Heartcode PALS Test Questions With All Correct Answers

Heartcode PALS Test Questions With All Correct Answers The infant is placed on the ambulance stretcher and responds with a groan when stimulated and has a temperature of 36.3 C (97.3 F) - CORRECT ANSWER -Monitor and support ABCs -Establish IV/IO access -Monitor heart rate, blood pressure, and pulse oximetry -Call for assistance if needed When you evaluate the patient, you find the lungs are clear, skin is cool and mottled, glucose is 97 mg/dL and capillary refill time is 5 seconds. What are the warning signs that the patient is progressing from compensated shock to hypotensive shock? - CORRECT ANSWER -Hypotension (late sign) -Increasing tachycardia The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________ shock. - CORRECT ANSWER Hypotensive What should be included in the initial treatment for this patient? - CORRECT ANSWER -Rapid fluid bolus administration -Establishing IV/IO access The mother does not recall the infant's most recent weight. What is the most appropriate way to rapidly determine her weight and calculate correct medication? - CORRECT ANSWER Measure her by using color-coded length-based tape You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? - CORRECT ANSWER Normal saline 20 mL/kg What is the most appropriate method of delivering rapid fluid boluses to this patient? - CORRECT ANSWER A syringe and 3-way stopcock After the first fluid bolus is administered, the child is reassessed and her vital signs are HR 167, BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her skin is still cool and pale and she is still lethargic and weak. What should be the next intervention? - CORRECT ANSWER Deliver a second fluid bolus of 20 mL/kg and reassess When should vasoactive therapy be considered be considered in managing distributive shock? - CORRECT ANSWER If the child remains hypotensive and poorly perfused despite rapid bolus fluid administration How does the clinical presentation of distributive shock compare with hypovolemic shock? - CORRECT ANSWER Distributive shock has more variable presentation than that of hypovolemic shock For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to __ minutes - CORRECT ANSWER For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to 20 minutes What signs distinguish anaphylactic shock from other types of shock? - CORRECT ANSWER -Angioedema (swelling of the face, lips and tongue) -Urticaria (hives) -Respiratory distress with stridor, wheezing or both in a child with anaphylactic shock, what is the most appropriate initial treatment? - CORRECT ANSWER IM epinephrine How soon after exposure do symptoms typically occur in anaphylactic shock? - CORRECT ANSWER Seconds to minutes What should you evaluate to recognize septic shock? - CORRECT ANSWER -Temp -Heart rate -Systemic perfusion -Blood pressure -Clinical signs of end-organ perfusion When should antibiotics be administered in septic shock? - CORRECT ANSWER Within the first hour What are the initial assessment findings for septic shock? - CORRECT ANSWER -Fever -Hypothermia -Normal, elevated or decreased WBC For septic shock, how soon should fluid resuscitation begin? - CORRECT ANSWER Within 10 to 15 minutes after recognizing shock What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? - CORRECT ANSWER 5 to 10 mL/kg over 10 to 20 minutes What is the focus of the initial management of distributive shock? - CORRECT ANSWER -Correcting hypovolemia -Filling expanded dilated vascular space -Expanding intravascular volume What are causes of obstructive shock? - CORRECT ANSWER -Pulmonary embolus -Tension pneumothorax -Congenital heart defects -Cardiac tamponade What signs are present as obstructive shock progresses? - CORRECT ANSWER -Increased respiratory effort -Cyanosis -Signs of vascular congestion Most patients in cardiogenic shock will need inotropic support with medications. Which of the following could be used? - CORRECT ANSWER -Milrinone -Epinephrine What is the main objective of managing obstructive shock? - CORRECT ANSWER -Correct the cause of cardiac output obstruction -Restore tissue perfusion Why is it important to immediately identify obstructive shock? - CORRECT ANSWER Obstructive shock can rapidly progress to cardiopulmonary failure and then cardiac arrest What is an assessment finding unique to tension pneumothorax? - CORRECT ANSWER Tracheal deviation In whom should you suspect a tension pneumothorax? - CORRECT ANSWER -Victim of chest trauma -Any intubated child who deteriorates suddenly while receiving in positive-pressure ventialtion -A child who deteriorates suddenly while receiving bag-mas ventialtion How do you know if a needle decompression is successful? - CORRECT ANSWER There is gush of air when the needle is placed What is the immediate treatment for tension pneumothorax? - CORRECT ANSWER Needle decompression What is the role of the diaphragm contraction during normal breathing in infants? - CORRECT ANSWER Pulls the ribs slight inward However, forcefully contracting the diaphragm results in a large drop in pressure within the chest, retracting What are common causes cardiogenic shock? - CORRECT ANSWER -Congenital heart disease -Myocarditis -Drug toxicity -Arrhythmias What are causes of cardiac tamponade in children? - CORRECT ANSWER -Penetrating trauma -Cardiac surgery -Infection of the percardium In the setting of impending or actual pulseless arrest when there is a strong suspicion of pericardial tamponade, what is the appropriate management? - CORRECT ANSWER Emergency pericardiocentesis Pulmonary embolisms are ____ in children. - CORRECT ANSWER Rare What is definitive treatment for most children with pulmonary embolism who are not in shock? - CORRECT ANSWER Anticoagulants In children with severe cardiovascular compromise from pulmonary embolism, what treatment should be considered? - CORRECT ANSWER Fibrinolytic agents What findings help distinguish pulmonary embolism from hypovolemic shock? - CORRECT ANSWER Systemic venous congestion and right heart failure What circulation findings are specific to pericardial tamponade? - CORRECT ANSWER -Tachycardia -Narrowed pulse pressures -Muffled or diminished heart sounds The child is awake, responsive and anxious. Her initial vitals signs are HR 168/min, BP 61/43 mm Hg, RR 44/min, SpO2 66%. What is the initial priority in treatment for this patient? - CORRECT ANSWER Administer oxygen (nonrebreating mask) Based on the child's blood pressure, what type of shock is the patient in? - CORRECT ANSWER Hypotensive Ausculating the patient's lungs demonstrates clear lung sounds on the left but absent lung sounds on the right. What is the most likely diagnosis for this patient? - CORRECT ANSWER Tension pneumothorax Treatment for tension pneumothorax should not be delayed. Based on the child's assessment, what immediate intervention should be performed? - CORRECT ANSWER Needle decompression Where should the needle be inserted for proper needle decompression? - CORRECT ANSWER Right side of the chest, over the third rib (second intercostal space) in the midclavicular line Needle decompression is performed on the patient. As the needle is inserted, there is a rush of air coming from the hub of the needle. Vital signs are reassessed and are now Hr 134/min, BP 70/40 mm Hg and SpO2 82%. The patient still has labored breathing. Her SpO2 does not go above 82%; lung sounds are more present but are still diminished on the right side. Which of the following interventions is the most incorporate to do next? - CORRECT ANSWER Performs a thoracostomy for chest tube placement After the chest tube is inserted, the patient's breathing and oxygenation are improved. Her vital signs are HR 98/min, BP 108/72 mm Hg, RR 18/min, SpO2 98%. How should proper chest tube placement be confirmed? - CORRECT ANSWER Obtain a chest x-ray What is the leading cause of symptomatic bradycardia in children? - CORRECT ANSWER Tissue hypoxia How is bradycardia defined in pediatric patients? - CORRECT ANSWER A heart rate that is slow in comparison with a normal heart rate range for the child's age, level of activity and clinical condition. What causes primary bradycardia? - CORRECT ANSWER Congenital or acquired heart conditions Whenever a child has an abnormal heart rate of rhythm, what must be done quickly? - CORRECT ANSWER Determine if the arrhythmia is causing hemodynamic instability or other signs of deterioration. What is the priority in initially managing arrhythmias? - CORRECT ANSWER Support the airway, breathing and circulation What are the causes of secondary bradycardia? - CORRECT ANSWER -Hypoxia -Acidosis -Hypotension -Hypothermia -Drugs What are the electrocardiographic characteristics of bradycardia? - CORRECT ANSWER -Heart rate slow compared with normal heart rate for age -P wave and QRS complex may be unrelrated -QRS complex may be narrow or wide What is a THIRD-degree atrioventricular block? - CORRECT ANSWER None of the atrial impulses conduct to the ventricles What is a FIRST-degree atrioventricular block - CORRECT ANSWER A prolonged PR interval representing slowed conduction through the atrioventricular node Why do children with cardiac tamponade improve temporarily with fluid administration? - CORRECT ANSWER Fluids augment cardiac and tissue perfusion until pericardial drainage can be performed What is the initial dose of epinephrine in the treatment of symptomatic bradycardia? - CORRECT ANSWER 0.01 mg/kg IV/IO In which patients would bradycardia be an expected finding and not be considered problematic? - CORRECT ANSWER -A healthy child who is sleeping This is due to reduced metabolic demand -A well-conditioned athlete This is due to high stroke volume and increased vagal tone What is the IV/IO dose of atropine for pediatric bradycardia? - CORRECT ANSWER 0.02 mg/kg What should your next steps be? - CORRECT ANSWER -Maintains a patent airway -Apply cardiac monitor to identify rhythm and monitor pulse, blood pressure, and oximetry -Complete the initial and primary assessment During the initial assessment, you find that the infant is unresponsive and has an HR of less than 60/min. What should be your next action? - CORRECT ANSWER Begin CPR CPR has been ongoing and IV access has been established. A pulse and rhythm check are done. He has the rhythm. What intervention would be most appropriate at this time? - CORRECT ANSWER Administer epinephrine What is the proper dosing for epinephrine (IV/IO) administration during CPR? - CORRECT ANSWER -0.01 mg/kg IO/IV -Repeat every 3 to 5 minutes. After 2 more minutes of CPR, you notice the patient is moving and his skin color improves. his vital signs are 114 RR 8/min and temperature 37.9 C (100.2 F). The infant is still slow to respond but is moving. What should be the next steps for this patient? - CORRECT ANSWER -Continue oxygen -Obtain expert consultation -Support ABC's -Identify and treat underlying causes What clinical findings may be presented in a child with a tachyarrhythmia? - CORRECT ANSWER -Palpitations -Light-headedness -Syncope