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PALS RED CROSS FINAL EXAM
QUESTIONS & ANSWERS
1. 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? ANS Airway clearance (e.g., suctioning)
2. A child being cared for in the pediatric telemetry unit suddenly displays
the following ECG waveform. The provider prepares to intervene because the child is demonstrating which type of arrhythmia? ANS Supraventricular tachycar- dia
3. 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)? ANS Hypotension, fever, hyperglycemia
4. 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 immediately? ANS Albuterol with or without ipratropium bromide
5. After ROSC, a child is experiencing post-cardiac arrest hypoperfusion.
The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload? ANS Isotonic fluid boluses
6. A 2-year-old child of unknown weight arrives at the emergency depart-
ment in cardiac arrest. When preparing to administer medications, which action would be appropriate for the team to take? ANS Estimate weight using a length-based resuscitation tape.
7. 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? ANS Deliver 1 BVM ventilation every 2 to 3 seconds.
8. The PALS team leader is conducting a debriefing session with the team.
Which topic(s) would the team leader most likely address during the ses- sion? ANS Discussion of the pros and cons of the interventions Evaluation of the objective data gathered during the event, Summary of the event, including what actions were taken, Identification of ways to improve
veals capillary refill of 3 seconds, diminished pulses, narrow pulse pres- sure and cool, mottled extremities. The emergency response team interprets these findings as indicating which type of septic shock? ANS Fluid-refractory
15. A 30-month old child has been diagnosed with moderate croup. Which
medication(s) would the provider administer? ANS Nebulized epinephrine, Corti- costeroids
16. A child exhibiting a narrow-complex tachycardia with adequate perfusion
is to receive adenosine. The provider would be alert for which result after administering this medication? ANS Transient asystole
17. A child experiencing bradycardia with inadequate perfusion despite sup-
porting oxygenation and ventilation is receiving compressions. Despite these efforts, the child's status remains unchanged. Which medication would the emergency response team expect to administer next? ANS Epinephrine
18. 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? ANS Monomorphic pulseless ventricular tachycardia
19. 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? ANS First-degree atrioventricular (AV) block
20. 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? ANS Nasal flaring Intercostal, substernal or suprasternal retractions Accessory muscle use
21. A 4-year-old patient presents with tachycardia, tachypnea, cold extremi-
ties and weak pulses. Assessment also reveals an enlarged liver and neck vein distension. The provider interprets these assessment findings as sug- gesting which type of shock? ANS Cardiogenic
22. A 6-year-old child is brought to the emergency department. The child has
been experiencing extremely watery stools over the past several days. After completing the assessment, the healthcare provider suspects that the child may be experiencing shock. Which type of shock would the provider most likely suspect? ANS Hypovolemic
23. A child is experiencing shock. The emergency response team prepares for
imminent cardiac arrest when assessment reveals which finding(s)?
inches Providing ventilations that last about 1 second each Giving 2 ventilations to every 15 compressions Allowing the chest to recoil fully after each compression
27. 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? ANS Oxygen delivery and oxygen demand
28. A 9-year-old patient is presenting with diminished breath sounds, brady-
cardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition? ANS Respiratory failure
29. An 11-year-old child develops ventricular tachycardia with a pulse with
inadequate perfusion. The PALS team would prepare the child for which intervention? ANS Synchronized electrical cardioversion
30. A PALS resuscitation team is preparing to defibrillate a child experienc-
ing cardiac arrest. For which rhythm(s) would this action be appropriate? ANS - pVT, VF
31. 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 perfusion and oxygen delivery?-
ANS Lactate
32. 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, after as- suring adequate oxygenation and ventilation? ANS Ensure adequate mean arterial pressure.
33. A provider is forming an initial impression of a child using the Pediatric
Assessment Triangle (PAT). For which part of the PAT may the provider use the mnemonic TICLS to assess the patient? ANS Appearance
34. A 2-year-old child is brought to the pediatric urgent care clinic by the
parent who says that the child has had a barking cough for two days. During the rapid assessment of the child, the provider hears audible inspiratory
displays the following ECG waveform. The team interprets this as which arrhythmia? ANS Second-degree atrioventricular (AV) block, type I
40. While performing a rapid assessment and formulating an initial impres-
sion using the Pediatric Assessment Triangle (PAT), the provider assesses the child's circulation. Which information would be important to consider?- ANS Flushing of the skin Evidence of bleeding Skin pallor (or gray/dusky color)
41. The PALS resuscitation team is providing care to an intubated child in
cardiac arrest. Which of the following can be used to monitor the adequacy of the team's chest compressions? ANS End-tidal carbon dioxide levels Presence of an arterial waveform or arterial blood pressure in patients with in- dwelling arterial catheters
42. An 8-year-old child being treated in the emergency department has signif-
icant respiratory distress. The child also exhibits hives, wheezing, angioede- ma, 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? ANS Epinephrine
43. A provider is assessing a child with suspected shock. Which statement
correctly describes hypotension and shock? ANS Hypotension is not a consistent feature of shock presentation in children.
44. A provider is caring for a 4-year-old child in the urgent care clinic. Primary
assessment reveals difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child's oxygen saturation to what percentage range? ANS 94% to 99%
45. What is considered inadequate perfusion when assessing/caring for a
pediatric patient with an arrhythmia? ANS Diminished peripheral pulses Acutely altered mental status Hypotension
46. 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? ANS 100 to 120 compressions per minute at a depth of about 2 inches
ment? ANS Auscultate over the lungs and epigastrium for air movement. Observe for bilateral chest rise. Evaluate results of capnography.
50. Which action would the PALS team initiate to manage increased intracra-
nial pressure in a pediatric patient? ANS Maintain the head in midline position.
