. Reassessment of
breath sounds and clinical status guides further management decisions.
