Pediatric Advanced Life Support Nursing
Competency Exam — Code: NUR-PALS-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A 4-year-old child is found unresponsive and not breathing normally. A
healthcare provider confirms no pulse after a pulse check. What is the most
appropriate immediate intervention?
A. Administer atropine
B. Begin chest compressions
C. Obtain a 12-lead ECG
D. Establish an intraosseous line before compressions
Answer: B. Begin chest compressions
,Rationale: In a pulseless, unresponsive child, high-quality CPR should begin
immediately. Vascular access, ECG acquisition, and medications should not
delay chest compressions.
2. During pediatric CPR, what compression depth is recommended for a child?
A. Approximately 1 cm
B. Approximately 2 cm
C. At least one-third the anterior-posterior diameter of the chest, approximately 5
cm
D. Approximately 7 cm
Answer: C. At least one-third the anterior-posterior diameter of the chest,
approximately 5 cm
Rationale: Pediatric chest compressions should reach at least one-third of the
chest's anterior-posterior diameter, which is approximately 5 cm in children.
Excessive depth can cause injury.
3. A 7-year-old child has a heart rate of 48/min, altered mental status,
hypotension, and poor peripheral perfusion despite oxygenation and
ventilation. What should the nurse anticipate?
A. Observation only
B. Immediate synchronized cardioversion
C. CPR and treatment of reversible causes
D. Oral beta-blocker administration
Answer: C. CPR and treatment of reversible causes
Rationale: Bradycardia with cardiopulmonary compromise requires immediate
intervention. If the heart rate remains below 60/min despite effective
oxygenation and ventilation, CPR is indicated while reversible causes are
addressed.
4. Which rhythm is most commonly associated with sudden cardiac arrest
requiring defibrillation?
,A. Sinus bradycardia
B. Ventricular fibrillation
C. First-degree AV block
D. Sinus tachycardia
Answer: B. Ventricular fibrillation
Rationale: Ventricular fibrillation is a shockable rhythm. Rapid defibrillation
combined with high-quality CPR is essential because the likelihood of successful
defibrillation decreases as untreated VF persists.
5. A child in cardiac arrest has ventricular fibrillation. Which intervention has
the highest priority after CPR is initiated?
A. Defibrillation
B. Atropine
C. Sodium bicarbonate routinely
D. Calcium chloride routinely
Answer: A. Defibrillation
Rationale: VF and pulseless ventricular tachycardia are shockable rhythms. Early
defibrillation is a critical determinant of survival and should not be
unnecessarily delayed.
6. During PALS resuscitation, which finding most strongly suggests inadequate
ventilation?
A. Normal chest rise
B. Bilateral breath sounds
C. Increasing end-tidal CO₂ with improving circulation
D. Poor chest expansion and absent breath sounds
Answer: D. Poor chest expansion and absent breath sounds
Rationale: Poor chest expansion and absent or markedly diminished breath
sounds suggest ineffective ventilation, airway obstruction, or equipment
, problems. The airway and ventilation strategy should be immediately
reassessed.
7. A child has severe respiratory distress with stridor and increasing fatigue.
Which action is most appropriate?
A. Delay intervention until cyanosis occurs
B. Provide appropriate oxygen and prepare for advanced airway management if
deterioration continues
C. Encourage oral fluids
D. Administer a sedative immediately
Answer: B. Provide appropriate oxygen and prepare for advanced airway
management if deterioration continues
Rationale: Stridor indicates upper-airway obstruction. Oxygenation and airway
support are priorities, and worsening fatigue may indicate impending
respiratory failure requiring advanced airway intervention.
8. Which clinical change most strongly indicates progression from respiratory
distress to respiratory failure?
A. Mild tachypnea with normal mental status
B. Nasal congestion
C. Decreasing respiratory effort with altered consciousness
D. Mild cough
Answer: C. Decreasing respiratory effort with altered consciousness
Rationale: A child who becomes lethargic and develops decreasing respiratory
effort is no longer compensating effectively. This is a critical sign of respiratory
failure and impending arrest.
9. A child with severe asthma develops worsening fatigue, decreased air
movement, and altered mental status. What is the nurse's priority?
A. Encourage ambulation
B. Prepare for assisted ventilation and advanced airway management
Competency Exam — Code: NUR-PALS-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A 4-year-old child is found unresponsive and not breathing normally. A
healthcare provider confirms no pulse after a pulse check. What is the most
appropriate immediate intervention?
A. Administer atropine
B. Begin chest compressions
C. Obtain a 12-lead ECG
D. Establish an intraosseous line before compressions
Answer: B. Begin chest compressions
,Rationale: In a pulseless, unresponsive child, high-quality CPR should begin
immediately. Vascular access, ECG acquisition, and medications should not
delay chest compressions.
2. During pediatric CPR, what compression depth is recommended for a child?
A. Approximately 1 cm
B. Approximately 2 cm
C. At least one-third the anterior-posterior diameter of the chest, approximately 5
cm
D. Approximately 7 cm
Answer: C. At least one-third the anterior-posterior diameter of the chest,
approximately 5 cm
Rationale: Pediatric chest compressions should reach at least one-third of the
chest's anterior-posterior diameter, which is approximately 5 cm in children.
Excessive depth can cause injury.
3. A 7-year-old child has a heart rate of 48/min, altered mental status,
hypotension, and poor peripheral perfusion despite oxygenation and
ventilation. What should the nurse anticipate?
A. Observation only
B. Immediate synchronized cardioversion
C. CPR and treatment of reversible causes
D. Oral beta-blocker administration
Answer: C. CPR and treatment of reversible causes
Rationale: Bradycardia with cardiopulmonary compromise requires immediate
intervention. If the heart rate remains below 60/min despite effective
oxygenation and ventilation, CPR is indicated while reversible causes are
addressed.
4. Which rhythm is most commonly associated with sudden cardiac arrest
requiring defibrillation?
,A. Sinus bradycardia
B. Ventricular fibrillation
C. First-degree AV block
D. Sinus tachycardia
Answer: B. Ventricular fibrillation
Rationale: Ventricular fibrillation is a shockable rhythm. Rapid defibrillation
combined with high-quality CPR is essential because the likelihood of successful
defibrillation decreases as untreated VF persists.
5. A child in cardiac arrest has ventricular fibrillation. Which intervention has
the highest priority after CPR is initiated?
A. Defibrillation
B. Atropine
C. Sodium bicarbonate routinely
D. Calcium chloride routinely
Answer: A. Defibrillation
Rationale: VF and pulseless ventricular tachycardia are shockable rhythms. Early
defibrillation is a critical determinant of survival and should not be
unnecessarily delayed.
6. During PALS resuscitation, which finding most strongly suggests inadequate
ventilation?
A. Normal chest rise
B. Bilateral breath sounds
C. Increasing end-tidal CO₂ with improving circulation
D. Poor chest expansion and absent breath sounds
Answer: D. Poor chest expansion and absent breath sounds
Rationale: Poor chest expansion and absent or markedly diminished breath
sounds suggest ineffective ventilation, airway obstruction, or equipment
, problems. The airway and ventilation strategy should be immediately
reassessed.
7. A child has severe respiratory distress with stridor and increasing fatigue.
Which action is most appropriate?
A. Delay intervention until cyanosis occurs
B. Provide appropriate oxygen and prepare for advanced airway management if
deterioration continues
C. Encourage oral fluids
D. Administer a sedative immediately
Answer: B. Provide appropriate oxygen and prepare for advanced airway
management if deterioration continues
Rationale: Stridor indicates upper-airway obstruction. Oxygenation and airway
support are priorities, and worsening fatigue may indicate impending
respiratory failure requiring advanced airway intervention.
8. Which clinical change most strongly indicates progression from respiratory
distress to respiratory failure?
A. Mild tachypnea with normal mental status
B. Nasal congestion
C. Decreasing respiratory effort with altered consciousness
D. Mild cough
Answer: C. Decreasing respiratory effort with altered consciousness
Rationale: A child who becomes lethargic and develops decreasing respiratory
effort is no longer compensating effectively. This is a critical sign of respiratory
failure and impending arrest.
9. A child with severe asthma develops worsening fatigue, decreased air
movement, and altered mental status. What is the nurse's priority?
A. Encourage ambulation
B. Prepare for assisted ventilation and advanced airway management
