PALS Exam Questions & Answers 2026 (11–20)

Question 1

You are assessing a 9-month-old with bronchiolitis. The PAT reveals: irritable but consolable when held, audible wheezing with subcostal and intercostal retractions, and pink skin with 2-second capillary refill. SpO2 is 93%. After your primary ABCDE assessment confirms patent airway, bilateral wheezing, and no hemodynamic instability, what is the MOST appropriate immediate identification?

TheoryPractice · Accepted Answer

Lower airway obstruction causing respiratory distress. Bronchiolitis produces lower airway obstruction; the clinical picture — wheezing, retractions, mild hypoxia with preserved mentation and normal perfusion — classifies this as lower airway obstruction in the respiratory distress category, not failure, because compensatory effort is still maintaining adequate (though mildly reduced) oxygenation.

Question 2

A 3-year-old presents after a near-drowning event. He is unconscious and apneic, with central cyanosis and no detectable pulse. His skin is cold and mottled diffusely. Applying the PAT rapidly, you identify abnormalities in all three components. What is the IMMEDIATE clinical implication of this three-component PAT failure?

TheoryPractice · Accepted Answer

The child is in cardiopulmonary arrest requiring CPR and activation of the full arrest algorithm. When all three PAT components are simultaneously abnormal — appearance (unconscious), work of breathing (apneic), and circulation (cyanotic, pulseless, cold) — the child is in cardiopulmonary arrest, mandating immediate CPR initiation and activation of the pediatric cardiac arrest algorithm.

Question 3

A febrile 8-year-old presents with tachycardia of 155 beats/min and a blood pressure of 78/46 mmHg. A trauma nurse reports capillary refill of 5 seconds and the child mumbles only to painful stimulation. The resident wants to give a 10 mL/kg isotonic fluid bolus and reassess in 30 minutes. What is wrong with this plan according to PALS principles?

TheoryPractice · Accepted Answer

The child has decompensated shock and requires immediate aggressive intervention, not a delayed reassessment. A blood pressure of 78 mmHg systolic is below the fifth-percentile threshold for an 8-year-old (approximately 86 mmHg), altered mental status indicates end-organ dysfunction, and this constellation defines decompensated shock requiring immediate escalating intervention — not a 30-minute observation window.

Question 4

When comparing respiratory distress with respiratory failure in a pediatric patient, which finding most reliably indicates the transition from distress to failure?

TheoryPractice · Accepted Answer

Decreased level of consciousness with poor muscle tone and inadequate respiratory effort. The hallmark that distinguishes respiratory failure from distress is decompensation of the central nervous system and/or respiratory mechanics — manifested as declining consciousness, hypotonia, and inadequate effort — because it signals the child can no longer maintain compensatory drive to sustain oxygenation and ventilation.

Question 5

A 5-year-old with severe sepsis has a heart rate of 165 beats/min, a systolic blood pressure of 75 mmHg, and capillary refill of 6 seconds. The team initiates the evaluate-identify-intervene loop. After identifying decompensated septic shock, what is the CORRECT next action according to PALS?

TheoryPractice · Accepted Answer

Intervene with fluid resuscitation and vascular access, then reassess (re-enter the evaluation loop). The PALS evaluate-identify-intervene loop is iterative: once decompensated shock is identified the provider intervenes immediately (vascular access, fluid bolus, antibiotics) and then re-enters the evaluation loop to assess response, not waits for secondary data before acting.

Question 6

A 14-month-old presents with a 2-day history of diarrhea and vomiting. On PAT, you note decreased tone with a blank stare, no abnormal airway sounds or retractions, and pale mottled extremities with 5-second capillary refill. Blood pressure is 68/44 mmHg. Which pattern of shock and severity does this child BEST represent?

TheoryPractice · Accepted Answer

Hypovolemic shock, decompensated phase. Prolonged diarrhea and vomiting produce hypovolemic shock; the combination of hypotension (systolic 68 mmHg is well below the age-appropriate lower limit of approximately 74 mmHg), markedly prolonged capillary refill, and depressed mental status defines decompensated (hypotensive) hypovolemic shock requiring immediate aggressive volume resuscitation.

Question 7

A 4-year-old child is found unresponsive and not breathing. A single rescuer is present. After activating emergency services and delivering 2 rescue breaths, what compression-to-ventilation ratio should the lone rescuer use?

TheoryPractice · Accepted Answer

30:2. A single rescuer performing CPR on a child or infant uses the adult ratio of 30:2, reserving the 15:2 ratio for two-rescuer pediatric CPR per AHA PALS guidelines.

Question 8

Two healthcare providers are performing CPR on a 7-year-old. One is delivering compressions while the other manages the airway. What is the correct compression-to-ventilation ratio for this two-rescuer scenario?

TheoryPractice · Accepted Answer

15:2. Two-rescuer pediatric CPR uses a 15:2 ratio, allowing more frequent ventilations appropriate for children's higher respiratory dependency compared to adults.

Question 9

During high-quality CPR on an 8-year-old child, what is the recommended chest compression rate per minute?

TheoryPractice · Accepted Answer

100–120 compressions per minute. The AHA recommends a compression rate of 100–120 per minute for both adults and pediatric patients to optimize cardiac output during CPR.

Question 10

A 3-year-old drowning victim is brought to the emergency department. Two nurses begin CPR. After 15 compressions, the airway nurse is unable to achieve visible chest rise on the first rescue breath. What is the most appropriate next action?

TheoryPractice · Accepted Answer

Reposition the head to optimize the airway and attempt the second breath. If the first rescue breath does not cause chest rise, the AHA recommends repositioning the head (head-tilt chin-lift or jaw thrust in trauma) before the second attempt, then proceeding with compressions regardless of success.

PALS Exam Questions & Answers 2026 (11–20)

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