AHA PALS EXAM QUESTIONS & ANSWERS 2025/2026 | VERIFIED 100% CORRECT |
PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION TEST BANK
SECTION 1: PEDIATRIC SYSTEMATIC ASSESSMENT & THE PEDIATRIC ASSESSMENT
TRIANGLE (Questions 1-25)
1. A 6-month-old infant is brought to the emergency department for lethargy. The PALS
provider performs a rapid assessment using the Pediatric Assessment Triangle. Which
component of the triangle is most immediately concerning?
A. The infant's work of breathing is moderate with nasal flaring
B. The infant's skin color is pale
C. The infant's appearance is listless, with no eye contact
D. The infant's circulation is warm with brisk capillary refill
Answer: C. The infant's appearance is listless, with no eye contact
Rationale: The Pediatric Assessment Triangle (Appearance, Work of Breathing, Circulation)
allows for rapid, non-invasive assessment. The "Appearance" component (including tone,
interactiveness, consolability, look/gaze) is the most sensitive indicator of overall central
nervous system function and critical illness. A listless infant with no eye contact signifies a
significant alteration in mental status and is a high-priority finding requiring immediate
evaluation and intervention.
2. What is the first step in the pediatric assessment using the PALS systematic
approach?
A. Obtain a detailed history from the caregiver
B. Evaluate responsiveness and perform the initial impression
,C. Perform a comprehensive head-to-toe physical examination
D. Check all vital signs including temperature
Answer: B. Evaluate responsiveness and perform the initial impression
Rationale: The PALS systematic approach begins with the initial impression, which is a
rapid, visual assessment of the child's appearance, breathing, and color. This is followed by
checking responsiveness. Determining the level of consciousness helps establish the
urgency of intervention and guides the subsequent primary assessment.
3. A lone healthcare provider finds a 3-year-old child unresponsive on a playground.
After confirming the scene is safe, what is the provider's first action?
A. Check for a carotid pulse for no more than 10 seconds
B. Check for responsiveness and breathing simultaneously
C. Begin chest compressions immediately
D. Activate the emergency response system and get an AED
Answer: B. Check for responsiveness and breathing simultaneously
Rationale: The BLS sequence for all ages begins with checking for responsiveness and
breathing simultaneously. For a child or infant, if the provider is alone, they should provide 2
minutes of CPR before activating the emergency response system. However, the absolute
first step is to assess responsiveness and breathing.
4. Which finding indicates respiratory distress in a pediatric patient during the initial
assessment?
A. Regular breathing pattern with equal chest rise
B. Retractions and nasal flaring
C. Normal skin color and capillary refill
D. Calm and alert demeanor
Answer: B. Retractions and nasal flaring
Rationale: Retractions (intercostal, subcostal, or suprasternal) and nasal flaring are classic
signs of increased work of breathing and respiratory distress in pediatric patients. These
findings indicate the child is using accessory muscles to maintain adequate ventilation and
oxygenation.
,5. The PALS systemic approach algorithm begins with the initial impression. This is an
assessment of which three characteristics?
A. Airway, Breathing, Circulation
B. Consciousness, Breathing, Color
C. Pain, Breathing, Skin color
D. Level of consciousness, Respiratory rate, Heart rate
Answer: B. Consciousness, Breathing, Color
Rationale: The initial impression in the PALS systemic approach evaluates three key
characteristics: consciousness (appearance/tone), breathing (work of breathing), and color
(circulation to skin). This rapid visual assessment takes only seconds but provides critical
information about the child's overall condition.
6. A child presents with lethargy, increased work of breathing, and mottled skin. The
primary assessment reveals the airway is open, respiratory rate is 32/min with
crackles, and heart rate is 170/min with sinus tachycardia on the monitor. Pulse
oximetry shows 92% on room air. What is the most appropriate initial intervention?
A. Administer a fluid bolus of 20 mL/kg normal saline
B. Apply supplemental oxygen and reassess
C. Prepare for immediate endotracheal intubation
D. Administer albuterol nebulizer treatment
Answer: B. Apply supplemental oxygen and reassess
Rationale: The child shows signs of respiratory distress with hypoxia (SpO2 92%). The initial
intervention should be to provide supplemental oxygen to correct hypoxemia, then
reassess the patient's response. Further interventions depend on the clinical response to
oxygenation.
7. What is the correct compression-to-ventilation ratio for two-rescuer CPR on an
infant or child?
A. 30:2
B. 15:2
C. 5:1
D. Continuous compressions with asynchronous ventilations
, Answer: B. 15:2
Rationale: For two-rescuer infant and child CPR, the recommended compression-to-
ventilation ratio is 15 compressions to 2 breaths. The 30:2 ratio is used for single-rescuer
CPR for all ages except newborns. The 15:2 ratio optimizes oxygenation during two-rescuer
CPR.
8. A 4-year-old child presents with a barking cough, stridor, and increased work of
breathing. These findings are most consistent with which condition?
A. Asthma exacerbation
B. Croup (laryngotracheobronchitis)
C. Bacterial tracheitis
D. Foreign body aspiration
Answer: B. Croup (laryngotracheobronchitis)
Rationale: Croup is characterized by a barking cough, stridor (inspiratory), and increased
work of breathing. It is caused by viral inflammation of the subglottic airway. Asthma
typically presents with wheezing and prolonged expiration. Bacterial tracheitis presents
with high fever and toxicity. Foreign body aspiration often has a sudden onset with choking
history.
9. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension with normal respiratory effort
C. An increase in serum pH (alkalosis)
D. Normal respiratory rate with bradypnea
Answer: A. Inadequate oxygenation and/or ventilation
Rationale: Respiratory failure is defined by inadequate oxygenation (hypoxemia) and/or
inadequate ventilation (hypercapnia) despite respiratory effort. It represents a failure of the
respiratory system to maintain adequate gas exchange. Hypotension is a sign of shock, not
primary respiratory failure.
10. What is the recommended chest compression depth for an infant during CPR?
PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION TEST BANK
SECTION 1: PEDIATRIC SYSTEMATIC ASSESSMENT & THE PEDIATRIC ASSESSMENT
TRIANGLE (Questions 1-25)
1. A 6-month-old infant is brought to the emergency department for lethargy. The PALS
provider performs a rapid assessment using the Pediatric Assessment Triangle. Which
component of the triangle is most immediately concerning?
A. The infant's work of breathing is moderate with nasal flaring
B. The infant's skin color is pale
C. The infant's appearance is listless, with no eye contact
D. The infant's circulation is warm with brisk capillary refill
Answer: C. The infant's appearance is listless, with no eye contact
Rationale: The Pediatric Assessment Triangle (Appearance, Work of Breathing, Circulation)
allows for rapid, non-invasive assessment. The "Appearance" component (including tone,
interactiveness, consolability, look/gaze) is the most sensitive indicator of overall central
nervous system function and critical illness. A listless infant with no eye contact signifies a
significant alteration in mental status and is a high-priority finding requiring immediate
evaluation and intervention.
2. What is the first step in the pediatric assessment using the PALS systematic
approach?
A. Obtain a detailed history from the caregiver
B. Evaluate responsiveness and perform the initial impression
,C. Perform a comprehensive head-to-toe physical examination
D. Check all vital signs including temperature
Answer: B. Evaluate responsiveness and perform the initial impression
Rationale: The PALS systematic approach begins with the initial impression, which is a
rapid, visual assessment of the child's appearance, breathing, and color. This is followed by
checking responsiveness. Determining the level of consciousness helps establish the
urgency of intervention and guides the subsequent primary assessment.
3. A lone healthcare provider finds a 3-year-old child unresponsive on a playground.
After confirming the scene is safe, what is the provider's first action?
A. Check for a carotid pulse for no more than 10 seconds
B. Check for responsiveness and breathing simultaneously
C. Begin chest compressions immediately
D. Activate the emergency response system and get an AED
Answer: B. Check for responsiveness and breathing simultaneously
Rationale: The BLS sequence for all ages begins with checking for responsiveness and
breathing simultaneously. For a child or infant, if the provider is alone, they should provide 2
minutes of CPR before activating the emergency response system. However, the absolute
first step is to assess responsiveness and breathing.
4. Which finding indicates respiratory distress in a pediatric patient during the initial
assessment?
A. Regular breathing pattern with equal chest rise
B. Retractions and nasal flaring
C. Normal skin color and capillary refill
D. Calm and alert demeanor
Answer: B. Retractions and nasal flaring
Rationale: Retractions (intercostal, subcostal, or suprasternal) and nasal flaring are classic
signs of increased work of breathing and respiratory distress in pediatric patients. These
findings indicate the child is using accessory muscles to maintain adequate ventilation and
oxygenation.
,5. The PALS systemic approach algorithm begins with the initial impression. This is an
assessment of which three characteristics?
A. Airway, Breathing, Circulation
B. Consciousness, Breathing, Color
C. Pain, Breathing, Skin color
D. Level of consciousness, Respiratory rate, Heart rate
Answer: B. Consciousness, Breathing, Color
Rationale: The initial impression in the PALS systemic approach evaluates three key
characteristics: consciousness (appearance/tone), breathing (work of breathing), and color
(circulation to skin). This rapid visual assessment takes only seconds but provides critical
information about the child's overall condition.
6. A child presents with lethargy, increased work of breathing, and mottled skin. The
primary assessment reveals the airway is open, respiratory rate is 32/min with
crackles, and heart rate is 170/min with sinus tachycardia on the monitor. Pulse
oximetry shows 92% on room air. What is the most appropriate initial intervention?
A. Administer a fluid bolus of 20 mL/kg normal saline
B. Apply supplemental oxygen and reassess
C. Prepare for immediate endotracheal intubation
D. Administer albuterol nebulizer treatment
Answer: B. Apply supplemental oxygen and reassess
Rationale: The child shows signs of respiratory distress with hypoxia (SpO2 92%). The initial
intervention should be to provide supplemental oxygen to correct hypoxemia, then
reassess the patient's response. Further interventions depend on the clinical response to
oxygenation.
7. What is the correct compression-to-ventilation ratio for two-rescuer CPR on an
infant or child?
A. 30:2
B. 15:2
C. 5:1
D. Continuous compressions with asynchronous ventilations
, Answer: B. 15:2
Rationale: For two-rescuer infant and child CPR, the recommended compression-to-
ventilation ratio is 15 compressions to 2 breaths. The 30:2 ratio is used for single-rescuer
CPR for all ages except newborns. The 15:2 ratio optimizes oxygenation during two-rescuer
CPR.
8. A 4-year-old child presents with a barking cough, stridor, and increased work of
breathing. These findings are most consistent with which condition?
A. Asthma exacerbation
B. Croup (laryngotracheobronchitis)
C. Bacterial tracheitis
D. Foreign body aspiration
Answer: B. Croup (laryngotracheobronchitis)
Rationale: Croup is characterized by a barking cough, stridor (inspiratory), and increased
work of breathing. It is caused by viral inflammation of the subglottic airway. Asthma
typically presents with wheezing and prolonged expiration. Bacterial tracheitis presents
with high fever and toxicity. Foreign body aspiration often has a sudden onset with choking
history.
9. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension with normal respiratory effort
C. An increase in serum pH (alkalosis)
D. Normal respiratory rate with bradypnea
Answer: A. Inadequate oxygenation and/or ventilation
Rationale: Respiratory failure is defined by inadequate oxygenation (hypoxemia) and/or
inadequate ventilation (hypercapnia) despite respiratory effort. It represents a failure of the
respiratory system to maintain adequate gas exchange. Hypotension is a sign of shock, not
primary respiratory failure.
10. What is the recommended chest compression depth for an infant during CPR?
