NPS NPS Emergency and Critical Care 2 — Questions and Answers
Question 1: What is the correct energy dose for the FIRST defibrillation attempt in a pediatric patient with ventricular fibrillation?
- 0.5 J/kg
- 2 J/kg (Correct answer)
- 4 J/kg
- 10 J/kg
Correct answer: 2 J/kg
PALS recommends an initial defibrillation dose of 2 J/kg for pediatric VF/pulseless VT, with subsequent shocks at 4 J/kg.
Question 2: A neonate in the NICU suddenly develops cyanosis, bradycardia, and absent breath sounds on the left. Chest transillumination is positive. What is the immediate intervention?
- Chest X-ray to confirm diagnosis
- Needle decompression of the left chest at the 2nd intercostal space, midclavicular line (Correct answer)
- Increase PEEP on the ventilator
- Administer epinephrine IV
Correct answer: Needle decompression of the left chest at the 2nd intercostal space, midclavicular line
A tension pneumothorax in a neonate requires immediate needle decompression at the 2nd ICS, MCL on the affected side — waiting for X-ray confirmation is inappropriate.
Question 3: During neonatal transport, a 27-week premature neonate becomes increasingly tachycardic and pale. Blood glucose is 22 mg/dL. What is the first intervention?
- IV epinephrine 0.01 mg/kg
- IV dextrose 10% at 2 mL/kg bolus (Correct answer)
- Increase ventilator rate by 5 breaths/min
- Administer sodium bicarbonate 2 mEq/kg
Correct answer: IV dextrose 10% at 2 mL/kg bolus
Symptomatic hypoglycemia in a neonate is treated with a D10W minibolus of 2 mL/kg IV, providing approximately 200 mg/kg glucose to rapidly restore euglycemia.
Question 4: A pediatric patient with traumatic brain injury has a GCS of 7. What is the initial target PaCO2?
- 25–30 mmHg (aggressive hyperventilation)
- 35–40 mmHg (normocapnia) (Correct answer)
- 45–50 mmHg (permissive hypercapnia)
- 50–60 mmHg
Correct answer: 35–40 mmHg (normocapnia)
Normocapnia (PaCO2 35–40 mmHg) is targeted in pediatric TBI to avoid cerebral vasoconstriction from hypocapnia; prophylactic hyperventilation is no longer recommended.
Question 5: Which sign indicates that a pediatric patient in shock has transitioned from compensated to decompensated shock?
- Tachycardia
- Bounding pulses
- Hypotension (Correct answer)
- Prolonged capillary refill
Correct answer: Hypotension
Hypotension marks the transition to decompensated shock in pediatric patients; children can maintain blood pressure for extended periods through vasoconstriction before decompensating.
Question 6: A term neonate has a 5-minute Apgar score of 2. Which therapeutic intervention, if initiated within 6 hours, improves neurological outcomes?
- IV magnesium sulfate
- Therapeutic hypothermia at 33–34°C for 72 hours (Correct answer)
- Phenobarbital prophylaxis
- High-dose corticosteroids
Correct answer: Therapeutic hypothermia at 33–34°C for 72 hours
Therapeutic hypothermia (whole-body cooling to 33–34°C for 72 hours) initiated within 6 hours of birth is the standard of care for moderate-severe HIE.
NPS NPS Emergency and Critical Care 2
What is the correct energy dose for the FIRST defibrillation attempt in a pediatric patient with ventricular fibrillation?