PALS Final Exam | 2026/2027 Actual Exam
2026/2027 | Complete Exam-Style Questions
with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Systematic Pediatric Assessment & Respiratory Emergencies
Q1: When you perform the Pediatric Assessment Triangle on a child, which three
components are you evaluating?
A. Airway, Breathing, and Circulation
B. Appearance, Work of Breathing, and Circulation to Skin [CORRECT]
C. AVPU status, pupillary response, and blood glucose
D. Respiratory distress, respiratory failure, and cardiopulmonary arrest
Correct Answer: B
Rationale: The best answer is Appearance, Work of Breathing, and Circulation to Skin —
these are the three sides of the Pediatric Assessment Triangle, and you can complete all
three in about ten seconds from the foot of the bed without touching the child or using any
equipment.
Q2: You approach the bedside of an 8-month-old and notice she is limp in her mother's
arms, makes no eye contact, and has a weak, high-pitched cry. Within the Pediatric
Assessment Triangle, what does this describe, and what does it tell you?
A. Normal appearance, since young infants are often floppy when sleeping
B. Abnormal work of breathing, indicating lower airway disease
C. Abnormal circulation to skin, indicating dehydration
D. Abnormal appearance, which is the strongest single indicator that the child is seriously ill
[CORRECT]
Correct Answer: D
Rationale: A limp, poorly interactive infant with a weak cry has an abnormal appearance,
and on the PAT that is the single most powerful "sick or not sick" indicator you will get —
remember, appearance is the TICLS assessment of tone, interactiveness, consolability, gaze,
and speech or cry, not the lungs or the skin.
Q3: A worried father brings his 2-year-old in with a barky, seal-like cough. The child is sitting
quietly on his lap, drooling is absent, SpO2 is 96%, but you hear loud inspiratory stridor at
rest and see moderate subcostal retractions. The child is calmer when held. What is the
most appropriate immediate intervention?
, A. Administer nebulized epinephrine [CORRECT]
B. Encourage oral fluids and observe for four hours
C. Proceed directly to immediate endotracheal intubation
D. Give dexamethasone alone and reassess in the morning
Correct Answer: A
Rationale: Stridor at rest is severe croup, so the intervention that acts fastest on the swollen
subglottic airway is nebulized epinephrine; dexamethasone absolutely belongs in the plan
but works too slowly to be your immediate move, and this child's airway can usually be
saved without intubation if you treat now and keep the child calm.
Q4: A 5-month-old with bronchiolitis has been wheezing and retracting all night. On
reassessment, the respiratory rate is now shallow and irregular, the infant is difficult to
arouse, and the heart rate has dropped from 170 to 60. What is the significance of the
falling heart rate in this child?
A. It is a reassuring sign that the infant is tiring out and settling
B. It is a pain response that will resolve with consoling
C. It is a late and ominous sign of impending respiratory failure requiring immediate assisted
ventilation [CORRECT]
D. It is an expected vagal response common in young infants with RSV
Correct Answer: C
Rationale: The PALS key here is that bradycardia in a child with respiratory compromise is a
late, ominous sign of hypoxia and impending respiratory failure — the fix is immediate
assisted ventilation with a bag-mask and oxygen, not watching and waiting for the heart
rate to come back on its own.
Q5: A 9-month-old suddenly starts choking at daycare. She cannot cry or make sounds, her
cough is silent and ineffective, and she is turning dusky around the mouth. What is your next
action?
A. Perform abdominal thrusts immediately
B. Deliver 5 back slaps followed by 5 chest thrusts [CORRECT]
C. Perform a blind finger sweep of the mouth
D. Attempt immediate endotracheal intubation
Correct Answer: B
Rationale: This is a complete airway obstruction, and in an infant the correct sequence is
five back slaps followed by five chest thrusts, repeated until the object clears or the infant
becomes unresponsive — abdominal thrusts are reserved for older children, and blind finger
sweeps can push the object deeper into the airway.
Q6: A 6-year-old with a severe asthma exacerbation has been wheezing loudly for the past
hour. Now his chest is suddenly silent, he is drowsy, and his SpO2 is 88% on high-flow
oxygen. What is the immediate priority?
A. Give a nebulized albuterol treatment before anything else
B. Reassess in 15 minutes to see if the wheezing returns
C. Obtain a chest x-ray to evaluate for pneumonia
2026/2027 | Complete Exam-Style Questions
with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Systematic Pediatric Assessment & Respiratory Emergencies
Q1: When you perform the Pediatric Assessment Triangle on a child, which three
components are you evaluating?
A. Airway, Breathing, and Circulation
B. Appearance, Work of Breathing, and Circulation to Skin [CORRECT]
C. AVPU status, pupillary response, and blood glucose
D. Respiratory distress, respiratory failure, and cardiopulmonary arrest
Correct Answer: B
Rationale: The best answer is Appearance, Work of Breathing, and Circulation to Skin —
these are the three sides of the Pediatric Assessment Triangle, and you can complete all
three in about ten seconds from the foot of the bed without touching the child or using any
equipment.
Q2: You approach the bedside of an 8-month-old and notice she is limp in her mother's
arms, makes no eye contact, and has a weak, high-pitched cry. Within the Pediatric
Assessment Triangle, what does this describe, and what does it tell you?
A. Normal appearance, since young infants are often floppy when sleeping
B. Abnormal work of breathing, indicating lower airway disease
C. Abnormal circulation to skin, indicating dehydration
D. Abnormal appearance, which is the strongest single indicator that the child is seriously ill
[CORRECT]
Correct Answer: D
Rationale: A limp, poorly interactive infant with a weak cry has an abnormal appearance,
and on the PAT that is the single most powerful "sick or not sick" indicator you will get —
remember, appearance is the TICLS assessment of tone, interactiveness, consolability, gaze,
and speech or cry, not the lungs or the skin.
Q3: A worried father brings his 2-year-old in with a barky, seal-like cough. The child is sitting
quietly on his lap, drooling is absent, SpO2 is 96%, but you hear loud inspiratory stridor at
rest and see moderate subcostal retractions. The child is calmer when held. What is the
most appropriate immediate intervention?
, A. Administer nebulized epinephrine [CORRECT]
B. Encourage oral fluids and observe for four hours
C. Proceed directly to immediate endotracheal intubation
D. Give dexamethasone alone and reassess in the morning
Correct Answer: A
Rationale: Stridor at rest is severe croup, so the intervention that acts fastest on the swollen
subglottic airway is nebulized epinephrine; dexamethasone absolutely belongs in the plan
but works too slowly to be your immediate move, and this child's airway can usually be
saved without intubation if you treat now and keep the child calm.
Q4: A 5-month-old with bronchiolitis has been wheezing and retracting all night. On
reassessment, the respiratory rate is now shallow and irregular, the infant is difficult to
arouse, and the heart rate has dropped from 170 to 60. What is the significance of the
falling heart rate in this child?
A. It is a reassuring sign that the infant is tiring out and settling
B. It is a pain response that will resolve with consoling
C. It is a late and ominous sign of impending respiratory failure requiring immediate assisted
ventilation [CORRECT]
D. It is an expected vagal response common in young infants with RSV
Correct Answer: C
Rationale: The PALS key here is that bradycardia in a child with respiratory compromise is a
late, ominous sign of hypoxia and impending respiratory failure — the fix is immediate
assisted ventilation with a bag-mask and oxygen, not watching and waiting for the heart
rate to come back on its own.
Q5: A 9-month-old suddenly starts choking at daycare. She cannot cry or make sounds, her
cough is silent and ineffective, and she is turning dusky around the mouth. What is your next
action?
A. Perform abdominal thrusts immediately
B. Deliver 5 back slaps followed by 5 chest thrusts [CORRECT]
C. Perform a blind finger sweep of the mouth
D. Attempt immediate endotracheal intubation
Correct Answer: B
Rationale: This is a complete airway obstruction, and in an infant the correct sequence is
five back slaps followed by five chest thrusts, repeated until the object clears or the infant
becomes unresponsive — abdominal thrusts are reserved for older children, and blind finger
sweeps can push the object deeper into the airway.
Q6: A 6-year-old with a severe asthma exacerbation has been wheezing loudly for the past
hour. Now his chest is suddenly silent, he is drowsy, and his SpO2 is 88% on high-flow
oxygen. What is the immediate priority?
A. Give a nebulized albuterol treatment before anything else
B. Reassess in 15 minutes to see if the wheezing returns
C. Obtain a chest x-ray to evaluate for pneumonia
