1
AHA PALS Exam 2025 Actual Test
Bank – 230 Authentic Questions
with 100% Verified Answers &
Detailed Rationales | A+ Graded
Student Name: _________________________
Date: _______________
Time Limit: 120 minutes
Total Questions: 230
Systematic Approach to Pediatric Assessment
1. MCQ: A healthcare provider arrives at the scene of a 5-year-old child who collapsed
during play. What is the first step in the PALS systematic approach?
a. Perform a detailed history
b. Conduct a rapid initial impression using the Pediatric Assessment Triangle (PAT)
c. Administer oxygen immediately
d. Begin chest compressions
Rationale: The PALS systematic approach begins with the PAT (appearance, breathing,
circulation) to quickly assess life-threatening conditions. A detailed history (a) delays
intervention, oxygen (c) is applied after assessment, and compressions (d) are for
pulseless patients, per AHA 2025 guidelines.
2. MCQ: During the PAT, a 3-year-old appears lethargic with weak muscle tone. This
finding is assessed under which component?
a. Breathing
b. Appearance
c. Circulation
d. Exposure
Rationale: Appearance in the PAT evaluates the child’s mental status, muscle tone, and
interaction (e.g., TICLS: Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry).
Lethargy and weak tone indicate abnormal appearance, per AHA guidelines.
3. MCQ: A provider performs a primary assessment on a 6-year-old with difficulty
breathing. What is the first step in the ABCDE protocol?
a. Check circulation
b. Assess airway patency
c. Evaluate disability
d. Expose the patient
, 2
Rationale: The ABCDE protocol prioritizes airway patency to ensure breathing and
oxygenation. Circulation (a), disability (c), and exposure (d) follow airway assessment,
per AHA PALS standards.
4. MCQ: During a secondary assessment, which acronym guides history collection for a
pediatric patient?
a. ABCDE
b. SPAM
c. AVPU
d. TICLS
Rationale: SPAM (Signs/Symptoms, Past medical history, Allergies, Medications) guides
the secondary assessment’s history collection. ABCDE (a) is for primary assessment,
AVPU (c) assesses consciousness, and TICLS (d) evaluates appearance, per AHA
guidelines.
5. MCQ: A 4-year-old is unresponsive to voice but responds to pain. What is the AVPU
classification?
a. Alert
b. Voice
c. Pain
d. Unresponsive
Rationale: The AVPU scale classifies responsiveness: Alert (fully awake), Voice
(responds to verbal stimuli), Pain (responds only to pain), Unresponsive (no response).
Response to pain is classified as Pain (c), per AHA PALS protocols.
6. MCQ: A provider uses the Glasgow Coma Scale (GCS) for a 7-year-old. What does a
score of 3 indicate?
a. Mild impairment
b. Severe neurological impairment
c. Moderate impairment
d. Normal function
Rationale: A GCS score of 3 (1 for eye, verbal, and motor responses) indicates severe
neurological impairment, often coma or brain death. Scores of 13–15 are mild, 9–12
moderate, and ≤8 severe, per AHA guidelines.
7. MCQ: A 2-year-old has mottled skin during the PAT. This finding is associated with
which component?
a. Appearance
b. Breathing
c. Circulation
d. Disability
Rationale: Mottled skin indicates poor perfusion, assessed under the circulation
component of the PAT. Appearance (a) evaluates mental status, breathing (b) assesses
respiratory effort, and disability (d) is not part of PAT, per AHA standards.
8. MCQ: During a primary assessment, a 5-year-old has a heart rate of 160/min. What
should the provider evaluate next?
a. Administer epinephrine
b. Assess for signs of hemodynamic compromise
c. Begin chest compressions
d. Order a 12-lead ECG
, 3
Rationale: A heart rate of 160/min in a 5-year-old suggests tachycardia. The provider
should assess for hemodynamic compromise (e.g., hypotension, poor perfusion) to
determine urgency, per AHA PALS algorithms. Compressions (c) are for pulseless
patients, and ECG (d) is secondary.
9. MCQ: A 6-month-old is pale with delayed capillary refill. This finding suggests what
condition?
a. Respiratory distress
b. Circulatory compromise
c. Neurological deficit
d. Hypoglycemia
Rationale: Pale skin and delayed capillary refill indicate poor perfusion, suggestive of
circulatory compromise (e.g., shock). Respiratory distress (a) involves breathing effort,
neurological deficits (c) affect consciousness, and hypoglycemia (d) requires testing, per
AHA guidelines.
10. MCQ: What is the purpose of the Pediatric Assessment Triangle (PAT)?
a. To diagnose specific diseases
b. To quickly identify life-threatening conditions
c. To replace the secondary assessment
d. To administer medications
Rationale: The PAT rapidly assesses appearance, breathing, and circulation to identify
life-threatening conditions requiring immediate intervention. It does not diagnose
diseases (a), replace secondary assessment (c), or involve medication (d), per AHA PALS
standards.
11. MCQ: A provider observes nasal flaring in a 3-year-old. Under which PAT component is
this assessed?
a. Appearance
b. Breathing
c. Circulation
d. Disability
Rationale: Nasal flaring indicates increased respiratory effort, assessed under the
breathing component of the PAT. Appearance (a) evaluates mental status, circulation (c)
assesses perfusion, and disability (d) is not part of PAT, per AHA guidelines.
12. MCQ: During a primary assessment, a 4-year-old has a clear airway but irregular
breathing. What is the next step?
a. Perform a neurological exam
b. Provide oxygen or ventilatory support
c. Check blood glucose
d. Administer fluids
Rationale: Irregular breathing after a clear airway requires oxygen or ventilatory support
to address respiratory distress or failure. Neurological exams (a), glucose checks (c), and
fluids (d) are secondary, per AHA PALS protocols.
13. MCQ: A 7-year-old has a GCS score of 12. What does this indicate?
a. Severe impairment
b. Moderate impairment
c. Normal function
d. Mild impairment
, 4
Rationale: A GCS score of 9–12 indicates moderate neurological impairment. Severe is
≤8, mild is 13–15, and 15 is normal, per AHA PALS guidelines.
14. MCQ: During the PAT, a 2-year-old is alert but has cyanosis. This is assessed under
which component?
a. Appearance
b. Breathing
c. Circulation
d. Exposure
Rationale: Cyanosis indicates poor oxygenation or perfusion, assessed under the
circulation component of the PAT. Appearance (a) evaluates alertness, breathing (b)
assesses respiratory effort, and exposure (d) is part of ABCDE, per AHA standards.
15. MCQ: What is the maximum time to check for a pulse in an unresponsive child before
starting CPR?
a. 5 seconds
b. 10 seconds
c. 15 seconds
d. 20 seconds
Rationale: AHA recommends checking for a pulse for no more than 10 seconds in an
unresponsive child to avoid delaying CPR. Longer times (c, d) delay intervention, and 5
seconds (a) is insufficient, per PALS guidelines.
16. MCQ: A provider assesses a 5-year-old using the AVPU scale. The child responds to
verbal commands. What is the classification?
a. Alert
b. Voice
c. Pain
d. Unresponsive
Rationale: The AVPU scale classifies a child responding to verbal commands as Voice
(b). Alert (a) is fully awake, Pain (c) is response to pain, and Unresponsive (d) is no
response, per AHA guidelines.
17. MCQ: During a primary assessment, a 6-year-old has a heart rate of 50/min. What is the
next step?
a. Administer oxygen
b. Assess for signs of poor perfusion
c. Begin chest compressions
d. Order a chest X-ray
Rationale: A heart rate of 50/min in a 6-year-old suggests bradycardia. The provider
should assess perfusion (e.g., capillary refill, blood pressure) to determine if intervention
is needed, per AHA PALS bradycardia algorithm. Compressions (c) are for severe cases,
per guidelines.
18. MCQ: A 3-year-old is unresponsive. What is the first action after confirming
unresponsiveness?
a. Administer epinephrine
b. Check breathing and pulse simultaneously
c. Perform a head-to-toe exam
d. Apply an AED
Rationale: After confirming unresponsiveness, check breathing and pulse simultaneously
AHA PALS Exam 2025 Actual Test
Bank – 230 Authentic Questions
with 100% Verified Answers &
Detailed Rationales | A+ Graded
Student Name: _________________________
Date: _______________
Time Limit: 120 minutes
Total Questions: 230
Systematic Approach to Pediatric Assessment
1. MCQ: A healthcare provider arrives at the scene of a 5-year-old child who collapsed
during play. What is the first step in the PALS systematic approach?
a. Perform a detailed history
b. Conduct a rapid initial impression using the Pediatric Assessment Triangle (PAT)
c. Administer oxygen immediately
d. Begin chest compressions
Rationale: The PALS systematic approach begins with the PAT (appearance, breathing,
circulation) to quickly assess life-threatening conditions. A detailed history (a) delays
intervention, oxygen (c) is applied after assessment, and compressions (d) are for
pulseless patients, per AHA 2025 guidelines.
2. MCQ: During the PAT, a 3-year-old appears lethargic with weak muscle tone. This
finding is assessed under which component?
a. Breathing
b. Appearance
c. Circulation
d. Exposure
Rationale: Appearance in the PAT evaluates the child’s mental status, muscle tone, and
interaction (e.g., TICLS: Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry).
Lethargy and weak tone indicate abnormal appearance, per AHA guidelines.
3. MCQ: A provider performs a primary assessment on a 6-year-old with difficulty
breathing. What is the first step in the ABCDE protocol?
a. Check circulation
b. Assess airway patency
c. Evaluate disability
d. Expose the patient
, 2
Rationale: The ABCDE protocol prioritizes airway patency to ensure breathing and
oxygenation. Circulation (a), disability (c), and exposure (d) follow airway assessment,
per AHA PALS standards.
4. MCQ: During a secondary assessment, which acronym guides history collection for a
pediatric patient?
a. ABCDE
b. SPAM
c. AVPU
d. TICLS
Rationale: SPAM (Signs/Symptoms, Past medical history, Allergies, Medications) guides
the secondary assessment’s history collection. ABCDE (a) is for primary assessment,
AVPU (c) assesses consciousness, and TICLS (d) evaluates appearance, per AHA
guidelines.
5. MCQ: A 4-year-old is unresponsive to voice but responds to pain. What is the AVPU
classification?
a. Alert
b. Voice
c. Pain
d. Unresponsive
Rationale: The AVPU scale classifies responsiveness: Alert (fully awake), Voice
(responds to verbal stimuli), Pain (responds only to pain), Unresponsive (no response).
Response to pain is classified as Pain (c), per AHA PALS protocols.
6. MCQ: A provider uses the Glasgow Coma Scale (GCS) for a 7-year-old. What does a
score of 3 indicate?
a. Mild impairment
b. Severe neurological impairment
c. Moderate impairment
d. Normal function
Rationale: A GCS score of 3 (1 for eye, verbal, and motor responses) indicates severe
neurological impairment, often coma or brain death. Scores of 13–15 are mild, 9–12
moderate, and ≤8 severe, per AHA guidelines.
7. MCQ: A 2-year-old has mottled skin during the PAT. This finding is associated with
which component?
a. Appearance
b. Breathing
c. Circulation
d. Disability
Rationale: Mottled skin indicates poor perfusion, assessed under the circulation
component of the PAT. Appearance (a) evaluates mental status, breathing (b) assesses
respiratory effort, and disability (d) is not part of PAT, per AHA standards.
8. MCQ: During a primary assessment, a 5-year-old has a heart rate of 160/min. What
should the provider evaluate next?
a. Administer epinephrine
b. Assess for signs of hemodynamic compromise
c. Begin chest compressions
d. Order a 12-lead ECG
, 3
Rationale: A heart rate of 160/min in a 5-year-old suggests tachycardia. The provider
should assess for hemodynamic compromise (e.g., hypotension, poor perfusion) to
determine urgency, per AHA PALS algorithms. Compressions (c) are for pulseless
patients, and ECG (d) is secondary.
9. MCQ: A 6-month-old is pale with delayed capillary refill. This finding suggests what
condition?
a. Respiratory distress
b. Circulatory compromise
c. Neurological deficit
d. Hypoglycemia
Rationale: Pale skin and delayed capillary refill indicate poor perfusion, suggestive of
circulatory compromise (e.g., shock). Respiratory distress (a) involves breathing effort,
neurological deficits (c) affect consciousness, and hypoglycemia (d) requires testing, per
AHA guidelines.
10. MCQ: What is the purpose of the Pediatric Assessment Triangle (PAT)?
a. To diagnose specific diseases
b. To quickly identify life-threatening conditions
c. To replace the secondary assessment
d. To administer medications
Rationale: The PAT rapidly assesses appearance, breathing, and circulation to identify
life-threatening conditions requiring immediate intervention. It does not diagnose
diseases (a), replace secondary assessment (c), or involve medication (d), per AHA PALS
standards.
11. MCQ: A provider observes nasal flaring in a 3-year-old. Under which PAT component is
this assessed?
a. Appearance
b. Breathing
c. Circulation
d. Disability
Rationale: Nasal flaring indicates increased respiratory effort, assessed under the
breathing component of the PAT. Appearance (a) evaluates mental status, circulation (c)
assesses perfusion, and disability (d) is not part of PAT, per AHA guidelines.
12. MCQ: During a primary assessment, a 4-year-old has a clear airway but irregular
breathing. What is the next step?
a. Perform a neurological exam
b. Provide oxygen or ventilatory support
c. Check blood glucose
d. Administer fluids
Rationale: Irregular breathing after a clear airway requires oxygen or ventilatory support
to address respiratory distress or failure. Neurological exams (a), glucose checks (c), and
fluids (d) are secondary, per AHA PALS protocols.
13. MCQ: A 7-year-old has a GCS score of 12. What does this indicate?
a. Severe impairment
b. Moderate impairment
c. Normal function
d. Mild impairment
, 4
Rationale: A GCS score of 9–12 indicates moderate neurological impairment. Severe is
≤8, mild is 13–15, and 15 is normal, per AHA PALS guidelines.
14. MCQ: During the PAT, a 2-year-old is alert but has cyanosis. This is assessed under
which component?
a. Appearance
b. Breathing
c. Circulation
d. Exposure
Rationale: Cyanosis indicates poor oxygenation or perfusion, assessed under the
circulation component of the PAT. Appearance (a) evaluates alertness, breathing (b)
assesses respiratory effort, and exposure (d) is part of ABCDE, per AHA standards.
15. MCQ: What is the maximum time to check for a pulse in an unresponsive child before
starting CPR?
a. 5 seconds
b. 10 seconds
c. 15 seconds
d. 20 seconds
Rationale: AHA recommends checking for a pulse for no more than 10 seconds in an
unresponsive child to avoid delaying CPR. Longer times (c, d) delay intervention, and 5
seconds (a) is insufficient, per PALS guidelines.
16. MCQ: A provider assesses a 5-year-old using the AVPU scale. The child responds to
verbal commands. What is the classification?
a. Alert
b. Voice
c. Pain
d. Unresponsive
Rationale: The AVPU scale classifies a child responding to verbal commands as Voice
(b). Alert (a) is fully awake, Pain (c) is response to pain, and Unresponsive (d) is no
response, per AHA guidelines.
17. MCQ: During a primary assessment, a 6-year-old has a heart rate of 50/min. What is the
next step?
a. Administer oxygen
b. Assess for signs of poor perfusion
c. Begin chest compressions
d. Order a chest X-ray
Rationale: A heart rate of 50/min in a 6-year-old suggests bradycardia. The provider
should assess perfusion (e.g., capillary refill, blood pressure) to determine if intervention
is needed, per AHA PALS bradycardia algorithm. Compressions (c) are for severe cases,
per guidelines.
18. MCQ: A 3-year-old is unresponsive. What is the first action after confirming
unresponsiveness?
a. Administer epinephrine
b. Check breathing and pulse simultaneously
c. Perform a head-to-toe exam
d. Apply an AED
Rationale: After confirming unresponsiveness, check breathing and pulse simultaneously
