PALS Practice Questions and Scenarios for Pediatric Advanced Life Support S) questions and answers with expert solutions + rationales

How long should assessing for breathing and a pulse take?

A) no longer than 5 seconds

B) no longer than 15 seconds

C) no longer than 20 seconds

D) no longer than 10 seconds

D

What should you do to check for breathing?

A) listen for lung sounds

B) look at the nose to check for nasal flaring

C) look for chest rise and fall

D) hold a mirror over the mouth, looking for condensation

C

Where can you check a pulse on an infant?

Brachial

Where can you check a pulse on a child?

Femoral

If the child does not have normal breathing and a pulse of 64/min is present, you will need to

A) monitor

C) provide rescue breathing

D) begin CPR

B

For an unwitnessed cardiac arrest, what should you do after determining unresponsiveness and there is no breathing and no pulse?

A) shout for help

B) provide rescue breaths

C) perform high-quality CPR for 2 minutes

D) activate the emergency response system

C

The appropriate rate for compressions for children is 100 to 120/min. What is the correct depth for children?

A) approximately 4 inches (two thirds AP diameter)

B) approximately 3 inches (one half AP diameter)

C) approximately 2 inches (one third AP diameter)

C

What is the compression-to-ventilation ratio for 1 and 2 rescuer CPR for children and infants?

A) single rescuer 15-2; 2 rescuers 30-2

B) 15-2 for both

C) 30-2

D) single rescuer 30-2; 2 rescuers 15-2

D

How should 1 rescuer infant compressions be delivered?

A) with 1 hand or 2 fingers

B) with 2 hands or 2 fingers

C) with 2 fingers or 2 thumbs

D) with 1 finger or 2 thumbs

C

What is the preferred technique for infant compressions when there are 2 or more rescuers present?

A) 2 finger technique

B) 1 thumb-encircling hands technique

C) 1 finger technique

D) 2 thumb encircling hands technique

D

What are the 4 universal steps for operation of an AED?

1. Turn on the AED

2. Attach pads to the patient

3. Analyze the heart rhythm

4. Deliver indicated shock

If the AED indicates no shock advised, what should be the next action?

A) call for help

B) give 2 rescue breaths

C) analyze heart rhythm again

D) start chest compressions

D

What does the A-B-C in the pediatric assessment triangle (PAT) stand for?

Appearance

Work of breathing

Circulation

When is the pediatric assessment triangle (PAT) performed to make an initial assessment?

A) during the transfer of care

B) during the secondary assessment

C) during the primary assessment

D) during the "from the doorway" observation

D

What sequence is used when caring for a seriously ill or injured child to help determine the best treatment or intervention? The _______, _______, ______ sequence

Evaluate, identify, and intervene

The evaluate -identify-intervene sequence should be continued until

A) the child is stable

B) the child is ready for discharge

C) interventions are provided for the child

D) the child is ready for transport

A

The primary assessment includes the ABCDE approach. What does it assess?

A) airway, breathing, circulation, disability, and exposure

B) assessment, breathing, color, disability, and exposure

C) airway, breath sounds, circulation, disability, and exposure

D) assessment, breath sounds, circulation, disability and exposure

A

How is the airway assessed?

A) heckling the pulse

B) immediately calling for help

C) determining if the airway is open/patent

D) looking for the patient to move

C

In the primary assessment, how should you pen the airway of a child who is not suspected of having a cervical spine injury?

A) with a jaw thrust

B) by flexing the neck

C) with a head tilt-chin lift

D) with endotracheal intubation

C

In infants, the abdomen may move ______ the chest

A) less than

B) more than

B

What is a characteristic of normal chest rise?

A) asymmetrical during inspiration

B) symmetrical during expiration

C) asymmetrical during expiration

D) symmetrical during inspiration

D

_____ is usually high-pitched breathing during inspiration, whereas _____ is usually during expiration

Stridor, wheezing

Snoring and gurgling are a result ______ airway obstruction

A) upper

B) lower

A

Crackles happen during _______, and grunting happens during______

A) inspiration, inspiration

B) expiration, expiration

C) inspiration, expiration

D) expiration, inspiration

C

Oxygen saturation less than _______ indicates low oxygen saturation, which is known as hypoxemia

A) 98%

B) 96%

C) 94%

C

Pulse oximetry indicates oxygen ______ but not oxygen delivery

A) inhalation

B) levels

C) saturation

C

Conditions that _______ air resistance lead to increased respiratory______

Increase, effort

What are signs of increased respiratory effort that can lead to fatigue and respiratory failure?

1. Retractions

2. Nasal flaring

3. Apnea

4. Head bobbing

5. Unlabored breathing

6. Seesaw respirations

1, 2, 4, 6

Determine the respiratory rate by counting the number of times the chest rises in ______ seconds and multiplying by_______

30, 2

Tachypnea is often the fast sign of respiratory _______ in infants

A) arrest

B) failure

C) distress

C

Hypotension for children 1 to 10. Years of age is a systolic blood pressure of less than

A) 40 mm Hg + (2x the age in years)

B) 60 mm Hg + (2x the age in years)

C) 70 mm Hg + (2x the age in years)

D) 50 mm Hg + (2x the age in years)

C

Automated blood pressure cuffs may provide _______ readings when the child is in shock

A) inaccurately low

B) inaccurately high

C) accurate

B

What does a prolonged capillary refill time indicate?

A) increased stroke volume

B) low cardiac rate

C) low cardiac output

D) increased cardiac output

C

Normal capillary refill time is _______ second(s) or less

A) 1

B) 2

C) 3

D) 4

E) 5

B

What pulses should b assessed to monitor systemic perfusion in a child?

A) peripheral and central

B) femoral and carotid

C) peel and radial

D) carotid and brachial

A

What do weak central pulses indicate a need for immediate intervention to prevent?

A) sepsis

B) cardiac arrest

C) hypovolemia

D) respiratory arrest

B

When oxygen delivery to the extremities becomes inadequate, the _______ and ________ are the first to exhibit signs

Hands and feet

What should be used to assess skin temperature?

A) the palm of the hand

B) the back of the hand

C) the side of the face

D) the bottom of the wrist

B

If pupils do not ______ in response to bright light, consider increased _______ pressure

Constrict, intracranial

If _______ is not identified and treated immediately, t can result in _____ injury

Hypoglycemia, brain

What are the 4 indicators of the AVPU scale that are used to determine responsiveness

1. Responsive

2. Verbal

3. Responds to pain

4. Unresponsive

5. Alert

6. Responds to voice

3, 4, 5, 6

If the child does not respond to voice, assess the child's response to _____

A) heat

B) cold

C) pain

C

What should you look for when exposing the child?

1. Bruising

2. Change in responsiveness

3. Low blood pressure

4. Bleeding

5. Purpura

6. Heart murmur

1, 4, 5

What should be included in the history when asking about medications?

1. Current prescribed medications

2. Medication use since birth

3. Allergies to medications

4. Over-the-counter medications

1, 4

Which component of SAMPLE assesses immunization status?

A) signs and symptoms

B) past medical history

C) medications

D) allergies

B

What are some examples of diagnostic assessments?

1. Vital signs

2. Venous blood gas (VBG)

3. Hemoglobin concentration

4. Temperature

5. Arterial blood gas (ABG)

2,3,5

What dictates the timing of diagnostic assessments?

A) order of assessment

B) first intervention

C) complete primary assessment

D) clinical situation

D

Which component of effective high-performance teams is represented by the use of real-time feedback devices?

A) administration

B) quality

C) timing

D) coordination

B

What is an advantage of effective teamwork?

A) division of tasks

B) mastery of resuscitation skills

C) immediate CPR

D) early defibrillation

A

What is the best example of the Team leader role?

A) models excellent team behavior

B) proficient at endotracheal intubation

C) performs within scope of practice

D) does not over ventilate the patient

A

What is the best example of a team member role?

A) helps train future team leaders

B) committed to success

C) monitors individual team members

D) focuses on comprehensive patient care

B

What is the primary purpose of the CPR coach on a resuscitation team?

A) improve CPR quality

B) resolve team conflicts

C) record CPR data

D) provide positive encouragement

A

How can the CPR coach improve CPR quality in a resuscitation event?

A) take charge as the team leader

B) stand at the foot of the patient

C) set an example as the fist compresor

D) coach to midrange targets

D

Which high-performance team member has the responsibility for assigning roles (positions)?

A) timer/recorder

B) monitor/defibrillator/CPR coach

C) IV/IO medications

D) team leader

D

What element of team dynamics describes when a team member needs to correct actions?

A) knowing your limitations

B) constructive intervention

C) knowledge sharing

D) summarizing information

B

Which of the following describe how to communicate?

1. Knowledge sharing

2. Closed-loop communication

3. Clear messaging

4. Knowing your limitations

5. Dividing the tasks

2, 3,

Which resuscitation strategy will result in an improved chest compression fraction?

A) switching chest compressors every 2 minutes

B) adhering to recommended drug dosing intervals

C) hovering over the chest during compression pauses

D) implementing physiologic monitoring devices

C

What is one way to increase chest compression fraction during a code?

A) giving epinephrine during a rhythm analysis

B) starting an IV/IO during a rhythm analysis

C) charging the defibrillator 15 seconds before a rhythm check

D) switching the airway and compressor roles during CPR

C

A chest compression fraction of at least ______ is recommended, and a goal of ______ is often achievable with good teamwork

60% and 80%

What is chest compression fraction

A) proportion of time that compressions are preformed

B)proportion of time that depth is adequate in compressions

C) proportion of time that compressions are not performed

D) proportion of time that recoil is adequate in compressions

A

What is the definition of oxygen saturation?

A) measurement of ventilation

B) the amount of oxygen bound to hemoglobin

C) amount of oxygen dissolved in the plasma

D) measurement of oxygen delivery

B

Children develop hypothermia and tissue hypoxia more quickly than adults because of their

A) lower respiratory rate

B) higher metabolic rate

C) lower oxygen demand

D) higher hemoglobin

B

Infants and toddlers, the tongue and epiglottis, relative to those of an adult, are

A) posterior

B) small

C) anterior

D) large

D

How can norma, spontaneous breathing be characterized?

A) associated with decreased lung compliance

B) noisy, withum unlabored inspiration

C) associated with upper airway resistance

D) quiet, with unlabored inspiration

D

increased work of breathing can be associated with _______ airway resistance and/or _______

Increased, decreased

What happens when airway resistance increases?

A) lung volume increases

B) work of breathing increases

C) airway dilation impedes airflow

D) impedance to airflow decreases

B

Which of the following describes laminar or normal airflow?

A) low airway resistance and a small driving pressure

B) larger airways need increased airway resistance

C) high airway resistance and a low driving pressure

D) smaller airways need increased airway resistance

A

What is the role of the diaphragm contraction during normal breathing in infants?

A) pulls the ribs slight inward

B) causes an increase in pressure in the chest

B) causes a decrease in pressure in the chest

D) pushes the lower ribs slightly out

A

Which is a characteristic of muscle weakness?

A) seesaw breathing

B) constant retraction

C) a strong cough

D) strong respiratory muscles

A

Which of the following is true about airway resistance?

A) impedance to airflow is decreased when the airways constrict

B) the smaller the airway, the lower the airway resistance

C) airway resistance decreases as lung volume remains unchanged

D) hewn airway resistance increases, work of breathing increases

D

During spontaneous breathing, what are the inspiratory muscles attempting to do?

A) increase intrathoracic volume

B) increase expiratory flow

C) decrease inspiratory flow

D) decrease intrathroacic volume

A

Which of these factors can override brain stem control of breathing in an infant?

A) turbulent airflow

B) breathing normally

C) breathing holding

D) laminar airflow

C

What do central chemoreceptors respond to?

A) CO2 in the bloodstream

B) CO2 int he cerebrospinal fluid

C) serum pH

D) hydrogen ions in the cerebrospinal fluid

D

Why may excessive ventilation during CPR be harmful?

1) it impedes venous return

2) it increases coronary perfusion

3) it increases intrathoracic pressure

4) it decreases intrathoracic pressure

1, 3,

What should you do if you cannot achieve effective ventilation with a bag-mask device?

1. Check the heart rate

2. Take the patient's blood pressure

3. Verify the mask size

4. Reposition on the airway

5. Increase ventilation rate

3, 4

How are effective oxygenation and ventilation assessed?

1. Oxygen saturation

2. Temperature

3. Capillary refill

4. Visible chest rise with each breath

5. Exhaled carbon dioxide

6. ECG

1, 4, 5

How can gastric inflation impaired bag-mask ventilation?

A) it decreases lung compliance

B) it increases exhalation time

C) it creates low pressure in the lungs

D) it increases lung volumes

A

What is the most appropriate precautionary action to minimize gastric inflation during bag-mask ventilation?

A) ventilate every 4-6 seconds

B) deliver each breath over about 1 second

C) hyperextend the next

D) apply cricoid pressure

B

Hypoxemia is defined as oxygen saturation less than ______

A) 90

B) 94

C) 96

D) 92

B

Which is true about the difference between hypoxemia and tissue hypoxia?

A) tissue hypoxia can occur with normal arterial oxygen saturation

B) hypoxemia always leads to low tissue saturation

C) tissue hypoxia cannot occurs unless arterial oxygen saturation is low

D) hypoxemia is normal tissue saturation

A

What does hyperventilation, which refers to increased alveolar ventilation, result in?

A) PaCO2 less than 35 mm Hg

B) PaCO2 equal to 40 mm Hg

C) PaCO2 greater than 45 mm Hg

D) PaCO2 less than 94%

A

What happens to the arterial oxygen level in a child with severe anemia?

A) may increase when dissolved oxygen is decreased

B) may increase when dissolved oxygen is increased

C) is not impacted by dissolved oxygen

D) may increase when dissolved oxygen is increased

B

Which is true of increased carbon dioxide tension in arterial blood?

A) is a result of inadequate oxygenation

B) produces respiratory alkalosis

C) may be caused by disordered control of breathing

D) may be secondary to a normal respiratory drive

C

What happens when ventilation is inadequate?

A) PaCO2 decreases

B) PaCO2 increases

C) acid-base balance is alkalosis

D) acid base balance is normal

B

What is a critical symptom of hypercarbia?

A) agitation

B) anxiety

C) decreased level of consciousness

D) low pulse oximetry readings

C

Which of the following indicates mild respiratory distress?

A) cyanosis

B) a decreased level of consciousness

C) mild increased in respiratory effort

D) very low oxygen saturation

C

Which of the following indicates severe respiratory distress?

A) normal airway sounds

B) mild tachypnea

C) marked tachypnea and/or apnea

D) mild nasal flaring and retractions

C

Which of the following statements about respiratory failure is true?

A) seldom leads to cardiac arrest if not treated

B) always has a low pulse oximetry reading

C) is defined by strict criteria

D) may occur without signs of respiratory distress

D

Which is most likely to be present in a child who has respiratory distress (not respiratory failure)?

A) bradypnea

B) lethargy

C) very poor air movement on auscultation

D) ability to maintain a patent airway

D

What steps should be taken as part of initial management of a child in respiratory distress?

1. Start cardiac compressions

2. Monitor O2 saturation by pulse oximetry

3. Insert advanced airway

4. Monitor heart rate, rhythm and blood pressure

5. Support an open airway

2, 4, 5

Which are ideal characteristics of face masks for ventilation?

1. Has a soft rim

2. Covers the mouth and above the eyes

3. Covers the mouth and nose

4. Has a rigid rim

5. Transparent

1, 3, 5

What is the rationale for using a transparent mask?

A) allows you to see the color of the child's lips

B) provides the ability to see condensation, which indicates inhalation

C) does not allow the child to regurgitate

D) provides a tight seal against the face

A

What is the function of the nonrebreathing outlet valve of a self-inflating bag?

A) allows the child to exhale

B) keeps exhaled gases contained

C) prevents rebreathing of carbon dioxide

D) opens when the child exhales

C

Which of the following is required to appropriately ventilate a child with a flow-inflating bag?

A) the outlet control valve must not be changed

B) face masks do not need to be fitted to the child

C) tidal volume needs to be delivered at the correct rate

D) the oxygen flow rate must remain constant

C

What should be checked to ensure proper function of a bag-mask system?

1. The pop-off valve can be closed

2. The cuff of the mask is deflated

3. The oxygen tubing does not have any leaks

4. Oxygen tubing is connected to the device and the oxygen source

1, 4

How is sniffing position achieved in an infant or a child?

A) hyperextend the neck

B) ensure the external ear canals is anterior to the shoulder

C) place the infant in a prone position

D) flex the neck behind the level of the shoulder

B

Where may padding be required under when properly positioning a child older than 2 years of age to maintain a patent airway?

A) padding is not required for children older than 2 years of age

B) the upper torso

C) the shoulders

D) the occiput

D

What actions are appropriate when providing 1 person bag-mask ventilation?

A) open the airway and barely squeeze the bag

B) open the airway, insert an oral airway, and squeeze the bag as hard as you can

C) perform a head tilt and squeeze the bag as hard as you can

D) perform a head tilt, insert an oral airway, and squeeze the bag until chest rise

D

What does the E-C clamp technique include?

1. Using the thumb and index finger of the same hand to hold the face mask

2. Using the second and third fingers of one hand to hold the face mask

3. Using the third, fourth and fifth fingers of one hand along the jaw to lift it forward

4. Pressing on the soft tissue under the chin to lift the jaw

1,3

When may a 2 person bag mask technique be preferable?

1. When using the head tilt-chin lift maneuver to open the airway

2. When there is a significant airway resistance

3. When providers need to take turns squeezing the bag

4,. When very large tidal volumes need to be delivered

5. When masking a seal is difficult

2, 5