AHA PALS EXAM NEWEST 2026 WITH
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
Section 1: Core Concepts & Respiratory Emergencies
1. A 4-year-old child is brought to the ED with stridor, drooling, and a tripod position. What is the
priority intervention?
A) Obtain a lateral neck x-ray
B) Visualize the oropharynx with a tongue depressor
C) Establish IV access
D) Prepare for immediate airway support and otolaryngology consult
Correct Answer: D
Rationale: The presentation (stridor, drooling, tripod) is classic for epiglottitis, a life-threatening airway
emergency. Manipulation of the airway (including x-rays or oral exams) can trigger complete
obstruction. The priority is to keep the child calm and prepare for definitive airway management by a
specialist.
2. A 6-month-old infant presents with severe respiratory distress, nasal flaring, and grunting. Oxygen
saturation is 82% on room air. What is the most appropriate initial action?
A) Apply a non-rebreather mask at 15 L/min
B) Begin bag-mask ventilation (BMV) with 100% oxygen
C) Administer albuterol via nebulizer
D) Start high-flow nasal cannula (HFNC) at 2 L/kg/min
Correct Answer: B
Rationale: The infant is in severe respiratory distress with hypoxemia (SpO2 < 90%) despite significant
work of breathing. Bag-mask ventilation is indicated for apnea or inadequate respiratory
effort/oxygenation. While HFNC is a supportive measure, the severe hypoxemia and grunting (sign of
impending failure) necessitate positive pressure ventilation.
,3. What is the hallmark of upper airway obstruction in a child?
A) Wheezing (expiratory)
B) Grunting
C) Stridor (inspiratory)
D) Crackles (rales)
Correct Answer: C
Rationale: Stridor is a harsh, high-pitched sound heard during inspiration, indicating obstruction at the
level of the pharynx, larynx, or trachea. Wheezing is lower airway (bronchioles). Grunting is a sign of
impending respiratory failure or parenchymal lung disease.
4. A 2-year-old is in respiratory failure. You are providing bag-mask ventilation. What is the most
reliable indicator of effective ventilation?
A) SpO2 reading of 95%
B) Mist in the mask
C) Visible chest rise
D) Heart rate of 120/min
Correct Answer: C
Rationale: Visible chest rise is the primary indicator that tidal volume is adequate. While heart rate and
SpO2 are important secondary indicators of improvement, chest rise confirms immediate effective
ventilation.
5. A child with a known history of asthma is in status asthmaticus. After albuterol and ipratropium,
the child remains in severe distress with poor air movement. What is the next appropriate
medication?
A) Magnesium sulfate
B) Adenosine
C) Amiodarone
D) Epinephrine 1:10,000 IV
Correct Answer: A
Rationale: Magnesium sulfate is a bronchodilator used in severe asthma exacerbations refractory to
initial beta-agonist and anticholinergic therapy. It helps relax smooth muscle. Epinephrine (1:10,000) is
used for cardiac arrest or anaphylaxis, not typically as a first-line bronchodilator in status asthmaticus
unless IM for anaphylaxis.
6. A 5-year-old child is choking on a piece of hot dog. He is conscious but cannot cough, speak, or
breathe. What is the correct intervention?
A) Back blows and chest thrusts
B) Abdominal thrusts (Heimlich maneuver)
, C) Blind finger sweep
D) Oxygen via non-rebreather
Correct Answer: B
Rationale: For a conscious child with complete airway obstruction (cannot cough/speak), abdominal
thrusts are indicated. For infants (<1 year), back blows/chest thrusts are used. Blind finger sweeps are
avoided as they may push the object deeper.
Section 2: Cardiac Rhythm Recognition & Management
7. What is the most common initial rhythm in pediatric cardiac arrest?
A) Ventricular fibrillation (VF)
B) Pulseless electrical activity (PEA)
C) Asystole
D) Supraventricular tachycardia (SVT)
Correct Answer: B
Rationale: While asystole is common in prolonged arrest, Pulseless Electrical Activity (PEA) and asystole
are the most frequent presenting rhythms in pediatric arrests, often secondary to hypoxia, acidosis, or
hypovolemia. VF is less common but has a higher chance of survival if defibrillated early.
8. You are monitoring a 7-year-old post-cardiac surgery. The rhythm shows a wide QRS complex, no P
waves, and a heart rate of 220/min. The child is hypotensive and lethargic. What is the correct
intervention?
A) Synchronized cardioversion at 0.5–1 J/kg
B) Adenosine 0.1 mg/kg rapid IV push
C) Defibrillation at 2 J/kg
D) Amiodarone 5 mg/kg over 20 minutes
Correct Answer: A
Rationale: The rhythm is unstable ventricular tachycardia (VT) with a pulse. Unstable tachycardia with a
pulse requires immediate synchronized cardioversion. Adenosine is for stable SVT. Defibrillation is for
pulseless VT/VF.
9. A 3-month-old infant presents with a heart rate of 280/min, P waves buried in the T waves, and
QRS duration of 0.06 seconds. The infant is alert and pink. What is the initial intervention?
A) Synchronized cardioversion
B) Vagal maneuvers (ice to the face)
C) IV Adenosine
D) Immediate defibrillation
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
Section 1: Core Concepts & Respiratory Emergencies
1. A 4-year-old child is brought to the ED with stridor, drooling, and a tripod position. What is the
priority intervention?
A) Obtain a lateral neck x-ray
B) Visualize the oropharynx with a tongue depressor
C) Establish IV access
D) Prepare for immediate airway support and otolaryngology consult
Correct Answer: D
Rationale: The presentation (stridor, drooling, tripod) is classic for epiglottitis, a life-threatening airway
emergency. Manipulation of the airway (including x-rays or oral exams) can trigger complete
obstruction. The priority is to keep the child calm and prepare for definitive airway management by a
specialist.
2. A 6-month-old infant presents with severe respiratory distress, nasal flaring, and grunting. Oxygen
saturation is 82% on room air. What is the most appropriate initial action?
A) Apply a non-rebreather mask at 15 L/min
B) Begin bag-mask ventilation (BMV) with 100% oxygen
C) Administer albuterol via nebulizer
D) Start high-flow nasal cannula (HFNC) at 2 L/kg/min
Correct Answer: B
Rationale: The infant is in severe respiratory distress with hypoxemia (SpO2 < 90%) despite significant
work of breathing. Bag-mask ventilation is indicated for apnea or inadequate respiratory
effort/oxygenation. While HFNC is a supportive measure, the severe hypoxemia and grunting (sign of
impending failure) necessitate positive pressure ventilation.
,3. What is the hallmark of upper airway obstruction in a child?
A) Wheezing (expiratory)
B) Grunting
C) Stridor (inspiratory)
D) Crackles (rales)
Correct Answer: C
Rationale: Stridor is a harsh, high-pitched sound heard during inspiration, indicating obstruction at the
level of the pharynx, larynx, or trachea. Wheezing is lower airway (bronchioles). Grunting is a sign of
impending respiratory failure or parenchymal lung disease.
4. A 2-year-old is in respiratory failure. You are providing bag-mask ventilation. What is the most
reliable indicator of effective ventilation?
A) SpO2 reading of 95%
B) Mist in the mask
C) Visible chest rise
D) Heart rate of 120/min
Correct Answer: C
Rationale: Visible chest rise is the primary indicator that tidal volume is adequate. While heart rate and
SpO2 are important secondary indicators of improvement, chest rise confirms immediate effective
ventilation.
5. A child with a known history of asthma is in status asthmaticus. After albuterol and ipratropium,
the child remains in severe distress with poor air movement. What is the next appropriate
medication?
A) Magnesium sulfate
B) Adenosine
C) Amiodarone
D) Epinephrine 1:10,000 IV
Correct Answer: A
Rationale: Magnesium sulfate is a bronchodilator used in severe asthma exacerbations refractory to
initial beta-agonist and anticholinergic therapy. It helps relax smooth muscle. Epinephrine (1:10,000) is
used for cardiac arrest or anaphylaxis, not typically as a first-line bronchodilator in status asthmaticus
unless IM for anaphylaxis.
6. A 5-year-old child is choking on a piece of hot dog. He is conscious but cannot cough, speak, or
breathe. What is the correct intervention?
A) Back blows and chest thrusts
B) Abdominal thrusts (Heimlich maneuver)
, C) Blind finger sweep
D) Oxygen via non-rebreather
Correct Answer: B
Rationale: For a conscious child with complete airway obstruction (cannot cough/speak), abdominal
thrusts are indicated. For infants (<1 year), back blows/chest thrusts are used. Blind finger sweeps are
avoided as they may push the object deeper.
Section 2: Cardiac Rhythm Recognition & Management
7. What is the most common initial rhythm in pediatric cardiac arrest?
A) Ventricular fibrillation (VF)
B) Pulseless electrical activity (PEA)
C) Asystole
D) Supraventricular tachycardia (SVT)
Correct Answer: B
Rationale: While asystole is common in prolonged arrest, Pulseless Electrical Activity (PEA) and asystole
are the most frequent presenting rhythms in pediatric arrests, often secondary to hypoxia, acidosis, or
hypovolemia. VF is less common but has a higher chance of survival if defibrillated early.
8. You are monitoring a 7-year-old post-cardiac surgery. The rhythm shows a wide QRS complex, no P
waves, and a heart rate of 220/min. The child is hypotensive and lethargic. What is the correct
intervention?
A) Synchronized cardioversion at 0.5–1 J/kg
B) Adenosine 0.1 mg/kg rapid IV push
C) Defibrillation at 2 J/kg
D) Amiodarone 5 mg/kg over 20 minutes
Correct Answer: A
Rationale: The rhythm is unstable ventricular tachycardia (VT) with a pulse. Unstable tachycardia with a
pulse requires immediate synchronized cardioversion. Adenosine is for stable SVT. Defibrillation is for
pulseless VT/VF.
9. A 3-month-old infant presents with a heart rate of 280/min, P waves buried in the T waves, and
QRS duration of 0.06 seconds. The infant is alert and pink. What is the initial intervention?
A) Synchronized cardioversion
B) Vagal maneuvers (ice to the face)
C) IV Adenosine
D) Immediate defibrillation
