PALS – RED CROSS FINAL EXAM QUESTIONS
AND ANSWERS 2025/2026 QUESTIONS ND
CORRECT ANSWERS
Section 1: Pediatric Assessment & Initial Impression (Questions 1–30)
1. A 6yearold child presents with a barky cough, stridor, and increased work
of breathing. The provider notes the child is sitting upright and drooling. What
is the most likely diagnosis?
A) Asthma
B) Bronchiolitis
C) Epiglottitis
D) Croup
Correct Answer: C) Epiglottitis
Rationale: Epiglottitis presents with rapid onset of fever, drooling, stridor, and
a tripod position. Croup typically presents with a barky cough and stridor but
without drooling. Asthma presents with wheezing, and bronchiolitis typically
affects infants with wheezing and crackles.
2. A child is brought to the emergency department with respiratory distress.
The pediatric assessment triangle (PAT) reveals an abnormal appearance,
,abnormal work of breathing, and normal circulation. What is the most
appropriate next step?
A) Begin chest compressions
B) Provide immediate bagmask ventilation
C) Perform a primary assessment (ABCDE)
D) Obtain a detailed history
Correct Answer: C) Perform a primary assessment (ABCDE)
Rationale: The PAT provides a rapid initial impression. Abnormal appearance
and work of breathing indicate the child is unstable; the next step is a
systematic primary assessment to identify and treat lifethreatening issues.
3. During the initial assessment of an infant, which of the following is the best
indicator of adequate perfusion?
A) Capillary refill time greater than 3 seconds
B) Warm, dry skin
C) Strong distal pulses
D) Urine output less than 1 mL/kg/hour
Correct Answer: C) Strong distal pulses
Rationale: Strong distal pulses indicate adequate cardiac output and
perfusion. Capillary refill time greater than 3 seconds is abnormal, and cool or
mottled skin suggests poor perfusion.
,4. A 2yearold child presents with fever, lethargy, and a petechial rash. The
provider should be most concerned about:
A) Viral exanthem
B) Meningococcemia
C) Roseola
D) Handfootmouth disease
Correct Answer: B) Meningococcemia
Rationale: Fever with lethargy and a petechial or purpuric rash in a child is
concerning for meningococcemia, a lifethreatening bacterial infection
requiring immediate antibiotics and supportive care.
5. A 4yearold child is unresponsive with abnormal breathing. The provider
notes a weak central pulse at a rate of 50/min. What is the most appropriate
action?
A) Begin CPR with chest compressions
B) Provide 1 rescue breath every 35 seconds
C) Provide positive pressure ventilation and reassess
D) Administer epinephrine 0.01 mg/kg IV
Correct Answer: C) Provide positive pressure ventilation and reassess
Rationale: The child has a pulse but is bradycardic with abnormal breathing.
In PALS, bradycardia with poor perfusion requires airway and breathing
support. If the heart rate does not improve with oxygenation and ventilation,
further interventions may be needed.
, 6. A 7yearold child presents with respiratory distress. The provider assesses
oxygen saturation at 88% on room air. What is the appropriate initial
intervention?
A) Administer supplemental oxygen via nasal cannula
B) Intubate immediately
C) Perform a headtilt chinlift maneuver
D) Administer albuterol nebulizer treatment
Correct Answer: A) Administer supplemental oxygen via nasal cannula
Rationale: Oxygen saturation below 90% in a child with respiratory distress
warrants supplemental oxygen. Intubation is not the first step unless the child
is in impending respiratory failure.
7. Which of the following findings in a child would be most concerning for
compensated shock?
A) Hypotension
B) Tachycardia with normal blood pressure
C) Bradycardia with hypotension
D) Normal heart rate and blood pressure
Correct Answer: B) Tachycardia with normal blood pressure
AND ANSWERS 2025/2026 QUESTIONS ND
CORRECT ANSWERS
Section 1: Pediatric Assessment & Initial Impression (Questions 1–30)
1. A 6yearold child presents with a barky cough, stridor, and increased work
of breathing. The provider notes the child is sitting upright and drooling. What
is the most likely diagnosis?
A) Asthma
B) Bronchiolitis
C) Epiglottitis
D) Croup
Correct Answer: C) Epiglottitis
Rationale: Epiglottitis presents with rapid onset of fever, drooling, stridor, and
a tripod position. Croup typically presents with a barky cough and stridor but
without drooling. Asthma presents with wheezing, and bronchiolitis typically
affects infants with wheezing and crackles.
2. A child is brought to the emergency department with respiratory distress.
The pediatric assessment triangle (PAT) reveals an abnormal appearance,
,abnormal work of breathing, and normal circulation. What is the most
appropriate next step?
A) Begin chest compressions
B) Provide immediate bagmask ventilation
C) Perform a primary assessment (ABCDE)
D) Obtain a detailed history
Correct Answer: C) Perform a primary assessment (ABCDE)
Rationale: The PAT provides a rapid initial impression. Abnormal appearance
and work of breathing indicate the child is unstable; the next step is a
systematic primary assessment to identify and treat lifethreatening issues.
3. During the initial assessment of an infant, which of the following is the best
indicator of adequate perfusion?
A) Capillary refill time greater than 3 seconds
B) Warm, dry skin
C) Strong distal pulses
D) Urine output less than 1 mL/kg/hour
Correct Answer: C) Strong distal pulses
Rationale: Strong distal pulses indicate adequate cardiac output and
perfusion. Capillary refill time greater than 3 seconds is abnormal, and cool or
mottled skin suggests poor perfusion.
,4. A 2yearold child presents with fever, lethargy, and a petechial rash. The
provider should be most concerned about:
A) Viral exanthem
B) Meningococcemia
C) Roseola
D) Handfootmouth disease
Correct Answer: B) Meningococcemia
Rationale: Fever with lethargy and a petechial or purpuric rash in a child is
concerning for meningococcemia, a lifethreatening bacterial infection
requiring immediate antibiotics and supportive care.
5. A 4yearold child is unresponsive with abnormal breathing. The provider
notes a weak central pulse at a rate of 50/min. What is the most appropriate
action?
A) Begin CPR with chest compressions
B) Provide 1 rescue breath every 35 seconds
C) Provide positive pressure ventilation and reassess
D) Administer epinephrine 0.01 mg/kg IV
Correct Answer: C) Provide positive pressure ventilation and reassess
Rationale: The child has a pulse but is bradycardic with abnormal breathing.
In PALS, bradycardia with poor perfusion requires airway and breathing
support. If the heart rate does not improve with oxygenation and ventilation,
further interventions may be needed.
, 6. A 7yearold child presents with respiratory distress. The provider assesses
oxygen saturation at 88% on room air. What is the appropriate initial
intervention?
A) Administer supplemental oxygen via nasal cannula
B) Intubate immediately
C) Perform a headtilt chinlift maneuver
D) Administer albuterol nebulizer treatment
Correct Answer: A) Administer supplemental oxygen via nasal cannula
Rationale: Oxygen saturation below 90% in a child with respiratory distress
warrants supplemental oxygen. Intubation is not the first step unless the child
is in impending respiratory failure.
7. Which of the following findings in a child would be most concerning for
compensated shock?
A) Hypotension
B) Tachycardia with normal blood pressure
C) Bradycardia with hypotension
D) Normal heart rate and blood pressure
Correct Answer: B) Tachycardia with normal blood pressure
