AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
AHA PALS Exam Questions & Answers 2026/2027
Verified 100% Correct | Pediatric Advanced Life Support
American Heart Association PALS Provider Manual | 2025 Guidelines Update
PALS Course Curriculum Standards 2026/2027 Edition
Total Questions 100 Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Sections 9 Format 80% Scenario-Based / 20% Direct Knowledge
Time Allocation 120 minutes Question Type Multiple Choice (4 options, single best answer)
Instructions to the Candidate: This examination consists of 100 multiple-choice questions divided into nine
sections. Each question presents a pediatric emergency scenario or knowledge statement followed by four
options (A-D). Select the single best answer for each question. The correct answer is indicated with
[CORRECT] and accompanied by a rationale referencing the AHA PALS Provider Manual, 2025 Guidelines
Update, and current PALS Course Curriculum Standards (2026/2027 Edition). This exam is aligned with AHA
PALS algorithms including the Systematic Approach, BLS, Respiratory and Shock Pathways, Cardiac Arrest
Algorithms (VF/pVT, Asystole/PEA, Bradycardia, Tachycardia), and Post-Resuscitation Care guidelines.
Section 1: Pediatric Assessment & Systematic Approach
Case: A 3-year-old boy is brought to the emergency department by his mother after a 2-day history of fever and
runny nose. He is alert, crying, and clings to his mother. Respiratory rate is 28, heart rate is 120, and SpO2 is
97% on room air.
Q1: The PALS systematic approach begins with the initial assessment. Which component is
the FIRST step in the systematic approach to a pediatric patient?
A. Detailed secondary assessment using SAMPLE history
B. Primary assessment using the ABCDE sequence
C. Initial impression formed before touching the patient, using the Pediatric Assessment
Triangle (PAT) [CORRECT]
D. Diagnostic testing including laboratory studies and imaging
Correct Answer: C
Rationale: The AHA PALS systematic approach begins with an initial impression formed by visual assessment
using the Pediatric Assessment Triangle (PAT) before touching the patient. The PAT evaluates appearance, work
of breathing, and circulation to color, providing a rapid snapshot of physiologic status. The primary assessment
(ABCDE) follows, then the secondary assessment, and finally diagnostic testing.
Case: A 2-year-old is brought to the ED for evaluation of lethargy. The PALS provider performs the primary
assessment.
Q2: What is the correct sequence for the primary assessment in the PALS systematic
approach?
A. Airway, Breathing, Circulation, Disability, Exposure (ABCDE) [CORRECT]
AHA PALS Provider Manual | 2025 Update Page 1 2026/2027 Edition
,AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
B. Circulation, Airway, Breathing, Disability, Exposure (CABDE)
C. Disability, Airway, Breathing, Circulation, Exposure (DABCE)
D. Airway, Circulation, Breathing, Disability, Exposure (ACBDE)
Correct Answer: A
Rationale: The PALS primary assessment uses the ABCDE sequence: Airway, Breathing, Circulation, Disability,
Exposure. Note that while CPR uses the CAB sequence (compressions first), assessment of an infant or child
with a pulse uses ABC. This distinction is a frequent PALS exam trap. The CAB sequence is initiated only when
no pulse is present or the heart rate is below 60 bpm with signs of poor perfusion.
Case: A 4-year-old presents with altered mental status. The team applies the Evaluate-Identify-Intervene (EII)
framework during the primary assessment.
Q3: In the Evaluate-Identify-Intervene (EII) framework, what is the correct order of operations?
A. Intervene first, then evaluate, then identify
B. Evaluate (assess), Identify (life threat or problem), Intervene (treat) [CORRECT]
C. Identify first, then evaluate, then intervene
D. Evaluate and intervene simultaneously, identification is not required
Correct Answer: B
Rationale: The EII framework structures every step of the systematic approach: Evaluate (gather information by
assessing the patient), Identify (determine whether a life-threatening problem or specific condition exists), and
Intervene (provide appropriate treatment). The PALS Provider Manual emphasizes this cycle is repeated
continuously throughout resuscitation, not just once. Skipping any of the three steps risks missing critical
interventions.
Case: A 5-year-old is brought to triage. The nurse performs the Pediatric Assessment Triangle (PAT) from
across the room before approaching the child.
Q4: Which three components make up the Pediatric Assessment Triangle (PAT)?
A. Appearance, Work of Breathing, Circulation to Skin [CORRECT]
B. Tone, Interactiveness, Consolability
C. Heart rate, Respiratory rate, Blood pressure
D. Pupils, Reflexes, Muscle tone
Correct Answer: A
Rationale: The PAT consists of three components: Appearance (the TICLS assessment - Tone, Interactiveness,
Consolability, Look/gaze, Speech/cry), Work of Breathing (assessed by observing respiratory effort), and
Circulation to Skin (assessing color). The PAT identifies the urgency and category of physiologic derangement
within 30-60 seconds. Heart rate, respiratory rate, and blood pressure require hands-on assessment and are part
of the primary assessment, not the PAT.
Case: An 8-month-old infant is being evaluated for poor feeding and lethargy. The provider applies the TICLS
mnemonic to assess appearance.
Q5: Which of the following correctly identifies the components of the TICLS assessment?
A. Tone, Interactiveness, Consolability, Look/gaze, Speech/cry [CORRECT]
B. Temperature, Injury, Circulation, Lung sounds, SpO2
C. Tone, Indrawing, Color, Level of consciousness, Symmetry
AHA PALS Provider Manual | 2025 Update Page 2 2026/2027 Edition
,AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
D. Trauma, Infection, Cardiac, Liver, Spleen
Correct Answer: A
Rationale: TICLS stands for Tone, Interactiveness, Consolability, Look/gaze, and Speech/cry - all components of
the Appearance arm of the Pediatric Assessment Triangle. This assessment is performed without touching the
patient, providing rapid insight into central nervous system function and overall physiologic status. The other
options are distractors using incorrect mnemonic expansions.
Case: A 2-year-old presents with respiratory distress. The provider assesses work of breathing as part of the
Pediatric Assessment Triangle.
Q6: Which finding, observed WITHOUT a stethoscope, would indicate SEVERE work of
breathing consistent with impending respiratory failure?
A. Mild nasal flaring and intermittent subcostal retractions
B. Head bobbing, marked retractions, grunting, and seesaw breathing pattern [CORRECT]
C. Respiratory rate of 30 with mild subcostal retractions
D. Occasional cough with normal respiratory effort
Correct Answer: B
Rationale: Severe work of breathing signs include head bobbing (use of sternocleidomastoid to maintain
ventilation), marked retractions, grunting (auto-PEEP to maintain FRC), and a seesaw (paradoxical) breathing
pattern indicating impending respiratory failure. Mild nasal flaring and intermittent subcostal retractions represent
moderate distress. PALS algorithm progression: normal → mild distress → moderate distress → severe distress
→ failure.
Case: A 6-month-old infant presents with cyanosis. The provider must distinguish central from peripheral
cyanosis.
Q7: Which finding is MOST consistent with central cyanosis and indicates hypoxemia
requiring immediate intervention?
A. Bluish discoloration of the fingers and toes with warm, pink central mucous membranes
B. Bluish discoloration of the lips, tongue, and oral mucosa [CORRECT]
C. Bluish discoloration of the hands after exposure to cold temperature
D. Acrocyanosis in a newborn during the first 24 hours of life
Correct Answer: B
Rationale: Central cyanosis (lips, tongue, oral mucosa) indicates hypoxemia and requires immediate evaluation
of oxygenation and ventilation. Peripheral cyanosis (fingers, toes) often reflects poor perfusion or vasoconstriction
(cold exposure) without hypoxemia. Acrocyanosis is normal in newborns during the first 24-48 hours of life due to
immature peripheral circulation. The PAT's Circulation to Skin component assesses central cyanosis as a sign of
significant cardiopulmonary compromise.
Case: A 4-year-old is being evaluated for possible sepsis. Capillary refill time is assessed.
Q8: What capillary refill time, when measured correctly, is the threshold for concern in a
pediatric patient?
A. Less than 1 second
B. 1 to 2 seconds
C. Greater than 2 seconds [CORRECT]
AHA PALS Provider Manual | 2025 Update Page 3 2026/2027 Edition
, AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
D. 5 to 7 seconds is normal in children
Correct Answer: C
Rationale: A capillary refill time greater than 2 seconds is considered abnormal and indicates poor peripheral
perfusion. To measure correctly, apply firm pressure to the nail bed or sternum for 5 seconds, release, and time
the return of color. Perfusion must be assessed in context: cold ambient temperature, fear, and poor technique
can prolong capillary refill without true pathology. A CRT >2 seconds combined with other signs (altered mental
status, decreased pulses, mottled skin) raises concern for compensated or decompensated shock.
Case: A 3-year-old with suspected sepsis is being assessed. The team must identify immediate life threats.
Q9: Which finding constitutes an IMMEDIATE life threat requiring intervention during the
primary assessment?
A. Complaint of headache and fever of 39 degrees C
B. Respiratory rate of 32, mild subcostal retractions, SpO2 95%
C. Stridor at rest with marked retractions, drooling, and tripod posture [CORRECT]
D. Capillary refill of 1 second with normal perfusion
Correct Answer: C
Rationale: Stridor at rest with drooling and tripod posture indicates severe upper airway obstruction (consider
epiglottitis) - an immediate life threat requiring protection of the airway. The PALS systematic approach prioritizes
life threats during the primary assessment, including upper airway obstruction, tension pneumothorax, severe
respiratory distress/failure, shock, and cardiac arrest. The other findings represent moderate distress or stable
conditions requiring further evaluation but not immediate airway intervention.
Case: A newborn is delivered in the ED and the team performs initial assessment using APGAR scoring
principles.
Q10: Which component is NOT a standard element of the APGAR assessment, and is instead
a separate assessment?
A. Appearance (color)
B. Pulse (heart rate)
C. Grimace (reflex irritability)
D. Glucose (blood sugar level) [CORRECT]
Correct Answer: D
Rationale: APGAR stands for Appearance, Pulse, Grimace, Activity, Respiration - the five components scored at
1 and 5 minutes after birth. Glucose is a separate assessment, with point-of-care glucose checks performed on
at-risk newborns (infants of diabetic mothers, prematurity, small/large for gestational age). PALS integrates
APGAR principles into newborn resuscitation but treats glucose assessment as part of the secondary evaluation
and management.
Case: A 6-month-old infant is evaluated for tachycardia. The team reviews age-appropriate vital sign ranges.
Q11: What is the normal resting heart rate range for an infant (1-12 months of age)?
A. 60 to 100 beats per minute
B. 100 to 160 beats per minute [CORRECT]
C. 70 to 120 beats per minute
D. 80 to 140 beats per minute
AHA PALS Provider Manual | 2025 Update Page 4 2026/2027 Edition
AHA PALS Exam Questions & Answers 2026/2027
Verified 100% Correct | Pediatric Advanced Life Support
American Heart Association PALS Provider Manual | 2025 Guidelines Update
PALS Course Curriculum Standards 2026/2027 Edition
Total Questions 100 Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Sections 9 Format 80% Scenario-Based / 20% Direct Knowledge
Time Allocation 120 minutes Question Type Multiple Choice (4 options, single best answer)
Instructions to the Candidate: This examination consists of 100 multiple-choice questions divided into nine
sections. Each question presents a pediatric emergency scenario or knowledge statement followed by four
options (A-D). Select the single best answer for each question. The correct answer is indicated with
[CORRECT] and accompanied by a rationale referencing the AHA PALS Provider Manual, 2025 Guidelines
Update, and current PALS Course Curriculum Standards (2026/2027 Edition). This exam is aligned with AHA
PALS algorithms including the Systematic Approach, BLS, Respiratory and Shock Pathways, Cardiac Arrest
Algorithms (VF/pVT, Asystole/PEA, Bradycardia, Tachycardia), and Post-Resuscitation Care guidelines.
Section 1: Pediatric Assessment & Systematic Approach
Case: A 3-year-old boy is brought to the emergency department by his mother after a 2-day history of fever and
runny nose. He is alert, crying, and clings to his mother. Respiratory rate is 28, heart rate is 120, and SpO2 is
97% on room air.
Q1: The PALS systematic approach begins with the initial assessment. Which component is
the FIRST step in the systematic approach to a pediatric patient?
A. Detailed secondary assessment using SAMPLE history
B. Primary assessment using the ABCDE sequence
C. Initial impression formed before touching the patient, using the Pediatric Assessment
Triangle (PAT) [CORRECT]
D. Diagnostic testing including laboratory studies and imaging
Correct Answer: C
Rationale: The AHA PALS systematic approach begins with an initial impression formed by visual assessment
using the Pediatric Assessment Triangle (PAT) before touching the patient. The PAT evaluates appearance, work
of breathing, and circulation to color, providing a rapid snapshot of physiologic status. The primary assessment
(ABCDE) follows, then the secondary assessment, and finally diagnostic testing.
Case: A 2-year-old is brought to the ED for evaluation of lethargy. The PALS provider performs the primary
assessment.
Q2: What is the correct sequence for the primary assessment in the PALS systematic
approach?
A. Airway, Breathing, Circulation, Disability, Exposure (ABCDE) [CORRECT]
AHA PALS Provider Manual | 2025 Update Page 1 2026/2027 Edition
,AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
B. Circulation, Airway, Breathing, Disability, Exposure (CABDE)
C. Disability, Airway, Breathing, Circulation, Exposure (DABCE)
D. Airway, Circulation, Breathing, Disability, Exposure (ACBDE)
Correct Answer: A
Rationale: The PALS primary assessment uses the ABCDE sequence: Airway, Breathing, Circulation, Disability,
Exposure. Note that while CPR uses the CAB sequence (compressions first), assessment of an infant or child
with a pulse uses ABC. This distinction is a frequent PALS exam trap. The CAB sequence is initiated only when
no pulse is present or the heart rate is below 60 bpm with signs of poor perfusion.
Case: A 4-year-old presents with altered mental status. The team applies the Evaluate-Identify-Intervene (EII)
framework during the primary assessment.
Q3: In the Evaluate-Identify-Intervene (EII) framework, what is the correct order of operations?
A. Intervene first, then evaluate, then identify
B. Evaluate (assess), Identify (life threat or problem), Intervene (treat) [CORRECT]
C. Identify first, then evaluate, then intervene
D. Evaluate and intervene simultaneously, identification is not required
Correct Answer: B
Rationale: The EII framework structures every step of the systematic approach: Evaluate (gather information by
assessing the patient), Identify (determine whether a life-threatening problem or specific condition exists), and
Intervene (provide appropriate treatment). The PALS Provider Manual emphasizes this cycle is repeated
continuously throughout resuscitation, not just once. Skipping any of the three steps risks missing critical
interventions.
Case: A 5-year-old is brought to triage. The nurse performs the Pediatric Assessment Triangle (PAT) from
across the room before approaching the child.
Q4: Which three components make up the Pediatric Assessment Triangle (PAT)?
A. Appearance, Work of Breathing, Circulation to Skin [CORRECT]
B. Tone, Interactiveness, Consolability
C. Heart rate, Respiratory rate, Blood pressure
D. Pupils, Reflexes, Muscle tone
Correct Answer: A
Rationale: The PAT consists of three components: Appearance (the TICLS assessment - Tone, Interactiveness,
Consolability, Look/gaze, Speech/cry), Work of Breathing (assessed by observing respiratory effort), and
Circulation to Skin (assessing color). The PAT identifies the urgency and category of physiologic derangement
within 30-60 seconds. Heart rate, respiratory rate, and blood pressure require hands-on assessment and are part
of the primary assessment, not the PAT.
Case: An 8-month-old infant is being evaluated for poor feeding and lethargy. The provider applies the TICLS
mnemonic to assess appearance.
Q5: Which of the following correctly identifies the components of the TICLS assessment?
A. Tone, Interactiveness, Consolability, Look/gaze, Speech/cry [CORRECT]
B. Temperature, Injury, Circulation, Lung sounds, SpO2
C. Tone, Indrawing, Color, Level of consciousness, Symmetry
AHA PALS Provider Manual | 2025 Update Page 2 2026/2027 Edition
,AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
D. Trauma, Infection, Cardiac, Liver, Spleen
Correct Answer: A
Rationale: TICLS stands for Tone, Interactiveness, Consolability, Look/gaze, and Speech/cry - all components of
the Appearance arm of the Pediatric Assessment Triangle. This assessment is performed without touching the
patient, providing rapid insight into central nervous system function and overall physiologic status. The other
options are distractors using incorrect mnemonic expansions.
Case: A 2-year-old presents with respiratory distress. The provider assesses work of breathing as part of the
Pediatric Assessment Triangle.
Q6: Which finding, observed WITHOUT a stethoscope, would indicate SEVERE work of
breathing consistent with impending respiratory failure?
A. Mild nasal flaring and intermittent subcostal retractions
B. Head bobbing, marked retractions, grunting, and seesaw breathing pattern [CORRECT]
C. Respiratory rate of 30 with mild subcostal retractions
D. Occasional cough with normal respiratory effort
Correct Answer: B
Rationale: Severe work of breathing signs include head bobbing (use of sternocleidomastoid to maintain
ventilation), marked retractions, grunting (auto-PEEP to maintain FRC), and a seesaw (paradoxical) breathing
pattern indicating impending respiratory failure. Mild nasal flaring and intermittent subcostal retractions represent
moderate distress. PALS algorithm progression: normal → mild distress → moderate distress → severe distress
→ failure.
Case: A 6-month-old infant presents with cyanosis. The provider must distinguish central from peripheral
cyanosis.
Q7: Which finding is MOST consistent with central cyanosis and indicates hypoxemia
requiring immediate intervention?
A. Bluish discoloration of the fingers and toes with warm, pink central mucous membranes
B. Bluish discoloration of the lips, tongue, and oral mucosa [CORRECT]
C. Bluish discoloration of the hands after exposure to cold temperature
D. Acrocyanosis in a newborn during the first 24 hours of life
Correct Answer: B
Rationale: Central cyanosis (lips, tongue, oral mucosa) indicates hypoxemia and requires immediate evaluation
of oxygenation and ventilation. Peripheral cyanosis (fingers, toes) often reflects poor perfusion or vasoconstriction
(cold exposure) without hypoxemia. Acrocyanosis is normal in newborns during the first 24-48 hours of life due to
immature peripheral circulation. The PAT's Circulation to Skin component assesses central cyanosis as a sign of
significant cardiopulmonary compromise.
Case: A 4-year-old is being evaluated for possible sepsis. Capillary refill time is assessed.
Q8: What capillary refill time, when measured correctly, is the threshold for concern in a
pediatric patient?
A. Less than 1 second
B. 1 to 2 seconds
C. Greater than 2 seconds [CORRECT]
AHA PALS Provider Manual | 2025 Update Page 3 2026/2027 Edition
, AHA PALS Exam Questions & Answers 2026/2027 Verified 100% Correct | Pediatric Advanced Life Support
D. 5 to 7 seconds is normal in children
Correct Answer: C
Rationale: A capillary refill time greater than 2 seconds is considered abnormal and indicates poor peripheral
perfusion. To measure correctly, apply firm pressure to the nail bed or sternum for 5 seconds, release, and time
the return of color. Perfusion must be assessed in context: cold ambient temperature, fear, and poor technique
can prolong capillary refill without true pathology. A CRT >2 seconds combined with other signs (altered mental
status, decreased pulses, mottled skin) raises concern for compensated or decompensated shock.
Case: A 3-year-old with suspected sepsis is being assessed. The team must identify immediate life threats.
Q9: Which finding constitutes an IMMEDIATE life threat requiring intervention during the
primary assessment?
A. Complaint of headache and fever of 39 degrees C
B. Respiratory rate of 32, mild subcostal retractions, SpO2 95%
C. Stridor at rest with marked retractions, drooling, and tripod posture [CORRECT]
D. Capillary refill of 1 second with normal perfusion
Correct Answer: C
Rationale: Stridor at rest with drooling and tripod posture indicates severe upper airway obstruction (consider
epiglottitis) - an immediate life threat requiring protection of the airway. The PALS systematic approach prioritizes
life threats during the primary assessment, including upper airway obstruction, tension pneumothorax, severe
respiratory distress/failure, shock, and cardiac arrest. The other findings represent moderate distress or stable
conditions requiring further evaluation but not immediate airway intervention.
Case: A newborn is delivered in the ED and the team performs initial assessment using APGAR scoring
principles.
Q10: Which component is NOT a standard element of the APGAR assessment, and is instead
a separate assessment?
A. Appearance (color)
B. Pulse (heart rate)
C. Grimace (reflex irritability)
D. Glucose (blood sugar level) [CORRECT]
Correct Answer: D
Rationale: APGAR stands for Appearance, Pulse, Grimace, Activity, Respiration - the five components scored at
1 and 5 minutes after birth. Glucose is a separate assessment, with point-of-care glucose checks performed on
at-risk newborns (infants of diabetic mothers, prematurity, small/large for gestational age). PALS integrates
APGAR principles into newborn resuscitation but treats glucose assessment as part of the secondary evaluation
and management.
Case: A 6-month-old infant is evaluated for tachycardia. The team reviews age-appropriate vital sign ranges.
Q11: What is the normal resting heart rate range for an infant (1-12 months of age)?
A. 60 to 100 beats per minute
B. 100 to 160 beats per minute [CORRECT]
C. 70 to 120 beats per minute
D. 80 to 140 beats per minute
AHA PALS Provider Manual | 2025 Update Page 4 2026/2027 Edition
