PALS PEDIATRIC EMERGENCY CARE ACTUAL EXAM 2025| 147
QUESTIONS WITH ACCURATE SOLUTIONS
1. A 7-year-old child with asthma is admitted to the emergency department
in respiratory distress and is unable to clear secretions effectively. What
should be the immediate next step in management after providing
supplemental oxygen?
Initiate intravenous corticosteroids
Perform airway clearance (e.g., suctioning)
Administer a nebulized bronchodilator
Prepare for intubation
2. A 4-year-old child is brought to the emergency department by the
parents. Assessment reveals that the child has only gasping respirations
and the pulse rate is 65 beats per minute. Which action would the provider
initiate first?
Begin chest compressions.
Deliver 1 BVM ventilation every 2 to 3 seconds.
Check pulse and breathing every 2 minutes.
Prepare the manual defibrillator.
3. The healthcare provider identifies that a pediatric patient is experiencing
tachycardia with inadequate perfusion and 12-lead ECG reveals wide QRS
complex ventricular tachycardia. What is the first action the provider
should implement?
Administration of atropine
Administration of procainamide
Synchronized electrical cardioversion
Administration of amiodarone
,4. A provider is forming an initial impression of a child using the Pediatric
Assessment Triangle (PAT). For which part of the PAT may the provider
use the mnemonic TICLS to assess the patient?
Appearance
Work of
breathing
Circulation
Exposure
5. A 6-year-old boy is brought to the emergency room by his parents
after attending a friend's birthday party. The parents report that he may
have inadvertently consumed a piece of cake containing peanuts, to
which he is known to be severely allergic. Within 15 minutes of eating, he
developed facial swelling, difficulty breathing, and hives. The child is now
anxious and has a faint, rapid pulse. Based on the clinical scenario, which
of the
following is the most appropriate immediate intervention?
Administer an oral antihistamine.
Administer intramuscular epinephrine.
Start intravenous corticosteroids.
Give the child a bronchodilator inhaler.
6. Explain why albuterol is the preferred medication for treating a
severe asthma exacerbation in pediatric patients.
It is a long-acting bronchodilator.
It provides immediate bronchodilation.
It reduces inflammation in the airways.
It is an antibiotic for respiratory infections.
7. In a scenario where a child presents with bradycardia and hypotension,
what immediate action should the emergency response team prioritize
to prevent cardiac arrest?
, Administer intravenous fluids only.
Initiate cardiopulmonary resuscitation (CPR) immediately.
Monitor vital signs and wait for further assessment.
Provide supplemental oxygen and reassess the child.
8. A 6-year-old child is successfully resuscitated after a cardiac arrest and
is being monitored in the intensive care unit. Which assessment finding
will the nurse identify as a potential sign of systemic/ischemic
reperfusion
injury?
resumption of urine output
edema and hypotension
increased oxygen saturation
nausea and vomiting
9. A 10-year-old child presents with signs of shock and a heart rate of 180
bpm due to ventricular tachycardia. After initial assessment, the PALS
team decides to administer synchronized electrical cardioversion. What
should be the next step in the management of this child after the
procedure?
Monitor vital signs and reassess perfusion
Immediately start CPR
Administer high-dose epinephrine
Prepare for intubation
10. In pediatric emergency care, which two cardiac rhythms are indicated
for defibrillation during a cardiac arrest scenario?
Asystole and PEA
pVT and VF
Atrial Fibrillation and Ventricular Tachycardia
Sinus Bradycardia and Ventricular Fibrillation
, 11. A 5-year-old child is brought to the emergency department in cardiac
arrest with a witnessed collapse. The monitor shows ventricular
fibrillation. After confirming the absence of a pulse, what should be the
immediate next step in the management of this child?
Administer 1 mg of epinephrine
Initiate defibrillation with 4 J/kg
Perform 2 minutes of CPR before defibrillation
Insert an advanced airway
12. What is one method used to monitor the effectiveness of chest
compressions during pediatric cardiac arrest?
End-tidal carbon dioxide levels
Heart rate monitoring
Capillary refill time
Oxygen saturation levels
13. Methods to confirm airway placement include which of the following?
Auscultation of lungs and epigastrium
Percussion of chest
wall Abdominal exam
Moving tube in and out of airway
14. The nurse is caring for a client with the following tracing on
the electrocardiogram (ECG). The nurse identifies this tracing
as:
QUESTIONS WITH ACCURATE SOLUTIONS
1. A 7-year-old child with asthma is admitted to the emergency department
in respiratory distress and is unable to clear secretions effectively. What
should be the immediate next step in management after providing
supplemental oxygen?
Initiate intravenous corticosteroids
Perform airway clearance (e.g., suctioning)
Administer a nebulized bronchodilator
Prepare for intubation
2. A 4-year-old child is brought to the emergency department by the
parents. Assessment reveals that the child has only gasping respirations
and the pulse rate is 65 beats per minute. Which action would the provider
initiate first?
Begin chest compressions.
Deliver 1 BVM ventilation every 2 to 3 seconds.
Check pulse and breathing every 2 minutes.
Prepare the manual defibrillator.
3. The healthcare provider identifies that a pediatric patient is experiencing
tachycardia with inadequate perfusion and 12-lead ECG reveals wide QRS
complex ventricular tachycardia. What is the first action the provider
should implement?
Administration of atropine
Administration of procainamide
Synchronized electrical cardioversion
Administration of amiodarone
,4. A provider is forming an initial impression of a child using the Pediatric
Assessment Triangle (PAT). For which part of the PAT may the provider
use the mnemonic TICLS to assess the patient?
Appearance
Work of
breathing
Circulation
Exposure
5. A 6-year-old boy is brought to the emergency room by his parents
after attending a friend's birthday party. The parents report that he may
have inadvertently consumed a piece of cake containing peanuts, to
which he is known to be severely allergic. Within 15 minutes of eating, he
developed facial swelling, difficulty breathing, and hives. The child is now
anxious and has a faint, rapid pulse. Based on the clinical scenario, which
of the
following is the most appropriate immediate intervention?
Administer an oral antihistamine.
Administer intramuscular epinephrine.
Start intravenous corticosteroids.
Give the child a bronchodilator inhaler.
6. Explain why albuterol is the preferred medication for treating a
severe asthma exacerbation in pediatric patients.
It is a long-acting bronchodilator.
It provides immediate bronchodilation.
It reduces inflammation in the airways.
It is an antibiotic for respiratory infections.
7. In a scenario where a child presents with bradycardia and hypotension,
what immediate action should the emergency response team prioritize
to prevent cardiac arrest?
, Administer intravenous fluids only.
Initiate cardiopulmonary resuscitation (CPR) immediately.
Monitor vital signs and wait for further assessment.
Provide supplemental oxygen and reassess the child.
8. A 6-year-old child is successfully resuscitated after a cardiac arrest and
is being monitored in the intensive care unit. Which assessment finding
will the nurse identify as a potential sign of systemic/ischemic
reperfusion
injury?
resumption of urine output
edema and hypotension
increased oxygen saturation
nausea and vomiting
9. A 10-year-old child presents with signs of shock and a heart rate of 180
bpm due to ventricular tachycardia. After initial assessment, the PALS
team decides to administer synchronized electrical cardioversion. What
should be the next step in the management of this child after the
procedure?
Monitor vital signs and reassess perfusion
Immediately start CPR
Administer high-dose epinephrine
Prepare for intubation
10. In pediatric emergency care, which two cardiac rhythms are indicated
for defibrillation during a cardiac arrest scenario?
Asystole and PEA
pVT and VF
Atrial Fibrillation and Ventricular Tachycardia
Sinus Bradycardia and Ventricular Fibrillation
, 11. A 5-year-old child is brought to the emergency department in cardiac
arrest with a witnessed collapse. The monitor shows ventricular
fibrillation. After confirming the absence of a pulse, what should be the
immediate next step in the management of this child?
Administer 1 mg of epinephrine
Initiate defibrillation with 4 J/kg
Perform 2 minutes of CPR before defibrillation
Insert an advanced airway
12. What is one method used to monitor the effectiveness of chest
compressions during pediatric cardiac arrest?
End-tidal carbon dioxide levels
Heart rate monitoring
Capillary refill time
Oxygen saturation levels
13. Methods to confirm airway placement include which of the following?
Auscultation of lungs and epigastrium
Percussion of chest
wall Abdominal exam
Moving tube in and out of airway
14. The nurse is caring for a client with the following tracing on
the electrocardiogram (ECG). The nurse identifies this tracing
as:
