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PALS PreTest 2025/2026 | ACTUAL PRACTICE QUESTIONS WITH
100% VERIFIED ANSWERS & EXPLANATIONS || PEDIATRIC
ADVANCED LIFE SUPPORT REVIEW || AHA GUIDELINES UPDATED ||
BRAND NEW & GRADED A+
You are called to help treat an infant with severe symptomatic bradycardia (heart rate 66/min)
associated with respiratory distress. The bradycardia persists despite establishment of an
effective airway, oxygenation, and ventilation. There is no heart block present. Which is the first
drug you should administer?
Epinephrine
Initial impression of a 2yo girl shows her to be alert with mild breathing difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory
sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room
air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Which is the most
appropriate initial intervention for this child?
Humidified oxygen as tolerated
You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest.
You delivered 2 unsynchronized shocks. A team member established IO access, so you give a
dose of epinephrine, 0.01 mg/kg IO. At the next rhythm check, persistent ventricular fibrillation
is present. You administer a 4 J/kg shock and resume CPR. Which drug and dose should be
administered next?
Amiodarone 5 mg/kg IO
Which statement is correct about the effects of epinephrine during attempted resuscitation?
Epinephrine stimulates spontaneous contractions when asystole is present
A previously healthy infant with a history of vomiting and diarrhea is brought to the emergency
department by her parents. During your assessment, you find that the infant responds only to
painful stimulation.
Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give D25W 2-4
ml/kg IV
Which statement is correct about endotracheal drug administration during resuscitative efforts for
pediatric patients?
It is the least desirable route of administration
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Which statement is correct about the use of calcium chloride in pediatric patients?
Routine administration is not indicated during cardiac arrest
A 9yo boy is agitated and leaning forward on the bed in obvious respiratory distress.
Albuterol
Which oxygen delivery system most reliably delivers a high (90% or greater) concentration of
inspired oxygen to a 7yo child?
Nonrebreathing face mask
Paramedics are called to the home of a 1yo child. Their initial assessment reveals a child who
responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the
abdomen, abdominal distention, and cyanosis
Rapid bolus of 20ml/kg of isotonic crystalloid
A 7yo boy is found unresponsive, apneic, and pulseless. CPR is ongoing
Identify and treat reversible causes
You are preparing to use a manual defibrillator in the pediatric setting. Which best describes
when it is appropriate to use the smaller, pediatric-sized paddles?
If the child weighs less than 10kg or is less than 1 year old
What compression-to-ventilation ratio should be used for 2-rescuer infant CPR?
15 compressions to 2 breaths
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout
for nearby help, but no one arrives. What action should you take next?
Provide CPR for about 2 minutes before leaving to activate the emergency response system
You are assisting in the elective intubation of an average-sized 4yo child with respiratory failure.
A colleague is retrieving the color-coded length-based tape from the resuscitation cart. Which of
the following is likely to be the estimated size of the uncuffed endotracheal tube for this child?
5mm tube
A pale and very sleepy but arousable 3yo child with a hx of diarrhea is brought to the hospital.
Primary assessment reveals a respiratory rate of 45/min with good breath sounds bilaterally
Administer a bolus of 20 ml/kg isotonic crystalloid
You are evaluating an irritable 6yo girl with mottled skin color.
Compensated shock associated with tachycardia and inadequate tissue perfusion
,3|Page
You assisted with the elective endotracheal intubation of a child with respiratory failure and a
perfusing rhythm
Adequate bilateral breath sounds and chest expansion plus detection of ETCO2 with waveform
capnography
You and another rescuer begin CPR. Your colleague begins compressions, and you notice that the
compression rate is too slow. What should you say to offer constructive feedback?
You need to compress at a rate of 100-120 per minute."
A 10mo infant boy is brought to the emergency department. Your initial assessment reveals a
lethargic, pale infant with slow respirations and slow, weak central pulses.
Epinephrine 0.01 mg/kg IV/IO
A 1yo boy is brought to the emergency department for evaluation of poor feeding, irritability, and
sweating
Administer adenosine 0.1 mg/kg IV rapid push
During bag-mask ventilation, how should you hold the mask to make an effective seal between
the child's face and the mask?
Position your fingers using the E-C clamp technique
An 8yo child was struck by a car. He arrives in the ED alert, anxious, and in respiratory distress.
His cervical spine is immobilized, and he is receiving a 10L/min flow of 100% oxygen by
nonrebreathing face mask.
Perform needle decompression of the right chest
You are caring for a 3yo with vomiting and diarrhea. You have established IV access. The child's
pulses are palpable but faint, and the child is now lethargic
Atropine 0.02 mg/kg IV
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for
delivering breaths?
1 breath every 3-5 seconds
A child becomes unresponsive in the emergency department and is not breathing. You are
uncertain if a faint pulse is present
Start high-quality CPR
You find a 10yo boy to be unresponsive. You shout for help, and after finding that he is not
breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the
, 4|Page
emergency response system.brings the emergency equipment, and places the child on a cardiac
monitor/defibrillator, which reveals the rhythm shown here. You attempt defibrillation at 2 J/kg
and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you
attempt defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose
of epinephrine 0.01 mg/kg. If ventricular fibrillation or pulseless ventricular tachycardia persists
after 2 minutes of CPR, you will administer another shock. Which drug and dose should be
administered next?
Lidocaine 1 mg/kg IV
A 4yo boy is in pulseless arrest in the PICU. High-quality CPR is in progress. You quickly
review his chart and find that his baseline-corrected QT interval on a 12-lead ECG is prolonged.
The monitor shows recurrent episodes of the rhythm shown here. The patient has received 1 dose
of epinephrine 0.01 mg/kg, but the rhythm shown here continues. If this rhythm persists at the
next rhythm check, which medication would be most appropriate to administer at that time?
Magnesium sulfate 25-50 mg/kg IV
A 3yo unresponsive, apneic child is brought to the emergency department. EMS personnel report
that the child became unresponsive as they arrived at the hospital. The child is receiving CPR
with bag-mask ventilation. The rhythm shown here is on the cardiac monitor. A biphasic manual
defibrillator is present. You quickly use the length from head to of the child on a color-coded
length-based resuscitation tape to estimate the approximate weight as 15kg. Which therapy is
most appropriate for this child at this time?
Attempt defibrillation at 30 J, and then resume CPR, beginning with compressions
You are alone and witness a child suddenly collapse. There is no suspected head or neck injury. A
colleague responded to your shout for help and is activating the emergency response system and
is retrieving the resuscitation equipment, including a defibrillator. After delivering 30
compressions, what would be your next action?
Open the airway with a head tilt-chin lift maneuver and give 2 breaths
You are giving chest compressions for a child in cardiac arrest? What is the proper depth of
compressions for a child?
Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)
An 8mo infant is brought to the emergency department for evaluation of severe diarrhea and
dehydration. On arrival to the emergency department, the infant becomes unresponsive, apneic,
and pulseless. You shout for help and start CPR. Another provider arrives, at which point you
switch to 2-rescuer CPR. The rhythm shown here is seen on the cardiac monitor. The infant is
intubated and ventilated with with 100% oxygen. An IO line is established, and a dose of
epinephrine is given. While continuing high-quality CPR, what do you do next?
PALS PreTest 2025/2026 | ACTUAL PRACTICE QUESTIONS WITH
100% VERIFIED ANSWERS & EXPLANATIONS || PEDIATRIC
ADVANCED LIFE SUPPORT REVIEW || AHA GUIDELINES UPDATED ||
BRAND NEW & GRADED A+
You are called to help treat an infant with severe symptomatic bradycardia (heart rate 66/min)
associated with respiratory distress. The bradycardia persists despite establishment of an
effective airway, oxygenation, and ventilation. There is no heart block present. Which is the first
drug you should administer?
Epinephrine
Initial impression of a 2yo girl shows her to be alert with mild breathing difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory
sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room
air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Which is the most
appropriate initial intervention for this child?
Humidified oxygen as tolerated
You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest.
You delivered 2 unsynchronized shocks. A team member established IO access, so you give a
dose of epinephrine, 0.01 mg/kg IO. At the next rhythm check, persistent ventricular fibrillation
is present. You administer a 4 J/kg shock and resume CPR. Which drug and dose should be
administered next?
Amiodarone 5 mg/kg IO
Which statement is correct about the effects of epinephrine during attempted resuscitation?
Epinephrine stimulates spontaneous contractions when asystole is present
A previously healthy infant with a history of vomiting and diarrhea is brought to the emergency
department by her parents. During your assessment, you find that the infant responds only to
painful stimulation.
Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give D25W 2-4
ml/kg IV
Which statement is correct about endotracheal drug administration during resuscitative efforts for
pediatric patients?
It is the least desirable route of administration
,2|Page
Which statement is correct about the use of calcium chloride in pediatric patients?
Routine administration is not indicated during cardiac arrest
A 9yo boy is agitated and leaning forward on the bed in obvious respiratory distress.
Albuterol
Which oxygen delivery system most reliably delivers a high (90% or greater) concentration of
inspired oxygen to a 7yo child?
Nonrebreathing face mask
Paramedics are called to the home of a 1yo child. Their initial assessment reveals a child who
responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the
abdomen, abdominal distention, and cyanosis
Rapid bolus of 20ml/kg of isotonic crystalloid
A 7yo boy is found unresponsive, apneic, and pulseless. CPR is ongoing
Identify and treat reversible causes
You are preparing to use a manual defibrillator in the pediatric setting. Which best describes
when it is appropriate to use the smaller, pediatric-sized paddles?
If the child weighs less than 10kg or is less than 1 year old
What compression-to-ventilation ratio should be used for 2-rescuer infant CPR?
15 compressions to 2 breaths
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout
for nearby help, but no one arrives. What action should you take next?
Provide CPR for about 2 minutes before leaving to activate the emergency response system
You are assisting in the elective intubation of an average-sized 4yo child with respiratory failure.
A colleague is retrieving the color-coded length-based tape from the resuscitation cart. Which of
the following is likely to be the estimated size of the uncuffed endotracheal tube for this child?
5mm tube
A pale and very sleepy but arousable 3yo child with a hx of diarrhea is brought to the hospital.
Primary assessment reveals a respiratory rate of 45/min with good breath sounds bilaterally
Administer a bolus of 20 ml/kg isotonic crystalloid
You are evaluating an irritable 6yo girl with mottled skin color.
Compensated shock associated with tachycardia and inadequate tissue perfusion
,3|Page
You assisted with the elective endotracheal intubation of a child with respiratory failure and a
perfusing rhythm
Adequate bilateral breath sounds and chest expansion plus detection of ETCO2 with waveform
capnography
You and another rescuer begin CPR. Your colleague begins compressions, and you notice that the
compression rate is too slow. What should you say to offer constructive feedback?
You need to compress at a rate of 100-120 per minute."
A 10mo infant boy is brought to the emergency department. Your initial assessment reveals a
lethargic, pale infant with slow respirations and slow, weak central pulses.
Epinephrine 0.01 mg/kg IV/IO
A 1yo boy is brought to the emergency department for evaluation of poor feeding, irritability, and
sweating
Administer adenosine 0.1 mg/kg IV rapid push
During bag-mask ventilation, how should you hold the mask to make an effective seal between
the child's face and the mask?
Position your fingers using the E-C clamp technique
An 8yo child was struck by a car. He arrives in the ED alert, anxious, and in respiratory distress.
His cervical spine is immobilized, and he is receiving a 10L/min flow of 100% oxygen by
nonrebreathing face mask.
Perform needle decompression of the right chest
You are caring for a 3yo with vomiting and diarrhea. You have established IV access. The child's
pulses are palpable but faint, and the child is now lethargic
Atropine 0.02 mg/kg IV
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for
delivering breaths?
1 breath every 3-5 seconds
A child becomes unresponsive in the emergency department and is not breathing. You are
uncertain if a faint pulse is present
Start high-quality CPR
You find a 10yo boy to be unresponsive. You shout for help, and after finding that he is not
breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the
, 4|Page
emergency response system.brings the emergency equipment, and places the child on a cardiac
monitor/defibrillator, which reveals the rhythm shown here. You attempt defibrillation at 2 J/kg
and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you
attempt defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose
of epinephrine 0.01 mg/kg. If ventricular fibrillation or pulseless ventricular tachycardia persists
after 2 minutes of CPR, you will administer another shock. Which drug and dose should be
administered next?
Lidocaine 1 mg/kg IV
A 4yo boy is in pulseless arrest in the PICU. High-quality CPR is in progress. You quickly
review his chart and find that his baseline-corrected QT interval on a 12-lead ECG is prolonged.
The monitor shows recurrent episodes of the rhythm shown here. The patient has received 1 dose
of epinephrine 0.01 mg/kg, but the rhythm shown here continues. If this rhythm persists at the
next rhythm check, which medication would be most appropriate to administer at that time?
Magnesium sulfate 25-50 mg/kg IV
A 3yo unresponsive, apneic child is brought to the emergency department. EMS personnel report
that the child became unresponsive as they arrived at the hospital. The child is receiving CPR
with bag-mask ventilation. The rhythm shown here is on the cardiac monitor. A biphasic manual
defibrillator is present. You quickly use the length from head to of the child on a color-coded
length-based resuscitation tape to estimate the approximate weight as 15kg. Which therapy is
most appropriate for this child at this time?
Attempt defibrillation at 30 J, and then resume CPR, beginning with compressions
You are alone and witness a child suddenly collapse. There is no suspected head or neck injury. A
colleague responded to your shout for help and is activating the emergency response system and
is retrieving the resuscitation equipment, including a defibrillator. After delivering 30
compressions, what would be your next action?
Open the airway with a head tilt-chin lift maneuver and give 2 breaths
You are giving chest compressions for a child in cardiac arrest? What is the proper depth of
compressions for a child?
Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)
An 8mo infant is brought to the emergency department for evaluation of severe diarrhea and
dehydration. On arrival to the emergency department, the infant becomes unresponsive, apneic,
and pulseless. You shout for help and start CPR. Another provider arrives, at which point you
switch to 2-rescuer CPR. The rhythm shown here is seen on the cardiac monitor. The infant is
intubated and ventilated with with 100% oxygen. An IO line is established, and a dose of
epinephrine is given. While continuing high-quality CPR, what do you do next?
