Pediatric Advanced Life Support 2023 Exam / PALS 2023 Exam (answered)

1. The PALS systemic approach algorithm begins with the initial impression. This is an assessment of which 3 characteristics? 2. The right branch of the systemic approach algo- rithm focuses on what sequence to prevent cardiopul- monary arrest? 3. The evaluate portion of the sequence consists of three assessment tools: 4. What is included in the primary assessment of a pa- tient? 5. What is included in the secondary assessment of a patient? 6. The initial impression of the PALS systematic ap- proach algorithm includes which of the following characteristics? (Choose all correct answers.) 1. Appearance 2. Breathing 3. Restlessness 4. Color 5. Pain 7. The second box of the PALS systematic approach algorithm contains a question. (Fill in the blank to complete the question.) Is the child or is immediate intervention needed? 8. In the PALS systematic approach algorithm, if the child is determined to be unresponsive or immediate 1. Consciousness 2. Breathing 3. Color Evaluate, Identify, Intervene 1. Primary 2. Secondary 3. Diagnostic A B C D E Vitals Focused history and a focused physical exam 1, 2, 4 unresponsive 3. intervention is needed what will be your next step? 1. Start CPR 2. Apply breathing with a bag valve mask 3. Activate emergency response 4. Check for a pulse 9. After the emergency response is activated, the next 4. intervention is to . 1. Lightly shake the child's shoulders. 2. Look, listen, and feel. 3. Open the airway. 4. Check for breathing and a pulse 10. After it is determined that the child has no pulse, what 2. should be done? 1. Call for help 2. Begin CPR 3. Provide 2 rescue breaths 4. Start an IV 11. A child is unresponsive and is not breathing.You have 4. activated the emergency response system and your pulse check reveals that the child has a pulse. What should you do now? 1. Perform a brief head to toe assessment. 2. Place the child in the recovery position. 3. Give epinephrine 1mg IV push 4. Open the airway and provide ventilations and oxy- gen. 12. A child is unresponsive and is not breathing. Emer- 1. gency response was activated and now a pulse check shows that the child does have a pulse. You then open the airway, provide age-appropriate ventilations, and 100% oxygen with a bag valve mask. The child's pulse is 60/min, and the child has signs of poor perfusion. What is your next intervention? 1. Begin CPR 2. Provide a 500ml NS bolus 3. Perform an ABG. 4. Intubate the patient. 13. The right branch of the PALS systematic approach algorithm is a sequence of three actions. In the proper sequence, the three actions are: (Fill in the blanks) , , 14. The evaluate portion of the evaluate-identify-inter- vene sequence consists of what clinical assessment tools? (Choose all correct answers) 1. Diagnostic tests 2. Pain assessment 3. Secondary assessment 4. Primary assessment 15. (True or False) The sequence of evaluate-identify-in- tervene should be used before and after each inter- vention and should continue until the child is stable. 1. True 2. False 16. A consistent respiratory rate less than 10 or more than breaths per minute in a child of any age is abnormal and suggests the presence of a potentially serious problem. 1. 40 2. 50 3. 60 4. 70 17. The primary objective of the Airway assessment in the ABCDE model is to assess airway . 1. effort of breathing 2. rate of breathing 3. disease 4. patency 18. Within the EVALUATE portion of the evaluate-identi- evaluate, identify, intervene 1, 3, 4 1. 3. 4. Airway fy-intervene sequence, The primary assessment uses Breathing the ABCDE model for a hands-on evaluation of the critically ill child. What does ABCDE stand for? (Fill in the blanks) A B C D E 19. Simple measures for maintaining airway patency in- clude all of the following EXCEPT which intervention? 1. Continuous positive airway pressure 2. Head tilt chin lift 3. Jaw thrust 4. Nasopharyngeal airway 20. Assessment of Breathing includes evaluation of: 1. Respiratory rate and effort 2. Chest expansion in air movement 3. Lung and airway sounds 4. O2 saturation 5. All of the above 21. Tachypnea can have both respiratory and non-respi- ratory causes. Select all of the non-respiratory cause of tachypnea. 1. Croup 2. Pneumonia 3. Bronchiolitis 4. High Fever 5. Asthma 6. Severe pain 7. Anemia 22. (True or False) Stridor is a sign of lower airway prob- lem. Circulation Disability Exposure 1. 5. 4, 6, 7 2. 1. True 2. False 23. (True or False) Grunting is often a sign of lung tissue disease resulting from small airway collapse, alveolar collapse or both. 1. True 2. False 24. Match each lung and airway sound with the appropri- ate definition. (drag and drop) A. Coarse, usually higher pitched breathing sound typically heard on inspiration B. High-pitched or low-pitched whistling or sighing sound heard most often during expiration C. Bubbling sound heard during inspiration or expira- tion D. Short, low pitched breathing sound heard during expiration E. Also known as rales and typically associated with pneumonia 25. An oxygen saturation of e % while a child is breathing room air usually indicates that oxygenation is adequate. 1. 90% 2. 92% 3. 94% 4. 98% 26. Heart rate and rhythm, pulses, capillary refill time, skin color and temperature, and blood pressure are all direct indicators of circulatory status. Which of the following are indirect indicators of circulatory status? (Choose all correct answers) 1. Urine output 2. Oxygen saturation 3. Level of consciousness 4. Respiratory rate 1. A. Stridor B. Wheezing C. Gurgling D. Grunting E. Crackles 3. 1, 3. 27. What is the most common cause of bradycardia in children? 1. Sepsis 2. Drug overdose 3. Hypoxia 4. Complete heart block 28. (True or False) Tachycardia is a normal physiologic response in the critically ill child? 1. True 2. False 29. An observed decrease in systolic blood pressure of mm Hg from baseline should prompt serial evaluations for additional signs of shock. 1. 5 mm Hg 2. 10 mm Hg 3. 15 mm Hg 4. 20 mm Hg 30. In healthy children, the heart rate may fluctuate with the respiratory cycle. The heart rate with inspiration and with expiration. (fill in each blank with a single word) 31. (True or False) When assessing circulation, it is only necessary to assess the central pulses. 1. True 2. False 32. What is a common cause of vasoconstriction and can result in a discrepancy between the peripheral and central pulses in children? (Choose all correct answers) 1. hot environment 2. cold environment 3. environmental stress 4. tachyarrhythmias 3. 1. 2. increases, de- creases 2. 2. 33. Normal capillary refill time in children is . 4. 1. d 5 seconds 2. d 3 seconds 3. 2 seconds 4. d 2 seconds 34. Skin color can be an indication of tissue perfusion. Match the skin characteristics with the correct defini- tions. A. Irregular or patchy discoloration of the skin which may be caused hypoxemia, hypovolemia, or shock. B. Paleness, lack of normal color in the skin or mu- cous membrane. C. Blue discoloration of the skin and mucous mem- branes D. Bluish discoloration of the hands and feet common- ly seen during the newborn period. E. Bluish discoloration of the hands and feet seen beyond the newborn period. 35. (True or False) A low hemoglobin (anemia) may make it harder to detect in cyanosis in a critically ill child. 1. True 2. False 36. The D(disability) of the primary assessment is a quick evaluation of . 1. ability to ambulate 2. the need for defibrillation 3. neurologic function 4. handicap status of the patient 37. Which of the following signs may be present with sud- den and severe cerebral hypoxia? (Choose all correct answers) 1. Decreased level of consciousness 2. Loss of muscular tone 3. Generalized seizures 4. Pupil dilation A. Pallor B. Mottling C. Cyanosis D. Acrocyanosis E. Peripheral Cyanosis 1. 3. 1, 2, 3, 4 38. When cerebral hypoxia develops more gradually, the neurologic signs are the same as when severe cere- bral hypoxia develops suddenly. 1. True 2. False 39. The AVPU scale is a scale used to evaluate cerebral cortex function and is used to rate a child's level of consciousness. What does the acronym AVPU stand for? 1. Alert, Voice, Painful, Unresponsive 2. Active, Verbal, Painful, Unresponsive 3. Alert, Voice, Pupils, Unresponsive 4. Alive, Voice, Pulses, Understands 40. The Glasgow coma scale is used to evaluate a child's level of consciousness and neurologic status. The child's best eye-opening, verbal, and motor responses are scored. If a child is intubated, unconscious, or preverbal, the most important part of this scale is response. 1. Eye-opening 2. Verbal 3. Motor 41. Pupil response to light is a indicator of function. 1. Cortex 2. Hypothalamus 3. Limbic 4. Brainstem 42. The D(disability) of the primary assessment is a quick evaluation of neurologic function. Which standard evaluations are included in this assessment? (choose all correct answers) 1. AVPU scale 2. Glasgow coma scale 3. Pupil response to light 2. 1. 3. 4. 1, 2, 3, 5 4. NIH stroke scale 5. Blood glucose test 43. The E of the ABCDE primary assessment acronym stands for . 1. Evidence 2. Emergency 3. Evaluate 4. Exposure 44. After completion of the primary assessment, if the child does not have a life-threatening condition, the secondary assessment should be completed. The secondary assessment consists of which of the fol- lowing components? (Choose all correct answers) 1. General physical exam 2. Family medical history 3. Focused history 4. Focused physical exam 45. The final aspect of the evaluate component for the evaluate - identify - intervene sequence is diagnostic tests. What is the primary diagnostic test for assess- ing the severity of respiratory problems? 1. Central venous oxygen saturation 2. Hemoglobin concentration 3. Arterial blood gas 4. Arterial lactate 46. Within the evaluate-identify-intervene sequence, there are 3 clinical assessments that occur. The 3 clin- ical assessments are primary assessment, secondary assessment, and tests. (fill in the blank with the correct answer) 47. An arterial blood gas is a diagnostic test that mea- sures amounts of certain gasses and other con- stituents in the arterial blood. Match each result with the proper definition. A. This value tells us about the acid-base balance. 4. 3, 4 3. Diagnostic A. pH (7.35-7.45) B. PaO2 (80-100) C. PaCO2 (35-45) D. HCO3 (22-26) E. SaO2 (80-100) B. This value tells us whether oxygenation is ade- quate. C. This value tells us whether ventilation is adequate. D. This value is used to determine if the source of an acid-base disturbance is respiratory or metabolic. E. This value tells us the percentage of hemoglobin saturated with oxygen. 48. (True or False) Hemoglobin concentration determines 1. the oxygen-carrying capacity of the blood. 1. True 2. False 49. In the seriously ill or injured child, the arterial lactate 2. level can as a result of tissue hypoxia and anaerobic metabolism. 1. Fall 2. Rise 50. (True or False) Pediatric cardiac arrest typically has a 1. primary cause that is related to respiratory failure or shock. 1. True 2. False 51. Pediatric cardiac arrest is typically the result of 2. resulting from respiratory failure and/or shock. 1. coronary occlusion 2. tissue hypoxia 3. pulmonary embolism 4. hypovolemia 52. (True or False) Outcomes for cardiac arrest in children 2. is generally good. 1. True 2. False 53. Which is the most common presenting initial rhythm 1. for children in cardiac arrest? 1. PEA/asystole 2. ventricular tachycardia 3. ventricular fibrillation 4. complete heart block 54. Sudden cardiac arrest is rare in children, and when it occurs, it is typically associated with underlying heart disease. Common causes include: (choose all that apply) 1. long QT syndrome 2. hypertrophic cardiomyopathy 3. myocarditis 4. drug intoxication 55. A majority of sudden cardiac arrest in children occurs during athletic activity. 1. True 2. False 56. The correct location to palpate for a pulse in an unre- sponsive CHILD is . (choose all correct answers) 1. carotid 2. radial 3. femoral 4. brachial 57. (True or False) To ensure proper treatment of cardiac arrest, the rhythm must be identified before initiating CPR. 1. True 2. False 58. In children, a pulse check should be limited to . 1. no more than 5 seconds 2. no more than 10 seconds 3. no more than 15 seconds 4. no more than 20 seconds 1, 2, 3, 4 1. 1, 3 2. 2. 59. Choose the scenarios that would require immediate CPR. 1. 3-year-old. not responsive, shallow breathing, weak pulse, HR 70 2. 7-year-old, not responsive, not breathing, weak pulse, poor perfusion, HR 55 3. 1-year-old, opens eyes, lethargic, rapid breathing, HR 55 4. 4-year-old, not responsive, agonal breathing, no pulse 2, 4