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PALS FINAL EXAM — COMPREHENSIVE BASED ON 2025
AHA GUIDELINES 2026/2027 COMPLETE (100) CURRENT
TESTING QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
PALS
Prepare for the PALS Final Exam with a focused study resource designed to reinforce
essential Pediatric Advanced Life Support concepts and emergency response skills. It
supports review of pediatric assessment, respiratory emergencies, high-quality CPR,
cardiac arrest, shock management, rhythm recognition, resuscitation medications,
and post-resuscitation care. Use the material to strengthen clinical decision-making,
prioritization, and confidence when working through pediatric emergency scenarios.
This resource is best suited for healthcare professionals, nursing students,
paramedics, respiratory therapists, and other providers preparing for a PALS final or
certification examination.
MULTIPLE CHOICE.
SECTION 1: SYSTEMATIC APPROACH & INITIAL ASSESSMENT
1. The PALS systematic approach algorithm begins with the initial
impression. This is an assessment of which three characteristics?
• A) Airway, Breathing, Circulation
• B) Consciousness, Breathing, Color
• C) Pulse, Respiratory Rate, Blood Pressure
• D) Temperature, Heart Rate, Oxygen Saturation
Answer: B) Consciousness, Breathing, Color
Rationale: The PALS systematic approach begins with the initial
impression, which is a quick assessment of the child's consciousness,
breathing, and color. This 5-10 second visual assessment helps determine
the urgency of the situation and guides the next steps.
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2. In the PALS systematic approach algorithm, if the child is determined to
be unresponsive or immediate intervention is needed, what is the next
step?
• A) Begin primary assessment (ABCDE)
• B) Activate the emergency response system
• C) Check for a pulse
• D) Begin CPR immediately
Answer: A) Begin primary assessment (ABCDE)
Rationale: If a child is unresponsive or requires immediate intervention,
the provider should proceed to the primary assessment using the ABCDE
approach (Airway, Breathing, Circulation, Disability, Exposure).
3. What does the "D" in the PALS primary assessment (ABCDE) represent?
• A) Defibrillation
• B) Disability (neurologic status)
• C) Drugs
• D) Defect
Answer: B) Disability (neurologic status)
Rationale: In the PALS primary assessment, "D" stands for Disability,
which includes assessment of neurologic status using the AVPU (Alert,
Voice, Pain, Unresponsive) scale or Glasgow Coma Scale, and evaluation
for signs of increased intracranial pressure or seizure activity.
4. A 3-year-old child presents with lethargy, increased work of breathing,
and pallor. The PALS team should first:
• A) Obtain a 12-lead ECG
• B) Perform the initial impression and primary assessment
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• C) Administer a fluid bolus
• D) Start high-flow oxygen
Answer: B) Perform the initial impression and primary assessment
Rationale: The PALS systematic approach directs providers to first obtain
an initial impression (consciousness, breathing, color) and then perform a
primary assessment (ABCDE) before initiating any specific interventions.
5. A child with altered mental status and respiratory distress is being
evaluated. Which of the following is part of the "B" (Breathing)
assessment?
• A) Palpating for a pulse
• B) Assessing respiratory rate, effort, and breath sounds
• C) Checking pupils
• D) Evaluating skin color
Answer: B) Assessing respiratory rate, effort, and breath sounds
Rationale: The Breathing assessment in the ABCDE approach includes
evaluating respiratory rate, work of breathing (retractions, nasal flaring,
grunting), breath sounds, and oxygen saturation. Airway is assessed first,
followed by breathing.
6. The "right branch" of the PALS systematic approach algorithm focuses
on which sequence to prevent cardiopulmonary arrest?
• A) Evaluate-Identify-Intervene
• B) Assess-Diagnose-Treat
• C) Look-Listen-Feel
• D) Check-Call-Compress
Answer: A) Evaluate-Identify-Intervene
Rationale: The right branch of the PALS systematic approach algorithm
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focuses on the Evaluate-Identify-Intervene sequence, which is used for
children who are responsive and do not require immediate life-saving
interventions.
7. A 6-year-old child presents with a barking cough, stridor, and
respiratory distress. The team's initial impression would most likely
identify this as:
• A) Cardiac arrest
• B) Respiratory distress
• C) Shock
• D) Seizure
Answer: B) Respiratory distress
Rationale: The initial impression would identify this child as having
respiratory distress based on the presence of increased work of breathing
(barking cough, stridor) and signs of respiratory compromise. This would
direct the team to the respiratory distress/failure pathway.
8. In the PALS systematic approach, a child who is unresponsive and not
breathing should immediately be assumed to be in:
• A) Respiratory failure
• B) Cardiac arrest
• C) Septic shock
• D) Status epilepticus
Answer: B) Cardiac arrest
Rationale: An unresponsive child who is not breathing (or only gasping)
should be assumed to be in cardiac arrest. The provider should
immediately begin CPR and activate the emergency response system (or
send someone to activate it).
PALS FINAL EXAM — COMPREHENSIVE BASED ON 2025
AHA GUIDELINES 2026/2027 COMPLETE (100) CURRENT
TESTING QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
PALS
Prepare for the PALS Final Exam with a focused study resource designed to reinforce
essential Pediatric Advanced Life Support concepts and emergency response skills. It
supports review of pediatric assessment, respiratory emergencies, high-quality CPR,
cardiac arrest, shock management, rhythm recognition, resuscitation medications,
and post-resuscitation care. Use the material to strengthen clinical decision-making,
prioritization, and confidence when working through pediatric emergency scenarios.
This resource is best suited for healthcare professionals, nursing students,
paramedics, respiratory therapists, and other providers preparing for a PALS final or
certification examination.
MULTIPLE CHOICE.
SECTION 1: SYSTEMATIC APPROACH & INITIAL ASSESSMENT
1. The PALS systematic approach algorithm begins with the initial
impression. This is an assessment of which three characteristics?
• A) Airway, Breathing, Circulation
• B) Consciousness, Breathing, Color
• C) Pulse, Respiratory Rate, Blood Pressure
• D) Temperature, Heart Rate, Oxygen Saturation
Answer: B) Consciousness, Breathing, Color
Rationale: The PALS systematic approach begins with the initial
impression, which is a quick assessment of the child's consciousness,
breathing, and color. This 5-10 second visual assessment helps determine
the urgency of the situation and guides the next steps.
, Page 2 of 44
2. In the PALS systematic approach algorithm, if the child is determined to
be unresponsive or immediate intervention is needed, what is the next
step?
• A) Begin primary assessment (ABCDE)
• B) Activate the emergency response system
• C) Check for a pulse
• D) Begin CPR immediately
Answer: A) Begin primary assessment (ABCDE)
Rationale: If a child is unresponsive or requires immediate intervention,
the provider should proceed to the primary assessment using the ABCDE
approach (Airway, Breathing, Circulation, Disability, Exposure).
3. What does the "D" in the PALS primary assessment (ABCDE) represent?
• A) Defibrillation
• B) Disability (neurologic status)
• C) Drugs
• D) Defect
Answer: B) Disability (neurologic status)
Rationale: In the PALS primary assessment, "D" stands for Disability,
which includes assessment of neurologic status using the AVPU (Alert,
Voice, Pain, Unresponsive) scale or Glasgow Coma Scale, and evaluation
for signs of increased intracranial pressure or seizure activity.
4. A 3-year-old child presents with lethargy, increased work of breathing,
and pallor. The PALS team should first:
• A) Obtain a 12-lead ECG
• B) Perform the initial impression and primary assessment
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• C) Administer a fluid bolus
• D) Start high-flow oxygen
Answer: B) Perform the initial impression and primary assessment
Rationale: The PALS systematic approach directs providers to first obtain
an initial impression (consciousness, breathing, color) and then perform a
primary assessment (ABCDE) before initiating any specific interventions.
5. A child with altered mental status and respiratory distress is being
evaluated. Which of the following is part of the "B" (Breathing)
assessment?
• A) Palpating for a pulse
• B) Assessing respiratory rate, effort, and breath sounds
• C) Checking pupils
• D) Evaluating skin color
Answer: B) Assessing respiratory rate, effort, and breath sounds
Rationale: The Breathing assessment in the ABCDE approach includes
evaluating respiratory rate, work of breathing (retractions, nasal flaring,
grunting), breath sounds, and oxygen saturation. Airway is assessed first,
followed by breathing.
6. The "right branch" of the PALS systematic approach algorithm focuses
on which sequence to prevent cardiopulmonary arrest?
• A) Evaluate-Identify-Intervene
• B) Assess-Diagnose-Treat
• C) Look-Listen-Feel
• D) Check-Call-Compress
Answer: A) Evaluate-Identify-Intervene
Rationale: The right branch of the PALS systematic approach algorithm
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focuses on the Evaluate-Identify-Intervene sequence, which is used for
children who are responsive and do not require immediate life-saving
interventions.
7. A 6-year-old child presents with a barking cough, stridor, and
respiratory distress. The team's initial impression would most likely
identify this as:
• A) Cardiac arrest
• B) Respiratory distress
• C) Shock
• D) Seizure
Answer: B) Respiratory distress
Rationale: The initial impression would identify this child as having
respiratory distress based on the presence of increased work of breathing
(barking cough, stridor) and signs of respiratory compromise. This would
direct the team to the respiratory distress/failure pathway.
8. In the PALS systematic approach, a child who is unresponsive and not
breathing should immediately be assumed to be in:
• A) Respiratory failure
• B) Cardiac arrest
• C) Septic shock
• D) Status epilepticus
Answer: B) Cardiac arrest
Rationale: An unresponsive child who is not breathing (or only gasping)
should be assumed to be in cardiac arrest. The provider should
immediately begin CPR and activate the emergency response system (or
send someone to activate it).
