Pediatric Advanced Life Support (PALS) Practice
Exam
2025 Guidelines Alignment | 100 Original Questions
Seven sections with multiple-choice answers and rationales
Unofficial educational study material. These are original practice questions, not actual AHA course
or certification exam items. No professor verification, official score, AHA/AAP endorsement, or
certification credit is claimed.
Guideline note: Content is aligned to 2025 AHA/AAP CPR and ECC guidance, including the
universal Cardiac Arrest Chain of Survival, infant compression updates, early epinephrine for initial
nonshockable arrest, and pediatric post-arrest care. PALS guidance addresses infants and
children outside newborn transition at birth. Confirm the current AHA course materials, institutional
protocols, and medication concentrations before clinical use.
Primary references: AHA/AAP 2025 Part 8: Pediatric Advanced Life Support; Part 6: Pediatric
Basic Life Support; Pediatric Cardiac Arrest Algorithm; Bradycardia With a Pulse Algorithm;
Post-Cardiac Arrest Care checklist; AHA PALS Provider Course overview.
For education and review only; not a substitute for live training, the official AHA PALS Provider
Manual, clinical judgment, or local protocols.
Page 1 of 41
,Table of Contents
Section 1: Pediatric Assessment & Systematic Approach . . . . . . . . . . . . . . . . . . . . . 3
Section 2: Respiratory Emergencies & Airway Management . . . . . . . . . . . . . . . . . . .9
Section 3: Shock Recognition & Management . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Section 4: Cardiac Arrhythmias & Electrical Therapy . . . . . . . . . . . . . . . . . . . . . . . 21
Section 5: Pediatric Cardiac Arrest & Resuscitation Algorithms . . . . . . . . . . . . . . . . . 27
Section 6: Pharmacology & Emergency Medications . . . . . . . . . . . . . . . . . . . . . . . 33
Section 7: Post-Cardiac Arrest Care & Team Dynamics . . . . . . . . . . . . . . . . . . . . . 38
Page 2 of 41
,Section 1: Pediatric Assessment & Systematic Approach
Q1: During the primary assessment of an ill child, what does the ABCDE sequence
represent?
A. Airway, Breathing, Circulation, Disability, Exposure [CORRECT]
B. Appearance, Blood pressure, Capillary refill, Disability, Examination
C. Airway, Breathing, Cardiac history, Diagnosis, Evaluation
D. Assessment, Breathing, Chest x-ray, Drug dose, Emergency plan
Correct Answer: A
Rationale: The primary assessment uses ABCDE to identify and treat immediate threats.
Focused history and diagnostic testing follow as the child is stabilized.
Q2: A 4-year-old has nasal flaring, retractions, and stridor but is alert with pink skin and strong
pulses. What is the best interpretation and next step?
A. The child is in cardiac arrest because stridor is present.
B. The Pediatric Assessment Triangle shows abnormal work of breathing; promptly support
airway and breathing while continuing the primary assessment. [CORRECT]
C. The child is stable because skin color is normal; defer assessment until a full history is
obtained.
D. The child has isolated circulatory failure; give a fluid bolus before assessing the airway.
Correct Answer: B
Rationale: The abnormal work of breathing is an immediate warning even when appearance
and circulation are initially preserved. Support airway and breathing while reassessing for
deterioration.
Page 3 of 41
, Q3: An 18-month-old is alert and breathing comfortably, but has pale mottled skin, weak
peripheral pulses, and a 5-second capillary refill. Which Pediatric Assessment Triangle
component is abnormal?
A. Appearance only
B. Work of breathing only
C. Circulation to the skin [CORRECT]
D. No component; the triangle is normal if breathing is easy
Correct Answer: C
Rationale: The Pediatric Assessment Triangle includes appearance, work of breathing, and
circulation to the skin. The findings point to an abnormal circulation-to-skin component despite
comfortable breathing.
Q4: In the PALS systematic approach, what is the main purpose of the secondary
assessment?
A. Replace the primary assessment with diagnostic imaging.
B. Deliver defibrillation before checking the child's condition.
C. Collect laboratory results before addressing immediate threats.
D. Obtain a focused history, such as SAMPLE, and perform a focused physical examination.
[CORRECT]
Correct Answer: D
Rationale: The secondary assessment gathers a focused history and physical findings after
immediate threats are addressed. It does not replace stabilization or the primary survey.
Q5: A toddler is unresponsive with gurgling respirations and visible secretions. No trauma is
suspected. What should the team do first while continuing the primary assessment?
A. Position and open the airway, suction visible secretions as needed, and support
oxygenation and ventilation. [CORRECT]
B. Begin a detailed SAMPLE history before touching the child.
C. Give oral fluids to clear the secretions.
D. Wait for a chest radiograph before positioning the airway.
Correct Answer: A
Rationale: Airway obstruction and secretions require immediate airway positioning and
suction as appropriate, followed by oxygenation or ventilation support. History and imaging
must not delay basic stabilization.
Page 4 of 41
Exam
2025 Guidelines Alignment | 100 Original Questions
Seven sections with multiple-choice answers and rationales
Unofficial educational study material. These are original practice questions, not actual AHA course
or certification exam items. No professor verification, official score, AHA/AAP endorsement, or
certification credit is claimed.
Guideline note: Content is aligned to 2025 AHA/AAP CPR and ECC guidance, including the
universal Cardiac Arrest Chain of Survival, infant compression updates, early epinephrine for initial
nonshockable arrest, and pediatric post-arrest care. PALS guidance addresses infants and
children outside newborn transition at birth. Confirm the current AHA course materials, institutional
protocols, and medication concentrations before clinical use.
Primary references: AHA/AAP 2025 Part 8: Pediatric Advanced Life Support; Part 6: Pediatric
Basic Life Support; Pediatric Cardiac Arrest Algorithm; Bradycardia With a Pulse Algorithm;
Post-Cardiac Arrest Care checklist; AHA PALS Provider Course overview.
For education and review only; not a substitute for live training, the official AHA PALS Provider
Manual, clinical judgment, or local protocols.
Page 1 of 41
,Table of Contents
Section 1: Pediatric Assessment & Systematic Approach . . . . . . . . . . . . . . . . . . . . . 3
Section 2: Respiratory Emergencies & Airway Management . . . . . . . . . . . . . . . . . . .9
Section 3: Shock Recognition & Management . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Section 4: Cardiac Arrhythmias & Electrical Therapy . . . . . . . . . . . . . . . . . . . . . . . 21
Section 5: Pediatric Cardiac Arrest & Resuscitation Algorithms . . . . . . . . . . . . . . . . . 27
Section 6: Pharmacology & Emergency Medications . . . . . . . . . . . . . . . . . . . . . . . 33
Section 7: Post-Cardiac Arrest Care & Team Dynamics . . . . . . . . . . . . . . . . . . . . . 38
Page 2 of 41
,Section 1: Pediatric Assessment & Systematic Approach
Q1: During the primary assessment of an ill child, what does the ABCDE sequence
represent?
A. Airway, Breathing, Circulation, Disability, Exposure [CORRECT]
B. Appearance, Blood pressure, Capillary refill, Disability, Examination
C. Airway, Breathing, Cardiac history, Diagnosis, Evaluation
D. Assessment, Breathing, Chest x-ray, Drug dose, Emergency plan
Correct Answer: A
Rationale: The primary assessment uses ABCDE to identify and treat immediate threats.
Focused history and diagnostic testing follow as the child is stabilized.
Q2: A 4-year-old has nasal flaring, retractions, and stridor but is alert with pink skin and strong
pulses. What is the best interpretation and next step?
A. The child is in cardiac arrest because stridor is present.
B. The Pediatric Assessment Triangle shows abnormal work of breathing; promptly support
airway and breathing while continuing the primary assessment. [CORRECT]
C. The child is stable because skin color is normal; defer assessment until a full history is
obtained.
D. The child has isolated circulatory failure; give a fluid bolus before assessing the airway.
Correct Answer: B
Rationale: The abnormal work of breathing is an immediate warning even when appearance
and circulation are initially preserved. Support airway and breathing while reassessing for
deterioration.
Page 3 of 41
, Q3: An 18-month-old is alert and breathing comfortably, but has pale mottled skin, weak
peripheral pulses, and a 5-second capillary refill. Which Pediatric Assessment Triangle
component is abnormal?
A. Appearance only
B. Work of breathing only
C. Circulation to the skin [CORRECT]
D. No component; the triangle is normal if breathing is easy
Correct Answer: C
Rationale: The Pediatric Assessment Triangle includes appearance, work of breathing, and
circulation to the skin. The findings point to an abnormal circulation-to-skin component despite
comfortable breathing.
Q4: In the PALS systematic approach, what is the main purpose of the secondary
assessment?
A. Replace the primary assessment with diagnostic imaging.
B. Deliver defibrillation before checking the child's condition.
C. Collect laboratory results before addressing immediate threats.
D. Obtain a focused history, such as SAMPLE, and perform a focused physical examination.
[CORRECT]
Correct Answer: D
Rationale: The secondary assessment gathers a focused history and physical findings after
immediate threats are addressed. It does not replace stabilization or the primary survey.
Q5: A toddler is unresponsive with gurgling respirations and visible secretions. No trauma is
suspected. What should the team do first while continuing the primary assessment?
A. Position and open the airway, suction visible secretions as needed, and support
oxygenation and ventilation. [CORRECT]
B. Begin a detailed SAMPLE history before touching the child.
C. Give oral fluids to clear the secretions.
D. Wait for a chest radiograph before positioning the airway.
Correct Answer: A
Rationale: Airway obstruction and secretions require immediate airway positioning and
suction as appropriate, followed by oxygenation or ventilation support. History and imaging
must not delay basic stabilization.
Page 4 of 41
