1
AHA PALS Exam Questions & Answers Actual
Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
[SECTION 1: Pediatric Assessment & Respiratory Emergencies — Questions 1-15]
Q1: A 4-year-old child presents with a barking cough, stridor that worsens when crying, and a
hoarse voice. The child's assessment using the Pediatric Assessment Triangle (PAT) shows
normal work of breathing and normal appearance at rest. What is the most likely diagnosis?
A. Bronchiolitis
B. Croup (viral laryngotracheobronchitis)
C. Epiglottitis
D. Aspiration of a foreign body
Correct Answer: B
Rationale: The classic presentation of croup includes a barking cough, stridor, and hoarseness.
The stridor often worsens with agitation or crying, as seen in this scenario. Epiglottitis typically
presents with a toxic appearance, drooling, and preference for sitting upright (tripod position),
which is not described here. Bronchiolitis usually affects infants and presents with wheezing and
crackles, not stridor. Foreign body aspiration usually has a sudden onset without preceding viral
symptoms, and the cough may not be "barking."
Q2: You are assessing a 6-month-old infant. The parents report the infant has been "breathing
fast" and "not eating well." On visual inspection, you note retractions, nasal flaring, and
grunting. Which component of the Pediatric Assessment Triangle (PAT) is most clearly
abnormal?
A. Appearance
B. Work of Breathing
C. Circulation to the Skin
D. Disability
,2
Correct Answer: B
Rationale: The Work of Breathing component of the PAT assesses the effort required to breathe.
Abnormal signs include retractions, nasal flaring, grunting, and abnormal positioning (e.g.,
tripod). While the infant's appearance might also be affected (lethargy), the specific signs listed
(retractions, flaring, grunting) are direct indicators of increased work of breathing. Circulation
and disability are not described as abnormal in this stem.
Q3: An 8-year-old child with a history of asthma presents in acute respiratory distress.
Auscultation reveals diffuse wheezing with decreased breath sounds on the right side. The child
is tachycardic and has an oxygen saturation of 88% on room air. What is the priority
intervention?
A. Administer a nebulized bronchodilator (albuterol)
B. Perform needle decompression of the chest
C. Administer systemic corticosteroids
D. Intubate immediately
Correct Answer: A
Rationale: Although the child has asymmetric breath sounds suggesting a potential complication
like pneumothorax or mucus plugging, the primary pathology is an acute asthma exacerbation.
The immediate priority is to reverse the bronchospasm with a bronchodilator. Needle
decompression is indicated for confirmed tension pneumothorax, but bronchodilator therapy is
the first-line intervention for wheezing. Steroids take time to work. Intubation is a last resort if
maximum medical therapy fails.
Q4: During the primary assessment of a pediatric patient, which finding indicates immediate life-
threatening compromise in the "Circulation" category?
A. Capillary refill time of 3 seconds
B. Blood pressure of 90/60 mm Hg in a 10-year-old
C. Weak central pulses and cool extremities
D. Heart rate of 140 bpm in a crying toddler
,3
Correct Answer: C
Rationale: In the ABCDE assessment, weak central pulses and cool extremities indicate shock
and compromised perfusion, requiring immediate intervention. While a prolonged capillary refill
(2 seconds is the upper limit of normal) is concerning, weak pulses are a more critical sign of
cardiovascular collapse. Blood pressure is a late sign of shock in children; they maintain BP until
decompensation is advanced. A heart rate of 140 bpm can be normal for a crying or stressed
toddler (normal range is roughly 80-150 bpm).
Q5: A 2-year-old child presents with sudden onset of high fever, drooling, muffled voice ("hot
potato voice"), and agitation. The child is sitting upright and leaning forward. What is the most
appropriate action?
A. Visualize the throat with a tongue depressor
B. Perform a nebulized racemic epinephrine treatment
C. Keep the child calm and avoid disturbing them; prepare for advanced airway management
D. Administer intravenous antibiotics
Correct Answer: C
Rationale: This presentation is classic for epiglottitis, which is a medical emergency due to the
risk of complete airway obstruction. Visualizing the throat or performing procedures like
nebulization can induce laryngospasm and total obstruction. The priority is to keep the child
calm, avoid invasive procedures in the emergency department, and have the equipment and
personnel ready for immediate intubation in a controlled setting (like the OR). Antibiotics are
necessary but secondary to airway security.
Q6: What is the formula for calculating the size of an uncuffed endotracheal tube (ETT) for
pediatric patients?
A. (Age in years / 4) + 3
B. (Age in years / 4) + 4
C. (Age in years / 2) + 12
D. (Age in years / 4) + 2
, 4
Correct Answer: B
Rationale: The standard formula for selecting an uncuffed ETT in children is (age in years
divided by 4) plus 4. For example, a 4-year-old would require a size (4/4)+4 = size 5.0 mm
internal diameter. For cuffed tubes, the formula is often (age/4)+3, as the cuff provides a better
seal, allowing a smaller diameter tube.
Q7: A 3-month-old infant presents with lethargy, staccato cough, and wheezing. The infant was
born at term and has no significant cardiac history. Based on the age and season, what is the most
likely cause of lower airway obstruction?
A. Asthma
B. Bronchiolitis (typically caused by RSV)
C. Foreign body aspiration
D. Pneumothorax
Correct Answer: B
Rationale: Bronchiolitis is the most common lower respiratory tract infection in infants under 2
years of age, typically caused by Respiratory Syncytial Virus (RSV). It presents with wheezing,
cough, and respiratory distress. Asthma is less common in infants under 1 year old. While
foreign body is possible, the viral prodrome and age point more strongly to bronchiolitis.
Q8: You are ventilating a 5-year-old child with a bag-mask device (BVM) during respiratory
arrest. Despite a good seal and proper head position, you notice significant chest rise but no
abdominal distention is present, and the SpO2 is not rising. What should you check next?
A. Gastric distention
B. Tube placement (intubation) if the child is intubated
C. Oxygen supply to the bag
D. Cricoid pressure
Correct Answer: C
AHA PALS Exam Questions & Answers Actual
Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
[SECTION 1: Pediatric Assessment & Respiratory Emergencies — Questions 1-15]
Q1: A 4-year-old child presents with a barking cough, stridor that worsens when crying, and a
hoarse voice. The child's assessment using the Pediatric Assessment Triangle (PAT) shows
normal work of breathing and normal appearance at rest. What is the most likely diagnosis?
A. Bronchiolitis
B. Croup (viral laryngotracheobronchitis)
C. Epiglottitis
D. Aspiration of a foreign body
Correct Answer: B
Rationale: The classic presentation of croup includes a barking cough, stridor, and hoarseness.
The stridor often worsens with agitation or crying, as seen in this scenario. Epiglottitis typically
presents with a toxic appearance, drooling, and preference for sitting upright (tripod position),
which is not described here. Bronchiolitis usually affects infants and presents with wheezing and
crackles, not stridor. Foreign body aspiration usually has a sudden onset without preceding viral
symptoms, and the cough may not be "barking."
Q2: You are assessing a 6-month-old infant. The parents report the infant has been "breathing
fast" and "not eating well." On visual inspection, you note retractions, nasal flaring, and
grunting. Which component of the Pediatric Assessment Triangle (PAT) is most clearly
abnormal?
A. Appearance
B. Work of Breathing
C. Circulation to the Skin
D. Disability
,2
Correct Answer: B
Rationale: The Work of Breathing component of the PAT assesses the effort required to breathe.
Abnormal signs include retractions, nasal flaring, grunting, and abnormal positioning (e.g.,
tripod). While the infant's appearance might also be affected (lethargy), the specific signs listed
(retractions, flaring, grunting) are direct indicators of increased work of breathing. Circulation
and disability are not described as abnormal in this stem.
Q3: An 8-year-old child with a history of asthma presents in acute respiratory distress.
Auscultation reveals diffuse wheezing with decreased breath sounds on the right side. The child
is tachycardic and has an oxygen saturation of 88% on room air. What is the priority
intervention?
A. Administer a nebulized bronchodilator (albuterol)
B. Perform needle decompression of the chest
C. Administer systemic corticosteroids
D. Intubate immediately
Correct Answer: A
Rationale: Although the child has asymmetric breath sounds suggesting a potential complication
like pneumothorax or mucus plugging, the primary pathology is an acute asthma exacerbation.
The immediate priority is to reverse the bronchospasm with a bronchodilator. Needle
decompression is indicated for confirmed tension pneumothorax, but bronchodilator therapy is
the first-line intervention for wheezing. Steroids take time to work. Intubation is a last resort if
maximum medical therapy fails.
Q4: During the primary assessment of a pediatric patient, which finding indicates immediate life-
threatening compromise in the "Circulation" category?
A. Capillary refill time of 3 seconds
B. Blood pressure of 90/60 mm Hg in a 10-year-old
C. Weak central pulses and cool extremities
D. Heart rate of 140 bpm in a crying toddler
,3
Correct Answer: C
Rationale: In the ABCDE assessment, weak central pulses and cool extremities indicate shock
and compromised perfusion, requiring immediate intervention. While a prolonged capillary refill
(2 seconds is the upper limit of normal) is concerning, weak pulses are a more critical sign of
cardiovascular collapse. Blood pressure is a late sign of shock in children; they maintain BP until
decompensation is advanced. A heart rate of 140 bpm can be normal for a crying or stressed
toddler (normal range is roughly 80-150 bpm).
Q5: A 2-year-old child presents with sudden onset of high fever, drooling, muffled voice ("hot
potato voice"), and agitation. The child is sitting upright and leaning forward. What is the most
appropriate action?
A. Visualize the throat with a tongue depressor
B. Perform a nebulized racemic epinephrine treatment
C. Keep the child calm and avoid disturbing them; prepare for advanced airway management
D. Administer intravenous antibiotics
Correct Answer: C
Rationale: This presentation is classic for epiglottitis, which is a medical emergency due to the
risk of complete airway obstruction. Visualizing the throat or performing procedures like
nebulization can induce laryngospasm and total obstruction. The priority is to keep the child
calm, avoid invasive procedures in the emergency department, and have the equipment and
personnel ready for immediate intubation in a controlled setting (like the OR). Antibiotics are
necessary but secondary to airway security.
Q6: What is the formula for calculating the size of an uncuffed endotracheal tube (ETT) for
pediatric patients?
A. (Age in years / 4) + 3
B. (Age in years / 4) + 4
C. (Age in years / 2) + 12
D. (Age in years / 4) + 2
, 4
Correct Answer: B
Rationale: The standard formula for selecting an uncuffed ETT in children is (age in years
divided by 4) plus 4. For example, a 4-year-old would require a size (4/4)+4 = size 5.0 mm
internal diameter. For cuffed tubes, the formula is often (age/4)+3, as the cuff provides a better
seal, allowing a smaller diameter tube.
Q7: A 3-month-old infant presents with lethargy, staccato cough, and wheezing. The infant was
born at term and has no significant cardiac history. Based on the age and season, what is the most
likely cause of lower airway obstruction?
A. Asthma
B. Bronchiolitis (typically caused by RSV)
C. Foreign body aspiration
D. Pneumothorax
Correct Answer: B
Rationale: Bronchiolitis is the most common lower respiratory tract infection in infants under 2
years of age, typically caused by Respiratory Syncytial Virus (RSV). It presents with wheezing,
cough, and respiratory distress. Asthma is less common in infants under 1 year old. While
foreign body is possible, the viral prodrome and age point more strongly to bronchiolitis.
Q8: You are ventilating a 5-year-old child with a bag-mask device (BVM) during respiratory
arrest. Despite a good seal and proper head position, you notice significant chest rise but no
abdominal distention is present, and the SpO2 is not rising. What should you check next?
A. Gastric distention
B. Tube placement (intubation) if the child is intubated
C. Oxygen supply to the bag
D. Cricoid pressure
Correct Answer: C
