Pediatric Emergency Care: Recognizing and Managing Critical Conditions, Exams of Nursing

Download Pediatric Emergency Care: Recognizing and Managing Critical Conditions and more Exams Nursing in PDF only on Docsity! 1 | P a g e PALS EXAM TEST BANK 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS|LATEST UPDATE an antibiotic You are caring for a 5 year old boy with a 4 day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His O2 sat is 72% on room air and 89% when on a NRB O2 mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. Which medication would be most appropriate? Give 30 compressions to 2 breaths What ratio for compressions to breaths should be used for 1 rescuer infant CPR Decreased level of consciousness An 8 year old child is brought to the ED by ambulance after being involved in a MVC. Which finding would suggest that immediate intervention is needed? upper airway obstruction You are Caring for a 9 month old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infants SpO2 is 94% On auscultation, the lungs are clear bilaterally. Which is the most likely cause of this infants respiratory distress? Epinephrine, nebulized You are Caring for a 9 month old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infants SpO2 is 94% On auscultation, the lungs are clear bilaterally. Which medication should you administer first? Lower airway obstruction 2 | P a g e Which condition is characterized by a prolonged excretory phase and wheezing? "I think the correct dose is 0.01 mg/kg. should I give that dose instead?" During a resuscitation attempt, the team leader asks you to administer an initial dose of Epinephrine at 0.1 mg/kg to be given IO. How should you respond? Distributive Septic Shock You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- Laberatory studies document a lactic acidosis. On the basis of the patients clinical assessment and history. Which type of shock does this patient most likely have? blood pressure You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- Which assessment finding is the most important in your determination of the severity of the patients condition? 20 ml/kg You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- Which NS bolus is most appropriate for this patient? Antibiotic Administration You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- In edition to oxygen administration and appropriate fluid resuscitation, which additional early intervention should you provide to the patient? respiratory failure A 3 year old boy is brought to the ED by his mother. His is lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk cap refill. To which immediate life treating condition could this Childs condition most likely progress if left untreated? Audible inspiratory stridor 5 | P a g e 40 Joules A 4 year old child in cardiac arrest is brought to the emergency department by ambulance. High quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. As the team leader, how many joules do you tell your team member to use to perform initial Defib? Allowing complete chest wall recoil after each compression You are the team leader during a pediatric resuscitation attempt. which action is an element of high quality CPR? blood pressure You are caring for a 3 month old boy with a 2 day history of fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant weighs 6 Kg. Which assessment finding indicates that the infant is in hypotensive shock? hypovolemic shock You are caring for a 3 month old boy with a 2 day history of fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant weighs 6 Kg. On the basis of this infants presentation, which type of shock does this infant have? 20 ml/kg normal saline You are caring for a 3 month old boy with a 2 day history of fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant weighs 6 Kg. You have decided that this infant Needs fluid resuscitation. How much fluid should you administer? It is Hypotensive 6 | P a g e A 2 week old infant is being evaluated for irritability and poor feeding. His BP is 55/40 mmHg, and cap refill time is 5 seconds. Which statement best describes your assessment of this infants BP? Ask for a new task or role A team member is unable to perform an assigned task because it is beyond the team members scope of practice. Which action should the team member take? crackles Which abnormality helps identify children with acute respiratory distress caused by lung tissue disease? cardiac arrest Which condition in a child would IO access most likely be attempted before vascular access? Begin CPR for 2 mins before leaving to activate the emergency response system. You respond to an infant who is unresponsive, in not breathing, and doe not have a pulse. You shout for nearby help, but no one arrives. What action should you take next? Supraventricular tachycardia An unresponsive 9 year old boy is pale and cool to the touch his blood pressure is 70/45 mmHg, heart rate is 190/min and respiratory rate is 12/min. The SpO2 is not detectable Cap refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here. What rhythm is seen on the patient cardiac monitor? Syncronized cardioversion. An unresponsive 9 year old boy is pale and cool to the touch his blood pressure is 70/45 mmHg, heart rate is 190/min and respiratory rate is 12/min. The SpO2 is not detectable Cap refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here. If initial treatment is unavailable or delayed, which intervention is indicated? inspiratory stridor You are performing the airway component of the primary assessment. Which finding would lead you to conclude that the child has an upper airway obstruction? 7 | P a g e Increased inspiratory effort with retractions A 3 year old child is having difficulty breathing. Which finding would most likely lead you to suspect an upper airway obstruction in this child? A child who is grunting You are caring for patients in the emergency department. Which 2 year old child requires immediate intervention? blood pressure You are evaluating a 10 year old child who is febrile and tachycardia. The Childs cap refill times 5 seconds. which parameter will determine if the child is in compensated shock? Respiratory rate of 24/min A 3 year old child is brought to the emergency department by his mother. Which is a normal finding for a 3 year old child? Sinus Bradycardia An unresponsive 9 year old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40 mmHg, HR is 45/min, respiratory rate is 6/min, and SpO2 is 60% no room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. Which rhythm is most consistent with this patients presentation and ECG findings? Provide bag-mask ventilation with 100% oxygen An unresponsive 9 year old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40 mmHg, HR is 45/min, respiratory rate is 6/min, and SpO2 is 60% no room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. What is your next action? Heart rate of 88/min A 10 year old child is being evaluated for a head ache. Which is a normal finding for this 10 year old child? 10 | P a g e A 6-month-old infant is unresponsive. You begin checking for breathing at the same time you check for the infant's pulse. What is the maximum time you should spend trying to simultaneously check for breathing and palpate the infant's pulse before starting CPR? 10 seconds A 10-year-old child is being evaluated for a headache. What is a normal finding for this 10-year-old child? Heart rate of 88 bpm A 6-year-old boy is being evaluated for difficulty breathing. What finding would suggest this child has respiratory distress? Audible inspiratory stridor A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High-quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. What dosage range should you use for initial defibrillation? 2 to 4 J/kg A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High-quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. As the Team Leader, how many joules do you tell your team member to use to perform initial defibrillation? 40J You respond to an infant who is unresponsive, is not breathing, and does not have a pulse. You do not have a mobile device, and you shout for nearby help but no one arrives. What action should you take next? Begin CPR for 2 minutes before leaving to activate the emergency response system What ratio for compressions to breaths should be used for 1-rescuer infant CPR? Give 30 compressions to 2 breaths 11 | P a g e A 3-year-old boy is brought to the emergency department by his mother. He is lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk capillary refill. Which immediate life-threatening condition could this child's condition most likely progress to if left untreated? Respiratory Failure You are evaluating a 10-year-old child who is febrile and tachycardic. The child's capillary refill time is 5 seconds. What parameter will determine if the child is in compensated shock? Blood Pressure An 18-month old has had vomiting and diarrhea for the past 2 days; the mother brings him to the emergency department because he is becoming more lethargic. What diagnostic test should you order first? Blood Glucose You are caring for a 3-month-old boy with a 2-day history of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190/min, temperature is 38.3°C (101°F), blood pressure is 59/29 mm Hg, respiratory rate is 70/min and shallow, and oxygen saturation is 94% on 100% oxygen. His capillary refili time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg. 24. What assessment finding indicates that the infant has hypotensive shock? Blood Pressure You are caring for a 3-month-old boy with a 2-day history of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190/min, temperature is 38.3°C (101°F), blood pressure is 59/29 mm Hg, respiratory rate is 70/min and shallow, and oxygen saturation is 94% on 100% oxygen. His capillary refili time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg. On the basis of this infant's presentation, what type of shock does this infant have? Hypovolemic Shock You are caring for a 3-month-old boy with a 2-day history of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190/min, temperature is 38.3°C (101°F), blood pressure is 59/29 mm Hg, respiratory rate is 70/min and shallow, and oxygen saturation is 94% on 100% oxygen. His capillary refili time is 4 to 5 seconds, and he has mottled, cool extremities. The infant weighs 6 kg. You have decided that this infant needs fluid resuscitation. How much fluid should you administer? 12 | P a g e 20 ml/kg normal saline What abnormality helps identify children with acute respiratory distress caused by lung tissue disease? Crackles You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant's SpOz is 94%. On auscultation, the lungs are clear bilaterally. What is the most likely cause of this infant's respiratory distress? Upper airway obstruction You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant's SpOz is 94%. On auscultation, the lungs are clear bilaterally. What medication should you administer first? Epinephrine, nebulized What condition is characterized by a prolonged expiratory phase and wheezing? Lower airway obstruction A 5-year-old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. You are using the primary assessment to evaluate the child. When assessing the child's neurologic status, you note that he has spontaneous eye opening, is fully oriented, and is able to follow commands. How would you document this child's AVPU (Alert, Voice, Painful, Unresponsive) Pediatric Response Scale finding? Alert A 4-year-old child is brought to the emergency department for seizures. The seizures stopped a few minutes ago, but the child continues to have slow and irregular respirations. What condition is most consistent with your assessment? Disordered control of breathing You are evaluating a 1-year-old child for respiratory distress. His heart rate is 168/min, and his respiratory rate has decreased from 65/min to 30/min. He now appears more lethargic and continues to 15 | P a g e access has been established, and blood cultures have been obtained. What is the most appropriate intervention? Administer 10 to 20 mL/kg of isotonic crystalloid over 5 to 10 minutes An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and Spoz is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. Sinus Bradycardia An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and Spoz is 60% on room air. He is unresponsive and cyanotic. What action do you take next? Provide bag-mask ventilation with 100% oxygen A 3-year-old child is brought to the emergency department by his mother. What is a normal finding for a 3-year-old child? Respiratory rate of 24/min A 6-month-old infant is being evaluated for bradycardia. What is the most likely cause of bradycardia? Hypoxia You are caring for a 5 year old boy with a 4 day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His O2 sat is 72% on room air and 89% when on a NRB O2 mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. Which assessment finding is consistent with respiratory failure in this child? Parents of a 1-year-old female phoned EMS when they picked up their daughter from the babysitter. Paramedics perform an initial impression revealing an obtunded infant with irregular breathing, bruises over the abdomen, abdominal distension, and cyanosis. Assisted bag-mask ventilation with 100% oxygen is initiated. On primary assessment heart rate is 36/min, peripheral pulses cannot be palpated, and central pulses are barely palpable. Cardiac monitor shows sinus bradycardia. Chest compressions are started at 15:2. In the ED the infant is intubated and ventilated, and IV access is established. The heart rate is now up to 150/min, but there are weak central pulses and no distal pulses. Systolic BP is 74. Of 16 | P a g e the following, which would be most useful in management of this infant? A. Synchronized cardioversion B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV C. Rapid bolus of 20 mL/kg of isotonic crystalloid D. Atropine 0.02 mg/kg IV C You enter a room to perform an initial impression of a previously stable 10-year-old male and find him unresponsive and apneic. A code is called and bag-mask ventilation is performed with 100% oxygen. The cardiac monitor shows a wide-complex tachycardia. The boy has no detectable pulses so compressions and ventilations are provided. As soon as the defibrillator arrives you deliver an unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of CPR reveals VF. You then deliver a shock of 4 J/kg and resume immediate CPR beginning with compressions. A team member has established IO access, so you give a dose of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second shock. At the next rhythm check, persistent VF is present. You administer another 4 J/kg shock and resume CPR. Based on the PALS Pulseless Arrest Algorithm, what is the next drug and dose to administer when CPR is restarted? A. Magnesium sulfate 25-50 mg/kg IO B. Atropine 0.02 mg/kg IO C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO D. Amiodarone 5 mg/kg IO D Which of the following statements about calcium is true? A. Calcium chloride 10% has the same bioavailability of elemental calcium as calcium gluconate in critically ill children B. The recommended dose is 1-2 mg/kg of calcium chloride. C. Indications for administration of calcium include hypercalcemia, hypokalemia, and hypomagnesemia. D. Routine administration of calcium is not indicated during cardiac arrest. D Initial impression of a 9-year-old male with increased work of breathing reveals the boy to be agitated and leaning forward on the bed with obvious respiratory distress. You administer 100% oxygen by 17 | P a g e nonrebreathing mask. The patient is speaking in short phrases and tells you that he has asthma but does not carry an inhaler. He has nasal flaring, severe suprasternal and intercostal retractions, and decreased air movement with prolonged expiratory time and wheezing. His SpO2 is 96% (on nonrebreathing mask). What is the next medical therapy to provide to this patient? A. Adenosine 0.1 mg/kg B. Amiodarone 5 mg/kg IV/IO C. Albuterol by nebulization D. Procainamide 15 mg/kg IV/IO C You are called to help resuscitate an infant with severe symptomatic bradycardia associated with respiratory distress. The bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. Which of the following is the first drug you should administer? A. Dopamine B. Adenosine C. Atropine D. Epinephrine D An infant with a history of vomiting and diarrhea arrives by ambulance. During your primary assessment the infant responds only to painful stimulation. The upper airway is patent, the repiratory rate is 40/min with good bilateral breath sounds, and 100% oxygen is being administered. The infant has cool extremities, weak pulses, and a cap refill of more than 5 seconds. The infant's BP is 85/65 mm Hg and glucose concentration is 30 mg/dL (1.65 mmol/L). Which of the following is the most appropriate treatment to provide for this infant? A. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over 10 to 20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a separate infusion. 20 | P a g e The child is receiving CPR, including bag-mask ventilation with 100% O2 and chest compressions at a rate of at least 100/min. Compressions and ventilations are being coordinated at a ratio of 15:2. You conform that apnea is present and that ventilation is producing bilateral breath sounds and chest expansion while a colleague confirms absent pulses. Cardiac monitor shows the above rhythm. A biphasic manual defibrillator is present. You quickly use the crown-heel length of the child on a length based, color-coded resuscitation tape to estimate the approximate weight as 15kg. Which of the following therapies is most appropriate for this child at this time? A. Establish IV/IO access and administer lidocaine 1 mg/kg IV/IO B. Establish IV/IO access and administer epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV/IO C. Attempt defibrillation at 30 J, then resume CPR beginning with compressions. D. Establish IV/IO access and administer amiodarone 5 mg/kg IV/IO. C A 3-year-old boy presents with multiple system trauma. The child was an unrestrained passenger in a motor vehicle crash. On primary assessment he is unresponsive to voice or painful stimulation. His respiratory rate is less than 6/min, heart rate is 170/min, systolic blood pressure is 60 mm Hg, cap refill is 5 seconds, and SpO2 is 75% in room air. Which of the following most accurately summarizes the first interventions you should take to support this child? A. Establish immediate vascular access, administer 20 mL/kg isotonic crystalloid, and reassess the patient; if the child's systemic perfusion does not improve, administer 10 to 20 mL/kg packed red blood cells. B. Provide 100% oxygen by simple mask and perform a head-to-toe survey to identify the extent of all injuries; begin an epinephrine infusion and titrate to maintain a systolic blood pressure of at least 76 mm Hg C. Open the airway (jaw-thrust technique) while stabilizing the cervical spine, administer positive- pressure ventilation with 100% oxygen, and establish immediate IV/IO access. D. Provide 100% oxygen by simple mask, stabilize the cervical spine, establish vascular access, and provide maintenance IV fluids. C 21 | P a g e Initial impression of a 10-month-old male in the emergency department reveals a lethargic pale infant with slow respirations. You begin assisted ventilation with a bag-mask device using 100% oxygen. On primary assessment heart rate is 38/min, central pulses are weak, but distal pulses cannot be palpated. Blood pressure is 60/40, and cap refill is 4 seconds. During your assessment, as colleague places the child on a cardiac monitor and you observe the rhythm above (sinus bradycardia, 40 bpm). The rhythm remains unchanged despite ventilation with 100% oxygen. What are your next management steps? A. Administer adenosine 0.1 mg/kg rapid IV/IO and prepare for synchronized cardioversion. B. Start chest compressions and give epinephrine 0.1 mg/kg (0.1 mg/kg of 1:1,000) IV/IO C. Start chest compressions and give epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO D. Administer 20 mL/kg isotonic crystalloid and epinephrine 0.1 mg/kg (0.1 mL/kg of 1:10,000) IV/IO C A 1-year-old male is brought to the emergency department for evaluation of poor feeding, fussiness, and sweating. On initial impression he is lethargic but arousable and has labored breathing and a dusky color. Primary assessment reveals a respiratory rate of 68/min, heart rate 300/min that does not very with activity or sleep, blood pressure 70/45 mm Hg, weak brachial pulses and absent radial pulses, cap refill 6 seconds, SpO2 85% in room air, and good bilateral breath sounds. You administer high-flow oxygen and place the child on a cardiac monitor. You see the above rhythm (SVT) with little beat-to-beat variability of the heart rate. Secondary assessment reveals no history of congenital heart disease. IV access has been established. Which of the following therapies is most appropriate for this infant? A. Adenosine 0.1 mg/kg IV rapidly; if adenosine is not immediately available, perform synchronized cardioversion. B. Make an appointment with a pediatric cardiologist for later in the week. C. Establish IV access and administer a flid bolus of 20 mL/kg isotonic crystalloid. D. Perform immediate defibrillation without waiting for IV access A 22 | P a g e You are preparing to use a manual defibrillator and paddles in the pediatric setting. When would it be most appropriate to use the smaller "pediatric" sized paddles for shock delivery? A. If the patient weighs less than approximately 10 kg or is less than 1 year of age. B. Whenever you can compress the victim's chest using only the heel of one hand C. To attempt synchronized cardioversion but not defibrillation D. If the patient weighs less than approximately 25 kg, or is less than 8 years of age. A Initial impression of a 10-year-old male shows him to be unresponsive. You shout for help, check breathing or only gasping. After finding that he is pulseless, you begin CPR. A colleague arrives and places the child on a cardiac monitor, revealing the above rhythm (V Tach). The two of you attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you attempt defibrillation using 4 J/kg. A third colleague establishes IO access and administers one dose of epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,0000) during the compressions following the second shock. If VF or pulseless VT persists after 2 minutes of CPR, what is the next drug/dose to administer? A. Adenosine 0.1 mg/kg IV B. Amiodarone 5 mg/kg IV C. Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000) IV D. Atropine 0.02 mg/kg IV B You are supervising another healthcare provider who is inserting an intraosseous (IO) needle into an infant's tibia. Which of the following signs should you tell the provider is the best indication of successful 25 | P a g e D. Equipment failure. A A child becomes unresponsive in the emergency department and is not breathing. You provide ventilation with 100% oxygen. You are uncertain if a faint pulse is present with the above rhythm (asystole). What is your next action? A. Order transcutaneous pacing. B. Start high quality CPR, beginning with compressions. C. Start an IV and give atropine 0.01 mg/kg IV D. Start an IV and give epinephrine 0.01 mg/kg IV (0.1 mL/kg of 1:10,000) B You have just assisted with the elective endotracheal intubation of a child with respiratory failure and a perfusing rhythm. Which of the following provides the most reliable, prompt assessment of correct endotracheal tube placement in this child? A. Absence of audible breath sounds over the abdomen during positive-pressure ventilation. B. Auscultation of breath sounds over the lateral chest bilaterally plus presence of mist in the endotracheal tube. C. Clinical assessment of adequate bilateral breath sounds and chest expansion plus presence of exhaled CO2 in a colormetric detection device after delivery of 6 positive-pressure ventilations. D. Confirmation of appropriate oxygen and carbon dioxide tensions on arterial blood gas analysis. C An 8-year-old child was struck by a car. He arrives in the emergency department alert, anxious, and in respiratory distress. His cervical spine is immobilized, and he is receiving a 10 L/min flow of 100% oxygen by nonrebreathing face mask. PRimary assessment reveals respiratory rate 60/min, heart rate 150/min, systolic blood pressure 70, and SpO2 84% on supplementary oxygen. Breath sounds are absent over the right chest, and the trachea is deviated to the left. He has weak central pulses and absent distal pulses. Which of the following is the most appropriate immediate intervention for this child? A. Provide bag-mask ventilation and call for a STAT chest x-ray 26 | P a g e B. Perform needle decompression of the right chest and assist ventilation with a bag and mask if necessary. C. Establish IV access and administer a 20 mL/kg normal saline fluid bolus D. Perform endotracheal intubation and call for a STAT chest x-ray B A 7-year-old boy is found unresponsive, apneic, and pulseless. CPR is ongoing. The child is intubated and vascular access is established. The ECG monitor reveals an organized rhythm, but a pulse check reveals no palpable pulses. Effective ventilations and compressions are resumed, and an initial IV dose of epinephrine is administered. Which of the following therapies should you perform next? A. Administer synchronized cardioversion at 1 J/kg B. Administer epinephrine 0.1 mg/kg IV (0.1 mL/kg of 1:1,000) C. Attempt defibrillation at 4 J/kg D. Attempt to identify and treat reversible causes (using the H's and T's as a memory aid) D A 4-year-old male is in pulseless arrest in the pediatric intensive care unit. A code is in progress. As the on-call physician you quickly review his chart and find that his baseline corrected QT interval on a 12- lead ECG is prolonged. A glance at the monitor shows recurrect episodes of the above rhythm. The boy has received one dose of epi, but continues to demonstrate the rhythm illustrated above (Torsades de Pointes). If this rhythm persists at the next rhythm check, which medication would be the most appropriate to administer at this time? A. Lidocaine 1 mg/kg IV B. Adenosine 0.1 mg/kg IV C. Epinephrine 0.1 mg/kg (1:1000) D. Magnesium sulfate 25 to 50 mg/kg IV D 27 | P a g e A pale and obtunded 3-year-old child with a history of diarrhea is brought to the hospital. Primary assessment reveals respiratory rate of 45/min with good breath sounds bilaterally. Heart rate is 150/min, blood pressure is 90/64, and SpO2 is 96% room air. Cap refill is 5 seconds and peripheral pulses are weak. After placing the child on a nonrebreathing face mask (10 L/min) with 100% O2 and obtaining vascular access, which of the following is the most appropriate immediate treatment for this child? A. Begin a maintenance crystalloid infusion B. Administer a bolus of 20 mL/kg isotonic crystalloid C. Obtain a chest x-ray D. Administer a dopamine infusion at 2 to 5 mcg/kg per minute. B An 8-month-old male is brought to the ED for evaluation of severe diarrhea and dehydration. In the ED the child becomes unresponsive and pulseless. You should for help and start CPR. Another provider arrives, and you begin a compression-to-ventilation ratio of 15:2. The cardiac monitor shows the above rhythm. The infant is intubated and ventilated with 100% O2. An IO line is rapidly established and a dose of epi is given. Of the following choices for management, which would be most appropriate to give next? A. Normal saline 20 mL/kg IV rapidly B. Amiodarone 5 mg/kg IO C. Defibrillation 2 J/kg D. High dose epinephrine 1:1,000, 0.1 mg/kg A You are participating in the elective intubation of a 4-year-old child with respiratory failure. You must select the appropriate sized uncuffed endotracheal tube. You do not have a Brazlow tape to use to estimate correct endotracheal tube size. Which of the following is the most appropriate uncuffed endotracheal tube for an average 4-year-old. A. 4-mm tube 30 | P a g e 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 suprasternal retractions are all indicators of increased work or effort of breathing. Grunting and inspiratory stridor are abnormal breath sounds. 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? First-line treatment for unstable wide-complex tachycardias consists of synchronized electrical cardioversion, particularly when signs of hemodynamic compromise are apparent. 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 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 is hemodynamically unstable. Which primary assessment findings indicate this? Difficulty breathing Hypotension Mottling Decreased level of consciousnes 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 31 | P a g e 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 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. 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 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 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 balance between tissue perfusion and metabolic demand with a focus on oxygen delivery and oxygen demand. 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? 32 | P a g e End-tidal carbon dioxide level between 15 and 20 mmHg 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? Summary of the event, including what actions were taken, Discussion of the pros and cons of the interventions, Identification of ways to improve, Evaluation of the objective data gathered during the event 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? Most children in septic shock present with cold shock (i.e., delayed capillary refill, diminished pulses, peripheral vasoconstriction, narrow pulse pressure, and cool, mottled extremities) instead of warm shock. 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 testing for the child in septic shock may include CBC, blood cultures, blood gasses, coagulation panel, renal function tests, liver function panel and lactate level. 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 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. 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