PALS Test Questions & Answers: 100% Verified:

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(Q) How long should assessing for breathing and a pulse take?
A) no longer than 5 seconds
B) no longer than 15 seconds
C) no longer than 20 seconds
D) no longer than 10 seconds - :-D

(Q) What should you do to check for breathing?

A) listen for lung sounds
B) look at the nose to check for nasal flaring
C) look for chest rise and fall
D) hold a mirror over the mouth, looking for condensation - :-C

(Q) Where can you check a pulse on an infant? - :-Brachial

(Q) Where can you check a pulse on a child? - :-Femoral

(Q) If the child does not have normal breathing and a pulse of 64/min is present,
you will need to
A) monitor
C) provide rescue breathing
D) begin CPR - :-B
 (Q) For an unwitnessed cardiac arrest, what should you do after determining
unresponsiveness and there is no breathing and no pulse?
A) shout for help
B) provide rescue breaths
C) perform high-quality CPR for 2 minutes
D) activate the emergency response system - :-C

(Q) The appropriate rate for compressions for children is 100 to 120/min. What is
the correct depth for children?
A) approximately 4 inches (two thirds AP diameter)
B) approximately 3 inches (one half AP diameter)
C) approximately 2 inches (one third AP diameter) - :-C

(Q) What is the compression-to-ventilation ratio for 1 and 2 rescuer CPR for
children and infants?
A) single rescuer 15-2; 2 rescuers 30-2
B) 15-2 for both
C) 30-2
D) single rescuer 30-2; 2 rescuers 15-2 - :-D

(Q) How should 1 rescuer infant compressions be delivered?

A) with 1 hand or 2 fingers
B) with 2 hands or 2 fingers
C) with 2 fingers or 2 thumbs
D) with 1 finger or 2 thumbs - :-C
(Q) What is the preferred technique for infant compressions when there are 2 or
more rescuers present?
A) 2 finger technique
B) 1 thumb-encircling hands technique
C) 1 finger technique
D) 2 thumb encircling hands technique - :-D

(Q) What are the 4 universal steps for operation of an AED? - :-1. Turn on the
AED
2. Attach pads to the patient
3. Analyze the heart rhythm
4. Deliver indicated shock

(Q) If the AED indicates no shock advised, what should be the next action?
A) call for help
B) give 2 rescue breaths
C) analyze heart rhythm again
D) start chest compressions - :-D

(Q) What does the A-B-C in the pediatric assessment triangle (PAT) stand for? - :-
Appearance
Work of breathing
Circulation

(Q) When is the pediatric assessment triangle (PAT) performed to make an initial
assessment?
A) during the transfer of care
B) during the secondary assessment
C) during the primary assessment
D) during the "from the doorway" observation - :-D

(Q) What sequence is used when caring for a seriously ill or injured child to help
determine the best treatment or intervention? The _______, _______, ______
sequence - :-Evaluate, identify, and intervene

(Q) The evaluate -identify-intervene sequence should be continued until

A) the child is stable
B) the child is ready for discharge
C) interventions are provided for the child
D) the child is ready for transport - :-A

(Q) The primary assessment includes the ABCDE approach. What does it assess?
A) airway, breathing, circulation, disability, and exposure
B) assessment, breathing, color, disability, and exposure
C) airway, breath sounds, circulation, disability, and exposure
D) assessment, breath sounds, circulation, disability and exposure - :-A

(Q) How is the airway assessed?

A) heckling the pulse
B) immediately calling for help
C) determining if the airway is open/patent
D) looking for the patient to move - :-C
 (Q) In the primary assessment, how should you pen the airway of a child who is
not suspected of having a cervical spine injury?
A) with a jaw thrust
B) by flexing the neck
C) with a head tilt-chin lift
D) with endotracheal intubation - :-C

(Q) In infants, the abdomen may move ______ the chest

A) less than
B) more than - :-B

(Q) What is a characteristic of normal chest rise?

A) asymmetrical during inspiration
B) symmetrical during expiration
C) asymmetrical during expiration
D) symmetrical during inspiration - :-D

(Q) _____ is usually high-pitched breathing during inspiration, whereas _____ is

usually during expiration - :-Stridor, wheezing

(Q) Snoring and gurgling are a result ______ airway obstruction

A) upper
B) lower - :-A

(Q) Crackles happen during _______, and grunting happens during______

A) inspiration, inspiration
B) expiration, expiration
C) inspiration, expiration
D) expiration, inspiration - :-C

(Q) Oxygen saturation less than _______ indicates low oxygen saturation, which
is known as hypoxemia
A) 98%
B) 96%
C) 94% - :-C

(Q) Pulse oximetry indicates oxygen ______ but not oxygen delivery
A) inhalation
B) levels
C) saturation - :-C

(Q) Conditions that _______ air resistance lead to increased respiratory______ - :-

Increase, effort

(Q) What are signs of increased respiratory effort that can lead to fatigue and
respiratory failure?
1. Retractions
2. Nasal flaring
3. Apnea
4. Head bobbing
5. Unlabored breathing
6. Seesaw respirations - :-1, 2, 4, 6
 (Q) Determine the respiratory rate by counting the number of times the chest rises
in ______ seconds and multiplying by_______ - :-30, 2

(Q) Tachypnea is often the fast sign of respiratory _______ in infants

A) arrest
B) failure
C) distress - :-C

(Q) Hypotension for children 1 to 10. Years of age is a systolic blood pressure of
less than
A) 40 mm Hg + (2x the age in years)
B) 60 mm Hg + (2x the age in years)
C) 70 mm Hg + (2x the age in years)
D) 50 mm Hg + (2x the age in years) - :-C

(Q) Automated blood pressure cuffs may provide _______ readings when the child
is in shock
A) inaccurately low
B) inaccurately high
C) accurate - :-B

(Q) What does a prolonged capillary refill time indicate?

A) increased stroke volume
B) low cardiac rate
C) low cardiac output
D) increased cardiac output - :-C

(Q) Normal capillary refill time is _______ second(s) or less

A) 1
B) 2
C) 3
D) 4
E) 5 - :-B

(Q) What pulses should b assessed to monitor systemic perfusion in a child?

A) peripheral and central
B) femoral and carotid
C) peel and radial
D) carotid and brachial - :-A

(Q) What do weak central pulses indicate a need for immediate intervention to
prevent?
A) sepsis
B) cardiac arrest
C) hypovolemia
D) respiratory arrest - :-B

(Q) When oxygen delivery to the extremities becomes inadequate, the _______
and ________ are the first to exhibit signs - :-Hands and feet

(Q) What should be used to assess skin temperature?

A) the palm of the hand
B) the back of the hand
C) the side of the face
D) the bottom of the wrist - :-B

(Q) If pupils do not ______ in response to bright light, consider increased

_______ pressure - :-Constrict, intracranial

(Q) If _______ is not identified and treated immediately, t can result in _____
injury - :-Hypoglycemia, brain

(Q) What are the 4 indicators of the AVPU scale that are used to determine
responsiveness
1. Responsive
2. Verbal
3. Responds to pain
4. Unresponsive
5. Alert
6. Responds to voice - :-3, 4, 5, 6

(Q) If the child does not respond to voice, assess the child's response to _____
A) heat
B) cold
C) pain - :-C

(Q) What should you look for when exposing the child?
1. Bruising
2. Change in responsiveness
3. Low blood pressure
4. Bleeding
5. Purpura
6. Heart murmur - :-1, 4, 5

(Q) What should be included in the history when asking about medications?
1. Current prescribed medications
2. Medication use since birth
3. Allergies to medications
4. Over-the-counter medications - :-1, 4

(Q) Which component of SAMPLE assesses immunization status?

A) signs and symptoms
B) past medical history
C) medications
D) allergies - :-B

(Q) What are some examples of diagnostic assessments?

1. Vital signs
2. Venous blood gas (VBG)
3. Hemoglobin concentration
4. Temperature
5. Arterial blood gas (ABG) - :-2,3,5
(Q) What dictates the timing of diagnostic assessments?
A) order of assessment
B) first intervention
C) complete primary assessment
D) clinical situation - :-D

(Q) Which component of effective high-performance teams is represented by the

use of real-time feedback devices?
A) administration
B) quality
C) timing
D) coordination - :-B

(Q) What is an advantage of effective teamwork?

A) division of tasks
B) mastery of resuscitation skills
C) immediate CPR
D) early defibrillation - :-A

(Q) What is the best example of the Team leader role?

A) models excellent team behavior
B) proficient at endotracheal intubation
C) performs within scope of practice
D) does not over ventilate the patient - :-A
(Q) What is the best example of a team member role?
A) helps train future team leaders
B) committed to success
C) monitors individual team members
D) focuses on comprehensive patient care - :-B

(Q) What is the primary purpose of the CPR coach on a resuscitation team?
A) improve CPR quality
B) resolve team conflicts
C) record CPR data
D) provide positive encouragement - :-A

(Q) How can the CPR coach improve CPR quality in a resuscitation event?
A) take charge as the team leader
B) stand at the foot of the patient
C) set an example as the fist compresor
D) coach to midrange targets - :-D

(Q) Which high-performance team member has the responsibility for assigning
roles (positions)?
A) timer/recorder
B) monitor/defibrillator/CPR coach
C) IV/IO medications
D) team leader - :-D
 (Q) What element of team dynamics describes when a team member needs to
correct actions?
A) knowing your limitations
B) constructive intervention
C) knowledge sharing
D) summarizing information - :-B

(Q) Which of the following describe how to communicate?

1. Knowledge sharing
2. Closed-loop communication
3. Clear messaging
4. Knowing your limitations
5. Dividing the tasks - :-2, 3,

(Q) Which resuscitation strategy will result in an improved chest compression

fraction?
A) switching chest compressors every 2 minutes
B) adhering to recommended drug dosing intervals
C) hovering over the chest during compression pauses
D) implementing physiologic monitoring devices - :-C

(Q) What is one way to increase chest compression fraction during a code?
A) giving epinephrine during a rhythm analysis
B) starting an IV/IO during a rhythm analysis
C) charging the defibrillator 15 seconds before a rhythm check
D) switching the airway and compressor roles during CPR - :-C
 (Q) A chest compression fraction of at least ______ is recommended, and a goal of
______ is often achievable with good teamwork - :-60% and 80%

(Q) What is chest compression fraction

A) proportion of time that compressions are preformed
B)proportion of time that depth is adequate in compressions
C) proportion of time that compressions are not performed
D) proportion of time that recoil is adequate in compressions - :-A

(Q) What is the definition of oxygen saturation?

A) measurement of ventilation
B) the amount of oxygen bound to hemoglobin
C) amount of oxygen dissolved in the plasma
D) measurement of oxygen delivery - :-B

(Q) Children develop hypothermia and tissue hypoxia more quickly than adults
because of their
A) lower respiratory rate
B) higher metabolic rate
C) lower oxygen demand
D) higher hemoglobin - :-B

(Q) Infants and toddlers, the tongue and epiglottis, relative to those of an adult, are
A) posterior
B) small
C) anterior
D) large - :-D

(Q) How can norma, spontaneous breathing be characterized?

A) associated with decreased lung compliance
B) noisy, withum unlabored inspiration
C) associated with upper airway resistance
D) quiet, with unlabored inspiration - :-D

(Q) increased work of breathing can be associated with _______ airway resistance
and/or _______ - :-Increased, decreased

(Q) What happens when airway resistance increases?

A) lung volume increases
B) work of breathing increases
C) airway dilation impedes airflow
D) impedance to airflow decreases - :-B

(Q) Which of the following describes laminar or normal airflow?

A) low airway resistance and a small driving pressure
B) larger airways need increased airway resistance
C) high airway resistance and a low driving pressure
D) smaller airways need increased airway resistance - :-A

(Q) What is the role of the diaphragm contraction during normal breathing in
infants?
A) pulls the ribs slight inward
B) causes an increase in pressure in the chest
B) causes a decrease in pressure in the chest
D) pushes the lower ribs slightly out - :-A

(Q) Which is a characteristic of muscle weakness?

A) seesaw breathing
B) constant retraction
C) a strong cough
D) strong respiratory muscles - :-A

(Q) Which of the following is true about airway resistance?

A) impedance to airflow is decreased when the airways constrict
B) the smaller the airway, the lower the airway resistance
C) airway resistance decreases as lung volume remains unchanged
D) hewn airway resistance increases, work of breathing increases - :-D

(Q) During spontaneous breathing, what are the inspiratory muscles attempting to
do?
A) increase intrathoracic volume
B) increase expiratory flow
C) decrease inspiratory flow
D) decrease intrathroacic volume - :-A

(Q) Which of these factors can override brain stem control of breathing in an
infant?
A) turbulent airflow
B) breathing normally
C) breathing holding
D) laminar airflow - :-C

(Q) What do central chemoreceptors respond to?

A) CO2 in the bloodstream
B) CO2 int he cerebrospinal fluid
C) serum pH
D) hydrogen ions in the cerebrospinal fluid - :-D

(Q) Why may excessive ventilation during CPR be harmful?

1) it impedes venous return
2) it increases coronary perfusion
3) it increases intrathoracic pressure
4) it decreases intrathoracic pressure - :-1, 3,

(Q) What should you do if you cannot achieve effective ventilation with a bag-
mask device?
1. Check the heart rate
2. Take the patient's blood pressure
3. Verify the mask size
4. Reposition on the airway
5. Increase ventilation rate - :-3, 4

(Q) How are effective oxygenation and ventilation assessed?

1. Oxygen saturation
2. Temperature
3. Capillary refill
4. Visible chest rise with each breath
5. Exhaled carbon dioxide
6. ECG - :-1, 4, 5

(Q) How can gastric inflation impaired bag-mask ventilation?

A) it decreases lung compliance
B) it increases exhalation time
C) it creates low pressure in the lungs
D) it increases lung volumes - :-A

(Q) What is the most appropriate precautionary action to minimize gastric

inflation during bag-mask ventilation?
A) ventilate every 4-6 seconds
B) deliver each breath over about 1 second
C) hyperextend the next
D) apply cricoid pressure - :-B

(Q) Hypoxemia is defined as oxygen saturation less than ______

A) 90
B) 94
C) 96
D) 92 - :-B
(Q) Which is true about the difference between hypoxemia and tissue hypoxia?
A) tissue hypoxia can occur with normal arterial oxygen saturation
B) hypoxemia always leads to low tissue saturation
C) tissue hypoxia cannot occurs unless arterial oxygen saturation is low
D) hypoxemia is normal tissue saturation - :-A

(Q) What does hyperventilation, which refers to increased alveolar ventilation,

result in?
A) PaCO2 less than 35 mm Hg
B) PaCO2 equal to 40 mm Hg
C) PaCO2 greater than 45 mm Hg
D) PaCO2 less than 94% - :-A

(Q) What happens to the arterial oxygen level in a child with severe anemia?
A) may increase when dissolved oxygen is decreased
B) may increase when dissolved oxygen is increased
C) is not impacted by dissolved oxygen
D) may increase when dissolved oxygen is increased - :-B

(Q) Which is true of increased carbon dioxide tension in arterial blood?

A) is a result of inadequate oxygenation
B) produces respiratory alkalosis
C) may be caused by disordered control of breathing
D) may be secondary to a normal respiratory drive - :-C

(Q) What happens when ventilation is inadequate?

A) PaCO2 decreases
B) PaCO2 increases
C) acid-base balance is alkalosis
D) acid base balance is normal - :-B

(Q) What is a critical symptom of hypercarbia?

A) agitation
B) anxiety
C) decreased level of consciousness
D) low pulse oximetry readings - :-C

(Q) Which of the following indicates mild respiratory distress?

A) cyanosis
B) a decreased level of consciousness
C) mild increased in respiratory effort
D) very low oxygen saturation - :-C

(Q) Which of the following indicates severe respiratory distress?

A) normal airway sounds
B) mild tachypnea
C) marked tachypnea and/or apnea
D) mild nasal flaring and retractions - :-C

(Q) Which of the following statements about respiratory failure is true?

A) seldom leads to cardiac arrest if not treated
B) always has a low pulse oximetry reading
C) is defined by strict criteria
D) may occur without signs of respiratory distress - :-D

(Q) Which is most likely to be present in a child who has respiratory distress (not
respiratory failure)?
A) bradypnea
B) lethargy
C) very poor air movement on auscultation
D) ability to maintain a patent airway - :-D

(Q) What steps should be taken as part of initial management of a child in

respiratory distress?
1. Start cardiac compressions
2. Monitor O2 saturation by pulse oximetry
3. Insert advanced airway
4. Monitor heart rate, rhythm and blood pressure
5. Support an open airway - :-2, 4, 5

(Q) Which are ideal characteristics of face masks for ventilation?

1. Has a soft rim
2. Covers the mouth and above the eyes
3. Covers the mouth and nose
4. Has a rigid rim
5. Transparent - :-1, 3, 5
(Q) What is the rationale for using a transparent mask?
A) allows you to see the color of the child's lips
B) provides the ability to see condensation, which indicates inhalation
C) does not allow the child to regurgitate
D) provides a tight seal against the face - :-A

(Q) What is the function of the nonrebreathing outlet valve of a self-inflating bag?
A) allows the child to exhale
B) keeps exhaled gases contained
C) prevents rebreathing of carbon dioxide
D) opens when the child exhales - :-C

(Q) Which of the following is required to appropriately ventilate a child with a

flow-inflating bag?
A) the outlet control valve must not be changed
B) face masks do not need to be fitted to the child
C) tidal volume needs to be delivered at the correct rate
D) the oxygen flow rate must remain constant - :-C

(Q) What should be checked to ensure proper function of a bag-mask system?

1. The pop-off valve can be closed
2. The cuff of the mask is deflated
3. The oxygen tubing does not have any leaks
4. Oxygen tubing is connected to the device and the oxygen source - :-1, 4

(Q) How is sniffing position achieved in an infant or a child?

A) hyperextend the neck
B) ensure the external ear canals is anterior to the shoulder
C) place the infant in a prone position
D) flex the neck behind the level of the shoulder - :-B

(Q) Where may padding be required under when properly positioning a child older
than 2 years of age to maintain a patent airway?
A) padding is not required for children older than 2 years of age
B) the upper torso
C) the shoulders
D) the occiput - :-D

(Q) What actions are appropriate when providing 1 person bag-mask ventilation?
A) open the airway and barely squeeze the bag
B) open the airway, insert an oral airway, and squeeze the bag as hard as you can
C) perform a head tilt and squeeze the bag as hard as you can
D) perform a head tilt, insert an oral airway, and squeeze the bag until chest rise - :-
D

(Q) What does the E-C clamp technique include?

1. Using the thumb and index finger of the same hand to hold the face mask
2. Using the second and third fingers of one hand to hold the face mask
3. Using the third, fourth and fifth fingers of one hand along the jaw to lift it
forward
4. Pressing on the soft tissue under the chin to lift the jaw - :-1,3
(Q) When may a 2 person bag mask technique be preferable?
1. When using the head tilt-chin lift maneuver to open the airway
2. When there is a significant airway resistance
3. When providers need to take turns squeezing the bag
4,. When very large tidal volumes need to be delivered
5. When masking a seal is difficult - :-2, 5

(Q) When suctioning a patient, which of the following should be monitored?

1. Temperature
2. ECG
3. Heart rate
4. Respiratory rate
5. Oxygen saturation
6. Clinical appearance - :-3, 5, 6

(Q) What should you do to help reduce the risk of hypoxemia during suctioning?
A) suction the back of the oropharynx
B) never interrupt suctioning
C) withdraw catheter with a twisting motion
D) limit suction attempts to 10 seconds or less - :-D

(Q) Under what circumstance should you use an oropharyngeal airway?

A) the child may be semiconscious
B) the child should have a gag reflex
C) the child may be conscious
D) the child must be unconscious - :-D

(Q) What can happen if the oropharyngeal airway is too large

A) it can push the tongue to the back of the throat
B) it may cause vomiting
C) it can block the airway
D) it will open the airway - :-C

(Q) When measuring for an oropharyngeal airway. It should extend form the
corner of the mouth to the angle of the ______
A) nose
B) jaw
C) ear
D) chin - :-B

(Q) The inspired oxygen concentration of a low flow oxygen delivery system is
between _____% to ______% - :-22 and 60

(Q) The appropriate flow rate for a simple mask is _____ to _____ L/min - :-6- 10

(Q) For nonrebreathing mask to be effective, the oxygen flow rate must be at least
______ L/min - :-10

(Q) High flow oxygen systems reliably deliver an oxygen concentration of greater
than ______%
A) 60
B) 70
C) 80
D) 90 - :-A

(Q) The gas flow rate for a nebulizar treatment is ____ to ____ L/min - :-5-6

(Q) What is an indication that a nebulizar treatment is complete?

A) the child doesn't want to do it any longer
B) the lung sounds are clear
C) the respiratory rate decreases
D) no mist is visible - :-D

(Q) When using a metered -dose inhaler (or MDI) with a spacer device, what
should you do?
A) shake the MDI and spacer vigorously
B) instruct the child to take only 1 to 2 quick breaths
C) instruct the child not to take short, shallow breaths after administration
D) activate the MDI during inhalation - :-A

(Q) When may pulse oximetry be inaccurate?

A) the child's appearance is normal
B) the displayed heart rate does not correlate with the child's heart rate
C) the blood flow to the extremity is adequate
D) the child has a normal heart rate and rhythm - :-B

(Q) When monitoring the pulse oximetry in a child, what finding would prompt
immediate evaluation of the child?
A) the child's heart rate correlates with the monitor's heart rate
B) the pulse oximetry has a strong signal
C) the child's appearance matches the pulse oximetry reading
D) there is a decrease in oxygen saturation - :-D

(Q) Which are appropriate interventions for an apneic child?

1. Provide a breath every 3 to 5 seconds
2. Check for a pulse every 1 minute while ventilating
3. Provide a breath every 2-3 seconds
4. Watch for chest rise - :-3, 4

(Q) Which of the following should be included in rescue breathing for an infant?
A) shout for help
B) provide a breath every 6 seconds
C) start chest compressions
D) use oxygen as soon as it is available - :-D

(Q) When should the use of an endotracheal tube be considered in a child?

A) child cannot maintain oxygenation despite initial intervention
B) child can maintain effective ventilation
C) child cannot maintain oxygenation on room air
D) child can maintain an effective airway - :-A

(Q) What is the first step for an intubated child whose condition deteriorates?
A) observe for chest rise and fall
B) auscultaste both sides of the chest
C) check the monitors
D) support oxygenation and ventilation - :-D

(Q) What are the common causes of upper airway obstruction?

1. Inability to swallow
2. Thick secretions
3. Difficulties swallowing
4. Airway swelling
5. Tonsillar hypertrophy - :-2, 4, 5

(Q) Which anatomical features may contribute to upper airway obstruction in

infants?
1. Large occiput
2. Large tongue
3. Difficultly swallowing
4. Prominent forehead - :-1, 2

(Q) What are the signs of upper airway obstruction?

1. Adequate chest rise and fall
2. Normal respiratory rate
3. Prolonged expiratory phase
4. Use of accessory muscles
5. Stridor - :-4 and 5

(Q) Which diagnoses may present with upper airway obstruction?

1. Croup
2. Epiglottitis
3. Asthma
4. Bronchiolitis
5. Foreign body obstruction - :-1, 2, 5

(Q) What should you do before suctioning a child who has upper airway
obstruction?
A) give corticosteroids
B) give nebulizad epinephrine
C) determine if there is blood ro debris in the airway
D) determine the underlying cause of the obstruction - :-D

(Q) In a less severe case of upper airway obstruction in a child, what intervention
can relieve obstruction caused by the tongue?
A) insert an oral airway
B) suction the child
C) decide if a surgical airway is needed
D) minimize agitation - :-A

(Q) A child presents with a barking cough, good air entry during auscultation, a
pulse oximetry reading of 93% on room air, and retractions at rest
What is the severity of the child's presentation?
A) moderate croup
B) impending respiratory failure
C) mild croup
D) severe croup - :-A

(Q) A child presents with a barking cough, good air entry during auscultation, a
pulse oximetry reading of 93% on room air, and retractions at rest
What are appropriate initial interventions?
1. Consider dexamethasone
2. Administer oxygen and prepare for a surgical airway
3. Administer oxygen and nebulizad epinephrine
4. Perform endotracheal intubation - :-1, 3

(Q) What is the treatment for a mild allergic reaction?

1. Monitor for wheezing
2. Use an epinephrine auto injector
3. Give an album Errol treatment
4. Remove the offending agent
5. Consider an antihistamine - :-4, 5

(Q) What is the most appropriate treatment for severe anaphylaxis?

A) administer IV epinephrine
B) administer IM epinephrine
C) start an IV
D) remove the offending agent - :-B

(Q) A responsive infant presents with severe foreign-body airway obstruction.

What is the appropriate management?

A) perform abdominal thrusts
B) lay the infant on a hard surface and begin CPR
C) perform a blind finger sweep
D) give 5 back blows followed by 5 chest thrusts - :-D

(Q) A responsive child presents with severe foreign-body airway obstruction and
is unable to speak

You determine that the child

A) should be lowered to the floor and that CPR should be initiated
B) should receive abdominal thrusts
C) has a severe airway obstruction; give 5 back blows followed by 5 chest thrusts
D) needs no intervention; call for help and allow the child to clear the obstruction -
:-B

(Q) SCENARIO 1
You are dispatched for an 8 month old boy who is having difficulty breathing. He
is lying on the couch and has a hoarse cry, barking cough, and is drooling. His
mother says that during the night, her son had difficulty breathing, which has
progressively worsened throughout the day.

The infant most likely has what type of respiratory emergency?

A) disordered control of breathing
B) lung tissue disease
C) lower airway obstruction
D) upper airway obstruction - :-D
(Q) SCENARIO 1

According to the systematic approach algorithm, what are the correct assessments
to perform during the evaluation phase?
A) primary, identification, intervention
B) primary intervention, treatment
C) initial, primary, secondary
D) initial, secondary tertiary - :-C

(Q) SCENARIO 1
The infant is responsive and breathing.
What is an initial measure that you can perform to maintain his airway?
A) perform a head tilt-chin lift or a jaw thrust
B) sit him up
C) suction his airway
D) insert an airway adjunct - :-B

(Q) SCENARIO 1
What are the components of the breathing assessment?
1. Temperature
2. Respiratory effort
3. Lung and airway sounds
4. Respiratory rate
5. Oxygen saturation
6. Chest expansion and air movement
7. Partial pressure of arterial carbon dioxide - :-2, 3, 4, 5, 6
(Q) SCENARIO 1
During the secondary assessment, the parents share that the barking cough started a
couple of hours ago and the child has been a febrile. They contacted their
pediatrician, who advised them to call an ambulance. The parents reported that
their son has no allergies and takes no medications
Breathing assessment: increased work of breathing and occasional barking cough.
The respiratory rate is 33/min with nasal flaring and high-pitched noises from the
airway. You see retractions and the use of accessory muscles. The patient SPO is
93% on room air.
Circulatory assessment: the circulatory assessment indicates the following: skin
flushed, warm and dry, HR 161/min; BP 78/55 mm Hg and capillary refill is less
than 2 seconds. His temperature is 38C (100.4F)
Disability and exposure assessments: no significant findings
Based on your findings, what is a most likely diagnosis for this patient?
A) pneumonia
B) croup - :-B

(Q) SCENARIO 1
What treatments would be most appropriate for this patient?
1. Dexamethasone
2. Nebulized albuterol
3. Nebulized epinephrine
4. Provide food to eat - :-1, 3

(Q) SCENARIO 1
Infants who begin to display signs of becoming weaker, decreased respiratory
effort, and poor air movement are at a high risk for _______
A) respiratory distress
B) pneumonia
C) respiratory failure
D) pneumothorax - :-C

(Q) SCENARIO 1
Infants and children who are at risk for respiratory failure should be ventilated and
prepared for intubation by a team member with significant pediatric expertise
When calculating the tube size based on the child's age, to avoid injury to the
subglottic area, you should use an endotracheal tuve that is:
A) half a size smaller than predicted for the child
B) the size indicated for the child
C) half a size larger than predicted for the child
D) a full size larger than predicted - :-A

(Q) What are the common causes of lower airway obstruction?

1. Croup
2. Asthma
3. Foreign body airway obstruction
4. Bronchiolitis - :-2, 4

(Q) How can small airways be obstructed in acute lower airway obstruction?
1. Increased expiratory flow
2. Decreased volume of gas in the lungs
3. Smooth muscle bronchial constriction
4. Decreased intrapleural pressure
5. Mucus plugging - :-3, 5

(Q) How do infants initially respond to lower airway obstruction?

A) increased respiratory rate
B) decreased respiratory rate
C) decreased Intrapleural pressure
D) increased tidal volumes - :-C

(Q) What is the first priority in managing lower airway obstruction?

A) restore adequate oxygenation
B) give racemic epinephrine
C) give an albuterol treatment
D) correct hypercarbia - :-A

(Q) Bag mask ventilation has been used on a child with lower airway obstruction
Which complications may occur?
1. Increased venous return to the heart
2. Decreased blood supply to the heart
3. Risk of lung collapse
4. Increased oxygenation - :-2,3

(Q) A child presents with audible wheezing, a heart rate greater than 120/min, a
respiratory rate of36/min, and the inability to talk in sentences.
What is the severity of this presentation
A) severe
B) mild
C) imminent respiratory arrest
D) moderate - :-A

(Q) When should administration of magnesium sulfate be considered in a child

with asthma?
A) respiratory arrest
B) moderate to severe distress
C) mild to moderate distress
D) impending respiratory failure - :-B

(Q) SCENARIO 2
You are dispatched to the local elementary school for a 6-year-old boy with
difficulty breathing, wheezing, and a cough that began during recess. His inhaler
failed to improve the condition, and he is now in the nurse's office.
He presents sitting in a char with initial vital signs of HR 118/min, BP 125/82 mm
Hg, RR 30, SPO2 92% temperature 98.6, he is conscious and responsive. His
father, who arrived at the school at the same time that you arrived, states that his
son became sick with a cold about 2 days ago and has really had to use his inhaler
a lot recently. The child can complete phrases when he speaks but cannot speak in
complete sentences

Upon assessment, you find that the child has retractions, a prolonged expiratory
phase, a lot of wheezing in the chest, and an SPO2 of 92% with high-flow oxygen.
On the basis of the initial indications, what is the most likely diagnosis for this
patient?
A) B - :-C

(Q) SCENARIO 2
On the basis of the presentation of the child, what is your assessment of his clinical
severity?
A) mild
B) respiratory failure imminent
C) moderate
D) severe - :-C

(Q) SCENARIO 2
Initial treatment for moderate asthma includes the administration of humidified
oxygen and the administration of what medication(s)?
A) albuterol and ipratropium
B) broad spectrum antibiotics and fluid bolts
C) IM epinephrine
D) antipyretics - :-A

(Q) SCENARIO 2
The anticipated results of the Nebulized treatment should include which of the
following improvements in the patient?
1. Decreased bronchoconstriction
2. Decreased airway edema
3. Improved cardiac output
4. Decreased oxygen saturation
5. Decreased alveolar surface tension
6. Decreased respiratory effort - :-1,2,6

(Q) SCENARIO 2
If the patient does not improve with medication, what is your next intervention to
ensure oxygenation?
A) oral airway insertion
B) noninvasive positive-pressure ventilation
C) nasopharyngeal airway insertion
D) cricothyromtomy - :-B

(Q) Which of the following is characterized by fluid accumulation in the alveoli

and/or interstitial?
A) lung tissue disease
B) a lower airway obstruction
C) disordered control of breathing
D) an upper airway obstruction - :-A

(Q) Which of the following are typical signs of lung tissue disease?
A) normal respiratory rate and hypoxemia
B) tachypnea and hypoxemia
C) tachypnea and hypercarbia
D) bradypnea and hypercarbia - :-B

(Q) What condition is characterized by signs of adequate carbon dioxide

elimination and hypoxemia?
A) upper airway obstruction
B) lower airway obstruction
C) lung tissue disease
D) disordered control of breathing - :-C
(Q) Which is true of increased carbon dioxide tension in arterial blood?
A) produces respiratory alkalosis
B) is a result of inadequate oxygenation
C) may be secondary to a normal respiratory drive
D) may be caused by disordered control of breathing - :-D

(Q) Which interventions are helpful in the management of acute infectious

pneumonia?
1. Administer antibiotic therapy
2. Perform diagnostic assessments
3. Provide racemic epinephrine
4. Administer corticosteroids - :-1, 2,

(Q) What intervention can reduce metabolic demand in a child with pneumonia?
A) give nebulizar treatments
B) provide positive and expiratory pressure
C) treat the fever
D) administer antibiotics - :-C

(Q) Which of the following are signs of disordered control of breathing?

1. Decreased air movement
2. Shallow breathing
3. Hypocarbia
4. Normal respiratory rate
5. Variable respiratory rate - :-1, 2, 5
 (Q) Which type of respiratory problem is most likely in a child with an altered
level of consciousness and variable respiratory rate?
A) lung tissue disease
B) disordered control of breathing
C) upper airway obstruction
D) lower airway obstruction - :-B

(Q) Which of the following are most commonly associated with disordered control
of breathing?
1. Allergic reaction
2. Drug overdose
3. Neurological disorder
4. Wheezing
5. Pneumonia - :-2,3

(Q) After supporting the airway and adequately oxygenation and ventilating a
child with a suspected opioid overdose, what is the next most appropriate
treatment?
A) administer flu a Neil
B) perform point-of care glucose testing
C) administer naloxone
D) perform endotracheal intubation - :-C

(Q) Which interventions may be included in the management of disordered control

of breathing due to increased intracranial pressure/
A) prophylactic hyperventilation
B) adequate oxygenation and ventilation
C) administering an antidote for the poison
D) suctioning the airway - :-B

(Q) SCENARIO 3
You are working the night shift and are called for a 6-month-old infant who is
having seizures. Upon arrival, you find the child in his mother's arm. He has a slow
respiratory rate with minimal chest rise and dose not react to his mother's voice or
to the noises in the environment.
When evaluating the child, you notice that he has an abnormal respiratory pattern
that produces inadequate minute ventilation.
What immediate interventions should be addressed for this child?
1. Position the infant to open his airway
2. Attach a pulse oximetry
3. Insert an oropharyngeal airway
4. Begin bag-mask ventilation with 100% oxygen
5. Administer oxygen with a nonrebreathing mask - :-1, 2, 4

(Q) SCENARIO 3
The patient's vital signs are HR 146/min BP 88/56 mm Hg, RR 12/min, SPO 80%
on room air, and temperature 193.5. While attempting to ventilate the patient, you
notice that initially there is no chest rise and there is poor air entry bilaterally
What should be the initial steps to improve ventilation
A) change the bag-mask device to a nonrebreathing mask
B) Initiate Nebulizer treatment
C) reposition and reopen the airway, attempt to lift the jaw, verify mask size, and
ensure a tight face mask seal
D) call for a physician to intubate the patient - :-C
(Q) SCENARIO 3
After the airway is repositioned, bag-mask ventilation improves. His vital signs are
HR 146/min, BP 88/56 mm Hg,and SPO 97%; however, the child is still lethargic
and is responsive only to painful stimuli
Before you start the secondary assessment, what other intervention is indicated for
this patient?
A) administer fluid bonus
B) administer epinephrine
C) perform endotracheal intubation
D) establish IV/IO access - :-D

(Q) SCENARIO 3
After the patient's oxygenation and ventilation are stabilized, the secondary
assessment should be conducted.
What is included in a secondary assessment?
1. Identification of reversible causes
2. Blood work
3. Physical examination
4. Chest x-ray
5. SAMPLE History - :-1, 3, 5

(Q) SCENARIO 3
The infant's respiratory rate has increased. Vital signs are hR 136/min, BP 94/58
mm Hg, rR 45 min and SPO 99% with inspired oxygen concentration of 100%.the
infant's neurological status is unchanged. He is still responsive only to painful
stimuli.
What additional diagnostic assessment should be prioritized?
A) chest x-ray
B) point-of care glucose testing
C) arterial blood draw
D) venous blood draw - :-B

(Q) SCENARIO 3
What would be indications for endotracheal intubation for this patient?
1. SPO less than 90%
2. Inadequate spontaneous respiratory effort
3. Failure to maintain a patent airway
4. Intact gag reflex
5. Signs of increased intracranial pressure - :-2, 3, 5

(Q) SCENARIO 3
En route to the hospital, you and your partner determine that the child should be
intubated. How would you estimate the size of the cuffed or uncuffed endotracheal
tube to use? The patient weighs 7kg and is 6 months old. - :-Cuffed - (Age in
years)/4 + 3.5
Uncuffed - (age in years)/4 +4

(Q) SCENARIO 3
After the child is intubated, how should tube placement be both confirmed and
monitored
A) direct visualization
B) auscultation of lung sounds
C) waveform capnography
D) chest x-ray - :-C
(Q) What is the most accurate definition of shock?
A) low blood pressure (hypotension)
B) increase in tissue oxygenation
C) Decreased metabolic demands
D) inadequate tissue perfusion - :-D

(Q) What should the first rescuer arriving on the scene of an unresponsive infant
or child do?
1. Check for responsiveness
2. Verify scene safety
3. Activate the emergency response system
4. Shout for help - :-2, 1, 4, 3

(Q) What are the characteristics of shock?

1. Inadequate peripheral perfusion
2. Increased urinary output
3. Normal capillary refill
4. Decreased en-organ perfusion
5. Decreased level of consciousness - :-1, 4, 5

(Q) What will occur if adequate oxygen delivery to the tissues is not maintained?
A) decrease in lactic acid
b) increased venous oxygen saturation
C) organ dysfunction
D) decreased tissue demand for oxygen - :-C
(Q) What are the major function(s) of the cardiopulmonary system?
1. Collects, processes, and responds to environmental sensory input
2. Regulates growth and metabolism
3. Utilizes anaerobic metabolism to produce energy
4. Delivers oxygen to body tissues
5. Removes metabolic by-products of cellular metabolism - :-4,5

(Q) What is the definition of cardiac output?

A) the difference between end-diastolic and end-systolic volumes
B) the volume of blood pumped by the heart per minute
C) the volume of blood in the left ventricle before systole
D) the percentage of cardiac contráctil it y - :-B

(Q) What is the body's first action to maintain cardiac output?

A) increase heart rate
B) increase venous smooth muscle tone
C) increase systemic vascular resistance
D) increase strength of cardiac contractions - :-A

(Q) When will you see signs of poor tissue perfusion?

A) only when blood pressure is below the fifth percentile
B) when heart rate and cardiac output are increased
C) when cardiac output is decreased and blood pressure is normal - :-C
(Q) The severity of shock is characterized by its effect on
A) end-organ perfusion
B) capillary refill time
C) blood pressure
D) heart rate - :-C

(Q) What are typical clinical findings with compensated shock?

1. Delayed capillary refill
2. Normal respiratory rate
3. Tachycardia
4. Wide pulse pressure
5. Increased urine output
6. Decreased urine output - :-1, 3, 6

(Q) Which type of shock is typically more difficult to identify?

A) hypotension
B) anaphylactic
C) cardiogenic
D) compensated - :-D

(Q) After supporting the airway and adequately oxygenating and ventilating a
child with a suspected opioid overdose, what is the next most appropriate
treatment?
A) perform endotracheal intubation
B) administer flumazenil
C) administer naloxone
D) perform point of car glucose testing - :-C

(Q) Low blood pressure in children is defined as a systolic blood pressure less
than the ______ percentile for age
A) fifth
B) tenth
C) fifteenth
D) twentieth - :-A

(Q) Hypotension in children is calculated as a systolic blood pressure of less than

_____ mmHg plus _____ times the age in years - :-70, 2

(Q) What are the goals in treating shock?

1. Prompt intubation
2. Prevent progression to cardiac arrest
3. Support organ function
4. Balance tissue perfusion and metabolic demand
5. Improve oxygen delivery
6. Ensure adequate analgesia and sedation - :-2, 3, 4, 5

(Q) As more time passes between the onset of signs of shock and the restoration of
adequate oxygen delivery and organ perfusion, the outcome is____
A) unknown
B) worse
C) better
D) unchanged - :-B
(Q) What is included in the treatment of shock?
A) optimizing oxygen content in the blood
B) decreasing cardiac output
C) administering vasoconstrictors
D) increasing oxygen demand - :-A

(Q) What is the preferred initial fluid for shock resuscitation?

A) hypertonic solutions
B) colloid solutions
C) isotonic crystalloids
D) dextrose-containing solutions - :-C

(Q) For general shock management, administer an isotonic crystalloid bolus of

______ mL/kg over _____ to ____ minutes - :-20
5
20

(Q) What are some common causes of hypovolemic shock?

1. Large burns
2. Severe infection
3. Respiratory distress
4. Hemorrhage
5. Osmotic diuretics - :-1, 4, 5
 (Q) What is the characteristics clinical finding associated with hypovolemic
shock?
A) bradycardia
B) brisk capillary refill
C) tachypnea
D) warm, dry skin - :-C

(Q) Hypovolemic shock refers to a clinical state of

1. Increased extravascular volume
2. Reduced extravascular volume
3. Increased intravascular volume
4. Reduced intravascular volume - :-2, 4

(Q) What is the primary therapy for hypovolemic shock?

A) administration of steroids
B) rapid administration of isotonic crystalloids
C) rapid administration of dextrose-containing fluids
D) avoiding administration of fluid overload - :-B

(Q) What could be the reason a child with hypotensive shock does not improve
after at least 3 fluid boluses?
A) the extent of fluid losses may be overestimated
B) there is persistent hyperglycemia
C) the initial assumption about the etiology may be incorrect
D) fluid resuscitation start too early - :-C
(Q) What best assesses a child's response to each fluid bolus?
1. Blood pH
2. Vital signs
3. Urinary output
4. Physical examination - :-2, 3, 4

(Q) What determines adequate fluid resuscitation in hypovolemic shock?

1. Extent of volume depletion
2. Oxygen saturation
3. Level of consciousness
4. Type of volume loss - :-1, 4

(Q) What treatment should be implemented if a child remains hemodynamically

unstable despite 2 to 3 boluses of 20 mL/kg isotonic crystalloids?
A) transfuse PRBs
B) administer a fluid bolus of a dextrose-contain solution
C) stop fluid resuscitation
D) administer colloid bolus - :-A

(Q) What should you use to begin fluid resuscitation in hemorrhagic shock?
A) dextrose containing solutions
B) packed red blood cells
C) isotonic crystalloids
D) fluid resuscitation is contraindicated in hemorrhagic shock - :-C

(Q) SCENARIO 4
Your advanced life support team is dispatched for a 7 month old infant who has
had vomiting, diarrhea, and irritability since yesterday. She appears weak and
listless. The basic life support ambulance is on scene and reports that the scene is
safe. Upon arrival, you find the infant in her mother's arms. The mother reports that
her daughter has no medical history and no known allergies
The infant is place on the ambulance stretcher and responds with a groan when
stimulated. Her vital signs are HR 173, BP 58/38, RR 60, SPO 92% and temp 97.3.
What are appropriate next steps to treat the patient?
1. Monitor heart rate, blood pressure, and pulse oximetry
2. Insert a nasopharyngeal airway
3. Monitor and support ABCs
4. Call for assistance if needed
5. Insert an oropharyngeal airway
6. Establish IV/IO access - :-1, 3,4,6

(Q) SCENARIO 4
When you evaluate the patient, you find that the lungs are clear, skin is cool and
mottled, glucose is 97 and capillary refill time is 5 seconds.
What are the warning signs that the patient is progressing from compensated shock
to hypotensive shock?
1. Warm distal extremities with normal capillary refill time
2. Increasing tachycardia
3. Strong distal pulses
4. Hypotension (late sign) - :-2, 4

(Q) SCENARIO 4
The patient still has a blood pressure of 58/38. Her condition would be classified as
_______ shock
A) compensated
B) anaphylactic
C) hypotensive
D) obstructive - :-C

(Q) SCENARIO 4
What should be included in the initial treatment for this patient?
1. Establishing IV/IO access
2. Slow fluid bolus administration
3. Intubating the infant
4. Rapid fluid bolus administration
5. Monitor and reassessing vital signs - :-1, 4

(Q) SCENARIO 4
The mother does not recall the infants most recent weight.
What is the most appropriate way to rapidly determine her weight and calculate
correct medication dosing?
A) estimate based on size
B) take her to a scale
C) measure her by using a color coded length based tape
D) call her pediatrician - :-C

(Q) SCENARIO 4
You measure the infant to be 7kg and prepare to administer a fluid bolus of what
type?
A) normal saline 20mL/kg
B) D10W 5 to 10 mL/kg
C) D25W 2 to 4 mL/kg
D) lactated ringer's 40 mL/kg - :-A

(Q) SCENARIO 4
What is the most appropriate method of delivering rapid fluid boluses to this
patient?
A) a syringe and 3way stopcock
B) a rapid infusion pumps
C) a calculated IV drop rate
D) wide open IV for 30 seconds at a time - :-A

(Q) SCENARIO 4
After the first fluid bolus is administered, the child is reassessed and her vital signs
are HR 167, BP 58/44, RR 56, and SPO 92%. her skin is still cool and pale, and
she is still lethargic and weak what should be the next intervention?
a) switch to dextrose-containing fluid
B) deliver a second fluid bonus of 20mL/kg and reassess
C) wait to see if she responds
D) increase fluid bonus - :-B

(Q) What is the most common type of distributive shock?

A) septic
B) neurogenic
C) anaphylactic
D) cardiogenic - :-A
 (Q) Septic shock often develops over ________, while anaphylactic shock may
occur over ________ - :-Hours, minutes

(Q) How does the clinical presentation of distributive shock compare with
hypovolemic shock?
A) distributive shock always presents the same as hypovolemic shock does
B) distributive shock has completely different pressing characteristics than those of
hypovolemic shock
C) distributive shock has more variable presentation than that of hypovolemic
shock
D) distributive shock presents with bradycardia while hypovolemic shock presents
with tachycardia - :-C

(Q) When is distributive shock present?

A) when there is inadequate blood flow to all tissue beds
B) when there is adequate blood flow to some tissue beds but too much to others
C) when there is excessive blood flow to all tissue beds
D) when there is inadequate blood flow to some tissue beds but too much to others
- :-D

(Q) When should vasoactive therapy be considered in managing distributive shock

A) if the diastolic pressure is high with narrow pulse pressure
B) if the child remains hypotension and poorly perfumed and no packed red blood
cells are available for administration
C) if the child remains hypotensive and poorly perfumed despite rapid bonus fluid
administration
D) after stress-dose steroids have been administered - :-C
(Q) What is the focus of the initial management of distributive shock?
1. Filing expanded dilated vascular space
2. Stopping additional fluid loss
3. Decreasing extra vascular volume
4. Expanding intravascular volume
5. Correcting hypovolemia - :-1, 4, 5

(Q) What signs distinguish anaphylactic shock from other types of shock ?
1. Angioedema (Swelling of the face, lips and tongue)
2. Anxiety and agitation
3. Respiratory distress with stridor, wheezing, or both
4. Nausea and vomiting
5. Urticaria (hives) - :-1, 3, 5

(Q) What should you use to begin fluid resuscitation in hemorrhagic shock ?
A) packed red blood cells
B) dextrose-containing solutions
C) fluid resuscitation is contraindicated in hemorrhagic shock
D) isotonic crystalloids - :-D

(Q) How soon after exposure do symptoms typically occur in anaphylactic shock?
A) days to weeks
B) seconds to minutes
C) hours to days
D) minutes to hours - :-B

(Q) In a child with anaphylactic shock, what is the most appropriate initial
treatment?
A) fluid resuscitation
B) antihistamines
C) IM epinephrine
D) corticosteroids - :-C

(Q) What are the initial assessment findings for septic shock?
1. Diarrhea
2. Fever
3. Normal, elevated, or decreased WBC
4. Bradycardia
5. Hypothermia - :-2, 3, 5

(Q) What should you evaluate to recognize septic shock?

1. Clinical signs of end-organ perfusion
2. Temperature
3. Difficulty breathing
4. Blood pressure
5. C-reactive protein
6. Heart rate
7. Systemic perfusion - :-1, 2, 4, 6, 7

(Q) For septic shock, how soon should fluid resuscitation begin?
A) within 10 to 15 minutes after recognizing shock
B) Within 15 to 30 minutes after recognizing shock
C) fluid resuscitation is contraindicated in septic shock
4) within 30 to 60 minutes after recognizing shock - :-A

(Q) When should antibiotics be administered in septic shock?

A) within the first hour
B) only if the child is unresponsive to vasoactive drugs
C) within the first 24 hours
D) only after adequate fluid resuscitation - :-A

(Q) SCENARIO 5
You are dispatched to the home of a 7 year old boy who presents with a 1 day
history of runny nose and progressive lethargy and fever. He has a decreased level
of consciousness and a rash on his trunk and legs, and his skin is hot to the touch.
The first responders report that the scene is safe, and the patient's vital signs are
HR 178, BP 61/38, RR 32, SPO 95% and temp 102.9

When you arrive at the house, the patient is sitting on the couch in the living room.
Given the status of the patient, what immediate next steps should be taken to
stabilize?
1. Establish IV/IO access
2. Monitor heart rate, blood pressure, and pulse oximetry
3. Insert an oropharyngeal airway
4. Monitor and support ABCs
5. Obtain chest x-ray - :-1,2,4
(Q) SCENARIO 5
An IV is establish. What is the next most appropriate intervention for this patient
with septic shock?
A) administer fluid bolus
B) consider medical control consult
C) initiate and ti trate vasoactive drugs
D) administer an antipyretic such as acetaminophen or ibuprofen - :-A

(Q) SCENARIO 5
In patients with septic shock, it is reasonable to administer fluid boluses in ______
aliquots with frequent assessment
A) 1-10 mL/kg
B) 30-40 mL/kg
C) 10-20mL/kg
D) 20-30 mL/kg - :-C

(Q) SCENARIO 5
Ongoing assessment of the child must be done while administering fluid boluses.
What are some of the adverse reactions that indicate you should stop rapid fluid
bolus administration?
1. Hepatomegaly
2. Mental status improvement
3. Increased urinary output
4. Respiratory distress
5. Rales - :-1, 4, 5,
(Q) SCENARIO 5
As you reassess the child after each fluid bolus, you found that shock symptoms
persist
Who should be consulted for this patient?
A) pediatrics
B) critical care
C) pharmacy
D) neurology - :-B

(Q) SCENARIO 5
What is the most appropriate vasoactive drug to use in fluid-refractory septic
shock?
A) phenylephrine
B) vasopressin
C) epinephrine or norepinephrine
D) milrinone - :-C

(Q) What are common causes of cardiogenic shock?

1. Drug toxicity
2. Congenital heart disease
3. Tension pneumothorax
4. Hypothermia
5. Myocarditis
6. Arrhythmias - :-1, 2, 5, 6,
 (Q) What assessment findings would you except to see in a child with cardiogenic
shock? - :-Heart rate - tachy
Systemic vascular resistance - high
Vasoconstriction - severe
Cardiac output - decreased

(Q) What is the recommendation for fluid bolus of isotonic crystalloids in

cardiogenic shock?
A) 5 to 10 mL/kg over 10 to 20 minutes
B) 10 to 20 mL/kg over 10 to 15 minutes
C) 20 mL/kg over 5 to 10 minutes
D) 40 mL'kg over 20 to 30 minutes - :-A

(Q) Most patients in cardiogenic shock will need inotropic support with
medications.
Which of the following could be used?
1. Milrinone
2. Norepinephrine
3. Vasopressin
4. Epinephrine - :-1, 4

(Q) What should the first rescuer arriving on scene of an unresponsive infant or
child do? (Put steps in order)
1. Check for responsiveness
2. Verify scene safety
3. Activate the emergency response system
4. Shout for help - :-2, 1, 4, 3
(Q) What are causes of obstructive shock?
1. Acute exacerbation asthma
2. Congenital heart defects
3. Pulmonary embolus
4. Cardiac tamponade
5. Cervical spine injury
6. Tension pneumothorax - :-2, 3, 4, 6

(Q) What signs are present as obstructive shock progresses?

1. Increased renal output
2. Cyanosis
3. Increased respiratory effort
4. Hypothermia
5. Signs of vascular congestion - :-2, 3, 5

(Q) Why is it important to immediately identify obstructive shock?

A) obstructive shock requires a slower fluid bolus rate
B) obstructive shock can rapidly progress to cardiopulmonary failure and then
cardiac arrest.
C) fluid resuscitation is more beneficial if administered immediately
D) treatment within the first hour is critical to prevent deterioration - :-B

(Q) What is the main objective of managing obstructive shock?

1. Restore tissue perfusion
2. Correct the cause of cardiac output obstruction
3. Monitor and evaluate basic life support
4. Assess for fluid-refractory hypotension - :-1, 2

(Q) In whom should you suspect a tension pneumothorax?

1. Any child younger than 5 years of age who is short of breath
2. Any child with known bacterial pneumonia
3. Any intubated child who deteriorates suddenly while receiving positive-pressure
ventilation
4. Victim of chest trauma
5. A child who deteriorates suddenly while receiving bag-mask ventilation - :-3, 4,
5

(Q) What is an assessment finding unique to tension pneumothorax?

A) tracheal deviation
B) rapid evolution from tachycardia to bradycardia
C) changes in level of consciousness
D) distended neck veins - :-A

(Q) What is the immediate treatment for tension pneumothorax?

A) thoracostomy for chest tube placement
B) needle decompression
C) endotracheal intubation
D) fluid bolus of 20mL/kg isotonic crystalloids - :-B

(Q) How do you know if a needle decompression is successful?

A) there is a sudden decrease in heart rate
B) there is a gush of air when the needle is placed
C) there is an immediate flash of blood when the needle is placed
D) there is a decrease in the pulse oximetry reading - :-B

(Q) What are causes of cardiac tamponade in children?

1. Tension pneumothorax
2. Infection of the pericardium
3. cardiac surgery
4. Extremely low white blood cell count
5. Penetrating trauma - :-2, 3, 5

(Q) What circulation findings are specific to pericardial tamponade?

1. Poor peripheral perfusion
2. Narrowed pulse pressure
3. Muffled or diminished heart sounds
4. Tachycardia - :-2, 3, 4

(Q) Why do children with cardiac tamponade improve temporarily with fluid
administration?
A) late phase symptoms are delayed with fluid administration
B) poor myocardial contractility is improved and pulmonary edema is minimized
with fluid administration
C) fluids will decreased cardiac output and improve hemodinámica state
D) fluids augment cardiac and tissue perfusion until pericardial drainage can be
performed - :-D
 (Q) In the setting of impending or actual púlseles arrest when there is a strong
suspicion of pericardial tamponade, what is the appropriate management?
A) packed red blood cells
B) consultation with an appropriate specialist
C) fluid bolus of 20 mL/kg over 5 to 20 minutes
D) emergency pericardiocentesis - :-D

(Q) What findings help distinguish pulmonary embolism from hypovolemic

shock?
A) systemic venous congestion and right heart failure
B) respiratory distress with increased respiratory rate and effort
C) tachycardia and hypotension
D) extremities may be cool and mottled - :-A

(Q) Pulmonary embolisms are _______ in children

A) rare
B) common
C) very common - :-A

(Q) What is the definitive treatment for most children with pulmonary embolism
who are not in shock?
A) vasodilators
B) glycoprotein IIb/IIIa inhibitors
C) anticoagulants
D) inotropic agents - :-C
 (Q) In children with severe cardiovascular compromise from pulmonary
embolism, what treatment should be considered?
A) platelet aggregation inhibitors
B) fibrinolytic agents
C) glycoprotein IIb/IIIa inhibitors
D) low-molecular weight heparin - :-B

(Q) SCENARIO 6
You are dispatched to the local elementary school for a 7 year old girl who says she
is having chest pain and difficulty breathing. During recess about 3 hours earlier,
she fell from a swing and reported right-side rib pain. When you arrive on scene,
you find the child in the nurse's office. The scene is safe
The child is awake, responsive, and anxious. Her vital signs are HR 168, BP 61/43,
RR 44 SPO 66%
What it's he initial priority in treatment for this patient?
A) intubate (by an experienced provider)
B) establish IV/IO access
C) administer oxygen (nonrebreathing mask)
D) administer oxygen (nasal cannula) - :-C

(Q) SCENARIO 6
Based on the child's blood pressure,what type of shock is the patient in?
A) hypovolemic
B) septic
C) compensated
D) hypotensive - :-D
(Q) SCENARIO 6
Auscultations the patient's lungs demonstrates clear lung sounds on the left but
absent lung sounds on the right.
What is the most likely diagnosis for this patient?
A) hypoglycemia
B) cardiac tamponade
C) tension pneumothorax
D) hypovolemia - :-C

(Q) SCENARIO 6
Treatment for tension pneumothorax should not be delayed.
Based on the child's assessment, what immediate intervention should be
performed?
A) needle decompression
B) fluid bolus
C) chest x-ray
D) pericardiocentesis - :-A

(Q) SCENARIO 6
Where should the needle be inserted for proper needle decompression?
A) left side of the chest, in the third intercostal space in the midclavicular line
B) right side of the chest, over the third rib (second intercostal space) in the
midclavicular line
C) left side of the chest, over the top of the third rib (second intercostal space) in
the midclavicular line
D) right side of the chest, between the first and second ribs in the midclavicular
line - :-B
(Q) SCENARIO 6
Needle decompression is performed on the patient. As the needle is inserted, there
is a rush of air coming from the hub of the needle. Vital signs are reassessed and
are now hR 134, BP 70/40, and SPO 82%. The patient still has labored breathing.
Her SPO does not go above 82%; lung sounds are now present but are still
diminished on the right side.
Which of the following interventions is the most appropriate to do next?
A) perform a thoracostomy for a chest tube placement
B) administer nebulizad albuterol
C) obtain a chest x-ray
D) administer 20 mL/kg normal saline or lactated ringer's bolus - :-A

(Q) SCENARIO 6
After the chest tube is inserted, the patient's breathing and oxygenation are
improved. Her vital signs are HR 98 and BP 108/72, RR 18 and normal, and SPO
98%
How should proper chest tube placement be confirmed?
A) use waveform capnograph
B) obtain a chest x-ray
C) ask the patient to breathe deeply
D) auscultaste lung sounds - :-B

(Q) Whenever a child has an abnormal heart rate or rhythm, what must be done
quickly?
A) transport the child to the emergency department or pediatric intensive care unit
B) seek expert consultation
C) contact family and collaboratively develop a plan for medical management
D) determine if the arrhythmia is causing hemodynamic instability or other signs
of deterioration - :-D

(Q) What is the priority in initially managing arrhythmias?

A) identify the underlying cause before initiating interventions
B) evaluate the potential reversible causes (H's and Ts)
C) obtain a SAMPLE medical history
D) support the airway, breathing and circulation - :-D

(Q) What is the leading cause of symptomatic bradycardia in children?

A) poor cardiac function
B) congenital abnormality
C) myocarditis
D) tissue hypoxia - :-D

(Q) How is bradycardia defined in pediatric patients?

A) a heart rate less than 80/min
B) a heart rate that is slow in comparison with a normal heart rate range for the
child's age, with signs of poor perfusion
C) a heart rate that is slow in comparison with a normal heart rate range for the
child's age, level of activity and clinical condition
D) a heart rate less than 60/min - :-C

(Q) What causes primary bradycardia?

A) no cardiac conditions that alter the normal function of the heart
B) increased cardiac output
C) medications
D) congenital or acquired heart conditions - :-D

(Q) What are the causes of secondary bradycardia?

1. Cardiomyopathy
2. Hypoxia
3. Drugs
4. Acidosis
5. Myocarditis
6. Hypothermia
7. Hypotension - :-2, 3, 4, 6, 7

(Q) What are the electrocardiographic characteristics of Bradycardia?

1. p wave and QRS complex may be unrelated
2. P waves always visible
3. prolongs PR interval
4. QRS complex may be narrow or wide
5. Heart rate slow compared with normal heart rate for age - :-1, 4, 5

(Q) In which patients would bradycardia be an expected finding and not be

considered problematic?
1. A child with hypoxia
2. A child who is hypotensive
3. A well conditioned athlete
4. A healthy child who is sleeping - :-3, 4
(Q) What is a first-degree atrioventricular block?
A) nonconduction of some of the atrial impulses to the ventrículo without any
change in the PR interval of the conduction impulses.
B) a progressive prolongation of the PR interval until an atrial impulse is not
conducted by the ventricles
C) a prolonged PR interval representing slowed conduction through the
atrioventricular node
D) non of the atrial impulses conduct to the ventricles - :-C

(Q) What is a third-degree atrioventicular block

A) a prolonged PR interval presenting slowed conduction through the
atrioventricular node
B) none of the atrial pulses conduct to the ventricles
C) non conduction of some of the atrial impulses to the ventricle without any
change in the PR interval of the conduction impulses
D) a progressive prolongation of the PR interval until an atrial impulse is not
conducted by the ventricles - :-B

(Q) What is the initial treatment for pediatric bradycardia with cardiopulmonary
compromise?
A) begin CPR
B) administer atropine
C) provide bag-mask ventilation with 100% oxygen
D) administer epinephrine - :-C

(Q) If bradycardia persists after initial treatment and the heart rate remains less
than 60/min what action should be taken out next? - :-Begin CPR
 (Q) What is the initial dose of epinephrine in the treatment of symptomatic
bradycardia?
A) 0.01 mg/kg IV/IO
B) 1mg/kg IV/IO
C) 0.01 mg/kg endotracheal
D) 1 mg/kg endotracheal - :-A

(Q) In what conditions is atropine preferred over epinephrine as the first choice
treatment of symptomatic bradycardia?
1. Persistent bradycardia despite effective oxygenation and ventilation
2. Cholinergic drug toxicity (organophosphates)
3. Atrioventricular block due to primary bradycardia
4. Atropine is not recommended as a first-choice treatment in any pediatric
bradycardia
5. Increased vagal tone - :-2, 3, 5

(Q) What is the IV/IO dose of atropine for pediatric bradycardia?

A) 0.5 mg
B) 0.04 mg/kg
C) 0.02 mg/kg
D) 1mg - :-C

(Q) SCENARIO 7
You are dispatched to respond to a 4 month old boy with difficulty breathing. You
arrive at the home and see the baby in his mother's arms. He is pale and has
mottled skin. His mother says he is very lethargic and has cold hands and feet
What should your next steps be?
1. Begin CPR
2. Apply cardiac monitor to identify rhythm and monitor pulse, Blood pressure,
and oximetry
3. Complete the initial and primary assessment
4. Obtain 12 lead ECG
5. Establish IV/IO access
6. Maintain a patent airway - :-2, 3, 6

(Q) SCENARIO 7
During the initial assessment, you find that the infant is unresponsive and has a HR
of less than 60/min
What should be your next action?
A) obtain blood glucose
B) stimulate the infant
C) being rescue breathing
D) begin CPR - :-D

(Q) SCENARIO 7
CPR has been ongoing and IV access has been established. A pulse and a rhythm
check are done. He has the heart rhythm shown here. (Bradycardia)
What intervention would be most appropriate at this time?
A) administer amiodarone
B) administer adenosine
C) perform cardioversion
D) administer epinephrine - :-D
(Q) SCENARIO 7
What is the proper dosing for epinephrine (IV/IO) administration during CPR?

_______ mg/kg IO/IV (0.1 mL/kg of 0.1 mg/mL concentration)

Repeat every______ minutes - :-0.01
3 to 5 minutes

(Q) SCENARIO 7
After 2 more minutes of CPR, you notice the patient is moving, and his skin color
improves. His vital signs are hR 114, BP 63/47, SPO 88%, spontaneous RR 8 and
temp 100.2. The fin ant is still slow to respond but is moving
What would be the next steps for this patient?
1. Continue oxygen
2. Identify and treat underlying causes
3. Support ABCs
4. Obtain expert consultation
5. Consider transthoracic pacing
6. Administer atropine - :-1, 2, 3, 4

(Q) What clinical findings may be present in a child with a tachyarrhythmia?

1. Palpitations
2. Light-headedness
3. Hypertension
4. Pyrexia
5. Syncope - :-1, 2, 5
(Q) How is tachycardia defined in pediatric patients?
A) a heart rate greater than 150/min
B) a heart rate greater than 100/min
C) a heart rate that is fast compared with the normal heart rate for the child's age
D) a heart that is fast compared with the normal heart rate for the child's age, with
signs of poor perfusion - :-C

(Q) Where do tachyarrhythmias originate?

A) only in the ventricles
B) atria or ventricles
C) only in the atria - :-B

(Q) How are tachycardia and tachyarrhythmias classified?

A) by the duration of the PR interval
B) by the presence of a p wave
C) by the width of the QRS
D) by the regularity of the R-R interval - :-C

(Q) Why does sinus tachycardia typically develop?

A) it's due to a bundle branch block
B) it is a recently mechanism
C) the body's oxygen demand is decreased
D) the body needs increased cardiac output - :-D

(Q) What is a characteristic feature of a Supraventricular tachycardia?

A) an abrupt increase in heart rate that varies with activity
B) a gradual increase in heart rate that varies with activity
C) a gradual increase in heart rate that does not vary with activity
D) an abrupt increase in heart rate that does not vary with activity - :-D

(Q) What are characteristics of atrial flutter?

1. Atrioventricular conduction is regular
2. A narrow-complex tachyarrhythmia
3. Can develop in children with congenital heart disease
4. Atrial rate can exceed 300/min and ventricular rate is slower
5. Not seen in newborn infants with normal hearts - :-2, 3, 4

(Q) What are the characteristics of ventricular tachycardia?

1. A rapid rate compromises ventricular filling
2. Atrioventricular conduction is regular
3. The rate is consistent and near normal
4. It is a wide QRS complex generated within the ventricles
5. The rapid rate may deteriorate into pulse less ventricular tachycardia or
ventricular fibrillation - :-1, 4, 5

(Q) What heart rate is consistent with sinus tachycardia?

Infant
Child - :-Less than 220/min
Less than 180/min

(Q) What history is consistent with supraventricular tachycardia?

A) symptoms of congenital heart disease
B) gradual onset
C) trauma
D) fever, pain or dehydration - :-A

(Q) What electrocardiographic characteristic is consistent with ventricular

tachycardia?
A) the R-R interval is consistent
B) the QRS complex is greater than 0.09
C) the rate is usually greater than 220/min in infants
D) the P wave is present and normal - :-B

(Q) What electrocardiographic characteristics are consistent with sinus

tachycardia?
A) P wave are often not identifiable
B) beat-to beat variability with changes in activity
C) p waves are absent or abnormal
D) no beat-to beat variability with activity - :-B

(Q) What is considered an initial management priority in managing

tachyarrhythmias?
1. Obtain consultation before initiating urgent interventions
2. Prepare for cardioversion
3. Attach a continuous electrocardiographic monitor/defibrillator and a pulse
oximetry
4. Obtain a 12 lead electrocardiogram if practical
5. Assess and support the airway, oxygenation and ventilation - :-3, 4, 5
(Q) Which signs and symptoms are consistent with sinus tachycardia?
1. Variable PR interval
2. Present and normal P waves
3. Abnormal P waves
4. Heart rate less than 220/min in an infant or less than 180/min in a child
5. Heart rate varies with activity or stimulation - :-2, 4, 5

(Q) Which signs and symptoms are consistent with supraventircular tachycardia?
1. Absent or abnormal P waves
2. Heart rate 220/min or greater in an infant or 180/min or greater in a child
3. Constant PR interval
4. Heart rate does not vary with activity or stimulation
5. Heart rate varies with activity or stimulation - :-1, 2, 4

(Q) How should sinus tachycardia be treated?

A) pharmacological and electrical interventions
B) pharmacologic interventions
C) by treating the underlying cause
D) electrical interventions - :-C

(Q) Which of the following should be considered for stable supraventricular

tachycardia?
1. Ask an older child to try to blow through an obstructed straw
2. Deliver an unsynchornized shock of 2J/kg
3. Place a bag with ice water over the upper half of the infant's face
4. Perform synchronized cardioversion at 0.5 to 1 J/kg - :-1, 3
(Q) What is the initial dose of adenosine?
A) 0.1 mg/kg IV/IO
B) 6mg IV/IO
C) 0.2 mg/kg IV/IO
D) 1mg/kg IV/IO - :-A

(Q) For stable patients with a regular wide complex, and monomorphic
tachycardia, consider
A) vagal stimulation
B) adenosine
C) synchronized cardioversion
D) 12-lead electrocardiography - :-B

(Q) If amiodarone or procainamide does not terminate the rapid rhythm, why
should adenosine be considered?
A) adenosine inhibits sodium channels, which slows conduction in the ventricles
and prolongs QRS duration
B) adenosine inhibits the outward potassium current so it prolongs the QT duration
C) tornadoes de pointes could be the underlying rhythm
D) a wide complex tachycardia could be supraventricular tachycardia with aberrant
ventricular conduction - :-D

(Q) What is the appropriate initial dose if synchronized cardioversion is needed?

A) 4 to 6 J/kg
B) 1 to 2 J/kg
C) 0.5 to 1 J/kg
D) 2 to 4 J/kg - :-C

(Q) SCENARIO 8
Your ambulance is dispatched for a 5 month old boy who has difficulty breathing,
poor feeding, and vomiting. When you arrive, the scene is safe. The infant is sitting
in a baby carrier in the living room, appears irritable, and has labored breathing.
You measure his blood pressure and SPO while attaching him to the cardiac
monitor. The patient has a HR 261, BP 72/54, RR 40 and SPO 96% and he is
crying
Your initial assessment indicates that the child is irritable and breathing rapidly.
Which of the following is the most appropriate initial intervention?
A) sit the child up
B) administer a bronchodilator
C) maintain patent airway; administer oxygen
D) ventilate by using a bag-mask device - :-C

(Q) SCENARIO 8
The patient has characteristics of supraventircular tachycardia, including a heart
rate of more than 220
How would be waves appear on ECG in a supraventricular tachycardia?
1. Present
2. Normal
3. Absent
4. Abnormal - :-3 and 4

(Q) SCENARIO 8
Vagal maneuvers are indicated for an infant with supraventricular tachycardia who
is stable, and they should be performed while preparations are being made for
administering adenosine and synchronized cardioversion (if necessary). Ice to the
face is a vagal maneuver that can be performed in infants and children of all ages.
What precautions should be taken when perform this vagal maneuver?
A) gently perform carotid sinus massage
B) use warm water
C) apply slight ocular pressure for increased response
D) do not cover the nose or mouth - :-D

(Q) SCENARIO 8
After you attempt a vagal maneuver, the infant's vital signs are HR 261 and BP
72/50, RR 46, SPO 96%. And he is crying. A 12 lead ECG was done.
What actions should be taken next
A) administer epinephrine IM
B) perform a second vagal stimulation of ice to the face
C) sit the patient up
D) administer adenosine - :-D

(Q) SCENARIO 8
You administer adenosine (0.1 mg/kg) via a rapid bolus followed by a rapid flush
of ______ normal saline
A) 1 to 3 mL
B) 5 to 10 mL
C) 100 mL
D) 20 mL/kg - :-B

(Q) SCENARIO 8
The infant does not respond to the initial dose of adenosine for SVT and now has
these vital signs HR 265 BP 72/50 RR 46 and SPO 96%
What should your next action be?
A) un synchronized cardioversion
B) repeat vagal maneuvers
C) attach a 12 lead ECG
D) administer a second does of adenosine at 0.2mg/kg (maximum second dose 12
mg) - :-D

(Q) SCENARIO 8
You administer a second dose of 0.2 mg/kg adenosine, but it does not convert the
tachycardia. The patient will require synchronized cardioversion. His weight is
6kg.
What should be the setting for the synchronized cardioversion?
A) 2J
B) 25 J
C) 6 J
D) 30J - :-C

(Q) SCENARIO 8
After synchronized cardioversion of 6J, the patient remains in supraventircular
tachycardia. A second synchronized cardioversion is ordered.
What is the recommended energy selection?
A) 12 J
B) 24 J
C) 16 J
D) 20 J - :-A
(Q) What are signs of cardiac arrest in children?
1. Responsiveness
2.Unresponsiveness
3. Pulse felt
4. Agonal gasps
5. No pulse felt - :-2, 4, 5

(Q) The most common cause of cardiac arrest in infants, children, and adolescents
is ________, which is the end result of progressive hypoxia and acidosis
A) sudden cardiac arrest
B) hypoxic/asphyxial arrest - :-B

(Q) What are the most common initial rhythms in both in-hospital and out of
hospital pediatric cardiac arrest, especially in children younger than 12 year?
1. PEA
2. Asystole
3, pVT
4. VF - :-1, 2

(Q) When ______ is present, the heart has no organized rhythm and no
coordinated contractions
A) PEA
b) VF - :-B

(Q) When treating persistent VF/pVT during cardiac arrest, administer epinephrine
A) every 8 to 10 minutes
B) every 1 to 3 minutes
C) every 5 to 7 minutes
D) every 3 to 5 minutes - :-D

(Q) What are initial steps of treating asystole/PEA?

1. Administer epinephrine
2. Provide CPR
3. Deliver 1 shock
4. Considered advanced airway
5. Establish IV/IO access - :-1, 2, 4, 5

(Q) What are the initial steps of the VF/pVT pathway of the pediatric cardiac
arrest algorithm?
1. Consider capnography
2. Perform CPR
3. Deliver 1 shock
4. Establish IV/IO access - :-2, 3, 4

(Q) What does optimal post-cardiac arrest care include?

A) identifying the specific underlying cause
B) invasive monitoring
C) identifying and treating organ system dysfunction
D) ensuring hemodynamic instability - :-C

(Q) What is considered part of post-cardiac arrest care?

1. Avoiding hypoxia
2. Providing adequate oxygenation and ventilation
3. Avoiding Hypertension
4. Ensuring adequate analgesia and sedation
5. Correcting acid-base electrolyte imbalances - :-2, 4, 5

(Q) What is included in the first phase of post-cardiac arrest management?

A) continued advanced life support for immediate life threatening conditions
B) targeted temperature management
C) stabilization of child's condition
D) coordinating transfer to tertiary care setting - :-A

(Q) What is included in the second phase of post-cardiac arrest management?

A) assess and mía tina adequate blood pressure and perfusion
B) use diagnostic equipment and assessments
C) assess and support the airway, oxygenation and ventilation
D) provide broad multi organ supportive care - :-D

(Q) How should appropriate endotracheal tube placement be confirmed?

A) end tidal carbon dioxide or capnography
B) chest rise and fall
C) bilateral breath sounds
D) chest x-ray - :-A