PALS PRETEST COMPLETE STUDY GUIDE WITH
ANSWERS
◉ You are called to help treat an infant with severe symptomatic
bradycardia (HR 66 bpm) associated with respiratory distress. The
bradycardia persists despite establishment of an effective airway,
oxygenation, and ventilation. There is no heart block present. What
is the 1st drug you should administer? Answer: epi
◉ 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 HR is 36 bpm.
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 ED, the child is intubated
and ventilated with 100% oxygen, and IV access is established. The
HR is now 150 bpm with weak central pulses but no distal pulses.
SBP is 74 mmHg. What intervention should be provided next?
Answer: rapid bolus of 20mL/kg of isotonic crystalloid
◉ A previously healthy infant with a history of vomiting and
diarrhea is brought to the ED by her parents. During your
assessment, you find that the infant only responds to painful
stimulation. The infant's RR is 40 bpm, and central pulses are rapid
,and weak. The infant has good bilateral breath sounds, cool
extremities, and a capillary refill time of >5 sec. The infant's BP is
86/65 mmHg, and glucose is 30mg/dL. You administer 100%
oxygen via face mask and start in IV. What is the most appropriate
treatment? Answer: bolus of isotonic crystalloid 20mL/kg over 5-20
min and D25W 2-4mL/kg IV
◉ Initial impression of a 2-year-old girl shows her to be alert with
mild breathing difficulty during inspiration and pale skin color. On
primary assessment, she makes high-pitched inspiratory sounds
(mild stridor) when agitated; otherwise, her breathing is quiet. Her
SpO2 is 92% on room air, and she has mild inspiratory intercostal
retractions. Lung auscultation reveals transmitted upper airway
sounds with adequate distal breath sounds bilaterally. What is the
most appropriate initial intervention for this child? Answer:
humidified oxygen as tolerated
◉ 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 HR is variable (range: 44-62
bpm). You begin bag-mask ventilation with 100% oxygen. When the
HR does not improve, you begin chest compressions. The rhythm
shown here is seen on the cardiac monitor. What would be the most
appropriate therapy to consider next? Answer: transcutaneous
pacing
, ◉ A 4-year-old boy is in pulseless arrest in the pediatric ICU. High-
quality CPR is in progress. You quickly review his chart and find that
this baseline-corrected QTI on a 12-lead EKG is prolonged. The
monitor shows recurrent episodes of the rhythm shown here. The
has received 1 dose of epi 0.01mg/kg, but the rhythm shown here
continues. If this rhythm persists at the next rhythm check, what
medication would be most appropriate to administer at that time?
Answer: MgSO4 25-50 mg/kg IV
◉ You and another rescuer begin CPR. Your colleague begins
compressions, and you notice that the compression rate is too low.
What should you say to offer constructive feedback? Answer: 'You
need to compress at a rate of 100-120/min'
◉ You are alone and witness a child suddenly collapse. There is no
suspected head or neck injury. A colleague responded to your shout
for help and is activating the emergency response system and is
retrieving the resuscitation equipment, including a defibrillator.
After delivering 30 compressions, what would be your next action?
Answer: one the airway with a head tilt-chin lift maneuver and give
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 RR has decreased from 65 bpm to 10 bpm, severe inspiratory
intercostal retractions are present, HR is 160 bpm, SpO2 is 65% on
ANSWERS
◉ You are called to help treat an infant with severe symptomatic
bradycardia (HR 66 bpm) associated with respiratory distress. The
bradycardia persists despite establishment of an effective airway,
oxygenation, and ventilation. There is no heart block present. What
is the 1st drug you should administer? Answer: epi
◉ 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 HR is 36 bpm.
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 ED, the child is intubated
and ventilated with 100% oxygen, and IV access is established. The
HR is now 150 bpm with weak central pulses but no distal pulses.
SBP is 74 mmHg. What intervention should be provided next?
Answer: rapid bolus of 20mL/kg of isotonic crystalloid
◉ A previously healthy infant with a history of vomiting and
diarrhea is brought to the ED by her parents. During your
assessment, you find that the infant only responds to painful
stimulation. The infant's RR is 40 bpm, and central pulses are rapid
,and weak. The infant has good bilateral breath sounds, cool
extremities, and a capillary refill time of >5 sec. The infant's BP is
86/65 mmHg, and glucose is 30mg/dL. You administer 100%
oxygen via face mask and start in IV. What is the most appropriate
treatment? Answer: bolus of isotonic crystalloid 20mL/kg over 5-20
min and D25W 2-4mL/kg IV
◉ Initial impression of a 2-year-old girl shows her to be alert with
mild breathing difficulty during inspiration and pale skin color. On
primary assessment, she makes high-pitched inspiratory sounds
(mild stridor) when agitated; otherwise, her breathing is quiet. Her
SpO2 is 92% on room air, and she has mild inspiratory intercostal
retractions. Lung auscultation reveals transmitted upper airway
sounds with adequate distal breath sounds bilaterally. What is the
most appropriate initial intervention for this child? Answer:
humidified oxygen as tolerated
◉ 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 HR is variable (range: 44-62
bpm). You begin bag-mask ventilation with 100% oxygen. When the
HR does not improve, you begin chest compressions. The rhythm
shown here is seen on the cardiac monitor. What would be the most
appropriate therapy to consider next? Answer: transcutaneous
pacing
, ◉ A 4-year-old boy is in pulseless arrest in the pediatric ICU. High-
quality CPR is in progress. You quickly review his chart and find that
this baseline-corrected QTI on a 12-lead EKG is prolonged. The
monitor shows recurrent episodes of the rhythm shown here. The
has received 1 dose of epi 0.01mg/kg, but the rhythm shown here
continues. If this rhythm persists at the next rhythm check, what
medication would be most appropriate to administer at that time?
Answer: MgSO4 25-50 mg/kg IV
◉ You and another rescuer begin CPR. Your colleague begins
compressions, and you notice that the compression rate is too low.
What should you say to offer constructive feedback? Answer: 'You
need to compress at a rate of 100-120/min'
◉ You are alone and witness a child suddenly collapse. There is no
suspected head or neck injury. A colleague responded to your shout
for help and is activating the emergency response system and is
retrieving the resuscitation equipment, including a defibrillator.
After delivering 30 compressions, what would be your next action?
Answer: one the airway with a head tilt-chin lift maneuver and give
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 RR has decreased from 65 bpm to 10 bpm, severe inspiratory
intercostal retractions are present, HR is 160 bpm, SpO2 is 65% on
