PALS ALL QUESTIONS EXAM LATEST 2026 COMPLETE EXAM
QUESTIONS AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED RATIONALES |
FULL STUDY GUIDE | EXAM PREP | PRACTICE TEST |
CERTIFICATION PREPARATION
1. A 6-year-old child presents with signs of respiratory distress, including nasal flaring, intercostal
retractions, and oxygen saturation of 89% on room air. What is the most appropriate initial
intervention?
A. Immediate endotracheal intubation
B. Administer high-flow oxygen via non-rebreather mask
C. Start chest compressions
D. Give IV epinephrine
Correct Answer: B. Administer high-flow oxygen via non-rebreather mask
Rationale: Initial management of pediatric respiratory distress focuses on improving oxygenation. A
non-rebreather mask provides high-concentration oxygen. Intubation is reserved for deterioration,
while chest compressions and epinephrine are not indicated without cardiac arrest.
2. A child is unresponsive and not breathing normally. What is the correct compression-to-
ventilation ratio for two-rescuer CPR?
A. 15:2
B. 30:2
C. 20:2
D. 10:1
Correct Answer: A. 15:2
Rationale: In pediatric two-rescuer CPR, the correct ratio is 15 compressions to 2 breaths to optimize
oxygenation and circulation. 30:2 is used for single-rescuer CPR.
3. A 4-year-old has a heart rate of 38/min with poor perfusion despite oxygen and ventilation
support. What is the next best step?
A. Immediate defibrillation
B. Begin chest compressions
C. Administer atropine
D. Start fluid bolus
Correct Answer: B. Begin chest compressions
Rationale: Severe bradycardia with poor perfusion in children is treated as impending cardiac arrest.
Chest compressions are initiated when HR <60/min with signs of poor perfusion despite oxygenation
and ventilation.
4. Which finding most strongly indicates poor systemic perfusion in a pediatric patient?
A. Warm extremities
B. Capillary refill of 1 second
C. Altered mental status
D. Heart rate of 110/min
Correct Answer: C. Altered mental status
,Rationale: Altered mental status reflects inadequate cerebral perfusion. Warm extremities and
normal capillary refill suggest adequate circulation.
5. A child in respiratory failure is receiving bag-mask ventilation. Which observation indicates
effective ventilation?
A. No chest rise
B. Minimal chest movement
C. Visible chest rise with each breath
D. Oxygen saturation below 85%
Correct Answer: C. Visible chest rise with each breath
Rationale: Effective bag-mask ventilation is confirmed by visible chest rise, indicating adequate tidal
volume delivery.
6. A 2-year-old presents with sudden onset stridor and drooling. What is the most likely diagnosis?
A. Asthma exacerbation
B. Croup
C. Epiglottitis
D. Bronchiolitis
Correct Answer: C. Epiglottitis
Rationale: Drooling and stridor suggest upper airway obstruction consistent with epiglottitis. It is a
medical emergency requiring airway protection.
7. What is the first-line medication for anaphylaxis in pediatric patients?
A. Diphenhydramine
B. Epinephrine
C. Albuterol
D. Corticosteroids
Correct Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis due to its rapid effects on airway
edema, vasodilation, and bronchospasm.
8. A child in supraventricular tachycardia is unstable. What is the immediate treatment?
A. IV adenosine
B. Synchronized cardioversion
C. Vagal maneuvers
D. Observation
Correct Answer: B. Synchronized cardioversion
Rationale: Unstable SVT requires immediate synchronized cardioversion to restore normal rhythm.
9. Which rhythm is most commonly associated with pulseless electrical activity (PEA)?
A. Organized electrical activity without a pulse
B. Ventricular fibrillation
C. Sinus bradycardia with pulse
D. Asystole with fibrillation waves
Correct Answer: A. Organized electrical activity without a pulse
Rationale: PEA presents as organized electrical rhythm without mechanical cardiac output.
10. A child has a heart rate of 210/min, narrow complex tachycardia, and is stable. What is the first
intervention?
A. Immediate cardioversion
, B. Adenosine administration
C. Vagal maneuvers
D. Defibrillation
Correct Answer: C. Vagal maneuvers
Rationale: Stable SVT should first be treated with vagal maneuvers before pharmacologic
intervention.
11. What is the recommended compression depth for pediatric CPR (1 year to puberty)?
A. 1 inch
B. At least 1.5 inches
C. About 2 inches (one-third chest depth)
D. More than 3 inches
Correct Answer: C. About 2 inches (one-third chest depth)
Rationale: Effective pediatric CPR compresses at least one-third of the chest depth.
12. Which drug is indicated for refractory ventricular fibrillation in pediatric cardiac arrest?
A. Atropine
B. Epinephrine
C. Adenosine
D. Calcium chloride
Correct Answer: B. Epinephrine
Rationale: Epinephrine is used in cardiac arrest algorithms including VF/pulseless VT.
13. A child has prolonged seizures lasting more than 5 minutes. What is the first-line medication?
A. Phenytoin
B. Diazepam or lorazepam
C. Phenobarbital
D. Levetiracetam
Correct Answer: B. Diazepam or lorazepam
Rationale: Benzodiazepines are first-line for status epilepticus due to rapid seizure termination.
14. Which sign is most consistent with compensated shock in a child?
A. Hypotension
B. Bradycardia
C. Tachycardia with delayed capillary refill
D. Cardiac arrest
Correct Answer: C. Tachycardia with delayed capillary refill
Rationale: Compensated shock shows tachycardia and poor perfusion without hypotension.
15. A pediatric patient is in asystole. What is the appropriate action?
A. Defibrillate immediately
B. Start chest compressions and administer epinephrine
C. Give adenosine
D. Perform synchronized cardioversion
Correct Answer: B. Start chest compressions and administer epinephrine
Rationale: Asystole requires high-quality CPR and epinephrine; defibrillation is not indicated.
16. What is the primary goal of pediatric airway management?
A. Immediate intubation
B. Maintain oxygenation and ventilation
QUESTIONS AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED RATIONALES |
FULL STUDY GUIDE | EXAM PREP | PRACTICE TEST |
CERTIFICATION PREPARATION
1. A 6-year-old child presents with signs of respiratory distress, including nasal flaring, intercostal
retractions, and oxygen saturation of 89% on room air. What is the most appropriate initial
intervention?
A. Immediate endotracheal intubation
B. Administer high-flow oxygen via non-rebreather mask
C. Start chest compressions
D. Give IV epinephrine
Correct Answer: B. Administer high-flow oxygen via non-rebreather mask
Rationale: Initial management of pediatric respiratory distress focuses on improving oxygenation. A
non-rebreather mask provides high-concentration oxygen. Intubation is reserved for deterioration,
while chest compressions and epinephrine are not indicated without cardiac arrest.
2. A child is unresponsive and not breathing normally. What is the correct compression-to-
ventilation ratio for two-rescuer CPR?
A. 15:2
B. 30:2
C. 20:2
D. 10:1
Correct Answer: A. 15:2
Rationale: In pediatric two-rescuer CPR, the correct ratio is 15 compressions to 2 breaths to optimize
oxygenation and circulation. 30:2 is used for single-rescuer CPR.
3. A 4-year-old has a heart rate of 38/min with poor perfusion despite oxygen and ventilation
support. What is the next best step?
A. Immediate defibrillation
B. Begin chest compressions
C. Administer atropine
D. Start fluid bolus
Correct Answer: B. Begin chest compressions
Rationale: Severe bradycardia with poor perfusion in children is treated as impending cardiac arrest.
Chest compressions are initiated when HR <60/min with signs of poor perfusion despite oxygenation
and ventilation.
4. Which finding most strongly indicates poor systemic perfusion in a pediatric patient?
A. Warm extremities
B. Capillary refill of 1 second
C. Altered mental status
D. Heart rate of 110/min
Correct Answer: C. Altered mental status
,Rationale: Altered mental status reflects inadequate cerebral perfusion. Warm extremities and
normal capillary refill suggest adequate circulation.
5. A child in respiratory failure is receiving bag-mask ventilation. Which observation indicates
effective ventilation?
A. No chest rise
B. Minimal chest movement
C. Visible chest rise with each breath
D. Oxygen saturation below 85%
Correct Answer: C. Visible chest rise with each breath
Rationale: Effective bag-mask ventilation is confirmed by visible chest rise, indicating adequate tidal
volume delivery.
6. A 2-year-old presents with sudden onset stridor and drooling. What is the most likely diagnosis?
A. Asthma exacerbation
B. Croup
C. Epiglottitis
D. Bronchiolitis
Correct Answer: C. Epiglottitis
Rationale: Drooling and stridor suggest upper airway obstruction consistent with epiglottitis. It is a
medical emergency requiring airway protection.
7. What is the first-line medication for anaphylaxis in pediatric patients?
A. Diphenhydramine
B. Epinephrine
C. Albuterol
D. Corticosteroids
Correct Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis due to its rapid effects on airway
edema, vasodilation, and bronchospasm.
8. A child in supraventricular tachycardia is unstable. What is the immediate treatment?
A. IV adenosine
B. Synchronized cardioversion
C. Vagal maneuvers
D. Observation
Correct Answer: B. Synchronized cardioversion
Rationale: Unstable SVT requires immediate synchronized cardioversion to restore normal rhythm.
9. Which rhythm is most commonly associated with pulseless electrical activity (PEA)?
A. Organized electrical activity without a pulse
B. Ventricular fibrillation
C. Sinus bradycardia with pulse
D. Asystole with fibrillation waves
Correct Answer: A. Organized electrical activity without a pulse
Rationale: PEA presents as organized electrical rhythm without mechanical cardiac output.
10. A child has a heart rate of 210/min, narrow complex tachycardia, and is stable. What is the first
intervention?
A. Immediate cardioversion
, B. Adenosine administration
C. Vagal maneuvers
D. Defibrillation
Correct Answer: C. Vagal maneuvers
Rationale: Stable SVT should first be treated with vagal maneuvers before pharmacologic
intervention.
11. What is the recommended compression depth for pediatric CPR (1 year to puberty)?
A. 1 inch
B. At least 1.5 inches
C. About 2 inches (one-third chest depth)
D. More than 3 inches
Correct Answer: C. About 2 inches (one-third chest depth)
Rationale: Effective pediatric CPR compresses at least one-third of the chest depth.
12. Which drug is indicated for refractory ventricular fibrillation in pediatric cardiac arrest?
A. Atropine
B. Epinephrine
C. Adenosine
D. Calcium chloride
Correct Answer: B. Epinephrine
Rationale: Epinephrine is used in cardiac arrest algorithms including VF/pulseless VT.
13. A child has prolonged seizures lasting more than 5 minutes. What is the first-line medication?
A. Phenytoin
B. Diazepam or lorazepam
C. Phenobarbital
D. Levetiracetam
Correct Answer: B. Diazepam or lorazepam
Rationale: Benzodiazepines are first-line for status epilepticus due to rapid seizure termination.
14. Which sign is most consistent with compensated shock in a child?
A. Hypotension
B. Bradycardia
C. Tachycardia with delayed capillary refill
D. Cardiac arrest
Correct Answer: C. Tachycardia with delayed capillary refill
Rationale: Compensated shock shows tachycardia and poor perfusion without hypotension.
15. A pediatric patient is in asystole. What is the appropriate action?
A. Defibrillate immediately
B. Start chest compressions and administer epinephrine
C. Give adenosine
D. Perform synchronized cardioversion
Correct Answer: B. Start chest compressions and administer epinephrine
Rationale: Asystole requires high-quality CPR and epinephrine; defibrillation is not indicated.
16. What is the primary goal of pediatric airway management?
A. Immediate intubation
B. Maintain oxygenation and ventilation
