vol 5 ch4 review

Your patient is a 16-year-old female cheerleader who fell while attempting a pyramid formation and struck her forehead on the back of another girl's head. She has a 2-cm laceration just above her right eyebrow. She is tearful and asks you if you think she is going to have a scar. Which of the following is the best response? A) "It's a small cut. The emergency department will do everything they can to minimize scarring." B) "I really can't say. You should probably see a plastic surgeon." C) "A doctor can provide a prognosis when the cut has healed." D) "It's likely, but it's not something to get upset about."

"It's a small cut. The emergency department will do everything they can to minimize scarring."

Your patient is a 14 month-old girl who has been taking an antibiotic for three days for an ear infection. Her parents have called EMS because the patient has not been eating or drinking, is irritable, has a fever, and generally appears very sick. Which of the following should you most highly suspect? A) Herpes zoster B) Bacterial meningitis C) Fifth disease D) An allergic reaction to the antibiotic

Bacterial meningitis

Which of the following is TRUE of asthma in the pediatric patient? A) Bronchodilators are more effective in pediatric patients than in adults, and steroids are rarely indicated. B) Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack. C) Bronchodilators are effective primarily when treating the second phase of an asthma attack. D) The primary therapeutic goal in the initial phase of an asthma attack is to rehydrate the patient and administer mucolytic and anti-inflammatory agents.

Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack.

You are caring for a seven-year-old in ventricular fibrillation. The child weighs 19 kg. You have just delivered your first shock, and another paramedic reports that she has obtained IO access. You should direct the paramedic to administer what dose of epinephrine? A) 1.019 mg of 1:10,000 B) 1.9 mg of 1:1,000 C) 0.19 mg of 1:10,000 D) 0.019 mg of 1:1,000

0.19 mg of 1:10,000

A nine-year-old weighing 28 kg is in supraventricular tachycardia. Which of the following is the appropriate dose of adenosine for this patient? A) 0.28 mg B) 2.8 mg C) 0.75 mg D) 6 mg

2.8 mg

Your patient is a toddler who was burned when he accidentally pulled the cord of a deep fryer sitting on a countertop and spilled hot oil on his head and back. He has burns to the back half of his head, as well as his entire back. What percentage of total body surface area does this account for? A) 36 percent B) 40 percent C) 27 percent D) 18 percent

27 percent

Your 12-month-old patient has burns covering the full length of both lower extremities circumferentially. Which of the following is the most accurate estimate of the percentage of total body surface area involved? A) 20 percent B) 36 percent C) 14 percent D) 28 percent

28 percent

At which of the following ages does the risk of foreign body airway obstruction become a significant concern in the normally developing infant? A) 3 months B) 18 months C) 1 month D) 6 months

6 months

Your patient is a seven-year-old girl with a history of bee-sting anaphylaxis. She was stung by a bee and nearly immediately began having difficulty swallowing and breathing. Her father administered her prescribed 0.15 mg epinephrine auto-injector without result. On your arrival, the patient responds to painful stimuli; has labored, rapid, wheezing respirations; a heart rate of 60; and a blood pressure of 92/60 mmHg. Which of the following is the best sequence of treatment for this patient? A) Administer only epinephrine 1:1,000 IM B) Administer only diphenhydramine IM C) Administer diphenhydramine IM and epinephrine 1:1,000 IV D) Administer both epinephrine 1:10,000 and diphenhydramine intravenously

Administer both epinephrine 1:10,000 and diphenhydramine intravenously

Your patient is a conscious eight-month-old infant who has a severe airway obstruction as a result of choking on a slice of canned peach. Which of the following is your FIRST intervention? A) A portable suction device, using a rigid tonsil tip and no more than 100 mmHg of vacuum B) The use of a manually triggered, flow-restricted, oxygen-powered ventilation device C) Abdominal thrusts interspersed with attempts to ventilate D) An alternating series of back blows and chest thrusts

An alternating series of back blows and chest thrusts

You are in the home of a 28-month-old boy whose mother called EMS because he fell while running and struck his forehead on the corner of a table. The patient has a hematoma on his forehead but seems to have forgotten about the injury and is entertaining himself with some building blocks. Which of the following is the best way to begin assessing the child? A) To avoid upsetting him, observe him from a distance and make no physical contact with him. B) Make him feel comfortable by calling him by a nickname. C) Sit next to him and ask if you can play with some of his toys. D) Ask his mother to pick him up and hold him on her lap.

Ask his mother to pick him up and hold him on her lap.

Your patient is a three-year-old girl who has had vomiting and diarrhea for 24 hours. Which of the following is the best way to gain her cooperation when assessing her vital signs? A) Avoid explanations, and finish the assessment quickly. B) Ask if you can check her doll to "see how the doll is feeling" before repeating the same procedures on the child. C) Say, "I'm going to take your blood pressure." D) Explain that you want to give her arm a hug.

Ask if you can check her doll to "see how the doll is feeling" before repeating the same procedures on the child.

You are in the home of a 17-year-old female patient who is complaining of abdominal pain. Her mother and father are hovering near her and answering most of the questions you ask her. You sense that the patient is uncomfortable answering questions in front of her parents. Which of the following is the best way to handle this situation? A) Tell the patient you know she might be embarrassed but that it is imperative that she give you the whole story so you know what to do for her. B) Defer the history to the triage nurse at the emergency department so as not to cause undue discomfort to the patient. C) Ask the parents to go to the kitchen with your partner so he can get some information for your paperwork. D) Tell the parents the daughter probably doesn't want to talk about her problems in front of them.

Ask the parents to go to the kitchen with your partner so he can get some information for your paperwork.

Your patient is an 11-year-old male quadriplegic who depends on a phrenic nerve stimulator to stimulate contraction of his diaphragm and allow him to breathe. You are called to the home during a thunderstorm that has caused a power outage. Which of the following is the best course of action? A) Advise dispatch that you will be on the scene indefinitely and ask them to notify the power company that restoring power to this residence is a priority. B) Teach the patient's family members how to use the bag-valve-mask device and tell them to contact the department with questions or difficulties. C) Request a generator from the fire department tactical support division. D) Assist his breathing with a bag-valve-mask device, and transport.

Assist his breathing with a bag-valve-mask device, and transport.

Which of the following conditions does NOT cause an upper airway obstruction? A) Epiglottitis B) Croup C) Bacterial tracheitis D) Asthma

Asthma

Your patient is a four-year-old boy with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparents' farm. The patient has pale, cool, moist skin with cyanosis of his nail beds. He has audible wheezing with a respiratory rate of 18, accessory muscle use, and a heart rate of 130. He appears fatigued, he is unable to speak more than one or two words at a time, and his head bobs with each breath. Which of the following best describes this patient's respiratory status? A) Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure. B) The child is in the early stages of his asthma attack, and is showing signs of respiratory distress. C) The patient is having some respiratory difficulty; however, a nebulizer treatment will likely correct all issues. D) The child's asthma was exacerbated by exercise and he is therefore tired. Rest will ease his respiratory distress.

Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure.

Which of these is not a typical condition to evaluate in assessment of the child's circulation? A) Heart rate B) Peripheral circulation C) Blood oxygenation D) End-organ perfusion

Blood oxygenation

Your patient is a nine-month-old infant in respiratory distress with grunting respirations of 50 per minute, nasal flaring, and intercostal retractions. He is pale, and you note scattered bilateral wheezing on auscultation of the lungs. The mother states that the child is healthy and up to date on all his immunizations. Which of the following conditions is most likely, based on this information? A) New-onset asthma B) Bacterial tracheitis C) Bronchiolitis due to respiratory syncytial virus D) Epiglottitis due to Haemophilus influenzae type B

Bronchiolitis due to respiratory syncytial virus

Which of the following is NOT a sign of respiratory distress in the pediatric patient? A) Grunting B) Tachypnea C) Tachycardia D) Central cyanosis

Central cyanosis

You arrive at an MCI. You see a non-ambulatory child who has been evaluated using the JumpSTART algorithm with a yellow tag. What does this represent? A) Provide immediate attention to this patient. B) Move on and look at other patients; this patient does not have a significant external injury. C) The patient is dead. D) Delayed response; check to see if there are significant external signs of injury.

Delayed response; check to see if there are significant external signs of injury.

Funding for a significant amount of prehospital pediatric education comes largely from a program known as: A) Emergency Medical Pediatric Association. B) Emergency Medical Services for Children. C) Pediatric Advanced Medical Care. D) Pediatric Emergency Care Program.

Emergency Medical Services for Children.

You have just arrived on the scene where an infant stopped breathing. You find a three-month-old child being held tightly by his mother, who is sobbing uncontrollably. On examination, you find that the child is apneic and pulseless and has dependent lividity and early rigor mortis. There are no obvious signs of injury. Which of the following is the best course of action? A) Begin limited resuscitative measures, then contact medical control for orders to terminate resuscitation in the field. B) Gently tell the mother that the baby is dead and that there is nothing that can be done for him; allow her to hold him. C) Tell the mother that the baby is dead but that you cannot allow her to hold him until the police verify that no crime has been committed. D) Begin CPR and continue BLS measures until you are inside the ambulance; notify the hospital that you are transporting a deceased SIDS infant.

Gently tell the mother that the baby is dead and that there is nothing that can be done for him; allow her to hold him.

Your patient is a 12-year-old boy who was accidentally shot with a handgun by a playmate. You note one gunshot wound to the right upper quadrant of the abdomen, but no exit wound. The patient is pale, with cool, mottled extremities. He is lethargic, has a heart rate of 140, a respiratory rate of 30, and a blood pressure of 92/60 mmHg. Which of the following can be said for certain about this patient? A) He is in compensated shock. B) He is in irreversible shock. C) He is in decompensated shock. D) It is not possible to say anything for certain about this patient.

He is in decompensated shock.

Your four-year-old female patient has injuries suspicious of abuse. Statistically, who is most likely the abuser? A) Her mother, who is a stay-at-home mom B) Her father, who works in a local steel mill C) Her seven-year-old brother, with whom she shares a bedroom D) Her teenaged aunt, who babysits her two evenings a week

Her mother, who is a stay-at-home mom

As the pediatric patient progresses from respiratory distress to respiratory failure, which of the following occurs? A) Hyperactivity B) Increased arterial carbon dioxide tension C) Peripheral cyanosis D) Muscular rigidity

Increased arterial carbon dioxide tension

Which of the following is the most common result of blunt chest trauma in children? A) Anterior flail segment B) Intrathoracic injury without external bruising of the thorax C) Associated spinal cord injury D) Fractured ribs with a high incidence of hemothorax

Intrathoracic injury without external bruising of the thorax

Which of these is not a component of the airway examination in the primary assessment? A) Is the airway patent? B) Is the airway maintainable with head positioning, suctioning, or airway adjuncts? C) Is the airway not maintainable? D) Is the airway a likely cause of cardiac arrest?

Is the airway a likely cause of cardiac arrest?

Your 15-year-old male patient was kicked in the scrotum while playing with some friends. He is complaining of excruciating pain in his testicles. Which of the following guidelines applies to the examination of this patient? A) Make sure the procedure takes place in a medical office. B) Make sure another paramedic is present during the exam. C) Make sure a paramedic of the same sex performs the exam. D) Make sure a paramedic of the opposite sex performs the exam.

Make sure a paramedic of the same sex performs the exam.

You have been called for a 1-week-old infant who is sick. Assessment reveals him to have a fever and rhonchi in the left lower lobe. Which of the following assessment findings would be most concerning to you, given the age of this patient? A) Respiratory rate of 33 breaths per minute B) Skin that is pink and warm C) Continual moaning and crying D) Nasal passages occluded by mucus

Nasal passages occluded by mucus

Your patient is a 9-month-old boy who was a restrained passenger in a motor vehicle collision. Prior to your arrival, his mother took him out of the seat and is now holding him. Which of the following is the best way to transport this patient? A) Place him back in the car seat and transport with the car seat on the gurney. B) Allow the mother to hold the child during transport. C) Secure the child to your gurney as you would an adult. D) Place the child on a long backboard with a folded towel under his shoulders, then place the backboard on the gurney.

Place him back in the car seat and transport with the car seat on the gurney.

Which of the following affects the lower airway? A) Epiglottitis B) Pneumonia C) Croup D) Pharyngitis

Pneumonia

Your patient is a five-year-old girl who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of the following is the best course of action? A) Start an IV for administration of succinylcholine and midazolam for RSI, intubate the trachea, and ventilate at a rate of 24 to 28 per minute. B) Provide high-concentration oxygen by nonrebreather mask, start an IV, and repeat a full set of vital signs every 5 minutes en route to the emergency department. C) Inspect the hypopharynx for edema and be prepared for immediate surgical cricothyrotomy if airway obstruction is imminent. D) Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her.

Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her.

Which of the following best explains the cause of sudden infant death syndrome (SIDS)? A) Congenital absence of the Hering-Breuer reflex B) SIDS, by definition, has no identifiable cause. C) Diffuse axonal injury occurring due to "shaken baby syndrome" D) Aspiration of vomited formula or breast milk

SIDS, by definition, has no identifiable cause.

Your patient is an eight-year-old girl. As you approach her, you note that she is holding her right arm against her body, cradling it with the left arm. To find out what happened, which of the following is the best approach? A) Ask the parents to tell you what happened while you examine the child. B) Sit next to the patient and ask her what happened. C) Take the parents aside and ask them what happened. D) Ask the parents to leave the room so you can talk to the patient.

Sit next to the patient and ask her what happened.

Your patient is a seven-month-old boy whose mother called because he suddenly became lethargic and pale. Your assessment reveals that he is in a supraventricular tachycardia at a rate of 244 per minute. The patient's extremities are mottled and his capillary refill time is 4 seconds. Which of the following is the best treatment plan for this patient? A) Adenosine, 0.1 mg/kg rapid IV push, repeated at 0.2 mg/kg if unsuccessful B) Verapamil, 0.3 mg/kg over 3 to 5 minutes C) Diltiazem, 0.25 mg/kg over 2 minutes D) Synchronized cardioversion beginning at 0.5-1.0 joules/kg

Synchronized cardioversion beginning at 0.5-1.0 joules/kg

Your patient is a 13 year-old male drowning victim. He was initially in cardiac arrest with a pulseless, wide-complex bradycardia. He is intubated and being ventilated with supplemental oxygen. After CPR and intubation, the patient is now in ventricular tachycardia with a weak radial pulse. Which of the following would be an appropriate treatment for this patient? A) Amiodarone, 5 mg/kg IV push B) Lidocaine, 3 mg/kg IV bolus, followed by a 3 mg/minute drip C) Procainamide, 20 mg per minute, up to 800 mg D) Synchronized cardioversion starting at 0.5-1.0 joules/kg

Synchronized cardioversion starting at 0.5-1.0 joules/kg

Your patient is a five-year-old boy who appears to be dehydrated after having the flu. Which of the following is the best way to communicate with the patient regarding the need for obtaining IV access? A) Just before placing the IV, tell him you must put a needle in his arm. Tell him it will hurt, but only for a second. B) Tell him you are going to "start an IV in his arm" but that it won't hurt a big boy like him. C) Tell him you need to give him fluids to help him feel better and that it might hurt a little when you start the IV. D) Have a parent distract him while you place the IV.

Tell him you need to give him fluids to help him feel better and that it might hurt a little when you start the IV.

You are at the scene of a collision involving a school bus carrying elementary school age children. You are concerned that some of the children may have spinal injuries. Which of the following is TRUE of cervical spine injuries in children? A) They are more often due to penetrating trauma than in adults. B) The heavier head of the child increases the incidence of cervical distraction injuries. C) Pediatric patients do not require cervical spine immobilization, as their bodies will self-splint the injury. D) The pediatric cervical spine should be immobilized in a position of moderate hyperextension.

The heavier head of the child increases the incidence of cervical distraction injuries.

What is NOT one of the objectives of JumpSTART? A) To optimize the primary triage of injured children in the MCI setting B) To reduce the emotional burden on triage personnel who may have to make rapid life-or-death decisions about the injured C) To allow responders to "think with their hearts" when treating the injured children D) To enhance the effectiveness of resource allocation of all MCI victims

To allow responders to "think with their hearts" when treating the injured children

Which of the following is NOT an acceptable estimate of the correct size of endotracheal tube for a pediatric patient? A) The patient's age in years plus 16, divided by 4 B) The diameter of the little finger C) A length-based resuscitation tape D) Twice the width of the naris

Twice the width of the naris

Which of the following statements regarding prehospital care of pediatric patients is TRUE? A) Up to 85 percent of children treated by EMS need nothing more than basic life support skills. B) The majority of pediatric calls are for allergic reactions. C) More than 50 percent of pediatric patients require advanced life support. D) Most pediatric patients seen by EMS personnel are from low-income families.

Up to 85 percent of children treated by EMS need nothing more than basic life support skills.

A woman has called 911 after not being able to wake her eight-year-old son. Upon arrival, the mother tells you that her son is a diabetic, and that his diabetic alert dog awoke her in the night indicating the child's blood sugar was low. You perform a blood glucose check and find that your glucometer reads 28 mg/dL. You should: A) administer IV dextrose at 30% concentration. B) administer 1 mg of IV glucagon. C) administer 1 mg of IM glucagon. D) administer IV dextrose at 25% concentration.

administer IV dextrose at 25% concentration.

You are delayed getting to a residence where a 16-month-old boy is actively seizing. The mother reports that he has had a fever for the past two days. A firefighter on scene informs you that the child has been seizing since their arrival approximately 15 minutes ago. You should: A) apply oxygen, administer intranasal midazolam, and transport. B) apply oxygen, administer fluids, and transport. C) actively cool the child with ice packs to the groin and axilla. D) actively warm the child with blankets.

apply oxygen, administer intranasal midazolam, and transport.

A 16-year-old girl has been complaining of abdominal pain, nausea, polyuria, and polydipsia for the past 4 days. She has no significant medical history. You suspect she may be suffering from: A) ovarian cysts. B) diabetic ketoacidosis. C) meningitis. D) ectopic pregnancy.

diabetic ketoacidosis.

All of the following are associated with an increased incidence of SIDS, EXCEPT: A) female infant. B) age between two and four months. C) low birth weight. D) fall and winter months.

female infant.

Your 15-year-old male patient has a stab wound along the right sternal border at the fourth intercostal space. The patient responds to painful stimuli and shows little evidence of external bleeding. His respirations are 30, his breath sounds are clear and equal, and his radial pulse is weak and disappears on inspiration. The patient has distended jugular veins and is dyspneic. This patient is most likely suffering from ________ shock due to ________. A) obstructive; cardiac tamponade B) hypovolemic; hemothorax C) distributive; loss of sympathetic nervous tone D) hypoxic; tension pneumothorax

obstructive; cardiac tamponade