PALS Pediatric Advanced Life Support |
American Heart Association | Academic Year
2026/2027 | Final Review Comprehensive
Certification Examination | Verified Practice
Questions with Answers & Detailed
Rationales
Section 1: Systematic Assessment & The Pediatric Assessment Triangle (PAT)
Q1. What is the FIRST step in the PALS systematic approach?
A. Initiate CPR immediately
B. Perform the initial impression (Pediatric Assessment Triangle)
C. Obtain a full medical history
D. Administer high-flow oxygen
Correct Answer: B
Rationale: The PALS systematic approach begins with the initial impression—a
rapid, hands-off visual and auditory assessment using the PAT. This takes seconds
and determines urgency before touching the patient. A is wrong because CPR is
only started if pulseless/apneic. C is wrong because history comes later. D is
wrong because oxygen is an intervention, not an assessment step .
Q2. Which three components are evaluated during the Pediatric Assessment
Triangle (PAT)?
A. Airway, Breathing, Circulation
B. Appearance, Work of Breathing, Circulation to Skin
C. Consciousness, Respiratory Rate, Heart Rate
D. Mental Status, Pupils, Skin Color
Correct Answer: B
Rationale: The PAT evaluates Appearance (via TICLS mnemonic), Work of
Breathing, and Circulation to Skin (pallor, mottling, cyanosis). A is the primary
,assessment (ABCDE). C and D mix elements from different assessments and aren't
the PAT framework .
Q3. According to the PAT, "Appearance" is best assessed using which
mnemonic?
A. AVPU (Alert, Verbal, Pain, Unresponsive)
B. TICLS (Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry)
C. ABC (Airway, Breathing, Circulation)
D. OPQRST (Onset, Provocation, Quality, Region, Severity, Time)
Correct Answer: B
Rationale: TICLS is the standard mnemonic for evaluating a child's neurologic
"Appearance" during the PAT. AVPU is a component of the primary/secondary
assessment, not the PAT .
Q4. A 4-year-old presents with nasal flaring, grunting, and head bobbing. Which
PAT category does this represent?
A. Upper airway obstruction
B. Increased work of breathing (lower airway disease)
C. Central nervous system depression
D. Compensated shock
Correct Answer: B
Rationale: Nasal flaring, grunting (compensatory PEEP generation), and head
bobbing (accessory muscle use) are classic visual signs of increased work of
breathing from lower airway disease like asthma or bronchiolitis. Upper airway
obstruction presents with stridor; CNS depression presents without increased
work of breathing .
Q5. According to the PAT, "Circulation to skin" is assessed by visual inspection
for which findings?
A. Femoral pulse strength
B. Pallor, mottling, or cyanosis
C. Blood pressure measurement
D. Capillary refill time by palpation
,Correct Answer: B
Rationale: The PAT is a rapid, hands-off assessment performed from the
doorway. The "Circulation to skin" arm evaluates skin color (pallor, mottling,
cyanosis) and any visible bleeding. Pulses, capillary refill, and blood pressure are
assessed later .
Section 2: Respiratory Emergencies
Q6. A 3-year-old child presents with a barking cough, inspiratory stridor at rest,
and mild retractions. The child is agitated but consolable, and skin color is pink.
According to the PAT, this child has:
A. Respiratory failure with poor perfusion
B. Moderate respiratory distress with adequate perfusion
C. Cardiopulmonary failure
D. Upper airway obstruction with decompensated shock
Correct Answer: B
Rationale: This child demonstrates moderate respiratory distress with preserved
circulation to skin (pink). Respiratory distress is a compensatory state; respiratory
failure occurs when compensatory mechanisms fail, presenting with lethargy,
decreased work of breathing, and cyanosis/mottling .
Q7. What is the recommended initial oxygen delivery device for a child in severe
respiratory distress who is breathing effectively but has hypoxemia (SpO₂ <
90%)?
A. Nasal cannula at 2 L/min
B. Nonrebreather mask at 10–15 L/min
C. Simple face mask at 5 L/min
D. Bag-valve-mask (BVM) ventilation
Correct Answer: B
Rationale: A nonrebreather mask delivers the highest concentration of oxygen
(up to 90–100%) to a spontaneously breathing patient and is preferred for severe
hypoxemia. Nasal cannula and simple face masks deliver lower FiO₂. BVM is
indicated when the child is not breathing effectively .
, Q8. When using a bag-valve-mask (BVM) for an infant, what is the appropriate
volume to deliver per breath?
A. Exactly 10 mL/kg
B. The volume needed to cause visible chest rise
C. As much volume as the BVM can hold
D. 5 mL/kg
Correct Answer: B
Rationale: The appropriate volume is the volume needed to produce visible
chest rise. Over-ventilation increases intrathoracic pressure, decreases venous
return, and can worsen outcomes .
Q9. A child with severe asthma is unresponsive to albuterol and ipratropium
nebulizers. The child is becoming drowsy with minimal air movement. Which
medication should be administered next?
A. Oral prednisolone
B. IV methylprednisolone
C. Subcutaneous or IM epinephrine
D. IV magnesium sulfate
Correct Answer: D
Rationale: For severe, refractory asthma (status asthmaticus) with poor air
movement and altered mental status, IV magnesium sulfate is indicated as a
bronchodilator after inhaled treatments have failed. Corticosteroids have delayed
onset and are not immediate rescue medications .
Q10. A 4-year-old presents with acute onset of stridor, drooling, and is sitting
upright leaning forward. What is the most appropriate initial intervention?
A. Obtain a lateral neck X-ray
B. Perform direct laryngoscopy
C. Administer nebulized racemic epinephrine
D. Prepare for immediate tracheal intubation
Correct Answer: D
American Heart Association | Academic Year
2026/2027 | Final Review Comprehensive
Certification Examination | Verified Practice
Questions with Answers & Detailed
Rationales
Section 1: Systematic Assessment & The Pediatric Assessment Triangle (PAT)
Q1. What is the FIRST step in the PALS systematic approach?
A. Initiate CPR immediately
B. Perform the initial impression (Pediatric Assessment Triangle)
C. Obtain a full medical history
D. Administer high-flow oxygen
Correct Answer: B
Rationale: The PALS systematic approach begins with the initial impression—a
rapid, hands-off visual and auditory assessment using the PAT. This takes seconds
and determines urgency before touching the patient. A is wrong because CPR is
only started if pulseless/apneic. C is wrong because history comes later. D is
wrong because oxygen is an intervention, not an assessment step .
Q2. Which three components are evaluated during the Pediatric Assessment
Triangle (PAT)?
A. Airway, Breathing, Circulation
B. Appearance, Work of Breathing, Circulation to Skin
C. Consciousness, Respiratory Rate, Heart Rate
D. Mental Status, Pupils, Skin Color
Correct Answer: B
Rationale: The PAT evaluates Appearance (via TICLS mnemonic), Work of
Breathing, and Circulation to Skin (pallor, mottling, cyanosis). A is the primary
,assessment (ABCDE). C and D mix elements from different assessments and aren't
the PAT framework .
Q3. According to the PAT, "Appearance" is best assessed using which
mnemonic?
A. AVPU (Alert, Verbal, Pain, Unresponsive)
B. TICLS (Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry)
C. ABC (Airway, Breathing, Circulation)
D. OPQRST (Onset, Provocation, Quality, Region, Severity, Time)
Correct Answer: B
Rationale: TICLS is the standard mnemonic for evaluating a child's neurologic
"Appearance" during the PAT. AVPU is a component of the primary/secondary
assessment, not the PAT .
Q4. A 4-year-old presents with nasal flaring, grunting, and head bobbing. Which
PAT category does this represent?
A. Upper airway obstruction
B. Increased work of breathing (lower airway disease)
C. Central nervous system depression
D. Compensated shock
Correct Answer: B
Rationale: Nasal flaring, grunting (compensatory PEEP generation), and head
bobbing (accessory muscle use) are classic visual signs of increased work of
breathing from lower airway disease like asthma or bronchiolitis. Upper airway
obstruction presents with stridor; CNS depression presents without increased
work of breathing .
Q5. According to the PAT, "Circulation to skin" is assessed by visual inspection
for which findings?
A. Femoral pulse strength
B. Pallor, mottling, or cyanosis
C. Blood pressure measurement
D. Capillary refill time by palpation
,Correct Answer: B
Rationale: The PAT is a rapid, hands-off assessment performed from the
doorway. The "Circulation to skin" arm evaluates skin color (pallor, mottling,
cyanosis) and any visible bleeding. Pulses, capillary refill, and blood pressure are
assessed later .
Section 2: Respiratory Emergencies
Q6. A 3-year-old child presents with a barking cough, inspiratory stridor at rest,
and mild retractions. The child is agitated but consolable, and skin color is pink.
According to the PAT, this child has:
A. Respiratory failure with poor perfusion
B. Moderate respiratory distress with adequate perfusion
C. Cardiopulmonary failure
D. Upper airway obstruction with decompensated shock
Correct Answer: B
Rationale: This child demonstrates moderate respiratory distress with preserved
circulation to skin (pink). Respiratory distress is a compensatory state; respiratory
failure occurs when compensatory mechanisms fail, presenting with lethargy,
decreased work of breathing, and cyanosis/mottling .
Q7. What is the recommended initial oxygen delivery device for a child in severe
respiratory distress who is breathing effectively but has hypoxemia (SpO₂ <
90%)?
A. Nasal cannula at 2 L/min
B. Nonrebreather mask at 10–15 L/min
C. Simple face mask at 5 L/min
D. Bag-valve-mask (BVM) ventilation
Correct Answer: B
Rationale: A nonrebreather mask delivers the highest concentration of oxygen
(up to 90–100%) to a spontaneously breathing patient and is preferred for severe
hypoxemia. Nasal cannula and simple face masks deliver lower FiO₂. BVM is
indicated when the child is not breathing effectively .
, Q8. When using a bag-valve-mask (BVM) for an infant, what is the appropriate
volume to deliver per breath?
A. Exactly 10 mL/kg
B. The volume needed to cause visible chest rise
C. As much volume as the BVM can hold
D. 5 mL/kg
Correct Answer: B
Rationale: The appropriate volume is the volume needed to produce visible
chest rise. Over-ventilation increases intrathoracic pressure, decreases venous
return, and can worsen outcomes .
Q9. A child with severe asthma is unresponsive to albuterol and ipratropium
nebulizers. The child is becoming drowsy with minimal air movement. Which
medication should be administered next?
A. Oral prednisolone
B. IV methylprednisolone
C. Subcutaneous or IM epinephrine
D. IV magnesium sulfate
Correct Answer: D
Rationale: For severe, refractory asthma (status asthmaticus) with poor air
movement and altered mental status, IV magnesium sulfate is indicated as a
bronchodilator after inhaled treatments have failed. Corticosteroids have delayed
onset and are not immediate rescue medications .
Q10. A 4-year-old presents with acute onset of stridor, drooling, and is sitting
upright leaning forward. What is the most appropriate initial intervention?
A. Obtain a lateral neck X-ray
B. Perform direct laryngoscopy
C. Administer nebulized racemic epinephrine
D. Prepare for immediate tracheal intubation
Correct Answer: D
