AHA PALS CERTIFICATION EXAM COMPREHENSIVE ACTUAL
RXAM WITH HIGH-YIELD QUESTIONS, DETAILED ANSWER
EXPLANATIONS, PEDIATRIC ADVANCED LIFE SUPPORT
ALGORITHMS, RHYTHM RECOGNITION REVIEW, EMERGENCY
PEDIATRIC CARE PRINCIPLES, TEST-TAKING STRATEGIES, AND
COMPLETE CERTIFICATION SUCCESS TOOLKIT | UPDATED FOR
2026/2027 | LATEST EDITION
1. A 5-year-old child presents with lethargy, increased work of breathing, and pale
color. The primary assessment reveals that the airway is open and the respiratory
rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows
sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen
saturation of 95% and a pulse rate of 93/min. On the basis of this information,
which of the following provides the best interpretation of the oxygen saturation
of 95% by pulse oximetry?
A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary
oxygen should be administered
C. Unreliable; no supplementary oxygen is indicated
D. Unreliable; supplementary oxygen should be administered -
ANSWERUnreliable; supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated
with chemotherapy. The child presents with lethargy and a high fever. Heart rate
is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and
capillary refill time is less than 2 seconds. What is the child's most likely
condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
D. Cardiogenic shock - ANSWER-Septic shock
,3. A 2-week-old infant presents with irritability and a history of poor feeding.
Blood pressure is 55/40 mm Hg. What term describes this infant's blood pressure?
A. Hypotensive
B. Normal
C. Hypertensive
D. Compensated - ANSWER-Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of
epinephrine at 0.1 mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - ANSWER-Respectfully ask the team leader to
clarify the dose
5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - ANSWER-Inadequate oxygenation and/or
ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase
and wheezing?
A. Disordered control of breathing
,B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - ANSWER-Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures
stopped a few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - ANSWER-Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory
distress caused by lung tissue disease?
A. Decreased oxygen saturation
B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort - ANSWER-Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is
being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What
would best describe this patient's condition? A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing - ANSWER-Respiratory distress
, 10. The parents of a 7-year-old child who is undergoing chemotherapy report that
the child has been febrile and has not been feeling well, with recent onset of
lethargy. Assessment reveals the following: The child is difficult to arouse, with
pale color. The child's heart rate is 160/min, respiratory rate is 30/min, blood
pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is
103°F (39.4°C). What is the most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over
30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over
5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert
consultation with an oncologist to determine the chemotherapeutic regimen -
ANSWER-Obtain vascular access and administer 20 mL/kg of isotonic crystalloid
over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial
impression reveals an unresponsive child with intermittent apnea and mottled
color. Heart rate is 166/min, respiratory rate is now being supported with bag-
mask ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F
(38.9°C). What is the best method of establishing immediate vascular access? A.
Two providers may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - ANSWER-Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic
shock with adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
RXAM WITH HIGH-YIELD QUESTIONS, DETAILED ANSWER
EXPLANATIONS, PEDIATRIC ADVANCED LIFE SUPPORT
ALGORITHMS, RHYTHM RECOGNITION REVIEW, EMERGENCY
PEDIATRIC CARE PRINCIPLES, TEST-TAKING STRATEGIES, AND
COMPLETE CERTIFICATION SUCCESS TOOLKIT | UPDATED FOR
2026/2027 | LATEST EDITION
1. A 5-year-old child presents with lethargy, increased work of breathing, and pale
color. The primary assessment reveals that the airway is open and the respiratory
rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows
sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen
saturation of 95% and a pulse rate of 93/min. On the basis of this information,
which of the following provides the best interpretation of the oxygen saturation
of 95% by pulse oximetry?
A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary
oxygen should be administered
C. Unreliable; no supplementary oxygen is indicated
D. Unreliable; supplementary oxygen should be administered -
ANSWERUnreliable; supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated
with chemotherapy. The child presents with lethargy and a high fever. Heart rate
is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and
capillary refill time is less than 2 seconds. What is the child's most likely
condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
D. Cardiogenic shock - ANSWER-Septic shock
,3. A 2-week-old infant presents with irritability and a history of poor feeding.
Blood pressure is 55/40 mm Hg. What term describes this infant's blood pressure?
A. Hypotensive
B. Normal
C. Hypertensive
D. Compensated - ANSWER-Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of
epinephrine at 0.1 mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - ANSWER-Respectfully ask the team leader to
clarify the dose
5. Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - ANSWER-Inadequate oxygenation and/or
ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase
and wheezing?
A. Disordered control of breathing
,B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - ANSWER-Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures
stopped a few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - ANSWER-Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory
distress caused by lung tissue disease?
A. Decreased oxygen saturation
B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort - ANSWER-Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is
being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What
would best describe this patient's condition? A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing - ANSWER-Respiratory distress
, 10. The parents of a 7-year-old child who is undergoing chemotherapy report that
the child has been febrile and has not been feeling well, with recent onset of
lethargy. Assessment reveals the following: The child is difficult to arouse, with
pale color. The child's heart rate is 160/min, respiratory rate is 30/min, blood
pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is
103°F (39.4°C). What is the most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over
30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over
5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert
consultation with an oncologist to determine the chemotherapeutic regimen -
ANSWER-Obtain vascular access and administer 20 mL/kg of isotonic crystalloid
over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial
impression reveals an unresponsive child with intermittent apnea and mottled
color. Heart rate is 166/min, respiratory rate is now being supported with bag-
mask ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F
(38.9°C). What is the best method of establishing immediate vascular access? A.
Two providers may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - ANSWER-Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic
shock with adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
