PFCCS CERTIFICATION EXAM 2026/2027 | Pediatric
Fundamental Critical Care Support | SCCM | All
Correct Answers | Complete Exam Prep | Pass
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Section 1: Assessment of the Critically Ill Child (Questions 1-18)
Q1. A 3-year-old child is brought to the emergency department after a motor vehicle
collision. Using the Pediatric Assessment Triangle (PAT), the nurse notes the child is
listless with poor muscle tone, has marked retractions and nasal flaring, and has
mottled skin with capillary refill of 4 seconds. Which PAT component combination
indicates the most immediate life threat?
A. Appearance + Work of Breathing
B. Work of Breathing + Circulation to Skin
C. Appearance + Circulation to Skin
D. Appearance + Work of Breathing + Circulation to Skin
D. Appearance + Work of Breathing + Circulation to Skin [CORRECT]
Rationale: The PAT consists of three components—appearance (muscle tone,
interactiveness, gaze, cry), work of breathing (retractions, nasal flaring, grunting, head
bobbing), and circulation to skin (pallor, mottling, cyanosis, capillary refill). All three
abnormal findings indicate multi-system compromise requiring immediate
intervention. Options A, B, and C are incomplete.
Correct Answer: D
Q2. Which vital sign parameter is consistent with compensated shock in a 6-month-
old infant?
A. Heart rate 120 bpm, capillary refill 1 second, blood pressure 70/45 mmHg
B. Heart rate 180 bpm, capillary refill 4 seconds, blood pressure 75/50 mmHg
,C. Heart rate 90 bpm, capillary refill 2 seconds, blood pressure 60/35 mmHg
D. Heart rate 160 bpm, capillary refill 3 seconds, blood pressure 65/40 mmHg
B. Heart rate 180 bpm, capillary refill 4 seconds, blood pressure 75/50 mmHg
[CORRECT]
Rationale: Compensated shock in infants is characterized by tachycardia (HR >160
bpm), delayed capillary refill (>2 seconds), and weak peripheral pulses with preserved
blood pressure. Option B demonstrates classic compensated shock with tachycardia
and poor perfusion but normal blood pressure. Option A shows normal perfusion;
Option C shows bradycardia (ominous sign); Option D has borderline BP but less
severe perfusion abnormalities.
Correct Answer: B
Q3. During the primary assessment of a critically ill 5-year-old, which finding requires
the FIRST immediate intervention according to the ABCDE approach?
A. Glasgow Coma Scale score of 10
B. Stridor at rest with severe retractions
C. Weak femoral pulses and cool extremities
D. Open femur fracture with active bleeding
B. Stridor at rest with severe retractions [CORRECT]
Rationale: The ABCDE approach prioritizes Airway first. Stridor at rest with severe
retractions indicates impending complete upper airway obstruction, which is an
immediate life threat. While options C and D are serious, they fall under Circulation
and are addressed after airway and breathing are secured. Option A (Disability) is
assessed after ABC.
Correct Answer: B
,Q4. A 2-year-old weighing 12 kg requires emergency medication administration.
Which estimated weight calculation using the Broselow tape or standard formula is
MOST accurate for resuscitation dosing?
A. (2 × 4) + 4 = 12 kg
B. (2 × 2) + 8 = 12 kg
C. (2 × 3) + 7 = 13 kg
D. (2 × 5) + 2 = 12 kg
B. (2 × 2) + 8 = 12 kg [CORRECT]
Rationale: For children ages 1-10 years, the standard formula is (age in years × 2) + 8
= weight in kg. For a 2-year-old: (2 × 2) + 8 = 12 kg. Option A uses the infant
formula (age × 4 + 4 for 0-12 months). Option C overestimates slightly. Option D is
not a standard pediatric weight estimation formula.
Correct Answer: B
Q5. Which age-specific heart rate range is considered NORMAL for a 4-year-old child
at rest?
A. 60-100 beats per minute
B. 70-110 beats per minute
C. 80-120 beats per minute
D. 98-140 beats per minute
B. 70-110 beats per minute [CORRECT]
Rationale: Normal heart rates decrease with age. For a 4-year-old, the normal range
is approximately 70-110 bpm. Option A is the adult range. Option C is typical for
toddlers (1-2 years). Option D is the infant range (0-12 months).
Correct Answer: B
, Q6. A 9-month-old infant presents with fever, irritability, and a bulging fontanelle.
During assessment, which vital sign trend is MOST concerning for impending
decompensation?
A. Heart rate decreasing from 160 to 140 bpm
B. Respiratory rate decreasing from 45 to 35 breaths per minute
C. Heart rate decreasing from 160 to 110 bpm with increasing irritability
D. Temperature increasing from 38.5°C to 39.2°C
C. Heart rate decreasing from 160 to 110 bpm with increasing irritability [CORRECT]
Rationale: In infants, bradycardia (relative or absolute) with altered mental status is
an ominous sign of impending cardiopulmonary failure. A drop from 160 to 110 bpm
in a febrile, irritable infant with a bulging fontanelle suggests rising intracranial
pressure and impending herniation. Options A and B show normalizing trends.
Option D is expected with fever.
Correct Answer: C
Q7. What is the normal respiratory rate range for a healthy 8-year-old child?
A. 12-20 breaths per minute
B. 18-25 breaths per minute
C. 20-30 breaths per minute
D. 25-40 breaths per minute
B. 18-25 breaths per minute [CORRECT]
Rationale: Normal respiratory rates decline with age. An 8-year-old typically has a
respiratory rate of 18-25 breaths per minute. Option A is the adolescent/adult range.
Option C is typical for preschoolers (3-5 years). Option D is the infant/toddler range.
Correct Answer: B
Q8. The pediatric shock index (SI) is calculated by dividing heart rate by systolic
blood pressure. Which SI value in a 7-year-old child is MOST suggestive of shock?
Fundamental Critical Care Support | SCCM | All
Correct Answers | Complete Exam Prep | Pass
Guaranteed - A+ Graded
Section 1: Assessment of the Critically Ill Child (Questions 1-18)
Q1. A 3-year-old child is brought to the emergency department after a motor vehicle
collision. Using the Pediatric Assessment Triangle (PAT), the nurse notes the child is
listless with poor muscle tone, has marked retractions and nasal flaring, and has
mottled skin with capillary refill of 4 seconds. Which PAT component combination
indicates the most immediate life threat?
A. Appearance + Work of Breathing
B. Work of Breathing + Circulation to Skin
C. Appearance + Circulation to Skin
D. Appearance + Work of Breathing + Circulation to Skin
D. Appearance + Work of Breathing + Circulation to Skin [CORRECT]
Rationale: The PAT consists of three components—appearance (muscle tone,
interactiveness, gaze, cry), work of breathing (retractions, nasal flaring, grunting, head
bobbing), and circulation to skin (pallor, mottling, cyanosis, capillary refill). All three
abnormal findings indicate multi-system compromise requiring immediate
intervention. Options A, B, and C are incomplete.
Correct Answer: D
Q2. Which vital sign parameter is consistent with compensated shock in a 6-month-
old infant?
A. Heart rate 120 bpm, capillary refill 1 second, blood pressure 70/45 mmHg
B. Heart rate 180 bpm, capillary refill 4 seconds, blood pressure 75/50 mmHg
,C. Heart rate 90 bpm, capillary refill 2 seconds, blood pressure 60/35 mmHg
D. Heart rate 160 bpm, capillary refill 3 seconds, blood pressure 65/40 mmHg
B. Heart rate 180 bpm, capillary refill 4 seconds, blood pressure 75/50 mmHg
[CORRECT]
Rationale: Compensated shock in infants is characterized by tachycardia (HR >160
bpm), delayed capillary refill (>2 seconds), and weak peripheral pulses with preserved
blood pressure. Option B demonstrates classic compensated shock with tachycardia
and poor perfusion but normal blood pressure. Option A shows normal perfusion;
Option C shows bradycardia (ominous sign); Option D has borderline BP but less
severe perfusion abnormalities.
Correct Answer: B
Q3. During the primary assessment of a critically ill 5-year-old, which finding requires
the FIRST immediate intervention according to the ABCDE approach?
A. Glasgow Coma Scale score of 10
B. Stridor at rest with severe retractions
C. Weak femoral pulses and cool extremities
D. Open femur fracture with active bleeding
B. Stridor at rest with severe retractions [CORRECT]
Rationale: The ABCDE approach prioritizes Airway first. Stridor at rest with severe
retractions indicates impending complete upper airway obstruction, which is an
immediate life threat. While options C and D are serious, they fall under Circulation
and are addressed after airway and breathing are secured. Option A (Disability) is
assessed after ABC.
Correct Answer: B
,Q4. A 2-year-old weighing 12 kg requires emergency medication administration.
Which estimated weight calculation using the Broselow tape or standard formula is
MOST accurate for resuscitation dosing?
A. (2 × 4) + 4 = 12 kg
B. (2 × 2) + 8 = 12 kg
C. (2 × 3) + 7 = 13 kg
D. (2 × 5) + 2 = 12 kg
B. (2 × 2) + 8 = 12 kg [CORRECT]
Rationale: For children ages 1-10 years, the standard formula is (age in years × 2) + 8
= weight in kg. For a 2-year-old: (2 × 2) + 8 = 12 kg. Option A uses the infant
formula (age × 4 + 4 for 0-12 months). Option C overestimates slightly. Option D is
not a standard pediatric weight estimation formula.
Correct Answer: B
Q5. Which age-specific heart rate range is considered NORMAL for a 4-year-old child
at rest?
A. 60-100 beats per minute
B. 70-110 beats per minute
C. 80-120 beats per minute
D. 98-140 beats per minute
B. 70-110 beats per minute [CORRECT]
Rationale: Normal heart rates decrease with age. For a 4-year-old, the normal range
is approximately 70-110 bpm. Option A is the adult range. Option C is typical for
toddlers (1-2 years). Option D is the infant range (0-12 months).
Correct Answer: B
, Q6. A 9-month-old infant presents with fever, irritability, and a bulging fontanelle.
During assessment, which vital sign trend is MOST concerning for impending
decompensation?
A. Heart rate decreasing from 160 to 140 bpm
B. Respiratory rate decreasing from 45 to 35 breaths per minute
C. Heart rate decreasing from 160 to 110 bpm with increasing irritability
D. Temperature increasing from 38.5°C to 39.2°C
C. Heart rate decreasing from 160 to 110 bpm with increasing irritability [CORRECT]
Rationale: In infants, bradycardia (relative or absolute) with altered mental status is
an ominous sign of impending cardiopulmonary failure. A drop from 160 to 110 bpm
in a febrile, irritable infant with a bulging fontanelle suggests rising intracranial
pressure and impending herniation. Options A and B show normalizing trends.
Option D is expected with fever.
Correct Answer: C
Q7. What is the normal respiratory rate range for a healthy 8-year-old child?
A. 12-20 breaths per minute
B. 18-25 breaths per minute
C. 20-30 breaths per minute
D. 25-40 breaths per minute
B. 18-25 breaths per minute [CORRECT]
Rationale: Normal respiratory rates decline with age. An 8-year-old typically has a
respiratory rate of 18-25 breaths per minute. Option A is the adolescent/adult range.
Option C is typical for preschoolers (3-5 years). Option D is the infant/toddler range.
Correct Answer: B
Q8. The pediatric shock index (SI) is calculated by dividing heart rate by systolic
blood pressure. Which SI value in a 7-year-old child is MOST suggestive of shock?
