Chapter 4 Pediatrics
Capillary refill time is considered reliable as a sign of perfusion primarily in children less than ______________ years of age. A six B seven C eight D nine
A
Conditions that place a pediatric patient at risk of cardiopulmonary arrest include all of the following except ______________. A respiratory rate greater than 40. B delayed capillary refill. C heart rate greater than 180 or less than 80 (under five years of age). D heart rate greater than 180 or less than 60 (over five years of age).
A
In the secondary assessment of a 7-year-old child with difficulty breathing and a history of reactive airway disease, which of the following would give the paramedic the least amount of relevant information about the patient's ventilation and oxygenation? A. Palpating the abdomen B. Pediatric GCS score C. Listening to the breath sounds D. Pulse oximetry reading
A
Several large EMS systems have abandoned the practice of pediatric endotracheal intubation in favor of simple: A. bag-valve mask (BVM) ventilation B. tracheotomy. C. CPAP. D. rapid transport.
A
What age should a pediatric patient be before blood pressures are routinely utilized? A. 3 years B. 5 years C. 1 year D. 1 month
A
What is the oxygenation goal for a pediatric patient receiving oxygen? A. SpO2 of 94 percent or greater B. SpO2 of 100 percent for pediatric patients without a history of pulmonary disease C. SpO2 of 95 percent or greater except newborns, who should always receive 100% O2 until reaching the ED regardless of SpO2 D. A heart rate of 100 is reached
A
What term is used to describe the situation in which a child is regularly threatened, yelled at, or humiliated but not otherwise harmed? A. Psychological abuse B. Physical abuse C. Social abuse D. Sexual abuse
A
Which of the following is the most common cause of cardiac arrest in an infant or young child? A. Airway and respiratory problems B. Commotio cordis C. Congenital heart disease D. Acute myocardial infarction
A
Which of the following statements is accurate regarding sudden infant death syndrome (SIDS)? A. The cause of SIDS is not yet known; SIDS is a diagnosis that is given when other potential causes of death have been ruled out. B. Frothy pink sputum or fluid from the mouth or nose of a deceased infant is not associated with SIDS. C. SIDS is generally caused by suffocation. D. SIDS usually is characterized by a combination of apnea, color change, limpness, and choking or gagging in an infant that alarms the caregiver.
A
Which of these statements best describes why paramedics should be knowledgeable about pediatric patients who are dependent on medical technology? A. EMS may be called when the medical condition worsens or a medical device fails. B. EMTs must be able to make emergency repairs or adjustments to life-sustaining equipment. C. EMS providers are involved in routine home health care of patients with special medical challenges. D. A public health function of EMS is to make routine checks of specialized medical devices.
A
Which statement best describes the purpose of the JumpSTART triage method? A. To do the most good for the greatest number of patients B. To find and treat all of a patient's injuries before moving him or her C. To treat all patients as they are discovered D. To treat the youngest, healthiest patients first
A
You are assessing a pediatric patient who has a rapid respiratory rate, absent alveolar breath sounds, a dropping pulse oximetry reading, and a spontaneous pulse of 102. What should you do next? A Initiate positive pressure ventilation. B Initiate an IV of normal saline or Ringer's lactate. C Gather a SAMPLE history from the patient's parents. D Apply oxygen via blow-by at 15 lpm.
A
You respond to a call for a 10-year-old patient who hit a road sign while traveling at high speed on a bicycle. The child is unconscious with no eye opening or motor or verbal response and has a severe contusion to the head. You note elevated blood pressure but a depressed heart rate with decreasing, deep respirations and an SpO2 of 92 percent. What do you assess as the problem and how do you manage this patient? A. Severe traumatic brain injury with increasing intracranial pressure, to be managed with rapid sequence intubation, ventilation, supplemental oxygen, and rapid transport to a pediatric trauma facility B. Moderate traumatic brain injury with increasing intracranial pressure, to be managed with endotracheal intubation, ventilation, supplemental oxygen, and rapid transport to a pediatric trauma facility C. Severe traumatic brain injury with increasing intracranial pressure, to be managed with rapid sequence intubation and rapid transport to a pediatric trauma facility D. Mild traumatic brain injury with decreasing intracranial pressure, to be managed with rapid sequence intubation, ventilation, supplemental oxygen, and rapid transport to a pediatric trauma facility
A
You respond to a shooting at a high school; the shooter has been apprehended, and law enforcement has certified the scene as safe. A 16-year-old patient presents with a small-caliber gunshot wound in the lower middle abdomen. The gunshot wound is small and not bleeding much, and there is no exit wound. This presentation suggests that: A. internal bleeding and possible organ damage should be suspected. B. there is little to no internal bleeding. C. the patient's injury is minor and self-contained. D. the patient should receive a full physical exam.
A
You should consider the heart rate of a 5-year-old patient to be bradycardic beginning at a rate below how many beats per minute? A. 70 B. 90 C. 80 D. 60
A
Above what respiratory rate would a 10-year-old child be considered to be breathing abnormally fast? A. 20/min B. 30/min C. 24/min D. 36/min
B
According to the pediatric assessment triangle, which of the following is used to assess circulation to the skin? A. Skin temperature B. Skin color C. Peripheral pulses D. Capillary refill time
B
A viral infection of the pediatric upper airway that results in inflammation of the subglottic region is known as: A. epiglottitis. B. croup. C. bronchitis. D. bronchiolitis.
B
An inflammation of an airway structure that is often due to a bacterial infection in children and is known to be potentially life threatening is: A. laryngeotracheobronchitis. B. epiglottitis. C. nasopharyngealitis. D. glottitis.
B
A seven-year-old female patient who was drowning in a pond was rescued and resuscitated prior to your arrival. It is a cold day and the water soaking the patient's clothing is very cold. What can you assume for this patient? A. Having been resuscitated, the child will suffer no ill effects from anoxia. B. The low temperature of the water might have helped protect the child against brain injury. C. The child experienced drowning without morbidity. D. The child is not in danger of neurological deficits because she only experienced a near drowning.
B
Children in which age group should be examined in toe-to-head order? A Infants, ages 1-5 months B Infants, ages 6-12 months C Preschoolers, ages 3-5 years D School-age children, ages 6-12 years
B
Evaluation of breathing adequacy in the pediatric patient includes assessment of all of the following conditions except ______________ A breath sounds. B heart rate. C respiratory rate. D respiratory effort.
B
Generally, adolescents: A. defer to authority. B. are good historians. C. follow their parents' lead. D. are unreliable witnesses.
B
JumpSTART provides a framework for triage decisions that is: A. unjust. B. objective. C. emotional. D. biased.
B
The ______________ was formed for the express purpose of improving the health of pediatric patients who suffer potentially life-threatening illnesses or injuries. A APLS B EMSC C AHA D PEPP
B
The combination of increased oxygen requirements and decreased oxygen reserves makes infants and children especially susceptible to ______________ A trauma. B hypoxia. C epilepsy. D diabetes.
B
What finding in a distressed infant or child may indicate hypoxia and is an ominous sign of cardiac arrest? A Retraction B Bradycardia C Tachycardia D Head bobbing
B
What is the most common cause of pediatric bradyarrhythmias? A Alkalosis B Hypoxia C Acidosis D Hypothermia
B
What should be the initial dosage of an isotonic crystaline solution for use in a 4-year-old hypovolemic shock patient? A 10 mL/kg B 20 mL/kg C 25 mL bolus D 30 mL bolus
B
Which of the following characterizes febrile seizures? A. Typically have no known cause B. Recent onset of fever or cold symptoms C. Generally occur in children between 5 and 10 years of age D. Generally occur when the external temperature is greater than 103 degrees Fahrenheit
B
Which of the following findings seems least consistent with child abuse? A. Bite marks on the shoulder of a 1-year-old B. Bruises on both knees of a 5-year-old C. Bilateral foot burns in a 6-month-old D. Circumoral ecchymosis of a 3-month-old
B
Which of the following medications is not used in pediatric cardiac arrest? A Epinephrine B Atropine C Lidocaine D Oxygen
B
Which of the following would arouse your suspicions of child neglect? A. Delay in reporting the injury B. Malnutrition C. Injuries to the genitals D. Unusual knowledge of sexual activity
B
Which of these terms should be used to convey the preventable nature of childhood trauma? A. Accident B. Injury C. Misadventure D. Mishap
B
Which stage of shock develops when the body can no longer compensate for decreased tissue perfusion and the patient enters cardiac arrest? A Compensated B Irreversible C Anaphylactic D Decompensated
B
A 12-year-old patient collided face first with another child while both were riding bikes. The patient bit his tongue when his jaw was struck and received a black right eye and bloody nose. He is alert and oriented, and after you suction some blood from his airway appears to have no respiratory compromise, with respirations clear bilaterally and 20/minute. Your index of suspicion should be high for what other injury? A. Cervical spine B. Severe traumatic brain injury C. Dental D. Chest
C
Above what respiratory rate would a 10-year-old child be considered to be breathing abnormally fast? A. 24/min B. 36/min C. 30/min D. 20/min
C
According to the pediatric assessment triangle, which of the following is used to assess the work of breathing when forming a general impression of the patient? A. Skin color B. Heart rate C. Presence of grunting, stridor, wheezing, crowing D. Auscultating the lung sounds
C
An inflammation of an airway structure that is often due to a bacterial infection in children and is known to be potentially life threatening is: A. glottitis. B. laryngeotracheobronchitis. C. epiglottitis. D. nasopharyngealitis.
C
A 2-year-old child ingested some lamp oil intended for use in an old-fashioned kerosene lamp. The patient presents with a depressed respiratory rate, gastrointestinal irritation, and a diminished level of consciousness. What type of poisoning do you suspect? A. Antihypertensive B. Digitalis C. Hydrocarbon D. Acetaminophen
C
A 7-year-old child following a drowning incident in a swimming pool is pulseless and apneic. Treatment for this patient should not include: A. administration of CPR. B. placement of an advanced airway. C. epinephrine administration every 5 to 15 minutes. D. placement of an IV.
C
A four-year-old male patient presents with stridor, a cough, and hoarseness when speaking. The paramedic should: A. begin CPR. B. perform a series of abdominal thrusts. C. place the patient in a position of comfort and transport immediately. D. perform a series back blows followed by a series of chest thrusts.
C
Compared to an adult's, an infant's or child's: A. chest muscles tire less easily. B. mediastinum is less mobile. C. lung tissues are more fragile. D. ribs are harder and stiffer.
C
The majority of childhood medical emergencies involve which body system? A Nervous B Endocrine C Respiratory D Cardiovascular
C
The mildest form of respiratory impairment is classified as respiratory ______________ A arrest. B failure. C distress. D compromise.
C
The term neonate describes infants from birth to what age? A One week B Two weeks C One month D Two months
C
What is the initial setting for asynchronous cardioversion in a pediatric cardiac arrest patient displaying ventricular tachycardia? A 2 joules per pound B 4 joules per pound C 2 joules per kilogram D 4 joules per kilogram
C
What is the single most common cause of injury in children? A Motor vehicle collisions B Burns C Falls D Drownings
C
Which information should raise the index of suspicion for abuse? A. A 10-month-old who was being taken for a stroll has an insect bite. B. A 16-year-old with a lacerated knee is wearing ripped jeans and a t-shirt that exposes one shoulder. C. Parents of a child with multiple bruises and burns offer inconsistent explanations that are not consistent with the types of injuries. D. A 9-year-old has bruises to her face, which she says are from falling while playing.
C
Which of the following actions should you take if you suspect that your pediatric patient is a victim of abuse? A. Tell the parents that you are obligated by law to contact law enforcement and that they need to stay on the scene until law enforcement arrives. B. Contact medical direction to report your suspicions and request direction about contacting law enforcement. C. Report your findings to the appropriate authorities, including to the receiving hospital personnel. D. Request a social services follow-up visit for after the child is discharged from the hospital.
C
Which of the following best identifies the age group of patients who should be triaged by using the JumpSTART system? A. School-age and adolescent children B. Infants, toddlers, and preschoolers C. Patients who look younger than a young adult D. Toddlers and preschoolers
C
Which of the following characterizes febrile seizures? A. Generally occur when the external temperature is greater than 103 degrees Fahrenheit B. Generally occur in children between 5 and 10 years of age C. Recent onset of fever or cold symptoms D. Typically have no known cause
C
Which of these is the best description of asthma? A. Bacterial infection of the lower airways B. Viral infection of the lower airways C. Inflammatory disease of the lower airways D. Bacterial or viral disease of the upper airways
C
Which of these statements is true? A. Something is not sexual abuse unless it involves an overt act involving physically touching the victim. B. The victims of sexual abuse typically do not know the perpetrators. C. The paramedic always must report suspected sexual abuse to the appropriate authorities and the medical personnel who will be assuming care of the patient. D. Sexual abuse typically causes physical harm and so rarely goes unreported for long.
C
While gathering information to document in your PCR report regarding a case of suspected abuse, which of the following activities should you avoid? A. Documenting statements from siblings B. Being supportive toward the parents C. Cross-examining the parents D. Allowing a parent to accompany you to the ED
C
While you are questioning a 4-year-old with abdominal pain, he tells you that his stomach started hurting last week. Which of the following should you do next? A. Understand that pain of this duration is always an emergency. B. Ask the parents why they waited so long to seek help. C. Continue questioning the child but verify information with the parents. D. Continue your interview with the parents because the child is unreliable.
C
You are caring for a 5-year-old who was injured when his older brother accidentally stabbed him in the thigh with a pocketknife. The patient has lost about 350 mL of blood. He is pale, with cool, diaphoretic skin, and is awake but very still. As part of your treatment, you have applied direct pressure to the wound, applied oxygen, and covered the patient with a blanket. The patient's mother is very upset and does not want to let go of the child's hand. How should you go about completing your treatment? A. Ask the mother why the boys weren't supervised more closely. B. Tell the mother she needs to stay out of the way so you can do your work. C. Show the mother where to sit so she can remain with the child while allowing you to work. D. Ask your partner to take the mother to another room so you can work.
C
You are on scene with a pediatric patient who is obtunded due to a congenital brain defect. As you are assessing the patient, you note that she has a gastric feeding tube and currently is hooked up to a machine that is delivering a feeding. You have not seen this type of pump before and have little experience with gastric tubes. What action should you take? A. Turn off the equipment in preparation for transport. B. Take the equipment with the patient. C. Ask the patient and caregivers about the device. D. Disable any alarms on the equipment in preparation for transport.
C
You are suctioning a 10-year-old female patient's airway following the patient having vomited. The patient has a decreased level of consciousness. You should: A. stimulate the vagus nerve. B. decrease suction pressure to less than 100 mmHg. C. suction no deeper than you can see. D. use the largest flexible catheter available.
C
You are transporting a dehydrated 9-month-old who has had a fever, vomiting, and diarrhea for 12 hours. He is lethargic with pale, cool, mottled skin and capillary refill time of 4 seconds. His respiratory rate is 38, and you have initiated oxygen administration and have started an IO infusion followed by an initial bolus of fluid according to protocol. The patient's perfusion has not improved. Which of the following is the best choice with regard to fluid resuscitation? A. Maintain the fluid at a keep-open rate B. Infuse fluids wide-open C. Give a second bolus of 20 mL/kg D. Give a larger second bolus of 40 mL/kg
C
You should consider the heart rate of a 5-year-old patient to be bradycardic beginning at a rate below how many beats per minute? A. 80 B. 60 C. 70 D. 90
C
Children in which age group worry about their physical image more than those in any other pediatric age group? A Infants, ages 1-5 months B Toddlers, ages 1-3 years C School-age children, ages 6-12 years D Adolescents, ages 13-18 years
D
Documenting a suspected child abuse case in your patient care report should: A. be accompanied by a detailed account of whether you feel mental illness is the cause of the abuse. B. be deferred until law enforcement has questioned the family. C. happen on arrival at the emergency department and transfer of care. D. follow a discussion with legal counsel regarding what you are allowed to document.
D
During the management of a pediatric patient with a reactive airway disease and wheezing, you elect to provide a nebulized bronchodilator. Any of the following drugs could be used for this purpose in a pediatric patient except ______________ A levalbuterol. B metaproterenol C albuterol D beclomethasone
D
High winds blew down a tent at an outdoor high school graduation reception. A fire started from the fuel used for the hot buffet. Several people were injured by the tent collapse, and several patients have burns. The first patient you triage is a 3-year-old girl. She is not breathing. You open her airway, but she does not start breathing. What is the next action? A. Deliver five rescue breaths. B. Categorize the patient as black. C. Start CPR, beginning with chest compressions. D. Check the patient's pulse.
D
If present, which of the following findings should alert the paramedic that a child is in respiratory failure? A. Retractions B. Grunting C. Head bobbing D. Profound cyanosis
D
The less frequently a paramedic uses a skill, the: A. more likely it is never to be necessary. B. less time it will take to perform. C. more frequently it should be practiced. D. more likely that it is outside the scope of the paramedic's practice.
D
What is a common complication of a tracheostomy tube that a mucus plug may cause? A. Air leakage B. Altered mental status C. Air embolism D. Obstruction
D
What is the proper dose of amiodarone for a pediatric patient? A 1.0 mg B 0.5 mg/kg C 2.5 mg D 5.0 mg/kg
D
What type of shock in the pediatric patient occurs when there is a marked decrease in peripheral vascular resistance? A. Cardiogenic B. Obstructive C. Hypovolemic D. Distributive
D
When does respiratory failure occur? A. The patient experiences an increase in arterial carbon dioxide tension. B. The cessation of breathing follows a period of bradypnea and agonal respirations. C. The patient experiences increased work of breathing. D. The respiratory system is unable to meet the body's demands for oxygen intake and carbon dioxide removal.
D
When performing ventilation on an infant receiving CPR, it may likely be necessary to: A. hyperextend the neck to open the airway. B. utilize a flow-restricted, oxygen-powered ventilation device. C. perform a needle cricothyrotomy. D. occlude the pop-off valve.
D
When responding to a report of a patient with difficulty breathing, you find a pediatric male about 3 years old in a hospital bed at home. He is cared for 24 hours a day by his parents. You note a small, round tube that exits from the patient's neck, through which he is breathing. Given this finding, which of these devices does the patient most likely have? A. Dual lumen catheter B. Airway catheter C. Endotracheal tube D. Tracheostomy tube
D
Which of the following airways can be used with a 4-year-old pediatric patient? A EOA B PtL C ETC D LMA
D
Which of the following is an example of a commonly used neuromuscular blocking agent that can be used in a pediatric RSI procedure? A Fentanyl B Etomidate C Thiopental D Succinylcholine
D
Which of the following presentations is most consistent with bronchiolitis? A. Runny nose, sore throat, cough, and low-grade fever that progress to ear pain in 2 to 3 days B. Mild upper respiratory signs and symptoms that progress in 1 to 2 days to inspiratory stridor, hoarseness, and a "seal bark" cough at night C. Rapid onset of high fever, dyspnea, inspiratory stridor, and drooling D. Mild upper respiratory infection signs and symptoms that progressively deteriorate over 1 to 2 days to respiratory distress with fever, cough, tachypnea, crackles in the lungs, and wheezing
D
Which of these statements regarding SIDS is correct? A. SIDS is the leading cause of death among infants and children between 1 month and 3 years of age. B. SIDS deaths are obvious, and because resuscitation rates are nearly zero, you should withhold resuscitation unless the parents insist. C. The typical SIDS case involves an infant with a recent history of viral infection, most often born at full term, between the ages of 4 weeks and 7 months. D. SIDS is defined as the sudden and unexpected death of an infant in which an autopsy fails to identify the cause of death.
D
Which of these terms is best applied to the majority of childhood injuries? A. Inevitable B. Unforeseeable C. Unavoidable D. Preventable
D
Why is it important for the paramedic to observe the child's respiratory rate before beginning the examination? A. There usually is not time for respiratory assessment later. B. A focused examination is unconcerned with respiration. C. This gives a baseline finding for respiratory effort. D. If the child becomes distressed during the examination, then the respiratory rate will be impossible to determine.
D
You are called to a residence for a 7-year-old child in hypovolemic shock. You note evidence of severe dehydration as well as malnutrition. The child is wearing dirty clothes and appears to be unwashed. The child's home is visibly unclean. What is your immediate priority? A. Carefully question the child's caregivers about the child's circumstances. B. Call in law enforcement to take the caregivers into custody for neglect while maintaining a safe distance. C. Immediately call in the case as child abuse. D. Treat the child for shock, administering oxygen and establishing IV access for the replacement of fluids.
D
You are caring for a 2-year-old child who has been sick with a fever, diarrhea, and vomiting for 24 hours. To assess perfusion, which of these would provide you with the least reliable information about dehydration? A. Dryness of mucous membranes B. Warmth and color of skin C. Mental status D. Blood pressure
D
You are caring for a 6-year-old who was struck by a car on the street in front of her home in a very impoverished part of town. Her distraught father yells at you to hurry up and says, "If this was a kid on the other side of the tracks, you would be moving faster!" Which of the following is the most appropriate response? A. "Sir, I can either pay attention to you and address your concerns or pay attention to your child. Please allow me to do my job." B. "Don't yell at us. We were not the ones who were responsible for keeping her out of the street." C. "Sir, if you don't calm down, the police are going to remove you from the scene." D. "I know this is upsetting. We are moving as fast as we can without making her condition worse. As long as I have your word that you won't yell at us, you can ride in the ambulance, and we will tell you everything we are doing."
D
You note gastric distention in a 6-month-old patient experiencing respiratory failure you are attempting to ventilate but for whom you are not able to achieve adequate tidal volume. What do you do? A. Administer a neuromuscular blocker. B. Insert a 12 French nasogastric tube. C. Place a laryngeal mask airway. D. Insert an 8.0 French nasogastric tube.
D
A viral infection of the pediatric upper airway that results in inflammation of the subglottic region is known as: A. bronchitis. B. bronchiolitis. C. epiglottitis. D. croup.
d
