PALS Pre-Course Test(answered & Updated for 2022-2023)
1. Parents of a 1-year-old female phoned EMS when they picked up their daughter from the babysitter... [Show More] . 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 compressions 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, hypokalemia, 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
D. Procainamide 15 mg/kg IV/IO - C
5. You are called to help resuscitate an infant with severe symptomatic bradycardia associated with respiratory distress. The bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. Which of the following is the first drug you should administer?
A. Dopamine
B. Adenosine
C. Atropine
D. Epinephrine - D
6. An infant with a history of vomiting and diarrhea arrives by ambulance. During your primary assessment the infant responds only to painful stimulation. The upper airway is patent, the repiratory rate is 40/min with good bilateral breath sounds, and 100% oxygen is being administered. The infant has cool extremities, weak pulses, and a cap refill of more than 5 seconds. The infant's BP is 85/65 mm Hg and glucose concentration is 30 mg/dL (1.65 mmol/L). Which of the following is the most appropriate treatment to provide for this infant?
A. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over 10 to 20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a separate infusion.
B. Establish IV or IO access and administer 20 mL/kg D50 .45% sodium chloride bolus over 15 minutes.
C. Establish IV or IO access and administer 20 mL/kg Lactated Ringer's solution over 60 minutes.
D. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg 1:1,000 via the endotracheal tube. - A
7. Which of the following statements about endotracheal drug administration is true?
A. Endotracheal doses of resuscitation drugs in children have been well established and are supported by evidence from clinical trials.
B. Endotracheal drug administration is the least desirable route of administration because of this route results in unpredictable drug levels and effects.
C. Endotracheal drug administration is the preferred route of drug administration dring resuscitation because is results in predictable drug levels and drug effects.
D. Intravenous drug doses for resuscitation drugs should be used whther you give the drugs by the IV, IO, or the endotracheal route. - B
8. Which of the following statements most accurately reflects the PALS recommendations for the use of magnesium sulfate in the treatment of cardiac arrest?
A. Routine use of magnesium sulfate is indicated for shock-refractory monomorphic VT.
B. Magnesium sulfate is indicated for torsades de pointes and VF/ pulseless VT associated with suspected hypomagnesemia.
C. Magnesium sulfate is indicated for VF refractory to repeated shocks and amiodarone or lidocaine.
D. Magnesium sulfate is contraindicated in VT associated with an abnormal QT interval during the preceding sinus rhythm. - B
9. Initial impression of a 2-year-old female reveals 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% in room air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which of the following is the most appropriate initial therapeutic intervention for this child?
A. Administer an IV dose of dexamethasone
B. Perform immediate endotracheal intubation
C. Administer humidified supplementary oxygen as tolerated and continue evaluation
D. Nebulize 2.5 mg of albuterol - C
10. Which of the following statements about the effects of epinephrine during attempted resuscitation is true?
A. Epinephrine decreases the peripheral vascular resistance and reduces myocardial afterload so that ventricular contractions are more effective
B. Epinephrine is contraindicated in ventricular fibrillation because it increases myocardial irritability.
C. Epinephrine improves coronary artery perfusion pressure and stimulates spontaneous contractions when asystole is present.
D. Epinephrine decreases myocardial oxygen consumption. - C [Show Less]
