AHA PALS EXAM – AMERICAN HEART ASSOCIATION
(AHA) / AMERICAN ACADEMY OF PEDIATRICS (AAP)
– 2026/2027 EDITION!!!
Section 1: Fundamentals of Nursing (Questions 1-50)
1. A nurse is caring for a client who is post-operative day 1 following a total
hip arthroplasty. Which of the following actions is the priority to prevent a
pulmonary embolism?
A) Apply sequential compression devices (SCDs).
B) Administer prescribed enoxaparin.
C) Encourage incentive spirometry use.
D) Assist the client with early ambulation.
Answer: B) Administer prescribed enoxaparin.
Rationale: While all options are important interventions, the administration of
prophylactic anticoagulation (enoxaparin) is the most direct and effective
pharmacological method to prevent venous thromboembolism (VTE) and
subsequent pulmonary embolism in a high-risk client. This is a priority action
based on Maslow's hierarchy (physiological/medication administration) and
safety.
2. The nurse is performing a skin assessment on an elderly client with dark
skin pigmentation. Which of the following findings is an early indication of a
stage 1 pressure injury?
A) Blanchable erythema.
B) A localized area of purple or maroon discoloration.
C) Non-blanchable erythema.
,D) Intact skin with a temperature difference.
Answer: D) Intact skin with a temperature difference.
Rationale: In clients with dark skin, the classic "non-blanchable erythema"
may not be visible. The first signs often include changes in skin temperature
(warmth or coolness), tissue consistency (firm or boggy), or sensation (pain
or itching) compared to adjacent tissue. A purple/maroon area indicates a
deep tissue injury, which is more severe.
3. A client is receiving a continuous enteral feeding via a nasogastric tube.
Which of the following nursing interventions is most important to prevent
aspiration?
A) Check gastric residual volumes every 4 hours.
B) Elevate the head of the bed to at least 30 degrees.
C) Change the feeding bag and tubing every 24 hours.
D) Flush the tube with 30 mL of water every 4 hours.
Answer: B) Elevate the head of the bed to at least 30 degrees.
Rationale: Elevating the head of the bed (HOB) to 30-45 degrees is the
primary intervention to prevent aspiration of gastric contents. While checking
residual volumes is also important, HOB elevation is a direct physical barrier
to reflux and is considered a standard of care for all clients receiving enteral
feedings.
4. A nurse is preparing to administer a medication via a nasogastric tube.
Which of the following actions should the nurse take first?
A) Crush all enteric-coated tablets.
B) Confirm the placement of the tube.
C) Dilute the medication with sterile water.
D) Flush the tube with 50 mL of air.
,Answer: B) Confirm the placement of the tube.
Rationale: Patient safety is the priority. Before administering any medication
through a nasogastric tube, the nurse must first verify the correct placement
of the tube (e.g., by aspirating gastric contents and checking pH or by X-ray) to
prevent accidental administration into the lungs. Enteric-coated tablets
should not be crushed.
5. The nurse is educating a client on fall prevention strategies. Which
statement by the client indicates a need for further teaching?
A) "I should wear my non-skid socks when walking."
B) "I will keep my room well-lit, especially at night."
C) "I will keep my walker within easy reach of my bed."
D) "I will leave my bed in the high position to make it easier to get out."
Answer: D) "I will leave my bed in the high position to make it easier to get
out."
Rationale: The bed should be in the lowest position to reduce the distance and
impact of a fall. Leaving the bed in a high position increases the risk of injury.
The other options are correct fall prevention strategies.
6. A client is diagnosed with a terminal illness and has a Do Not Resuscitate
(DNR) order. The client becomes unresponsive and stops breathing. Which of
the following is the nurse's priority action?
A) Begin chest compressions.
B) Call a code blue.
C) Provide emotional support to the family.
D) Ensure the DNR order is valid and documented.
Answer: D) Ensure the DNR order is valid and documented.
, Rationale: The nurse must first verify the DNR order. If the order is valid, the
nurse should not initiate CPR. The priority is to confirm the legal and medical
document to guide the appropriate end-of-life care actions and then provide
support.
7. A client is receiving a blood transfusion. Fifteen minutes after the start of
the transfusion, the client reports chills, low back pain, and feeling flushed.
What is the nurse's priority action?
A) Slow the infusion rate.
B) Stop the transfusion.
C) Administer diphenhydramine.
D) Notify the healthcare provider.
Answer: B) Stop the transfusion.
Rationale: These are classic signs of a hemolytic transfusion reaction (an acute
immune reaction). The priority is to stop the transfusion immediately to
prevent further infusion of incompatible blood, maintain IV access with
normal saline, and then notify the provider.
8. The nurse is assessing a client's pain using the PQRST method. What does
the "R" in PQRST stand for?
A) Region and Radiation
B) Relief and Rating
C) Risk factors
D) Reaction
Answer: A) Region and Radiation
Rationale: PQRST is a mnemonic for pain assessment: P
(Provocation/Palliation), Q (Quality/Quantity), R (Region/Radiation), S
(Severity Scale), and T (Timing).
(AHA) / AMERICAN ACADEMY OF PEDIATRICS (AAP)
– 2026/2027 EDITION!!!
Section 1: Fundamentals of Nursing (Questions 1-50)
1. A nurse is caring for a client who is post-operative day 1 following a total
hip arthroplasty. Which of the following actions is the priority to prevent a
pulmonary embolism?
A) Apply sequential compression devices (SCDs).
B) Administer prescribed enoxaparin.
C) Encourage incentive spirometry use.
D) Assist the client with early ambulation.
Answer: B) Administer prescribed enoxaparin.
Rationale: While all options are important interventions, the administration of
prophylactic anticoagulation (enoxaparin) is the most direct and effective
pharmacological method to prevent venous thromboembolism (VTE) and
subsequent pulmonary embolism in a high-risk client. This is a priority action
based on Maslow's hierarchy (physiological/medication administration) and
safety.
2. The nurse is performing a skin assessment on an elderly client with dark
skin pigmentation. Which of the following findings is an early indication of a
stage 1 pressure injury?
A) Blanchable erythema.
B) A localized area of purple or maroon discoloration.
C) Non-blanchable erythema.
,D) Intact skin with a temperature difference.
Answer: D) Intact skin with a temperature difference.
Rationale: In clients with dark skin, the classic "non-blanchable erythema"
may not be visible. The first signs often include changes in skin temperature
(warmth or coolness), tissue consistency (firm or boggy), or sensation (pain
or itching) compared to adjacent tissue. A purple/maroon area indicates a
deep tissue injury, which is more severe.
3. A client is receiving a continuous enteral feeding via a nasogastric tube.
Which of the following nursing interventions is most important to prevent
aspiration?
A) Check gastric residual volumes every 4 hours.
B) Elevate the head of the bed to at least 30 degrees.
C) Change the feeding bag and tubing every 24 hours.
D) Flush the tube with 30 mL of water every 4 hours.
Answer: B) Elevate the head of the bed to at least 30 degrees.
Rationale: Elevating the head of the bed (HOB) to 30-45 degrees is the
primary intervention to prevent aspiration of gastric contents. While checking
residual volumes is also important, HOB elevation is a direct physical barrier
to reflux and is considered a standard of care for all clients receiving enteral
feedings.
4. A nurse is preparing to administer a medication via a nasogastric tube.
Which of the following actions should the nurse take first?
A) Crush all enteric-coated tablets.
B) Confirm the placement of the tube.
C) Dilute the medication with sterile water.
D) Flush the tube with 50 mL of air.
,Answer: B) Confirm the placement of the tube.
Rationale: Patient safety is the priority. Before administering any medication
through a nasogastric tube, the nurse must first verify the correct placement
of the tube (e.g., by aspirating gastric contents and checking pH or by X-ray) to
prevent accidental administration into the lungs. Enteric-coated tablets
should not be crushed.
5. The nurse is educating a client on fall prevention strategies. Which
statement by the client indicates a need for further teaching?
A) "I should wear my non-skid socks when walking."
B) "I will keep my room well-lit, especially at night."
C) "I will keep my walker within easy reach of my bed."
D) "I will leave my bed in the high position to make it easier to get out."
Answer: D) "I will leave my bed in the high position to make it easier to get
out."
Rationale: The bed should be in the lowest position to reduce the distance and
impact of a fall. Leaving the bed in a high position increases the risk of injury.
The other options are correct fall prevention strategies.
6. A client is diagnosed with a terminal illness and has a Do Not Resuscitate
(DNR) order. The client becomes unresponsive and stops breathing. Which of
the following is the nurse's priority action?
A) Begin chest compressions.
B) Call a code blue.
C) Provide emotional support to the family.
D) Ensure the DNR order is valid and documented.
Answer: D) Ensure the DNR order is valid and documented.
, Rationale: The nurse must first verify the DNR order. If the order is valid, the
nurse should not initiate CPR. The priority is to confirm the legal and medical
document to guide the appropriate end-of-life care actions and then provide
support.
7. A client is receiving a blood transfusion. Fifteen minutes after the start of
the transfusion, the client reports chills, low back pain, and feeling flushed.
What is the nurse's priority action?
A) Slow the infusion rate.
B) Stop the transfusion.
C) Administer diphenhydramine.
D) Notify the healthcare provider.
Answer: B) Stop the transfusion.
Rationale: These are classic signs of a hemolytic transfusion reaction (an acute
immune reaction). The priority is to stop the transfusion immediately to
prevent further infusion of incompatible blood, maintain IV access with
normal saline, and then notify the provider.
8. The nurse is assessing a client's pain using the PQRST method. What does
the "R" in PQRST stand for?
A) Region and Radiation
B) Relief and Rating
C) Risk factors
D) Reaction
Answer: A) Region and Radiation
Rationale: PQRST is a mnemonic for pain assessment: P
(Provocation/Palliation), Q (Quality/Quantity), R (Region/Radiation), S
(Severity Scale), and T (Timing).
