PALS Written Exam A

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American Heart Association

PALS Provider Written Exam

Version A

October 12, 2011

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PALS Provider Exam Version A (33 questions) Please do not mark on this exam. Record the best answer on the separate answer sheet.

1. A 5-year-old child presents with lethargy, increased work of breathing, and pale color. The primary assessment reveals that the airway is open and the respiratory rate is 30/min, with crackles heard on auscultation. The cardiac monitor shows sinus tachycardia at a rate'of 165/min. The pulse oximeter displays an oxygen saturation of 95% and a pulse rate of 93/min. On the basis of this information, which of the following provides the best interpretation of the oxygen saturation of 95% by pulse oximetry?

A. Reliable; no supplementary oxygen is indicated B. Reliable; supplementary oxygen should be administered C. Unreliable; no supplementary oxygen is indicated D. Unreliable; supplementary oxygen should be administered

2. A 3-year-old child was recently diagnosed with leukemia and has been treated with chemotherapy. The child presents with lethargy and a high fever. Heart rate is 195/min, respiratory rate is 36/min, blood pressure is 85/40 mm Hg, and capillary refill time is less than 2 seconds. What is the child's most likely condition?

A. Septic shock B. Hypovolemic shock C. Significant bradycardia D. Cardiogenic shock

3. A 2-week-old infant presents with irritability and a history of poor feeding. Blood pressure is 55/40 mm Hg. What term describes this infant's blood pressure?

A. Hypotensive B. Normal C. Hypertensive D. Compensated

4. During a resuscitation attempt, the team leader orders an initial dose of epinephrine at 0.1 mglkg to be given 10. What should the team member do?

A. Administer the drug as ordered B. Administer 0.01 mg/kg of epinephrine C. Respectfully ask the team leader to clarify the dose D. Refuse to administer the drug

) 2 PALS Provider Written Exam Version A, October 12,2011 © 20 II American Heart Association

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Heart Association ® 5. Which of the following is a characteristic of respiratory failure? A. B. C. D.

Inadequate oxygenation and/or ventilation Hypotension An increase in serum pH (alkalosis) Abnormal respiratory sounds

6. Which of the following is most likely to produce a prolonged expiratory phase and wheezing? A. B. C. D.

Disordered control of breathing Hypovolemic shock Lower airway obstruction Upper airway obstruction

7. A 4-year-old child presents with seizures and irregular respirations. The seizures stopped a few minutes ago. Which of the following most likely to be abnormal? A. B. C. D.

Vascular resistance Pulse rate Lung compliance Control of breathing

8. What abnormality is most likely to be present in children with acute respiratory distress caused by lung tissue disease? A. B. C. D.

Decreased oxygen saturation Stridor Normal respiratory rate Decreased respiratory effort

9. An alert 2-year-old child with an increased work of breathing and pink color is being evaluated. Heart rate is 110/min, and respiratory rate is 30/min. What would best describe this patient's condition? A. B. C. D.

Respiratory distress Respiratory arrest Respiratory failure Disordered control of breathing

3 PALS Provider Wrinen Exam Version A, October 12, 2011 © 2011 American Heart Association

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10. The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals the following: The child is difficult to arouse, with pale color. The child's heart rate is 160/min, respiratory rate is 30/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 103°F (39.4°C). What is the most appropriate intervention? A. B. C. D.

Obtain vascular access and administer 20 mUkg of isotonic crystalloid over 30 minutes Obtain vascular access and administer 20 mUkg of isotonic crystalloid over 5 to 10 minutes Obtain immediate blood cultures and chest x-ray Obtain expert consultation with an oncologist to determine the chemotherapeutic regimen ..

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11. A 2-year-old child presents with a 4-day history of vomiting. The initial impression reveals an unresponsive child with intermittent apnea and mottled color. Heart rate is 166/min, respiratory rate is now being supported with bag-maSk ventilation, capillary refill time is 5 to 6 seconds, and temperature is 102°F (38.9°C). What is the best method of establishing immediate vascular access? A. B. C. D.

Two providers may attempt peripheral vascular access twice each Three providers may attempt peripheral vascular access once each Place a central venous line Place an intraosseous line

12. What is the appropriate fluid bolus to administer for a child with hypovolemic shock with adequate myocardial function? A. B. C. D.

10 mUkg 20 mUkg 20 mUkg 10 mUkg

normal saline of 5% dextrose and 0.2% sodium chloride normal saline lactated Ringer's

13. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. The child's color is pink. What is the most appropriate initial intervention? A. B. C. D.

Obtain a chest radiograph Administer nebulized epinephrine Prepare for a surgical airway Use an epinephrine autoinjector

4 PALS Provider Written Exam Version A, October 12, 20 II © 20 II American Heart Association

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Heart Association ® 14. An 8-year-old child presents with a history of vomiting and diarrhea. The child has the following vital signs: heart rate 168/min, respiratory rate 15/min, blood pressure 90/60 mm Hg, and temperature 98.6°F (37°C). The child's capillary refill time is 4 seconds. After 2 IV boluses of normal saline (20 mUkg each), the child's vital signs are now as follows: heart rate 130/min, respiratory rate 16/min, blood pressure 94162 mm Hg, capillary refill 2 seconds, and temperature 98.6°F (37°C). The child's urine output is 1 to 2 mL/kg in the past hour. The child is still lethargic. What diagnostic tests or information should be obtained first?

A. Arterial blood gas B. Serum potassium concentration C. Glucose D. A 12-lead ECG

15. A 15-year-old boy presents with acute onset of severe respiratory distress, with retractions and an oxygen saturation of 85%. His trachea is deviated to the right, and there are no breath sounds on the left. His heart rate is 140/min, his blood pressure is 84/60 mm Hg, and his capillary refill time is 3 seconds. What is the most appropriate intervention?

A. Obtain a chest x-ray B. Perform needle decompression on the left chest , C. Insert a chest tube on the left side D. Insert an IV and administer 20 mUkg of normal saline

16. A 4-year-old is being treated for hypovoiemic shock and has received a single fluid bolus of 20 mUkg of normal saline. On reevaluation the child remains anxious, with a heart rate of 140/min, a blood pressure of 84154 mm Hg, and a capillary refill time of 4 seconds. What describes this patient's condition?

A. Hypotensive shock B. Compensated shock C. No longer in shock D. Cardiogenic shock

5 PALS Provider Written Exam Version A, October 12, 20 II ~ 2011 American Heart Association

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Heart Association ® 17. An 8-year-old child had a sudden onset of palpitations and light-headedness. At the time of evaluation the child is alert. His respiratory rate is 26/min, and his blood pressure is 104170 mm Hg. A cardiac monitor is applied, and the rhythm below Is noted. :;;: ::: ~ : I

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A. Provide synchronized cardioversion at 0.5 to 1 J/kg B. Attempt vagal maneuvers C. Administer adenosine 0.1 mg/kg over 5 minutes D. Administer amiodarone 5 mg/kg over 20 minutes 18. A 10-year-old child- had a sudden witnessed cardiac arrest and received immediate bystander CPR and defibrillation within 3 minutes. He had a return of spontaneous circulation. The child remains unresponsive and has an advanced airway in place. There is no history of trauma or signs of shock. What is the target range for oxygen saturation for this child?

A. 92% to 100% B. 92% to 99% C. 94% to 99% D. 94% to 100%

6 PA LS Provider Written Exam Version A, October 12,2011 © 20 II Ameri can Heart Assoc iation

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Heart Association ® 19. A 3-month-old infant with bronchiolitis is suctioned to remove upper airway secretions. The infant's heart rate decreases from 155/min to 65/min as shown below.

The infant remains alert, with easily palpable pulses. Capillary refill time is 1 second. What is the most appropriate initial intervention?

A. Administer oxygen and ensure adequate ventilation ; be prepared to intervene further if heart rate does not increase B. Establish IVIIO access and administer epinephrine 0.01 mg/kg IV C. Establish IVIIO access and administer atropine 0.02 mg/kg IV D. Call for help and prepare to provide transthoracic pacing/transvenous pacing

20. A 3-month-old infant with bronchiolitis is intubated for management of respiratory failure. During transport, the infant develops bradycardia with a heart rate of 60/min, and the infant's oxygen saturation decreases to 75%. There are breath sounds on the right side, but no air entry is heard on the left side. What is the most appropriate initial intervention?

A. B. C. D.

Administer epinephrine 0.01 mg/kg IV Place a chest tube on the left Verify the endotracheal tube position Aggressively suction the endotracheal tube

21. For a 6-month-old infant with supraventricular tachycardia and adequate perfusion, which of the following is the preferred vagal maneuver?

A. B. C. D.

Ocular pressure Carotid pressure Valsalva maneuver Ice to the face

7 PALS Provider Written Exam Version A, October 12, 2011 © 20 II American Heart Association

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22. A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10 minutes after eating peanuts. What is the most appropriate initial medication for this child? Nebulized albuterol B. Epinephrine 1M C. Isotonic crystalloid IV D. Methylprednisolone IV

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23. A 2-year-old child was found submerged in a swimming pool. She is unresponsive, not breathing, and pulseless. In addition to performing high-quality CPR and establishing vascular access, which of the following is the most appropriate intervention? Give atropine 0.02 mg/kg IO/lV B. Apply cricoid pressure C. Give epinephrine 0.01 mg/kg IO/lV D. Provide transthoracic pacing

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24. A 3-year-old child is unresponsive, not breathing, and pulseless. High-quality CPR is in progress. A cardiac monitor is applied, and the rhythm below is noted.

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8 PALS Provider Written Exam Version A, October 12,2011 © 20 II American Heart Association

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Heart Association ® 25. A pulseless 6-week-old infant arrives in the emergency department, and high-quality CPR is in progress. The initial rhythm strip is shown below.

CPR continues, and vascular access has been established. What is the next appropriate intervention?

A. B. C. D.

Administer atropine 0.02 mg/kg IO/IV Attempt defibrillation with a 2 J/kg shock Administer epinephrine 0.01 mg/kg IOIlV Consider insertion of an advanced airway

26. A 6-month-old infant is unresponsive and not breathing. What is the maximum time that should be spent trying to palpate the pulse before starting CPR?

A. B. C. D.

10 seconds 15 seconds 30 seconds 60 seconds

27. What is the recommended location to check for a pulse in a 3-month-old infant?

A. B. C. D.

Carotid Radial Brachial Cardiac apex

9 PALS Provider Written Exam Version A, October 12,2011 © 2011 American Heart Assoc iation

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28. A 7-year-old child presents in pulseless arrest. The child's ECG shows the rhythm below.

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Ventricular escape rhythm Ventricular tachycardia Pulseless electrical activity Sinus bradycardia

29. While you are performing CPR on an infant in cardiac arrest at a doctor's office, a second rescuer arrives with an AED. Which of the following best describes the use of an AED on this infant?

A. B. C. D.

The use of AEDs is not recommended on an infant. There are not enough data to recommend for or against the use of AEDs on infants. Only pediatric pads may be used on infants. If pediatric pads are unavailable, it is acceptable to use adult pads.

30. A 12-year-old child suddenly collapses while playing sports. He is unresponsive and not breathing. Emergency response is activated. The child has no pulse, and CPR is initiated. An AED arrives. What is the most appropriate next intervention?

A. B. C. D.

Contact the child's family Provide CPR for 2 minutes Drive the child to the hospital Use the AED

31. A 6-year-old child is found unresponsive, not breathing, and pulseless. What is the correct compression-to-ventilation ratio when 2 or more healthcare providers are present to perform CPR? A. 3:1 B. 10:1 C. 15:2 D. 30:2

10 PALS Provider Written Exam Version A, October 12, 2011 © 20 II American Heart Assoc iation

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Heart Association ® 32. A 5-year-old child has had severe respiratory distress for 2 days. During assessment the child's heart rate decreases from 140/min to gO/min, and the child's respiratory rate decreases from 66/min to S/min. What intervention is most appropriate? A. B, C, D,

Provide rescue breaths at a rate of 12 to 20/min Provide rescue breaths at a rate of 6 to 10/min Initiate chest compressions at a rate of at least 100/min Initiate chest compressions at a rate of 60/min

33. A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and poor perfusion. Pulses are weak and thready. Vascular access cannot be established. What is the most appropriate intervention? A. B, C, D,

Unsynchronized shock with 0,5 to 1 J/kg Synchronized shock with 0,5 to 1 J/kg Unsynchronized shock with 2 J/kg Synchronized shock with 2 J/kg

11 PALS Provider Written Exam Version A, October 12, 20 II © 2011 American Heart Association