Pediatric Advanced Life Support| 224 QUESTIONS| WITH
COMPLETE SOLUTIONS
Recognize *supraventricular tachycardia* Correct Answer:
Recognize *wide-complex tachycardia* Correct Answer:
Recognize *SVT converting to sinus rhythm after adenosine administration* Correct Answer:
What oxygen delivery system most reliably delivers a high (90% of greater) concentration of
inspired oxygen to a 7-year-old child? Correct Answer: Nonrebreathing face mask
You are called to help treat an infant with severe symptomatic bradycardia (heart rate 66/min)
associated with respiratory distress. Bradycardia persists despite establishment of an effective
airway, oxygenation, and ventilation. There is no heart block present. What first drug should you
administer? Correct Answer: *Epinephrine*
You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest.
You deliver 2 unsynchronized shocks. A team member established IO access, so you give a dose
of epinephrine, 0.01 mg/kg IO. At next rhythm check, persistent ventricular fibrillation is
present. You administer a 4-J/kg shock and resume CPR. What drug and dose should be
administered next? Correct Answer: *Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
Initial impression of a 2-year-old girl shows her to be alert with mild breathing difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory
sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room
air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Most appropriate initial
intervention for this child? Correct Answer: *Humidified oxygen as tolerated*
,7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing. Child is intubated,
and vascular access is established. ECG monitor shows organized rhythm with heart rate of
45/min, but a pulse check reveals no palpable pulses. High-quality CPR is resumed, and an initial
IV dose of epinephrine is administered. What intervention should you perform next? Correct
Answer: *Identify and treat reversible causes*
You are caring for a 6-year-old patient who is receiving positive-pressure mechanical ventilation
via an endotracheal tube. Child begins to move his head and suddenly becomes cyanotic, and his
heart rate decreases. His SpO2 is 65%. You remove child from mechanical ventilator and begin
to provide manual ventilation with a bag via endotracheal tube. During manual ventilation with
100% oxygen, child's color and heart rate improve slightly and his BP remains adequate. Breath
sounds and chest expansion are present and adequate on right side and are present but
consistently diminished on left side. Trachea not deviated, and neck veins are not distended.
Suction catheter passes easily beyond tip of the endotracheal tube. Most likely cause of this
child's acute deterioration? Correct Answer: *Tracheal tube displacement into right main
bronchus*
You are giving chest compressions for a child in cardiac arrest. What is the proper depth of
compressions for a child? Correct Answer: *Compress the chest at least one third the depth of
the chest, about 2 inches (5 cm)*
During PALS, you and another rescuers begin CPR. Your colleague begins compressions, and
you noticed that the compression rate is too slow. What should you say to offer constructive
feedback? Correct Answer: *You need to compress at a rate of 100 to 120 per minute*
You are preparing to use a manual defibrillator in the pediatric setting. What best describes when
it is appropriate to use the smaller pediatric-sized paddles? Correct Answer: *If the child weighs
less than 10 kg or is less than 1 year old*
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate
for delivering breaths? Correct Answer: *1 breath every 3 to 5 seconds*
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout
for nearby help, but no one arrives. What action should you take next? Correct Answer:
*Provide CPR for about 2 minutes before leaving to activate the emergency response system*
3 yo boy presents with multiple-system trauma. Child was an unrestrained passenger in a high-
speed MVC. On primary assessment, he is unresponsive to voice or painful stimulation. His RR
is 5/min, HR and pulses are 170/min, systolic BC is 60 mmHg, capillary refill is 5 seconds, and
SpO2 is 75% on room air. What action should you take first? Correct Answer: *While a
colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-
mask ventilation*
You are assisting in the elective intubation of an average-sized 4 yo child with respiratory
failure. Colleague is retrieving the color-coded length-based tape from the resuscitation chart.
, What is likely to be the estimated size of the uncuffed endotracheal tube for this child? Correct
Answer: *5-mm tube*
You find a 10 yo boy to be unresponsive. You shout for help, and after finding that he is not
breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the
emergency response system, brings the emergency equipment, and places the child on a cardiac
monitor/defibrillator, which reveals ventricular tachycardia. You attempt defib at 2 J/kg and give
2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you attempt
defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of
epinephrine 0.01 mg/kg. If v fib or pulseless ventricular tachycardia persists after 2 minutes of
CPR, you will administer another shock. What drug and dose should be administered? Correct
Answer: *Lidocaine 1 mg/kg IV*
During bag-mask ventilation, how should you hold the mask to make an effective seal between
the child's face and the mask? Correct Answer: *Position your fingers using the E-C clamp
technique*
Age of infants Correct Answer: <1 yo (excluding the newly born)
Age of children Correct Answer: from 1 year of age to puberty
To perform a pulse check in an infant, palpate a Correct Answer: brachial pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning with chest
compressions
To perform a pulse check in a child, palpate a Correct Answer: carotid or femoral pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning with chest
compressions
Compression depth in infants Correct Answer: at least 1/3 the AP diameter of the chest or about
1 1/2 inches (4 cm)
If a head or neck injury is suspected, use what to open the airway? Correct Answer: jaw-thrust
maneuver
- if jaw thrust does not open the airway, use the head tilt-chin lift
The primary assessment (primary survey) uses a hands-on ABCDE approach and includes
assessment of the patient's vital signs .. what does ABCDE stand for? Correct Answer: Airway
Breathing
Circulation
Disability
Exposure
COMPLETE SOLUTIONS
Recognize *supraventricular tachycardia* Correct Answer:
Recognize *wide-complex tachycardia* Correct Answer:
Recognize *SVT converting to sinus rhythm after adenosine administration* Correct Answer:
What oxygen delivery system most reliably delivers a high (90% of greater) concentration of
inspired oxygen to a 7-year-old child? Correct Answer: Nonrebreathing face mask
You are called to help treat an infant with severe symptomatic bradycardia (heart rate 66/min)
associated with respiratory distress. Bradycardia persists despite establishment of an effective
airway, oxygenation, and ventilation. There is no heart block present. What first drug should you
administer? Correct Answer: *Epinephrine*
You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest.
You deliver 2 unsynchronized shocks. A team member established IO access, so you give a dose
of epinephrine, 0.01 mg/kg IO. At next rhythm check, persistent ventricular fibrillation is
present. You administer a 4-J/kg shock and resume CPR. What drug and dose should be
administered next? Correct Answer: *Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
Initial impression of a 2-year-old girl shows her to be alert with mild breathing difficulty during
inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory
sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room
air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Most appropriate initial
intervention for this child? Correct Answer: *Humidified oxygen as tolerated*
,7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing. Child is intubated,
and vascular access is established. ECG monitor shows organized rhythm with heart rate of
45/min, but a pulse check reveals no palpable pulses. High-quality CPR is resumed, and an initial
IV dose of epinephrine is administered. What intervention should you perform next? Correct
Answer: *Identify and treat reversible causes*
You are caring for a 6-year-old patient who is receiving positive-pressure mechanical ventilation
via an endotracheal tube. Child begins to move his head and suddenly becomes cyanotic, and his
heart rate decreases. His SpO2 is 65%. You remove child from mechanical ventilator and begin
to provide manual ventilation with a bag via endotracheal tube. During manual ventilation with
100% oxygen, child's color and heart rate improve slightly and his BP remains adequate. Breath
sounds and chest expansion are present and adequate on right side and are present but
consistently diminished on left side. Trachea not deviated, and neck veins are not distended.
Suction catheter passes easily beyond tip of the endotracheal tube. Most likely cause of this
child's acute deterioration? Correct Answer: *Tracheal tube displacement into right main
bronchus*
You are giving chest compressions for a child in cardiac arrest. What is the proper depth of
compressions for a child? Correct Answer: *Compress the chest at least one third the depth of
the chest, about 2 inches (5 cm)*
During PALS, you and another rescuers begin CPR. Your colleague begins compressions, and
you noticed that the compression rate is too slow. What should you say to offer constructive
feedback? Correct Answer: *You need to compress at a rate of 100 to 120 per minute*
You are preparing to use a manual defibrillator in the pediatric setting. What best describes when
it is appropriate to use the smaller pediatric-sized paddles? Correct Answer: *If the child weighs
less than 10 kg or is less than 1 year old*
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate
for delivering breaths? Correct Answer: *1 breath every 3 to 5 seconds*
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout
for nearby help, but no one arrives. What action should you take next? Correct Answer:
*Provide CPR for about 2 minutes before leaving to activate the emergency response system*
3 yo boy presents with multiple-system trauma. Child was an unrestrained passenger in a high-
speed MVC. On primary assessment, he is unresponsive to voice or painful stimulation. His RR
is 5/min, HR and pulses are 170/min, systolic BC is 60 mmHg, capillary refill is 5 seconds, and
SpO2 is 75% on room air. What action should you take first? Correct Answer: *While a
colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-
mask ventilation*
You are assisting in the elective intubation of an average-sized 4 yo child with respiratory
failure. Colleague is retrieving the color-coded length-based tape from the resuscitation chart.
, What is likely to be the estimated size of the uncuffed endotracheal tube for this child? Correct
Answer: *5-mm tube*
You find a 10 yo boy to be unresponsive. You shout for help, and after finding that he is not
breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the
emergency response system, brings the emergency equipment, and places the child on a cardiac
monitor/defibrillator, which reveals ventricular tachycardia. You attempt defib at 2 J/kg and give
2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you attempt
defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of
epinephrine 0.01 mg/kg. If v fib or pulseless ventricular tachycardia persists after 2 minutes of
CPR, you will administer another shock. What drug and dose should be administered? Correct
Answer: *Lidocaine 1 mg/kg IV*
During bag-mask ventilation, how should you hold the mask to make an effective seal between
the child's face and the mask? Correct Answer: *Position your fingers using the E-C clamp
technique*
Age of infants Correct Answer: <1 yo (excluding the newly born)
Age of children Correct Answer: from 1 year of age to puberty
To perform a pulse check in an infant, palpate a Correct Answer: brachial pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning with chest
compressions
To perform a pulse check in a child, palpate a Correct Answer: carotid or femoral pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning with chest
compressions
Compression depth in infants Correct Answer: at least 1/3 the AP diameter of the chest or about
1 1/2 inches (4 cm)
If a head or neck injury is suspected, use what to open the airway? Correct Answer: jaw-thrust
maneuver
- if jaw thrust does not open the airway, use the head tilt-chin lift
The primary assessment (primary survey) uses a hands-on ABCDE approach and includes
assessment of the patient's vital signs .. what does ABCDE stand for? Correct Answer: Airway
Breathing
Circulation
Disability
Exposure
