PALS Pediatric Advanced Life Support
American Heart Association
Academic Year 2026/2027
Final Comprehensive Certification Practice Examination
Questions 1–50
Instructions: Select the single best answer for each question. Correct answers are
italicized.
1.
A 4-year-old child is brought to the emergency department with respiratory distress. Which
assessment should be performed first?
A. Obtain a complete medical history
B. Assess airway, breathing, and circulation
C. Obtain a chest radiograph
D. Establish a detailed medication history
Answer: B. Assess airway, breathing, and circulation
,2.
Which finding is most concerning for impending respiratory failure in a child?
A. Mild tachypnea with normal mental status
B. Occasional cough
C. Decreasing respiratory effort with altered mental status
D. Mild nasal congestion
Answer: C. Decreasing respiratory effort with altered mental status
3.
A child with respiratory distress becomes lethargic and develops shallow respirations. What
does this change most strongly suggest?
A. Improvement
B. Anxiety
C. Respiratory failure
D. Mild dehydration
Answer: C. Respiratory failure
4.
Which finding is generally associated with compensated shock in a child?
A. Severe hypotension
B. Pulselessness
C. Tachycardia with prolonged capillary refill
D. Fixed pupils
, Answer: C. Tachycardia with prolonged capillary refill
5.
Which finding is most characteristic of decompensated shock?
A. Warm extremities and normal mental status
B. Normal urine output
C. Hypotension with altered mental status
D. Mild tachycardia only
Answer: C. Hypotension with altered mental status
6.
A child has severe respiratory distress but is still breathing spontaneously. Which
intervention should generally be considered first?
A. Immediate chest compressions
B. Support oxygenation and ventilation as needed
C. Administer an antiarrhythmic
D. Begin defibrillation
Answer: B. Support oxygenation and ventilation as needed
7.
Which device is most appropriate for delivering a controlled concentration of oxygen to a
spontaneously breathing child?
American Heart Association
Academic Year 2026/2027
Final Comprehensive Certification Practice Examination
Questions 1–50
Instructions: Select the single best answer for each question. Correct answers are
italicized.
1.
A 4-year-old child is brought to the emergency department with respiratory distress. Which
assessment should be performed first?
A. Obtain a complete medical history
B. Assess airway, breathing, and circulation
C. Obtain a chest radiograph
D. Establish a detailed medication history
Answer: B. Assess airway, breathing, and circulation
,2.
Which finding is most concerning for impending respiratory failure in a child?
A. Mild tachypnea with normal mental status
B. Occasional cough
C. Decreasing respiratory effort with altered mental status
D. Mild nasal congestion
Answer: C. Decreasing respiratory effort with altered mental status
3.
A child with respiratory distress becomes lethargic and develops shallow respirations. What
does this change most strongly suggest?
A. Improvement
B. Anxiety
C. Respiratory failure
D. Mild dehydration
Answer: C. Respiratory failure
4.
Which finding is generally associated with compensated shock in a child?
A. Severe hypotension
B. Pulselessness
C. Tachycardia with prolonged capillary refill
D. Fixed pupils
, Answer: C. Tachycardia with prolonged capillary refill
5.
Which finding is most characteristic of decompensated shock?
A. Warm extremities and normal mental status
B. Normal urine output
C. Hypotension with altered mental status
D. Mild tachycardia only
Answer: C. Hypotension with altered mental status
6.
A child has severe respiratory distress but is still breathing spontaneously. Which
intervention should generally be considered first?
A. Immediate chest compressions
B. Support oxygenation and ventilation as needed
C. Administer an antiarrhythmic
D. Begin defibrillation
Answer: B. Support oxygenation and ventilation as needed
7.
Which device is most appropriate for delivering a controlled concentration of oxygen to a
spontaneously breathing child?
