AHA PALS – Pediatric Advanced Life Support
Recommended Practice Exam (79 Questions with
Answers & Rationales) PDF
Comprehensive practice exam for the AHA Pediatric Advanced Life Support (PALS) certification,
including scenario-based questions, answer key, and detailed rationales for exam-level preparation.
1. A 3-year-old presents with respiratory distress and nasal flaring, retractions,
and stridor. What is the most appropriate first action?
A. Start chest compressions
B. Administer epinephrine IV
C. Provide high-flow oxygen and prepare for airway management
D. Give albuterol
Answer: C
Rationale: Respiratory distress with upper airway obstruction signs (stridor,
retractions) requires oxygen, assessment of airway patency, and preparation for
advanced airway if needed.
2. A 6-month-old infant is unresponsive, apneic, and pulseless. What is the
immediate next step?
A. Check blood pressure
B. Start CPR with chest compressions
C. Give epinephrine
D. Apply AED pads without compressions
Answer: B
Rationale: For pediatric cardiac arrest, CPR should begin immediately.
Compressions and ventilations are the first priority; AED/defibrillation is applied
as soon as possible.
,3. In PALS, what is the recommended compression-to-ventilation ratio for 1
rescuer on an infant?
A. 15:2
B. 30:2
C. 30:2
D. 3:1
Answer: C
Rationale: For a single rescuer on an infant, the 30:2 ratio is recommended; for 2
rescuers, 15:2 may be used.
4. A 4-year-old has bradycardia with poor perfusion despite adequate
oxygenation and ventilation. First-line medication?
A. Epinephrine IV/IO
B. Atropine IV/IO
C. Amiodarone
D. Adenosine
Answer: B
Rationale: Symptomatic bradycardia in children is often treated first with
atropine if vagal-mediated; epinephrine is used if atropine is ineffective.
5. Which rhythm is most likely to respond to defibrillation in PALS?
A. Asystole
B. Pulseless VT / VF
C. Sinus bradycardia
D. Junctional rhythm
Answer: B
Rationale: Shockable pediatric rhythms include VF and pulseless VT. Asystole and
PEA are non-shockable.
, 6. A 7-year-old presents with respiratory failure and a heart rate of 60 bpm.
What is the next step?
A. Begin CPR immediately
B. Provide ventilatory support
C. Provide oxygen and bag-mask ventilation
D. Give atropine
Answer: C
Rationale: In pediatric patients, bradycardia is often secondary to hypoxia.
Correcting oxygenation and ventilation is the first priority.
7. During PALS, how often should rescuers switch compressors to prevent
fatigue?
A. Every 1 minute
B. Every 2 minutes
C. Every 5 minutes
D. Only when tired
Answer: B
Rationale: Switching every 2 minutes ensures high-quality compressions are
maintained.
8. Which dose of epinephrine is recommended for pediatric cardiac arrest?
A. 0.01 mg/kg IV/IO
B. 0.1 mg/kg
C. 1 mg/kg
D. 0.001 mg/kg
Answer: A
Rationale: Standard pediatric dosing for epinephrine is 0.01 mg/kg IV/IO every 3–
5 minutes during cardiac arrest.
Recommended Practice Exam (79 Questions with
Answers & Rationales) PDF
Comprehensive practice exam for the AHA Pediatric Advanced Life Support (PALS) certification,
including scenario-based questions, answer key, and detailed rationales for exam-level preparation.
1. A 3-year-old presents with respiratory distress and nasal flaring, retractions,
and stridor. What is the most appropriate first action?
A. Start chest compressions
B. Administer epinephrine IV
C. Provide high-flow oxygen and prepare for airway management
D. Give albuterol
Answer: C
Rationale: Respiratory distress with upper airway obstruction signs (stridor,
retractions) requires oxygen, assessment of airway patency, and preparation for
advanced airway if needed.
2. A 6-month-old infant is unresponsive, apneic, and pulseless. What is the
immediate next step?
A. Check blood pressure
B. Start CPR with chest compressions
C. Give epinephrine
D. Apply AED pads without compressions
Answer: B
Rationale: For pediatric cardiac arrest, CPR should begin immediately.
Compressions and ventilations are the first priority; AED/defibrillation is applied
as soon as possible.
,3. In PALS, what is the recommended compression-to-ventilation ratio for 1
rescuer on an infant?
A. 15:2
B. 30:2
C. 30:2
D. 3:1
Answer: C
Rationale: For a single rescuer on an infant, the 30:2 ratio is recommended; for 2
rescuers, 15:2 may be used.
4. A 4-year-old has bradycardia with poor perfusion despite adequate
oxygenation and ventilation. First-line medication?
A. Epinephrine IV/IO
B. Atropine IV/IO
C. Amiodarone
D. Adenosine
Answer: B
Rationale: Symptomatic bradycardia in children is often treated first with
atropine if vagal-mediated; epinephrine is used if atropine is ineffective.
5. Which rhythm is most likely to respond to defibrillation in PALS?
A. Asystole
B. Pulseless VT / VF
C. Sinus bradycardia
D. Junctional rhythm
Answer: B
Rationale: Shockable pediatric rhythms include VF and pulseless VT. Asystole and
PEA are non-shockable.
, 6. A 7-year-old presents with respiratory failure and a heart rate of 60 bpm.
What is the next step?
A. Begin CPR immediately
B. Provide ventilatory support
C. Provide oxygen and bag-mask ventilation
D. Give atropine
Answer: C
Rationale: In pediatric patients, bradycardia is often secondary to hypoxia.
Correcting oxygenation and ventilation is the first priority.
7. During PALS, how often should rescuers switch compressors to prevent
fatigue?
A. Every 1 minute
B. Every 2 minutes
C. Every 5 minutes
D. Only when tired
Answer: B
Rationale: Switching every 2 minutes ensures high-quality compressions are
maintained.
8. Which dose of epinephrine is recommended for pediatric cardiac arrest?
A. 0.01 mg/kg IV/IO
B. 0.1 mg/kg
C. 1 mg/kg
D. 0.001 mg/kg
Answer: A
Rationale: Standard pediatric dosing for epinephrine is 0.01 mg/kg IV/IO every 3–
5 minutes during cardiac arrest.
