PALS Pediatric Advanced Life Support
American Heart Association | Academic Year 2026/2027
Final Comprehensive Certification Practice Examination
Questions 1–200
These are original practice questions for study purposes, not reproduced AHA examination
questions. They are aligned broadly with the current PALS course framework and the 2025
AHA CPR/ECC guidance, which is reflected in the PALS materials used from 2026 onward.
Questions 1–50
1. A child presents with severe respiratory distress, cyanosis, and altered mental
status. What is the priority?
A. Obtain a detailed medical history
B. Begin immediate assessment and support of airway and breathing
C. Obtain a chest radiograph
D. Administer oral fluids
Correct answer: B. Begin immediate assessment and support of airway and breathing
2. Which finding is most concerning for pediatric respiratory failure?
A. Mild tachypnea
B. Nasal congestion
C. Altered mental status with poor respiratory effort
D. Mild cough
,Correct answer: C. Altered mental status with poor respiratory effort
3. Which is an early sign of respiratory distress in a child?
A. Bradycardia
B. Increased work of breathing
C. Apnea
D. Severe hypotension
Correct answer: B. Increased work of breathing
4. Which finding indicates progression from respiratory distress toward respiratory
failure?
A. Improved alertness
B. Decreasing respiratory effort despite worsening oxygenation
C. Mild tachycardia
D. Normal skin color
Correct answer: B. Decreasing respiratory effort despite worsening oxygenation
5. A child with respiratory distress has oxygen saturation of 88%. What is an
appropriate initial intervention?
A. Withhold oxygen
B. Provide supplemental oxygen and reassess
C. Give oral antibiotics
D. Begin chest compressions immediately
Correct answer: B. Provide supplemental oxygen and reassess
,6. Which airway maneuver is generally appropriate for an unconscious child without
suspected cervical spine trauma?
A. Head tilt–chin lift
B. Abdominal thrusts
C. Blind finger sweep
D. Neck flexion
Correct answer: A. Head tilt–chin lift
7. When cervical spine injury is suspected, the preferred airway maneuver is:
A. Head tilt–chin lift with forceful extension
B. Jaw thrust without head extension
C. Neck rotation
D. Hyperflexion of the neck
Correct answer: B. Jaw thrust without head extension
8. Which device can provide positive-pressure ventilation to a child who is not
breathing adequately?
A. Nasal cannula
B. Bag-mask device
C. Pulse oximeter
D. Stethoscope
Correct answer: B. Bag-mask device
9. Effective bag-mask ventilation should primarily produce:
, A. Visible chest rise
B. Abdominal distention
C. Facial flushing
D. Bradycardia
Correct answer: A. Visible chest rise
10. Excessive ventilation during pediatric resuscitation can:
A. Improve venous return
B. Reduce intrathoracic pressure
C. Impede venous return and reduce cardiac output
D. Always improve oxygenation
Correct answer: C. Impede venous return and reduce cardiac output
11. Which finding is most consistent with upper-airway obstruction?
A. Stridor
B. Crackles
C. Peripheral edema
D. Bradycardia only
Correct answer: A. Stridor
12. Wheezing most commonly suggests:
A. Lower-airway obstruction
B. Complete cardiac arrest
American Heart Association | Academic Year 2026/2027
Final Comprehensive Certification Practice Examination
Questions 1–200
These are original practice questions for study purposes, not reproduced AHA examination
questions. They are aligned broadly with the current PALS course framework and the 2025
AHA CPR/ECC guidance, which is reflected in the PALS materials used from 2026 onward.
Questions 1–50
1. A child presents with severe respiratory distress, cyanosis, and altered mental
status. What is the priority?
A. Obtain a detailed medical history
B. Begin immediate assessment and support of airway and breathing
C. Obtain a chest radiograph
D. Administer oral fluids
Correct answer: B. Begin immediate assessment and support of airway and breathing
2. Which finding is most concerning for pediatric respiratory failure?
A. Mild tachypnea
B. Nasal congestion
C. Altered mental status with poor respiratory effort
D. Mild cough
,Correct answer: C. Altered mental status with poor respiratory effort
3. Which is an early sign of respiratory distress in a child?
A. Bradycardia
B. Increased work of breathing
C. Apnea
D. Severe hypotension
Correct answer: B. Increased work of breathing
4. Which finding indicates progression from respiratory distress toward respiratory
failure?
A. Improved alertness
B. Decreasing respiratory effort despite worsening oxygenation
C. Mild tachycardia
D. Normal skin color
Correct answer: B. Decreasing respiratory effort despite worsening oxygenation
5. A child with respiratory distress has oxygen saturation of 88%. What is an
appropriate initial intervention?
A. Withhold oxygen
B. Provide supplemental oxygen and reassess
C. Give oral antibiotics
D. Begin chest compressions immediately
Correct answer: B. Provide supplemental oxygen and reassess
,6. Which airway maneuver is generally appropriate for an unconscious child without
suspected cervical spine trauma?
A. Head tilt–chin lift
B. Abdominal thrusts
C. Blind finger sweep
D. Neck flexion
Correct answer: A. Head tilt–chin lift
7. When cervical spine injury is suspected, the preferred airway maneuver is:
A. Head tilt–chin lift with forceful extension
B. Jaw thrust without head extension
C. Neck rotation
D. Hyperflexion of the neck
Correct answer: B. Jaw thrust without head extension
8. Which device can provide positive-pressure ventilation to a child who is not
breathing adequately?
A. Nasal cannula
B. Bag-mask device
C. Pulse oximeter
D. Stethoscope
Correct answer: B. Bag-mask device
9. Effective bag-mask ventilation should primarily produce:
, A. Visible chest rise
B. Abdominal distention
C. Facial flushing
D. Bradycardia
Correct answer: A. Visible chest rise
10. Excessive ventilation during pediatric resuscitation can:
A. Improve venous return
B. Reduce intrathoracic pressure
C. Impede venous return and reduce cardiac output
D. Always improve oxygenation
Correct answer: C. Impede venous return and reduce cardiac output
11. Which finding is most consistent with upper-airway obstruction?
A. Stridor
B. Crackles
C. Peripheral edema
D. Bradycardia only
Correct answer: A. Stridor
12. Wheezing most commonly suggests:
A. Lower-airway obstruction
B. Complete cardiac arrest
