1
PALS PEDIATRIC EMERGENCY
RESUSCITATION FINAL EXAM Actual Exam
2026/2027 Complete Questions and Verified
Answers with Detailed Rationales Updated
Questions Aligned with 2026 AHA Guidelines
Pass Guaranteed - A+ Graded
Section 1: PALS Final Exam
Q1: During the primary assessment of a 3-year-old child with respiratory distress, which
component of the Pediatric Assessment Triangle (PAT) assesses the child's muscle tone and
mental status?
A. Work of Breathing
B. Circulation to Skin
C. Appearance [CORRECT]
D. Airway patency
Correct Answer: C
Rationale: The Appearance component of the PAT evaluates the child's muscle tone, mental
status, level of consciousness, and interactiveness, providing immediate information about brain
perfusion and overall function.
Q2: A 5-year-old patient presents with stridor at rest, tripod positioning, and drooling. The nurse
notes the child appears anxious and has a fever. Which condition should be suspected first?
A. Asthma exacerbation
B. Croup
C. Epiglottitis [CORRECT]
D. Bronchiolitis
Correct Answer: C
Rationale: Epiglottitis presents with the classic triad of sudden onset of high fever, drooling, and
stridor, along with anxiety and tripod positioning due to severe upper airway obstruction.
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Q3: The PALS team is managing a 2-year-old in cardiac arrest. The rhythm strip shows a chaotic,
irregular waveform with no discernible P waves or QRS complexes. What is the rhythm?
A. Pulseless electrical activity
B. Asystole
C. Ventricular fibrillation [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: Ventricular fibrillation is characterized by a chaotic, irregular waveform without
organized electrical activity, requiring immediate defibrillation.
Q4: What is the correct initial dose of epinephrine for a pediatric patient in pulseless arrest?
A. 0.1 mg/kg of 1:1,000 concentration
B. 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO [CORRECT]
C. 0.1 mg/kg of 1:10,000 concentration
D. 1 mg regardless of weight
Correct Answer: B
Rationale: The standard pediatric dose for epinephrine in cardiac arrest is 0.01 mg/kg (0.1 mL/kg
of the 1:10,000 concentration) administered IV or IO, repeated every 3-5 minutes.
Q5: A 4-year-old child presents with wheezing, respiratory rate of 48, and mild intercostal
retractions. The child is alert and has good muscle tone. According to the PAT, this represents:
A. Respiratory failure
B. Respiratory distress [CORRECT]
C. Respiratory arrest
D. Compensated shock
Correct Answer: B
Rationale: This child demonstrates increased work of breathing (wheezing, retractions,
tachypnea) but maintains good appearance (alert, good tone), consistent with respiratory distress
rather than failure.
Q6: Which Hs and Ts cause of PEA/asystole is characterized by jugular venous distension,
muffled heart sounds, and hypotension?
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, 3
A. Tension pneumothorax
B. Cardiac tamponade [CORRECT]
C. Hypovolemia
D. Pulmonary thrombosis
Correct Answer: B
Rationale: Cardiac tamponade presents with Beck's triad: jugular venous distension, muffled
heart sounds, and hypotension, caused by fluid accumulation in the pericardium restricting
cardiac filling.
Q7: During the secondary assessment, which mnemonic is used to obtain the history of the
present illness?
A. ABCDE
B. OPQRST
C. SAMPLE [CORRECT]
D. AVPU
Correct Answer: C
Rationale: SAMPLE history (Signs/Symptoms, Allergies, Medications, Past medical history, Last
meal, Events leading to present illness) is the standard mnemonic for gathering comprehensive
history during the secondary assessment.
Q8: A 6-month-old infant with bronchiolitis has a respiratory rate of 68, nasal flaring, and
grunting. Oxygen saturation is 88% on room air. What is the priority intervention?
A. Immediate intubation
B. High-flow nasal cannula or CPAP and supplemental oxygen [CORRECT]
C. Nebulized albuterol
D. Chest physiotherapy
Correct Answer: B
Rationale: This infant shows signs of respiratory failure with hypoxemia; the priority is
providing non-invasive respiratory support with oxygen to prevent progression to respiratory
arrest.
Q9: In the pediatric bradycardia algorithm, at what heart rate should intervention be considered if
the child shows signs of poor perfusion?
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PALS PEDIATRIC EMERGENCY
RESUSCITATION FINAL EXAM Actual Exam
2026/2027 Complete Questions and Verified
Answers with Detailed Rationales Updated
Questions Aligned with 2026 AHA Guidelines
Pass Guaranteed - A+ Graded
Section 1: PALS Final Exam
Q1: During the primary assessment of a 3-year-old child with respiratory distress, which
component of the Pediatric Assessment Triangle (PAT) assesses the child's muscle tone and
mental status?
A. Work of Breathing
B. Circulation to Skin
C. Appearance [CORRECT]
D. Airway patency
Correct Answer: C
Rationale: The Appearance component of the PAT evaluates the child's muscle tone, mental
status, level of consciousness, and interactiveness, providing immediate information about brain
perfusion and overall function.
Q2: A 5-year-old patient presents with stridor at rest, tripod positioning, and drooling. The nurse
notes the child appears anxious and has a fever. Which condition should be suspected first?
A. Asthma exacerbation
B. Croup
C. Epiglottitis [CORRECT]
D. Bronchiolitis
Correct Answer: C
Rationale: Epiglottitis presents with the classic triad of sudden onset of high fever, drooling, and
stridor, along with anxiety and tripod positioning due to severe upper airway obstruction.
1
,2
Q3: The PALS team is managing a 2-year-old in cardiac arrest. The rhythm strip shows a chaotic,
irregular waveform with no discernible P waves or QRS complexes. What is the rhythm?
A. Pulseless electrical activity
B. Asystole
C. Ventricular fibrillation [CORRECT]
D. Ventricular tachycardia
Correct Answer: C
Rationale: Ventricular fibrillation is characterized by a chaotic, irregular waveform without
organized electrical activity, requiring immediate defibrillation.
Q4: What is the correct initial dose of epinephrine for a pediatric patient in pulseless arrest?
A. 0.1 mg/kg of 1:1,000 concentration
B. 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO [CORRECT]
C. 0.1 mg/kg of 1:10,000 concentration
D. 1 mg regardless of weight
Correct Answer: B
Rationale: The standard pediatric dose for epinephrine in cardiac arrest is 0.01 mg/kg (0.1 mL/kg
of the 1:10,000 concentration) administered IV or IO, repeated every 3-5 minutes.
Q5: A 4-year-old child presents with wheezing, respiratory rate of 48, and mild intercostal
retractions. The child is alert and has good muscle tone. According to the PAT, this represents:
A. Respiratory failure
B. Respiratory distress [CORRECT]
C. Respiratory arrest
D. Compensated shock
Correct Answer: B
Rationale: This child demonstrates increased work of breathing (wheezing, retractions,
tachypnea) but maintains good appearance (alert, good tone), consistent with respiratory distress
rather than failure.
Q6: Which Hs and Ts cause of PEA/asystole is characterized by jugular venous distension,
muffled heart sounds, and hypotension?
2
, 3
A. Tension pneumothorax
B. Cardiac tamponade [CORRECT]
C. Hypovolemia
D. Pulmonary thrombosis
Correct Answer: B
Rationale: Cardiac tamponade presents with Beck's triad: jugular venous distension, muffled
heart sounds, and hypotension, caused by fluid accumulation in the pericardium restricting
cardiac filling.
Q7: During the secondary assessment, which mnemonic is used to obtain the history of the
present illness?
A. ABCDE
B. OPQRST
C. SAMPLE [CORRECT]
D. AVPU
Correct Answer: C
Rationale: SAMPLE history (Signs/Symptoms, Allergies, Medications, Past medical history, Last
meal, Events leading to present illness) is the standard mnemonic for gathering comprehensive
history during the secondary assessment.
Q8: A 6-month-old infant with bronchiolitis has a respiratory rate of 68, nasal flaring, and
grunting. Oxygen saturation is 88% on room air. What is the priority intervention?
A. Immediate intubation
B. High-flow nasal cannula or CPAP and supplemental oxygen [CORRECT]
C. Nebulized albuterol
D. Chest physiotherapy
Correct Answer: B
Rationale: This infant shows signs of respiratory failure with hypoxemia; the priority is
providing non-invasive respiratory support with oxygen to prevent progression to respiratory
arrest.
Q9: In the pediatric bradycardia algorithm, at what heart rate should intervention be considered if
the child shows signs of poor perfusion?
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