JBL Obstetrics and Peds

Following an injury, a 5-year-old child moans and makes incomprehensible sounds. According to the modified Glasgow Coma Scale for children, what score should be assigned for verbal response? A) 1 B) 2 C) 3 D) 4

A (5: engages in oriented convo. 4: child is confused, but still converses. 3: cries in response to pain. 2: uses inappropriate words. 1: child moans, is using incomprehensible words or making incomprehensible sounds, or there is no response at all)

Compared to nonpregnant women, otherwise healthy pregnant woman are at greater risk for: A) joint dislocations. B) type 1 diabetes. C) pathologic fractures. D) congestive heart failure.

A (Blood volume, cardiac output and HR all increase with pregnancy. BP decreases slightly. Uterus expands which affects the respiratory system by pushing up on the diaphragm which increases the respiratory rate and decreases minute volume [pregnant women breathe faster but have a hard time taking a deep breath]. Increased hormones make the joints looser and less stable; this increases risk of joint dislocations. Some pregnant women develop gestational diabetes, which is caused when the pregnancy hormones create insulin resistance; this is different from Type 1 diabetes, where the body does not produce any insulin)

In contrast to the contractions associated with true labor, Braxton-Hicks contractions: A) do not increase in intensity and are alleviated by a change in position. B) may be intensified by activity and are accompanied by a pink discharge. C) generally follow rupture of the amniotic sac and occur with regularity. D) consistently become stronger and are not alleviated by changing position.

A (Braxton-Hicks: false labor. Do not represent true labor since they do not increase in intensity, are not regular, and are typically alleviated by activity or a change in position. Contractions during true labor, once they begin: consistently get stronger and closer together and are regular; change in position does not help; may be followed by rupture of amniotic sac and a pink or red vaginal discharge that is gen. accompanied by mucus [bloody show])

Which of the following clinical findings would differentiate epiglottitis from other causes of respiratory distress in a child? A) High fever and drooling B) Low-grade fever and stridor C) Low-grade fever and wheezing D) High fever and cracking breath sounds

A (Epiglottitis: bacterial infection of the soft tissue in the area above the vocal cods. In preschool and school age children especially, the epiglottis can swell two-three times its normal size, potentially causing an airway obstruction. S/Sx: high fever, sore throat, and respiratory distress. Because it hurts to swallow, drooling is very common. In many cases, you will find the child in tripod position. Wheezing: lower airway obstruction, such as asthma or bronchiolitis. Fever, crackles heard in the lungs and respiratory distress are common findings with pneumonia)

You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before, but had a miscarriage at 19 weeks. You should document her obstetric history as: A) gravida 2, para 0. B) gravida 1, para 1. C) gravida 0, para 2. D) gravida 2, para 1.

A (Gravida: # of times a woman has been pregnant, regardless of whether she carried the infant to term. Para: # of times a woman has carried a fetus beyond 28 weeks. Since this pt has not yet delivered the baby she is currently carrying, she is para 0)

Which of the following is an abnormal finding? A) Heart rate of 80 beats/min in a 3-month-old infant B) Rapid, irregular breathing in a newly born infant C) Systolic BP of 100 mm Hg in a 10-year-old child D) Respiratory rate of 26 breaths/min in a 2-year-old child

A (HR for an infant up to 3mo averages 140bpm. 80bpm is grossly abnormal in this same age group and indicates bradycardia. Newborn infants normally have irregular breathing that ranges between 40 and 60 breaths/min. The systolic BP for a child between 6 and 12 years of age ranges between 90 and 115mmHg. The respiratory rate in a child between 1 and 3 years of age typically ranges between 24 and 40 breaths/min)

Which of the following is the MOST common cause of shock in infants and children? A) Hypovolemia B) Cardiac failure C) Accidental poisoning D) Severe allergic reaction

A (Hypovolemia can occur as a result of dehydration, prolonged and excessive fever, and blood loss from trauma. Less common causes include severe allergic rxns, cardiac failure, and poisonings)

A 3-year-old girl presents with respiratory distress. She is crying and is clinging to her mother. Her heart rate is 150 beats/min and her oxygen saturation is 89%. What should you do? A) Administer blow-by oxygen via nonrebreathing mask B) Administer an inhaled bronchodilator via face mask C) Ventilate with a bag-mask device at 20 breaths/min D) Ventilate with a bag-mask device at 12 breaths/min

A (If a child presents with respiratory difficulty, the method of O2 delivery depends on his or her mental status, respiratory effort, and HR. O2 for a child with respiratory distress should be given by the least threatening method. Give the child O2 via the blow-by technique; allow the parent to hold the O2 mask near the child's face. If the child develops signs or respiratory failure, such as a decreased LOC, signs of physical exhaustion, reduced tidal volume [shallow breathing], cyanosis, and bradycardia, you should ventilate with BVM attached to supplemental O2)

During delivery of the head, it is noted that the umbilical cord is wrapped tightly around the baby's neck. An attempt to slide the cord over the baby's head is unsuccessful. The EMT should: A) clamp and cut the umbilical cord. B) position the mother on her left side. C) gently pull on the cord to loosen it. D) place an oxygen mask on the baby.

A (If removing the nuchal cord is not successful the first time or it is not possible to slide the nuchal cord over the baby, you should clamp and cut the cord and continue with the delivery. Do not pull on the umbilical cord as doing so could cause it to tear and bleed)

When is it appropriate to clamp and cut the umbilical cord? A) As soon as the cord has stopped pulsating B) After the placenta has completely delivered C) Before the newborn has taken its first breath D) Immediately following delivery of the newborn

A (If the cord does not stop pulsating and/or the baby is not breathing adequately, the cord should not be clamped and cut and the baby should be kept at the level of the mother's perineum and managed appropriately en route)

A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding from her mouth and nose. You should: A) open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations. B) open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via nonrebreathing mask. C) manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and suction her oropharynx. D) suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist her ventilations.

A (In any semiconscious or unconscious pt with a head injury, you should manually stabilize the head and open the airway with jaw-thrust maneuver. Suction any secretions. If possible, insert a simple airway adjunct. Slow, irregular breathing will not provide adequate minute volume and should be treated with ventilatory assistance)

Which of the following signs or symptoms is/are more common in children than in adults following an isolated head injury? A) Nausea and vomiting B) Altered mental status C) Tachycardia and diaphoresis D) Changes in pupillary reaction

A (It is relatively common for children to vomit following a head injury such as a concussion. In adults, vomiting [less common] is an ominous sign and indicates increased ICP. AMS and pupillary changes following a head injury are equally as common in children and adults. Tachycardia and diaphoresis are signs of shock and are not commonly observed in pts with an isolated head injury)

Which of the following is the definitive sign of imminent delivery of a baby? A) Crowning B) Urge to defecate C) Lengthy contractions D) Contractions less than 3 minutes apart

A (Key word: DEFINITIVE. Nothing is more definitive than visualization of the presenting part of the baby at the vaginal opening [crowning])

A 29-year-old woman, who is 38 weeks pregnant, presents with heavy vaginal bleeding, a blood pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies abdominal cramping or pain. What should you suspect? A) Placenta previa B) Abruptio placenta C) Ruptured ovarian cyst D) Ruptured ectopic pregnancy

A (Placenta previa: the placenta develops over and covers some or all of the cervix. As the cervix dilates, the vasculature that attaches the placenta to the uterine wall tears, resulting in vaginal bleeding that can cause shock. Abruptio placenta: the placenta prematurely separates from the uterine wall; tearing abdominal pain; heavy vaginal bleeding; and shock. Both occur during later stages of pregnancy. Ectopic pregnancy rupture: presents with sudden stabbing pain in the lower abdomen and shock due to intra-abdominal hemorrhage)

A 29-year-old pregnant female complains of a severe headache, blurred vision, and swelling of her hands and feet. Which of the following additional assessment findings would the EMT MOST likely encounter? A) Hypertension B) Hyperglycemia C) Abdominal pain D) Vaginal bleeding

A (Preeclampsia: condition that could lead to seizures [eclampsia]. S/Sx: hypertension, headache, visual disturbances, and edema. Hyperglycemia during pregnancy is a possible sign of gestational diabetes, not preeclampsia. Abdominal pain and vaginal bleeding are not commonly observed in pts with preeclampsia)

A 30-year-old woman is 22 weeks pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. What should you suspect? A) Preeclampsia B) Gestational diabetes C) A hypertensive emergency D) A condition unrelated to pregnancy

A (Preeclampsia: typically develops after the 20th week of gestation; it most commonly occurs in primigravida (1st time pregnancy) women. Characterized by a headache, visual disturbances, edema to the hands and feet, anxiety, and persistent hypertension. Gestational diabetes: the pregnancy hormones estrogen and progesterone impair the effects of insulin [insulin resistance]. Hypertensive emergency: occurs when systolic BP rises above 180mmHg)

Which of the following signs is the MOST ominous in a child with respiratory distress? A) Bradypnea B) Tachycardia C) Nasal flaring D) Retractions

A (Retractions, nasal flaring, and tachycardia are all common findings in infants and children with respiratory distress. As the child begins to tire, retractions often become weak and ineffective and the accessory muscles become less prominent during breathing. Bradypnea indicates impending respiratory arrest; indicates that their condition has deteriorated)

You receive a call for a 3-month-old infant who was found unresponsive by his mother when she woke up. The infant is pulseless and apneic and his skin is cold and pale. You should: A) carefully inspect the environment in which the infant was found. B) attempt full resuscitative measures and transport the infant to the hospital. C) perform CPR for 10 minutes and then contact medical control for further direction. D) withhold chest compressions but apply the AED to analyze the infant's cardiac rhythm.

A (SUID: sudden unexpected infant death; three tasks to do: assessment and management of the infant, commemorating with and providing emotional support to the family, and assessing the scene. It is clear the infant in this scenario is deceased; therefore, resuscitation would be futile. When assessing the scene, note the position in which the infant was found, any signs that suggest the infant was recently ill [medications, humidifiers], and the general condition of the house [clear or dirty])

Oxygen and other nutrients are transferred to the developing fetus via the: A) umbilical vein. B) amniotic fluid. C) umbilical arteries. D) mother's liver.

A (The organ of O2 and CO2 exchange between the mother and the developing fetus is the placenta. The fetus is attached to the placenta by the umbilical cord, which contains two arteries and one vein. The fetus receives its supply of O2 and other nutrients from the placenta via the umbilical vein. CO2 and other waste products are returned from the fetus to the placenta via the umbilical arteries. The amniotic sac acts as a cushion for the developing fetus and helps protect it from infection)

A woman who is 39 weeks pregnant is unresponsive, apneic, and pulseless. When treating her, the EMT should: A) manually displace her uterus to the left. B) ventilate her at a rate of 20 breaths/min. C) ensure that she is positioned on her left side. D) delay defibrillation until ALS is at the scene.

A (This pt is in cardiac arrest; she must remain supine [even though this should be avoided in later stages of pregnancy because it can compress the aorta and IVC thus impairing blood flow] in order to perform effective CPR. Therefore, if the uterine fundus [top of the uterus] is above the level of the umbilicus, the EMT should manually displace her uterus to the left to relieve pressure off the IVC)

A 4-year-old boy with a tracheostomy tube has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should: A) ventilate through the tracheostomy tube. B) carefully suction the tracheostomy tube. C) remove the tracheostomy tube and clean it. D) place an oxygen mask over the tracheostomy tube.

B

After attaching the AED to a 7-year-old child in cardiac arrest, you push the analyze button and receive a shock advised message. After delivering the shock, you should: A) assess for a carotid pulse. B) immediately perform CPR. C) reanalyze the cardiac rhythm. D) open the airway and ventilate.

B

Of the following, the MOST detrimental effect of gastric distention in infants and children is: A) tracheal rupture. B) decreased ventilatory volume. C) acute rupture of the diaphragm. D) less effective chest compressions.

B

The appropriate technique for performing two-rescuer CPR on a 4-year-old child includes: A) 30 compressions to 2 ventilations, compressing the chest one-third the depth of the chest, and delivering each breath over 1 second. B) 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs. C) 30 compressions to 2 ventilations, compressing the sternum with the heel of both hands, and delivering each breath over 1 to 2 seconds. D) 15 compressions to 2 ventilations, compressing the sternum with your thumbs, and delivering 100 to 120 compressions per minute.

B

Treatment for a responsive 4-year-old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color, includes: A) oxygen, back slaps, and transport. B) supplemental oxygen and transport. C) assisted ventilations, back slaps, and transport. D) subdiaphragmatic thrusts until the object is expelled.

B

You and your partner are performing CPR on a 2-year-old female in cardiac arrest. During your resuscitation attempt, you should: A) hyperventilate her because she is severely hypoxic. B) allow the chest to fully recoil in between compressions. C) perform compressions and ventilations at a ratio of 30:2. D) attach the AED pads after 5 minutes of high-quality CPR.

B

You will know that the third stage of labor has begun when: A) the placenta has delivered. B) the entire baby has delivered. C) the mother's contractions become regular. D) the baby's head is visible at the vaginal opening.

B (1st stage: onset of contractions and ends when the cervix is fully dilated [the appearance of crowning is used to mark the end of the first stage of labor. As the 1st stage progresses, the mother's contractions become more frequent and regular. 2nd: begins with full cervical dilation [crowning] and ends when the baby is completely delivered. 3rd: begins with the birth of the baby and ends when the placenta [afterbirth] has delivered)

A 6-month-old infant with a head injury moans in response to pain. According to the modified Glasgow Coma Scale for infants, what score should be assigned for verbal response? A) 1 B) 2 C) 3 D) 4

B (5: infant coos or babbles; 4: infants has irritable cry; 3: infant cries in response to pain; 2: moans in response to pain; 1: no response)

A newborn is considered to be premature if it: A) weighs less than 6.5 pounds. B) is born before 37 weeks gestation. C) is born to a heroin-addicted mother. D) has meconium in or around its mouth.

B (A term gestation is between 37 and 42 weeks. A premature newborn is one that is born before 37 weeks gestation or weighs less than 5.5 pounds. The risk of the fetus voiding its first bowel movement [meconium] in utero increases any time the fetus is distressed, regardless of its gestational age or weight; the presence of meconium does not define a preemie)

After an advanced airway device has been inserted in a 6-month-old infant in cardiopulmonary arrest, you should deliver ventilations at a rate of: A) 8 breaths/min. B) 10 breaths/min. C) 12 breaths/min. D) 20 breaths/min.

B (After an advanced airway device [ET tube, supraglottic airway] has been inserted during cardiac arrest, ventilate the pt at a rate of 10 breaths/min [one breath every 6 seconds]. This ventilation rate applies to all age groups, except the newborn. A ventilation rate of 12-20 breaths/min would be appropriate for an apneic infant or child who has a pulse)

Which of the following statements regarding crowning is correct? A) Crowning represents the end of the second stage of labor. B) Gentle pressure should be applied to the baby's head during crowning. C) It is safe to transport the patient during crowning if the hospital is close. D) Crowning always occurs immediately after the amniotic sac has ruptured.

B (Apply gentle pressure to the infant's head to prevent an explosive delivery. Care must be taken to avoid putting pressure on the fontanelles. If the infants head is born and the amniotic sac is still intact, you need to pinch the thin membrane with your fingers, which will usually cause the sac to easily rupture, and then suction the infants mouth and nose)

Which of the following assessment parameters is a more reliable indicator of perfusion in infants than adults? A) Pulse quality B) Capillary refill C) Blood pressure D) Level of orientation

B (Capillary refill time (CRT): reliable in children younger than 6yo. Peripheral perfusion decreases with age, CRT is less reliable of an indicator of perfusion. Pulse quality is reliable in pts of any age; weak or absent peripheral pulses indicate poor perfusion in anyone. BP is the least reliable indicator of perfusion in pts of any age; it usually does not fall until the body's compensatory mechanisms have failed)

A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have: A) slow, shallow respirations. B) a slow capillary refill time. C) strong, bounding radial pulses. D) a weakly palpable carotid pulse

B (Compensated shock in the infant or child is characterized by poor peripheral perfusion [delayed CRT, weak peripheral pulses, pallor], tachycardia, and tachypnea. In compensated shock, the child's BP is maintained and his or her mental status is adequate. In decamp shock, the child's compensatory mechanisms have failed; BP falls, central pulses become weak, mental status begins to deteriorate)

A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have: A) slow, shallow respirations. B) a slow capillary refill time. C) strong, bounding radial pulses. D) a weakly palpable carotid pulse.

B (Compensated shock in the infant or child is characterized by poor peripheral perfusion [delayed CRT, weak peripheral pulses, pallor], tachycardia, and tachypnea. The child's BP is maintained and his or her mental status is adequate. In decomp shock, the child's compensatory mechanisms have failed; BP falls, central pulses become weak, and mental status begins to deteriorate)

A 3-year-old child experienced a seizure that lasted about 10 minutes. He has a fever of 103.5°F, his skin is hot to the touch, and he has a rash on his trunk. What should you suspect? A) Epilepsy B) Meningitis C) Intracranial hemorrhage D) An allergic reaction

B (Febrile seizures and fever with seizures are not one in the same. Febrile seizures: caused by fever and fever alone. Fever with seizures could be something else. Since the child had a rash on their trunk, it indicates possible sepsis, and should suspect meningitis. A rash is not a common finding with simple febrile seizures. Rash and fever are not common findings with intracranial hemorrhage)

A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and administer supplemental oxygen. En route to the hospital, you should be MOST alert for: A) hypotension. B) convulsions. C) combativeness. D) respiratory distress.

B (High fever and AMS indicate sepsis. A generalized rash should alert you to the possibility of meningitis [a condition caused by infection and inflammation of the meninges that protect the brain and spinal cord]. Children with meningitis are at risk for seizures, usually due to increased ICP and/or high fever. Seizure deaths are caused by cerebral hypoxia)

Following delivery of a baby, the newborn has a strong cry and a heart rate of 130 beats/min. What should you do? A) Suction the baby's mouth and nose B) Keep the baby warm and transport C) Ventilate with a bag-mask device D) Administer free-flow oxygen by mask

B (If the newborn has no signs of distress, has pink skin, and a HR greater than 100bpm, simply keep the baby warm and transport to the hospital. Re-suctioning the mouth and nose is not necessary if the newborn is breathing adequately. BVM is indicated if the newborn is apneic or has gasping respirations, or if the HR is less than 100bpm. If the baby has central cyanosis, administer free-flow O2 by face mask or tubing)

During transport of a woman in labor, the patient tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. You should: A) allow the head to deliver and check for the location of the cord. B) advise your partner to stop the ambulance and assist with the delivery. C) ask the mother to take short, quick breaths until you arrive at the hospital. D) apply gentle pressure to the baby's head and notify the hospital immediately.

B (If, during transport, the mother begins to deliver the infant, your first action should ben to advise your partner to stop the ambulance and assist you with the delivery. Delivery of the baby should never be attempted in the back of a moving ambulance)

Which of the following statements regarding pediatric anatomy is correct? A) The child's trachea is more rigid and less prone to collapse. B) The occiput is proportionately larger when compared to an adult. C) Relative to the overall size of the airway, a child's epiglottis is smaller. D) Airway obstruction is common in children because of their large uvula.

B (Infants and children are at risk for an airway obstruction because their entire airway is smaller, not because their uvula is large. An infant's or child's trachea is less rigid than an adult's, therefore, it collapses more easily during respiratory distress. An infant's or a child's airway has a relatively large, floppy epiglottis)

A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. You should transport her in which position? A) Prone B) Left side C) Supine D) Semi-Fowler

B (Initial care for pt who is seizing: ensuring a patent airway, ensuring adequate ventilation, and administering high-flow O2. The pregnant pt should be placed on her left side [lateral recumbent position]; this will prevent supine hypotensive syndrome [condition where the pregnant uterus compresses the IVC and reduces cardiac output]. A lateral recumbent position will also facilitate the drainage of oral secretions, thus minimizing the risk of aspiration)

Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. You should: A) immediately resuction its mouth and nose. B) begin ventilations with a bag-valve-mask. C) gently flick the soles of its feet for up to 60 seconds. D) start CPR if the heart rate is less than 80 beats/min.

B (Initial steps of newborn resuscitation: drying, warming, positioning, suctioning, and tactile stimulation. If newborn remains apneic [gasping] after initial steps or has a HR less than 100bpm, begin PPV with BVM at rate of 40-60 breaths/min. Continued tactile stimulation [flicking soles of feet, rubbing the lateral thorax] of an apneic newborn WASTES TIME. If the newborn's HR is less than 60bpm despite effective PPV, you should begin chest compressions)

Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. What should you do? A) Position the mother ina semi-Fowler's position and administer oxygen B) Position the mother with her hips elevated and administering high-flow oxygen C) Apply gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord. D) Give the mother 100% oxygen and attempt to manipulate the protruding limb so that delivery can occur.

B (Limb presentations: do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the brith canal and remove pressure from the umbilical cord. Administer high-flow O2 to the mother, covering the protruding limb with a sterile sheet, and rapid transport)

Which of the following is considered a severe burn in a pediatric patient? A) Partial thickness burns to 15% of the body surface area B) Any full-thickness burn, regardless of body surface coverage C) Any partial-thickness burn that involves the lower extremities D) Superficial burns that cover 5% to 10% of the body surface area

B (Minor burns in pediatric pts include small coverage area superficial burns and partial-thickness burns that involve less than 10% of BSA. Partial-thickness burns involving 10%-20% of the BSA are classified as moderate burns. Severe burns in peds are any full-thickness burns, regardless of location or BSA coverage, and partial-thickness burns involving more than 20% of the BSA, and any burn involving the hands, feet, face, airway, or genitalia)

A 5-year-old child is unresponsive and cyanotic. His pulses are weak and slow and his breathing is slow. What should you do? A) Begin chest compressions B) Ventilate with a bag-mask device C) Give oxygen by nonrebreathing mask D) Apply the AED

B (Most cardiac arrests in infants and children are caused by hypoxia secondary to respiratory failure. When infants and children become hypoxic, they develop bradycardia. Any infant or child who has bradycardia and poor breathing should be ventilated with a BVM. Cyanosis indicates severe hypoxia. If the child's HR is below 60bpm start chest compressions)

While assessing a woman in labor, the EMT notices that a loop of the umbilical cord is protruding from her vagina. In which position should the EMT place the patient? A) Left side with her head elevated B) Supine with her pelvis elevated C) Left side with her legs elevated D) Semi-sitting with her knees bent

B (PROLAPSED UMBILICAL CORD: Elevate the mother's pelvis; this will allow the baby to slide slightly back into the vagina, off the cord. The knee to chest position may also help to accomplish the same goal. Cover any exposed cord with a moist, sterile dressing, administer O2 to mother, and rapid transport.

Your assessment of a 2-year-old boy reveals that he has is not interacting normally and has poor muscle tone. His respirations are 30 breaths/min and unlabored and his skin is pink. These findings suggest a problem with which of the following body systems? A) Cardiac B) Neurologic C) Respiratory D) Circulatory

B (Pedatric Assessment Triangle [PAT]: neurologic, respiratory, circulatory. Composed of three components: appearance, work of breathing, and skin circulation. Abnormal mentation and poor muscle tone suggest abnormal neurologic function, such as what caused by hypoglycemia, stroke, or other neurologic problems)

A 9-month-old infant presents with a cough, runny nose, and respiratory distress. A whoop sound is heard during inhalation. What should you suspect? A) Croup B) Pertussis C) Bronchiolitis D) Pneumonia

B (Pertussis: whooping cough; a communicable disease caused by a bacterium that is spread via the droplet route. S/Sx: similar to a common cold, and include coughing, sneezing, and a runny nose. As the disease progresses, the coughing becomes more severe and is characterized by a distinctive whoop sound heard during inhalation. Infants with pertussis may develop pneumonia or respiratory failure. Croup is unlikely; it is caused by upper airway inflammation and is characterized by stridor and a seal-bark cough. Bronchiolitis is also unlikely; it is a viral infection that causes lower airway constriction and inflammation. Wheezing is commonly observed in children with bronchiolitis)

While performing a visual inspection of a 30-year-old woman in labor, you can see the umbilical cord at the vaginal opening. What should you do? A) Massage the uterus to facilitate delivery of the fetus B) Relieve pressure from the cord with your gloved fingers C) Place the mother on her left side and provide rapid transport D) Elevate the mother's lower extremities and provide rapid transport

B (Prolapsed umbilical cord: goal in treatment is to maintain a pulsatile cord. Place your gloved fingers into the vagina and lift the presenting part of the baby off the umbilical cord. Positioning the mother with her hips elevated may allow the baby to slide off the umbilical cord. Keep the cord moist by covering it in saline-soaked dressings. Give mother high-flow O2 and provide rapid transport)

A 5-year-old boy was struck by a car and is found lying 15 feet away. Based on the child's age and mechanism of injury, you should suspect that the PRIMARY injury occurred to the: A) head. B) pelvis. C) lower legs. D) upper thorax.

B (Since the child is shorter, initial impact typically occurs at or near the pelvis. Secondary injuries occurs when the chest collides with the vehicle's grill. Tertiary injuries occur when the child strikes his or her head on the pavement after being propelled away from the vehicle)

You are transporting a woman who is 35 weeks pregnant and complains of a headache. She suddenly becomes pale, lightheaded, and tachycardic. What should you do? A) Administer high-flow oxygen B) Position her on her left side C) Reassess her blood pressure D) Elevate her lower extremities

B (Supine hypotensive syndrome: can occur beyond the 2nd trimester. When the mother lies supine, the pregnant uterus can compress the inferior vena cava (IVC), which reduced venous return to the right side of the heart. As a result, cardiac output decreases and the pt develops signs of shock [pallor, tachycardia, hypotension]. Position the mother on her left side to relieve pressure off the IVC)

The MOST important initial steps of assessing and managing a newborn include: A) suctioning the airway and obtaining a heart rate. B) clearing the airway and keeping the infant warm. C) keeping the infant warm and counting respirations. D) drying and warming the infant and obtaining an Apgar score.

B (The APGAR score should not be relied on as the initial indicator for resuscitation because it is not performed until the child is 1 minute old; this is too long to wait before assessment and intervention. After the airway has been cleared and the newborn has been warmed, the respirations, HR, color, and SpO2 should be assessed and managed accordingly)

A 3-year-old girl is unresponsive and has slow, shallow breathing. Her heart rate is 65 beats/min and her skin is cyanotic. Her caregiver advises that the child ingested an unknown quantity of her narcotic painkillers. What should you do? A) Administer naloxone via the intranasal route B) Ventilate with a bag-mask device at 16 breaths/min C) Begin chest compressions at a rate of 100 to 120/min D) Administer high-flow oxygen via nonrebreathing mask

B (The child's breathing is clearly inadequate and she is significantly hyperemic. Initial treatment for an opiod OD is to optimize ventilation and oxygenation. After restoring ventilation and oxygenation, administer naloxone [Narcan] via the intranasal route. If her HR falls below 60bpm despite adequate ventilation and oxygenation, begin chest compressions)

Following a motor vehicle crash, a 3-year-old girl has an obvious deformity to the mid-shaft humerus. What should you suspect? A) This is not an uncommon injury in a small child B) She was exposed to significant traumatic force C) She has a greenstick fracture because her bones are soft D) She has an underlying condition that causes brittle bones

B (The deformity indicates a complete fracture. Fractures of the humerus or femur do not normally occur without major trauma. Infants and small children are more likely to experience a greenstick (incomplete) fracture, as opposed to complete fractures, due to their soft and pliable bones)

Which of the following would MOST likely occur in conjunction with a breech presentation? A) Vertex presentation B) Prolapsed umbilical cord C) Maternal hypertension D) Premature rupture of the amniotic sac

B (Vertex presentation: common; the baby's head is the presenting part. Breech presentation: baby's head is not the presenting part; the butt usually is. Breech presentations are associated with a higher incidence of prolapsed umbilical cord and increase the risk of delivery-related trauma to the baby)

A 7-year-old boy has respiratory distress. He is wheezing and has widespread hives and facial edema. What should you suspect? A) Heat illness B) Allergic reaction C) Acute asthma attack D) Poison oak exposure

B (Wheezing, hives, edema are hallmark findings of an allergic rxn. This pt is having a severe rxn)

Which of the following parameters is the LEAST reliable when assessing the perfusion status of a 2-year-old child? A) Capillary refill time B) Systolic blood pressure C) Skin color and temperature D) Presence of peripheral pulses

B (You should not rely on the SBP when concluding the perfusion status of anyone)

A newborn has a heart rate of 130 beats/min, cyanosis of the hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists attempts to straighten its legs. You should assign an Apgar score of: A) 7 B) 8 C) 9 D) 10

C (APGAR: obtained 1-5 minutes after birth (and every 5 minutes thereafter) is assigned to appearance, pulse, grimace, activity, and respirations. 1: APPEARANCE if the newborn is pink, but hands and feet remain blue. 2: PULSE if HR greater than 100bpm. 2: GRIMACE/IRRITABILITY if cries and tries to move its foot away when soles of its feet are flicked. 2: ACTIVITY/MUSCLE TONE if resists to attempt to straighten its hips and knees. 2: RESPIRATIONS are rapid)

Which of the following would be the MOST significant finding in a 2-month-old infant who is dehydrated? A) Dry mucous membranes B) Absence of tear production C) Delayed capillary refill time D) Heart rate of 130 beats/min

C (All the clinical findings listed are consistent with dehydration. Delayed capillary refill indicates decreased perfusion, therefore, it is the most significant finding of the options listed. Tachycardia is expected in any pt who is dehydrated)

You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be: A) preparing to treat her for a febrile seizure. B) taking her temperature to see how high it is. C) assessing the need for ventilation assistance. D) determining if the child has a history of croup.

C (Croup: laryngotracheobronchitis; a viral upper airway infection. Stridor: high-pitched sound heard during inhalation indicates the swelling of the upper airway. Signs of respiratory failure: signs of physical exhaustion, bradycardia, bradypnea)

Which of the following is a sign of inadequate breathing in an infant? A) Sunken fontanelles B) Abdominal breathing C) Expiratory grunting D) Heart rate of 130 beats/min

C (Expiratory grunting: in an infant or child with a respiratory problem is an ominous sign; it indicated impending respiratory arrest. Grunting represents the child's attempt to maintain O2 reserve in the lungs. Sunken fontanelles indicate dehydration. Bradycardia in an infant or a child with a respiratory problem indicated impending cardiopulmonary arrest)

You arrive at a residence shortly after a 4-year-old boy experienced an apparent febrile seizure. The child is alert and crying. His skin is flushed, hot, and moist. His mother tells you that the seizure lasted about 2 minutes. You should: A) begin rapid cooling measures at once. B) give him acetaminophen or ibuprofen. C) provide supportive care and transport. D) allow the mother to take her child to the doctor.

C (Febrile seizures are common in children between the ages of 6mo and 6yo. They occur when the child's body temperature suddenly rises or when an already febrile child experiences an acute fever spike. Treatment: supportive care [monitoring ABCs, administering O2 as tolerated] and transporting to the hospital. Any infant or child who experienced a seizure should be transported by EMS. A cause for the seizure may be meningitis)

A 9-year-old girl was struck by a car. She has a large contusion over the left upper quadrant of her abdomen and signs of shock. Which of the following organs has MOST likely been injured? A) Liver B) Kidney C) Spleen D) Pancreas

C (LUQ: spleen. RUQ: liver. Pancreas and kidneys lie in the retroperitoneal space)

Which of the following findings should make the EMT suspect an ectopic pregnancy in a woman who complains of abdominal pain? A) Menstrual period began 3 days ago B) Spontaneous abortion 6 months ago C) Recent pelvic inflammatory disease D) Cesarean section scar on the abdomen

C (Pelvic inflammatory disease [PID] and scarring of the fallopian tubes are risk factors for ectopic pregnancy. Is is important to remember that acute abdominal pain in any female of childbearing age, especially with a missed menstrual period, is an ectopic pregnancy until proven otherwise)

A week after a near-drowning incident, a 6-year-old boy presents with respiratory distress, tachypnea, and fever. What should you suspect? A) Asthma B) Pertussis C) Pneumonia D) Bronchiolitis

C (Pneumonia: infection of the lungs; often a secondary infection and commonly occurs during or after a pre-existing infection such as a cold. It can also be caused by direct lung injuries [accidental chemical ingestion or a submersion incident]. S/Sx: tachypnea, breathing with grunting or wheezing sounds, nasal flaring, and hypothermia or fever. Hallmark of asthma: wheezing, however, a fever is not usually present. Bronchiolitis is likely but due to this certain situation, pneumonia is more likely, and bronchiolitis more commonly affects infants and toddlers. Pertussis [whooping cough] is not likely because the child does not have a cough)

Following delivery of the baby and placenta, the mother continues to experience moderate vaginal bleeding. The EMT should: A) carefully insert several gauze pads into her vagina. B) sit her up and apply direct pressure to her vaginal area. C) keep her supine and massage the fundus of her uterus. D) place her on her side and elevate her lower extremities.

C (Postpartum hemorrhage: place mother supine and firmly massage the funds (top) of the uterus. Fundal massages causes vasoconstriction of the uterine blood vessels, which helps control bleeding. Another option is to allow the mother to nurse her baby; doing so causes her pituitary gland to release oxytocin which also causes vasoconstriction of the uterus. AWARE OF SHOCK WITH ANY BLEEDING)

In which of the following situations would the EMT MOST likely deliver a baby at the scene? A) Contractions are 8 to 10 minutes apart and irregular B) The hospital is 15 miles away and crowning is not present C) Contractions are 3 minutes apart and mother feels the urge to push D) The amniotic sac has ruptured and contractions occur regularly

C (Prepare for delivery when at the scene when delivery is imminent or can be expected within a few minutes [the mother feels the urge to push, contractions are 2-3 minutes apart and regular, crowning is present]; when a natural disaster has occurred and your route to the hospital is blocked; and when transportation is not available)

A high normal respiratory rate for an infant between 1 month and 1 year of age is: A) 30 breaths/min. B) 40 breaths/min. C) 60 breaths/min. D) 70 breaths/min.

C (The high range for 1mo-1yo is between 30-60 breaths/min. Normal respiratory rates for a toddle [1yo-3yo]: 24-40 breaths/min. Preschool children [4-5yo]: 22-34 breaths/min. School age children [6-12yo]: 18-30 breaths/min)

A child typically begins to develop stranger anxiety when he or she is a/an: A) infant. B) neonate. C) toddler. D) preschooler.

C (Toddler: 1-3yo. Toddlers often resist separation from caregivers and are afraid to let others come near them)

When you begin to assess a woman in labor, she states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be MOST appropriate to ask next? A) Has your bag of waters broken yet? B) Have you had regular prenatal care? C) At how many weeks' gestation are you? D) How many other children do you have?

C (When assessing a pregnant pt, the first question you ask is how far along in the pregnancy she is. FI she is less than 39 weeks gestation [this is considered a full term] you should prepare for possible resuscitation of the newborn if delivery occurs in the field. You should also inquire as to how many times the pt has been pregnant, regardless of whether she carries the baby to term [gravida], and the number of times she has carried a baby beyond 28 weeks, regardless of whether it was born dead or alive [para])

During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should: A) gently push the protruding arm back into the vagina. B) encourage the mother to push and give her high-flow oxygen. C) cover the arm with a sterile towel and transport immediately. D) insert your gloved fingers into the vagina and try to turn the baby.

C (You can not successfully deliver a limb presentation in the field. Instruct the mother to stop pushing if she is experiencing a contraction and instruct her to pant. Pushing may place pressure on the fetus, potentially causing injury. Cover the protruding limb with a sterile dressing or towel and transport immediately. Place the mother on her back, with head down and pelvis elevated. Give mother high-flow O2)

You are performing CPR on a 3-year-old child while your partner prepares the AED. What compression to ventilation ratio should you be providing? A) 3 to 1 B) 15 to 2 C) 30 to 1 D) 30 to 2

D

The purpose of the pediatric assessment triangle is to: A) identify if the child has a medical condition or a traumatic injury. B) detect immediate life threats through a quick hands-on assessment. C) determine whether or not the child requires a hands-on assessment. D) form a general impression of the child without touching him or her.

D ("First glance" assessment to identify the general category of the child's physiologic problem and to establish urgency for treatment and/or transport. Consists of three elements: appearance [muscle tone and mental status], work of breathing, and circulation to the skin)

A 32-year-old woman who is 36 weeks pregnant complains of a sudden onset of severe abdominal pain, which she describes as a tearing sensation, and vaginal bleeding. Her medical history includes hypertension and she admits to using cocaine. Which of the following should you suspect? A) The umbilical cord is wrapped around the baby's neck B) The placenta has implanted over the cervical opening C) Excessive fetal movement has torn the amniotic sac D) The placenta has detached from the wall of the uterus

D (Abruptio placenta: when the placenta acutely detaches from the uterine wall. S/Sx: acute severe abdominal pain that is often described as a ripping or tearing sensation; vaginal bleeding; signs of shock. Risk factors: hypertension, abdominal trauma, and cocaine use. Cocaine is a vasoconstrictor and frequent use can cause vascular injury. In pregnant pts, this can cause premature placental separation. Placenta previa: when part or all of the placenta implants over the cervical opening; vaginal bleeding is common, but abdominal pain is not)

You receive a call for a 4-month-old male who suddenly became limp, cyanotic, and apneic. Upon EMS arrival, the mother tells you that she flicked his feet and he woke up. He is breathing adequately. He has good muscle tone and his skin is warm and pink. What should you do? A) Administer oxygen via nonrebreathing mask B) Allow a parent to transport him to the hospital C) Contact the infant's pediatrician to seek advice D) Transport to the hospital and monitor him en route

D (Apparent life-threatening event [ATLE]: when parents sometimes find their child who has cyanosis and apneic and are unresponsive, but resume normal breathing and normal color with stimulation. Characterized by a distinct change in muscle tone [limpness] and choking or gasping. After ATLE, you may find an infant who appears healthy and shows no signs of illness or distress. Even though the infant appears normal now, something happened acutely to cause the initial problem)

If a woman is having her first child, the first stage of labor: A) generally does not allow time for you to transport. B) is typically very short and lasts only about 2 hours. C) is shorter than in women who have had other children. D) is usually the longest and lasts an average of 16 hours.

D (Because the cervix has to be stretched thin by uterine contractions and until the opening is large enough for the fetus to pass through inmate the vagina, the first stage is usually the longest, lasting an average of 16 hours for a first delivery. With subsequent pregnancies, the first stage typically progresses faster. You will usually have enough time to transport the mother during the first stage of labor, especially if this is her first pregnancy)

A newborn has cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do? A) Resuction the mouth B) Briskly dry off the infant C) Begin chest compressions D) Begin artificial ventilations

D (Central cyanosis [head, face, and trunk] alone should be treated with blow-by O2; however, when it is accompanied by HR less than 100bpm, artificial ventilations should be initiated and continued until the HR exceeds 100bpm. Chest compressions are needed when HR is less than 60bpm, despited 30 seconds of adequate positive-pressure ventilation)

At what stage during pregnancy does the embryo become a fetus? A) 2 weeks B) 6 weeks C) 8 weeks D) 10 weeks

D (Embryo: 0-10 weeks after fertilization; fetus: 10 weeks-delivery [40 weeks])

A woman is 30 weeks pregnant. During your assessment, she tells you that she delivered a stillborn baby at 38 weeks and currently has no living children. How should you document her obstetric history? A) Gravida 1; para 1 B) Gravida 2; para 1 C) Gravida 1; para 2 D) Gravida 2; para 2

D (Gravida= # of times a woman has been pregnant, regardless of the length of the pregnancy. Para= # of babies carried beyond 28 weeks, regardless of whether the baby was born dead or alive. Since this pt has surpassed week 28 of her current pregnancy, and delivered her last baby past 28 weeks, she is para 2)

During respiratory distress, a child is trying to keep the alveoli open by increasing pressure in the chest cavity. What sound would you expect to hear? A) Stridor B) Crackles C) Wheezing D) Grunting

D (Grunting sound is head during exhalation reflects the pediatric pt's attempt to keep the alveoli open by increasing pressure in the chest cavity; it is a sign of inadequate oxygenation. Stridor: high-pitched sound head during inhalation; it indicates inflammation or a partial obstruction of the upper airway. Crackling or bubbling: fluid in the lungs. Wheezing: high or low pitched whistling sound that is usually heard during exhalation; it indicates a partial lower airway obstruction caused by bronchospasm [asthma, bronchiolitis])

After drying, warming, and suctioning a newborn's mouth and nose, assessment reveals central cyanosis, a weak cry, and a heart rate of 60 beats/min. What should you do? A) Clamp and cut the umbilical cord and transport at once B) Begin chest compressions and reassess after 30 seconds C) Resuction the mouth and nose and reassess the heart rate D) Ventilate with a bag-valve-mask at 40 to 60 breaths/min.

D (Initial treatment for a cyanotic and bradycardia newborn is PPV. Ventilate the newborn with a BVM at a rate of 40-60 breaths/min and then reassess the HR after 30 seconds. If the HR is below 60bpm after 30 seconds of adequate PPV, you should begin chest compressions. The umbilical cord should not be clamped and cut until it stops pulsating and the newborn is breathing adequately)

To maintain neutral alignment of an 18-month-old child's airway, you should: A) hyperextend the head. B) slightly flex the head. C) place a rolled towel under the back of the head. D) place padding in between the shoulder blades.

D (Padding behind the head places the child's head in the sniffing position, which is used to facilitate intubation. If the infant's or child's head is hyperextended, the large occiput [back of the head] may push the head forward, resulting in hyperextension. Flexing the child's head can collapse the trachea)

You should assist with the delivery of the baby's head by: A) carefully rotating its head to where it is facing up when it delivers. B) placing the palm of your hand firmly against the back of the baby's skull. C) grasping each side of the baby's head and gently pulling to facilitate delivery. D) placing your fingers on the bony part of the skull and applying gentle pressure.

D (Place flat parts of your fingers on the bony part of the skull as it emerges from the vagina and then applying gentle pressure to avoid an explosive delivery)

Which of the following clinical signs would you MOST likely observe in an infant or small child with a tension pneumothorax? A) Tracheal deviation B) An irregular pulse C) Distended jugular veins D) Progressive respiratory distress

D (Progressive respiratory distress following a chest injury is a critical finding in any pt and should make you suspect increasing pleural tension with resultant collapsing of the lung. Due to their short neck, jugular veins can be very difficult to assess in infants and small children. Tracheal deviation, and extremely late sign, occurs on the lower part of the trachea, near the carina; without a chest x-ray, one cannot appreciate this finding. An irregular pulse is not a common finding in pts with a tension pneumothorax, regardless of age)

A prolapsed umbilical cord is dangerous because the: A) cord might pull the placenta from the uterine wall during delivery. B) mother may die of hypoxia due to compromised placental blood flow. C) cord may be wrapped around the baby's neck, causing strangulation. D) baby's head may compress the cord, cutting off its supply of oxygen.

D (Prolapsed umbilical cord: a portion of the umbilical cord delivers before the baby, cutting off its own supply of O2. When a prolapsed umbilical cord is discovered, it is important to act fast. Place the mother in a position in which her hips are elevated. It may be necessary to insert your gloved fingers into the vagina and lift the baby's head off the cord. Nuchal cord: when the umbilical cord is wrapped around the baby's neck. A nuchal cord and a prolapsed umbilical cord usually do not occur at the same time)

A 4-year-old child has had several generalized tonic clonic seizures over the past 20 minutes, but never woke up in between the seizures. The child's skin is hot and flushed. What should you suspect? A) febrile seizure B) A focal motor seizure C) An absence seizure D) Status epilepticus

D (Status epilepticus: prolonged [greater than 20 min] seizure or multiple seizures without return of consciousness in between seizures. Febrile seizure: last less than 5 minutes, have resolved by the time EMS arrives at the scene, and are not followed by a postictal period. Absence seizure: characterized by blank stare and an absence of tonic-clonic motor activity; usually of short duration and are not followed by a postictal period. Focal motor seizure: isolated to one part of the body [such as an extremity] but can progress to a generalized tonic clonic seizure)

Prevention of cardiac arrest in infants and small children should focus primarily on: A) keeping the child warm. B) avoiding upsetting the child. C) providing immediate transport. D) ensuring adequate ventilation

D (The most common cause of cardiac arrest in infants and children is failure of the respiratory system. It is key to ensure adequate ventilation and oxygenation to prevent cardiac arrest)

Which of the following assessment findings would indicate primary central nervous system dysfunction in an infant or small child? A) Nasal flaring B) Easily distracted C) Pale extremities D) Poor muscle tone

D (When assessing a child or infant, the pediatric assessment triangle [PAT] will enable you to determine, by visual inspection, if the problem is neurologic, respiratory, or circulatory)

Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should: A) massage the lower part of the mother's uterus until the placenta delivers. B) give the newborn high-flow oxygen via a nonrebreathing mask and transport. C) reassess the newborn every 5 minutes and transport after the placenta delivers. D) keep the newborn warm, give oxygen to the mother if needed, and transport.

D (You should not wait at the scene for the placenta to deliver; it can take up to 45 minutes. Massaging the uterine fundus is indicated for women with postpartum vaginal bleeding [both baby and placenta have delivered])

A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. What should you suspect? A) Croup B) Epiglottitis C) Lower respiratory infection D) Foreign body airway obstruction

D (You should suspect a foreign body airway obstruction in any child who presents with an acute onset of respiratory distress in the absence of fever or any other symptoms that could be caused by infection. Croup, epiglottis, and lower airway infections [bronchiolitis, bronchitis] commonly present with a fever. If signs fo a severe airway obstruction are present [ineffective cough, decreased LOC, cyanosis], you should perform abdominal thrusts until the object is expelled or the child becomes unresponsive. If the child becomes unresponsive, perform chest compressions)

After the baby's head delivers, it is usually tilted: A) with the face up. B) posteriorly, face down. C) posteriorly, to one side. D) anteriorly, with the chin up.

C

Immediately upon delivery of a newborn's head, you should: A) dry the face. B) cover the eyes. C) suction the nose. D) check for a nuchal cord.

D

A 3-year-old girl presents with respiratory distress. Her mother is holding the child, who does not react to your presence. This finding indicates that the child: A) has severe hypoxia. B) probably is sleeping. C) is afraid of your presence. D) is reacting normally for her age.

A

A 5-year-old child has burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned? A) 45% B) 54% C) 63% D) 72%

A

You are assessing a 5-year-old boy with major trauma. His blood pressure is 70/40 mm Hg and his pulse rate is 140 beats/min. and weak. The child's blood pressure: A) indicates decompensated shock. B) reflects adequate compensation. C) is appropriate based on his age. D) suggests increased intracranial pressure.

A

A 5-year-old child has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should: A) lower the extremities and reassess the child. B) begin positive-pressure ventilations and reassess the child. C) insert a nasopharyngeal airway and increase the oxygen flow. D) listen to the lungs with a stethoscope for abnormal breath sounds.

A (Because infants and small children rely heavily on their diaphragm for breathing [belly breathers], elevating their lower extremities can cause the diaphragm to shift into the thoracic cavity and decrease the effectiveness of breathing. Therefore, you should lower the lower extremities and reassess. A supine position is recommended for any pt in shock, regardless of age)

General guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion include: A) examining the child in the parent's arms. B) palpating the painful area of the abdomen first. C) placing the child supine and palpating the abdomen. D) separating the child from the parent to ensure a reliable examination.

A (If the child's condition is stable, the parent should be allowed to hold the child during the examination. This will minimize the anxiety in the child and will make the assessment easier for you. You should avoid separating the child and parents unless the child's condition warrants it)

While triaging patients at the scene of a mass-casualty incident, you encounter a 3-year-old boy who is unresponsive and apneic. After opening his airway, you determine that he remains apneic. According to the JumpSTART triage model, what should you do next? A) Assess for a palpable pulse B) Deliver 5 rescue breaths C) Assign him as immediate D) Assign him as deceased

A (JumpSTART triage model: intended for children younger than 8 years of age or who appear to weigh less than 100 lbs. If the child is unresponsive and apneic, you should open the airway. If the child begins to breathe, assign an immediate category. If the child remains apneic, assess for the presence of a pulse. If there is no palpable pulse, a decreased category is assigned. If a palpable pulse is present, deliver 5 rescue breaths. If breathing resumes after 5 rescue breaths, assign an immediate category. If the child remains apneic, assign a deceased category)

Signs and symptoms of pelvic inflammatory disease include: A) generalized lower abdominal pain, nausea, and fever. B) pain around the umbilicus and heavy vaginal bleeding. C) abdominal cramping and an odorless vaginal discharge. D) upper abdominal pain, diarrhea, and an absence of fever.

A (PID: infection of the upper female reproductive organs [uterus, ovaries, and fallopian tubes]. It occurs almost exclusively in sexually active women, In PID, disease-causing organisms enter the vagina during sexual activity and migrate through the cervical opening and into the uterine cavity. The infection may then progress to the Fallopian tubes, producing scarring that can increase the risk for ectopic abdominal pain. S/Sx: abnormal and often foul-smelling vaginal discharge, increased pain during sex, fever, general malaise, and nausea and vomiting. Diarrhea and vaginal bleeding are not common signs of PID)

Upon assessing a newborn, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What should you do? A) Initiate positive-pressure ventilations B) Provide blow-by oxygen with oxygen tubing C) Assess the newborn's skin condition and color D) Start chest compressions and contact medical control

A (PPV is indicated in the newborn if he or she is apneic or has gasping respirations, HR less than 100bpm, or if central cyanosis persists despite the delivery of blow-by O2)

A 5-year-old, 40-pound child was bitten by fire ants and is semiconscious. His breathing is labored and shallow, he has audible stridor, and his blood pressure is low. Which of the following would be the MOST appropriate treatment for him? A) Ventilation with a bag-mask device and 0.15 mg epinephrine via auto-injector B) Oxygen via nonrebreathing mask and 0.3 mg epinephrine via auto-injector C) Ventilation with a bag-mask device and 0.3 mg epinephrine via auto-injector D) Oxygen via nonrebreathing mask and 0.15 mg epinephrine via auto-injector

A (Pts who weigh between 15 and 30kg [33 to 66 lbs] should take 0.15 mg via EpiPen Jr. Pts who weigh more than 30kg [66lbs] should receive 0.3 mg of epinephrine)

A 3-year-old female presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal retractions and an oxygen saturation of 91%. What should you do? A) Gently restrain the child and assist her ventilations B) Ask the mother to hold an oxygen mask near the child's face C) Apply a nasal cannula with the flow rate set to 6 L/min D) Apply a nonrebreathing mask with the flow rate set to 12 L/min

B

The function of the uterus is to: A) dilate and expel the baby from the cervix. B) house the fetus as it grows for 40 weeks. C) provide oxygen and other nutrients to the fetus. D) provide a cushion and protect the fetus from infection.

B

Which of the following statements regarding two-rescuer child CPR is correct? A) The chest should not be allowed to fully recoil in between compressions, as this may impair venous return. B) Compress the chest with one or two hands to a depth that is equal to one-third the diameter of the chest. C) The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered. D) A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations.

B

A 2-year-old boy experienced a seizure that lasted 3 minutes. His mother states that he began running a fever earlier in the day. He is alert, crying, and is clinging to his mother. His skin is hot and flushed and his heart rate is 140 beats/min. What should you do? A) Place him in a cold-water bath to reduce his fever B) Remove any unnecessary clothing and transport C) Administer chewable aspirin if his mother has any D) Allow his mother to transport him to his pediatrician

B (Febrile seizure: most are short-lived. The primary focus of treatment is to make the child comfortable, remove any heat-retaining clothing, and transport to the hospital. Administer O2 if there is evidence of hypoxemia. Aspririn should not be administered to children because it increases the risk of Reye's syndrome [rare but serious condition that causes swelling in the liver and brain])

After 30 seconds of positive-pressure ventilation, a newborn's heart rate is 50 beats/min and its face and trunk are cyanotic. The EMT should: A) give blow-by oxygen. B) begin chest compressions. C) increase the ventilation rate. D) resuction the mouth and nose.

B (Immediate treatment for newborn bradycardia [less than 100bpm] involved positive-pressure ventilation. If the heart falls below 60bpm despite PPV, begin chest compressions)

The preferred method for inserting an oropharyngeal airway in a small child is to: A) insert the airway with the curvature toward the roof of the mouth and then rotate it 180 degrees. B) depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue. C) open the airway with the tongue-jaw lift maneuver and insert the airway until you meet slight resistance. D) insert the airway as you would in an adult, but use an airway that is one size smaller than you would normally use.

B (Since the child's tongue is proportionately large, insert the OPA by using a tongue blade to depress the tongue and slide the airway straight in, with the downward curve of the airway facing the tongue, and until it rests just beyond the curvature of the tongue)

A 30-year-old female presents with vaginal bleeding and lightheadedness. She states that she has soaked four sanitary pads. Her BP is 90/50 mm Hg, her pulse rate is 120 beats/min, and her respiratory rate is 24 breaths/min. What should you do? A) Instruct her to insert a tampon to help control the bleeding B) Position her supine and prepare for immediate transport C) Position her on her side and reassess her blood pressure D) Place a trauma dressing over her vagina and apply pressure

B (The pt is in shock and requires immediate transport. Position her supine, keep her warm, and administer supplemental O2. her bleeding is coming from a source that you cannot control. Direct pressure to the vaginal area will not accomplish bleeding control, nor will a tampon)

The MAIN reason why small children should ride in the backseat of a vehicle is because: A) they are much less likely to be ejected from the vehicle. B) the back of the front seat will provide a cushion during a crash. C) they can experience severe injury or death if the air bag deploys. D) their legs are highly prone to injury from striking the dashboard.

C

Which of the following injuries is MOST indicative of child abuse? A) Small laceration to the chin B) Burned hand with splash marks C) Bruising to the upper back D) Multiple bruises to the shins

C

You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. What should you do? A) Inform the parents of your suspicions B) Call the police and have the parents arrested C) Advise the parents that the child needs to be transported D) Transport the child to the hospital regardless of the parent's wishes

C

Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include: A) high-flow oxygen via nonrebreathing mask and rapid transport. B) oxygen via a nasal cannula at 6 L/min and rapid transport. C) positive-pressure ventilation, chest compressions, and rapid transport. D) back slaps and chest thrusts while attempting artificial ventilations.

C (A HR less than 60bpm in an infant or child, especially accompanied by signs of poor perfusion and inadequate breathing, should be treated with PPV, chest compressions, and rapid transport. Passive oxygenation [nasal cannula, NRB] is not appropriate for a child with inadequate ventilation, especially accompanied with bradycardia)

Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. Treatment should include: A) uterine massage for 5 minutes, and then transport. B) placing her in a left-lateral recumbent position and transport. C) treating for shock and performing uterine massage during transport. D) placing sterile pads into her vagina and treating for shock during transport.

C (Blood loss of up to 500mL within the first 24 hours after delivery is considered normal and usually is well tolerated by the mother. However, any bleeding, regardless of severity, with accompanying signs of shock, must be treated at once. In this case, high flow O2, treat for shock [keep her supine and cover her with warm blankets], and provide rapid transport while massaging the uterine fundus en route)

A woman who is 34 weeks pregnant is in cardiac arrest. During the resuscitation attempt, you should: A) defer defibrillation until arrival at the hospital. B) perform chest compressions at a faster rate. C) manually displace the uterus toward the left. D) allow partial chest recoil in between compressions.

C (If the women is in the last month or two of pregnancy, compressions may need to be performed a little higher on the sternum than usual. This is because the pregnant uterus can push the heart higher into the chest cavity. Otherwise, compressions should be at a rate of 100-120/min, at a depth of at least 2 inches. Full recoil of the chest is critical in allowing more blood to return to the heart. A person should be assigned to manually displace the uterus to the left; this relieves pressure from the inferior vena cava and facilitates blood return to the heart)

Which artery should you palpate when assessing for a pulse in an unresponsive 6-month-old patient? A) Radial B) Carotid C) Femoral D) Brachial

D (Assess the brachial pulse in infants younger than 1yo. The femoral or carotid pulse can be assessed in children older than 1yo)

When caring for a woman who was sexually assaulted, the EMT should: A) ask the patient if she wishes to change her clothes. B) obtain a concise, detailed account of what happened. C) place any articles of her clothing in a clean plastic bag. D) focus any assessments on life-threatening conditions.

D (Your immediate assessment should focus on finding and treating immediately life threatening injuries or conditions. Discourage the pt from showering, urinating, or changing clothes. Any articles of clothing should be placed in a paper bag. Documentation of the call should include information that is relevant to pt care; concise, detailed info regarding what happened will be gathered by law enforcement personnel)