The Pediatric Advanced Life Support (PALS) certification exam is notoriously challenging. It requires healthcare providers to quickly synthesize information regarding physiology, pharmacology, and ECG interpretation to make critical decisions. As an experienced instructor in emergency medical training, I have guided hundreds of students through this process.
While memorization has its place, the PALS exam is primarily application-based. It tests your ability to recognize the “sick” child and intervene according to the latest AHA guidelines.
Whether you are a paramedic, nurse, or physician, this guide is designed as a study resource. We have compiled the most high-yield questions that appear on the written exam and the megacode station. By mastering these concepts, you will solidify your understanding of pediatric emergency care.
How to Pass the PALS Exam: Top 10 Questions You Must Know
1. What is the priority for a child with Bradycardia and poor perfusion?
Answer: If the heart rate is < 60 bpm with signs of poor perfusion (altered mental status, weak pulses) despite oxygenation, the immediate action is starting high-quality CPR.
2. What is the weight-based dose for Epinephrine in PALS?
Answer: The standard dose is 0.01 mg/kg (0.1 mL/g of 1:10,000 solution). This is administered every 3 to 5 minutes during cardiac arrest.
3. How do you distinguish SVT from Sinus Tachycardia?
Answer:
- Sinus Tachycardia: Usually has discernible P-waves; rate is typically < 220 bpm in infants or < 180 bpm in children.
- SVT: P-waves are absent/abnormal; rate is usually > 220 bpm in infants or > 180 bpm in children.
4. What is the initial energy dose for pediatric defibrillation?
Answer: For shockable rhythms (VF/Pulseless VT), the initial shock is 2 J/kg. The second dose is 4 J/kg, with subsequent doses of at least 4 J/kg (not to exceed 10 J/kg).
5. What is the most reliable way to confirm ET tube placement?
Answer: While bilateral breath sounds are checked, continuous waveform capnography (ETCO2) is the gold standard for confirming and monitoring correct endotracheal tube position.
6. What fluid bolus is used for pediatric shock?
Answer: For hypovolemic or distributive shock, administer 20 mL/kg of isotonic crystalloid (Normal Saline or Lactated Ringer’s) over 5 to 20 minutes.
7. What are the “H’s and T’s” of Pediatric Cardiac Arrest?
Answer:
H’s:
– Hypovolemia
– Hypoxia
– Hydrogen ion (acidosis)
– Hypoglycemia
– Hypo/Hyperkalemia
– Hypothermia
T’s:
– Tension pneumothorax
– Cardiac tamponade
– Toxins
– Thrombosis (pulmonary or coronary)
8. What is the compression ratio for 2-rescuer pediatric CPR?
Answer: The ratio is 15:2. (Note: 1-rescuer CPR remains 30:2).
9. How do you treat Asystole/PEA?
Answer: These are non-shockable rhythms. The priority is immediate CPR and administering Epinephrine as soon as IV/IO access is available.
10. What is the post-resuscitation Oxygen target?
Answer: Once a pulse is restored (ROSC), titrate oxygen to maintain an SpO2 between 94% and 99%. Avoid 100% to prevent reperfusion injury.
Boosting Your Exam Readiness
Understanding these questions is the first step toward certification. For those looking to move beyond the theory and complete their hands-on skills or full certification, explore our AHA PALS Certification Classes near you to complete your training and skills testing.
Remember, the goal of the PALS course is not just to pass a test, but to improve outcomes for pediatric patients in emergencies. Use this guide as a supplement to your course materials and hands-on practice sessions.
PALS Exam Prep FAQ
What is the passing score for the PALS exam?
The American Heart Association (AHA) PALS provider exam consists of 50 multiple-choice questions. A passing score of 84% is required, meaning you must answer at least 42 questions correctly.
How difficult is the PALS written test?
The PALS exam is considered challenging because it is scenario-based. It tests your ability to apply algorithms to clinical cases rather than just reciting facts.
Are PALS questions the same for new and renewal students?
Yes. Under the AHA HeartCode and instructor-led models, the core cognitive requirements and exam questions are the same for both initial and renewal students to ensure a universal standard of care.