PALSPrecourseSelf-Assessment Answers 2023
Section1:RhythmIdentification Answers
For section 1 identify the rhythm by selecting thesingle best answer.
pulses. Clinical clues: heart rate 44/min; no detectable
Pulseless electrical activity
Answer: Pulseless electrical activity.
Clinical clue: heart rate 214/min.
Wide plex tachycardia
Answer: Wide plex tachycardia
Clinical clues: age 7 years; heart rate 38/min.
Sinus bradycardia
Answer: Sinus bradycardia.
Clinical clues: initial rhythm associated with heart rate 300/min.
SVT converting to sinus rhythm after adenosineadministration
Answer: SVT converting to sinus rhythm afteradenosine administration.
Clinical clues: heart rate 150/min.
Wide-plex tachycardia
Answer: Wide plex tachycardia.
Clinical clues: age 8 years; heart rate 78/min.
Normal sinus rhythm
Answer: Normal sinus rhythm.
Clinical clues: febrile infant; heart rate 188/min.
Sinus tachycardia
Answer: Sinus tachycardia.
Clinical clues: age 3 months; heart rate 65/min.
Sinus bradycardia
Answer: Sinus bradycardia.
Clinical clues: heart rate 200/min; no detectable pulses.
Torsades de pointed
Answer: Torsades de pointed.
Clinical clue: no detectable pulses.
Asystole
Answer: Asystole.
Clinical clues: initial rhythm associated with nodetectable pulses.
organized rhythm VF with successful defib and resumption of
Answer: VF with successful defib and resumption of organized rhythm.
Clinical clues: no consistent heart rate detected; nodetectable pulses.
Ventricular fibrillation
Answer: Ventricullar fibrillation.
Clinical clue: heart rate 300/min.
Supraventricular tachycardia
Answer: Supraventricular tachycardia (SVT).
Section 2:Pharmacology Answers
the bed in obvious respiratory distress. The patient A 9-year-old boy is agitated and leaning forward onis speaking in short phrases and tells you that he hasflaring severe suprasternal and intercostal asthma but does not carry an inhaler. He has nasalretractions and decreased air movement withprolonged expiratory time and wheezing. YouHis SpO2 is 92%. Which medication do you prepareto give to this patient?
A. AdenosineB.ProcainamideD.Albuterol (Correct) C.Amiodarone
Which oxygen delivery systemmost reliablydelivers a high (90% or greater) concentration of inspired oxygen to a 7-year-old child?
A. Face tent B.Simple oxygen maskC.Nonrebreathing face mask (Correct)D. Nasal cannula
s oeenochild with ventricular fibrillation cardiac arrest. YouestablishedIaccessoyougiveadosef delivered 2 unsynchronized shocks. A team memberepinephrine 0.01 mg/kg IO. At the next rhythmcheck persistent ventricular fibrillation is present.Which drug and dose should be administered next? You administer a 4-J/kg shock and resume CPR.
A. Magnesium sulfate 25 to 50 mg/kg IO B. Epinephrine 0.1 mg/kg IOC. Atropine 0.02 mg/kg IOD. Amiodarone 5 mg/kg IO (Correct)
Which statement is correct about the effects of
A. Epinephrine decreases myocardial oxygenconsumptionB. Epinephrine is contraindicated in ventricularC. Epinephrine stimulates spontaneous fibrillationcontractions when asystole is present (Correct)D. Epinephrine decreases peripheral vascular resistance and reduces myocardial afterload
You are called to help treat an infant with severesymptomatic bradycardia (heart rate 66/min)persists despite establishment of an effective associated with respiratory distress. The bradycardiaairway oxygenation andventilation.here is noheart block present. Which is the first drug you should administer?
B.Dopamine A. AtropineC.AdenosineD.Epinephrine (Correct)
Which statement is correct about endotracheal drug administration during resuscitative efforts forpediatric patients?
A. The intravenous drug dose should be usedB. It is the preferred route of drug administration
(Correct) C. It is the least desirable route of administration
dose D. The drug dose used is lower than the intravenous
Which statement is correct about the use of calciumchloride in pediatric patients?
A. It has the same bioavailability of elementalcalcium as calcium gluconateB. The remended dose is 1 to 2 mg/kg C. Routine administration is not indicatedduring cardiac arrest (Correct)D. It is indicated for hypercalcemia hypokalemia and hypomagnesemia
A previously healthy infant with a history ofvomiting and diarrhea is brought to the emergencyyou find that the infant responds only to painful department by her parents. During your assessment stimulation. The infant's respiratory rate is 40breaths per minute and central pulses are rapid and weak. The infant has good bilateral breath sounds cool extremities and a capillary refilltime of moremm Hg and glucose is 30 mg/dL (1.65 mmol/L). than 5 seconds. The infant’s blood pressure is 85/65You administer 100% oxygen via face mask andstart an IV. Which treatment is the most appropriatefor this infant?
A.Administer a bolus of isotonic crystalloid 202 to 4 mL/kg IV (Correct)B. Administer lactated Ringer’s solution 20 mL/kgover 60 minutes C. Administer D50W 0.45% sodium chloride 20mL/kg bolus over 15 minutesD. Administer D10W 20 mL/kg bolus over 5minutes
mL/kg over 5 to 20 minutes and also give D25W
Initial impression of a 2-year-old girl shows her tobe alert with mild breathing difficulty duringinspiration and pale skin color. On primary assessment she makes high-pitched inspiratorysounds (mild stridor) when agitated; otherwise her
breathing is quiet. Her SpO2 is 92% on room air and she has mild inspiratory intercostal retractions.Lung auscultation reveals transmitted upper airway sounds with adequate distal breath soundsbilaterally. Which is the most appropriate initialintervention for this child?
A. IV dexamethasoneB.Humidified oxygen as tolerated (Correct)C. Nebulized albuterol D. Endotracheal intubation
Paramedics are called to the home of a 1-year-oldchild. Their initial assessment reveals a child who responds only to painful stimuli and has irregularbreathing faint central pulsesbruises over hmask ventilation with 100% oxygen is initiated. The abdomen abdominal distention and cyanosis. Bag-child’s heart rate is 36/min. Peripheral pulses cannotbe palpated and central pulses are barely palpable.The cardiac monitor shows sinus bradycardia. Two- rescuer CPR is started. Upon arrival to theemergency department the child is intubated andventilated with 100% oxygen and IV access is established. The heart rate is now 150/min withweak central pulses but no distal pulses. Systolicblood pressure is 74 mm Hg. Which interventionshould be provided next?
crystalloid (Correct) A. Rapid bolus of 20 mL/kg of isotonicB. Amiodarone 5 mg/kg IVC. Atropine 0.02 mg/kg IVD. Epinephrine 0.01 mg/kg IV
Section 3:Practical Application Answers
You need to provide rescue breaths to a child victimdelivering breaths? with a pulse. What is the appropriate rate for
B. 1 breath every 3 to 5 seconds A. 1 breath every 6 secondsC. 2 breaths every 6 to 8 secondsD. 1 breath every 2 to 3 seconds (Correct)
A 3-year-old unresponsive apneic child is broughtthat the child became unresponsive as they arrived to the emergency department. EMS personnel reportat the hospital. The child is receiving CPR with bag-mask ventilation. The rhythm shown here is on the cardiac monitor. A biphasic manual defibrillator ispresent. You quickly use the length from head toresuscitation tape to estimate the approximate heel of the child on a color-coded length-basedweight as 15 kg. Which therapy is most appropriatefor this child at this time?
A. Attempt defibrillation at 10 J and then resumeCPR beginning with pressionsB. Attempt defibrillation at 30 J and then open the airway and check for a pulseC. Attempt defibrillation at 30 J and thenresume CPR beginning with pressions (Correct)D. Establish IV/IO access and administerepinephrine 0.01 mg/kg IV/IO
needle into an infant’s tibia. The student asks you You are supervising a student who is inserting an IOwhat she should look for to know that she hassuccessfully inserted the needle into the bone marrow cavity. What do you tell her?
A. “Once inserted the shaft of the needle moves easily in all directions within the bone."B. “Proper placement will always yield bloodreturn." C. “Pulsatile blood flow will be present in theneedle hub."D. “Fluids can be administered freely withoutlocal soft tissue swelling."(Correct)
A 4-year-old boy is in pulseless arrest in thepediatric intensive care unit. High-quality CPR is in progress. You quickly review his chart and find that
his baseline-corrected QT interval on a 12-leadECG is prolonged. The monitor shows recurrentreceived 1 dose of epinephrine 0.01 mg/kg but the episodes of the rhythm shown here. The patient hasrhythm shown here continues. If this rhythmpersists at the next rhythm check which medication would be most appropriate to administer at thattime?
A. Epinephrine 0.1 mg/kg IVB. Lidocaine 1 mg/kg IVC. Adenosine 0.1 mg/kg IVD. Magnesium sulfate 25 to 50 mg/kg IV (Correct)
You are caring for a 3-year-old with vomiting anddiarrhea. You have established IV access. Thenow lethargic.The heart rate is variable range child’s pulses are palpable but faint and the child is44/min to 62/min). You begin bag-mask ventilationimprove you begin chest pressions. The rhythm with 100% oxygen. When the heart rate does notshown here is seen on the cardiac monitor. Whichwould be the most appropriate therapy to consider next?
A. Atropine 0.02 mg/kg IV (Correct)B. Epinephrine 0.1 mg/kg IVC. Transcutaneous pacing D. Synchronized cardioversion at 0.5 J/kg
What ratio of pressions to breaths should beused for 1-rescuer child CPR?
A. 100 to 120 pressions per minute with nobreathsB. 30 pressions to 2 breaths (Correct)
C. 15 pressions to 2 breathsD. 50 pressions to 1 breath
A pale and very sleepy but arousable 3-year-oldhospital. Primary assessment reveals a respiratory child with a history of diarrhea is brought to therate of 45/min with good breath sounds bilaterally.Heart rate is 150/min blood pressure is 90/64 mm Hg and SpO2 is 92% in room air. Capillary refill is5 seconds and peripheral pulses are weak. After(10-L/min flow) with 100% oxygen and obtaining placing the child on a nonrebreathing face maskvascular access which is the most appropriateimmediate treatment for this child?
A. Administer a dopamine infusion at 2 to 5 mcg/kgper minuteC. Obtain a chest x-ray B. Begin a maintenance crystalloid infusionD. Administer a bolus of 20 mL/kg isotoniccrystalloid (Correct)
How can rescuers ensure that they are providingeffective breaths when using a bag-mask device?
A. By delivering breaths quickly and forcefully B. By observing the chest rise with each breath(Correct)D. By always having oxygen attached to the bag C. By allowing air to release around the mask
You are giving chest pressions for a child incardiac arrest. What is the proper depth of pressions for a child?
depth of the chest approximately 2 inches (5 m) A. Compress the chest at least one third the(Correct)
B. Compress the chest at least one fourth the depthof the chest approximately 1.5 inches (4 cm) C. Compress the chest at least two thirds the depthof the chest approximately 4 inches (10 cm)the chest approximately 3 inches (8 cm) D. Compress the chest at least one half the depth of
