PEDIATRIC ADVANCED LIFE SUPPORT (PALS) EXAM GUIDE QUESTIONS
AND CORRECT ANSWERS 2026
A 3-year-old child presents with moderate respiratory distress, oxygen
saturation of 91% on room air, and mild retractions. The child is alert
and crying. What is the most appropriate initial intervention?
A. Immediate endotracheal intubation
B. High-flow nasal cannula oxygen at 2 L/kg/min
C. Supplemental oxygen via nasal cannula or face mask to maintain
SpO2 ≥94%
D. Intravenous bolus of 20 mL/kg normal saline
Correct Answer: C
Explanation: For a child with moderate respiratory distress and SpO2
91%, the initial step is supplemental oxygen to maintain saturation
≥94%. Intubation is reserved for respiratory failure. High-flow nasal
cannula at 2 L/kg/min is excessive and not standard initial therapy. IV
fluids are not indicated unless shock is present.
During a PALS cardiac arrest scenario, a 5-year-old child receives
epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV every 3-5 minutes.
What is the maximum single dose of epinephrine for pediatric cardiac
arrest?
A. 0.5 mg
B. 1 mg
C. 2 mg
D. 5 mg
Correct Answer: B
Explanation: The maximum single dose of epinephrine for pediatric
,cardiac arrest is 1 mg (equivalent to adult dose). Doses above 1 mg are
not recommended in children. 0.5 mg is below maximum, and 2-5 mg
exceed safe limits.
A 2-year-old infant presents with bradycardia (heart rate 50 bpm), poor
perfusion, and cyanosis despite adequate oxygenation and ventilation.
What is the first-line medication?
A. Atropine 0.02 mg/kg
B. Epinephrine 0.01 mg/kg IV/IO
C. Amiodarone 5 mg/kg IV
D. Dopamine 5 mcg/kg/min infusion
Correct Answer: B
Explanation: For symptomatic bradycardia with poor perfusion despite
oxygenation/ventilation, epinephrine is first-line per PALS bradycardia
algorithm. Atropine is second-line for vagally-mediated or AV block
bradycardia. Amiodarone is for tachycardia. Dopamine is for shock.
Which rhythm is most commonly associated with pediatric cardiac
arrest?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Sinus tachycardia
Correct Answer: C
Explanation: Asystole is the most common initial rhythm in pediatric
cardiac arrest, unlike adults where VF is more common. Pediatric arrest
,is typically respiratory-driven leading to asystole. VF and pulseless VT
are less common in children.
A 6-year-old child with suspected septic shock presents with
hypotension, tachycardia, delayed capillary refill (>3 seconds), and weak
pulses. What is the initial fluid bolus recommendation?
A. 10 mL/kg crystalloid over 10 minutes
B. 20 mL/kg crystalloid over 5-10 minutes
C. 30 mL/kg crystalloid over 30 minutes
D. 5 mL/kg colloid over 5 minutes
Correct Answer: B
Explanation: PALS guidelines recommend 20 mL/kg crystalloid bolus
over 5-10 minutes for pediatric septic shock. 10 mL/kg is insufficient. 30
mL/kg is excessive for initial bolus. Colloids are not first-line.
What is the correct compression-to-ventilation ratio for two-rescuer
infant CPR?
A. 30:2
B. 15:2
C. 5:1
D. 50:2
Correct Answer: B
Explanation: For two-rescuer infant/child CPR, the ratio is 15:2. 30:2 is
for single-rescuer adult CPR. 5:1 was older guideline. 50:2 is not
standard.
, A 4-year-old child in cardiac arrest has an established IV. What is the
correct epinephrine dose and concentration?
A. 0.01 mg/kg of 1:1,000 concentration
B. 0.01 mg/kg of 1:10,000 concentration
C. 0.1 mg/kg of 1:10,000 concentration
D. 0.001 mg/kg of 1:1,000 concentration
Correct Answer: B
Explanation: Epinephrine for pediatric cardiac arrest is 0.01 mg/kg of
1:10,000 concentration (0.1 mL/kg) IV/IO every 3-5 minutes. 1:1,000 is
for IM anaphylaxis. 0.1 mg/kg is 10x overdose.
Which of the following is the most reliable early sign of deteriorating
respiratory status in a child?
A. Hypotension
B. Tachypnea
C. Bradycardia
D. Decreased level of consciousness
Correct Answer: B
Explanation: Tachypnea is an early compensatory sign of respiratory
distress in children. Hypotension and bradycardia are late signs. Altered
consciousness is also a late sign of respiratory failure.
A 7-year-old presents with narrow-complex tachycardia (HR 240 bpm),
stable blood pressure, and no signs of shock. What is the first-line
treatment?
A. Synchronized cardioversion at 0.5-1 J/kg
B. Vagal maneuvers followed by adenosine 0.1 mg/kg
AND CORRECT ANSWERS 2026
A 3-year-old child presents with moderate respiratory distress, oxygen
saturation of 91% on room air, and mild retractions. The child is alert
and crying. What is the most appropriate initial intervention?
A. Immediate endotracheal intubation
B. High-flow nasal cannula oxygen at 2 L/kg/min
C. Supplemental oxygen via nasal cannula or face mask to maintain
SpO2 ≥94%
D. Intravenous bolus of 20 mL/kg normal saline
Correct Answer: C
Explanation: For a child with moderate respiratory distress and SpO2
91%, the initial step is supplemental oxygen to maintain saturation
≥94%. Intubation is reserved for respiratory failure. High-flow nasal
cannula at 2 L/kg/min is excessive and not standard initial therapy. IV
fluids are not indicated unless shock is present.
During a PALS cardiac arrest scenario, a 5-year-old child receives
epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV every 3-5 minutes.
What is the maximum single dose of epinephrine for pediatric cardiac
arrest?
A. 0.5 mg
B. 1 mg
C. 2 mg
D. 5 mg
Correct Answer: B
Explanation: The maximum single dose of epinephrine for pediatric
,cardiac arrest is 1 mg (equivalent to adult dose). Doses above 1 mg are
not recommended in children. 0.5 mg is below maximum, and 2-5 mg
exceed safe limits.
A 2-year-old infant presents with bradycardia (heart rate 50 bpm), poor
perfusion, and cyanosis despite adequate oxygenation and ventilation.
What is the first-line medication?
A. Atropine 0.02 mg/kg
B. Epinephrine 0.01 mg/kg IV/IO
C. Amiodarone 5 mg/kg IV
D. Dopamine 5 mcg/kg/min infusion
Correct Answer: B
Explanation: For symptomatic bradycardia with poor perfusion despite
oxygenation/ventilation, epinephrine is first-line per PALS bradycardia
algorithm. Atropine is second-line for vagally-mediated or AV block
bradycardia. Amiodarone is for tachycardia. Dopamine is for shock.
Which rhythm is most commonly associated with pediatric cardiac
arrest?
A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Sinus tachycardia
Correct Answer: C
Explanation: Asystole is the most common initial rhythm in pediatric
cardiac arrest, unlike adults where VF is more common. Pediatric arrest
,is typically respiratory-driven leading to asystole. VF and pulseless VT
are less common in children.
A 6-year-old child with suspected septic shock presents with
hypotension, tachycardia, delayed capillary refill (>3 seconds), and weak
pulses. What is the initial fluid bolus recommendation?
A. 10 mL/kg crystalloid over 10 minutes
B. 20 mL/kg crystalloid over 5-10 minutes
C. 30 mL/kg crystalloid over 30 minutes
D. 5 mL/kg colloid over 5 minutes
Correct Answer: B
Explanation: PALS guidelines recommend 20 mL/kg crystalloid bolus
over 5-10 minutes for pediatric septic shock. 10 mL/kg is insufficient. 30
mL/kg is excessive for initial bolus. Colloids are not first-line.
What is the correct compression-to-ventilation ratio for two-rescuer
infant CPR?
A. 30:2
B. 15:2
C. 5:1
D. 50:2
Correct Answer: B
Explanation: For two-rescuer infant/child CPR, the ratio is 15:2. 30:2 is
for single-rescuer adult CPR. 5:1 was older guideline. 50:2 is not
standard.
, A 4-year-old child in cardiac arrest has an established IV. What is the
correct epinephrine dose and concentration?
A. 0.01 mg/kg of 1:1,000 concentration
B. 0.01 mg/kg of 1:10,000 concentration
C. 0.1 mg/kg of 1:10,000 concentration
D. 0.001 mg/kg of 1:1,000 concentration
Correct Answer: B
Explanation: Epinephrine for pediatric cardiac arrest is 0.01 mg/kg of
1:10,000 concentration (0.1 mL/kg) IV/IO every 3-5 minutes. 1:1,000 is
for IM anaphylaxis. 0.1 mg/kg is 10x overdose.
Which of the following is the most reliable early sign of deteriorating
respiratory status in a child?
A. Hypotension
B. Tachypnea
C. Bradycardia
D. Decreased level of consciousness
Correct Answer: B
Explanation: Tachypnea is an early compensatory sign of respiratory
distress in children. Hypotension and bradycardia are late signs. Altered
consciousness is also a late sign of respiratory failure.
A 7-year-old presents with narrow-complex tachycardia (HR 240 bpm),
stable blood pressure, and no signs of shock. What is the first-line
treatment?
A. Synchronized cardioversion at 0.5-1 J/kg
B. Vagal maneuvers followed by adenosine 0.1 mg/kg
