PALS TEST CERTIFICATION SCRIPT
2026 QUESTIONS WITH SOLUTIONS
GRADED A+
◍ 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: 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: Septic shock
◍ AHA Child (1 y.o.-puberty) 1-Rescuer CPR.
Answer: 1. Check responsiveness2. Assess breathing
, (gasping/agonal/absent) & carotid/femoral pulse simultaneously Abnormal
breathing WITH pulse: Breaths only q2-3sec with pulse check q2min; stop
steps HR < 60/min with poor perfusion despite oxygenation and
ventilation: CPR indicated; continue steps No definite pulse within 10 sec:
CPR indicated; continue steps3(a). WITNESSED COLLAPSE: Activate
emergency response system & retrieve AED3(b). NOT WITNESSED:
Begin CPR (Steps 5-8) immediately → after 2 mins (5 cycles), leave to
activate emergency response system & retrieve AED4. Apply AED pads to
bare skin → turn on prompts → hands-off the child when rhythm check
prompted (~q2min) → after shock delivery or no shock advised,
begin/resume CPR (Steps 5-8)5. Chest Compressions X 30 (100-120/min;
~2 in)- Place child on a hard, flat surface → place heel of one hand on lower
sternum and heel of other hand on top of first hand → compress 1/3 AP
diameter6. Open Airway- Head Tilt-Chin Lift: Place one palm on child's
forehead and fingers of other hand under bony part of lower jaw, near chin
(avoiding soft tissue) → push palm to tilt the head back while lifting chin
forward- Jaw Thrust: Position yourself at head → place one hand on each
side of head with fingers under the angle of lower jaw → lift jaw forward →
use your thumbs to push lower lip down *Jaw must be tried FIRST if you
suspect a head or spinal injury to reduce spine movement7. Breaths X 2-
Place your mouth over child's mouth to create an airtight seal → blow
breath for ~1 sec → watch for chest rise → second breath- If no chest rise,
repeat head tilt-chin lift to reopen airway & try again8. Continue alternating
30 compressions-2 breaths with AED rhythm checks/shocks until
professionals arrive
◍ 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: 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: Respectfully ask the team leader to clarify the dose
◍ AHA Child (1 y.o.-puberty) Bag Mask Device.
Answer: 1. Select a transparent mask that covers the mouth and nose
completely without covering the eyes or overlapping the chin2. Select a
self-inflating bag with enough volume to achieve chest rise- Infants/Young
Children: at least 450-500 mL- Older Children/Adolescents: 1000+ mL3.
Check the bag for leaks by occluding the patient outlet valve with your hand
and squeezing the bag4. Connect supplemental oxygen when available5.
Perform a head tilt-chin lift to open the airway. Press the mask to the face as
you lift the jaw, making a seal between the child's face and the mask by
using the E-C clamp technique (pictured)6(a). ALONE: With the other
hand, squeeze the ventilation bag until the chest rises, delivering each breath
over 1 sec6(b). 2 PROVIDERS:- 1 will do step 5 with both hands- 1 will
squeeze the ventilation bag until the chest rises, delivering each breath over
1 sec
◍ 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: Inadequate oxygenation and/or ventilation
◍ AHA Relief of Child (1 y.o.-puberty) Choking: Responsive.
Answer: 1. Ask, "Are you choking?" If the child nods or otherwise indicates
"yes," say you're going to help- Making no sound, unable to cough, has poor
, or no air exchange, makes a high-pitched noise while inhaling or no noise at
all, and/or has increased respiratory difficulty2. Activate emergency
response system in case the child becomes unresponsive3. Back Blows X 5-
Use the heel of your hand and forcefully strike the child's back in between
their shoulder blades 5 times5. Abdominal Thrusts X 5 (if back blows did
not relieve choking)- Stand/kneel behind the child and wrap your arms
around the child's waist → make a fist with one hand → place the thumb
side of your fist against the child's abdomen slightly above the navel and
well below the sternum → grasp your fist with your other hand and press
your fist into the child's abdomen with a quick, forceful upward thrust 5
times6. Continue alternating 5 back blows-5 abdominal thrusts until the
object is dislodged or the child becomes unresponsive
◍ 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: 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: 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
2026 QUESTIONS WITH SOLUTIONS
GRADED A+
◍ 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: 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: Septic shock
◍ AHA Child (1 y.o.-puberty) 1-Rescuer CPR.
Answer: 1. Check responsiveness2. Assess breathing
, (gasping/agonal/absent) & carotid/femoral pulse simultaneously Abnormal
breathing WITH pulse: Breaths only q2-3sec with pulse check q2min; stop
steps HR < 60/min with poor perfusion despite oxygenation and
ventilation: CPR indicated; continue steps No definite pulse within 10 sec:
CPR indicated; continue steps3(a). WITNESSED COLLAPSE: Activate
emergency response system & retrieve AED3(b). NOT WITNESSED:
Begin CPR (Steps 5-8) immediately → after 2 mins (5 cycles), leave to
activate emergency response system & retrieve AED4. Apply AED pads to
bare skin → turn on prompts → hands-off the child when rhythm check
prompted (~q2min) → after shock delivery or no shock advised,
begin/resume CPR (Steps 5-8)5. Chest Compressions X 30 (100-120/min;
~2 in)- Place child on a hard, flat surface → place heel of one hand on lower
sternum and heel of other hand on top of first hand → compress 1/3 AP
diameter6. Open Airway- Head Tilt-Chin Lift: Place one palm on child's
forehead and fingers of other hand under bony part of lower jaw, near chin
(avoiding soft tissue) → push palm to tilt the head back while lifting chin
forward- Jaw Thrust: Position yourself at head → place one hand on each
side of head with fingers under the angle of lower jaw → lift jaw forward →
use your thumbs to push lower lip down *Jaw must be tried FIRST if you
suspect a head or spinal injury to reduce spine movement7. Breaths X 2-
Place your mouth over child's mouth to create an airtight seal → blow
breath for ~1 sec → watch for chest rise → second breath- If no chest rise,
repeat head tilt-chin lift to reopen airway & try again8. Continue alternating
30 compressions-2 breaths with AED rhythm checks/shocks until
professionals arrive
◍ 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: 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: Respectfully ask the team leader to clarify the dose
◍ AHA Child (1 y.o.-puberty) Bag Mask Device.
Answer: 1. Select a transparent mask that covers the mouth and nose
completely without covering the eyes or overlapping the chin2. Select a
self-inflating bag with enough volume to achieve chest rise- Infants/Young
Children: at least 450-500 mL- Older Children/Adolescents: 1000+ mL3.
Check the bag for leaks by occluding the patient outlet valve with your hand
and squeezing the bag4. Connect supplemental oxygen when available5.
Perform a head tilt-chin lift to open the airway. Press the mask to the face as
you lift the jaw, making a seal between the child's face and the mask by
using the E-C clamp technique (pictured)6(a). ALONE: With the other
hand, squeeze the ventilation bag until the chest rises, delivering each breath
over 1 sec6(b). 2 PROVIDERS:- 1 will do step 5 with both hands- 1 will
squeeze the ventilation bag until the chest rises, delivering each breath over
1 sec
◍ 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: Inadequate oxygenation and/or ventilation
◍ AHA Relief of Child (1 y.o.-puberty) Choking: Responsive.
Answer: 1. Ask, "Are you choking?" If the child nods or otherwise indicates
"yes," say you're going to help- Making no sound, unable to cough, has poor
, or no air exchange, makes a high-pitched noise while inhaling or no noise at
all, and/or has increased respiratory difficulty2. Activate emergency
response system in case the child becomes unresponsive3. Back Blows X 5-
Use the heel of your hand and forcefully strike the child's back in between
their shoulder blades 5 times5. Abdominal Thrusts X 5 (if back blows did
not relieve choking)- Stand/kneel behind the child and wrap your arms
around the child's waist → make a fist with one hand → place the thumb
side of your fist against the child's abdomen slightly above the navel and
well below the sternum → grasp your fist with your other hand and press
your fist into the child's abdomen with a quick, forceful upward thrust 5
times6. Continue alternating 5 back blows-5 abdominal thrusts until the
object is dislodged or the child becomes unresponsive
◍ 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: 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: 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
