AHA PALS Provider Exam 2025/2026
– Verified Questions and Correct
Answers with Rationales
Question 1
What is the first step in the PALS systematic approach algorithm when encountering a pediatric
patient in an emergency?
A. Administer oxygen
B. Perform a primary assessment
C. Obtain vital signs
D. Initiate CPR
Correct Answer: B. Perform a primary assessment
Rationale: The PALS systematic approach begins with a primary assessment to evaluate the
child’s condition using the ABCDE framework (Airway, Breathing, Circulation, Disability,
Exposure). This structured assessment helps identify life-threatening conditions and guides
subsequent interventions. Administering oxygen, obtaining vital signs, or initiating CPR may
follow based on the findings but are not the first step.
Question 2
A 4-year-old child is unresponsive, apneic, and pulseless. What is the appropriate compression-
to-ventilation ratio for one-rescuer CPR?
A. 15:2
B. 30:2
C. 5:1
D. 3:1
Correct Answer: B. 30:2
Rationale: For one-rescuer CPR in pediatric patients, the AHA recommends a compression-to-
ventilation ratio of 30:2, consistent with adult guidelines, to balance adequate circulation and
oxygenation. The 15:2 ratio is used for two-rescuer CPR in children to allow more frequent
ventilations due to higher metabolic demands.
,Question 3
Which of the following is the recommended initial dose of epinephrine for a pediatric patient in
cardiac arrest?
A. 0.1 mg/kg IV/IO
B. 0.01 mg/kg IV/IO
C. 0.001 mg/kg IV/IO
D. 1 mg/kg IV/IO
Correct Answer: B. 0.01 mg/kg IV/IO
Rationale: The AHA PALS guidelines recommend an initial epinephrine dose of 0.01 mg/kg
(0.1 mL/kg of 1:10,000 solution) administered intravenously (IV) or intraosseously (IO) every 3–
5 minutes during cardiac arrest. Higher doses (e.g., 0.1 mg/kg) were historically used but are no
longer recommended due to lack of evidence for improved outcomes.
Question 4
A 6-year-old child presents with severe respiratory distress and stridor at rest. What is the most
likely cause?
A. Asthma
B. Pneumonia
C. Foreign body aspiration
D. Bronchiolitis
Correct Answer: C. Foreign body aspiration
Rationale: Stridor at rest in a pediatric patient suggests upper airway obstruction, commonly
caused by foreign body aspiration, especially in young children. Asthma typically presents with
wheezing, pneumonia with fever and crackles, and bronchiolitis with wheezing and nasal flaring
in younger infants.
Question 5
What is the recommended depth of chest compressions for a 2-year-old child during CPR?
A. At least one-third the depth of the chest
B. At least one-half the depth of the chest
,C. At least two-thirds the depth of the chest
D. At least 2 inches regardless of chest size
Correct Answer: A. At least one-third the depth of the chest
Rationale: For pediatric patients, the AHA recommends chest compressions to a depth of at least
one-third the anterior-posterior diameter of the chest (approximately 1.5 inches in infants and 2
inches in children). This ensures adequate circulation without excessive force that could cause
injury.
Question 6
A 3-year-old child is in ventricular fibrillation. What is the initial defibrillation dose?
A. 2 J/kg
B. 4 J/kg
C. 10 J/kg
D. 1 J/kg
Correct Answer: A. 2 J/kg
Rationale: The initial defibrillation dose for pediatric ventricular fibrillation or pulseless
ventricular tachycardia is 2 J/kg using a manual defibrillator. Subsequent doses may increase to 4
J/kg if needed, but the initial dose is lower to minimize myocardial injury.
Question 7
What is the preferred method for delivering ventilations to an infant with a pulse but inadequate
breathing?
A. Mouth-to-mouth ventilation
B. Bag-mask ventilation
C. Endotracheal intubation
D. Non-rebreather mask
Correct Answer: B. Bag-mask ventilation
Rationale: Bag-mask ventilation is the preferred method for delivering ventilations in a pediatric
patient with inadequate breathing but a pulse. It is non-invasive, effective, and allows precise
control of ventilation. Endotracheal intubation is reserved for cases where bag-mask ventilation
is inadequate or prolonged support is needed.
, Question 8
A 5-year-old child is in septic shock. What is the initial fluid bolus volume recommended?
A. 10 mL/kg of isotonic crystalloid
B. 20 mL/kg of isotonic crystalloid
C. 5 mL/kg of isotonic crystalloid
D. 30 mL/kg of isotonic crystalloid
Correct Answer: B. 20 mL/kg of isotonic crystalloid
Rationale: In pediatric septic shock, the AHA recommends an initial fluid bolus of 20 mL/kg of
isotonic crystalloid (e.g., normal saline or lactated Ringer’s) administered rapidly to restore
perfusion. This can be repeated based on reassessment, with careful monitoring for fluid
overload.
Question 9
Which rhythm requires immediate defibrillation in a pediatric patient?
A. Supraventricular tachycardia
B. Ventricular tachycardia with a pulse
C. Pulseless ventricular tachycardia
D. Sinus bradycardia
Correct Answer: C. Pulseless ventricular tachycardia
Rationale: Pulseless ventricular tachycardia (VT) is a shockable rhythm requiring immediate
defibrillation to restore a perfusing rhythm. Supraventricular tachycardia and VT with a pulse
may require cardioversion if unstable, while sinus bradycardia is managed with oxygenation and
ventilation initially.
Question 10
What is the recommended rate of chest compressions for a pediatric patient during CPR?
A. 60–80 compressions per minute
B. 80–100 compressions per minute
C. 100–120 compressions per minute
D. 120–140 compressions per minute
– Verified Questions and Correct
Answers with Rationales
Question 1
What is the first step in the PALS systematic approach algorithm when encountering a pediatric
patient in an emergency?
A. Administer oxygen
B. Perform a primary assessment
C. Obtain vital signs
D. Initiate CPR
Correct Answer: B. Perform a primary assessment
Rationale: The PALS systematic approach begins with a primary assessment to evaluate the
child’s condition using the ABCDE framework (Airway, Breathing, Circulation, Disability,
Exposure). This structured assessment helps identify life-threatening conditions and guides
subsequent interventions. Administering oxygen, obtaining vital signs, or initiating CPR may
follow based on the findings but are not the first step.
Question 2
A 4-year-old child is unresponsive, apneic, and pulseless. What is the appropriate compression-
to-ventilation ratio for one-rescuer CPR?
A. 15:2
B. 30:2
C. 5:1
D. 3:1
Correct Answer: B. 30:2
Rationale: For one-rescuer CPR in pediatric patients, the AHA recommends a compression-to-
ventilation ratio of 30:2, consistent with adult guidelines, to balance adequate circulation and
oxygenation. The 15:2 ratio is used for two-rescuer CPR in children to allow more frequent
ventilations due to higher metabolic demands.
,Question 3
Which of the following is the recommended initial dose of epinephrine for a pediatric patient in
cardiac arrest?
A. 0.1 mg/kg IV/IO
B. 0.01 mg/kg IV/IO
C. 0.001 mg/kg IV/IO
D. 1 mg/kg IV/IO
Correct Answer: B. 0.01 mg/kg IV/IO
Rationale: The AHA PALS guidelines recommend an initial epinephrine dose of 0.01 mg/kg
(0.1 mL/kg of 1:10,000 solution) administered intravenously (IV) or intraosseously (IO) every 3–
5 minutes during cardiac arrest. Higher doses (e.g., 0.1 mg/kg) were historically used but are no
longer recommended due to lack of evidence for improved outcomes.
Question 4
A 6-year-old child presents with severe respiratory distress and stridor at rest. What is the most
likely cause?
A. Asthma
B. Pneumonia
C. Foreign body aspiration
D. Bronchiolitis
Correct Answer: C. Foreign body aspiration
Rationale: Stridor at rest in a pediatric patient suggests upper airway obstruction, commonly
caused by foreign body aspiration, especially in young children. Asthma typically presents with
wheezing, pneumonia with fever and crackles, and bronchiolitis with wheezing and nasal flaring
in younger infants.
Question 5
What is the recommended depth of chest compressions for a 2-year-old child during CPR?
A. At least one-third the depth of the chest
B. At least one-half the depth of the chest
,C. At least two-thirds the depth of the chest
D. At least 2 inches regardless of chest size
Correct Answer: A. At least one-third the depth of the chest
Rationale: For pediatric patients, the AHA recommends chest compressions to a depth of at least
one-third the anterior-posterior diameter of the chest (approximately 1.5 inches in infants and 2
inches in children). This ensures adequate circulation without excessive force that could cause
injury.
Question 6
A 3-year-old child is in ventricular fibrillation. What is the initial defibrillation dose?
A. 2 J/kg
B. 4 J/kg
C. 10 J/kg
D. 1 J/kg
Correct Answer: A. 2 J/kg
Rationale: The initial defibrillation dose for pediatric ventricular fibrillation or pulseless
ventricular tachycardia is 2 J/kg using a manual defibrillator. Subsequent doses may increase to 4
J/kg if needed, but the initial dose is lower to minimize myocardial injury.
Question 7
What is the preferred method for delivering ventilations to an infant with a pulse but inadequate
breathing?
A. Mouth-to-mouth ventilation
B. Bag-mask ventilation
C. Endotracheal intubation
D. Non-rebreather mask
Correct Answer: B. Bag-mask ventilation
Rationale: Bag-mask ventilation is the preferred method for delivering ventilations in a pediatric
patient with inadequate breathing but a pulse. It is non-invasive, effective, and allows precise
control of ventilation. Endotracheal intubation is reserved for cases where bag-mask ventilation
is inadequate or prolonged support is needed.
, Question 8
A 5-year-old child is in septic shock. What is the initial fluid bolus volume recommended?
A. 10 mL/kg of isotonic crystalloid
B. 20 mL/kg of isotonic crystalloid
C. 5 mL/kg of isotonic crystalloid
D. 30 mL/kg of isotonic crystalloid
Correct Answer: B. 20 mL/kg of isotonic crystalloid
Rationale: In pediatric septic shock, the AHA recommends an initial fluid bolus of 20 mL/kg of
isotonic crystalloid (e.g., normal saline or lactated Ringer’s) administered rapidly to restore
perfusion. This can be repeated based on reassessment, with careful monitoring for fluid
overload.
Question 9
Which rhythm requires immediate defibrillation in a pediatric patient?
A. Supraventricular tachycardia
B. Ventricular tachycardia with a pulse
C. Pulseless ventricular tachycardia
D. Sinus bradycardia
Correct Answer: C. Pulseless ventricular tachycardia
Rationale: Pulseless ventricular tachycardia (VT) is a shockable rhythm requiring immediate
defibrillation to restore a perfusing rhythm. Supraventricular tachycardia and VT with a pulse
may require cardioversion if unstable, while sinus bradycardia is managed with oxygenation and
ventilation initially.
Question 10
What is the recommended rate of chest compressions for a pediatric patient during CPR?
A. 60–80 compressions per minute
B. 80–100 compressions per minute
C. 100–120 compressions per minute
D. 120–140 compressions per minute
