PALS Certification Exam 2026/2027 | 100
Pediatric Advanced Life Support Practice
Questions with Answers & Explanations
Description:
Master the PALS certification exam 2026/2027 with 100 high-yield practice questions
covering ECG interpretation, shock management, cardiac arrest, respiratory failure, and
pharmacology. Each question includes detailed answers and clinical explanations written to
current AHA guidelines. Ideal for medical students, nurses, paramedics, and PALS
providers.
Download the complete 2026/2027 examination paper today and pass your PALS certification with
confidence.
, PALS Exam Prep 2026/2027: 100 Practice Questions
Section 1: ECG Rhythm Interpretation
Question 1
A 12-year-old child being evaluated in the pediatric intensive care unit displays an ECG
waveform with a consistent pattern of progressive PR interval prolongation followed by a non-
conducted P wave. The team interprets this as which arrhythmia?
A. First-degree atrioventricular block
B. Second-degree atrioventricular block, Mobitz type I (Wenckebach)
C. Second-degree atrioventricular block, Mobitz type II
D. Third-degree atrioventricular block
Answer: B
Explanation: Second-degree AV block, Mobitz type I (Wenckebach), is characterized by
progressive lengthening of the PR interval until a P wave is not conducted. This pattern
distinguishes it from Mobitz type II, which has constant PR intervals with intermittent non-
conducted P waves.
Question 2
A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with
Lyme disease 2 months ago. A rhythm strip reveals a prolonged PR interval (0.24 seconds) with
all P waves conducted to the QRS complexes. The provider interprets this rhythm as indicating
which arrhythmia?
A. Second-degree AV block, type I
B. Second-degree AV block, type II
C. First-degree atrioventricular (AV) block
D. Sinus arrhythmia with first-degree block
Answer: C
Explanation: First-degree AV block is defined by a PR interval exceeding the upper limit of
normal for age (typically >0.20 seconds in older children) with consistent 1:1 conduction. This
rhythm is commonly associated with Lyme carditis in pediatric patients.
,Question 3
A 10-year-old child has collapsed in the gymnasium. The school nurse determines the child is
unresponsive, not breathing, and has no pulse. The cardiac monitor displays a rhythm with
organized, wide QRS complexes at a rate of 180 beats per minute. The team interprets this as
which arrhythmia?
A. Monomorphic ventricular tachycardia
B. Supraventricular tachycardia with aberrancy
C. Polymorphic ventricular tachycardia
D. Accelerated idioventricular rhythm
Answer: A
Explanation: Monomorphic ventricular tachycardia presents with wide QRS complexes
(typically >0.09 seconds) that have a uniform appearance. In a pulseless patient, this is classified
as pulseless ventricular tachycardia and requires immediate defibrillation.
Question 4
A 12-year-old is being treated in the urgent care clinic. The mother reports fever, vomiting, and
multiple episodes of watery diarrhea. The rhythm strip shows a regular rhythm with a rate of 128
beats per minute, normal P waves preceding each QRS, and a normal PR interval. The provider
interprets this as which type of arrhythmia?
A. Supraventricular tachycardia
B. Sinus tachycardia
C. Atrial flutter
D. Junctional tachycardia
Answer: B
Explanation: Sinus tachycardia demonstrates normal P wave morphology and axis, appropriate
rate for age (school-aged child: 70-120 bpm at rest, but can be 120-150 bpm with fever or
dehydration), and rate variability with activity or stimulus. The clinical context of fever and
dehydration supports this diagnosis.
, Question 5
The PALS resuscitation team notes an ECG waveform with varying QRS morphologies and no
identifiable pulse. The rhythm appears chaotic without discrete QRS complexes. The team
prepares to intervene to address which arrhythmia?
A. Monomorphic ventricular tachycardia
B. Ventricular fibrillation
C. Torsades de pointes
D. Supraventricular tachycardia
Answer: B
Explanation: Ventricular fibrillation is characterized by chaotic, irregular electrical activity with
no discernible QRS complexes and no effective cardiac output. Immediate defibrillation is the
priority intervention.
Section 2: Laboratory and Diagnostic Assessment
Question 6
Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic,
tachypneic, lethargic, and pale. Which test would the provider use to determine the adequacy of
oxygen delivery?
A. Serum glucose
B. Complete blood count
C. Lactate
D. Electrolyte panel
Answer: C
Explanation: Lactate is a sensitive marker of inadequate oxygen delivery and tissue
hypoperfusion. Elevated lactate indicates anaerobic metabolism resulting from insufficient
oxygen delivery relative to metabolic demand, commonly seen in hypovolemic shock from
dehydration.
Pediatric Advanced Life Support Practice
Questions with Answers & Explanations
Description:
Master the PALS certification exam 2026/2027 with 100 high-yield practice questions
covering ECG interpretation, shock management, cardiac arrest, respiratory failure, and
pharmacology. Each question includes detailed answers and clinical explanations written to
current AHA guidelines. Ideal for medical students, nurses, paramedics, and PALS
providers.
Download the complete 2026/2027 examination paper today and pass your PALS certification with
confidence.
, PALS Exam Prep 2026/2027: 100 Practice Questions
Section 1: ECG Rhythm Interpretation
Question 1
A 12-year-old child being evaluated in the pediatric intensive care unit displays an ECG
waveform with a consistent pattern of progressive PR interval prolongation followed by a non-
conducted P wave. The team interprets this as which arrhythmia?
A. First-degree atrioventricular block
B. Second-degree atrioventricular block, Mobitz type I (Wenckebach)
C. Second-degree atrioventricular block, Mobitz type II
D. Third-degree atrioventricular block
Answer: B
Explanation: Second-degree AV block, Mobitz type I (Wenckebach), is characterized by
progressive lengthening of the PR interval until a P wave is not conducted. This pattern
distinguishes it from Mobitz type II, which has constant PR intervals with intermittent non-
conducted P waves.
Question 2
A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with
Lyme disease 2 months ago. A rhythm strip reveals a prolonged PR interval (0.24 seconds) with
all P waves conducted to the QRS complexes. The provider interprets this rhythm as indicating
which arrhythmia?
A. Second-degree AV block, type I
B. Second-degree AV block, type II
C. First-degree atrioventricular (AV) block
D. Sinus arrhythmia with first-degree block
Answer: C
Explanation: First-degree AV block is defined by a PR interval exceeding the upper limit of
normal for age (typically >0.20 seconds in older children) with consistent 1:1 conduction. This
rhythm is commonly associated with Lyme carditis in pediatric patients.
,Question 3
A 10-year-old child has collapsed in the gymnasium. The school nurse determines the child is
unresponsive, not breathing, and has no pulse. The cardiac monitor displays a rhythm with
organized, wide QRS complexes at a rate of 180 beats per minute. The team interprets this as
which arrhythmia?
A. Monomorphic ventricular tachycardia
B. Supraventricular tachycardia with aberrancy
C. Polymorphic ventricular tachycardia
D. Accelerated idioventricular rhythm
Answer: A
Explanation: Monomorphic ventricular tachycardia presents with wide QRS complexes
(typically >0.09 seconds) that have a uniform appearance. In a pulseless patient, this is classified
as pulseless ventricular tachycardia and requires immediate defibrillation.
Question 4
A 12-year-old is being treated in the urgent care clinic. The mother reports fever, vomiting, and
multiple episodes of watery diarrhea. The rhythm strip shows a regular rhythm with a rate of 128
beats per minute, normal P waves preceding each QRS, and a normal PR interval. The provider
interprets this as which type of arrhythmia?
A. Supraventricular tachycardia
B. Sinus tachycardia
C. Atrial flutter
D. Junctional tachycardia
Answer: B
Explanation: Sinus tachycardia demonstrates normal P wave morphology and axis, appropriate
rate for age (school-aged child: 70-120 bpm at rest, but can be 120-150 bpm with fever or
dehydration), and rate variability with activity or stimulus. The clinical context of fever and
dehydration supports this diagnosis.
, Question 5
The PALS resuscitation team notes an ECG waveform with varying QRS morphologies and no
identifiable pulse. The rhythm appears chaotic without discrete QRS complexes. The team
prepares to intervene to address which arrhythmia?
A. Monomorphic ventricular tachycardia
B. Ventricular fibrillation
C. Torsades de pointes
D. Supraventricular tachycardia
Answer: B
Explanation: Ventricular fibrillation is characterized by chaotic, irregular electrical activity with
no discernible QRS complexes and no effective cardiac output. Immediate defibrillation is the
priority intervention.
Section 2: Laboratory and Diagnostic Assessment
Question 6
Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic,
tachypneic, lethargic, and pale. Which test would the provider use to determine the adequacy of
oxygen delivery?
A. Serum glucose
B. Complete blood count
C. Lactate
D. Electrolyte panel
Answer: C
Explanation: Lactate is a sensitive marker of inadequate oxygen delivery and tissue
hypoperfusion. Elevated lactate indicates anaerobic metabolism resulting from insufficient
oxygen delivery relative to metabolic demand, commonly seen in hypovolemic shock from
dehydration.
