Pediatric Advanced Life Support Provider Exam

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Welcome to the Pediatric Advanced Life Support written exam!
The AHA has authorized RCHS to store and administer this exam due to the COVID-19 pandemic. You must score an 84% or greater to pass. You may retake the exam if you do not pass. Per American Heart Association Guidelines, you may use your Provider Manual to assist you during this exam. Please do not close this window until exam is complete.

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The exam you are about to take is copyrighted content from the American Heart Association. RC Health Services has obtained special permission to administer the exam this way through the "Interim Guidance: Virtual Training Options during COVID-19 Outbreak" memo from the American Heart Association Training Network. This exam is to be kept confidential. You may not share the content, answers, questions, or any other material to anyone through any means.
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1. In which of the following situations may IO access be used?*
- An extremity with signs of a crush injury
- An extremity with slow a capillary refill time
- An extremity with a previous unsuccessful IO attempt
- An extremity with signs of infection

2. A 2-week-old infant is being evaluated for irritability and poor feeding. His blood pressure is 55/40 mm Hg, and capillary refill time is 5 seconds. Which statement best describes your assessment of this infant’s blood pressure?*
- It represents compensated shock.
- It is normal.
- It is hypertensive.
- It is hypotensive.

3. You are caring for patients in the emergency department. Which 2-year-old child requires immediate intervention?*
- A child with an SpO2 of 95% on room air
- A child with a systolic blood pressure of 92 mm Hg
- A child with a temperature of 37.4°C (99.3°F)
- A child who is grunting

4. A 3-year-old child is having difficulty breathing. Which finding would most likely lead you to suspect an upper airway obstruction in this child?*
- Increased inspiratory effort with retractions
- Expiratory breath sounds
- Normal inspiratory sounds
- Decreased expiratory effort

5. A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take?*
- Do it anyway
- Ask for a new task or role
- Seek expert consultation
- Refuse to perform the task

6. You are the team leader during a pediatric resuscitation attempt. Which action is an element of high- quality CPR?*
- Providing a compression rate of 80 to 100/min
- Providing a compression depth of one fourth the depth of the chest
- Allowing complete chest wall recoil after each compression
- Performing pulse checks every minute

7. An 8-year-old child is brought to the emergency department by his mother for difficulty breathing. He has a history of asthma and nut allergies. His mother tells you that he recently ate a cookie at a family picnic. Which condition is most likely to be present in this child?*
- Disordered control of breathing
- Lung tissue disease
- Hypovolemic shock
- Upper airway obstruction

8. An 8-year-old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. Which finding would suggest that immediate intervention is needed?*
- Temperature of 38.1°C (100.5°F)
- Decreased level of consciousness
- Systolic blood pressure of 106 mm Hg
- Warm, moist skin

9. A 6-year-old child is found unresponsive, not breathing, and without a pulse. One healthcare worker leaves to activate the emergency response system and get the resuscitation equipment. You and another healthcare provider immediately begin performing CPR. Which compression-to-ventilation ratio do you use?*
- 30:1
- 15:1
- 15:2
- 30:2

10. A 3-year-old child is in cardiac arrest, and high-quality CPR is in progress. You are the Team Leader. The first rhythm check reveals the rhythm shown here. Defibrillation is attempted with a shock dose of 2 J/kg. After shock administration, what should you say to your team members?*

Defibrillation is attempted with a shock dose of 2 J/kg. After administration of the shock, what should you say to your team members?
- “Check for a pulse.”
- “Let’s check the rhythm.”
- “Resume compressions.”
- “Give epinephrine 0.01 mg/kg.”

Use this scenario to answer the next 2 questions:
You are caring for a 5-year-old boy with a 4-day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His oxygen saturation is 72% on room air and 89% when on a nonrebreathing oxygen mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles.
11. What assessment finding is consistent with respiratory failure in this child?*
- Cough
- Respiratory rate
- Oxygen saturation
- Fever
12. Which medication would be most appropriate?*
- An antibiotic
- A vasopressor
- A corticosteroid
- A bronchodilator

13. During a resuscitation attempt, the team leader asks you to administer an initial dose of epinephrine at 0.1 mg/kg to be given IO. How should you respond?*
- “OK. I will administer epinephrine 0.1 mg/kg.”
- “I can’t administer the drug at the dose you ordered.”
- “OK, but I will administer epinephrine 0.01 mg/kg.”
- “I think the correct dose is 0.01 mg/kg. Should I give that dose instead?”

14. A 6-month-old infant is unresponsive. You begin checking for breathing at the same time you check for the infant’s pulse. What is the maximum time you should spend when trying to simultaneously check for breathing and palpate the infant’s pulse before starting CPR?*
- 30 seconds
- 60 seconds
- 10 seconds
- 15 seconds

15. A 10-year-old child is being evaluated for a headache. Which is a normal finding for this 10-year-old child?*
- Blood pressure of 60/50 mm Hg
- Heart rate of 88/min
- Respiratory rate of 8/min
- Temperature of 39.6°C (103.2°F)

16. A 6-year-old boy is being evaluated for difficulty breathing. Which finding would suggest this child has respiratory distress?*
- Audible inspiratory stridor
- Oxygen saturation of 95%
- Respiratory rate of 8/min
- Decreased respiratory effort

Use this scenario to answer the next 2 questions:
A 4-year-old child in cardiac arrest is brought to the emergency department by ambulance. High-quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg.
17. What dosage range should you use for initial defibrillation?*
- 0.5 to 2 J/kg
- 6 to 8 J/kg
- 2 to 4 J/kg
- 4 to 6 J/kg
18. As the Team Leader, how many joules do you tell your team member to use to perform initial defibrillation?*
- 10 J
- 100 J
- 40 J
- 140 J

19. You respond to an infant who is unresponsive, is not breathing, and does not have a pulse. You do not have a mobile device, and you shout for nearby help but no one arrives. What action should you take next?*
- Begin CPR for 1 minute before leaving to activate the emergency response system
- Activate the emergency response system after giving CPR for 5 minutes
- Begin CPR for 2 minutes before leaving to activate the emergency response system
- Activate the emergency response system after giving CPR for 10 minutes

20. What ratio for compressions to breaths should be used for 1-rescuer infant CPR?*
- Give 30 compressions to 2 breaths
- Give 5 compressions to 1 breath
- Give 20 compressions to 2 breaths
- Give 15 compressions to 2 breaths

21. A 3-year-old boy is brought to the emergency department by his mother. He is lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk capillary refill. Which immediate life-threatening condition could this child’s condition most likely progress to if left untreated?*
- Respiratory failure
- Respiratory distress
- Hypovolemic shock
- Cardiogenic shock

22. You are evaluating a 10-year-old child who is febrile and tachycardic. The child’s capillary refill time is 5 seconds. Which parameter will determine if the child is in compensated shock?*
- Respiratory effort
- Chest movement
- Respiratory rate
- Blood pressure

23. An 18-month old has had vomiting and diarrhea for the past 2 days; the mother brings him to the emergency department because he is becoming more lethargic. What diagnostic test should you order first?*
- Blood glucose
- Arterial blood gases
- Serum potassium
- 12-lead ECG

27. What abnormality helps identify children with acute respiratory distress caused by lung tissue disease?*
- Crackles
- Prolonged inspiratory time
- Stridor
- Wheezes

Use this scenario to answer the next 2 questions:
You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant’s SpO2 is 94%. On auscultation, the lungs are clear bilaterally.
28. What is the most likely cause of this infant’s respiratory distress?*
- Lower airway obstruction
- Disordered control of breathing
- Upper airway obstruction
- Parenchymal lung disease
29. What medication should you administer first?*
- Epinephrine, nebulized
- Albuterol, nebulized
- Ceftriaxone, IV
- Dexamethasone, PO/IM

30. What condition is characterized by a prolonged expiratory phase and wheezing?*
- Hypovolemic shock
- Disordered control of breathing
- Lower airway obstruction
- Upper airway obstruction

31. A 5-year-old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. You are using the primary assessment to evaluate the child. When assessing the child’s neurologic status, you note that he has spontaneous eye opening, is fully oriented, and is able to follow commands. How would you document this child’s AVPU (Alert, Voice, Painful, Unresponsive) Pediatric Response Scale finding?*
- Painful
- Alert
- Voice
- Unresponsive

32. A 4-year-old child is brought to the emergency department for seizures. The seizures stopped a few minutes ago, but the child continues to have slow and irregular respirations. Which condition is most consistent with your assessment?*
- Lower airway obstruction
- Upper airway obstruction
- Lung tissue disease
- Disordered control of breathing

33. You are evaluating a 1-year-old child for respiratory distress. His heart rate is 168/min, and his respiratory rate has decreased from 65/min to 30/min. He now appears more lethargic and continues to have severe subcostal retractions. On the basis of your assessment, which is the most likely reason for this change in the child’s condition?*
- The child’s status is improving.
- The child has signs of probable respiratory failure.
- The child has a neurologic problem rather than a respiratory problem.
- The child likely has an arrhythmia rather than a respiratory problem.

34. A 7-year-old child in cardiac arrest is brought to the emergency department by ambulance. No palpable pulses are detected. The child’s ECG is shown here. How would you characterize this child’s rhythm?*

How would you characterize this child’s rhythm?
- Pulseless electrical activity
- Ventricular tachycardia
- Ventricular escape rhythm
- Sinus bradycardia

Use this scenario to answer the next 2 questions:
After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen saturation is 94% on 2 L of nasal cannula oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally.
35. What action should you take next?*
- Perform endotracheal intubation
- Administer naloxone
- Reposition the patient and insert an oral airway
- Increase nasal cannula flow
36. If the patient continues to deteriorate after your initial intervention, which next step is most appropriate?*
- Perform nasal suctioning
- Increase nasal cannula flow
- Administer nebulized epinephrine
- Provide bag-mask ventilation

37. You are performing the airway component of the primary assessment. What finding would lead you to conclude that the child has an upper airway obstruction?*
- Wheezing
- Inspiratory stridor
- Subcostal retractions
- Dry, nonproductive cough

38. In management of post–cardiac arrest patients, extra care should be taken to avoid reperfusion injury. What should the ideal oxygen saturation range most likely be?*
- 94% to 100%
- 94% to 99%
- 98% to 100%
- 90% to 98%

43. A 10-year-old child is brought to the emergency department for fever and cough. You obtain an oxygen saturation on the child. Which oxygen saturation would indicate that immediate intervention is needed?*
- 88% on 4 L/min of nasal oxygen
- 95% on room air
- 96% on room air
- 97% on 50% oxygen

Use this scenario to answer the next 2 questions:
An unresponsive 14-year-old girl is pale and cool to the touch. Her blood pressure is 70/45 mm Hg, heart rate is 190/min, and respiratory rate is 12/min. The SpO2 is not detectable. Capillary refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here.
44. What rhythm is seen on the patient’s cardiac monitor?*
- Sinus tachycardia
- Supraventricular tachycardia
- Ventricular tachycardia
- Normal sinus rhythm
45. If pharmacological interventions are unavailable or delayed, what intervention is indicated?*
- High-quality CPR
- Defibrillation
- 20 mL/kg bolus isotonic crystalloid
- Synchronized cardioversion

46. 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 that the child is difficult to arouse and her skin color is pale. The child’s heart rate is 160/min, respiratory rate is 38/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 39.4°C (103°F). IV access has been established, and blood cultures have been obtained. What is the most appropriate intervention?*
- Administer 5 to 10 mL/kg of packed red blood cells
- Obtain a chest x-ray
- Administer 20 to 30 mL/kg of isotonic crystalloid over 30 minutes
- Administer 10 to 20 mL/kg of isotonic crystalloid over 5 to 10 minutes

Use this scenario to answer the next 2 questions:
An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and SpO2 is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here.
47. What rhythm is most consistent with this patient’s presentation and ECG findings?*
- Normal sinus rhythm
- Pulseless electrical activity
- Sinus bradycardia
- Second-degree heart block (Mobitz type II)
48. Which action do you take next?*
- Perform endotracheal intubation
- Administer epinephrine IV
- Perform transcutaneous pacing
- Provide bag-mask ventilation with 100% oxygen

49. A 3-year-old child is brought to the emergency department by his mother. Which is a normal finding for a 3-year-old child?*
- Blood pressure of 55/30 mm Hg
- Heart rate of 220/min
- Respiratory rate of 24/min
- Oxygen saturation of 90%

50. A 6-month-old infant is being evaluated for bradycardia. Which is the most likely cause of bradycardia?*
- Hypovolemia
- Drug toxicity
- Hypoxia
- Hyperglycemia
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Pediatric Advanced Life Support Provider Exam

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