PALS Final Exam Study Guide
2025-2026 Actual Exam
Pediatric Advanced Life
Support Certification 300
Verified Questions and 100%
Correct Answers A+ Graded
,SECTION 1: PEDIATRIC ASSESSMENT AND SYSTEMATIC
APPROACH
Question 1
A 3-year-old child is brought to the emergency department with lethargy, poor feeding,
and a fever of 102°F. The child's heart rate is 180 bpm, respiratory rate is 40 breaths per
minute, and blood pressure is 80/50 mmHg. Which of the following best describes the
child's condition?
A) Compensated shock
B) Hypotensive shock
C) Respiratory failure
D) Cardiac arrest
Answer: A) Compensated shock
Clinical Pearl: In compensated shock, the body maintains blood pressure through
compensatory mechanisms (tachycardia, increased systemic vascular resistance).
Hypotensive shock occurs when blood pressure drops below normal for age.
Rationale: This child has tachycardia (180 bpm, elevated for age), tachypnea, and fever
with signs of poor perfusion (lethargy, poor feeding). However, the blood pressure is
normal for a 3-year-old (normal systolic BP ≈ 90 + [2 × age] = 96 mmHg). Normal BP
with signs of poor perfusion indicates compensated shock. Hypotensive shock (B) would
be indicated by hypotension. Respiratory failure (C) would have primary respiratory
symptoms. Cardiac arrest (D) would be pulseless.
Question 2
A 6-month-old infant is brought to the clinic with a 2-day history of cough, congestion,
and fever. The infant has intercostal retractions, nasal flaring, and a respiratory rate of 70
breaths per minute. Oxygen saturation is 88% on room air. Which of the following is the
most appropriate initial intervention?
,A) Administer high-flow oxygen via nasal cannula
B) Administer albuterol nebulizer
C) Administer epinephrine IM
D) Perform chest physiotherapy
Answer: A) Administer high-flow oxygen via nasal cannula
Clinical Pearl: The pediatric assessment triangle (PAT) evaluates appearance, work of
breathing, and circulation. This infant has abnormal work of breathing (retractions, nasal
flaring) and hypoxemia, requiring immediate oxygen therapy.
Rationale: This infant has hypoxemia (SpO2 88%) with increased work of breathing. The
most appropriate initial intervention is supplemental oxygen. High-flow nasal cannula
can provide heated, humidified oxygen with some positive pressure. Albuterol (B) is not
indicated for bronchiolitis (likely diagnosis) as it has limited benefit. Epinephrine IM (C) is
for anaphylaxis or severe asthma, not bronchiolitis. Chest physiotherapy (D) is not first-
line.
Question 3
A 4-year-old child presents with a barking cough, stridor, and respiratory distress. The
child is sitting upright and drooling. Which of the following is the most appropriate
immediate intervention?
A) Administer racemic epinephrine
B) Administer dexamethasone
C) Prepare for endotracheal intubation
D) Perform a chest x-ray
Answer: C) Prepare for endotracheal intubation
Clinical Pearl: Stridor with drooling suggests epiglottitis, a life-threatening upper airway
obstruction. Epiglottitis has decreased in incidence since the Hib vaccine but remains a
critical airway emergency.
Rationale: The presence of stridor WITH drooling suggests epiglottitis (supraglottitis)
rather than croup. Epiglottitis is a medical emergency that can progress rapidly to
complete airway obstruction. The most appropriate intervention is to prepare for
endotracheal intubation by the most experienced provider. Racemic epinephrine (A) and
, dexamethasone (B) are used for croup. Chest x-ray (D) should not delay airway
management.
Question 4
A 2-year-old child is found unresponsive and not breathing. The child's parent reports
that the child was eating hot dogs moments before. Which of the following is the most
appropriate initial intervention?
A) Start CPR with chest compressions
B) Perform abdominal thrusts (Heimlich maneuver)
C) Perform back blows and chest thrusts
D) Attempt to visualize and remove the obstruction with a finger sweep
Answer: B) Perform abdominal thrusts (Heimlich maneuver)
Clinical Pearl: For a conscious child with severe airway obstruction (cannot cough,
speak, or breathe), abdominal thrusts are indicated. For an unconscious child, CPR is
initiated with chest compressions that can help dislodge the object.
Rationale: This child is unresponsive and not breathing. The history suggests foreign
body airway obstruction (FBAO). For an unresponsive child with suspected FBAO, the
appropriate intervention is to start CPR with chest compressions (A), as compressions
can generate pressure to dislodge the object. Abdominal thrusts (B) are for conscious
obstruction. Back blows and chest thrusts (C) are for infants <1 year. Finger sweeps (D)
are not recommended unless the object is visible.
Question 5
A 10-year-old child is in the pediatric intensive care unit on a ventilator. The high-
pressure alarm is sounding. Which of the following is the most likely cause?
A) Disconnected tubing
B) Patient biting the endotracheal tube
2025-2026 Actual Exam
Pediatric Advanced Life
Support Certification 300
Verified Questions and 100%
Correct Answers A+ Graded
,SECTION 1: PEDIATRIC ASSESSMENT AND SYSTEMATIC
APPROACH
Question 1
A 3-year-old child is brought to the emergency department with lethargy, poor feeding,
and a fever of 102°F. The child's heart rate is 180 bpm, respiratory rate is 40 breaths per
minute, and blood pressure is 80/50 mmHg. Which of the following best describes the
child's condition?
A) Compensated shock
B) Hypotensive shock
C) Respiratory failure
D) Cardiac arrest
Answer: A) Compensated shock
Clinical Pearl: In compensated shock, the body maintains blood pressure through
compensatory mechanisms (tachycardia, increased systemic vascular resistance).
Hypotensive shock occurs when blood pressure drops below normal for age.
Rationale: This child has tachycardia (180 bpm, elevated for age), tachypnea, and fever
with signs of poor perfusion (lethargy, poor feeding). However, the blood pressure is
normal for a 3-year-old (normal systolic BP ≈ 90 + [2 × age] = 96 mmHg). Normal BP
with signs of poor perfusion indicates compensated shock. Hypotensive shock (B) would
be indicated by hypotension. Respiratory failure (C) would have primary respiratory
symptoms. Cardiac arrest (D) would be pulseless.
Question 2
A 6-month-old infant is brought to the clinic with a 2-day history of cough, congestion,
and fever. The infant has intercostal retractions, nasal flaring, and a respiratory rate of 70
breaths per minute. Oxygen saturation is 88% on room air. Which of the following is the
most appropriate initial intervention?
,A) Administer high-flow oxygen via nasal cannula
B) Administer albuterol nebulizer
C) Administer epinephrine IM
D) Perform chest physiotherapy
Answer: A) Administer high-flow oxygen via nasal cannula
Clinical Pearl: The pediatric assessment triangle (PAT) evaluates appearance, work of
breathing, and circulation. This infant has abnormal work of breathing (retractions, nasal
flaring) and hypoxemia, requiring immediate oxygen therapy.
Rationale: This infant has hypoxemia (SpO2 88%) with increased work of breathing. The
most appropriate initial intervention is supplemental oxygen. High-flow nasal cannula
can provide heated, humidified oxygen with some positive pressure. Albuterol (B) is not
indicated for bronchiolitis (likely diagnosis) as it has limited benefit. Epinephrine IM (C) is
for anaphylaxis or severe asthma, not bronchiolitis. Chest physiotherapy (D) is not first-
line.
Question 3
A 4-year-old child presents with a barking cough, stridor, and respiratory distress. The
child is sitting upright and drooling. Which of the following is the most appropriate
immediate intervention?
A) Administer racemic epinephrine
B) Administer dexamethasone
C) Prepare for endotracheal intubation
D) Perform a chest x-ray
Answer: C) Prepare for endotracheal intubation
Clinical Pearl: Stridor with drooling suggests epiglottitis, a life-threatening upper airway
obstruction. Epiglottitis has decreased in incidence since the Hib vaccine but remains a
critical airway emergency.
Rationale: The presence of stridor WITH drooling suggests epiglottitis (supraglottitis)
rather than croup. Epiglottitis is a medical emergency that can progress rapidly to
complete airway obstruction. The most appropriate intervention is to prepare for
endotracheal intubation by the most experienced provider. Racemic epinephrine (A) and
, dexamethasone (B) are used for croup. Chest x-ray (D) should not delay airway
management.
Question 4
A 2-year-old child is found unresponsive and not breathing. The child's parent reports
that the child was eating hot dogs moments before. Which of the following is the most
appropriate initial intervention?
A) Start CPR with chest compressions
B) Perform abdominal thrusts (Heimlich maneuver)
C) Perform back blows and chest thrusts
D) Attempt to visualize and remove the obstruction with a finger sweep
Answer: B) Perform abdominal thrusts (Heimlich maneuver)
Clinical Pearl: For a conscious child with severe airway obstruction (cannot cough,
speak, or breathe), abdominal thrusts are indicated. For an unconscious child, CPR is
initiated with chest compressions that can help dislodge the object.
Rationale: This child is unresponsive and not breathing. The history suggests foreign
body airway obstruction (FBAO). For an unresponsive child with suspected FBAO, the
appropriate intervention is to start CPR with chest compressions (A), as compressions
can generate pressure to dislodge the object. Abdominal thrusts (B) are for conscious
obstruction. Back blows and chest thrusts (C) are for infants <1 year. Finger sweeps (D)
are not recommended unless the object is visible.
Question 5
A 10-year-old child is in the pediatric intensive care unit on a ventilator. The high-
pressure alarm is sounding. Which of the following is the most likely cause?
A) Disconnected tubing
B) Patient biting the endotracheal tube
