I85PREP
⌘ K
AHA PALS Provider study materials
AHA PALS Provider study resources

AHA PALS Provider practice questions

One question at a time. Build your AHA PALS Provider understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Recognition and Management of Respiratory and Circulatory Emergencies

A 3-year-old with 2 days of cough now has grunting, retractions, and is increasingly sleepy with shallow breaths. Which finding most specifically indicates progression from respiratory distress to respiratory failure?

  1. Decreasing level of consciousness with shallow breathing Correct answer.
  2. Audible expiratory wheezing throughout both lung fields
  3. Nasal flaring accompanied by intercostal retractions
  4. Respiratory rate of 44 breaths per minute with mild retractions

Explanation

Respiratory distress is increased work of breathing with preserved ventilation and mentation, whereas respiratory failure means oxygenation or ventilation is inadequate. A falling level of consciousness with shallow breaths signals inadequate alveolar ventilation and impending apnea, which requires immediate assisted ventilation.

Question 2Recognition and Management of Respiratory and Circulatory Emergencies

A febrile 4-year-old has sudden inspiratory stridor, drooling, a muffled voice, and sits leaning forward. Which action is most appropriate?

  1. Place the child supine and apply cricoid pressure during bag-mask ventilation
  2. Allow the child to remain upright and prepare for controlled intubation Correct answer.
  3. Inspect the posterior pharynx with a tongue blade to identify the swollen epiglottis
  4. Obtain a lateral neck radiograph in the radiology suite before any airway intervention

Explanation

These findings suggest acute epiglottitis with critical upper airway obstruction; the priority is to keep the child calm in a position of comfort while assembling personnel and equipment for controlled airway management. Any maneuver that agitates the child can precipitate complete obstruction.

Question 3Recognition and Management of Respiratory and Circulatory Emergencies

Which agent is the first-line bronchodilator for a child treated in the emergency department for an acute asthma exacerbation?

  1. Intravenous magnesium sulfate
  2. Inhaled ipratropium bromide as monotherapy
  3. Inhaled albuterol Correct answer.
  4. Oral montelukast

Explanation

Inhaled short-acting beta-2 agonists such as albuterol relax bronchial smooth muscle and are the initial bronchodilator for acute asthma, delivered by nebulizer or metered-dose inhaler with a spacer. The other agents are either add-on therapy for severe exacerbations or chronic controllers.

Question 4Recognition and Management of Respiratory and Circulatory Emergencies

A 6-year-old with hypoxia and poor perfusion has a heart rate of 50/min and remains bradycardic after effective oxygenation and ventilation. What is the next intervention?

  1. Deliver synchronized cardioversion at 0.5 J/kg
  2. Give a 20 mL/kg isotonic fluid bolus
  3. Start chest compressions and give epinephrine Correct answer.
  4. Give atropine 0.5 mg IV and reassess in 2 minutes

Explanation

Symptomatic bradycardia in a child that persists despite oxygenation and ventilation is managed as cardiac arrest, with chest compressions and epinephrine. Atropine is reserved for bradycardia due to vagal stimulation or primary atrioventricular block.

Question 5Recognition and Management of Respiratory and Circulatory Emergencies

Which set of findings is most consistent with supraventricular tachycardia in an infant?

  1. Heart rate 190/min with wide QRS and a gradual onset over 20 minutes
  2. Heart rate 240/min with narrow QRS and absent P waves Correct answer.
  3. Heart rate 160/min with visible P waves and variable R-R intervals
  4. Heart rate 120/min with an irregularly irregular rhythm and normal QRS

Explanation

Infant SVT is a narrow-complex tachycardia, typically above 220/min, with abrupt onset, absent or abnormal P waves, and a fixed R-R interval. Sinus tachycardia generally has visible P waves, variability, and a rate that rarely exceeds 220/min in infants.

Question 6Recognition and Management of Respiratory and Circulatory Emergencies

Which findings best describe compensated shock in a child?

  1. Bradycardia with bounding pulses and warm extremities
  2. Tachycardia with delayed capillary refill and a normal blood pressure Correct answer.
  3. Normal heart rate with narrow pulse pressure and normal mentation
  4. Hypotension that persists after two 20 mL/kg isotonic fluid boluses

Explanation

In compensated shock, tachycardia and vasoconstriction maintain blood pressure while peripheral perfusion is already abnormal, producing delayed capillary refill, cool extremities, and altered mentation. Hypotension is a late finding in children and marks decompensated shock.

Question 7Recognition and Management of Respiratory and Circulatory Emergencies

A spontaneously breathing child needs the highest practical inspired oxygen concentration during resuscitation. Which device provides approximately 95% to 100% FiO2?

  1. A simple face mask at 6 L/min
  2. A nasal cannula at 2 L/min
  3. A Venturi mask delivering 28% oxygen
  4. A nonrebreather mask at 10 to 15 L/min Correct answer.

Explanation

A nonrebreather mask with a reservoir bag at 10 to 15 L/min delivers close to 100% oxygen to a spontaneously breathing patient. Nasal cannulas and simple or Venturi masks are lower-flow devices that deliver a lower, more variable inspired concentration.

Question 8Recognition and Management of Respiratory and Circulatory Emergencies

A toddler has a barking cough and inspiratory stridor at rest. Which treatment is indicated?

  1. Nebulized epinephrine plus a systemic corticosteroid Correct answer.
  2. Immediate intubation without any prior medication
  3. Inhaled albuterol every 20 minutes along with oral prednisone
  4. Oral antibiotics with close observation in the emergency department

Explanation

Stridor at rest marks moderate croup; nebulized epinephrine rapidly reduces subglottic edema and a corticosteroid such as dexamethasone decreases inflammation and the need for repeat treatments. Albuterol targets lower airway bronchospasm and antibiotics have no role in viral croup.

Question 9Recognition and Management of Respiratory and Circulatory Emergencies

A 2-year-old with fever, hypotension, and mottled extremities has no signs of heart failure. Which initial fluid resuscitation is most appropriate?

  1. Isotonic crystalloid 5 mL/kg over 30 minutes
  2. Isotonic crystalloid 20 mL/kg over 5 to 20 minutes, reassessing after each bolus Correct answer.
  3. Packed red blood cells 10 mL/kg over 30 minutes as the initial step
  4. No intravenous fluids until a central venous catheter is placed and its position is confirmed by radiograph

Explanation

Septic shock in a child without cardiac or renal dysfunction is treated with rapid isotonic crystalloid boluses of 20 mL/kg, with reassessment after each bolus for fluid overload or worsening perfusion. Smaller aliquots are used when cardiac dysfunction is suspected.

Question 10Recognition and Management of Respiratory and Circulatory Emergencies

A 7-year-old develops urticaria, wheezing, and hypotension minutes after an antibiotic infusion begins. Which is the correct dose and route of epinephrine?

  1. 0.1 mg/kg of 1:10,000 concentration given by slow intravenous push over 5 minutes
  2. 0.5 mg/kg of 1:1000 concentration IM in the gluteus
  3. 0.01 mg/kg of 1:1000 concentration IM in the anterolateral thigh, maximum 0.5 mg Correct answer.
  4. 0.01 mg/kg of 1:1000 concentration given subcutaneously in the deltoid muscle, repeated once

Explanation

Anaphylaxis is treated with intramuscular epinephrine 0.01 mg/kg of the 1:1000 concentration, up to 0.5 mg, injected into the vastus lateralis and repeated every 5 to 15 minutes as needed. Absorption from the thigh is faster and more reliable than subcutaneous dosing.

Question 11Recognition and Management of Respiratory and Circulatory Emergencies

What is the initial defibrillation energy dose for a child in ventricular fibrillation?

  1. 10 J/kg
  2. 4 J/kg
  3. 2 J/kg Correct answer.
  4. 0.5 J/kg

Explanation

The first shock for pediatric ventricular fibrillation or pulseless ventricular tachycardia is 2 J/kg. Subsequent shocks are increased to at least 4 J/kg, and a defibrillation mode rather than synchronized cardioversion is used for pulseless rhythms.

Question 12Recognition and Management of Respiratory and Circulatory Emergencies

Which epinephrine dose is given intravenously or intraosseously during pediatric cardiac arrest?

  1. 0.1 mg/kg of 1:10,000 concentration
  2. 1 mg of 1:10,000 concentration
  3. 0.01 mg/kg of 1:10,000 concentration Correct answer.
  4. 0.01 mg/kg of 1:1000 concentration

Explanation

The arrest dose is 0.01 mg/kg, which equals 0.1 mL/kg of the 1:10,000 (0.1 mg/mL) preparation, repeated every 3 to 5 minutes. The more concentrated 1:1000 solution is intended for intramuscular use and is not given as an intravenous bolus.

Question 13Recognition and Management of Respiratory and Circulatory Emergencies

During CPR on a child in cardiac arrest, the end-tidal CO2 reading remains at 6 mmHg. What does this most likely indicate?

  1. Chest compressions are not generating adequate forward flow Correct answer.
  2. The patient has achieved return of spontaneous circulation
  3. The child has developed a severe metabolic alkalosis
  4. The tracheal tube is correctly positioned and ventilation is adequate

Explanation

End-tidal CO2 during CPR reflects pulmonary blood flow, so persistently low values, generally under 10 mmHg, suggest inadequate chest compressions and should prompt improvement in compression quality. An abrupt rise toward normal values suggests return of spontaneous circulation.

Question 14Recognition and Management of Respiratory and Circulatory Emergencies

A 5-month-old with bronchiolitis has moderate distress and an oxygen saturation of 92% on room air. Which management approach is best supported?

  1. Supportive care with suctioning, oxygen as needed, and hydration Correct answer.
  2. Routine nebulized albuterol with a course of systemic corticosteroids
  3. Chest physiotherapy every 4 hours until wheezing resolves
  4. Prophylactic broad-spectrum antibiotics to prevent secondary pneumonia

Explanation

Bronchiolitis is usually viral and is managed with supportive care: airway clearance, supplemental oxygen to correct hypoxemia, and maintenance of hydration. Routine bronchodilators, corticosteroids, antibiotics, and chest physiotherapy have not been shown to improve outcomes.

Question 15Recognition and Management of Respiratory and Circulatory Emergencies

An inspiratory stridor that is loudest over the neck and worsens when the child cries most likely reflects obstruction at which level?

  1. Small bronchi and bronchioles
  2. Extrathoracic (upper) airway Correct answer.
  3. Intrathoracic trachea
  4. Alveolar-capillary membrane

Explanation

Inspiratory stridor arises from extrathoracic obstruction because negative intrathoracic pressure during inspiration draws the narrowed segment closed. Intrathoracic airway obstruction instead produces predominantly expiratory noise.

Question 16Recognition and Management of Respiratory and Circulatory Emergencies

A 10-year-old with new-onset diabetes has a glucose of 600 mg/dL, pH 7.1, and bicarbonate of 8 mEq/L. Which initial management step is most appropriate?

  1. Immediate insulin bolus of 0.1 units/kg followed by a continuous infusion
  2. Sodium bicarbonate to correct the acidosis before starting fluids
  3. Isotonic fluid bolus of 10 to 20 mL/kg, then an insulin infusion Correct answer.
  4. Rapid free water replacement with 5% dextrose in water

Explanation

Diabetic ketoacidosis is treated first with volume resuscitation using isotonic crystalloid at 10 to 20 mL/kg, followed by an insulin infusion once fluid therapy has begun; insulin boluses are avoided. Bicarbonate is not given routinely because it can worsen hypokalemia and cerebral edema.

Question 17Recognition and Management of Respiratory and Circulatory Emergencies

A teenager is found unresponsive with pinpoint pupils and slow, shallow breathing but a palpable pulse. After opening the airway and beginning ventilation, what is the most appropriate next step?

  1. Begin chest compressions immediately at 100 to 120 per minute
  2. Give epinephrine 0.01 mg/kg intravenously
  3. Give naloxone and continue ventilatory support Correct answer.
  4. Give flumazenil to reverse the suspected sedation

Explanation

Opioid-associated respiratory depression is treated by supporting ventilation and administering naloxone, a competitive opioid antagonist. Chest compressions are started only when there is no pulse, and flumazenil reverses benzodiazepines rather than opioids.

Question 18Recognition and Management of Respiratory and Circulatory Emergencies

A child in cardiac arrest has organized electrical activity on the monitor but no palpable pulse. What is the priority management?

  1. Deliver synchronized cardioversion at 0.5 J/kg
  2. Continue CPR, give epinephrine, and identify reversible causes Correct answer.
  3. Pause compressions for up to 30 seconds to obtain a diagnostic 12-lead ECG
  4. Deliver an unsynchronized shock at 2 J/kg and resume compressions immediately

Explanation

Pulseless electrical activity is managed with high-quality CPR, epinephrine every 3 to 5 minutes, and a systematic search for reversible causes such as hypovolemia, hypoxia, tamponade, tension pneumothorax, and hypothermia. Shocks are not delivered for this rhythm.

Question 19Recognition and Management of Respiratory and Circulatory Emergencies

Which combination of findings most suggests cardiogenic shock in an infant?

  1. Warm extremities with bounding pulses and a wide pulse pressure
  2. Fever with mottled skin and a history of vomiting and diarrhea
  3. Hepatomegaly, a gallop murmur, and jugular venous distention Correct answer.
  4. Bradycardia with prolonged capillary refill after a hypoxic event

Explanation

Cardiogenic shock produces venous congestion and poor forward flow, so hepatomegaly, a gallop murmur, elevated jugular venous pressure, cool extremities, and rales are expected. Distributive shock instead presents early with warm skin and bounding pulses.

Question 20Recognition and Management of Respiratory and Circulatory Emergencies

A child with a severe asthma exacerbation has received three albuterol treatments and remains in marked distress. Which addition to therapy is best supported?

  1. Oral montelukast at twice the usual daily dose
  2. Ipratropium bromide given with each albuterol treatment Correct answer.
  3. Chest percussion and postural drainage every 2 hours
  4. Prophylactic broad-spectrum antibiotics

Explanation

Adding ipratropium to a short-acting beta-2 agonist in moderate-to-severe exacerbations improves bronchodilation and reduces hospital admission. Antibiotics, chest physiotherapy, and leukotriene modifiers are not part of acute exacerbation management.

Question 21Recognition and Management of Respiratory and Circulatory Emergencies

A child receiving positive-pressure ventilation suddenly develops severe hypoxemia, unilateral absent breath sounds, and hypotension. What is the most appropriate immediate action?

  1. Obtain a portable chest radiograph to confirm the diagnosis
  2. Give a 20 mL/kg isotonic fluid bolus rapidly
  3. Perform needle decompression of the affected hemithorax Correct answer.
  4. Increase positive end-expiratory pressure by 5 cm H2O

Explanation

Tension pneumothorax is a clinical diagnosis; in an unstable child the pleural pressure must be relieved immediately with needle decompression followed by tube thoracostomy. Waiting for imaging or raising airway pressure worsens the obstruction to venous return.

Question 22Recognition and Management of Respiratory and Circulatory Emergencies

For a child who remains comatose after return of spontaneous circulation following cardiac arrest, which temperature management strategy is recommended?

  1. Maintain a core temperature between 32°C and 36°C for at least 24 hours Correct answer.
  2. Actively rewarm to 38°C within the first hour after return of spontaneous circulation
  3. Cool the child to 28°C and maintain that temperature for 48 hours
  4. Allow the temperature to rise to 39°C to promote immune function

Explanation

Post-arrest care includes preventing fever and applying targeted temperature management, keeping the core temperature between 32°C and 36°C for at least 24 hours in comatose patients. Deep hypothermia and permissive hyperthermia are both avoided.

Question 23Recognition and Management of Respiratory and Circulatory Emergencies

A child with severe pediatric acute respiratory distress syndrome is being mechanically ventilated. Which ventilation strategy is recommended?

  1. Zero end-expiratory pressure to avoid barotrauma
  2. Tidal volumes near 6 mL/kg of predicted body weight with adequate PEEP Correct answer.
  3. Routine high-frequency oscillatory ventilation for every patient
  4. Tidal volumes of 12 mL/kg to normalize the carbon dioxide level

Explanation

Lung-protective ventilation with tidal volumes near 6 mL/kg of predicted body weight and adequate PEEP limits ventilator-induced lung injury. Larger tidal volumes and zero PEEP increase volutrauma and atelectrauma and worsen outcomes.

Question 24Recognition and Management of Respiratory and Circulatory Emergencies

Which finding is most consistent with cardiac tamponade in a child after penetrating chest trauma?

  1. Diffuse wheezing with prolonged expiration and use of accessory muscles
  2. Unilateral absent breath sounds with tracheal deviation away from the affected side
  3. Wide pulse pressure with bounding peripheral pulses and warm skin
  4. Narrow pulse pressure, distended neck veins, and muffled heart sounds Correct answer.

Explanation

Tamponade impairs ventricular filling, producing the findings of hypotension, distended neck veins, and muffled heart sounds, often with a narrow pulse pressure and pulsus paradoxus. Unilateral absent breath sounds with tracheal deviation instead indicates tension pneumothorax.

Question 25Recognition and Management of Respiratory and Circulatory Emergencies

A 10-day-old presents with poor feeding, weak pulses, hepatomegaly, and acidosis; femoral pulses are diminished and the preductal oxygen saturation is 85%. Which intervention is most likely to improve systemic perfusion?

  1. Aggressive fluid boluses totaling 40 mL/kg given rapidly
  2. Prostaglandin E1 infusion to maintain ductal patency Correct answer.
  3. High-dose epinephrine infusion as the only therapy
  4. Immediate defibrillation at 2 J/kg

Explanation

A neonate with shock, weak femoral pulses, and cyanosis may have a ductal-dependent lesion such as critical coarctation or interrupted aortic arch; maintaining ductal patency with prostaglandin E1 restores systemic blood flow. Large fluid boluses can precipitate pulmonary edema when ventricular function is impaired.

Question 26Recognition and Management of Respiratory and Circulatory Emergencies

Which condition is the most common cause of shock in children?

  1. Cardiac tamponade
  2. Anaphylaxis
  3. Hypovolemia Correct answer.
  4. Cardiogenic failure

Explanation

Loss of intravascular volume from vomiting, diarrhea, or hemorrhage is by far the most frequent cause of pediatric shock. It is treated with rapid isotonic crystalloid boluses while the source of loss is corrected.

Question 27Recognition and Management of Respiratory and Circulatory Emergencies

A 4-year-old has sudden high fever, drooling, a muffled voice, and sits leaning forward with the neck extended. Which action is most appropriate?

  1. Place the child supine for bag-mask ventilation
  2. Obtain a throat swab for culture
  3. Inspect the oropharynx with a tongue blade
  4. Keep the child calm and prepare for airway control Correct answer.

Explanation

These findings suggest epiglottitis, and any manipulation of the pharynx can precipitate complete airway obstruction. The child should be kept calm and in a position of comfort while personnel and equipment for emergency airway management are assembled.

Question 28Recognition and Management of Respiratory and Circulatory Emergencies

A 6-month-old who was chewing a cracker suddenly cannot cry or make sounds and remains conscious. Which maneuver is correct?

  1. Immediate laryngoscopy and intubation
  2. Five back blows alternating with five chest thrusts Correct answer.
  3. Blind finger sweeps of the mouth
  4. Abdominal thrusts with the infant supine

Explanation

For a conscious infant with complete foreign body airway obstruction, deliver five back blows followed by five chest thrusts, repeating the cycle until the object is expelled or the infant becomes unresponsive. Abdominal thrusts and blind finger sweeps are not used in infants.

Question 29Recognition and Management of Respiratory and Circulatory Emergencies

An infant receiving effective bag-mask ventilation has a heart rate of 50 beats/min with cyanosis and poor perfusion. What is the next step?

  1. Give atropine 0.02 mg/kg IV
  2. Begin chest compressions with 100% oxygen Correct answer.
  3. Apply a nonrebreather mask at 15 L/min
  4. Continue ventilation and reassess in 2 minutes

Explanation

A heart rate below 60 beats/min with signs of poor perfusion that persists despite adequate oxygenation and ventilation is an indication to start chest compressions. Compressions are delivered with high-concentration oxygen, and epinephrine is given if bradycardia continues.

Question 30Recognition and Management of Respiratory and Circulatory Emergencies

A 3-month-old has a heart rate of 280 beats/min that started abruptly, feeds poorly, and has no visible P waves on the ECG. Which rhythm is most likely?

  1. Supraventricular tachycardia Correct answer.
  2. Atrial fibrillation
  3. Sinus tachycardia
  4. Ventricular tachycardia

Explanation

An abrupt onset of a very fast, fixed rate with absent or hidden P waves and a narrow QRS in an infant is characteristic of supraventricular tachycardia. Sinus tachycardia has identifiable P waves and varies with stimulation or fever.

Question 31Recognition and Management of Respiratory and Circulatory Emergencies

A child with supraventricular tachycardia has poor perfusion and hypotension and does not respond to vagal maneuvers. What is the initial energy dose for synchronized cardioversion?

  1. 2 J/kg
  2. 0.5 to 1 J/kg Correct answer.
  3. 0.05 to 0.1 J/kg
  4. 4 J/kg

Explanation

Synchronized cardioversion for an unstable tachyarrhythmia starts at 0.5 to 1 J/kg and may be escalated to 2 J/kg if the first shock is ineffective. Defibrillation for ventricular fibrillation uses a higher initial dose of 2 J/kg.

Question 32Recognition and Management of Respiratory and Circulatory Emergencies

A 9-year-old in status asthmaticus has barely audible breath sounds, is drowsy, and has a falling respiratory rate despite continuous albuterol. What do these findings indicate?

  1. A simple side effect of albuterol
  2. Mild persistent asthma
  3. Impending respiratory failure Correct answer.
  4. Resolution of bronchospasm

Explanation

Decreasing air entry, drowsiness, and a slowing respiratory rate in a child with severe asthma signal fatigue and imminent respiratory failure. These children need immediate assisted ventilation planning along with continued bronchodilators and IV therapy.

Question 33Recognition and Management of Respiratory and Circulatory Emergencies

A 3-year-old who choked on candy is coughing forcefully and can speak. What is the best action?

  1. Deliver abdominal thrusts immediately
  2. Perform blind finger sweeps
  3. Encourage coughing and monitor closely Correct answer.
  4. Begin bag-mask ventilation

Explanation

With an effective cough and the ability to phonate, the airway is only partially obstructed and the child's own cough is the most effective way to clear it. Interventions are reserved for an ineffective cough, stridor with silent airflow, or loss of consciousness.

Question 34Recognition and Management of Respiratory and Circulatory Emergencies

A 5-week-old born at 34 weeks' gestation has a brief apneic episode without wheezing, and nasal secretions are positive for respiratory syncytial virus. Which statement best explains this presentation?

  1. The absence of wheezing reliably excludes bronchiolitis in neonates
  2. Apnea in this age group always reflects a primary seizure disorder
  3. Apnea can be the presenting sign in young infants Correct answer.
  4. Respiratory syncytial virus does not cause apnea in infants

Explanation

In infants younger than about 2 months, and especially in those born prematurely, apnea may be the primary or only manifestation of bronchiolitis. These infants require cardiorespiratory monitoring and support of oxygenation and ventilation.

Question 35Recognition and Management of Respiratory and Circulatory Emergencies

A child with a tracheostomy has increasing distress and no air movement through the tube despite suctioning. What is the next appropriate step?

  1. Instill 5 mL of saline and suction again
  2. Obtain a chest radiograph before intervening
  3. Remove the tube and ventilate via the stoma or face Correct answer.
  4. Increase humidification of the oxygen supply

Explanation

When a tracheostomy tube cannot be cleared by suctioning and ventilation is inadequate, the tube should be removed and the child ventilated through the stoma or, if that fails, by bag-mask over the mouth and nose. A blocked or displaced tube is a rapidly fatal airway emergency.

Question 36Recognition and Management of Respiratory and Circulatory Emergencies

A child with pneumonia has worsening grunting and retractions, and an arterial blood gas shows a PaCO2 of 65 mm Hg with a pH of 7.20. What does this indicate?

  1. Mild respiratory distress
  2. Hypercapnic respiratory failure Correct answer.
  3. Compensated metabolic acidosis
  4. Adequate alveolar ventilation

Explanation

A rising PaCO2 with acidemia in a child working hard to breathe means the respiratory muscles can no longer maintain adequate alveolar ventilation. This defines respiratory failure and calls for assisted ventilation rather than continued observation.

Question 37Recognition and Management of Respiratory and Circulatory Emergencies

A cyanotic newborn has a PaO2 of 40 mm Hg on room air that rises only to 45 mm Hg while receiving 100% oxygen. What does this most likely indicate?

  1. Lung disease as the sole cause
  2. Anemia with normal oxygen content
  3. Cyanotic congenital heart disease Correct answer.
  4. Normal transition after birth

Explanation

Failure of the PaO2 to rise substantially with 100% oxygen suggests a fixed right-to-left shunt, which in a newborn points to cyanotic congenital heart disease. Lung disease usually improves oxygenation appreciably with a high inspired oxygen concentration.

Question 38Recognition and Management of Respiratory and Circulatory Emergencies

A 4-month-old with tetralogy of Fallot becomes deeply cyanotic and tachypneic after a prolonged crying episode. Which intervention should come first?

  1. Start a prostaglandin E1 infusion
  2. Calm the infant and place in the knee-chest position Correct answer.
  3. Give a rapid 20 mL/kg normal saline bolus
  4. Administer nebulized albuterol

Explanation

A hypercyanotic spell is treated first by decreasing agitation and raising systemic vascular resistance with the knee-chest position, which reduces the right-to-left shunt. Oxygen, IV fluids, morphine, and a beta-blocker are added if the spell persists.

Question 39Recognition and Management of Respiratory and Circulatory Emergencies

A 12-year-old with a high cervical spine injury has a blood pressure of 78/50 mm Hg, a heart rate of 52 beats/min, and warm, dry extremities. Which type of shock is most likely?

  1. Neurogenic (distributive) shock Correct answer.
  2. Cardiogenic shock
  3. Obstructive shock
  4. Hypovolemic shock

Explanation

Loss of sympathetic outflow after cervical cord injury produces vasodilation with bradycardia, warm dry skin, and hypotension. Treatment includes cautious fluids, vasoactive support, and atropine or pacing for symptomatic bradycardia.

Question 40Recognition and Management of Respiratory and Circulatory Emergencies

A child with myocarditis has a blood pressure of 82/60 mm Hg, hepatomegaly, crackles, and cool extremities. Which initial therapy is most appropriate?

  1. A rapid 60 mL/kg normal saline bolus
  2. Inotropic support with careful fluid restriction Correct answer.
  3. Synchronized cardioversion at 1 J/kg
  4. A rapid 20 mL/kg normal saline bolus

Explanation

These findings indicate cardiogenic shock, in which the myocardium cannot handle additional volume. Treatment centers on inotropes and cautious, small fluid challenges because large boluses precipitate pulmonary edema.

Question 41Airway Management and Ventilation

When performing one-person bag-mask ventilation of a child using the E-C clamp technique, how should the rescuer's hand be positioned?

  1. Thumb and index finger form a C on the mask while the other three fingers form an E that lifts the jaw Correct answer.
  2. All four fingers press the mask down onto the face while the thumb pulls the chin toward the chest
  3. The palm covers the mask opening while the fingers squeeze the self-inflating bag
  4. The thumb and middle finger pinch the nose while the index finger seals the mask

Explanation

The E-C clamp technique uses the thumb and index finger to hold the mask against the face in a C shape while the remaining three fingers hook under the mandible in an E shape to lift the jaw and open the airway. This combination maintains a seal and airway patency while the other hand squeezes the bag.

Question 42Airway Management and Ventilation

When choosing an oropharyngeal airway for a child, the correct size is determined by measuring from the:

  1. central incisors to the thyroid cartilage
  2. corner of the mouth to the angle of the mandible Correct answer.
  3. tip of the nose to the sternal notch
  4. nostril to the earlobe

Explanation

An oropharyngeal airway is sized by placing it alongside the face so the flange sits at the corner of the mouth and the tip reaches the angle of the mandible. A tube that is too long can push the tongue back or trigger laryngospasm, and one that is too short will not hold the tongue away from the posterior pharynx.

Question 43Airway Management and Ventilation

A nasopharyngeal airway should be avoided in a child with which finding?

  1. Moderate dehydration
  2. Suspected basilar skull fracture Correct answer.
  3. Acute asthma exacerbation
  4. A recent febrile seizure

Explanation

Passing a nasopharyngeal tube in a child with a suspected basilar skull fracture risks driving the tube into the cranial vault through a disrupted cribriform plate. An oropharyngeal airway or another airway adjunct should be used instead when facial or skull base trauma is suspected.

Question 44Airway Management and Ventilation

What is the appropriate internal diameter of an uncuffed endotracheal tube for a 4-year-old child?

  1. 3.5 mm
  2. 5.0 mm Correct answer.
  3. 4.5 mm
  4. 4.0 mm

Explanation

For children older than 1 year, the uncuffed tube size is estimated as age in years divided by 4 plus 4, which gives 5.0 mm at age 4. The calculated size is a starting point, and a tube one-half size smaller and larger should be available at the bedside.

Question 45Airway Management and Ventilation

Using the cuffed endotracheal tube formula, what internal diameter should be selected for an 8-year-old child?

  1. 4.5 mm
  2. 5.5 mm Correct answer.
  3. 5.0 mm
  4. 6.0 mm

Explanation

For a cuffed tube in a child older than 1 year, the estimate is age in years divided by 4 plus 3.5, which yields 5.5 mm at age 8. Cuffed tubes are preferred in most pediatric patients because they reduce leak and aspiration risk when cuff pressure is monitored.

Question 46Airway Management and Ventilation

An orotracheal tube with a 4.0 mm internal diameter has just been placed in a child. At what depth at the lip should it be secured?

  1. 12 cm Correct answer.
  2. 16 cm
  3. 20 cm
  4. 9 cm

Explanation

Orotracheal insertion depth in centimeters is estimated as three times the internal tube diameter, so a 4.0 mm tube is secured at about 12 cm at the lip. Depth should then be adjusted based on auscultation and the chest radiograph.

Question 47Airway Management and Ventilation

Which method is the most reliable primary confirmation of endotracheal tube placement in a child with a perfusing rhythm?

  1. Continuous waveform capnography Correct answer.
  2. Auscultation of the anterior chest and epigastrium
  3. Pulse oximetry trending
  4. Observation of chest rise with each breath

Explanation

Continuous waveform capnography is the recommended standard for confirming and monitoring endotracheal tube position because it detects exhaled carbon dioxide breath by breath. Clinical signs are used together with it, but they are less reliable on their own.

Question 48Airway Management and Ventilation

During CPR of a child with an advanced airway in place, how frequently should ventilations be delivered?

  1. 1 breath every 2 seconds
  2. 1 breath every 4 seconds
  3. 1 breath every 3 seconds
  4. 1 breath every 6 seconds Correct answer.

Explanation

Once an advanced airway is in place, compressions are delivered continuously without pauses and a breath is given every 6 seconds, or 10 breaths per minute, for infants and children. This rate avoids the harmful effects of hyperventilation on intrathoracic pressure and cerebral blood flow.

Question 49Airway Management and Ventilation

Two rescuers are performing CPR on a 5-year-old child who has no advanced airway. Which compression-to-ventilation ratio should be used?

  1. 15:2 Correct answer.
  2. 3:1
  3. 30:2
  4. 5:1

Explanation

For two-rescuer pediatric CPR without an advanced airway, the ratio is 15 compressions to 2 ventilations. A single rescuer uses 30:2 for any age, and 3:1 is reserved for newborn resuscitation immediately after birth.

Question 50Airway Management and Ventilation

A previously well 8-month-old has a witnessed choking episode, cannot make sound, and has an ineffective cough. After calling for help, what should the rescuer do?

  1. Deliver abdominal thrusts with the infant supine
  2. Give 5 back slaps followed by 5 chest thrusts Correct answer.
  3. Perform a blind finger sweep of the mouth
  4. Begin chest compressions at a ratio of 15:2

Explanation

For a conscious infant with severe foreign body airway obstruction, the recommended sequence is repeated cycles of 5 back slaps and 5 chest thrusts while supporting the head. Abdominal thrusts are avoided in infants because of the risk of intra-abdominal injury.