PALS HEARTCODE EXAM REVIEW 2026
COMPLETE STUDY GUIDE WITH ANSWERS
◉ 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? Answer: -
Hypotension (late sign)
-Increasing tachycardia
◉ The patient still has a blood pressure of 58/38 mm Hg. Her
condition would be classified as ___________ shock. Answer:
Hypotensive
◉ What should be included in the initial treatment for this patient?
Answer: -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? Answer: Measure her by using color-
coded length-based tape
,◉ You measure the infant to be 7 kg and prepare to administer a
fluid bolus of what type? Answer: Normal saline 20 mL/kg
◉ What is the most appropriate method of delivering rapid fluid
boluses to this patient? Answer: 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? Answer: Deliver a second
fluid bolus of 20 mL/kg and reassess
◉ When should vasoactive therapy be considered be considered in
managing distributive shock? Answer: 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? Answer: 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 Answer: 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? Answer: -Angioedema (swelling of the face, lips and tongue)
-Urticaria (hives)
-Respiratory distress with stridor, wheezing or both
◉ in a child with anaphylactic shock, what is the most appropriate
initial treatment? Answer: IM epinephrine
◉ How soon after exposure do symptoms typically occur in
anaphylactic shock? Answer: Seconds to minutes
◉ What should you evaluate to recognize septic shock? Answer: -
Temp
-Heart rate
-Systemic perfusion
-Blood pressure
-Clinical signs of end-organ perfusion
◉ When should antibiotics be administered in septic shock? Answer:
Within the first hour
COMPLETE STUDY GUIDE WITH ANSWERS
◉ 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? Answer: -
Hypotension (late sign)
-Increasing tachycardia
◉ The patient still has a blood pressure of 58/38 mm Hg. Her
condition would be classified as ___________ shock. Answer:
Hypotensive
◉ What should be included in the initial treatment for this patient?
Answer: -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? Answer: Measure her by using color-
coded length-based tape
,◉ You measure the infant to be 7 kg and prepare to administer a
fluid bolus of what type? Answer: Normal saline 20 mL/kg
◉ What is the most appropriate method of delivering rapid fluid
boluses to this patient? Answer: 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? Answer: Deliver a second
fluid bolus of 20 mL/kg and reassess
◉ When should vasoactive therapy be considered be considered in
managing distributive shock? Answer: 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? Answer: 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 Answer: 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? Answer: -Angioedema (swelling of the face, lips and tongue)
-Urticaria (hives)
-Respiratory distress with stridor, wheezing or both
◉ in a child with anaphylactic shock, what is the most appropriate
initial treatment? Answer: IM epinephrine
◉ How soon after exposure do symptoms typically occur in
anaphylactic shock? Answer: Seconds to minutes
◉ What should you evaluate to recognize septic shock? Answer: -
Temp
-Heart rate
-Systemic perfusion
-Blood pressure
-Clinical signs of end-organ perfusion
◉ When should antibiotics be administered in septic shock? Answer:
Within the first hour
