PALS 2025 Questions with 100% Correct Answers | Verified | Latest Update, Exams of Advanced Education

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PALS 2025 Questions with 100% Correct

Answers | Verified | Latest Update

Which pulses should be assessed to monitor systemic perfusion in a child? - Correct Answer-peripheral and central What should the first rescuer arriving on the scene of an unresponsive infant or child do? (in order) - Correct Answer-1. verify scene safety

2. check for responsiveness
3. shout for help
4. activate the emergency response system Why may excessive ventilation during CPR be harmful? - Correct Answer-- it increases intrathoracic pressure

• it impedes venous return If you cannot achieve effective ventilation (ie, the chest does not rise), do the following: - Correct Answer-- reposition/reopen the airway (sniffing position)
• verify mask size and ensure a tight face-mask seal
• suction the airway if needed
• check the O2 source
• check the ventilation bag and mask
• treat gastric inflation (NG/OG)
• consider 2-person bag-mask ventilation and inserting an OPA Ventilation rate - Correct Answer-1 breath every 2-3 seconds delivered over 1 second (20-30 breaths per minute) Early signs of tissue hypoxia - Correct Answer-- tachypnea
• increased respiratory effort (nasal flaring, retractions)
• tachycardia
• pallor, mottling, cyanosis
• agitation, anxiety, irritability Late signs of tissue hypoxia - Correct Answer-- bradypnea, inadequate respiratory effort, apnea
• increased respiratory effort (head bobbing, seesaw respirations, grunting)
• bradycardia
• pallor, mottling, cyanosis
• decreased level of consciousness What is the role of the diaphragm during normal breathing in infants? - Correct Answer- pulls the ribs slightly inward

S/S mild respiratory distress - Correct Answer-- mild tachypnea

• mild increase in respiratory effort (nasal flaring, retractions)
• abnormal airway sounds (stridor, wheezing, grunting) S/S Severe respiratory distress - Correct Answer-- marked tachypnea
• marked increase in respiratory effort
• paradoxical throacoabdominal breathing (seesaw breathing)
• accessory muscle use (head bobbing)
• abnormal airway sounds (grunting)
• decreased level of consciousness S/S Impending respiratory arrest - Correct Answer-- bradypnea, apnea, respiratory pauses
• low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen
• inadequate respiratory effort (shallow respirations)
• decreased level of consciousness (unresponsive)
• bradycardia What steps should be taken as part of initial management of a child in respiratory distress? - Correct Answer-- monitor O2 sat by pulse ox
• monitor HR, rhythm, and, BP
• support an open airway Stridor - Correct Answer-high-pitched breathing during inspirations Crackles - Correct Answer-breath sounds heart during expirations How should 1-rescuer infant compressions be delivered? - Correct Answer-- two fingers or two thumbs
• rate of 100-
• single rescuer (30:2)
• two rescuer (15:2) How should 1-rescurer child compressions be delivered? - Correct Answer-either one or two hands
• compress at least 1/3 the chest diameter (approximately 2 inches) Guidelines for rescue breathing for infants and children - Correct Answer-- give 1 breath every 2-3 seconds (about 20-30/min)
• given each breath in 1 second
• visible chest rise
• check pulse every 2 minutes
• use oxygen as soon as it is available

2-person bag mask ventilation may be necessary when: - Correct Answer-- making a seal is difficult

• the provider's hands are too small
• significant airway resistance (asthma) or poor lung compliance)
• restricting spinal motion is necessary Best position to maintain an open airway - Correct Answer-- infant: place padding underneath shoulders
• child: place padding underneath occiput Evaluate-Identify-Intervene Sequence - Correct Answer-evaluate (primary assessment, secondary assessment, diagnostic assessment) Evaluate - Primary Assessment - Correct Answer-a rapid hands-on ABCDE approach to evaluate respiratory, cardiac, and neurologic function; includes assessment of vital signs and pulse ox Evaluate - Secondary Assessment - Correct Answer-a focused medical history and focused physical exam Evaluate - Diagnostic Assessment - Correct Answer-laboratory, radiographic, and other advanced tests that help to identify the child's physiologic condition and diagnosis The evaluate-identify-intervene sequence should be continued until - Correct Answer- the child is stable Flow rate for pediatric nebulizer - Correct Answer-5-6 L/min Causes of upper airway obstruction - Correct Answer-- foreign body aspiration
• airway swelling (anaphylaxis, tonsillar hypertrophy, coup, epiglottitis)
• masses
• thick secretion
• congenital airway abnormality
• poor control of upper airway due to decreased level of consciousness S/S of Upper Airway Obstruction - Correct Answer-- stridor
• hoarseness
• change in voice or cry
• inspiratory retractions
• use of accessory muscles
• nasal flaring
• increased respiratory rate and effort
• drooling, snoring, gurgling sounds
• poor chest rise

What is chest compression fraction? - Correct Answer-the proportion of time that chest compressions are performed during a cardiac arrest Mild Croup - Correct Answer-S/S:

• occasional barking cough
• little or no stridor at rest
• absent or mild retractions treatment:
• consider dexamethasone Moderate Croup - Correct Answer-S/S:
• frequent barking cough
• easily audible stridor at rest
• retractions at rest
• little or no agitation
• good air entry in the peripheral lung fields treatment:
• administer humidified O
• NPO
• administer nebulized epinephrine (observe for 2 hours after)
• administer dexamethasone
• consider using heliox Severe Croup - Correct Answer-S/S:
• frequent barking cough
• prominent inspiratory and occasional expiratory stridor
• marked retractions
• significant agitation
• decreased air entry by auscultating the lungs treatment:
• administer humidified O
• NPO
• administer nebulized epinephrine (observe for 2 hours after)
• administer dexamethasone
• consider using heliox Severe Croup Treatment - Correct Answer-- administer high concentration of O (nonrebreather)
• administer dexamethasone
• provide assisted ventilation
• perform ET intubation (use a half size smaller than predicted for the childs age ET tube)
• prepare for surgical airway if needed

Mild allergic reaction interventions - Correct Answer-- remove the offending agent

• get help
• ask the child/caregiver about history of allergy
• look for a medical alert bracelet or necklace
• consider an oral dose of antihistamine Moderate to severe allergic reaction interventions - Correct Answer-- administer IM epinephrine every 10-15 minutes as needed, repeat doses as needed
• treat bronchospasm (wheezing) with albuterol MDI or neb
• give continuous nebulization if indicated
• for severe respiratory distress anticipate airway spelling and prepare for intubation to treat hypotension:
• place supine
• methylprednisolone IV
• diphenhydramine IV
• administer isotonic crystalloid 20ml/kg bolus repeat as needed
• if unresponsive to fluid administer epinephrine gtt Mild Asthma - Correct Answer-S/S:
• talks in sentences
• increased RR
• moderate end expiratory wheezing
• pulse less than 100
• SpO2 on room air >95% treatment:
• administer humidified O
• administer MDI or neb albuterol
• administer oral corticosteroids Moderate Asthma - Correct Answer-S/S:
• talks in phrases
• increased RR
• accessory muscle use with retractions
• loud wheeze
• pulse 100-
• pulsus paradoxus may be present
• SpO2 on room air 91-95% treatment:
• administer humidified O
• administer MDI or neb albuterol
• administer oral corticosteroids

Severe Asthma - Correct Answer-S/S:

• talks in single words
• usually agitated
• accessory muscle use and retractions
• usually loud wheezing
• pulse >
• pulsus paradoxus often present
• SpO2 on room air <90% treatment:
• administer O
• administer albuterol MID or neb
• administer ipratropium neb
• administer IV/PO corticosteroids
• consider mag bolus over 15-30min Asthma progressing to imminent respiratory arrest - Correct Answer-S/S:
• drowsy or confused
• paradoxical thoracoabdominal movement
• absence of wheeze
• bradycardia
• respiratory muscle fatigue treatment:
• admin O
• continuous albuterol neb
• IV corticosteroid
• terbutaline
• bilevel positive airway pressure
• intubate for refractory hypoxemia and worsening clinical condition Lung Tissue Disease - Correct Answer-- involves the parenchyma or tissue of the lung
• the lungs become stiff because of fluid accumulation in the alveoli and or interstitium causes:
• pneumonia
• pulmonary contusion (trauma)
• allergic reaction
• toxins
• vasculitis
• infiltrative disease treatment:

Disordered Control of Breathing - Correct Answer-increased ICP

treatment:

• verify open/patent airway, adequate oxygenation, and adequate ventilation
• administer 20ml/kg IV isotonic crystalloid
• administer pharamacological therapy (osmotic agent, hypertonic saline)
• treat agitation and pain aggressively
• avoid hypotension
• avoid and aggressively treat fever