AHA PALS Practice exam

1. A 13-year-old patient with asthma just received oxygen and albuterol via a nebulizer. What is the next most appropriate intervention? A. Administer 0.1 mg/kg of adenosine B. Obtain a blood sample to evaluate arterial or venous blood gases C. Reassess breath sounds and clinical status D. Repeat the albuterol treatment - answer-Reassess breath sounds and clinical status 1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate of 165/min. The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry? A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be administered C. Unreliable; no supplementary oxygen is indicated D. Unreliable; supplementary oxygen should be administered - answer-Unreliable; supplementary oxygen should be administered 10. A 2-year-old child with a 2-day history of a barking cough presents with audible stridor on inspiration, intercostal retractions, and agitation. What is the most appropriate intervention for this child? A. Lay the child flat on a stretcher B. Suction the mouth and nose C. Administer nebulized epinephrine D. Administer inhaled albuterol - answer-Administer nebulized epinephrine 10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the following: The child is difficult to arouse, with pale color. The child's heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the most appropriate intervention? A. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 30 minutes B. Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes C. Obtain immediate blood cultures and chest x-ray D. Obtain expert consultation with an oncologist to determine the chemotherapeutic regimen - answer-Obtain vascular access and administer 20 mL/kg of isotonic crystalloid over 5 to 10 minutes 11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is now being supported with bag-mask ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. Two providers may attempt peripheral vascular access twice each B. Three providers may attempt peripheral vascular access once each C. Place a central venous line D. Place an intraosseous line - answer-Place an intraosseous line 11. Which of the following oxygen saturations indicates the need for additional intervention? A. 96% on room air B. 95% on room air C. 93% on 4 L of oxygen D. 97% on 50% oxygen - answer-93% on 4 L of oxygen 12. A 3-year-old child presents with a 2-day history of nausea and vomiting. She is alert, with no increase in respiratory effort, and is pale in color. The child's heart rate is 160/min, respiratory rate is 40/min, and blood pressure is 100/70 mm Hg. Her extremities are cool, with sluggish capillary refill. Which term best describes this child's physiologic state? A. Compensated shock B. Cardiogenic shock C. Hypotensive shock D. Obstructive shock - answer-Compensated shock 12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock with adequate myocardial function? A. 10 mL/kg normal saline B. 20 mL/kg of 5% dextrose and 0.2% sodium chloride C. 20 mL/kg normal saline D. 10 mL/kg lactated Ringer's - answer-20 mL/kg normal saline 13. A 3-year-old child presents with dehydration after a 2-day history of vomiting and diarrhea. The child after has received 2 fluid boluses of 20 mL/ kg of normal saline. After the second bolus, the child is alert and interacting. Her heart rate is 110/ min, respiratory rate is 30/min, and blood pressure is 92/64 mm Hg. Her capillary refill time is 2 seconds, and oxygen saturation is 98%. What is the most appropriate next intervention for this child? A. Administer another 20 mL/kg normal saline fluid bolus B. Administer 10 mL/kg of packed red cells C. Continue to monitor and reevaluate the child D. Initiate a dopamine drip of 20 mcg/kg per minute - answer-Continue to monitor and reevaluate the child 13. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's color is pink. What is the most appropriate initial intervention? A. Obtain a chest radiograph B. Administer nebulized epinephrine C. Prepare for a surgical airway D. Use an epinephrine autoinjector - answer-Administer nebulized epinephrine 14. A 3-year-old child presents with a high fever and a petechial rash. The child is lethargic, has no signs of increased work of breathing, and is pale in color. His heart rate is 180/min, respiratory rate is 30/min, blood pressure is 80/68 mm Hg. Capillary refill time is 4 seconds, and oxygen saturation is 88%. Airway and lungs are clear. Peripheral pulses are diminished. Which of the following is the most appropriate initial intervention? A. Provide 100% oxygen via a nonrebreathing mask B. Obtain IV access C. Administer dopamine D. Administer an antibiotic - answer-Provide 100% oxygen via a nonrebreathing mask 14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has the following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure 9060 mm Hg, and temperature 98.6°F (37°C). The child's capillary refill time is 4 seconds. After 2 IV boluses of normal saline (20 mL/kg each), the child's vital signs are now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94/62 mm Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child's urine output is 1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or information should be obtained first? A. Arterial blood gas B. Serum potassium concentration C. Glucose D. A 12-lead ECG - answer-Glucose 15. A 15-year-old boy presents with acute onset of severe respiratory distress, with retractions and an oxygen saturation of 85%. His trachea is deviated to the right, and there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is 84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate intervention? A. Obtain a chest x-ray B. Perform needle decompression on the left chest C. Insert a chest tube on the left side D. Insert an IV and administer 20 mL/kg of normal saline - answer-Perform needle decompression on the left chest 16. A 4-year-old is being treated for hypovolemic shock and has received a single fluid bolus of 20 mL/kg of normal saline. On reevaluation the child remains anxious, with a heart rate of 140/min, a blood pressure of 84/54 mm Hg, and a capillary refill time of 4 seconds. What describes this patient's condition? A. Hypotensive shock B. Compensated shock C. No longer in shock D. Cardiogenic shock - answer-Compensated shock 16. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's color is pink. What is the most appropriate initial intervention? A. Obtain a chest radiograph B. Administer nebulized epinephrine C. Prepare for a surgical airway D. Use an epinephrine autoinjector - answer-Administer nebulized epinephrine 17. An 8-year-old child had a sudden onset of palpitations and light-headedness. At the time of evaluation the child is alert. His respiratory rate is 26/ min, and his blood pressure is 104/70 mm Hg. A cardiac monitor is applied, and the rhythm below is noted. What is the most appropriate initial intervention? A. Provide synchronized cardioversion at 0.5 to 1 J/kg B. Attempt vagal maneuvers C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone 5 mg/kg over 20 minutes - answer-Attempt vagal maneuvers 17. The initial impression of a 4-year-old child reveals a lethargic child who is diaphoretic, with no increased work of breathing and pink color. Her heart rate is 220/min, respiratory rate is 24/min, blood pressure is 84/46 mm Hg, and capillary refill time is 5 seconds. IV access has been established. The rhythm below is seen on the cardiac monitor. What is the most appropriate initial intervention? A. Give adenosine 0.1 mg/kg rapid IV push B. Perform carotid sinus massage C. Perform synchronized cardioversion at 0.5 J/kg D. Attempt defibrillation at 2 J/kg - answer-Give adenosine 0.1 mg/kg rapid IV push 18. A 10-year-old child had a sudden witnessed cardiac arrest and received immediate bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous circulation. The child remains unresponsive and has an advanced airway in place. There is no history of trauma or signs of shock. What is the target range for oxygen saturation for this child? A. 92% to 100% B. 92% to 99% C. 94% to 99% D. 94% to 100% - answer-94% to 99% 18. An 8-month-old infant is being evaluated. The child's mother says the infant has not been feeding well. The infant is alert with rapid but unlabored breathing, and the infant's color is pale. A cardiac monitor is applied, and the rhythm below is noted. Distal pulses are readily palpable. You give oxygen and establish IV access. What is the most appropriate vagal maneuver? A. Valsalva maneuver B. Carotid massage C. Ocular pressure D. Ice to the face - answer-Ice to the face 19. A 3-month-old infant with bronchiolitis is suctioned to remove upper airway secretions. The infant's heart rate decreases from 155/min to 65/min as shown below. The infant remains alert, with easily palpable pulses. Capillary refill time is 1 second. What is the most appropriate initial intervention? A. Administer oxygen and ensure adequate ventilation; be prepared to intervene further if heart rate does not increase B. Establish IV/IO access and administer epinephrine 0.01 mg/kg IV C. Establish IV/IO access and administer atropine 0.02 mg/kg IV D. Call for help and prepare to provide transthoracic pacing/transvenous pacing - answer-Administer oxygen and ensure adequate ventilation; be prepared to intervene further if heart rate 19. A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be established. What is the most appropriate intervention? A. Unsynchronized shock with 0.5 to 1 J/kg B. Synchronized shock with 0.5 to 1 J/kg C. Unsynchronized shock with 2 J/kg D. Synchronized shock with 2 J/kg - answer-Synchronized shock with 0.5 to 1 J/kg 2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child's most likely condition? A. Septic shock B. Hypovolemic shock C. Significant bradycardia D. Cardiogenic shock - answer-Septic shock 2. The respiratory rate of a 1-year-old child with respiratory distress has decreased from 65/min to 30/min. The child is more lethargic and continues to have subcostal retractions. What does this change likely indicate? A. Respiratory distress is unchanged B. Progression toward respiratory failure C. Improved respiratory status D. Neurologic impairment - answer-Progression toward respiratory failure 20. A 3-month-old infant presents with lethargy and a 3-day history of vomiting, diarrhea, and poor feeding. The initial impression reveals lethargy, increased respiratory effort with retractions, and pale, mottled skin color. Vital signs are as follows: heart rate 210/min, respiratory rate 60/min, and blood pressure 60/40 mm Hg. Peripheral pulses are thready, and capillary refill time is 4 seconds. The cardiac monitor displays the rhythm below. After administration of oxygen and establishment of vascular access, what is the most appropriate intervention? A. Adenosine O.1 mg/kg IV rapid push B. Vagal maneuvers C. Synchronized shock at 0.5 to 1 J/kg D. IV fluid bolus of 20 mL/kg normal saline - answer-IV fluid bolus of 20 mL/kg normal saline 20. A 3-month-old infant with bronchiolitis is intubated for management of respiratory failure. During transport, the infant develops bradycardia with a heart rate of 60/min, and the infant's oxygen saturation decreases to 75%. There are breath sounds on the right side, but no air entry is heard on the left side. What is the most appropriate initial intervention? A. Administer epinephrine 0.01 mg/kg IV B. Place a chest tube on the left C. Verify the endotracheal tube position D. Aggressively suction the endotracheal tube - answer-Verify the endotracheal tube position 21. A 3-year-old child is unresponsive, gasping, and has no detectable pulse. CPR is initiated. A monitor is attached, and the rhythm is shown below. What is the appropriate next therapy? A. Attempted defibrillation with 2 J/kg B. Synchronized cardioversion with 0.5 to 1 J/kg C. Epinephrine 0.01 mg/kg 10/IV D. Amiodarone 5 mg/kg 1O/IV - answer-Attempted defibrillation with 2 J/kg 21. For a 6-month-old infant with supraventricular tachycardia and adequate perfusion, which of the following is the preferred vagal maneuver? A. Ocular pressure B. Carotid pressure C. Valsalva maneuver D. I