PALS Systematic Assessment 2 — Questions and Answers
Question 1: During the initial impression of a critically ill child, which three elements are assessed simultaneously using the Pediatric Assessment Triangle (PAT)?
- Appearance, Work of Breathing, Circulation to Skin (Correct answer)
- Airway, Breathing, Circulation
- Level of Consciousness, Respiratory Rate, Heart Rate
- Skin Color, Capillary Refill, Blood Pressure
Correct answer: Appearance, Work of Breathing, Circulation to Skin
The PAT assesses Appearance, Work of Breathing, and Circulation to Skin — a rapid across-the-room assessment before touching the patient.
Question 2: A 4-year-old has mottled skin, weak peripheral pulses, and altered mental status but no increased work of breathing. Which PAT category best describes this presentation?
- Respiratory distress
- Shock compensated (Correct answer)
- Cardiopulmonary failure
- Respiratory failure with shock
Correct answer: Shock compensated
Abnormal circulation to skin with altered appearance but normal work of breathing indicates compensated shock without respiratory compromise.
Question 3: When using AVPU to assess pediatric level of consciousness, what does the 'V' represent?
- Verbal — responds to voice stimuli (Correct answer)
- Voluntary — moves voluntarily
- Visual — responds to visual stimuli
- Vital — vital signs are stable
Correct answer: Verbal — responds to voice stimuli
V in AVPU stands for Verbal, meaning the patient responds to voice or verbal stimuli.
Question 4: A 6-month-old has grunting, nasal flaring, and subcostal retractions but pink skin and alert appearance. Which PAT interpretation is correct?
- Respiratory distress only (Correct answer)
- Respiratory failure
- Compensated shock
- Cardiopulmonary failure
Correct answer: Respiratory distress only
Increased work of breathing with normal appearance and circulation to skin indicates respiratory distress without failure.
Question 5: In the PALS systematic approach, after the initial impression, the provider moves to the primary assessment. What does the 'E' in the ABCDE primary assessment stand for?
- Exposure and Environment (Correct answer)
- Electrolytes and ECG
- Evaluation and Examination
- Edema and Extremities
Correct answer: Exposure and Environment
E stands for Exposure and Environment — exposing the patient to identify injuries, rashes, or environmental factors while preventing heat loss.
Question 6: Which finding during the primary assessment most directly indicates the need for immediate intervention before completing the full assessment?
- Heart rate of 110 in a 3-year-old
- Absent radial pulses with central pulses present
- Respiratory rate of 28 in a 2-year-old
- A life-threatening problem identified in any ABCDE step (Correct answer)
Correct answer: A life-threatening problem identified in any ABCDE step
The PALS systematic approach mandates immediate intervention for any life-threatening problem identified during the primary assessment before proceeding.
Question 7: A 10-year-old with diabetic ketoacidosis has deep, rapid, unlabored breathing. How should this breathing pattern be classified in the PAT?
- Normal work of breathing despite abnormal rate (Correct answer)
- Increased work of breathing
- Agonal breathing
- Obstructive pattern
Correct answer: Normal work of breathing despite abnormal rate
Kussmaul breathing is deep and rapid but unlabored (no accessory muscle use or retractions), so work of breathing in the PAT is normal.
PALS Systematic Assessment 2
During the initial impression of a critically ill child, which three elements are assessed simultaneously using the Pediatric Assessment Triangle (PAT)?