AHA PEARS Provider Exam — Questions and Answers

Question 1: You are assessing a 2-year-old child with a 3-day history of vomiting and diarrhea. The child is tachycardic (HR 170/min), has cool extremities, and a capillary refill time of 4 seconds, but their blood pressure is within the normal range for their age. These findings are most consistent with which stage of shock?

Cardiogenic shock
Decompensated shock
Compensated shock (Correct answer)
Septic shock

Correct answer: Compensated shock

The child is exhibiting classic signs of shock, including tachycardia, cool extremities, and prolonged capillary refill. However, because the blood pressure is still normal, the body is successfully compensating for the fluid loss. This stage is known as compensated shock. Decompensated shock is characterized by hypotension, a late and ominous sign.

Question 2: Which of the following clinical signs is a definitive indicator that a child has progressed from compensated shock to decompensated (hypotensive) shock?

Hypotension (Correct answer)
Altered mental status
Delayed capillary refill
Tachycardia

Correct answer: Hypotension

Hypotension (low blood pressure) is the hallmark sign that differentiates decompensated shock from compensated shock. In compensated shock, the body maintains a normal blood pressure through mechanisms like tachycardia and vasoconstriction, even though tissue perfusion is impaired. When these mechanisms fail, blood pressure drops, signifying decompensated shock, which is a late and critical finding.

Question 3: What technique must be used when giving adenosine via peripheral IV to ensure it reaches circulation?

Rapid IV push followed by a large saline flush (Correct answer)
Mix with D5W and give over 10 minutes
Dilute in 100 mL normal saline
Slow infusion over 30 minutes

Correct answer: Rapid IV push followed by a large saline flush

Adenosine has an extremely short half-life (<10 seconds), so it must be given as a rapid bolus immediately followed by a large saline flush to reach central circulation.

Question 4: Which clinical sign best indicates that a post-ROSC pediatric patient is developing re-arrest risk?

Improving capillary refill from 4 to 2 seconds
Increasing bradycardia with decreasing blood pressure (Correct answer)
Rising urine output to 2 mL/kg/hour
Decreasing lactate from 6 to 3 mmol/L

Correct answer: Increasing bradycardia with decreasing blood pressure

Bradycardia combined with falling blood pressure is a critical warning sign of impending cardiovascular collapse and re-arrest.

Question 5: A 5-year-old child with a history of a severe peanut allergy is brought to the emergency department with urticaria, wheezing, and hypotension after accidentally ingesting a cookie containing peanuts. Which of the following is the most critical initial intervention?

Administering an albuterol nebulizer treatment
Administering intramuscular epinephrine (Correct answer)
Giving an oral dose of an antihistamine
Establishing intravenous access for a fluid bolus

Correct answer: Administering intramuscular epinephrine

In anaphylactic shock, the immediate priority is to administer intramuscular epinephrine. Epinephrine is a life-saving medication that counteracts the systemic effects of anaphylaxis by causing vasoconstriction, bronchodilation, and reducing inflammation. While other interventions like fluid resuscitation and bronchodilators are important, they are secondary to the administration of epinephrine.

Question 6: A 3-year-old presents with sudden onset of stridor, drooling, and refusal to swallow. Which intervention is most appropriate initially?

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

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

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

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: Which position can help improve breathing in a child with respiratory distress?

Left lateral
Upright or sniffing position (Correct answer)
Prone
Supine

Correct answer: Upright or sniffing position

An upright or sniffing position can help open the airway and improve breathing effort.

Question 9: During management of a pediatric patient in respiratory distress, which finding best indicates that bag-mask ventilation is effective?

Visible chest rise with each breath (Correct answer)
Oxygen saturation immediately reaches 100%
The child begins crying vigorously
Heart rate increases to above 160 bpm

Correct answer: Visible chest rise with each breath

Visible and bilateral chest rise confirms adequate tidal volume delivery during bag-mask ventilation.

Question 10: Why is the PAT performed BEFORE touching or fully exposing the child?

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

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 11: What is ventricular tachycardia (VT) characterized by on ECG?

Irregular rhythm with a fibrillatory baseline
Wide QRS complex (≥0.09 sec in children) at a rate greater than 120 bpm (Correct answer)
Narrow QRS complex at a rate greater than 100 bpm
P waves without associated QRS complexes

Correct answer: Wide QRS complex (≥0.09 sec in children) at a rate greater than 120 bpm

Ventricular tachycardia is defined by a wide QRS complex (≥0.09 sec in children) at a rate greater than 120 bpm, originating from the ventricles.

Question 12: What does a capillary refill time longer than 2 seconds suggest in a child?

Elevated blood pressure
Good hydration
Delayed perfusion (Correct answer)
Normal circulation

Correct answer: Delayed perfusion

A capillary refill time >2 seconds may indicate poor perfusion, suggesting possible shock or dehydration.

Question 13: Which antiarrhythmic drug is recommended for VF or pulseless VT refractory to defibrillation in children?

Atropine
Amiodarone (Correct answer)
Epinephrine
Adenosine

Correct answer: Amiodarone

Amiodarone (or lidocaine as an alternative) is used for shock-refractory VF or pulseless VT in pediatric cardiac arrest after CPR and epinephrine.

Question 14: A 3-year-old is in pulseless ventricular tachycardia. After the first shock at 2 J/kg fails, what energy dose should be used for the second shock?

1 J/kg
4 J/kg or higher (Correct answer)
10 J/kg
2 J/kg again

Correct answer: 4 J/kg or higher

Subsequent defibrillation attempts use 4 J/kg or higher after the initial 2 J/kg dose fails.

Question 15: What precaution must be taken when administering calcium chloride rapidly IV in pediatric resuscitation?

Administer only via IO route
Ensure IV patency and avoid extravasation; give slowly through a confirmed IV to prevent tissue necrosis (Correct answer)
Avoid in patients with cardiac arrest
Mix with sodium bicarbonate before administration

Correct answer: Ensure IV patency and avoid extravasation; give slowly through a confirmed IV to prevent tissue necrosis

Calcium chloride is highly irritating to tissues; extravasation can cause severe necrosis, so confirmed IV patency and careful administration are essential.

Question 16: A 7-year-old child is brought in after a traumatic injury with significant blood loss. The child is pale, tachycardic, and has weak distal pulses. Based on the cause, what is the most likely type of shock?

Hypovolemic (Correct answer)
Obstructive
Cardiogenic
Distributive

Correct answer: Hypovolemic

Hypovolemic shock is caused by a loss of intravascular volume. In this scenario, the significant blood loss from trauma directly leads to a decrease in circulating volume, resulting in hypovolemic shock. This is the most common type of shock in children, often caused by hemorrhage or dehydration from illnesses like gastroenteritis.

Question 17: In the PAT, 'Interactivity' is BEST assessed by:

Testing deep tendon reflexes
Checking pupillary response to light
Observing whether the child reaches for objects or engages with the environment (Correct answer)
Measuring the Glasgow Coma Scale score

Correct answer: Observing whether the child reaches for objects or engages with the environment

Interactivity is assessed by watching whether the child appropriately engages with toys, caregivers, or the environment — a hands-off behavioral observation.

Question 18: A 5-year-old post-trauma has normal skin color, is alert and speaking, but has paradoxical chest wall movement. Which PAT component is MOST abnormal?

Appearance
Work of Breathing (Correct answer)
Circulation to Skin
All components equally abnormal

Correct answer: Work of Breathing

Paradoxical chest movement indicates flail chest physiology, a severe Work of Breathing abnormality, while appearance and circulation remain intact.

Question 19: Why is effective teamwork essential in pediatric emergencies?

To ensure coordinated and efficient care (Correct answer)
To allow multitasking by individuals
To reduce the number of staff
To minimize documentation

Correct answer: To ensure coordinated and efficient care

Teamwork ensures timely, coordinated care, reducing errors and improving outcomes in pediatric emergencies.

Question 20: Which PAT finding in a 3-month-old should concern you MOST about a central nervous system problem?

Nasal flaring with tachypnea
Poor muscle tone and absent eye tracking (Correct answer)
Mottled skin
Intercostal retractions

Correct answer: Poor muscle tone and absent eye tracking

Poor muscle tone and absence of visual tracking are abnormal appearance findings that directly point to CNS dysfunction or severe metabolic illness.

Question 21: What is the PRIMARY purpose of continuing education requirements in Pediatric Assessment Triangle for PEARS professionals?

Earning additional credentials for career advancement
Networking with other professionals in the field
Fulfilling mandatory regulatory requirements only
Maintaining current knowledge and competency as the field evolves (Correct answer)

Correct answer: Maintaining current knowledge and competency as the field evolves

Continuing education in Pediatric Assessment Triangle ensures professionals maintain current knowledge and skills as standards, technologies, and best practices evolve in the Pediatric Emergency Assessment, Recognition, and Stabilization field.

Question 22: What is the recommended initial dose of adenosine for pediatric SVT?

1 mg/kg slow IV infusion
10 mg flat dose
0.01 mg/kg IV push
0.1 mg/kg rapid IV/IO push (max 6 mg) (Correct answer)

Correct answer: 0.1 mg/kg rapid IV/IO push (max 6 mg)

The initial adenosine dose is 0.1 mg/kg (maximum 6 mg) given as a rapid IV or IO push with a flush.

Question 23: Which of the following is a shockable cardiac arrest rhythm?

Pulseless electrical activity (PEA)
Ventricular fibrillation (VF) (Correct answer)
Asystole
Severe symptomatic bradycardia

Correct answer: Ventricular fibrillation (VF)

Ventricular fibrillation (and pulseless VT) are shockable rhythms; asystole and PEA are non-shockable rhythms treated with CPR and epinephrine.

Question 24: Nasal flaring in an infant is classified under which PAT component?

Appearance
Work of Breathing (Correct answer)
It is not part of the PAT
Circulation to Skin

Correct answer: Work of Breathing

Nasal flaring is a sign of increased respiratory effort and is assessed under Work of Breathing in the PAT.

Question 25: A child with bronchiolitis has a respiratory rate of 70/min, subcostal and intercostal retractions, SpO2 90%, and is unable to feed. What is the most appropriate classification?

Upper airway obstruction
Mild respiratory distress
Moderate respiratory distress
Respiratory failure (Correct answer)

Correct answer: Respiratory failure

SpO2 of 90%, severe retractions, marked tachypnea, and inability to feed indicate respiratory failure requiring immediate support.

Question 26: A child achieves ROSC after cardiac arrest. What ventilation parameter should be carefully monitored to prevent secondary brain injury?

Respiratory rate only
End-tidal CO2 (ETCO2) to maintain normocarbia (Correct answer)
Peak inspiratory pressure only
FiO2 set permanently at 1.0

Correct answer: End-tidal CO2 (ETCO2) to maintain normocarbia

Monitoring ETCO2 to target normocapnia (35–45 mmHg) prevents vasoconstriction from hypocarbia or vasodilation from hypercarbia.

Question 27: A 9-year-old with a history of asthma has audible wheeze, SpO2 92%, is using accessory muscles, and can only speak 2–3 words at a time. How would you classify this child?

Moderate respiratory distress
Compensated respiratory distress
Mild respiratory distress
Respiratory failure (Correct answer)

Correct answer: Respiratory failure

SpO2 of 92%, accessory muscle use, and inability to speak in full sentences indicate respiratory failure requiring urgent intervention.

Question 28: In third-degree (complete) AV block, what is the relationship between P waves and QRS complexes?

P waves and QRS complexes are completely independent with no consistent relationship (Correct answer)
P waves are absent but QRS complexes occur regularly
Each P wave is followed by a progressively longer PR interval until a QRS is dropped
Every other P wave is conducted with a normal PR interval

Correct answer: P waves and QRS complexes are completely independent with no consistent relationship

In complete AV block, the atria and ventricles beat independently—there is no consistent PR relationship between P waves and QRS complexes.

Question 29: What is a key step in managing a child with shock?

Limit fluids
Administer diuretics
Monitor urine output first
Give isotonic fluid bolus (Correct answer)

Correct answer: Give isotonic fluid bolus

Rapid administration of isotonic fluids can help restore perfusion in a pediatric patient with shock.

Question 30: In PEARS, which component of the Pediatric Assessment Triangle (PAT) specifically evaluates breathing?

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

Correct answer: Work of breathing

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

Question 31: During the Primary Assessment of a pediatric patient, which of the following is evaluated under 'D' for Disability?

Delayed capillary refill and skin color
Difficult breathing and retractions
Pupil response and level of consciousness (Correct answer)
Presence of rashes and body temperature

Correct answer: Pupil response and level of consciousness

In the PEARS systematic approach, the Primary Assessment follows the ABCDE sequence. 'D' stands for Disability, which involves a brief neurological evaluation including level of consciousness (using a scale like AVPU), and assessing pupil size and reactivity to light.

Question 32: A 6-month-old infant with a known congenital heart defect presents with signs of poor perfusion, including mottled skin, weak peripheral pulses, and lethargy. You also note crackles on lung auscultation and hepatomegaly. When managing this infant's suspected cardiogenic shock, which principle is most important?

Immediately preparing for synchronized cardioversion
Using smaller, more cautious fluid boluses (e.g., 5-10 mL/kg) while assessing for fluid overload (Correct answer)
Prioritizing vasopressor therapy before any fluid administration
Administering a rapid 20 mL/kg fluid bolus to improve preload

Correct answer: Using smaller, more cautious fluid boluses (e.g., 5-10 mL/kg) while assessing for fluid overload

In cardiogenic shock, the heart's pumping function is impaired. Aggressive fluid resuscitation can worsen pulmonary edema and cardiac failure. Therefore, fluid should be given judiciously in smaller boluses of 5 to 10 mL/kg over a longer period (10-20 minutes), with careful reassessment for signs of fluid overload, such as worsening crackles.

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

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

cpr.heart.org — Test delivery, eligibility, exam format, passing score, time limit, score validity · verified Oct 2026