PALS HEARTCODE FINAL TEST PAPER
2026 QUESTIONS AND SOLUTIONS
GRADED A+ CERTIFICATION EVALUATION
●● 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
2026 QUESTIONS AND SOLUTIONS
GRADED A+ CERTIFICATION EVALUATION
●● 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
