PALS Pre-Course Test Questions and
Answers
1. Parents of a 1-year-old female phoned EMS when they picked up
their daughter from the babysitter. Paramedics perform an initial
impression revealing an obtunded infant with irregular breathing,
bruises over the abdomen, abdominal distension, and cyanosis.
Assisted bag-mask ventilation with 100% oxygen is initiated. On
primary assessment heart rate is 36/min, peripheral pulses cannot
be palpated, and central pulses are barely palpable. Cardiac monitor
shows sinus bradycardia. Chest compressions are started at 15:2. In
the ED the infant is intubated and ventilated, and IV access is
established. The heart rate is now up to 150/min, but there are weak
central pulses and no distal pulses. Systolic BP is 74. Of the
following, which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV: C
2. You enter a room to perform an initial impression of a previously
stable
,10-year-old male and find him unresponsive and apneic. A code is
called and bag-mask ventilation is performed with 100% oxygen.
The cardiac monitor shows a wide-complex tachycardia. The boy has
no detectable pulses so com- pressions and ventilations are
provided. As soon as the defibrillator arrives you deliver an
unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes
of CPR reveals VF. You then deliver a shock of 4 J/kg and resume
immediate CPR beginning with compressions. A team member has
established IO access, so you give a dose of epi, 0.01 mg/kg (0.1
mL/kg of 1:10,000 dilution) IO after second shock. At the next
rhythm check, persistent VF is present. You administer another 4 J/kg
shock and resume CPR. Based on the PALS Pulseless Arrest Algorithm,
what is the next drug and dose to administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO: D
3. Which of the following statements about calcium is true?
A. Calcium chloride 10% has the same bioavailability of elemental
, calcium as calcium gluconate in critically ill children
B. The recommended dose is 1-2 mg/kg of calcium chloride.
C. Indications for administration of calcium include
hypercalcemia, hy- pokalemia, and hypomagnesemia.
D. Routine administration of calcium is not indicated during cardiac
arrest.: D
4. Initial impression of a 9-year-old male with increased work of
breathing reveals the boy to be agitated and leaning forward on
the bed with obvious respiratory distress. You administer 100%
oxygen by nonrebreathing mask. The patient is speaking in short
phrases and tells you that he has asthma but does not carry an
inhaler. He has nasal flaring, severe suprasternal and intercostal
retractions, and decreased air movement with prolonged
expiratory time and wheezing. His SpO2 is 96% (on nonrebreathing
mask). What is the next medical therapy to provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
Answers
1. Parents of a 1-year-old female phoned EMS when they picked up
their daughter from the babysitter. Paramedics perform an initial
impression revealing an obtunded infant with irregular breathing,
bruises over the abdomen, abdominal distension, and cyanosis.
Assisted bag-mask ventilation with 100% oxygen is initiated. On
primary assessment heart rate is 36/min, peripheral pulses cannot
be palpated, and central pulses are barely palpable. Cardiac monitor
shows sinus bradycardia. Chest compressions are started at 15:2. In
the ED the infant is intubated and ventilated, and IV access is
established. The heart rate is now up to 150/min, but there are weak
central pulses and no distal pulses. Systolic BP is 74. Of the
following, which would be most useful in management of this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV: C
2. You enter a room to perform an initial impression of a previously
stable
,10-year-old male and find him unresponsive and apneic. A code is
called and bag-mask ventilation is performed with 100% oxygen.
The cardiac monitor shows a wide-complex tachycardia. The boy has
no detectable pulses so com- pressions and ventilations are
provided. As soon as the defibrillator arrives you deliver an
unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes
of CPR reveals VF. You then deliver a shock of 4 J/kg and resume
immediate CPR beginning with compressions. A team member has
established IO access, so you give a dose of epi, 0.01 mg/kg (0.1
mL/kg of 1:10,000 dilution) IO after second shock. At the next
rhythm check, persistent VF is present. You administer another 4 J/kg
shock and resume CPR. Based on the PALS Pulseless Arrest Algorithm,
what is the next drug and dose to administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
B. Atropine 0.02 mg/kg IO
C. Epinephrine 0.1 mg/kg of 1:10,000 dilution IO
D. Amiodarone 5 mg/kg IO: D
3. Which of the following statements about calcium is true?
A. Calcium chloride 10% has the same bioavailability of elemental
, calcium as calcium gluconate in critically ill children
B. The recommended dose is 1-2 mg/kg of calcium chloride.
C. Indications for administration of calcium include
hypercalcemia, hy- pokalemia, and hypomagnesemia.
D. Routine administration of calcium is not indicated during cardiac
arrest.: D
4. Initial impression of a 9-year-old male with increased work of
breathing reveals the boy to be agitated and leaning forward on
the bed with obvious respiratory distress. You administer 100%
oxygen by nonrebreathing mask. The patient is speaking in short
phrases and tells you that he has asthma but does not carry an
inhaler. He has nasal flaring, severe suprasternal and intercostal
retractions, and decreased air movement with prolonged
expiratory time and wheezing. His SpO2 is 96% (on nonrebreathing
mask). What is the next medical therapy to provide to this patient?
A. Adenosine 0.1 mg/kg
B. Amiodarone 5 mg/kg IV/IO
C. Albuterol by nebulization
