AHA PALS Exam – American Heart Association
(AHA) / American Academy of Pediatrics (AAP)
– 2026/2027 Edition – 230 Questions with
Answers and Scenario-Based Clinical
Application | with complete solutions.
SECTION 1: SYSTEMATIC ASSESSMENT AND
RESPIRATORY EMERGENCIES (Questions 1-30)
1. A 6-month-old infant is unresponsive and not breathing. What is
the maximum time that should be spent trying to palpate the pulse
before starting CPR?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
Answer: B) 10 seconds
Rationale: The maximum time to check for a pulse in a pediatric patient is
10 seconds. If a pulse cannot be palpated within 10 seconds, CPR should be
initiated immediately. For infants, the brachial pulse is the preferred site for
pulse check.
Source: AHA PALS Exam Test Bank 2026, Stuvia
,2. What is the compression-to-ventilation ratio for a 6-year-old child
in cardiac arrest with a single rescuer?
A) 15:2
B) 30:2
C) 15:1
D) 30:1
Answer: A) 15:2
Rationale: For pediatric cardiac arrest with two rescuers, the compression-
to-ventilation ratio is 15:2. With a single rescuer, the ratio is 30:2. For infants
and children, high-quality CPR with adequate depth and recoil is essential.
Source: AHA PALS Exam Test Bank 2026, Stuvia
3. The PALS systematic approach begins with the primary
assessment, which is structured as:
A) A-B-C-D-E
B) C-A-B-D-E
C) A-B-C-D-E with the exception of cardiac arrest where C-A-B is used
D) D-A-B-C-E
Answer: A) A-B-C-D-E
Rationale: The PALS primary assessment is structured as A-B-C-D-E: Airway,
Breathing, Circulation, Disability, and Exposure. This systematic approach
helps providers identify and treat life-threatening conditions in a logical
,sequence. Evaluation, identification, and intervention are the three key
steps.
Source: AffordableACLS PALS Guide
4. A 3-year-old child presents with stridor, drooling, and a fever of
102°F. The child is sitting upright in a tripod position. What is the
most appropriate initial management?
A) Attempt oral intubation
B) Perform a throat culture
C) Administer racemic epinephrine
D) Provide oxygen, keep the child calm, and prepare for controlled airway
management
Answer: D) Provide oxygen, keep the child calm, and prepare for
controlled airway management
Rationale: Stridor, drooling, fever, and tripod positioning are classic signs of
epiglottitis, a life-threatening airway emergency. Manipulation of the airway
can cause complete obstruction. The priority is to keep the child calm,
provide oxygen, and prepare for controlled airway management by the most
experienced provider.
Source: AHA PALS Clinical Scenarios
5. Which of the following findings differentiates respiratory distress
from respiratory failure?
A) Increased work of breathing
B) Tachycardia
C) Inadequate ventilation or oxygenation leading to cyanosis
D) Nasal flaring
, Answer: C) Inadequate ventilation or oxygenation leading to
cyanosis
Rationale: Respiratory distress is characterized by increased work of
breathing (tachypnea, nasal flaring, retractions) with adequate gas
exchange. Respiratory failure occurs when the respiratory system can no
longer maintain adequate oxygenation or ventilation, resulting in cyanosis,
altered mental status, and eventually apnea.
Source: AHA PALS Provider Manual; Saving American Hearts
6. A 12-year-old child with status asthmaticus is receiving albuterol
nebulizer treatments. The child's condition is deteriorating with
increasing respiratory effort and decreased air movement. What is
the most appropriate next intervention?
A) Repeat albuterol every 20 minutes
B) Administer epinephrine IM
C) Prepare for intubation and mechanical ventilation
D) Administer magnesium sulfate IV
Answer: D) Administer magnesium sulfate IV
Rationale: For severe status asthmaticus unresponsive to standard therapy,
IV magnesium sulfate (25-50 mg/kg, max 2 g) is a recommended
bronchodilator. Magnesium acts as a smooth muscle relaxant and can help
reverse bronchospasm when other therapies are failing. Intubation should be
considered if the child continues to deteriorate despite maximal therapy.
Source: ERC 2025 PALS Guidelines; SureFire CPR
(AHA) / American Academy of Pediatrics (AAP)
– 2026/2027 Edition – 230 Questions with
Answers and Scenario-Based Clinical
Application | with complete solutions.
SECTION 1: SYSTEMATIC ASSESSMENT AND
RESPIRATORY EMERGENCIES (Questions 1-30)
1. A 6-month-old infant is unresponsive and not breathing. What is
the maximum time that should be spent trying to palpate the pulse
before starting CPR?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
Answer: B) 10 seconds
Rationale: The maximum time to check for a pulse in a pediatric patient is
10 seconds. If a pulse cannot be palpated within 10 seconds, CPR should be
initiated immediately. For infants, the brachial pulse is the preferred site for
pulse check.
Source: AHA PALS Exam Test Bank 2026, Stuvia
,2. What is the compression-to-ventilation ratio for a 6-year-old child
in cardiac arrest with a single rescuer?
A) 15:2
B) 30:2
C) 15:1
D) 30:1
Answer: A) 15:2
Rationale: For pediatric cardiac arrest with two rescuers, the compression-
to-ventilation ratio is 15:2. With a single rescuer, the ratio is 30:2. For infants
and children, high-quality CPR with adequate depth and recoil is essential.
Source: AHA PALS Exam Test Bank 2026, Stuvia
3. The PALS systematic approach begins with the primary
assessment, which is structured as:
A) A-B-C-D-E
B) C-A-B-D-E
C) A-B-C-D-E with the exception of cardiac arrest where C-A-B is used
D) D-A-B-C-E
Answer: A) A-B-C-D-E
Rationale: The PALS primary assessment is structured as A-B-C-D-E: Airway,
Breathing, Circulation, Disability, and Exposure. This systematic approach
helps providers identify and treat life-threatening conditions in a logical
,sequence. Evaluation, identification, and intervention are the three key
steps.
Source: AffordableACLS PALS Guide
4. A 3-year-old child presents with stridor, drooling, and a fever of
102°F. The child is sitting upright in a tripod position. What is the
most appropriate initial management?
A) Attempt oral intubation
B) Perform a throat culture
C) Administer racemic epinephrine
D) Provide oxygen, keep the child calm, and prepare for controlled airway
management
Answer: D) Provide oxygen, keep the child calm, and prepare for
controlled airway management
Rationale: Stridor, drooling, fever, and tripod positioning are classic signs of
epiglottitis, a life-threatening airway emergency. Manipulation of the airway
can cause complete obstruction. The priority is to keep the child calm,
provide oxygen, and prepare for controlled airway management by the most
experienced provider.
Source: AHA PALS Clinical Scenarios
5. Which of the following findings differentiates respiratory distress
from respiratory failure?
A) Increased work of breathing
B) Tachycardia
C) Inadequate ventilation or oxygenation leading to cyanosis
D) Nasal flaring
, Answer: C) Inadequate ventilation or oxygenation leading to
cyanosis
Rationale: Respiratory distress is characterized by increased work of
breathing (tachypnea, nasal flaring, retractions) with adequate gas
exchange. Respiratory failure occurs when the respiratory system can no
longer maintain adequate oxygenation or ventilation, resulting in cyanosis,
altered mental status, and eventually apnea.
Source: AHA PALS Provider Manual; Saving American Hearts
6. A 12-year-old child with status asthmaticus is receiving albuterol
nebulizer treatments. The child's condition is deteriorating with
increasing respiratory effort and decreased air movement. What is
the most appropriate next intervention?
A) Repeat albuterol every 20 minutes
B) Administer epinephrine IM
C) Prepare for intubation and mechanical ventilation
D) Administer magnesium sulfate IV
Answer: D) Administer magnesium sulfate IV
Rationale: For severe status asthmaticus unresponsive to standard therapy,
IV magnesium sulfate (25-50 mg/kg, max 2 g) is a recommended
bronchodilator. Magnesium acts as a smooth muscle relaxant and can help
reverse bronchospasm when other therapies are failing. Intubation should be
considered if the child continues to deteriorate despite maximal therapy.
Source: ERC 2025 PALS Guidelines; SureFire CPR
