AHA Pediatric Advanced Life Support (PALS) FINAL EXAM |QUESTIONS
WITH EXPERT SOLUTIONS|2026 LATEST UPDATED |GET A+
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 - (answer)Unreliable;
supplementary oxygen should be administered
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 - (answer)Septic shock
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 - (answer)Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1
mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - (answer)Respectfully ask the team leader to clarify the dose
5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - (answer)Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - (answer)Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a
few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - (answer)Control of breathing
,8. What abnormality is most likely to be present in children with acute respiratory distress
caused by lung tissue disease?
A. Decreased oxygen saturation
B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort - (answer)Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is being
evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this
patient's condition? A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing - (answer)Respiratory distress
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has
been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals
the following: The child is difficult to arouse, with pale color. The child's heart rate is 160/min,
respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds,
and temperature is 103°F (39.4°C). What is the most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an
oncologist to determine the chemotherapeutic regimen - (answer)Obtain vascular access and
administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an
unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory
rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and
, temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular
access? A. Two providers may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - (answer)Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock with
adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
C. 20 mL/kg normal saline
D. 10 mL/kg lactated Ringer's - (answer)20 mL/kg normal saline
13. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions.
The child's color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector - (answer)Administer nebulized epinephrine
14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has the
following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure 9060 mm Hg,
and temperature 98.6°F (37°C). The child's capillary refill time is 4 seconds. After 2 IV boluses of
normal saline (20 mL/kg each), the child's vital signs are now as follows: heart rate 130/min,
respiratory rate 16/min, blood pressure 94/62 mm Hg, capillary refill 2 seconds, and
temperature 98.6°F (37°C). The child's urine output is 1 to 2 mL/kg in the past hour. The child is
still lethargic. What diagnostic tests or information should be obtained first?
A. Arterial blood gas
B. Serum potassium concentration
WITH EXPERT SOLUTIONS|2026 LATEST UPDATED |GET A+
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 - (answer)Unreliable;
supplementary oxygen should be administered
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 - (answer)Septic shock
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 - (answer)Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1
mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - (answer)Respectfully ask the team leader to clarify the dose
5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - (answer)Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - (answer)Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a
few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - (answer)Control of breathing
,8. What abnormality is most likely to be present in children with acute respiratory distress
caused by lung tissue disease?
A. Decreased oxygen saturation
B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort - (answer)Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is being
evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this
patient's condition? A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing - (answer)Respiratory distress
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has
been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals
the following: The child is difficult to arouse, with pale color. The child's heart rate is 160/min,
respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds,
and temperature is 103°F (39.4°C). What is the most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an
oncologist to determine the chemotherapeutic regimen - (answer)Obtain vascular access and
administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an
unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory
rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and
, temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular
access? A. Two providers may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - (answer)Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock with
adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
C. 20 mL/kg normal saline
D. 10 mL/kg lactated Ringer's - (answer)20 mL/kg normal saline
13. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions.
The child's color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector - (answer)Administer nebulized epinephrine
14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has the
following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure 9060 mm Hg,
and temperature 98.6°F (37°C). The child's capillary refill time is 4 seconds. After 2 IV boluses of
normal saline (20 mL/kg each), the child's vital signs are now as follows: heart rate 130/min,
respiratory rate 16/min, blood pressure 94/62 mm Hg, capillary refill 2 seconds, and
temperature 98.6°F (37°C). The child's urine output is 1 to 2 mL/kg in the past hour. The child is
still lethargic. What diagnostic tests or information should be obtained first?
A. Arterial blood gas
B. Serum potassium concentration
