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PALS Updated Final Exam Questions with Verified
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 ar- rhythmia?: 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?: 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?: 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?: 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 arrhyth- mia?: 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 re- sponse to ischemia/reperfusion. The team bases this determination on which finding(s)?: 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 emergency de- partment providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR?: 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
8. A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which
rhythm(s) would this action be appropriate?: VF and pVT are shockable cardiac arrest rhythms.
9. A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and
shock?: Hypotension is not a consistent feature of shock;
10. 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 above what percentage?: Supplemental oxygen should be administered as needed to maintain an oxygen saturation above 94%.
11. 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 first?: Albuterol plus ipratropium bromid
12. A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this
child, which circulation finding might be pre- sent?: Pallor is a circulation finding that may be seen in patients with respiratory distress.
13. A healthcare provider is performing a primary assessment of a child in respiratory distress. The provider
Triangle (PAT), the provider assesses the child's circulation. Which information would be important to consider?: When assessing the adequacy of circulation, consider skin color and visible mucous mem- branes for pallor (or gray/dusky color), cyanosis, mottling or flushing and evidence of any bleeding, including life-threatening bleeding.
20. Assessment of a 3-month-old infant admitted with respiratory distress reveals fever, grunting and a wet,
"junky" cough. The infant's parents said the child had a recent respiratory infection with a fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider most likely suspect as the cause?: bronchiolitis
21. PALS resuscitation team notes the following ECG waveform and the child does not have a pulse. The team
prepares to intervene to address which arrhythmia?: torsades
22. 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?: The primary goal in shock, regardless of cause, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on oxygen delivery and oxygen demand.
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?: 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 session?- : 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 ex- tremities. The emergency response team interprets these findings as indicat- ing which type of septic shock?: Most children in septic shock present 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?: 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 extremities and weak pulses. Assessment also
reveals an enlarged liver and neck vein distension. The provider interprets these assessment findings as suggesting which type of shock?: 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?: 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?: Supraventricular tachycardia
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. The provider suspects obstructive shock caused by what condition?: tension pneumothorax
31. A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial
treatment would the provider administer?: va- gal
32. An unresponsive 7-year-old child with no pulse is brought to the pediatric urgent care center by his parents
and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action would the PALS team take first?- : initiate defibrillation with 2 J/kg.
child, at which location would the lead for V4 be placed?: 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?: 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?: 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)?: Hypoten- sion, Bradycardia, Diminished central pulses
44. A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider
administer?: 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 restore intravascular volume and optimize preload?: Isotonic fluid boluses
46. 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?: Airway clearance
47. A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). During
which step of the PAT may the provider use the mnemonic TICLS to assess the patient?: appearance
48. 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: Monomorphic pulseless ventricular tachycardia
49. A child experiencing unstable bradycardia is receiving CPR. Despite ef- forts with CPR, including assuring
oxygenation and ventilation, the child's status remains unchanged. Which medication would the emergency response team expect to administer next?: 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?: rapid
