PALS UPDATED FINAL EXAM / NEWEST 2025/2026 / ACTUAL QUESTIONS (A+
GUIDE SOLUTION) NEWEST 2025/2026
Question 1
A 12-year-old child's ECG shows a progressively lengthening PR interval until a P wave is not
followed by a QRS complex, after which the cycle repeats. The team interprets this as which
arrhythmia?
A) First-degree AV block
B) Second-degree AV block, Mobitz I (Wenckebach)
C) Second-degree AV block, Mobitz II
D) Third-degree AV block
Correct Answer: B) Second-degree AV block, Mobitz I (Wenckebach)
Rationale: The key feature of Second-degree AV block, Mobitz I is the progressive
prolongation of the PR interval followed by a "dropped" QRS beat. This pattern is
characteristic of Wenckebach.
Question 2
A child who has been vomiting for 3 days appears lethargic, tachypneic, and pale. To determine
the adequacy of tissue oxygen delivery and identify tissue hypoxia, which laboratory test is most
crucial?
A) Complete Blood Count (CBC)
B) Serum Lactate
C) Blood Urea Nitrogen (BUN)
D) Serum Glucose
Correct Answer: B) Serum Lactate
Rationale: Lactate is a byproduct of anaerobic metabolism, which occurs when oxygen
delivery to the tissues is inadequate. An elevated lactate level is a key indicator of tissue
hypoxia and is a critical marker in evaluating the severity of shock.
Question 3
A 9-year-old patient presents with bradycardia, a slowed respiratory rate, and low oxygen
saturation. The provider interprets these findings as ominous signs indicating which condition?
,A) Respiratory distress
B) Respiratory failure
C) Compensated shock
D) Cardiac arrest
Correct Answer: B) Respiratory failure
Rationale: Respiratory failure is an advanced state where the respiratory system can no longer
maintain adequate oxygenation or ventilation. Signs of impending arrest, such as bradycardia
and a slowing respiratory rate (due to fatigue), indicate that respiratory failure is progressing
to cardiopulmonary failure.
Question 4
A 4-year-old child is found with only gasping respirations and a pulse rate of 65 beats per
minute. Which action should the provider initiate first?
A) Start chest compressions immediately.
B) Deliver 1 ventilation every 3 to 5 seconds with a BVM device.
C) Administer a fluid bolus of 20 mL/kg.
D) Attach an AED and analyze the rhythm.
Correct Answer: B) Deliver 1 ventilation every 3 to 5 seconds with a BVM device.
Rationale: The child has a pulse but is not breathing effectively (gasping is not effective
breathing). The immediate priority is to provide rescue breathing to correct the hypoxia,
which is likely the cause of the bradycardia. Chest compressions are not initiated unless the
pulse is less than 60 bpm with signs of poor perfusion.
Question 5
A 15-year-old is being evaluated 2 months after a Lyme disease diagnosis. An ECG reveals a
constant PR interval of 0.24 seconds. The provider interprets this rhythm as which arrhythmia?
A) Normal sinus rhythm
B) First-degree atrioventricular (AV) block
C) Second-degree AV block, Mobitz I
D) Sinus bradycardia
Correct Answer: B) First-degree atrioventricular (AV) block
,Rationale: First-degree AV block is characterized by a prolonged, but constant, PR interval
greater than 0.20 seconds. Lyme disease is a known cause of carditis and AV conduction
delays.
Question 6
A child achieves Return of Spontaneous Circulation (ROSC) but develops hypotension, fever, and
hyperglycemia. The team recognizes these findings as a systemic response to
ischemia/reperfusion, also known as:
A) Systemic Inflammatory Response Syndrome (SIRS)
B) Post–cardiac arrest syndrome (PCAS)
C) Septic shock
D) Cardiogenic shock
Correct Answer: B) Post–cardiac arrest syndrome (PCAS)
Rationale: PCAS is a complex pathophysiological state that occurs after ROSC. It involves brain
injury, myocardial dysfunction, and a systemic ischemia/reperfusion response, which can
manifest as fever, hypotension, and hyperglycemia.
Question 7
A 2-year-old child is in cardiac arrest. Two providers are performing high-quality CPR. Which of
the following actions demonstrates correct technique for two-rescuer child CPR?
A) Providing 1 ventilation for every 30 compressions.
B) Compressing the chest about 1.5 inches deep.
C) Providing 2 ventilations for every 15 compressions.
D) Allowing the chest to partially recoil between compressions.
Correct Answer: C) Providing 2 ventilations for every 15 compressions.
Rationale: For two-rescuer CPR on a child, the correct compression-to-ventilation ratio is 15:2.
The chest should be compressed to a depth of about 2 inches (5 cm), and full chest recoil
must be allowed.
Question 8
For which of the following cardiac arrest rhythms is defibrillation an appropriate intervention?
, A) Asystole and Pulseless Electrical Activity (PEA)
B) Pulseless Ventricular Tachycardia (pVT) and Ventricular Fibrillation (VF)
C) Atrial Fibrillation and Atrial Flutter
D) Sinus Bradycardia and First-Degree AV Block
Correct Answer: B) Pulseless Ventricular Tachycardia (pVT) and Ventricular Fibrillation (VF)
Rationale: VF and pVT are the two "shockable" cardiac arrest rhythms. Defibrillation is used
to deliver an electrical shock that depolarizes the myocardial cells simultaneously, with the
hope of restoring an organized cardiac rhythm.
Question 9
When evaluating a child with suspected shock, which statement about hypotension is correct?
A) Hypotension is always the first sign of shock in children.
B) Hypotension is a late and ominous sign of shock in children.
C) If the blood pressure is normal, the child cannot be in shock.
D) Hypotension is only a feature of septic shock.
Correct Answer: B) Hypotension is a late and ominous sign of shock in children.
Rationale: Children have very effective compensatory mechanisms and can maintain their
blood pressure until they are in a state of decompensated shock. Therefore, hypotension is a
sign of impending cardiac arrest and is not a consistent or early feature of shock.
Question 10
A provider administers supplemental oxygen to a 4-year-old child in respiratory distress. The
goal of this intervention is to maintain the child's oxygen saturation above what percentage?
A) 88%
B) 90%
C) 92%
D) 94%
Correct Answer: D) 94%
Rationale: PALS guidelines recommend administering supplemental oxygen as needed to
maintain an arterial oxygen saturation of 94% or greater to ensure adequate tissue
oxygenation.
GUIDE SOLUTION) NEWEST 2025/2026
Question 1
A 12-year-old child's ECG shows a progressively lengthening PR interval until a P wave is not
followed by a QRS complex, after which the cycle repeats. The team interprets this as which
arrhythmia?
A) First-degree AV block
B) Second-degree AV block, Mobitz I (Wenckebach)
C) Second-degree AV block, Mobitz II
D) Third-degree AV block
Correct Answer: B) Second-degree AV block, Mobitz I (Wenckebach)
Rationale: The key feature of Second-degree AV block, Mobitz I is the progressive
prolongation of the PR interval followed by a "dropped" QRS beat. This pattern is
characteristic of Wenckebach.
Question 2
A child who has been vomiting for 3 days appears lethargic, tachypneic, and pale. To determine
the adequacy of tissue oxygen delivery and identify tissue hypoxia, which laboratory test is most
crucial?
A) Complete Blood Count (CBC)
B) Serum Lactate
C) Blood Urea Nitrogen (BUN)
D) Serum Glucose
Correct Answer: B) Serum Lactate
Rationale: Lactate is a byproduct of anaerobic metabolism, which occurs when oxygen
delivery to the tissues is inadequate. An elevated lactate level is a key indicator of tissue
hypoxia and is a critical marker in evaluating the severity of shock.
Question 3
A 9-year-old patient presents with bradycardia, a slowed respiratory rate, and low oxygen
saturation. The provider interprets these findings as ominous signs indicating which condition?
,A) Respiratory distress
B) Respiratory failure
C) Compensated shock
D) Cardiac arrest
Correct Answer: B) Respiratory failure
Rationale: Respiratory failure is an advanced state where the respiratory system can no longer
maintain adequate oxygenation or ventilation. Signs of impending arrest, such as bradycardia
and a slowing respiratory rate (due to fatigue), indicate that respiratory failure is progressing
to cardiopulmonary failure.
Question 4
A 4-year-old child is found with only gasping respirations and a pulse rate of 65 beats per
minute. Which action should the provider initiate first?
A) Start chest compressions immediately.
B) Deliver 1 ventilation every 3 to 5 seconds with a BVM device.
C) Administer a fluid bolus of 20 mL/kg.
D) Attach an AED and analyze the rhythm.
Correct Answer: B) Deliver 1 ventilation every 3 to 5 seconds with a BVM device.
Rationale: The child has a pulse but is not breathing effectively (gasping is not effective
breathing). The immediate priority is to provide rescue breathing to correct the hypoxia,
which is likely the cause of the bradycardia. Chest compressions are not initiated unless the
pulse is less than 60 bpm with signs of poor perfusion.
Question 5
A 15-year-old is being evaluated 2 months after a Lyme disease diagnosis. An ECG reveals a
constant PR interval of 0.24 seconds. The provider interprets this rhythm as which arrhythmia?
A) Normal sinus rhythm
B) First-degree atrioventricular (AV) block
C) Second-degree AV block, Mobitz I
D) Sinus bradycardia
Correct Answer: B) First-degree atrioventricular (AV) block
,Rationale: First-degree AV block is characterized by a prolonged, but constant, PR interval
greater than 0.20 seconds. Lyme disease is a known cause of carditis and AV conduction
delays.
Question 6
A child achieves Return of Spontaneous Circulation (ROSC) but develops hypotension, fever, and
hyperglycemia. The team recognizes these findings as a systemic response to
ischemia/reperfusion, also known as:
A) Systemic Inflammatory Response Syndrome (SIRS)
B) Post–cardiac arrest syndrome (PCAS)
C) Septic shock
D) Cardiogenic shock
Correct Answer: B) Post–cardiac arrest syndrome (PCAS)
Rationale: PCAS is a complex pathophysiological state that occurs after ROSC. It involves brain
injury, myocardial dysfunction, and a systemic ischemia/reperfusion response, which can
manifest as fever, hypotension, and hyperglycemia.
Question 7
A 2-year-old child is in cardiac arrest. Two providers are performing high-quality CPR. Which of
the following actions demonstrates correct technique for two-rescuer child CPR?
A) Providing 1 ventilation for every 30 compressions.
B) Compressing the chest about 1.5 inches deep.
C) Providing 2 ventilations for every 15 compressions.
D) Allowing the chest to partially recoil between compressions.
Correct Answer: C) Providing 2 ventilations for every 15 compressions.
Rationale: For two-rescuer CPR on a child, the correct compression-to-ventilation ratio is 15:2.
The chest should be compressed to a depth of about 2 inches (5 cm), and full chest recoil
must be allowed.
Question 8
For which of the following cardiac arrest rhythms is defibrillation an appropriate intervention?
, A) Asystole and Pulseless Electrical Activity (PEA)
B) Pulseless Ventricular Tachycardia (pVT) and Ventricular Fibrillation (VF)
C) Atrial Fibrillation and Atrial Flutter
D) Sinus Bradycardia and First-Degree AV Block
Correct Answer: B) Pulseless Ventricular Tachycardia (pVT) and Ventricular Fibrillation (VF)
Rationale: VF and pVT are the two "shockable" cardiac arrest rhythms. Defibrillation is used
to deliver an electrical shock that depolarizes the myocardial cells simultaneously, with the
hope of restoring an organized cardiac rhythm.
Question 9
When evaluating a child with suspected shock, which statement about hypotension is correct?
A) Hypotension is always the first sign of shock in children.
B) Hypotension is a late and ominous sign of shock in children.
C) If the blood pressure is normal, the child cannot be in shock.
D) Hypotension is only a feature of septic shock.
Correct Answer: B) Hypotension is a late and ominous sign of shock in children.
Rationale: Children have very effective compensatory mechanisms and can maintain their
blood pressure until they are in a state of decompensated shock. Therefore, hypotension is a
sign of impending cardiac arrest and is not a consistent or early feature of shock.
Question 10
A provider administers supplemental oxygen to a 4-year-old child in respiratory distress. The
goal of this intervention is to maintain the child's oxygen saturation above what percentage?
A) 88%
B) 90%
C) 92%
D) 94%
Correct Answer: D) 94%
Rationale: PALS guidelines recommend administering supplemental oxygen as needed to
maintain an arterial oxygen saturation of 94% or greater to ensure adequate tissue
oxygenation.
