PALS PRE ASSESSMENT 1 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 4-year-old child is found unresponsive and not breathing normally. What is the first
appropriate action?
A. Check pulse for 60 seconds
B. Begin chest compressions immediately
C. Open airway and give two rescue breaths
D. Apply automated external defibrillator (AED)
Correct Answer: C. Open airway and give two rescue breaths
Rationale: In pediatric cardiac arrest, respiratory causes are common. Opening the airway and
providing rescue breaths is the immediate priority if no normal breathing is detected. Pulse check
should be brief and not delay ventilation.
2. A child has a heart rate of 45/min with poor perfusion. What is the most appropriate initial
intervention?
A. Immediate defibrillation
B. Start chest compressions
C. Administer adenosine
D. Give atropine first
Correct Answer: B. Start chest compressions
Rationale: Bradycardia with poor perfusion in children is treated with high-quality CPR. Defibrillation
is not indicated unless rhythm is shockable.
3. Which sign most strongly indicates respiratory failure in a child?
A. Mild tachycardia
B. Nasal flaring with retractions
C. Increased appetite
D. Bradycardia without distress
Correct Answer: B. Nasal flaring with retractions
Rationale: Increased work of breathing such as nasal flaring and retractions indicates respiratory
distress progressing toward failure.
4. A child in respiratory distress has oxygen saturation of 85% despite oxygen therapy. What is next
best step?
A. Reduce oxygen flow
B. Prepare for assisted ventilation
C. Give oral fluids
D. Reassess in 30 minutes
Correct Answer: B. Prepare for assisted ventilation
Rationale: Failure to maintain oxygenation despite oxygen therapy suggests impending respiratory
failure requiring ventilatory support.
,5. Which rhythm is shockable in pediatric cardiac arrest?
A. Asystole
B. Pulseless electrical activity
C. Ventricular fibrillation
D. Sinus bradycardia
Correct Answer: C. Ventricular fibrillation
Rationale: Ventricular fibrillation and pulseless ventricular tachycardia are shockable rhythms.
6. A child presents with supraventricular tachycardia (SVT) and is unstable. What is first-line
treatment?
A. Vagal maneuvers
B. Adenosine
C. Synchronized cardioversion
D. Amiodarone infusion
Correct Answer: C. Synchronized cardioversion
Rationale: Unstable SVT requires immediate synchronized cardioversion rather than medication.
7. Which finding is most consistent with compensated shock?
A. Hypotension
B. Altered mental status with bradycardia
C. Tachycardia with delayed capillary refill
D. Cardiac arrest
Correct Answer: C. Tachycardia with delayed capillary refill
Rationale: Compensated shock maintains blood pressure but shows tachycardia and poor perfusion.
8. What is the preferred initial fluid bolus for pediatric septic shock?
A. 5 mL/kg normal saline
B. 10 mL/kg D5W
C. 20 mL/kg isotonic crystalloid
D. 50 mL/kg albumin
Correct Answer: C. 20 mL/kg isotonic crystalloid
Rationale: Current guidelines recommend 20 mL/kg isotonic fluid bolus for septic shock with
reassessment.
9. A child becomes pulseless and apneic. After starting CPR, what is the next priority?
A. Obtain IV access immediately
B. Administer epinephrine
C. Intubate the patient first
D. Check blood glucose
Correct Answer: B. Administer epinephrine
Rationale: Epinephrine should be given as soon as possible in pediatric cardiac arrest during CPR.
10. Which airway maneuver is most appropriate for a suspected cervical spine injury?
A. Head tilt–chin lift
B. Jaw-thrust maneuver
C. Neck hyperextension
D. Lateral positioning
Correct Answer: B. Jaw-thrust maneuver
Rationale: Jaw-thrust maintains airway without moving the cervical spine.
, 11. A child is in respiratory distress with wheezing and accessory muscle use. What is the most
likely condition?
A. Pneumonia only
B. Asthma exacerbation
C. Congestive heart failure
D. Diabetic ketoacidosis
Correct Answer: B. Asthma exacerbation
Rationale: Wheezing and accessory muscle use are classic signs of asthma exacerbation.
12. Which medication is first-line for anaphylaxis?
A. Diphenhydramine
B. Epinephrine
C. Albuterol
D. Prednisone
Correct Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis and should not be delayed.
13. A child has narrow-complex tachycardia but is stable. What is next step?
A. Immediate cardioversion
B. Adenosine administration
C. Defibrillation
D. Epinephrine infusion
Correct Answer: B. Adenosine administration
Rationale: Stable SVT is treated initially with vagal maneuvers and adenosine.
14. Which is a sign of late decompensated shock?
A. Tachycardia
B. Cool extremities
C. Hypotension
D. Mild irritability
Correct Answer: C. Hypotension
Rationale: Hypotension indicates late and severe decompensated shock.
15. What is the correct compression-to-ventilation ratio for two-rescuer pediatric CPR?
A. 30:2
B. 15:2
C. 15:1
D. 10:1
Correct Answer: B. 15:2
Rationale: Two-rescuer pediatric CPR uses a 15:2 compression-to-ventilation ratio.
16. A child is bradycardic with adequate perfusion. What is the appropriate action?
A. Start chest compressions
B. Administer epinephrine immediately
C. Support airway and oxygenation
D. Defibrillate
Correct Answer: C. Support airway and oxygenation
Rationale: Bradycardia with adequate perfusion is managed with airway and oxygen support, not
CPR.
EXAM QUESTIONS AND VERIFIED ANSWERS | 2026–2027
LATEST UPDATE | GUARANTEED PASS | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP | PRACTICE
TEST | CERTIFICATION PREPARATION
1. A 4-year-old child is found unresponsive and not breathing normally. What is the first
appropriate action?
A. Check pulse for 60 seconds
B. Begin chest compressions immediately
C. Open airway and give two rescue breaths
D. Apply automated external defibrillator (AED)
Correct Answer: C. Open airway and give two rescue breaths
Rationale: In pediatric cardiac arrest, respiratory causes are common. Opening the airway and
providing rescue breaths is the immediate priority if no normal breathing is detected. Pulse check
should be brief and not delay ventilation.
2. A child has a heart rate of 45/min with poor perfusion. What is the most appropriate initial
intervention?
A. Immediate defibrillation
B. Start chest compressions
C. Administer adenosine
D. Give atropine first
Correct Answer: B. Start chest compressions
Rationale: Bradycardia with poor perfusion in children is treated with high-quality CPR. Defibrillation
is not indicated unless rhythm is shockable.
3. Which sign most strongly indicates respiratory failure in a child?
A. Mild tachycardia
B. Nasal flaring with retractions
C. Increased appetite
D. Bradycardia without distress
Correct Answer: B. Nasal flaring with retractions
Rationale: Increased work of breathing such as nasal flaring and retractions indicates respiratory
distress progressing toward failure.
4. A child in respiratory distress has oxygen saturation of 85% despite oxygen therapy. What is next
best step?
A. Reduce oxygen flow
B. Prepare for assisted ventilation
C. Give oral fluids
D. Reassess in 30 minutes
Correct Answer: B. Prepare for assisted ventilation
Rationale: Failure to maintain oxygenation despite oxygen therapy suggests impending respiratory
failure requiring ventilatory support.
,5. Which rhythm is shockable in pediatric cardiac arrest?
A. Asystole
B. Pulseless electrical activity
C. Ventricular fibrillation
D. Sinus bradycardia
Correct Answer: C. Ventricular fibrillation
Rationale: Ventricular fibrillation and pulseless ventricular tachycardia are shockable rhythms.
6. A child presents with supraventricular tachycardia (SVT) and is unstable. What is first-line
treatment?
A. Vagal maneuvers
B. Adenosine
C. Synchronized cardioversion
D. Amiodarone infusion
Correct Answer: C. Synchronized cardioversion
Rationale: Unstable SVT requires immediate synchronized cardioversion rather than medication.
7. Which finding is most consistent with compensated shock?
A. Hypotension
B. Altered mental status with bradycardia
C. Tachycardia with delayed capillary refill
D. Cardiac arrest
Correct Answer: C. Tachycardia with delayed capillary refill
Rationale: Compensated shock maintains blood pressure but shows tachycardia and poor perfusion.
8. What is the preferred initial fluid bolus for pediatric septic shock?
A. 5 mL/kg normal saline
B. 10 mL/kg D5W
C. 20 mL/kg isotonic crystalloid
D. 50 mL/kg albumin
Correct Answer: C. 20 mL/kg isotonic crystalloid
Rationale: Current guidelines recommend 20 mL/kg isotonic fluid bolus for septic shock with
reassessment.
9. A child becomes pulseless and apneic. After starting CPR, what is the next priority?
A. Obtain IV access immediately
B. Administer epinephrine
C. Intubate the patient first
D. Check blood glucose
Correct Answer: B. Administer epinephrine
Rationale: Epinephrine should be given as soon as possible in pediatric cardiac arrest during CPR.
10. Which airway maneuver is most appropriate for a suspected cervical spine injury?
A. Head tilt–chin lift
B. Jaw-thrust maneuver
C. Neck hyperextension
D. Lateral positioning
Correct Answer: B. Jaw-thrust maneuver
Rationale: Jaw-thrust maintains airway without moving the cervical spine.
, 11. A child is in respiratory distress with wheezing and accessory muscle use. What is the most
likely condition?
A. Pneumonia only
B. Asthma exacerbation
C. Congestive heart failure
D. Diabetic ketoacidosis
Correct Answer: B. Asthma exacerbation
Rationale: Wheezing and accessory muscle use are classic signs of asthma exacerbation.
12. Which medication is first-line for anaphylaxis?
A. Diphenhydramine
B. Epinephrine
C. Albuterol
D. Prednisone
Correct Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis and should not be delayed.
13. A child has narrow-complex tachycardia but is stable. What is next step?
A. Immediate cardioversion
B. Adenosine administration
C. Defibrillation
D. Epinephrine infusion
Correct Answer: B. Adenosine administration
Rationale: Stable SVT is treated initially with vagal maneuvers and adenosine.
14. Which is a sign of late decompensated shock?
A. Tachycardia
B. Cool extremities
C. Hypotension
D. Mild irritability
Correct Answer: C. Hypotension
Rationale: Hypotension indicates late and severe decompensated shock.
15. What is the correct compression-to-ventilation ratio for two-rescuer pediatric CPR?
A. 30:2
B. 15:2
C. 15:1
D. 10:1
Correct Answer: B. 15:2
Rationale: Two-rescuer pediatric CPR uses a 15:2 compression-to-ventilation ratio.
16. A child is bradycardic with adequate perfusion. What is the appropriate action?
A. Start chest compressions
B. Administer epinephrine immediately
C. Support airway and oxygenation
D. Defibrillate
Correct Answer: C. Support airway and oxygenation
Rationale: Bradycardia with adequate perfusion is managed with airway and oxygen support, not
CPR.
