AHA PALS EXAM 2025 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) | PROFESSOR VERIFIED | LATEST
VERSION (JUST RELEASED)
Introduction
This 2025 AHA PALS (Pediatric Advanced Life Support) provider-level simulation
reproduces the exact question count and cognitive complexity of the live American
Heart Association exam. Content spans pediatric assessment, respiratory emergencies,
shock, cardiac arrest & resuscitation algorithms, rhythm disturbances, electrical
therapy, pharmacology, and post-arrest care/team dynamics. Every item is original,
scenario-based, and aligned with the 2025 AHA PALS guidelines to support mastery-
level performance.
General Instructions
• 57 multiple-choice items (matches live PALS provider exam length)
• Four-option, clinically nuanced stems
• One bold-face Adobe Devanagari answer; concise guideline-based rationale
• Clean Markdown only—no color, no files
Examination
Question 1:
An 8-year-old (25 kg) is pulled unconscious from a swimming pool. Pulse is palpable at
60 bpm with gasping respirations. EMS is 8 minutes away. Which action is most
appropriate?
A. Begin chest compressions at 100–120/min
B. Provide 1 rescue breath every 2–3 seconds
C. Start 30:2 compressions:ventilations
D. Apply AED pads immediately
Answer: B. Provide 1 rescue breath every 2–3 seconds
Solution: Bradycardia (≤ 60 bpm) with poor perfusion is the compression threshold;
here pulse is palpable—support airway & breathing (pediatric BLS sequence 2025).
pg. 1
,Question 2:
A 3-year-old (15 kg) in the ED has severe respiratory distress, SpO₂ 86 % on room air.
Auscultation reveals diffuse wheezing. Which immediate intervention is best?
A. High-flow nasal cannula at 2 L/kg/min
B. Nebulized albuterol 2.5 mg via mask
C. Rapid sequence intubation with 4 mg/kg ketamine
D. Epinephrine 0.01 mg/kg IM
Answer: B. Nebulized albuterol 2.5 mg via mask
Solution: Bronchodilator is first-line for wheeze in a stable but distressed child; high-
flow (A) is second-line, intubation (C) if respiratory failure.
Question 3:
During bag-mask ventilation a child’s chest does not rise. Head is tilted, jaw lifted, no
secretions. Next step?
A. Insert oral airway and increase rate
B. Reposition airway, attempt 2-person technique
C. Proceed directly to intubation
D. Perform needle cricothyrotomy
Answer: B. Reposition airway, attempt 2-person technique
Solution: PALS airway algorithm emphasizes airway repositioning and seal
improvement before escalating; 2-person BMV improves tidal volume.
Question 4:
A 6-year-old (20 kg) develops wide-complex tachycardia at 200 bpm, BP 60/30, altered.
Vascular access is obtained. Which ordered drug dose is correct?
A. Adenosine 0.1 mg/kg rapid push (max 6 mg)
B. Amiodarone 5 mg/kg over 20 min
C. Epinephrine 0.01 mg/kg IV
D. Synchronized cardioversion 0.5 J/kg
Answer: D. Synchronized cardioversion 0.5 J/kg
Solution: Hypotensive unstable VT → immediate synchronized cardioversion (0.5–1
J/kg); adenosine is for narrow-complex re-entry.
Question 5:
Epinephrine dosing for pediatric asystole is:
A. 0.01 mg/kg IV every 3–5 min
B. 0.1 mg/kg IV every 3–5 min
pg. 2
, C. 0.01 mg/kg via ETT every minute
D. 1 mg IV (adult dose) for > 8 yrs
Answer: A. 0.01 mg/kg IV every 3–5 min
Solution: Standard cardiac arrest dose 0.01 mg/kg (0.1 mL/kg of 1:10 000) IV/IO q3–5
min; high-dose (0.1 mg/kg) is no longer routine.
Question 6:
A 4-year-old (17 kg) post-tonsillectomy has sudden bleeding and HR 180, BP 70/30, cap
refill 5 s. Estimated blood loss 20 %; lungs clear. This child is in which PALS shock
category?
A. Compensated shock
B. Hypotensive (decompensated) shock
C. Distributive shock
D. Irreversible shock
Answer: B. Hypotensive (decompensated) shock
Solution: Hypotension for age (4 y norm ~90 systolic) + delayed cap refill defines
decompensated hemorrhagic shock.
Question 7:
Initial fluid resuscitation for the above child is:
A. 250 mL 0.9 % saline over 15 min
B. 340 mL LR over 15 min
C. 170 mL D5½NS over 5 min
D. 10 mL/kg blood transfusion immediately
Answer: B. 340 mL LR over 15 min
Solution: Shock fluid bolus = 20 mL/kg (17 kg × 20 = 340 mL) isotonic crystalloid;
repeat as needed before blood.
Question 8:
A 1-year-old (10 kg) ingests 10 tablets of grandma’s verapamil 120 mg. HR 50, BP
70/40. Which antidote/dose is appropriate?
A. Glucagon 1 mg IV
B. Calcium chloride 10 mg/kg IV
C. High-dose insulin 1 unit/kg/h
D. Atropine 0.02 mg/kg IV
Answer: B. Calcium chloride 10 mg/kg IV
Solution: Calcium channel blocker toxicity → calcium salts reverse hypotension; give
10–20 mg/kg CaCl (or 30–60 Ca-gluconate) bolus.
pg. 3
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) | PROFESSOR VERIFIED | LATEST
VERSION (JUST RELEASED)
Introduction
This 2025 AHA PALS (Pediatric Advanced Life Support) provider-level simulation
reproduces the exact question count and cognitive complexity of the live American
Heart Association exam. Content spans pediatric assessment, respiratory emergencies,
shock, cardiac arrest & resuscitation algorithms, rhythm disturbances, electrical
therapy, pharmacology, and post-arrest care/team dynamics. Every item is original,
scenario-based, and aligned with the 2025 AHA PALS guidelines to support mastery-
level performance.
General Instructions
• 57 multiple-choice items (matches live PALS provider exam length)
• Four-option, clinically nuanced stems
• One bold-face Adobe Devanagari answer; concise guideline-based rationale
• Clean Markdown only—no color, no files
Examination
Question 1:
An 8-year-old (25 kg) is pulled unconscious from a swimming pool. Pulse is palpable at
60 bpm with gasping respirations. EMS is 8 minutes away. Which action is most
appropriate?
A. Begin chest compressions at 100–120/min
B. Provide 1 rescue breath every 2–3 seconds
C. Start 30:2 compressions:ventilations
D. Apply AED pads immediately
Answer: B. Provide 1 rescue breath every 2–3 seconds
Solution: Bradycardia (≤ 60 bpm) with poor perfusion is the compression threshold;
here pulse is palpable—support airway & breathing (pediatric BLS sequence 2025).
pg. 1
,Question 2:
A 3-year-old (15 kg) in the ED has severe respiratory distress, SpO₂ 86 % on room air.
Auscultation reveals diffuse wheezing. Which immediate intervention is best?
A. High-flow nasal cannula at 2 L/kg/min
B. Nebulized albuterol 2.5 mg via mask
C. Rapid sequence intubation with 4 mg/kg ketamine
D. Epinephrine 0.01 mg/kg IM
Answer: B. Nebulized albuterol 2.5 mg via mask
Solution: Bronchodilator is first-line for wheeze in a stable but distressed child; high-
flow (A) is second-line, intubation (C) if respiratory failure.
Question 3:
During bag-mask ventilation a child’s chest does not rise. Head is tilted, jaw lifted, no
secretions. Next step?
A. Insert oral airway and increase rate
B. Reposition airway, attempt 2-person technique
C. Proceed directly to intubation
D. Perform needle cricothyrotomy
Answer: B. Reposition airway, attempt 2-person technique
Solution: PALS airway algorithm emphasizes airway repositioning and seal
improvement before escalating; 2-person BMV improves tidal volume.
Question 4:
A 6-year-old (20 kg) develops wide-complex tachycardia at 200 bpm, BP 60/30, altered.
Vascular access is obtained. Which ordered drug dose is correct?
A. Adenosine 0.1 mg/kg rapid push (max 6 mg)
B. Amiodarone 5 mg/kg over 20 min
C. Epinephrine 0.01 mg/kg IV
D. Synchronized cardioversion 0.5 J/kg
Answer: D. Synchronized cardioversion 0.5 J/kg
Solution: Hypotensive unstable VT → immediate synchronized cardioversion (0.5–1
J/kg); adenosine is for narrow-complex re-entry.
Question 5:
Epinephrine dosing for pediatric asystole is:
A. 0.01 mg/kg IV every 3–5 min
B. 0.1 mg/kg IV every 3–5 min
pg. 2
, C. 0.01 mg/kg via ETT every minute
D. 1 mg IV (adult dose) for > 8 yrs
Answer: A. 0.01 mg/kg IV every 3–5 min
Solution: Standard cardiac arrest dose 0.01 mg/kg (0.1 mL/kg of 1:10 000) IV/IO q3–5
min; high-dose (0.1 mg/kg) is no longer routine.
Question 6:
A 4-year-old (17 kg) post-tonsillectomy has sudden bleeding and HR 180, BP 70/30, cap
refill 5 s. Estimated blood loss 20 %; lungs clear. This child is in which PALS shock
category?
A. Compensated shock
B. Hypotensive (decompensated) shock
C. Distributive shock
D. Irreversible shock
Answer: B. Hypotensive (decompensated) shock
Solution: Hypotension for age (4 y norm ~90 systolic) + delayed cap refill defines
decompensated hemorrhagic shock.
Question 7:
Initial fluid resuscitation for the above child is:
A. 250 mL 0.9 % saline over 15 min
B. 340 mL LR over 15 min
C. 170 mL D5½NS over 5 min
D. 10 mL/kg blood transfusion immediately
Answer: B. 340 mL LR over 15 min
Solution: Shock fluid bolus = 20 mL/kg (17 kg × 20 = 340 mL) isotonic crystalloid;
repeat as needed before blood.
Question 8:
A 1-year-old (10 kg) ingests 10 tablets of grandma’s verapamil 120 mg. HR 50, BP
70/40. Which antidote/dose is appropriate?
A. Glucagon 1 mg IV
B. Calcium chloride 10 mg/kg IV
C. High-dose insulin 1 unit/kg/h
D. Atropine 0.02 mg/kg IV
Answer: B. Calcium chloride 10 mg/kg IV
Solution: Calcium channel blocker toxicity → calcium salts reverse hypotension; give
10–20 mg/kg CaCl (or 30–60 Ca-gluconate) bolus.
pg. 3
