PALS HEARTCODE FINAL PAPER 2026 EXAM
PREP QUESTIONS AND SOLUTIONS
◉ A responsive infant presents w/ severe foreign-body airway
obstruction.
What is the appropriate management? Answer: Give 5 back blows
followed by 5 chest thrusts
◉ A responsive child presents w/ severe foreign-body airway
obstruction & is unable to speak.
You determine the child Answer: Should receive abdominal thrusts
◉ Scenario:
You are dispatched to a for an 8-month old boy who is having
difficulty breathing. He is lying on the couch & has a hoarse cry,
barking cough, & is drooling. His mother says that during the night,
her son had difficulty breathing, which has progressively worsened
throughout the day. Answer: The infant most likely has what type of
respiratory emergency?
Upper airway obstruction
According to the Systematic Approach Algorithm, what are the
correct assessments to perform during the evaluation phase?
Initial, primary, secondary
,The infant is responsive & breathing. What is an initial measure that
you can perform to maintain his airway?
Sit him up
◉ What are the components of the breathing assessment? Answer:
Lung & airway sounds
Respiratory effort
Chest expansion & air movement
Respiratory rate
Oxygen saturation
◉ During the secondary assessment, the parents share that the
barking cough started a couple of hours ago & the child has been
afebrile. They contacted their pediatrician, who advised them to call
an ambulance. the parents reported that their son has no allergies &
takes no medications.
Breathing Assessment:
Increased work of breathing & occasional barking cough. The
respiratory rate is 33/min w/ nasal faring & high-pitched noises
from the airway. You see retractions & the use of accessory muscles.
The patient's SpO2 is 93% on room air.
Circulatory Assessment:
The circulatory assessment indicates the following: skin flushed,
warm, & dry; HR 161/min; BP 78/55 mm Hg & capillary refill is less
than 2 seconds. His temperature is 38 degrees C [100.4 degrees F].
,Disability & Exposure Assessment:
No significant findings
Based on your findings, what is a most likely diagnosis for this
patient? Answer: Croup
◉ What treatments would be most appropriate for this patient?
Answer: Dexamethasone
Nebulized epinephrine
◉ Infants who begin to display signs of becoming weaker, decreased
respiratory effort, & poor air movement are at high risk for [blank].
Answer: Respiratory failure
◉ Infants & children who are at risk for respiratory failure should be
ventilated & prepared for intubation by a team member with
significant pediatric expertise.
When calculating the tube size based on the child's age, to avoid
injury to the subglottic area, you should use an endotracheal tube
that is: Answer: Half a size smaller than predicted for the child
◉ What are the common causes of lower airway obstruction?
Answer: Asthma
Bronchiolitis
, ◉ How can small airways be obstructed in acute lower airway
obstruction? Answer: Smooth muscle bronchial constriction
Mucus plugging
◉ How do infants initially respond to lower airway obstruction?
Answer: Decreased interpleural pressure
◉ What is the first priority in managing lower airway obstruction?
Answer: Restore adequate oxygenation
◉ Bag-mask ventilation has been used on a child w/ lower airway
obstruction.
Which complications may occur? Answer: Risk of lung collapse
Decreased blood supply to the heart
◉ A child presents w/ audible wheezing, a heart rate greater than
120/min, a respiratory rate of 36/min, & the inability to talk in
sentences.
What is the severity of this presentation? Answer: Severe
◉ A responsive infant presents w/ severe foreign-body airway
obstruction.
What is the appropriate management? Answer: Give 5 back blows
followed by 5 chest thrusts
PREP QUESTIONS AND SOLUTIONS
◉ A responsive infant presents w/ severe foreign-body airway
obstruction.
What is the appropriate management? Answer: Give 5 back blows
followed by 5 chest thrusts
◉ A responsive child presents w/ severe foreign-body airway
obstruction & is unable to speak.
You determine the child Answer: Should receive abdominal thrusts
◉ Scenario:
You are dispatched to a for an 8-month old boy who is having
difficulty breathing. He is lying on the couch & has a hoarse cry,
barking cough, & is drooling. His mother says that during the night,
her son had difficulty breathing, which has progressively worsened
throughout the day. Answer: The infant most likely has what type of
respiratory emergency?
Upper airway obstruction
According to the Systematic Approach Algorithm, what are the
correct assessments to perform during the evaluation phase?
Initial, primary, secondary
,The infant is responsive & breathing. What is an initial measure that
you can perform to maintain his airway?
Sit him up
◉ What are the components of the breathing assessment? Answer:
Lung & airway sounds
Respiratory effort
Chest expansion & air movement
Respiratory rate
Oxygen saturation
◉ During the secondary assessment, the parents share that the
barking cough started a couple of hours ago & the child has been
afebrile. They contacted their pediatrician, who advised them to call
an ambulance. the parents reported that their son has no allergies &
takes no medications.
Breathing Assessment:
Increased work of breathing & occasional barking cough. The
respiratory rate is 33/min w/ nasal faring & high-pitched noises
from the airway. You see retractions & the use of accessory muscles.
The patient's SpO2 is 93% on room air.
Circulatory Assessment:
The circulatory assessment indicates the following: skin flushed,
warm, & dry; HR 161/min; BP 78/55 mm Hg & capillary refill is less
than 2 seconds. His temperature is 38 degrees C [100.4 degrees F].
,Disability & Exposure Assessment:
No significant findings
Based on your findings, what is a most likely diagnosis for this
patient? Answer: Croup
◉ What treatments would be most appropriate for this patient?
Answer: Dexamethasone
Nebulized epinephrine
◉ Infants who begin to display signs of becoming weaker, decreased
respiratory effort, & poor air movement are at high risk for [blank].
Answer: Respiratory failure
◉ Infants & children who are at risk for respiratory failure should be
ventilated & prepared for intubation by a team member with
significant pediatric expertise.
When calculating the tube size based on the child's age, to avoid
injury to the subglottic area, you should use an endotracheal tube
that is: Answer: Half a size smaller than predicted for the child
◉ What are the common causes of lower airway obstruction?
Answer: Asthma
Bronchiolitis
, ◉ How can small airways be obstructed in acute lower airway
obstruction? Answer: Smooth muscle bronchial constriction
Mucus plugging
◉ How do infants initially respond to lower airway obstruction?
Answer: Decreased interpleural pressure
◉ What is the first priority in managing lower airway obstruction?
Answer: Restore adequate oxygenation
◉ Bag-mask ventilation has been used on a child w/ lower airway
obstruction.
Which complications may occur? Answer: Risk of lung collapse
Decreased blood supply to the heart
◉ A child presents w/ audible wheezing, a heart rate greater than
120/min, a respiratory rate of 36/min, & the inability to talk in
sentences.
What is the severity of this presentation? Answer: Severe
◉ A responsive infant presents w/ severe foreign-body airway
obstruction.
What is the appropriate management? Answer: Give 5 back blows
followed by 5 chest thrusts
