HEARTCODE PALS EXAM 2025
QUESTIONS AND ANSWERS
The infant is placed on the ambulance stretcher and responds with a groan when stimulated
and has a temperature of 36.3 C (97.3 F) - ANS -Monitor and support ABCs
-Establish IV/IO access
-Monitor heart rate, blood pressure, and pulse oximetry
-Call for assistance if needed
When you evaluate the patient, you find the lungs are clear, skin is cool and mottled, glucose is
97 mg/dL and capillary refill time is 5 seconds. What are the warning signs that the patient is
progressing from compensated shock to hypotensive shock? - ANS -Hypotension (late sign)
-Increasing tachycardia
The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as
___________ shock. - ANS Hypotensive
What should be included in the initial treatment for this patient? - ANS -Rapid fluid bolus
administration
-Establishing IV/IO access
The mother does not recall the infant's most recent weight. What is the most appropriate way
to rapidly determine her weight and calculate correct medication? - ANS Measure her by
1
using color-coded length-based tape
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, You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? -
ANS Normal saline 20 mL/kg
What is the most appropriate method of delivering rapid fluid boluses to this patient? -
ANS A syringe and 3-way stopcock
After the first fluid bolus is administered, the child is reassessed and her vital signs are HR 167,
BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her skin is still cool and pale and she is still
lethargic and weak.
What should be the next intervention? - ANS Deliver a second fluid bolus of 20 mL/kg and
reassess
When should vasoactive therapy be considered be considered in managing distributive shock? -
ANS If the child remains hypotensive and poorly perfused despite rapid bolus fluid
administration
How does the clinical presentation of distributive shock compare with hypovolemic shock? -
ANS Distributive shock has more variable presentation than that of hypovolemic shock
For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to
__ minutes - ANS For general shock management, administer an isotonic crytalloid bolus of
20 mL/kg over 5 to 20 minutes
What signs distinguish anaphylactic shock from other types of shock? - ANS -Angioedema
(swelling of the face, lips and tongue)
-Urticaria (hives)
-Respiratory distress with stridor, wheezing or both
2
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, in a child with anaphylactic shock, what is the most appropriate initial treatment? - ANS IM
epinephrine
How soon after exposure do symptoms typically occur in anaphylactic shock? - ANS Seconds
to minutes
What should you evaluate to recognize septic shock? - ANS -Temp
-Heart rate
-Systemic perfusion
-Blood pressure
-Clinical signs of end-organ perfusion
When should antibiotics be administered in septic shock? - ANS Within the first hour
What are the initial assessment findings for septic shock? - ANS -Fever
-Hypothermia
-Normal, elevated or decreased WBC
For septic shock, how soon should fluid resuscitation begin? - ANS Within 10 to 15 minutes
after recognizing shock
What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? -
ANS 5 to 10 mL/kg over 10 to 20 minutes
What is the focus of the initial management of distributive shock? - ANS -Correcting
hypovolemia
-Filling expanded dilated vascular space
3
-Expanding intravascular volume
Page
@COPYRIGHT @THEBRIGHT 2025/2026
QUESTIONS AND ANSWERS
The infant is placed on the ambulance stretcher and responds with a groan when stimulated
and has a temperature of 36.3 C (97.3 F) - ANS -Monitor and support ABCs
-Establish IV/IO access
-Monitor heart rate, blood pressure, and pulse oximetry
-Call for assistance if needed
When you evaluate the patient, you find the lungs are clear, skin is cool and mottled, glucose is
97 mg/dL and capillary refill time is 5 seconds. What are the warning signs that the patient is
progressing from compensated shock to hypotensive shock? - ANS -Hypotension (late sign)
-Increasing tachycardia
The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as
___________ shock. - ANS Hypotensive
What should be included in the initial treatment for this patient? - ANS -Rapid fluid bolus
administration
-Establishing IV/IO access
The mother does not recall the infant's most recent weight. What is the most appropriate way
to rapidly determine her weight and calculate correct medication? - ANS Measure her by
1
using color-coded length-based tape
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? -
ANS Normal saline 20 mL/kg
What is the most appropriate method of delivering rapid fluid boluses to this patient? -
ANS A syringe and 3-way stopcock
After the first fluid bolus is administered, the child is reassessed and her vital signs are HR 167,
BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her skin is still cool and pale and she is still
lethargic and weak.
What should be the next intervention? - ANS Deliver a second fluid bolus of 20 mL/kg and
reassess
When should vasoactive therapy be considered be considered in managing distributive shock? -
ANS If the child remains hypotensive and poorly perfused despite rapid bolus fluid
administration
How does the clinical presentation of distributive shock compare with hypovolemic shock? -
ANS Distributive shock has more variable presentation than that of hypovolemic shock
For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to
__ minutes - ANS For general shock management, administer an isotonic crytalloid bolus of
20 mL/kg over 5 to 20 minutes
What signs distinguish anaphylactic shock from other types of shock? - ANS -Angioedema
(swelling of the face, lips and tongue)
-Urticaria (hives)
-Respiratory distress with stridor, wheezing or both
2
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, in a child with anaphylactic shock, what is the most appropriate initial treatment? - ANS IM
epinephrine
How soon after exposure do symptoms typically occur in anaphylactic shock? - ANS Seconds
to minutes
What should you evaluate to recognize septic shock? - ANS -Temp
-Heart rate
-Systemic perfusion
-Blood pressure
-Clinical signs of end-organ perfusion
When should antibiotics be administered in septic shock? - ANS Within the first hour
What are the initial assessment findings for septic shock? - ANS -Fever
-Hypothermia
-Normal, elevated or decreased WBC
For septic shock, how soon should fluid resuscitation begin? - ANS Within 10 to 15 minutes
after recognizing shock
What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? -
ANS 5 to 10 mL/kg over 10 to 20 minutes
What is the focus of the initial management of distributive shock? - ANS -Correcting
hypovolemia
-Filling expanded dilated vascular space
3
-Expanding intravascular volume
Page
@COPYRIGHT @THEBRIGHT 2025/2026
