Safety Training Seminars
Safety Training Seminars
Preparing for the Pediatric Advanced Life Support (PALS) written test can feel overwhelming. You’re not just memorizing facts—you’re learning skills that could save a child’s life.
The PALS certification is essential for healthcare providers who respond to emergencies involving infants and children. Whether you work in an emergency department, pediatric unit, or ambulance service, passing this test proves you can handle critical situations with confidence.
This guide breaks down the most common PALS written test questions you’ll encounter. We’ll cover respiratory emergencies, cardiac arrest scenarios, rhythm recognition, medication dosages, and systematic assessment approaches. By the end, you’ll understand not just the answers, but the reasoning behind them.
The PALS provider course emphasizes a structured method for assessing pediatric patients. This systematic approach forms the foundation of many test questions.
Question: What is the correct order of the PALS systematic approach?
Answer: The sequence follows this pattern: Initial impression, Primary assessment (ABCDEs), Secondary assessment, Diagnostic tests, and Ongoing reassessments.
Your initial impression happens within seconds of seeing the child. You quickly assess appearance, work of breathing, and circulation to the skin. This rapid evaluation determines if the child is stable, in respiratory distress, in shock, or in cardiopulmonary failure.
The primary assessment uses the ABCDE mnemonic:
Question: What does the “Evaluate-Identify-Intervene” sequence mean in PALS?
Answer: This cycle means you continuously evaluate the patient’s condition, identify problems as they arise, and intervene immediately when needed. You don’t wait to complete your entire assessment before acting on life-threatening conditions.
For example, if you identify severe respiratory distress during your breathing assessment, you provide oxygen and position the airway immediately. You don’t delay intervention until completing circulation and disability checks.
Respiratory problems are the most common cause of cardiac arrest in children. The PALS test heavily emphasizes recognition and management of these emergencies.
Question: What distinguishes respiratory distress from respiratory failure?
Answer: Respiratory distress shows increased work of breathing with adequate gas exchange. Signs include tachypnea, retractions, nasal flaring, and head bobbing. The child remains alert and has good color.
Respiratory failure shows inadequate gas exchange despite increased work of breathing. You’ll see altered mental status, cyanosis, decreased muscle tone, and diminished breath sounds. The child may appear tired or lethargic. This is a pre-arrest condition requiring immediate intervention.
Question: A 3-year-old presents with stridor, drooling, and tripod positioning. What should you do first?
Answer: Keep the child in a position of comfort and avoid agitation. Do not force the child to lie down, insert anything in the mouth, or attempt IV access until the airway is secured by an experienced provider. This clinical picture suggests epiglottitis or severe croup, where agitation can cause complete airway obstruction.
Allow a parent to hold the child. Provide supplemental oxygen in a non-threatening manner. Prepare for potential airway management while summoning experienced help.
Question: What medications treat bronchiolitis in an infant with severe wheezing and respiratory distress?
Answer: The primary treatment includes bronchodilators (albuterol), supplemental oxygen, and potentially epinephrine for severe cases. Some infants may also benefit from corticosteroids if there’s a suspected asthma component.
However, the test may include a trick answer. Many cases of viral bronchiolitis don’t respond to bronchodilators. The correct answer depends on whether the wheezing improves with initial bronchodilator treatment. If there’s no improvement after a trial dose, continuing bronchodilators isn’t indicated.
PALS providers must recognize pediatric cardiac rhythms quickly and initiate appropriate treatment protocols.
Question: A 6-month-old has a heart rate of 55 bpm with poor perfusion despite effective ventilation with 100% oxygen. What’s your next intervention?
Answer: Begin chest compressions. In infants and children, a heart rate below 60 bpm with signs of poor perfusion should be treated like cardiac arrest, even if a pulse is present. This is because the low heart rate isn’t providing adequate cardiac output.
While continuing compressions and ventilation, prepare to administer epinephrine. The bradycardia algorithm calls for epinephrine if the heart rate remains below 60 bpm despite effective CPR.
Question: What are the two categories of pediatric cardiac arrest rhythms and their treatments?
Answer: Pediatric arrest rhythms divide into shockable and non-shockable categories.
Shockable rhythms include ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT). Treatment involves immediate defibrillation followed by CPR and epinephrine after the second shock.
Non-shockable rhythms include asystole and pulseless electrical activity (PEA). Treatment focuses on high-quality CPR and epinephrine administration every 3-5 minutes. You must also identify and treat reversible causes (the Hs and Ts).
Question: How do you differentiate supraventricular tachycardia (SVT) from sinus tachycardia?
Answer: Several key features help distinguish these rhythms:
SVT characteristics:
Sinus tachycardia characteristics:
Medication errors pose significant risks in pediatric emergencies. PALS test questions often focus on correct dosing calculations and administration routes.
Question: What’s the correct dose of epinephrine for a child in cardiac arrest, and how often do you administer it?
Answer: The dose is 0.01 mg/kg of 1:10,000 concentration (0.1 mL/kg) given intravenously or intraosseously. The maximum single dose is 1 mg. Administer epinephrine every 3-5 minutes during ongoing CPR.
If IV/IO access isn’t available, you can give epinephrine via endotracheal tube at a dose of 0.1 mg/kg of 1:1,000 concentration (0.1 mL/kg), though this route is less preferred.
Question: How do you properly administer adenosine to a stable child with SVT?
Answer: Adenosine requires rapid administration followed immediately by a saline flush. The initial dose is 0.1 mg/kg (maximum first dose 6 mg) given as a rapid IV/IO push. Follow it immediately with at least 5 mL of normal saline flush.
If the first dose doesn’t convert the rhythm within 1-2 minutes, give a second dose of 0.2 mg/kg (maximum second dose 12 mg). Use the same rapid push technique with immediate saline flush.
Adenosine has an extremely short half-life (less than 10 seconds), so the rapid push and flush are critical for the medication to reach the heart before breaking down.
Question: When treating a child with pulseless VT/VF that’s refractory to defibrillation, which antiarrhythmic do you use?
Answer: Amiodarone is the preferred first-line antiarrhythmic medication. The dose is 5 mg/kg IV/IO push. You can give a second dose of 5 mg/kg if VF/pVT persists.
Lidocaine is an acceptable alternative if amiodarone isn’t available. The dose is 1 mg/kg IV/IO push.
Both medications are given after the third shock in the VF/pVT algorithm, along with continuing high-quality CPR and epinephrine administration.
Shock is a clinical state where oxygen delivery to tissues is inadequate to meet metabolic demands. Recognizing shock early prevents progression to cardiac arrest.
Question: What are the main categories of shock in pediatric patients?
Answer: Pediatric shock falls into four main categories:
Question: What findings indicate a child has progressed from compensated to decompensated shock?
Answer: In compensated shock, the child maintains normal blood pressure through compensatory mechanisms like tachycardia and increased systemic vascular resistance. You’ll see delayed capillary refill, cool extremities, weak peripheral pulses, and altered mental status, but blood pressure remains normal.
Decompensated shock develops when compensatory mechanisms fail and blood pressure drops. This is a critical finding because hypotension in children indicates severe cardiovascular compromise and imminent cardiac arrest. The child may become lethargic or unresponsive.
Blood pressure is a late sign of shock in children. Never wait for hypotension to diagnose shock.
Question: What’s the appropriate initial fluid bolus for a child in shock?
Answer: Give 20 mL/kg of isotonic crystalloid (normal saline or lactated Ringer’s) as rapidly as possible via IV or IO access. Reassess the child after each bolus.
Many children in shock require multiple boluses. You may give 2-3 boluses (60 mL/kg total) in the first hour for hypovolemic or distributive shock. However, use caution with fluid administration in suspected cardiogenic shock, where excessive fluids can worsen pulmonary edema.
After the initial bolus, reassess vital signs, perfusion, and mental status to determine if additional fluids, vasopressors, or other interventions are needed.
The period immediately following return of spontaneous circulation (ROSC) is critical for optimizing outcomes and preventing secondary injury.
Question: What temperature goals should you target in a child after cardiac arrest?
Answer: Avoid hyperthermia (temperature above 38°C or 100.4°F) as it worsens neurological outcomes. For infants and children who remain comatose after cardiac arrest, continuous monitoring and treatment of fever is essential.
Therapeutic hypothermia (32-34°C or 89.6-93.2°F) or targeted temperature management (36°C or 96.8°F) may be considered in specific cases, particularly after out-of-hospital cardiac arrest, but this should be done in consultation with pediatric critical care specialists.
Question: What are the appropriate oxygen and ventilation targets after ROSC?
Answer: Target oxygen saturation between 94-99%. Both hyperoxia (too much oxygen) and hypoxia (too little oxygen) can harm the recovering brain.
For ventilation, aim for age-appropriate normocarbia with an end-tidal CO2 of 35-40 mmHg. Avoid hyperventilation, which causes cerebral vasoconstriction and reduced blood flow to the brain. Also avoid hypoventilation, which can cause hypercarbia and increased intracranial pressure.
Question: What blood pressure should you maintain after ROSC in a pediatric patient?
Answer: Maintain blood pressure at or above the 5th percentile for age. Hypotension after ROSC reduces cerebral perfusion and worsens outcomes. You may need to use fluid boluses, vasopressors (dopamine, epinephrine, norepinephrine), or inotropes (dobutamine, milrinone) to support blood pressure.
Avoid excessive hypertension as well, which can increase the risk of hemorrhage or cerebral edema.
Understanding these concepts is just the beginning. The PALS written test requires you to apply this knowledge in clinical scenarios, often under time pressure.
At Safety Training Seminars, we’ve been helping healthcare professionals master PALS certification since 1989. As an official American Heart Association Training Center, we offer a streamlined approach that makes complex material accessible and practical.
Our PALS course combines flexibility with thoroughness. You’ll complete the cognitive portion online at your own pace—typically 2-3 hours—then demonstrate your skills in person during a focused 30-minute testing session at one of our 70+ California locations. We offer classes every day, including evenings and weekends, so you can find a time that works with your schedule.
What sets us apart is our commitment to same-day certification. Walk in for your skills test and walk out with your official American Heart Association PALS card. No waiting weeks for your credentials. This matters when you need to start a new position or renew an expiring certification quickly.
We also back our courses with California’s lowest price guarantee. Quality PALS training shouldn’t break your budget, and we ensure you get exceptional value alongside expert instruction.
Our instructors bring real-world experience to every session. They’ve managed the emergencies you’re learning about, and they can answer the practical questions that textbooks don’t always address. Whether you’re preparing for your first PALS certification or renewing after two years, you’ll benefit from their insights.
Beyond PALS, we offer the full range of American Heart Association certifications—BLS, ACLS, and NRP—plus courses for childcare providers and the general public. Many of our students return year after year because we’ve streamlined what’s often a frustrating process into something efficient and even enjoyable.
Ready to tackle your PALS written test with confidence? Visit our website to view available class dates and times. Our customer service team is available every day from 8 AM to 10 PM to answer questions and help you register. You can also call us at any of our 70+ locations throughout California to find the office nearest you.
The children you care for deserve a healthcare provider who’s fully prepared for emergencies. We’re here to help you become that provider.