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PALS UPDATED FINAL EXAM
QUESTIONS & ANSWERS
1. 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? ANS second degree
2. 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? ANS Lactate
3. A 9-year-old patient is presenting with decreased 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
4. 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 3 to 5 seconds.
5. 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
6. 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
7. 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 emer- gency department providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR? ANS Allowing the chest to recoil fully after each compression Providing ventilations that last about 1 second each Compressing the chest about 2 inches Giving 2 ventilations to every 15 compressions
when which findings are observed? ANS 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.
14. An 11-year-old child develops unstable wide-complex tachycardia. As-
sessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which inter- vention? ANS First-line treatment for unstable wide-complex tachycardias consists of synchronized electrical cardioversion, particularly when signs of hemodynamic compromise are apparent.
15. 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? ANS Sudden infant death syndrome
16. A 9-year-old child is brought to the emergency department because
the child suddenly collapsed at school. The child's ECG reveals the fol-
lowing waveform, and primary assessment findings indicate that the child is hemodynamically unstable. Which primary assessment findings indicate this? ANS Difficulty breathing Hypotension Mottling Decreased level of consciousnes
17. 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 stridor. Which common cause of partial upper airway obstruction in children would the provider most likely suspect? ANS croup
18. 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
19. 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 When assessing the adequacy of circulation, consider skin color and visible mucous membranes for pallor (or gray/dusky color), cyanosis, mottling or flushing and evidence of any bleeding, including life-threatening bleeding.
23. 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? ANS End-tidal carbon dioxide level between 15 and 20 mmHg
24. 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 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
25. 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? ANS Most children in septic shock pre- sent with cold shock (i.e., delayed capillary refill, diminished pulses, peripheral vasoconstriction, narrow pulse pressure, and cool, mottled extremities) instead of warm shock.
26. 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? ANS Labo- ratory testing for the child in septic shock may include CBC, blood cultures, blood gasses, coagulation panel, renal function tests, liver function panel and lactate level.
27. 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 cardio
28. A 10-year-old child has collapsed in the gym of the elementary school.
The school nurse arrives and determines that the child is unresponsive. The school nurse then simultaneously checks for breathing and a central pulse, limiting this assessment to which time frame? ANS 5 seconds, but no more than 10.
29. 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
30. 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.
action would be appropriate for the team to take? ANS tape
36. 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? ANS ensure MAP
37. 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? ANS sinus tahy
38. A child requires cardiac monitoring. A three-electrode system is being
used. At which location would the provider place the red electrode? ANS On the lower left abdomen
39. An advanced airway was placed in a 5-year-old child. Which action(s)
would be most appropriate for the team to take to confirm correct place-
ment? ANS Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography.
40. A 12-lead ECG is ordered for a child complaining of a "racing heart." When
placing the electrodes on the child, at which location would the lead for V4 be placed? ANS fifth intercostal space at the midclavicular line on the patient's left side.
41. 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 inch
42. Which action would the PALS team initiate to manage increased intracra-
nial pressure in a pediatric patient? ANS Maintain the head in midline position with 30-degree elevation
43. child is experiencing shock. The emergency response team prepares for
imminent cardiac arrest when assessment reveals which finding(s)? ANS Hy- potension, Bradycardia, Diminished central pulses
44. A 30-month old child has been diagnosed with moderate croup. Which
medication(s) would the provider administer? ANS Corticosteroids, Racemic epi- nephrine
45. After ROSC, a child is experiencing post-cardiac arrest hemodynamic
instability. The PALS resuscitation team would administer which element to
status remains unchanged. Which medication would the emergency re- sponse team expect to administer next? ANS epi
50. A 4-year-old child suddenly collapses in the playroom of the facility. A
healthcare provider observes the event and hurries over to assess the child. The healthcare provider completes which assessment first? ANS rapid
