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PALS EXAM STUDY QUESTIONS & ANSWERS
1. 10 seconds: A 6 month old infant is unresponsive. You begin checking for
breathing at the same time you check for the infants pulse. Which is the maximum time you should spend when trying to simultaneously check for breathing and palpate the infants pulse before starting CPR?
2. Disordered Control of Breathing: A 4 year old child is brought to the emer-
gency department for seizures. The seizures stopped a few minutes ago, but the child continues to have slow and irregular respirations. Which condition is most consistent with your assessment?
3. blood glucose: An 8 year old child is brought to the emergency department with
a 2 day history of lethargy and polyuria. The child has new onset rapid, deep, and labored breathing. Which diagnostic test should you order first?
4. Reposition the patient, and insert an oral airway: 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?
5. Provide bag mask ventilation: 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?
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6. 15:2: 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?
7. 94%-99%: In post resuscitation management after cardiac arrest, extra care
should be taken to avoid repercussion injury. what should the ideal oxygen sat- uration range most likely be?
8. "resume compressions": 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?
9. 2-4 J/kg: A 4 year old child in cardiac arrest is brought to the em
department by ambulance. High quality CPR is being performed. T
14. 20 ml/kg normal saline: 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?
15. It is Hypotensive: 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?
16. Ask for a new task or role: 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?
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17. crackles: Which abnormality helps identify children with acute respiratory
distress caused by lung tissue disease?
18. cardiac arrest: Which condition in a child would IO access most likely be
attempted before vascular access?
19. Begin CPR for 2 mins before leaving to activate the emergency response
system.: You respond to an infant who is unresponsive, in not breathing, and doe not have a pulse. You shout for nearby help, but no one arrives. What action should you take next?
20. Supraventricular tachycardia: An unresponsive 9 year old boy is pale and
cool to the touch his blood pressure is 70/45 mmHg, heart rate is 190/min and respiratory rate is 12/min. The SpO2 is not detectable Cap refill time An IV is in place. The cardiac monitor displays the rhythm shown here. What rhythm is seen on the patient cardiac monitor?
21. Syncronized cardioversion.: An unresponsive 9 year old boy is pale and cool
to the touch his blood pressure is 70/45 mmHg, heart rate is 190/min and respiratory rate is 12/min. The SpO2 is not detectable Cap refill time An IV is in place. The cardiac monitor displays the rhythm shown here. If initial treatment is unavailable or delayed, which intervention is indicated?
22. inspiratory stridor: You are performing the airway component of the primary
assessment. Which finding would lead you to conclude that the child has an upper airway obstruction?
23. Increased inspiratory effort with retractions: A 3 year old child is having
SpO2 is 60%
28. Provide bag-mask ventilation with 100% oxygen: 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 no room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. What is your next action?
29. Heart rate of 88/min: A 10 year old child is being evaluated for a head ache.
Which is a normal finding for this 10 year old child?
30. Alert: 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?
31. Hypoxia: A 6 month old infant is being evaluated for bradycardia. Which is the
most likely cause of bradycardia?
32. oxygen saturation: 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?
33. an antibiotic: 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?
34. Give 30 compressions to 2 breaths: What ratio for compressions to breaths
should be used for 1 rescuer infant CPR
35. Decreased level of consciousness: 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?
36. upper airway obstruction: 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?
42. 20 ml/kg: 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.--- Which NS bolus is most appropriate for this patient?
43. Antibiotic Administration: 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.--- In edition to oxygen administration
and appropriate fluid resuscitation, which additional early intervention should you provide to the patient?
44. respiratory failure: A 3 year old boy is brought to the ED by his mother. His is
lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk cap refill. To which immediate life treating condition could this Childs condition most likely progress if left untreated?
45. Audible inspiratory stridor: A 6 year old boy is being evaluated for difficulty
breathing. Which finding would suggest this child has respiratory distress?
46. upper airway obstruction: An 8 year old child is brought to the ED by his
mother for difficulty breathing. He has a history of asthma and nut allergies. He's mother tells you that he recently ate a cookie at a family picnic. Which condition is most likely to be present in this child?
47. 88% on 4L of Nasal oxygen: A 10 year old child is brought to the ED for fever
and cough. You obtain an O2 sat on the child. Which oxygen saturation would indicate that immediate intervention is needed?
48. The child has signs of probable respiratory failure: You are evaluating a 1
yer old child for respiratory distress. His HR 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, which is the most likely reason for this change in the Childs condition.
49. Administer 20 ml/kg of isotonic crystalloid over 5 to 10 mins: 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.
