PALS VERSION B PEDIATRIC ADVANCED LIFE SUPPORT
EXAM 200 ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST 2026 ALREADY GRADED A+
The PALS (Pediatric Advanced Life Support) exam is a comprehensive
certification for healthcare providers managing critically ill children. It covers
systematic assessment using the Evaluate-Identify-Intervene sequence and the
Pediatric Assessment Triangle (Appearance, Breathing, Circulation). Key
content includes pediatric cardiac arrest algorithms (asystole/PEA,
VFib/pVT), respiratory emergencies (asthma, croup, epiglottitis), shock
management (septic, hypovolemic, cardiogenic), and brady/tachyarrhythmia
algorithms. The exam tests knowledge of high-quality CPR, medication dosing
(epinephrine, amiodarone, adenosine), defibrillation/cardioversion, airway
management, and reversible causes. Certification is valid for 2 years.
1. A 4-year-old child is found unresponsive and not breathing. You activate the
emergency response system. What is the next priority action?
A. Check for a pulse for 10 seconds
B. Open the airway and give 2 rescue breaths
C. Begin chest compressions at a rate of 100-120/min
D. Attach the AED pads
Answer: C
Rationale: In pediatric cardiac arrest, high-quality CPR should be started
immediately after unresponsiveness and abnormal breathing are confirmed. The
2025 AHA guidelines emphasize immediate chest compressions for witnessed or
unwitnessed pediatric arrest, as delays in compressions decrease survival. The
pulse check should be brief (≤10 seconds) and should not delay the start of CPR .
2. The correct depth for chest compressions in a child (1 year to puberty) during
CPR is:
A. At least 1.5 inches (4 cm)
B. At least 2 inches (5 cm)
C. At least 2.4 inches (6 cm)
D. One-third the anterior-posterior diameter of the chest
Answer: B
Rationale: For children, compressions should be at least 2 inches (5 cm) deep,
which is one-third of the chest depth. For infants, the depth is approximately 1.5
,inches (4 cm) (one-third of the chest depth) . Compressions that are too shallow
reduce perfusion; too deep can cause injury.
3. What is the correct compression-to-ventilation ratio for a child with two
rescuers?
A. 30:2
B. 15:2
C. 5:1
D. 3:1
Answer: B
Rationale: For two-rescuer CPR in children and infants, the compression-to-
ventilation ratio is 15:2. For single rescuer, the ratio is 30:2 . The higher
compression rate in two-rescuer scenarios ensures adequate perfusion while still
providing ventilations.
4. You are called to the bedside for a 6-month-old infant with a sudden onset of
stridor and respiratory distress. What is the most appropriate initial PALS
algorithm?
A. Cardiac Arrest Algorithm
B. Bradycardia with a Pulse Algorithm
C. PALS Systematic Approach Algorithm
D. Pediatric Septic Shock Algorithm
Answer: C
Rationale: The PALS Systematic Approach Algorithm is the starting point for all
pediatric emergencies. It begins with the initial impression (appearance, breathing,
and circulation) to rapidly identify a life-threatening problem and determine the
appropriate treatment pathway (respiratory, shock, or cardiac arrest). Stridor
suggests upper airway obstruction, which fits the respiratory distress/failure
pathway .
5. Which of the following findings is a sign of compensated shock in a pediatric
patient?
A. Hypotension
B. Tachycardia
C. Bradycardia
D. Cyanosis
Answer: B
Rationale: Compensated shock is characterized by the body’s attempt to maintain
blood pressure through compensatory mechanisms. Tachycardia is a hallmark
finding in pediatric compensated shock due to increased catecholamine release.
,Hypotension is a sign of decompensated shock. Bradycardia is a preterminal
finding .
6. A 10-year-old has a heart rate of 45 bpm with hypotension and altered mental
status. What is the appropriate PALS algorithm?
A. Tachycardia with a Pulse Algorithm
B. Bradycardia with a Pulse Algorithm
C. Cardiac Arrest Algorithm
D. Septic Shock Algorithm
Answer: B
Rationale: Symptomatic bradycardia (heart rate below normal for age with signs of
poor perfusion, hypotension, or altered mental status) is managed with the
Bradycardia with a Pulse Algorithm. Treatment includes establishing an airway,
oxygen, IV/IO access, and if unresponsive to ventilation/oxygen, administering
epinephrine or atropine .
7. What is the first-line medication for symptomatic bradycardia in a pediatric
patient?
A. Adenosine
B. Atropine
C. Epinephrine
D. Amiodarone
Answer: C
Rationale: The 2025 PALS guidelines emphasize early epinephrine in symptomatic
bradycardia. While atropine may be used, epinephrine is the primary drug for
bradycardia with poor perfusion. If the bradycardia is due to increased vagal tone
or primary AV block, atropine may be considered .
8. A 3-year-old child is in supraventricular tachycardia (SVT) with a heart rate of
240, palpable pulses, and is lethargic. What is the appropriate first action?
A. Administer adenosine IV push
B. Synchronized cardioversion
C. Vagal maneuvers
D. Administer amiodarone IV
Answer: C
Rationale: For stable pediatric SVT with a pulse, vagal maneuvers are the first-line
intervention. If ineffective, adenosine is administered. Synchronized cardioversion
is reserved for unstable SVT with signs of shock, hypotension, or altered mental
status .
, 9. What is the initial dose of adenosine for a child with supraventricular
tachycardia?
A. 0.1 mg/kg
B. 0.2 mg/kg
C. 0.5 mg/kg
D. 1 mg/kg
Answer: A
Rationale: The initial dose of adenosine for pediatric SVT is 0.1 mg/kg rapid IV
push. If ineffective, a second dose of 0.2 mg/kg may be given. The maximum first
dose is 6 mg; maximum second dose is 12 mg .
10. A 12-year-old with a shockable rhythm (ventricular fibrillation) is in cardiac
arrest. What is the energy dose for the first shock?
A. 2 J/kg
B. 4 J/kg
C. 5 J/kg
D. 10 J/kg
Answer: A
Rationale: For pediatric defibrillation, the initial energy dose is 2 J/kg. If the
rhythm persists, a second shock of 4 J/kg may be given, and subsequent shocks can
be escalated to 4 J/kg or higher (up to 10 J/kg). The maximum pediatric dose is the
adult dose (200 J for biphasic) .
11. What is the recommended compression rate for high-quality pediatric CPR?
A. 80-100 per minute
B. 100-120 per minute
C. 120-140 per minute
D. 140-160 per minute
Answer: B
Rationale: High-quality CPR requires a compression rate of 100-120 per minute
for all ages, including children and infants. Compressions should be delivered with
minimal interruptions to maximize coronary and cerebral perfusion .
12. What is the maximum time recommended to check for a pulse during a
pediatric code?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: B
EXAM 200 ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST 2026 ALREADY GRADED A+
The PALS (Pediatric Advanced Life Support) exam is a comprehensive
certification for healthcare providers managing critically ill children. It covers
systematic assessment using the Evaluate-Identify-Intervene sequence and the
Pediatric Assessment Triangle (Appearance, Breathing, Circulation). Key
content includes pediatric cardiac arrest algorithms (asystole/PEA,
VFib/pVT), respiratory emergencies (asthma, croup, epiglottitis), shock
management (septic, hypovolemic, cardiogenic), and brady/tachyarrhythmia
algorithms. The exam tests knowledge of high-quality CPR, medication dosing
(epinephrine, amiodarone, adenosine), defibrillation/cardioversion, airway
management, and reversible causes. Certification is valid for 2 years.
1. A 4-year-old child is found unresponsive and not breathing. You activate the
emergency response system. What is the next priority action?
A. Check for a pulse for 10 seconds
B. Open the airway and give 2 rescue breaths
C. Begin chest compressions at a rate of 100-120/min
D. Attach the AED pads
Answer: C
Rationale: In pediatric cardiac arrest, high-quality CPR should be started
immediately after unresponsiveness and abnormal breathing are confirmed. The
2025 AHA guidelines emphasize immediate chest compressions for witnessed or
unwitnessed pediatric arrest, as delays in compressions decrease survival. The
pulse check should be brief (≤10 seconds) and should not delay the start of CPR .
2. The correct depth for chest compressions in a child (1 year to puberty) during
CPR is:
A. At least 1.5 inches (4 cm)
B. At least 2 inches (5 cm)
C. At least 2.4 inches (6 cm)
D. One-third the anterior-posterior diameter of the chest
Answer: B
Rationale: For children, compressions should be at least 2 inches (5 cm) deep,
which is one-third of the chest depth. For infants, the depth is approximately 1.5
,inches (4 cm) (one-third of the chest depth) . Compressions that are too shallow
reduce perfusion; too deep can cause injury.
3. What is the correct compression-to-ventilation ratio for a child with two
rescuers?
A. 30:2
B. 15:2
C. 5:1
D. 3:1
Answer: B
Rationale: For two-rescuer CPR in children and infants, the compression-to-
ventilation ratio is 15:2. For single rescuer, the ratio is 30:2 . The higher
compression rate in two-rescuer scenarios ensures adequate perfusion while still
providing ventilations.
4. You are called to the bedside for a 6-month-old infant with a sudden onset of
stridor and respiratory distress. What is the most appropriate initial PALS
algorithm?
A. Cardiac Arrest Algorithm
B. Bradycardia with a Pulse Algorithm
C. PALS Systematic Approach Algorithm
D. Pediatric Septic Shock Algorithm
Answer: C
Rationale: The PALS Systematic Approach Algorithm is the starting point for all
pediatric emergencies. It begins with the initial impression (appearance, breathing,
and circulation) to rapidly identify a life-threatening problem and determine the
appropriate treatment pathway (respiratory, shock, or cardiac arrest). Stridor
suggests upper airway obstruction, which fits the respiratory distress/failure
pathway .
5. Which of the following findings is a sign of compensated shock in a pediatric
patient?
A. Hypotension
B. Tachycardia
C. Bradycardia
D. Cyanosis
Answer: B
Rationale: Compensated shock is characterized by the body’s attempt to maintain
blood pressure through compensatory mechanisms. Tachycardia is a hallmark
finding in pediatric compensated shock due to increased catecholamine release.
,Hypotension is a sign of decompensated shock. Bradycardia is a preterminal
finding .
6. A 10-year-old has a heart rate of 45 bpm with hypotension and altered mental
status. What is the appropriate PALS algorithm?
A. Tachycardia with a Pulse Algorithm
B. Bradycardia with a Pulse Algorithm
C. Cardiac Arrest Algorithm
D. Septic Shock Algorithm
Answer: B
Rationale: Symptomatic bradycardia (heart rate below normal for age with signs of
poor perfusion, hypotension, or altered mental status) is managed with the
Bradycardia with a Pulse Algorithm. Treatment includes establishing an airway,
oxygen, IV/IO access, and if unresponsive to ventilation/oxygen, administering
epinephrine or atropine .
7. What is the first-line medication for symptomatic bradycardia in a pediatric
patient?
A. Adenosine
B. Atropine
C. Epinephrine
D. Amiodarone
Answer: C
Rationale: The 2025 PALS guidelines emphasize early epinephrine in symptomatic
bradycardia. While atropine may be used, epinephrine is the primary drug for
bradycardia with poor perfusion. If the bradycardia is due to increased vagal tone
or primary AV block, atropine may be considered .
8. A 3-year-old child is in supraventricular tachycardia (SVT) with a heart rate of
240, palpable pulses, and is lethargic. What is the appropriate first action?
A. Administer adenosine IV push
B. Synchronized cardioversion
C. Vagal maneuvers
D. Administer amiodarone IV
Answer: C
Rationale: For stable pediatric SVT with a pulse, vagal maneuvers are the first-line
intervention. If ineffective, adenosine is administered. Synchronized cardioversion
is reserved for unstable SVT with signs of shock, hypotension, or altered mental
status .
, 9. What is the initial dose of adenosine for a child with supraventricular
tachycardia?
A. 0.1 mg/kg
B. 0.2 mg/kg
C. 0.5 mg/kg
D. 1 mg/kg
Answer: A
Rationale: The initial dose of adenosine for pediatric SVT is 0.1 mg/kg rapid IV
push. If ineffective, a second dose of 0.2 mg/kg may be given. The maximum first
dose is 6 mg; maximum second dose is 12 mg .
10. A 12-year-old with a shockable rhythm (ventricular fibrillation) is in cardiac
arrest. What is the energy dose for the first shock?
A. 2 J/kg
B. 4 J/kg
C. 5 J/kg
D. 10 J/kg
Answer: A
Rationale: For pediatric defibrillation, the initial energy dose is 2 J/kg. If the
rhythm persists, a second shock of 4 J/kg may be given, and subsequent shocks can
be escalated to 4 J/kg or higher (up to 10 J/kg). The maximum pediatric dose is the
adult dose (200 J for biphasic) .
11. What is the recommended compression rate for high-quality pediatric CPR?
A. 80-100 per minute
B. 100-120 per minute
C. 120-140 per minute
D. 140-160 per minute
Answer: B
Rationale: High-quality CPR requires a compression rate of 100-120 per minute
for all ages, including children and infants. Compressions should be delivered with
minimal interruptions to maximize coronary and cerebral perfusion .
12. What is the maximum time recommended to check for a pulse during a
pediatric code?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: B
