AHA PEARS Provider Exam — Questions and Answers

Question 1: Which of the following is a sign of impending respiratory failure in a child with severe asthma?

SpO2 of 94%
Respiratory rate of 32/min
Audible wheezing on auscultation
Silent chest on auscultation (Correct answer)

Correct answer: Silent chest on auscultation

A silent chest in a patient with asthma indicates minimal air movement and is an ominous sign of impending respiratory failure.

Question 2: Which finding during the PEARS 'Disability' assessment most urgently requires intervention?

AVPU score of 'Unresponsive' (Correct answer)
AVPU score of 'Voice'
Pupils equal and reactive
GCS of 15

Correct answer: AVPU score of 'Unresponsive'

An AVPU score of Unresponsive indicates severely altered mental status and requires immediate airway management and intervention.

Question 3: A child in shock receives supplemental oxygen. What SpO2 target should guide therapy?

Exactly 100%
Greater than 94% (Correct answer)
Greater than 88%
Greater than 80%

Correct answer: Greater than 94%

Maintaining SpO2 greater than 94% ensures adequate oxygen delivery to tissues during shock resuscitation.

Question 4: In PEARS, the term 'cardiopulmonary failure' refers to:

Mild hypoxia with normal perfusion
Isolated respiratory arrest only
Combined failure of oxygenation and perfusion leading to imminent cardiac arrest (Correct answer)
A stable child with both asthma and a congenital heart defect

Correct answer: Combined failure of oxygenation and perfusion leading to imminent cardiac arrest

Cardiopulmonary failure occurs when both respiratory and circulatory systems fail together, placing the child at immediate risk of cardiac arrest.

Question 5: When administering a medication via IO route, what confirms correct IO needle placement before drug administration?

An X-ray confirming position
The needle stands upright without support, marrow can be aspirated, and fluid infuses without subcutaneous swelling (Correct answer)
Only that the needle penetrated the skin
Bright red blood return in a flash chamber

Correct answer: The needle stands upright without support, marrow can be aspirated, and fluid infuses without subcutaneous swelling

Correct IO placement is confirmed by a needle that stands upright, ability to aspirate marrow, and free fluid flow without extravasation.

Question 6: A 4-year-old in shock needs vasopressors. Which route should be used if central access is unavailable?

Endotracheal administration
Rectal suppository
Subcutaneous injection
Intraosseous infusion (Correct answer)

Correct answer: Intraosseous infusion

Vasoactive medications can be safely administered through IO access when central venous access is not available.

Question 7: What is the recommended initial isotonic crystalloid fluid bolus for a child in hypovolemic or septic shock?

30 mL/kg as fast as possible
10 mL/kg over 30 minutes
5 mL/kg over 60 minutes
20 mL/kg over 5 to 20 minutes (Correct answer)

Correct answer: 20 mL/kg over 5 to 20 minutes

According to AHA and septic shock guidelines, the standard initial fluid bolus for a child in most forms of shock (excluding cardiogenic) is 20 mL/kg of an isotonic crystalloid (like normal saline or Lactated Ringer's solution) administered over 5 to 20 minutes. This rapid infusion helps to quickly restore intravascular volume.

Question 8: A Broselow tape is used during a pediatric emergency primarily to:

Measure blood pressure
Estimate weight-based medication doses and equipment sizes (Correct answer)
Determine IV fluid tonicity
Calculate oxygen flow rates manually

Correct answer: Estimate weight-based medication doses and equipment sizes

The Broselow tape correlates a child's length with estimated weight to provide pre-calculated medication doses and appropriate equipment sizes rapidly.

Question 9: Why is the PAT performed BEFORE touching or fully exposing the child?

To allow the child to calm down before assessment
To give caregivers time to provide history
To comply with infection control protocols
To obtain an initial impression without causing distress that could alter findings (Correct answer)

Correct answer: To obtain an initial impression without causing distress that could alter findings

Performing the PAT hands-off minimizes iatrogenic agitation, allowing the clinician to observe the child's baseline respiratory effort, appearance, and skin color.

Question 10: When is it appropriate to use an automated external defibrillator (AED) on an infant under 1 year of age?

AEDs are the preferred device for infants
AEDs should never be used on infants
AEDs can be used with pediatric pads if a manual defibrillator is unavailable (Correct answer)
Only adult pads should be used on infants

Correct answer: AEDs can be used with pediatric pads if a manual defibrillator is unavailable

An AED with pediatric dose-attenuating pads may be used on infants when a manual defibrillator is not available.

Question 11: A 2-year-old is brought in after a seizure and is now post-ictal. Using AVPU, she responds only to painful stimuli. What AVPU level does this represent?

Voice
Unresponsive
Pain (Correct answer)
Alert

Correct answer: Pain

Responding only to painful stimuli corresponds to the 'Pain' level on the AVPU scale, indicating significant alteration in level of consciousness.

Question 12: Which of the following is the preferred route for drug administration when IV access cannot be rapidly established during cardiac arrest?

Rectal administration
Endotracheal (ET) tube
Intraosseous (IO) route (Correct answer)
Subcutaneous injection

Correct answer: Intraosseous (IO) route

Intraosseous (IO) access provides rapid, reliable vascular access when IV access cannot be quickly established during cardiac arrest.

Question 13: In PEARS, which component of the Pediatric Assessment Triangle (PAT) specifically evaluates breathing?

Mental status
Appearance
Work of breathing (Correct answer)
Circulation to skin

Correct answer: Work of breathing

The Work of Breathing component of the PAT assesses for abnormal breathing sounds, position, retractions, and nasal flaring.

Question 14: Adenosine is used in pediatric emergencies to treat which rhythm?

Asystole
Supraventricular tachycardia (SVT) (Correct answer)
Sinus bradycardia
Ventricular fibrillation

Correct answer: Supraventricular tachycardia (SVT)

Adenosine transiently blocks AV conduction to terminate reentry SVT and is the first-line drug for stable SVT in children.

Question 15: A 6-year-old presents with sudden palpitations and a heart rate of 230 bpm; ECG shows narrow QRS complexes with no identifiable P waves. What is the most likely rhythm?

Sinus tachycardia
Atrial flutter
Supraventricular tachycardia (Correct answer)
Ventricular tachycardia

Correct answer: Supraventricular tachycardia

SVT characteristically presents as a very rapid narrow-complex tachycardia with absent or retrograde P waves and an abrupt onset in children.

Question 16: During septic shock management, which antibiotic principle is most critical for improving outcomes?

Delay antibiotics until culture results are available
Antibiotics are not indicated until fever exceeds 39°C
Administer broad-spectrum antibiotics as soon as possible after obtaining cultures (Correct answer)
Use narrow-spectrum antibiotics to prevent resistance

Correct answer: Administer broad-spectrum antibiotics as soon as possible after obtaining cultures

Early broad-spectrum antibiotic administration after obtaining cultures significantly reduces mortality in pediatric septic shock.

Question 17: Which monitoring parameter is MOST helpful for tracking tissue oxygen delivery during shock resuscitation?

Respiratory rate
Serum lactate trend (Correct answer)
Temperature
Blood pressure alone

Correct answer: Serum lactate trend

Serial lactate measurement reflects tissue hypoperfusion; a declining lactate confirms improving oxygen delivery with resuscitation.

Question 18: During the initial assessment of a child with respiratory distress, which finding most directly indicates the need for immediate intervention?

Occasional cough
Mild nasal flaring
Respiratory rate of 30/min
SpO2 of 91% on room air (Correct answer)

Correct answer: SpO2 of 91% on room air

SpO2 below 94% indicates inadequate oxygenation and requires immediate oxygen therapy or ventilatory support.

Question 19: A 3-year-old presents with sudden onset of stridor, drooling, and refusal to swallow. Which intervention is most appropriate initially?

Begin bag-mask ventilation with 100% oxygen
Perform direct laryngoscopy to inspect the airway
Insert a nasopharyngeal airway immediately
Allow the child to maintain a position of comfort and prepare for airway management (Correct answer)

Correct answer: Allow the child to maintain a position of comfort and prepare for airway management

In suspected epiglottitis, allowing the child to assume a position of comfort (usually tripod position) minimizes agitation and reduces risk of complete airway obstruction.

Question 20: In pediatric assessment, which sequence correctly represents the order of the PEARS systematic approach?

PAT → Primary assessment → Identify/intervene → Secondary assessment (Correct answer)
Diagnostic tests → PAT → Primary assessment → Secondary assessment
Primary assessment → PAT → Secondary assessment → Diagnostic tests
Secondary assessment → PAT → Primary assessment → Diagnostics

Correct answer: PAT → Primary assessment → Identify/intervene → Secondary assessment

PEARS uses PAT first for a rapid across-the-room impression, followed by primary assessment (ABCDEs), then secondary assessment and diagnostics.

Question 21: Which of the following breath sound findings is most consistent with pneumonia in a child?

Inspiratory stridor
Diffuse expiratory wheeze
Focal decreased breath sounds with crackles (Correct answer)
Prolonged expiratory phase

Correct answer: Focal decreased breath sounds with crackles

Focal crackles and decreased breath sounds localized to one area suggest consolidation consistent with pneumonia.

Question 22: In a child with obstructive shock from tension pneumothorax, which intervention is most immediately life-saving?

Endotracheal intubation
IV fluid bolus 20 mL/kg
Epinephrine infusion
Needle decompression of the chest (Correct answer)

Correct answer: Needle decompression of the chest

Needle decompression immediately relieves the tension pneumothorax and restores cardiac output.

Question 23: What temperature management strategy should be used for a pediatric patient who remains comatose after ROSC?

Induced hypothermia to 28°C
Active warming to 40°C
Targeted temperature management to prevent hyperthermia (Correct answer)
No temperature intervention needed

Correct answer: Targeted temperature management to prevent hyperthermia

Current guidelines recommend preventing fever and maintaining normothermia or mild hypothermia (32°C–36°C) in comatose post-ROSC patients.

Question 24: A child presents with grunting respirations. What does grunting indicate in a pediatric patient?

Normal expiratory sound in toddlers
Upper airway obstruction
Attempt to maintain functional residual capacity (Correct answer)
Bronchospasm

Correct answer: Attempt to maintain functional residual capacity

Grunting is the child's attempt to create auto-PEEP by exhaling against a partially closed glottis, trying to maintain alveolar volume and oxygenation.

Question 25: Which of the following clinical signs is most indicative of a pediatric patient transitioning from respiratory distress to respiratory failure?

Anxious appearance and intercostal retractions
Tachycardia and nasal flaring
A significant decrease in respiratory rate and effort (Correct answer)
Loud, audible stridor or wheezing

Correct answer: A significant decrease in respiratory rate and effort

While tachycardia, nasal flaring, anxiety, retractions, and audible breath sounds are signs of respiratory distress, a significant decrease in respiratory rate and effort (bradypnea or inadequate breathing) is an ominous sign. [5, 8] It indicates the child is tiring and can no longer compensate, which is a hallmark of respiratory failure. [5, 8]

Question 26: In a child with cardiogenic shock, which PAT finding combination would be MOST expected?

Abnormal appearance, normal work of breathing, flushed warm skin
Appears normal, normal work of breathing, mottled skin
Normal appearance, nasal flaring only, warm flushed skin
Abnormal appearance, increased work of breathing, mottled/pale skin (Correct answer)

Correct answer: Abnormal appearance, increased work of breathing, mottled/pale skin

Cardiogenic shock impairs both perfusion and oxygenation, producing altered mental status (abnormal appearance), pulmonary edema (increased work of breathing), and poor circulation (mottled/pale skin).

Question 27: In pediatric cardiogenic shock, which physical finding is most characteristic compared to hypovolemic shock?

Tachycardia
Hepatomegaly and crackles on lung auscultation (Correct answer)
Decreased skin turgor
Dry mucous membranes

Correct answer: Hepatomegaly and crackles on lung auscultation

Hepatomegaly and pulmonary crackles indicate fluid overload and heart failure, hallmarks of cardiogenic shock.

Question 28: A 2-year-old with bronchiolitis has increased work of breathing and SpO2 of 90% on room air. Which intervention is the priority?

Administer nebulized albuterol every 20 minutes
Perform nasotracheal suctioning every 15 minutes
Apply supplemental oxygen to achieve SpO2 ≥94% (Correct answer)
Initiate IV corticosteroids immediately

Correct answer: Apply supplemental oxygen to achieve SpO2 ≥94%

Supplemental oxygen to maintain SpO2 ≥94% is the primary supportive intervention for bronchiolitis, as bronchodilators and steroids have not shown consistent benefit.

Question 29: A lone rescuer is performing CPR on a 6-year-old. What is the correct compression-to-ventilation ratio?

20:2
15:1
30:2 (Correct answer)
15:2

Correct answer: 30:2

A single rescuer uses a 30:2 ratio for CPR on children, consistent with adult single-rescuer CPR, to minimize interruptions.

Question 30: During the PEARS primary assessment, what does 'D' in the ABCDE mnemonic stand for?

Dysrhythmia
Disability (neurologic status) (Correct answer)
Dehydration
Diastolic blood pressure

Correct answer: Disability (neurologic status)

In the ABCDE framework, D stands for Disability, which refers to a rapid neurologic assessment including AVPU and pupillary response.

Question 31: What is a common sign of early shock in children?

Tachycardia (Correct answer)
Normal heart rate
Bradycardia
Hypertension

Correct answer: Tachycardia

Tachycardia is often an early physiological response to compensate for poor perfusion in shock.

Question 32: A 7-year-old with asthma has audible wheezing, a respiratory rate of 36/min, and subcostal retractions but speaks in full sentences. Her oxygen saturation is 94%. What is the priority intervention?

Immediate intubation
IV fluid bolus
Oxygen via nasal cannula and bronchodilator therapy (Correct answer)
Epinephrine IM injection

Correct answer: Oxygen via nasal cannula and bronchodilator therapy

The child is in respiratory distress with bronchospasm; supplemental oxygen and a bronchodilator (albuterol) are the priority interventions for asthma exacerbation.

AHA PEARS Provider Exam

The AHA PEARS (Pediatric Emergency Assessment, Recognition, and Stabilization) exam certifies healthcare providers in systematic pediatric assessment and management of respiratory emergencies, shock, and cardiac arrest in children.

Questions

45 min

Time Limit

84%

To Pass

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