PALS Certification Practice Test 2026/2027 |
105 Pediatric Advanced Life Support
Questions with Answers | Updated for AHA
Guidelines
Description:
Master the 2026/2027 PALS certification exam with 105 high-yield practice questions
covering cardiac arrest, shock, arrhythmias, respiratory failure, and post-cardiac arrest
care. Each answer includes detailed clinical explanations aligned with current AHA guidelines.
Download the complete examination paper now and pass your PALS recertification with
confidence.
, PALS Practice Exam 2026/2027: 105 Questions & Answers
Level: Advanced Pediatric Provider Certification
Format: Multiple Choice Questions (MCQs)
Instructions: Select the single best answer for each question.
Section 1: Airway and Respiratory Management
Question 1
A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory
distress. The child is breathing spontaneously and receiving supplemental oxygen. Which
additional intervention is a critical component of airway management for this patient?
A. Endotracheal intubation
B. Airway clearance (e.g., suctioning)
C. Non-invasive positive pressure ventilation
D. Placement of a nasopharyngeal airway
Answer: B
Explanation: Children with chronic neuromuscular disease often have ineffective cough and
poor airway clearance due to respiratory muscle weakness. Airway clearance techniques,
including suctioning, are critical to remove secretions that can cause obstruction, atelectasis, and
infection, even in the spontaneously breathing child receiving oxygen.
Question 2
A healthcare provider is performing a primary assessment of a child in respiratory distress. The
provider documents increased work of breathing when which findings are observed? (Select all
that apply)
A. Nasal flaring
B. Intercostal, substernal or suprasternal retractions
C. Accessory muscle use
D. Bradypnea
Answer: A, B, C
Explanation: Increased work of breathing is clinically evidenced by nasal flaring (to reduce
,airway resistance), retractions (indicating high negative intrathoracic pressure generation), and
accessory muscle use (neck and abdominal muscles). Bradypnea typically indicates impending
respiratory failure rather than increased work of breathing.
Question 3
A 3-month-old infant admitted with respiratory distress reveals fever, grunting and a wet,
"junky" cough. The infant's parents said the child had a recent respiratory infection with a fever.
A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider
most likely suspect as the cause?
A. Pneumonia
B. Bronchiolitis
C. Pertussis
D. Bacterial tracheitis
Answer: B
Explanation: The clinical triad of fever, grunting (a compensatory mechanism to generate
positive end-expiratory pressure), and a wet cough in an infant with confirmed RSV is classic for
bronchiolitis. This condition involves inflammation and mucus plugging of the small airways,
leading to increased work of breathing and hypoxemia.
Question 4
Primary assessment of a 10-year-old child reveals difficulty breathing and an oxygen saturation
of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child's
oxygen saturation to what percentage range?
A. 88% to 92%
B. 90% to 94%
C. 94% to 99%
D. 100%
Answer: C
Explanation: The target oxygen saturation range for a child with respiratory distress is 94% to
99%. This range ensures adequate oxygen delivery while avoiding the risks of hyperoxia,
including oxygen toxicity and absorption atelectasis. Saturation above 99% is generally
unnecessary and potentially harmful.
, Question 5
An 11-year-old soccer player is brought to the emergency department. After a quick assessment,
the team realizes this patient is experiencing a severe asthma exacerbation. Which medication
would the team administer immediately?
A. Oral prednisolone
B. Intravenous magnesium sulfate
C. Albuterol with or without ipratropium bromide
D. Epinephrine intramuscularly
Answer: C
Explanation: In severe asthma exacerbation, rapid-acting bronchodilators are first-line therapy.
Albuterol (a beta-2 agonist) with or without ipratropium bromide (an anticholinergic) provides
synergistic bronchodilation. Corticosteroids and magnesium are important adjuncts but not the
immediate first medication.
Question 6
A 9-year-old patient is presenting with diminished breath sounds, bradycardia, slowed
respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating
which condition?
A. Mild respiratory distress
B. Moderate asthma exacerbation
C. Respiratory failure
D. Upper airway obstruction
Answer: C
Explanation: Diminished breath sounds combined with bradycardia (a late sign of hypoxemia in
children), decreased respiratory rate (indicating fatigue), and hypoxemia despite apparent
breathing efforts are hallmark signs of impending or established respiratory failure. This
represents a critical deterioration requiring immediate advanced airway management.
105 Pediatric Advanced Life Support
Questions with Answers | Updated for AHA
Guidelines
Description:
Master the 2026/2027 PALS certification exam with 105 high-yield practice questions
covering cardiac arrest, shock, arrhythmias, respiratory failure, and post-cardiac arrest
care. Each answer includes detailed clinical explanations aligned with current AHA guidelines.
Download the complete examination paper now and pass your PALS recertification with
confidence.
, PALS Practice Exam 2026/2027: 105 Questions & Answers
Level: Advanced Pediatric Provider Certification
Format: Multiple Choice Questions (MCQs)
Instructions: Select the single best answer for each question.
Section 1: Airway and Respiratory Management
Question 1
A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory
distress. The child is breathing spontaneously and receiving supplemental oxygen. Which
additional intervention is a critical component of airway management for this patient?
A. Endotracheal intubation
B. Airway clearance (e.g., suctioning)
C. Non-invasive positive pressure ventilation
D. Placement of a nasopharyngeal airway
Answer: B
Explanation: Children with chronic neuromuscular disease often have ineffective cough and
poor airway clearance due to respiratory muscle weakness. Airway clearance techniques,
including suctioning, are critical to remove secretions that can cause obstruction, atelectasis, and
infection, even in the spontaneously breathing child receiving oxygen.
Question 2
A healthcare provider is performing a primary assessment of a child in respiratory distress. The
provider documents increased work of breathing when which findings are observed? (Select all
that apply)
A. Nasal flaring
B. Intercostal, substernal or suprasternal retractions
C. Accessory muscle use
D. Bradypnea
Answer: A, B, C
Explanation: Increased work of breathing is clinically evidenced by nasal flaring (to reduce
,airway resistance), retractions (indicating high negative intrathoracic pressure generation), and
accessory muscle use (neck and abdominal muscles). Bradypnea typically indicates impending
respiratory failure rather than increased work of breathing.
Question 3
A 3-month-old infant admitted with respiratory distress reveals fever, grunting and a wet,
"junky" cough. The infant's parents said the child had a recent respiratory infection with a fever.
A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider
most likely suspect as the cause?
A. Pneumonia
B. Bronchiolitis
C. Pertussis
D. Bacterial tracheitis
Answer: B
Explanation: The clinical triad of fever, grunting (a compensatory mechanism to generate
positive end-expiratory pressure), and a wet cough in an infant with confirmed RSV is classic for
bronchiolitis. This condition involves inflammation and mucus plugging of the small airways,
leading to increased work of breathing and hypoxemia.
Question 4
Primary assessment of a 10-year-old child reveals difficulty breathing and an oxygen saturation
of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child's
oxygen saturation to what percentage range?
A. 88% to 92%
B. 90% to 94%
C. 94% to 99%
D. 100%
Answer: C
Explanation: The target oxygen saturation range for a child with respiratory distress is 94% to
99%. This range ensures adequate oxygen delivery while avoiding the risks of hyperoxia,
including oxygen toxicity and absorption atelectasis. Saturation above 99% is generally
unnecessary and potentially harmful.
, Question 5
An 11-year-old soccer player is brought to the emergency department. After a quick assessment,
the team realizes this patient is experiencing a severe asthma exacerbation. Which medication
would the team administer immediately?
A. Oral prednisolone
B. Intravenous magnesium sulfate
C. Albuterol with or without ipratropium bromide
D. Epinephrine intramuscularly
Answer: C
Explanation: In severe asthma exacerbation, rapid-acting bronchodilators are first-line therapy.
Albuterol (a beta-2 agonist) with or without ipratropium bromide (an anticholinergic) provides
synergistic bronchodilation. Corticosteroids and magnesium are important adjuncts but not the
immediate first medication.
Question 6
A 9-year-old patient is presenting with diminished breath sounds, bradycardia, slowed
respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating
which condition?
A. Mild respiratory distress
B. Moderate asthma exacerbation
C. Respiratory failure
D. Upper airway obstruction
Answer: C
Explanation: Diminished breath sounds combined with bradycardia (a late sign of hypoxemia in
children), decreased respiratory rate (indicating fatigue), and hypoxemia despite apparent
breathing efforts are hallmark signs of impending or established respiratory failure. This
represents a critical deterioration requiring immediate advanced airway management.
