PALS Updated Practice Exam NEWEST EXAM
PALS UPDATED PRACTICE EXAM NEWEST EXAM COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) WITH RATIONALES |ALREADY GRADED A+||BRAND
NEW VERSION!!
1. A 4-year-old becomes suddenly unresponsive after choking on a grape. He has
no pulse and no chest rise despite two breaths. What is the next action?
A. Begin chest compressions
B. Perform a blind finger sweep
C. Attempt another set of 2 rescue breaths
D. Deliver back blows
Answer: A. Begin chest compressions
Rationale: In an unresponsive child with foreign-body airway obstruction, if initial
rescue breaths do not go in, start CPR. Compressions may help dislodge the
object. Blind finger sweeps are avoided.
2. A 7-year-old in respiratory distress has a respiratory rate of 48/min, subcostal
retractions, and SpO₂ 85% on 6 L/min nasal cannula. What is the next best
intervention?
A. Increase nasal cannula to 10 L/min
B. Switch to high-flow nasal cannula (HFNC) or non-rebreather
C. Prepare for intubation immediately
D. Administer naloxone IM
Answer: B. Switch to HFNC or non-rebreather
Rationale: Severe hypoxemia despite standard oxygen indicates need for
escalation of oxygen delivery method. Jumping to intubation is premature unless
failure continues.
1|Page
, PALS Updated Practice Exam NEWEST EXAM
3. You are evaluating a 2-year-old with suspected compensated shock. Which
finding supports this?
A. Hypotension
B. Weak central pulses
C. Cool extremities with delayed capillary refill
D. Bradypnea
Answer: C. Cool extremities with delayed cap refill
Rationale: Children maintain blood pressure until late. Cool skin, tachycardia, and
prolonged cap refill indicate compensated shock. Hypotension is decompensated
shock.
4. A child has a wide-complex tachycardia at 180/min but is alert and perfusing
normally. What is the initial management?
A. Immediate synchronized cardioversion
B. Vagal maneuvers
C. Obtain expert consultation and consider adenosine
D. Begin CPR
Answer: C. Obtain consultation; consider adenosine
Rationale: A wide-complex tachycardia in a stable child warrants expert support.
Adenosine may be used if rhythm is suspected SVT with aberrancy.
5. You begin CPR on a 5-year-old with a single rescuer. Which ratio is correct?
A. 15:2
B. 30:2
C. 5:1
D. Continuous compressions with breaths every 6 seconds
Answer: B. 30:2
Rationale: Single-rescuer CPR for any age (except newborn) uses 30:2.
2|Page
, PALS Updated Practice Exam NEWEST EXAM
6. A 3-month-old has a HR 56/min and poor perfusion. After 30 seconds of
effective ventilation the HR remains at 56/min. Next step?
A. Continue ventilations only
B. Begin chest compressions
C. Administer epinephrine
D. Give 20 mL/kg NS bolus
Answer: B. Begin chest compressions
Rationale: HR < 60/min with signs of poor perfusion after adequate ventilation →
start compressions.
7. A child in anaphylaxis is wheezing, hypotensive, and cyanotic. IM epinephrine is
given. What is the next immediate treatment?
A. Give albuterol
B. Give IV fluid bolus
C. Give methylprednisolone
D. Place cold packs on extremities
Answer: B. Give IV fluid bolus
Rationale: Anaphylaxis often causes distributive shock → rapid isotonic boluses
help restore perfusion.
8. A 10-year-old with severe asthma is tiring and has a rising ETCO₂. What is the
most concerning sign requiring immediate intervention?
A. Wheezing getting louder
B. Silent chest
C. Tachycardia
D. Nasal flaring
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, PALS Updated Practice Exam NEWEST EXAM
Answer: B. Silent chest
Rationale: A “silent chest” indicates minimal air movement and impending
respiratory arrest.
9. A child with ROSC remains unresponsive. What is the target oxygen saturation?
A. 100%
B. 94–99%
C. >85%
D. 88–92%
Answer: B. 94–99%
Rationale: Post-ROSC care avoids both hypoxia and hyperoxia.
10. A child in septic shock receives two 20 mL/kg boluses but remains tachycardic
with hypotension. Next step?
A. Give another 20 mL/kg bolus
B. Start epinephrine or norepinephrine infusion
C. Observe
D. Give sodium bicarbonate
Answer: B. Start epinephrine or norepinephrine infusion
Rationale: Persistent hypotension after two boluses indicates fluid-refractory
shock → inotropes or vasopressors.
11. During resuscitation you cannot obtain peripheral IV access. What is the next
step?
A. Attempt another IV for 10 minutes
B. Begin intraosseous (IO) access
C. Use subcutaneous fluids
D. Stop the resuscitation
4|Page
PALS UPDATED PRACTICE EXAM NEWEST EXAM COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) WITH RATIONALES |ALREADY GRADED A+||BRAND
NEW VERSION!!
1. A 4-year-old becomes suddenly unresponsive after choking on a grape. He has
no pulse and no chest rise despite two breaths. What is the next action?
A. Begin chest compressions
B. Perform a blind finger sweep
C. Attempt another set of 2 rescue breaths
D. Deliver back blows
Answer: A. Begin chest compressions
Rationale: In an unresponsive child with foreign-body airway obstruction, if initial
rescue breaths do not go in, start CPR. Compressions may help dislodge the
object. Blind finger sweeps are avoided.
2. A 7-year-old in respiratory distress has a respiratory rate of 48/min, subcostal
retractions, and SpO₂ 85% on 6 L/min nasal cannula. What is the next best
intervention?
A. Increase nasal cannula to 10 L/min
B. Switch to high-flow nasal cannula (HFNC) or non-rebreather
C. Prepare for intubation immediately
D. Administer naloxone IM
Answer: B. Switch to HFNC or non-rebreather
Rationale: Severe hypoxemia despite standard oxygen indicates need for
escalation of oxygen delivery method. Jumping to intubation is premature unless
failure continues.
1|Page
, PALS Updated Practice Exam NEWEST EXAM
3. You are evaluating a 2-year-old with suspected compensated shock. Which
finding supports this?
A. Hypotension
B. Weak central pulses
C. Cool extremities with delayed capillary refill
D. Bradypnea
Answer: C. Cool extremities with delayed cap refill
Rationale: Children maintain blood pressure until late. Cool skin, tachycardia, and
prolonged cap refill indicate compensated shock. Hypotension is decompensated
shock.
4. A child has a wide-complex tachycardia at 180/min but is alert and perfusing
normally. What is the initial management?
A. Immediate synchronized cardioversion
B. Vagal maneuvers
C. Obtain expert consultation and consider adenosine
D. Begin CPR
Answer: C. Obtain consultation; consider adenosine
Rationale: A wide-complex tachycardia in a stable child warrants expert support.
Adenosine may be used if rhythm is suspected SVT with aberrancy.
5. You begin CPR on a 5-year-old with a single rescuer. Which ratio is correct?
A. 15:2
B. 30:2
C. 5:1
D. Continuous compressions with breaths every 6 seconds
Answer: B. 30:2
Rationale: Single-rescuer CPR for any age (except newborn) uses 30:2.
2|Page
, PALS Updated Practice Exam NEWEST EXAM
6. A 3-month-old has a HR 56/min and poor perfusion. After 30 seconds of
effective ventilation the HR remains at 56/min. Next step?
A. Continue ventilations only
B. Begin chest compressions
C. Administer epinephrine
D. Give 20 mL/kg NS bolus
Answer: B. Begin chest compressions
Rationale: HR < 60/min with signs of poor perfusion after adequate ventilation →
start compressions.
7. A child in anaphylaxis is wheezing, hypotensive, and cyanotic. IM epinephrine is
given. What is the next immediate treatment?
A. Give albuterol
B. Give IV fluid bolus
C. Give methylprednisolone
D. Place cold packs on extremities
Answer: B. Give IV fluid bolus
Rationale: Anaphylaxis often causes distributive shock → rapid isotonic boluses
help restore perfusion.
8. A 10-year-old with severe asthma is tiring and has a rising ETCO₂. What is the
most concerning sign requiring immediate intervention?
A. Wheezing getting louder
B. Silent chest
C. Tachycardia
D. Nasal flaring
3|Page
, PALS Updated Practice Exam NEWEST EXAM
Answer: B. Silent chest
Rationale: A “silent chest” indicates minimal air movement and impending
respiratory arrest.
9. A child with ROSC remains unresponsive. What is the target oxygen saturation?
A. 100%
B. 94–99%
C. >85%
D. 88–92%
Answer: B. 94–99%
Rationale: Post-ROSC care avoids both hypoxia and hyperoxia.
10. A child in septic shock receives two 20 mL/kg boluses but remains tachycardic
with hypotension. Next step?
A. Give another 20 mL/kg bolus
B. Start epinephrine or norepinephrine infusion
C. Observe
D. Give sodium bicarbonate
Answer: B. Start epinephrine or norepinephrine infusion
Rationale: Persistent hypotension after two boluses indicates fluid-refractory
shock → inotropes or vasopressors.
11. During resuscitation you cannot obtain peripheral IV access. What is the next
step?
A. Attempt another IV for 10 minutes
B. Begin intraosseous (IO) access
C. Use subcutaneous fluids
D. Stop the resuscitation
4|Page
