AHA PEARS Provider Exam — Questions and Answers

Question 1: In Pediatric Assessment Triangle, what is the FIRST step a PEARS professional should take when encountering a new case or situation?

Consult with a supervisor before taking any action
Implement an immediate solution based on past experience
Document the situation and wait for further instructions
Conduct a comprehensive assessment and gather all relevant information (Correct answer)

Correct answer: Conduct a comprehensive assessment and gather all relevant information

In Pediatric Assessment Triangle, a thorough initial assessment ensures all relevant factors are identified before deciding on an appropriate course of action. This systematic approach is fundamental to Pediatric Emergency Assessment, Recognition, and Stabilization practice.

Question 2: A child has wide-complex tachycardia at 180 bpm with hypotension and altered mental status. What is the priority treatment?

Administer amiodarone IV over 20-60 minutes
Administer adenosine IV rapidly
Perform synchronized cardioversion (Correct answer)
Attempt vagal maneuvers first

Correct answer: Perform synchronized cardioversion

Hemodynamically unstable tachycardia requires immediate synchronized cardioversion regardless of QRS width, as waiting for drugs risks further deterioration.

Question 3: A child has a normal PAT but deteriorates during the primary assessment. What is the MOST appropriate action?

Repeat the PAT to confirm deterioration
Document the PAT findings and continue the examination
Reassess and immediately address any life threats found (Correct answer)
Proceed directly to the secondary survey

Correct answer: Reassess and immediately address any life threats found

The PAT is dynamic; if the child deteriorates, the clinician must stop, reassess, and treat life-threatening problems as they are identified.

Question 4: Which rhythm is characterized by chaotic, irregular electrical activity with no identifiable P waves or QRS complexes?

Ventricular fibrillation (Correct answer)
Pulseless electrical activity
Ventricular tachycardia
Asystole

Correct answer: Ventricular fibrillation

Ventricular fibrillation produces chaotic, disorganized electrical activity with no recognizable P waves or QRS complexes, resulting in no effective cardiac output.

Question 5: A child presents with grunting on expiration. What physiological purpose does grunting serve in a child with respiratory distress?

It creates auto-PEEP to prevent alveolar collapse (Correct answer)
It relaxes bronchospasm by increasing intrathoracic pressure
It increases respiratory rate to improve ventilation
It signals pain rather than respiratory compromise

Correct answer: It creates auto-PEEP to prevent alveolar collapse

Grunting creates auto-PEEP by partially closing the glottis, maintaining alveolar recruitment and preventing collapse.

Question 6: What is the maximum recommended total volume of isotonic fluid boluses in pediatric septic shock resuscitation within the first hour?

100 mL/kg
40 mL/kg
20 mL/kg
60 mL/kg (Correct answer)

Correct answer: 60 mL/kg

Current PEARS guidelines recommend up to 60 mL/kg (three 20 mL/kg boluses) before initiating vasoactive therapy.

Question 7: 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)
Slow infusion over 30 minutes
Mix with D5W and give over 10 minutes
Dilute in 100 mL normal saline

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 8: Which finding would prompt you to stop fluid administration and reassess in a child receiving bolus therapy?

Capillary refill improving from 4 to 2 seconds
BP increasing from 70/40 to 85/55
Development of respiratory crackles and worsening work of breathing (Correct answer)
HR decreasing from 170 to 150

Correct answer: Development of respiratory crackles and worsening work of breathing

New crackles and increased work of breathing suggest pulmonary edema, indicating fluid overload and need to pause resuscitation.

Question 9: A pediatric patient in anaphylaxis requires epinephrine. What is the preferred route and dose?

IV push of 1 mg regardless of weight
Intramuscular (IM) into the anterolateral thigh, 0.01 mg/kg of 1:1,000 (max 0.5 mg) (Correct answer)
Inhaled epinephrine as first-line
Subcutaneous injection only

Correct answer: Intramuscular (IM) into the anterolateral thigh, 0.01 mg/kg of 1:1,000 (max 0.5 mg)

IM epinephrine 0.01 mg/kg of 1:1,000 solution (max 0.5 mg) into the anterolateral thigh provides the fastest absorption for anaphylaxis treatment.

Question 10: Which rhythm is characterized by absent P waves, narrow QRS complexes, and a rate of 40-60 bpm?

Idioventricular rhythm
Junctional escape rhythm (Correct answer)
Sinus bradycardia
First-degree AV block

Correct answer: Junctional escape rhythm

A junctional escape rhythm occurs when the AV node acts as pacemaker, producing narrow QRS complexes at 40-60 bpm with absent or retrograde P waves.

Question 11: A child is sitting on her parent's lap, crying, with subcostal retractions and diffuse expiratory wheezing. Her skin is pink. Which PAT pattern is present?

Compensated shock
Normal PAT — crying indicates adequate tone
Respiratory distress with one abnormal component (Correct answer)
Respiratory failure with two abnormal components

Correct answer: Respiratory distress with one abnormal component

Retractions and wheezing reflect increased work of breathing, while normal appearance and pink skin indicate only one PAT component is abnormal, consistent with respiratory distress.

Question 12: After a difficult pediatric resuscitation, the team leader says, 'Let's take five minutes to debrief.' What is the PRIMARY goal of this debriefing?

Identify what went well and what can be improved for future events (Correct answer)
Satisfy documentation requirements for quality assurance
Allow team members to express grief without discussing clinical performance
Assign blame to the team member who made an error

Correct answer: Identify what went well and what can be improved for future events

Debriefing is a structured review of team performance to reinforce effective behaviors and identify areas for improvement.

Question 13: In a child with obstructive shock from tension pneumothorax, which intervention is most immediately life-saving?

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

Correct answer: Needle decompression of the chest

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

Question 14: A healthcare provider is gathering a history for a 6-year-old who fell off his bike. The provider asks the parent, 'What was the last thing he had to eat or drink?' This question is part of which assessment component?

Life-Threatening Interventions
Secondary Assessment (SAMPLE history) (Correct answer)
Primary Assessment (ABCDE)
Pediatric Assessment Triangle (PAT)

Correct answer: Secondary Assessment (SAMPLE history)

The Secondary Assessment involves a focused history and physical exam. The SAMPLE mnemonic is a tool used to gather this history. The 'L' in SAMPLE stands for 'Last Oral Intake,' which includes the last food and drink consumed.

Question 15: 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
Tachycardia
Delayed capillary refill

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 16: During the PAT, a 2-year-old has decreased muscle tone, poor eye contact, and weak cry. Work of breathing is labored. What does this combination suggest?

Respiratory failure with CNS depression from hypoxia (Correct answer)
Respiratory distress with CNS compensation
Normal sleepy toddler behavior
Mild respiratory distress with normal CNS status

Correct answer: Respiratory failure with CNS depression from hypoxia

Abnormal appearance (decreased tone, poor eye contact) combined with labored breathing indicates respiratory failure causing CNS depression.

Question 17: What is the first-line drug for stable SVT in a child when vagal maneuvers have failed?

Adenosine (Correct answer)
Amiodarone
Lidocaine
Epinephrine

Correct answer: Adenosine

Adenosine is the first-line pharmacological treatment for stable SVT in children after vagal maneuvers have failed, given as a rapid IV bolus.

Question 18: Which is the most important initial action when a child with a foreign body airway obstruction becomes unconscious?

Perform five back blows followed by five chest thrusts
Administer three rescue breaths before starting compressions
Immediately perform blind finger sweeps
Call for help and begin CPR starting with chest compressions (Correct answer)

Correct answer: Call for help and begin CPR starting with chest compressions

When an FBAO victim becomes unconscious, CPR is initiated immediately, and each time the airway is opened for ventilation, look for and remove any visible object.

Question 19: A 10-year-old with a known peanut allergy develops urticaria, stridor, and hypotension after eating at a restaurant. What is the FIRST-LINE treatment?

IV methylprednisolone
Epinephrine 0.01 mg/kg IM to lateral thigh (Correct answer)
Nebulized albuterol
IV diphenhydramine 25 mg

Correct answer: Epinephrine 0.01 mg/kg IM to lateral thigh

Epinephrine IM to the anterolateral thigh is the first-line and most critical treatment for anaphylaxis because it reverses bronchospasm, vasodilation, and laryngeal edema.

Question 20: A child in shock receives supplemental oxygen. What SpO2 target should guide therapy?

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

Correct answer: Greater than 94%

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

Question 21: A 6-month-old has a respiratory rate of 70 breaths/min, nasal flaring, and subcostal retractions. How should this infant's respiratory status be categorized?

Respiratory distress (Correct answer)
Respiratory failure
Respiratory arrest
Normal respiratory effort

Correct answer: Respiratory distress

Tachypnea with accessory muscle use (nasal flaring and retractions) indicates respiratory distress, signaling increased work of breathing.

Question 22: 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?

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

Correct answer: Respiratory failure

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

Question 23: Which component of the Pediatric Assessment Triangle is assessed by observing the child's skin color from across the room?

Appearance
Respiratory Rate
Work of Breathing
Circulation to Skin (Correct answer)

Correct answer: Circulation to Skin

Circulation to Skin is evaluated by observing pallor, mottling, or cyanosis, which can be seen before physically touching the child.

Question 24: What is the appropriate action if the rhythm check after 2 minutes of CPR reveals asystole?

Deliver a defibrillation shock
Perform synchronized cardioversion
Resume CPR immediately and continue looking for reversible causes (Correct answer)
Administer atropine and recheck in 1 minute

Correct answer: Resume CPR immediately and continue looking for reversible causes

Asystole is a non-shockable rhythm; resume CPR immediately, give epinephrine, and address reversible causes (Hs and Ts).

Question 25: A child in cardiac arrest has a shockable rhythm. After the first defibrillation attempt, what should be done immediately?

Deliver a second shock immediately
Check the pulse for 30 seconds
Administer epinephrine before resuming CPR
Resume CPR for 2 minutes before rechecking the rhythm (Correct answer)

Correct answer: Resume CPR for 2 minutes before rechecking the rhythm

After defibrillation, immediately resume CPR for 2 minutes before pausing to recheck the rhythm, as the heart needs time to recover.

Question 26: A respiratory therapist believes the child needs a higher FiO₂ but the physician has not ordered it. Using assertive communication, which response is BEST?

'Doctor, I'm concerned the SpO₂ is dropping — can we increase the FiO₂?' (Correct answer)
'I'll just turn up the oxygen without telling anyone since it's safer.'
'I'll document my concern and let the charge nurse decide.'
'Someone should probably check the oxygen.'

Correct answer: 'Doctor, I'm concerned the SpO₂ is dropping — can we increase the FiO₂?'

Assertive communication means directly addressing the decision-maker by name with a clear patient-safety concern and a suggested action.

Question 27: 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?

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

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.

Question 28: A 4-year-old in shock needs vasopressors. Which route should be used if central access is unavailable?

Rectal suppository
Subcutaneous injection
Endotracheal administration
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 29: Adenosine is used in pediatric emergencies to treat which rhythm?

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

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

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

Correct answer: Hepatomegaly and crackles on lung auscultation

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

Question 31: A child with anaphylaxis has audible stridor, hives, and a blood pressure of 60/30 mmHg. Which PEARS clinical category best describes this presentation?

Respiratory distress only
Cardiopulmonary failure
Compensated shock
Decompensated shock with upper airway compromise (Correct answer)

Correct answer: Decompensated shock with upper airway compromise

Hypotension with stridor and hives in anaphylaxis represents decompensated shock combined with upper airway obstruction — a combined, immediately life-threatening presentation.

Question 32: A lone healthcare provider finds an 8-month-old infant is unresponsive, apneic, and pulseless. After shouting for help and activating the emergency response system, what is the correct compression-to-ventilation ratio the provider should use?

30 compressions to 2 breaths (Correct answer)
15 compressions to 1 breath
15 compressions to 2 breaths
30 compressions to 1 breath

Correct answer: 30 compressions to 2 breaths

According to the American Heart Association (AHA) guidelines, a single rescuer performing CPR on an infant or child should use a compression-to-ventilation ratio of 30:2. The 15:2 ratio is reserved for two-rescuer CPR for infants and children.

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%

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