American
Heart Association
Pediatric
Advanced Life Support
Pretest
October
2001
© 2001
American Heart Association
Pediatric
Advanced Life Support Course
American Heart
Written
Examination
Association
Please
do not mark on this evaluation. Record the best answer on the separate answer
sheet.
1. Which of the
following statements is true
regarding about poisoning and overdose in the
pediatric population is true?
a. whenever a poison or toxin is
ingested, you should induce vomiting to eliminate it from the
body
b. poisoning and overdose cause a
significant number of deaths in the 15- to 24-year-old age
group
c. poisoning and overdose do not occur
in the pediatric population
d. the first priority of management
for the child with poisoning or a drug overdose is to "get the
antidote"
2. A 3-year-old
unresponsive, apneic child is brought to
the Emergency Department. unresponsive and
apneic. The EMTs transporting the child indicate that tell you
the child became pulseless as they pulled up to the hospital. The
child is receiving CPR, including positive-pressure ventilation
with bag and mask and 100% oxygen and chest compressions. You confirm that apnea
is present and that ventilation is producing bilateral breath sounds and chest
expansion while a colleague confirms absence of spontaneous central pulses and
other signs of circulation. A third colleague places the patient on
attaches the ECG monitor and reports that
ventricular fibrillation is present. Which of the following therapies would be
is most appropriate for you to
provide at this time for this child at this
time?
a. establish IV/IO/intraosseous access and administer
amiodarone 5 mg/kg IV
b. establish IV/IO/intraosseous access
and administer lidocaine 1 mg/kg IV
c. attempt defibrillation at 2
J/kg
d. establish IV/IO/intraosseous access
and administer epinephrine 0.01 mg/kg IV
3. During
the attempted You are
attempting resuscitation of the an
infant or child with severe symptomatic bradycardia and no evidence
of vagal etiology., that
The bradycardia persists despite
establishment of an effective airway, oxygenation, and
ventilation., Which of the following
is the first drug you
should administer?
a. atropine
b. dopamine
c. adenosine
d.
epinephrine
4. You are preparing
to use a manual external defibrillator and external paddles in the pediatric
setting. When would it be most
appropriate to utilize use the smaller "pediatric"
sized "pediatric-sized” paddles for delivery of
direct-current energy?
a. the smaller paddles should be used
for provide synchronized cardioversion but
not for defibrillation
b. the smaller paddles should be used
when the patient weighs less than approximately
25 kg or is under
less than 8 years of ageold
c. the smaller paddles should be used
when the patient weighs less than approximately 10 kg or is under
less than 1 year of ageold
d. the smaller paddles should be used
whenever you can compress the victim's chest using only the heel of one
hand
5. A 7-year-old boy
is found unresponsive, apneic, and pulseless. CPR is provided,
and endotracheal intubation and vascular
access are achieved. The ECG monitor reveals pulseless electrical activity
(PEA). An initial IV dose of epinephrine has been administered, and effective
ventilations and compressions continue for one 1
minute. Which of the following therapies should be
you performed next?
a. attempt to identify and treat
reversible causes (useing the 4 H's and 4
T's as a memory aid)
b. attempt defibrillation at 4
J/kg
c. administer escalating doses of
epinephrine
d. administer synchronized
cardioversion
6. Which of the
following statements about the effects of epinephrine during attempted
resuscitation is true?
a. epinephrine decreases peripheral
vascular resistance and reduces myocardial afterload so that
ventricular contractions are more effective
b. epinephrine can improve coronary
artery perfusion pressure and can stimulate spontaneous contractions
when asystole is present
c. epinephrine is not useful in
ventricular fibrillation because it will increase myocardial
irritability
d. epinephrine decreases myocardial
oxygen consumption
7. You are
participating in the elective intubation of a 4-year-old child with respiratory
failure. You must select the appropriate size of uncuffed tracheal tube. Which
of the following would besizes is the
most appropriate size for an average
4-year-old?
a. 3-mm tube
b. 4-mm tube
c. 5-mm tube
d. 6-mm tube
8. A 9-month-old
infant presents with a respiratory rate of 45 breaths/minute, and a heart rate of
250
/minutebpm with narrow
(<0.08 seconds) QRS complexes. The infant is
receiving 100% oxygen by face mask, and an IV catheter is in place. The
infant's systolic blood pressure is 64 mm Hg
/and palpable with
faint pulses, and capillary refill time
is 5 to- 6
seconds. The infant is respondsing
only to painful stimulation, and there is
he has no history of vomiting or
diarrhea. What Which of the following
is the most appropriate initial treatment for this
infant?
a. attempt immediate
defibrillation
b. administration of
administer a 20 mL/kg fluid bolus of
normal
saline0.9% sodium chloride {{FG/JM: 0.9% sodium
chloride vs normal saline?}} over 20 minutes or
less
c. administration
ofadminister adenosine 0.1 mg/kg using
rapid bolus (two-syringe) administration
technique(2-syringe
technique)
d. administration of
administer
verapamil
9. You are in a
restaurant when a woman at the next table cries out, "I think he's choking." You
look over and see a 3-year-old child who does appear to be choking. You go to
the table and confirm that the child is responsive, but he is cyanotic,
unable to cough or talk, and is not moving air. Which of the following is the
most appropriate initial therapy for you to providethis
child?
a. give 5 back blows, and then 5 chest
thrusts
b. attempt perform
a blind finger sweep
c. do not intervene unless the child
becomes unresponsive; then perform abdominal thrusts
d. tell the victim you will help and
give abdominal thrusts
10. You are evaluating a
7-month-old infant boy. The infant presented with a
history of poor feeding, fussiness, and sweating. He is alert and responsive,
and he has a respiratory rate of 48 breaths/min with good bilateral breath
sounds. Heart rate is 250 bpm with narrow (<0.08 seconds) QRS complexes, and
the heart rate does not vary with activity or cry.
Pulses are readily palpable, and capillary refill is 2 seconds. Which of the
following therapies is most
appropriate for this infant?
a. make an appointment with a
pediatric cardiologist for later in the week
b. consider vagal maneuvers (eg, ice
to the face) while IV access is attempted and provide IV adenosine once access
is established
c. perform immediate synchronized
cardioversion without awaiting establishment of IV access
d. establish IV access, administer a
fluid bolus of 20 mL/kg of isotonic crystalloid, and administer
antibiotics
11. You are evaluating a
responsive 6-year-old girl. The child presented with fever, irritability,
mottled color, cool extremities, and a prolonged capillary refill time. Her
heart rate is 160 bpm, respiratory rate is 45 breaths/min, and the
BP is 98/56 mm Hg. Which of the following most accurately describes
this child's condition, using the terminology taught in the PALS
course?
a. decompensated shock associated with
inadequate tissue perfusion
b. decompensated shock associated with
inadequate tissue perfusion and significant hypotension
c. compensated shock requiring no
intervention
d. compensated shock associated with
inadequate tissue perfusion
12. An 8-year-old child has
beenwas struck by a car. He arrives in the
Emergency Department alert, anxious, and in respiratory distress. His cervical
spine is immobilized, and he is receiving a 10 L/min flow of
100% oxygen by face mask. Respirations are 60 breaths/minute, his
heart rate is 150/minute bpm, and his
systolic BP blood pressure is 60
mm Hg. No
breath sounds are absent heard over the right
chest, and the trachea is clearly deviated to
the left. Pulse oximetry reveals an oxyhemoglobin saturation of 84%. Which of
the following is the most appropriate immediate intervention
for this child?
a. perform immediate endotracheal intubation and call for
a
"STAT" chest
x-ray
b. obtain a chest x-ray and provide
bag-mask ventilation until the x-ray is read
c. establish IV access and administer
an
immediate fluid bolus of a 20 mL/kg bolus
of normal saline
d. perform needle decompression of the
right chest and assist ventilation with a bag- and mask if
necessary
13. {{Julie--this is
identical to #18 in Exam A}}A 2-year-old child presents with gradual onset of
mild difficulty in breathing of gradual onset.
She is alert, but she has a sore throat and is making
coarse, high-pitched inspiratory sounds (mild stridor). Her oxyhemoglobin
saturation is 942% in room air, and
her lung sounds are clear with adequate breath sounds bilaterally. Which of the
following is the most appropriate initial therapy intervention
for this child?
a. perform immediate
endotracheal
intubation
b. obtain immediate
radiologic evaluation of the soft tissues of the neck
c. begin pulse oximetry to evaluate
evaluation of oxyhemoglobin saturation
with pulse
oximetry and obtain an analysis of arterial
blood gases analysis to determine
if hypercarbia is present
d. administer administration
of humidified supplemental oxygen as tolerated and continued
evaluation
14. An 18-month-old child
presents with a 1-week history of a cough and a runny nose. He is
cyanotic and responsive responds only to
painful stimulation. His heart rate is 160 bpmper
minute; respirations have dropped from 65 to 10 per minute with
severe intercostal retractions and a capillary refill time of less than 2
seconds. Which of the following would beis the most
appropriate immediate treatment for
this toddler?
a. establish vascular access and
administer a 20 mL/kg bolus of isotonic fluids
bolus
b. open the airway and provide
positive-pressure ventilation using 100% oxygen and a bag-mask
device
c. administer 100% oxygen by face
mask, establish vascular access, and obtain a STAT chest
x-ray
d. administer 100% oxygen by face
mask, obtain blood and for arterial blood
gases analysis, and
establish vascular access
15. You are supervising another
healthcare provider in the insertion of an intraosseous needle into an infant's
tibia. Which of the following signs should you tell the provider will best indicate successful insertion of a
needle into the bone marrow cavity?
a. pulsatile blood flow will be
present in the needle hub
b. fluids or drugs can be administered
freely without local soft tissue swelling
c. resistance to insertion suddenly increases as the tip
of the needle passes through the bony cortex into the
marrow
d. once inserted,
the needle
shaft of the needle moves easily in all
directions within the bone
16. An anxious but alert
7-year-old child is brought to the Emergency Department.
presents with The child has a heart
rate of 260/minute bpm with narrow QRS
complexes and no variability in heart rate with activity. Respirations are
30
breaths/minute and unlabored. Extremities are warm,
and capillary refill time is less than 2 seconds. He is awake and alert, and
he
denies chest pain or shortness of breath. Which of the following
would be
is the most appropriate initial treatment that you should
provide for this child?
a. perform immediate synchronized
cardioversion (0.5 to 1 J/kg)
b. establish vascular access and
administer a 20 mL/kg fluid bolus of 0.9% sodium
chloridenormal saline ((FG and JM--0.9% sodium chloride vs normal
saline?}}
c. attempt vagal maneuvers by asking
having the child to blow into an
occluded straw, and establish vascular access to deliver adenosine if
needed
d. begin immediate transcutaneous
overdrive pacing
17. A pale and obtunded
3-year-old child with a history of diarrhea is brought to
the hospital. with a history of
diarrhea. Respirations are 45 breaths/minute
with no distress and good breath sounds bilaterally. The Heart rate is
150/minute bpm, and the
BP is 88/64 mm Hg. Capillary refill time is 5 seconds,
and peripheral pulses are weak. After placing the child on a 10 L/min flow of
100% oxygen and obtaining vascular access, which of the following would be
is the most appropriate immediate treatment for
this child?
a. obtain a chest
x-ray
b. administer a maintenance
crystalloid infusion
c. administer a bolus of
20 mL/kg bolus of IV or IO intraosseous
isotonic fluids
d. administer a dopamine infusion
at approximately a rate of 2- to 5 mcmg/kg
/per
minute
18. An infant arrives by
ambulance with a history of vomiting and diarrhea arrives by
ambulance. The infant is responsive responds only to
painful
stimulation. The upper airway is patent, the respiratory rate
is 40
breaths/minute with good bilateral breath sounds,
and 100% oxygen is being administered. She has cool extremities, weak
pulses, and a capillary refill time of more
than 5 seconds. Her Blood pressure is 85/65 mm Hg, and
glucose concentration (measured by bedside test)
is 100 mg/dL. Which of the following would be is the most appropriate treatment for you to
provide for this infant?
a. achieve IV/IOestablish IV or
IO access and administer 20 mL/kg of 5% dextrose and
0.45% sodium chloride over 5 minutes
b. achieve establish
IV /or
IO access and administer 20 mL/kg of lactated Ringer's
solution
over 60 minutes
c. perform tracheal intubation and
administer 0.1 mg/kg (0.1 mL/kg of 1:1,000 solution) of
epinephrine (0.1 mL/kg of 1:1000 solution) by
tracheal routetube
d. administer 20 mL/kg of
isotonic crystalloid over 10 -to 20
minutes
19. Which of the following is the most reliable equipment for
devices will most reliably
delivering a high (90% or greater)
concentration of inspired oxygen?
a. a nasal cannula with oxygen flow of
4 L/min
b. a simple oxygen
mask
c. a non-rebreathing face mask with an
oxygen reservoir
d. a partial rebreathing
mask
20. You are transporting a
6-year-old tracheally intubated patient who is receiving positive-pressure
mechanical ventilation. The child begins to move his head and suddenly becomes
cyanotic and bradycardic. You remove the child from the mechanical ventilator
circuit and provide manual assisted ventilation with a bag via the tracheal
tube. During manual ventilation with 100% oxygen, the child's color and heart
rate improve slightly and his blood pressure remains adequate. Breath sounds and
chest expansion are present and adequate on the right side, but they
are consistently diminished on the left side. The trachea is not deviated, and
the neck veins are not distended. A suction catheter passes easily beyond the
tip of the tracheal tube. Which of the following is the most likely cause of this child's acute
deterioration?
a. tracheal tube
displacement
b. tracheal tube
obstruction
c. tension
pneumothorax
d. equipment
failure
21. An 11-year-old skateboarder
suffered multiple system trauma without no obvious midface
injury. He is obtunded and apneic. After bag-mask ventilation with 100% oxygen
and appropriate cervical spine immobilization, which of the following is the
preferred method for tracheal intubation?
a. nasotracheal
route
b. orotracheal
route
c.
cricothyrotomy
d. nasogastric
tube
22. An unresponsive 7-month-old
infant presents with cold extremities and a capillary refill time of more than 5
seconds. His heart rate is 260 bpm with weak pulses and narrow QRS complexes. IV
access is established with difficulty. The infant is receiving 100% oxygen by
non-rebreathing face mask, and oxygenation and ventilation are adequate.
Pediatric monitor/defibrillation/pacing electrode pads are in correct position
on the infant's chest. You attempt to flush the IV line with normal saline and
note that it is no longer patent. Which of the following is the most appropriate initial treatment for
this infant?
a. perform immediate tracheal
intubation
b. reattempt vascular access to enable
administration of IV adenosine
c. establish IO access and administer
a 20 mL/kg bolus of isotonic crystalloid followed by
adenosine
d. perform immediate synchronized
cardioversion
23. A pulseless 11-month-old
infant arrives in the Emergency Department in
with ventricular fibrillation arrives in the
Emergency Department. with CPR is in progress. You
ensure that bag-mask ventilation with 100% oxygen is producing effective chest
expansion and breath sounds bilaterally, establish an IV with a large catheter,
attempt defibrillation 3 times, and administer a first dose of
epinephrine. The child remains in ventricular fibrillation after 30
to- 60 seconds of CPR.
Which of the following actions should be you
performed next?
a. provide lidocaine 1 mg/kg IV or
amiodarone 5 mg/kg bolus IV
b. attempt defibrillation at 4
J/kg
c. provide 2ndsecond dose of epinephrine IV
0.1 mg/kg IV (1:1000 solution, 0.1
mL/kg)
d. consider adenosine at
0.1 to- 0.2
mg/kg
24. You are preparing to provide
attempt synchronized
cardioversion for a child with supraventricular tachycardia. What is the
recommended initial energy dose for
synchronized cardioversion for infants and children?
a. 0.05 to 0.1
J/kg
b. 0.5 to 1 J/kg
c. 2 to 4 J/kg
d. 6 to 10 J/kg
25. You are participating in the
attempted resuscitation of a 3-year-old child in pulseless ventricular
tachycardia. You have attempted defibrillation 3 times without converting the VT
to a perfusing rhythm. The airway is secure and ventilation is effective.
Attempts at IV access have been unsuccessful, but IO access has
been attainedestablished. You have
not
been unable to identify any reversible cause
of the VT. After administering IO epinephrine, circulating it
for 30 to 60 seconds, and unsuccessful defibrillation, what is the next therapy that will be most
appropriate if the child remains in VT?You administer epinephrine,
circulate it for 30 to 60 seconds, and attempt defibrillation a fourth time, but
VT persists. Which of the following drugs should you
administer next?
a. tracheal epinephrine
0.1 mg/kg by tracheal tube (1:1000
solution, 0.1 mL/kg)
b. adenosine 0.1 mg/kg IV
push
c. IO epinephrine 0.1
mg/kg IO
(1:1000 solution, 0.1
mL/kg)
d. lidocaine 1 mg/kg IO or amiodarone
5 mg/kg IO
26. An 18-month-old submersion
(near-drowning) victim is currently stable in a community hospital ED. A
tracheal tube is in place with proper position confirmed. The toddler is
receiving mechanical ventilation and a low-dose dopamine infusion to support
blood pressure and perfusion. Which of the following options is most appropriate for
transporting this child from the community hospital to a tertiary care
center?
a. a helicopter team with no pediatric
experience that is 20 minutes away
b. the local EMS service with a Basic
EMT
c. a pediatric critical care transport
team from the receiving tertiary care center that is 30 minutes
away
d. the local basic EMS service with a
pediatric nurse along to help
27. A 3-year-old boy presents
with multiple system trauma. The child was an unrestrained passenger in a motor
vehicle crash. He is unresponsive to voice or painful stimula-tion, and his
right pupil is dilated and responds sluggishly to light. His respiratory rate is
less than 6 breaths/min, heart rate is 170 bpm, systolic blood pressure is 60 mm
Hg, and capillary refill time is 5 seconds. Which of the following most
accurately summarizes What are the first actions you should take to support
this child?
a. provide 100% oxygen by simple mask,
immobilize the cervical spine, establish vascular access, and provide
maintenance IV fluids
b. provide 100% oxygen by simple mask
and perform a head-to-toe survey to identify the extent of all injuries; begin
an epinephrine infusion and titrate to maintain a systolic blood pressure of at
least 76 mm Hg
c. establish immediate vascular
access, administer 20 mL/kg of isotonic crystalloid, and reassess the patient;
if the child's systemic perfusion does not improve, administer 10 to 20 mL/kg of
packed red blood cells
d. open the airway (jaw thrust
technique) while immobilizing the cervical spine, administer positive-pressure ventilation, and
attempt immediate tracheal intubation
28. You are caring for a
7-year-old boy. The child was a pedestrian struck by a car. He is breathing
spontaneously with oxygen supplementation, and he has good central pulses. He
has an open mid-shaft fracture of the right femur; his right thigh is swollen
and bleeding heavily. The child arrives in your medical facility with adequate
ventilation and perfusion, and his spine is
immobilizedimmobilization. Which of the following
are the best initial steps for you to take to treat this
the child's leg injury?
a. apply direct pressure to the wound
and continue to evaluate and support systemic perfusion, including perfusion of
the leg
b. call the orthopedic surgeon and do
not touch the leg
c. attempt to align the fracture and
apply a tourniquet above the wound
d. attempt to control bleeding with
hemostatic clamps, apply a tourniquet, and then attempt to align the
fracture
29. Which of the following
statements about pediatric injury in the United States is true?
a. motor vehicle–related trauma
accounts for less than 10% of all pediatric injuries resulting in
death
b. injuries are the leading cause of
death in children older than 6 months
c. bicycle helmets will not reduce the
severity of most bicycle-related head injuries
d. most fire-related deaths occur in
schools
30. You are a lone rescuer
alone when you see your neighbor's’ 13-year-old adolescent
daughter floating face-down in her home
their swimming pool. She is unresponsive,
limp, and cyanotic when you pull her from the
water. You did not witness her entry into the water. Which of the following best
summarizes the first steps you should
perform
take to maximize this adolescent's
chances of survival?
a. shout for help, open her airway
with a jaw thrust while keeping her cervical spine immobilized, check
breathing, and if she is not breathing
adequately provide 2 rescue breaths if she is not
breathing adequately
b. carefully lay her on the
ground, and leave her to
phone 911, and then return,
and open her airway, and continue the steps of
CPR
c. immediately begin cycles of 5 chest
compressions and 1 ventilation
d. shout for help and if no one
arrives, open her airway with a head tilt–chin lift maneuver, check
breathing, and if she is not breathing adequately
provide 2 rescue breaths if she is not breathing
adequately
31. You find an
7-year-old boy is unresponsive in his bed. You open his
airway and check breathing and find that that he is not
breathing at all. You deliver 2 effective rescue breaths. You now want to check
for signs of circulation. Which of the following choices best describes the
assessments you should you
perform to determine if signs of circulation are present in this
child?
a. attempt to feel a carotid pulse and
check for adequate breathing, coughing, or movement in
response to the 2 rescue breaths
b. palpate a radial pulse and check
the child's blood pressure during both inspiration and
exhalation
c. look at the child's color and
recheck responsiveness
d. look to see if the child resumes
normal breathing
32. You have just assisted with
the elective tracheal intubation of a child with respiratory failure and a
perfusing rhythm. You perform a clinical assessment during assisted manual
ventilation to verify proper tracheal tube position, and you want to confirm
tube position with a secondary technique. Which of the following would
provides the most reliable, prompt secondary confirmation of correct
tracheal tube placement in this child?
a. some color improvement, some chest
rise, and an oxygen saturation (per pulse oximetry) above
70%
b. auscultation of breath sounds over
the lateral chest bilaterally
peripheral areas of both lung fields and
presence of inspiratory sounds over the abdomen during assisted manual
ventilation
c. presence of mist in the tracheal
tube
d. presence of exhaled CO2
in a
colorimetric detector after delivery of 6 positive-pressure
breaths
33. You are assisting at a
statewide track and field event, in a professional sports
facility., when You witness a
young teenage girl collapse while running. She is unresponsive.
when you arrive at her side., Other bystanders
have called for EMS support and are performing well-coordinated CPR. They report
that the teen has no known health problems, and
but she is now apneic and
pulseless. Which of the following therapies could
you add to this teen's resuscitation that would
be most likely to improve her
survival?Which of the following actions would most
likely improve this teen’s chance of
survival?
a. you should take over
mouth-to-mouth resuscitation
b. you should attach and
operate an AED as soon as one can be is
retrieved
c. you should provide
crowd control
d. you should get a
blanket to keep the patient warm