ESTUDYR
HEARTCODE PALS |2025|COMPLETE EXAM SET (QUESTIONS
AND VERIFIED ANSWERS) FREQUENTLY MOST TESTED
1. An infant on an ambulance stretcher groans to stimulation and has a temp of 36.3°C
(97.3°F). What is the immediate priority?
A. Give acetaminophen.
B. ✅Monitor and support ABCs; establish IV/IO access; monitor HR, BP, SpO₂; call for
assistance.
C. Transport without intervention.
D. Obtain a full blood panel first.
Rationale: Initial management of any unstable pediatric patient is airway, breathing,
circulation (ABCs), vascular access and continuous monitoring.
2. Clear lungs, cool mottled skin, glucose 97 mg/dL, capillary refill 5 seconds. Which sign
suggests progression from compensated to hypotensive shock?
A. Bradycardia.
B. ✅Hypotension (late sign) and increasing tachycardia.
C. Warm, flushed skin.
D. Immediate normotension.
Rationale: Hypotension is a late sign in children; rising tachycardia with prolonged
capillary refill indicates deterioration toward hypotension.
3. A child with BP 58/38 mm Hg would be classified as:
A. Compensated shock.
B. Pre-shock.
C. ✅Hypotensive shock.
D. Normal.
Rationale: A systolic BP this low for a child indicates hypotensive (decompensated)
shock.
4. Initial treatment priorities for a hypotensive infant include:
A. Oral fluids and observation.
B. ✅Rapid isotonic fluid bolus; establish IV/IO access.
C. Immediate intubation without fluids.
D. Give sedative medications.
Rationale: Rapid restoration of intravascular volume with IV/IO isotonic crystalloids is
the first-line step.
,ESTUDYR
5. Mother doesn’t know infant’s weight. Best rapid method to estimate weight and med
dosing:
A. Ask neighboring parent.
B. Use reported average weight for age.
C. ✅Use color-coded length-based (Broselow) tape.
D. Weigh after transport only.
Rationale: Length-based tapes provide fast, weight-based dosing/volumes in
emergencies.
6. For a 7-kg infant, the appropriate initial fluid bolus is:
A. Dextrose 5% 10 mL/kg.
B. ✅Normal saline (isotonic crystalloid) 20 mL/kg.
C. LR 5 mL/kg.
D. Packed RBCs 20 mL/kg.
Rationale: Standard initial pediatric shock bolus is 20 mL/kg isotonic crystalloid (NS or
LR).
7. The most appropriate method to deliver rapid fluid boluses in infants:
A. Gravity infusion only.
B. Peripheral infusion pump at slow rate.
C. ✅Syringe push with 3-way stopcock (or manual rapid infuser for larger volumes).
D. Subcutaneous infusion.
Rationale: Syringe and stopcock allow rapid, controlled boluses in small infants when
pressure bags or rapid infusers aren’t available.
8. After first bolus, reassessment shows HR 167, BP 58/44, SpO₂ 92%, cool pale skin,
lethargy. Next step:
A. Observe for 30 minutes.
B. Start vasopressors immediately without more fluids.
C. ✅Give a second 20 mL/kg fluid bolus and reassess.
D. Administer insulin.
Rationale: Repeat bolus is indicated if persistent signs of poor perfusion and
hypotension (unless signs of fluid overload or cardiogenic shock).
9. When should vasoactive therapy be considered in distributive (e.g., septic) shock?
A. Only after 24 hours.
B. ✅If hypotension and poor perfusion persist despite rapid bolus fluid administration.
C. Never — vasopressors are contraindicated.
D. Before giving any fluids.
, ESTUDYR
Rationale: Vasopressors are indicated when hypotension persists after adequate fluid
resuscitation.
10. How does clinical presentation of distributive shock compare with hypovolemic shock?
A. They are identical.
B. ✅Distributive shock has more variable presentation (warm or cool skin, variable BP)
vs. typically cold/clammy in hypovolemia.
C. Distributive always causes bradycardia.
D. Hypovolemic always causes fever.
Rationale: Distributive shock (e.g., septic, anaphylactic) can present with vasodilation
and variable skin perfusion, unlike classic hypovolemia.
11. For general pediatric shock management, administer isotonic crystalloid bolus of __
mL/kg over __ to __ minutes.
A. 10 mL/kg over 30–60 minutes.
B. ✅20 mL/kg over 5–20 minutes.
C. 5 mL/kg over 1 minute.
D. 50 mL/kg over 5 minutes.
Rationale: Standard guideline: 20 mL/kg isotonic crystalloid rapidly (5–20 min
depending on severity).
12. What findings help identify anaphylactic shock?
A. Gradual onset over days only.
B. ✅Angioedema, urticaria (hives), respiratory distress with stridor/wheezing.
C. Isolated hypotension with no skin or respiratory signs.
D. Only GI symptoms.
Rationale: Anaphylaxis often includes mucocutaneous signs and upper/lower airway
compromise.
13. Most appropriate initial treatment for pediatric anaphylactic shock:
A. IV antihistamine.
B. ✅Intramuscular (IM) epinephrine (into lateral thigh).
C. Nebulized albuterol only.
D. Steroids only.
Rationale: IM epinephrine is the first-line life-saving treatment for anaphylaxis.
14. Typical onset of anaphylactic symptoms after exposure:
A. Days to weeks.
B. Hours.
C. ✅Seconds to minutes.
HEARTCODE PALS |2025|COMPLETE EXAM SET (QUESTIONS
AND VERIFIED ANSWERS) FREQUENTLY MOST TESTED
1. An infant on an ambulance stretcher groans to stimulation and has a temp of 36.3°C
(97.3°F). What is the immediate priority?
A. Give acetaminophen.
B. ✅Monitor and support ABCs; establish IV/IO access; monitor HR, BP, SpO₂; call for
assistance.
C. Transport without intervention.
D. Obtain a full blood panel first.
Rationale: Initial management of any unstable pediatric patient is airway, breathing,
circulation (ABCs), vascular access and continuous monitoring.
2. Clear lungs, cool mottled skin, glucose 97 mg/dL, capillary refill 5 seconds. Which sign
suggests progression from compensated to hypotensive shock?
A. Bradycardia.
B. ✅Hypotension (late sign) and increasing tachycardia.
C. Warm, flushed skin.
D. Immediate normotension.
Rationale: Hypotension is a late sign in children; rising tachycardia with prolonged
capillary refill indicates deterioration toward hypotension.
3. A child with BP 58/38 mm Hg would be classified as:
A. Compensated shock.
B. Pre-shock.
C. ✅Hypotensive shock.
D. Normal.
Rationale: A systolic BP this low for a child indicates hypotensive (decompensated)
shock.
4. Initial treatment priorities for a hypotensive infant include:
A. Oral fluids and observation.
B. ✅Rapid isotonic fluid bolus; establish IV/IO access.
C. Immediate intubation without fluids.
D. Give sedative medications.
Rationale: Rapid restoration of intravascular volume with IV/IO isotonic crystalloids is
the first-line step.
,ESTUDYR
5. Mother doesn’t know infant’s weight. Best rapid method to estimate weight and med
dosing:
A. Ask neighboring parent.
B. Use reported average weight for age.
C. ✅Use color-coded length-based (Broselow) tape.
D. Weigh after transport only.
Rationale: Length-based tapes provide fast, weight-based dosing/volumes in
emergencies.
6. For a 7-kg infant, the appropriate initial fluid bolus is:
A. Dextrose 5% 10 mL/kg.
B. ✅Normal saline (isotonic crystalloid) 20 mL/kg.
C. LR 5 mL/kg.
D. Packed RBCs 20 mL/kg.
Rationale: Standard initial pediatric shock bolus is 20 mL/kg isotonic crystalloid (NS or
LR).
7. The most appropriate method to deliver rapid fluid boluses in infants:
A. Gravity infusion only.
B. Peripheral infusion pump at slow rate.
C. ✅Syringe push with 3-way stopcock (or manual rapid infuser for larger volumes).
D. Subcutaneous infusion.
Rationale: Syringe and stopcock allow rapid, controlled boluses in small infants when
pressure bags or rapid infusers aren’t available.
8. After first bolus, reassessment shows HR 167, BP 58/44, SpO₂ 92%, cool pale skin,
lethargy. Next step:
A. Observe for 30 minutes.
B. Start vasopressors immediately without more fluids.
C. ✅Give a second 20 mL/kg fluid bolus and reassess.
D. Administer insulin.
Rationale: Repeat bolus is indicated if persistent signs of poor perfusion and
hypotension (unless signs of fluid overload or cardiogenic shock).
9. When should vasoactive therapy be considered in distributive (e.g., septic) shock?
A. Only after 24 hours.
B. ✅If hypotension and poor perfusion persist despite rapid bolus fluid administration.
C. Never — vasopressors are contraindicated.
D. Before giving any fluids.
, ESTUDYR
Rationale: Vasopressors are indicated when hypotension persists after adequate fluid
resuscitation.
10. How does clinical presentation of distributive shock compare with hypovolemic shock?
A. They are identical.
B. ✅Distributive shock has more variable presentation (warm or cool skin, variable BP)
vs. typically cold/clammy in hypovolemia.
C. Distributive always causes bradycardia.
D. Hypovolemic always causes fever.
Rationale: Distributive shock (e.g., septic, anaphylactic) can present with vasodilation
and variable skin perfusion, unlike classic hypovolemia.
11. For general pediatric shock management, administer isotonic crystalloid bolus of __
mL/kg over __ to __ minutes.
A. 10 mL/kg over 30–60 minutes.
B. ✅20 mL/kg over 5–20 minutes.
C. 5 mL/kg over 1 minute.
D. 50 mL/kg over 5 minutes.
Rationale: Standard guideline: 20 mL/kg isotonic crystalloid rapidly (5–20 min
depending on severity).
12. What findings help identify anaphylactic shock?
A. Gradual onset over days only.
B. ✅Angioedema, urticaria (hives), respiratory distress with stridor/wheezing.
C. Isolated hypotension with no skin or respiratory signs.
D. Only GI symptoms.
Rationale: Anaphylaxis often includes mucocutaneous signs and upper/lower airway
compromise.
13. Most appropriate initial treatment for pediatric anaphylactic shock:
A. IV antihistamine.
B. ✅Intramuscular (IM) epinephrine (into lateral thigh).
C. Nebulized albuterol only.
D. Steroids only.
Rationale: IM epinephrine is the first-line life-saving treatment for anaphylaxis.
14. Typical onset of anaphylactic symptoms after exposure:
A. Days to weeks.
B. Hours.
C. ✅Seconds to minutes.
