Pals pretest

a. some color improvement, some chest rise, and an oxygen saturation (per pulse oximetry) b. auscultation of breath sounds over the lateral chest bilaterally and presence of inspiratory sounds over the abdomen during assisted manual ventilation c. presence of mist in the tracheal tube d. presence of exhaled CO2 after delivery of 6 positive-pressure breaths 33. You are assisting at a statewide track and field event, in a sports facility, when You
witness a young teenage girl collapse while running. She is unresponsive. when you
arrive at her side, Other bystanders have called for EMS support and are performing
well-coordinated CPR. They report that the teen has no known health problems and is
now apneic and pulseless. Which of the following therapies could you add to this
teen's resuscitation that would be most likely to improve her survival?
a. you should take over mouth-to-mouth resuscitation b. you should attach and operate an AED as soon as one can be retrieved c. you should provide crowd control d. you should get a blanket to keep the patient warm 29. Which of the following statements about pediatric injury in the United States is true?

a. motor vehicle–related trauma accounts for less than 10% of all pediatric injuries resulting b. injuries are the leading cause of death in children older than 6 months c. bicycle helmets will not reduce the severity of most bicycle-related head injuries d. most fire-related deaths occur in schools
30. You are a lone rescuer when you see your neighbor's 13-year-old adolescent floating
face-down in her home swimming pool. She is unresponsive, limp and cyanotic when
you pull her from the water. You did not witness her entry into the water. Which of the
following best summarizes the first steps you should perform to maximize this
adolescent's chances of survival?
a. shout for help, open her airway with a jaw thrust while keeping her cervical spine immobilized, check breathing and if she is not breathing adequately provide 2 rescue breaths b. carefully lay her on the ground and leave her to phone 911, then return and open her c. immediately begin cycles of 5 chest compressions and 1 ventilation d. shout for help and if no one arrives, open her airway with a head tilt–chin lift maneuver, check breathing and if she is not breathing adequately provide 2 rescue breaths
31. You find an 7-year-old boy is unresponsive in his bed. You open his airway and check
breathing and find that that he is not breathing at all. You deliver 2 effective rescue
breaths. You now want to check for signs of circulation. Which of the following
choices best describes the assessment you should perform to determine if signs of
circulation are present in this child?
a. attempt to feel a carotid pulse and check for adequate breathing, coughing or movement b. palpate a radial pulse and check the child's blood pressure during both inspiration and c. look at the child's color and recheck responsiveness d. look to see if the child resumes normal breathing 32. You have just assisted with the elective tracheal intubation of a child with respiratory
failure and a perfusing rhythm. You perform a clinical assessment during assisted
manual ventilation to verify proper tracheal tube position, and you want to confirm
tube position with a secondary technique. Which of the following provides the most
reliable, prompt secondary confirmation of correct tracheal tube placement in this
child?
26. An 18-month-old submersion (near-drowning) victim is currently stable in a
community hospital ED. A tracheal tube is in place with proper position confirmed.
The toddler is receiving mechanical ventilation and a low-dose dopamine infusion to
support blood pressure and perfusion. Which of the following options is most
appropriate for transporting this child from the community hospital to a tertiary care
center?
a. a helicopter team with no pediatric experience that is 20 minutes away b. the local EMS service with a Basic EMT c. a pediatric critical care transport team from the receiving tertiary care center that is 30 d. the local basic EMS service with a pediatric nurse along to help 27. A 3-year-old boy presents with multiple system trauma. The child was an unrestrained
passenger in a motor vehicle crash. He is unresponsive to voice or painful stimula-
tion, and his right pupil is dilated and responds sluggishly to light. His respiratory rate
is less than 6 breaths/min, heart rate is 170 bpm, systolic blood pressure is 60 mm Hg,
and capillary refill time is 5 seconds. Which of the following most accurately
summarizes the first actions you should take to support this child?
a. provide 100% oxygen by simple mask, immobilize the cervical spine, establish vascular access, and provide maintenance IV fluids b. provide 100% oxygen by simple mask and perform a head-to-toe survey to identify the extent of all injuries; begin an epinephrine infusion and titrate to maintain a systolic blood pressure of at least 76 mm Hg c. establish immediate vascular access, administer 20 mL/kg of isotonic crystalloid, and reassess the patient; if the child's systemic perfusion does not improve, administer 10 to 20 mL/kg of packed red blood cells d. open the airway (jaw thrust technique) while immobilizing the cervical spine, administer positivepressure, and attempt immediate tracheal intubation
28. You are caring for a 7-year-old boy. The child was a pedestrian struck by a car. He is
breathing spontaneously with oxygen supplementation, and he has good central
pulses. He has an open mid-shaft fracture of the right femur; his right thigh is swollen
and bleeding heavily. The child arrives in your medical facility with adequate
ventilation and perfusion and spine immobilization. Which of the following are the
best initial steps for you to take to treat the child's leg injury?
a. apply direct pressure to the wound and continue to evaluate and support systemic perfusion, including perfusion of the leg b. call the orthopedic surgeon and do not touch the leg c. attempt to align the fracture and apply a tourniquet above the wound d. attempt to control bleeding with hemostatic clamps, apply a tourniquet, and then attempt 22. An unresponsive 7-month-old infant presents with cold extremities and a capillary
refill time of more than 5 seconds. His heart rate is 260 bpm with weak pulses and
narrow QRS complexes. IV access is established with difficulty. The infant is receiving
100% oxygen by non-rebreathing face mask, and oxygenation and ventilation are
adequate. Pediatric monitor/defibrillation/pacing electrode pads are in correct position
on the infant's chest. You attempt to flush the IV line with normal saline and note that
it is no longer patent. Which of the following is the most appropriate initial treatment
for this infant?
a. perform immediate tracheal intubation b. reattempt vascular access to enable administration of IV adenosine c. establish IO access and administer a 20 mL/kg bolus of isotonic crystalloid followed by d. perform immediate synchronized cardioversion
23. A pulseless 11-month-old infant arrives in the Emergency Department in ventricular
fibrillation with CPR in progress. You ensure that bag-mask ventilation with 100%
oxygen is producing effective chest expansion and breath sounds bilaterally,
establish an IV with a large catheter, attempt defibrillation 3 times and administer a
first dose of epinephrine. The child remains in ventricular fibrillation after 30-60
seconds of CPR. Which of the following should be performed next?
a. provide lidocaine 1 mg/kg IV or amiodarone 5mg/kg bolus IV b. attempt defibrillation at 4 J/kg c. provide 2nd dose of epinephrine IV 0.1 mg/kg (1:1000, 0.1 mL/kg) d. consider adenosine at 0.1 - 0.2 mg/kg 24. You are preparing to provide synchronized cardioversion for a child with
supraventricular tachycardia. What is the recommended initial energy dose for
synchronized cardioversion for infants and children?
a. 0.05 to 0.1 J/kg b. 0.5 to 1 J/kg c. 2 to 4 J/kg d. 6 to 10 J/kg
25. You are participating in the attempted resuscitation of a 3-year-old child in pulseless
ventricular tachycardia. You have attempted defibrillation 3 times without converting
the VT to a perfusing rhythm. The airway is secure and ventilation is effective.
Attempts at IV access have been unsuccessful but IO access has been attained. You
have not been able to identify any reversible cause of the VT. After administering IO
epinephrine, circulating it for 30 to 60 seconds, and unsuccessful defibrillation, what
is the next therapy that will be most appropriate if the child remains in VT?
a. tracheal epinephrine 0.1 mg/kg (1:1000, 0.1 mL/kg) b. adenosine 0.1 mg/kg IV push c. IO epinephrine 0.1 mg/kg (1:1000, 0.1 mL/kg) d. lidocaine 1 mg/kg IO or amiodarone 5 mg/kg IO a. achieve IV/IO access and administer 20 mL/kg of 5% dextrose and 0.45% sodium b. achieve IV/IO access and administer 20 mL/kg of lactated Ringer's over 60 minutes c. perform tracheal intubation and administer 0.1 mg/kg (0.1 mL/kg of 1:1,000 solution) of d. administer 20 mL/kg of isotonic crystalloid over 10-20 minutes
19. Which of the following is the most reliable equipment for delivering a high (90% or
greater) concentration of inspired oxygen?
a. a nasal cannula with oxygen flow of 4 L/min b. a simple oxygen mask c. a non-rebreathing face mask with an oxygen reservoir d. a partial rebreathing mask
20. You are transporting a 6-year-old tracheally intubated patient who is receiving
positive-pressure mechanical ventilation. The child begins to move his head and
suddenly becomes cyanotic and bradycardic. You remove the child from the
mechanical ventilator circuit and provide manual assisted ventilation with a bag via
the tracheal tube. During manual ventilation with 100% oxygen, the child's color and
heart rate improve slightly and his blood pressure remains adequate. Breath sounds
and chest expansion are present, but they are consistently diminished on the left side.
The trachea is not deviated, and the neck veins are not distended. A suction catheter
passes easily beyond the tip of the tracheal tube. Which of the following is the most
likely cause of this child's acute deterioration?
a. tracheal tube displacement b. tracheal tube obstruction c. tension pneumothorax d. equipment failure
21. An 11-year-old skateboarder suffered multiple system trauma without obvious midface
injury. He is obtunded and apneic. After bag-mask ventilation with 100% oxygen and
appropriate cervical spine immobilization, which of the following is the preferred
method for tracheal intubation?
a. nasotracheal route b. orotracheal route c. cricothyrotomy d. nasogastric tube 15. You are supervising another healthcare provider in the insertion of an intraosseous
needle into an infant's tibia. Which of the following signs should you tell the provider
will best indicate successful insertion of a needle into the bone marrow cavity?
a. pulsatile blood flow will be present in the needle hub b. fluids or drugs can be administered freely without local soft tissue swelling c. resistance to insertion suddenly increases as the tip of the needle passes through the d. once inserted, the needle shaft moves easily in all directions within the bone 16. An anxious but alert 7-year-old child presents with a heart rate of 260/minute with
narrow QRS complexes and no variability in heart rate with activity. Respirations are
30/minute and unlabored. Extremities are warm, and capillary refill time is less than 2
seconds. He is awake and alert, and denies chest pain or shortness of breath. Which
of the following would be the most appropriate initial treatment that you should
provide for this child?
a. perform immediate synchronized cardioversion (0.5 to 1 J/kg) b. establish vascular access and administer 20 mL/kg fluid bolus of 0.9% sodium chloride ((FG and JM--0.9% sodium chloride vs normal saline?}}
c. attempt vagal maneuvers by asking the child to blow into an occluded straw, and establish vascular access to deliver adenosine if needed d. begin immediate transcutaneous overdrive pacing
17. A pale and obtunded 3-year-old child is brought to the hospital with a history of
diarrhea. Respirations are 45/minute with no distress and good breath sounds
bilaterally. The Heart rate is 150/minute, and the BP is 88/64 mm Hg. Capillary refill is 5
seconds, and peripheral pulses are weak. After placing the child on a 10 L/min flow of
100% oxygen and obtaining vascular access, which of the following would be the
most appropriate immediate treatment for this child?
a. obtain a chest x-ray b. administer maintenance crystalloid infusion c. administer a bolus of 20 mL/kg of IV or intraosseous isotonic fluids d. administer dopamine infusion at approximately 2-5 mcg/kg/minute
18. An infant arrives by ambulance with a history of vomiting and diarrhea. The infant is
responsive only to pain. The upper airway is patent, the respiratory rate is 40/minute
with good bilateral breath sounds, and 100% oxygen is being administered. She has
cool extremities, weak pulses and a capillary refill time of more than 5 seconds. Her
Blood pressure is 85/65 mm Hg, and glucose concentration by bedside test is 100
mg/dL. Which of the following would be the most appropriate treatment for you to
provide for this infant?
a. decompensated shock associated with inadequate tissue perfusion b. decompensated shock associated with inadequate tissue perfusion and significant c. compensated shock requiring no intervention d. compensated shock associated with inadequate tissue perfusion
12. An 8-year-old child has been struck by a car. He arrives in the Emergency Department
alert, anxious, and in respiratory distress. His cervical spine is immobilized and he is
receiving a 10 L/min flow of 100% oxygen by face mask. Respirations are 60/minute,
his heart rate is 150/minute, and his systolic BP is 60 mm Hg. breath sounds are
absent over the right chest and the trachea is clearly deviated to the left. Pulse
oximetry reveals an oxyhemoglobin saturation of 84%. Which of the following is the
most appropriate immediate intervention for this child?
a. perform immediate endotracheal intubation and call for "STAT" chest x-ray b. obtain a chest x-ray and provide bag-mask ventilation until the x-ray is read c. establish IV access and administer an immediate fluid bolus of 20 mL/kg of normal saline d. perform needle decompression of the right chest and assist ventilation with bag-mask if
13. {{Julie--this is identical to #18 in Exam A}}A 2-year-old child presents with gradual
onset of mild difficulty in breathing. She is alert, has a sore throat and is making
coarse, high-pitched inspiratory sounds (mild stridor). Her oxyhemoglobin saturation
is 92% in room air, and her lung sounds are clear with adequate breath sounds
bilaterally. Which of the following is the most appropriate initial therapy for this child?
a. perform immediate endotracheal intubation b. obtain immediate radiologic evaluation of the soft tissues of the neck c. begin pulse oximetry to evaluate oxyhemoglobin saturation and obtain an arterial blood gas analysis to determine if hypercarbia is present d. administer humidified supplemental oxygen as tolerated and continue evaluation 14. An 18-month-old child presents with a 1-week history of a cough and a runny nose. He
is cyanotic and responsive only to painful stimulation. His heart rate is 160 per
minute; respirations have dropped from 65 to 10 per minute with severe intercostal
retractions and a capillary refill time of less than 2 seconds. Which of the following
would be the most appropriate immediate treatment for this toddler?
a. establish vascular access and administer a 20 mL/kg isotonic fluid bolus b. open the airway and provide positive-pressure ventilation using 100% oxygen and bag- c. administer 100% oxygen by face mask, establish vascular access and obtain a STAT d. administer 100% oxygen by face mask, obtain blood and arterial gases, and establish A 9-month-old infant presents with a respiratory rate of 45/minute, and a heart rate of
250/minute with narrow (<0.08 sec) QRS complexes. The infant is receiving 100%
oxygen by face mask and an IV catheter is in place. The infant's blood pressure is
64/palpable with faint pulses and capillary refill is 5-6 seconds. The infant is
responding only to pain and there is no history of vomiting or diarrhea. What is the
most appropriate initial treatment for this infant?
a. immediate defibrillation b. administration of a 20 mL/kg fluid bolus of 0.9% sodium chloride {{FG/JM: 0.9% sodium chloride vs normal saline?}} over 20 minutes or less c. administration ofadenosine 0.1 mg/kg using rapid bolus (two-syringe) administration You are in a restaurant when a woman at the next table cries out, "I think he's
choking." You look over and see a 3-year-old child who does appear to be choking.
You go to the table and confirm that the child is responsive, but is cyanotic, unable to
cough or talk, and is not moving air. Which of the following is the most appropriate
initial therapy for you to provide?
a. give 5 back blows, then 5 chest thrusts b. attempt a blind finger sweep c. do not intervene unless the child becomes unresponsive; then perform abdominal thrusts d. give abdominal thrusts
10. You are evaluating a 7-month-old infant boy. The infant presented with a history of
poor feeding, fussiness, and sweating. He is alert and responsive, and he has a
respiratory rate of 48 breaths/min with good bilateral breath sounds. Heart rate is 250
bpm with narrow (<0.08 seconds) QRS complexes, and the heart ratedoes not vary
with activity or cry. Pulses are readily palpable, and capillary refill is 2 seconds. Which
of the following therapies is most appropriate for this infant?
a. make an appointment with a pediatric cardiologist for later in the week b. consider vagal maneuvers (eg, ice to the face) while IV access is attempted and provide c. perform immediate synchronized cardioversion without awaiting establishment of IV d. establish IV access, administer a fluid bolus of 20 mL/kg of isotonic crystalloid and 11. You are evaluating a responsive 6-year-old girl. The child presented with fever,
irritability, mottled color, cool extremities, and a prolonged capillary refill time. Her
heart rate is 160 bpm, respiratory rate is 45 breaths/min, and the BP is 98/56 mm Hg.
Which of the following most accurately describes this child's condition, using the
terminology taught in the PALS course?
You are preparing to use a manual external defibrillator and external paddles in the
pediatric setting. When would it be most appropriate to utilize the smaller "pediatric"
sized paddles for delivery of direct-current energy?
a. the smaller paddles should be used for provide synchronized cardioversion but not for b. the smaller paddles should be used when the patient weighs less than approximately c. the smaller paddles should be used when the patient weighs less than approximately 10 d. the smaller paddles should be used whenever you can compress the victim's chest using A 7-year-old boy is found unresponsive, apneic and pulseless. CPR is provided and
endotracheal intubation and vascular access are achieved. The ECG monitor reveals
pulseless electrical activity (PEA). An initial IV dose of epinephrine has been
administered, and effective ventilations and compressions continue for one minute.
Which of the following therapies should be performed next?
a. attempt to identify and treat reversible causes (use the 4 H's and 4 T's as a memory aid) b. attempt defibrillation at 4 J/kg c. administer escalating doses of epinephrine d. administer synchronized cardioversion Which of the following statements about the effects of epinephrine during attempted
resuscitation is true?
a. epinephrine decreases peripheral vascular resistance and reduce myocardial afterload so that ventricular contractions are more effective b. epinephrine can improve coronary artery perfusion pressure and can stimulate spontaneous contraction when asystole is present c. epinephrine is not useful in ventricular fibrillation because it will increase myocardial d. epinephrine decreases myocardial oxygen consumption You are participating in the elective intubation of a 4-year-old child with respiratory
failure. You must select the appropriate size of uncuffed tracheal tube. Which of the
following would be the most appropriate size for an average 4-year-old?
a. 3-mm tube b. 4-mm tube c. 5-mm tube d. 6-mm tube Pediatric Advanced Life Support Course
American
Heart
Written Examination
Association
Please do not mark on this evaluation. Record the best answer on the separate answer sheet.
Which of the following statements is true regarding poisoning and overdose in the
pediatric population?
a. whenever a poison or toxin is ingested, you should induce vomiting to eliminate it from b. poisoning and overdose cause a significant number of deaths in the 15-24yearold age c. poisoning and overdose do not occur in the pediatric population d. the first priority of management for the child with poisoning or a drug overdose is to "get A 3-year-old child is brought to the Emergency Department unresponsive and apneic.
The EMTs transporting the child indicate that the child became pulseless as they
pulled up to the hospital. The child is receiving CPR, including positivepressure
ventilation with bag and mask and 100% oxygen and chest compressions. You
confirm that apnea is present and that ventilation is producing bilateral breath sounds
and chest expansion while a colleague confirms absence of spontaneous central
pulses and other signs of circulation. A third colleague places the patient on the ECG
monitor and reports that ventricular fibrillation is present. Which of the following
therapies would be most appropriate for you to provide at this time for this child?
a. establish IV/intraosseous access and administer amiodarone 5 mg/kg IV b. establish IV/intraosseous access and administer lidocaine 1 mg/kg IV c. attempt defibrillation at 2 J/kg d. establish IV/intraosseous access and administer epinephrine 0.01 mg/kg IV During the attempted resuscitation of the infant or child with severe symptomatic
bradycardia and no evidence of vagal etiology, that persists despite establishment of
an effective airway, oxygenation and ventilation, Which is the first drug you should
administer?
a. atropine b. dopamine c. adenosine d. epinephrine American Heart Association
Pediatric Advanced Life Support
October 2001

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