AHA PALS Exam Newest Actual Exam With Complete 230 Questions And Correct
Detailed Answers (Verified Answers) |Already Graded A+
Question 1
A 5-year-old child presents with lethargy, increased work of breathing, and pale color. Primary
assessment reveals an open airway, respiratory rate of 30/min with crackles, and a cardiac
monitor showing sinus tachycardia at 165/min. The pulse oximeter displays 95% saturation but a
pulse rate of 93/min. Which of the following is the best interpretation?
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
E) Reliable; the child is experiencing a normal stress response
Correct Answer: D) Unreliable; supplementary oxygen should be administered
Rationale: The pulse oximetry reading is considered unreliable because the pulse rate
displayed on the oximeter (93/min) does not correlate with the actual heart rate on the
cardiac monitor (165/min). This discrepancy suggests poor peripheral perfusion or a
motion artifact. Because the child is symptomatic (lethargy, pale color, crackles, and
increased work of breathing), the nurse must assume the oxygenation is inadequate and
provide supplementary oxygen regardless of the numerical value shown.
Question 2
A 3-year-old child recently diagnosed with leukemia presents with lethargy and a high fever.
Vital signs: HR 195/min, RR 36/min, BP 85/40 mm Hg, and capillary refill time less than 2
seconds. Which of the following is the most likely condition?
A) Septic shock
B) Hypovolemic shock
C) Significant bradycardia
D) Cardiogenic shock
E) Obstructive shock
Correct Answer: A) Septic shock
Rationale: Septic shock in children often presents initially as "warm shock," characterized
by tachycardia, fever, and brisk capillary refill (flash refill) due to peripheral vasodilation,
despite being hypotensive. Given the child’s history of leukemia and chemotherapy, they
are highly immunocompromised, making sepsis the most likely cause of their clinical
deterioration.
Question 3
A 2-week-old infant presents with irritability and a history of poor feeding. The blood pressure is
55/40 mm Hg. How should the nurse categorize this blood pressure?
A) Hypotensive
B) Normal
, 2
C) Hypertensive
D) Compensated
E) Isolated Systolic Hypertension
Correct Answer: A) Hypotensive
Rationale: In neonates (0 to 28 days), a systolic blood pressure (SBP) of less than 60 mm Hg
is defined as hypotension. For infants aged 1 month to 1 year, SBP less than 70 mm Hg is
hypotensive. Recognizing hypotension in infants is critical because they have a limited
ability to increase stroke volume; they rely on heart rate and vascular resistance to
maintain cardiac output.
Question 4
During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mg/kg
to be given IV. What is the most appropriate action for the team member?
A) Administer the drug as ordered immediately
B) Administer 0.01 mg/kg of epinephrine instead
C) Respectfully ask the team leader to clarify the dose
D) Refuse to administer the drug and leave the room
E) Ask the pharmacist to calculate the dose
Correct Answer: C) Respectfully ask the team leader to clarify the dose
Rationale: The standard IV/IO dose for epinephrine in pediatric cardiac arrest is 0.01
mg/kg (0.1 mL/kg of the 0.1 mg/mL concentration). The order of 0.1 mg/kg is ten times the
recommended dose. To ensure patient safety and maintain closed-loop communication, the
team member should clarify the order before administration to prevent a potentially fatal
medication error.
Question 5
Which of the following findings is the hallmark characteristic of respiratory failure?
A) Inadequate oxygenation and/or ventilation
B) Compensated hypotension
C) An increase in serum pH (alkalosis)
D) Audible expiratory wheezing
E) Tachypnea with clear breath sounds
Correct Answer: A) Inadequate oxygenation and/or ventilation
Rationale: Respiratory failure is a clinical state where the digestive or respiratory system
cannot maintain adequate gas exchange. This results in hypoxemia (inadequate
oxygenation), hypercapnia (inadequate ventilation/CO2 clearance), or both. While
abnormal sounds or tachypnea may be present, the defining factor is the failure to meet the
body's metabolic demands via gas exchange.
Question 6
A 6-year-old child presents with a prolonged expiratory phase and diffuse wheezing. Which of
, 3
the following conditions is most likely present?
A) Disordered control of breathing
B) Hypovolemic shock
C) Lower airway obstruction
D) Upper airway obstruction
E) Lung tissue disease
Correct Answer: C) Lower airway obstruction
Rationale: Lower airway obstructions (such as asthma or bronchiolitis) are characterized
by difficulty moving air out of the lungs. This leads to an increased expiratory time and
wheezing. Upper airway obstructions (like croup) typically produce inspiratory stridor.
Lung tissue diseases (like pneumonia) usually present with crackles and grunting.
Question 7
A 4-year-old child presents with seizures and irregular respirations. The seizures stopped five
minutes ago. Which of the following physiological functions is most likely to be abnormal?
A) Vascular resistance
B) Pulse rate
C) Lung compliance
D) Control of breathing
E) Cardiac contractility
Correct Answer: D) Control of breathing
Rationale: Post-ictal states, head trauma, or drug ingestions often result in "disordered
control of breathing." This is characterized by an abnormal respiratory pattern (irregular,
shallow, or gasping) despite the lungs themselves being healthy. The problem lies in the
neurological drive to breathe rather than an obstruction or tissue disease.
Question 8
What clinical finding is most likely to be present in children with acute respiratory distress
caused by lung tissue disease?
A) Decreased oxygen saturation
B) High-pitched inspiratory stridor
C) Normal respiratory rate
D) Decreased respiratory effort
E) Clear breath sounds bilaterally
Correct Answer: A) Decreased oxygen saturation
Rationale: Lung tissue diseases, such as pneumonia or pulmonary edema, affect the alveoli
and the interstitium, causing a "shunting" or "V/Q mismatch." This directly impairs the
diffusion of oxygen into the blood, leading to hypoxemia and decreased oxygen saturation
(SpO2). Patients typically exhibit tachypnea and grunting to maintain alveolar volume.
, 4
Question 9
An alert 2-year-old child with an increased work of breathing and pink color is being evaluated.
The heart rate is 110/min and the respiratory rate is 30/min. How should the nurse describe this
patient's condition?
A) Respiratory distress
B) Respiratory arrest
C) Respiratory failure
D) Disordered control of breathing
E) Normal physiological state
Correct Answer: A) Respiratory distress
Rationale: Respiratory distress is characterized by an increased work of breathing
(tachypnea, retractions, nasal flaring) while still maintaining adequate gas exchange
(indicated by the pink color and alert status). If the child’s color was cyanotic or their
mental status was depressed, it would indicate a progression to respiratory failure.
Question 10
A 7-year-old child on chemotherapy is difficult to arouse, pale, and febrile (103°F). Vital signs:
HR 160/min, RR 30/min, BP 76/45 mm Hg, and capillary refill of 6 seconds. What is the most
appropriate intervention?
A) Administer 20 mL/kg of isotonic crystalloid over 30 minutes
B) Administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C) Obtain blood cultures and a chest x-ray immediately
D) Consult an oncologist regarding the next chemo dose
E) Administer an oral antipyretic for the fever
Correct Answer: B) Administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
Rationale: The child is in hypotensive (decompensated) septic shock, as evidenced by low
blood pressure, delayed capillary refill, and altered mental status. In pediatric shock, the
priority is rapid fluid resuscitation with 20 mL/kg of an isotonic crystalloid (NS or LR)
delivered as a bolus over 5-10 minutes to restore intravascular volume and perfusion.
Question 11
A 2-year-old child with a 4-day history of vomiting is unresponsive with intermittent apnea and
mottled skin. After failing at peripheral IV attempts, what is the best method of establishing
immediate vascular access?
A) Attempt peripheral access for 2 more minutes
B) Use a venous cut-down procedure
C) Place a central venous line
D) Place an intraosseous (IO) line
E) Administer fluids via a nasogastric tube
Correct Answer: D) Place an intraosseous (IO) line
Detailed Answers (Verified Answers) |Already Graded A+
Question 1
A 5-year-old child presents with lethargy, increased work of breathing, and pale color. Primary
assessment reveals an open airway, respiratory rate of 30/min with crackles, and a cardiac
monitor showing sinus tachycardia at 165/min. The pulse oximeter displays 95% saturation but a
pulse rate of 93/min. Which of the following is the best interpretation?
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
E) Reliable; the child is experiencing a normal stress response
Correct Answer: D) Unreliable; supplementary oxygen should be administered
Rationale: The pulse oximetry reading is considered unreliable because the pulse rate
displayed on the oximeter (93/min) does not correlate with the actual heart rate on the
cardiac monitor (165/min). This discrepancy suggests poor peripheral perfusion or a
motion artifact. Because the child is symptomatic (lethargy, pale color, crackles, and
increased work of breathing), the nurse must assume the oxygenation is inadequate and
provide supplementary oxygen regardless of the numerical value shown.
Question 2
A 3-year-old child recently diagnosed with leukemia presents with lethargy and a high fever.
Vital signs: HR 195/min, RR 36/min, BP 85/40 mm Hg, and capillary refill time less than 2
seconds. Which of the following is the most likely condition?
A) Septic shock
B) Hypovolemic shock
C) Significant bradycardia
D) Cardiogenic shock
E) Obstructive shock
Correct Answer: A) Septic shock
Rationale: Septic shock in children often presents initially as "warm shock," characterized
by tachycardia, fever, and brisk capillary refill (flash refill) due to peripheral vasodilation,
despite being hypotensive. Given the child’s history of leukemia and chemotherapy, they
are highly immunocompromised, making sepsis the most likely cause of their clinical
deterioration.
Question 3
A 2-week-old infant presents with irritability and a history of poor feeding. The blood pressure is
55/40 mm Hg. How should the nurse categorize this blood pressure?
A) Hypotensive
B) Normal
, 2
C) Hypertensive
D) Compensated
E) Isolated Systolic Hypertension
Correct Answer: A) Hypotensive
Rationale: In neonates (0 to 28 days), a systolic blood pressure (SBP) of less than 60 mm Hg
is defined as hypotension. For infants aged 1 month to 1 year, SBP less than 70 mm Hg is
hypotensive. Recognizing hypotension in infants is critical because they have a limited
ability to increase stroke volume; they rely on heart rate and vascular resistance to
maintain cardiac output.
Question 4
During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mg/kg
to be given IV. What is the most appropriate action for the team member?
A) Administer the drug as ordered immediately
B) Administer 0.01 mg/kg of epinephrine instead
C) Respectfully ask the team leader to clarify the dose
D) Refuse to administer the drug and leave the room
E) Ask the pharmacist to calculate the dose
Correct Answer: C) Respectfully ask the team leader to clarify the dose
Rationale: The standard IV/IO dose for epinephrine in pediatric cardiac arrest is 0.01
mg/kg (0.1 mL/kg of the 0.1 mg/mL concentration). The order of 0.1 mg/kg is ten times the
recommended dose. To ensure patient safety and maintain closed-loop communication, the
team member should clarify the order before administration to prevent a potentially fatal
medication error.
Question 5
Which of the following findings is the hallmark characteristic of respiratory failure?
A) Inadequate oxygenation and/or ventilation
B) Compensated hypotension
C) An increase in serum pH (alkalosis)
D) Audible expiratory wheezing
E) Tachypnea with clear breath sounds
Correct Answer: A) Inadequate oxygenation and/or ventilation
Rationale: Respiratory failure is a clinical state where the digestive or respiratory system
cannot maintain adequate gas exchange. This results in hypoxemia (inadequate
oxygenation), hypercapnia (inadequate ventilation/CO2 clearance), or both. While
abnormal sounds or tachypnea may be present, the defining factor is the failure to meet the
body's metabolic demands via gas exchange.
Question 6
A 6-year-old child presents with a prolonged expiratory phase and diffuse wheezing. Which of
, 3
the following conditions is most likely present?
A) Disordered control of breathing
B) Hypovolemic shock
C) Lower airway obstruction
D) Upper airway obstruction
E) Lung tissue disease
Correct Answer: C) Lower airway obstruction
Rationale: Lower airway obstructions (such as asthma or bronchiolitis) are characterized
by difficulty moving air out of the lungs. This leads to an increased expiratory time and
wheezing. Upper airway obstructions (like croup) typically produce inspiratory stridor.
Lung tissue diseases (like pneumonia) usually present with crackles and grunting.
Question 7
A 4-year-old child presents with seizures and irregular respirations. The seizures stopped five
minutes ago. Which of the following physiological functions is most likely to be abnormal?
A) Vascular resistance
B) Pulse rate
C) Lung compliance
D) Control of breathing
E) Cardiac contractility
Correct Answer: D) Control of breathing
Rationale: Post-ictal states, head trauma, or drug ingestions often result in "disordered
control of breathing." This is characterized by an abnormal respiratory pattern (irregular,
shallow, or gasping) despite the lungs themselves being healthy. The problem lies in the
neurological drive to breathe rather than an obstruction or tissue disease.
Question 8
What clinical finding is most likely to be present in children with acute respiratory distress
caused by lung tissue disease?
A) Decreased oxygen saturation
B) High-pitched inspiratory stridor
C) Normal respiratory rate
D) Decreased respiratory effort
E) Clear breath sounds bilaterally
Correct Answer: A) Decreased oxygen saturation
Rationale: Lung tissue diseases, such as pneumonia or pulmonary edema, affect the alveoli
and the interstitium, causing a "shunting" or "V/Q mismatch." This directly impairs the
diffusion of oxygen into the blood, leading to hypoxemia and decreased oxygen saturation
(SpO2). Patients typically exhibit tachypnea and grunting to maintain alveolar volume.
, 4
Question 9
An alert 2-year-old child with an increased work of breathing and pink color is being evaluated.
The heart rate is 110/min and the respiratory rate is 30/min. How should the nurse describe this
patient's condition?
A) Respiratory distress
B) Respiratory arrest
C) Respiratory failure
D) Disordered control of breathing
E) Normal physiological state
Correct Answer: A) Respiratory distress
Rationale: Respiratory distress is characterized by an increased work of breathing
(tachypnea, retractions, nasal flaring) while still maintaining adequate gas exchange
(indicated by the pink color and alert status). If the child’s color was cyanotic or their
mental status was depressed, it would indicate a progression to respiratory failure.
Question 10
A 7-year-old child on chemotherapy is difficult to arouse, pale, and febrile (103°F). Vital signs:
HR 160/min, RR 30/min, BP 76/45 mm Hg, and capillary refill of 6 seconds. What is the most
appropriate intervention?
A) Administer 20 mL/kg of isotonic crystalloid over 30 minutes
B) Administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C) Obtain blood cultures and a chest x-ray immediately
D) Consult an oncologist regarding the next chemo dose
E) Administer an oral antipyretic for the fever
Correct Answer: B) Administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
Rationale: The child is in hypotensive (decompensated) septic shock, as evidenced by low
blood pressure, delayed capillary refill, and altered mental status. In pediatric shock, the
priority is rapid fluid resuscitation with 20 mL/kg of an isotonic crystalloid (NS or LR)
delivered as a bolus over 5-10 minutes to restore intravascular volume and perfusion.
Question 11
A 2-year-old child with a 4-day history of vomiting is unresponsive with intermittent apnea and
mottled skin. After failing at peripheral IV attempts, what is the best method of establishing
immediate vascular access?
A) Attempt peripheral access for 2 more minutes
B) Use a venous cut-down procedure
C) Place a central venous line
D) Place an intraosseous (IO) line
E) Administer fluids via a nasogastric tube
Correct Answer: D) Place an intraosseous (IO) line
