AHA PALS Exam Questions & Answers Fall 2025/2026
. A 7-year-old child presents in pulseless arrest. The child's ECG shows the rhythm
below. Which of the following describes the patient's condition?
A. Ventricular escape rhythm
B. Ventricular tachycardia
C. Pulseless electrical activity
D. Sinus bradycardia - answer-C. Pulseless electrical activity
. A 12-year-old child suddenly collapses while playing sports. He is unresponsive and
not breathing. Emergency response is activated. The child has no pulse, and CPR is
initiated. An AED arrives. What is the most appropriate next intervention?
A. Contact the child's family
B. Provide CPR for 2 minutes
C. Drive the child to the hospital
D. Use the AED - answer-D. Use the AED
. A 6-year-old child is found unresponsive, not breathing, and pulseless. What is the
correct compression-to-ventilation ratio when 2 or more healthcare providers are
present to perform CPR? - answer-15:2
. A 5-year-old child has had severe respiratory distress for 2 days. During assessment
the child's heart rate decreases from 140/min to 90/min, and the child's respiratory rate
decreases from 66/min to 8/min. What intervention is most appropriate?
A. Provide rescue breaths at a rate of 12 to 20/min B. Provide rescue breaths at a rate
of 6 to 10/min
C. Initiate chest compressions at a rate of at least 100/min
D. Initiate chest compressions at a rate of 60/min - answer-B. Provide rescue breaths at
a rate of 12 to 20/min
A 7-year-old child presents with a narrow-complex supraventricular tachycardia,
lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be
established. What is the most appropriate intervention?
A. Unsynchronized shock with 0.5 to 1 J/kg
B. Synchronized shock with 0.5 to 1 J/kg
C. Unsynchronized shock with 2 J/kg
D. Synchronized shock with 2 J/kg - answer-B. Synchronized shock with 0.5 to 1 J/kg
1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color.
The primary assessment reveals that the airway is open and the respiratory rate is
30/min, with crackles heard on auscultation. The cardiac monitor shows sinus
tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of
95% and a pulse rate of 93/min. On the basis of this information, 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 - answer-D. Unreliable;
supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with
chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min,
respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less
than 2 seconds. What is the child's most likely condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
D. Cardiogenic shock - answer-A. Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood
pressure is 55/40 mm Hg. What term describes this infant's blood pressure?
A. Hypotensive
B. Normal
C. Hypertensive
D. Compensated - answer-A. Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine
at 0.1 mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - answer-C. Respectfully ask the team leader to clarify
the dose
5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - answer-A. Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and
wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - answer-C. Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures
stopped a few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - answer-D. Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory
distress caused by lung tissue disease?
A. Decreased oxygen saturation
,B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort - answer-A. Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is being
evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best
describe this patient's condition?
A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing - answer-A. Respiratory distress
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the
child has been febrile and has not been feeling well, with recent onset of lethargy.
Assessment reveals the following: The child is difficult to arouse, with pale color. The
child's heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg,
capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the
most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30
minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10
minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with
an oncologist to determine the chemotherapeutic regimen - answer-B. Obtain vascular
access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression
reveals an unresponsive child with intermittent apnea and mottled color. Heart rate is
166/min, respiratory rate is now being supported with bag-mask ventilation, capillary
refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method
of establishing immediate vascular access? A. Two providers may attempt peripheral
vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - answer-D. Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock
with adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
C. 20 mL/kg normal saline
D. 10 mL/kg lactated Ringer's - answer-C. 20 mL/kg normal saline
13. An alert toddler presents with a barking cough, moderate stridor, and moderate
retractions. The child's color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector - answer-B. Administer nebulized epinephrine
, 14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has
the following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure
9060 mm Hg, and temperature 98.6°F (37°C). The child's capillary refill time is 4
seconds. After 2 IV boluses of normal saline (20 mL/kg each), the child's vital signs are
now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94/62 mm
Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child's urine output is
1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or
information should be obtained first?
A. Arterial blood gas
B. Serum potassium concentration
C. Glucose
D. A 12-lead ECG - answer-C. Glucose
15. A 15-year-old boy presents with acute onset of severe respiratory distress, with
retractions and an oxygen saturation of 85%. His trachea is deviated to the right, and
there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is
84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate
intervention?
A. Obtain a chest x-ray
B. Perform needle decompression on the left chest
C. Insert a chest tube on the left side
D. Insert an IV and administer 20 mL/kg of normal saline - answer-B. Perform needle
decompression on the left chest
16. A 4-year-old is being treated for hypovolemic shock and has received a single fluid
bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a
heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4
seconds. What describes this patient's condition?
A. Hypotensive shock
B. Compensated shock
C. No longer in shock
D. Cardiogenic shock - answer-B. Compensated shock
17. An 8-year-old child had a sudden onset of palpitations and light-headedness. At the
time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood
pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted.
What is the most appropriate initial intervention?
A. Provide synchronized cardioversion at 0.5 to 1 J/kg
B. Attempt vagal maneuvers
C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone 5 mg/kg
over 20 minutes - answer-B. Attempt vagal maneuvers
18. A 10-year-old child had a sudden witnessed cardiac arrest and received immediate
bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous
circulation. The child remains unresponsive and has an advanced airway in place.
There is no history of trauma or signs of shock. What is the target range for oxygen
saturation for this child?
A. 92% to 100%
B. 92% to 99%
C. 94% to 99%
D. 94% to 100% - answer-C. 94% to 99%
. A 7-year-old child presents in pulseless arrest. The child's ECG shows the rhythm
below. Which of the following describes the patient's condition?
A. Ventricular escape rhythm
B. Ventricular tachycardia
C. Pulseless electrical activity
D. Sinus bradycardia - answer-C. Pulseless electrical activity
. A 12-year-old child suddenly collapses while playing sports. He is unresponsive and
not breathing. Emergency response is activated. The child has no pulse, and CPR is
initiated. An AED arrives. What is the most appropriate next intervention?
A. Contact the child's family
B. Provide CPR for 2 minutes
C. Drive the child to the hospital
D. Use the AED - answer-D. Use the AED
. A 6-year-old child is found unresponsive, not breathing, and pulseless. What is the
correct compression-to-ventilation ratio when 2 or more healthcare providers are
present to perform CPR? - answer-15:2
. A 5-year-old child has had severe respiratory distress for 2 days. During assessment
the child's heart rate decreases from 140/min to 90/min, and the child's respiratory rate
decreases from 66/min to 8/min. What intervention is most appropriate?
A. Provide rescue breaths at a rate of 12 to 20/min B. Provide rescue breaths at a rate
of 6 to 10/min
C. Initiate chest compressions at a rate of at least 100/min
D. Initiate chest compressions at a rate of 60/min - answer-B. Provide rescue breaths at
a rate of 12 to 20/min
A 7-year-old child presents with a narrow-complex supraventricular tachycardia,
lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be
established. What is the most appropriate intervention?
A. Unsynchronized shock with 0.5 to 1 J/kg
B. Synchronized shock with 0.5 to 1 J/kg
C. Unsynchronized shock with 2 J/kg
D. Synchronized shock with 2 J/kg - answer-B. Synchronized shock with 0.5 to 1 J/kg
1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color.
The primary assessment reveals that the airway is open and the respiratory rate is
30/min, with crackles heard on auscultation. The cardiac monitor shows sinus
tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of
95% and a pulse rate of 93/min. On the basis of this information, 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 - answer-D. Unreliable;
supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with
chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min,
respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less
than 2 seconds. What is the child's most likely condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
D. Cardiogenic shock - answer-A. Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood
pressure is 55/40 mm Hg. What term describes this infant's blood pressure?
A. Hypotensive
B. Normal
C. Hypertensive
D. Compensated - answer-A. Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine
at 0.1 mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - answer-C. Respectfully ask the team leader to clarify
the dose
5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - answer-A. Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and
wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - answer-C. Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures
stopped a few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - answer-D. Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory
distress caused by lung tissue disease?
A. Decreased oxygen saturation
,B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort - answer-A. Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is being
evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best
describe this patient's condition?
A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing - answer-A. Respiratory distress
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the
child has been febrile and has not been feeling well, with recent onset of lethargy.
Assessment reveals the following: The child is difficult to arouse, with pale color. The
child's heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg,
capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the
most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30
minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10
minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with
an oncologist to determine the chemotherapeutic regimen - answer-B. Obtain vascular
access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression
reveals an unresponsive child with intermittent apnea and mottled color. Heart rate is
166/min, respiratory rate is now being supported with bag-mask ventilation, capillary
refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method
of establishing immediate vascular access? A. Two providers may attempt peripheral
vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - answer-D. Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock
with adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
C. 20 mL/kg normal saline
D. 10 mL/kg lactated Ringer's - answer-C. 20 mL/kg normal saline
13. An alert toddler presents with a barking cough, moderate stridor, and moderate
retractions. The child's color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector - answer-B. Administer nebulized epinephrine
, 14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has
the following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure
9060 mm Hg, and temperature 98.6°F (37°C). The child's capillary refill time is 4
seconds. After 2 IV boluses of normal saline (20 mL/kg each), the child's vital signs are
now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94/62 mm
Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child's urine output is
1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or
information should be obtained first?
A. Arterial blood gas
B. Serum potassium concentration
C. Glucose
D. A 12-lead ECG - answer-C. Glucose
15. A 15-year-old boy presents with acute onset of severe respiratory distress, with
retractions and an oxygen saturation of 85%. His trachea is deviated to the right, and
there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is
84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate
intervention?
A. Obtain a chest x-ray
B. Perform needle decompression on the left chest
C. Insert a chest tube on the left side
D. Insert an IV and administer 20 mL/kg of normal saline - answer-B. Perform needle
decompression on the left chest
16. A 4-year-old is being treated for hypovolemic shock and has received a single fluid
bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a
heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4
seconds. What describes this patient's condition?
A. Hypotensive shock
B. Compensated shock
C. No longer in shock
D. Cardiogenic shock - answer-B. Compensated shock
17. An 8-year-old child had a sudden onset of palpitations and light-headedness. At the
time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood
pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted.
What is the most appropriate initial intervention?
A. Provide synchronized cardioversion at 0.5 to 1 J/kg
B. Attempt vagal maneuvers
C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone 5 mg/kg
over 20 minutes - answer-B. Attempt vagal maneuvers
18. A 10-year-old child had a sudden witnessed cardiac arrest and received immediate
bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous
circulation. The child remains unresponsive and has an advanced airway in place.
There is no history of trauma or signs of shock. What is the target range for oxygen
saturation for this child?
A. 92% to 100%
B. 92% to 99%
C. 94% to 99%
D. 94% to 100% - answer-C. 94% to 99%
