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Pals Heartcode EXAM latest update, Exams of Nursing

Johns Hopkins University (JHU)Nursing

Pals Heartcode EXAM latest update

Typology: Exams

2025/2026

Available from 06/30/2026

Prof.-Robert-Atkins
Prof.-Robert-Atkins ๐Ÿ‡บ๐Ÿ‡ธ

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Pals Heartcode EXAM 2024-2025
The infant is placed on the ambulance stretcher and responds with a groan
when stimulated and has a temperature of 36.3 C (97.3 F) - ANSWER>>-
Monitor and support ABCs
-Establish IV/IO access
-Monitor heart rate, blood pressure, and pulse oximetry
-Call for assistance if needed
When you evaluate the patient, you find the lungs are clear, skin is cool
and mottled, glucose is 97 mg/dL and capillary refill time is 5 seconds.
What are the warning signs that the patient is progressing from
compensated shock to hypotensive shock? - ANSWER>>-Hypotension
(late sign)
-Increasing tachycardia
The patient still has a blood pressure of 58/38 mm Hg. Her condition would
be classified as ___________ shock. - ANSWER>>Hypotensive
What should be included in the initial treatment for this patient? -
ANSWER>>-Rapid fluid bolus administration
-Establishing IV/IO access
The mother does not recall the infant's most recent weight. What is the
most appropriate way to rapidly determine her weight and calculate correct
medication? - ANSWER>>Measure her by using color-coded length-based
tape
You measure the infant to be 7 kg and prepare to administer a fluid bolus of
what type? - ANSWER>>Normal saline 20 mL/kg
What is the most appropriate method of delivering rapid fluid boluses to this
patient? - ANSWER>>A syringe and 3-way stopcock
After the first fluid bolus is administered, the child is reassessed and her
vital signs are HR 167, BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her
skin is still cool and pale and she is still lethargic and weak.
What should be the next intervention? - ANSWER>>Deliver a second fluid
bolus of 20 mL/kg and reassess
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Pals Heartcode EXAM 2024- 2025

The infant is placed on the ambulance stretcher and responds with a groan when stimulated and has a temperature of 36.3 C (97.3 F) - ANSWER>>- Monitor and support ABCs

  • Establish IV/IO access
  • Monitor heart rate, blood pressure, and pulse oximetry
  • Call for assistance if needed When you evaluate the patient, you find the lungs are clear, skin is cool and mottled, glucose is 97 mg/dL and capillary refill time is 5 seconds. What are the warning signs that the patient is progressing from compensated shock to hypotensive shock? - ANSWER>>-Hypotension (late sign)
  • Increasing tachycardia The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________ shock. - ANSWER>>Hypotensive What should be included in the initial treatment for this patient? - ANSWER>>-Rapid fluid bolus administration
  • Establishing IV/IO access The mother does not recall the infant's most recent weight. What is the most appropriate way to rapidly determine her weight and calculate correct medication? - ANSWER>>Measure her by using color-coded length-based tape You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? - ANSWER>>Normal saline 20 mL/kg What is the most appropriate method of delivering rapid fluid boluses to this patient? - ANSWER>>A syringe and 3-way stopcock After the first fluid bolus is administered, the child is reassessed and her vital signs are HR 167, BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her skin is still cool and pale and she is still lethargic and weak. What should be the next intervention? - ANSWER>>Deliver a second fluid bolus of 20 mL/kg and reassess

When should vasoactive therapy be considered be considered in managing distributive shock? - ANSWER>>If the child remains hypotensive and poorly perfused despite rapid bolus fluid administration How does the clinical presentation of distributive shock compare with hypovolemic shock? - ANSWER>>Distributive shock has more variable presentation than that of hypovolemic shock For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to __ minutes - ANSWER>>For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to 20 minutes What signs distinguish anaphylactic shock from other types of shock? - ANSWER>>-Angioedema (swelling of the face, lips and tongue)

  • Urticaria (hives)
  • Respiratory distress with stridor, wheezing or both in a child with anaphylactic shock, what is the most appropriate initial treatment? - ANSWER>>IM epinephrine How soon after exposure do symptoms typically occur in anaphylactic shock? - ANSWER>>Seconds to minutes What should you evaluate to recognize septic shock? - ANSWER>>-Temp
  • Heart rate
  • Systemic perfusion
  • Blood pressure
  • Clinical signs of end-organ perfusion When should antibiotics be administered in septic shock? - ANSWER>>Within the first hour What are the initial assessment findings for septic shock? - ANSWER>>- Fever
  • Hypothermia
  • Normal, elevated or decreased WBC
  • Any intubated child who deteriorates suddenly while receiving in positive- pressure ventialtion
  • A child who deteriorates suddenly while receiving bag-mas ventialtion How do you know if a needle decompression is successful? - ANSWER>>There is gush of air when the needle is placed What is the immediate treatment for tension pneumothorax? - ANSWER>>Needle decompression What is the role of the diaphragm contraction during normal breathing in infants? - ANSWER>>Pulls the ribs slight inward However, forcefully contracting the diaphragm results in a large drop in pressure within the chest, retracting What are common causes cardiogenic shock? - ANSWER>>-Congenital heart disease
  • Myocarditis
  • Drug toxicity
  • Arrhythmias What are causes of cardiac tamponade in children? - ANSWER>>- Penetrating trauma
  • Cardiac surgery
  • Infection of the percardium In the setting of impending or actual pulseless arrest when there is a strong suspicion of pericardial tamponade, what is the appropriate management? - ANSWER>>Emergency pericardiocentesis Pulmonary embolisms are ____ in children. - ANSWER>>Rare What is definitive treatment for most children with pulmonary embolism who are not in shock? - ANSWER>>Anticoagulants In children with severe cardiovascular compromise from pulmonary embolism, what treatment should be considered? - ANSWER>>Fibrinolytic agents

What findings help distinguish pulmonary embolism from hypovolemic shock? - ANSWER>>Systemic venous congestion and right heart failure What circulation findings are specific to pericardial tamponade? - ANSWER>>-Tachycardia

  • Narrowed pulse pressures
  • Muffled or diminished heart sounds The child is awake, responsive and anxious. Her initial vitals signs are HR 168/min, BP 61/43 mm Hg, RR 44/min, SpO2 66%. What is the initial priority in treatment for this patient? - ANSWER>>Administer oxygen (nonrebreating mask) Based on the child's blood pressure, what type of shock is the patient in? - ANSWER>>Hypotensive Ausculating 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? - ANSWER>>Tension pneumothorax Treatment for tension pneumothorax should not be delayed. Based on the child's assessment, what immediate intervention should be performed? - ANSWER>>Needle decompression Where should the needle be inserted for proper needle decompression? - ANSWER>>Right side of the chest, over the third rib (second intercostal space) in the midclavicular line 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/min, BP 70/40 mm Hg and SpO 82%. The patient still has labored breathing. Her SpO2 does not go above 82%; lung sounds are more present but are still diminished on the right side.

What is a FIRST-degree atrioventricular block - ANSWER>>A prolonged PR interval representing slowed conduction through the atrioventricular node Why do children with cardiac tamponade improve temporarily with fluid administration? - ANSWER>>Fluids augment cardiac and tissue perfusion until pericardial drainage can be performed What is the initial dose of epinephrine in the treatment of symptomatic bradycardia? - ANSWER>>0.01 mg/kg IV/IO In which patients would bradycardia be an expected finding and not be considered problematic? - ANSWER>>-A healthy child who is sleeping This is due to reduced metabolic demand

  • A well-conditioned athlete This is due to high stroke volume and increased vagal tone What is the IV/IO dose of atropine for pediatric bradycardia? - ANSWER>>0.02 mg/kg What should your next steps be? - ANSWER>>-Maintains a patent airway
  • Apply cardiac monitor to identify rhythm and monitor pulse, blood pressure, and oximetry
  • Complete the initial and primary assessment During the initial assessment, you find that the infant is unresponsive and has an HR of less than 60/min. What should be your next action? - ANSWER>>Begin CPR CPR has been ongoing and IV access has been established. A pulse and rhythm check are done. He has the rhythm. What intervention would be most appropriate at this time? - ANSWER>>Administer epinephrine What is the proper dosing for epinephrine (IV/IO) administration during CPR? - ANSWER>>-0.01 mg/kg IO/IV
  • Repeat every 3 to 5 minutes.

After 2 more minutes of CPR, you notice the patient is moving and his skin color improves. his vital signs are 114 RR 8/min and temperature 37.9 C (100.2 F). The infant is still slow to respond but is moving. What should be the next steps for this patient? - ANSWER>>-Continue oxygen

  • Obtain expert consultation
  • Support ABC's
  • Identify and treat underlying causes What clinical findings may be presented in a child with a tachyarrhythmia? - ANSWER>>-Palpitations
  • Light-headedness
  • Syncope How is tachycardia defined in pediatric patients? - ANSWER>>A heart rate that is fast compared with the normal heart rate for the child's age Where do tacharrhythmias originate? - ANSWER>>Atria or ventricles How are tachycardia and tacharrhythmias classifed? - ANSWER>>By the width of the QRS complex What is initial treatment for pediatric bradycardia with cardiopulmonary compromise? - ANSWER>>Provide bag-mask ventilation with 100% oxygen if bradycardia persists after initial treatment and the heart rate remains less than 60/min, what action should be taken next? - ANSWER>>Begin CPR What are the characteristics of ventricular tachycardia? - ANSWER>>-It is a wide QRS complex generated within the ventricles
  • The rapid rate may deteriorate into pulseless ventricular tachycardia or ventricular fibrillation
  • A rapid rate compromises ventricular filling Why does sinus tachycardia typically develop? - ANSWER>>The body needs increased cardiac output

How should sinus tachycardia be treated? - ANSWER>>By treating the underlying cause If amiodarone or procainamide does not terminate the rapid rhythm, why should adenosine be considered? - ANSWER>>A wide-complex tachycardia could be supraventricular tachycardia with aberrant ventricular conduction What is considered an initial management priority in managing tachyarrhythmias? - ANSWER>>-Assess and support the airway, oxygenation and ventiliation

  • Obtain a 12-lead electrocardiogram if practical
  • Attach a continuous electrocardiographic monitor/defibrillator and a pulse oximeter Which signs and symptoms are consistent with supraventricular tachycardia? - ANSWER>>-Absent or abnormal P waves
  • Heart rate 220/min or greater in an infant or 180/min or greater in a child
  • Heart rate does not vary with activity or stimulation For stable patients with a regular wide complex, and monomorphic tachycardia consider: - ANSWER>>Adenosine Which of the following should be considered for stable supraventricular tachycardia? - ANSWER>>-Ask an older child to try to blow through an obstructed straw
  • Place a bag with ice water over the upper half of the infant's face What is the initial dose of denosine? - ANSWER>>0.1 mg/kg IV/IO Your initial assessment indicates that the child is irritable and breathing rapidly. Which of the following is the most appropriate initial intervention? - ANSWER>>Maintain patent airway; administer oxygen What is the most likely rhythm? (IMG_8681) - ANSWER>>Supraventricular tachycardia

The patient has characteristics of supraventricular tachycardia, including a heart rate of more than 220/in. How would P waves appear on an ECG in a supraventricular tachycardia? - ANSWER>>-Abnormal

  • Absent Vagal maneuvers are indicated for an infant with supraventricular tachycardia who is stable and they should be performed while preparations are being made for admistering adenosine and synchronized cardioversion (if necessary). Ice for the face is vagal maneuver that can be performed in infants and children of all ages. What precautions should be taken when performing this vagal maneuver? - ANSWER>>Do not cover the nose or mouth After you attempt a vagal maneuver , the infrant's vital signs are HR 261/min, BP 72/50, RR 46/mm, SpO2 96% and he is crying. A 12 lead ECG is taken. What actions should be taken next? (IMG_8684) - ANSWER>>Administer adenosine You administer adenosine (0.1 mg/kg) via a rapid bolus followed by a rapid flush of _________ normal saline. - ANSWER>>5 to 10 mL The infant does not respond to the initial dose of adenosine for supraventricular tachycardia and now has these vital signs HR 265 SpO 96% - ANSWER>>Administer a second dose of adenosine at 0.2 mg/kg (maximum second dose 12 mg) 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 6 kg. What should be the setting for the synchronized cardioversion? - ANSWER>>6 J After synchronized cardioversion of 6 J, the patient remains in a supraventricular tachycardia. A second synchronized cardioversion. What is the recommended energy selection? - ANSWER>>12 J What is the appropriate initial dose if synchronized cardioversion is needed? - ANSWER>>0.5 to 1 J/kg
  • Deliver ONE shock
  • Establish IV/IO access How should appropriate endotracheal tube placement be confirmed? - ANSWER>>End-tidal carbon dioxide or capnography Oxygen should be titrated to maintain a pulse oximetry saturation level between what range? - ANSWER>>94% to 99% If myocardial function remains poor in a post-cardiac arrest child, what medication(s) should be considered? - ANSWER>>-Milrinone
  • Epinephrine What does optimal post-cardiac arrest care include? - ANSWER>>Identifying and treating organ system dysfunction