Part 2 — Answer key

Compare your answers after you have finished Part 1.

1. You are performing a rapid pediatric assessment on a stable 4-year-old child. Which capillary refill time is considered normal in a warm environment?
   1 second
2. In high-quality pediatric CPR, you should allow complete chest recoil after each compression.
   True
3. You arrive to find a 6-year-old child unresponsive on the floor. You verify scene safety, tap and shout, and the child does not respond. What is your next action according to pediatric basic life support for healthcare providers?
   Check for breathing and a central pulse simultaneously for no more than 10 seconds
4. For pediatric cardiac arrest with no pulse, the recommended epinephrine dose is 0.1 mg/kg IV/IO every 3 to 5 minutes.
   False
5. A 4-year-old with suspected septic shock has poor perfusion but normal blood pressure. You obtain IV access and are ready to start fluids. What is the recommended initial isotonic crystalloid bolus?
   20 mL/kg
6. During triage, you assess a 3-year-old with respiratory distress. Which finding is most concerning for impending respiratory failure?
   Slowing respiratory rate with poor chest rise
7. During a PALS resuscitation, only the team leader should speak, and other team members should remain silent unless spoken to.
   False
8. A 5-year-old with suspected early septic shock is alert but pale, tachycardic, and has cool extremities with delayed capillary refill. Blood pressure is normal. Which findings in this child are most consistent with compensated shock? Select all that apply.
   Cool extremities with delayed capillary refill; Tachycardia
9. A 7-year-old with a history of asthma presents with moderate respiratory distress, audible wheezing, and SpO₂ of 93% on room air. She is speaking in short sentences and has good air movement. What is the most appropriate initial treatment?
   Provide inhaled bronchodilator therapy
10. A 9-year-old presents with a narrow-complex tachycardia at 210 beats per minute that is regular and does not vary with activity. Blood pressure and perfusion are stable, and P waves are not clearly visible. What is the best next step in management?
    Treat as stable supraventricular tachycardia and attempt vagal maneuvers first
11. You are treating a 6-year-old with symptomatic bradycardia (heart rate 40 beats per minute) and poor perfusion despite effective oxygenation and chest compressions. Which additional interventions are appropriate if the rhythm persists? Select all that apply.
    Prepare for transcutaneous pacing; Administer epinephrine IV/IO; Consider atropine if increased vagal tone is suspected
12. A 10-year-old with a history of severe allergies suddenly develops generalized hives, wheezing, hypotension, and stridor after eating at a camp. You suspect anaphylaxis. What is the recommended first-line medication and route?
    IM epinephrine 0.01 mg/kg (maximum 0.5 mg) of 1 mg/mL in the lateral thigh
13. You are evaluating a 2-year-old with respiratory distress. Which signs specifically indicate increased work of breathing in this child? Select all that apply.
    Nasal flaring; Head bobbing; Grunting
14. In a child with suspected septic shock, you should begin vascular access, fluid resuscitation, and antibiotics as soon as possible, without waiting for hypotension to develop.
    True
15. A 3-year-old with severe asthma is in marked respiratory distress despite high-flow oxygen and continuous inhaled bronchodilators. He is now lethargic with shallow respirations, a rising CO₂ level, and decreasing SpO₂. Breath sounds are diminished bilaterally. What is the most appropriate next step?
    Prepare for endotracheal intubation with rapid sequence induction
16. Arrange the key actions in the correct order for starting single-rescuer pediatric CPR on a collapsed child you just witnessed, when you have a mobile phone but no AED immediately available.
    Correct order: Verify that the scene is safe and check the child for responsiveness → Shout for help and activate the emergency response system using your phone on speaker → Check breathing and a central pulse for no more than 10 seconds → Begin high-quality chest compressions → Provide 2 rescue breaths and continue cycles of compressions and breaths
17. During a PALS resuscitation, you notice that the provider managing the bag-mask device is ventilating too rapidly. As the team leader, what is the most appropriate communication to correct this?
    Address the provider by name and give a clear instruction using closed-loop communication
18. An 8-year-old has been in a bicycle crash and may have a cervical spine injury. He is unresponsive and not breathing but has a palpable central pulse. You are ready to open the airway and begin bag-mask ventilation. What is the best initial airway maneuver?
    Jaw thrust without head tilt
19. A 7-year-old with supraventricular tachycardia remains unstable with poor perfusion after vagal maneuvers and a rapid adenosine dose. You prepare for synchronized cardioversion. What is the recommended initial energy dose?
    0.5 to 1 J/kg synchronized
20. A 6-year-old is in cardiac arrest with pulseless ventricular tachycardia that has a polymorphic pattern consistent with torsades de pointes. After high-quality CPR and defibrillation, which medications are appropriate to include in ongoing management? Select all that apply.
    Magnesium sulfate for torsades; Amiodarone 5 mg/kg IV/IO bolus; Epinephrine 0.01 mg/kg IV/IO every 3 to 5 minutes
21. Two healthcare providers are performing CPR on an infant in cardiac arrest with no advanced airway in place. What compression-to-ventilation ratio should they use?
    15:2