AHA PALS Exam : 150 Questions with Answers & Rationales | Pediatric Advanced Life Support

AHA PALS Exam Questions & Answers 2026/2027
AHA PALS - AMERICAN HEART ASSOCIATION |
Pediatric Advanced Life Support
Questions & Verified Solutions with Detailed Rationales




SECTION 1: PEDIATRIC ADVANCED LIFE SUPPORT (PALS)


Question 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?

1) Reliable; no supplementary oxygen is indicated
2) Reliable; supplementary oxygen should be administered
3) Unreliable; no supplementary oxygen is indicated
4) Unreliable; supplementary oxygen should be administered

Correct Answer: 4) Unreliable; supplementary oxygen should be administered

Rationale: The pulse oximeter reading is unreliable because the displayed
pulse rate (93/min) does not match the monitor's heart rate (165/min),
indicating poor perfusion or motion artifact. Oxygen should be administered
while addressing the underlying respiratory distress.




Question 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?

1) Septic shock

,2) Hypovolemic shock
3) Significant bradycardia
4) Cardiogenic shock

Correct Answer: 1) Septic shock

Rationale: This immunocompromised child with fever, tachycardia, tachypnea,
and hypotension (85/40) shows signs of septic shock. Early recognition and
antibiotic administration are critical.


Question 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?

1) Hypotensive
2) Normal
3) Hypertensive
4) Compensated

Correct Answer: 1) Hypotensive

Rationale: Normal systolic BP for a neonate is >60 mmHg. A BP of 55/40 mmHg
is hypotensive and indicates poor perfusion requiring immediate intervention.



Question 4: During a resuscitation attempt, the team leader orders an initial
dose of epinephrine 0.1 mg/kg to be given. What should the team member do?

1) Administer the drug as ordered
2) Administer 0.01 mg/kg of epinephrine
3) Respectfully ask the team leader to clarify the dose
4) Refuse to administer the drug

Correct Answer: 3) Respectfully ask the team leader to clarify the dose

Rationale: The correct initial PALS epinephrine dose is 0.01 mg/kg (0.1 mL/kg
of 1:10,000). The ordered dose (0.1 mg/kg) is ten times too high. The team
member should respectfully seek clarification.



Question 5: Which of the following is a characteristic of respiratory failure?

,1) Inadequate oxygenation and/or ventilation
2) Hypotension
3) An increase in serum pH (alkalosis)
4) Abnormal respiratory sounds

Correct Answer: 1) Inadequate oxygenation and/or ventilation

Rationale: Respiratory failure is defined by inadequate oxygenation (hypoxemia)
and/or ventilation (hypercapnia), leading to respiratory acidosis.


Question 6: Which of the following is most likely to produce a prolonged
expiratory phase and wheezing?

1) Disordered control of breathing
2) Hypovolemic shock
3) Lower airway obstruction
4) Cardiogenic shock

Correct Answer: 3) Lower airway obstruction

Rationale: Lower airway obstruction (asthma, bronchiolitis, foreign body)
causes air trapping, prolonged expiration, and wheezing.


Question 7: A 4-year-old child is in cardiac arrest. The team is performing
high-quality CPR. What is the appropriate compression-to-ventilation ratio
for a single rescuer?

1) 30:2
2) 15:2
3) 3:1
4) 5:1

Correct Answer: 2) 15:2

Rationale: For pediatric cardiac arrest, the compression-to-ventilation
ratio is 15:2 for two rescuers and 30:2 for a single rescuer.


Question 8: What is the initial energy dose for defibrillation in a pediatric
patient with shockable rhythm?

1) 1 J/kg
2) 2 J/kg

, 3) 4 J/kg
4) 10 J/kg

Correct Answer: 2) 2 J/kg

Rationale: The initial defibrillation dose for pediatric patients is 2 J/kg.
Subsequent doses may be increased to 4 J/kg if needed.


Question 9: A 6-month-old infant presents with severe respiratory distress,
grunting, and nasal flaring. Oxygen saturation is 88% on room air. What is
the most appropriate initial intervention?

1) Prepare for intubation
2) Administer supplemental oxygen
3) Administer albuterol nebulizer
4) Administer epinephrine

Correct Answer: 2) Administer supplemental oxygen

Rationale: The infant shows signs of hypoxemia (SpO2 88%). Supplemental
oxygen should be administered immediately while assessing the underlying cause.


Question 10: Which medication is the first-line vasopressor for pediatric
septic shock?

1) Epinephrine
2) Dopamine
3) Norepinephrine
4) Dobutamine

Correct Answer: 1) Epinephrine

Rationale: Epinephrine is the first-line vasopressor in pediatric septic
shock due to its combined alpha and beta effects, improving perfusion.


Question 11: A child has a heart rate of 220/min, is lethargic, and has poor
perfusion. The ECG shows narrow QRS complex tachycardia. What is the most
appropriate immediate intervention?

1) Synchronized cardioversion
2) Adenosine IV
3) Amiodarone IV