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PALS Exam Prep: Advanced Assessment & Management

PALS Test 02: Respiratory & Cardiac Focus

This exam reviews Distress vs. Failure, Rhythm Identification, and Emergency Drug Selection.

Respiratory Failure: Look for bradycardia and cyanosis. These are late signs that mean the body can no longer keep up.
Epinephrine: This is the first drug you should give for both asystole and slow heart rates that cause distress.
Suctioning: Never suction a child's airway for more than 10 seconds. Doing it too long can drop their oxygen levels.
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Q:1Clinical signs of respiratory distress may include all of the following EXCEPT:
Warm, pink skin is a sign of adequate perfusion. Respiratory distress is characterized by signs of increased work of breathing, such as rapid rate, grunting, and altered mental status.
Q:2Late and ominous signs of respiratory failure include all of the following EXCEPT:
Rapid respiratory rate is a sign of respiratory distress, not failure. Late signs of failure include cyanosis, bradycardia, and a declining level of consciousness.
Q:3The 8-year-old child you are treating has a palpable pulse and a heart rate of 200. The rhythm on the monitor is rapid with narrow QRS complexes and no discernible P waves. The rhythm is most likely:
A very fast rate with narrow QRS and absent P waves is classic for supraventricular tachycardia (SVT). Sinus tachycardia has P waves and is rarely over 180 bpm in an 8-year-old.
Q:4You are doing CPR on a child with symptomatic bradycardia. An intravenous line is in place. What is the first drug of choice for this patient?
Epinephrine is the first-line drug for symptomatic bradycardia, especially when associated with cardiopulmonary compromise. Atropine is a second-line drug for this condition.
Q:5High-quality CPR for young children includes all of the following EXCEPT:
On an older child, two hands are often needed to achieve the correct compression depth. Using one hand is appropriate for a small child or infant.
Q:6You are the team leader on a team resuscitating a child without a pulse or respirations. The monitor shows a disorganized rhythm with chaotic electrical activity. This rhythm is most likely:
Ventricular fibrillation (VF) is a chaotic, disorganized rhythm that lacks a pulse. Asystole is a flatline, and PEA has electrical activity without a pulse.
Q:7The goal of the PALS team in the treatment of shock is to:
The overall goal is to improve oxygen delivery to vital organs, prevent permanent organ injury, and stop the progression to cardiac arrest.
Q:8When evaluating a child's bradycardia, it is important to consider the child's:
A child's baseline rate, activity level, and overall clinical condition are all critical factors in determining the significance of a slow heart rate.
Q:9For asystole, the team should do CPR. The drug of choice for asystole is:
Epinephrine is the primary drug for asystole and pulseless electrical activity (PEA). Amiodarone and Lidocaine are antiarrhythmics used for shockable rhythms.
Q:10The most common initial rhythms seen in pediatric cardiac arrest are:
Unlike adults, children most often experience cardiac arrest due to respiratory failure or shock, which typically leads to asystole or PEA rather than ventricular fibrillation (VF) or VT.
Q:11When administering a fluid bolus to a patient in cardiogenic shock, the dose should be:
In cardiogenic shock, fluids must be given cautiously to avoid pulmonary edema. The recommended approach is small, titrated fluid boluses of 5-10 mL/kg, with frequent reassessment of the patient's status.
Q:12An accumulation of pressurized air in the pleural space, leading to lung collapse, is described as a:
Tension pneumothorax is a life-threatening condition where air builds up in the pleural space, compressing the lung and shifting the mediastinum, impairing cardiac output.
Q:13In a case of sinus tachycardia, the heart rate is:
Sinus tachycardia is a rhythm originating from the sinus node with a heart rate faster than normal for the child’s age. It is a compensatory mechanism.
Q:14Is ventricular tachycardia a common cause of cardiac arrest in children?
Ventricular tachycardia is a rare cause of cardiac arrest in children. The most common rhythms in pediatric cardiac arrest are asystole and pulseless electrical activity.
Q:15What is typically the first sign of a child's or infant's defensive response to shock?
Tachycardia is often the earliest compensatory response to inadequate cardiac output and poor tissue perfusion in pediatric patients experiencing shock.
Q:16Each attempt for catheter insertion and suctioning of an infant's airway should not surpass:
Suctioning for more than 10 seconds can cause hypoxia and bradycardia. Each attempt should be limited to 5-10 seconds with reoxygenation in between.
Q:17The first warning sign of respiratory dysfunction is typically an:
The body's first compensatory mechanism to poor oxygenation is an increase in the respiratory rate (tachypnea) to improve gas exchange.
Q:18When providing blow-by oxygen to a stable newborn who needs supplemental oxygen, what is the standard recommended flow rate?
A flow rate of 5 L/min is the standard for blow-by oxygen. It provides enough oxygen to the baby without being too forceful or wasting gas.
Q:19Croup is most common in what age group?
Croup, or laryngotracheobronchitis, is most common in young children between 6 months and 3 years of age, characterized by a distinctive "barking" cough.
Q:20What is the recommended first energy level for defibrillation in children?
The recommended initial energy dose for defibrillation in children with a shockable rhythm is 2 J/kg. Subsequent doses should be increased to 4 J/kg.

Test 02 Study Summary

1. Shock Response A fast heart rate is usually the very first sign that a child's body is trying to fight off shock.
2. SVT vs. Sinus Tachycardia SVT has a very fast, narrow rhythm without visible P waves. Sinus tachycardia usually stays under 180 beats per minute in older kids.
3. Cardiogenic Shock Fluids When the heart is weak, give very small fluid amounts (5 to 10 mL per kg) to prevent fluid buildup in the lungs.

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