PALS- PEDIATRIC ADVANCED LIFE SUPPORT

QUESTIONS AND VERIFIED ANSWERS 2024

(Q) The PALS systemic approach algorithm begins with the initial impression. This
is an assessment of which 3 characteristics? - :-
1. Consciousness
2. Breathing
3. Color

(Q) The right branch of the systemic approach algorithm focuses on what
sequence to prevent cardiopulmonary arrest? - :-Evaluate, Identify, Intervene

(Q) The evaluate portion of the sequence consists of three assessment tools: - :
-1. Primary
2. Secondary
3. Diagnostic

(Q) What is included in the primary assessment of a patient? –

A
B
C
D
E
Vitals

(Q) What is included in the secondary assessment of a patient? - :-

Focused history and a focused physical exam

(Q) The initial impression of the PALS systematic approach algorithm includes
which of the following characteristics? (Choose all correct answers.)
1. Appearance
2. Breathing
3. Restlessness
4. Color
5. Pain - :-1, 2, 4

(Q) The second box of the PALS systematic approach algorithm contains a
question. (Fill in the blank to complete the question.)
Is the child ____________ or is immediate intervention needed? - :-unresponsive

(Q) In the PALS systematic approach algorithm, if the child is determined to be

unresponsive or immediate intervention is needed what will be your next step?
1. Start CPR
2. Apply breathing with a bag valve mask
3. Activate emergency response
4. Check for a pulse - :-3.

(Q) After the emergency response is activated, the next intervention is to

____________.
1. Lightly shake the child's shoulders.
2. Look, listen, and feel.
3. Open the airway.
4. Check for breathing and a pulse - :-4.
(Q) After it is determined that the child has no pulse, what should be done?
1. Call for help
2. Begin CPR
3. Provide 2 rescue breaths
4. Start an IV - :-2.

(Q) A child is unresponsive and is not breathing. You have activated the
emergency response system and your pulse check reveals that the child has a pulse.
What should you do now?
1. Perform a brief head to toe assessment.
2. Place the child in the recovery position.
3. Give epinephrine 1mg IV push
4. Open the airway and provide ventilations and oxygen. - :-4.

(Q) A child is unresponsive and is not breathing. Emergency response was

activated and now a pulse check shows that the child does have a pulse. You then
open the airway, provide age-appropriate ventilations, and 100% oxygen with a
bag valve mask. The child's pulse is < 60/min, and the child has signs of poor
perfusion. What is your next intervention?
1. Begin CPR
2. Provide a 500ml NS bolus
3. Perform an ABG.
4. Intubate the patient. - :-1.

(Q) The right branch of the PALS systematic approach algorithm is a sequence of
three actions. In the proper sequence, the three actions are: (Fill in the blanks)
__________, __________, __________ - :-evaluate, identify, intervene
(Q) The evaluate portion of the evaluate-identify-intervene sequence consists of
what clinical assessment tools? (Choose all correct answers)
1. Diagnostic tests
2. Pain assessment
3. Secondary assessment
4. Primary assessment - :-1, 3, 4

(Q) (True or False) The sequence of evaluate-identify-intervene should be used

before and after each intervention and should continue until the child is stable.
1. True
2. False - :-1.

(Q) A consistent respiratory rate less than 10 or more than _____ breaths per
minute in a child of any age is abnormal and suggests the presence of a potentially
serious problem.
1. 40
2. 50
3. 60
4. 70 - :-3.

(Q) The primary objective of the Airway assessment in the ABCDE model is to
assess airway _________.
1. effort of breathing
2. rate of breathing
3. disease
4. patency - :-4.
 (Q) Within the EVALUATE portion of the evaluate-identify-intervene sequence,
The primary assessment uses the ABCDE model for a hands-on evaluation of the
critically ill child. What does ABCDE stand for? (Fill in the blanks)
A

E - :-Airway
Breathing
Circulation
Disability
Exposure

(Q) Simple measures for maintaining airway patency include all of the following
EXCEPT which intervention?
1. Continuous positive airway pressure
2. Head tilt chin lift
3. Jaw thrust
4. Nasopharyngeal airway - :-1.

(Q) Assessment of Breathing includes evaluation of:

1. Respiratory rate and effort
2. Chest expansion in air movement
3. Lung and airway sounds
4. O2 saturation
5. All of the above - :-5.

(Q) Tachypnea can have both respiratory and non-respiratory causes. Select all of
the non-respiratory cause of tachypnea.
1. Croup
2. Pneumonia
3. Bronchiolitis
4. High Fever
5. Asthma
6. Severe pain
7. Anemia - :-4, 6, 7

(Q) (True or False) Stridor is a sign of lower airway problem.

1. True
2. False - :-2.

(Q) (True or False) Grunting is often a sign of lung tissue disease resulting from
small airway collapse, alveolar collapse or both.
1. True
2. False - :-1.

(Q) Match each lung and airway sound with the appropriate definition. (drag and
drop)
A. Coarse, usually higher pitched breathing sound typically heard on inspiration
B. High-pitched or low-pitched whistling or sighing sound heard most often during
expiration
C. Bubbling sound heard during inspiration or expiration
D. Short, low pitched breathing sound heard during expiration
E. Also known as rales and typically associated with pneumonia - :-A. Stridor
B. Wheezing
C. Gurgling
D. Grunting
E. Crackles

(Q) An oxygen saturation of ≥ _____% while a child is breathing room air usually
indicates that oxygenation is adequate.
1. 90%
2. 92%
3. 94%
4. 98% - :-3.

(Q) Heart rate and rhythm, pulses, capillary refill time, skin color and temperature,
and blood pressure are all direct indicators of circulatory status. Which of the
following are indirect indicators of circulatory status? (Choose all correct answers)
1. Urine output
2. Oxygen saturation
3. Level of consciousness
4. Respiratory rate - :-1, 3.

(Q) What is the most common cause of bradycardia in children?

1. Sepsis
2. Drug overdose
3. Hypoxia
4. Complete heart block - :-3.

(Q) (True or False) Tachycardia is a normal physiologic response in the critically

ill child?
1. True
2. False - :-1.

(Q) An observed decrease in systolic blood pressure of ________ mm Hg from

baseline should prompt serial evaluations for additional signs of shock.
1. 5 mm Hg
2. 10 mm Hg
3. 15 mm Hg
4. 20 mm Hg - :-2.

(Q) In healthy children, the heart rate may fluctuate with the respiratory cycle.
The heart rate __________ with inspiration and __________ with expiration. (fill
in each blank with a single word) - :-increases, decreases

(Q) (True or False) When assessing circulation, it is only necessary to assess the
central pulses.
1. True
2. False - :-2.
 (Q) What is a common cause of vasoconstriction and can result in a discrepancy
between the peripheral and central pulses in children? (Choose all correct answers)
1. hot environment
2. cold environment
3. environmental stress
4. tachyarrhythmias - :-2.

(Q) Normal capillary refill time in children is ___________.

1. ≤ 5 seconds
2. ≤ 3 seconds
3. < 2 seconds
4. ≤ 2 seconds - :-4.

(Q) Skin color can be an indication of tissue perfusion. Match the skin
characteristics with the correct definitions.
A. Irregular or patchy discoloration of the skin which may be caused hypoxemia,
hypovolemia, or shock.
B. Paleness, lack of normal color in the skin or mucous membrane.
C. Blue discoloration of the skin and mucous membranes
D. Bluish discoloration of the hands and feet commonly seen during the newborn
period.
E. Bluish discoloration of the hands and feet seen beyond the newborn period. - :-
A. Pallor
B. Mottling
C. Cyanosis
D. Acrocyanosis
E. Peripheral Cyanosis
 (Q) (True or False) A low hemoglobin (anemia) may make it harder to detect in
cyanosis in a critically ill child.
1. True
2. False - :-1.

(Q) The D(disability) of the primary assessment is a quick evaluation of

________________.
1. ability to ambulate
2. the need for defibrillation
3. neurologic function
4. handicap status of the patient - :-3.

(Q) Which of the following signs may be present with sudden and severe cerebral
hypoxia? (Choose all correct answers)
1. Decreased level of consciousness
2. Loss of muscular tone
3. Generalized seizures
4. Pupil dilation - :-1, 2, 3, 4

(Q) When cerebral hypoxia develops more gradually, the neurologic signs are the
same as when severe cerebral hypoxia develops suddenly.
1. True
2. False - :-2.
 (Q) The AVPU scale is a scale used to evaluate cerebral cortex function and is
used to rate a child's level of consciousness. What does the acronym AVPU stand
for?
1. Alert, Voice, Painful, Unresponsive
2. Active, Verbal, Painful, Unresponsive
3. Alert, Voice, Pupils, Unresponsive
4. Alive, Voice, Pulses, Understands - :-1.

(Q) The Glasgow coma scale is used to evaluate a child's level of consciousness
and neurologic status. The child's best eye-opening, verbal, and motor responses
are scored. If a child is intubated, unconscious, or preverbal, the most important
part of this scale is _____________ response.
1. Eye-opening
2. Verbal
3. Motor - :-3.

(Q) Pupil response to light is a indicator of ______________ function.

1. Cortex
2. Hypothalamus
3. Limbic
4. Brainstem - :-4.

(Q) The D(disability) of the primary assessment is a quick evaluation of

neurologic function. Which standard evaluations are included in this assessment?
(choose all correct answers)
1. AVPU scale
2. Glasgow coma scale
3. Pupil response to light
4. NIH stroke scale
5. Blood glucose test - :-1, 2, 3, 5

(Q) The E of the ABCDE primary assessment acronym stands for

________________.
1. Evidence
2. Emergency
3. Evaluate
4. Exposure - :-4.

(Q) After completion of the primary assessment, if the child does not have a life-
threatening condition, the secondary assessment should be completed. The
secondary assessment consists of which of the following components? (Choose all
correct answers)
1. General physical exam
2. Family medical history
3. Focused history
4. Focused physical exam - :-3, 4

(Q) The final aspect of the evaluate component for the evaluate - identify -
intervene sequence is diagnostic tests. What is the primary diagnostic test for
assessing the severity of respiratory problems?
1. Central venous oxygen saturation
2. Hemoglobin concentration
3. Arterial blood gas
4. Arterial lactate - :-3.
 (Q) Within the evaluate-identify-intervene sequence, there are 3 clinical
assessments that occur. The 3 clinical assessments are primary assessment,
secondary assessment, and _________ tests. (fill in the blank with the correct
answer) - :-Diagnostic

(Q) An arterial blood gas is a diagnostic test that measures amounts of certain
gasses and other constituents in the arterial blood. Match each result with the
proper definition.
A. This value tells us about the acid-base balance.
B. This value tells us whether oxygenation is adequate.
C. This value tells us whether ventilation is adequate.
D. This value is used to determine if the source of an acid-base disturbance is
respiratory or metabolic.
E. This value tells us the percentage of hemoglobin saturated with oxygen. - :-A.
pH (7.35-7.45)
B. PaO2 (80-100)
C. PaCO2 (35-45)
D. HCO3 (22-26)
E. SaO2 (80-100)

(Q) (True or False) Hemoglobin concentration determines the oxygen-carrying

capacity of the blood.
1. True
2. False - :-1.

(Q) In the seriously ill or injured child, the arterial lactate level can __________ as
a result of tissue hypoxia and anaerobic metabolism.
1. Fall
2. Rise - :-2.

(Q) (True or False) Pediatric cardiac arrest typically has a primary cause that is
related to respiratory failure or shock.
1. True
2. False - :-1.

(Q) Pediatric cardiac arrest is typically the result of _________ resulting from
respiratory failure and/or shock.
1. coronary occlusion
2. tissue hypoxia
3. pulmonary embolism
4. hypovolemia - :-2.

(Q) (True or False) Outcomes for cardiac arrest in children is generally good.
1. True
2. False - :-2.

(Q) Which is the most common presenting initial rhythm for children in cardiac
arrest?
1. PEA/asystole
2. ventricular tachycardia
3. ventricular fibrillation
4. complete heart block - :-1.
 (Q) Sudden cardiac arrest is rare in children, and when it occurs, it is typically
associated with underlying heart disease. Common causes include: (choose all that
apply)
1. long QT syndrome
2. hypertrophic cardiomyopathy
3. myocarditis
4. drug intoxication - :-1, 2, 3, 4

(Q) A majority of sudden cardiac arrest in children occurs during athletic activity.
1. True
2. False - :-1.

(Q) The correct location to palpate for a pulse in an unresponsive CHILD is

_____________. (choose all correct answers)
1. carotid
2. radial
3. femoral
4. brachial - :-1, 3

(Q) (True or False) To ensure proper treatment of cardiac arrest, the rhythm must
be identified before initiating CPR.
1. True
2. False - :-2.

(Q) In children, a pulse check should be limited to _____________.

1. no more than 5 seconds
2. no more than 10 seconds
3. no more than 15 seconds
4. no more than 20 seconds - :-2.

(Q) Choose the scenarios that would require immediate CPR.

1. 3-year-old. not responsive, shallow breathing, weak pulse, HR 70
2. 7-year-old, not responsive, not breathing, weak pulse, poor perfusion, HR 55
3. 1-year-old, opens eyes, lethargic, rapid breathing, HR 55
4. 4-year-old, not responsive, agonal breathing, no pulse - :-2, 4