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PALS PRECOURSE SELF-ASSESSMENT 2025
QUESTIONS AND ANSWERS
Identify the rhythm. - Ventricular Fibrillation (VF) Identify the rhythm. - Normal Sinus Rhythm Identify the rhythm. - VF with successful defibrillation and resumption of organized rhythm Identify the rhythm. - SVT converting to sinus rhythm after adenosine administration Identify the rhythm. - Torsades de pointes Identify the rhythm. - Supreaventricular Tachycardia (SVT) Identify the rhythm. - Sinus Tachycardia Identify the rhythm. - Sinus Bradycardis Identify the rhythm. - Asystole Identify the rhythm. - Wide-Complex Tachycardia Identify the rhythm. - Pulseless Electrical Activity
Which statement is correct about endotracheal drug administration during resuscitative efforts for pediatric patients? - It is the least desirable route of administration Which oxygen delivery system most reliably delivers a high (90% or greater) concentration of inspired oxygen to a 7-year-old child? - Nonrebreathing face mask Paramedics are called to the home of a 1-year-old child. Their initial assessment reveals a child who responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the abdomen, abdominal distention, and cyanosis. Bag-mask ventilation with 100% oxygen is initiated. The child's heart rate is 36/min. Peripheral pulses cannot be palpated, and central pulses are barely palpable. The cardiac monitor shows sinus bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency department, the child is intubated and ventilated with 100% oxygen, and IV access is established. The heart rate is now 150/min with weak central pulses but no distal pulses. Systolic blood pressure is 74 mm Hg. Which intervention should be provided next? - Rapid bolus of 20 mL/kg of isotonic crystalloid A previously healthy infant with a history of vomiting and diarrhea is brought to the emergency department by her parents. During your assessment, you find that the infant responds only to painful stimulation. The infant's respiratory rate is 40 breaths per minute, and central pulses are rapid and weak. The infant has good bilateral breath sounds, cool extremities, and a capillary refill time of more than 5 seconds. The infant's blood pressure is 85/65 mm Hg, and glucose is 30 mg/dL (1.65 mol/L). You administer 100% oxygen via face mask and start an IV. Which treatment is the most appropriate for this infant? - Administer a bolus of isotonic crystalloid 20 mL/kg over 5 to 20 minutes, and also give D2;W 2 to 4 mL/kg IV A 9-year-old boy is agitated and leaning forward on the bed in obvious respiratory distress. 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. You administer 100% oxygen by a nonrebreathing mask. His SpO, is 92%. Which medication do you prepare to give to this patient?
A 4-year-old boy is in pulseless arrest in the pediatric intensive care unit. High-quality CPR is in progress. You quickly review his chart and find that his baseline-corrected OT interval on a 12- lead ECG is prolonged. The monitor shows recurrent episodes of the rhythm shown here. The patient has received 1 dose of epinephrine 0.01 mg/kg, but the rhythm shown here continues. If this rhythm persists at the next rhythm check, which medication would be most appropriate to administer at that time? - Magnesium sulfate 25 to 50 mg/kg IV What ratio of compressions to breaths should be used for 1-rescuer child CPR? - 30 compressions to 2 breaths An 18-month-old child has a 1-week history of cough and runny nose. The child has diffuse cyanosis and is responsive only to painful stimulation with slow respirations and rapid central pulses. The child's respiratory rate has decreased from 65/min to 10/min, severe inspiratory intercostal retractions are present, heart rate is 160/min, SpOz is 65% in room air, and capillary refill is less than 2 seconds. Which are the most appropriate immediate interventions for this toddler? - Open the airway and provide positive-pressure ventilation using 100% oxygen and a bag-mask device 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 shows an organized rhythm with a 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. Which intervention should you perform next? - Identify and treat reversible causes You are evaluating an irritable 6-year-old girl with mottled skin color. The patient is febrile (temperature 40°C [104°FI), and her extremities are cold with capillary refill of 5 seconds. Distal pulses are absent and central pulses are weak. Heart rate is 180/min, respiratory rate is 45/min, and blood pressure is 98/56 mm Hg. How would you categorize this child's condition? - Compensated shock associated with tachycardia and inadequate tissue perfusion You are caring for a 6-year-old patient who is receiving positive-pressure mechanical ventilation via an endotracheal tube. The child begins to move his head and suddenly becomes cyanotic,
and his heart rate decreases. His SpO2 is 65%. You remove the child from the mechanical ventilator and begin to provide manual ventilation with a bag via the endotracheal tube. During manual ventilation with 100% oxygen, the child's color and heart rate improve slightly and his blood pressure remains adequate. Breath sounds and chest expansion are present and adequate on the right side and are present but consistently diminished on the left side. The trachea is not deviated, and the neck veins are not distended. A suction catheter passes easily beyond the tip of the endotracheal tube. Which of the following is the most likely cause of this child's acute deterioration? - Tracheal tube displacement into the right main bronchus You are giving chest compressions for a child in cardiac arrest. What is the proper depth of compressions for a child? - Compress the chest at least one third the depth of the chest, approximately 2 inches (5 cm) You are assisting in the elective intubation of an average-sized 4-year-old child with respiratory failure. A colleague is retrieving the color-coded length-based tape from the resuscitation cart. Which of the following is likely to be the estimated size of the uncuffed endotracheal tube for this child? - 5-mm tube During bag-mask ventilation, how should vou hold the mask to make an effective seal between the child's face and the mask? - Position your fingers using the E-C clamp technique An 8-month-old infant is brought to the emergency department for evaluation of severe diarrhea and dehydration. On arrival to the emergency department, the infant becomes unresponsive, apneic, and pulseless. You shout for help and start CPR. Another provider arrives, at which point you switch to 2-rescuer CPR. The rhythm shown here is seen on the cardiac monitor. The infant is intubated and ventilated with 100% oxygen. An 10 line is established, and a dose of epinephrine is given. While continuing high-quality CPR, what do you do next? - Give normal saline 20 mL/kg IO rapidly You are supervising a student who is inserting an IO needle into an infant's tibia. The student asks you what she should look for to know that she has successfully inserted the needle into the bone marrow cavity. What do you tell her? - "Fluids can be administered freely without local soft tissue swelling."
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? - Provide CPR for about 2 minutes before leaving to activate the emergency response system You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for delivering breaths? - 1 breath every 2-3 seconds A child becomes unresponsive in the emergency department and is not breathing. You are uncertain if a faint pulse is present. You shout for help and provide ventilation with 100% oxygen. The rhythm shown here is seen on the cardiac monitor. What is your next action? - Start high-quality CPR A pale and very sleepy but arousable 3-year-old child with a history of diarrhea is brought to the hospital. Primary assessment reveals a respiratory rate of 45/min with good breath sounds bilaterally. Heart rate is 150/min, blood pressure is 90/64 mm Hg, and SpO, is 92% in room air. Capillary refill is 5 seconds, and peripheral pulses are weak. After placing the child on a nonrebreathing face mask (10-L/min flow) with 100% oxygen and obtaining vascular access, which is the most appropriate immediate treatment for this child? - Administer a bolus of 20 mL/kg isotonic crystalloid What compression-to-ventilation ratio should be used for 2-rescuer infant CPR? - 15 compressions to 2 breaths A 3-year-old boy presents with multiple-system trauma. The child was an unrestrained passenger in a high-speed motor vehicle crash. On primary assessment, he is unresponsive to voice or painful stimulation. His respiratory rate is 5/min, heart rate and pulses are 170/min, systolic blood pressure is 60 mm Hg, capillary refill is 5 seconds, and SpOz is 75% on room air. Which action should you take first? - While a colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask ventilation
A 10-month-old infant boy is brought to the emergency department. Your initial assessment reveals a lethargic, pale infant with slow respirations and slow, weak central pulses. One team member begins ventilation with a bag-mask device with 100% oxygen. A second team member attaches the monitor/defibrillator and obtains vital signs while a third team member attempts to establish IV/O access. The patient's heart rate is 38/min with the rhythm shown here. The infant's blood pressure is 58/38 mm Hg, and capillary refill is 4 seconds. His central pulses remain weak, and distal pulses cannot be palpated. Chest compressions are started and I access is obtained. Which medication do you anticipate will be given next? - Epinephrine 0. mg/kg IV/IO You are caring for a 3-year-old with vomiting and diarrhea. You have established IV access. The child's pulses are palpable but faint, and the child is now lethargic. The heart rate is variable (range, 44/min to 62/min). You begin bag-mask ventilation with 100% oxygen. When the heart rate does not improve, you begin chest compressions. The rhythm shown here is seen on the cardiac monitor. Which would be the most appropriate therapy to consider next? - Atropine 0.02 mg/kg IV
