PALS Exam Questions & Answers 2026 (21–30)

Question 1

During two-rescuer infant CPR, the compressor uses a two-thumb encircling technique. The ventilator delivers a breath every time compressions pause. Which statement best describes the CORRECT pause for ventilation with this technique?

TheoryPractice · Accepted Answer

After every 15 compressions, pause 1–2 seconds for 2 breaths. Two-rescuer infant CPR uses a 15:2 ratio; the compressor pauses after every 15 compressions to allow the ventilator to deliver 2 breaths, then compressions resume immediately.

Question 2

During a resuscitation drill, a team leader notices the compressor's chest recoil is incomplete between compressions. Which specific physiological consequence is MOST directly caused by inadequate chest recoil?

TheoryPractice · Accepted Answer

Reduced venous return to the heart, lowering coronary perfusion pressure. Incomplete chest recoil keeps intrathoracic pressure elevated, impairing venous return and thereby reducing both cardiac filling and coronary perfusion pressure — a key determinant of ROSC.

Question 3

A 9-year-old is in pulseless arrest. Three healthcare providers are present. Provider A is compressing, Provider B is managing the airway and ventilating, and Provider C is preparing medications. Provider A has been compressing for 2 minutes. Which action BEST reflects optimal team dynamics per AHA PALS standards?

TheoryPractice · Accepted Answer

Provider C switches with Provider A at the next pulse check, limiting the pause to under 10 seconds. AHA team dynamics emphasize planned role switches at structured intervals (every 2 minutes or at rhythm checks) with clear communication, keeping any CPR pause to less than 10 seconds to preserve perfusion pressure.

Question 4

A rescuer has been performing lone CPR on a 2-year-old for 3 minutes using 30:2. At the 3-minute mark, a second trained rescuer arrives. What change, if any, should immediately be made to the CPR protocol?

TheoryPractice · Accepted Answer

Switch to 15:2 and transition to the two-thumb encircling technique if feasible. When a second trained rescuer joins pediatric CPR, the AHA directs a switch to the 15:2 two-rescuer ratio; for infants the two-thumb encircling technique is preferred for two rescuers as it generates higher peak pressures.

Question 5

During CPR on a 7-year-old, the team's capnography monitor shows an end-tidal CO2 (ETCO2) of 8 mmHg after 10 minutes of resuscitation. Which interpretation and action is MOST appropriate?

TheoryPractice · Accepted Answer

ETCO2 of 8 mmHg suggests poor CPR quality; reassess compression technique and rate. An ETCO2 persistently below 10–15 mmHg during CPR indicates poor cardiac output from ineffective compressions; the team should reassess rate, depth, recoil, and minimize interruptions.

Question 6

A pediatric code team is 15 minutes into resuscitation of a 6-year-old in VF arrest. A sudden rise in ETCO2 from 12 mmHg to 38 mmHg is noted WITHOUT a rhythm change on the monitor. What does this finding MOST likely indicate?

TheoryPractice · Accepted Answer

Return of spontaneous circulation. A sudden sustained rise in ETCO2 to near-normal levels (35–45 mmHg) without a ventilation change is a reliable early indicator of ROSC, as restored cardiac output rapidly clears CO2 from pulmonary circulation.

Question 7

An 18-month-old is found unresponsive in a crib. A lone rescuer confirms no breathing and no pulse. The rescuer has a mobile phone. In what order should the lone rescuer act?

TheoryPractice · Accepted Answer

Call 911 immediately using the speakerphone while beginning CPR. For infants and children, AHA guidelines recommend a lone rescuer perform approximately 2 minutes of CPR before leaving to call EMS, BUT if a mobile phone is available, the rescuer should activate EMS via speakerphone simultaneously while starting CPR.

Question 8

During a simulated pediatric arrest, a new team member begins delivering rescue breaths that are visibly causing the child's chest to rise excessively. Which consequence is the team leader MOST correct to warn about?

TheoryPractice · Accepted Answer

Excessive tidal volume reducing cardiac output by raising intrathoracic pressure and causing gastric distension. Excessive tidal volumes during CPR raise intrathoracic pressure, impede venous return and cardiac output, and cause gastric distension with aspiration risk; AHA guidelines recommend delivering only enough volume to produce visible chest rise.

Question 9

A resuscitation team achieves ROSC in a 5-year-old after 12 minutes of CPR. During post-ROSC monitoring, SpO2 climbs to 100% on FiO2 1.0. What is the most appropriate oxygen management step according to post-resuscitation care guidelines?

TheoryPractice · Accepted Answer

Titrate FiO2 to maintain SpO2 94–99% to avoid hyperoxia-related reperfusion injury. AHA post-resuscitation guidelines recommend titrating inspired oxygen after ROSC to maintain SpO2 between 94–99%, as hyperoxia (SpO2 100% on high FiO2) is associated with increased oxidative injury and worse neurological outcomes.

Question 10

A 3-year-old presents with stridor, a barking cough, and mild retractions but is alert and maintaining oxygen saturation of 95% on room air. Which best describes this child's respiratory status?

TheoryPractice · Accepted Answer

Respiratory distress with upper airway obstruction. Stridor and barking cough indicate upper airway obstruction (croup pattern), and the child remains alert with adequate saturations, meeting the definition of respiratory distress rather than failure.

PALS Exam Questions & Answers 2026 (21–30)

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