AHA Pediatric Advanced Life Support 2023 Exam / PALS 2023 Exam (answered)

The PALS systemic approach algorithm begins with the initial impression. This is an assessment of which 3 characteristics?

1. Consciousness
2. Breathing
3. Color

The right branch of the systemic approach algorithm focuses on what sequence to prevent cardiopulmonary arrest?
Evaluate, Identify, Intervene

The evaluate portion of the sequence consists of three assessment tools:

1. Primary
2. Secondary
3. Diagnostic

What is included in the primary assessment of a patient?
A
B
C
D
E
Vitals

What is included in the secondary assessment of a patient?
Focused history and a focused physical exam

The initial impression of the PALS systematic approach algorithm includes which of the following characteristics? (Choose all correct answers.)

1. Appearance
2. Breathing
3. Restlessness
4. Color
5. Pain
   1, 2, 4

The second box of the PALS systematic approach algorithm contains a question. (Fill in the blank to complete the question.)
Is the child __ or is immediate intervention needed?
unresponsive

In the PALS systematic approach algorithm, if the child is determined to be unresponsive or immediate intervention is needed what will be your next step?

1. Start CPR
2. Apply breathing with a bag valve mask
3. Activate emergency response
4. Check for a pulse
   3.

After the emergency response is activated, the next intervention is to __.

1. Lightly shake the child’s shoulders.
2. Look, listen, and feel.
3. Open the airway.
4. Check for breathing and a pulse
   4.

After it is determined that the child has no pulse, what should be done?

1. Call for help
2. Begin CPR
3. Provide 2 rescue breaths
4. Start an IV
   2.

A child is unresponsive and is not breathing. You have activated the emergency response system and your pulse check reveals that the child has a pulse. What should you do now?

1. Perform a brief head to toe assessment.
2. Place the child in the recovery position.
3. Give epinephrine 1mg IV push
4. Open the airway and provide ventilations and oxygen.
   4.

A child is unresponsive and is not breathing. Emergency response was activated and now a pulse check shows that the child does have a pulse. You then open the airway, provide age-appropriate ventilations, and 100% oxygen with a bag valve mask. The child’s pulse is < 60/min, and the child has signs of poor perfusion. What is your next intervention?

1. Begin CPR
2. Provide a 500ml NS bolus
3. Perform an ABG.
4. Intubate the patient.
   1.

The right branch of the PALS systematic approach algorithm is a sequence of three actions. In the proper sequence, the three actions are: (Fill in the blanks)
_, _, __
evaluate, identify, intervene

The evaluate portion of the evaluate-identify-intervene sequence consists of what clinical assessment tools? (Choose all correct answers)

1. Diagnostic tests
2. Pain assessment
3. Secondary assessment
4. Primary assessment
   1, 3, 4

(True or False) The sequence of evaluate-identify-intervene should be used before and after each intervention and should continue until the child is stable.

1. True
2. False
   1.

A consistent respiratory rate less than 10 or more than _ breaths per minute in a child of any age is abnormal and suggests the presence of a potentially serious problem.

1. 40
2. 50
3. 60
4. 70
   3.

The primary objective of the Airway assessment in the ABCDE model is to assess airway _.

1. effort of breathing
2. rate of breathing
3. disease
4. patency
   4.

Within the EVALUATE portion of the evaluate-identify-intervene sequence, The primary assessment uses the ABCDE model for a hands-on evaluation of the critically ill child. What does ABCDE stand for? (Fill in the blanks)
A

B

C

D

E
Airway
Breathing
Circulation
Disability
Exposure

Simple measures for maintaining airway patency include all of the following EXCEPT which intervention?

1. Continuous positive airway pressure
2. Head tilt chin lift
3. Jaw thrust
4. Nasopharyngeal airway
   1.

Assessment of Breathing includes evaluation of:

1. Respiratory rate and effort
2. Chest expansion in air movement
3. Lung and airway sounds
4. O2 saturation
5. All of the above
   5.

Tachypnea can have both respiratory and non-respiratory causes. Select all of the non-respiratory cause of tachypnea.

1. Croup
2. Pneumonia
3. Bronchiolitis
4. High Fever
5. Asthma
6. Severe pain
7. Anemia
   4, 6, 7

(True or False) Stridor is a sign of lower airway problem.

1. True
2. False
   2.

(True or False) Grunting is often a sign of lung tissue disease resulting from small airway collapse, alveolar collapse or both.

1. True
2. False
   1.

Match each lung and airway sound with the appropriate definition. (drag and drop)
A. Coarse, usually higher pitched breathing sound typically heard on inspiration
B. High-pitched or low-pitched whistling or sighing sound heard most often during expiration
C. Bubbling sound heard during inspiration or expiration
D. Short, low pitched breathing sound heard during expiration
E. Also known as rales and typically associated with pneumonia
A. Stridor
B. Wheezing
C. Gurgling
D. Grunting
E. Crackles

An oxygen saturation of ≥ _% while a child is breathing room air usually indicates that oxygenation is adequate.

1. 90%
2. 92%
3. 94%
4. 98%
   3.

Heart rate and rhythm, pulses, capillary refill time, skin color and temperature, and blood pressure are all direct indicators of circulatory status. Which of the following are indirect indicators of circulatory status? (Choose all correct answers)

1. Urine output
2. Oxygen saturation
3. Level of consciousness
4. Respiratory rate
   1, 3.

What is the most common cause of bradycardia in children?

1. Sepsis
2. Drug overdose
3. Hypoxia
4. Complete heart block
   3.

(True or False) Tachycardia is a normal physiologic response in the critically ill child?

1. True
2. False
   1.

An observed decrease in systolic blood pressure of __ mm Hg from baseline should prompt serial evaluations for additional signs of shock.

1. 5 mm Hg
2. 10 mm Hg
3. 15 mm Hg
4. 20 mm Hg
   2.

In healthy children, the heart rate may fluctuate with the respiratory cycle.
The heart rate _ with inspiration and _ with expiration. (fill in each blank with a single word)
increases, decreases

(True or False) When assessing circulation, it is only necessary to assess the central pulses.

1. True
2. False
   2.

What is a common cause of vasoconstriction and can result in a discrepancy between the peripheral and central pulses in children? (Choose all correct answers)

1. hot environment
2. cold environment
3. environmental stress
4. tachyarrhythmias
   2.

Normal capillary refill time in children is _.

1. ≤ 5 seconds
2. ≤ 3 seconds
3. < 2 seconds
4. ≤ 2 seconds
   4.

Skin color can be an indication of tissue perfusion. Match the skin characteristics with the correct definitions.
A. Irregular or patchy discoloration of the skin which may be caused hypoxemia, hypovolemia, or shock.
B. Paleness, lack of normal color in the skin or mucous membrane.
C. Blue discoloration of the skin and mucous membranes
D. Bluish discoloration of the hands and feet commonly seen during the newborn period.
E. Bluish discoloration of the hands and feet seen beyond the newborn period.
A. Pallor
B. Mottling
C. Cyanosis
D. Acrocyanosis
E. Peripheral Cyanosis

(True or False) A low hemoglobin (anemia) may make it harder to detect in cyanosis in a critically ill child.

1. True
2. False
   1.

The D(disability) of the primary assessment is a quick evaluation of ____.

1. ability to ambulate
2. the need for defibrillation
3. neurologic function
4. handicap status of the patient
   3.

Which of the following signs may be present with sudden and severe cerebral hypoxia? (Choose all correct answers)

1. Decreased level of consciousness
2. Loss of muscular tone
3. Generalized seizures
4. Pupil dilation
   1, 2, 3, 4

When cerebral hypoxia develops more gradually, the neurologic signs are the same as when severe cerebral hypoxia develops suddenly.

1. True
2. False
   2.

The AVPU scale is a scale used to evaluate cerebral cortex function and is used to rate a child’s level of consciousness. What does the acronym AVPU stand for?

1. Alert, Voice, Painful, Unresponsive
2. Active, Verbal, Painful, Unresponsive
3. Alert, Voice, Pupils, Unresponsive
4. Alive, Voice, Pulses, Understands
   1.

The Glasgow coma scale is used to evaluate a child’s level of consciousness and neurologic status. The child’s best eye-opening, verbal, and motor responses are scored. If a child is intubated, unconscious, or preverbal, the most important part of this scale is _ response.

1. Eye-opening
2. Verbal
3. Motor
   3.

Pupil response to light is a indicator of __ function.

1. Cortex
2. Hypothalamus
3. Limbic
4. Brainstem
   4.

The D(disability) of the primary assessment is a quick evaluation of neurologic function. Which standard evaluations are included in this assessment? (choose all correct answers)

1. AVPU scale
2. Glasgow coma scale
3. Pupil response to light
4. NIH stroke scale
5. Blood glucose test
   1, 2, 3, 5

The E of the ABCDE primary assessment acronym stands for ____.

1. Evidence
2. Emergency
3. Evaluate
4. Exposure
   4.

After completion of the primary assessment, if the child does not have a life-threatening condition, the secondary assessment should be completed. The secondary assessment consists of which of the following components? (Choose all correct answers)

1. General physical exam
2. Family medical history
3. Focused history
4. Focused physical exam
   3, 4

The final aspect of the evaluate component for the evaluate – identify – intervene sequence is diagnostic tests. What is the primary diagnostic test for assessing the severity of respiratory problems?

1. Central venous oxygen saturation
2. Hemoglobin concentration
3. Arterial blood gas
4. Arterial lactate
   3.

Within the evaluate-identify-intervene sequence, there are 3 clinical assessments that occur. The 3 clinical assessments are primary assessment, secondary assessment, and _ tests. (fill in the blank with the correct answer)
Diagnostic

An arterial blood gas is a diagnostic test that measures amounts of certain gasses and other constituents in the arterial blood. Match each result with the proper definition.
A. This value tells us about the acid-base balance.
B. This value tells us whether oxygenation is adequate.
C. This value tells us whether ventilation is adequate.
D. This value is used to determine if the source of an acid-base disturbance is respiratory or metabolic.
E. This value tells us the percentage of hemoglobin saturated with oxygen.
A. pH (7.35-7.45)
B. PaO2 (80-100)
C. PaCO2 (35-45)
D. HCO3 (22-26)
E. SaO2 (80-100)

(True or False) Hemoglobin concentration determines the oxygen-carrying capacity of the blood.

1. True
2. False
   1.

In the seriously ill or injured child, the arterial lactate level can __ as a result of tissue hypoxia and anaerobic metabolism.

1. Fall
2. Rise
   2.

(True or False) Pediatric cardiac arrest typically has a primary cause that is related to respiratory failure or shock.

1. True
2. False
   1.

Pediatric cardiac arrest is typically the result of _ resulting from respiratory failure and/or shock.

1. coronary occlusion
2. tissue hypoxia
3. pulmonary embolism
4. hypovolemia
   2.

(True or False) Outcomes for cardiac arrest in children is generally good.

1. True
2. False
   2.

Which is the most common presenting initial rhythm for children in cardiac arrest?

1. PEA/asystole
2. ventricular tachycardia
3. ventricular fibrillation
4. complete heart block
   1.

Sudden cardiac arrest is rare in children, and when it occurs, it is typically associated with underlying heart disease. Common causes include: (choose all that apply)

1. long QT syndrome
2. hypertrophic cardiomyopathy
3. myocarditis
4. drug intoxication
   1, 2, 3, 4

A majority of sudden cardiac arrest in children occurs during athletic activity.

1. True
2. False
   1.

The correct location to palpate for a pulse in an unresponsive CHILD is _. (choose all correct answers)

1. carotid
2. radial
3. femoral
4. brachial
   1, 3

(True or False) To ensure proper treatment of cardiac arrest, the rhythm must be identified before initiating CPR.

1. True
2. False
   2.

In children, a pulse check should be limited to _.

1. no more than 5 seconds
2. no more than 10 seconds
3. no more than 15 seconds
4. no more than 20 seconds
   2.

Choose the scenarios that would require immediate CPR.

1. 3-year-old. not responsive, shallow breathing, weak pulse, HR 70
2. 7-year-old, not responsive, not breathing, weak pulse, poor perfusion, HR 55
3. 1-year-old, opens eyes, lethargic, rapid breathing, HR 55
4. 4-year-old, not responsive, agonal breathing, no pulse
   2, 4

1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry?
   A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be administered
   C. Unreliable; no supplementary oxygen is indicated
   D. Unreliable; supplementary oxygen should be administered
   Unreliable; supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child’s most likely condition?
   A. Septic shock
   B. Hypovolemic shock
   C. Significant bradycardia
   D. Cardiogenic shock
   Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is 55/40 mm Hg. What term describes this infant’s blood pressure?
   A. Hypotensive
   B. Normal
   C. Hypertensive
   D. Compensated
   Hypotensive
4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mg/kg to be given 10. What should the team member do?
   A. Administer the drug as ordered
   B. Administer 0.01 mg/kg of epinephrine
   C. Respectfully ask the team leader to clarify the dose
   D. Refuse to administer the drug
   Respectfully ask the team leader to clarify the dose
5. Which of the following is a characteristic of respiratory failure?
   A. Inadequate oxygenation and/or ventilation
   B. Hypotension
   C. An increase in serum pH (alkalosis)
   D. Abnormal respiratory sounds
   Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
   A. Disordered control of breathing
   B. Hypovolemic shock
   C. Lower airway obstruction
   D. Upper airway obstruction
   Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a few minutes ago. Which of the following most likely to be abnormal?
   A. Vascular resistance
   B. Pulse rate
   C. Lung compliance
   D. Control of breathing
   Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory distress caused by lung tissue disease?
   A. Decreased oxygen saturation
   B. Stridor
   C. Normal respiratory rate
   D. Decreased respiratory effort
   Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this patient’s condition? A. Respiratory distress
   B. Respiratory arrest
   C. Respiratory failure
   D. Disordered control of breathing
   Respiratory distress
10. 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. Assessment reveals the following: The child is difficult to arouse, with pale color. The child’s heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the most appropriate intervention?
    A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes
    B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
    C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an oncologist to determine the chemotherapeutic regimen
    Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes
11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. Two providers may attempt peripheral vascular access twice each
    B. Three providers may attempt peripheral vascular access once each
    C. Place a central venous line
    D. Place an intraosseous line
    Place an intraosseous line
12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock with adequate myocardial function?
    A. 10 mL/kg normal saline
    B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride
    C. 20 mL/kg normal saline
    D. 10 mL/kg lactated Ringer’s
    20 mL/kg normal saline
13. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child’s color is pink. What is the most appropriate initial intervention?
    A. Obtain a chest radiograph
    B. Administer nebulized epinephrine
    C. Prepare for a surgical airway
    D. Use an epinephrine autoinjector
    Administer nebulized epinephrine
14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has the following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure 9060 mm Hg, and temperature 98.6°F (37°C). The child’s capillary refill time is 4 seconds. After 2 IV boluses of normal saline (20 mL/kg each), the child’s vital signs are now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94/62 mm Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child’s urine output is 1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or information should be obtained first?
    A. Arterial blood gas
    B. Serum potassium concentration
    C. Glucose
    D. A 12-lead ECG
    Glucose
15. A 15-year-old boy presents with acute onset of severe respiratory distress, with retractions and an oxygen saturation of 85%. His trachea is deviated to the right, and there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is 84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate intervention?
    A. Obtain a chest x-ray
    B. Perform needle decompression on the left chest C. Insert a chest tube on the left side
    D. Insert an IV and administer 20 mL/kg of normal saline
    Perform needle decompression on the left chest
16. A 4-year-old is being treated for hypovolemic shock and has received a single fluid bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4 seconds. What describes this patient’s condition?
    A. Hypotensive shock
    B. Compensated shock
    C. No longer in shock
    D. Cardiogenic shock
    Compensated shock
17. An 8-year-old child had a sudden onset of palpitations and light-headedness. At the time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted. What is the most appropriate initial intervention?
    A. Provide synchronized cardioversion at 0.5 to 1 J/kg
    B. Attempt vagal maneuvers
    C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone 5 mg/kg over 20 minutes
    Attempt vagal maneuvers
18. A 10-year-old child had a sudden witnessed cardiac arrest and received immediate bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous circulation. The child remains unresponsive and has an advanced airway in place. There is no history of trauma or signs of shock. What is the target range for oxygen saturation for this child?
    A. 92% to 100%
    B. 92% to 99%
    C. 94% to 99%
    D. 94% to 100%
    94% to 99%
19. A 3-month-old infant with bronchiolitis is suctioned to remove upper airway secretions. The infant’s heart rate decreases from 155/min to 65/min as shown below. The infant remains alert, with easily palpable pulses. Capillary refill time is 1 second. What is the most appropriate initial intervention?
    A. Administer oxygen and ensure adequate ventilation; be prepared to intervene further if heart rate does not increase
    B. Establish IV/IO access and administer epinephrine 0.01 mg/kg IV
    C. Establish IV/IO access and administer atropine 0.02 mg/kg IV
    D. Call for help and prepare to provide transthoracic pacing/transvenous pacing
    Administer oxygen and ensure adequate ventilation; be prepared to intervene further if heart rate
20. A 3-month-old infant with bronchiolitis is intubated for management of respiratory failure. During transport, the infant develops bradycardia with a heart rate of 60/min, and the infant’s oxygen saturation decreases to 75%. There are breath sounds on the right side, but no air entry is heard on the left side. What is the most appropriate initial intervention?
    A. Administer epinephrine 0.01 mg/kg IV
    B. Place a chest tube on the left
    C. Verify the endotracheal tube position
    D. Aggressively suction the endotracheal tube
    Verify the endotracheal tube position
21. For a 6-month-old infant with supraventricular tachycardia and adequate perfusion, which of the following is the preferred vagal maneuver?
    A. Ocular pressure
    B. Carotid pressure
    C. Valsalva maneuver
    D. Ice to the face
    Ice to the face
22. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes after eating peanuts. What is the most appropriate initial medication for this child?
    A. Nebulized albuterol
    B. Epinephrine IM
    C. Isotonic crystalloid IV
    D. Methylprednisolone
    Epinephrine IM
23. A 2-year-old child was found submerged in a swimming pool. She is unresponsive, not breathing, and pulseless. In addition to performing high-quality CPR and establishing vascular access, which of the following is the most appropriate intervention?
    A. Give atropine 0.02 mg/kg lIO/IV
    B. Apply cricoid pressure
    C. Give epinephrine 0.01 mg/kg IO/IV
    D. Provide transthoracic pacing
    Give epinephrine 0.01 mg/kg IO/IV
24. A 3-year-old child is unresponsive, not breathing, and pulseless. High-quality CPR is in progress. A cardiac monitor is applied, and the rhythm below is noted. What is the next appropriate intervention?
    A. Attempt defibrillation with a 2 J/kg shock
    B. Administer epinephrine 0.01 mg/kg
    C. Consider placement of an advanced airway
    D. Administer amiodarone 5 mg/kg
    Attempt defibrillation with a 2 J/kg shock
25. A pulseless 6-week-old infant arrives in the emergency department, and high-quality CPR is in progress. The initial rhythm strip is shown below. CPR continues, and vascular access has been established. What is the next appropriate intervention?
    A. Administer atropine 0.02 mg/kg IO/IV
    B. Attempt defibrillation with a 2 J/kg shock
    C. Administer epinephrine 0.01 mg/kg IO/IV
    D. Consider insertion of an advanced airway
    Administer epinephrine 0.01 mg/kg IO/IV
26. A 6-month-old infant is unresponsive and not breathing. What is the maximum time that should be spent trying to palpate the pulse before starting CPR?
    A. 10 seconds
    B. 15 seconds
    C. 30 seconds
    D. 60 seconds
    10 seconds
27. What is the recommended location to check for a pulse in a 3- month-old infant?
    A. Carotid
    B. Radial
    C. Brachial
    D. Cardiac apex
    C. Brachial
28. A 7-year-old child presents in pulseless arrest. The child’s ECG shows the rhythm below. Which of the following describes the patient’s condition?
    A. Ventricular escape rhythm
    B. Ventricular tachycardia
    C. Pulseless electrical activity
    D. Sinus bradycardia
    Pulseless electrical activity
29. A 12-year-old child suddenly collapses while playing sports. He is unresponsive and not breathing. Emergency response is activated. The child has no pulse, and CPR is initiated. An AED arrives. What is the most appropriate next intervention?
    A. Contact the child’s family
    B. Provide CPR for 2 minutes
    C. Drive the child to the hospital
    D. Use the AED
    Use the AED
30. A 6-year-old child is found unresponsive, not breathing, and pulseless. What is the correct compression-to-ventilation ratio when 2 or more healthcare providers are present to perform CPR?
    15:2
31. A 5-year-old child has had severe respiratory distress for 2 days. During assessment the child’s heart rate decreases from 140/min to 90/min, and the child’s respiratory rate decreases from 66/min to 8/min. What intervention is most appropriate?
    A. Provide rescue breaths at a rate of 12 to 20/min B. Provide rescue breaths at a rate of 6 to 10/min
    C. Initiate chest compressions at a rate of at least 100/min
    D. Initiate chest compressions at a rate of 60/min
    Provide rescue breaths at a rate of 12 to 20/min
32. A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be established. What is the most appropriate intervention?
    A. Unsynchronized shock with 0.5 to 1 J/kg
    B. Synchronized shock with 0.5 to 1 J/kg
    C. Unsynchronized shock with 2 J/kg
    D. Synchronized shock with 2 J/kg
    Synchronized shock with 0.5 to 1 J/kg
33. A 13-year-old patient with asthma just received oxygen and albuterol via a nebulizer. What is the next most appropriate intervention?
    A. Administer 0.1 mg/kg of adenosine
    B. Obtain a blood sample to evaluate arterial or venous blood gases
    C. Reassess breath sounds and clinical status
    D. Repeat the albuterol treatment
    Reassess breath sounds and clinical status
34. The respiratory rate of a 1-year-old child with respiratory distress has decreased from 65/min to 30/min. The child is more lethargic and continues to have subcostal retractions. What does this change likely indicate?
    A. Respiratory distress is unchanged
    B. Progression toward respiratory failure
    C. Improved respiratory status
    D. Neurologic impairment
    Progression toward respiratory failure
35. What is the most likely cause of head bobbing in infants?
    A. Increased respiratory effort
    B. Improving respiratory status
    C. Decompensated shock
    D. Brain injury
    Increased respiratory effort
36. Several healthcare providers are participating in an attempted resuscitation. Which of the following is most consistent with the responsibilities of the team leader of the resuscitation?
    A. Records medications and interventions
    B. Assigns roles to team members
    C. Administers defibrillation shocks
    D. Provides compressions
    Assigns roles to team members
37. Which of the following conditions is appropriate for use of an oropharyngeal airway?
    A. Conscious with no gag reflex
    B. Unconscious with a gag reflex
    C. Unconscious with no gag reflex
    D. Conscious with a gag reflex
    Unconscious with no gag reflex
38. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes after eating peanuts. What is the most appropriate initial medication for this child?
    A. Nebulized albuterol
    B. Epinephrine IM
    C. Isotonic crystalloid IV
    D. Methylprednisolone IV
    Epinephrine IM
39. A mother brings her 7-year-old child to the emergency department. The mother states that the child has had a fever for the past 4 days and has had little to eat or drink during the past 24 hours. Your initial impression reveals a lethargic child with increased respiratory rate and pale color. Heart rate is 160/min, respiratory rate is 38/min, and blood pressure is 86/48 mm Hg. Capillary refill is 4 seconds. Which of the following is the most appropriate intervention for this child?
    A. Fluid bolus of 10 mL/kg of isotonic crystalloid
    B. Fluid bolus of 20 mL/kg of isotonic crystalloid
    C. Maintenance fluid infusion of isotonic crystalloid at 10 mL/h
    D. Maintenance fluid infusion of 5% dextrose and water at 20 mL/h
    Fluid bolus of 20 mL/kg of isotonic crystalloid
40. An intubated 5-year-old child who was in a motor vehicle collision becomes increasingly more difficult to ventilate. The child has diminished breath sounds and chest expansion on the right side of the chest, with audible breath sounds and visible chest expansion on the left. The endotracheal tube insertion depth has not changed. What is the most appropriate intervention?
    A. Deflate the cuff and pull the tube back
    B. Perform needle decompression on the right chest
    C. Perform needle decompression on the left chest D. Insert a gastric tube
    Perform needle decompression on the right chest
41. A 2-year-old child with a 2-day history of a barking cough presents with audible stridor on inspiration, intercostal retractions, and agitation. What is the most appropriate intervention for this child?
    A. Lay the child flat on a stretcher
    B. Suction the mouth and nose
    C. Administer nebulized epinephrine
    D. Administer inhaled albuterol
    Administer nebulized epinephrine
42. Which of the following oxygen saturations indicates the need for additional intervention?
    A. 96% on room air
    B. 95% on room air
    C. 93% on 4 L of oxygen
    D. 97% on 50% oxygen
    93% on 4 L of oxygen
43. A 3-year-old child presents with a 2-day history of nausea and vomiting. She is alert, with no increase in respiratory effort, and is pale in color. The child’s heart rate is 160/min, respiratory rate is 40/min, and blood pressure is 100/70 mm Hg. Her extremities are cool, with sluggish capillary refill. Which term best describes this child’s physiologic state?
    A. Compensated shock
    B. Cardiogenic shock
    C. Hypotensive shock
    D. Obstructive shock
    Compensated shock
44. A 3-year-old child presents with dehydration after a 2-day history of vomiting and diarrhea. The child after has received 2 fluid boluses of 20 mL/ kg of normal saline. After the second bolus, the child is alert and interacting. Her heart rate is 110/ min, respiratory rate is 30/min, and blood pressure is 92/64 mm Hg. Her capillary refill time is 2 seconds, and oxygen saturation is 98%. What is the most appropriate next intervention for this child?
    A. Administer another 20 mL/kg normal saline fluid bolus
    B. Administer 10 mL/kg of packed red cells
    C. Continue to monitor and reevaluate the child
    D. Initiate a dopamine drip of 20 mcg/kg per minute
    Continue to monitor and reevaluate the child
45. A 3-year-old child presents with a high fever and a petechial rash. The child is lethargic, has no signs of increased work of breathing, and is pale in color. His heart rate is 180/min, respiratory rate is 30/min, blood pressure is 80/68 mm Hg. Capillary refill time is 4 seconds, and oxygen saturation is 88%. Airway and lungs are clear. Peripheral pulses are diminished. Which of the following is the most appropriate initial intervention?
    A. Provide 100% oxygen via a nonrebreathing mask B. Obtain IV access
    C. Administer dopamine
    D. Administer an antibiotic
    Provide 100% oxygen via a nonrebreathing mask
46. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child’s color is pink. What is the most appropriate initial intervention?
    A. Obtain a chest radiograph
    B. Administer nebulized epinephrine
    C. Prepare for a surgical airway
    D. Use an epinephrine autoinjector
    Administer nebulized epinephrine
47. The initial impression of a 4-year-old child reveals a lethargic child who is diaphoretic, with no increased work of breathing and pink color. Her heart rate is 220/min, respiratory rate is 24/min, blood pressure is 84/46 mm Hg, and capillary refill time is 5 seconds. IV access has been established. The rhythm below is seen on the cardiac monitor. What is the most appropriate initial intervention?
    A. Give adenosine 0.1 mg/kg rapid IV push
    B. Perform carotid sinus massage
    C. Perform synchronized cardioversion at 0.5 J/kg D. Attempt defibrillation at 2 J/kg
    Give adenosine 0.1 mg/kg rapid IV push
48. An 8-month-old infant is being evaluated. The child’s mother says the infant has not been feeding well. The infant is alert with rapid but unlabored breathing, and the infant’s color is pale. A cardiac monitor is applied, and the rhythm below is noted. Distal pulses are readily palpable. You give oxygen and establish IV access. What is the most appropriate vagal maneuver?
    A. Valsalva maneuver
    B. Carotid massage
    C. Ocular pressure
    D. Ice to the face
    Ice to the face
49. A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be established. What is the most appropriate intervention?
    A. Unsynchronized shock with 0.5 to 1 J/kg
    B. Synchronized shock with 0.5 to 1 J/kg
    C. Unsynchronized shock with 2 J/kg
    D. Synchronized shock with 2 J/kg
    Synchronized shock with 0.5 to 1 J/kg
50. A 3-month-old infant presents with lethargy and a 3-day history of vomiting, diarrhea, and poor feeding. The initial impression reveals lethargy, increased respiratory effort with retractions, and pale, mottled skin color. Vital signs are as follows: heart rate 210/min, respiratory rate 60/min, and blood pressure 60/40 mm Hg. Peripheral pulses are thready, and capillary refill time is 4 seconds. The cardiac monitor displays the rhythm below. After administration of oxygen and establishment of vascular access, what is the most appropriate intervention?
    A. Adenosine O.1 mg/kg IV rapid push
    B. Vagal maneuvers
    C. Synchronized shock at 0.5 to 1 J/kg
    D. IV fluid bolus of 20 mL/kg normal saline
    IV fluid bolus of 20 mL/kg normal saline
51. A 3-year-old child is unresponsive, gasping, and has no detectable pulse. CPR is initiated. A monitor is attached, and the rhythm is shown below. What is the appropriate next therapy?
    A. Attempted defibrillation with 2 J/kg
    B. Synchronized cardioversion with 0.5 to 1 J/kg
    C. Epinephrine 0.01 mg/kg 10/IV
    D. Amiodarone 5 mg/kg 1O/IV
    Attempted defibrillation with 2 J/kg
52. A 2-year-old child is in pulseless arrest. The child has received high-quality CPR, 2 shocks, and a dose of IV epinephrine. The next rhythm check reveals the rhythm shown below. What would be an appropriate energy dose for the third defibrillation attempt?
    A. 2 J/kg
    B. 2 to 4 J/kg
    C. 4 J/kg or greater
    D. Greater than 10 J/kg
    4 J/kg or greater
53. A 12-year-old child suddenly collapses while playing sports. He is unresponsive and not breathing. Emergency response is activated. The child has no pulse, and CPR is initiated. An AED arrives. What is the most appropriate next intervention?
    A. Contact the child’s family
    B. Provide CPR for 2 minutes
    C. Drive the child to the hospital
    D. Use the AED
    Use the AED
54. A 3-year-old child is in cardiac arrest, and high- quality CPR is in progress. The first rhythm check reveals the rhythm below. Defibrillation is attempted with a shock dose of 2 J/kg. After administration of the shock, what is the most appropriate next intervention?
    A. Resume CPR, beginning with chest compressions
    B. Check for a pulse
    C. Analyze the rhythm
    D. Administer epinephrine
    Resume CPR, beginning with chest compressions
55. Which of the following is a characteristic of respiratory failure?
    A. Inadequate oxygenation and/or ventilation
    B. Hypotension
    C. An increase in serum pH (alkalosis)
    D. Abnormal respiratory sounds
    Inadequate oxygenation and/or ventilation
56. A 3-year-old child is in cardiac arrest, and a resuscitation attempt is in progress. The child is in ventricular fibrillation and was given a shock at 2 J/kg, followed by immediate CPR. At the next rhythm check, ventricular fibrillation is again noted on the cardiac monitor. What is the most appropriate next intervention?
    A. Attempt defibrillation with a 4 J/kg shock
    B. Attempt defibrillation with a 2 J/kg shock
    C. Resume CPR
    D. Check for a pulse for at least 10 seconds
    A. Attempt defibrillation with a 4 J/kg shock
57. CPR is in progress on a 10-month-old infant who was unresponsive and not breathing, with no palpable pulse. A cardiac monitor is applied, and sinus bradycardia at a rate of 42/min is noted. CPR is resumed, and vascular access is obtained. Which of the following is the most appropriate intervention?
    A. Epinephrine 0.01 mg/kg IO/IV
    B. Atropine 0.5 mg/kg IO/IV
    C. Amiodarone 5 mg/kg IO/IV
    D. Lidocaine 1 mg/kg IO/IV
    Epinephrine 0.01 mg/kg IO/IV
58. During a pediatric resuscitation attempt, what is most likely to contribute to high-quality CPR?
    A. A depth of compressions of about one fourth the anterior-posterior depth of the chest
    B. A compression rate of 80/min
    C. Pulse checks performed once per minute
    D. Allowing the chest wall to recoil completely between compressions
    Allowing the chest wall to recoil completely between compressions
59. While you are performing CPR on an infant in cardiac arrest at a doctor’s office, a second rescuer arrives with an AED. Which of the following best describes the use of an AED on this infant?
    A. The use of AEDS is not recommended on an infant.
    B. There are not enough data to recommend for or against the use of AEDS on infants.
    C. Only pediatric pads may be used on infants.
    D. If pediatric pads are unavailable, it is acceptable to use adult pads.
    D. If pediatric pads are unavailable, it is acceptable to use adult pads.
60. A 5-year-old child is hit in the chest with a baseball and suddenly collapses. High-quality CPR is being performed. When the AED arrives, only adult AED pads are available. What should the rescuer do?
    A. Use the AED with adult pads
    B. Wait for pediatric AED pads and use them as soon as they are available
    C. Continue the steps of CPR for 2 minutes before using the AED
    D. Await arrival of a manual defibrillator
    Use the AED with adult pads
61. A team is attempting to resuscitate a child who was brought to the emergency department by EMS after a traumatic injury. The family members arrive at the child’s bedside and request to remain in the room during the resuscitation attempt. What does the American Heart Association recommend?
    A. Allow the family to stay at the bedside alone, but they should not talk to anyone
    B. Allow the family to stay at the bedside with a staff member who is assigned to provide information and assistance
    C. Escort the family to an assigned family room where they can be given regular updates
    D. Take the family to the chapel or an assigned quiet room so they can receive expert consultation.
    Allow the family to stay at the bedside with a staff member who is assigned to provide information and assistance
62. Which of the following is most likely to produce a prolonged expiratory phase and wheezing?
    A. Disordered control of breathing
    B. Hypovolemic shock
    C. Lower airway obstruction
    D. Upper airway obstruction
    Lower airway obstruction
63. A 5-year-old child has had severe respiratory distress for 2 days. During assessment the child’s heart rate decreases from 140/min to 90/min, and the child’s respiratory rate decreases from 66/min to 8/min. Which of the following is the next appropriate intervention?
    A. Rescue breaths at a rate of 12 to 20/min
    B. Rescue breaths at a rate of 6 to 10/min
    C. Chest compressions at a rate of at least 100/min D. Chest compressions at a rate of 60/min
    Rescue breaths at a rate of 12 to 20/min