AHA PALS EXAM – NEWEST 2025/2026 ACTUAL EXAM TEST
BANK
50 Verified Questions with Detailed Answers and Rationales | A+ Graded | Latest Version
1. A 4-year-old child is brought to the emergency department with severe respiratory distress, stridor, and
drooling. The child is sitting upright and leaning forward. What is the most appropriate initial intervention?
A. Obtain a lateral neck X-ray
B. Perform direct laryngoscopy
C. Administer nebulized racemic epinephrine
D. Prepare for immediate tracheal intubation
Correct Answer: D
Rationale: This presentation is classic for acute epiglottitis, which can rapidly cause airway obstruction. Immediate
airway management (intubation) is the priority. X-rays and nebulized epinephrine are delayed; laryngoscopy may
precipitate complete obstruction.
2. A 6-month-old infant with bronchiolitis has a respiratory rate of 72/min, heart rate 180/min, and SpO2 88% on
room air. The infant is irritable, with nasal flaring and retractions. What is the most appropriate initial therapy?
A. Intubation and mechanical ventilation
B. Nebulized albuterol
C. Supplemental oxygen via nasal cannula
D. Chest physiotherapy
Correct Answer: C
Rationale: Hypoxemia (SpO2 <90%) with increased work of breathing warrants supplemental oxygen. Albuterol may be
used if wheezing, but oxygen is the priority. Intubation is for respiratory failure; chest physiotherapy is not acute.
3. A 2-year-old child presents with a 3-day history of fever, cough, and now worsening respiratory distress. Chest
X-ray shows right upper lobe consolidation. Which pathogen is most likely?
A. Respiratory syncytial virus
B. Streptococcus pneumoniae
C. Mycoplasma pneumoniae
D. Bordetella pertussis
Correct Answer: B
Rationale: Lobar consolidation in a toddler is classic for bacterial pneumonia, most commonly Streptococcus
pneumoniae. RSV typically causes bronchiolitis; Mycoplasma is more common in older children; pertussis presents with
paroxysmal cough.
4. A 10-year-old child with asthma presents with a severe exacerbation. The child is unable to speak in full
sentences, has a silent chest, and is diaphoretic. What is the most appropriate immediate management?
A. Continuous albuterol nebulization and IV corticosteroids
B. Inhaled corticosteroids
C. Oral corticosteroids
D. Heliox therapy
, Correct Answer: A
Rationale: Life-threatening asthma with silent chest requires aggressive therapy: continuous albuterol and systemic
corticosteroids. Inhaled steroids are for maintenance; Heliox may be used but not first-line.
5. A 3-year-old child is in cardiac arrest. The rhythm is asystole. What is the most appropriate drug and dose for
initial treatment?
A. Epinephrine 0.1 mg/kg IV
B. Epinephrine 0.01 mg/kg IV
C. Atropine 0.02 mg/kg IV
D. Amiodarone 5 mg/kg IV
Correct Answer: B
Rationale: For pediatric cardiac arrest, epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) is the first-line drug for asystole
and PEA. Atropine is not recommended for asystole; amiodarone is for shock-refractory VF/pVT.
6. An 8-year-old child with a history of congenital heart disease presents with sudden-onset palpitations, dizziness,
and a heart rate of 220/min. ECG shows a regular, narrow-complex tachycardia. The child is hemodynamically
stable. What is the first-line treatment?
A. Adenosine 0.1 mg/kg rapid IV push
B. Vagal maneuvers
C. Amiodarone 5 mg/kg IV
D. Cardioversion
Correct Answer: B
Rationale: For stable supraventricular tachycardia, vagal maneuvers are first-line. If ineffective, adenosine is used.
Amiodarone and cardioversion are for unstable or refractory cases.
7. A 5-year-old child with a history of reactive airway disease presents with acute respiratory distress, wheezing,
and a peak flow of 50% of personal best. Which medication should be administered first?
A. Inhaled albuterol
B. Oral prednisone
C. Inhaled ipratropium
D. IV magnesium sulfate
Correct Answer: A
Rationale: In acute asthma exacerbation, rapid-acting bronchodilator (albuterol) is the first-line therapy. Systemic
corticosteroids are given early but not before bronchodilator; ipratropium is adjunct; magnesium is for severe cases.
8. A 9-month-old infant is brought in with a 2-day history of vomiting and diarrhea. The infant is lethargic, with
sunken eyes, dry mucous membranes, and a capillary refill time of 4 seconds. What is the most appropriate initial
fluid therapy?
A. 20 mL/kg normal saline IV bolus
B. 10 mL/kg normal saline IV bolus
C. Oral rehydration solution
D. 5% dextrose in 0.45% saline
BANK
50 Verified Questions with Detailed Answers and Rationales | A+ Graded | Latest Version
1. A 4-year-old child is brought to the emergency department with severe respiratory distress, stridor, and
drooling. The child is sitting upright and leaning forward. What is the most appropriate initial intervention?
A. Obtain a lateral neck X-ray
B. Perform direct laryngoscopy
C. Administer nebulized racemic epinephrine
D. Prepare for immediate tracheal intubation
Correct Answer: D
Rationale: This presentation is classic for acute epiglottitis, which can rapidly cause airway obstruction. Immediate
airway management (intubation) is the priority. X-rays and nebulized epinephrine are delayed; laryngoscopy may
precipitate complete obstruction.
2. A 6-month-old infant with bronchiolitis has a respiratory rate of 72/min, heart rate 180/min, and SpO2 88% on
room air. The infant is irritable, with nasal flaring and retractions. What is the most appropriate initial therapy?
A. Intubation and mechanical ventilation
B. Nebulized albuterol
C. Supplemental oxygen via nasal cannula
D. Chest physiotherapy
Correct Answer: C
Rationale: Hypoxemia (SpO2 <90%) with increased work of breathing warrants supplemental oxygen. Albuterol may be
used if wheezing, but oxygen is the priority. Intubation is for respiratory failure; chest physiotherapy is not acute.
3. A 2-year-old child presents with a 3-day history of fever, cough, and now worsening respiratory distress. Chest
X-ray shows right upper lobe consolidation. Which pathogen is most likely?
A. Respiratory syncytial virus
B. Streptococcus pneumoniae
C. Mycoplasma pneumoniae
D. Bordetella pertussis
Correct Answer: B
Rationale: Lobar consolidation in a toddler is classic for bacterial pneumonia, most commonly Streptococcus
pneumoniae. RSV typically causes bronchiolitis; Mycoplasma is more common in older children; pertussis presents with
paroxysmal cough.
4. A 10-year-old child with asthma presents with a severe exacerbation. The child is unable to speak in full
sentences, has a silent chest, and is diaphoretic. What is the most appropriate immediate management?
A. Continuous albuterol nebulization and IV corticosteroids
B. Inhaled corticosteroids
C. Oral corticosteroids
D. Heliox therapy
, Correct Answer: A
Rationale: Life-threatening asthma with silent chest requires aggressive therapy: continuous albuterol and systemic
corticosteroids. Inhaled steroids are for maintenance; Heliox may be used but not first-line.
5. A 3-year-old child is in cardiac arrest. The rhythm is asystole. What is the most appropriate drug and dose for
initial treatment?
A. Epinephrine 0.1 mg/kg IV
B. Epinephrine 0.01 mg/kg IV
C. Atropine 0.02 mg/kg IV
D. Amiodarone 5 mg/kg IV
Correct Answer: B
Rationale: For pediatric cardiac arrest, epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) is the first-line drug for asystole
and PEA. Atropine is not recommended for asystole; amiodarone is for shock-refractory VF/pVT.
6. An 8-year-old child with a history of congenital heart disease presents with sudden-onset palpitations, dizziness,
and a heart rate of 220/min. ECG shows a regular, narrow-complex tachycardia. The child is hemodynamically
stable. What is the first-line treatment?
A. Adenosine 0.1 mg/kg rapid IV push
B. Vagal maneuvers
C. Amiodarone 5 mg/kg IV
D. Cardioversion
Correct Answer: B
Rationale: For stable supraventricular tachycardia, vagal maneuvers are first-line. If ineffective, adenosine is used.
Amiodarone and cardioversion are for unstable or refractory cases.
7. A 5-year-old child with a history of reactive airway disease presents with acute respiratory distress, wheezing,
and a peak flow of 50% of personal best. Which medication should be administered first?
A. Inhaled albuterol
B. Oral prednisone
C. Inhaled ipratropium
D. IV magnesium sulfate
Correct Answer: A
Rationale: In acute asthma exacerbation, rapid-acting bronchodilator (albuterol) is the first-line therapy. Systemic
corticosteroids are given early but not before bronchodilator; ipratropium is adjunct; magnesium is for severe cases.
8. A 9-month-old infant is brought in with a 2-day history of vomiting and diarrhea. The infant is lethargic, with
sunken eyes, dry mucous membranes, and a capillary refill time of 4 seconds. What is the most appropriate initial
fluid therapy?
A. 20 mL/kg normal saline IV bolus
B. 10 mL/kg normal saline IV bolus
C. Oral rehydration solution
D. 5% dextrose in 0.45% saline
