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AHA PALS EXAM 2024 ACTUAL EXAM TEST BANK 230
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+||NEWEST VERSION
How long should assessing for breathing and a pulse take? A) no longer than 20 seconds B) no longer than 10 seconds C) no longer than 15 seconds D) no longer than 5 seconds - answer-B) no longer than 10 seconds What should you do to check for breathing? A) look for chest rise and fall B) place your hand on the chest C) look at the nose to check for nasal flaring D) listen for lung sounds - answer-A) look for chest rise and fall Where do you check a pulse on an infant and child? - answer-Infant: brachial Child: femoral or carotid If the child does not have normal breathing and a pulse of 64 bpm is present, you will need to: A) begin CPR B) monitor C) provide rescue breathing - answer-C) provide rescue breathing For an unwitnessed cardiac arrest, what should you do after determining unresponsiveness and there is no breathing and no pulse? A) shout for help B) perform high quality CPR for 2 minutes C) provide rescue breaths
D) activate the emergency response system - answer-B) perform high quality CPR for 2 minutes The appropriate rate for compressions for children is 100-120/min. What is the correct depth for children? A) approximately 2 inches (one third the AP diameter) B) approximately 3 inches (one half AP diameter) C) approximately 4 inches (two thirds AP diameter) - answer-A) approximately 2 inches (one third the AP diameter) What is the compression to ventilation ratio for 1- and 2-rescuer CPR for children and infants? A) 15:2 for both B) 30:2 for both C) single rescuer 15:2, 2 rescuers 30: D) single rescuer 30:2, 2 rescuers 15:2 - answer-D) single rescuer 30:2, 2 rescuers 15: How should 1-rescuer infant compressions be delivered? A) with 2 fingers or 2 thumbs B) with 1 finger or 2 thumbs C) with 2 hands or 2 fingers D) with 1 hand or 2 fingers - answer-A) with 2 fingers or 2 thumbs What is the preferred technique for infant compressions when there are 2 or more rescuers present? A) 1 finger technique B) 1 thumb encircling hands technique C) 2 thumb encircling hands technique D) 2 finger technique - answer-C) 2 thumb encircling hands technique If the AED indicates no shock advised, what should be the next action? A) start chest compressions
What does a prolonged capillary refill time indicate? A) low cardiac rate B) increased stroke volume C) increased cardiac output D) low cardiac output - answer-D) low cardiac output What pulses should be assessed to monitor systemic perfusion in a child? A) carotid and brachial B) pedal and radial C) peripheral and central D) femoral and carotid - answer-C) peripheral and central What do weak central pulses indicate a need for immediate intervention to prevent? A) hypovolemia B) sepsis C) respiratory arrest D) cardiac arrest - answer-D) cardiac arrest Which resuscitation strategy will result in an improved chest compression fraction? A) hovering over the chest during compression pauses B) switching compressors every 2 minutes C) implementing physiologic monitoring devices D) adhering to recommended drug dosing intervals - answer-A) hovering over the chest during compression pauses What is one way to increase chest compression fraction during a code? A) switching the airway and compressor roles during CPR B) starting an IV/IO during rhythm analysis C) charging the defibrillator 15 seconds before a rhythm check
D) giving epinephrine during a rhythm analysis - answer-C) charging the defibrillator 15 seconds before a rhythm check What is chest compression fraction? A) proportion of time that compression are not performed B) proportion of time that compressions are performed C) proportion of time that recoil is adequate in compressions D) proportion of time that depth is adequate in compressions - answer-B) proportion of time that compressions are performed Children develop hypoxemia and tissue hypoxia more quickly than adults because of their: A) lower respiratory rate B) higher HGB C) higher metabolic rate D) lower oxygen demand - answer-C) higher metabolic rate Which of the following describes laminar or normal airflow? A) low airway resistance and a small driving pressure B) smaller airways need increased airways resistance C) larger airways need increased airway resistance D) high airway resistance and low driving pressure - answer-A) low airway resistance and a small driving pressure Which of the following is true about airway resistance? A) the smaller the airway, the lower the airway resistance B) impedance to airflow is decreased when the airways constrict C) airway resistance decreases as lung volume remains unchanged D) when airway resistance increases, work of breathing increases - answer-D) when airway resistance increases, work of breathing increases
C) laminar airflow D) breath holding - answer-D) breath holding What does the EC clamp technique include? A) using the thumb and index finger of the same hand to hold the face mask B) pressing on the soft tissue under the chin to lift the jaw C) using the third, fourth, and fifth fingers of one hand along the jaw to lift it forward D) using the second and third fingers of one hand to hold the face mask - answer-A and C What should you do to help reduce the risk of hypoxemia during suctioning? A) never interrupt suctioning B) suction the back of the oropharynx C) withdraw the catheter in a twisting motion D) limit suction attempts to 10 seconds or less - answer-D) limit suction attempts to 10 seconds or less What can happen if the OPA is too large? A) it can push the tongue to the back of the throat B) it can block the airway C) it may cause vomiting D) it will open the airway - answer-B) it can block the airway Which are appropriate interventions for an apneic child? A) provide a breath every 2-3 seconds B) provide a breath every 2 seconds C) provide a breath every 3-5 seconds D) watch for chest rise - answer-A and D Which of the following should be included in rescue breathing for an infant? A) provide a breath every 6 seconds
B) check for a pulse every 5 minutes C) start chest compressions D) use oxygen as soon as it is available - answer-D) use oxygen as soon as it is available What should you do before suctioning a child who has an upper airway obstruction? A) give nebulized epinephrine B) give corticosteroids C) determine the underlying cause of the obstruction D) determine if there is blood or debris in the airway - answer-C) determine the underlying cause of the obstruction In a less severe case of upper airway obstruction in a child, what can relieve obstruction caused by the tongue? A) suction B) decide if a surgical airway is needed C) insert an oral airway D) minimize agitation - answer-C) insert an oral airway Where may padding be required under when properly positioning a child older than 2 years of age to maintain a patent airway? A) the shoulders B) the occiput C) the upper torso D) padding is not required for children older than 2 years of age - answer-B) the occiput A responsive infant presents with severe foreign body airway obstruction. What is the appropriate management? A) perform abdominal thrusts B) lay the infant on a hard surface and begin CPR C) perform a blind finger sweep
How do infants initially respond to lower airway obstruction? A) increased tidal volumes B) increased respiratory rate C) decreased respiratory rate D) decreased intrapleural pressure - answer-D) decreased intrapleural pressure BVM ventilation has been used on a child with a lower airway obstruction. Which complications may occur? A) increased venous return to the heart B) decreased blood supply to the heart C) risk of lung collapse D) increased oxygenation - answer-B and C Which of the following are typical signs of lung tissue disease? A) bradypnea and hypercarbia B) tachypnea and hypoxemia C) normal respiratory rate and hypoxemia D) tachypnea and hypercarbia - answer-B) tachypnea and hypoxemia How would you estimate the size of a cuffed or uncuffed ET tube to use for a patient that is 7 kg and 6 months old? - answer-cuffed: (age in years)/4 + 3. uncuffed: (age in years)/4 + 4 How does the clinical presentation of distributive shock compare to hypovolemic shock? A) distributive shock has completely different presenting characteristics than those of hypovolemic shock B) distributive shock presents with bradycardia while hypovolemic shock presents with tachycardia C) distributive shock has a more variable presentation than that of hypovolemic shock
D) distributive shock always presents the same as hypovolemic shock - answer-C) distributive shock has a more variable presentation than that of hypovolemic shock When is distributive shock present? A) when there is excessive blood flow to all tissue beds B) when there is adequate blood flow to some tissue beds but too much to others C) when there is inadequate blood flow to all tissue beds D) when there is inadequate blood flow to some tissue beds but too much to others - answer-D) when there is inadequate blood flow to some tissue beds but too much to others What is the focus of the initial management of distributive shock? A) filling expanded dilated vascular space B) stopping additional fluid loss C) decreasing extravascular volume D) expanding intravascular volume E) correcting hypovolemia - answer-A, D, E You are dispatched to the home of a 7 y/o male who presents with a 1-day history of runny nose and progressive lethargy and fever. He has a decreased LOC and a rash on his trunk and legs. He is hot to the touch. The first responders report that the scene is safe. The patient's vital signs are HR 178 bpm, BP 61/38, RR 32/min, SpO2 95%, and temperature 102.9 degrees. When you arrive at the house, the patient is sitting on the couch in the living room. Given the status of the patient, what immediate steps should you take to stabilize him? A) insert an OPA B) monitor and support ABCs C) establish IV/IO access D) monitor HR, BP, and SpO E) obtain chest XR - answer- You establish an IV in your 7 y/o patient with septic shock. What is the next most appropriate intervention? A) administer fluid bolus
D) norepinephrine - answer-B and C Why is it important to immediately identify obstructive shock? A) obstructive shock can rapidly progress to cardiopulmonary failure and cardiac arrest B) obstructive shock requires a slower fluid bolus rate C) treatment within the first hour is crucial to prevent deterioration D) fluid resuscitation is more beneficial if administered immediately - answer-A) obstructive shock can rapidly progress to cardiopulmonary failure and cardiac arrest What is the main objective of managing obstructive shock? A) assess for fluid-refractory hypotension B) restore tissue perfusion C) correct the cause of cardiac output obstruction D) monitor and evaluate basic life support - answer-B and C What circulation findings are specific to pericardial tamponade? A) muffled or diminished heart sounds B) poor peripheral perfusion C) narrowed pulse pressures D) tachycardia - answer-A, C, D Why do children with cardiac tamponade improve temporarily with fluid administration? A) late-phase symptoms are delayed with fluid administration B) fluids will decrease cardiac output and improve hemodynamic status C) poor myocardial contractility is improved and pulmonary edema is minimized with fluid administration D) fluids augment cardiac and tissue perfusion until pericardial drainage is performed - answer-D) fluids augment cardiac and tissue perfusion until pericardial drainage is performed
In the setting of actual or impending pulseless arrest when there is strong suspicion of pericardial tamponade, what is the appropriate management? A) PRBCs B) emergency pericardiocentesis C) fluid bolus of 20 mL/kg over 5-20 mins D) consultation with an appropriate specialist - answer-B) emergency pericardiocentesis What findings help distinguish PE from hypovolemic shock? A) tachycardia and hypotension B) respiratory distress with increased respiratory rate and effort C) extremities may be cool and mottled D) systemic venous congestion and right heart failure - answer-D) systemic venous congestion and right heart failure What is the definitive treatment for most children with PE who are not in shock? A) anticoagulants B) vasodilators C) inotropic agents D) glycoprotein IIb/IIIa inhibitors - answer-A) anticoagulants In children with severe cardiovascular compromise from PE, what treatment should be considered? A) glycoprotein IIb/IIIa inhibitors B) platelet aggregation inhibitors C) fibrinolytic agents D) low-molecular-weight heparin - answer-C) fibrinolytic agents You are dispatched to the local elementary school for a 7 yo girl who says she is having chest pain and difficulty breathing. During recess about 3 hours earlier, she fell from a swing and reported right-sided rib pain. When you arrive on scene, you find the child in the nurse's office. The child is awake, responsive, and anxious. Her initial vital signs are HR 168 bpm, BP 61/43, RR 44/min, and SpO2 66%. What is the initial treatment priority for this patient?
A) administer nebulized albuterol B) administer 20 mL/kg NS or LR bolus C) obtain a CXR D) perform a thoracostomy for chest tube placement - answer-D) perform a thoracostomy for chest tube placement After a chest tube is inserted, the patient's breathing and oxygenation are improved. Her vital signs are HR 98 bpm, BP 108/72, RR 18/min and normal, and SpO2 98%. How should proper chest tube placement be confirmed? A) obtain a CXR B) ask the patient to breathe deeply C) auscultate lung sounds D) use waveform capnography - answer-A) obtain a CXR Whenever a child has an abnormal heart rate or rhythm, what must be done quickly? A) transport the child to the ED or pediatric ICU B) seek expert consultation C) contact family and collaboratively develop a plan for medical management D) determine if the arrhythmia is causing hemodynamic instability or other signs of deterioration - answer-D) determine if the arrhythmia is causing hemodynamic instability or other signs of deterioration What is the priority in initially managing arrhythmias? A) obtain a SAMPLE history B) evaluate the potential reversible causes (Hs and Ts) C) support the ABCs D) identify the underlying cause before initiating interventions - answer-C) support the ABCs What is the leading cause of symptomatic bradycardia in children? A) poor cardiac function
B) congenital abnormality C) myocarditis D) tissue hypoxia - answer-D) tissue hypoxia What causes primary bradycardia? A) medications B) congenital or acquired heart conditions C) increased cardiac output D) non-cardiac conditions that later the normal function of tue heart - answer-B) congenital or acquired heart conditions What are the causes of secondary bradycardia? A) hypothermia B) hypotension C) myocarditis D) hypoxia E) cardiomyopathy F) drugs G) acidosis - answer-A, B, D, F, G What are the electrocardiographic characteristics of bradycardia? A) P waves always visible B) HR slow compared with normal HR for age C) prolonged PR interval D) P wave and QRS may be unrelated E) QRS complex may be narrow or wide - answer-B, D, and E In which patients would bradycardia be an expected finding and not be considered problematic? A) a healthy child who is sleeping
D) provide BVM ventilation with 100% oxygen - answer-B) begin CPR What is the initial dose of epinephrine in the treatment of symptomatic bradycardia? A) 0.01 mg/kg endotracheal B) 1 mg/kg endotracheal C) 1 mg/kg IO D) 0.01 mg/kg IV/IO - answer-D) 0.01 mg/kg IV/IO In what conditions is atropine preferred over epinephrine as the first-choice treatment of symptomatic bradycardia? A) AV block due to a primary bradycardia B) atropine is not recommended as a first-choice treatment in any pediatric bradycardia C) increased vagal tone D) persistent bradycardia despite effective oxygenation and ventilation E) cholinergic drug toxicity (organophosphates) - answer-A, C, E What is the IV/IO dose of atropine for pediatric bradycardia? A) 0.5 mg B) 1 mg C) 0.02 mg/kg D) 0.04 mg/kd - answer-C) 0.02 mg/kg You are dispatched to respond to a 4 month old boy with difficulty breathing. You arrive at the home and see the baby in his mother's arms. He is pale and has mottled skin. His mother says he is very lethargic and has cold hands and feet. What should your next steps be? A) apply cardiac monitor to identify rhythm and monitor pulse, BP, and oximetry B) establish IV/IO access C) complete the initial and primary assessment D) obtain 12-lead ECG E) maintain a patent airway
F) begin CPR - answer-A, C, and E During the initial assessment, you find that an infant is unresponsive and has HR of less than 60/min. What should be your next action? A) stimulate the infant B) begin rescue breathing C) obtain BGL D) begin CPR - answer-D) begin CPR After 2 more minutes of CPR, you notice that the patient is moving, and his skin color improves. His vitals are HR 114/min, BP 63/47, SpO2 88%, spontaneous RR 8/min, and temperature 100.2 degrees. The infant is still slow to respond but is moving. What would be the next steps for this patient? A) obtain expert consultation B) continue oxygen C) administer atropine D) consider transthoracic pacing E) identify and treat underlying causes F) support ABCs - answer-A, B, E, F What is the proper dosing for epinephrine IV/IO administration during CPR? - answer-0.01 mg/kg IV/IO (0.1 mL/kg of 0.1 mg/mL concentration), repeated every 3-5 minutes What clinical findings may be present in a child with a tachyarrhythmia? A) palpitations B) lightheadedness C) pyrexia D) hypertension E) syncope - answer-A, B, and E How is tachycardia defined in pediatric patients?
