TheoryPALS Study Guide
Study for the PALS with exam topics, practice questions, a free PDF, video walkthrough and timed mock exam links.
How to study for PALS
- Read the topic list so you know what the exam is likely to cover.
- Answer the free practice questions and read every explanation.
- Download the PDF for offline review.
- Use timed mock exams when your untimed practice feels comfortable.
Topics to review
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial and physiological integrity
- Pharmacology, infection control and patient safety
Try PALS questions now
Q1A 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?
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✓ Correct answer: Work of breathing only
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.
Q2In the PALS systematic approach, after you perform the initial PAT and find an abnormality, your next step is to:
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✓ Correct answer: Perform a primary assessment (ABCDE) and identify the problem
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.
Q3A 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:
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✓ Correct answer: Respiratory distress
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.
Q4A 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?
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✓ Correct answer: Respiratory failure
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.
Q5An 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:
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✓ Correct answer: Compensated shock
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.
Q6A 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?
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✓ Correct answer: Decompensated shock
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).
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