PALS RED CROSS CRITICAL EXAM 2023-2024 ACTUAL EXAM 100 QUESTIONS AND CORRECT ANSWERS|ALREADY GRADED A+

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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?
sudden infant death syndrome is the most common cause in infants younger than 6 months of age.

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

The emergency response team is providing care to a preschooler who is experiencing shock. Which therapeutic goal, common to all types of shock, does the team work to achieve?
The primary therapeutic goal in shock, regardless of cause, is to restore a favorable balance between oxygen delivery and oxygen demand.

A 9-year-old child is brought to the emergency department because the child suddenly collapsed at school. The child’s ECG reveals the following waveform, and primary assessment findings indicate that the child is hemodynamically unstable. Which primary assessment findings indicate this?
Decreased level of consciousness, Hypotension, Difficulty breathing, Mottling

A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?
Hypotension, Bradycardia, Diminished central pulses

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 bromide

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?
Ensuring adequate mean arterial pressure

child in the pediatric intensive care unit displays the following ECG waveform and does not have a palpable central pulse. The resuscitation team interprets this as which arrhythmia?
pulseless ventricular tachycardia (pVT)

Which action would the PALS resuscitation team initiate to minimize increased intracranial pressure after cardiac arrest?
Maintain the head in midline position with 30-degree elevation

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 assessment

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

A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition?
Respiratory failure

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

A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?
Ventricular fibrillation (VF), Pulseless ventricular tachycardia (pVT),

A 4-year-old child is brought to the emergency department by the parents. Assessment reveals that the child is gasping 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

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

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 placement?
Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography.

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?
Sinus tachycardia

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

A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?
Corticosteroids, Racemic epinephrine

A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which finding would be considered a late sign for this condition?
Cyanosis

Assessment of a 7-year-old patient with septic shock reveals capillary refill of 3 seconds, diminished pulse and narrow pulse pressure. The emergency response team interprets these findings as indicating which type of septic shock?
hypotensive

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?
cardiogenic shock

An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, tachycardia and tachypnea. 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?
Epinephrine

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.

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?
fifth intercostal space at the midclavicular line on the patient’s left side.

A child who is stable and exhibiting a wide-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication?
Transient asystole

The 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 de pointes

A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest. When preparing to administer medications, which action would be appropriate for the team to take?
Estimate weight using a length-based resuscitation tape.

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?
Sternal retractions, Nasal flaring, Accessory muscle use

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 finding(s) would support the diagnosis?
Elevated creatinine level, Elevated lactate level, Prolonged prothrombin time (PT)

A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?
Hypotension is not a consistent feature of shock in children.

While formulating initial impressions using the Pediatric Assessment Triangle, the provider assesses the child’s circulation. Which information would be important to consider?
Skin pallor (or gray/dusky color), Evidence of bleeding, Flushing of the skin

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?
Second-degree atrioventricular (AV) block, type I

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

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?
Hypovolemic shock

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

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?
First-degree AV block

A child requires cardiac monitoring. A three-electrode system is being used. At which location would the provider place the red electrode?
On the lower left abdomen

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)?
Fever, Hyperglycemia, Hypotension

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 department providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR?
Allowing the chest to recoil fully after each compression, Giving 2 ventilations to every 15 compressions, Providing ventilations that last about 1 second each, Compressing the chest about 2 inches

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 inches

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.

Following a cardiac arrest, 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

A child experiencing unstable bradycardia is receiving CPR. Despite efforts with CPR, the child’s status remains unchanged. Which medication would the emergency response team expect to administer next?
Epinephrine

An 11-year-old child develops unstable wide complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention?
Synchronized cardioversion

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 at least what percentage?
94%

A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer?
Vagal maneuvers

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 stridor. Which diagnosis would the provider most likely suspect?
Select the correct answer to this
Croup

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

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?
Isotonic fluid boluses

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 2 to 3 seconds.

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?
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

The 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 de pointes

What is the correct IV/IO dose of epinephrine for a pediatric patient in cardiac arrest?
0.01 mg/kg every 3 to 5 min (max single dose 1 mg)

A child is experiencing supraventricular tachycardia (SVT) with adequate perfusion and is to receive treatment. Which initial treatment would the provider administer?
Vagal maneuvers

A healthcare provider notices petechiae on the arms and legs while performing a rapid skin assessment of a child with a high fever and respiratory distress. Based on this assessment, which condition should the provider consider?
Life-threatening systemic infection

A 7-year-old patient with septic shock has received three balanced/buffered crystalloid fluid boluses (60-mL/kg) and reassessment 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?
Fluid-refractory

A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?
Nebulized epinephrine, Corticosteroids

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?
Transient asystole

A child experiencing bradycardia with inadequate perfusion despite supporting 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?
Epinephrine

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

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?
Nasal flaring
Intercostal, substernal or suprasternal retractions
Accessory muscle use

A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?
Bradycardia
Diminished central pulses
Hypotension

Primary assessment of a 10-year-old child reveals septic shock. As part of the secondary assessment, if not already done as part of initial sepsis care, laboratory testing is completed to evaluate the child’s status. Which laboratory tests would be ordered for this child?
Complete blood count (CBC)
Lactate level
Blood cultures

Providing ventilations that last about 1 second each

Giving 2 ventilations to every 15 compressions

Allowing the chest to recoil fully after each compression

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?
Oxygen delivery and oxygen demand

A 9-year-old patient is presenting with diminished breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition?
Respiratory failure

An 11-year-old child develops ventricular tachycardia with a pulse with inadequate perfusion. The PALS team would prepare the child for which intervention?
Synchronized electrical cardioversion

A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?
pVT, VF

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?
Appearance

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 stridor. Which common cause of partial upper airway obstruction in children would the provider most likely suspect?
Croup

A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals chest pain on inspiration, diminished breath sounds on the right side, and respiratory distress. The provider suspects obstructive shock caused by what condition?
Tension pneumothorax

While performing a rapid assessment and formulating an initial impression using the Pediatric Assessment Triangle (PAT), the provider assesses the child’s circulation. Which information would be important to consider?
Flushing of the skin

Evidence of bleeding

Skin pallor (or gray/dusky color)

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?
End-tidal carbon dioxide levels
Presence of an arterial waveform or arterial blood pressure in patients with indwelling arterial catheters

An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, 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?
Epinephrine

A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?
Hypotension is not a consistent feature of shock presentation in children.

What is considered inadequate perfusion when assessing/caring for a pediatric patient with an arrhythmia?
Diminished peripheral pulses

Acutely altered mental status

Hypotension

A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present?
Pallor

A 9-year-old child is brought to the emergency department because the child suddenly collapsed at school. The child’s ECG reveals the following waveform, and primary assessment findings indicate that the child has inadequate perfusion. Which primary assessment findings indicate this?
Signs of shock

Acutely altered mental status

Hypotension

Observe for bilateral chest rise.

Evaluate results of capnography.

Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient?
Maintain the head in midline position.

Which is the primary goal and focus of post-cardiac arrest care?
Preservation of neurologic function

In children and infants, cardiac arrest most often arises from which complication?
Respiratory failure

Which medications may be used in the cardiac arrest care of a patient with a “shockable” rhythm?

Amiodarone
Epinephrine
Magnesium Sulfate
Lidocaine

Which finding indicates adequate end-organ and tissue perfusion?
Urine output greater than 1 mL/kg/h

A patient admitted to the pediatric emergency department is in cardiac arrest. The rhythm on the defibrillator monitor is ventricular fibrillation (VF). Which energy dose should the team leader order to administer an initial shock?
2 J/kg

Which statement correctly describes the completion of the primary assessment of a patient in cardiac arrest?
The primary assessment should be delayed in order to provide prompt, life-saving measures.

A healthcare provider suspects that hyperkalemia may be the cause of the patient’s cardiac arrest. Which should the provider order to confirm hyperkalemia?
Serum electrolyte panel

The healthcare provider notes that an infant receiving post-cardiac arrest care has an increase in temperature. The provider understands treatment should be initiated if the temperature rises at least which amount above normal?
1 degree increase

The healthcare provider understands that an ischemia/reperfusion response during post-cardiac arrest syndrome (PCAS) is similar to which kind of shock?
Septic

Which ECG rhythm is identified in the following image?
Polymorphic ventricular tachycardia (torsades de pointes) looks like scribbed signature mountain/upside down mountains

The PALS team is actively attempting to resuscitate a 9-kg infant in cardiac arrest. The team leader instructs the monitor team member to administer a second defibrillation. How many joules should the team member administer?
36 joules:

Activate emergency medical services, call a pediatric “code blue”, obtain AED or defibrillator
Is the rhythm shockable?
Rhythm IS shockable (ventricular fibrillation or unstable ventricular tachycardia)
Administer shock at 2 Joules/kg
Administer high-quality CPR for 2 minutes
Check rhythm
If not shockable, move to asystole/PEA rhythm protocol
If shockable, continue
Administer shock at 4 Joules/kg
Administer epinephrine 0.01 mg/kg IV or 0.1 mg/kg per ETT every 3-5 minutes
Administer high-quality CPR for 2 minutes
Check rhythm
If not shockable, move to asystole/PEA rhythm protocol
If shockable, continue
Administer shock at >4 Joules/kg
Administer amiodarone 5 mg/kg IV (repeat 2 times if needed) or lidocaine 1 mg/kg IV
Administer high-quality CPR for 2 minutes
Check rhythm
If not shockable, move to asystole/PEA rhythm protocol
If shockable, repeat steps 8-11
Rhythm IS NOT shockable (asystole or pulseless electrical activity)
Administer high-quality CPR for 2 minutes
Administer epinephrine 0.01 mg/kg IV or 0.1 mg/kg per ETT every 3-5 minutes
Check rhythm
If shockable, move to VF/VT rhythm protocol
If not shockable, continue
Administer high-quality CPR for 2 minutes
Check rhythm
If shockable, move to VF/VT rhythm protocol
If not shockable, continue
Administer amiodarone 5 mg/kg IV (repeat 2 times if needed)
Administer high-quality CPR for 2 minutes
Check rhythm
If shockable, move to shockable rhythm protocol
If not shockable, continue CPR and medications

While performing post-cardiac arrest care, the healthcare provider observes seizure activity. Which medication does the provider anticipate to be ordered?
Benzodiazepines

A child in cardiac arrest presents with the ECG rhythm seen in the following image, but a central pulse cannot be palpated. The provider correctly identifies this as which rhythm?
Pulseless ventricular tachycardia (pVT)

While reassessing a patient receiving mechanical ventilation via an endotracheal tube (ETT), the respiratory therapist notes the patient suddenly begins deteriorating and suspects a problem with the advanced airway therapy. The respiratory therapist uses which mnemonic to assess for complications?
DOPE

What are the components of post-cardiac arrest syndrome (PCAS)?

Myocardial dysfunction
Systemic response to ischemia/reperfusion
Brain injury

A patient has received 2 minutes of high-quality CPR for asystole with no response. Which medication should the team leader order?
Administer epinephrine 0.01 mg/kg

During a resuscitative event, the PALS team notes a change in cardiac rhythm on the defibrillator monitor. The monitor team member assesses for a central pulse, but notes that no pulse is present. The PALS team correctly identifies this as which rhythm?
Pulseless electrical activity (PEA)

Ensuring an adequate mean arterial pressure (MAP) post-cardiac arrest is critical to optimizing which factor?
Cerebral perfusion

During a resuscitative event of a child in cardiac arrest, the team leader orders amiodarone to be administered. The medication team member determines which dose to be correct?
5 mg/kg IV/IO

Which ECG rhythm is identified in the following image?
Ventricular fibrillation (VF) – looks like radar noises

After achievement of return of spontaneous circulation (ROSC), an indwelling arterial catheter is placed in the patient and connected to the cardiac monitor. Which finding should the provider report to the team leader given its association with poor outcomes after cardiac arrest?
Hypotension

Which indicator is the best measure of chest compression adequacy in a patient experiencing cardiac arrest?
ETCO2 levels between 15 and 20 mmHg

Which is the most common cause of cardiac arrest in infants younger than 6 months of age?
Sudden infant death syndrome

Which statement correctly describes one of the uses of a length-based resuscitation tape?
Used for determining dosages of medications

Which statement correctly describes the etiology of sudden cardiac arrest from a primary arrhythmia in children and infants?
It is rare in children and infants.

The PALS team leader correctly alternates the chest compressor role after which duration?
Every 2 minutes

The pediatric intensive care team is caring for a child post-cardiac arrest. During which assessment should the need for an advanced airway be determined?
Primary

Which ECG rhythm is identified in the following image?
Asystole (flat)

After completing a focused physical examination, the provider suspects that a seizure may have caused cardiac arrest in an assigned patient. Which diagnostic test will the provider likely order?
Electroencephalogram

Which statement correctly describes the goal of O2 administration after return of spontaneous circulation (ROSC)?
Administer at the lowest concentration required to maintain O2 saturation above 94% to below 100%.

Which cardiac arrest rhythms does the healthcare provider correctly identify as “nonshockable” rhythms?

Ventricular tachycardia (VT)
Asystole
Pulseless electrical activity (PEA)

Which neuroprotective measures should the provider implement?

Maintain normoglycemia.
Institute seizure precautions.
Ensure a minimal stimulation environment.

A 7-year-old patient is in obstructive shock after a bicycle accident. Assessment findings reveal hyperresonance and decreased breath sounds on the left side. These assessment findings most likely indicate which complication?
Tension pneumothorax

A nurse is following the Pediatric Assessment Triangle (PAT) to assess a patient. The PAT is used during which stage of patient assessment?
Rapid assessment

The PALS team understands that the priority treatment for most types of shock includes which intervention?
Early fluid resuscitation with normal saline

The healthcare provider understands which dose-dependent medication can cause both vasodilation and vasoconstriction?
Dopamine

Hypotension is a key characteristic of which type of shock?
Uncompensated shock

Decreased cardiac output in cardiogenic shock is typically caused by which disorder of the heart’s function?
Impaired contractility of the heart

A parent presents to the emergency department and states, “My baby has had diarrhea and has been vomiting for days now.” The healthcare provider understands the infant is at risk for which type of shock?
Hypovolemic

A toddler is experiencing hemorrhagic shock and has lost an estimated 45 mL of blood. How many mL of crystalloid solution should be administered to the patient?
135mL – 3:1 so 3mL of every 1mL of estimated blood loss (45×3 = 135)

Which assessment findings would the healthcare provider expect to note in a patient experiencing compensated shock?
Irritability, tachypnea and capillary refill of 3 seconds

The PALS medication team member is unsuccessful with placing an IV in a patient experiencing shock. The team member understands which statement is true regarding when to initiate IO placement?
If unable to secure IV access within 5 minutes or after 3 attempts

A pediatric patient is brought to the emergency department experiencing anaphylactic shock from exposure to an allergen. Which symptoms would the healthcare provider expect to assess in this patient?
Tachycardia and hypotension

The PALS team is preparing a fluid bolus for a patient in cardiogenic shock. How many mL/kg should the team prepare to administer?
5 to 10 mL/kg

The healthcare provider reviews a patient’s lab results and notes an elevated lactate level. The provider understands this is an indication of which complication?
Insufficient oxygen delivery

The healthcare provider determines that a patient is experiencing warm shock. Which assessment finding is a characteristic of warm shock?
Bounding peripheral pulses

Cardiac tamponade is a common cause of which type of shock?
Obstructive shock

The PALS team leader consults with the pediatric critical care team regarding medication therapy to increase vasoconstriction in a patient experiencing shock. Which medications would be most appropriate to administer?

Norepinephrine
Epinephrine

When using invasive monitoring to care for a patient in septic shock, the healthcare provider should titrate fluid and epinephrine therapy to maintain ScvO2 to which percentage?

70%

A 4-year-old patient is being treated for hypoglycemia. Assessment findings include tachycardia, pallor, irritability and refusal to eat or drink. Which intervention is most appropriate?
Administer IV dextrose.

A child has been experiencing vomiting and diarrhea for over 36 hours. Lab findings indicate the patient is hypokalemic. Which item should be administered to the child?
Potassium

Which types of shock are classified as distributive?

Septic
Anaphylactic
Neurogenic

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?

second degree

Lactate

Respiratory failure

Deliver 1 BVM ventilation every 3 to 5 seconds.

First-degree atrioventricular (AV) block

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)?

Hypotension

Fever

Hyperglycemia

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

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.

A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?

Hypotension is not a consistent feature of shock;

Supplemental oxygen should be administered as needed to maintain an oxygen saturation above 94%.

Albuterol plus ipratropium bromid

A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present?

Pallor is a circulation finding that may be seen in patients with respiratory distress.

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?

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.

An 11-year-old child develops unstable wide-complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention?

First-line treatment for unstable wide-complex tachycardias consists of synchronized electrical cardioversion, particularly when signs of hemodynamic compromise are apparent.

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?

Sudden infant death syndrome

Difficulty breathing

Hypotension

Mottling

Decreased level of consciousnes

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?

croup

hypovolemic

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.

bronchiolitis

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

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.

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

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

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?

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.

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?

Laboratory 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.

cardio

5 seconds, but no more than 10.

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

tension pneumothorax

A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer?

vagal

initiate defibrillation with 2 J/kg.

A child who is stable and exhibiting a narrow-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication?

Patients may have a brief period of “asystole” following the administration of adenosine. This is normal and typically self-limited.

epi

A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest. When preparing to administer medications, which action would be appropriate for the team to take?

tape

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?

ensure MAP

sinus tahy

A child requires cardiac monitoring. A three-electrode system is being used. At which location would the provider place the red electrode?

On the lower left abdomen

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 placement?

Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography.

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?

fifth intercostal space at the midclavicular line on the patient’s left side.

100 to 120 compressions per minute at a depth of about 2 inch

Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient?

Maintain the head in midline position with 30-degree elevation

child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?

Hypotension, Bradycardia, Diminished central pulses

A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?

Corticosteroids, Racemic epinephrine

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

Airway clearance

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

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

A child experiencing unstable bradycardia is receiving CPR. Despite efforts 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

rapid

A 7-year-old child in cardiac arrest is transported to the pediatric emergency department via emergency medical services. You understand the most common cause of cardiac arrest in children and infants is:
Respiratory Failure

During your primary assessment of an 8-year-old patient, you suspect the child is experiencing respiratory failure. Which findings would you likely note?
Respiratory rate-10/min
Diminished Breath sounds
Oxygen saturation of 88%

In which clinical conditions would you anticipate an initial respiratory finding of tachypnea?
Respiratory Distress
Metabolic acidosis
Tension Pneumothorax
Pneumonia

While conducting your rapid assessment on an infant, you identify respiratory distress with suprasternal, substernal and intercostal retractions. Where would you see suprasternal retractions?
top of sternum- near throat on picture

Now where would you see substernal retractions?
Substernal retractions are inward movement of the abdomen at the bottom of the sternum.

Finally, where would you see intercostal retractions?
Intercostal retractions are inward movement of the skin between the ribs.

A 4-year-old child arrives in the emergency department after being rushed to the healthcare facility by her parents. As you approach the child you notice that her skin has a bluish cast. You recognize immediately that she is experiencing what sign of impending or actual respiratory failure?
Cyanosis, a bluish color to the skin or mucous membrane, is a sign of impending or actual respiratory failure. It is often due to a lack of oxygen in the blood and decrease in perfusion.

A 10-year-old child is admitted to the emergency department with an acute exacerbation of asthma. Which abnormal breath sound will you likely auscultate?
expiratory wheezes

Which common disorder is a cause of lower airway obstruction in children?
asthma

You are training a colleague and discussing common pediatric respiratory emergencies. Which of the following upper airway complications would you tell your colleague they are most likely to see?
Foreign body aspiration
Allergic reaction/ anaphylaxis
croup

You suspect your adolescent patient is experiencing respiratory depression secondary to an opioid overdose. Which location is responsible for regulating the respiratory drive?
brain/ brain stem

A 10-year-old boy is brought to the emergency department by his grandmother. His breathing is rapid and labored with audible grunting. Your assessment reveals crackles on auscultation, tachycardia and a temperature of 39º C (102.2º F). You suspect he has a lung tissue disease. Which of the following is a common lung tissue disease in children?
Infectious Pneumonia

A parent calls the urgent care clinic and states they are concerned about their child’s “barky, seal-like” cough. You recognize this finding as a hallmark sign of which disorder?
croup

A child is brought to the emergency department with decreased level of consciousness, tachypnea and hyperpnea. You perform a rapid blood glucose test that reveals a level of 315 g/dL. The abnormal respiratory findings may be related to which condition?
Diabetic ketoacidosis (DKA)

A child arrives in the emergency department with obvious signs of respiratory distress and an oxygen saturation level of 92%. Which of the following actions are included during the immediate care of a pediatric patient with a respiratory emergency?
Assist with keeping the airway patent, if necessary.
Provide supplemental humidified O2 to maintain oxygen saturation of 94% to 99%

The pediatric clinical team is caring for a child who is experiencing a respiratory emergency caused by increased intracranial pressure (ICP). Which of the following steps of care for ensuring adequate cerebral perfusion pressure should the team leader consider when caring for this child?
Aggressively treat fever.
Initiate pharmacologic therapy for ICP.
Avoid hypotension.
Keep head midline.

Initial supportive measures have been ineffective for a child with bronchiolitis who is in respiratory distress. A trial of which class of medications may the healthcare provider consider?
Trial of bronchodilators

A child arrives in the urgent care clinic in respiratory distress. After assessment is complete, the physician assistant suspects the underlying cause of the child’s distress is a lung tissue disease. Administration of diuretics is most often considered for the patient with which lung tissue disease?
Cardiogenic pulmonary edema

Based on the primary assessment, Mark suspects which of the following is the cause of Sullivan’s respiratory distress?
Croup

Which of the following interventions should Mark include in next steps of care for Sullivan?
Administration of dexamethasone
Administration of nebulized epinephrine

Which additional therapeutic intervention should be considered at this time?
Heliox

The team notes the following when assessing Maya:Airway: Patent airwayBreathing: Respiratory rate of 28; retractions with breathing; breath sounds present in all fields, wheezing and prolonged expiration noted throughout; oxygen saturation of 92% on room airCirculation: No cyanosis/pallor noted; heart rate of 116; blood pressure 102/61; skin warm and dryDisability: AlertExposure: Temperature 101° F (38.3° C); weight 20 kgBased on the rapid and primary assessment findings recorded in the patient chart and the grandparent’s verbalizations, the team recognizes that Maya is experiencing a _ asthma exacerbation.
Moderate

Which first-line asthma medication would Joanne order to administer to Maya immediately?
Albuterol via nebulized solution

Based on these assessment findings, what is the appropriate next step of care?
Administer a second dose of albuterol after 20 minutes

Jeremy prepares the prednisolone dose for Maya. Which of the following is the correct oral dose of prednisolone (5 mL/15 mg) to administer to Maya, based on her weight of 20 kg?
6.6

Using critical thinking and assessment data, what is the next best course of action?
Administer a third dose of albuterol

A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?
-Nebulized epinephrine
-Corticosteroids

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 stridor. Which common cause of partial upper airway obstruction in children would the provider most likely suspect?
Croup

A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?
-Ventricular fibrillation (VF) -Pulseless ventricular tachycardia (pVT)

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 placement?
-Auscultate over the lungs and epigastrium for air movement.
-Observe for bilateral chest rise.
-Evaluate results of capnography.

What is considered inadequate perfusion when assessing/caring for a pediatric patient with an arrhythmia?
-Acutely altered mental status
-Diminished peripheral pulses
-Hypotension

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 department providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR?
-Providing ventilations that last about 1 second each
-Compressing the chest about 2 inches
-Giving 2 ventilations to every 15 compressions
-Allowing the chest to recoil fully after each compression

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?
-Evaluation of the objective data gathered during the event
-Discussion of the pros and cons of the interventions
-Summary of the event, including what actions were taken
-Identification of ways to improve

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?
-Accessory muscle use
-Intercostal, substernal or suprasternal retractions
-Nasal flaring

A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present?
Pallor

A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?
Hypotension is not a consistent feature of shock presentation in children.

A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?
-Diminished central pulses
-Bradycardia
-Hypotension

Primary assessment of a 10-year-old child reveals septic shock. As part of the secondary assessment, if not already done as part of initial sepsis care, laboratory testing is completed to evaluate the child’s status. Which laboratory tests would be ordered for this child?
-Lactate level
-Blood cultures
-Complete blood count (CBC)

A 9-year-old child is brought to the emergency department because the child suddenly collapsed at school. The child’s ECG reveals the following waveform, and primary assessment findings indicate that the child has inadequate perfusion. Which primary assessment findings indicate this?
-Hypotension
-Acutely altered mental status
-Signs of shock

An 11-year-old child develops ventricular tachycardia with a pulse with inadequate perfusion. The PALS team would prepare the child for which intervention?
Synchronized electrical cardioversion

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?
Transient asystole

A child is experiencing supraventricular tachycardia (SVT) with adequate perfusion and is to receive treatment. Which initial treatment would the provider administer?
Vagal maneuvers

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?
-Presence of an arterial waveform or arterial blood pressure in patients with indwelling arterial catheters
-End-tidal carbon dioxide levels

What is the correct IV/IO dose of epinephrine for a pediatric patient in cardiac arrest?
0.01 mg/kg every 3 to 5 min (max single dose 1 mg)

The 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 de pointes

Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient?
Maintain the head in midline position.

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