PALS RED CROSS FINAL EXAM
What is the correct IV/IO dose of epinephrine for a pediatric patient in cardiac arrest?
0.01 mg/kg every 3 to 5 min (max single dose 1 mg)
A 7-year-old child collapses on the playground at school. The school nurse is called to the scene and determines that the child is unresponsive and is not breathing and has no pulse. The nurse initiates CPR. At what rate and depth would the nurse deliver compressions to this child?
100 to 120 compressions per minute at a depth of about 2 inches
A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child's oxygen saturation to what percentage range?
94% to 99%
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?
Airway clearance (e.g., suctioning)
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?
Albuterol with or without ipratropium bromide
A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). For which part of the PAT may the provider use the mnemonic TICLS to assess the patient?
Appearance
An advanced airway was placed in a 5-year-old child. Which action(s) would be most appropriate for the team to take to confirm correct placement?
Auscultate over the lungs and epigastrium for air movement. Observe for bilateral chest rise. Evaluate results of capnography.
A 4-year-old patient presents with tachycardia, tachypnea, cold extremities and weak pulses. Assessment also reveals an enlarged liver and neck vein distension. The provider interprets these assessment findings as suggesting which type of shock?
Cardiogenic
A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?
Bradycardia Diminished central pulses Hypotension
Assessment of a 3-month-old infant admitted with respiratory distress reveals fever, grunting and a wet, "junky" cough. The infant's parents said the child had a recent respiratory infection with a fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider most likely suspect as the cause?
Bronchiolitis
Primary assessment of a 10-year-old child reveals septic shock. As part of the secondary assessment, if not already done as part of initial sepsis care, laboratory testing is completed to evaluate the child's status. Which laboratory tests would be ordered for this child?
Complete blood count (CBC) Lactate level Blood cultures
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?
Compressing the chest about 2 inches Providing ventilations that last about 1 second each Giving 2 ventilations to every 15 compressions Allowing the chest to recoil fully after each compression
A 2-year-old child is brought to the pediatric urgent care clinic by the parent who says that the child has had a barking cough for two days. During the rapid assessment of the child, the provider hears audible inspiratory stridor. Which common cause of partial upper airway obstruction in children would the provider most likely suspect?
Croup
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?
Deliver 1 BVM ventilation every 2 to 3 seconds.
What is considered inadequate perfusion when assessing/caring for a pediatric patient with an arrhythmia?
Diminished peripheral pulses Acutely altered mental status Hypotension
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?
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 is providing care to an intubated child in cardiac arrest. Which of the following can be used to monitor the adequacy of the team's chest compressions?
End-tidal carbon dioxide levels Presence of an arterial waveform or arterial blood pressure in patients with indwelling arterial catheters
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, after assuring adequate oxygenation and ventilation?
Ensure adequate mean arterial pressure.
A child experiencing bradycardia with inadequate perfusion despite supporting oxygenation and ventilation is receiving compressions. Despite these efforts, the child's status remains unchanged. Which medication would the emergency response team expect to administer next?
Epinephrine
An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, tachycardia and dyspnea. 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?
Epinephrine
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?
Estimate weight using a length-based resuscitation tape.
An unresponsive 7-year-old child with no pulse is brought to the pediatric urgent care center by his parents and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action would the PALS team take first?
Initiate defibrillation with 2 J/kg.
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?
Isotonic fluid boluses
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?
Rapid assessment
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 perfusion and oxygen delivery?
Lactate
A healthcare provider notices petechiae on the arms and legs while performing a rapid skin assessment of a child with a high fever and respiratory distress. Based on this assessment, which condition should the provider consider?
Life-threatening systemic infection
Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient?
Maintain the head in midline position.
A child in the pediatric intensive care unit displays the following ECG waveform. The child has no pulse. The resuscitation team interprets this as which arrhythmia?
Monomorphic pulseless ventricular tachycardia
A healthcare provider is performing a primary assessment of a child in respiratory distress. The provider documents increased work of breathing when which findings are observed?
Nasal flaring Intercostal, substernal or suprasternal retractions Accessory muscle use
A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?
Nebulized epinephrine, Corticosteroids
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?
No more than 10 seconds
The emergency response team is providing care to a preschooler who is experiencing shock. The primary goal, common to all types of shock, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on what?
Oxygen delivery and oxygen demand
A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present?
Pallor
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?
First-degree atrioventricular (AV) block
A 7-year-old patient with septic shock has received three balanced/buffered crystalloid fluid boluses (60-mL/kg) and reassessment reveals capillary refill of 3 seconds, diminished pulses, narrow pulse pressure and cool, mottled extremities. The emergency response team interprets these findings as indicating which type of septic shock?
Fluid-refractory
While performing a rapid assessment and formulating an initial impression using the Pediatric Assessment Triangle (PAT), the provider assesses the child's circulation. Which information would be important to consider?
Flushing of the skin Evidence of bleeding Skin pallor (or gray/dusky color)
A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?
Hypotension is not a consistent feature of shock presentation in children.
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)?
Hypotension, fever, hyperglycemia
A 6-year-old child is brought to the emergency department. The child has been experiencing extremely watery stools over the past several days. After completing the assessment, the healthcare provider suspects that the child may be experiencing shock. Which type of shock would the provider most likely suspect?
Hypovolemic
A 9-year-old patient is presenting with diminished breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition?
Respiratory failure
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?
Second-degree atrioventricular (AV) block, type I
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 has inadequate perfusion. Which primary assessment findings indicate this?
Signs of shock Acutely altered mental status Hypotension
A 12-year-old is being treated in the urgent care clinic. The mother reports that the child came home from school yesterday with a high fever, vomiting and multiple episodes of watery diarrhea. The healthcare provider obtains a rhythm strip and notes the following waveform. The provider interprets this as which type of arrhythmia?
Sinus tachycardia
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?
Supraventricular tachycardia
An 11-year-old child develops ventricular tachycardia with a pulse with inadequate perfusion. The PALS team would prepare the child for which intervention?
Synchronized electrical cardioversion
A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals chest pain on inspiration, diminished breath sounds on the right side, and respiratory distress. The provider suspects obstructive shock caused by what condition?
Tension pneumothorax
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?
Torsades de pointes
A child exhibiting a narrow-complex tachycardia with adequate perfusion is to receive adenosine. The provider would be alert for which result after administering this medication?
Transient asystole
A child is experiencing supraventricular tachycardia (SVT) with adequate perfusion and is to receive treatment. Which initial treatment would the provider administer?
Vagal maneuvers
A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?
pVT, VF
