PALS Certification 2023 with verified questions and answers

Previously healthy infant w hx of vomting and diarrhea. Infant only responts to painful stimulation. RR is 40, central pulses rapid and weak. Good bilatearl breath sounds, cool extremities, and cap refill time 5 seconds. BP 85/65 mm Hg, glucose 30 mg/dL. You give 100% O2 via face mask and start an IV. Which tx is the most appropriate? A. D10W 20 mL/kg bolus over 5 minutes B. LR solution 20 mL/kg bolus over 15 minutes C. D50W 0.45% NaCl 20 mL/kg bolus over 15 minutes D. Bolus of isotonic crystalloid 20 mL/kg over 5 - 20 minutes, and D25W2 to 4 mL/kg IV D. Bolus of isotonic crystalloid 20 mL/kg over 5 - 20 minutes, and D25W2 to 4 mL/kg IV Which statement is correct about endotracheal drug administration during resuscitative efforts for peds pt? A. It is the preferred route of drug administration B. it is the least desirable route of administration C. the IV drug dose should be used D. The drug does used is lower than the IV drug B. it is the least desirable route of administration Which statement is correct about the use of calcium chloride in peds patients? A. It has the same bioavailability of elemental Calcium as calcium gluconate B. it is indicated for hypercalcemia, hypokalemia, and hypomanesemia C. the recommended dose is 1 to 2 mg/kg D. Routine administration is not indicated during cardiac arrest D. Routine administration is not indicated during cardiac arrest You are part of a team attempting to resuscitate a child with V fib cardiac arrest. You gave 2 unsynchronized shocks. IO access is obtained, you give Epinephirne 0.01 mg/kg IO. At next rhythm check, persistent V fib. You administer 4-J/kg shock and resume CPR. What drug and dose should be administered next? A. Mag sulfrate 25 - 50 mg/kg IO B. Epinephirne 0.1 mg/kg IO C. Atropine 0.02 mg/kg IO D. Amiodarone 5 mg/kg IO D. Amiodarone 5 mg/kg IO Paramedics are called for 1 yo. Initial assessment reveals a child who responds to only painful stimuli and has irregular breathing, faint central pulse, bruises over abdomen, abdominal distention, and cyanosis. Bag ventilation with 100% O2 is started. HR is 36. Pulses cannot be palpated, central pulses are barely palpable. Cardiac monitor shows sinus brady. 2 rescuer CPR is started. Upon arrival to ED, child is intubated and ventilated with 100% O2 and IV access is established. HR is now 150/min with weak central pulses but no distal pulses. SBP is 74. Which intervention should be next? A. Atropine 0.02 mg/kg IV B. Amiodarone 5 mg/kg IV C. Rapid bolus of 20 mL/kg of isotonic cystalloid D. Epinephine 0.01 mg/kg IV C. Rapid bolus of 20 mL/kg of isotonic cystalloid 9 yo boy is agitated and leaning forward on bed in obvious resp. distress. Pt is speaking in short phrases and has Hx of asthma but does not have inhaler. Has nasal flaring, severe suprasternal and intercostal retractions and decreased air movement with prolonged expiratory time and wheezing. You give 100 % O2 by nonrebreathing mask. SpO2 92%. What med do you give? A. Albuterol B. Adenosine C. Procainamide D. Ammiodarone A. Albuterol Which O2 delivery system most reliably delivers a high (90% or greater) concentration of inspired O2 to a 7 yo? A. Simple Oxygen mask B. Face tent C. Nonrebreathing face mask D. nasal cannula C. Nonrebreathing face mask Which is correct about effects of epineprhine during resuscitation? A. Epi is contraindicated in v fib B. epi decreases peripheral vascular resistance and reduces myocardial afterload C. Epi stimulates spontaneous contractions when asystole is present D. Epi decreases myocardial oxygen consumption C. Epi stimulates spontaneous contractions when asystole is present you are called to help tx an infant with severe symptomatic bradycardia (66) associated with resp. distress. Brady persisted despite effective airway, oxygenation and ventilation. No heart block. Which is the first drug you give? A. atropine B. Dopamine C. Epinephrine D. Adenosine Epinephrine 2 yo girl is alert with mild breathing difficulty during inspiration and pale skin. She has mild stridor when agitated, otherwise breathing is quiet. 92% O2 on RA, mild inspiratory intercostal retractions. Auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which is the most appropriate inital intervention? A. IV dex C. Nebulized albuterol C. humidified oxygen as tolerated D. endotracheal intubation C. humidified oxygen as tolerated 6 yo with mottled skin color. Pt is febrile (104) and her extremities are cold with cap refill of 5 seconds. Distal pulses are absent and central pulses are weak. HR is 180, RR 45, BP 98/56. How would you categorize child's condition? A. compensated shock requiring no intervention B. compensated shock associated with tachy and inadequate tissue perfusion C. Hypotensive shock associated with inadequate tissue perfusion and significant hypotension D. hypotensive shock associated with inadequate tissue perfusion B. compensated shock associated with tachy and inadequate tissue perfusion 8 yo struck by car. He arrives in ED alert, anxious, and respiratory distress. Cerv spine is immobilized, and he is getting 10 L/min flow of 100% O@ by nonrebreathing face mask. RR 60, HR 150, SBP 70, SpO2 84%. Breath sounds absent over the R chest but over L, treachea deviated to L. Weak central pulses and absent distal pulses. Which intervention should be performed next? A. Perform needle decompression of R chest B. Perform endotracheal intubation C. Establish IV access D. Provide bag-mask ventilation A. Perform needle decompression of R chest You and another person start CPR. other person does compressions and you notice that rate is too slow. What should you say? A. Need to compress 120/minute at least B. Need to compress 100 - 120/minute at least C. Need to compress 100/minute at least D. Need to compress 80 - 120 minute at least B. Need to compress 100 - 120/minute at least First AED shock should be how many Joules per kg? What about 2nd and 3rd shock etc.? 1st = 2 J/kg 2nd = 4 J/kg 3rd+ = 6 - 10 J/kg or adult shock What are the 2 shock-able rhythms? Ventricular fibrillation Pulseless ventricular tachycardia What are the 2 non-shock-able rhythms? Pulseless electrical activity (PEA) Asystole After how many shocks can you give epinephrine? After 2 shocks What is the dosage of epinephrine? (dose how often?) Epinephrine 0.01 mg/kg every 3 - 5 minutes What is the dosage of amiodarone? (dose how often?) Amiodarone 5 mg/kg - may repeat up to 2 times Once an endotracheal airway is in, how often do you give rescue breaths? 1 every 6 seconds What is the formula for figuring out uncuffed endotracheal tube size? (Age in years/4) + 4 What is the formula for figuring out cuffed endotracheal tube size? (Age in years/4) = 3.5 When a HR is less than _____, start CPR? 60 bpm What 2 medications can you give for bradycardia? Epinephrine Atropine What is the dose of Atropine you can give for bradycardia Atropine 0.02 mg/kg - may repeat once What is the universal rate for chest compressions? 100 - 120 What is the ratio of compressions:breaths with a single provider for infants? what about for children both 30:2 What is the ratio of compressions:breaths with two providers for infants? what about for children 15:2 How are compressions different for infants when you're by yourself vs. with someone else? Alone: 2 finger technique 2 rescuer: 2 thumb encircling hand technique What is the depth of compressions for infants 1 1/2 inch or 4 cm OR 1/3 the AP diameter of the chest What is the depth of compressions for children 2 inches or 5 cm OR 1/3 the AP diameter of the chest What is the definition of compensated shock? Shock with adequate BP Synchronized cardioversion should start at what J/kg then increase to what? Start at 0.5 - 1 J/kg then increase to 2 J/kg What is the ratio of backslaps:chest thrust for removal of foreign body in baby 1 yo? 5 backslaps: 5 chest thrusts What is the timing you call for help for a witnessed vs. witness cardiac arrest ? Witnessed: can call for help before compressions Unwitnessed: call for help only have 2 minutes of chest compressions What is the normal rescue breathing rate without an endotracheal tube? 1 breath every 3 - 5 seconds (just enough to see the chest rise) What fluid and dose do you give for hypotension? Isotonic crystalloid (Normal saline, Lactated Ringer) 20 mL/kg bolus what statement is correct about endotracheal drug administration during recuscitative efforts for peds patients? A: It is the least desirable route of administration B: The drug dose is used lover than the IV dose C: It is the preferred route D: The IV drug dose should be used A: It is the least desirable route of administration What oxygen delivering system delivers a high (90% or greater) concentration of inspired O2 to a 7 yo? A: Face tent B: simple oxygen mask C: Nonthreatening face mask D: Nasal cannula C: Nonthreatening face mask Which of the following is correct about the effects of epi during attempted resuscitation? A: Epi is contraindicated in v fib B: Epi decreases myocardial O2 consumption C: Epi decreases peripheral vascular resistance and reduces myocardial afterload D: Epi stimulates spontaneous contractions when asystole is present D: Epi stimulates spontaneous contractions when asystole is present Which statement is correct about the use of calcium chloride in pediatric patients? A: It has the same bioavailability of elemental calcium as calcium gluconate B: Route administration is not indicated during cardiac arrest C: It is indicated for hypercalcemia, hypokalemia and hypomagnesemia D: The recommended dose is 1 - 2 mg/kg D: B: Route administration is not indicated during cardiac arrest What weight/age is it appropriate to use the smaller pediatric paddles for a manual defibrillator? A: 40 kg or 10 yo B: 30 kg or 5 yo C: 10 kg or 1 yo D: 20 kg or 3 yo C: 10 kg or 1 yo you find an infant who is unresponsive, is not breathing, and without a pulse. You shout for nearby help, but no one arrives. What action should you do next? A: CPR for 60 secs before leaving to activate EMS B: CPR for 2 minutes before leaving to activate EMS C: Activate EMR after giving CPR for 10 minutes D: C: Activate EMR after giving CPR for 60 seconds B: CPR for 2 minutes before leaving to activate EMS you are evaluating n irritable 6 yo girl with mottled skin color. She is febrile, extremities are cold with cap refill of 5 sec. Distal pulses are absent and central pulses are weak. HR is 180/min, RR is 45/min, and BP is 98/56 mm Hg. How would you categorize this child's condition? A: Compensated shock requiring no intervention B: Compensated shock associated with tachycardia and inadequate tissue perfusion C: Hypotensive shock associated w inadequate tissue perfusion and significant hypotension D: Hypotensive shock associated w inadequate tissue perfusion B: Compensated shock associated with tachycardia and inadequate tissue perfusion What sign do you look for to know you are in the right place for an IO insertion? A: The needle moves easily in all directions within the bone B: Fluids can be administered freely w/o soft tissue swelling C: Pulsatile blood flow in the needle hub D: It will yield blood return B: Fluids can be administered freely w/o soft tissue swelling