ECC

American Heart Association

Pediatric Advanced
Life Support
Written Precourse
Self-Assessment
Questions and Answer Key
for Students

January 2012

2012 American Heart Association

PALS Written 2011 Precourse Self-Assessment

ECG Rhythm Identification
The PALS ECG Rhythm Identification self-assessment test is designed to test your ability to
identify rhythms you may encounter as a PALS provider. The rhythms in the list below are the
core PALS rhythms that you should be able to identify during the PALS Provider Course
teaching and testing stations. If you have difficulty with pediatric ECG rhythm identification, it is
strongly suggested that you spend additional time reviewing basic pediatric arrhythmias before
the PALS Provider Course. Sources of information about pediatric ECG rhythm identification
include the PALS Provider Manual and Learn: Rhythm Pediatric, available on OnlineAHA.org.
This self-assessment test is composed of 13 multiple-choice questions. For all questions, select
the single best answer. An answer may be used more than once. There are 3 self-assessment
tests: ECG Rhythm Identification, Pharmacology, and Practical Application.
Pediatric Rhythms:
A.
B.
C.
D.
E.
F.
G.
H.

Normal sinus rhythm

Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia; presumed ventricular tachycardia (monomorphic)
Ventricular fibrillation (VF)
Asystole
Pulseless electrical activity (PEA)

Rhythms 1 to 8: Core PALS Rhythms (select single best answer from rhythms A to H)

Rhythm 1 (clinical clue: heart rate 214/min)

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

Rhythm 2 (clinical clues: heart rate 44/min; no detectable pulses)

Rhythm 3 (clinical clues: age 8 years; heart rate 50/min)

Rhythm 4 (clinical clue: no detectable pulses)

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

Rhythm 5 (clinical clue: no consistent heart rate detected; no detectable pulses)

Rhythm 6 (clinical clues: age 3 years; heart rate 188/min)

Rhythm 7 (clinical clue: heart rate 300/min)

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

Rhythm 8 (clinical clues: age 8 years; heart rate 75/min)

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

PALS Written 2011 Precourse Self-Assessment

Pharmacology
The PALS Pharmacology self-assessment test is designed to test your knowledge of core drugs
that will be used in the PALS Provider Course.
If this self-assessment shows that your knowledge of the pharmacology and indications for
these drugs is deficient, it is strongly suggested that you spend additional time reviewing basic
resuscitation drug pharmacology before taking a PALS course. Sources of PALS drug
information include the PALS Provider Manual and the 2010 Handbook of Emergency
Cardiovascular Care for Healthcare Providers (ECC Handbook).
The Pharmacology self-assessment consists of 11 multiple-choice questions. Select the single
best answer. There are 3 self-assessment tests: ECG Rhythm Identification, Pharmacology, and
Practical Application.

1.

You are called to help resuscitate an infant with severe symptomatic bradycardia
associated with respiratory distress. The bradycardia persists despite
establishment of an effective airway, oxygenation, and ventilation. There is no heart
block present. Which of the following is the first drug you should administer?
A.
B.
C.
D.

2.

Atropine
Dopamine
Adenosine
Epinephrine

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 improves coronary artery perfusion pressure and stimulates spontaneous
contractions when asystole is present
C. Epinephrine is contraindicated in ventricular fibrillation because it increases myocardial
irritability
D. Epinephrine decreases myocardial oxygen consumption

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

3.

Initial impression of a 2-year-old female reveals her to be alert with mild breathing
difficulty during inspiration and pale skin color. On primary assessment, she makes
high-pitched inspiratory sounds (mild stridor) when agitated; otherwise her
breathing is quiet. Her SpO2 is 92% in room air, and she has mild inspiratory
intercostal retractions. Lung auscultation reveals transmitted upper airway sounds
with adequate distal breath sounds bilaterally. Which of the following is the most
appropriate initial therapeutic intervention for this child?
A.
B.
C.
D.

4.

Which of the following most reliably delivers a high (90% or greater) concentration
of inspired oxygen in a toddler or older child?
A.
B.
C.
D.

5.

Perform immediate endotracheal intubation

Administer an IV dose of dexamethasone
Nebulize 2.5 mg of albuterol
Administer humidified supplementary oxygen as tolerated and continue evaluation

Nasal cannula with 4 L/min oxygen flow

Simple oxygen mask with 15 L/min oxygen flow
Nonrebreathing face mask with 12 L/min oxygen flow
Face tent with 15 L/min oxygen flow

Which of the following statements about endotracheal drug administration is true?

A. Endotracheal drug administration is the preferred route of drug administration during
resuscitation because it results in predictable drug levels and drug effects
B. Endotracheal doses of resuscitation drugs in children have been well established and
are supported by evidence from clinical trials
C. Intravenous drug doses for resuscitation drugs should be used whether you give the
drugs by the IV, the intraosseous (IO), or the endotracheal route
D. Endotracheal drug administration is the least desirable route of administration because
this route results in unpredictable drug levels and effects

6.

Which of the following statements most accurately reflects the PALS

recommendations for the use of magnesium sulfate in the treatment of cardiac
arrest?
A. Magnesium sulfate is indicated for VF refractory to repeated shocks and amiodarone
or lidocaine
B. Routine use of magnesium sulfate is indicated for shock-refractory monomorphic VT
C. Magnesium sulfate is indicated for torsades de pointes and VF/pulseless VT
associated with suspected hypomagnesemia
D. Magnesium sulfate is contraindicated in VT associated with an abnormal QT interval
during the preceding sinus rhythm

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

7.

You enter a room to perform an initial impression of a previously stable 10-year-old

male and find him unresponsive and apneic. A code is called and bag-mask
ventilation is performed with 100% oxygen. The cardiac monitor shows a widecomplex tachycardia. The boy has no detectable pulses, so compressions and
ventilations are provided. As soon as the defibrillator arrives you deliver an
unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of CPR
reveals VF. You then deliver a shock of 4 J/kg and resume immediate CPR
beginning with compressions. A team member had established IO access, so you
give a dose of epinephrine, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO, when
CPR is restarted after the second shock. At the next rhythm check, persistent VF is
present. You administer a 4 J/kg shock and resume CPR. Based on the PALS
Pediatric Cardiac Arrest Algorithm, what are the next drug and dose to administer
when CPR is restarted?
A.
B.
C.
D.

8.

Parents of a 1-year-old female phoned the Emergency Response System when they
picked up their daughter from the babysitter. Paramedics perform an initial
impression revealing an obtunded infant with irregular breathing, bruises over the
abdomen, abdominal distention, and cyanosis. Assisted bag-mask ventilation with
100% oxygen is initiated. On primary assessment heart rate is 36/min, peripheral
pulses cannot be palpated, and central pulses are barely palpable. Cardiac monitor
shows sinus bradycardia. Two-rescuer CPR is started with a 15:2 compression-toventilation ratio. In the emergency department the infant is intubated and ventilated
with 100% oxygen, and IV access is established. The heart rate is now up to 150/min
but there are weak central pulses and no distal pulses. Systolic blood pressure is
74 mm Hg. Of the following, which would be most useful in management of this
infant?
A.
B.
C.
D.

9.

Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IO

Atropine 0.02 mg/kg IO
Amiodarone 5 mg/kg IO
Magnesium sulfate 25 to 50 mg/kg IO

Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV

Rapid bolus of 20 mL/kg of isotonic fluid
Atropine 0.02 mg/kg IV
Synchronized cardioversion

Which of the following statements about calcium is true?

A. Routine administration of calcium is not indicated during cardiac arrest
B. The recommended dose is 1 to 2 mg/kg of calcium chloride
C. Calcium chloride 10% has the same bioavailability of elemental calcium as calcium
gluconate in critically ill children
D. Indications for administration of calcium include hypercalcemia, hypokalemia, and
hypomagnesemia

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

10.

An infant with a history of vomiting and diarrhea arrives by ambulance. During your
primary assessment the infant responds only to painful stimulation. The upper
airway is patent, the respiratory rate is 40/min with good bilateral breath sounds,
and 100% oxygen is being administered. The infant has cool extremities, weak
pulses, and a capillary refill time of more than 5 seconds. The infants blood
pressure is 85/65 mm Hg, and glucose concentration (measured by bedside test) is
30 mg/dL (1.65 mmol/L). Which of the following is the most appropriate treatment to
provide for this infant?
A. Establish IV or IO access and administer 20 mL/kg D50.45% sodium chloride bolus
over 15 minutes
B. Establish IV or IO access and administer 20 mL/kg Lactated Ringer's solution over 60
minutes
C. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg 1:1,000 via the
endotracheal tube
D. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over 10 to 20
minutes, and simultaneously administer D25W 2 to 4 mL/kg in a separate infusion

11.

Initial impression of a 9-year-old male with increased work of breathing reveals the
boy to be agitated and leaning forward on the bed with obvious respiratory distress.
You administer 100% oxygen by nonrebreathing mask. 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 retractions, and decreased air
movement with prolonged expiratory time and wheezing. His SpO2 is 92% (on
nonrebreathing mask). What is the next medical therapy to provide to this patient?
A.
B.
C.
D

Adenosine 0.1 mg/kg

Amiodarone 5 mg/kg IV/IO
Albuterol by nebulization
Procainamide 15 mg/kg IV/IO

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

PALS Written 2011 Precourse Self-Assessment

Practical Application
The PALS Practical Application self-assessment test is designed to test your knowledge of
appropriate treatment selections based on pediatric assessment information provided in case
scenarios. This exercise specifically evaluates your ability to identify core PALS rhythms (if
presented), knowledge of core drugs, knowledge of the PALS flowcharts and algorithms for
respiratory distress/respiratory failure and shock, and knowledge of the PALS algorithms for
rhythm disturbances.
If you have difficulty with the practical application questions, it is strongly suggested that you
review the core PALS rhythms, core drug information, the PALS flowcharts and algorithms for
respiratory distress/failure and shock, and the PALS rhythm disturbances algorithms. Sources of
this information include the PALS Provider Manual and the 2010 Handbook of Emergency
Cardiovascular Care for Healthcare Providers (ECC Handbook).
This self-assessment consists of 19 multiple-choice questions. Select the single best answer.
There are 3 self-assessment tests: ECG Rhythm Identification, Pharmacology, and Practical
Application.

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

10

1.

An 8-month-old male is brought to the emergency department (ED) for evaluation

of severe diarrhea and dehydration. In the ED the child becomes unresponsive
and pulseless. You shout for help and start CPR at a compression rate of at least
100/min and a compression-to-ventilation ratio of 30:2. Another provider arrives,
at which point you switch to 2-rescuer CPR with a compression-to-ventilation ratio
of 15:2. The cardiac monitor shows the following rhythm:

The infant is intubated and ventilated with 100% oxygen. An IO line is rapidly
established and a dose of epinephrine is given. Of the following choices for
management, which would be most appropriate to give next?
A.
B.
C.
D.

2.

Defibrillation 2 J/kg
Normal saline 20 mL/kg IV rapidly
High-dose epinephrine, 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution), IO
Amiodarone 5 mg/kg IO

Initial impression of a 10-month-old male in the emergency department reveals a

lethargic pale infant with slow respirations. You begin assisted ventilation with a
bag-mask device using 100% oxygen. On primary assessment heart rate is 38/min,
central pulses are weak but distal pulses cannot be palpated, blood pressure is
60/40 mm Hg, and capillary refill is 4 seconds. During your assessment a
colleague places the child on a cardiac monitor and you observe the following
rhythm:

The rhythm remains unchanged despite ventilation with 100% oxygen. What are
your next management steps?

PALS Written 2011 Precourse Self-Assessment

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11

A.
B.
C.
D.

3.

Administer adenosine 0.1 mg/kg rapid IV/IO and prepare for synchronized
cardioversion
Start chest compressions and give epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000
dilution) IV/IO
Start chest compressions and give epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000
dilution) IV/IO
Administer 20 mL/kg isotonic crystalloid and epinephrine 0.01 mg/kg (0.1 mL/kg of
1:10,000 dilution) IV/IO

A 3-year-old unresponsive, apneic child is brought to the emergency department.

EMS personnel report that the child became unresponsive as they arrived at the
hospital. The child is receiving CPR, including bag-mask ventilation with 100%
oxygen and chest compressions at a rate of at least 100/min. Compressions and
ventilations are being coordinated at a ratio of 15:2. You confirm that apnea is
present and that ventilation is producing bilateral breath sounds and chest
expansion while a colleague confirms absent pulses. Cardiac monitor shows the
following rhythm:

A biphasic manual defibrillator is present. You quickly use the crown-heel length of
the child on a length-based, color-coded resuscitation tape to estimate the
approximate weight as 15 kg. Which of the following therapies is most appropriate
for this child at this time?
A.
B.
C.
D.

Establish IV/IO access and administer amiodarone 5 mg/kg IV/IO

Establish IV/IO access and administer lidocaine 1 mg/kg IV/IO
Attempt defibrillation at 30 J, then resume CPR beginning with compressions
Establish IV/IO access and administer epinephrine 0.01 mg/kg (0.1 mL/kg of
1:10,000 dilution) IV/IO

PALS Written 2011 Precourse Self-Assessment

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4.

Initial impression of a 10-year-old male shows him to be unresponsive. You shout

for help and check for breathing or only gasping. After finding that he is
pulseless, you begin cycles of compressions and ventilations with a compression
rate of at least 100/min and compression-to-ventilation ratio of 30:2. A colleague
arrives and places the child on a cardiac monitor, revealing the following rhythm:

The two of you attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The
rhythm persists at the second rhythm check, at which point you attempt
defibrillation using 4 J/kg. A third colleague establishes IO access and
administers one dose of epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution)
during the compressions following the second shock. If VF or pulseless VT
persists after 2 minutes of CPR, what is the next drug/dose to administer?
A.
B.
C.
D.

Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IV

Adenosine 0.1 mg/kg IV
Amiodarone 5 mg/kg IV
Atropine 0.02 mg/kg IV

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5.

A 1-year-old male is brought to the emergency department for evaluation of poor

feeding, fussiness, and sweating. On initial impression he is lethargic but
arousable and has labored breathing and a dusky color. Primary assessment
reveals a respiratory rate of 68/min, heart rate 300/min that does not vary with
activity or sleep, blood pressure 70/45 mm Hg, weak brachial pulses and absent
radial pulses, capillary refill 6 seconds, SpO2 85% in room air, and good bilateral
breath sounds. You administer high-flow oxygen and place the child on a cardiac
monitor. You see the following rhythm with little beat-to-beat variability of the
heart rate:

Secondary assessment reveals no history of congenital heart disease. IV access

has been established. Which of the following therapies is most appropriate for
this infant?
A.
B.
C.
D.

6.

Make an appointment with a pediatric cardiologist for later in the week

Adenosine 0.1 mg/kg IV rapidly; if adenosine is not immediately available, perform
synchronized cardioversion
Perform immediate defibrillation without waiting for IV access
Establish IV access and administer a fluid bolus of 20 mL/kg isotonic crystalloid

A child becomes unresponsive in the emergency department and is not breathing.

You provide ventilation with 100% oxygen. You are uncertain if a faint pulse is
present with the following rhythm:

What is your next action?

PALS Written 2011 Precourse Self-Assessment
2012 American Heart Association

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A.
B.
C.
D.

7.

You are preparing to use a manual defibrillator and paddles in the pediatric
setting. When would it be most appropriate to use the smaller pediatric sized
paddles for shock delivery?
A.
B.
C.
D.

8.

To attempt synchronized cardioversion but not defibrillation

If the patient weighs less than approximately 25 kg or is less than 8 years of age
If the patient weighs less than approximately 10 kg or is less than 1 year of age
Whenever you can compress the victim's chest using only the heel of one hand

A 7-year-old boy is found unresponsive, apneic, and pulseless. CPR is ongoing.

The child is intubated and vascular access is established. The ECG monitor
reveals an organized rhythm, but a pulse check reveals no palpable pulses.
Effective ventilations and compressions are resumed, and an initial IV dose of
epinephrine is administered. Which of the following therapies should you perform
next?
A.
B.
C.
D.

9.

Start high-quality CPR beginning with chest compressions

Order transcutaneous pacing
Start an IV and give atropine 0.01 mg/kg IV
Start an IV and give epinephrine 0.01 mg/kg IV (0.1 mL/kg of 1:10,000 dilution)

Attempt to identify and treat reversible causes (using the H's and T's as a memory
aid)
Attempt defibrillation at 4 J/kg
Administer epinephrine 0.1 mg/kg IV (0.1 mL/kg of 1:1,000 dilution)
Administer synchronized cardioversion at 1 J/kg

You are evaluating an irritable 6-year-old girl with mottled color. On primary
assessment she is febrile (temperature 40C [104F]), and her extremities are cold
(despite a warm ambient temperature in the room) with capillary refill of 5
seconds. Distal pulses are absent and central pulses are weak. Heart rate is
180/min, respiratory rate is 45/min, and blood pressure is 98/56 mm Hg. Which of
the following most accurately describes the categorization of this child's
condition using the terminology taught in the PALS Provider Course?
A.
B.
C.
D.

Hypotensive shock associated with inadequate tissue perfusion

Hypotensive shock associated with inadequate tissue perfusion and significant
hypotension
Compensated shock requiring no intervention
Compensated shock associated with tachycardia and inadequate tissue perfusion

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2012 American Heart Association

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10.

An 8-year-old child was 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 nonrebreathing face mask.
Primary assessment reveals respiratory rate 60/min, heart rate 150/min, systolic
blood pressure 70 mm Hg, and SpO2 84% on supplementary oxygen. Breath
sounds are absent over the right chest, and the trachea is deviated to the left. He
has weak central pulses and absent distal pulses. Which of the following is the
most appropriate immediate intervention for this child?
A.
B.
C.
D.

11.

An 18-month-old child presents with a 1-week history of cough and runny nose.
You perform an initial impression, which reveals a toddler responsive only to
painful stimulation with slow respirations and diffuse cyanosis. You begin a
primary assessment and find that the childs respiratory rate has fallen from
65/min to 10/min, severe inspiratory intercostal retractions are present, heart rate
is 160/min, SpO2 is 65% in room air, and capillary refill is less than 2 seconds.
Which of the following is the most appropriate immediate treatment for this
toddler?
A.
B.
C.
D.

12.

Perform endotracheal intubation and call for a STAT chest x-ray

Provide bag-mask ventilation and call for a STAT chest x-ray
Establish IV access and administer a 20 mL/kg normal saline fluid bolus
Perform needle decompression of the right chest and assist ventilation with a bag
and mask if necessary

Establish vascular access and administer a 20 mL/kg bolus of isotonic crystalloid

Open the airway and provide positive-pressure ventilation using 100% oxygen and
a bag-mask device
Administer 100% oxygen by face mask, establish vascular access, and obtain a
STAT chest x-ray
Administer 100% oxygen by face mask, obtain an arterial blood gas, and establish
vascular access

You are supervising another healthcare provider who is inserting an intraosseous

(IO) needle into an infant's tibia. Which of the following signs should you tell the
provider is the best indication of successful insertion of a needle into the bone
marrow cavity?
A.
B.
C.
D.

Pulsatile blood flow will be present in the needle hub

Fluids can be administered freely without local soft tissue swelling
You are unable to aspirate any blood through the needle
Once inserted, the needle shaft of the needle moves easily in all directions within
the bone

PALS Written 2011 Precourse Self-Assessment

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13.

A pale and obtunded 3-year-old child with a history of diarrhea is brought to the
hospital. Primary assessment reveals 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 of the following is the most
appropriate immediate treatment for this child?
A.
B.
C.
D.

14.

You have just assisted with the elective endotracheal intubation of a child with
respiratory failure and a perfusing rhythm. Which of the following provides the
most reliable, prompt assessment of correct endotracheal tube placement in this
child?
A.
B.
C.
D.

15.

Obtain a chest x-ray

Begin a maintenance crystalloid infusion
Administer a bolus of 20 mL/kg isotonic crystalloid
Administer a dopamine infusion at 2 to 5 mcg/kg per minute

Absence of audible breath sounds over the abdomen during positive-pressure

ventilation
Auscultation of breath sounds over the lateral chest bilaterally plus presence of
mist in the endotracheal tube
Confirmation of appropriate oxygen and carbon dioxide tensions on arterial blood
gas analysis
Clinical assessment of adequate bilateral breath sounds and chest expansion plus
presence of exhaled CO2 in a colorimetric detection device after delivery of 6
positive-pressure ventilations

A 4-year-old male is in pulseless arrest in the pediatric intensive care unit. A code
is in progress. As the on-call physician you quickly review his chart and find that
his baseline corrected QT interval on a 12-lead ECG is prolonged. A glance at the
monitor shows recurrent episodes of the following rhythm:

The boy has received one dose of epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000
dilution) but continues to demonstrate the rhythm illustrated above. If this rhythm
persists at the next rhythm check, which medication would be most appropriate to
administer at this time?
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A.
B.
C.
D.

16.

You are participating in the elective intubation of a 4-year-old child with

respiratory failure. You must select the appropriate sized uncuffed endotracheal
tube. You do not have a color-coded, length-based tape to use to estimate correct
endotracheal tube size. Which of the following is the most appropriate estimated
size uncuffed endotracheal tube for an average 4-year-old?
A.
B.
C.
D.

17.

Adenosine 0.1 mg/kg IV

Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IV
Lidocaine 1 mg/kg IV
Magnesium sulfate 25 to 50 mg/kg IV

3-mm tube
4-mm tube
5-mm tube
6-mm tube

You are caring for a 3-year-old with vomiting and diarrhea. You have established
IV access. When you place an orogastric tube, the child begins gagging and
continues to gag after the tube is placed. The childs color has deteriorated;
pulses are palpable but faint and the child is now lethargic. The heart rate is
variable (range 44/min to 62/min). You begin bag-mask ventilation with 100%
oxygen. When the heart rate does not improve, you begin chest compressions.
The cardiac monitor shows

Which of the following would be the most appropriate therapy to consider next?
A.
B.
C.
D.

Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IV

Atropine 0.02 mg/kg IV
Attempt synchronized cardioversion at 0.5 J/kg
Cardiology consult for transcutaneous pacing

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18.

You are transporting a 6-year-old endotracheally intubated patient who is

receiving positive-pressure mechanical ventilation. The child begins to move his
head and suddenly becomes cyanotic and bradycardic. SpO2 is 65% with good
pulse signal. You remove the child from the mechanical ventilator circuit and
provide manual ventilation with a bag via the endotracheal 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 endotracheal tube. Which of
the following is the most likely cause of this child's acute deterioration?
A.
B.
C.
D.

19.

Tracheal tube displacement into the right main bronchus

Tracheal tube obstruction
Tension pneumothorax on the right side
Equipment failure

A 3-year-old boy presents with multiple system trauma. The child was an
unrestrained passenger in a motor vehicle crash. On primary assessment he is
unresponsive to voice or painful stimulation. His respiratory rate is <6/min, heart
rate is 170/min, systolic blood pressure is 60 mm Hg, capillary refill is 5 seconds,
and SpO2 is 75% in room air. Which of the following most accurately summarizes
the first actions you should take to support this child?
A.
B.

C.

D.

Provide 100% oxygen by simple mask, stabilize the cervical spine, establish
vascular access, and provide maintenance IV fluids
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
Establish immediate vascular access, administer 20 mL/kg isotonic crystalloid, and
reassess the patient; if the child's systemic perfusion does not improve, administer
10 to 20 mL/kg packed red blood cells
Open the airway (jaw-thrust technique) while stabilizing the cervical spine,
administer positive-pressure ventilation with 100% oxygen, and establish
immediate IV/IO access

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2012 American Heart Association

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PALS Written 2011 Precourse Self-Assessment

ECG Rhythm Identification Answer Sheet
Pediatric Rhythms (core PALS rhythms A to H)
A.
B.
C.
D.
E.
F.
G.
H.

Normal sinus rhythm

Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia; presumed ventricular tachycardia (monomorphic)
Ventricular fibrillation (VF)
Asystole
Pulseless electrical activity (PEA)

Question
1.
2.
3.
4.
5.
6.
7.
8.

A
A
A
A
A
A
A

B
B
B
B
B

B
B

Answer

D
D
E
D
E
D
E
D
E
D
E

E
D
E

C
C

C
C
C
C
C

F
F
F
F

F
F
F

G
G
G

G
G
G
G

H
H
H
H
H
H

Page in PALS
Provider Manual
125
146
114
145
146
122
122
241

Pharmacology Answer Sheet

Question
1.

Page in PALS
Provider Manual
119

2.

213-214

3.

51

4.

239

5.

151

6.

153

7.

161

8.

163

9.

153

10.

95

11.

53

Answer

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

20

Practical Application Answer Sheet

Question
1.

Page in PALS
Provider Manual
162

2.

119

3.

156-157

4.

161

5.

135-136

6.

161

7.

157

8.

162

9.

73

10.

105

11.

50

12.

110

13.

96-97

14.

239

15.

153

16.

111

17.

119

18.

176

19.

163

Answer

PALS Written 2011 Precourse Self-Assessment

2012 American Heart Association

21