PALS Pediatric Advanced Life Support Exam — 2026/2027
PALS PEDIATRIC ADVANCED LIFE SUPPORT EXAM —
2026/2027
This comprehensive examination consists of 50 questions designed to assess knowledge of the AHA PALS
Provider Manual (2020 Guidelines with 2023 Focused Updates). The exam covers systematic pediatric
assessment, respiratory management, shock recognition and treatment, cardiac arrest algorithms,
arrhythmia management, post-cardiac arrest care, pharmacology, team dynamics, and special
resuscitation situations. Question formats include single-best-answer multiple-choice, select-all-that-apply,
ordered response, and scenario-based clinical decision-making items. Each question includes a rationale
with evidence-based explanations.
Domain 1: Systematic Pediatric Assessment Approach (Questions 1–5)
Q1. Which of the following are the three components of the Pediatric Assessment Triangle
(PAT) used during the initial impression of a pediatric patient? (Select all that apply)
A. Appearance
B. Work of Breathing
C. Circulation to Skin
D. Glasgow Coma Scale score
Correct Answer: A, B, and C
Rationale: The Pediatric Assessment Triangle (PAT) consists of three components: Appearance, Work of
Breathing, and Circulation to Skin. These are assessed visually within seconds of first contact, without
touching the child. The Glasgow Coma Scale is part of the detailed physical examination, not the PAT.
Q2. In the primary assessment ABCDE framework, what is the correct sequential order of
evaluation?
A. Airway → Breathing → Circulation → Disability → Exposure
B. Airway → Breathing → Disability → Circulation → Exposure
C. Breathing → Airway → Circulation → Exposure → Disability
D. Disability → Airway → Breathing → Circulation → Exposure
Correct Answer: A. Airway → Breathing → Circulation → Disability → Exposure
Rationale: The correct sequence for the primary assessment in PALS is Airway, Breathing, Circulation,
Disability, and Exposure (ABCDE). This systematic approach ensures life-threatening conditions are
identified and addressed in order of priority. Airway must always be assessed and secured before
breathing, and circulation is evaluated after adequate ventilation is established.
Q3. A 4-year-old child presents to the emergency department. The team leader asks you to
perform the initial impression using the PAT. Which of the following best describes the key
difference between the PAT and the ABCDE primary assessment?
A. The PAT involves hands-on measurement of vital signs, whereas the ABCDE assessment is visual only
B. The PAT is a quick visual and auditory assessment from across the room, whereas the ABCDE involves
hands-on evaluation and interventions
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, PALS Pediatric Advanced Life Support Exam — 2026/2027
C. The PAT is performed only on infants, whereas the ABCDE is performed on children older than 1 year
D. The PAT and ABCDE are identical frameworks used interchangeably in pediatric assessment
Correct Answer: B. The PAT is a quick visual and auditory assessment from across the room,
whereas the ABCDE involves hands-on evaluation and interventions
Rationale: The Pediatric Assessment Triangle (PAT) is performed at a distance without touching the child
and provides an immediate impression of the child’s overall physiologic state. It takes only seconds. The
ABCDE primary assessment follows the PAT and involves hands-on evaluation, vital sign measurement,
and potential interventions. The PAT applies to all pediatric age groups, not just infants.
Q4. When obtaining a SAMPLE history from the parent of a pediatric patient, what does the
letter “S” represent?
A. Signs and symptoms
B. Severity of illness
C. Signs of shock
D. Sudden onset
Correct Answer: A. Signs and symptoms
Rationale: In the SAMPLE mnemonic, “S” stands for Signs and Symptoms. The full SAMPLE history
includes: Signs and Symptoms, Allergies, Medications, Past medical history, Last meal, and Events leading
to the illness or injury. This structured approach helps gather essential information efficiently during
pediatric emergency assessment.
Q5. A 6-year-old child is being resuscitated after a motor vehicle crash. The team has
completed the primary assessment and initiated interventions. How frequently should the
team perform a reassessment of the ABCDEs during ongoing resuscitation?
A. Every 30 minutes
B. After every intervention and at least every 2 minutes during CPR, or every 5 minutes for non-arrest
situations
C. Only when the patient’s condition visibly changes
D. Once at the beginning and once at the end of resuscitation
Correct Answer: B. After every intervention and at least every 2 minutes during CPR, or every
5 minutes for non-arrest situations
Rationale: Reassessment is a critical and ongoing component of PALS. The primary assessment should be
repeated after every intervention to evaluate the patient’s response. During CPR, rhythm and pulse checks
occur at least every 2 minutes. In non-arrest situations, the ABCDEs should be reassessed frequently, at
minimum every 5 minutes, and whenever there is a change in the patient’s condition. Waiting only for
visible changes delays recognition of deterioration.
Domain 2: Respiratory Distress and Failure Management (Questions 6–11)
Q6. A 3-year-old presents with a barking cough, stridor, and inspiratory chest retractions that
worsen at night. The child has a low-grade fever and appears anxious but is alert and
consolable. A 10-month-old in the next room has a sudden onset of high fever, drooling, toxic
appearance, and prefers a tripod sitting position. Which of the following correctly
differentiates these two conditions?
A. The first child has epiglottitis; the second child has croup
B. The first child has croup; the second child has epiglottitis
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, PALS Pediatric Advanced Life Support Exam — 2026/2027
C. Both children have croup with varying severity
D. Both children have bacterial tracheitis requiring IV antibiotics
Correct Answer: B. The first child has croup; the second child has epiglottitis
Rationale: The 3-year-old with a barking cough, stridor, low-grade fever, and nighttime worsening has
croup (laryngotracheobronchitis), which is typically viral and self-limiting. The 10-month-old with sudden
high fever, drooling, toxic appearance, and tripod positioning has epiglottitis, a medical emergency.
Epiglottitis is characterized by the “4 Ds”: drooling, dysphagia, dysphonia, and distress. The child with
suspected epiglottitis should not have instrumentation of the airway until prepared for emergency
intubation.
Q7. A responsive 2-year-old child is choking on a piece of candy. The child is coughing
forcefully but has stridor between coughs and appears anxious. What is the most appropriate
initial intervention?
A. Perform abdominal thrusts immediately
B. Perform back blows and chest thrusts
C. Allow the child to continue coughing and do not intervene at this time
D. Begin bag-mask ventilation to push the object down
Correct Answer: C. Allow the child to continue coughing and do not intervene at this time
Rationale: When a responsive child has a forceful cough (indicating a mild or partially obstructed
airway), the rescuer should encourage the child to continue coughing and not interfere. Abdominal thrusts,
back blows, or other interventions are indicated only when the cough becomes ineffective, the child can no
longer make sounds, or the child becomes unresponsive. Bag-mask ventilation in a patient with a foreign
body airway obstruction could push the object deeper and worsen the obstruction.
Q8. A 9-year-old with a history of asthma presents with severe respiratory distress, accessory
muscle use, SpO2 of 89% on room air, and difficulty speaking in full sentences. Which of the
following is the most appropriate initial management?
A. Administer supplemental oxygen, a nebulized short-acting beta-2 agonist (albuterol), and systemic
corticosteroids
B. Administer supplemental oxygen and observe for 30 minutes before any medications
C. Administer intravenous epinephrine and prepare for immediate intubation
D. Administer a nebulized anticholinergic (ipratropium) only, as bronchodilators are contraindicated in
acute asthma
Correct Answer: A. Administer supplemental oxygen, a nebulized short-acting beta-2 agonist
(albuterol), and systemic corticosteroids
Rationale: Initial management of a severe asthma exacerbation includes supplementary oxygen to
maintain SpO2 ≥ 94%, a short-acting beta-2 agonist (SABA) such as albuterol by nebulizer or metered-dose
inhaler with a spacer, and systemic corticosteroids (e.g., prednisolone or methylprednisolone) to reduce
airway inflammation. Ipratropium bromide may be added for severe exacerbations. Observation without
treatment is inappropriate for severe distress. IV epinephrine is not first-line. Bronchodilators are the
cornerstone of acute asthma management.
Q9. Which of the following best describes the current evidence-based management approach
for an infant with bronchiolitis caused by respiratory syncytial virus (RSV)?
A. Administer nebulized albuterol, systemic corticosteroids, and high-flow nasal cannula as first-line
therapy
3
PALS PEDIATRIC ADVANCED LIFE SUPPORT EXAM —
2026/2027
This comprehensive examination consists of 50 questions designed to assess knowledge of the AHA PALS
Provider Manual (2020 Guidelines with 2023 Focused Updates). The exam covers systematic pediatric
assessment, respiratory management, shock recognition and treatment, cardiac arrest algorithms,
arrhythmia management, post-cardiac arrest care, pharmacology, team dynamics, and special
resuscitation situations. Question formats include single-best-answer multiple-choice, select-all-that-apply,
ordered response, and scenario-based clinical decision-making items. Each question includes a rationale
with evidence-based explanations.
Domain 1: Systematic Pediatric Assessment Approach (Questions 1–5)
Q1. Which of the following are the three components of the Pediatric Assessment Triangle
(PAT) used during the initial impression of a pediatric patient? (Select all that apply)
A. Appearance
B. Work of Breathing
C. Circulation to Skin
D. Glasgow Coma Scale score
Correct Answer: A, B, and C
Rationale: The Pediatric Assessment Triangle (PAT) consists of three components: Appearance, Work of
Breathing, and Circulation to Skin. These are assessed visually within seconds of first contact, without
touching the child. The Glasgow Coma Scale is part of the detailed physical examination, not the PAT.
Q2. In the primary assessment ABCDE framework, what is the correct sequential order of
evaluation?
A. Airway → Breathing → Circulation → Disability → Exposure
B. Airway → Breathing → Disability → Circulation → Exposure
C. Breathing → Airway → Circulation → Exposure → Disability
D. Disability → Airway → Breathing → Circulation → Exposure
Correct Answer: A. Airway → Breathing → Circulation → Disability → Exposure
Rationale: The correct sequence for the primary assessment in PALS is Airway, Breathing, Circulation,
Disability, and Exposure (ABCDE). This systematic approach ensures life-threatening conditions are
identified and addressed in order of priority. Airway must always be assessed and secured before
breathing, and circulation is evaluated after adequate ventilation is established.
Q3. A 4-year-old child presents to the emergency department. The team leader asks you to
perform the initial impression using the PAT. Which of the following best describes the key
difference between the PAT and the ABCDE primary assessment?
A. The PAT involves hands-on measurement of vital signs, whereas the ABCDE assessment is visual only
B. The PAT is a quick visual and auditory assessment from across the room, whereas the ABCDE involves
hands-on evaluation and interventions
1
, PALS Pediatric Advanced Life Support Exam — 2026/2027
C. The PAT is performed only on infants, whereas the ABCDE is performed on children older than 1 year
D. The PAT and ABCDE are identical frameworks used interchangeably in pediatric assessment
Correct Answer: B. The PAT is a quick visual and auditory assessment from across the room,
whereas the ABCDE involves hands-on evaluation and interventions
Rationale: The Pediatric Assessment Triangle (PAT) is performed at a distance without touching the child
and provides an immediate impression of the child’s overall physiologic state. It takes only seconds. The
ABCDE primary assessment follows the PAT and involves hands-on evaluation, vital sign measurement,
and potential interventions. The PAT applies to all pediatric age groups, not just infants.
Q4. When obtaining a SAMPLE history from the parent of a pediatric patient, what does the
letter “S” represent?
A. Signs and symptoms
B. Severity of illness
C. Signs of shock
D. Sudden onset
Correct Answer: A. Signs and symptoms
Rationale: In the SAMPLE mnemonic, “S” stands for Signs and Symptoms. The full SAMPLE history
includes: Signs and Symptoms, Allergies, Medications, Past medical history, Last meal, and Events leading
to the illness or injury. This structured approach helps gather essential information efficiently during
pediatric emergency assessment.
Q5. A 6-year-old child is being resuscitated after a motor vehicle crash. The team has
completed the primary assessment and initiated interventions. How frequently should the
team perform a reassessment of the ABCDEs during ongoing resuscitation?
A. Every 30 minutes
B. After every intervention and at least every 2 minutes during CPR, or every 5 minutes for non-arrest
situations
C. Only when the patient’s condition visibly changes
D. Once at the beginning and once at the end of resuscitation
Correct Answer: B. After every intervention and at least every 2 minutes during CPR, or every
5 minutes for non-arrest situations
Rationale: Reassessment is a critical and ongoing component of PALS. The primary assessment should be
repeated after every intervention to evaluate the patient’s response. During CPR, rhythm and pulse checks
occur at least every 2 minutes. In non-arrest situations, the ABCDEs should be reassessed frequently, at
minimum every 5 minutes, and whenever there is a change in the patient’s condition. Waiting only for
visible changes delays recognition of deterioration.
Domain 2: Respiratory Distress and Failure Management (Questions 6–11)
Q6. A 3-year-old presents with a barking cough, stridor, and inspiratory chest retractions that
worsen at night. The child has a low-grade fever and appears anxious but is alert and
consolable. A 10-month-old in the next room has a sudden onset of high fever, drooling, toxic
appearance, and prefers a tripod sitting position. Which of the following correctly
differentiates these two conditions?
A. The first child has epiglottitis; the second child has croup
B. The first child has croup; the second child has epiglottitis
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, PALS Pediatric Advanced Life Support Exam — 2026/2027
C. Both children have croup with varying severity
D. Both children have bacterial tracheitis requiring IV antibiotics
Correct Answer: B. The first child has croup; the second child has epiglottitis
Rationale: The 3-year-old with a barking cough, stridor, low-grade fever, and nighttime worsening has
croup (laryngotracheobronchitis), which is typically viral and self-limiting. The 10-month-old with sudden
high fever, drooling, toxic appearance, and tripod positioning has epiglottitis, a medical emergency.
Epiglottitis is characterized by the “4 Ds”: drooling, dysphagia, dysphonia, and distress. The child with
suspected epiglottitis should not have instrumentation of the airway until prepared for emergency
intubation.
Q7. A responsive 2-year-old child is choking on a piece of candy. The child is coughing
forcefully but has stridor between coughs and appears anxious. What is the most appropriate
initial intervention?
A. Perform abdominal thrusts immediately
B. Perform back blows and chest thrusts
C. Allow the child to continue coughing and do not intervene at this time
D. Begin bag-mask ventilation to push the object down
Correct Answer: C. Allow the child to continue coughing and do not intervene at this time
Rationale: When a responsive child has a forceful cough (indicating a mild or partially obstructed
airway), the rescuer should encourage the child to continue coughing and not interfere. Abdominal thrusts,
back blows, or other interventions are indicated only when the cough becomes ineffective, the child can no
longer make sounds, or the child becomes unresponsive. Bag-mask ventilation in a patient with a foreign
body airway obstruction could push the object deeper and worsen the obstruction.
Q8. A 9-year-old with a history of asthma presents with severe respiratory distress, accessory
muscle use, SpO2 of 89% on room air, and difficulty speaking in full sentences. Which of the
following is the most appropriate initial management?
A. Administer supplemental oxygen, a nebulized short-acting beta-2 agonist (albuterol), and systemic
corticosteroids
B. Administer supplemental oxygen and observe for 30 minutes before any medications
C. Administer intravenous epinephrine and prepare for immediate intubation
D. Administer a nebulized anticholinergic (ipratropium) only, as bronchodilators are contraindicated in
acute asthma
Correct Answer: A. Administer supplemental oxygen, a nebulized short-acting beta-2 agonist
(albuterol), and systemic corticosteroids
Rationale: Initial management of a severe asthma exacerbation includes supplementary oxygen to
maintain SpO2 ≥ 94%, a short-acting beta-2 agonist (SABA) such as albuterol by nebulizer or metered-dose
inhaler with a spacer, and systemic corticosteroids (e.g., prednisolone or methylprednisolone) to reduce
airway inflammation. Ipratropium bromide may be added for severe exacerbations. Observation without
treatment is inappropriate for severe distress. IV epinephrine is not first-line. Bronchodilators are the
cornerstone of acute asthma management.
Q9. Which of the following best describes the current evidence-based management approach
for an infant with bronchiolitis caused by respiratory syncytial virus (RSV)?
A. Administer nebulized albuterol, systemic corticosteroids, and high-flow nasal cannula as first-line
therapy
3
