PALS exam -with 100% verified solutions 2024-2025, Exams of Nursing

Download PALS exam -with 100% verified solutions 2024-2025 and more Exams Nursing in PDF only on Docsity! PALS exam -with 100% verified solutions 2024-2025 You are caring for a child who was resuscitated after a drowning event. The child is intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and the central pulses are weak. Intravenous access has been established. The core temperature is 37.3ºC. Based on the PALS bradycardia algorithm, which of the following should be provided first? a) Epinephrine IV b) Transcutaneous pacing c) Atropine IV d) Dobutamine IV infusion a) Epinephrine IV You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not palpable. Which of the following would be the best treatment to provide without delay? a) Place cold packs on the distal upper and lower extremities b) Ask the child to blow through a small straw c) Exert light pressure on the eyes bilaterally d) Provide synchronized cardioversion at 0.5 to 1 J/kg d) Provide synchronized cardioversion at 0.5 to 1 J/kg You are initiating treatment for a child with septic shock and hypotension. While administering high-flow oxygen you determine that the child's respirations are adequate and SpO2 is 100%. You have just established vascular access and obtained blood samples. Which of the following is the next most appropriate therapy to support systemic perfusion? a) Administer repeated fluid boluses of isotonic colloid b) Administer repeated fluid boluses of isotonic crystalloid c) Begin immediate dopamine infusion d) Begin immediate dobutamine infusion b) Administer repeated fluid boluses of isotonic crystalloid You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion. You attempted synchronized cardioversion without success. While seeking expert consultation, it would be most appropriate to: a) Administer a loading dose of milrinone b) Consider possible metabolic and toxicologic causes c) Initiate overdrive pacing transcutaneously d) Deliver an unsynchronized shock b) Consider possible metabolic and toxicologic causes You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical ventilation. The child's heart rate suddenly drops to 40/min and his color becomes mottled. You should respond to these changes by: a) Increasing the ventilator rate b) Increasing tidal volume c) Increasing positive end-expiratory pressure (PEEP) d) Using a resuscitation bag provide manual ventilation with 100% oxygen d) Using a resuscitation bag provide manual ventilation with 100% oxygen You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated high-flow oxygen using a nonrebreathing mask about 10 minutes ago and established intravenous access. Initially the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's respiratory rate falls to 6/min with significant intercostals retractions, and little air movement is heard. The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the following treatments would be best for you to provide now? a) Administer epinephrine IV You are treating a 10-year-old patient after a motor vehicle crash. The patient is unresponsive and flexes his arms at the elbow in response to a painful stimulus. An endotracheal tube is in place with position confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an SPO2 of 95% and good chest excursion bilaterally. The blood pressure is 130/70 mmHg, and the heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time? a) Obtain a CT scan of the head and neck b) Begin manual hyperventilation c) Provide continuous positive airway pressure d) Give an intravenous bolus of mannitol a) Obtain a CT scan of the head and neck You arrive on the scene of a 12-year-old child who suddenly collapsed on the playground. The child is unresponsive, apneic, and pulseless and CPR is in progress. A lay rescuer just brought the school AED, turned it on, and attached it. The AED recommends a shock. Which of the following should be done next? a) Obtain intravenous access b) Attempt defibrillation c) Change compressions:ventilations from 30:2 to 15:2 d) Attempt endotracheal intubation b) Attempt defibrillation You are caring for a child in persistent ventricular fibrillation. Which of the following would best describe the child's cardiac condition? a) The heart is not pumping blood at all b) The heart is beating too slowly to maintain circulation c) There is no electrical activity in the heart d) The heart is pumping so fast that it cannot fill completely between beats a) The heart is not pumping blood at all You are called to treat a 5-year-old with a 3-day history of worsening respiratory distress. The child responds only to pain. The heart rate is initially 45/min and regular with poor capillary refill. You provide bag-mask ventilations (BMV) with high-flow oxygen that produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for you to do first? a) Perform transcutaneous pacing b) Administer epinephrine IV c) Administer atropine IV d) Resume bag-mask ventilation d) Resume bag-mask ventilation You are caring for an 8-month-old with bradycardia and very poor perfusion that has persisted despite effective ventilations with high-flow oxygen. You should begin chest compressions if the heart rate is: a) More than 200/min b) More than 150/min c) Less than 100/min d) Less than 60/min d) Less than 60/min You are caring for a 2-year-old with a 1-day history of respiratory distress and stridor. The patient is alert. The child's respiratory rate is 32/min with good chest rise. SPO2 is 98% in room air. The heart rate is 128/min and capillary refill is normal. Skin is warm, pink, and dry. At this point you should: a) Assist ventilations with bag-mask device b) Use a nonrebreathing mask with tight mask seal c) Keep the patient calm and comfortable d) Give IV methylprednisolone (Solumedrol) c) Keep the patient calm and comfortable You are caring for a 7-year-old with respiratory distress that has worsened over the past few hours. The child is alert and in moderate respiratory distress with prolonged exhalation time. The respiratory rate is 28/min with bilateral expiratory wheezes. The heart rate is 112/min with good capillary refill. The wheezing in this patient indicates: a) Lung tissue (parenchymal) lung disease b) Disordered control of breathing c) Upper airway obstruction d) Lower airway obstruction d) Lower airway obstruction Which of the following assessments is most useful in evaluating the effectiveness of bag-mask ventilations? disorder control of breathing unorganized pattern of breathing; can mimic trauma (think seizures) if a child is lethargic check the blood glucose BLS before ALS dual-response CPR ratio 15:2 single-response CPR ratio 30:2 SpO2 goal for pediatrics 94-99% after shocking the pediatric patient, get back on the chest compressions joules defibrillation dosages 2J/kg, 4J/kg, 6J/kg, 8J/kg (start with the lowest setting and increase, never decrease) cardioversion rates 0.5-1.0 J/kg followed by 2 J/kg hypotension in the pediatric patient is indicative of hypovolemic shock acute respiratory distress lung tissue disease where the tissues are broken down and turned into fluids (will hear rales) IV access in pediatrics cardiac arrest go straight to IO rates of SVT > 220 in infants > 180 in pediatrics treatment for an unstable tachycardic dysrhythmia cardioversion stridor is indicative of an upper airway obstruction grunting in a pediatric patient the patient is attempting to "PEEP" himself by grunting at the end of expiration (not good!) what is a good indicator for the pediatric patient's compensation? blood pressure if a patient's heart rate is below 60 in a pediatric patient, start CPR pediatric AVPU scale A - awake V - responds to verbal P - responds to painful