PALS
What is the proper dosing for epinephrine IV/IO administration during CPR?
0.01 mg/kg IV/IO (0.1 mL/kg of 0.1 mg/mL concentration), repeated every 3-5 minutes
What are the common causes of lower airway obstruction? A) bronchiolitis B) asthma C) epiglottitis D) foreign body airway obstruction
A and B
What is the treatment for mild allergic reaction? A) consider an antihistamine B) remove the offending agent C) monitor for wheezing D) use an epinephrine autoinjector D) give an albuterol treatment
A and B
What does the EC clamp technique include? A) using the thumb and index finger of the same hand to hold the face mask B) pressing on the soft tissue under the chin to lift the jaw C) using the third, fourth, and fifth fingers of one hand along the jaw to lift it forward D) using the second and third fingers of one hand to hold the face mask
A and C
In which patients would bradycardia be an expected finding and not be considered problematic? A) a healthy child who is sleeping B) a child who is hypotensive C) a child with hypoxia D) a well-conditioned athlete
A and D
Which are appropriate interventions for an apneic child? A) provide a breath every 2-3 seconds B) provide a breath every 2 seconds C) provide a breath every 3-5 seconds D) watch for chest rise
A and D
You are dispatched to the local elementary school for a 7 yo girl who says she is having chest pain and difficulty breathing. During recess about 3 hours earlier, she fell from a swing and reported right-sided rib pain. When you arrive on scene, you find the child in the nurse's office. The child is awake, responsive, and anxious. Her initial vital signs are HR 168 bpm, BP 61/43, RR 44/min, and SpO2 66%. What is the initial treatment priority for this patient? A) administer O2 (NRB) B) intubate (by an experienced provider) C) establish IV/IO access D) administer O2 (NC)
A) administer O2 (NRB)
You establish an IV in your 7 y/o patient with septic shock. What is the next most appropriate intervention? A) administer fluid bolus B) consider medical control consult C) initiate and titrate vasoactive drugs D) administer an antipyretic
A) administer fluid bolus
What is the definitive treatment for most children with PE who are not in shock? A) anticoagulants B) vasodilators C) inotropic agents D) glycoprotein IIb/IIIa inhibitors
A) anticoagulants
The appropriate rate for compressions for children is 100-120/min. What is the correct depth for children? A) approximately 2 inches (one third the AP diameter) B) approximately 3 inches (one half AP diameter) C) approximately 4 inches (two thirds AP diameter)
A) approximately 2 inches (one third the AP diameter)
Where do tachyarrhythmias originate? A) atria or ventricles B) only in the ventricles C) only in the atria
A) atria or ventricles
How should sinus tachycardia be treated? A) by treating the underlying cause B) pharmacologic interventions C) electrical interventions D) pharmacologic and electrical interventions
A) by treating the underlying cause
When is the Pediatric Assessment Triangle (PAT) performed to make an initial assessment? A) during the "from the doorway" observation B) during the primary assessment C) during the transfer of care D) during the secondary assessment
A) during the "from the doorway" observation
What is the most appropriate vasoactive drug to use in fluid-refractory septic shock? A) epinephrine or norepinephrine B) vasopressin C) milrinone D) phenylephrine
A) epinephrine or norepinephrine
Which resuscitation strategy will result in an improved chest compression fraction? A) hovering over the chest during compression pauses B) switching compressors every 2 minutes C) implementing physiologic monitoring devices D) adhering to recommended drug dosing intervals
A) hovering over the chest during compression pauses
What do central chemoreceptors respond to? A) hydrogen ions in the CSF B) CO2 in the CSF C) CO2 in the bloodstream D) serum pH
A) hydrogen ions in the CSF
What should you do to check for breathing? A) look for chest rise and fall B) place your hand on the chest C) look at the nose to check for nasal flaring D) listen for lung sounds
A) look for chest rise and fall
Which of the following describes laminar or normal airflow? A) low airway resistance and a small driving pressure B) smaller airways need increased airways resistance C) larger airways need increased airway resistance D) high airway resistance and low driving pressure
A) low airway resistance and a small driving pressure
Why is it important to immediately identify obstructive shock? A) obstructive shock can rapidly progress to cardiopulmonary failure and cardiac arrest B) obstructive shock requires a slower fluid bolus rate C) treatment within the first hour is crucial to prevent deterioration D) fluid resuscitation is more beneficial if administered immediately
A) obstructive shock can rapidly progress to cardiopulmonary failure and cardiac arrest
After a chest tube is inserted, the patient's breathing and oxygenation are improved. Her vital signs are HR 98 bpm, BP 108/72, RR 18/min and normal, and SpO2 98%. How should proper chest tube placement be confirmed? A) obtain a CXR B) ask the patient to breathe deeply C) auscultate lung sounds D) use waveform capnography
A) obtain a CXR
If the AED indicates no shock advised, what should be the next action? A) start chest compressions B) call for help C) remove AED pads D) give 2 rescue breaths
A) start chest compressions
What EKG characteristic is consistent with ventricular tachycardia? A) the QRS complex is greater than 0.09 seconds B) the P wave is present and normal C) the rate usually greater than 220/min in infants D) the R-R interval is consistent
A) the QRS complex is greater than 0.09 seconds
The evaluate-identify-intervene sequence should be continued until: A) the child is stable B) the child is ready for transport C) the child is ready for discharge D) interventions are provided for the child
A) the child is stable
How should 1-rescuer infant compressions be delivered? A) with 2 fingers or 2 thumbs B) with 1 finger or 2 thumbs C) with 2 hands or 2 fingers D) with 1 hand or 2 fingers
A) with 2 fingers or 2 thumbs
What are the causes of secondary bradycardia? A) hypothermia B) hypotension C) myocarditis D) hypoxia E) cardiomyopathy F) drugs G) acidosis
A, B, D, F, G
After 2 more minutes of CPR, you notice that the patient is moving, and his skin color improves. His vitals are HR 114/min, BP 63/47, SpO2 88%, spontaneous RR 8/min, and temperature 100.2 degrees. The infant is still slow to respond but is moving. What would be the next steps for this patient? A) obtain expert consultation B) continue oxygen C) administer atropine D) consider transthoracic pacing E) identify and treat underlying causes F) support ABCs
A, B, E, F
What clinical findings may be present in a child with a tachyarrhythmia? A) palpitations B) lightheadedness C) pyrexia D) hypertension E) syncope
A, B, and E
What circulation findings are specific to pericardial tamponade? A) muffled or diminished heart sounds B) poor peripheral perfusion C) narrowed pulse pressures D) tachycardia
A, C, D
In what conditions is atropine preferred over epinephrine as the first-choice treatment of symptomatic bradycardia? A) AV block due to a primary bradycardia B) atropine is not recommended as a first-choice treatment in any pediatric bradycardia C) increased vagal tone D) persistent bradycardia despite effective oxygenation and ventilation E) cholinergic drug toxicity (organophosphates)
A, C, E
You are dispatched to respond to a 4 month old boy with difficulty breathing. You arrive at the home and see the baby in his mother's arms. He is pale and has mottled skin. His mother says he is very lethargic and has cold hands and feet. What should your next steps be? A) apply cardiac monitor to identify rhythm and monitor pulse, BP, and oximetry B) establish IV/IO access C) complete the initial and primary assessment D) obtain 12-lead ECG E) maintain a patent airway F) begin CPR
A, C, and E
What is the focus of the initial management of distributive shock? A) filling expanded dilated vascular space B) stopping additional fluid loss C) decreasing extravascular volume D) expanding intravascular volume E) correcting hypovolemia
A, D, E
What is considered an initial management priority in managing tachyarrhythmias? A) attach a continuous ECG monitor/defibrillator and a pulse oximeter B) obtain consultation before initiating urgent interventions C) obtain IV/IO acces D) assess and support the airway, oxygenation, and ventilation E) obtain a 12-lead ECG if practical
A, D, and E
BVM ventilation has been used on a child with a lower airway obstruction. Which complications may occur? A) increased venous return to the heart B) decreased blood supply to the heart C) risk of lung collapse D) increased oxygenation
B and C
Most patients in cardiogenic shock will need inotropic support with medications. Which of the following could be used? A) vasopressin B) epinephrine C) milrinone D) norepinephrine
B and C
What is the main objective of managing obstructive shock? A) assess for fluid-refractory hypotension B) restore tissue perfusion C) correct the cause of cardiac output obstruction D) monitor and evaluate basic life support
B and C
Which of the following should be considered for stable SVT? A) deliver an unsynchronized shock of 2 J/kg B) place a bag with ice water over the upper half of the infant's face C) ask an older child to try to blow through an obstructed straw D) perform synchronized cardio version at 0.5-1 J/kg
B and C
What is a first degree AV block? A) a progressive prolongation of the PR interval until an atrial impulse is not conducted by the ventricles B) a prolonged PR interval representing slowed conduction through the AV node C) none of the atrial impulses conduct to the ventricles D) nonconduction of some of the atrial impulses to the ventricle without any change in the PR interval of the conduction impulses
B) a prolonged PR interval representing slowed conduction through the AV node
If bradycardia persists after initial treatment and the HR remains less than 60/min, what action should you take next? A) administer epinephrine B) begin CPR C) administer atropine D) provide BVM ventilation with 100% oxygen
B) begin CPR
What causes primary bradycardia? A) medications B) congenital or acquired heart conditions C) increased cardiac output D) non-cardiac conditions that later the normal function of tue heart
B) congenital or acquired heart conditions
In the setting of actual or impending pulseless arrest when there is strong suspicion of pericardial tamponade, what is the appropriate management ? A) PRBCs B) emergency pericardiocentesis C) fluid bolus of 20 mL/kg over 5-20 mins D) consultation with an appropriate specialist
B) emergency pericardiocentesis
What can happen if the OPA is too large? A) it can push the tongue to the back of the throat B) it can block the airway C) it may cause vomiting D) it will open the airway
B) it can block the airway
Treatment for PTX should not be delayed. Based on the child's assessment, what immediate intervention should be performed? A) CXR B) needle decompression C) fluid bolus D) pericardiocentesis
B) needle decompression
How long should assessing for breathing and a pulse take? A) no longer than 20 seconds B) no longer than 10 seconds C) no longer than 15 seconds D) no longer than 5 seconds
B) no longer than 10 seconds
For an unwitnessed cardiac arrest, what should you do after determining unresponsiveness and there is no breathing and no pulse? A) shout for help B) perform high quality CPR for 2 minutes C) provide rescue breaths D) activate the emergency response system
B) perform high quality CPR for 2 minutes
What is chest compression fraction? A) proportion of time that compression are not performed B) proportion of time that compressions are performed C) proportion of time that recoil is adequate in compressions D) proportion of time that depth is adequate in compressions
B) proportion of time that compressions are performed
A responsive child presents with severe foreign body airway obstruction is unable to speak. You determine that the child: A) should be lowered to the floor and CPR should be initiated B) should receive abdominal thrusts C) needs no intervention; call for help and allow the child to clear the obstruction D) has a severe airway obstruction; give 5 back blows and 5 chest thrusts
B) should receive abdominal thrusts
Which of the following are typical signs of lung tissue disease? A) bradypnea and hypercarbia B) tachypnea and hypoxemia C) normal respiratory rate and hypoxemia D) tachypnea and hypercarbia
B) tachypnea and hypoxemia
Where may padding be required under when properly positioning a child older than 2 years of age to maintain a patent airway? A) the shoulders B) the occiput C) the upper torso D) padding is not required for children older than 2 years of age
B) the occiput
Which signs and symptoms are consistent with SVT? A) constant PR interval B) HR does not vary with activity or stimulation C) HR 220/min or greater in an infant or 180/min or greater in a child D) HR varies with activity or stimulation E) absent or abnormal P waves
B, C, and E
Ongoing assessment of your 7 y/o septic shock patient must be done while administering fluid boluses. What are some of the adverse effects that indicate that you should stop rapid fluid bolus administration? A) increased urinary output B) hepatomegaly C) mental status improvement D) rales E) respiratory distress
B, D, E
What are the characteristics of V-tach? A) AV conduction is regular B) the rapid rate may deteriorate into pulseless V-tach or v-fib C) the rate is consistent and near normal D) it is a wide QRS complex generated within the ventricles E) a rapid rate compromises ventricular filling
B, D, and E
What are the electrocardiographic characteristics of bradycardia? A) P waves always visible B) HR slow compared with normal HR for age C) prolonged PR interval D) P wave and QRS may be unrelated E) QRS complex may be narrow or wide
B, D, and E
How can small airways be obstructed in lower airway obstruction? A) increased expiratory flow B) decreased volume of gas in the lungs C) smooth muscle bronchial constriction D) decreased intrapleural pressure E) mucus plugging
C and E
What is the IV/IO dose of atropine for pediatric bradycardia? A) 0.5 mg B) 1 mg C) 0.02 mg/kg D) 0.04 mg/kd
C) 0.02 mg/kg
What is the preferred technique for infant compressions when there are 2 or more rescuers present? A) 1 finger technique B) 1 thumb encircling hands technique C) 2 thumb encircling hands technique D) 2 finger technique
C) 2 thumb encircling hands technique
What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? A) 40 mL/kg over 20-30 mins B) 10-20 mL/kg over 10-15 mins C) 5-10 mL/kg over 10-20 mins D) 20 mL/kg over 5-10 mins
C) 5-10 mL/kg over 10-20 mins
Hypotension for children 1-10 years of age is a SBP of less than: A) 50 + (2 x age in years) B) 40 + (2 x age in years) C) 70 + (2 x age in years) D) 60 + (2 x age in years)
C) 70 + (2 x age in years)
How is tachycardia defined in pediatric patients? A) a HR that is fast compared with the normal HR for the child's age, with signs of poor perfusion B) HR >150/min C) HR that is fast compared with the normal heart rate for the child's age D) HR >100/min
C) HR that is fast compared with the normal heart rate for the child's age
What is a characteristic feature of SVT? A) a gradual increase in HR that does not vary with activity B) an abrupt increase in HR that varies with activity C) an abrupt increase in HR that does not vary with activity D) a gradual increase in HR that varies with activity
C) an abrupt increase in HR that does not vary with activity
What is one way to increase chest compression fraction during a code? A) switching the airway and compressor roles during CPR B) starting an IV/IO during rhythm analysis C) charging the defibrillator 15 seconds before a rhythm check D) giving epinephrine during a rhythm analysis
C) charging the defibrillator 15 seconds before a rhythm check
What should you do before suctioning a child who has an upper airway obstruction? A) give nebulized epinephrine B) give corticosteroids C) determine the underlying cause of the obstruction D) determine if there is blood or debris in the airway
C) determine the underlying cause of the obstruction
How does the clinical presentation of distributive shock compare to hypovolemic shock? A) distributive shock has completely different presenting characteristics than those of hypovolemic shock B) distributive shock presents with bradycardia while hypovolemic shock presents with tachycardia C) distributive shock has a more variable presentation than that of hypovolemic shock D) distributive shock always presents the same as hypovolemic shock
C) distributive shock has a more variable presentation than that of hypovolemic shock
In children with severe cardiovascular compromise from PE, what treatment should be considered? A) glycoprotein IIb/IIIa inhibitors B) platelet aggregation inhibitors C) fibrinolytic agents D) low-molecular-weight heparin
C) fibrinolytic agents
Children develop hypoxemia and tissue hypoxia more quickly than adults because of their: A) lower respiratory rate B) higher HGB C) higher metabolic rate D) lower oxygen demand
C) higher metabolic rate
In a less severe case of upper airway obstruction in a child, what can relieve obstruction caused by the tongue? A) suction B) decide if a surgical airway is needed C) insert an oral airway D) minimize agitation
C) insert an oral airway
What is a third degree AV block? A) a progressive prolongation of the PR interval until an atrial impulse is not conducted by the ventricles B) a prolonged PR interval representing slowed conduction through the AV node C) none of the atrial impulses conduct to the ventricles D) nonconduction of some of the atrial impulses to the ventricle without any change in the PR interval of the conduction impulses
C) none of the atrial impulses conduct to the ventricles
What pulses should be assessed to monitor systemic perfusion in a child? A) carotid and brachial B) pedal and radial C) peripheral and central D) femoral and carotid
C) peripheral and central
What is the function of the nonrebreathing outlet valve of a self-inflating bag? A) keeps exhaled gases contained B) opens when the child exhales C) prevents rebreathing of CO2 D) allows the child to exhale
C) prevents rebreathing of CO2
If the child does not have normal breathing and a pulse of 64 bpm is present, you will need to: A) begin CPR B) monitor C) provide rescue breathing
C) provide rescue breathing
Where should the needle be inserted for proper needle decompression? A) left side of the chest, over the top of the third rib (second intercostal space), in the midclavicular line B) right side of the chest, between the first and second ribs in the midclavicular line C) right side of the chest, over the third rib (second intercostal space), in the midclavicular line D) left side of the chest, in the third intercostal space in the midclavicular line
C) right side of the chest, over the third rib (second intercostal space), in the midclavicular line
What is the priority in initially managing arrhythmias? A) obtain a SAMPLE history B) evaluate the potential reversible causes (Hs and Ts) C) support the ABCs D) identify the underlying cause before initiating interventions
C) support the ABCs
Why does sinus tachycardia typically develop? A) it is a reentry mechanism B) the body's oxygen demand is decreased C) the body needs increased cardiac output D) it's due to a bundle branch block
C) the body needs increased cardiac output
Which of the following is required to appropriately ventilate a child with a self-inflating bag? A) the oxygen flow rate must remain constant B) face masks do not need to be fitted to the child C) tidal volume needs to be delivered at the correct rate D) the outlet control valve must not be changed
C) tidal volume needs to be delivered at the correct rate
What are characteristics of atrial flutter? A) AV conduction is regular B) not seen in newborn infants with normal hearts C) atrial rate can exceed 300 bpm, and ventricular rate is slower D) a narrow-complex tachyarrhythmias E) can develop in children with congenital heart disease
C, D, and E
Needle decompression is performed on the patient. As the needle is inserted, there is a rush of air coming from the hub of the needle. Vital signs are reassessed and are now HR 134 bpm, BP 70/40, and SpO2 82%. The patient still has labored breathing. Her SpO2 does not go above 82%. Her lung sounds are now present but diminished on the right side. Which of the following interventions is appropriate to do next? A) administer nebulized albuterol B) administer 20 mL/kg NS or LR bolus C) obtain a CXR D) perform a thoracostomy for chest tube placement
D) perform a thoracostomy for chest tube placement
What is the initial treatment for pediatric bradycardia with cardiopulmonary compromise? A) administer atropine B) begin CPR C) administer epinephrine D) provide BVM with 100% oxygen
D) provide BVM with 100% oxygen
What is the compression to ventilation ratio for 1- and 2-rescuer CPR for children and infants? A) 15:2 for both B) 30:2 for both C) single rescuer 15:2, 2 rescuers 30:2 D) single rescuer 30:2, 2 rescuers 15:2
D) single rescuer 30:2, 2 rescuers 15:2
What findings help distinguish PE from hypovolemic shock? A) tachycardia and hypotension B) respiratory distress with increased respiratory rate and effort C) extremities may be cool and mottled D) systemic venous congestion and right heart failure
D) systemic venous congestion and right heart failure
Auscultating the 7 y/o girl's lungs demonstrates clear lung sounds on the left but absent lung sounds on the right. What is the most likely diagnosis for this patient? A) hypoglycemia B) hypovolemia C) cardiac tamponade D) tension PTX
D) tension PTX
What is the leading cause of symptomatic bradycardia in children? A) poor cardiac function B) congenital abnormality C) myocarditis D) tissue hypoxia
D) tissue hypoxia
Which of the following should be included in rescue breathing for an infant? A) provide a breath every 6 seconds B) check for a pulse every 5 minutes C) start chest compressions D) use oxygen as soon as it is available
D) use oxygen as soon as it is available
Which of the following is true about airway resistance? A) the smaller the airway, the lower the airway resistance B) impedance to airflow is decreased when the airways constrict C) airway resistance decreases as lung volume remains unchanged D) when airway resistance increases, work of breathing increases
D) when airway resistance increases, work of breathing increases
When is distributive shock present? A) when there is excessive blood flow to all tissue beds B) when there is adequate blood flow to some tissue beds but too much to others C) when there is inadequate blood flow to all tissue beds D) when there is inadequate blood flow to some tissue beds but too much to others
D) when there is inadequate blood flow to some tissue beds but too much to others
In the primary assessment, how should you open the airway of a child who is not suspected of having a c-spine injury? A) with ET intubation B) with a jaw thrust C) by flexing the neck D) with a head tilt-chin lift
D) with a head tilt-chin lift
Where do you check a pulse on an infant and child?
Infant: brachial Child: femoral or carotid
How would you estimate the size of a cuffed or uncuffed ET tube to use for a patient that is 7 kg and 6 months old?
cuffed: (age in years)/4 + 3.5 uncuffed: (age in years)/4 + 4
Why do children with cardiac tamponade improve temporarily with fluid administration? A) late-phase symptoms are delayed with fluid administration B) fluids will decrease cardiac output and improve hemodynamic status C) poor myocardial contractility is improved and pulmonary edema is minimized with fluid administration D) fluids augment cardiac and tissue perfusion until pericardial drainage is performed
D) fluids augment cardiac and tissue perfusion until pericardial drainage is performed
A responsive infant presents with severe foreign body airway obstruction. What is the appropriate management? A) perform abdominal thrusts B) lay the infant on a hard surface and begin CPR C) perform a blind finger sweep D) give 5 back blows followed by 5 chest thrusts
D) give 5 back blows followed by 5 chest thrusts
What do central chemoreceptors respond to? A) CO2 in the CSF B) serum pH C) CO2 in the bloodstream D) hydrogen ions in the CSF
D) hydrogen ions in the CSF
What should you do to help reduce the risk of hypoxemia during suctioning? A) never interrupt suctioning B) suction the back of the oropharynx C) withdraw the catheter in a twisting motion D) limit suction attempts to 10 seconds or less
D) limit suction attempts to 10 seconds or less
What does a prolonged capillary refill time indicate? A) low cardiac rate B) increased stroke volume C) increased cardiac output D) low cardiac output
D) low cardiac output
How are tachycardia and tachyarrhythmias classified? A) by the regularity of the R-R interval B) by the duration of the P-R interval C) by the present of a P wave D) by the width of the QRS complex
D) by the width of the QRS complex
What do weak central pulses indicate a need for immediate intervention to prevent? A) hypovolemia B) sepsis C) respiratory arrest D) cardiac arrest
D) cardiac arrest
How do infants initially respond to lower airway obstruction? A) increased tidal volumes B) increased respiratory rate C) decreased respiratory rate D) decreased intrapleural pressure
D) decreased intrapleural pressure
Whenever a child has an abnormal heart rate or rhythm, what must be done quickly? A) transport the child to the ED or pediatric ICU B) seek expert consultation C) contact family and collaboratively develop a plan for medical management D) determine if the arrhythmia is causing hemodynamic instability or other signs of deterioration
D) determine if the arrhythmia is causing hemodynamic instability or other signs of deterioration
How is sniffing position achieved in an infant or child? A) place the infant in a prone position B) flex the neck behind the level of the shoulder C) hyperextend the neck D) ensure the external ear canal is anterior to the shoulder
D) ensure the external ear canal is anterior to the shoulder
What is the initial dose of epinephrine in the treatment of symptomatic bradycardia? A) 0.01 mg/kg endotracheal B) 1 mg/kg endotracheal C) 1 mg/kg IO D) 0.01 mg/kg IV/IO
D) 0.01 mg/kg IV/IO
During the initial assessment, you find that an infant is unresponsive and has HR of less than 60/min. What should be your next action? A) stimulate the infant B) begin rescue breathing C) obtain BGL D) begin CPR
D) begin CPR
Which of these factors can override brainstem control of breathing in an infant? A) turbulent airflow B) breathing normally C) laminar airflow D) breath holding
D) breath holding
