PALS PreAssessment 5

Team Response Scenario: Sophia Giamanti

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Sophia's weight is 8 kg. Which of the following doses of epinephrine IV/IO should Marco administer to Sophia? Select the correct answer to this question. 0.02 mg 0.06 mg 0.08 mg 0.09 mg

0.08 mg

A patient admitted to the pediatric emergency department is in cardiac arrest. The rhythm on the defibrillator monitor is ventricular fibrillation (VF). Which energy dose should the team leader order to administer an initial shock? Select the correct answer to this question. 1 J/kg 2 J/kg 5 J/kg 10 J/kg

2 J/kg

The team knows it is appropriate to give a second dose of epinephrine at what time interval? Select the correct answer to this question. 1 to 2 minutes 3 to 5 minutes 6 to 8 minutes 7 to 9 minutes

3 to 5 minutes

What is the appropriate dose that should be administered to Sophia for a second shock? Enter your answer in joules.

8x4 32 Joules

Based on these assessment findings, which initial intervention should Marco implement? Select the correct answer to this question. Start an epinephrine infusion. Administer a fluid bolus.

Administer a fluid bolus.

After the initial fluid bolus, Marco notes that Sophia's heart rate and blood pressure are slightly improved, but she is still tachycardic and her skin remains cool and mottled. Which action should he take? Select the correct answer to this question. Administer a second fluid bolus. Discontinue the intravenous fluid. Continue to monitor. Prepare for inotropic therapy.

Administer a second fluid bolus.

While performing post-cardiac arrest care, the healthcare provider observes seizure activity. What should the provider do? Select the correct answer to this question. Elevate the head of the bed Turn the patient into a side-lying position Administer an anti-convulsant Continue to monitor and only treat if seizures are severe

Administer an anti-convulsant

Based on a rectal temperature that is elevated to 39° C, which treatment options are appropriate? Select all correct options that apply. Administer an antipyretic. Continue monitoring and treat if temperature reaches 41° C. Reassess temperature via tympanic route. Implement active cooling. Prepare IV fluid bolus.

Administer an antipyretic. Implement active cooling.

The healthcare provider notes that an infant receiving post-cardiac arrest care has an increase in temperature. The provider should do which of the following? Select the correct answer to this question. Administer antipyretics or implement active cooling Treat only if temperature increases 5° C above normal No measures are necessary; an increase in temperature post-cardiac arrest is normal Administer IV dextrose

Administer antipyretics or implement active cooling

Which statement correctly describes the goal of O2 administration after return of spontaneous circulation (ROSC)? Select the correct answer to this question. Administer at any concentration required to maintain O2 saturation of 90% to 100%. Administer at any concentration required to maintain O2 saturation of 90% to 95%. Administer at the lowest concentration required to maintain O2 saturation of 92% to 97%. Administer at the lowest concentration required to maintain O2 saturation of 94% to 99%.

Administer at the lowest concentration required to maintain O2 saturation of 94% to 99%.

A patient in asystole is receiving high-quality CPR and vascular access has been achieved. Which action should the team leader order? Select the correct answer to this question. Administer epinephrine 0.01 mg/kg Administer lidocaine 1 mg/kg Administer a shock with 10 J/kg Administer amiodarone 5 mg/kg

Administer epinephrine 0.01 mg/kg

The cardiac monitor reveals the patient's rhythm is asystole. In addition to high-quality CPR, which of the following should be included as soon as possible in the treatment? Select the correct answer to this question. Perform defibrillation. Administer amiodarone. Administer epinephrine. Administer lidocaine.

Administer epinephrine.

As Sophia is being weaned, all sedation has been turned off, but when she was checked she was unresponsive. Which of the following should Jeremy do immediately after checking for responsiveness? Select all correct options that apply. Assess for respiratory effort. Check for central pulse. Prepare for intubation. Start chest compressions. Perform defibrillation.

Assess for respiratory effort. Check for central pulse.

Which cardiac arrest rhythms does the healthcare provider correctly identify as "nonshockable" rhythms? Asystole Pulseless electrical activity (PEA) Ventricular fibrillation (VF) Pulseless ventricular tachycardia (pVT)

Asystole Pulseless electrical activity (PEA)

What are the components of post-cardiac arrest syndrome (PCAS)? Select all correct options that apply. Temperature regulation dysfunction Brain injury Systemic vasoconstriction Systemic response to ischemia/reperfusion Myocardial dysfunction

Brain injury Systemic response to ischemia/reperfusion Myocardial dysfunction

Ensuring an adequate mean arterial pressure (MAP) post-cardiac arrest is critical to optimizing which factor? Select the correct answer to this question. Cerebral perfusion Airway integrity Oxygenation and ventilation Glucose management

Cerebral perfusion

While reassessing an intubated patient receiving mechanical ventilation, the respiratory therapist notes the patient suddenly begins deteriorating and suspects a problem with the advanced airway therapy. The respiratory therapist uses which mnemonic to assess for complications? Select the correct answer to this question. ABCDE TICLS PAT DOPE

DOPE

What is the immediate next step for this cardiac rhythm? Select the correct answer to this question. Defibrillation with 4 J/kg Administration of amiodarone Defibrillation with 2 J/kg Administration of epinephrine

Defibrillation with 2 J/kg

Which of the following is used to monitor chest compression adequacy in a patient experiencing cardiac arrest? Select the correct answer to this question. ECG rhythm Blood pH ETCO2 levels O2 saturation

ETCO2 levels

After completing a focused physical examination post-return of spontaneous circulation (ROSC), the provider suspects that a seizure may have caused cardiac arrest in an assigned patient. Which diagnostic test will the provider likely order? Select the correct answer to this question. Echocardiogram Computed tomography Electroencephalogram Chest radiography

Electroencephalogram

The PALS team leader correctly alternates the chest compressor role after which duration? Select the correct answer to this question. Every 2 minutes Every 3 minutes Every 5 minutes Every 10 minutes

Every 2 minutes

The PALS team is actively attempting to resuscitate a 9-kg infant in cardiac arrest. The team leader instructs the monitor team member to administer a second defibrillation. How many joules should the team member administer?

First shock 2 joules/kg Second shock 4 joules/kg 36 joules

After achievement of return of spontaneous circulation (ROSC), an indwelling arterial catheter is placed in the patient and connected to the cardiac monitor. Which finding should the provider report to the team leader given its association with poor outcomes after cardiac arrest? Select the correct answer to this question. Hypotension Tachycardia Polyuria Hypertension

Hypotension

After the second fluid bolus finished infusing, Sophia is still showing signs of inadequate perfusion as evidenced by blood pressure that has improved but is still low for age, and by the fact that she is still tachycardic with delayed capillary refill. Based on these assessment findings, what would the next step of care be? Select the correct answer to this question. Administer another fluid bolus Continue to monitor Initiate pharmacological therapy Treat for seizures

Initiate pharmacological therapy

Which neuroprotective measures should the provider implement after achievement of return of spontaneous circulation (ROSC)? Select all correct options that apply. Prepare for prompt extubation. Administer vasopressors. Initiate targeted temperature management Optimize cerebral perfusion.

Initiate targeted temperature management Optimize cerebral perfusion.

Which statement correctly describes the etiology of sudden cardiac arrest from an arrhythmia in children and infants? Select the correct answer to this question. It is common in children, rare in infants. It is common in children and infants. It is rare in children and infants. It is rare in children, common in infants.

It is rare in children and infants.

Which medications may be used in the cardiac arrest care of a patient with a "shockable" rhythm? Select all correct options that apply. Lidocaine Epinephrine Atropine Amiodarone

Lidocaine Epinephrine Amiodarone

After reconnecting Sophia to the mechanical ventilator, Jenny adjusts the settings for the ventilator knowing which of the following are appropriate interventions to optimize oxygenation and ventilation after cardiac arrest? Select all correct options that apply. Minimize tidal volume to the minimal needed to provide adequate ventilation. Maximize tidal volume. Maintain normocapnia (PaCO2 of 35 to 45 mmHg). Avoid hyperventilation. Maintain O2 saturation of 94% to 99%.

Minimize tidal volume to the minimal needed to provide adequate ventilation. Maintain normocapnia (PaCO2 of 35 to 45 mmHg). Avoid hyperventilation. Maintain O2 saturation of 94% to 99%.

After determining that the infant is not breathing and does not have a central pulse, which of the following should the nurses start immediately? Perform defibrillation. Achieve IO access. Administer epinephrine. Perform high-quality CPR. Provide ventilations with high flow 100% O2 via BVM.

Perform high-quality CPR. Provide ventilations with high flow 100% O2 via BVM.

Which ECG rhythm is identified in the following image? Monomorphic ventricular tachycardia Atrial flutter Ventricular fibrillation Polymorphic ventricular tachycardia (torsades de pointes)

Polymorphic ventricular tachycardia (torsades de pointes)

The PICU team understands that this spike in ETCO2 mmHg level likely indicates what? Select the correct answer to this question. Possible ROSC Death Ineffective chest compressions Ineffective ventilations

Possible ROSC

Joanne knows that adequacy of the compressions can be assessed by monitoring end-tidal carbon dioxide (ETCO2) levels and which of the following? Select all correct options that apply. Glucose levels Presence of a palpable central pulse with each compression Arterial waveform or arterial blood pressure in patients with arterial catheters Potassium levels Brain wave activity in patients with continuous EEG monitoring in place

Presence of a palpable central pulse with each compression Arterial waveform or arterial blood pressure in patients with arterial catheters Brain wave activity in patients with continuous EEG monitoring in place

Which is the primary goal and focus of post-cardiac arrest care? Select the correct answer to this question. Avoiding tachycardia Preservation of neurologic function Maintaining normal blood pressure Avoiding bradycardia

Preservation of neurologic function

The pediatric intensive care team is caring for a child post-cardiac arrest. During which assessment should the need for an advanced airway be determined? Select the correct answer to this question. Secondary Focused Rapid Primary

Primary

During a resuscitative event, the PALS team notes a change in cardiac rhythm on the defibrillator monitor. The monitor team member assesses for a central pulse, but notes that no pulse is present. The PALS team correctly identifies this as which rhythm? Pulseless electrical activity (PEA) Ventricular fibrillation (VF) Atrioventricular (AV) block Asystole

Pulseless electrical activity (PEA)

A child in cardiac arrest presents with the ECG rhythm seen in the following image, but a central pulse cannot be palpated. The provider correctly identifies this as which rhythm? Torsades de pointes Pulseless electrical activity (PEA) Pulseless ventricular tachycardia (pVT) Sinus bradycardia

Pulseless ventricular tachycardia (pVT)

In children and infants, cardiac arrest most often arises from which complication? Select the correct answer to this question. Respiratory failure Congenital heart defects Mitochondrial diseases Seizures

Respiratory Failure

Cardiac arrest in infants is nearly always due to which of the following? Select all correct options that apply. Respiratory failure Heart disease Diabetes Stroke Airway obstruction

Respiratory failure Airway obstruction

A healthcare provider suspects that hyperkalemia may be the cause of the patient's cardiac arrest. Which should the provider order to confirm hyperkalemia? Select the correct answer to this question. Complete blood count Serum electrolyte panel Cardiac enzymes Chest radiograph

Serum electrolyte panel

Which statement correctly describes the completion of the typical ABCDE primary assessment of a patient in cardiac arrest? Select the correct answer to this question. The primary assessment (typical ABCDE) should be performed after the rapid assessment is completed. The primary assessment (typical ABCDE) should be delayed in order to provide prompt CPR and cardiac arrest care, and should be performed as soon as resources permit. The primary assessment (typical ABCDE) should be done simultaneously along with the rapid assessment. The primary assessment (typical ABCDE) should be completed immediately after CPR has been initiated.

The primary assessment (typical ABCDE) should be delayed in order to provide prompt CPR and cardiac arrest care, and should be performed as soon as resources permit.

Which finding indicates adequate end-organ and tissue perfusion? Select the correct answer to this question. Central venous pressure (CVP) higher than 5 mmHg Increasing lactate levels Central venous oxygen saturation (ScvO2) less than 60% Urine output normal for age (1.5-2 mL/kg/h for infants and young children and 1 mL/kg/h for adolescents)

Urine output normal for age (1.5-2 mL/kg/h for infants and young children and 1 mL/kg/h for adolescents)

The infant's rhythm has changed, but it is unorganized. Which of the following rhythms does this image show? PEA pVT Bradycardia VF

VF

Which ECG rhythm is identified in the following image? Ventricular fibrillation Monomorphic ventricular tachycardia Atrial flutter Polymorphic ventricular tachycardia (torsades de pointes)

Ventricular fibrillation