PALS EXAM BANK 2025 EXAM QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES VERIFIED
FOR GUARANTEED PASS LATEST UPDATE
1. In which of the following situations may IO access be used?
A. An extremity with signs of infection
B. An extremity with a sign of a crush injury
C. An extremity with a previous unsuccessful IO attempt
D. An extremity with slow capillary refill time
Correct Answer: D. An extremity with slow capillary refill time
Rationale:
Slow capillary refill indicates poor peripheral perfusion, which is a sign that rapid vascular
access is needed. It is not a contraindication for IO access; rather, it signals that the extremity
may be used when other access routes are challenging.
2. A 2-week-old infant is being evaluated for irritability and poor feeding. His BP is 55/40
mmHg, and capillary refill time is 5 seconds. Which statement best describes your
assessment of this infant’s BP?
A. It represents compensated shock
B. It is hypertensive
C. It is hypotensive
D. It is normal
Correct Answer: C. It is hypotensive
Rationale:
A blood pressure of 55/40 mmHg in a neonate—combined with a prolonged capillary refill—
indicates inadequate perfusion and is consistent with hypotension.
3. You are caring for patients in the emergency department. Which 2-year-old child
requires immediate intervention?
A. A child who is grunting
B. A child with an SpO₂ of 95% on room air
C. A child with a systolic blood pressure of 92 mm Hg
D. A child with a temperature of 37.4°C (99.3°F)
Correct Answer: A. A child who is grunting
Rationale:
Grunting in a toddler is a clinical sign of respiratory distress, indicating the child is working hard
to maintain oxygenation and requires prompt intervention.
Page | 1
, PALS EXAM BANK 2025 EXAM QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES VERIFIED
FOR GUARANTEED PASS LATEST UPDATE
4. A 3-year-old child is having difficulty breathing. Which finding would most likely lead
you to suspect an upper airway obstruction?
A. Expiratory breath sounds
B. Decreased expiratory effort
C. Increased inspiratory effort with retractions
D. Normal inspiratory sounds
Correct Answer: C. Increased inspiratory effort with retractions
Rationale:
Increased inspiratory effort with retractions is indicative of the child struggling to pull air past a
narrowed upper airway, making it the key sign of upper airway obstruction.
5. A team member is unable to perform an assigned task because it is beyond the team
member’s scope of practice. Which action should the team member take?
A. Ask for a new task or role
B. Refuse to perform the task
C. Do it anyway
D. Seek expert consultation
Correct Answer: A. Ask for a new task or role
Rationale:
Asking for a new task or role is the appropriate professional response because it ensures the team
member works within their scope while still contributing to patient care.
6. You are the team leader during a pediatric resuscitation attempt. Which action is an
element of high-quality CPR?
A. Providing a compression depth of one-fourth the depth of the chest
B. Providing a compression rate of 80 to 100/min
C. Allowing complete chest wall recoil after each compression
D. Performing pulse checks every minute
Correct Answer: C. Allowing complete chest wall recoil after each compression
Rationale:
Complete chest wall recoil maximizes venous return and overall blood flow during CPR, making
it a critical component of high-quality chest compressions.
7. An 8-year-old child is brought to the ED by his mother for difficulty breathing. He has a
history of asthma and nut allergies. His mother tells you that he recently ate a cookie at a
family picnic. Which condition is most likely to be present?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lung tissue disease
D. Upper airway obstruction
Page | 2
, PALS EXAM BANK 2025 EXAM QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES VERIFIED
FOR GUARANTEED PASS LATEST UPDATE
Correct Answer: D. Upper airway obstruction
Rationale:
In a child with known nut allergies and recent ingestion of a potential allergen, an allergic
reaction can lead to upper airway edema, causing obstruction and necessitating immediate
management.
8. An 8-year-old child is brought to the ED by ambulance after being involved in an MVC.
Which finding would suggest that immediate intervention is needed?
A. Decreased level of consciousness
B. Systolic blood pressure of 106 mm Hg
C. Temperature of 38.1°C (100.5°F)
D. Warm, moist skin
Correct Answer: A. Decreased level of consciousness
Rationale:
A decreased level of consciousness signals possible head injury or shock, which is a critical sign
that immediate intervention is required.
9. A 6-year-old child is found unresponsive, not breathing, and without a pulse. One
healthcare worker leaves to activate the emergency response system and get the
resuscitation equipment. You and another healthcare provider immediately begin CPR.
Which compression-to-ventilation ratio do you use?
A. 15:1
B. 30:1
C. 15:2
D. 30:2
Correct Answer: C. 15:2
Rationale:
For pediatric patients with two rescuers present, the recommended compression-to-ventilation
ratio is 15:2, balancing the need for compressions with appropriate ventilation.
10. A 3-year-old child is in cardiac arrest, and high-quality CPR is in progress. You are the
team leader. The first rhythm check reveals the rhythm shown. Defibrillation is attempted
with a shock dose of 2 J/kg. After administration of the shock, what should you say to your
team members?
A. Check for a pulse
B. Give epinephrine 0.01 mg/kg
C. Let's check the rhythm
D. Resume compressions
Correct Answer: D. Resume compressions
Rationale:
Page | 3
DETAILED ANSWERS WITH RATIONALES VERIFIED
FOR GUARANTEED PASS LATEST UPDATE
1. In which of the following situations may IO access be used?
A. An extremity with signs of infection
B. An extremity with a sign of a crush injury
C. An extremity with a previous unsuccessful IO attempt
D. An extremity with slow capillary refill time
Correct Answer: D. An extremity with slow capillary refill time
Rationale:
Slow capillary refill indicates poor peripheral perfusion, which is a sign that rapid vascular
access is needed. It is not a contraindication for IO access; rather, it signals that the extremity
may be used when other access routes are challenging.
2. A 2-week-old infant is being evaluated for irritability and poor feeding. His BP is 55/40
mmHg, and capillary refill time is 5 seconds. Which statement best describes your
assessment of this infant’s BP?
A. It represents compensated shock
B. It is hypertensive
C. It is hypotensive
D. It is normal
Correct Answer: C. It is hypotensive
Rationale:
A blood pressure of 55/40 mmHg in a neonate—combined with a prolonged capillary refill—
indicates inadequate perfusion and is consistent with hypotension.
3. You are caring for patients in the emergency department. Which 2-year-old child
requires immediate intervention?
A. A child who is grunting
B. A child with an SpO₂ of 95% on room air
C. A child with a systolic blood pressure of 92 mm Hg
D. A child with a temperature of 37.4°C (99.3°F)
Correct Answer: A. A child who is grunting
Rationale:
Grunting in a toddler is a clinical sign of respiratory distress, indicating the child is working hard
to maintain oxygenation and requires prompt intervention.
Page | 1
, PALS EXAM BANK 2025 EXAM QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES VERIFIED
FOR GUARANTEED PASS LATEST UPDATE
4. A 3-year-old child is having difficulty breathing. Which finding would most likely lead
you to suspect an upper airway obstruction?
A. Expiratory breath sounds
B. Decreased expiratory effort
C. Increased inspiratory effort with retractions
D. Normal inspiratory sounds
Correct Answer: C. Increased inspiratory effort with retractions
Rationale:
Increased inspiratory effort with retractions is indicative of the child struggling to pull air past a
narrowed upper airway, making it the key sign of upper airway obstruction.
5. A team member is unable to perform an assigned task because it is beyond the team
member’s scope of practice. Which action should the team member take?
A. Ask for a new task or role
B. Refuse to perform the task
C. Do it anyway
D. Seek expert consultation
Correct Answer: A. Ask for a new task or role
Rationale:
Asking for a new task or role is the appropriate professional response because it ensures the team
member works within their scope while still contributing to patient care.
6. You are the team leader during a pediatric resuscitation attempt. Which action is an
element of high-quality CPR?
A. Providing a compression depth of one-fourth the depth of the chest
B. Providing a compression rate of 80 to 100/min
C. Allowing complete chest wall recoil after each compression
D. Performing pulse checks every minute
Correct Answer: C. Allowing complete chest wall recoil after each compression
Rationale:
Complete chest wall recoil maximizes venous return and overall blood flow during CPR, making
it a critical component of high-quality chest compressions.
7. An 8-year-old child is brought to the ED by his mother for difficulty breathing. He has a
history of asthma and nut allergies. His mother tells you that he recently ate a cookie at a
family picnic. Which condition is most likely to be present?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lung tissue disease
D. Upper airway obstruction
Page | 2
, PALS EXAM BANK 2025 EXAM QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES VERIFIED
FOR GUARANTEED PASS LATEST UPDATE
Correct Answer: D. Upper airway obstruction
Rationale:
In a child with known nut allergies and recent ingestion of a potential allergen, an allergic
reaction can lead to upper airway edema, causing obstruction and necessitating immediate
management.
8. An 8-year-old child is brought to the ED by ambulance after being involved in an MVC.
Which finding would suggest that immediate intervention is needed?
A. Decreased level of consciousness
B. Systolic blood pressure of 106 mm Hg
C. Temperature of 38.1°C (100.5°F)
D. Warm, moist skin
Correct Answer: A. Decreased level of consciousness
Rationale:
A decreased level of consciousness signals possible head injury or shock, which is a critical sign
that immediate intervention is required.
9. A 6-year-old child is found unresponsive, not breathing, and without a pulse. One
healthcare worker leaves to activate the emergency response system and get the
resuscitation equipment. You and another healthcare provider immediately begin CPR.
Which compression-to-ventilation ratio do you use?
A. 15:1
B. 30:1
C. 15:2
D. 30:2
Correct Answer: C. 15:2
Rationale:
For pediatric patients with two rescuers present, the recommended compression-to-ventilation
ratio is 15:2, balancing the need for compressions with appropriate ventilation.
10. A 3-year-old child is in cardiac arrest, and high-quality CPR is in progress. You are the
team leader. The first rhythm check reveals the rhythm shown. Defibrillation is attempted
with a shock dose of 2 J/kg. After administration of the shock, what should you say to your
team members?
A. Check for a pulse
B. Give epinephrine 0.01 mg/kg
C. Let's check the rhythm
D. Resume compressions
Correct Answer: D. Resume compressions
Rationale:
Page | 3
