AHA PALS Practice Exam (2025/2026) |
Pediatric Advanced Life Support | Verified
Q&A Pack
Title: AHA PALS Certification Practice Exam | 2025/2026 Exam Cycle | Verified Questions, Correct
Answers & Comprehensive Rationales | Aligned with Latest American Heart Association Guidelines
Instructions: This practice exam contains 90 multiple-choice questions covering the full spectrum of
Pediatric Advanced Life Support competencies. Each question is followed by the correct answer and a
detailed rationale in italicized format. Work through systematically, selecting your answer before
reviewing the rationale.
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
Correct Answer: D
Rationale: The pulse oximeter reading is unreliable because the displayed pulse rate (93/min)
does not match the cardiac monitor rate (165/min). A discrepancy between the pulse oximeter
heart rate and the ECG heart rate indicates poor signal quality, likely due to poor perfusion,
motion artifact, or venous pulsation. Despite the 95% reading, the child shows clinical signs of
respiratory distress and poor perfusion. Supplementary oxygen should be administered based on
clinical assessment, not the unreliable oximetry value.
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
Correct Answer: A
,Rationale: The combination of fever, tachycardia, hypotension, and a recent history of
chemotherapy-induced immunosuppression strongly suggests septic shock. Children with
leukemia are at high risk for neutropenic sepsis. The rapid capillary refill does not rule out shock;
children compensate by increasing heart rate and peripheral vasoconstriction until
decompensation occurs.
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
Correct Answer: A
Rationale: For a 2-week-old neonate, a systolic blood pressure of 55 mm Hg is below the
expected lower limit. The PALS definition of hypotension in neonates is a systolic BP <60 mm Hg.
This infant is hypotensive and requires immediate evaluation and intervention.
4. A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme
disease 2 months ago. A rhythm strip is obtained. The provider interprets this rhythm as indicating
which arrhythmia?
A. First-degree AV block
B. Second-degree AV block Type I
C. Second-degree AV block Type II
D. Complete heart block
Correct Answer: A
Rationale: Lyme disease commonly causes first-degree AV block, presenting as a consistently
prolonged PR interval on ECG without dropped beats. Recognition is important to assess disease
progression and need for treatment. Higher-degree blocks require more complex management.
5. A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which
rhythm(s) would this action be appropriate?
A. Pulseless electrical activity (PEA) and asystole
B. Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT)
C. Sinus bradycardia and second-degree AV block
D. First-degree AV block and supraventricular tachycardia (SVT)
Correct Answer: B
Rationale: Defibrillation is indicated only for shockable rhythms: VF and pulseless VT. PEA and
asystole are non-shockable and require CPR and epinephrine administration. Recognizing
shockable rhythms promptly improves survival chances.
, 6. A provider is assessing a child with suspected shock. Which statement correctly describes
hypotension and shock?
A. Hypotension is always present in shock
B. Hypotension is a late and unreliable sign of shock in children
C. Hypotension confirms the diagnosis of shock early
D. Hypotension excludes compensated shock
Correct Answer: B
Rationale: Children compensate well and maintain blood pressure until late in shock.
Hypotension signals decompensation and impending cardiovascular collapse. This is why blood
pressure is not part of the early shock assessment criteria in PALS.
7. An 11-year-old soccer player is brought to the emergency department. After a quick assessment,
the team realizes this patient is experiencing a severe asthma exacerbation. Which medication would
the team administer first?
A. Ipratropium bromide alone
B. Albuterol alone
C. Albuterol plus ipratropium bromide
D. Oral corticosteroids
Correct Answer: C
Rationale: In severe asthma exacerbations, prompt administration of nebulized beta-agonists
(albuterol) plus anticholinergics (ipratropium bromide) provides bronchodilation. Early
treatment reduces airway edema and bronchospasm, improving outcomes. Corticosteroids are
important but administered after initial bronchodilation.
8. A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this
child, which circulation finding might be present?
A. Pallor
B. Flushing
C. Cyanosis only
D. Mucosal bleeding
Correct Answer: A
Rationale: Poor perfusion from respiratory distress leads to compensatory vasoconstriction,
resulting in pallor. Flushing would suggest vasodilation (e.g., fever, sepsis). Cyanosis is a late
sign of hypoxemia. Mucosal bleeding is unrelated to respiratory distress.
9. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
Pediatric Advanced Life Support | Verified
Q&A Pack
Title: AHA PALS Certification Practice Exam | 2025/2026 Exam Cycle | Verified Questions, Correct
Answers & Comprehensive Rationales | Aligned with Latest American Heart Association Guidelines
Instructions: This practice exam contains 90 multiple-choice questions covering the full spectrum of
Pediatric Advanced Life Support competencies. Each question is followed by the correct answer and a
detailed rationale in italicized format. Work through systematically, selecting your answer before
reviewing the rationale.
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
Correct Answer: D
Rationale: The pulse oximeter reading is unreliable because the displayed pulse rate (93/min)
does not match the cardiac monitor rate (165/min). A discrepancy between the pulse oximeter
heart rate and the ECG heart rate indicates poor signal quality, likely due to poor perfusion,
motion artifact, or venous pulsation. Despite the 95% reading, the child shows clinical signs of
respiratory distress and poor perfusion. Supplementary oxygen should be administered based on
clinical assessment, not the unreliable oximetry value.
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
Correct Answer: A
,Rationale: The combination of fever, tachycardia, hypotension, and a recent history of
chemotherapy-induced immunosuppression strongly suggests septic shock. Children with
leukemia are at high risk for neutropenic sepsis. The rapid capillary refill does not rule out shock;
children compensate by increasing heart rate and peripheral vasoconstriction until
decompensation occurs.
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
Correct Answer: A
Rationale: For a 2-week-old neonate, a systolic blood pressure of 55 mm Hg is below the
expected lower limit. The PALS definition of hypotension in neonates is a systolic BP <60 mm Hg.
This infant is hypotensive and requires immediate evaluation and intervention.
4. A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme
disease 2 months ago. A rhythm strip is obtained. The provider interprets this rhythm as indicating
which arrhythmia?
A. First-degree AV block
B. Second-degree AV block Type I
C. Second-degree AV block Type II
D. Complete heart block
Correct Answer: A
Rationale: Lyme disease commonly causes first-degree AV block, presenting as a consistently
prolonged PR interval on ECG without dropped beats. Recognition is important to assess disease
progression and need for treatment. Higher-degree blocks require more complex management.
5. A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which
rhythm(s) would this action be appropriate?
A. Pulseless electrical activity (PEA) and asystole
B. Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT)
C. Sinus bradycardia and second-degree AV block
D. First-degree AV block and supraventricular tachycardia (SVT)
Correct Answer: B
Rationale: Defibrillation is indicated only for shockable rhythms: VF and pulseless VT. PEA and
asystole are non-shockable and require CPR and epinephrine administration. Recognizing
shockable rhythms promptly improves survival chances.
, 6. A provider is assessing a child with suspected shock. Which statement correctly describes
hypotension and shock?
A. Hypotension is always present in shock
B. Hypotension is a late and unreliable sign of shock in children
C. Hypotension confirms the diagnosis of shock early
D. Hypotension excludes compensated shock
Correct Answer: B
Rationale: Children compensate well and maintain blood pressure until late in shock.
Hypotension signals decompensation and impending cardiovascular collapse. This is why blood
pressure is not part of the early shock assessment criteria in PALS.
7. An 11-year-old soccer player is brought to the emergency department. After a quick assessment,
the team realizes this patient is experiencing a severe asthma exacerbation. Which medication would
the team administer first?
A. Ipratropium bromide alone
B. Albuterol alone
C. Albuterol plus ipratropium bromide
D. Oral corticosteroids
Correct Answer: C
Rationale: In severe asthma exacerbations, prompt administration of nebulized beta-agonists
(albuterol) plus anticholinergics (ipratropium bromide) provides bronchodilation. Early
treatment reduces airway edema and bronchospasm, improving outcomes. Corticosteroids are
important but administered after initial bronchodilation.
8. A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this
child, which circulation finding might be present?
A. Pallor
B. Flushing
C. Cyanosis only
D. Mucosal bleeding
Correct Answer: A
Rationale: Poor perfusion from respiratory distress leads to compensatory vasoconstriction,
resulting in pallor. Flushing would suggest vasodilation (e.g., fever, sepsis). Cyanosis is a late
sign of hypoxemia. Mucosal bleeding is unrelated to respiratory distress.
9. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
