Pediatric Advanced Life Support Exam | PALS Test Exam 2024 with
Questions and 100% Correct Answers
1. In which of the following situations may IO access be used?
A. An extremity with signs of infection
B. An extremity with signs of a crush injury
C. An extremity with a previous unsuccessful IO attempt
D. An extremity with slow a capillary refill time
Correct Answer D. Intraosseous (IO) cannulation is a relatively simple and effective method of rapidly
establishing vascular access for emergency fluids or medications. It provides access to a noncollapsible marrow
venous plexus, which serves as a rapid, safe, and reliable route for administration of drugs, crystalloids, colloids,
and blood during resuscitation. IO access can be achieved in children of all ages, often in about 30 to 60 seconds.
In certain circumstances (eg, cardiac arrest or severe shock with severe vasoconstriction), it may be considered
for the initial vascular access attempted. [PALS Provider Manual, Part 10: Managing Shock > Resources for
Managing Circulatory Emergencies > Intraosseous Access; page 223]
2. A 2-week-old infant is being evaluated for irritability and poor feeding. His blood pressure is 55/40 mm Hg,
and capillary refill time is 5 seconds. Which statement best describes your assessment of this infant’s blood
pressure?
A. It represents compensated shock.
B. It is hypertensive.
C. It is hypotensive.
D. It is normal.
Correct Answer C. The normal blood pressure for a 2-week-old infant should be within the systolic range of 67
to 84 mm Hg and a diastolic range of 35 to 53 mm Hg. [PALS Provider Manual, Part 4: Systematic Approach to
the Seriously Ill or Injured Child > Primary Assessment > Circulation > Blood Pressure; page 57]
3. You are caring for clients 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. Grunting produces early glottic closure during expiration. Grunting is a compensatory
mechanism to maintain positive airway pressure and prevent collapse of the alveoli and small airways. Grunting is
a serious sign and may indicate respiratory distress or respiratory failure. [PALS Provider Manual, Part 4:
Systematic Approach to the Seriously Ill or Injured Child > Primary Assessment > Breathing > Lung and Airway
Sounds > Grunting; page 50]
,4. A 3-year-old child is having difficulty breathing. What finding would most likely lead you to suspect an upper
airway obstruction in this child?
A. Expiratory breath sounds
B. Decreased expiratory effort
C. Increased inspiratory effort with retractions
D. Normal inspiratory sounds
Correct Answer C. The major clinical signs typically occur during the inspiratory phase of the respiratory cycle,
such as stridor, hoarseness, or a change in voice or cry. Inspiratory retractions, use of accessory muscles, and
nasal flaring are often present. The respiratory rate is often only mildly elevated because upper airway obstruction
is worse with faster breathing. Examples include foreign body obstruction, croup, and epiglottitis. [PALS Provider
Manual, Part 7: Recognizing Respiratory Distress and Failure > Identifying Respiratory Problems by Type > Upper
Airway Obstruction > Signs of Upper Airway Obstruction; page 120]
5. A team member is unable to perform an assigned task because it is beyond the team member’s scope of
practice. What 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. Not only should everyone on the team know their own limitations and capabilities, but the
Team Leader should also be aware of them. This allows the Team Leader to evaluate team resources and call
for backup from team members when assistance is needed. High-performance team members should anticipate
situations in which they might require assistance and inform the Team Leader. [PALS Provider Manual, Part 6:
Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics >
Knowing Your Limitations; page 105]
6. You are the Team Leader during a pediatric resuscitation attempt. What 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. During CPR, push fast (100 to 120 compressions per minute), push hard (at least one third
the depth of the anteroposterior diameter of the chest, or about 2 inches for a child or about 1½ inches for an
infant), allow complete chest recoil after each compression, minimize interruptions in chest compressions, and
avoid excessive ventilation. [PALS Provider Manual, Part 5: Recognizing and Managing Cardiac Arrest >
Managing Cardiac Arrest > Monitoring for CPR Quality; page 82]
,7. An 8-year-old child is brought to the emergency department 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. What
condition is most likely to be present in this child?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lung tissue disease
D. Upper airway obstruction
Correct Answer D. Common causes of upper airway obstruction are foreign-body aspiration (eg, food or a small
object), infection, and swelling of the airway (eg, anaphylaxis, tonsillar hypertrophy, croup, or epiglottitis). [PALS
Provider Manual, Part 7: Recognizing Respiratory Distress and Failure > Identifying Respiratory Problems by
Type > Upper Airway Obstruction > Causes of Upper Airway Obstruction; page 119]
8. An 8-year-old child is brought to the emergency department by ambulance after being involved in a motor
vehicle collision. What 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. Signs of a life-threatening condition that would require immediate intervention include
complete or severe airway obstruction (Airway); apnea, significant increased work of breathing, or bradypnea
(Breathing); weak or absent pulses, poor perfusion, hypotension, or bradycardia (Circulation); unresponsiveness
or decreased level of consciousness (Disability); and significant hypothermia, significant bleeding, petechiae, or
purpura consistent with septic shock or coagulation problem (Exposure). [PALS Provider Manual, Part 5:
Recognizing and Managing Cardiac Arrest > Life-Threatening Problems; page 73]
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 performing CPR. What compression-to-ventilation ratio do you use?
A. 15:1
B. 30:1
C. 15:2
D. 30:2
Correct Answer C. If 2 rescuers are present for the resuscitation attempt of an infant or a child, use a
compression-to-ventilation ratio of 15:2. [PALS Provider Manual, Part 2: Review of BLS and AED for Infants and
Children > BLS for Infants and Children > Infant/Child Chest Compressions > Compression Rate and
Compression-to-Ventilation Ratio; page 18]
, 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 here. Defibrillation is attempted with a shock dose of 2 J/kg. After
shock administration, 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. When attempting defibrillation, provide compressions until the defibrillator is charged, deliver 1
shock, and immediately resume CPR, starting with chest compressions. [PALS Provider Manual, Part 5:
Recognizing and Managing Cardiac Arrest > Managing Cardiac Arrest > PALS in Cardiac Arrest > Defibrillation;
page 85]
Use this scenario to answer the next 2 questions:
You are caring for a 5-year-old boy with a 4-day history of high fever and cough. He is having increasing
lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His
oxygen saturation is 72% on room air and 89% when on a nonrebreathing oxygen mask. He has shallow
respirations with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles.
11. What assessment finding is consistent with respiratory failure in this child?
A. Cough
B. Fever
C. Oxygen saturation
D. Respiratory rate
Correct Answer C. Signs of probable respiratory failure include very rapid or inadequate respiratory rate;
possible apnea; significant, inadequate, or absent respiratory effort; absent distal air movement; extreme
tachycardia (bradycardia often indicates life-threatening deterioration); low oxygen saturation (hypoxemia)
despite high-flow supplemental oxygen; decreased level of consciousness; and cyanosis. [PALS Provider
Manual, Part 4: Systematic Approach to the Seriously Ill or Injured Child > Primary Assessment > Breathing >
Oxygen Saturation by Pulse Oximetry > Caution in Interpreting Pulse Oximetry Readings; page 53]
