TheoryPALS
Practice Test
Build pediatric emergency skills with PALS-focused practice questions covering rhythms, algorithms, and clinical scenarios. Be ready for certification.
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PALS exam — full Q&A walkthrough
Every question read aloud with the answer explained. Play it on your commute, then test yourself.
30 free PALS questions
Sampled across every topic area — not just the first page. Try them as a quiz or flip them as flashcards.
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Pediatric Advanced Life Support
A 3-year-old is brought in by a parent who reports the child has been 'breathing fast' since this morning. You observe the child sitting upright, looking at you, with audible stridor and mild intercostal retractions. His skin is pink and warm. Using the Pediatric Assessment Triangle (PAT), which component is primarily abnormal?
Correct — D. The PAT assesses Appearance, Work of Breathing, and Circulation to skin; stridor and intercostal retractions indicate abnormal work of breathing, while the child's alertness and pink skin indicate normal appearance and circulation. -
Pediatric Advanced Life Support
In the PALS systematic approach, after you perform the initial PAT and find an abnormality, your next step is to:
Correct — C. The PALS evaluate-identify-intervene loop directs the provider to follow the initial PAT with a hands-on primary (ABCDE) assessment to identify the type and severity of physiologic derangement before choosing an intervention. -
Pediatric Advanced Life Support
A 7-year-old presents with rapid breathing, oxygen saturation of 91% on room air, nasal flaring, and subcostal retractions, but responds normally to her name and maintains her airway independently. Blood pressure is 98/62 mmHg. This clinical picture BEST represents:
Correct — B. Respiratory distress is characterized by increased work of breathing (flaring, retractions), mild hypoxia, and preserved mental status and airway control; respiratory failure requires signs of inadequate gas exchange such as markedly altered mentation, apnea, or severe hypoxia that exceeds the child's compensatory effort. -
Pediatric Advanced Life Support
A 5-year-old with a history of asthma is found barely responsive, with agonal breathing at 4 breaths/min, oxygen saturation unmeasurable by pulse oximetry, and cyanotic lips. Which category of respiratory dysfunction does this child demonstrate?
Correct — B. Respiratory failure is identified when the child's breathing effort is insufficient to maintain adequate oxygenation and ventilation, evidenced here by near-apneic rate, unmeasurable SpO2, cyanosis, and markedly decreased level of consciousness. -
Pediatric Advanced Life Support
An 18-month-old is tachycardic at 178 beats/min, has cool mottled extremities with a capillary refill of 4 seconds, and is irritable but responsive to voice. Blood pressure is 86/54 mmHg, which is within the lower-normal range for age. This presentation BEST fits:
Correct — B. Compensated shock describes a state in which compensatory mechanisms (tachycardia, vasoconstriction) maintain blood pressure within an acceptable range despite signs of poor peripheral perfusion such as cool extremities, prolonged capillary refill, and tachycardia. -
Pediatric Advanced Life Support
A 4-year-old involved in a motor vehicle crash arrives with tachycardia of 160 beats/min, blood pressure of 62/40 mmHg, mottled and pale skin, capillary refill of 5 seconds, and a Glasgow Coma Scale score of 10. Which best describes this child's condition?
Correct — D. Decompensated shock is present when compensatory mechanisms fail and blood pressure falls below the fifth percentile for age, accompanied by signs of severely impaired perfusion; a systolic BP of 62 mmHg is clearly hypotensive for a 4-year-old (normal lower limit approximately 70 + 2× age = 78 mmHg). -
Pediatric Advanced Life Support
A 6-year-old presents with a heart rate of 170 beats/min and a blood pressure of 84/50 mmHg. He is lethargic but arousable. Capillary refill is 3 seconds centrally. His skin is warm and flushed with bounding peripheral pulses. Lungs are clear. Which type of shock MOST likely explains his findings?
Correct — B. Distributive shock (early septic shock is the classic pediatric example) produces warm, flushed skin with bounding pulses and widened pulse pressure due to pathologic vasodilation, distinguishing it from the cold, clamped extremities seen in hypovolemic or cardiogenic shock. -
Pediatric Advanced Life Support
During the PAT of a 2-year-old, you note she has a weak cry but keeps her eyes fixed on her mother and does not explore her environment. Breathing is quiet with no abnormal sounds. Skin appears pale at the nail beds but pink centrally. How would you classify the PAT findings?
Correct — B. A weak cry and failure to interact with the environment indicate abnormal appearance (tone/interactivity), and peripheral pallor reflects abnormal circulation to skin; absent increased work of breathing means that component is normal, pointing toward a circulatory or neurological rather than respiratory etiology. -
Pediatric Advanced Life Support
Which mnemonic is used in PALS to quickly evaluate the five domains of pediatric appearance during the PAT?
Correct — D. TICLS (Tone, Interactivity, Consolability, Look/gaze, Speech/cry) is the AHA-endorsed mnemonic for assessing the Appearance component of the Pediatric Assessment Triangle. -
Pediatric Advanced Life Support
A 10-year-old with known congenital heart disease presents with severe respiratory distress, oxygen saturation of 84% despite 15 L/min non-rebreather mask, frothy pink sputum, and diffuse crackles bilaterally. His heart rate is 140 beats/min and blood pressure is 80/60 mmHg. Which PAT pattern does this child display?
Correct — C. The simultaneous presence of severe increased work of breathing (frothy sputum, crackles, refractory hypoxia) and signs of poor perfusion (low BP, pale or mottled skin) indicates abnormality in both work of breathing and circulation to skin, reflecting combined cardiopulmonary failure — a finding that mandates the most aggressive intervention. -
Pediatric Advanced Life Support
You are assessing a 9-month-old with bronchiolitis. The PAT reveals: irritable but consolable when held, audible wheezing with subcostal and intercostal retractions, and pink skin with 2-second capillary refill. SpO2 is 93%. After your primary ABCDE assessment confirms patent airway, bilateral wheezing, and no hemodynamic instability, what is the MOST appropriate immediate identification?
Correct — D. Bronchiolitis produces lower airway obstruction; the clinical picture — wheezing, retractions, mild hypoxia with preserved mentation and normal perfusion — classifies this as lower airway obstruction in the respiratory distress category, not failure, because compensatory effort is still maintaining adequate (though mildly reduced) oxygenation. -
Pediatric Advanced Life Support
A 3-year-old presents after a near-drowning event. He is unconscious and apneic, with central cyanosis and no detectable pulse. His skin is cold and mottled diffusely. Applying the PAT rapidly, you identify abnormalities in all three components. What is the IMMEDIATE clinical implication of this three-component PAT failure?
Correct — A. When all three PAT components are simultaneously abnormal — appearance (unconscious), work of breathing (apneic), and circulation (cyanotic, pulseless, cold) — the child is in cardiopulmonary arrest, mandating immediate CPR initiation and activation of the pediatric cardiac arrest algorithm. -
Pediatric Advanced Life Support
A febrile 8-year-old presents with tachycardia of 155 beats/min and a blood pressure of 78/46 mmHg. A trauma nurse reports capillary refill of 5 seconds and the child mumbles only to painful stimulation. The resident wants to give a 10 mL/kg isotonic fluid bolus and reassess in 30 minutes. What is wrong with this plan according to PALS principles?
Correct — A. A blood pressure of 78 mmHg systolic is below the fifth-percentile threshold for an 8-year-old (approximately 86 mmHg), altered mental status indicates end-organ dysfunction, and this constellation defines decompensated shock requiring immediate escalating intervention — not a 30-minute observation window. -
Pediatric Advanced Life Support
When comparing respiratory distress with respiratory failure in a pediatric patient, which finding most reliably indicates the transition from distress to failure?
Correct — C. The hallmark that distinguishes respiratory failure from distress is decompensation of the central nervous system and/or respiratory mechanics — manifested as declining consciousness, hypotonia, and inadequate effort — because it signals the child can no longer maintain compensatory drive to sustain oxygenation and ventilation. -
Pediatric Advanced Life Support
A 5-year-old with severe sepsis has a heart rate of 165 beats/min, a systolic blood pressure of 75 mmHg, and capillary refill of 6 seconds. The team initiates the evaluate-identify-intervene loop. After identifying decompensated septic shock, what is the CORRECT next action according to PALS?
Correct — B. The PALS evaluate-identify-intervene loop is iterative: once decompensated shock is identified the provider intervenes immediately (vascular access, fluid bolus, antibiotics) and then re-enters the evaluation loop to assess response, not waits for secondary data before acting. -
Pediatric Advanced Life Support
A 14-month-old presents with a 2-day history of diarrhea and vomiting. On PAT, you note decreased tone with a blank stare, no abnormal airway sounds or retractions, and pale mottled extremities with 5-second capillary refill. Blood pressure is 68/44 mmHg. Which pattern of shock and severity does this child BEST represent?
Correct — C. Prolonged diarrhea and vomiting produce hypovolemic shock; the combination of hypotension (systolic 68 mmHg is well below the age-appropriate lower limit of approximately 74 mmHg), markedly prolonged capillary refill, and depressed mental status defines decompensated (hypotensive) hypovolemic shock requiring immediate aggressive volume resuscitation. -
Pediatric Advanced Life Support
A 4-year-old child is found unresponsive and not breathing. A single rescuer is present. After activating emergency services and delivering 2 rescue breaths, what compression-to-ventilation ratio should the lone rescuer use?
Correct — D. A single rescuer performing CPR on a child or infant uses the adult ratio of 30:2, reserving the 15:2 ratio for two-rescuer pediatric CPR per AHA PALS guidelines. -
Pediatric Advanced Life Support
Two healthcare providers are performing CPR on a 7-year-old. One is delivering compressions while the other manages the airway. What is the correct compression-to-ventilation ratio for this two-rescuer scenario?
Correct — C. Two-rescuer pediatric CPR uses a 15:2 ratio, allowing more frequent ventilations appropriate for children's higher respiratory dependency compared to adults. -
Pediatric Advanced Life Support
During high-quality CPR on an 8-year-old child, what is the recommended chest compression rate per minute?
Correct — B. The AHA recommends a compression rate of 100–120 per minute for both adults and pediatric patients to optimize cardiac output during CPR. -
Pediatric Advanced Life Support
A 3-year-old drowning victim is brought to the emergency department. Two nurses begin CPR. After 15 compressions, the airway nurse is unable to achieve visible chest rise on the first rescue breath. What is the most appropriate next action?
Correct — A. If the first rescue breath does not cause chest rise, the AHA recommends repositioning the head (head-tilt chin-lift or jaw thrust in trauma) before the second attempt, then proceeding with compressions regardless of success. -
Pediatric Advanced Life Support
During two-rescuer infant CPR, the compressor uses a two-thumb encircling technique. The ventilator delivers a breath every time compressions pause. Which statement best describes the CORRECT pause for ventilation with this technique?
Correct — D. Two-rescuer infant CPR uses a 15:2 ratio; the compressor pauses after every 15 compressions to allow the ventilator to deliver 2 breaths, then compressions resume immediately. -
Pediatric Advanced Life Support
During a resuscitation drill, a team leader notices the compressor's chest recoil is incomplete between compressions. Which specific physiological consequence is MOST directly caused by inadequate chest recoil?
Correct — D. Incomplete chest recoil keeps intrathoracic pressure elevated, impairing venous return and thereby reducing both cardiac filling and coronary perfusion pressure — a key determinant of ROSC. -
Pediatric Advanced Life Support
A 9-year-old is in pulseless arrest. Three healthcare providers are present. Provider A is compressing, Provider B is managing the airway and ventilating, and Provider C is preparing medications. Provider A has been compressing for 2 minutes. Which action BEST reflects optimal team dynamics per AHA PALS standards?
Correct — C. AHA team dynamics emphasize planned role switches at structured intervals (every 2 minutes or at rhythm checks) with clear communication, keeping any CPR pause to less than 10 seconds to preserve perfusion pressure. -
Pediatric Advanced Life Support
A rescuer has been performing lone CPR on a 2-year-old for 3 minutes using 30:2. At the 3-minute mark, a second trained rescuer arrives. What change, if any, should immediately be made to the CPR protocol?
Correct — C. When a second trained rescuer joins pediatric CPR, the AHA directs a switch to the 15:2 two-rescuer ratio; for infants the two-thumb encircling technique is preferred for two rescuers as it generates higher peak pressures. -
Pediatric Advanced Life Support
During CPR on a 7-year-old, the team's capnography monitor shows an end-tidal CO2 (ETCO2) of 8 mmHg after 10 minutes of resuscitation. Which interpretation and action is MOST appropriate?
Correct — D. An ETCO2 persistently below 10–15 mmHg during CPR indicates poor cardiac output from ineffective compressions; the team should reassess rate, depth, recoil, and minimize interruptions. -
Pediatric Advanced Life Support
A pediatric code team is 15 minutes into resuscitation of a 6-year-old in VF arrest. A sudden rise in ETCO2 from 12 mmHg to 38 mmHg is noted WITHOUT a rhythm change on the monitor. What does this finding MOST likely indicate?
Correct — B. A sudden sustained rise in ETCO2 to near-normal levels (35–45 mmHg) without a ventilation change is a reliable early indicator of ROSC, as restored cardiac output rapidly clears CO2 from pulmonary circulation. -
Pediatric Advanced Life Support
An 18-month-old is found unresponsive in a crib. A lone rescuer confirms no breathing and no pulse. The rescuer has a mobile phone. In what order should the lone rescuer act?
Correct — A. For infants and children, AHA guidelines recommend a lone rescuer perform approximately 2 minutes of CPR before leaving to call EMS, BUT if a mobile phone is available, the rescuer should activate EMS via speakerphone simultaneously while starting CPR. -
Pediatric Advanced Life Support
During a simulated pediatric arrest, a new team member begins delivering rescue breaths that are visibly causing the child's chest to rise excessively. Which consequence is the team leader MOST correct to warn about?
Correct — C. Excessive tidal volumes during CPR raise intrathoracic pressure, impede venous return and cardiac output, and cause gastric distension with aspiration risk; AHA guidelines recommend delivering only enough volume to produce visible chest rise. -
Pediatric Advanced Life Support
A resuscitation team achieves ROSC in a 5-year-old after 12 minutes of CPR. During post-ROSC monitoring, SpO2 climbs to 100% on FiO2 1.0. What is the most appropriate oxygen management step according to post-resuscitation care guidelines?
Correct — C. AHA post-resuscitation guidelines recommend titrating inspired oxygen after ROSC to maintain SpO2 between 94–99%, as hyperoxia (SpO2 100% on high FiO2) is associated with increased oxidative injury and worse neurological outcomes. -
Pediatric Advanced Life Support
A 3-year-old presents with stridor, a barking cough, and mild retractions but is alert and maintaining oxygen saturation of 95% on room air. Which best describes this child's respiratory status?
Correct — B. Stridor and barking cough indicate upper airway obstruction (croup pattern), and the child remains alert with adequate saturations, meeting the definition of respiratory distress rather than failure.
PALS sample questions
Tap any question below to reveal the answer and a plain-English explanation.
Pediatric Advanced Life Support An unconscious 8-month-old infant is placed supine for airway assessment. What is the correct head position to open the airway in an infant without suspected cervical spine injury?
A. Neutral or slight extension ('sniffing') position to align the airway ✓
B. Full flexion with the chin tucked to the chest
C. Hyperextended ('sniffing') position with chin maximally tilted back
D. Lateral decubitus to allow secretions to drain
Correct — A. In infants, the relatively large occiput naturally flexes the neck; a neutral to slight extension ('sniffing') position aligns the oral, pharyngeal, and tracheal axes without hyperextension that could kink the compliant infant airway.
Real Exam Practice The most common cause of cardiac arrest in pediatric patients is:
A. A blow to the chest
B. Congenital heart disease
C. Respiratory failure ✓
D. Drowning
Correct — C. Respiratory failure is the most common cause of cardiac arrest in children. If intervention is not done early and aggressively, the outcome is usually very poor.
Pediatric Advanced Life Support A 5-year-old with known reactive airway disease develops acute expiratory wheezing and mild retractions. Oxygen saturation is 93%. Which category best classifies this presentation?
A. Respiratory distress due to lower airway obstruction ✓
B. Respiratory distress due to upper airway obstruction
C. Compensated shock with respiratory compensation
D. Respiratory failure due to lung tissue disease
Correct — A. Expiratory wheezing localizes the obstruction to the lower airway (bronchioles); the child retains some reserve (alert, SpO2 93%) consistent with distress, not failure.
Real Exam Practice After stabilizing a patient in respiratory failure, the most important clinical goal is:
A. Identify and treat the disease that is causing the respiratory failure ✓
B. Send the patient for a total-body MRI scan
C. Insert bilateral chest tubes to prevent pneumothorax
D. None of the above
Correct — A. Determining the underlying cause and beginning aggressive treatment is essential, as mechanical ventilation alone won't address conditions like bacterial pneumonia.
Pediatric Advanced Life Support A 7-year-old with pneumonia has a respiratory rate of 42/min, grunting, severe subcostal retractions, and SpO2 of 86% on 10 L/min non-rebreather mask. He responds only to pain. Which intervention is most immediately indicated?
A. Initiate bag-mask ventilation and prepare for definitive airway management ✓
B. Apply a high-flow nasal cannula and reassess in 15 minutes
C. Obtain a chest radiograph to confirm diagnosis before intervening
D. Administer nebulized albuterol for suspected bronchospasm
Correct — A. Failure to maintain SpO2 >90% on maximum supplemental oxygen, altered mental status, and grunting are hallmarks of respiratory failure, which requires immediate assisted ventilation rather than additional passive oxygen delivery.
Real Exam Practice Where should you check for a peripheral pulse?
A. Wrist (radial)
B. Foot (pedal)
C. Upper arm (brachial) ✓
D. Neck (carotid)
Correct — C. The brachial artery is a major blood vessel located in the upper arm and is the recommended site for pulse check in infants per PALS guidelines.
Pediatric Advanced Life Support During bag-mask ventilation of a 2-year-old in respiratory failure, you notice the chest is not rising and the SpO2 is dropping. You reposition the airway, recheck the mask seal, and suction visible secretions — but chest rise remains absent. What is the next most appropriate step?
A. Immediately perform needle cricothyrotomy
B. Increase the flow rate on the oxygen source
C. Insert an oropharyngeal airway and reattempt bag-mask ventilation ✓
D. Administer racemic epinephrine via nebulizer
Correct — C. The AHA PALS framework for failed bag-mask ventilation calls for repositioning, suctioning, and then adjunct airway insertion (OPA or NPA) before escalating to invasive airway rescue; the OPA lifts the tongue off the posterior pharynx in unconscious patients.
Real Exam Practice Remembering which of the following acronyms will help you assess a child's mental status?
A. SAMPLE
B. ABCDE
C. BREATH
D. AVPU ✓
Correct — D. AVPU (Alert, Voice, Pain, Unresponsive) is used to assess a child's mental status.
About the PALS test
Study for your PALS (Pediatric Advanced Life Support) exam with original practice questions written for this app from the publicly available current AHA PALS guidelines. Every question has a clear explanation.
What you get
- Pediatric assessment, high-quality CPR, respiratory emergencies, shock, the cardiac arrest and bradycardia/tachycardia algorithms, and medications and post-resuscitation care.
- A clear explanation for every question.
- Timed practice tests that mirror the real exam style.
Original & safe
Every question is written for this app from public study material. Nothing is copied from any real exam, test pool or third-party question bank.
You will be tested on
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial and physiological integrity
- Pharmacology, infection control and patient safety
How TheoryPractice helps you pass
- Real exam-style questions with instant, detailed explanations
- Full timed mock exams that mirror the real test format
- Flashcards & quiz modes from the same question bank
- Progress tracking so you know exactly when you're ready
Topics in this question bank
Safe and effective care environment
Health promotion and maintenance
Psychosocial and physiological integrity
Pharmacology, infection control and patient safety
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