AHA PALS COMPREHENSIVE CERTIFICATION
EXAM UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
◉ Evaluate capillary refill in a neutral thermal environment (ie,
room temperature) by. Answer: • Lifting the extremity slightly above
the level of the heart
• Pressing on the skin
• Rapidly releasing the pressure
◉ BGL in pediatrics. Answer: Hypoglycemia refers to blood glucose
45 mg/dL or less in the newly born and 60 mg/dL or less in a child.
It may result in brain injury if not recognized and effectively treated.
Base treatment decisions on patient symptoms, and potentially
include oral glucose. Monitor the blood glucose concentration of any
seriously ill infant or child. A low blood glucose concentration may
cause altered level of consciousness or even brain injury if it is not
quickly identified and adequately treated. Measure the blood glucose
concentration with a point-of-care glucose test.
◉ Important factors associated with increased work of breathing:.
Answer: • Increased airway resistance (upper and lower)
• Decreased lung compliance
• Use of accessory muscles of respiration
,• Disordered central nervous system control of breathing
◉ Airway resistance. Answer: • Airway resistance, or the impedance
to airflow within the airways, is primarily increased by reducing the
size of the conducting airways, either by airway constriction or
inflammation. Turbulent airflow also causes increased airway
resistance. Airflow may become turbulent when the flow rate
increases, even if the airway size remains unchanged. When airway
resistance increases, work of breathing increases in an attempt to
maintain airflow despite the increase in airway resistance.
• Larger airways provide lower resistance to airflow than smaller.
Airway resistance decreases as lung volume increases (inflation)
because airway dilation accompanies lung inflation.
• Conditions such as edema, bronchoconstriction, secretions, mucus,
or a mediastinal mass impinging on large or small airways can
decrease airway size, thereby increasing airway resistance.
• Resistance in the upper airway, particularly in the nasal or
nasopharyngeal passages, can represent a significant portion of tot
◉ Lung compliance. Answer: • Compliance refers to the
distensibility of the lung, chest wall, or both. Specifically, lung
compliance is defined as the change in lung volume produced by a
change in driving pressure across the lung. When lung compliance is
high, the lungs easily inflate, a large change in volume produced by a
slight change in driving pressure.
• The lungs are stiffer in a child with low lung compliance, so it takes
more effort to inflate them. To create a significant pressure gradient
,to produce air flow into the stiff lung, the diaphragm contracts more
forcefully, increasing intrathoracic volume and reducing
intrathoracic pressure. Poorly compliant lungs will also lead to
increased work of breathing. During mechanical ventilation,
increased positive airway pressure is needed to achieve adequate
ventilation when lung compliance decreases.
◉ Decreased lung compliance. Answer: • The chest wall in infants
and young children is compliant. Therefore, relatively small pressure
changes can move the chest wall. During normal breathing,
diaphragm contraction in infants pulls the lower ribs slightly inward
but does not cause significant chest retraction. However, forcefully
contracting the diaphragm results in a large drop in pressure within
the chest, pulling the chest inward (ie, retracting it) during
inspiration.
• When lung compliance is reduced, maximum inspiratory effort
may not produce adequate tidal volume because marked retractions
of the chest wall limit lung expansion during inspiration.
◉ Breathing is controlled by complex mechanisms involving....
Answer: • Brainstem respiratory centers
• Central and peripheral chemoreceptors
• Voluntary control
◉ Respiratory center. Answer: A group of respiratory centers located
in the brainstem controls spontaneous breathing. Voluntary control
, from the cerebral cortex, such as breath holding, panting, and
sighing, can also override breathing. Conditions like infection of the
central nervous system, traumatic brain injury, and drug overdose
can impair respiratory drive, resulting in hypoventilation or even
apnea.
◉ Chemoreceptors. Answer: Note that central chemoreceptors
respond to changes in the hydrogen ion concentration of
cerebrospinal fluid, which is largely determined by the arterial CO2
tension (Paco,). Peripheral chemoreceptors (eg, the carotid body)
respond primarily to a decrease in arterial oxygen (Pa02); some
receptors also respond to an increase in Paco2
◉ Healthcare providers often deliver excessive ventilation during
CPR, which is harmful because it.... Answer: • Increases intrathoracic
pressure and impedes venous return, thus decreasing filling of the
heart between compressions, reducing blood flow generated by the
next compression, and reducing coronary perfusion and cerebral
blood flow
• Causes air trapping and barotrauma in children with small airway
obstruction
• Increases the risk of regurgitation and aspiration in children
without an advanced airway
◉ Awareness of Lung Compliance. Answer: • When performing bag-
mask ventilation, be aware of the child's lung compliance. A poorly
compliant lung is "stiff" or difficult to inflate. A sudden increase in
EXAM UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
◉ Evaluate capillary refill in a neutral thermal environment (ie,
room temperature) by. Answer: • Lifting the extremity slightly above
the level of the heart
• Pressing on the skin
• Rapidly releasing the pressure
◉ BGL in pediatrics. Answer: Hypoglycemia refers to blood glucose
45 mg/dL or less in the newly born and 60 mg/dL or less in a child.
It may result in brain injury if not recognized and effectively treated.
Base treatment decisions on patient symptoms, and potentially
include oral glucose. Monitor the blood glucose concentration of any
seriously ill infant or child. A low blood glucose concentration may
cause altered level of consciousness or even brain injury if it is not
quickly identified and adequately treated. Measure the blood glucose
concentration with a point-of-care glucose test.
◉ Important factors associated with increased work of breathing:.
Answer: • Increased airway resistance (upper and lower)
• Decreased lung compliance
• Use of accessory muscles of respiration
,• Disordered central nervous system control of breathing
◉ Airway resistance. Answer: • Airway resistance, or the impedance
to airflow within the airways, is primarily increased by reducing the
size of the conducting airways, either by airway constriction or
inflammation. Turbulent airflow also causes increased airway
resistance. Airflow may become turbulent when the flow rate
increases, even if the airway size remains unchanged. When airway
resistance increases, work of breathing increases in an attempt to
maintain airflow despite the increase in airway resistance.
• Larger airways provide lower resistance to airflow than smaller.
Airway resistance decreases as lung volume increases (inflation)
because airway dilation accompanies lung inflation.
• Conditions such as edema, bronchoconstriction, secretions, mucus,
or a mediastinal mass impinging on large or small airways can
decrease airway size, thereby increasing airway resistance.
• Resistance in the upper airway, particularly in the nasal or
nasopharyngeal passages, can represent a significant portion of tot
◉ Lung compliance. Answer: • Compliance refers to the
distensibility of the lung, chest wall, or both. Specifically, lung
compliance is defined as the change in lung volume produced by a
change in driving pressure across the lung. When lung compliance is
high, the lungs easily inflate, a large change in volume produced by a
slight change in driving pressure.
• The lungs are stiffer in a child with low lung compliance, so it takes
more effort to inflate them. To create a significant pressure gradient
,to produce air flow into the stiff lung, the diaphragm contracts more
forcefully, increasing intrathoracic volume and reducing
intrathoracic pressure. Poorly compliant lungs will also lead to
increased work of breathing. During mechanical ventilation,
increased positive airway pressure is needed to achieve adequate
ventilation when lung compliance decreases.
◉ Decreased lung compliance. Answer: • The chest wall in infants
and young children is compliant. Therefore, relatively small pressure
changes can move the chest wall. During normal breathing,
diaphragm contraction in infants pulls the lower ribs slightly inward
but does not cause significant chest retraction. However, forcefully
contracting the diaphragm results in a large drop in pressure within
the chest, pulling the chest inward (ie, retracting it) during
inspiration.
• When lung compliance is reduced, maximum inspiratory effort
may not produce adequate tidal volume because marked retractions
of the chest wall limit lung expansion during inspiration.
◉ Breathing is controlled by complex mechanisms involving....
Answer: • Brainstem respiratory centers
• Central and peripheral chemoreceptors
• Voluntary control
◉ Respiratory center. Answer: A group of respiratory centers located
in the brainstem controls spontaneous breathing. Voluntary control
, from the cerebral cortex, such as breath holding, panting, and
sighing, can also override breathing. Conditions like infection of the
central nervous system, traumatic brain injury, and drug overdose
can impair respiratory drive, resulting in hypoventilation or even
apnea.
◉ Chemoreceptors. Answer: Note that central chemoreceptors
respond to changes in the hydrogen ion concentration of
cerebrospinal fluid, which is largely determined by the arterial CO2
tension (Paco,). Peripheral chemoreceptors (eg, the carotid body)
respond primarily to a decrease in arterial oxygen (Pa02); some
receptors also respond to an increase in Paco2
◉ Healthcare providers often deliver excessive ventilation during
CPR, which is harmful because it.... Answer: • Increases intrathoracic
pressure and impedes venous return, thus decreasing filling of the
heart between compressions, reducing blood flow generated by the
next compression, and reducing coronary perfusion and cerebral
blood flow
• Causes air trapping and barotrauma in children with small airway
obstruction
• Increases the risk of regurgitation and aspiration in children
without an advanced airway
◉ Awareness of Lung Compliance. Answer: • When performing bag-
mask ventilation, be aware of the child's lung compliance. A poorly
compliant lung is "stiff" or difficult to inflate. A sudden increase in
