Ace Your PALS Certification 2026: Free
Practice Test & Expert Answers
Description:
Preparing for your Pediatric Advanced Life Support (PALS) exam? This targeted PALS
Practice Test 2026 is designed for healthcare students and professionals—from paramedics and
nurses to physicians—seeking to confidently pass their certification. We provide free PALS
questions and answers aligned with the latest AHA guidelines, featuring real-world scenarios,
rhythm interpretation, and drug dosing (like epinephrine and amiodarone) you need to know.
Each question includes detailed explanations to strengthen your critical thinking and test-taking
skills. Whether you're looking for a PALS pretest, PALS review 2026, or PALS quiz, our
resource helps you identify knowledge gaps and master key algorithms.
Stop stressing—start mastering. Download your free PALS study guide now and walk into your
exam with confidence!
, PALS Practice Test 2026: Free Q&A with Expert Explanations
1. A 9-year-old boy with a known history of asthma presents in significant respiratory distress. He
is agitated, leaning forward, and speaking in short phrases. On exam, he has nasal flaring, severe
suprasternal retractions, and expiratory wheezing with prolonged expiration. After applying
100% oxygen via a non-rebreather mask, his SpO2 is 92%. Which medication should be
prepared for immediate administration?
a) Ipratropium bromide
b) Methylprednisolone
c) Albuterol
d) Epinephrine
Answer: c) Albuterol
Explanation: The clinical presentation is classic for a severe asthma exacerbation. The
cornerstone of initial treatment is a rapid-acting bronchodilator. Albuterol is a short-acting beta-
agonist that provides immediate relief of bronchospasm. While oxygen and steroids are
important adjuncts, the first-line medication for reversing acute bronchoconstriction is albuterol.
2. During the resuscitation of a child in ventricular fibrillation, two unsynchronized shocks have
been delivered, and an initial dose of epinephrine has been administered via an intraosseous (IO)
line. The rhythm check still shows persistent VF. After delivering a subsequent shock and
resuming CPR, which antiarrhythmic medication should be administered next?
a) Lidocaine 1 mg/kg IO
b) Amiodarone 5 mg/kg IO
c) Magnesium sulfate 25 mg/kg IO
d) Procainamide 1 mg/kg IO
Answer: b) Amiodarone 5 mg/kg IO
Explanation: For shock-refractory VF/pulseless VT, amiodarone is the preferred first-line
antiarrhythmic agent according to current PALS guidelines. Lidocaine is an acceptable
alternative if amiodarone is not available.
3. For a 7-year-old child in respiratory failure who requires a high and reliable concentration of
inspired oxygen, which oxygen delivery system is most appropriate?
a) Nasal cannula
b) Simple face mask
, c) Non-rebreather face mask
d) Bag-mask device with a reservoir
Answer: c) Non-rebreather face mask
Explanation: A non-rebreather mask with a one-way valve and a reservoir bag, supplied with a
high flow of oxygen (10-15 L/min), can deliver a consistently high FiO2, often exceeding 90%.
This makes it the most reliable non-invasive device for delivering high-concentration oxygen to
a spontaneously breathing child.
4. An infant with severe symptomatic bradycardia (HR 50 bpm) associated with respiratory failure
continues to have a low heart rate despite effective ventilation with 100% oxygen and
establishment of a patent airway. There is no evidence of heart block. What is the first drug to
administer?
a) Atropine 0.02 mg/kg
b) Epinephrine 0.01 mg/kg
c) Dopamine 5 mcg/kg/min
d) Calcium Chloride 20 mg/kg
Answer: b) Epinephrine 0.01 mg/kg
Explanation: For bradycardia with poor perfusion that is unresponsive to adequate oxygenation
and ventilation, epinephrine is the first-line pharmacologic intervention. It acts on alpha and
beta-adrenergic receptors to increase heart rate, cardiac output, and vascular tone.
5. A 1-year-old child is brought in by paramedics with altered mental status, irregular breathing,
and faint pulses. Physical exam reveals bruising and abdominal distention. In the ED, after
intubation and establishment of IV access, the heart rate is 150 bpm with weak central pulses, no
distal pulses, and a systolic BP of 74 mmHg. What is the next critical intervention?
a) Administer a 20 mL/kg bolus of isotonic crystalloid
b) Start a dopamine infusion
c) Transfuse packed red blood cells
d) Obtain a stat CT scan of the head and abdomen
Answer: a) Administer a 20 mL/kg bolus of isotonic crystalloid
Explanation: The child is showing signs of decompensated shock (weak pulses, hypotension,
poor perfusion) in the context of potential traumatic injury. The initial management for
Practice Test & Expert Answers
Description:
Preparing for your Pediatric Advanced Life Support (PALS) exam? This targeted PALS
Practice Test 2026 is designed for healthcare students and professionals—from paramedics and
nurses to physicians—seeking to confidently pass their certification. We provide free PALS
questions and answers aligned with the latest AHA guidelines, featuring real-world scenarios,
rhythm interpretation, and drug dosing (like epinephrine and amiodarone) you need to know.
Each question includes detailed explanations to strengthen your critical thinking and test-taking
skills. Whether you're looking for a PALS pretest, PALS review 2026, or PALS quiz, our
resource helps you identify knowledge gaps and master key algorithms.
Stop stressing—start mastering. Download your free PALS study guide now and walk into your
exam with confidence!
, PALS Practice Test 2026: Free Q&A with Expert Explanations
1. A 9-year-old boy with a known history of asthma presents in significant respiratory distress. He
is agitated, leaning forward, and speaking in short phrases. On exam, he has nasal flaring, severe
suprasternal retractions, and expiratory wheezing with prolonged expiration. After applying
100% oxygen via a non-rebreather mask, his SpO2 is 92%. Which medication should be
prepared for immediate administration?
a) Ipratropium bromide
b) Methylprednisolone
c) Albuterol
d) Epinephrine
Answer: c) Albuterol
Explanation: The clinical presentation is classic for a severe asthma exacerbation. The
cornerstone of initial treatment is a rapid-acting bronchodilator. Albuterol is a short-acting beta-
agonist that provides immediate relief of bronchospasm. While oxygen and steroids are
important adjuncts, the first-line medication for reversing acute bronchoconstriction is albuterol.
2. During the resuscitation of a child in ventricular fibrillation, two unsynchronized shocks have
been delivered, and an initial dose of epinephrine has been administered via an intraosseous (IO)
line. The rhythm check still shows persistent VF. After delivering a subsequent shock and
resuming CPR, which antiarrhythmic medication should be administered next?
a) Lidocaine 1 mg/kg IO
b) Amiodarone 5 mg/kg IO
c) Magnesium sulfate 25 mg/kg IO
d) Procainamide 1 mg/kg IO
Answer: b) Amiodarone 5 mg/kg IO
Explanation: For shock-refractory VF/pulseless VT, amiodarone is the preferred first-line
antiarrhythmic agent according to current PALS guidelines. Lidocaine is an acceptable
alternative if amiodarone is not available.
3. For a 7-year-old child in respiratory failure who requires a high and reliable concentration of
inspired oxygen, which oxygen delivery system is most appropriate?
a) Nasal cannula
b) Simple face mask
, c) Non-rebreather face mask
d) Bag-mask device with a reservoir
Answer: c) Non-rebreather face mask
Explanation: A non-rebreather mask with a one-way valve and a reservoir bag, supplied with a
high flow of oxygen (10-15 L/min), can deliver a consistently high FiO2, often exceeding 90%.
This makes it the most reliable non-invasive device for delivering high-concentration oxygen to
a spontaneously breathing child.
4. An infant with severe symptomatic bradycardia (HR 50 bpm) associated with respiratory failure
continues to have a low heart rate despite effective ventilation with 100% oxygen and
establishment of a patent airway. There is no evidence of heart block. What is the first drug to
administer?
a) Atropine 0.02 mg/kg
b) Epinephrine 0.01 mg/kg
c) Dopamine 5 mcg/kg/min
d) Calcium Chloride 20 mg/kg
Answer: b) Epinephrine 0.01 mg/kg
Explanation: For bradycardia with poor perfusion that is unresponsive to adequate oxygenation
and ventilation, epinephrine is the first-line pharmacologic intervention. It acts on alpha and
beta-adrenergic receptors to increase heart rate, cardiac output, and vascular tone.
5. A 1-year-old child is brought in by paramedics with altered mental status, irregular breathing,
and faint pulses. Physical exam reveals bruising and abdominal distention. In the ED, after
intubation and establishment of IV access, the heart rate is 150 bpm with weak central pulses, no
distal pulses, and a systolic BP of 74 mmHg. What is the next critical intervention?
a) Administer a 20 mL/kg bolus of isotonic crystalloid
b) Start a dopamine infusion
c) Transfuse packed red blood cells
d) Obtain a stat CT scan of the head and abdomen
Answer: a) Administer a 20 mL/kg bolus of isotonic crystalloid
Explanation: The child is showing signs of decompensated shock (weak pulses, hypotension,
poor perfusion) in the context of potential traumatic injury. The initial management for
