PALS Final Exam

A 10-year-old child has collapsed in the gym of the elementary school. The school nurse arrives
and determines that the child is unresponsive. The school nurse then simultaneously checks for
breathing and a central pulse, limiting this assessment to which time frame? - ANS-No more
than 10 seconds

A 12-year-old child being evaluated in the pediatric intensive care unit displays the following
ECG waveform. The team interprets this as which arrhythmia? - ANS-Second-degree
atrioventricular (AV) block, type I

A 12-year-old is being treated in the urgent care clinic. The mother reports that the child came
home from school yesterday with a high fever, vomiting and multiple episodes of watery
diarrhea. The healthcare provider obtains a rhythm strip and notes the following waveform. The
provider interprets this as which type of arrhythmia? - ANS-Sinus tachycardia

A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme
disease 2 months ago. A rhythm strip is obtained as shown below. The provider interprets this
rhythm as indicating which arrhythmia? - ANS-First-degree atrioventricular (AV) block

A 2-year-old child arrives at the emergency department with the parents. The child is
unresponsive, is not breathing and has no pulse. Two emergency department providers begin
high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR? -
ANS-Compressing the chest about 2 inches
Providing ventilations that last about 1 second each
Giving 2 ventilations to every 15 compressions
Allowing the chest to recoil fully after each compression

A 2-year-old child is brought to the pediatric urgent care clinic by the parent who says that the
child has had a barking cough for two days. During the rapid assessment of the child, the
provider hears audible inspiratory stridor. Which common cause of partial upper airway
obstruction in children would the provider most likely suspect? - ANS-Croup

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

A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the
provider administer? - ANS-Nebulized epinephrine
Corticosteroids
A 4-year-old child is brought to the emergency department by the parents. Assessment reveals
that the child has only gasping respirations and the pulse rate is 65 beats per minute. Which
action would the provider initiate first? - ANS-Deliver 1 BVM ventilation every 2 to 3 seconds.

A 4-year-old child suddenly collapses in the playroom of the facility. A healthcare provider
observes the event and hurries over to assess the child. The healthcare provider completes
which assessment first? - ANS-Rapid assessment

A 4-year-old patient presents with tachycardia, tachypnea, cold extremities and weak pulses.
Assessment also reveals an enlarged liver and neck vein distension. The provider interprets
these assessment findings as suggesting which type of shock? - ANS-Cardiogenic

A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory

distress. The child is breathing spontaneously and receiving supplemental oxygen. Which
additional intervention is a critical component of airway management for this patient? -
ANS-Airway clearance (e.g., suctioning)

A 6-year-old child is brought to the emergency department. The child has been experiencing
extremely watery stools over the past several days. After completing the assessment, the
healthcare provider suspects that the child may be experiencing shock. Which type of shock
would the provider most likely suspect? - ANS-Hypovolemia

A 6-year-old patient is brought to the emergency department after a bicycle accident.

Assessment reveals chest pain on inspiration, diminished breath sounds on the right side, and
respiratory distress. The provider suspects obstructive shock caused by what condition? -
ANS-Tension pneumothorax

A 7-year-old child collapses on the playground at school. The school nurse is called to the
scene and determines that the child is unresponsive and is not breathing and has no pulse. The
nurse initiates CPR. At what rate and depth would the nurse deliver compressions to this child?
- ANS-100 to 120 compressions per minute at a depth of about 2 inches

A 7-year-old patient with septic shock has received three balanced/buffered crystalloid fluid
boluses (60-mL/kg) and reassessment reveals capillary refill of 3 seconds, diminished pulses,
narrow pulse pressure and cool, mottled extremities. The emergency response team interprets
these findings as indicating which type of septic shock? - ANS-Fluid-refractory

A 9-year-old child is brought to the emergency department because the child suddenly
collapsed at school. The child's ECG reveals the following waveform, and primary assessment
findings indicate that the child has inadequate perfusion. Which primary assessment findings
indicate this? - ANS-Signs of shock
Acutely altered mental status
Hypotension
A 9-year-old patient is presenting with diminished breath sounds, bradycardia, slowed
respiratory rate and a low O2 saturation level. The provider interprets these findings as
indicating which condition? - ANS-Respiratory failure

A child being cared for in the pediatric telemetry unit suddenly displays the following ECG
waveform. The provider prepares to intervene because the child is demonstrating which type of
arrhythmia? - ANS-Supraventricular tachycardia

A child exhibiting a narrow-complex tachycardia with adequate perfusion is to receive

adenosine. The provider would be alert for which result after administering this medication? -
ANS-Transient asystole

A child experiencing bradycardia with inadequate perfusion despite supporting oxygenation and
ventilation is receiving compressions. Despite these efforts, the child's status remains
unchanged. Which medication would the emergency response team expect to administer next?
- ANS-Epinephrine

A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of
post-cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is
experiencing a systemic response to ischemia/reperfusion. The team bases this determination
on which finding(s)? - ANS-Hypotension
Fever
Hyperglycemia

A child in the pediatric intensive care unit displays the following ECG waveform. The child has
no pulse. The resuscitation team interprets this as which arrhythmia? - ANS-Monomorphic
pulseless ventricular tachycardia

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

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

A child is experiencing supraventricular tachycardia (SVT) with adequate perfusion and is to

receive treatment. Which initial treatment would the provider administer? - ANS-Vagal
maneuvers

A healthcare provider is performing a primary assessment of a child in respiratory distress. The

provider documents increased work of breathing when which findings are observed? -
ANS-Nasal flaring
Intercostal, substernal or suprasternal retractions
Accessory muscle use

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

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

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

A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals
difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal
cannula with the goal of improving the child's oxygen saturation to what percentage range? -
ANS-94% to 99%

A provider is forming an initial impression of a child using the Pediatric Assessment Triangle
(PAT). For which part of the PAT may the provider use the mnemonic TICLS to assess the
patient? - ANS-Appearance

After ROSC, a child is experiencing post-cardiac arrest hypoperfusion. The PALS resuscitation
team would administer which element to restore intravascular volume and optimize preload? -
ANS-Isotonic fluid boluses

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

An 11-year-old soccer player is brought to the emergency department. After a quick

assessment, the team realizes this patient is experiencing a severe asthma exacerbation.
Which medication would the team administer immediately? - ANS-Albuterol with or without
ipratropium bromide

An 8-year-old child being treated in the emergency department has significant respiratory
distress. The child also exhibits hives, wheezing, angioedema, tachycardia and dyspnea. The
parents state that the child, who is allergic to peanuts, had eaten some popcorn that had
peanuts in it. The team initiates care, preparing to administer which agent first? -
ANS-Epinephrine
An advanced airway was placed in a 5-year-old child. Which action(s) would be most
appropriate for the team to take to confirm correct placement? - ANS-Auscultate over the lungs
and epigastrium for air movement.
Observe for bilateral chest rise.
Evaluate results of capnography.

An unresponsive 7-year-old child with no pulse is brought to the pediatric urgent care center by
his parents and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action
would the PALS team take first? - ANS-Initiate defibrillation with 2 J/kg.

Assessment of a 3-month-old infant admitted with respiratory distress reveals fever, grunting
and a wet, "junky" cough. The infant's parents said the child had a recent respiratory infection
with a fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the
provider most likely suspect as the cause? - ANS-Bronchiolitis

Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic,
tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of
perfusion and oxygen delivery? - ANS-Lactate

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

The emergency response team is providing care to a preschooler who is experiencing shock.
The primary goal, common to all types of shock, is to restore a favorable balance between
tissue perfusion and metabolic demand with a focus on what? - ANS-Oxygen delivery and
oxygen demand

The PALS resuscitation team is providing care to an intubated child in cardiac arrest. Which of
the following can be used to monitor the adequacy of the team's chest compressions? -
ANS-End-tidal carbon dioxide levels
Presence of an arterial waveform or arterial blood pressure in patients with indwelling arterial
catheters

The PALS resuscitation team notes the following ECG waveform and the child does not have a
pulse. The team prepares to intervene to address which arrhythmia? - ANS-Torsades de pointes

The PALS team is providing post-cardiac arrest care to an 8-year-old child in the pediatric
intensive care unit. Which intervention would the team implement to achieve the primary goal of
post-cardiac arrest care, after assuring adequate oxygenation and ventilation? - ANS-Ensure
adequate mean arterial pressure.
The PALS team leader is conducting a debriefing session with the team. Which topic(s) would
the team leader most likely address during the session? - ANS-Discussion of the pros and cons
of the interventionsEvaluation of the objective data gathered during the event, Summary of the
event, including what actions were taken, Identification of ways to improve

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

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

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

While performing a rapid assessment and formulating an initial impression using the Pediatric
Assessment Triangle (PAT), the provider assesses the child's circulation. Which information
would be important to consider? - ANS-Flushing of the skin
Evidence of bleeding
Skin pallor (or gray/dusky color)