PALS VERSION A EXAM
QUESTIONS AND ANSWERS | COMPREHENSIVE REVIEW
PEDIATRIC ADVANCED LIFE SUPPORT (PALS) –
AMERICAN HEART ASSOCIATION
CURRENT GUIDELINES | VERIFIED | GRADED A+
INTRODUCTION .
This comprehensive practice examination is designed for healthcare professionals (pediatricians,
emergency physicians, nurses, paramedics, respiratory therapists) preparing for the PALS
(Pediatric Advanced Life Support) Version A written exam for the current AHA guidelines
certification cycle. The PALS course focuses on recognition and management of respiratory
emergencies, shock, and cardiac arrest in infants and children .
Section 1: Pediatric Assessment and Systematic Approach (Questions 1-15)
Q1: A 3-year-old child presents with stridor, barking cough, and respiratory distress. The child is
sitting upright and drooling. What is the most likely diagnosis?
A. Asthma
B. Croup (laryngotracheobronchitis)
C. Anaphylaxis
D. Foreign body aspiration
[CORRECT] B. Croup (laryngotracheobronchitis)
Rationale:
Croup presents with barking cough, stridor, and respiratory distress, often worse at night. The
child may sit upright to improve airway patency. Drooling is more concerning for epiglottitis
(rare now due to Hib vaccine).
Asthma typically presents with wheezing, not stridor.
Anaphylaxis would likely include urticaria, angioedema, or hypotension.
Foreign body aspiration usually has a sudden onset with choking history.
,Q2: A 6-month-old infant is brought to the emergency department with difficulty breathing. On
assessment, the infant has nasal flaring, grunting, and subcostal retractions. What is the most
appropriate initial intervention?
A. Endotracheal intubation
B. Bag-mask ventilation with 100% oxygen
C. Position the airway and suction if needed, administer oxygen, and support ventilation as
needed
D. Needle decompression of the chest
[CORRECT] C. Position the airway and suction if needed, administer oxygen, and support
ventilation as needed
Rationale:
The PALS systematic approach begins with airway (position, suction), then breathing (oxygen,
ventilation).
Grunting is a sign of respiratory distress (increased end-expiratory pressure to keep alveoli
open).
Bag-mask ventilation may be needed if ineffective breathing develops.
Intubation is reserved for respiratory failure, not initial distress.
Q3: A 2-year-old child is unresponsive and not breathing. The healthcare provider should first:
A. Check for a pulse for up to 10 seconds
B. Begin CPR with 30:2 compressions to breaths
C. Give two rescue breaths
D. Activate emergency response system
[CORRECT] A. Check for a pulse for up to 10 seconds
Rationale:
For an unresponsive child not breathing, the provider should check for a pulse for up to 10
seconds.
If no pulse or uncertain within 10 seconds, begin CPR.
For a single rescuer, start with 30:2 compressions to breaths.
,Activation of emergency response should occur simultaneously if others are present.
Q4: The initial impression (first quick assessment) in PALS includes evaluation of: (Select all that
apply)
A. Appearance
B. Work of breathing
C. Circulation of skin
D. Blood pressure
[CORRECT] A, B, C
Rationale:
The initial impression includes appearance (AVPU: alert, voice, pain, unresponsive), work of
breathing (increased, decreased, abnormal sounds), and circulation of skin (color, pallor,
mottling, cyanosis).
Blood pressure is measured during primary assessment (Circulation), not initial impression.
This assessment takes only seconds and guides immediate interventions.
Q5: A 4-year-old child has a respiratory rate of 40 breaths/min, oxygen saturation of 88% on
room air, and subcostal retractions. This child is in:
A. Respiratory distress
B. Respiratory failure
C. Compensated shock
D. Cardiac arrest
[CORRECT] A. Respiratory distress
Rationale:
Respiratory distress presents with increased work of breathing (retractions, nasal flaring,
grunting) and hypoxemia but maintains adequate ventilation and oxygenation.
Respiratory failure occurs when compensation fails, leading to inadequate gas exchange (altered
mental status, bradycardia, cyanosis despite oxygen).
Normal RR for 4-year-old is 20-30; 40 is elevated indicating distress.
Q6: During the primary assessment, which of the following is evaluated under "Disability"?
, A. Heart rate and pulse quality
B. Pupillary response and level of consciousness
C. Breath sounds and oxygen saturation
D. Temperature and skin turgor
[CORRECT] B. Pupillary response and level of consciousness
Rationale:
Disability in the ABCDE approach assesses neurologic function: level of consciousness (AVPU),
pupillary response, and posturing.
Heart rate/pulse are part of Circulation.
Breath sounds/O2 sat are part of Breathing.
Temperature is part of Exposure.
Q7: A 5-year-old child has a heart rate of 150 bpm, capillary refill of 2 seconds, and blood
pressure of 80/50 mm Hg. These findings are consistent with:
A. Normal perfusion for age
B. Compensated shock
C. Hypotensive shock
D. Normal vital signs
[CORRECT] C. Hypotensive shock
Rationale:
Normal BP for 5-year-old: ~90-110/55-70 mm Hg (formula: 90 + 2×age for systolic).
BP of 80/50 is hypotensive for this age.
Even with relatively normal capillary refill, hypotension indicates decompensated (hypotensive)
shock.
Tachycardia is present but BP is the critical finding.
Q8: The "Evaluate-Identify-Intervene" sequence in PALS refers to:
A. Rapid sequence intubation steps
B. The systematic approach to pediatric assessment
QUESTIONS AND ANSWERS | COMPREHENSIVE REVIEW
PEDIATRIC ADVANCED LIFE SUPPORT (PALS) –
AMERICAN HEART ASSOCIATION
CURRENT GUIDELINES | VERIFIED | GRADED A+
INTRODUCTION .
This comprehensive practice examination is designed for healthcare professionals (pediatricians,
emergency physicians, nurses, paramedics, respiratory therapists) preparing for the PALS
(Pediatric Advanced Life Support) Version A written exam for the current AHA guidelines
certification cycle. The PALS course focuses on recognition and management of respiratory
emergencies, shock, and cardiac arrest in infants and children .
Section 1: Pediatric Assessment and Systematic Approach (Questions 1-15)
Q1: A 3-year-old child presents with stridor, barking cough, and respiratory distress. The child is
sitting upright and drooling. What is the most likely diagnosis?
A. Asthma
B. Croup (laryngotracheobronchitis)
C. Anaphylaxis
D. Foreign body aspiration
[CORRECT] B. Croup (laryngotracheobronchitis)
Rationale:
Croup presents with barking cough, stridor, and respiratory distress, often worse at night. The
child may sit upright to improve airway patency. Drooling is more concerning for epiglottitis
(rare now due to Hib vaccine).
Asthma typically presents with wheezing, not stridor.
Anaphylaxis would likely include urticaria, angioedema, or hypotension.
Foreign body aspiration usually has a sudden onset with choking history.
,Q2: A 6-month-old infant is brought to the emergency department with difficulty breathing. On
assessment, the infant has nasal flaring, grunting, and subcostal retractions. What is the most
appropriate initial intervention?
A. Endotracheal intubation
B. Bag-mask ventilation with 100% oxygen
C. Position the airway and suction if needed, administer oxygen, and support ventilation as
needed
D. Needle decompression of the chest
[CORRECT] C. Position the airway and suction if needed, administer oxygen, and support
ventilation as needed
Rationale:
The PALS systematic approach begins with airway (position, suction), then breathing (oxygen,
ventilation).
Grunting is a sign of respiratory distress (increased end-expiratory pressure to keep alveoli
open).
Bag-mask ventilation may be needed if ineffective breathing develops.
Intubation is reserved for respiratory failure, not initial distress.
Q3: A 2-year-old child is unresponsive and not breathing. The healthcare provider should first:
A. Check for a pulse for up to 10 seconds
B. Begin CPR with 30:2 compressions to breaths
C. Give two rescue breaths
D. Activate emergency response system
[CORRECT] A. Check for a pulse for up to 10 seconds
Rationale:
For an unresponsive child not breathing, the provider should check for a pulse for up to 10
seconds.
If no pulse or uncertain within 10 seconds, begin CPR.
For a single rescuer, start with 30:2 compressions to breaths.
,Activation of emergency response should occur simultaneously if others are present.
Q4: The initial impression (first quick assessment) in PALS includes evaluation of: (Select all that
apply)
A. Appearance
B. Work of breathing
C. Circulation of skin
D. Blood pressure
[CORRECT] A, B, C
Rationale:
The initial impression includes appearance (AVPU: alert, voice, pain, unresponsive), work of
breathing (increased, decreased, abnormal sounds), and circulation of skin (color, pallor,
mottling, cyanosis).
Blood pressure is measured during primary assessment (Circulation), not initial impression.
This assessment takes only seconds and guides immediate interventions.
Q5: A 4-year-old child has a respiratory rate of 40 breaths/min, oxygen saturation of 88% on
room air, and subcostal retractions. This child is in:
A. Respiratory distress
B. Respiratory failure
C. Compensated shock
D. Cardiac arrest
[CORRECT] A. Respiratory distress
Rationale:
Respiratory distress presents with increased work of breathing (retractions, nasal flaring,
grunting) and hypoxemia but maintains adequate ventilation and oxygenation.
Respiratory failure occurs when compensation fails, leading to inadequate gas exchange (altered
mental status, bradycardia, cyanosis despite oxygen).
Normal RR for 4-year-old is 20-30; 40 is elevated indicating distress.
Q6: During the primary assessment, which of the following is evaluated under "Disability"?
, A. Heart rate and pulse quality
B. Pupillary response and level of consciousness
C. Breath sounds and oxygen saturation
D. Temperature and skin turgor
[CORRECT] B. Pupillary response and level of consciousness
Rationale:
Disability in the ABCDE approach assesses neurologic function: level of consciousness (AVPU),
pupillary response, and posturing.
Heart rate/pulse are part of Circulation.
Breath sounds/O2 sat are part of Breathing.
Temperature is part of Exposure.
Q7: A 5-year-old child has a heart rate of 150 bpm, capillary refill of 2 seconds, and blood
pressure of 80/50 mm Hg. These findings are consistent with:
A. Normal perfusion for age
B. Compensated shock
C. Hypotensive shock
D. Normal vital signs
[CORRECT] C. Hypotensive shock
Rationale:
Normal BP for 5-year-old: ~90-110/55-70 mm Hg (formula: 90 + 2×age for systolic).
BP of 80/50 is hypotensive for this age.
Even with relatively normal capillary refill, hypotension indicates decompensated (hypotensive)
shock.
Tachycardia is present but BP is the critical finding.
Q8: The "Evaluate-Identify-Intervene" sequence in PALS refers to:
A. Rapid sequence intubation steps
B. The systematic approach to pediatric assessment
