1
AHA PALS Pediatric Emergency Care Exam
2026/2027 Actual Exam | 130 Verified Questions with
Detailed Answers & Rationales | Newest Version
Graded A+ | Pass Guaranteed - A+ Graded
Section 1: Systematic Approach to Pediatric Assessment
Q1: A 3-year-old child is brought to the emergency department with respiratory distress. Using
the Pediatric Assessment Triangle (PAT), which of the following components is assessed FIRST?
A. Airway patency and breath sounds
B. Appearance, work of breathing, and circulation to skin [CORRECT]
C. Blood pressure and heart rate
D. Oxygen saturation and capnography
Correct Answer: B
Rationale: The Pediatric Assessment Triangle (PAT) is a rapid, hands-off assessment evaluating
appearance, work of breathing, and circulation to skin. This initial assessment takes 30-60
seconds and guides the urgency of intervention. Options A, C, and D are part of the primary and
secondary assessments which require "hands-on" evaluation.
Q2: A 2-year-old child presents with lethargy, nasal flaring, and intercostal retractions. The
child's skin is pale and capillary refill is 3 seconds. According to the PAT, this child has:
A. Normal appearance, abnormal breathing, normal circulation
B. Abnormal appearance, abnormal breathing, abnormal circulation [CORRECT]
C. Abnormal appearance, normal breathing, abnormal circulation
D. Normal appearance, normal breathing, abnormal circulation
Correct Answer: B
,2
Rationale: The PAT reveals abnormal appearance (lethargy), abnormal work of breathing (nasal
flaring, retractions), and abnormal circulation to skin (pale, delayed capillary refill). This
indicates a critically ill child requiring immediate intervention.
Q3: The "TICLS" mnemonic is used to assess the "Appearance" arm of the Pediatric Assessment
Triangle. What does the "I" stand for?
A. Irritability
B. Interactivity [CORRECT]
C. Intubation
D. Inspection
Correct Answer: B
Rationale: TICLS stands for Tone, Interactivity, Consolability, Look/Gaze, and Speech/Cry.
"Interactivity" assesses the child's ability to interact with the environment or examiner.
Q4: During the Primary Assessment (ABCDE), a nurse assesses a 5-year-old child. Which
finding indicates the need for immediate intervention?
A. Respiratory rate of 28 breaths/min
B. Heart rate of 110 beats/min
C. Capillary refill of 5 seconds [CORRECT]
D. Blood pressure of 95/60 mmHg
Correct Answer: C
Rationale: Capillary refill should be <2 seconds in a warm environment. A refill time of 5
seconds indicates significant poor perfusion and shock. The respiratory rate (A) and heart rate
(B) are within normal limits for a 5-year-old. The blood pressure (D) is normal.
Q5: A 6-month-old infant is assessed using the AVPU scale. The infant opens eyes only when
touched but does not track the examiner. How would this level of consciousness be documented?
A. Alert
,3
B. Verbal
C. Pain [CORRECT]
D. Unresponsive
Correct Answer: C
Rationale: AVPU stands for Alert, Verbal, Pain, Unresponsive. If the infant only opens eyes to
tactile stimulation (touch/pain), it corresponds to "Pain" or a response to physical stimuli.
"Verbal" would be response to voice.
Q6: Which of the following is the correct formula for estimating the lower limit of normal
systolic blood pressure (5th percentile) in children aged 1-10 years?
A. 70 + (2 × age in years) [CORRECT]
B. 80 + (2 × age in years)
C. 90 + (age in years)
D. 100 + (age in years)
Correct Answer: A
Rationale: The formula for the 5th percentile lower limit is 70 + (2 × age in years). Hypotension
is defined as systolic BP less than this value. For children >1 year, 70 + 2(age) is standard.
Q7: When obtaining a SAMPLE history during the secondary assessment, what does the "M"
stand for?
A. Mechanism of injury
B. Medications [CORRECT]
C. Medical history
D. Meals
Correct Answer: B
, 4
Rationale: SAMPLE stands for Signs/Symptoms, Allergies, Medications, Past medical history,
Last meal, and Events leading to the illness/injury.
Q8: A 10-year-old child is being evaluated for shock. The cardiac monitor shows a narrow QRS
complex tachycardia. To differentiate Sinus Tachycardia from Supraventricular Tachycardia
(SVT), the nurse should look for:
A. Heart rate > 180 bpm
B. Presence of P waves and variability in heart rate [CORRECT]
C. Abrupt onset and termination
D. History of fever or dehydration
Correct Answer: B
Rationale: Sinus Tachycardia typically has visible P waves, a rate usually <180 in children
(though variable), and variability with breathing/stimulation. SVT is usually fixed rate, often
>220 in infants, with absent or abnormal P waves and abrupt onset.
Q9: Which of the following is a "hands-on" component of the Primary Assessment?
A. Work of breathing
B. Circulation to skin
C. Disability (AVPU) [CORRECT]
D. Appearance
Correct Answer: C
Rationale: The Primary Assessment is the "hands-on" ABCDE assessment (Airway, Breathing,
Circulation, Disability, Exposure). Work of breathing, Appearance, and Circulation to skin are
the 3 components of the "hands-off" PAT.
Q10: A capnography waveform shows a sudden drop in ETCO2 from 40 mmHg to 20 mmHg in
a ventilated patient. What does this indicate?
A. Improved perfusion
AHA PALS Pediatric Emergency Care Exam
2026/2027 Actual Exam | 130 Verified Questions with
Detailed Answers & Rationales | Newest Version
Graded A+ | Pass Guaranteed - A+ Graded
Section 1: Systematic Approach to Pediatric Assessment
Q1: A 3-year-old child is brought to the emergency department with respiratory distress. Using
the Pediatric Assessment Triangle (PAT), which of the following components is assessed FIRST?
A. Airway patency and breath sounds
B. Appearance, work of breathing, and circulation to skin [CORRECT]
C. Blood pressure and heart rate
D. Oxygen saturation and capnography
Correct Answer: B
Rationale: The Pediatric Assessment Triangle (PAT) is a rapid, hands-off assessment evaluating
appearance, work of breathing, and circulation to skin. This initial assessment takes 30-60
seconds and guides the urgency of intervention. Options A, C, and D are part of the primary and
secondary assessments which require "hands-on" evaluation.
Q2: A 2-year-old child presents with lethargy, nasal flaring, and intercostal retractions. The
child's skin is pale and capillary refill is 3 seconds. According to the PAT, this child has:
A. Normal appearance, abnormal breathing, normal circulation
B. Abnormal appearance, abnormal breathing, abnormal circulation [CORRECT]
C. Abnormal appearance, normal breathing, abnormal circulation
D. Normal appearance, normal breathing, abnormal circulation
Correct Answer: B
,2
Rationale: The PAT reveals abnormal appearance (lethargy), abnormal work of breathing (nasal
flaring, retractions), and abnormal circulation to skin (pale, delayed capillary refill). This
indicates a critically ill child requiring immediate intervention.
Q3: The "TICLS" mnemonic is used to assess the "Appearance" arm of the Pediatric Assessment
Triangle. What does the "I" stand for?
A. Irritability
B. Interactivity [CORRECT]
C. Intubation
D. Inspection
Correct Answer: B
Rationale: TICLS stands for Tone, Interactivity, Consolability, Look/Gaze, and Speech/Cry.
"Interactivity" assesses the child's ability to interact with the environment or examiner.
Q4: During the Primary Assessment (ABCDE), a nurse assesses a 5-year-old child. Which
finding indicates the need for immediate intervention?
A. Respiratory rate of 28 breaths/min
B. Heart rate of 110 beats/min
C. Capillary refill of 5 seconds [CORRECT]
D. Blood pressure of 95/60 mmHg
Correct Answer: C
Rationale: Capillary refill should be <2 seconds in a warm environment. A refill time of 5
seconds indicates significant poor perfusion and shock. The respiratory rate (A) and heart rate
(B) are within normal limits for a 5-year-old. The blood pressure (D) is normal.
Q5: A 6-month-old infant is assessed using the AVPU scale. The infant opens eyes only when
touched but does not track the examiner. How would this level of consciousness be documented?
A. Alert
,3
B. Verbal
C. Pain [CORRECT]
D. Unresponsive
Correct Answer: C
Rationale: AVPU stands for Alert, Verbal, Pain, Unresponsive. If the infant only opens eyes to
tactile stimulation (touch/pain), it corresponds to "Pain" or a response to physical stimuli.
"Verbal" would be response to voice.
Q6: Which of the following is the correct formula for estimating the lower limit of normal
systolic blood pressure (5th percentile) in children aged 1-10 years?
A. 70 + (2 × age in years) [CORRECT]
B. 80 + (2 × age in years)
C. 90 + (age in years)
D. 100 + (age in years)
Correct Answer: A
Rationale: The formula for the 5th percentile lower limit is 70 + (2 × age in years). Hypotension
is defined as systolic BP less than this value. For children >1 year, 70 + 2(age) is standard.
Q7: When obtaining a SAMPLE history during the secondary assessment, what does the "M"
stand for?
A. Mechanism of injury
B. Medications [CORRECT]
C. Medical history
D. Meals
Correct Answer: B
, 4
Rationale: SAMPLE stands for Signs/Symptoms, Allergies, Medications, Past medical history,
Last meal, and Events leading to the illness/injury.
Q8: A 10-year-old child is being evaluated for shock. The cardiac monitor shows a narrow QRS
complex tachycardia. To differentiate Sinus Tachycardia from Supraventricular Tachycardia
(SVT), the nurse should look for:
A. Heart rate > 180 bpm
B. Presence of P waves and variability in heart rate [CORRECT]
C. Abrupt onset and termination
D. History of fever or dehydration
Correct Answer: B
Rationale: Sinus Tachycardia typically has visible P waves, a rate usually <180 in children
(though variable), and variability with breathing/stimulation. SVT is usually fixed rate, often
>220 in infants, with absent or abnormal P waves and abrupt onset.
Q9: Which of the following is a "hands-on" component of the Primary Assessment?
A. Work of breathing
B. Circulation to skin
C. Disability (AVPU) [CORRECT]
D. Appearance
Correct Answer: C
Rationale: The Primary Assessment is the "hands-on" ABCDE assessment (Airway, Breathing,
Circulation, Disability, Exposure). Work of breathing, Appearance, and Circulation to skin are
the 3 components of the "hands-off" PAT.
Q10: A capnography waveform shows a sudden drop in ETCO2 from 40 mmHg to 20 mmHg in
a ventilated patient. What does this indicate?
A. Improved perfusion
