AHA Pediatric Advanced Life Support Exam || PALS Exam (Answered) 2026/2027
AHA Pediatric Advanced Life Support Exam
PALS Exam (Answered) 2026/2027
75-Question Comprehensive Certification Examination
Aligned with 2026-2027 American Heart Association PALS Guidelines
Total Questions: 75 | Cognitive Levels: 25% Recall, 50% Application, 25% Analysis
Question Style: 70% Scenario-Based | 20% Direct Recall | 10% Rhythm/Case Analysis
Section Topic Question Range
Section 1 Pediatric Assessment, Respiratory Failure, and Shock Recognition Q1 - Q15
Section 2 Pediatric BLS and High-Quality CPR Q16 - Q22
Section 3 Airway Management, Oxygenation, and Ventilation Q23 - Q30
Section 4 Cardiac Rhythm Recognition and Electrical Therapy Q31 - Q38
Section 5 Resuscitation Medications and Pharmacology Q39 - Q46
Section 6 Tachyarrhythmias and Bradyarrhythmias Management Algorithms Q47 - Q54
Section 7 Post-Cardiac Arrest Care and Neuroprotective Strategies Q55 - Q60
Section 8 Special Resuscitation Scenarios and Reversible Causes Q61 - Q68
Section 9 Team Dynamics, Crisis Resource Management, and Comprehensive Case Integration
Q69 - Q75
Section 1: Pediatric Assessment, Respiratory Failure, and Shock Recognition
(Q1-Q15)
Q1: A 4-month-old infant presents with poor muscle tone, no spontaneous interaction with the environment,
inability to be consoled by parents, absent eye gaze, and a weak, high-pitched cry. Which component of the
Pediatric Assessment Triangle (PAT) is primarily abnormal?
A. Work of breathing only
B. Circulation to skin only
C. Appearance (evaluated by TICLS: Tone, Interactivity, Consolability, Look/Gaze, Speech/Cry)
[CORRECT]
D. All three PAT components are normal
Correct Answer: C
Rationale: The Appearance limb of the PAT is evaluated using the TICLS mnemonic (Tone, Interactivity, Consolability,
Look/Gaze, Speech/Cry). The described findings (poor tone, no interaction, no consolability, absent gaze, weak cry)
indicate a markedly abnormal Appearance, signaling serious illness and the need for immediate escalation of care.
Aligned with 2026-2027 AHA PALS Guidelines Page 1
,AHA Pediatric Advanced Life Support Exam || PALS Exam (Answered) 2026/2027
Q2: A 3-year-old child presents with marked subcostal and intercostal retractions, nasal flaring, and audible
stridor at rest. PAT evaluation reveals which abnormal limb?
A. Appearance
B. Work of Breathing [CORRECT]
C. Circulation to Skin
D. Disability
Correct Answer: B
Rationale: Retractions, nasal flaring, and stridor are objective signs of increased work of breathing, the second limb of
the PAT. These findings reflect respiratory distress and warrant further primary assessment (ABCDE) and pulse
oximetry to determine the severity and need for intervention.
Q3: A 2-year-old presents with mottled, cool extremities and capillary refill of 4 seconds. Which PAT limb is
abnormal?
A. Appearance
B. Work of Breathing
C. Circulation to Skin [CORRECT]
D. All PAT components are within normal limits
Correct Answer: C
Rationale: Mottling, cool extremities, and prolonged capillary refill (>2 seconds) reflect abnormal circulation to the skin,
the third limb of the PAT. This sign indicates peripheral vasoconstriction and is an early indicator of compensated shock
requiring rapid evaluation and fluid resuscitation.
Q4: When performing the primary assessment on an unresponsive 5-year-old, the correct sequential approach
is:
A. Airway, Breathing, Circulation, Disability, Exposure (ABCDE) [CORRECT]
B. Breathing, Airway, Circulation, Disability, Exposure
C. Circulation, Airway, Breathing, Disability, Exposure
D. Airway, Circulation, Breathing, Exposure, Disability
Correct Answer: A
Rationale: The primary assessment follows the standardized ABCDE sequence: Airway, Breathing, Circulation,
Disability (AVPU/GCS, pupils, glucose), and Exposure. This order ensures life-threatening problems are identified and
treated in priority sequence and is the foundation of the systematic pediatric resuscitation approach.
Q5: Which set of findings most strongly indicates respiratory failure (rather than respiratory distress) in a
pediatric patient?
A. Increased work of breathing with SpO2 of 96% on room air
B. Hypoxemia despite supplemental oxygen, hypercapnia, and decreased respiratory effort [CORRECT]
C. Mild tachypnea with normal mental status and SpO2 95%
D. Intermittent cough with normal oxygenation
Correct Answer: B
Rationale: Respiratory failure is defined by inadequate oxygenation (hypoxemia unresponsive to supplemental O2),
inadequate ventilation (hypercapnia), or both, often with fatigue/decreased effort. Respiratory distress maintains
adequate gas exchange; failure requires immediate positive-pressure ventilation and escalation of airway support.
Aligned with 2026-2027 AHA PALS Guidelines Page 2
, AHA Pediatric Advanced Life Support Exam || PALS Exam (Answered) 2026/2027
Q6: A 4-year-old in compensated shock will most likely display which hemodynamic profile?
A. Normal blood pressure with compensatory tachycardia and vasoconstriction [CORRECT]
B. Hypotension with bradycardia
C. Hypertension with bounding pulses and warm extremities
D. Normal heart rate with prolonged capillary refill only
Correct Answer: A
Rationale: In compensated shock, blood pressure remains normal because compensatory mechanisms (tachycardia,
increased systemic vascular resistance, vasoconstriction) preserve perfusion to vital organs. Hypotension signals
decompensated shock and represents a late, dangerous finding in pediatric patients.
Q7: What is the most common cause of shock in children worldwide?
A. Cardiogenic shock
B. Hypovolemic shock (most commonly from dehydration and fluid losses) [CORRECT]
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: Hypovolemia from gastroenteritis, vomiting, diarrhea, or hemorrhage is the leading cause of shock in
children worldwide. Early recognition and aggressive isotonic crystalloid resuscitation (20 mL/kg boluses) are
cornerstones of management, with reassessment after each bolus.
Q8: A pediatric patient in warm (distributive) shock characteristically exhibits which findings?
A. Cold extremities, weak pulses, narrow pulse pressure
B. Warm extremities, bounding pulses, wide pulse pressure [CORRECT]
C. Cool clammy skin, weak pulses, normal pulse pressure
D. Mottled skin, absent pulses, narrow pulse pressure
Correct Answer: B
Rationale: Warm shock results from pathologic vasodilation (as in early septic or anaphylactic shock), producing warm
extremities, bounding pulses, and a wide pulse pressure. Cold shock, more common in pediatric sepsis, produces
vasoconstriction, cool extremities, weak pulses, and narrow pulse pressure.
Q9: Which findings are typical of cardiogenic shock in a 6-month-old infant?
A. Hepatomegaly, gallop rhythm, cool extremities, increased work of breathing [CORRECT]
B. Bounding pulses, warm extremities, wide pulse pressure
C. Sudden onset with no preceding symptoms and normal perfusion
D. Isolated respiratory distress without any cardiac findings
Correct Answer: A
Rationale: Cardiogenic shock manifests with signs of poor pump function: hepatomegaly (from venous congestion),
gallop rhythm, cool poorly perfused extremities, tachycardia, and respiratory distress from pulmonary edema. Fluid
boluses must be administered cautiously (5-10 mL/kg) with close monitoring.
Aligned with 2026-2027 AHA PALS Guidelines Page 3
AHA Pediatric Advanced Life Support Exam
PALS Exam (Answered) 2026/2027
75-Question Comprehensive Certification Examination
Aligned with 2026-2027 American Heart Association PALS Guidelines
Total Questions: 75 | Cognitive Levels: 25% Recall, 50% Application, 25% Analysis
Question Style: 70% Scenario-Based | 20% Direct Recall | 10% Rhythm/Case Analysis
Section Topic Question Range
Section 1 Pediatric Assessment, Respiratory Failure, and Shock Recognition Q1 - Q15
Section 2 Pediatric BLS and High-Quality CPR Q16 - Q22
Section 3 Airway Management, Oxygenation, and Ventilation Q23 - Q30
Section 4 Cardiac Rhythm Recognition and Electrical Therapy Q31 - Q38
Section 5 Resuscitation Medications and Pharmacology Q39 - Q46
Section 6 Tachyarrhythmias and Bradyarrhythmias Management Algorithms Q47 - Q54
Section 7 Post-Cardiac Arrest Care and Neuroprotective Strategies Q55 - Q60
Section 8 Special Resuscitation Scenarios and Reversible Causes Q61 - Q68
Section 9 Team Dynamics, Crisis Resource Management, and Comprehensive Case Integration
Q69 - Q75
Section 1: Pediatric Assessment, Respiratory Failure, and Shock Recognition
(Q1-Q15)
Q1: A 4-month-old infant presents with poor muscle tone, no spontaneous interaction with the environment,
inability to be consoled by parents, absent eye gaze, and a weak, high-pitched cry. Which component of the
Pediatric Assessment Triangle (PAT) is primarily abnormal?
A. Work of breathing only
B. Circulation to skin only
C. Appearance (evaluated by TICLS: Tone, Interactivity, Consolability, Look/Gaze, Speech/Cry)
[CORRECT]
D. All three PAT components are normal
Correct Answer: C
Rationale: The Appearance limb of the PAT is evaluated using the TICLS mnemonic (Tone, Interactivity, Consolability,
Look/Gaze, Speech/Cry). The described findings (poor tone, no interaction, no consolability, absent gaze, weak cry)
indicate a markedly abnormal Appearance, signaling serious illness and the need for immediate escalation of care.
Aligned with 2026-2027 AHA PALS Guidelines Page 1
,AHA Pediatric Advanced Life Support Exam || PALS Exam (Answered) 2026/2027
Q2: A 3-year-old child presents with marked subcostal and intercostal retractions, nasal flaring, and audible
stridor at rest. PAT evaluation reveals which abnormal limb?
A. Appearance
B. Work of Breathing [CORRECT]
C. Circulation to Skin
D. Disability
Correct Answer: B
Rationale: Retractions, nasal flaring, and stridor are objective signs of increased work of breathing, the second limb of
the PAT. These findings reflect respiratory distress and warrant further primary assessment (ABCDE) and pulse
oximetry to determine the severity and need for intervention.
Q3: A 2-year-old presents with mottled, cool extremities and capillary refill of 4 seconds. Which PAT limb is
abnormal?
A. Appearance
B. Work of Breathing
C. Circulation to Skin [CORRECT]
D. All PAT components are within normal limits
Correct Answer: C
Rationale: Mottling, cool extremities, and prolonged capillary refill (>2 seconds) reflect abnormal circulation to the skin,
the third limb of the PAT. This sign indicates peripheral vasoconstriction and is an early indicator of compensated shock
requiring rapid evaluation and fluid resuscitation.
Q4: When performing the primary assessment on an unresponsive 5-year-old, the correct sequential approach
is:
A. Airway, Breathing, Circulation, Disability, Exposure (ABCDE) [CORRECT]
B. Breathing, Airway, Circulation, Disability, Exposure
C. Circulation, Airway, Breathing, Disability, Exposure
D. Airway, Circulation, Breathing, Exposure, Disability
Correct Answer: A
Rationale: The primary assessment follows the standardized ABCDE sequence: Airway, Breathing, Circulation,
Disability (AVPU/GCS, pupils, glucose), and Exposure. This order ensures life-threatening problems are identified and
treated in priority sequence and is the foundation of the systematic pediatric resuscitation approach.
Q5: Which set of findings most strongly indicates respiratory failure (rather than respiratory distress) in a
pediatric patient?
A. Increased work of breathing with SpO2 of 96% on room air
B. Hypoxemia despite supplemental oxygen, hypercapnia, and decreased respiratory effort [CORRECT]
C. Mild tachypnea with normal mental status and SpO2 95%
D. Intermittent cough with normal oxygenation
Correct Answer: B
Rationale: Respiratory failure is defined by inadequate oxygenation (hypoxemia unresponsive to supplemental O2),
inadequate ventilation (hypercapnia), or both, often with fatigue/decreased effort. Respiratory distress maintains
adequate gas exchange; failure requires immediate positive-pressure ventilation and escalation of airway support.
Aligned with 2026-2027 AHA PALS Guidelines Page 2
, AHA Pediatric Advanced Life Support Exam || PALS Exam (Answered) 2026/2027
Q6: A 4-year-old in compensated shock will most likely display which hemodynamic profile?
A. Normal blood pressure with compensatory tachycardia and vasoconstriction [CORRECT]
B. Hypotension with bradycardia
C. Hypertension with bounding pulses and warm extremities
D. Normal heart rate with prolonged capillary refill only
Correct Answer: A
Rationale: In compensated shock, blood pressure remains normal because compensatory mechanisms (tachycardia,
increased systemic vascular resistance, vasoconstriction) preserve perfusion to vital organs. Hypotension signals
decompensated shock and represents a late, dangerous finding in pediatric patients.
Q7: What is the most common cause of shock in children worldwide?
A. Cardiogenic shock
B. Hypovolemic shock (most commonly from dehydration and fluid losses) [CORRECT]
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: Hypovolemia from gastroenteritis, vomiting, diarrhea, or hemorrhage is the leading cause of shock in
children worldwide. Early recognition and aggressive isotonic crystalloid resuscitation (20 mL/kg boluses) are
cornerstones of management, with reassessment after each bolus.
Q8: A pediatric patient in warm (distributive) shock characteristically exhibits which findings?
A. Cold extremities, weak pulses, narrow pulse pressure
B. Warm extremities, bounding pulses, wide pulse pressure [CORRECT]
C. Cool clammy skin, weak pulses, normal pulse pressure
D. Mottled skin, absent pulses, narrow pulse pressure
Correct Answer: B
Rationale: Warm shock results from pathologic vasodilation (as in early septic or anaphylactic shock), producing warm
extremities, bounding pulses, and a wide pulse pressure. Cold shock, more common in pediatric sepsis, produces
vasoconstriction, cool extremities, weak pulses, and narrow pulse pressure.
Q9: Which findings are typical of cardiogenic shock in a 6-month-old infant?
A. Hepatomegaly, gallop rhythm, cool extremities, increased work of breathing [CORRECT]
B. Bounding pulses, warm extremities, wide pulse pressure
C. Sudden onset with no preceding symptoms and normal perfusion
D. Isolated respiratory distress without any cardiac findings
Correct Answer: A
Rationale: Cardiogenic shock manifests with signs of poor pump function: hepatomegaly (from venous congestion),
gallop rhythm, cool poorly perfused extremities, tachycardia, and respiratory distress from pulmonary edema. Fluid
boluses must be administered cautiously (5-10 mL/kg) with close monitoring.
Aligned with 2026-2027 AHA PALS Guidelines Page 3
