PALS

Welcome to your PALS Exam
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You are only allowed 2 attempts for this exam.

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1.

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

Add description here!

A. An extremity with signs of infection

B. An extremity with signs of a crush injury

C. An extremity with a previous unsuccessful IO attempt

D. An extremity with slow a capillary refill time

1 out of 50

2.

A 2-week-old infant is being evaluated for 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 infant’s blood pressure?

A. It represents compensated shock.

B. It is hypertensive.

C. It is hypotensive.

D. It is normal.

2 out of 50

3.

You are caring for patients in the emergency department. Which 2-year-old child requires immediate intervention?

A. A child who is grunting

B. A child with an SpO2 of 95% on room air

C. A child with a systolic blood pressure of 92 mm Hg

D. A child with a temperature of 37.4°C (99.3°F)

3 out of 50

4.

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

A. Expiratory breath sounds

B. Decreased expiratory effort

C. Increased inspiratory effort with retractions

D. Normal inspiratory sounds

4 out of 50

5.

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?

A. Ask for a new task or role

B. Refuse to perform the task

C. Do it anyway

D. Seek expert consultation

5 out of 50

6.

You are the Team Leader during a pediatric resuscitation attempt. What action is an element of high-quality CPR?

A. Providing a compression depth of one fourth the depth of the chest

B. Providing a compression rate of 80 to 100/min

C. Allowing complete chest wall recoil after each compression

D. Performing pulse checks every minute

6 out of 50

7.

An 8-year-old child is brought to the emergency department by his mother for difficulty breathing. He has a history of asthma and nut allergies. His mother tells you that he recently ate a cookie at a family picnic. What condition is most likely to be present in this child?

A. Disordered control of breathing

B. Hypovolemic shock

C. Lung tissue disease

D. Upper airway obstruction

7 out of 50

8.

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?

A. Decreased level of consciousness

B. Systolic blood pressure of 106 mm Hg

C. Temperature of 38.1°C (100.5°F)

D. Warm, moist skin

8 out of 50

9.

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?

A. 15:1

B. 30:1

C. 15:2

D. 30:2

9 out of 50

10.

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?

A. “Check for a pulse.”

B. “Give epinephrine 0.01 mg/kg.”

C. “Let’s check the rhythm.”

D. “Resume compressions.”

10 out of 50

11.

What assessment finding is consistent with respiratory failure in this child?

Use this scenario to answer the next 2 questions:
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.

Cough

B. Fever

C. Oxygen saturation

D. Respiratory rate

11 out of 50

12.

What medication would be most appropriate?

A. A bronchodilator

B. An antibiotic

C. A corticosteroid

D. A vasopressor

12 out of 50

13.

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?

A. “I can’t administer the drug at the dose you ordered.”

B. “OK, but I will administer epinephrine 0.01 mg/kg.”

C. “OK. I will administer epinephrine 0.1 mg/kg.”

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

13 out of 50

14.

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?

A. 10 seconds

B. 15 seconds

C. 30 seconds

D. 60 seconds

14 out of 50

15.

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

Add description here!

Blood pressure of 60/50 mm Hg

Heart rate of 88/min

Respiratory rate of 8/min

Temperature of 39.6°C (103.2°F)

15 out of 50

16.

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

A. Audible inspiratory stridor

B. Decreased respiratory effort

C. Oxygen saturation of 95%

D. Respiratory rate of 8/min

16 out of 50

17.

17. What dosage range should you use for initial defibrillation?

Use this scenario to answer the next 2 questions:
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.

A. 0.5 to 2 J/kg

B. 4 to 6 J/kg

C. 6 to 8 J/kg

D. 2 to 4 J/kg

17 out of 50

18.

As the Team Leader, how many joules do you tell your team member to use to perform initial defibrillation?

Use this scenario to answer the next 2 questions:
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.

A. 10 J

B. 40 J

C. 100 J

D. 140 J

18 out of 50

19.

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?

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

B. Begin CPR for 1 minute before leaving to activate the emergency response system

C. Activate the emergency response system after giving CPR for 10 minutes

D. Activate the emergency response system after giving CPR for 5 minutes

19 out of 50

20.

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

A. Give 30 compressions to 2 breaths

B. Give 5 compressions to 1 breath

C. Give 20 compressions to 2 breaths

D. Give 15 compressions to 2 breaths

20 out of 50

21.

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?

A. Cardiogenic shock

B. Hypovolemic shock

C. Respiratory distress

D. Respiratory failure

21 out of 50

22.

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?

A. Blood pressure

B. Chest movement

C. Respiratory effort

D. Respiratory rate

22 out of 50

23.

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?

A. 12-lead ECG

B. Arterial blood gases

C. Blood glucose

D. Serum potassium

23 out of 50

24.

What assessment finding indicates that the infant has hypotensive shock?

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 refill time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg.

A. Blood pressure

B. Capillary refill time

C. Heart rate

D. Tachypnea

24 out of 50

25.

On the basis of this infant’s presentation, what type of shock does this infant have?

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 refill time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg.

A. Cardiogenic

B. Distributive

C. Hypovolemic

D. Obstructive

25 out of 50

26.

You have decided that this infant needs fluid resuscitation. How much fluid should you administer?

A. 10 mL/kg lactated Ringer’s

B. 15 mL/kg 5% dextrose in 0.45% normal saline

C. 20 mL/kg normal saline

D. 20 mL/kg 0.45% normal saline

26 out of 50

27.

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

A. Crackles

B. Prolonged inspiratory time

C. Stridor

D. Wheezes

27 out of 50

28.

What is the most likely cause of this infant’s respiratory distress?

Use this scenario to answer the next 2 questions:
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 SpO2 is 94%. On auscultation, the lungs are clear bilaterally.

A. Disordered control of breathing

B. Lower airway obstruction

C. Parenchymal lung disease

D. Upper airway obstruction

28 out of 50

29.

What medication should you administer first?

Use this scenario to answer the next 2 questions:
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 SpO2 is 94%. On auscultation, the lungs are clear bilaterally.

A. Albuterol, nebulized

B. Ceftriaxone, IV

C. Dexamethasone, PO/IM

D. Epinephrine, nebulized

29 out of 50

30.

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

A. Disordered control of breathing

B. Hypovolemic shock

C. Lower airway obstruction

D. Upper airway obstruction

30 out of 50

31.

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?

A. Alert

B. Voice

C. Painful

D. Unresponsive

31 out of 50

32.

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?

A. Disordered Control of Breathing

B. Lower airway obstruction

C. Lung tissue disease

D. Upper airway obstruction

32 out of 50

33.

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?

A. The child has a neurologic problem rather than a respiratory problem.

B. The child has signs of respiratory failure.

C. The child likely has an arrhythmia rather than a respiratory problem.

D. The child’s status is improving.

33 out of 50

34.

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?

A. Pulseless Electrical Activity

B. Sinus bradycardia

C. Ventricular escape rhythm

D. Ventricular tachycardia

34 out of 50

35.

What action should you take next?

After rectal administration of diazepam, an 8-year old boy with a history of seizures is now unresponsive to pain 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.

A. Administer Naloxone

B. Perform Endotracheal Intubation

Increase Nasal Cannula Flow

Reposition the patient and insert an oral airway

35 out of 50

36.

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?

Use this scenario to answer the next 2 questions:
After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to painful 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.

A. Increase nasal cannula flow

B. Provide bag-mask ventilation

C. Administer nebulized epinephrine

D. Perform nasal suctioning

36 out of 50

37.

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?

A. Dry, nonproductive cough

B. Inspiratory stridor

C. Subcostal retractions

D. Wheezing

37 out of 50

38.

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?

A. 90% to 98%

B. 94% to 99%

C. 94% to 100%

D. 98% to 100%

38 out of 50

39.

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?

Use this scenario to answer the next 4 questions:
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.

A. Cardiogenic

B. Distributive, neurogenic

C. Distributive, septic

D. Obstructive

39 out of 50

40.

What assessment finding is most important in your determination of the severity of the patient’s condition?

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.

A. Blood pressure

B. Heart rate

C. Oxygen saturation

D. Respiratory rate

40 out of 50

41.

What is the most appropriate amount to administer for the first normal saline fluid bolus?

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.

A. 5 to 10 mL/kg

B. 10 to 20 mL/kg

C. 20 to 30 mL/kg

D. 30 to 40 mL/kg

41 out of 50

42.

In addition to oxygen administration and appropriate fluid resuscitation, what additional early intervention should you provide to this patient?

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.

A. Bronchodilator administration

B. Antibiotic administration

C. Corticosteroid administration

D. Glucose administration

42 out of 50

43.

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?

A. 88% on 4 L/min of nasal oxygen

B. 95% on room air

C. 96% on room air

D. 97% on 50% oxygen

43 out of 50

44.

What rhythm is seen on the patient’s cardiac monitor?

Use this scenario to answer the next 2 questions:
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 SpO2 is not detectable. Capillary refill time is 5
seconds. An IV is in place. The cardiac monitor displays the rhythm shown here.

A. Normal sinus rhythm

B. Sinus tachycardia

C. Supraventricular tachycardia

D. Ventricular tachycardia

44 out of 50

45.

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

Use this scenario :
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 SpO2 is not detectable. Capillary refill time is 5
seconds. An IV is in place. The cardiac monitor displays the rhythm shown here.

The correct answer is D. If initial treatment with adenosine is unavailable (or delayed), synchronized
cardioversion (with an initial dose of 0.5 to 1 J/kg) is indicated. [PALS Provider Manual, Part 12: Managing
Arrhythmias > Pediatric Tachycardia With a Pulse Algorithm; pages 257-258]

A. Defibrillation

B. 20 mL/kg bolus isotonic crystalloid

C. High-quality CPR

D. Synchronized cardioversion

45 out of 50

46.

What is the most appropriate intervention?

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). IV access has been
established, and blood cultures have been obtained.

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

B. Administer 20 to 30 mL/kg of isotonic crystalloid over 30 minutes

C. Administer 5 to 10 mL/kg of packed red blood cells

D. Obtain a chest x-ray

46 out of 50

47.

What rhythm is most consistent with this patient’s presentation and ECG findings?

Use this scenario to answer the next 2 questions:
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 SpO2 is 60% on room air. He
is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here.

A. Normal sinus rhythm

B. Second-degree heart block (Mobitz type II)

C. Sinus bradycardia

D. Pulseless electrical activity

47 out of 50

48.

What action do you take next?

Use this scenario to answer the question:
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 SpO2 is 60% on room air. He
is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here.

A. Administer epinephrine IV

B. Perform transcutaneous pacing

C. Provide bag-mask ventilation with 100% oxygen

D. Perform endotracheal intubation

48 out of 50

49.

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?

A. Blood pressure of 55/30 mm Hg

B. Heart rate of 220/min

C. Oxygen saturation of 90%

D. Respiratory rate of 24/min

49 out of 50

50.

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

A. Hypovolemia

B. Hypoxia

C. Drug toxicity

D. Hyperglycemia

50 out of 50

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