PEARS Systematic Assessment 3 — Questions and Answers
Question 1: A 5-year-old is alert, crying vigorously, and has intercostal retractions with an SpO2 of 91% on room air. Which PEARS category best describes this child?
- Respiratory failure
- Respiratory distress (Correct answer)
- Compensated shock
- Cardiopulmonary failure
Correct answer: Respiratory distress
The child is alert and maintaining airway but showing signs of increased work of breathing with mild hypoxia, consistent with respiratory distress.
Question 2: Which of the following best describes 'compensated shock' in a pediatric patient?
- Hypotension with tachycardia and altered mental status
- Normal blood pressure maintained despite inadequate perfusion (Correct answer)
- Bradycardia with bounding pulses
- Hypertension with decreased capillary refill
Correct answer: Normal blood pressure maintained despite inadequate perfusion
In compensated shock, the child maintains normal blood pressure through compensatory mechanisms (tachycardia, vasoconstriction) despite inadequate tissue perfusion.
Question 3: During the PAT, a toddler does not make eye contact, has limp muscle tone, and does not cry when you enter. This appearance is best described as:
- Normal for a shy child
- Consistent with severe illness or altered mental status (Correct answer)
- Indicating only pain
- A sign of respiratory distress alone
Correct answer: Consistent with severe illness or altered mental status
Lack of eye contact, limp tone, and absent cry are ominous findings suggesting severe illness, critical injury, or markedly altered mental status.
Question 4: In pediatric assessment, which sequence correctly represents the order of the PEARS systematic approach?
- Primary assessment → PAT → Secondary assessment → Diagnostic tests
- PAT → Primary assessment → Identify/intervene → Secondary assessment (Correct answer)
- Secondary assessment → PAT → Primary assessment → Diagnostics
- Diagnostic tests → PAT → Primary assessment → Secondary assessment
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 5: 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
- Oxygen via nasal cannula and bronchodilator therapy (Correct answer)
- IV fluid bolus
- 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.
Question 6: When assessing circulation during the PEARS primary assessment, which finding is most specific for early decompensation in a pediatric patient?
- Hypotension
- Tachycardia with weak peripheral pulses (Correct answer)
- Bradypnea
- Normal capillary refill
Correct answer: Tachycardia with weak peripheral pulses
Tachycardia with weak peripheral pulses is an early and sensitive indicator of circulatory compromise before hypotension develops.
Question 7: A child's blood glucose is measured at 38 mg/dL during a PEARS secondary assessment. This finding should prompt:
- Repeat measurement in 30 minutes
- Immediate dextrose administration (Correct answer)
- Insulin administration
- No action if the child appears awake
Correct answer: Immediate dextrose administration
A blood glucose of 38 mg/dL is hypoglycemia in a child and requires immediate dextrose administration to prevent neurologic injury.
PEARS Systematic Assessment 3
A 5-year-old is alert, crying vigorously, and has intercostal retractions with an SpO2 of 91% on room air.
Which PEARS category best describes this child?