2026 AHA PALS Certification Exam Prep
Questions | Pediatric Life Support Questions,
Exams of Pediatrics
Section 1: Foundational Concepts & Systematic Assessment (Questions 1-20)
1. The PALS systematic approach algorithm begins with which initial impression?
A) Secondary Assessment
B) Initial impression (Appearance, Breathing, Circulation/Color)
C) Diagnostic tests
D) Primary Assessment (ABCDE)
Answer: B
Rationale: The PALS systematic approach begins with the initial impression. This is a
rapid, visual and auditory assessment of the child's appearance, work of breathing, and
color/circulation. It is performed as you enter the room to identify life-threatening
conditions and determine the need for immediate intervention.
2. A child presents with lethargy, nasal flaring, and mottled skin. According to the PALS
systematic assessment algorithm, what should be the immediate priority?
A) Perform a detailed secondary assessment
B) Begin a Primary Assessment (ABCDE) and Initiate Emergency Care
C) Obtain a full set of vital signs
D) Call for the child's parent to obtain history
Answer: B
Rationale: The PALS systematic assessment is a Evaluate-Identify-Intervene sequence.
The "Evaluate" phase includes the Initial Impression and the Primary Assessment
(ABCDE). The child is presenting as a sick patient (lethargy, respiratory distress, shock
signs). Therefore, you must begin the Primary Assessment immediately, identify the likely
category of illness (respiratory distress/failure, shock, or cardiac arrest), and intervene.
3. A patient with suspected septic shock has cold, mottled extremities and a delayed
capillary refill time of 4 seconds. This presentation is most consistent with which type of
shock?
A) Distributive shock (Cold/Warm)
B) Hypovolemic shock
,C) Cardiogenic shock
D) Obstructive shock
Answer: A
Rationale: Distributive shock can present as "warm" shock (bounding pulses, flash CRT)
or "cold" shock (delayed CRT, mottled extremities). This variation depends on the stage
of sepsis and the patient's systemic vascular resistance (SVR). Cold, mottled skin with
delayed CRT indicates high SVR, which is common in the early stages of septic shock or
fluid-refractory shock.
4. When performing the Primary Assessment for a critically ill child, what does the "C" in
the ABCDE mnemonic specifically assess?
A) Cardiac rhythm on the monitor
B) Circulation: Heart rate, pulses, capillary refill time, and skin color
C) Complete blood count
D) Core body temperature
Answer: B
*Rationale: In the Primary Assessment (ABCDE), "C" stands for Circulation. It is a rapid
bedside assessment of circulatory adequacy. It includes evaluating heart rate (bradycardia
is an ominous sign), peripheral vs. central pulse quality, capillary refill time (normal is <2
seconds), and skin color/mottling.*
5. A 6-year-old child is found in cardiac arrest. According to PALS, after initiating high-
quality CPR and attaching an AED/monitor, the next step is to:
A) Immediately establish an advanced airway
B) Defibrillate if a shockable rhythm is present
C) Administer Epinephrine immediately
D) Start an IV for fluid resuscitation
Answer: B
Rationale: The Cardiac Arrest Algorithm prioritizes immediate defibrillation for
shockable rhythms (VF/pVT). High-quality CPR is continued while charging the
defibrillator. Epinephrine is given after the second shock and during cycles of CPR.
6. A nurse is using the "Evaluate-Identify-Intervene" sequence for a child with respiratory
distress. After evaluating the Primary Assessment (ABCDE), what is the next step?
A) Identify the likely category of illness (Respiratory, Shock, or Arrest)
B) Perform diagnostic tests (Chest X-ray, ABG)
C) Immediately intubate the patient
D) Re-evaluate the initial impression
,Answer: A
Rationale: The PALS algorithm follows the cycle: Evaluate (Initial Impression + Primary
Assessment + Secondary Assessment), Identify (categorize the child as Respiratory
Distress/Failure, Shock (Compensated/Hypotensive), or Cardiorespiratory
Failure/Arrest), and Intervene (perform specific actions matching the identified
category).
7. A child is in the post-cardiac arrest phase with return of spontaneous circulation
(ROSC). What is the goal for oxygen saturation during post-resuscitation management?
A) 100%
B) 94% to 99% (Weaning oxygen to avoid hyperoxia)
C) 88% to 92%
D) Titrate to maintain SpO2 >94%, but avoid hyperoxia
Answer: D
*Rationale: Post-cardiac arrest guidelines recommend titrating oxygen to achieve normal
saturation (94-99%) while avoiding hyperoxia. Hyperoxia may worsen reperfusion injury
and increase mortality.*
8. A 4-year-old child is brought to the emergency department with a barking cough,
stridor, and increased work of breathing that is worse at night. The child is alert and has
normal color. This clinical picture is most consistent with:
A) Upper Airway Obstruction (Croup)
B) Lower Airway Obstruction (Asthma)
C) Lung Tissue Disease (Pneumonia)
D) Disordered Control of Breathing (Apnea)
Answer: A
Rationale: Croup (laryngotracheobronchitis) is a classic upper airway obstruction. It is
characterized by a "barking" or seal-like cough, inspiratory stridor, and worsening
symptoms at night. It is typically viral in origin.
9. PALS guidelines state that the depth of chest compressions for an infant should be
approximately:
A) 1 inch (2.5 cm)
B) 1.5 inches (4 cm)
C) 2 inches (5 cm)
D) 2.4 inches (6 cm)
Answer: B
*Rationale: The 2020 AHA guidelines recommend a compression depth of approximately
, 1.5 inches (4 cm) for infants. This is about one-third the anterior-posterior (AP) diameter
of the chest.*
10. For a child requiring a supraglottic airway (e.g., LMA) during CPR, providers should
note that:
A) It provides a definitive airway equal to an endotracheal tube
B) It may be used as a rescue device when bag-mask ventilation is ineffective
C) It eliminates the need for chest compressions
D) It is contraindicated in children under 2 years old
Answer: B
Rationale: Supraglottic airways are acceptable as a rescue device in pediatric CPR when
bag-mask ventilation is ineffective and if the provider is not trained in endotracheal
intubation.
11. A 3-year-old child has a tracheostomy tube in place and is in cardiac arrest. What is the
correct ventilation method for this child?
A) Perform mouth-to-tracheostomy ventilation
B) Use a bag-mask device over the face
C) Ventilate directly through the tracheostomy tube with a bag-valve device
D) Remove the tracheostomy tube and perform standard CPR
Answer: C
Rationale: For a child with a tracheostomy, ventilation should be delivered directly
through the tracheostomy tube using a bag-valve device. Avoid ventilation through the
mouth/nose, as air will escape through the stoma.
12. A 5-year-old child has a heart rate of 210 bpm, P waves are absent, and the QRS
complex is narrow (<0.09 sec). This rhythm is most likely:
A) Sinus Tachycardia
B) Supraventricular Tachycardia (SVT)
C) Ventricular Tachycardia
D) Second-degree AV block
Answer: B
Rationale: SVT is characterized by a narrow QRS complex (<0.09 sec), absent or abnormal
P waves, and a heart rate usually >180 bpm in children (often >220 in infants).
13. A 10 kg child is in supraventricular tachycardia with adequate perfusion. What is the
initial vagal maneuver recommended for infants and young children?
A) Carotid sinus massage
B) Applying ice to the face (diving reflex)
Questions | Pediatric Life Support Questions,
Exams of Pediatrics
Section 1: Foundational Concepts & Systematic Assessment (Questions 1-20)
1. The PALS systematic approach algorithm begins with which initial impression?
A) Secondary Assessment
B) Initial impression (Appearance, Breathing, Circulation/Color)
C) Diagnostic tests
D) Primary Assessment (ABCDE)
Answer: B
Rationale: The PALS systematic approach begins with the initial impression. This is a
rapid, visual and auditory assessment of the child's appearance, work of breathing, and
color/circulation. It is performed as you enter the room to identify life-threatening
conditions and determine the need for immediate intervention.
2. A child presents with lethargy, nasal flaring, and mottled skin. According to the PALS
systematic assessment algorithm, what should be the immediate priority?
A) Perform a detailed secondary assessment
B) Begin a Primary Assessment (ABCDE) and Initiate Emergency Care
C) Obtain a full set of vital signs
D) Call for the child's parent to obtain history
Answer: B
Rationale: The PALS systematic assessment is a Evaluate-Identify-Intervene sequence.
The "Evaluate" phase includes the Initial Impression and the Primary Assessment
(ABCDE). The child is presenting as a sick patient (lethargy, respiratory distress, shock
signs). Therefore, you must begin the Primary Assessment immediately, identify the likely
category of illness (respiratory distress/failure, shock, or cardiac arrest), and intervene.
3. A patient with suspected septic shock has cold, mottled extremities and a delayed
capillary refill time of 4 seconds. This presentation is most consistent with which type of
shock?
A) Distributive shock (Cold/Warm)
B) Hypovolemic shock
,C) Cardiogenic shock
D) Obstructive shock
Answer: A
Rationale: Distributive shock can present as "warm" shock (bounding pulses, flash CRT)
or "cold" shock (delayed CRT, mottled extremities). This variation depends on the stage
of sepsis and the patient's systemic vascular resistance (SVR). Cold, mottled skin with
delayed CRT indicates high SVR, which is common in the early stages of septic shock or
fluid-refractory shock.
4. When performing the Primary Assessment for a critically ill child, what does the "C" in
the ABCDE mnemonic specifically assess?
A) Cardiac rhythm on the monitor
B) Circulation: Heart rate, pulses, capillary refill time, and skin color
C) Complete blood count
D) Core body temperature
Answer: B
*Rationale: In the Primary Assessment (ABCDE), "C" stands for Circulation. It is a rapid
bedside assessment of circulatory adequacy. It includes evaluating heart rate (bradycardia
is an ominous sign), peripheral vs. central pulse quality, capillary refill time (normal is <2
seconds), and skin color/mottling.*
5. A 6-year-old child is found in cardiac arrest. According to PALS, after initiating high-
quality CPR and attaching an AED/monitor, the next step is to:
A) Immediately establish an advanced airway
B) Defibrillate if a shockable rhythm is present
C) Administer Epinephrine immediately
D) Start an IV for fluid resuscitation
Answer: B
Rationale: The Cardiac Arrest Algorithm prioritizes immediate defibrillation for
shockable rhythms (VF/pVT). High-quality CPR is continued while charging the
defibrillator. Epinephrine is given after the second shock and during cycles of CPR.
6. A nurse is using the "Evaluate-Identify-Intervene" sequence for a child with respiratory
distress. After evaluating the Primary Assessment (ABCDE), what is the next step?
A) Identify the likely category of illness (Respiratory, Shock, or Arrest)
B) Perform diagnostic tests (Chest X-ray, ABG)
C) Immediately intubate the patient
D) Re-evaluate the initial impression
,Answer: A
Rationale: The PALS algorithm follows the cycle: Evaluate (Initial Impression + Primary
Assessment + Secondary Assessment), Identify (categorize the child as Respiratory
Distress/Failure, Shock (Compensated/Hypotensive), or Cardiorespiratory
Failure/Arrest), and Intervene (perform specific actions matching the identified
category).
7. A child is in the post-cardiac arrest phase with return of spontaneous circulation
(ROSC). What is the goal for oxygen saturation during post-resuscitation management?
A) 100%
B) 94% to 99% (Weaning oxygen to avoid hyperoxia)
C) 88% to 92%
D) Titrate to maintain SpO2 >94%, but avoid hyperoxia
Answer: D
*Rationale: Post-cardiac arrest guidelines recommend titrating oxygen to achieve normal
saturation (94-99%) while avoiding hyperoxia. Hyperoxia may worsen reperfusion injury
and increase mortality.*
8. A 4-year-old child is brought to the emergency department with a barking cough,
stridor, and increased work of breathing that is worse at night. The child is alert and has
normal color. This clinical picture is most consistent with:
A) Upper Airway Obstruction (Croup)
B) Lower Airway Obstruction (Asthma)
C) Lung Tissue Disease (Pneumonia)
D) Disordered Control of Breathing (Apnea)
Answer: A
Rationale: Croup (laryngotracheobronchitis) is a classic upper airway obstruction. It is
characterized by a "barking" or seal-like cough, inspiratory stridor, and worsening
symptoms at night. It is typically viral in origin.
9. PALS guidelines state that the depth of chest compressions for an infant should be
approximately:
A) 1 inch (2.5 cm)
B) 1.5 inches (4 cm)
C) 2 inches (5 cm)
D) 2.4 inches (6 cm)
Answer: B
*Rationale: The 2020 AHA guidelines recommend a compression depth of approximately
, 1.5 inches (4 cm) for infants. This is about one-third the anterior-posterior (AP) diameter
of the chest.*
10. For a child requiring a supraglottic airway (e.g., LMA) during CPR, providers should
note that:
A) It provides a definitive airway equal to an endotracheal tube
B) It may be used as a rescue device when bag-mask ventilation is ineffective
C) It eliminates the need for chest compressions
D) It is contraindicated in children under 2 years old
Answer: B
Rationale: Supraglottic airways are acceptable as a rescue device in pediatric CPR when
bag-mask ventilation is ineffective and if the provider is not trained in endotracheal
intubation.
11. A 3-year-old child has a tracheostomy tube in place and is in cardiac arrest. What is the
correct ventilation method for this child?
A) Perform mouth-to-tracheostomy ventilation
B) Use a bag-mask device over the face
C) Ventilate directly through the tracheostomy tube with a bag-valve device
D) Remove the tracheostomy tube and perform standard CPR
Answer: C
Rationale: For a child with a tracheostomy, ventilation should be delivered directly
through the tracheostomy tube using a bag-valve device. Avoid ventilation through the
mouth/nose, as air will escape through the stoma.
12. A 5-year-old child has a heart rate of 210 bpm, P waves are absent, and the QRS
complex is narrow (<0.09 sec). This rhythm is most likely:
A) Sinus Tachycardia
B) Supraventricular Tachycardia (SVT)
C) Ventricular Tachycardia
D) Second-degree AV block
Answer: B
Rationale: SVT is characterized by a narrow QRS complex (<0.09 sec), absent or abnormal
P waves, and a heart rate usually >180 bpm in children (often >220 in infants).
13. A 10 kg child is in supraventricular tachycardia with adequate perfusion. What is the
initial vagal maneuver recommended for infants and young children?
A) Carotid sinus massage
B) Applying ice to the face (diving reflex)
