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PALS version B Study Guide 2025, Exams of Nursing

Chamberlain College of NursingNursing

PALS version B Study Guide 2025

Typology: Exams

2024/2025

Available from 06/21/2025

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PALS version B Study Guide 2025
You are treating an 8-year-old with ventricular tachycardia (VT) with pulses and adequate
perfusion. You attempted synchronized cardioversion without success. While seeking
expert consultation, it would be most appropriate to:
Administer a loading dose of milrinone
Initiate overdrive pacing transcutaneously
Consider possible metabolic and toxicologic causes
Deliver an unsynchronized shock - Answer Consider possible metabolic and toxicologic
causes
You are caring for a patient who developed a tension pneumothorax after several hours of
positive-pressure ventilation. Which of the following would be the most appropriate site for
needle decompression?
Over the third rib (ie, second intercostal space) at the mid-clavicular line
Under the eighth rib at the midaxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line - Answer Over the third rib (ie, second
intercostal space) at the mid-clavicular line
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?
Administer repeated fluid boluses of isotonic colloidge
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
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You are treating an 8-year-old with ventricular tachycardia (VT) with pulses and adequate perfusion. You attempted synchronized cardioversion without success. While seeking expert consultation, it would be most appropriate to: Administer a loading dose of milrinone Initiate overdrive pacing transcutaneously Consider possible metabolic and toxicologic causes Deliver an unsynchronized shock - Answer Consider possible metabolic and toxicologic causes You are caring for a patient who developed a tension pneumothorax after several hours of positive-pressure ventilation. Which of the following would be the most appropriate site for needle decompression? Over the third rib (ie, second intercostal space) at the mid-clavicular line Under the eighth rib at the midaxillary line Over the fifth rib at the sternal border Under the sixth rib at the midclavicular line - Answer Over the third rib (ie, second intercostal space) at the mid-clavicular line 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? Administer repeated fluid boluses of isotonic colloidge Administer repeated fluid boluses of isotonic crystalloid Begin immediate dopamine infusion

Begin immediate dobutamine infusion - Answer Administer repeated fluid boluses of isotonic crystalloid You are caring for a 5-year-old patient with supraventricular tachycardia (SVT) (heart rate is 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? Provide synchronized cardioversion at 0.5 to 1 J/kg Place cold packs on the distal upper and lower extremities Ask the child to blow through a small straw Exert light pressure on the eyes bilaterally - Answer Provide synchronized cardioversion at 0.5 to 1 J/kg You attempted synchronized cardioversion for an infant with SVT and poor perfusion. The SVT persists after the initial shock of 1 J/kg. Which of the following should you attempt now? Synchronized cardioversion at a dose of 4 J/kg Synchronized cardioversion at a dose of 2 J/kg Unsynchronized cardioversion at a dose of 2 J/kg Unsynchronized cardioversion at a dose of 4 J/kg - Answer Synchronized cardioversion at a dose of 2 J/kg 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: Increasing the ventilator rate

Which of the following is likely to be the most helpful technique to identify potentially reversible metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest? Soliciting a history from the caregiver or family Obtaining a urine sample for toxicology screen Obtaining chest and abdominal radiographs Obtaining a venous blood gas - Answer Soliciting a history from the caregiver or family Which of the following rhythms is shown on this ECG rhythm strip? Sinus bradycardia Ventricular fibrillation (VF) Asystole Supraventricular tachycardia) - Answer Ventricular fibrillation (VF) 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: More than 200/min More than 150/min Less than 100/min Less than 60/min - Answer Less than 60/min You are caring for a 3-year-old with myocarditis and heart failure. She has become poorly responsive to a sternal rub and is difficult to rouse. She has a sinus rhythm with a heart rate of 175/min, and a blood pressure of 88/65 mm Hg. Her skin is cool and mottled, capillary

refill time is 5 seconds and she has barely palpable distal pulses. Oxygen saturation is 90% on high-flow, high-concentration oxygen by face mask. Her respirations are labored at 50/min with moderate retractions, and crackles are heard at the bases. Which of the following would be the most appropriate therapy for this child? Obtain a STAT echocardiogram and chest x-ray Perform synchronized cardioversion at 0.5 joules/kg Provide assisted ventilations with 100% oxygen and prepare for endotracheal intubation Administer epinephrine 0.1 mL/kg of 1:10,000 solution IV - Answer Provide assisted ventilations with 100% oxygen and prepare for endotracheal intubation You are treating a 5-month-old with a 2-day history of vomiting and diarrhea. The patient is listless. The respiratory rate is 52/min and unlabored. The heart rate is 170/min and pulses are present but weak. Capillary refill is delayed. You are administering high-flow oxygen and intravenous access is in place. At this point the most important therapy is to: Administer an epinephrine bolus Begin bag-mask ventilation Provide a rapid 20 mL/kg isotonic crystalloid fluid bolus Administer a bolus of 0.5 g/kg of dextrose - Answer Provide a rapid 20 mL/kg isotonic crystalloid fluid bolus Which of the following groups of clinical findings would be most consistent with categorizing a patient with compensated shock? Decreased level of consciousness, extensor posturing in response to pain, hypertension, and apnea Normal systolic blood pressure, decreased level of consciousness, cool extremities with delayed capillary refill, and faint or nonpalpable distal pulsesd.

You are caring for a child in persistent VF. Which of the following would best describe the child's cardiac condition? The heart is not pumping blood at all The heart is beating too slowly to maintain circulation There is no electrical activity in the heart The heart is pumping so fast that it cannot fill completely between beats - Answer 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 ventilation with high-flow oxygen, which 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? Perform transcutaneous pacing Resume bag-mask ventilation Administer epinephrine IV Administer atropine IV - Answer Resume bag-mask ventilation 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: Disordered control of breathing Lung tissue (parenchymal) lung disease Lower airway obstruction

Upper airway obstruction - Answer Lower airway obstruction Which of the following assessments is most useful in evaluating the effectiveness of bagmask ventilation? Hearing an air leak around the mask when the bag is fully compressed Seeing the abdomen rise during ventilationcation Observation of visible chest rise A normal systolic, diastolic, and mean arterial pressure - Answer Observation of visible chest rise You are assessing a 6-year-old child who appears to be unconscious after striking his head on a concrete step. You pinch the patient's chest and the patient grabs your hand. You would document this response as: Localization of a painful stimulus Withdrawal from a painful stimulus Decerebrate posturing Decorticate posturing - Answer Localization of a painful stimulus You are treating a 10-year-old victim of multisystem trauma. The child is very anxious and confused. The respiratory rate is 44/min and unlabored. The pulse is rapid and weak. Capillary refill is delayed. High-flow oxygen and an intravenous line are in place. The most appropriate initial fluid for rapid volume expansion is: 10% dextrose in water 5% dextrose in Ringer's lactate 5% dextrose in normal saline

Assist ventilations with a bag-mask devicecation Give IV methylprednisolone (Solumedrol) Use a nonrebreathing mask with a tight mask seal - Answer Keep the patient calm and comfortable