PALS TEST COMPREHENSIVE STUDY
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ You are caring for a child who was resuscitated after a drowning event. The
child is intubated & ventilated with 100% oxygen with equal breath sounds
& exhaled C02 detected. The HR is slow & the monitor shows sinus
bradycardia. The skin is cool, mottled, & moist; distal pulses are not
palpable & the central pulses are weak. Intravenous access has been
established. The core temperature is 37.3o
C. Based on the PALS bradycardia algorithm, which of the following should
be provided first?.
Answer: Epinephrine IV
◍ A 12-year-old child being evaluated in the pediatric intensive care unit
displays the following ECG waveform. The team interprets this as which
arrhythmia?.
Answer: second degree
◍ You are caring for a 5 yo patient with SV
T. The child is lethargic. The skin is pale & cool with delayed capillary
refill. Distal pulses are not palpable. Which of the following would be the
best treatment to provide without delay?.
Answer: Provide synchronized cardioversion at 0.5 to 1 J/kg
◍ Laboratory tests are ordered for a child who has been vomiting for 3 days
and is diaphoretic, tachypneic, lethargic and pale. Which test would the
provider use to determine the adequacy of oxygen delivery?.
Answer: Lactate
◍ A 9-year-old patient is presenting with decreased breath sounds,
, bradycardia, slowed respiratory rate and a low O2 saturation level. The
provider interprets these findings as indicating which condition?.
Answer: Respiratory failure
◍ You are initiating treatment for a child with septic shock & hypotension.
While administering high-flow oxygen you determine that the child's
respirations are adequate & Sp02 is 100%. You have just established
vascular access & obtained blood samples. Which of the following is the
next most appropriate therapy to support systemic perfusion?.
Answer: Administer repeated fluid boluses of isotonic crystalloid
◍ You are treating an 8 yo with ventricular tachycardia with pulses &
adequate perfusion. You attempted synchronized cardioversion without
success. While seeking expert consultation, it would be most appropriate to:.
Answer: Consider possible metabolic & toxicologic causes
◍ What is considered in adequate perfusion when assessing or caring for a
pediatric patient with an arrhythmia?.
Answer: Acutely altered mental status, hypotension, diminished peripheral
pulses
◍ A child in the pediatric stepped down Unit is exhibiting signs of respiratory
distress. When assessing this child, which circulation finding might be
present?.
Answer: Pallor
◍ Laboratory tests are ordered for a child who has been vomiting for three
days and is diaphoretic, tachypneic, lethargic and pale. Which test would the
provider use to determine the adequacy of perfusion and oxygen delivery?.
Answer: Lactate
◍ A 5-year-old child with a history of 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?.
Answer: Airway clearance (e.g., suctioning)
, ◍ The PALS resuscitation team is providing care to an intubated child in
cardiac arrest. Which of the following can be used to monitor the adequacy
of the teams compressions?.
Answer: End-title carbon dioxide levels, presence of an arterial weight form
or arterial blood pressure in patients with indwelling arterial catheters
◍ You are caring for a 2 yo unconscious pt who is intubated & receiving
mechanical ventilation. The child's HR suddenly drops to 40/min & his
color becomes mottled. You should respond to these changes by:.
Answer: Using a resuscitation bag provide manual ventilation with 100%
oxygen
◍ After ROSC, a child is experiencing post cardiac arrest hypoperfusion. The
PALS resuscitation team would administer which element to restore
intravascular volume and optimize preload?.
Answer: Isotonic fluid boluses
◍ A 15-year-old. Patient is being evaluated during a follow-up visit after being
diagnosed with Lyme disease two months ago. A rhythm strip is obtained
and shown below. The provider interprets this rhythm as indicating which
arrhythmia?.
Answer: First-degree AV block
◍ A 4-year-old patient presents with tachycardia, tachypnea, cold extremities
and weak pulses. Assessment also reveals an enlarged liver and neck vein
distention. The provider interprets these assessment findings as suggesting
which type of shock?.
Answer: Cardiogenic
◍ Primary assessment of a 10-year-old child reveals septic shock. As part of
the secondary assessment, if not already done as part of initial, sepsis care,
laboratory testing is completed to evaluate the child's status. Which
laboratory test would be ordered for this child?.
Answer: CBC, blood cultures, lactate level
◍ You are caring for a 9 mo pt with pronounced respiratory distress. You
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ You are caring for a child who was resuscitated after a drowning event. The
child is intubated & ventilated with 100% oxygen with equal breath sounds
& exhaled C02 detected. The HR is slow & the monitor shows sinus
bradycardia. The skin is cool, mottled, & moist; distal pulses are not
palpable & the central pulses are weak. Intravenous access has been
established. The core temperature is 37.3o
C. Based on the PALS bradycardia algorithm, which of the following should
be provided first?.
Answer: Epinephrine IV
◍ A 12-year-old child being evaluated in the pediatric intensive care unit
displays the following ECG waveform. The team interprets this as which
arrhythmia?.
Answer: second degree
◍ You are caring for a 5 yo patient with SV
T. The child is lethargic. The skin is pale & cool with delayed capillary
refill. Distal pulses are not palpable. Which of the following would be the
best treatment to provide without delay?.
Answer: Provide synchronized cardioversion at 0.5 to 1 J/kg
◍ Laboratory tests are ordered for a child who has been vomiting for 3 days
and is diaphoretic, tachypneic, lethargic and pale. Which test would the
provider use to determine the adequacy of oxygen delivery?.
Answer: Lactate
◍ A 9-year-old patient is presenting with decreased breath sounds,
, bradycardia, slowed respiratory rate and a low O2 saturation level. The
provider interprets these findings as indicating which condition?.
Answer: Respiratory failure
◍ You are initiating treatment for a child with septic shock & hypotension.
While administering high-flow oxygen you determine that the child's
respirations are adequate & Sp02 is 100%. You have just established
vascular access & obtained blood samples. Which of the following is the
next most appropriate therapy to support systemic perfusion?.
Answer: Administer repeated fluid boluses of isotonic crystalloid
◍ You are treating an 8 yo with ventricular tachycardia with pulses &
adequate perfusion. You attempted synchronized cardioversion without
success. While seeking expert consultation, it would be most appropriate to:.
Answer: Consider possible metabolic & toxicologic causes
◍ What is considered in adequate perfusion when assessing or caring for a
pediatric patient with an arrhythmia?.
Answer: Acutely altered mental status, hypotension, diminished peripheral
pulses
◍ A child in the pediatric stepped down Unit is exhibiting signs of respiratory
distress. When assessing this child, which circulation finding might be
present?.
Answer: Pallor
◍ Laboratory tests are ordered for a child who has been vomiting for three
days and is diaphoretic, tachypneic, lethargic and pale. Which test would the
provider use to determine the adequacy of perfusion and oxygen delivery?.
Answer: Lactate
◍ A 5-year-old child with a history of 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?.
Answer: Airway clearance (e.g., suctioning)
, ◍ The PALS resuscitation team is providing care to an intubated child in
cardiac arrest. Which of the following can be used to monitor the adequacy
of the teams compressions?.
Answer: End-title carbon dioxide levels, presence of an arterial weight form
or arterial blood pressure in patients with indwelling arterial catheters
◍ You are caring for a 2 yo unconscious pt who is intubated & receiving
mechanical ventilation. The child's HR suddenly drops to 40/min & his
color becomes mottled. You should respond to these changes by:.
Answer: Using a resuscitation bag provide manual ventilation with 100%
oxygen
◍ After ROSC, a child is experiencing post cardiac arrest hypoperfusion. The
PALS resuscitation team would administer which element to restore
intravascular volume and optimize preload?.
Answer: Isotonic fluid boluses
◍ A 15-year-old. Patient is being evaluated during a follow-up visit after being
diagnosed with Lyme disease two months ago. A rhythm strip is obtained
and shown below. The provider interprets this rhythm as indicating which
arrhythmia?.
Answer: First-degree AV block
◍ A 4-year-old patient presents with tachycardia, tachypnea, cold extremities
and weak pulses. Assessment also reveals an enlarged liver and neck vein
distention. The provider interprets these assessment findings as suggesting
which type of shock?.
Answer: Cardiogenic
◍ Primary assessment of a 10-year-old child reveals septic shock. As part of
the secondary assessment, if not already done as part of initial, sepsis care,
laboratory testing is completed to evaluate the child's status. Which
laboratory test would be ordered for this child?.
Answer: CBC, blood cultures, lactate level
◍ You are caring for a 9 mo pt with pronounced respiratory distress. You
