AHA Pediatric Advanced Life Support (PALS) Exam AHA PALS | 2026/2027 Edition | Answered
AHA Pediatric Advanced Life Support (PALS) Exam
PALS Exam (Answered) — Verified Questions & A+ Graded Rationales
American Heart Association | Latest 2026/2027 Edition
Total Questions 75 Time Limit 90 minutes
Total Points 75 Passing Score A+ (≥ 84%)
Format Multiple Choice (A-D) Cognitive Mix 25% recall / 55% application / 20% analysis
Question Style 80% scenario-based, 20% direct recallEdition 2026/2027 (current)
Examination Instructions
This examination is designed to assess mastery of the AHA Pediatric Advanced Life Support (PALS) course
objectives for the 2026-2027 academic year. The exam contains 75 multiple-choice questions across six sections:
(1) Pediatric Assessment and Recognition of Respiratory Distress/Failure; (2) Pediatric Cardiac Arrest and Shock
Management; (3) Pediatric Respiratory and Cardiovascular Emergencies; (4) Pediatric Pharmacology and Special
Considerations; (5) Post-Resuscitation Care and Team Dynamics; and (6) Special Resuscitation Scenarios. Each
question presents four options (A, B, C, D) with exactly one best answer. Questions are written using an 80%
scenario-based and 20% direct recall distribution, and cognitive levels follow the 25% recall / 55% application /
20% analysis framework. Read each stem carefully. Mark the single best response by identifying the option
designated with the [CORRECT] marker, which is the verified answer key. After each question, a detailed
PALS/AHA-specific rationale is provided that explains why the correct answer is best and why the other options
are incorrect, including AHA algorithm steps, physiology, pharmacology, and team dynamics. Distractors are
engineered around common AHA PALS exam pitfalls (incorrect respiratory failure vs. distress identification,
algorithm sequence errors, medication dosing mistakes, rhythm misidentification, defibrillation dose errors,
shock vs. respiratory cause confusion, and team communication failures) to test essential pediatric emergency
clinical reasoning. Question content aligns with current AHA PALS Provider Manual and 2026/2027 updates.
Section Domain Question Range # Qs
1 Pediatric Assessment and Recognition of Respiratory Distress/Failure
Q1 — Q15 15
2 Pediatric Cardiac Arrest and Shock Management Q16 — Q30 15
3 Pediatric Respiratory and Cardiovascular Emergencies Q31 — Q45 15
4 Pediatric Pharmacology and Special Considerations Q46 — Q55 10
5 Post-Resuscitation Care and Team Dynamics Q56 — Q65 10
6 Special Resuscitation Scenarios Q66 — Q75 10
Verified AHA PALS Provider Exam | Latest 2026/2027 Page 1
,AHA Pediatric Advanced Life Support (PALS) Exam AHA PALS | 2026/2027 Edition | Answered
TOTAL 75
Section 1: Pediatric Assessment and Recognition of Respiratory Distress/Failure
Q1 — Q15 | 15 Questions | PAT, Primary/Secondary Survey, Respiratory Distress vs. Failure
This section evaluates application of the Pediatric Assessment Triangle (PAT: Appearance, Work of Breathing,
Circulation to Skin), Primary Survey (ABCDE), and Secondary Survey, with emphasis on differentiating
respiratory distress from respiratory failure and identifying the physiologic compensatory stage that precedes
cardiopulmonary collapse. Per AHA PALS 2026/2027, the PAT provides the initial 'across-the-room' impression
and guides the pace of intervention.
Q1. An 18-month-old is brought to the emergency department with respiratory symptoms. On the
PAT, the child appears listless with little spontaneous movement, has audible grunting and marked
retractions, and is pale with cool extremities. Which interpretation best describes this presentation?
A. Respiratory distress with adequate perfusion, managed with humidified oxygen and outpatient
observation
B. Respiratory failure with physiologic compensation; the PAT indicates Appearance (abnormal),
Work of breathing (abnormal), and Circulation (abnormal) — a 'sick' child requiring immediate
escalation of care [CORRECT]
C. Stable upper airway obstruction managed supportively without need for airway intervention
D. Mild dehydration with normal respiratory findings, requiring oral rehydration alone
Correct Answer: B
Rationale: The PAT components (Appearance, Work of Breathing, Circulation) are all abnormal — listlessness,
retractions with grunting, and pallor with cool extremities — indicating decompensated respiratory failure with shock
physiology, the 'sick child' who requires immediate escalation. Respiratory distress with adequate perfusion would
show normal Appearance and Circulation, and the other options underestimate the severity indicated by the abnormal
PAT.
Verified AHA PALS Provider Exam | Latest 2026/2027 Page 2
, AHA Pediatric Advanced Life Support (PALS) Exam AHA PALS | 2026/2027 Edition | Answered
Q2. A 4-year-old with suspected pneumonia has the following PAT findings: normal interaction with
parents, intermittent nasal flaring with mild subcostal retractions, and pink, warm skin with brisk
capillary refill. Which best characterizes the child's status and the next step?
A. Respiratory distress; proceed to Primary Survey (ABCDE) and provide supplemental oxygen
while continuing evaluation [CORRECT]
B. Respiratory failure; prepare for immediate endotracheal intubation
C. Cardiopulmonary failure; initiate chest compressions without delay
D. Stable; discharge home with reassurance and supportive care
Correct Answer: A
Rationale: A normal Appearance (interactive), abnormal Work of Breathing (nasal flaring, retractions), and normal
Circulation (pink, warm, brisk refill) indicate respiratory distress with preserved perfusion — the child is
compensating and requires prompt Primary Survey and oxygen therapy. Respiratory failure would include abnormal
Appearance or Circulation (cyanosis, lethargy); immediate intubation or compressions are reserved for failure or
arrest.
Q3. During the Primary Survey (ABCDE) of a 6-year-old in respiratory distress, you note inspiratory
stridor at rest, moderate retractions, oxygen saturation 90% on room air, and equal but diminished
breath sounds. Which Primary Survey component is the priority concern?
A. Airway — partial upper airway obstruction requiring immediate airway positioning, humidified
oxygen, and preparation for advanced airway management [CORRECT]
B. Breathing — lower airway bronchospasm requiring bronchodilator therapy
C. Circulation — fluid bolus of 20 mL/kg isotonic crystalloid
D. Disability — immediate administration of naloxone for opioid reversal
Correct Answer: A
Rationale: Inspiratory stridor at rest signals upper airway obstruction (e.g., croup, foreign body, epiglottitis); within
ABCDE, Airway is the priority because without a patent airway, Breathing and Circulation cannot be supported. The
AHA PALS algorithm directs minimal stimulation, positioning, humidified oxygen, and preparation for advanced
airway if obstruction worsens. Bronchodilators target lower airway disease, fluid bolus treats shock not airway
obstruction, and naloxone is for opioid-induced respiratory depression.
Verified AHA PALS Provider Exam | Latest 2026/2027 Page 3
AHA Pediatric Advanced Life Support (PALS) Exam
PALS Exam (Answered) — Verified Questions & A+ Graded Rationales
American Heart Association | Latest 2026/2027 Edition
Total Questions 75 Time Limit 90 minutes
Total Points 75 Passing Score A+ (≥ 84%)
Format Multiple Choice (A-D) Cognitive Mix 25% recall / 55% application / 20% analysis
Question Style 80% scenario-based, 20% direct recallEdition 2026/2027 (current)
Examination Instructions
This examination is designed to assess mastery of the AHA Pediatric Advanced Life Support (PALS) course
objectives for the 2026-2027 academic year. The exam contains 75 multiple-choice questions across six sections:
(1) Pediatric Assessment and Recognition of Respiratory Distress/Failure; (2) Pediatric Cardiac Arrest and Shock
Management; (3) Pediatric Respiratory and Cardiovascular Emergencies; (4) Pediatric Pharmacology and Special
Considerations; (5) Post-Resuscitation Care and Team Dynamics; and (6) Special Resuscitation Scenarios. Each
question presents four options (A, B, C, D) with exactly one best answer. Questions are written using an 80%
scenario-based and 20% direct recall distribution, and cognitive levels follow the 25% recall / 55% application /
20% analysis framework. Read each stem carefully. Mark the single best response by identifying the option
designated with the [CORRECT] marker, which is the verified answer key. After each question, a detailed
PALS/AHA-specific rationale is provided that explains why the correct answer is best and why the other options
are incorrect, including AHA algorithm steps, physiology, pharmacology, and team dynamics. Distractors are
engineered around common AHA PALS exam pitfalls (incorrect respiratory failure vs. distress identification,
algorithm sequence errors, medication dosing mistakes, rhythm misidentification, defibrillation dose errors,
shock vs. respiratory cause confusion, and team communication failures) to test essential pediatric emergency
clinical reasoning. Question content aligns with current AHA PALS Provider Manual and 2026/2027 updates.
Section Domain Question Range # Qs
1 Pediatric Assessment and Recognition of Respiratory Distress/Failure
Q1 — Q15 15
2 Pediatric Cardiac Arrest and Shock Management Q16 — Q30 15
3 Pediatric Respiratory and Cardiovascular Emergencies Q31 — Q45 15
4 Pediatric Pharmacology and Special Considerations Q46 — Q55 10
5 Post-Resuscitation Care and Team Dynamics Q56 — Q65 10
6 Special Resuscitation Scenarios Q66 — Q75 10
Verified AHA PALS Provider Exam | Latest 2026/2027 Page 1
,AHA Pediatric Advanced Life Support (PALS) Exam AHA PALS | 2026/2027 Edition | Answered
TOTAL 75
Section 1: Pediatric Assessment and Recognition of Respiratory Distress/Failure
Q1 — Q15 | 15 Questions | PAT, Primary/Secondary Survey, Respiratory Distress vs. Failure
This section evaluates application of the Pediatric Assessment Triangle (PAT: Appearance, Work of Breathing,
Circulation to Skin), Primary Survey (ABCDE), and Secondary Survey, with emphasis on differentiating
respiratory distress from respiratory failure and identifying the physiologic compensatory stage that precedes
cardiopulmonary collapse. Per AHA PALS 2026/2027, the PAT provides the initial 'across-the-room' impression
and guides the pace of intervention.
Q1. An 18-month-old is brought to the emergency department with respiratory symptoms. On the
PAT, the child appears listless with little spontaneous movement, has audible grunting and marked
retractions, and is pale with cool extremities. Which interpretation best describes this presentation?
A. Respiratory distress with adequate perfusion, managed with humidified oxygen and outpatient
observation
B. Respiratory failure with physiologic compensation; the PAT indicates Appearance (abnormal),
Work of breathing (abnormal), and Circulation (abnormal) — a 'sick' child requiring immediate
escalation of care [CORRECT]
C. Stable upper airway obstruction managed supportively without need for airway intervention
D. Mild dehydration with normal respiratory findings, requiring oral rehydration alone
Correct Answer: B
Rationale: The PAT components (Appearance, Work of Breathing, Circulation) are all abnormal — listlessness,
retractions with grunting, and pallor with cool extremities — indicating decompensated respiratory failure with shock
physiology, the 'sick child' who requires immediate escalation. Respiratory distress with adequate perfusion would
show normal Appearance and Circulation, and the other options underestimate the severity indicated by the abnormal
PAT.
Verified AHA PALS Provider Exam | Latest 2026/2027 Page 2
, AHA Pediatric Advanced Life Support (PALS) Exam AHA PALS | 2026/2027 Edition | Answered
Q2. A 4-year-old with suspected pneumonia has the following PAT findings: normal interaction with
parents, intermittent nasal flaring with mild subcostal retractions, and pink, warm skin with brisk
capillary refill. Which best characterizes the child's status and the next step?
A. Respiratory distress; proceed to Primary Survey (ABCDE) and provide supplemental oxygen
while continuing evaluation [CORRECT]
B. Respiratory failure; prepare for immediate endotracheal intubation
C. Cardiopulmonary failure; initiate chest compressions without delay
D. Stable; discharge home with reassurance and supportive care
Correct Answer: A
Rationale: A normal Appearance (interactive), abnormal Work of Breathing (nasal flaring, retractions), and normal
Circulation (pink, warm, brisk refill) indicate respiratory distress with preserved perfusion — the child is
compensating and requires prompt Primary Survey and oxygen therapy. Respiratory failure would include abnormal
Appearance or Circulation (cyanosis, lethargy); immediate intubation or compressions are reserved for failure or
arrest.
Q3. During the Primary Survey (ABCDE) of a 6-year-old in respiratory distress, you note inspiratory
stridor at rest, moderate retractions, oxygen saturation 90% on room air, and equal but diminished
breath sounds. Which Primary Survey component is the priority concern?
A. Airway — partial upper airway obstruction requiring immediate airway positioning, humidified
oxygen, and preparation for advanced airway management [CORRECT]
B. Breathing — lower airway bronchospasm requiring bronchodilator therapy
C. Circulation — fluid bolus of 20 mL/kg isotonic crystalloid
D. Disability — immediate administration of naloxone for opioid reversal
Correct Answer: A
Rationale: Inspiratory stridor at rest signals upper airway obstruction (e.g., croup, foreign body, epiglottitis); within
ABCDE, Airway is the priority because without a patent airway, Breathing and Circulation cannot be supported. The
AHA PALS algorithm directs minimal stimulation, positioning, humidified oxygen, and preparation for advanced
airway if obstruction worsens. Bronchodilators target lower airway disease, fluid bolus treats shock not airway
obstruction, and naloxone is for opioid-induced respiratory depression.
Verified AHA PALS Provider Exam | Latest 2026/2027 Page 3
