PALS Final Exams | 5 Different Versions for 2023 and 2024, Exams of Nursing

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breathing. Grunting and inspiratory stridor are abnormal breath sounds. suprasternal retractions are all indicators of increased work or effort of

PALS Final Exams | 5 Different Versions for 2023

and 2024 | Each Version has all 50 Questions and

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PALS Final Exam 1

1. 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 first? Albuterol plus ipratropium bromid
2. A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present? Pallor is a circulation finding that may be seen in patients with respiratory Distress.
3. 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? cardio

4. 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? 5 seconds, but no more than 10.

5. 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? Supraventricular tachycardia
6. 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? Nasal flaring, use of accessory muscles to breathe and intercostal, substernal or
7. An 11 - year-old child develops unstable wide-complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention?

hemodynamic compromis synchronized electrical cardioversion, particularly when signs of First-line treatment for unstable wide-complex tachycardias consists of e are apparent.

8. A 4-month old infant is brought to the emergency department in cardiac arrest. Which condition would the team identify as the most common cause of cardiac arrest in an infant of this age? Sudden infant death syndrome
9. 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? second degree 10.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 oxygen delivery? Lactate 11.A 9 - year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition? Respiratory failure 12.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? Deliver 1 BVM ventilation every 3 to 5 seconds. 13.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? First-degree atrioventricular (AV) block
10. 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)? Hypotension Fever

oxygen delivery and oxygen demand. balance between tissue perfusion and metabolic demand with a focus on

17. 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? croup
18. 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? hypovolemic
19. 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? When assessing the adequacy of circulation, consider skin color and visible mucous membranes for pallor (or gray/dusky color), cyanosis, mottling or flushing and evidence of any bleeding, including life-threatening bleeding.
20. 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? bronchiolitis
21. 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? torsades
22. 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? The primary goal in shock, regardless of cause, is to restore a favorable

level. gasses, coagulation panel, renal function tests, liver function panel and lactat testing for the child in septic shock may include CBC, blood cultures, bl and cool, mottled extremities) instead of warm shock Most children in septic shock present with cold shock (i.e., delayed capillary refill, diminished pulses, peripheral vasoconstriction, narrow pulse pressure,

26. The PALS resuscitation team is providing care to an intubated child in cardiac arrest. Which result best determines the adequacy of the team's chest compressions? End-tidal carbon dioxide level between 15 and 20 mmHg
27. 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?
28. Assessment of a 7 - year-old patient with septic shock 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? .
29. Primary assessment of a 10 - year-old child reveals septic shock. As part of the secondary assessment, laboratory testing is completed to evaluate the child's status. Which laboratory tests would be ordered for this child? Laboratory ood e
30. A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals tracheal deviation to the left side, chest pain on inspiration and decreased breath sounds on the right side. The provider suspects obstructive shock caused by what condition? tension pneumothorax
31. A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer? vagal
32. 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? initiate defibrillation with 2 J/kg. Evaluation of the objective data gathered during the event pros and cons of the interventions, Identification of ways to improve, Summary of the event, including what actions were taken, Discussion of the

placing the electrodes on the child, at which location would the lead for V4 be placed? fifth intercostal space at the midclavicular line on the patient's left side.

41. 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? 100 to 120 compressions per minute at a depth of about 2 inch
42. Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient? Maintain the head in midline position with 30 - degree elevation
43. child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)? Hypotension, Bradycardia, Diminished central pulses
44. A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer? Corticosteroids, Racemic epinephrine
45. After ROSC, a child is experiencing post-cardiac arrest hemodynamic instability. The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload? Isotonic fluid boluses
46. 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? Airway clearance
47. A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). During which step of the PAT may the provider use the mnemonic TICLS to assess the patient? appearance
48. 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 Monomorphic pulseless ventricular tachycardia
49. A child experiencing unstable bradycardia is receiving CPR. Despite efforts

with CPR, including assuring oxygenation and ventilation, the child's status remains unchanged. Which medication would the emergency response team expect to administer next? epi

50. 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? Rapid

PALS Final Exam 2

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? ----Correct Answer------Airway clearance (e.g., suctioning) 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? ----Correct Answer------Supraventricular tachycardia 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)? ----Correct Answer------Hypotension, fever, hyperglycemia 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? ----Correct Answer------ Albuterol with or without ipratropium bromide 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? ----Correct Answer------Isotonic fluid boluses 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? ----Correct Answer------Estimate weight using a length-based resuscitation tape. 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? ----Correct Answer------Deliver 1 BVM ventilation every 2 to 3 seconds.

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? ----Correct Answer------First-degree atrioventricular (AV) block 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? ----Correct Answer------Nasal flaring Intercostal, substernal or suprasternal retractions Accessory muscle use 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? ----Correct Answer------Cardiogenic 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? ----Correct Answer------ Hypovolemic A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)? ----Correct Answer------ Bradycardia Diminished central pulses Hypotension 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? ----Correct Answer------Complete blood count (CBC) Lactate level Blood cultures 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? ----Correct Answer------No more than 10 seconds 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? ----Correct Answer------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

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? ----Correct Answer------Oxygen delivery and oxygen demand 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? ----Correct Answer------Respiratory failure An 11-year-old child develops ventricular tachycardia with a pulse with inadequate perfusion. The PALS team would prepare the child for which intervention? ----Correct Answer------Synchronized electrical cardioversion A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate? ----Correct Answer------pVT, VF 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? ----Correct Answer------Lactate 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? ---- Correct Answer------Ensure adequate mean arterial pressure. 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? ----Correct Answer------Appearance 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? ----Correct Answer-- ----Croup 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? ----Correct Answer------Rapid assessment 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? ----Correct Answer---- --Sinus tachycardia 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? ----Correct Answer------Tension pneumothorax 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

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? ----Correct Answer------Signs of shock Acutely altered mental status Hypotension 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? ----Correct Answer------ Auscultate over the lungs and epigastrium for air movement. Observe for bilateral chest rise. Evaluate results of capnography. Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient? ----Correct Answer------Maintain the head in midline position. PALS Final Exam 3

1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry? A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be administered C. Unreliable; no supplementary oxygen is indicated D. Unreliable; supplementary oxygen should be administered -----Correct Answer----- Unreliable; supplementary oxygen should be administered
2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child's most likely condition? A. Septic shock B. Hypovolemic shock C. Significant bradycardia D. Cardiogenic shock -----Correct Answer-----Septic shock
3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is 55/40 mm Hg. What term describes this infant's blood pressure? A. Hypotensive B. Normal C. Hypertensive D. Compensated -----Correct Answer-----Hypotensive

4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mg/kg to be given 10. What should the team member do? A. Administer the drug as ordered B. Administer 0.01 mg/kg of epinephrine C. Respectfully ask the team leader to clarify the dose D. Refuse to administer the drug -----Correct Answer-----Respectfully ask the team leader to clarify the dose
5. Which of the following is a characteristic of respiratory failure? A. Inadequate oxygenation and/or ventilation B. Hypotension C. An increase in serum pH (alkalosis) D. Abnormal respiratory sounds -----Correct Answer-----Inadequate oxygenation and/or ventilation
6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing? A. Disordered control of breathing B. Hypovolemic shock C. Lower airway obstruction D. Upper airway obstruction -----Correct Answer-----Lower airway obstruction
7. A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a few minutes ago. Which of the following most likely to be abnormal? A. Vascular resistance B. Pulse rate C. Lung compliance D. Control of breathing -----Correct Answer-----Control of breathing
8. What abnormality is most likely to be present in children with acute respiratory distress caused by lung tissue disease? A. Decreased oxygen saturation B. Stridor C. Normal respiratory rate D. Decreased respiratory effort -----Correct Answer-----Decreased oxygen saturation
9. An alert 2-year-old child with an increased work of breathing and pink color is being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this patient's condition? A. Respiratory distress B. Respiratory arrest C. Respiratory failure D. Disordered control of breathing -----Correct Answer-----Respiratory distress
10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the following: The child is difficult to arouse, with pale color. The child's heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the most appropriate intervention? A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes

16. A 4-year-old is being treated for hypovolemic shock and has received a single fluid bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4 seconds. What describes this patient's condition? A. Hypotensive shock B. Compensated shock C. No longer in shock D. Cardiogenic shock -----Correct Answer-----Compensated shock
17. An 8-year-old child had a sudden onset of palpitations and light-headedness. At the time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted. What is the most appropriate initial intervention? A. Provide synchronized cardioversion at 0.5 to 1 J/kg B. Attempt vagal maneuvers C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone 5 mg/kg over 20 minutes -----Correct Answer-----Attempt vagal maneuvers
18. A 10-year-old child had a sudden witnessed cardiac arrest and received immediate bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous circulation. The child remains unresponsive and has an advanced airway in place. There is no history of trauma or signs of shock. What is the target range for oxygen saturation for this child? A. 92% to 100% B. 92% to 99% C. 94% to 99% D. 94% to 100% -----Correct Answer-----94% to 99%
19. A 3 - month-old infant with bronchiolitis is suctioned to remove upper airway secretions. The infant's heart rate decreases from 155/min to 65/min as shown below. The infant remains alert, with easily palpable pulses. Capillary refill time is 1 second. What is the most appropriate initial intervention? A. Administer oxygen and ensure adequate ventilation; be prepared to intervene further if heart rate does not increase B. Establish IV/IO access and administer epinephrine 0.01 mg/kg IV C. Establish IV/IO access and administer atropine 0.02 mg/kg IV D. Call for help and prepare to provide transthoracic pacing/transvenous pacing ----- Correct Answer-----Administer oxygen and ensure adequate ventilation; be prepared to intervene further if heart rate
20. A 3-month-old infant with bronchiolitis is intubated for management of respiratory failure. During transport, the infant develops bradycardia with a heart rate of 60/min, and the infant's oxygen saturation decreases to 75%. There are breath sounds on the right side, but no air entry is heard on the left side. What is the most appropriate initial intervention? A. Administer epinephrine 0.01 mg/kg IV B. Place a chest tube on the left C. Verify the endotracheal tube position D. Aggressively suction the endotracheal tube -----Correct Answer-----Verify the endotracheal tube position

21. For a 6-month-old infant with supraventricular tachycardia and adequate perfusion, which of the following is the preferred vagal maneuver? A. Ocular pressure B. Carotid pressure C. Valsalva maneuver D. Ice to the face -----Correct Answer-----Ice to the face
22. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes after eating peanuts. What is the most appropriate initial medication for this child? A. Nebulized albuterol B. Epinephrine IM C. Isotonic crystalloid IV D. Methylprednisolone -----Correct Answer-----Epinephrine IM
23. A 2-year-old child was found submerged in a swimming pool. She is unresponsive, not breathing, and pulseless. In addition to performing high-quality CPR and establishing vascular access, which of the following is the most appropriate intervention? A. Give atropine 0.02 mg/kg lIO/IV B. Apply cricoid pressure C. Give epinephrine 0.01 mg/kg IO/IV D. Provide transthoracic pacing -----Correct Answer-----Give epinephrine 0.01 mg/kg IO/IV
24. A 3-year-old child is unresponsive, not breathing, and pulseless. High-quality CPR is in progress. A cardiac monitor is applied, and the rhythm below is noted. What is the next appropriate intervention? A. Attempt defibrillation with a 2 J/kg shock B. Administer epinephrine 0.01 mg/kg C. Consider placement of an advanced airway D. Administer amiodarone 5 mg/kg -----Correct Answer-----Attempt defibrillation with a 2 J/kg shock
25. A pulseless 6-week-old infant arrives in the emergency department, and high-quality CPR is in progress. The initial rhythm strip is shown below. CPR continues, and vascular access has been established. What is the next appropriate intervention? A. Administer atropine 0.02 mg/kg IO/IV B. Attempt defibrillation with a 2 J/kg shock C. Administer epinephrine 0.01 mg/kg IO/IV D. Consider insertion of an advanced airway -----Correct Answer-----Administer epinephrine 0.01 mg/kg IO/IV
26. A 6 - month-old infant is unresponsive and not breathing. What is the maximum time that should be spent trying to palpate the pulse before starting CPR? A. 10 seconds B. 15 seconds C. 30 seconds D. 60 seconds -----Correct Answer-----10 seconds
27. What is the recommended location to check for a pulse in a 3- month-old infant? A. Carotid B. Radial C. Brachial

C. Improved respiratory status D. Neurologic impairment -----Correct Answer-----Progression toward respiratory failure

3. What is the most likely cause of head bobbing in infants? A. Increased respiratory effort B. Improving respiratory status C. Decompensated shock D. Brain injury -----Correct Answer-----Increased respiratory effort
4. Several healthcare providers are participating in an attempted resuscitation. Which of the following is most consistent with the responsibilities of the team leader of the resuscitation? A. Records medications and interventions B. Assigns roles to team members C. Administers defibrillation shocks D. Provides compressions -----Correct Answer-----Assigns roles to team members
5. Which of the following conditions is appropriate for use of an oropharyngeal airway? A. Conscious with no gag reflex B. Unconscious with a gag reflex C. Unconscious with no gag reflex D. Conscious with a gag reflex -----Correct Answer-----Unconscious with no gag reflex
6. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes after eating peanuts. What is the most appropriate initial medication for this child? A. Nebulized albuterol B. Epinephrine IM C. Isotonic crystalloid IV D. Methylprednisolone IV -----Correct Answer-----Epinephrine IM
7. A mother brings her 7-year-old child to the emergency department. The mother states that the child has had a fever for the past 4 days and has had little to eat or drink during the past 24 hours. Your initial impression reveals a lethargic child with increased respiratory rate and pale color. Heart rate is 160/min, respiratory rate is 38/min, and blood pressure is 86/48 mm Hg. Capillary refill is 4 seconds. Which of the following is the most appropriate intervention for this child? A. Fluid bolus of 10 mL/kg of isotonic crystalloid B. Fluid bolus of 20 mL/kg of isotonic crystalloid C. Maintenance fluid infusion of isotonic crystalloid at 10 mL/h D. Maintenance fluid infusion of 5% dextrose and water at 20 mL/h -----Correct Answer----

• Fluid bolus of 20 mL/kg of isotonic crystalloid

9. An intubated 5-year-old child who was in a motor vehicle collision becomes increasingly more difficult to ventilate. The child has diminished breath sounds and chest expansion on the right side of the chest, with audible breath sounds and visible chest expansion on the left. The endotracheal tube insertion depth has not changed. What is the most appropriate intervention? A. Deflate the cuff and pull the tube back B. Perform needle decompression on the right chest C. Perform needle decompression on the left chest D. Insert a gastric tube -----Correct Answer-----Perform needle decompression on the right chest

10. A 2-year-old child with a 2-day history of a barking cough presents with audible stridor on inspiration, intercostal retractions, and agitation. What is the most appropriate intervention for this child? A. Lay the child flat on a stretcher B. Suction the mouth and nose C. Administer nebulized epinephrine D. Administer inhaled albuterol -----Correct Answer-----Administer nebulized epinephrine
11. Which of the following oxygen saturations indicates the need for additional intervention? A. 96% on room air B. 95% on room air C. 93% on 4 L of oxygen D. 97% on 50% oxygen -----Correct Answer-----93% on 4 L of oxygen
12. A 3-year-old child presents with a 2-day history of nausea and vomiting. She is alert, with no increase in respiratory effort, and is pale in color. The child's heart rate is 160/min, respiratory rate is 40/min, and blood pressure is 100/70 mm Hg. Her extremities are cool, with sluggish capillary refill. Which term best describes this child's physiologic state? A. Compensated shock B. Cardiogenic shock C. Hypotensive shock D. Obstructive shock -----Correct Answer-----Compensated shock
13. A 3-year-old child presents with dehydration after a 2-day history of vomiting and diarrhea. The child after has received 2 fluid boluses of 20 mL/ kg of normal saline. After the second bolus, the child is alert and interacting. Her heart rate is 110/ min, respiratory rate is 30/min, and blood pressure is 92/64 mm Hg. Her capillary refill time is 2 seconds, and oxygen saturation is 98%. What is the most appropriate next intervention for this child? A. Administer another 20 mL/kg normal saline fluid bolus B. Administer 10 mL/kg of packed red cells C. Continue to monitor and reevaluate the child D. Initiate a dopamine drip of 20 mcg/kg per minute -----Correct Answer-----Continue to monitor and reevaluate the child
14. A 3-year-old child presents with a high fever and a petechial rash. The child is lethargic, has no signs of increased work of breathing, and is pale in color. His heart rate is 180/min, respiratory rate is 30/min, blood pressure is 80/68 mm Hg. Capillary refill time is 4 seconds, and oxygen saturation is 88%. Airway and lungs are clear. Peripheral pulses are diminished. Which of the following is the most appropriate initial intervention? A. Provide 100% oxygen via a nonrebreathing mask B. Obtain IV access C. Administer dopamine D. Administer an antibiotic -----Correct Answer-----Provide 100% oxygen via a nonrebreathing mask
15. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's color is pink. What is the most appropriate initial intervention? A. Obtain a chest radiograph B. Administer nebulized epinephrine C. Prepare for a surgical airway