PFCCS CERTIFICATION EXAM 2026/2027 | Pediatric
Fundamental Critical Care Support | SCCM Complete
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Section 1: Pediatric Assessment & Recognition of Critical Illness (Q1-18)
Q1. The Pediatric Assessment Triangle (PAT) consists of three components used for
rapid visual assessment. Which of the following correctly identifies these three
components?
A. Airway, Breathing, Circulation
B. Appearance, Work of Breathing, Circulation to Skin
C. Heart rate, Respiratory rate, Blood pressure
D. Tone, Interactiveness, Consolability
B. Appearance, Work of Breathing, Circulation to Skin [CORRECT]
Rationale: The PAT is a rapid visual assessment tool using Appearance (muscle tone,
interactiveness, gaze, speech/cry), Work of Breathing (retractions, nasal flaring,
grunting, positioning), and Circulation to Skin (pallor, mottling, cyanosis, capillary
refill). Option A describes the primary survey, C describes vital signs, and D lists only
appearance components.
Correct Answer: B
Q2. During the "Appearance" component of the PAT, which finding would be most
concerning for a critically ill infant?
A. Strong cry and tracking gaze
B. Normal muscle tone with spontaneous movement
C. Limp posture and weak, intermittent cry
D. Consolable with parental interaction
C. Limp posture and weak, intermittent cry [CORRECT]
Rationale: The appearance component assesses muscle tone, interactiveness,
consolability, gaze, and speech/cry. A limp posture and weak cry indicate poor
perfusion to the brain and severe illness. Options A, B, and D represent normal or
,reassuring findings.
Correct Answer: C
Q3. A 4-month-old infant presents with visible subcostal and intercostal retractions,
nasal flaring, and audible grunting. These findings represent which component of the
Pediatric Assessment Triangle?
A. Appearance
B. Work of Breathing
C. Circulation to Skin
D. Disability
B. Work of Breathing [CORRECT]
Rationale: Retractions, nasal flaring, and grunting are classic signs of increased work
of breathing. The PAT does not include "Disability" as a component; that is part of
the ABCDE primary survey. Appearance assesses tone/interactiveness, and circulation
to skin assesses color/perfusion.
Correct Answer: B
Q4. A nurse is using a Pediatric Early Warning Score (PEWS) tool to assess a 6-year-
old on the general pediatric floor. Which parameter is typically NOT included in
standard PEWS scoring systems?
A. Respiratory rate and oxygen requirement
B. Heart rate and capillary refill
C. Blood pressure and level of consciousness
D. Temperature and urine output
D. Temperature and urine output [CORRECT]
Rationale: Standard PEWS tools typically monitor respiratory status (rate, O2 need,
work of breathing), cardiovascular status (HR, BP, capillary refill), and neurologic
status (behavior/consciousness). Temperature and urine output are important clinical
parameters but are not core components of most validated PEWS systems.
Correct Answer: D
Q5. Which heart rate range is considered normal for a healthy 3-month-old infant at
rest?
A. 60-100 beats per minute
B. 80-140 beats per minute
,C. 100-160 beats per minute
D. 120-180 beats per minute
B. 80-140 beats per minute [CORRECT]
Rationale: Normal heart rates by age: neonate (0-1 month) 100-160 bpm, infant (1-12
months) 80-140 bpm, toddler/preschool 80-130/80-120 bpm, school-age 70-110
bpm, adolescent 60-100 bpm. Option A is adolescent normal, C is neonate normal,
and D is tachycardic.
Correct Answer: B
Q6. A 5-year-old child has a respiratory rate of 32 breaths per minute while sleeping.
According to age-specific norms, this finding is:
A. Normal for age
B. Mildly elevated but acceptable
C. Tachypneic and concerning
D. Bradypneic and concerning
C. Tachypneic and concerning [CORRECT]
Rationale: Normal respiratory rates: toddler (1-2 years) 22-37, preschool (3-5 years)
20-28, school-age (6-12 years) 18-25, adolescent 12-20. A rate of 32 in a 5-year-old
exceeds the normal upper limit of 28 and represents tachypnea requiring evaluation.
Bradypnea would be <20 for this age.
Correct Answer: C
Q7. The expected systolic blood pressure for a 7-year-old child can be estimated
using which formula?
A. 70 + (2 × age in years)
B. 80 + (2 × age in years)
C. 90 + (2 × age in years)
D. 100 + (2 × age in years)
C. 90 + (2 × age in years) [CORRECT]
Rationale: The standard formula for estimating lower limit of normal systolic BP in
children >1 year is 70 + (2 × age). However, the expected systolic BP is
approximately 90 + (2 × age). For a 7-year-old: 90 + 14 = 104 mmHg. Hypotension is
defined as <70 + (2 × age) or <5th percentile for age.
Correct Answer: C
, Q8. A 2-year-old with gastroenteritis has tachycardia (HR 160), cool extremities,
delayed capillary refill (4 seconds), and weak peripheral pulses, but blood pressure
remains at 85/55 mmHg. This presentation is most consistent with:
A. Decompensated hypovolemic shock
B. Compensated hypovolemic shock
C. Septic shock with warm presentation
D. Cardiogenic shock
B. Compensated hypovolemic shock [CORRECT]
Rationale: In compensated shock, children maintain blood pressure through
tachycardia and vasoconstriction despite poor perfusion (cool skin, delayed capillary
refill, weak pulses). Decompensated shock would show hypotension. Septic warm
shock presents with bounding pulses and flash cap refill. Cardiogenic shock typically
shows hepatomegaly and gallop rhythm.
Correct Answer: B
Q9. Which of the following vital sign changes in a febrile 8-month-old infant is most
indicative of decompensated septic shock?
A. Heart rate 160 bpm, capillary refill 3 seconds
B. Heart rate 80 bpm, blood pressure 55/30 mmHg
C. Heart rate 180 bpm, blood pressure 70/45 mmHg
D. Heart rate 140 bpm, respiratory rate 50/min
B. Heart rate 80 bpm, blood pressure 55/30 mmHg [CORRECT]
Rationale: Decompensated shock is characterized by hypotension (for 8-month-old,
SBP should be >70 + [2×0.67] ≈ 71 mmHg; 55 is severely hypotensive) and
bradycardia (80 bpm is bradycardic for an infant, indicating cardiovascular collapse).
Tachycardia with normal BP (A, C) suggests compensation. Option D shows
respiratory distress without shock.
Correct Answer: B
Q10. According to age-modified SIRS criteria, which combination defines systemic
inflammatory response syndrome (SIRS) in a 4-year-old child?
A. Temperature >38.5°C or <36°C, HR >140, RR >30, WBC >15,000 or <4,000
B. Temperature >38°C or <36.5°C, HR >100, RR >24, WBC >12,000 or <4,000
Fundamental Critical Care Support | SCCM Complete
Questions with Correct Answers | Pass Guaranteed -
A+ Graded
Section 1: Pediatric Assessment & Recognition of Critical Illness (Q1-18)
Q1. The Pediatric Assessment Triangle (PAT) consists of three components used for
rapid visual assessment. Which of the following correctly identifies these three
components?
A. Airway, Breathing, Circulation
B. Appearance, Work of Breathing, Circulation to Skin
C. Heart rate, Respiratory rate, Blood pressure
D. Tone, Interactiveness, Consolability
B. Appearance, Work of Breathing, Circulation to Skin [CORRECT]
Rationale: The PAT is a rapid visual assessment tool using Appearance (muscle tone,
interactiveness, gaze, speech/cry), Work of Breathing (retractions, nasal flaring,
grunting, positioning), and Circulation to Skin (pallor, mottling, cyanosis, capillary
refill). Option A describes the primary survey, C describes vital signs, and D lists only
appearance components.
Correct Answer: B
Q2. During the "Appearance" component of the PAT, which finding would be most
concerning for a critically ill infant?
A. Strong cry and tracking gaze
B. Normal muscle tone with spontaneous movement
C. Limp posture and weak, intermittent cry
D. Consolable with parental interaction
C. Limp posture and weak, intermittent cry [CORRECT]
Rationale: The appearance component assesses muscle tone, interactiveness,
consolability, gaze, and speech/cry. A limp posture and weak cry indicate poor
perfusion to the brain and severe illness. Options A, B, and D represent normal or
,reassuring findings.
Correct Answer: C
Q3. A 4-month-old infant presents with visible subcostal and intercostal retractions,
nasal flaring, and audible grunting. These findings represent which component of the
Pediatric Assessment Triangle?
A. Appearance
B. Work of Breathing
C. Circulation to Skin
D. Disability
B. Work of Breathing [CORRECT]
Rationale: Retractions, nasal flaring, and grunting are classic signs of increased work
of breathing. The PAT does not include "Disability" as a component; that is part of
the ABCDE primary survey. Appearance assesses tone/interactiveness, and circulation
to skin assesses color/perfusion.
Correct Answer: B
Q4. A nurse is using a Pediatric Early Warning Score (PEWS) tool to assess a 6-year-
old on the general pediatric floor. Which parameter is typically NOT included in
standard PEWS scoring systems?
A. Respiratory rate and oxygen requirement
B. Heart rate and capillary refill
C. Blood pressure and level of consciousness
D. Temperature and urine output
D. Temperature and urine output [CORRECT]
Rationale: Standard PEWS tools typically monitor respiratory status (rate, O2 need,
work of breathing), cardiovascular status (HR, BP, capillary refill), and neurologic
status (behavior/consciousness). Temperature and urine output are important clinical
parameters but are not core components of most validated PEWS systems.
Correct Answer: D
Q5. Which heart rate range is considered normal for a healthy 3-month-old infant at
rest?
A. 60-100 beats per minute
B. 80-140 beats per minute
,C. 100-160 beats per minute
D. 120-180 beats per minute
B. 80-140 beats per minute [CORRECT]
Rationale: Normal heart rates by age: neonate (0-1 month) 100-160 bpm, infant (1-12
months) 80-140 bpm, toddler/preschool 80-130/80-120 bpm, school-age 70-110
bpm, adolescent 60-100 bpm. Option A is adolescent normal, C is neonate normal,
and D is tachycardic.
Correct Answer: B
Q6. A 5-year-old child has a respiratory rate of 32 breaths per minute while sleeping.
According to age-specific norms, this finding is:
A. Normal for age
B. Mildly elevated but acceptable
C. Tachypneic and concerning
D. Bradypneic and concerning
C. Tachypneic and concerning [CORRECT]
Rationale: Normal respiratory rates: toddler (1-2 years) 22-37, preschool (3-5 years)
20-28, school-age (6-12 years) 18-25, adolescent 12-20. A rate of 32 in a 5-year-old
exceeds the normal upper limit of 28 and represents tachypnea requiring evaluation.
Bradypnea would be <20 for this age.
Correct Answer: C
Q7. The expected systolic blood pressure for a 7-year-old child can be estimated
using which formula?
A. 70 + (2 × age in years)
B. 80 + (2 × age in years)
C. 90 + (2 × age in years)
D. 100 + (2 × age in years)
C. 90 + (2 × age in years) [CORRECT]
Rationale: The standard formula for estimating lower limit of normal systolic BP in
children >1 year is 70 + (2 × age). However, the expected systolic BP is
approximately 90 + (2 × age). For a 7-year-old: 90 + 14 = 104 mmHg. Hypotension is
defined as <70 + (2 × age) or <5th percentile for age.
Correct Answer: C
, Q8. A 2-year-old with gastroenteritis has tachycardia (HR 160), cool extremities,
delayed capillary refill (4 seconds), and weak peripheral pulses, but blood pressure
remains at 85/55 mmHg. This presentation is most consistent with:
A. Decompensated hypovolemic shock
B. Compensated hypovolemic shock
C. Septic shock with warm presentation
D. Cardiogenic shock
B. Compensated hypovolemic shock [CORRECT]
Rationale: In compensated shock, children maintain blood pressure through
tachycardia and vasoconstriction despite poor perfusion (cool skin, delayed capillary
refill, weak pulses). Decompensated shock would show hypotension. Septic warm
shock presents with bounding pulses and flash cap refill. Cardiogenic shock typically
shows hepatomegaly and gallop rhythm.
Correct Answer: B
Q9. Which of the following vital sign changes in a febrile 8-month-old infant is most
indicative of decompensated septic shock?
A. Heart rate 160 bpm, capillary refill 3 seconds
B. Heart rate 80 bpm, blood pressure 55/30 mmHg
C. Heart rate 180 bpm, blood pressure 70/45 mmHg
D. Heart rate 140 bpm, respiratory rate 50/min
B. Heart rate 80 bpm, blood pressure 55/30 mmHg [CORRECT]
Rationale: Decompensated shock is characterized by hypotension (for 8-month-old,
SBP should be >70 + [2×0.67] ≈ 71 mmHg; 55 is severely hypotensive) and
bradycardia (80 bpm is bradycardic for an infant, indicating cardiovascular collapse).
Tachycardia with normal BP (A, C) suggests compensation. Option D shows
respiratory distress without shock.
Correct Answer: B
Q10. According to age-modified SIRS criteria, which combination defines systemic
inflammatory response syndrome (SIRS) in a 4-year-old child?
A. Temperature >38.5°C or <36°C, HR >140, RR >30, WBC >15,000 or <4,000
B. Temperature >38°C or <36.5°C, HR >100, RR >24, WBC >12,000 or <4,000
