AHA PALS EXAM NEWEST 2026-2027 ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
COMPLETE SOLUTIONS.
1. A 3-year-old child presents with dehydration after a 2-day history of vomiting and diarrhea. The child
after has received 2 fluid boluses of 20 mL/ kg of normal saline. After the second bolus, the child is alert
and interacting. Her heart rate is 110/ min, respiratory rate is 30/min, and blood pressure is 92/64 mm
Hg. Her capillary refill time is 2 seconds, and oxygen saturation is 98%. What is the most appropriate
next intervention for this child?
A. Administer another 20 mL/kg normal saline fluid bolus
B. Administer 10 mL/kg of packed red cells C. Continue to monitor and reevaluate the child
espiratory failure
D. Disordered control of breathing <CORRECT ANS> Respiratory distress
1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary
assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on
auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter
displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which
of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry?
A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be
administered
C. Unreliable; no supplementary oxygen is indicated
D. Unreliable; supplementary oxygen should be administered <CORRECT ANS> Unreliable;
supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy.
The child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min,
blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child's most
likely condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
, D. Cardiogenic shock <CORRECT ANS> Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is 55/40
mm Hg. What term describes this infant's blood pressure? A. Hypotensive
B. Normal
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been
febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the following:
The child is difficult to arouse, with pale color. The child's heart rate is 160/min, respiratory rate is
30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F
(39.4°C). What is the most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an
oncologist to determine the chemotherapeutic regimen <CORRECT ANS> Obtain vascular access and
administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an
unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is
now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and temperature
is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. Two providers
may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line <CORRECT ANS> Place an intraosseous line
C. R10. A 2-year-old child with a 2-day history of a barking cough presents with
audible stridor on inspiration, intercostal retractions, and agitation. What is the most appropriate
intervention for this child?
A. Lay the child flat on a stretcher
B. Suction the mouth and nose
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
COMPLETE SOLUTIONS.
1. A 3-year-old child presents with dehydration after a 2-day history of vomiting and diarrhea. The child
after has received 2 fluid boluses of 20 mL/ kg of normal saline. After the second bolus, the child is alert
and interacting. Her heart rate is 110/ min, respiratory rate is 30/min, and blood pressure is 92/64 mm
Hg. Her capillary refill time is 2 seconds, and oxygen saturation is 98%. What is the most appropriate
next intervention for this child?
A. Administer another 20 mL/kg normal saline fluid bolus
B. Administer 10 mL/kg of packed red cells C. Continue to monitor and reevaluate the child
espiratory failure
D. Disordered control of breathing <CORRECT ANS> Respiratory distress
1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary
assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on
auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter
displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which
of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry?
A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be
administered
C. Unreliable; no supplementary oxygen is indicated
D. Unreliable; supplementary oxygen should be administered <CORRECT ANS> Unreliable;
supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy.
The child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min,
blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child's most
likely condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
, D. Cardiogenic shock <CORRECT ANS> Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is 55/40
mm Hg. What term describes this infant's blood pressure? A. Hypotensive
B. Normal
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been
febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the following:
The child is difficult to arouse, with pale color. The child's heart rate is 160/min, respiratory rate is
30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F
(39.4°C). What is the most appropriate intervention?
A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an
oncologist to determine the chemotherapeutic regimen <CORRECT ANS> Obtain vascular access and
administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an
unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is
now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and temperature
is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. Two providers
may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line <CORRECT ANS> Place an intraosseous line
C. R10. A 2-year-old child with a 2-day history of a barking cough presents with
audible stridor on inspiration, intercostal retractions, and agitation. What is the most appropriate
intervention for this child?
A. Lay the child flat on a stretcher
B. Suction the mouth and nose
