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PALS Updated FINAL EXAM 50 Complete
Question and Correct Solutions.
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? second degree 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 oxygen delivery? Lactate We have an expert-written solution to this problem! A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition? Respiratory failure We have an expert-written solution to this problem! 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?
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Deliver 1 BVM ventilation every 3 to 5 seconds. We have an expert-written solution to this problem! 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? First-degree atrioventricular (AV) block 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)? Hypotension Fever Hyperglycemia 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?
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Supplemental oxygen should be administered as needed to maintain an oxygen saturation above 94%. We have an expert-written solution to this problem! 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 first? Albuterol plus ipratropium bromid We have an expert-written solution to this problem! A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present? Pallor is a circulation finding that may be seen in patients with respiratory distress. We have an expert-written solution to this problem! 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? Nasal flaring, use of accessory muscles to breathe and intercostal, substernal or suprasternal retractions are all indicators of increased work or effort of breathing. Grunting and inspiratory stridor are abnormal breath sounds.
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We have an expert-written solution to this problem! An 11-year-old child develops unstable wide-complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention? First-line treatment for unstable wide-complex tachycardias consists of synchronized electrical cardioversion, particularly when signs of hemodynamic compromise are apparent. We have an expert-written solution to this problem! A 4-month old infant is brought to the emergency department in cardiac arrest. Which condition would the team identify as the most common cause of cardiac arrest in an infant of this age? Sudden infant death syndrome We have an expert-written solution to this problem! 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 is hemodynamically unstable. Which primary assessment findings indicate this? Difficulty breathing Hypotension Mottling Decreased level of consciousnes
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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? bronchiolitis We have an expert-written solution to this problem! 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? torsades We have an expert-written solution to this problem! 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? The primary goal in shock, regardless of cause, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on oxygen delivery and oxygen demand. We have an expert-written solution to this problem!
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The PALS resuscitation team is providing care to an intubated child in cardiac arrest. Which result best determines the adequacy of the team’s chest compressions? End-tidal carbon dioxide level between 15 and 20 mmHg 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? Summary of the event, including what actions were taken, Discussion of the pros and cons of the interventions, Identification of ways to improve, Evaluation of the objective data gathered during the event Assessment of a 7-year-old patient with septic shock 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? Most children in septic shock present with cold shock (i.e., delayed capillary refill, diminished pulses, peripheral vasoconstriction, narrow pulse pressure, and cool, mottled extremities) instead of warm shock. We have an expert-written solution to this problem! Primary assessment of a 10-year-old child reveals septic shock. As part of the secondary assessment, laboratory testing is completed to evaluate the child’s status. Which laboratory tests would be ordered for this child?
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A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals tracheal deviation to the left side, chest pain on inspiration and decreased breath sounds on the right side. The provider suspects obstructive shock caused by what condition? tension pneumothorax A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer? vagal We have an expert-written solution to this problem! 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? initiate defibrillation with 2 J/kg. We have an expert-written solution to this problem! A child who is stable and exhibiting a narrow-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication? Patients may have a brief period of "asystole" following the administration of adenosine. This is normal and typically self-limited.
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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? epi We have an expert-written solution to this problem! 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? tape We have an expert-written solution to this problem! 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? ensure MAP 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?
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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? 100 to 120 compressions per minute at a depth of about 2 inch We have an expert-written solution to this problem! Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient? Maintain the head in midline position with 30-degree elevation We have an expert-written solution to this problem! child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)? Hypotension, Bradycardia, Diminished central pulses We have an expert-written solution to this problem! A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer? Corticosteroids, Racemic epinephrine
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We have an expert-written solution to this problem! After ROSC, a child is experiencing post–cardiac arrest hemodynamic instability. The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload? Isotonic fluid boluses 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? Airway clearance We have an expert-written solution to this problem! A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). During which step of the PAT may the provider use the mnemonic TICLS to assess the patient? appearance We have an expert-written solution to this problem! 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
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Reposition the patient, and insert an oral airway - Correct answer After rectal
administration of diazepam, an 8 year old boy with a history of seizures is no
unresponsive to painful stimuli. His respirations are shallow, at a rate of 10/min. His
Oxygen saturation is 94% on 2L of NC oxygen. On examination, the child is snoring with
poor chest rise and poor air entry bilaterally. What action should you take next?
Provide bag mask ventilation - Correct answer After rectal administration of
diazepam, an 8 year old boy with a history of seizures is no unresponsive to painful
stimuli. His respirations are shallow, at a rate of 10/min. His Oxygen saturation is 94%
on 2L of NC oxygen. On examination, the child is snoring with poor chest rise and poor
air entry bilaterally. After repositioning the patient and you insert an Oral airway, the
patient continues to deteriorate. What next step is the most appropriate?
15:2 - Correct answer A 6 year old child is found unresponsive, not breathing, and
without a pulse. one health care worker leaves to activate the emergency response
system and get the resuscitation equipment. You and another healthcare provider
immediatly begin CPR. Which compression to ventilation ratio do you use?
94%-99% - Correct answer In post resuscitation management after cardiac arrest,
extra care should be taken to avoid repercussion injury. what should the ideal oxygen
saturation range most likely be?
"resume compressions" - Correct answer 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 administration of the shock, what should you say to you team members?
2-4 J/kg - Correct answer 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 dose range should you use for the initial defibrillation?
40 Joules - Correct answer 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 Defib?
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Allowing complete chest wall recoil after each compression - Correct answer You
are the team leader during a pediatric resuscitation attempt. which action is an element
of high quality CPR?
blood pressure - Correct answer 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 HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/
mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His
capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant
weighs 6 Kg. Which assessment finding indicates that the infant is in hypotensive
shock?
hypovolemic shock - Correct answer 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 HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/
mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His
capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant
weighs 6 Kg. On the basis of this infants presentation, which type of shock does this
infant have?
20 ml/kg normal saline - Correct answer 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 HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure
is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100%
oxygen. His capillary refills time is 4-5 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?
It is Hypotensive - Correct answer A 2 week old infant is being evaluated for
irritability and poor feeding. His BP is 55/40 mmHg, and cap refill time is 5 seconds.
Which statement best describes your assessment of this infants BP?
Ask for a new task or role - Correct answer A team member is unable to perform
an assigned task because it is beyond the team members scope of practice. Which
action should the team member take?
crackles - Correct answer Which abnormality helps identify children with acute
respiratory distress caused by lung tissue disease?
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Sinus Bradycardia - Correct answer An unresponsive 9 year old boy was given a
dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40 mmHg,
HR is 45/min, respiratory rate is 6/min, and SpO2 is 60% no room air. He is
unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. Which
rhythm is most consistent with this patients presentation and ECG findings?
Provide bag-mask ventilation with 100% oxygen - Correct answer An
unresponsive 9 year old boy was given a dose of rectal valium by his caretaker for a
prolonged seizure. His BP is 80/40 mmHg, HR is 45/min, respiratory rate is 6/min, and
SpO2 is 60% no room air. He is unresponsive and cyanotic. The cardiac monitor
displays the rhythm shown here. What is your next action?
Heart rate of 88/min - Correct answer A 10 year old child is being evaluated for a
head ache. Which is a normal finding for this 10 year old child?
Alert - Correct answer A 5 year old child is brought to the emergency department
by ambulance after being involved in a MVC. You are using the primary assessment to
evaluate the child. When assessing the Childs neurological status, you note that he has
spontaneous eye opening, is fully oriented, and is able to follow command. How would
you document this Childs AVPU pediatric response scale finding?
Hypoxia - Correct answer A 6 month old infant is being evaluated for bradycardia.
Which is the most likely cause of bradycardia?
oxygen saturation - Correct answer 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
O2 sat is 72% on room air and 89% when on a NRB O2 mask. He has shallow
respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral
crackles. Which assessment finding is consistent with respiratory failure in this child?
an antibiotic - Correct answer 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
O2 sat is 72% on room air and 89% when on a NRB O2 mask. He has shallow
respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral
crackles. Which medication would be most appropriate?
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Give 30 compressions to 2 breaths - Correct answer What ratio for compressions
to breaths should be used for 1 rescuer infant CPR
Decreased level of consciousness - Correct answer An 8 year old child is brought
to the ED by ambulance after being involved in a MVC. Which finding would suggest
that immediate intervention is needed?
upper airway obstruction - Correct answer 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 infants SpO2 is 94% On auscultation, the
lungs are clear bilaterally. Which is the most likely cause of this infants respiratory
distress?
Epinephrine, nebulized - Correct answer 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 infants SpO2 is 94% On auscultation, the
lungs are clear bilaterally. Which medication should you administer first?
Lower airway obstruction - Correct answer Which condition is characterized by a
prolonged excretory phase and wheezing?
"I think the correct dose is 0.01 mg/kg. should I give that dose instead?" - Correct
answer 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?
Distributive Septic Shock - Correct answer 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 Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory
rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your
assessment reveals mild increase in work of breathing and bounding pulses. The child
is receiving 100% Oxygen by NRB mask.--- Laberatory studies document a lactic
acidosis. On the basis of the patients clinical assessment and history. Which type of
shock does this patient most likely have?
blood pressure - Correct answer 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 Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min,
BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild
