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PALS ALL POSSIBLE EXAM
QUESTIONS AND ANSWERS
1. You are caring for a child who was resuscitated after a drowning event. The
child is intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and the central pulses are weak. Intravenous access has been established. The core temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the following should be provided first? Epinephrine IV Transcutaneous pacing Atropine IV Dobutamine IV infusion: Epinephrine IV
2. You are caring for a 5-year-old patient with supraventricular tachycardia
(heart rate = 220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not palpable. Which of the following would be the best treatment to provide without delay? Place cold packs on the distal upper and lower extremities Ask the child to blow through a small straw Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg: Provide synchronized cardioversion at 0.5 to 1 J/kg
3. You are initiating treatment for a child with septic shock and hypotension.
While administering high-flow oxygen you determine that the child's respi- rations are adequate and SpO2 is 100%. You have just established vascular access and obtained blood samples. Which of the following is the next most appropriate therapy to support systemic perfusion? Administer repeated fluid boluses of isotonic colloid Administer repeated fluid boluses of isotonic crystalloid Begin immediate dopamine infusion Begin immediate dobutamine infusion: Administer repeated fluid boluses of isotonic crystalloid
4. You are treating an 8-year-old with ventricular tachycardia with pulses and
adequate perfusion. You attempted synchronized cardioversion without success. While seeking expert consultation, it would be most appropriate to: Administer a loading dose of milrinone
Administer magnesium sulfate IV Intubate and ventilate: Provide bag-mask ventilation
7. Which of the following is likely to be the most helpful technique to iden-
tify potentially reversible metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest? Obtaining a urine sample for toxicology screen Obtaining chest and abdominal radiographs Soliciting a history from the caregiver or family Obtaining a venous blood gas: Soliciting a history from the caregiver or family
8. You are caring for a patient who developed a tension pneumothorax after
several hours of positive-pressure ventilation. Which of the following would be the most appropriate site for needle decompression?
Over the third rib at the midclavicular line Under the eighth rib at the midaxillary line Over the fifth rib at the sternal border Under the sixth rib at the midclavicular line: Over the third rib at the midclavic- ular line
9. You attempted synchronized cardioversion for an infant with supraventric-
ular tachycardia (SVT) and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following should you attempt now? Synchronized cardioversion at a dose of 2 J/kg Synchronized cardioversion at a dose of 4 J/kg Unsynchronized cardioversion at a dose of 2 J/kg Unsynchronized cardioversion at a dose of 4 J/kg: Synchronized cardioversion at a dose of 2 J/kg
10. You are treating a 5-month-old with a 2-day history of vomiting and
diarrhea. The patient is listless. The respiratory rate is 52/min and unlabored. The heart rate is 170/min and pulses are present but weak. Capillary refill is delayed. You are administering high-flow oxygen, and intravenous access is in place. At this point the most important therapy is to: Administer an epinephrine bolus Begin bag-mask ventilation Provide a rapid 20 ml/kg isotonic crystalloid fluid bolus Administer a bolus of 0.5 g/kg of dextrose: Provide a rapid 20 ml/kg isotonic
12. You are treating a 10-year-old patient after a motor vehicle crash. The
patient is unresponsive and flexes his arms at the elbow in response to a painful stimulus. An endotracheal tube is in place with position confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an SPO2 of 95% and good chest excursion bilaterally. The blood pressure is 130/70 mm Hg, and the heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time? Obtain a CT scan of the head and neck Begin manual hyperventilation Provide continuous positive airway pressure Give an intravenous bolus of mannitol: Obtain a CT scan of the head and neck
13. You arrive on the scene of a 12-year-old child who suddenly collapsed on
the playground. The child is unresponsive, apneic, and pulseless and CPR is in progress. A lay rescuer just brought the school AED, turned it on, and attached it. The AED recommends a shock. Which of the following should be done next? Obtain intravenous access Attempt defibrillation Change compressions:ventilations from 30:2 to 15: Attempt endotracheal intubation: Attempt defibrillation
14. You are caring for a child in persistent ventricular fibrillation. Which of
the following would best describe the child's cardiac condition?
The heart is not pumping blood at all The heart is beating too slowly to maintain circulation There is no electrical activity in the heart The heart is pumping so fast that it cannot fill completely between beats: The heart is not pumping blood at all
15. You are called to treat a 5-year-old with a 3-day history of worsening
respiratory distress. The child responds only to pain. The heart rate is ini- tially 45/min and regular with poor capillary refill. You provide bag-mask ventilations (BMV) with high-flow oxygen that produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for
able
18. You are caring for a 7-year-old with respiratory distress that has wors-
ened over the past few hours. The child is alert and in moderate respiratory distress with prolonged exhalation time. The respiratory rate is 28/min with bilateral expiratory wheezes. The heart rate is 112/min with good capillary refill. The wheezing in this patient indicates: Lung tissue (parenchymal) lung disease Disordered control of breathing Upper airway obstruction Lower airway obstruction: Lower airway obstruction
19. Which of the following assessments is most useful in evaluating the
effectiveness of bag-mask ventilations? Hearing an air leak around the mask when the bag is fully compressed
Seeing the abdomen rise during ventilation Observation of visible chest rise A normal systolic, diastolic, and mean arterial pressure: Observation of visible chest rise
20. You are assessing a 6-year-old child who appears unconscious after
striking his head on a concrete step. You pinch the patient's chest and the patient grabs your hand. You would document this response as: Decerebrate posturing Decorticate posturing Withdrawal from a painful stimulus Localization of a painful stimulus: Localization of a painful stimulus
21. You are caring for an 8-year-old child who was struck by a car. The child is
alert, very anxious, and in respiratory distress. The child is receiving high- flow oxygen by face mask, has a respiratory rate of 60/min, the heart rate is 150/min, systolic blood pressure is 70 mm Hg, and a SpO2 of 86% and falling. Breath sounds and chest rise are absent over the right chest. Which of the following is the most likely cause of this child's distress? Tension Pneumothorax Cardiac temponade Severe hypovolemia Cardiac asthma: Tension Pneumothorax
22. You are treating a 10-year-old victim of multisystem trauma. The child is
very anxious and confused. The respiratory rate is 44/min and unlabored. the
Pushing fast - compress at a rate of 150/min Allowing complete recoil - let the chest return to its original position between compressions Minimizing interruptions - do not permit interruptions for more than 1 minute- : Allowing complete recoil - let the chest return to its original position between compressions
24. You are treating an 8-year-old with ventricular tachycardia (VT) with
pulses and adequate perfusion. You attempted synchronized cardioversion without success. While seeking expert consultation, it would be most appro- priate to: Administer a loading dose of milrinone Initiate overdrive pacing transcutaneously Consider possible metabolic and toxicologic causes Deliver an unsynchronized shock: Consider possible metabolic and toxicologic causes
25. You are caring for a patient who developed a tension pneumothorax after
several hours of positive-pressure ventilation. Which of the following would be the most appropriate site for needle decompression? Over the third rib (ie, second intercostal space) at the mid-clavicular line Under the eighth rib at the midaxillary line Over the fifth rib at the sternal border Under the sixth rib at the midclavicular line: Over the third rib (ie, second intercostal space) at the mid-clavicular line
26. You are initiating treatment for a child with septic shock and hypotension.
While administering high-flow oxygen, you determine that the child's respi- rations are adequate and SpO2 is 100%. You have just established vascular access and obtained blood samples. Which of the following is the next most appropriate therapy to support systemic perfusion? Administer repeated fluid boluses of isotonic colloidge Administer repeated fluid boluses of isotonic crystalloid Begin immediate dopamine infusion Begin immediate dobutamine infusion: Administer repeated fluid boluses of isotonic crystalloid
27. You are caring for a 5-year-old patient with supraventricular tachycardia
(SVT) (heart rate is 220/min). The child is lethargic. The skin is pale and
Increasing positive end-expiratory pressure (PEEP): Using a resuscitation bag to provide manual ventilation with 100% oxygen
30. You are caring for a 9-month-old patient with pronounced respiratory
distress. You initiated high-flow oxygen using a nonrebreathing mask about 10 minutes ago and established intravenous access. Initially the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's respiratory rate falls to 6/min with significant intercostal retractions, and little air movement is heard. The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the following treatments would be best for you to provide now? Administer epinephrine IV Provide bag-mask ventilation
Administer magnesium sulfate IV lntubate and ventilate: Provide bag-mask ventilation
31. You are caring for an 8-year-old child who was struck by a car. The child is
alert, very anxious, and in respiratory distress. The child is receiving high- flow oxygen by face mask, has a respiratory rate of 60/min, heart rate of 150/min, systolic blood pressure of 70 mm Hg, and Spot of 86% and falling. Breath sounds and chest rise are absent over the right chest. Which of the following is the most likely cause of this child's distress? Cardiac tamponade Severe hypovolemia Tension pneumothorax Cardiac asthma: Tension pneumothorax
32. Which of the following is likely to be the most helpful technique to iden-
tify potentially reversible metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest? Soliciting a history from the caregiver or family Obtaining a urine sample for toxicology screen Obtaining chest and abdominal radiographs Obtaining a venous blood gas: Soliciting a history from the caregiver or family
33. Which of the following rhythms is shown on this ECG rhythm strip?
Sinus bradycardia Ventricular fibrillation (VF)
Provide assisted ventilations with 100% oxygen and prepare for endotra- cheal intubation Administer epinephrine 0.1 mL/kg of 1:10,000 solution IV: Provide assisted ventilations with 100% oxygen and prepare for endotracheal intubation
35. You are treating a 5-month-old with a 2-day history of vomiting and
diarrhea. The patient is listless. The respiratory rate is 52/min and unlabored. The heart rate is 170/min and pulses are present but weak. Capillary refill is delayed. You are administering high-flow oxygen and intravenous access is in place. At this point the most important therapy is to: Administer an epinephrine bolus Begin bag-mask ventilation Provide a rapid 20 mL/kg isotonic crystalloid fluid bolus Administer a bolus of 0.5 g/kg of dextrose: Provide a rapid 20 mL/kg isotonic crystalloid fluid bolus
36. Which of the following groups of clinical findings would be most consis-
tent with categorizing a patient with compensated shock? Decreased level of consciousness, extensor posturing in response to pain, hypertension, and apnea Normal systolic blood pressure, decreased level of consciousness, cool ex- tremities with delayed capillary refill, and faint or nonpalpable distal pulsesd. Normal blood pressure, normal level of consciousness, bounding distal pulses, hypercarbia, hypoxemia, and normal urine output Unresponsiveness, normal breathing, and good distal pulses: Normal systolic blood pressure, decreased level
of consciousness, cool extremities with delayed capillary refill, and faint or nonpalpable distal pulsesd.
37. You are treating a 10-year-old patient after a motor vehicle crash. The
patient is unresponsive and flexes his arms at the elbow in response to a painful stimulus. An endotracheal tube is in place with position confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an Spot of 95% and good chest excursion bilaterally. Blood pressure is 130/70 mm Hg and heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time? Give an intravenous bolus of mannitol Provide continuous positive airway pressure (CPAP)
