PALS Precourse Self-Assessment

Answers 2023
SVT converting to sinus rhythm after adenosine
Section 1: Rhythm Identification
administration
Answers
Answer: SVT converting to sinus rhythm after
For section 1, identify the rhythm by selecting the adenosine administration.
single best answer.

Clinical clues: heart rate 44/min; no detectable

pulses. Clinical clues: heart rate 150/min.

Pulseless electrical activity

Wide-complex tachycardia
Answer: Pulseless electrical activity.
Answer: Wide complex tachycardia.

Clinical clue: heart rate 214/min.

Clinical clues: age 8 years; heart rate 78/min.

Wide complex tachycardia

Answer: Wide complex tachycardia. Normal sinus rhythm

Answer: Normal sinus rhythm.

Clinical clues: age 7 years; heart rate 38/min.

Clinical clues: febrile infant; heart rate 188/min.

Sinus bradycardia
Sinus tachycardia
Answer: Sinus bradycardia.
Answer: Sinus tachycardia.

Clinical clues: initial rhythm associated with heart

rate 300/min. Clinical clues: age 3 months; heart rate 65/min.
Sinus bradycardia Ventricular fibrillation
Answer: Sinus bradycardia. Answer: Ventricullar fibrillation.

Clinical clues: heart rate 200/min; no detectable Clinical clue: heart rate 300/min.
pulses.

Supraventricular tachycardia

Torsades de pointed Answer: Supraventricular tachycardia (SVT).

Answer: Torsades de pointed.

Section 2: Pharmacology Answers

Clinical clue: no detectable pulses. A 9-year-old boy is agitated and leaning forward on
the bed in obvious respiratory distress. 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
Asystole retractions, and decreased air movement with
prolonged expiratory time and wheezing. You
Answer: Asystole. administer 100% oxygen by a nonrebreathing mask.
His SpO2 is 92%. Which medication do you prepare
to give to this patient?

Clinical clues: initial rhythm associated with no A. Adenosine

detectable pulses. B. Procainamide
C. Amiodarone
D. Albuterol (Correct)

VF with successful defib and resumption of

organized rhythm Which oxygen delivery system most reliably
delivers a high (90% or greater) concentration of
Answer: VF with successful defib and resumption inspired oxygen to a 7-year-old child?
of organized rhythm.
A. Face tent
B. Simple oxygen mask
C. Nonrebreathing face mask (Correct)
D. Nasal cannula
Clinical clues: no consistent heart rate detected; no
detectable pulses.
You are part of a team attempting to resuscitate a C. It is the least desirable route of administration
child with ventricular fibrillation cardiac arrest. You (Correct)
delivered 2 unsynchronized shocks. A team member D. The drug dose used is lower than the intravenous
established IO access, so you give a dose of dose
epinephrine, 0.01 mg/kg IO. At the next rhythm
check, persistent ventricular fibrillation is present.
You administer a 4-J/kg shock and resume CPR.
Which drug and dose should be administered next? Which statement is correct about the use of calcium
chloride in pediatric patients?
A. Magnesium sulfate 25 to 50 mg/kg IO
B. Epinephrine 0.1 mg/kg IO A. It has the same bioavailability of elemental
C. Atropine 0.02 mg/kg IO calcium as calcium gluconate
D. Amiodarone 5 mg/kg IO (Correct) B. The recommended dose is 1 to 2 mg/kg
C. Routine administration is not indicated
during cardiac arrest (Correct)
D. It is indicated for hypercalcemia, hypokalemia,
Which statement is correct about the effects of and hypomagnesemia
epinephrine during attempted resuscitation?

A. Epinephrine decreases myocardial oxygen

consumption A previously healthy infant with a history of
B. Epinephrine is contraindicated in ventricular vomiting and diarrhea is brought to the emergency
fibrillation department by her parents. During your assessment,
C. Epinephrine stimulates spontaneous you find that the infant responds only to painful
contractions when asystole is present (Correct) stimulation. The infant’s respiratory rate is 40
D. Epinephrine decreases peripheral vascular breaths per minute, and central pulses are rapid and
resistance and reduces myocardial afterload weak. The infant has good bilateral breath sounds,
cool extremities, and a capillary refill time of more
than 5 seconds. The infant’s blood pressure is 85/65
mm Hg, and glucose is 30 mg/dL (1.65 mmol/L).
You are called to help treat an infant with severe You administer 100% oxygen via face mask and
symptomatic bradycardia (heart rate 66/min) start an IV. Which treatment is the most appropriate
associated with respiratory distress. The bradycardia for this infant?
persists despite establishment of an effective
airway, oxygenation, and ventilation. There is no A. Administer a bolus of isotonic crystalloid 20
heart block present. Which is the first drug you mL/kg over 5 to 20 minutes, and also give D25W
should administer? 2 to 4 mL/kg IV (Correct)
B. Administer lactated Ringer’s solution 20 mL/kg
A. Atropine over 60 minutes
B. Dopamine C. Administer D50W 0.45% sodium chloride 20
C. Adenosine mL/kg bolus over 15 minutes
D. Epinephrine (Correct) D. Administer D10W 20 mL/kg bolus over 5
minutes

Which statement is correct about endotracheal drug

administration during resuscitative efforts for Initial impression of a 2-year-old girl shows her to
pediatric patients? be alert with mild breathing difficulty during
inspiration and pale skin color. On primary
A. The intravenous drug dose should be used assessment, she makes high-pitched inspiratory
B. It is the preferred route of drug administration sounds (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 A 3-year-old unresponsive, apneic child is brought
sounds with adequate distal breath sounds to the emergency department. EMS personnel report
bilaterally. Which is the most appropriate initial that the child became unresponsive as they arrived
intervention for this child? at the hospital. The child is receiving CPR with bag-
mask ventilation. The rhythm shown here is on the
A. IV dexamethasone cardiac monitor. A biphasic manual defibrillator is
B. Humidified oxygen as tolerated (Correct) present. You quickly use the length from head to
C. Nebulized albuterol heel of the child on a color-coded length-based
D. Endotracheal intubation resuscitation tape to estimate the approximate
weight as 15 kg. Which therapy is most appropriate
for this child at this time?

Paramedics are called to the home of a 1-year-old

child. Their initial assessment reveals a child who
responds only to painful stimuli and has irregular
breathing, faint central pulses, bruises over the
abdomen, abdominal distention, and cyanosis. Bag-
A. Attempt defibrillation at 10 J, and then resume
mask ventilation with 100% oxygen is initiated. The
CPR, beginning with compressions
child’s heart rate is 36/min. Peripheral pulses cannot
B. Attempt defibrillation at 30 J, and then open the
be palpated, and central pulses are barely palpable.
airway and check for a pulse
The cardiac monitor shows sinus bradycardia. Two-
C. Attempt defibrillation at 30 J, and then
rescuer CPR is started. Upon arrival to the
resume CPR, beginning with compressions
emergency department, the child is intubated and
(Correct)
ventilated with 100% oxygen, and IV access is
D. Establish IV/IO access and administer
established. The heart rate is now 150/min with
epinephrine 0.01 mg/kg IV/IO
weak central pulses but no distal pulses. Systolic
blood pressure is 74 mm Hg. Which intervention
should be provided next?

A. Rapid bolus of 20 mL/kg of isotonic You are supervising a student who is inserting an IO
crystalloid (Correct) needle into an infant’s tibia. The student asks you
B. Amiodarone 5 mg/kg IV what she should look for to know that she has
C. Atropine 0.02 mg/kg IV successfully inserted the needle into the bone
D. Epinephrine 0.01 mg/kg IV 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 blood
Section 3: Practical Application return.”
Answers C. “Pulsatile blood flow will be present in the
needle hub.”
You need to provide rescue breaths to a child victim D. “Fluids can be administered freely without
with a pulse. What is the appropriate rate for local soft tissue swelling.”(Correct)
delivering breaths?

A. 1 breath every 6 seconds

B. 1 breath every 3 to 5 seconds
C. 2 breaths every 6 to 8 seconds A 4-year-old boy is in pulseless arrest in the
D. 1 breath every 2 to 3 seconds (Correct) pediatric 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-lead C. 15 compressions to 2 breaths
ECG is prolonged. The monitor shows recurrent D. 50 compressions to 1 breath
episodes of the rhythm shown here. The patient has
received 1 dose of epinephrine 0.01 mg/kg, but the
rhythm shown here continues. If this rhythm
persists at the next rhythm check, which medication A pale and very sleepy but arousable 3-year-old
would be most appropriate to administer at that child with a history of diarrhea is brought to the
time? hospital. Primary assessment reveals a respiratory
rate 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 is
5 seconds, and peripheral pulses are weak. After
placing the child on a nonrebreathing face mask
(10-L/min flow) with 100% oxygen and obtaining
vascular access, which is the most appropriate
A. Epinephrine 0.1 mg/kg IV immediate treatment for this child?
B. Lidocaine 1 mg/kg IV
C. Adenosine 0.1 mg/kg IV A. Administer a dopamine infusion at 2 to 5 mcg/kg
D. Magnesium sulfate 25 to 50 mg/kg IV per minute
(Correct) B. Begin a maintenance crystalloid infusion
C. Obtain a chest x-ray
D. Administer a bolus of 20 mL/kg isotonic
crystalloid (Correct)
You are caring for a 3-year-old with vomiting and
diarrhea. You have established IV access. The
child’s pulses are palpable but faint, and the child is
now lethargic. The heart rate is variable (range, How can rescuers ensure that they are providing
44/min to 62/min). You begin bag-mask ventilation effective breaths when using a bag-mask device?
with 100% oxygen. When the heart rate does not
improve, you begin chest compressions. The rhythm A. By delivering breaths quickly and forcefully
shown here is seen on the cardiac monitor. Which B. By observing the chest rise with each breath
would be the most appropriate therapy to consider (Correct)
next? C. By allowing air to release around the mask
D. By always having oxygen attached to the bag

You are giving chest compressions for a child in

cardiac arrest. What is the proper depth of
A. Atropine 0.02 mg/kg IV (Correct) compressions for a child?
B. Epinephrine 0.1 mg/kg IV
C. Transcutaneous pacing A. Compress the chest at least one third the
D. Synchronized cardioversion at 0.5 J/kg depth of the chest, approximately 2 inches (5 cm)
(Correct)
B. Compress the chest at least one fourth the depth
of the chest, approximately 1.5 inches (4 cm)
What ratio of compressions to breaths should be C. Compress the chest at least two thirds the depth
used for 1-rescuer child CPR? of the chest, approximately 4 inches (10 cm)
D. Compress the chest at least one half the depth of
A. 100 to 120 compressions per minute with no the chest, approximately 3 inches (8 cm)
breaths
B. 30 compressions to 2 breaths (Correct)
 IV
D. Start high-quality CPR (Correct)

You find an infant who is unresponsive, is not

breathing, and does not have a pulse. You shout for
nearby help, but no one arrives. What action should An 8-month-old infant is brought to the emergency
you take next? department for evaluation of severe diarrhea and
dehydration. On arrival to the emergency
A. Provide CPR for 60 seconds before leaving to department, the infant becomes unresponsive,
activate the emergency response system apneic, and pulseless. You shout for help and start
B. Activate the emergency response system after CPR. Another provider arrives, at which point you
giving CPR for 90 seconds switch to 2-rescuer CPR. The rhythm shown here is
C. Provide CPR for approximately 2 minutes seen on the cardiac monitor. The infant is intubated
before leaving to activate the emergency and ventilated with 100% oxygen. An IO line is
response system (Correct) established, and a dose of epinephrine is given.
D. Activate the emergency response system after While continuing high-quality CPR, what do you do
giving CPR for 10 minutes next?

You and another rescuer begin CPR. Your

colleague begins compressions, and you notice that
the compression rate is too slow. What should you
say to offer constructive feedback? A. Give atropine 0.02 mg/kg IO
B. Give amiodarone 5 mg/kg IO
A. “You need to compress at a rate of 100 to 120 C. Give normal saline 20 mL/kg IO rapidly
per minute.” (Correct) (Correct)
B. “You need to compress at a rate of at least 100 D. Give epinephrine 0.1 mg/kg IO
per minute.”
C. “You need to compress at a rate of at least 120
per minute.”
D. “You need to compress at a rate of 80 to 120 per A 3-year-old boy presents with multiple-system
minute.” trauma. The child was an unrestrained passenger in
a high-speed motor vehicle crash. On primary
assessment, he is unresponsive to voice or painful
stimulation. His respiratory rate is 5/min, heart rate
A child becomes unresponsive in the emergency and pulses are 170/min, systolic blood pressure is
department and is not breathing. You are uncertain 60 mm Hg, capillary refill is 5 seconds, and SpO2 is
if a faint pulse is present. You shout for help and 75% on room air. Which action should you take
provide ventilation with 100% oxygen. The rhythm first?
shown here is seen on the cardiac monitor. What is
your next action? A. Establish immediate vascular access
B. Provide 100% oxygen by simple mask
C. While a colleague provides spinal motion
restriction, open the airway with a jaw thrust
and provide bag-mask ventilation (Correct)
D. Perform immediate endotracheal intubation
A. Establish IV access and give epinephrine 0.01
mg/kg IV
B. Prepare for transcutaneous pacing
C. Establish IV access and give atropine 0.01 mg/kg
A 7-year-old boy is found unresponsive, apneic, and from 65/min to 10/min, severe inspiratory
pulseless. CPR is ongoing. The child is intubated, intercostal retractions are present, heart rate is
and vascular access is established. The ECG 160/min, SpO2 is 65% in room air, and capillary
monitor shows an organized rhythm with a heart refill is less than 2 seconds. Which are the most
rate of 45/min, but a pulse check reveals no appropriate immediate interventions for this
palpable pulses. High-quality CPR is resumed, and toddler?
an initial IV dose of epinephrine is administered.
Which intervention should you perform next? A. Administer 100% oxygen by face mask, obtain
an arterial blood gas, and establish vascular access
A. Perform defibrillation B. Administer 100% oxygen by face mask, establish
B. Perform synchronized cardioversion vascular access, and obtain a chest x-ray stat
C. Administer epinephrine C. Open the airway and provide positive-
D. Identify and treat reversible causes (Correct) pressure ventilation using 100% oxygen and a
bag-mask device (Correct)
D. Establish vascular access and administer a 20
mL/kg bolus of isotonic crystalloid
You are preparing to use a manual defibrillator in
the pediatric setting. Which best describes when it is
appropriate to use the smaller, pediatric-sized
paddles? An 8-year-old child was struck by a car. He arrives
in the emergency department alert, anxious, and in
A. If the child weights less than 40 kg or is less than respiratory distress. His cervical spine is
10 years old immobilized, and he is receiving a 10-L/min flow of
B. If the child weights less than 20 kg or is less than 100% oxygen by nonrebreathing face mask. His
3 years old respiratory rate is 60/min, heart rate 150/min,
C. If the child weights less than 30 kg or is less than systolic blood pressure 70 mm Hg, and SpO2 84%.
5 years old Breath sounds are absent over the right chest but
D. If the child weighs less than 10 kg or is less present over the left chest, and the trachea is
than 1 year old (Correct) deviated to the left. He has weak central pulses and
absent distal pulses. Which intervention should be
performed next?

During bag-mask ventilation, how should you hold A. Perform needle decompression of the right
the mask to make an effective seal between the chest (Correct)
child’s face and the mask? B. Provide bag-mask ventilation
C. Establish IV access
A. Push the jaw forward by using a jaw-thrust D. Perform endotracheal intubation
maneuver
B. Position your fingers using the E-C clamp
technique (Correct)
C. Position your fingers using the bridge of the nose
as a guide What compression-to-ventilation ratio should be
D. Use the 2 thumb‒encircling hands technique used for 2-rescuer infant CPR?

A. 15 compressions to 2 breaths (Correct)

B. 5 compressions to 1 breath
An 18-month-old child has a 1-week history of C. 20 compressions to 2 breaths
cough and runny nose. The child has diffuse D. 30 compressions to 2 breaths
cyanosis and is responsive only to painful
stimulation with slow respirations and rapid central
pulses. The child’s respiratory rate has decreased
You just assisted with the elective endotracheal arousable. He has labored breathing, very rapid
intubation of a child with respiratory failure and a pulses, and a dusky color. His respiratory rate is
perfusing rhythm. Which provides a reliable, 68/min, heart rate 300/min, and blood pressure
prompt assessment of correct endotracheal tube 70/45 mm Hg. He has weak brachial pulses and
placement in this child? absent radial pulses, a capillary refill of 6 seconds,
SpO2 85% in room air, and good bilateral breath
A. Adequate bilateral breath sounds and chest sounds. You administer high-flow oxygen and place
expansion plus detection of ETCO2 with the child on a cardiac monitor and see the rhythm
waveform capnography (Correct) shown here. The child has no history of congenital
B. Absence of audible breath sounds over the heart disease. IV access has been established.
abdomen during positive-pressure ventilation Which therapy is most appropriate for this child?
C. Confirmation of appropriate oxygen and carbon
dioxide tensions on arterial blood gas analysis
D. Auscultation of breath sounds over the lateral
chest bilaterally plus presence of mist in the
endotracheal tube
A. Administer isotonic crystalloid fluid bolus of 20
mL/kg
B. Consult with pediatric cardiology
A 10-month-old infant boy is brought to the C. Perform immediate defibrillation
emergency department. Your initial assessment D. Administer adenosine 0.1 mg/kg IV rapid
reveals a lethargic, pale infant with slow push (Correct)
respirations and slow, weak central pulses. One
team member begins ventilation with a bag-mask
device with 100% oxygen. A second team member
attaches the monitor/defibrillator and obtains vital
You are evaluating an irritable 6-year-old girl with
signs while a third team member attempts to
mottled skin color. The patient is febrile
establish IV/IO access. The patient’s heart rate is
(temperature 40°C [104°F]), and her extremities are
38/min with the rhythm shown here. The infant’s
cold with capillary refill of 5 seconds. Distal pulses
blood pressure is 58/38 mm Hg, and capillary refill
are absent and central pulses are weak. Heart rate is
is 4 seconds. His central pulses remain weak, and
180/min, respiratory rate is 45/min, and blood
distal pulses cannot be palpated. Chest
pressure is 98/56 mm Hg. How would you
compressions are started and IO access is obtained.
categorize this child’s condition?
Which medication do you anticipate will be given
next?
A. Hypotensive shock associated with inadequate
tissue perfusion
B. Compensated shock associated with
tachycardia and inadequate tissue perfusion
(Correct)
C. Hypotensive shock associated with inadequate
tissue perfusion and significant hypotension
A. Atropine 0.02 mg/kg IV/IO D. Compensated shock requiring no intervention
B. Epinephrine 0.01 mg/kg IV/IO (Correct)
C. Epinephrine 0.1 mg/kg IV/IO
D. Adenosine 0.1 mg/kg rapid IV/IO
You find a 10-year-old boy to be unresponsive. You
shout for help, and after finding that he is not
breathing and has no pulse, you and a colleague
A 1-year-old boy is brought to the emergency begin CPR. Another colleague activates the
department for evaluation of poor feeding, emergency response system, brings the emergency
irritability, and sweating. The child is lethargic but equipment, and places the child on a cardiac
monitor/defibrillator, which reveals the rhythm retrieving the resuscitation equipment, including a
shown here. You attempt defibrillation at 2 J/kg and defibrillator. After delivering 30 compressions,
give 2 minutes of CPR. The rhythm persists at the what would be your next action?
second rhythm check, at which point you attempt
defibrillation with 4 J/kg. A fourth colleague A. Use a bag-mask device to deliver 6 breaths per
arrives, starts an IV, and administers 1 dose of minute
epinephrine 0.01 mg/kg. If ventricular fibrillation or B. Check for a carotid pulse for no more than 10
pulseless ventricular tachycardia persists after 2 seconds
minutes of CPR, you will administer another shock. C. Open the airway with a head tilt‒chin lift
Which drug and dose should be administered next? maneuver and give 2 breaths (Correct)
D. Assess for lack of breathing or only gasping for
10 seconds

You are caring for a 6-year-old patient who is

A. Atropine 0.02 mg/kg IV
receiving positive-pressure mechanical ventilation
B. Lidocaine 1 mg/kg IV (Correct)
via an endotracheal tube. The child begins to move
C. Adenosine 0.1 mg/kg IV
his head and suddenly becomes cyanotic, and his
D. Epinephrine 0.1 mg/kg IV
heart rate decreases. His SpO2 is 65%. You remove
the child from the mechanical ventilator and begin
to provide manual ventilation with a bag via the
endotracheal tube. During manual ventilation with
Why is allowing complete chest recoil important
100% oxygen, the child’s color and heart rate
when performing high-quality CPR?
improve slightly and his blood pressure remains
adequate. Breath sounds and chest expansion are
A. The heart will refill with blood between present and adequate on the right side and are
compressions (Correct) present but consistently diminished on the left side.
B. It will reduce the risk of rib fractures The trachea is not deviated, and the neck veins are
C. The rate of chest compressions will increase not distended. A suction catheter passes easily
D. There will be a reduction in rescuer fatigue beyond the tip of the endotracheal tube. Which of
the following is the most likely cause of this child’s
acute deterioration?
You are assisting in the elective intubation of an A. Tension pneumothorax on the right side
average-sized 4-year-old child with respiratory B. Equipment failure
failure. A colleague is retrieving the color-coded C. Tracheal tube displacement into the right
length-based tape from the resuscitation cart. Which main bronchus (Correct)
of the following is likely to be the estimated size of D. Tracheal tube obstruction
the uncuffed endotracheal tube for this child?

A. 4-mm tube
B. 6-mm tube
C. 5-mm tube (Correct)
D. 3-mm tube

You are alone and witness a child suddenly

collapse. There is no suspected head or neck injury.
A colleague responded to your shout for help and is
activating the emergency response system and is