PALS Final
What is the correct IV/IO dose of epinephrine for a pediatric patient in cardiac arrest? Select the correct answer to this question. 0.01 mg/kg every 3 to 5 min (max single dose 1 mg) 10 mg/kg every 3 to 5 min (max single dose 20 mg) 5 mg/kg every 3 to 5 min (max single dose 10 mg) 1 mg/kg every 3 to 5 min (max single dose 2 mg)
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? Select the correct answer to this question. 100 to 120 compressions per minute at a depth of about 1½ inches 120 to 140 compressions per minute at a depth of about 1½ inches 100 to 120 compressions per minute at a depth of about 2 inches 120 to 140 compressions per minute at a depth of about 2 inches
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? Select the correct answer to this question. 92% to 95% 94% to 99% 96% to 100% 97% to 99%
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? Select the correct answer to this question. Assisted ventilation Bronchodilator administration Airway clearance (e.g., suctioning) Advanced airway
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? Select the correct answer to this question. Terbutaline Magnesium sulfate Albuterol with or without ipratropium bromide Prednisone
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? Select the correct answer to this question. Appearance Work of breathing Circulation Exposure
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? Select all correct options that apply. Auscultate over the lungs and epigastrium for air movement. Look for fogging in the tube. Observe for bilateral chest rise. Assess for improved perfusion. Evaluate results of capnography.
Auscultate over the lungs and epigastrium for air movement. Observe for bilateral chest rise. Evaluate results of capnography.
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? Select all correct options that apply. Blood cultures Lactate level Complete blood count (CBC) Toxicology screen
Blood cultures Lactate level Complete blood count (CBC)
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? Select the correct answer to this question. Asthma Croup Bronchiolitis Pneumonia
Bronchiolitis
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? Select the correct answer to this question. Cardiogenic Obstructive Distributive Hypovolemic
Cardiogenic
A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer? Select all correct options that apply. Diuretics Antibiotics Corticosteroids Nebulized epinephrine Albuterol
Corticosteroids Nebulized epinephrine
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? Select the correct answer to this question. Epiglottitis Asthma Croup Pneumonia
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? Select the correct answer to this question. Begin chest compressions. Deliver 1 BVM ventilation every 2 to 3 seconds. Check pulse and breathing every 2 minutes. Prepare the manual defibrillator.
Deliver 1 BVM ventilation every 2 to 3 seconds
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? Select the correct answer to this question. Induce shivering with therapeutic hypothermia. Increase the child's intracranial pressure. Administer glucose to promote hyperglycemia. Ensure adequate mean arterial pressure.
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? Select the correct answer to this question. Epinephrine Norepinephrine Adenosine Propranolol
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? Select the correct answer to this question. Methylprednisolone Epinephrine Diphenhydramine Phenylephrine
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? Select the correct answer to this question. Estimate weight using growth chart data in accordance with patient age and sex. Estimate weight based on the team's clinical experience. Find the parents and ask them how much the child weighs. Estimate weight using a length-based resuscitation tape.
Estimate weight using a length-based resuscitation tape.
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? Select all correct options that apply. Evidence of bleeding Skin pallor (or gray/dusky color) Nasal flaring Accessory muscle use Flushing of the skin
Evidence of bleeding Skin pallor (or gray/dusky color) Flushing of the skin
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)? Select all correct options that apply. Seizures Hypoglycemia Fever Hypotension Hyperglycemia
Fever Hypotension Hyperglycemia
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? Select the correct answer to this question. Second-degree atrioventricular (AV) block, type I Second-degree atrioventricular (AV) block, type II First-degree atrioventricular (AV) block Third-degree (complete) atrioventricular (AV) block
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? Select the correct answer to this question. Fluid-responsive Hypertensive Fluid-refractory Mild
Fluid-refractory
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? Select all correct options that apply. Waiting 2 seconds after compressions to give ventilations Giving 2 ventilations to every 15 compressions Allowing 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 Allowing the chest to recoil fully after each compression Providing ventilations that last about 1 second each Compressing the chest about 2 inches
A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)? Select all correct options that apply. Hypotension Diminished central pulses Atrial flutter Bradycardia Cool extremities
Hypotension Diminished central pulses Bradycardia
What is considered inadequate perfusion when assessing/caring for a pediatric patient with an arrhythmia? Select all correct options that apply. Hypotension Diminished peripheral pulses Capillary refill < 2 seconds Acutely altered mental status
Hypotension Diminished peripheral pulses Acutely altered mental status
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? Hypertension Hypotension Signs of shock Acutely altered mental status Normotension
Hypotension Signs of shock Acutely altered mental status
A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock? Select the correct answer to this question. Hypotension affects children with shock more often than adults. Hypotension is not a consistent feature of shock presentation in children. Hypotension is usually an early marker of shock in children. Hypotension during shock in children is rarely a cause of concern.
Hypotension is not a consistent feature of shock presentation in children.
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? Select the correct answer to this question. Hypovolemic Obstructive Cardiogenic Distributive
Hypovolemic
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? Select the correct answer to this question. Continue with CPR. Administer epinephrine. Initiate cardioversion. Initiate defibrillation with 2 J/kg.
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? Select the correct answer to this question. Hypertonic fluid boluses Platelets Isotonic fluid boluses Hypotonic fluid boluses
Isotonic fluid boluses
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? Select the correct answer to this question. Electrolyte panel Platelets Blood culture Lactate
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? Select the correct answer to this question. Contact dermatitis Photosensitivity Poison ivy allergic response Life-threatening systemic infection
Life-threatening systemic infection
Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient? Select the correct answer to this question. Administer hypotonic fluids. Maintain the head in midline position. Avoid giving hypertonic saline or mannitol. Ensure hyperstimulation to maintain consciousness.
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? Torsades de pointes Ventricular fibrillation Asystole Monomorphic pulseless ventricular tachycardia
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? Select all correct options that apply. Nasal flaring Intercostal, substernal or suprasternal retractions Accessory muscle use Inspiratory stridor Rales
Nasal flaring Intercostal, substernal or suprasternal retractions Accessory muscle use
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? Select the correct answer to this question. No more than 3 seconds No more than 5 seconds No more than 10 seconds No more than 15 seconds
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? Select the correct answer to this question. A normal resting heart rate Oxygen delivery and oxygen demand Oxygen and carbon dioxide levels Restoring blood pressure
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? Select the correct answer to this question. Pallor Grunting Jaundice Wheezing
Pallor
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? Select all correct options that apply. Pulse oximetry reading with an oxygen saturation of at least 98% Presence of an arterial waveform or arterial blood pressure in patients with indwelling arterial catheters Visible evidence that cyanosis has resolved End-tidal carbon dioxide levels
Presence of an arterial waveform or arterial blood pressure in patients with indwelling arterial catheters End-tidal carbon dioxide levels
A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate? Select all correct options that apply. Supraventricular tachycardia (SVT) Pulseless ventricular tachycardia (pVT) Asystole Ventricular fibrillation (VF) Pulseless electrical activity (PEA)
Pulseless ventricular tachycardia (pVT) Ventricular fibrillation (VF)
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? Select the correct answer to this question. Primary assessment Focused assessment Rapid assessment Secondary assessment
Rapid assessment
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? Select the correct answer to this question. Respiratory failure Respiratory distress Respiratory arrest
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? Select the correct answer to this question. Second-degree atrioventricular (AV) block, type II First-degree atrioventricular (AV) block Third-degree (complete) atrioventricular (AV) block Second-degree atrioventricular (AV) block, type I
Second-degree atrioventricular (AV) block, type I
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? Select the correct answer to this question. Sinus bradycardia Atrial flutter Sinus tachycardia Ventricular tachycardia
Sinus tachycardia
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? Select all correct options that apply. Recommendation of methods to decrease resuscitation time Summary of the event, including what actions were taken Evaluation of the objective data gathered during the event Discussion of the pros and cons of the interventions Identification of ways to improve
Summary of the event, including what actions were taken Evaluation of the objective data gathered during the event Discussion of the pros and cons of the interventions Identification of ways to improve
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? Select the correct answer to this question. Atrial flutter Monomorphic ventricular tachycardia Supraventricular tachycardia Bradycardia
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? Select the correct answer to this question. Transthoracic pacing Vagal maneuvers Synchronized electrical cardioversion Sedation
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? Select the correct answer to this question. Obstructive cardiac lesion Cardiac tamponade Pulmonary embolism Tension pneumothorax
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? Select the correct answer to this question. Asystole Monomorphic pulseless ventricular tachycardia Ventricular fibrillation Torsades de pointes
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? Select the correct answer to this question. Transient asystole Transient atrial flutter Transient tachycardia Transient bradycardia
Transient asystole
A child is experiencing supraventricular tachycardia (SVT) with adequate perfusion and is to receive treatment. Which initial treatment would the provider administer? Select the correct answer to this question. Adenosine therapy Cardioversion Defibrillation Vagal maneuvers
Vagal maneuvers
