PALS 2025 EXAMINATION PREPARATION: 300 UNIQUE
MULTIPLE-CHOICE QUESTIONS AND CORRECT
ANSWERS|2026 UPDATES| WITH COMPLETE SOLUTIONS.
SECTION 1: SYSTEMATIC APPROACH & PEDIATRIC ASSESSMENT (Questions 1-40)
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Question 1
A 4-year-old child is brought to the emergency department with respiratory
distress. The initial impression reveals the child is conscious, breathing rapidly
with nasal flaring, and has pink skin. What is the next step in the PALS Systematic
Approach?
A) Begin immediate CPR
B) Activate the emergency response system
C) Proceed to the primary assessment (ABCDE)
D) Obtain a detailed history from the parents
Correct Answer: C
Rationale: The PALS Systematic Approach begins with an initial impression
(consciousness, breathing, color). Since the child is conscious, breathing, and not
in cardiac arrest, the provider should proceed to the Primary Assessment using
the ABCDE approach. The algorithm directs that if the child is not unresponsive
,with no breathing or gasping, you move to the Primary Assessment to identify life-
threatening problems .
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Question 2
Which of the following correctly describes the "Evaluate-Identify-Intervene"
sequence in PALS?
A) Evaluate the environment, Identify the parents, Intervene with comfort
measures
B) Evaluate the response to therapy, Identify changes in condition, Intervene with
appropriate actions
C) Evaluate vital signs, Identify the diagnosis, Intervene with medications only
D) Evaluate the team performance, Identify gaps in training, Intervene with
education
Correct Answer: B
Rationale: The Evaluate-Identify-Intervene sequence is a dynamic process that
should be repeated after each intervention to assess the patient's response. This
cycle ensures continuous reassessment and adjustment of therapy based on the
child's changing condition .
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Question 3
,During the Primary Assessment, you note that a 6-year-old patient has an open
airway but is breathing at 8 breaths per minute with poor chest rise. The heart
rate is 50 bpm with weak central pulses. According to the PALS Systematic
Approach Algorithm, what is your immediate action?
A) Administer epinephrine
B) Provide bag-mask ventilation and begin CPR
C) Administer atropine for bradycardia
D) Obtain a 12-lead ECG
Correct Answer: B
Rationale: When a child has a pulse <60 bpm with signs of poor perfusion despite
adequate oxygenation and ventilation, CPR should be initiated. The algorithm
specifically directs: "Is the pulse <60/min with poor perfusion despite oxygenation
and ventilation? → Start CPR." Bag-mask ventilation addresses the inadequate
breathing while CPR supports circulation .
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Question 4
A 2-year-old child presents with respiratory distress. During the Primary
Assessment, which finding would most concern you for impending respiratory
failure?
A) Respiratory rate of 30 breaths per minute
B) Nasal flaring and intercostal retractions
, C) Oxygen saturation of 92%
D) Gasping respirations with poor air movement
Correct Answer: D
Rationale: Gasping respirations with poor air movement indicates respiratory
failure, which is a life-threatening emergency requiring immediate intervention.
This represents inadequate ventilation and oxygenation that can rapidly progress
to cardiac arrest. Nasal flaring and retractions indicate respiratory distress but not
failure. A respiratory rate of 30 is normal for a 2-year-old, and SpO2 of 92%
requires intervention but is not the most concerning finding .
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Question 5
You are assessing a child with suspected shock. The blood pressure is normal.
Which of the following statements is correct regarding shock identification in
children?
A) A normal blood pressure excludes the diagnosis of shock
B) Children can be in compensated shock with normal blood pressure
C) Hypotension is always the first sign of shock
D) Blood pressure is the most reliable indicator of shock in children
Correct Answer: B
Rationale: Children can maintain normal blood pressure through compensatory
mechanisms (tachycardia, vasoconstriction) even while in shock. This is called
MULTIPLE-CHOICE QUESTIONS AND CORRECT
ANSWERS|2026 UPDATES| WITH COMPLETE SOLUTIONS.
SECTION 1: SYSTEMATIC APPROACH & PEDIATRIC ASSESSMENT (Questions 1-40)
---
Question 1
A 4-year-old child is brought to the emergency department with respiratory
distress. The initial impression reveals the child is conscious, breathing rapidly
with nasal flaring, and has pink skin. What is the next step in the PALS Systematic
Approach?
A) Begin immediate CPR
B) Activate the emergency response system
C) Proceed to the primary assessment (ABCDE)
D) Obtain a detailed history from the parents
Correct Answer: C
Rationale: The PALS Systematic Approach begins with an initial impression
(consciousness, breathing, color). Since the child is conscious, breathing, and not
in cardiac arrest, the provider should proceed to the Primary Assessment using
the ABCDE approach. The algorithm directs that if the child is not unresponsive
,with no breathing or gasping, you move to the Primary Assessment to identify life-
threatening problems .
---
Question 2
Which of the following correctly describes the "Evaluate-Identify-Intervene"
sequence in PALS?
A) Evaluate the environment, Identify the parents, Intervene with comfort
measures
B) Evaluate the response to therapy, Identify changes in condition, Intervene with
appropriate actions
C) Evaluate vital signs, Identify the diagnosis, Intervene with medications only
D) Evaluate the team performance, Identify gaps in training, Intervene with
education
Correct Answer: B
Rationale: The Evaluate-Identify-Intervene sequence is a dynamic process that
should be repeated after each intervention to assess the patient's response. This
cycle ensures continuous reassessment and adjustment of therapy based on the
child's changing condition .
---
Question 3
,During the Primary Assessment, you note that a 6-year-old patient has an open
airway but is breathing at 8 breaths per minute with poor chest rise. The heart
rate is 50 bpm with weak central pulses. According to the PALS Systematic
Approach Algorithm, what is your immediate action?
A) Administer epinephrine
B) Provide bag-mask ventilation and begin CPR
C) Administer atropine for bradycardia
D) Obtain a 12-lead ECG
Correct Answer: B
Rationale: When a child has a pulse <60 bpm with signs of poor perfusion despite
adequate oxygenation and ventilation, CPR should be initiated. The algorithm
specifically directs: "Is the pulse <60/min with poor perfusion despite oxygenation
and ventilation? → Start CPR." Bag-mask ventilation addresses the inadequate
breathing while CPR supports circulation .
---
Question 4
A 2-year-old child presents with respiratory distress. During the Primary
Assessment, which finding would most concern you for impending respiratory
failure?
A) Respiratory rate of 30 breaths per minute
B) Nasal flaring and intercostal retractions
, C) Oxygen saturation of 92%
D) Gasping respirations with poor air movement
Correct Answer: D
Rationale: Gasping respirations with poor air movement indicates respiratory
failure, which is a life-threatening emergency requiring immediate intervention.
This represents inadequate ventilation and oxygenation that can rapidly progress
to cardiac arrest. Nasal flaring and retractions indicate respiratory distress but not
failure. A respiratory rate of 30 is normal for a 2-year-old, and SpO2 of 92%
requires intervention but is not the most concerning finding .
---
Question 5
You are assessing a child with suspected shock. The blood pressure is normal.
Which of the following statements is correct regarding shock identification in
children?
A) A normal blood pressure excludes the diagnosis of shock
B) Children can be in compensated shock with normal blood pressure
C) Hypotension is always the first sign of shock
D) Blood pressure is the most reliable indicator of shock in children
Correct Answer: B
Rationale: Children can maintain normal blood pressure through compensatory
mechanisms (tachycardia, vasoconstriction) even while in shock. This is called
