PALS Pretest Answers
Chest Compression depth: Infant
1.5 inch or 4 cm (1/3 AP Diameter)
Chest Compression depth: Child
2 inches or 5 cm (1/3 AP Diameter)
Maximum Compression depth: Infant
2.4 in or 6cm
Infant/children/adolescent compression rate
100-120 compressions a minute
Ratio for single rescuer
30 compressions 2 breaths
Ratio for 2 rescuer
15 compressions 2 breaths
Rate of rescue breathing
1 breath every 6-8 seconds or 8-10 breaths/min
Isotonic Crystalloids 2 examples
NS & Lactated Ringers
Fluid challenge is how much (in hypotension)?
20mL/kg (18kg gets 260 mL)
BP parameters for PALS (minimum systolic in 4 age groups)
0-1month old= min 60 systolic
1 month-1 year= min 70 systolic
1 year-10 year= min 70+(2xage) systolic
over 10 years= min 90 systolic
1 month-1 year= min 70 systolic
1 year-10 year= min 70+(2xage) systolic
over 10 years= min 90 systolic
Atropine dose pre-intubation
Atropine 0.02 mg/kg
Med: Shock refractory VF or pulseless Tachycardia
Lidocaine or Amiodarone (used in field had better chance of survival but in hospital, either drug has same outcome)
Amiodarone dosage
5mg/kg
Epinephrine in Cardiac Arrest Indication
all pulseless arrests, hypotensive shock, anaphylaxis, asthma, croup
Targeted Temperature management post cardiac arrest
5 days of normothermia (36C-37.5C or 96.8F-99.5F)- NOT HYPOTHERMIA
Inotrope drugs (3)
Dopamine, Dobutamine, epinephrine (epi also vasopressor)
Normoxemia is what %?
94% or above oxygenation
6 roles in PALS:
team leader
airway
compressor
monitor
medication
recorder
airway
compressor
monitor
medication
recorder
Oxygen saturation level goals
94%-99%
Fluid bolus during post cardiac arrest care
5-10 mL/kg over 10-20 minutes
Causes of Secondary Brain Injury
Hyperthermia
Hypotension
Hypoglycemia
Hypoxia
Hypotension
Hypoglycemia
Hypoxia
Defibrillation Joules (initial and refractory)
2J and then if refractory 4J
Temp & timing for Permissive hypothermia post-cardiac arrest… how many days of normothermia after?
32C-34C (89.6-98.2) for 2 days followed by 3 days of normothermia
4 Spots for IO
proximal tibia
medial malleolus
distal femur
ASIS
medial malleolus
distal femur
ASIS
How to evaluate alert/awake/responsive?
Appearance, Breathing, Circulation
What should always follow IO?
NS flush 5-10mL
PALS 2022 Test Questions
Q:1-A 5-year-old child in supraventricular tachycardia has adequate pulses with the rhythm. Supplemental oxygen is in place and vital signs are stable except for the elevated heart rate. The most appropriate next intervention for this child is:
Mark one answer:
- Unsynchronized cardioversion
- Vagal maneuvers
- Synchronized cardioversion
- Amiodarone
Q:2-A child has an advanced airway in place during cardiac arrest. How frequently should ventilations be given?
Mark one answer:
- Every 3 seconds
- Every 6 seconds
- Every 10 seconds
- Every 12 seconds
Q:3-You are using a bag-valve mask to resuscitate an infant, while another rescuer is performing chest compressions. What is the correct ratio of chest compressions to ventilations?
Mark one answer:
- 30 chest compressions to 2 ventilations
- 15 chest compressions to 2 ventilations
- 30 ventilations to 2 chest compressions
- 15 ventilations to 2 chest compressions
Q:4-You are alone performing infant CPR. What is the correct ratio of chest compressions to ventilations?
Mark one answer:
- 30 chest compressions to 2 ventilations
- 15 chest compressions to 2 ventilations
- 30 ventilations to 2 chest compressions
- 15 ventilations to 2 chest compressions
Q:5-A 7 month old appears to be unconscious and not breathing. You check for a pulse at the ________ artery.
Mark one answer:
- Brachial
- Femoral
- Carotid
- Coronary
Q:6-A clear sign of upper airway obstruction is:
Mark one answer:
- Decreased inspiratory effort
- Breath sounds in all lung fields
- Crying
- A “whistling” sound during breathing
Q:7-In children, which of the following is the most common form of arrest?
Mark one answer:
- Respiratory arrest
- Ventricular fibrillation – cardiac arrest
- Ventricular tachycardia – cardiac arrest
- PEA – cardiac arrest
Q:8-In small children, a rescue breath should be given:
Mark one answer:
- As quickly as possible
- As slowly as possible
- Over one second
- Over three seconds
Q:9-What is the normal range of heart rates for an 8-year-old child?
Mark one answer:
- 80-205 per minute
- 75-190 per minute
- 60-140 per minute
- 50-100 per minute
Q:10-The child you are caring for is very pale. You know that this pallor can be caused by all of the following EXCEPT:
Mark one answer:
- Anemia
- Heat
- Shock
- Albinism
PALS Final Exam Answers
A 12-year-old child being evaluated in the pediatric intensive care unit displays the following ECG waveform. The team interprets this as which arrhythmia?
second degree
Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic, tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of oxygen delivery?
Lactate
A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition?
Respiratory failure
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?
Deliver 1 BVM ventilation every 3 to 5 seconds.
A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme disease 2 months ago. A rhythm strip is obtained as shown below. The provider interprets this rhythm as indicating which arrhythmia?
First-degree atrioventricular (AV) block
A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of post-cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is experiencing a systemic response to ischemia/reperfusion. The team bases this determination on which finding(s)?
Hypotension
Fever
Hyperglycemia
A 2-year-old child arrives at the emergency department with the parents. The child is unresponsive, is not breathing and has no pulse. Two emergency department providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR?
Allowing the chest to recoil fully after each compression
Providing ventilations that last about 1 second each
Compressing the chest about 2 inches
Giving 2 ventilations to every 15 compressions
A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?
VF and pVT are shockable cardiac arrest rhythms.
A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?
Hypotension is not a consistent feature of shock;
A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child’s oxygen saturation above what percentage?
Supplemental oxygen should be administered as needed to maintain an oxygen saturation above 94%.
An 11-year-old soccer player is brought to the emergency department. After a quick assessment, the team realizes this patient is experiencing a severe asthma exacerbation. Which medication would the team administer first?
Albuterol plus ipratropium bromid
A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present?
Pallor is a circulation finding that may be seen in patients with respiratory distress.
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
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
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?
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
A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals tracheal deviation to the left side, chest pain on inspiration and decreased breath sounds on the right side. The provider suspects obstructive shock caused by what condition?
tension pneumothorax
A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer?
vagal
An unresponsive 7-year-old child with no pulse is brought to the pediatric urgent care center by his parents and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action would the PALS team take first?
initiate defibrillation with 2 J/kg.
A child who is stable and exhibiting a narrow-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication?
Patients may have a brief period of “asystole” following the administration of adenosine. This is normal and typically self-limited.
An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, tachycardia and dyspnea. The parents state that the child, who is allergic to peanuts, had eaten some popcorn that had peanuts in it. The team initiates care, preparing to administer which agent first?
epi
A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest. When preparing to administer medications, which action would be appropriate for the team to take?
tape
The PALS team is providing post-cardiac arrest care to an 8-year-old child in the pediatric intensive care unit. Which intervention would the team implement to achieve the primary goal of post-cardiac arrest care?
ensure MAP
A 12-year-old is being treated in the urgent care clinic. The mother reports that the child came home from school yesterday with a high fever, vomiting and multiple episodes of watery diarrhea. The healthcare provider obtains a rhythm strip and notes the following waveform. The provider interprets this as which type of arrhythmia?
sinus tahy
A child requires cardiac monitoring. A three-electrode system is being used. At which location would the provider place the red electrode?
On the lower left abdomen
An advanced airway was placed in a 5-year-old child. Which action(s) would be most appropriate for the team to take to confirm correct placement?
Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography.
A 12-lead ECG is ordered for a child complaining of a “racing heart.” When placing the electrodes on the child, at which location would the lead for V4 be placed?
fifth intercostal space at the midclavicular line on the patient’s left side.
A 7-year-old child collapses on the playground at school. The school nurse is called to the scene and determines that the child is unresponsive and is not breathing and has no pulse. The nurse initiates CPR. At what rate and depth would the nurse deliver compressions to this child?
100 to 120 compressions per minute at a depth of about 2 inch
Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient?
Maintain the head in midline position with 30-degree elevation
child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?
Hypotension, Bradycardia, Diminished central pulses
A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?
Corticosteroids, Racemic epinephrine
After ROSC, a child is experiencing post-cardiac arrest hemodynamic instability. The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload?
Isotonic fluid boluses
A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory distress. The child is breathing spontaneously and receiving supplemental oxygen. Which additional intervention is a critical component of airway management for this patient?
Airway clearance
A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). During which step of the PAT may the provider use the mnemonic TICLS to assess the patient?
appearance
A child in the pediatric intensive care unit displays the following ECG waveform. The child has no pulse. The resuscitation team interprets this as which arrhythmia
Monomorphic pulseless ventricular tachycardia
A child experiencing unstable bradycardia is receiving CPR. Despite efforts with CPR, including assuring oxygenation and ventilation, the child’s status remains unchanged. Which medication would the emergency response team expect to administer next?
epi
A 4-year-old child suddenly collapses in the playroom of the facility. A healthcare provider observes the event and hurries over to assess the child. The healthcare provider completes which assessment first?
rapid
PALS 2019 Test Questions
Q:1-Clinical signs of respiratory distress may include all of the following EXCEPT:
Mark one answer:
- Rapid respiratory rate
- Grunting respirations
- Warm, pink skin
- Diminished level of consciousness
Q:2-Late and ominous signs of respiratory failure include all of the following EXCEPT:
Mark one answer:
- Rapid respiratory rate
- Cyanosis
- Bradycardia
- Diminished level of consciousness
Q:3-The 8-year-old child you are treating has a palpable pulse and a heart rate of 200. You look at the monitor and see a rapid rhythm with narrow QRS complexes. There are no discernible P waves on the monitor. The rhythm is probably:
Mark one answer:
- Sinus tachycardia
- Supraventricular tachycardia
- Sinus rhythm
- Ventricular tachycardia
Q:4-You are doing CPR on a child with symptomatic bradycardia. An intravenous line is in place. What is the first drug of choice for the patient?
Mark one answer:
- Atropine
- Epinephrine
- Sodium bicarbonate
- Dopamine
Q:5-High-quality CPR for young children includes:
Mark one answer:
- Compress to a depth of at least one third of the child’s chest diameter
- Compress at a rate between 100 and 120 compressions per minute
- Minimize interruptions to chest compressions
- All of the above
Q:6-You are the team leader on a team resuscitating a child without a pulse or respirations. When you look at the monitor, you see a disorganized rhythm with chaotic electrical activity. This rhythm is most likely:
Mark one answer:
- Asystole
- PEA
- Ventricular fibrillation
- Ventricular tachycardia
Q:7-The goal of the PALS team in the treatment of shock is to:
Mark one answer:
- Improve oxygen delivery
- Prevent organ injury
- Stop the progression to cardiopulmonary failure
- All of the above
Q:8-When evaluating a child’s bradycardia, it is important to consider the child’s:
Mark one answer:
- Baseline rate
- Level of activity
- Clinical condition
- All of the above
Q:9-For asystole, the team should do CPR until IV or IO access is achieved. The drug of choice for asystole is:
Mark one answer:
- Amiodarone
- Epinephrine
- Lidocaine
- Atropine
Q:10-In school age children and infants, the two most common initial rhythms seen in pediatric cardiac arrest are:
Mark one answer:
- Asystole and PEA
- Asystole and VF
- PEA and VF
- Pulseless VT and VF
Tips For Passing The PALS Certification Exam
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