PEDIATRIC ADVANCED LIFE SUPPORT 2025/2026 EXAM
STANDARDIZED QUESTIONS AND ANSWERS
Annotated Answer Key Pediatric
Advanced Life Support Exam A
Provider Manual page numbers below refer to the printed book and the eBook as viewed through the offline
desktop/laptop reader, not the eBook as viewed through the mobile apps or ebooks.heart.org.
1. A 6-month-old infant is unresponsive. You begin checking for breathing at the same time you check for the
infant’s pulse. Which is the maximum time you should spend when trying to simultaneously check for
breathing and palpate the infant’s pulse before starting CPR?
A. 10 seconds
B. 15 seconds
C. 30 seconds
D. 60 seconds
The correct answer is A. To minimize delay in starting CPR, you may assess breathing at the same time as you check
the pulse. This should take no more than 10 seconds. [PALS Provider Manual, Part 2: Review of BLS and AED for
Infants and Children > Infant and Child 1-Rescuer BLS Sequence > Assess for Breathing and Pulse (Box 3); page 17]
2. A 4-year-old child is brought to the emergency department for seizures. The seizures stopped a few minutes
ago, but the child continues to have slow and irregular respirations. Which condition is most consistent with
your assessment?
A. Disordered control of breathing
B. Lower airway obstruction
C. Lung tissue disease
D. Upper airway obstruction
The correct answer is A. Disordered control of breathing may result from a host of conditions, including neurologic
disorders (eg, seizures, central nervous system infections, head injury, brain tumor, hydrocephalus, neuromuscular
disease), metabolic abnormalities, and drug overdose. Because disordered control of breathing is typically
associated with conditions that impair neurologic function, these children often have a decreased level of
consciousness. [PALS Provider Manual, Part 6: Recognition of Respiratory Distress and Failure > Identification of
Respiratory Problems by Type > Disordered Control of Breathing > Causes of Disordered Control of Breathing; page
126]
3. An 8-year-old child is brought to the emergency department with a 2-day history of lethargy and polyuria.
The child has new-onset rapid, deep, and labored breathing. Which diagnostic test should you order first?
A. 12-lead ECG
B. Arterial blood gases
C. Blood glucose
D. Serum potassium
The correct answer is C. In a pediatric patient with altered mental status, hypoglycemia should be considered and
blood glucose evaluated as soon as possible. Altered mental status refers to the range of mental states from
agitation to coma. [PALS Provider Manual, Part 3: Systematic Approach to the Seriously Ill or Injured Child >
Primary Assessment > Disability > AVPU Pediatric Response Scale;
page 56]
1
,Use this scenario to answer the next 2 questions:
After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to
painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen saturation is 94% on 2 L of nasal
cannula oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally.
4. Which action should you take next?
A. Administer naloxone
B. Perform endotracheal intubation
C. Apply hyponasal cannula
D. Reposition the patient, and insert an oral airway
The correct answer is D. Support of airway and ventilation is the main therapeutic intervention for management of
respiratory distress or failure caused by poisoning or drug overdose. [PALS Provider Manual, Part 7: Management of
Respiratory Distress and Failure > Management of Disordered Control of Breathing > Specific Management of
Disordered Control of Breathing by Etiology > Management of Respiratory Distress/Failure in Poisoning or Drug
Overdose; page 144]
5. If the patient continues to deteriorate after your initial intervention, which next step is most
appropriate?
A. Apply nasal cannula
B. Provide bag-mask ventilation
C. Administer nebulized epinephrine
D. Perform nasal suctioning
The correct answer is B. Bag-mask ventilation can provide adequate oxygenation and ventilation for a child with no
breathing or inadequate breathing despite an open/patent airway. Signs of inadequate breathing are apnea,
abnormal respiratory rate, inadequate breath sounds, and hypoxemia despite supplementary oxygen. [PALS
Provider Manual, Resources for Management of Respiratory Emergencies
> Bag-Mask Ventilation > Overview; page 147]
6. A 6-year-old child is found unresponsive, not breathing, and without a pulse. One healthcare worker leaves
to activate the emergency response system and get the resuscitation equipment. You and another
healthcare provider immediately begin performing CPR. Which compression -to-ventilation ratio do you
use?
A. 15:1
B. 30:1
C. 15:2
D. 30:2
The correct answer is C. If 2 rescuers are present for the resuscitation attempt of an infant or a child, use a
compression-to-ventilation ratio of 15:2. [PALS Provider Manual, Part 2: Review of BLS and AED for
Infants and Children > BLS for Infants and Children > Infant/Child Chest Compressions > Compression Rate and
Compression-to-Ventilation Ratio; page 20]
2
,7. In postresuscitation management after cardiac arrest, extra care should be taken to avoid reperfusion injury.
What should the ideal oxygen saturation range most likely be?
A. 90% to 98%
B. 94% to 99%
C. 94% to 100%
D. 98% to 100%
The correct answer is B. After return of spontaneous circulation (ROSC), it may be reasonable for rescuers to
titrate oxygen administration to achieve normoxemia, which is an oxygen saturation of 94% or above. When
possible, oxygen should be weaned to target an oxyhemoglobin saturation within the range of 94% to 99%. The
goal should be to strictly avoid hypoxemia. [PALS Provider Manual, Part 1: Course Overview > Science Update >
Post–Cardiac Arrest PaO2 and PaCO2 ; page 14]
8. A 3-year-old child is in cardiac arrest, and high-quality CPR is in progress. You are the team leader. The first
rhythm check reveals the rhythm shown here.
Defibrillation is attempted with a shock dose of 2 J/kg. After administration of the shock, what should you say
to your team members?
A. “Check for a pulse.”
B. “Give epinephrine 0.01 mg/kg.”
C. “Let’s check the rhythm.”
D. “Resume compressions.”
The correct answer is D. When attempting defibrillation, provide compressions until the defibrillator is charged,
deliver 1 shock, and immediately resume CPR, starting with chest compressions. [PALS Provider Manual, Part 4:
Recognition and Management of Cardiac Arrest > Management of Cardiac Arrest
> PALS in Cardiac Arrest > Defibrillation; page 85]
3
, Use this scenario to answer the next 2 questions:
A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High -quality CPR is
being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20
kg.
9. Which dosage range should you use for initial defibrillation?
A. 0.5 to 2 J/kg
B. 4 to 6 J/kg
C. 6 to 8 J/kg
D. 2 to 4 J/kg
The correct answer is D. For manual defibrillation, an initial dose of 2 to 4 J/kg is acceptable, and for ease of
teaching, a 2 J/kg (biphasic or monophasic waveform) may be considered. [PALS Provider Manual, Part 4:
Recognition and Management of Cardiac Arrest > Management of Cardiac Arrest > Pediatric Cardiac Arrest
Algorithm > Shockable Rhythm: VF/pVT (Step 2); page 90]
10. As the team leader, how many joules do you tell your team member to use to perform initial
defibrillation?
A. 10 J
B. 40 J
C. 100 J
D. 140 J
The correct answer is B. For manual defibrillation, an initial dose of 2 to 4 J/kg is acceptable. Because the
estimated weight of the child is 20 kg (2 J × 20 kg), 40 J should be used. [PALS Provider Manual, Part 4:
Recognition and Management of Cardiac Arrest > Management of Cardiac Arrest > Pediatric Cardiac Arrest
Algorithm > Shockable Rhythm: VF/pVT (Step 2); page 90]
4
STANDARDIZED QUESTIONS AND ANSWERS
Annotated Answer Key Pediatric
Advanced Life Support Exam A
Provider Manual page numbers below refer to the printed book and the eBook as viewed through the offline
desktop/laptop reader, not the eBook as viewed through the mobile apps or ebooks.heart.org.
1. A 6-month-old infant is unresponsive. You begin checking for breathing at the same time you check for the
infant’s pulse. Which is the maximum time you should spend when trying to simultaneously check for
breathing and palpate the infant’s pulse before starting CPR?
A. 10 seconds
B. 15 seconds
C. 30 seconds
D. 60 seconds
The correct answer is A. To minimize delay in starting CPR, you may assess breathing at the same time as you check
the pulse. This should take no more than 10 seconds. [PALS Provider Manual, Part 2: Review of BLS and AED for
Infants and Children > Infant and Child 1-Rescuer BLS Sequence > Assess for Breathing and Pulse (Box 3); page 17]
2. A 4-year-old child is brought to the emergency department for seizures. The seizures stopped a few minutes
ago, but the child continues to have slow and irregular respirations. Which condition is most consistent with
your assessment?
A. Disordered control of breathing
B. Lower airway obstruction
C. Lung tissue disease
D. Upper airway obstruction
The correct answer is A. Disordered control of breathing may result from a host of conditions, including neurologic
disorders (eg, seizures, central nervous system infections, head injury, brain tumor, hydrocephalus, neuromuscular
disease), metabolic abnormalities, and drug overdose. Because disordered control of breathing is typically
associated with conditions that impair neurologic function, these children often have a decreased level of
consciousness. [PALS Provider Manual, Part 6: Recognition of Respiratory Distress and Failure > Identification of
Respiratory Problems by Type > Disordered Control of Breathing > Causes of Disordered Control of Breathing; page
126]
3. An 8-year-old child is brought to the emergency department with a 2-day history of lethargy and polyuria.
The child has new-onset rapid, deep, and labored breathing. Which diagnostic test should you order first?
A. 12-lead ECG
B. Arterial blood gases
C. Blood glucose
D. Serum potassium
The correct answer is C. In a pediatric patient with altered mental status, hypoglycemia should be considered and
blood glucose evaluated as soon as possible. Altered mental status refers to the range of mental states from
agitation to coma. [PALS Provider Manual, Part 3: Systematic Approach to the Seriously Ill or Injured Child >
Primary Assessment > Disability > AVPU Pediatric Response Scale;
page 56]
1
,Use this scenario to answer the next 2 questions:
After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to
painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen saturation is 94% on 2 L of nasal
cannula oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally.
4. Which action should you take next?
A. Administer naloxone
B. Perform endotracheal intubation
C. Apply hyponasal cannula
D. Reposition the patient, and insert an oral airway
The correct answer is D. Support of airway and ventilation is the main therapeutic intervention for management of
respiratory distress or failure caused by poisoning or drug overdose. [PALS Provider Manual, Part 7: Management of
Respiratory Distress and Failure > Management of Disordered Control of Breathing > Specific Management of
Disordered Control of Breathing by Etiology > Management of Respiratory Distress/Failure in Poisoning or Drug
Overdose; page 144]
5. If the patient continues to deteriorate after your initial intervention, which next step is most
appropriate?
A. Apply nasal cannula
B. Provide bag-mask ventilation
C. Administer nebulized epinephrine
D. Perform nasal suctioning
The correct answer is B. Bag-mask ventilation can provide adequate oxygenation and ventilation for a child with no
breathing or inadequate breathing despite an open/patent airway. Signs of inadequate breathing are apnea,
abnormal respiratory rate, inadequate breath sounds, and hypoxemia despite supplementary oxygen. [PALS
Provider Manual, Resources for Management of Respiratory Emergencies
> Bag-Mask Ventilation > Overview; page 147]
6. A 6-year-old child is found unresponsive, not breathing, and without a pulse. One healthcare worker leaves
to activate the emergency response system and get the resuscitation equipment. You and another
healthcare provider immediately begin performing CPR. Which compression -to-ventilation ratio do you
use?
A. 15:1
B. 30:1
C. 15:2
D. 30:2
The correct answer is C. If 2 rescuers are present for the resuscitation attempt of an infant or a child, use a
compression-to-ventilation ratio of 15:2. [PALS Provider Manual, Part 2: Review of BLS and AED for
Infants and Children > BLS for Infants and Children > Infant/Child Chest Compressions > Compression Rate and
Compression-to-Ventilation Ratio; page 20]
2
,7. In postresuscitation management after cardiac arrest, extra care should be taken to avoid reperfusion injury.
What should the ideal oxygen saturation range most likely be?
A. 90% to 98%
B. 94% to 99%
C. 94% to 100%
D. 98% to 100%
The correct answer is B. After return of spontaneous circulation (ROSC), it may be reasonable for rescuers to
titrate oxygen administration to achieve normoxemia, which is an oxygen saturation of 94% or above. When
possible, oxygen should be weaned to target an oxyhemoglobin saturation within the range of 94% to 99%. The
goal should be to strictly avoid hypoxemia. [PALS Provider Manual, Part 1: Course Overview > Science Update >
Post–Cardiac Arrest PaO2 and PaCO2 ; page 14]
8. A 3-year-old child is in cardiac arrest, and high-quality CPR is in progress. You are the team leader. The first
rhythm check reveals the rhythm shown here.
Defibrillation is attempted with a shock dose of 2 J/kg. After administration of the shock, what should you say
to your team members?
A. “Check for a pulse.”
B. “Give epinephrine 0.01 mg/kg.”
C. “Let’s check the rhythm.”
D. “Resume compressions.”
The correct answer is D. When attempting defibrillation, provide compressions until the defibrillator is charged,
deliver 1 shock, and immediately resume CPR, starting with chest compressions. [PALS Provider Manual, Part 4:
Recognition and Management of Cardiac Arrest > Management of Cardiac Arrest
> PALS in Cardiac Arrest > Defibrillation; page 85]
3
, Use this scenario to answer the next 2 questions:
A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High -quality CPR is
being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20
kg.
9. Which dosage range should you use for initial defibrillation?
A. 0.5 to 2 J/kg
B. 4 to 6 J/kg
C. 6 to 8 J/kg
D. 2 to 4 J/kg
The correct answer is D. For manual defibrillation, an initial dose of 2 to 4 J/kg is acceptable, and for ease of
teaching, a 2 J/kg (biphasic or monophasic waveform) may be considered. [PALS Provider Manual, Part 4:
Recognition and Management of Cardiac Arrest > Management of Cardiac Arrest > Pediatric Cardiac Arrest
Algorithm > Shockable Rhythm: VF/pVT (Step 2); page 90]
10. As the team leader, how many joules do you tell your team member to use to perform initial
defibrillation?
A. 10 J
B. 40 J
C. 100 J
D. 140 J
The correct answer is B. For manual defibrillation, an initial dose of 2 to 4 J/kg is acceptable. Because the
estimated weight of the child is 20 kg (2 J × 20 kg), 40 J should be used. [PALS Provider Manual, Part 4:
Recognition and Management of Cardiac Arrest > Management of Cardiac Arrest > Pediatric Cardiac Arrest
Algorithm > Shockable Rhythm: VF/pVT (Step 2); page 90]
4
