PALS Test

A 2 - week old infant is being evaluated irritability and poor feeding. His blood pressure is 55/40 mm Hg and capillary refill time is 5 seconds. Which statement best describes your assessment of this infants blood pressure?

It is Hypotensive

What condition is characterized by a prolonged expiratory phase and wheezing?

Lower airway obstruction

A 6-month-old infant is unresponsive. You begin checking for breathing at the same time you check for the infant's pulse. What is the maximum time you should spend trying to simultaneously check for breathing and palpate the infant's pulse before starting CPR?

10 seconds

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask. What is the most appropriate amount to administer for the first normal saline fluid bolus?

10-20 ml/kg

A 6-year-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. What compression-to-ventilation -ratio do you use?

15:2

A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High-quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. What dosage range should you use for initial defibrillation?

2 to 4 J/kg

You are caring for a 3-month-old boy with a 2-day history of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190/min, temperature is 38.3°C (101°F), blood pressure is 59/29 mm Hg, respiratory rate is 70/min and shallow, and oxygen saturation is 94% on 100% oxygen. His capillary refili time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg. You have decided that this infant needs fluid resuscitation. How much fluid should you administer?

20 ml/kg normal saline

A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High-quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. As the Team Leader, how many joules do you tell your team member to use to perform initial defibrillation?

40J

A 10-year-old child is brought to the emergency department for fever and cough. You obtain an oxygen saturation on the child. What oxygen saturation would indicate that immediate intervention is needed?

88% on 4 L/min of nasal oxygen

In management of post-cardiac arrest patients, extra care should be taken to avoid reperfusion injury. What should the ideal oxygen saturation range most likely be?

94%- 99%

You are caring for patients in the emergency department. Which two year old requires immediate interventions?

A child who is grunting

The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals that the child is difficult to arouse, and her skin color is pale. The child's heart rate is 160/min, respiratory rate is 38/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 39.4°C (103°F). I access has been established, and blood cultures have been obtained. What is the most appropriate intervention?

Administer 10 to 20 mL/kg of isotonic crystalloid over 5 to 10 minutes

A 5-year-old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. You are using the primary assessment to evaluate the child. When assessing the child's neurologic status, you note that he has spontaneous eye opening, is fully oriented, and is able to follow commands. How would you document this child's AVPU (Alert, Voice, Painful, Unresponsive) Pediatric Response Scale finding?

Alert

You are the team lead during a pediatric resuscitation attempt. Which action is high quality CPR?

Allow complete chest wall recoil after each compression.

In which of the following situations may IO access be used?

An extremity with slow capillary refill time.

A 8 year old child is brought to the emergency department by his mother for difficultly breathing. He has a history is asthma and nut allergies. His mother tells you that he has recently ate a cookie at a family picnic. Which condition is most likely present with this child?

Upper airy way obstruction

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask. In addition to oxygen administration and appropriate fluid resuscitation, what additional early intervention should you provide to this patient?

Antibiotic administration

You are caring for a 5-year-old boy with a 4-day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His oxygen saturation is 72% on room air and 89% when on a nonrebreathing oxygen mask. He has shallow respirations with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. What medication would be most appropriate?

Antibiotics

A team member is unable to perform an assigned task because it is beyond the team member's scope of practice. What action should the team member take?

Ask for a new task or role.

A 6-year-old boy is being evaluated for difficulty breathing. What finding would suggest this child has respiratory distress?

Audible inspiratory stridor

You respond to an infant who is unresponsive, is not breathing, and does not have a pulse. You do not have a mobile device, and you shout for nearby help but no one arrives. What action should you take next?

Begin CPR for 2 minutes before leaving to activate the emergency response system

An 18-month old has had vomiting and diarrhea for the past 2 days; the mother brings him to the emergency department because he is becoming more lethargic. What diagnostic test should you order first?

Blood Glucose

You are caring for a 3-month-old boy with a 2-day history of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190/min, temperature is 38.3°C (101°F), blood pressure is 59/29 mm Hg, respiratory rate is 70/min and shallow, and oxygen saturation is 94% on 100% oxygen. His capillary refili time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg. 24. What assessment finding indicates that the infant has hypotensive shock?

Blood Pressure

You are evaluating a 10-year-old child who is febrile and tachycardic. The child's capillary refill time is 5 seconds. What parameter will determine if the child is in compensated shock?

Blood Pressure

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask. What assessment finding is most important in your determination of the severity of the patient's condition?

Blood pressure

What abnormality helps identify children with acute respiratory distress caused by lung tissue disease?

Crackles

An 8-year-old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. What finding would suggest that immediate intervention is needed?

Decreased level of consciousness

A 4-year-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. What condition is most consistent with your assessment?

Disordered control of breathing

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask. Laboratory studies document lactic acidosis. On the basis of the patient's clinical assessment and history, what type of shock does this patient most likely have?

Distributive, septic

You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant's SpOz is 94%. On auscultation, the lungs are clear bilaterally. What medication should you administer first?

Epinephrine, nebulized

What ratio for compressions to breaths should be used for 1-rescuer infant CPR?

Give 30 compressions to 2 breaths

A 10-year-old child is being evaluated for a headache. What is a normal finding for this 10-year-old child?

Heart rate of 88 bpm

You are caring for a 3-month-old boy with a 2-day history of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190/min, temperature is 38.3°C (101°F), blood pressure is 59/29 mm Hg, respiratory rate is 70/min and shallow, and oxygen saturation is 94% on 100% oxygen. His capillary refili time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg. On the basis of this infant's presentation, what type of shock does this infant have?

Hypovolemic Shock

A 6-month-old infant is being evaluated for bradycardia. What is the most likely cause of bradycardia?

Hypoxia

During a resuscitation attempt, the Team Leader asks you to administer an initial dose of epinephrine at 0.1 mg/kg to be given IO. How should you respond?

I think the correct dose is 0.01 mg/kg. Should I give that dose instead?'

A 3 year old child is having difficulty breathing. What finding would most likely lead you to expect an upper airway obstruction in this child?

Increased inspiratory effort with retractions

You are performing the airway component of the primary assessment. What finding would lead you to conclude that the child has an upper airway obstruction?

Inspiratory strides

You are caring for a 5-year-old boy with a 4-day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His oxygen saturation is 72% on room air and 89% when on a nonrebreathing oxygen mask. He has shallow respirations with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. 11. What assessment finding is consistent with respiratory failure in this child?

Oxygen Saturation

If the patient continues to snore and exhibit poor chest rise and poor air entry bilaterally after your initial intervention, what next step is most appropriate?

Provide bag-mask ventilation

An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and Spoz is 60% on room air. He is unresponsive and cyanotic. What action do you take next?

Provide bag-mask ventilation with 100% oxygen

A 7-year-old child in cardiac arrest is brought to the emergency department by ambulance. No palpable pulses are detected. The child's ECG is shown here. How would you characterize this child's rhythm?

Pulseless electrical activity

After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to paintul stimulation. His respirations are shallow, at a rate of 10/min. His oxygen saturation is 94% on 2 L/min of nasal cannula oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally. What action should you take next?

Reposition the patient and insert an oral airway

A 3-year-old boy is brought to the emergency department by his mother. He is lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk capillary refill. Which immediate life-threatening condition could this child's condition most likely progress to if left untreated?

Respiratory Failure

A 3-year-old child is brought to the emergency department by his mother. What is a normal finding for a 3-year-old child?

Respiratory rate of 24/min

A 3-year-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. Defibrillation is attempted with a shock dose of 2 J/kg. After shock administration, what should you say to your team members?

Resume compressions

An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and Spoz is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here.

Sinus Bradycardia

An unresponsive 14-year-old girl is pale and cool to the touch. Her blood pressure is 70/45 mm Hg, heart rate is 190/min, and respiratory rate is 12/min. The Spoz is not detectable. Capillary refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here.

Supraventricular tachycardia

If pharmacological interventions are unavailable or delayed, what intervention is indicated?

Synchronized cardioversion

You are evaluating a 1-year-old child for respiratory distress. His heart rate is 168/min, and his respiratory rate has decreased from 65/min to 30/min. He now appears more lethargic and continues to have severe subcostal retractions. On the basis of your assessment, what is the most likely reason for this change in the child's condition?

The child has signs of respiratory failure.

You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant's SpOz is 94%. On auscultation, the lungs are clear bilaterally. What is the most likely cause of this infant's respiratory distress?

Upper airway obstruction