PALS Final Exam Questions & Answers
A 12-year-old child being evaluated in the pediatric intensive care unit displays the
following ECG waveform. The team interprets this as which arrhythmia?
(ANS- second degree
Laboratory tests are ordered for a child who has been vomiting for 3 days and is
diaphoretic, tachypneic, lethargic and pale. Which test would the provider use to
determine the adequacy of oxygen delivery?
(ANS- Lactate
A 9-year-old patient is presenting with decreased breath sounds, bradycardia,
slowed respiratory rate and a low O2 saturation level. The provider interprets these
findings as indicating which condition?
(ANS- Respiratory failure
A 4-year-old child is brought to the emergency department by the parents.
Assessment reveals that the child has only gasping respirations and the pulse rate is
65 beats per minute. Which action would the provider initiate first?
(ANS- Deliver 1 BVM ventilation every 3 to 5 seconds.
A 15-year-old patient is being evaluated during a follow-up visit after being
diagnosed with Lyme disease 2 months ago. A rhythm strip is obtained as shown
below. The provider interprets this rhythm as indicating which arrhythmia?
(ANS- First-degree atrioventricular (AV) block
A child in cardiac arrest experiences return of spontaneous circulation but is
exhibiting signs of post-cardiac arrest syndrome (PCAS). The PALS resuscitation
team determines that the child is experiencing a systemic response to
ischemia/reperfusion. The team bases this determination on which finding(s)?
(ANSHypotension
Fever
Hyperglycemia
A 2-year-old child arrives at the emergency department with the parents. The child
is unresponsive, is not breathing and has no pulse. Two emergency department
providers begin high-quality CPR. Which action(s) by the providers demonstrates
high-quality CPR?
(ANSAllowing the chest to recoil fully after each compression
Providing ventilations that last about 1 second each
Compressing the chest about 2 inches
Giving 2 ventilations to every 15 compressions
A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac
arrest. For which rhythm(s) would this action be appropriate?
(ANS- VF and pVT are shockable cardiac arrest rhythms.
PALS Red Cross Final Exam
A 4-month old infant is brought to the emergency department in cardiac arrest.
Which condition would the team identify as the most common cause of cardiac
arrest in an infant of this age?
(ANS- sudden infant death syndrome is the most common cause in infants
younger than 6 months of age.
The PALS resuscitation team is providing care to an intubated child in cardiac
arrest. Which result best determines the adequacy of the team’s chest
compressions?
(ANS- End-tidal carbon dioxide level between 15 and 20 mmHg
The emergency response team is providing care to a preschooler who is
experiencing shock. Which therapeutic goal, common to all types of shock, does
the team work to achieve?
(ANS- The primary therapeutic goal in shock, regardless of cause, is to restore a
favorable balance between oxygen delivery and oxygen demand.
A 9-year-old child is brought to the emergency department because the child
suddenly collapsed at school. The child’s ECG reveals the following waveform,
and primary assessment findings indicate that the child is hemodynamically
unstable. Which primary assessment findings indicate this?
(ANS- Decreased level of consciousness, Hypotension, Difficulty breathing,
Mottling
A child is experiencing shock. The emergency response team prepares for
imminent cardiac arrest when assessment reveals which finding(s)?
(ANS- Hypotension, Bradycardia, Diminished central pulses
An 11-year-old soccer player is brought to the emergency department. After a
quick assessment, the team realizes this patient is experiencing a severe asthma
exacerbation. Which medication would the team administer first?
(ANS- Albuterol plus ipratropium bromide
The PALS team is providing post-cardiac arrest care to an 8-year-old child in the
pediatric intensive care unit. Which intervention would the team implement to
achieve the primary goal of post-cardiac arrest care?
(ANS- Ensuring adequate mean arterial pressure
child in the pediatric intensive care unit displays the following ECG waveform and
does not have a palpable central pulse. The resuscitation team interprets this as
which arrhythmia?
(ANS- pulseless ventricular tachycardia (pVT)
Which action would the PALS resuscitation team initiate to minimize increased
intracranial pressure after cardiac arrest?
(ANS- Maintain the head in midline position with 30-degree elevation
A 4-year-old child suddenly collapses in the playroom of the facility. A healthcare
provider observes the event and hurries over to assess the child. The healthcare
provider completes which assessment first?
(ANS- Rapid assessment
PALS – Written Test and Case Study Review
Material
CPR Sequence
(AnsC-A-B
Circulation-Airway-Breathing
Algorithm: Pediatric Septic Shock
First hour…
(AnsOxygen & support ventilation
Establish IV, draw labs (glucose, blood cultures)
Begin resuscitation
Push repeated 20 mL/kg isotonic crystalloid (3-4) unless rales, resp distress,
hepatomegaly
Correct hypo-glycemia/calcemia
Admin 1st dose antibiotics STAT
STAT vasopressor drip/stress-dose hydrocortisone
Establish 2nd IV
Algorithm: Pediatric Septic Shock
Fluid Responsive?
(AnsYes – ICU
No – Vasoactive drug & titrate for normotension
Normo: begin dopamine
Hypo/warm: norepi
Hypo/cold: epi
Adenosine (slows HR)
(AnsSVT
0.1 mg/kg – dose 1
0.2 mg/kg – dose 2
max = 6 mg
RAPID push
Amiodarone (antiarrythmic)
(AnsVF/VT (pulseless)
5 mg/kg
Bolus
max = 300 mg
SVT, VT (with pulses)
5 mg/kg
over 20-60 mins
max = 300 mg
Atropine (increases HR)
(AnsBradycardia
0.02 mg/kg
may repeat once
Epinepherine (increases HR)
(AnsBradycardia/Pulseless Arrest
0.01 mg/kg (1:10,000) every 3-5 min
Hypotensive Shock
0.1-1 mcg/kg per min
Anaphylaxis
0.01 mg/kg every 3-5 min
Algorithm: Pediatric Cardiac Arrest
(AnsShout for help
CPR
Oxygen, AED
If no shock – CPR for 2 min, IV, Epi q 3-5 min, reassess
If shock – after…CPR for 2 min, IV, reassess
If 2nd shock – CPR for 2 min, Epi q 3-5 min, reassess
If 3rd shock – CPR for 2 min, Amiodarone, treat cause, reassess…
Post Resuscitation Care
Shock Doses
(Ans1st shock – 2 j/kg
2nd shock – 4 j/kg
Max 10 j/kg
Reversible Causes of Pediatric Cardiac Arrest (H&T’s)
6 H’s
(G,K,T,V,X,DRO)
(Ans1. Hypo-Glycemia
- Hypo/hyper-Kalemia
- Hypo-Thermia
- Hypo-Volemia
- Hypo-Xia
- HyDROgen ion (acidosis)
Reversible Causes of Pediatric Cardiac Arrest (H&T’s)
5 T’s
(A,E,HC,HP,O)
(Ans1. Tamponade, cardiac
PALS – Red Cross Final Exam: Questions &
Answers
Laboratory tests are ordered for a child who has been vomiting for 3 days
and is diaphoretic, tachypneic, lethargic and pale. Which test would the
provider use to determine the adequacy of oxygen delivery?
(Ans- Lactate
A provider is forming an initial impression of a child using the Pediatric
Assessment Triangle (PAT). During which step of the PAT may the
provider use the mnemonic TICLS to assess the patient?
(Ans- Appearance
A child being cared for in the pediatric telemetry unit suddenly displays the
following ECG waveform. The provider prepares to intervene because the
child is demonstrating which type of arrhythmia?
(Ans- Supraventricular tachycardia
A 2-year-old child of unknown weight arrives at the emergency department
in cardiac arrest. When preparing to administer medications, which action
would be appropriate for the team to take?
(Ans- Estimate weight using a length-based resuscitation tape.
A 9-year-old patient is presenting with decreased breath sounds,
bradycardia, slowed respiratory rate and a low O2 saturation level. The
provider interprets these findings as indicating which condition?
(Ans- Respiratory failure
A 5-year-old child with a history of a chronic neuromuscular disease is
experiencing respiratory distress. The child is breathing spontaneously and
receiving supplemental oxygen. Which additional intervention is a critical
component of airway management for this patient?
(Ans- Airway clearance
An 8-year-old child being treated in the emergency department has
significant respiratory distress. The child also exhibits hives, wheezing,
angioedema, tachycardia and tachypnea. The parents state that the child,
who is allergic to peanuts, had eaten some popcorn that had peanuts in it.
The team initiates care, preparing to administer which agent first?
(Ans- Epinephrine
A 12-lead ECG is ordered for a child complaining of a “racing heart.” When
placing the electrodes on the child, at which location would the lead for V4
be placed?
(Ans- Fifth intercostal space at midclavicular line, left side
A 10-year-old child has collapsed in the gym of the elementary school. The
school nurse arrives and determines that the child is unresponsive. The
school nurse then simultaneously checks for breathing and a central pulse,
limiting this assessment to which time frame?
(Ans- At least 5 seconds, but no more than 10
AHA PALS Practice Exam; Questions &
Answers
- A 5-year-old child presents with lethargy, increased work of breathing, and pale
color. The primary assessment reveals that the airway is open and the respiratory
rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows
sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen
saturation of 95% and a pulse rate of 93/min. On the basis of this information,
which of the following provides the best interpretation of the oxygen saturation of
95% by pulse oximetry?
A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary
oxygen should be administered
C. Unreliable; no supplementary oxygen is indicated
D. Unreliable; supplementary oxygen should be administered
(Ans- Unreliable; supplementary oxygen should be administered - A 3-year-old child was recently diagnosed with leukemia and has been treated
with chemotherapy. The child presents with lethargy and a high fever. Heart rate is
195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary
refill time is less than 2 seconds. What is the child’s most likely condition?
A. Septic shock
B. Hypovolemic shock
C. Significant bradycardia
D. Cardiogenic shock
(Ans- Septic shock - A 2-week-old infant presents with irritability and a history of poor feeding.
Blood pressure is 55/40 mm Hg. What term describes this infant’s blood pressure?
A. Hypotensive
B. Normal
C. Hypertensive
D. Compensated
(Ans- Hypotensive - During a resuscitation attempt, the team leader orders an initial dose of
epinephrine at 0.1 mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug
(Ans- Respectfully ask the team leader to clarify the dose - Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds
(Ans- Inadequate oxygenation and/or ventilation - Which of the following is most likely to produce a prolonged expiratory phase
and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction
(Ans- Lower airway obstruction
- A 4-year-old child presents with seizures and irregular respirations. The seizures
stopped a few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing
(Ans- Control of breathing - What abnormality is most likely to be present in children with acute respiratory
distress caused by lung tissue disease?
A. Decreased oxygen saturation
B. Stridor
C. Normal respiratory rate
D. Decreased respiratory effort
(Ans- Decreased oxygen saturation - An alert 2-year-old child with an increased work of breathing and pink color is
being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would
best describe this patient’s condition? A. Respiratory distress
B. Respiratory arrest
C. Respiratory failure
D. Disordered control of breathing
(Ans- Respiratory distress
PALS Red Cross Final Exam
A 5-year-old child with a history of a chronic neuromuscular disease is
experiencing respiratory distress. The child is breathing spontaneously and
receiving supplemental oxygen. Which additional intervention is a critical
component of airway management for this patient?
(Ans- Airway clearance (e.g., suctioning)
A child being cared for in the pediatric telemetry unit suddenly displays the
following ECG waveform. The provider prepares to intervene because the child is
demonstrating which type of arrhythmia?
(Ans- Supraventricular tachycardia
A child in cardiac arrest experiences return of spontaneous circulation but is
exhibiting signs of post-cardiac arrest syndrome (PCAS). The PALS resuscitation
team determines that the child is experiencing a systemic response to
ischemia/reperfusion. The team bases this determination on which finding(s)?
(Ans- Hypotension, fever, hyperglycemia
An 11-year-old soccer player is brought to the emergency department. After a
quick assessment, the team realizes this patient is experiencing a severe asthma
exacerbation. Which medication would the team administer immediately?
(Ans- Albuterol with or without ipratropium bromide
After ROSC, a child is experiencing post-cardiac arrest hypoperfusion. The PALS
resuscitation team would administer which element to restore intravascular volume
and optimize preload?
(Ans- Isotonic fluid boluses
A 2-year-old child of unknown weight arrives at the emergency department in
cardiac arrest. When preparing to administer medications, which action would be
appropriate for the team to take?
(Ans- Estimate weight using a length-based resuscitation tape.
A 4-year-old child is brought to the emergency department by the parents.
Assessment reveals that the child has only gasping respirations and the pulse rate is
65 beats per minute. Which action would the provider initiate first?
(Ans- Deliver 1 BVM ventilation every 2 to 3 seconds.
The PALS team leader is conducting a debriefing session with the team. Which
topic(s) would the team leader most likely address during the session?
(Ans- Discussion of the pros and cons of the interventions
Evaluation of the objective data gathered during the event, Summary of the event,
including what actions were taken, Identification of ways to improve
The PALS resuscitation team notes the following ECG waveform and the child
does not have a pulse. The team prepares to intervene to address which
arrhythmia?
(Ans- Torsades de pointes
PALS Possible Test Questions & Answers
You are caring for a child who was resuscitated after a drowning event. The child
is intubated and ventilated with 100% oxygen with equal breath sounds and
exhaled CO2 detected. The heart rate is slow and the monitor shows sinus
bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and
the central pulses are weak. Intravenous access has been established. The core
temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the
following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
(ANS- Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate
= 220/min). The child is lethargic. The skin is pale and cool with delayed capillary
refill. Distal pulses are not palpable. Which of the following would be the best
treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
(ANS- Provide synchronized cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While
administering high-flow oxygen you determine that the child’s respirations are
adequate and SpO2 is 100%. You have just established vascular access and
obtained blood samples. Which of the following is the next most appropriate
therapy to support systemic perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
(ANS- Administer repeated fluid boluses of isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and
adequate perfusion. You attempted synchronized cardioversion without success.
While seeking expert consultation, it would be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock
(ANS- Consider possible metabolic and toxicologic causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving
mechanical ventilation. The child’s heart rate suddenly drops to 40/min and his
color becomes mottled. You should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
(ANS- Using a resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You
initiated high-flow oxygen using a nonrebreathing mask about 10 minutes ago and
established intravenous access. Initially the infant’s heart rate was in the 150/min
range with strong pulses. Suddenly the infant’s respiratory rate falls to 6/min with
significant intercostals retractions, and little air movement is heard. The infant
becomes cyanotic and the heart rate decreases to 95/min. Which of the following
treatments would be best for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate
(ANS- Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify
potentially reversible metabolic and toxic causes during the attempted resuscitation
of a young child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas
(ANS- Soliciting a history from the caregiver or family
You are caring for a patient who developed a tension pneumothorax after several
hours of positive-pressure ventilation. Which of the following would be the most
appropriate site for needle decompression?
Over the third rib at the midclavicular line
Under the eighth rib at the midaxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line
(ANS- Over the third rib at the midclavicular line
You attempted synchronized cardioversion for an infant with supraventricular
tachycardia (SVT) and poor perfusion. The SVT persists after the initial 1 J/kg
shock. Which of the following should you attempt now?
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 J/kg
Unsynchronized cardioversion at a dose of 2 J/kg
Unsynchronized cardioversion at a dose of 4 J/kg
(ANS- Synchronized cardioversion at a dose of 2 J/kg
PALS Exam Questions & Answers
A 6 month old infant is unresponsive. You begin checking for breathing at
the same time you check for the infant’s pulse. Which is the max time you
should spend when trying to simultaneously check for breathing and
palpate the infant’s pulse before starting CPR?
(Ans- 10 secs
A 4 yr old child is brought to the emergency department for seizures. The
seizures stopped a few minutes ago, but the child continues to have slow
and irregular respirations. Which condition is consistent with your
assessment?
(Ans- Disordered control of breathing
An 8 yr old is brought to the emergency department with a 2 day hx of
lethargy and polyuria. The child has new-onset rapid, deep and labored
breathing. Which diagnostic test should you order first?
(Ans- Blood glucose
After rectal administration of diazepam, an 8 yr old boy with a hx of
seizures is now unresponsive to painful stimulation. His respirations are
shallow, at a rate of 10/min. His oxygen sat is 94% on 2L via NC. On
examination, the child is snoring with poor chest rise and poor air entry
bilaterally. Which action should you take next?
(Ans- Reposition the patient and insert an oral airway.
After rectal administration of diazepam, an 8 yr old boy with a hx of
seizures is now unresponsive to painful stimulation. His respirations are
shallow, at a rate of 10/min. His oxygen sat is 94% on 2L via NC. On
examination, the child is snoring with poor chest rise and poor air entry
bilaterally. If the patient continues to deteriorate after your initial
intervention, which next step is most appropriate?
(Ans- Provide BVM respirations
A 6 yr old child is found unresponsive, not breathing, and without a pulse.
One healthcare worker leaves to activate the emergency response system
and get the resuscitation equipment. you and another healthcare provider
immediately begin performing CPR. Which compression-to-ventilation ratio
do you use?
(Ans- 15:2
In postresusitation management after cardiac arrest, extra care should be
taken to avoid reperfusion injury. What should the ideal oxygen saturation
range most likely be?
(Ans- 94%-99%
A 3 yr old child is in cardiac arrest, and high-quality CPR is in progress.
You are the team leader. The first rhythm check reveals the rhythm shown
here. (V-Fib) Defibrillation is attempted with a shock dose of 2 J/kg. After
administration of the shock, what should you say to your team members?
(Ans- Resume Compressions
PALS Final Exam Review: Questions &
Answers
Mikey, a 2-year-old boy, is sitting upright on a hospital bed in room 3 of
your emergency department. Your initial impression from the door does not
raise immediate concern. On your entry to the room, you are able to look at
Mikey more closely and notice on inhalation his nostrils are flaring. This is a
sign of:
(Ans – Respiratory distress
The proper site for a peripheral pulse assessment in the infant patient is:
(Ans – brachial
You are called to the scene of a 3-year-old patient who was found anxious,
cyanotic and lethargic after a fall down a flight of stairs. On assessing the
patient, you find vital signs with a respiratory rate of 30, regular pulse rate
of 130, regular capillary refill time of 4 seconds, and a blood pressure of
102/61. What kind of shock is the patient experiencing?
(Ans – compensate shock
A mnemonic that aids in performing a primary assessment is:
(Ans – ABCDE
A consideration of treatment for a pediatric patient with acute fulminant
myocarditis who is in cardiac arrest or at a high risk of cardiac arrest is:
(Ans – Extracorporeal membrane oxygenation (ECMO)
Which of the following is the correct meaning for one of the individual
letters in the AVPU scale?
(Ans – Alert – The child is alert and awake and responds to normal stimuli
based upon age and environment
The recommended route of vascular access on a hypotensive pediatric
patient is:
(Ans – central IV
You are called to the bedside of a 12-year-old male patient who was
admitted after a week of persistent vomiting, diarrhea and limiting oral
intake of both solids and liquids. The patient’s airway is patent, ventilatory
rate is within normal limits and the patient’s circulatory status presents with
tachycardia, a blood pressure of 70/40 and a capillary refill time of 5
seconds. The patient is speaking incoherently. The patient has no history of
cardiac problems or congenital defects. The appropriate fluid administration
dose for this patient is:
(Ans – 20 ml/kg 0.9% NaCl over 10 minutes
You suspect your 8-year-old female patient of being hypovolemic. Her
parents brought her to the emergency department with persistent vomiting
and diarrhea for 5 days. The patient presents with mottled skin and
reports of periods where “she just stopped breathing!” according to her
parents. The patient is being managed with a BVM and supplemental
oxygen. What is the best route of establishing vascular access for the
purpose of fluid resuscitation?
(Ans – IV
Which of the following cannot be administered through an ETT?
(Ans – Sodium bicarbonate
You are examining the rhythm strip of a patient who presents with
bradycardia. Which of the following characteristics may you notice in the
rhythm?
(Ans – The most obvious sign of bradycardia on an ECG is slow heart rate.
The characteristics of P-waves and the QRS complex may vary. When
looking at an EKG, the following characteristics are seen with bradycardia
patients: Slow heart rate, P-waves may not be noticeable, QRS complex
may be wide or narrow, and P-waves and QRS complex may not be related
to bradycardia.
Latin 1 PALS Final Exam
ad + Acc.
(Ans- to, toward
adveniō, advenīre, advenī, adventus
(Ans- to arrive, reach
ager, agrī m.
(Ans- field
alter…alter
(Ans- one…the other
ambulō, ambulāre, ambulāvī, ambulātus
(Ans- to walk
amicus, ī m.
(Ans- friend
amō, āre, āvī, ātus
(Ans- to love
arbor, arboris f.
(Ans- tree
atrium, ī n.
(Ans- reception area, atrium
audio, audīre, audīvī, audītus
(Ans- to hear
canis, canis m/f
(Ans- dog
cibus, ī m.
(Ans- food
circumspectō, āre, āvī, ātus
(Ans- to look around
clamō, āre, āvī, ātus
(Ans- to shout
clamor, clamoris m.
(Ans- a shout
PALS Review Questions & Answers
The most determining factor in relation to a child’s cardiac output is the?
(Ans- Heart rate
What pharmacologic intervention in the presence of anaphylactic shock has
almost no immediate benefit?
(Ans- Corticosteroids.
What side effect is not commonly associated with the administration of
albuterol?
(Ans- Bradycardia.
When performing a pulse check in a child, the provider should?
(Ans- palpate the carotid pulse ( brachial artery in infants).
The grunting sound heard in many lower airway diseases is caused by?
(Ans- air pushing up against the glottis.
The most common type of shock in children worldwide is?
(Ans- hypovolemic shock.
The most common cause of nonsinus tachycardia in children is?
(Ans- accessory pathway SVT.
The most common cause of acute cardiogenic pulmonary edema is?
(Ans- CHF.
You are doing CPR on a child with bradycardia. An intravenous line is in
place. What is the first drug of choice for the patient?
(Ans- Epinephrine 0.01 mg/kg of 1:10000 concentration every 3 to 5
minutes
You are on a resuscitation team caring for an 8 year old child. You know
that the normal resting heart rate HIGH for a child of this age is?
(Ans- 140
Your pediatric patient is in septic shock with vasodilated (warm) shock. Pt
received multiple fluid boluses and continues to be hypotensive. The
vasoactive drug of choice is?
(AnsNorepinephrine
(0.1 to 2mcg/kg/min)
A 10 year-old child is brought to the ED with a systolic blood pressure of
100, a heart rate of 110, slightly delayed capillary refill and cool, pale skin.
You suspect that the child is in __ shock ?
(Ans- Compensated shock
PALS Pretest Questions & Answers
what should the first rescuer arriving on the scene of an unresponsive
infant or child do?
(Ans- verify scene safety, check responsiveness, shout for help, activate
emergency response system
How long should assessing for breathing and checking for a pulse take?
(Ans- No longer than 10 seconds
If the AED indicates no shock advised, what should be the next action?
(Ans- Start chest compressions
What is the compression-to-breath ratio for 1- and 2-rescuer CPR for
children and infants?
(Ans- 1-rescuer, 30:2; 2-rescuer, 15:2
Systematic Approach video 1: Blonde, 18-month-old child with pacifier.
Does this patient need immediate intervention?
(Ans- Yes
Systematic Approach video 1: Blonde, 18-month-old child with pacifier.
What is the patient’s appearance?
(Ans- Awake
Systematic Approach video 1: Blonde, 18-month-old child with pacifier.
What is the patient’s work of breathing?
(Ans- Increased work of breathing
Systematic Approach video 1: Blonde, 18-month-old child with pacifier.
What is this patient’s color?
(Ans- Pale
Systematic Approach video 2: 3-year-old child in yellow shirt. Does this
patient need immediate intervention?
(Ans- No
Systematic Approach video 2: 3-year-old child in yellow shirt. What is the
patient’s appearance?
(Ans- Increased interaction
Systematic Approach video 2: 3-year-old child in yellow shirt. What is the
patient’s work of breathing?
(Ans- Normal
Systematic Approach video 2: 3-year-old child in yellow shirt. What is this
patient’s color?
(Ans- Pink mucous membranes
Primary Assessment video 1: Patient with dragon nebulizer. Does this
patient need immediate intervention?
(Ans- Yes
PALS Questions & Answers
You are caring for a child who was resuscitated after a drowning event. The
child is intubated and ventilated with 100% oxygen with equal breath
sounds and exhaled CO2 detected. The heart rate is slow and the monitor
shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses
are not palpable and the central pulses are weak. Intravenous access has
been established. The core temperature is 37.3oC. Based on the PALS
bradycardia algorithm, which of the following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
(Ans- Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia
(heart rate = 220/min). The child is lethargic. The skin is pale and cool with
delayed capillary refill. Distal pulses are not palpable. Which of the
following would be the best treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
(Ans- Provide synchronized cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension.
While administering high-flow oxygen you determine that the child’s
respirations are adequate and SpO2 is 100%. You have just established
vascular access and obtained blood samples. Which of the following is the
next most appropriate therapy to support systemic perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
(Ans- Administer repeated fluid boluses of isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and
adequate perfusion. You attempted synchronized cardioversion without
success. While seeking expert consultation, it would be most appropriate
to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing transcutaneously
Deliver an unsynchronized shock
(Ans- Consider possible metabolic and toxicologic causes
You are caring for a 2-year-old unconscious patient who is intubated and
receiving mechanical ventilation. The child’s heart rate suddenly drops to
40/min and his color becomes mottled. You should respond to these
changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
(Ans- Using a resuscitation bag provide manual ventilation with 100%
oxygen
You are caring for a 9-month-old patient with pronounced respiratory
distress. You initiated high-flow oxygen using a nonrebreathing mask about
10 minutes ago and established intravenous access. Initially the infant’s
heart rate was in the 150/min range with strong pulses. Suddenly the
infant’s respiratory rate falls to 6/min with significant intercostals retractions,
and little air movement is heard. The infant becomes cyanotic and the heart
rate decreases to 95/min. Which of the following treatments would be best
for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate
(Ans- Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify
potentially reversible metabolic and toxic causes during the attempted
resuscitation of a young child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas
(Ans- Soliciting a history from the caregiver or family
You are caring for a patient who developed a tension pneumothorax after
several hours of positive-pressure ventilation. Which of the following would
be the most appropriate site for needle decompression?
Over the third rib at the midclavicular line
Under the eighth rib at the midaxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line
(Ans- Over the third rib at the midclavicular line
You attempted synchronized cardioversion for an infant with
supraventricular tachycardia (SVT) and poor perfusion. The SVT persists
after the initial 1 J/kg shock. Which of the following should you attempt
now?
Synchronized cardioversion at a dose of 2 J/kg
PALS Questions and Answers
Ratio of compressions to ventilations for two rescuer CPR on
infant or child?
(Ans- 15:2
Pedi SBP HOTN formula for ages 1-10?
(Ans- 70 + (2x age in years)
Hypoglycemia infant?
(Ans- <60 mg/dl
Hypoglycemia Neonate?
(Ans- <45 mg/dl
HOTN SBP Infant?
(Ans- 70 mm hg
HOTN SBP Neonate?
(Ans- 60 mm hg
Uncuffed tube size formula
(Ans- Age in years / 4+4
Possible/Probable rate issue in infants
(Ans- 220 bpm
Possible/ Probable rate issue Child
(Ans- 180 bpm
PEDI Sync Cardioversion Dosage
(Ans- First dose 0.5 – 1 J/KG.
Subsequent dosage is 2 J/KG
PEDI Defib Dosage
(AnsFirst is 2 j/kg.
Second is 4j/kg
Subsequent dosage is 8 j/kg
Sudden deterioration in an intubate patient
(AnsDOPE
Disloged
Obstructed
Pnumo