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PALS PRECOURSE TEST QUESTIONS & ANSWERS
1. Parents of a 1-year-old female phoned EMS when they picked up their
daughter from the babysitter. Paramedics perform an initial impression re- vealing an obtunded infant with irregular breathing, bruises over the ab- domen, abdominal distension, and cyanosis. Assisted bag-mask ventilation with 100% oxygen is initiated. On primary assessment heart rate is 36/min, peripheral pulses cannot be palpated, and central pulses are barely palpable. Cardiac monitor shows sinus bradycardia. Chest compressions are started at 15:2. In the ED the infant is intubated and ventilated, and IV access is established. The heart rate is now up to 150/min, but there are weak central pulses and no distal pulses. Systolic BP is 74. Of the following, which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV: C
2. You enter a room to perform an initial impression of a previously stable 10-
year-old male and find him unresponsive and apneic. A code is called and bag- mask ventilation is performed with 100% oxygen. The cardiac monitor shows a wide-complex tachycardia. The boy has no detectable pulses so compressions and ventilations are provided. As soon as the defibrillator arrives you deliver an unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of CPR reveals VF. You then deliver a shock of 4 J/kg and
resume immediate CPR beginning with compressions. A team member has established IO access, so you give a dose of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second shock. At the next rhythm check, persistent VF is present. You administer another 4 J/kg shock and resume CPR. Based on the PALS Pulseless Arrest Algorithm, what is the next drug and dose to administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO: D
C. Albuterol by nebulization
D. Procainamide 15 mg/kg IV/IO: C
5. You are called to help resuscitate an infant with severe symptomatic
bradycardia associated with respiratory distress. The bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. Which of the following is the first drug you should administer?
A. Dopamine
B. Adenosine
C. Atropine
D. Epinephrine: D
6. An infant with a history of vomiting and diarrhea arrives by ambulance.
During your primary assessment the infant responds only to painful stim- ulation. The upper airway is patent, the repiratory rate is 40/min with good bilateral breath sounds, and 100% oxygen is being administered. The infant has cool extremities, weak pulses, and a cap refill of more than 5 seconds. The infant's BP is 85/65 mm Hg and glucose concentration is 30 mg/dL (1. mmol/L). Which of the following is the most appropriate treatment to provide for this infant?
A. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over
10 to 20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a separate infusion.
B. Establish IV or IO access and administer 20 mL/kg D50 .45% sodium
chloride bolus over 15 minutes.
C. Establish IV or IO access and administer 20 mL/kg Lactated Ringer's
solution over 60 minutes.
D. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg
1:1,000 via the endotracheal tube.: A
7. Which of the following statements about endotracheal drug administration
8. Which of the following statements most accurately reflects the PALS rec-
ommendations for the use of magnesium sulfate in the treatment of cardiac arrest?
A. Routine use of magnesium sulfate is indicated for shock-refractory
monomorphic VT.
B. Magnesium sulfate is indicated for torsades de pointes and VF/ pulseless
VT associated with suspected hypomagnesemia.
C. Magnesium sulfate is indicated for VF refractory to repeated shocks and
amiodarone or lidocaine.
D. Magnesium sulfate is contraindicated in VT associated with an abnormal
QT interval during the preceding sinus rhythm.: B
9. Initial impression of a 2-year-old female reveals her to be alert with mild
breathing difficulty during inspiration and pale skin color. On primary as- sessment, she makes high-pitched inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% in room air, and she has mild inspiratory intercostal retractions. Lung auscultation re- veals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which of the following is the most appropriate initial therapeutic intervention for this child?
A. Administer an IV dose of dexamethasone
B. Perform immediate endotracheal intubation
C. Administer humidified supplementary oxygen as tolerated and continue
evaluation
D. Nebulize 2.5 mg of albuterol: C
10. Which of the following statements about the effects of epinephrine during
attempted resuscitation is true?
A. Epinephrine decreases the peripheral vascular resistance and reduces
myocardial afterload so that ventricular contractions are more effective
B. Epinephrine is contraindicated in ventricular fibrillation because it in-
crown-heel length of the child on a length based, color-coded resuscitation tape to estimate the approximate weight as 15kg. Which of the f therapies is most appropriate for this child at this time?
A. Establish IV/IO access and administer lidocaine 1 mg/kg IV/IO
B. Establish IV/IO access and administer epinephrine 0.01 mg/kg (0.1 mL/kg
of 1:10,000 dilution) IV/IO
C. Attempt defibrillation at 30 J, then resume CPR beginning with compres-
sions.
D. Establish IV/IO access and administer amiodarone 5 mg/kg IV/IO.: C
13. A 3-year-old boy presents with multiple system trauma. The child was an
unrestrained passenger in a motor vehicle crash. On primary assessment he is unresponsive to voice or painful stimulation. His respiratory rate is less than 6/min, heart rate is 170/min, systolic blood pressure is 60 mm Hg, cap refill is 5 seconds, and SpO2 is 75% in room air. Which of the following most accurately summarizes the first interventions you should take to support this child?
A. Establish immediate vascular access, administer 20 mL/kg isotonic crys-
talloid, and reassess the patient; if the child's systemic perfusion does not improve, administer 10 to 20 mL/kg packed red blood cells.
B. Provide 100% oxygen by simple mask and perform a head-to-toe survey to
identify the extent of all injuries; begin an epinephrine infusion and titrate to maintain a systolic blood pressure of at least 76 mm Hg
C. Open the airway (jaw-thrust technique) while stabilizing the cervical spine,
administer positive-pressure ventilation with 100% oxygen, and establish immediate IV/IO access.
D. Provide 100% oxygen by simple mask, stabilize the cervical spine, estab-
lish vascular access, and provide maintenance IV fluids.: C
14. Initial impression of a 10-month-old male in the emergency department
reveals a lethargic pale infant with slow respirations. You begin assisted ventilation with a bag-mask device using 100% oxygen. On primary assess-
1:10,000) IV/IO
D. Administer 20 mL/kg isotonic crystalloid and epinephrine 0.1 mg/kg (0.
mL/kg of 1:10,000) IV/IO: C
15. A 1-year-old male is brought to the emergency department for evaluation
of poor feeding, fussiness, and sweating. On initial impression he is lethargic but arousable and has labored breathing and a dusky color. Primary assess- ment reveals a respiratory rate of 68/min, heart rate 300/min that does not very with activity or sleep, blood pressure 70/45 mm Hg, weak brachial pulses and absent radial pulses, cap refill 6 seconds, SpO2 85% in room air, and good bilateral breath sounds. You administer high-flow oxygen and place the child on a cardiac monitor. You see the above rhythm (SVT) with little beat-to-beat variability of the heart rate. Secondary assessment reveals no history of congenital heart disease. IV access has been established. Which of the following therapies is most appropriate for this infant?
A. Adenosine 0.1 mg/kg IV rapidly; if adenosine is not immediately available,
perform synchronized cardioversion.
B. Make an appointment with a pediatric cardiologist for later in the week.
C. Establish IV access and administer a flid bolus of 20 mL/kg isotonic
crystalloid.
D. Perform immediate defibrillation without waiting for IV access: A
16. You are preparing to use a manual defibrillator and paddles in the pedi-
atric setting. When would it be most appropriate to use the smaller "pedi- atric" sized paddles for shock delivery?
A. If the patient weighs less than approximately 10 kg or is less than 1 year
of age.
B. Whenever you can compress the victim's chest using only the heel of one
hand
C. To attempt synchronized cardioversion but not defibrillation
D. If the patient weighs less than approximately 25 kg, or is less than 8 years
of age.: A
C. Once inserted, the shaft of the needle moves easily in all directions within
the bone.
D. Fluids can be administered freely without local soft tissue swelling.: D
19. You are evaluating an irritable 6-year-old girl with mottled color. On
primary assessment she is febrile ( temperature 104 F) and her extremities are cold (despite a warm ambient temperature in the room) with cap refill of 5 seconds. Distal pulses are absent and central pulses are weak. Heart rate is 180/min, respiratory rate is 45/min, and blood pressure is 98/56. Which of the following most accurately describes the categorization of this chil's condition using the terminology taught in the PALS Provider Course?
A. Hypotensive shock associated with inadequate tissue perfusion.
B. Compensated shock associated with tachycardia and inadequate tissue
perfusion.
C. Hypotensive shock associated with inadequate tissue perfusion and sig-
nificant hypotension.
D. Compensated shock requiring no intervention.: B
20. You are caring for a 3-year-old with vomiting and diarrhea. You have
established IV access. When you place an orogastric tube, the child begins gagging and continues to gag after the tube is placed. The child's color has deteriorated; pulses are palpable but faint and the child is now lethargic. The heart rate is variable (range 44/min to 62/min). You begin bag-mask ventilation with 100% oxygen. When the heart rate does not improve, you begin chest compressions. The cardiac monitor shows the above rhythm (Sinus Bradycardia at 50 bpm). Which of the following would be the most appropriate therapy to consider next.
A. Cardiology consult for transcutaneous pacing.
B. Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000) IV
C. Atropine 0.02 mg/kg IV
B. Administer 100% oxygen by face mask, establish vascular access, and
obtain a STAT chest x-ray.
C. Establish vascular access and administer a 20 mL/kg bolus of isotonic
crystalloid.
D. Open the airway and provide positive-pressure ventilation using 100%
oxygen and a bag-mask device.: D
22. You are transporting a 6-year-old endotracheally intubated patient who is
receiving positive-pressure mechanical ventilation. The child begins to move his head and suddenly becomes cyanotic and bradycardic. SpO2 is 65% with good pulse signal. You remove the child from the mechanical ventilator circuit and provide manual ventilation with a bag via the endotracheal tube. During manual ventilation with 100% oxygen, the child's color and heart rate improve slightly and his blood pressure remains adequate. Breath sounds and chest expansion are present and adequate on the right side, but they are consistently diminished on the left side. The trachea is not deviated, and the neck veins are not distended. A suction catheter passes easily beyond the tip of the endotracheal tube. Which of the following is the most likely cause of this child's acute deterioration?
A. Tracheal tube displacement into the right main bronchus
B. Tension pneumothorax on the right side
C. Tracheal tube obstruction
D. Equipment failure.: A
23. A child becomes unresponsive in the emergency department and is not
breathing. You provide ventilation with 100% oxygen. You are uncertain if a faint pulse is present with the above rhythm (asystole). What is your next action?
A. Order transcutaneous pacing.
B. Start high quality CPR, beginning with compressions.
C. Start an IV and give atropine 0.01 mg/kg IV
