AHA PEARS Provider Exam — Questions and Answers

Question 1: Which component of the pediatric assessment triangle indicates respiratory distress?

Circulation
Work of breathing (Correct answer)
Mental status
Skin turgor

Correct answer: Work of breathing

Work of breathing reflects the child’s respiratory effort, which helps identify potential respiratory problems.

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

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

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 is the recommended initial dose of adenosine for pediatric SVT?

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

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 4: What should a team member do if they notice the team leader has given an incorrect drug dose during resuscitation?

Remain silent to avoid conflict
Administer the dose anyway and document it
Leave the room to find a supervisor
Speak up respectfully using the 'I'm concerned' technique (Correct answer)

Correct answer: Speak up respectfully using the 'I'm concerned' technique

Team members must voice safety concerns assertively and respectfully, using structured language to alert the leader without disrupting care.

Question 5: A 10-year-old with diabetic ketoacidosis has a respiratory rate of 40/min with deep, sighing breaths. This breathing pattern is called:

Cheyne-Stokes breathing
Kussmaul respirations (Correct answer)
Agonal breathing
Biot's breathing

Correct answer: Kussmaul respirations

Kussmaul respirations — deep, rapid breathing — are the body's compensatory response to metabolic acidosis, as seen in diabetic ketoacidosis.

Question 6: Which of the following is the most appropriate initial intervention for a child with lower airway obstruction, such as asthma, who is in moderate respiratory distress?

Preparing for immediate intubation
Administering a nebulized bronchodilator (Correct answer)
Applying cool mist to the face
Performing a blind finger sweep

Correct answer: Administering a nebulized bronchodilator

Lower airway obstruction, commonly seen in asthma and bronchiolitis, involves bronchoconstriction. A nebulized bronchodilator like albuterol is a first-line treatment to open the airways and improve air exchange.

Question 7: When is it appropriate to use an automated external defibrillator (AED) on an infant under 1 year of age?

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

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 8: Which of the following is a Work of Breathing finding in the PAT that is assessed visually rather than auditorily?

Subcostal retractions (Correct answer)
Grunting
Expiratory wheezing
Stridor

Correct answer: Subcostal retractions

Subcostal retractions are visible indrawing of the chest wall below the ribs that is seen rather than heard, unlike audible breath sounds.

Question 9: In the PEARS systematic approach, the 'Evaluate-Identify-Intervene' sequence means you should:

Always complete full assessment before any intervention
Intervene immediately when a life threat is identified during evaluation (Correct answer)
Identify the diagnosis before evaluating the patient
Evaluate only after all interventions are complete

Correct answer: Intervene immediately when a life threat is identified during evaluation

The evaluate-identify-intervene sequence is iterative — when a life-threatening finding is identified, intervene before continuing the full assessment.

Question 10: Which of the following best describes compensated shock in a pediatric patient?

Hypertension with altered mental status
Normal blood pressure with signs of poor perfusion (Correct answer)
Hypotension with tachycardia
Bradycardia with normal capillary refill

Correct answer: Normal blood pressure with signs of poor perfusion

In compensated shock, the child maintains normal blood pressure through compensatory mechanisms but shows signs of poor perfusion such as tachycardia, prolonged capillary refill, and decreased urine output.

Question 11: Which fluid is recommended as the first-line resuscitation fluid for hypovolemic shock in a pediatric patient?

Hypotonic saline (0.45%)
Isotonic crystalloid (0.9% normal saline or lactated Ringer's) (Correct answer)
5% dextrose in water (D5W)
Albumin 25%

Correct answer: Isotonic crystalloid (0.9% normal saline or lactated Ringer's)

Isotonic crystalloids such as normal saline or lactated Ringer's are the first-line fluids for pediatric hypovolemic shock resuscitation.

Question 12: A child with cardiogenic shock is being considered for vasoactive support. Which medication is most appropriate as initial inotropic therapy?

Dobutamine (Correct answer)
Norepinephrine
Vasopressin
Phenylephrine

Correct answer: Dobutamine

Dobutamine is an inotrope that increases cardiac contractility without significantly increasing afterload, making it ideal for cardiogenic shock.

Question 13: A 5-year-old with known peanut allergy suddenly develops urticaria, stridor, and hypotension. What is the priority intervention?

Intramuscular epinephrine 0.01 mg/kg (Correct answer)
20 mL/kg IV normal saline bolus
IV diphenhydramine 1 mg/kg
Nebulized albuterol

Correct answer: Intramuscular epinephrine 0.01 mg/kg

IM epinephrine is the first-line treatment for anaphylactic shock and must be given immediately.

Question 14: Which of the following is a shockable cardiac arrest rhythm?

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

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 15: 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?

Compensated respiratory distress
Respiratory failure (Correct answer)
Mild 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 16: 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?

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

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 17: Which assessment finding differentiates distributive shock from hypovolemic shock in a child?

Tachycardia present in both
Warm, flushed skin with bounding pulses in distributive shock (Correct answer)
Decreased urine output in hypovolemic shock only
Altered mental status in distributive shock only

Correct answer: Warm, flushed skin with bounding pulses in distributive shock

Distributive shock (e.g., septic, anaphylactic, neurogenic) causes vasodilation leading to warm skin and bounding pulses early, whereas hypovolemic shock typically presents with cool, clammy skin.

Question 18: A family member becomes disruptive at the bedside during a pediatric resuscitation. Which team member should ideally manage this?

A designated family support person or social worker (Correct answer)
The team leader
The recorder
The compressor

Correct answer: A designated family support person or social worker

Assigning a dedicated person to support the family prevents the team leader and core members from being distracted.

Question 19: A child in respiratory failure due to bronchiolitis is receiving blow-by oxygen but remains cyanotic with SpO2 of 78%. What is the most appropriate next intervention?

Apply a non-rebreather mask
Administer nebulized albuterol
Increase blow-by oxygen flow rate
Begin bag-mask ventilation (Correct answer)

Correct answer: Begin bag-mask ventilation

SpO2 of 78% with cyanosis despite supplemental oxygen indicates respiratory failure requiring immediate bag-mask ventilation.

Question 20: When is it appropriate to interrupt the systematic PEARS assessment to perform a life-saving intervention?

Never — always complete PAT first
Only after the full secondary assessment is completed
Immediately upon identifying any life-threatening finding during any phase of assessment (Correct answer)
Only when directed by medical control

Correct answer: Immediately upon identifying any life-threatening finding during any phase of assessment

The evaluate-identify-intervene model is iterative; any life-threatening finding identified at any point requires immediate intervention before continuing the assessment.

Question 21: Which of the following is a sign of impending respiratory failure in a child with severe asthma?

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

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 22: A 3-year-old presents with a barky cough, inspiratory stridor at rest, and mild retractions. Which condition does this presentation most suggest?

Epiglottitis
Croup (laryngotracheobronchitis) (Correct answer)
Foreign body aspiration
Bronchiolitis

Correct answer: Croup (laryngotracheobronchitis)

Barky cough with inspiratory stridor and mild retractions at rest is the classic presentation of croup.

Question 23: A 7-year-old is in cardiac arrest. Two rescuers are present. What compression-to-ventilation ratio should they use?

15:2 (Correct answer)
30:2
20:2
10:1

Correct answer: 15:2

Two rescuers performing CPR on a child use a 15:2 compression-to-ventilation ratio to optimize oxygenation.

Question 24: Which sign differentiates distributive shock from hypovolemic shock in a febrile child?

Hypotension
Warm, flushed extremities with bounding pulses (Correct answer)
Tachycardia
Decreased urine output

Correct answer: Warm, flushed extremities with bounding pulses

Distributive (septic) shock in early stages causes vasodilation, resulting in warm extremities and bounding pulses unlike the cool, clammy periphery of hypovolemic shock.

Question 25: During the initial assessment of an infant, you observe nasal flaring, grunting, and significant subcostal retractions. These are signs of which type of respiratory problem?

Respiratory failure (Correct answer)
Disordered control of breathing
Compensated shock
Mild respiratory distress

Correct answer: Respiratory failure

Grunting is an ominous sign indicating the child is trying to maintain positive end-expiratory pressure to keep alveoli open. Combined with significant retractions and nasal flaring, these findings point towards respiratory failure, where the body can no longer compensate.

Question 26: In a child with obstructive shock from tension pneumothorax, which intervention is most immediately life-saving?

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

Correct answer: Needle decompression of the chest

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

Question 27: Which clinical sign indicates that a child in shock is responding adequately to fluid resuscitation?

Capillary refill improving to less than 2 seconds (Correct answer)
Persistent tachycardia
Ongoing cool extremities
Unchanged mental status

Correct answer: Capillary refill improving to less than 2 seconds

Capillary refill time normalizing to under 2 seconds reflects improved peripheral perfusion and treatment response.

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

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

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?

Supraventricular tachycardia (SVT) (Correct answer)
Asystole
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 30: Which position best opens the airway of an unresponsive infant without suspected cervical spine injury?

Hyperextended neck position
Flexed neck position
Neutral sniffing position (Correct answer)
Semi-prone recovery position

Correct answer: Neutral sniffing position

The neutral sniffing position aligns the airway axes optimally in infants without cervical injury.

Question 31: A 4-year-old with altered mental status, pinpoint pupils, and slow, irregular breathing most likely has which type of emergency?

Hypertensive emergency
Opioid toxidrome (Correct answer)
Hypoglycemia
Meningitis

Correct answer: Opioid toxidrome

Pinpoint pupils, CNS depression, and respiratory depression form the classic opioid toxidrome, which can be confirmed and treated with naloxone.

Question 32: When assessing circulation in the PAT, which skin finding indicates poor perfusion in a child?

Mottling, pallor, or cyanosis (Correct answer)
Diaphoresis only
Capillary refill of 1 second
Flushed, warm skin

Correct answer: Mottling, pallor, or cyanosis

Mottling, pallor, and cyanosis of the skin are signs of poor peripheral perfusion and indicate circulatory compromise in the PAT assessment.

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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