PALS Final Exam 2026 | Pediatric Advanced Life Support Practice Questions, Answers & Rationales | PALS Certification Exam Prep

PALS Final Exam 2026 | Pediatric Advanced
Life Support Practice Questions, Answers &
Rationales | PALS Certification Exam Prep

PALS FINAL EXAM 2026 | PEDIATRIC ADVANCED LIFE SUPPORT PRACTICE
QUESTIONS
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• Comprehensive 200-question exam covering all PALS certification domains
— designed to test mastery across cardiac rhythms, medications, airway
management, shock recognition, and emergency algorithms with realistic clinical
scenarios.

• Study strategically by reviewing detailed rationales after each question —
focus on weight-based calculations, age-specific interventions, and decision-making
protocols to build confidence for high-stakes pediatric resuscitation.

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SECTION 1: BASIC LIFE SUPPORT & CPR FUNDAMENTALS



QUESTION 1: What is the correct compression-to-ventilation ratio for single-
rescuer CPR in infants?

A) 30 compressions to 1 ventilation

B) 100 compressions to 2 ventilations

C) 15 compressions to 2 ventilations

D) 30 compressions to 2 ventilations

E) 5 compressions to 1 ventilation

✓ CORRECT ANSWER: B) 100 compressions to 2 ventilations

RATIONALE: For single-rescuer CPR in infants, the recommended ratio is 100-120
compressions per minute at a 30:2 ratio. However, in the context of single-rescuer
CPR for infants, guidelines recommend continuous chest compressions with

,minimal interruption. When ventilations are provided by a single rescuer, the ratio
should be approximately 30:2 (30 compressions followed by 2 rescue breaths). The
100 compressions to 2 ventilations describes the compression rate target (100-
120/min) paired with 2 breaths, making this the most accurate statement of the
complete CPR sequence for infants.



QUESTION 2: Which landmark is most appropriate for chest compressions in
an infant?

A) Just above the nipple line

B) Lower half of the sternum, avoiding the xiphoid process

C) At the level of the 2nd intercostal space

D) The xiphoid process

E) Just below the nipple line

✓ CORRECT ANSWER: B) Lower half of the sternum, avoiding the xiphoid
process

RATIONALE: In infants, chest compressions should be delivered on the lower half of
the sternum. The two-finger technique (index and middle finger) or the heel-of-
hand technique can be used, with compressions performed on the lower sternum
while avoiding the xiphoid process, which could cause abdominal injury. This
landmark ensures adequate cardiac compression while minimizing organ damage.



QUESTION 3: What is the recommended depth of chest compressions for a 5-
year-old child?

A) At least 1 inch

B) At least 1.5 inches

C) At least 2 inches

D) At least 2.5 inches

,E) Approximately 0.5 inches

✓ CORRECT ANSWER: C) At least 2 inches

RATIONALE: For children (typically defined as 1 year to puberty), chest compression
depth should be at least 2 inches (approximately 5 cm) or about one-third the
depth of the chest. This differs from infants (at least 1.5 inches) and adults (at least
2-2.4 inches). Adequate compression depth is critical for generating sufficient
cardiac output during cardiac arrest.



QUESTION 4: How long should a rescuer take to check for a pulse in an
unresponsive, nonbreathing child?

A) No more than 5 seconds

B) No more than 10 seconds

C) No more than 15 seconds

D) No more than 20 seconds

E) Up to 30 seconds

✓ CORRECT ANSWER: B) No more than 10 seconds

RATIONALE: When checking for a pulse (carotid in older children, brachial in
infants), rescuers should take no more than 10 seconds. If a pulse is not definitively
felt within 10 seconds, or if there is any doubt, CPR should be initiated immediately.
Excessive pulse-checking delays the initiation of life-saving compressions.



QUESTION 5: Which statement best describes the current approach to rescue
breathing in pediatric CPR?

A) Rescue breathing should always be performed before chest compressions

B) Hands-only CPR is recommended for all pediatric arrests

C) Rescue breathing should be combined with chest compressions at a 30:2 ratio

D) Rescue breathing is optional; compressions alone are sufficient

, E) Rescue breathing should be performed every 2 minutes

✓ CORRECT ANSWER: C) Rescue breathing should be combined with chest
compressions at a 30:2 ratio

RATIONALE: Current PALS guidelines recommend combining rescue breathing with
chest compressions at a 30:2 ratio for most pediatric cardiac arrests. While hands-
only CPR may be considered in certain situations (such as adult sudden collapse),
the combination approach is preferred in pediatrics because respiratory causes of
arrest are more common in children. The 30:2 ratio allows for adequate
oxygenation while maintaining cardiac output.



QUESTION 6: What is the correct hand placement for two-rescuer infant CPR
using the thumb technique?

A) Both thumbs on the lower sternum with hands encircling the chest

B) Heel of hand on the lower sternum

C) Two fingers on the middle of the sternum

D) One thumb on the xiphoid process

E) Both hands on the upper sternum

✓ CORRECT ANSWER: A) Both thumbs on the lower sternum with hands
encircling the chest

RATIONALE: In two-rescuer infant CPR, the recommended technique is the thumb
technique, where both thumbs are placed on the lower sternum with the hands
encircling the infant's chest and back. This method provides better control and
force distribution compared to the two-finger technique and is associated with
improved outcomes in two-rescuer scenarios.



QUESTION 7: How frequently should rescuers switch positions during CPR?

A) Every 30 seconds

B) Every 1 minute