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AHA PALS 63 Practice Revision exam
Queries
- During a pediatric resuscitation attempt, what is most likely to contribute to high-quality CPR?
A. A depth of compressions of about one fourth the anterior- posterior depth of the chest
B. A compression rate of 80/min
C. Pulse checks performed once per minute
D. Allowing the chest wall to recoil completely between compressions - ✔ ✔ Allowing the chest wall to recoil
completely between compressions
- While you are performing CPR on an infant in cardiac arrest at a doctor's office, a second rescuer arrives with an AED. Which of the following best describes the use of an AED on this infant?
A. The use of AEDS is not recommended on an infant.
B. There are not enough data to recommend for or against the use of AEDS on infants.
C. Only pediatric pads may be used on infants.
D. If pediatric pads are unavailable, it is acceptable to use adult
pads. - ✔ ✔ D. If pediatric pads are unavailable, it is acceptable to use adult pads.
- A 5-year-old child is hit in the chest with a baseball and suddenly collapses. High-quality CPR is being performed. When
the AED arrives, only adult AED pads are available. What should the rescuer do?
A. Use the AED with adult pads
B. Wait for pediatric AED pads and use them as soon as they are available
C. Continue the steps of CPR for 2 minutes before using the AED
D. Await arrival of a manual defibrillator - ✔ ✔ Use the AED
with adult pads
- Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
A. Disordered control of breathing
B. Hypovolemic shock
C. Lower airway obstruction
D. Upper airway obstruction - ✔ ✔ Lower airway obstruction
- A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a few minutes ago. Which of the following most likely to be abnormal?
A. Vascular resistance
B. Pulse rate
C. Lung compliance
D. Control of breathing - ✔ ✔ Control of breathing
- What abnormality is most likely to be present in children with acute respiratory distress caused by lung tissue disease?
C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an oncologist to determine the chemotherapeutic regimen - ✔ ✔ Obtain vascular access and
administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
- A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. Two providers may attempt peripheral vascular access twice each
B. Three providers may attempt peripheral vascular access once each
C. Place a central venous line
D. Place an intraosseous line - ✔ ✔ Place an intraosseous line
- What is the appropriate fluid bolus to administer for a child with hypovolemic shock with adequate myocardial function?
A. 10 mL/kg normal saline
B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
C. 20 mL/kg normal saline
D. 10 mL/kg lactated Ringer's - ✔ ✔ 20 mL/kg normal saline
- An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector - ✔ ✔ Administer nebulized
epinephrine
- An 8-year-old child presents with a history of vomiting and diarrhea. The child has the following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure 9060 mm Hg, and temperature 98.6°F (37°C). The child's capillary refill time is 4 seconds. After 2 IV boluses of normal saline (20 mL/kg each), the child's vital signs are now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94/62 mm Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child's urine output is 1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or information should be obtained first?
A. Arterial blood gas
B. Serum potassium concentration
C. Glucose
D. A 12-lead ECG - ✔ ✔ Glucose
- A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the
- During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mg/kg to be given 10. What should the team member do?
A. Administer the drug as ordered
B. Administer 0.01 mg/kg of epinephrine
C. Respectfully ask the team leader to clarify the dose
D. Refuse to administer the drug - ✔ ✔ Respectfully ask the
team leader to clarify the dose
- Which of the following is a characteristic of respiratory failure?
A. Inadequate oxygenation and/or ventilation
B. Hypotension
C. An increase in serum pH (alkalosis)
D. Abnormal respiratory sounds - ✔ ✔ Inadequate oxygenation and/or ventilation
- A 15-year-old boy presents with acute onset of severe respiratory distress, with retractions and an oxygen saturation of 85%. His trachea is deviated to the right, and there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is 84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate intervention?
A. Obtain a chest x-ray
B. Perform needle decompression on the left chest C. Insert a chest tube on the left side
D. Insert an IV and administer 20 mL/kg of normal saline - ✔ ✔
Perform needle decompression on the left chest
- A 4-year-old is being treated for hypovolemic shock and has received a single fluid bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4 seconds. What describes this patient's condition?
A. Hypotensive shock
B. Compensated shock
C. No longer in shock
D. Cardiogenic shock - ✔ ✔ Compensated shock
- An 8-year-old child had a sudden onset of palpitations and light-headedness. At the time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted. What is the most appropriate initial intervention?
A. Provide synchronized cardioversion at 0.5 to 1 J/kg
B. Attempt vagal maneuvers
C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer
amiodarone 5 mg/kg over 20 minutes - ✔ ✔ Attempt vagal maneuvers
- A 10-year-old child had a sudden witnessed cardiac arrest and received immediate bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous circulation. The child remains unresponsive and has an advanced airway in place.
the right side, but no air entry is heard on the left side. What is the most appropriate initial intervention?
A. Administer epinephrine 0.01 mg/kg IV
B. Place a chest tube on the left
C. Verify the endotracheal tube position
D. Aggressively suction the endotracheal tube - ✔ ✔ Verify the endotracheal tube position
- For a 6-month-old infant with supraventricular tachycardia and adequate perfusion, which of the following is the preferred vagal maneuver?
A. Ocular pressure
B. Carotid pressure
C. Valsalva maneuver
D. Ice to the face - ✔ ✔ Ice to the face
- A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes after eating peanuts. What is the most appropriate initial medication for this child?
A. Nebulized albuterol
B. Epinephrine IM
C. Isotonic crystalloid IV
D. Methylprednisolone - ✔ ✔ Epinephrine IM
- A 2-year-old child was found submerged in a swimming pool. She is unresponsive, not breathing, and pulseless. In addition to
performing high-quality CPR and establishing vascular access, which of the following is the most appropriate intervention?
A. Give atropine 0.02 mg/kg lIO/IV
B. Apply cricoid pressure
C. Give epinephrine 0.01 mg/kg IO/IV
D. Provide transthoracic pacing - ✔ ✔ Give epinephrine 0. mg/kg IO/IV
- A 3-year-old child is unresponsive, not breathing, and pulseless. High-quality CPR is in progress. A cardiac monitor is applied, and the rhythm below is noted. What is the next appropriate intervention?
A. Attempt defibrillation with a 2 J/kg shock
B. Administer epinephrine 0.01 mg/kg
C. Consider placement of an advanced airway
D. Administer amiodarone 5 mg/kg - ✔ ✔ Attempt defibrillation
with a 2 J/kg shock
- A pulseless 6-week-old infant arrives in the emergency department, and high-quality CPR is in progress. The initial rhythm strip is shown below. CPR continues, and vascular access has been established. What is the next appropriate intervention?
A. Administer atropine 0.02 mg/kg IO/IV
B. Attempt defibrillation with a 2 J/kg shock
C. Administer epinephrine 0.01 mg/kg IO/IV
- A 12-year-old child suddenly collapses while playing sports. He is unresponsive and not breathing. Emergency response is activated. The child has no pulse, and CPR is initiated. An AED arrives. What is the most appropriate next intervention?
A. Contact the child's family
B. Provide CPR for 2 minutes
C. Drive the child to the hospital
D. Use the AED - ✔ ✔ Use the AED
- A 6-year-old child is found unresponsive, not breathing, and pulseless. What is the correct compression-to-ventilation ratio when 2 or more healthcare providers are present to perform
CPR? - ✔ ✔ 15:
- A 5-year-old child has had severe respiratory distress for 2 days. During assessment the child's heart rate decreases from 140/min to 90/min, and the child's respiratory rate decreases from 66/min to 8/min. What intervention is most appropriate?
A. Provide rescue breaths at a rate of 12 to 20/min B. Provide rescue breaths at a rate of 6 to 10/min
C. Initiate chest compressions at a rate of at least 100/min
D. Initiate chest compressions at a rate of 60/min - ✔ ✔
Provide rescue breaths at a rate of 12 to 20/min
- A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be established. What is the most appropriate intervention?
A. Unsynchronized shock with 0.5 to 1 J/kg
B. Synchronized shock with 0.5 to 1 J/kg
C. Unsynchronized shock with 2 J/kg
D. Synchronized shock with 2 J/kg - ✔ ✔ Synchronized shock
with 0.5 to 1 J/kg
- A 13-year-old patient with asthma just received oxygen and albuterol via a nebulizer. What is the next most appropriate intervention?
A. Administer 0.1 mg/kg of adenosine
B. Obtain a blood sample to evaluate arterial or venous blood gases
C. Reassess breath sounds and clinical status
D. Repeat the albuterol treatment - ✔ ✔ Reassess breath sounds and clinical status
- The respiratory rate of a 1-year-old child with respiratory distress has decreased from 65/min to 30/min. The child is more lethargic and continues to have subcostal retractions. What does this change likely indicate?
A. Respiratory distress is unchanged
B. Progression toward respiratory failure
C. Improved respiratory status
D. Neurologic impairment - ✔ ✔ Progression toward respiratory failure
A. Nebulized albuterol
B. Epinephrine IM
C. Isotonic crystalloid IV
D. Methylprednisolone IV - ✔ ✔ Epinephrine IM
- A mother brings her 7-year-old child to the emergency department. The mother states that the child has had a fever for the past 4 days and has had little to eat or drink during the past 24 hours. Your initial impression reveals a lethargic child with increased respiratory rate and pale color. Heart rate is 160/min, respiratory rate is 38/min, and blood pressure is 86/48 mm Hg. Capillary refill is 4 seconds. Which of the following is the most appropriate intervention for this child?
A. Fluid bolus of 10 mL/kg of isotonic crystalloid
B. Fluid bolus of 20 mL/kg of isotonic crystalloid
C. Maintenance fluid infusion of isotonic crystalloid at 10 mL/h
D. Maintenance fluid infusion of 5% dextrose and water at 20 mL/h - ✔ ✔ Fluid bolus of 20 mL/kg of isotonic crystalloid
- An intubated 5-year-old child who was in a motor vehicle collision becomes increasingly more difficult to ventilate. The child has diminished breath sounds and chest expansion on the right side of the chest, with audible breath sounds and visible chest expansion on the left. The endotracheal tube insertion depth has not changed. What is the most appropriate intervention?
A. Deflate the cuff and pull the tube back
B. Perform needle decompression on the right chest
C. Perform needle decompression on the left chest D. Insert a gastric tube - ✔ ✔ Perform needle decompression on the right
chest
- A 2-year-old child with a 2-day history of a barking cough presents with audible stridor on inspiration, intercostal retractions, and agitation. What is the most appropriate intervention for this child?
A. Lay the child flat on a stretcher
B. Suction the mouth and nose
C. Administer nebulized epinephrine
D. Administer inhaled albuterol - ✔ ✔ Administer nebulized
epinephrine
- Which of the following oxygen saturations indicates the need for additional intervention?
A. 96% on room air
B. 95% on room air
C. 93% on 4 L of oxygen
D. 97% on 50% oxygen - ✔ ✔ 93% on 4 L of oxygen
- A 3-year-old child presents with a 2-day history of nausea and vomiting. She is alert, with no increase in respiratory effort, and is pale in color. The child's heart rate is 160/min, respiratory rate is 40/min, and blood pressure is 100/70 mm Hg. Her extremities are cool, with sluggish capillary refill. Which term best describes this child's physiologic state?
C. Administer dopamine
D. Administer an antibiotic - ✔ ✔ Provide 100% oxygen via a
nonrebreathing mask
- An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's color is pink. What is the most appropriate initial intervention?
A. Obtain a chest radiograph
B. Administer nebulized epinephrine
C. Prepare for a surgical airway
D. Use an epinephrine autoinjector - ✔ ✔ Administer nebulized
epinephrine
- The initial impression of a 4-year-old child reveals a lethargic child who is diaphoretic, with no increased work of breathing and pink color. Her heart rate is 220/min, respiratory rate is 24/min, blood pressure is 84/46 mm Hg, and capillary refill time is 5 seconds. IV access has been established. The rhythm below is seen on the cardiac monitor. What is the most appropriate initial intervention?
A. Give adenosine 0.1 mg/kg rapid IV push
B. Perform carotid sinus massage
C. Perform synchronized cardioversion at 0.5 J/kg D. Attempt
defibrillation at 2 J/kg - ✔ ✔ Give adenosine 0.1 mg/kg rapid IV push
- An 8-month-old infant is being evaluated. The child's mother says the infant has not been feeding well. The infant is alert with
rapid but unlabored breathing, and the infant's color is pale. A cardiac monitor is applied, and the rhythm below is noted. Distal pulses are readily palpable. You give oxygen and establish IV access. What is the most appropriate vagal maneuver?
A. Valsalva maneuver
B. Carotid massage
C. Ocular pressure
D. Ice to the face - ✔ ✔ Ice to the face
- A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be established. What is the most appropriate intervention?
A. Unsynchronized shock with 0.5 to 1 J/kg
B. Synchronized shock with 0.5 to 1 J/kg
C. Unsynchronized shock with 2 J/kg
D. Synchronized shock with 2 J/kg - ✔ ✔ Synchronized shock
with 0.5 to 1 J/kg
- A 3-month-old infant presents with lethargy and a 3-day history of vomiting, diarrhea, and poor feeding. The initial impression reveals lethargy, increased respiratory effort with retractions, and pale, mottled skin color. Vital signs are as follows: heart rate 210/min, respiratory rate 60/min, and blood pressure 60/40 mm Hg. Peripheral pulses are thready, and capillary refill time is 4 seconds. The cardiac monitor displays the rhythm below.
