Ch 35

Blood pressure is usually not assessed in children younger than _____ years. b) 4 c) 5 a) 3 d) 6

a) 3

Blood pressure is usually not assessed in children younger than _____ years. c) 5 b) 4 a) 3 d) 6

a) 3

If the situation allows, a child should be transported in a car seat if he or she weighs less than _____ pounds. c) 60 d) 70 b) 50 a) 40

a) 40

Which of the following represents a low normal systolic blood pressure for a 6-year-old child? b) 88 mm Hg c) 90 mm Hg d) 98 mm Hg a) 82 mm Hg

a) 82 mm Hg

Which of the following inquiries should you make in private when obtaining a SAMPLE history from an adolescent patient? d) Duration of symptoms b) Past medical history c) Change in bladder habits a) Sexual activity

a) Sexual activity

Which of the following statements regarding the use of nasopharyngeal airways in children is correct? d) Blanching of the nares after insertion indicates correct placement. b) It is the recommended adjunct for children with head trauma. a) They are rarely used in infants younger than 1 year. c) They are usually not well tolerated in children with a gag reflex.

a) They are rarely used in infants younger than 1 year.

Which of the following signs or symptoms would most likely cause the EMT to mistake a head injury for an abdominal injury in a child? a) Vomiting c) Lethargy b) Restlessness d) Tachycardia

a) Vomiting

Submersion injuries in the adolescent age group are most commonly associated with: d) swimming pools. a) alcohol. c) hyperthermia. b) child abuse.

a) alcohol.

The components of the pediatric assessment triangle (PAT) are: a) appearance, work of breathing, and skin circulation. d) activity, respiratory quality, and level of consciousness. c) skin condition, respiratory rate, and level of alertness. b) mental status, heart rate, and systolic blood pressure.

a) appearance, work of breathing, and skin circulation.

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler: d) en route to the hospital. a) at the feet. b) at the head. c) in the ambulance.

a) at the feet.

Death caused by shaken baby syndrome is usually the result of: d) fracture of the cervical spine. c) intra-abdominal hemorrhage. a) bleeding in the brain. b) multiple open fractures.

a) bleeding in the brain.

Signs of severe dehydration in an infant include all of the following, except: c) delayed capillary refill. d) dry mucous membranes. b) profound tachycardia. a) bulging fontanelles.

a) bulging fontanelles.

An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of inhalation by: d) retracting the intercostal muscles. a) grunting. c) assuming a tripod position. b) wheezing.

a) grunting.

Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the: b) rib cage is rigid and provides little flexibility. a) intercostal muscles are not well developed. d) upper airway is smaller and easily collapsible. c) abdominal organs force the diaphragm upward.

a) intercostal muscles are not well developed.

Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the: d) upper airway is smaller and easily collapsible. a) intercostal muscles are not well developed. c) abdominal organs force the diaphragm upward. b) rib cage is rigid and provides little flexibility.

a) intercostal muscles are not well developed.

The first month of life after birth is referred to as the: b) toddler period. c) start of infancy. d) premature phase. a) neonatal period.

a) neonatal period.

A 2-year-old child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a small toy. You should: d) give oxygen and transport at once. a) perform abdominal thrusts. c) perform a blind finger sweep. b) visualize the child's airway.

a) perform abdominal thrusts.

When administering oxygen to a frightened child, it would be most appropriate to: b) tightly secure the oxygen mask straps to the face. c) have a parent restrain the child as you give oxygen. d) use a nasal cannula instead of a nonrebreathing mask. a) place oxygen tubing through a hole in a paper cup.

a) place oxygen tubing through a hole in a paper cup.

Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because they are: c) spaced further apart, which causes them to shift following trauma. b) more vascular even though they are proportionately smaller. a) proportionately larger and situated more anteriorly. d) lower in the abdominal cavity, where the muscles are not as strong.

a) proportionately larger and situated more anteriorly.

EMTs are assessing a 2-year-old child who was riding in a car seat when the vehicle struck a tree while traveling at 45 MPH. The child is conscious and appears alert. There are no obvious signs of trauma to the child, and the car seat does not appear to be damaged. The EMTs should: d) secure the child in the car seat with straps and apply a pediatric-sized cervical collar. b) leave the child in the car seat, but pad around the child's head with towels or a pillow. a) remove the child from the car seat and secure him to a pediatric immobilization device. c) remove the child from the car seat and secure both him and his mother to the stretcher.

a) remove the child from the car seat and secure him to a pediatric immobilization device.

Bruising to the _________ is least suggestive of child abuse. b) back c) face a) shins d) buttocks

a) shins

A high-pitched inspiratory sound that indicates a partial upper airway obstruction is called: c) grunting. d) wheezing. a) stridor. b) rhonchi.

a) stridor.

When assessing or treating an adolescent patient, it is important to remember that: c) they often request medication to help in the relief of severe pain. a) they usually do not wish to be observed during a procedure. d) they cannot understand complex concepts and treatment options. b) it is generally not necessary to explain procedures in advance.

a) they usually do not wish to be observed during a procedure.

The signs and symptoms of poisoning in children: b) are typically consistent among all age and weight groups. a) vary widely, depending on the child's age and weight. d) are most severe if the child ingested a poisonous substance. c) usually present within the first 10 minutes of ingestion.

a) vary widely, depending on the child's age and weight.

The signs and symptoms of poisoning in children: b) are typically consistent among all age and weight groups. c) usually present within the first 10 minutes of ingestion. a) vary widely, depending on the child's age and weight. d) are most severe if the child ingested a poisonous substance.

a) vary widely, depending on the child's age and weight.

Which of the following is an appropriate dose of activated charcoal for a 20-kg child? b) 20 g d) 50 g c) 25 g a) 12.5 g

b) 20 g

Febrile seizures are most common in children between: d) 18 months and 10 years. b) 6 months and 6 years. a) 3 months and 4 years. c) 8 months and 8 years.

b) 6 months and 6 years.

Febrile seizures are most common in children between: d) 18 months and 10 years. b) 6 months and 6 years. c) 8 months and 8 years. a) 3 months and 4 years.

b) 6 months and 6 years.

A child might begin to show signs of separation anxiety as early as: b) 6 months. a) 2 months. d) 18 months. c) 12 months.

b) 6 months.

Capillary refill time is most reliable as an indicator of end-organ perfusion in children younger than: d) 10 years. c) 8 years. a) 4 years. b) 6 years.

b) 6 years.

The normal respiratory rate for a newborn should not exceed ______ breaths/min. b) 60 c) 70 a) 50 d) 80

b) 60

Which of the following is the least reliable assessment parameter to evaluate when determining the presence of shock in infants and children? b) Blood pressure a) Pulse rate d) Capillary refill c) Skin condition

b) Blood pressure

During the attempted resuscitation of an infant with suspected SIDS: b) allow the family to observe if they wish. a) discourage the family from observing. d) give detailed updates to the infant's parents. c) a law enforcement officer must be present.

b) allow the family to observe if they wish.

The purpose of the pediatric assessment triangle (PAT) is to: c) facilitate a rapid head-to-toe assessment of the child by visualization only. b) allow you to rapidly and visually form a general impression of the child. d) gather critical data by performing a rapid hands-on assessment of the child. a) determine if the child's vital signs are within the age-appropriate limits.

b) allow you to rapidly and visually form a general impression of the child.

An oropharyngeal airway should not be used in children who have ingested a caustic or petroleum-based product because it might: b) cause the child to vomit. d) result in a soft-tissue injury. c) result in airway swelling. a) depress the gag reflex.

b) cause the child to vomit.

A common cause of shock in an infant is: d) cardiovascular disease. c) excessive tachycardia. b) dehydration from vomiting and diarrhea. a) a cardiac dysrhythmia.

b) dehydration from vomiting and diarrhea.

Before assessing the respiratory adequacy of a semiconscious infant or child, you must: b) ensure that the airway is patent and clear of obstructions. d) ensure that his or her head is in a hyperextended position. a) routinely suction the mouth to remove oral secretions. c) insert a nasopharyngeal or oropharyngeal airway adjunct.

b) ensure that the airway is patent and clear of obstructions.

When caring for a female child who has possibly been sexually abused, you should: b) have a female EMT remain with her if possible. a) encourage the child to urinate and take a shower. c) carefully examine the genitalia for signs of injury. d) immediately report your suspicions to the parents.

b) have a female EMT remain with her if possible.

A 6-month-old male presents with 2 days of vomiting and diarrhea. He is conscious, but his level of activity is decreased. The infant's mother tells you that he has not had a soiled diaper in over 12 hours. The infant's heart rate is 140 beats/min, and his anterior fontanelle appears to be slightly sunken. You should suspect: c) severe dehydration. a) mild dehydration. b) moderate dehydration. d) hypovolemic shock.

b) moderate dehydration.

A 4-year-old, 16-kg female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she is conscious and alert, is breathing adequately, and has skin burns around her mouth. You should: c) determine why the ingestion occurred. b) monitor her airway and give oxygen. d) administer 16 g of activated charcoal. a) place her supine and elevate her legs.

b) monitor her airway and give oxygen.

After determining that an infant or child has strong central pulses, you should: b) not rule out compensated shock. a) assume the child is hypertensive. d) assess his or her respiratory effort. c) conclude that the child is stable.

b) not rule out compensated shock.

While triaging patients at the scene of a motor-vehicle crash, you encounter a 5-year-old child who is unresponsive and apneic. After positioning his airway, you should: b) palpate for a carotid pulse. d) categorize him as immediate. a) deliver 5 rescue breaths. c) categorize him as deceased.

b) palpate for a carotid pulse.

Severe burns in children include: b) partial-thickness burns covering more than 20% of the body surface. c) second-degree burns covering more than 10% of the body surface. d) superficial burns covering more than 10% to 15% of the body surface. a) any superficial or partial-thickness burn that involves the legs or arms.

b) partial-thickness burns covering more than 20% of the body surface.

Effective methods for providing pain relief to a child with an extremity injury include: c) avoiding the placement of a splint, if possible. b) positioning, ice packs, and extremity elevation. d) heat compresses and lowering the injured extremity. a) separating the child from his or her parents.

b) positioning, ice packs, and extremity elevation.

Drawing in of the muscles between the ribs or of the sternum during inspiration is called: d) accessory muscle use. a) tenting. b) retracting. c) hyperpnea.

b) retracting.

When a child is struck by a car, the area of greatest injury depends mostly on the: a) speed at which the car was traveling when impact occurred. d) height of the child and the speed at which the car was traveling. c) age of the child and the size of the car that struck him or her. b) size of the child and the height of the bumper upon impact.

b) size of the child and the height of the bumper upon impact.

You are dispatched to a local elementary school for an injured child. As you approach the child, you note that he is lying at the base of the monkey bars. He is unresponsive, and there are no signs of breathing. You should: a) begin immediate rescue breathing. b) stabilize his head and check for a pulse. c) perform a head tilt-chin lift maneuver. d) open his airway and look in his mouth.

b) stabilize his head and check for a pulse.

When assessing an 8-year-old child, you should: a) refrain from taking a blood pressure. c) use a toe-to-head assessment approach. b) talk to the child, not just the caregiver. d) rely solely on the parent for information.

b) talk to the child, not just the caregiver.

Signs of vasoconstriction in the infant or child include: c) a rapid heart rate. a) warm, dry skin. b) weak distal pulses. d) brisk capillary refill.

b) weak distal pulses.

Signs of vasoconstriction in the infant or child include: c) a rapid heart rate. a) warm, dry skin. d) brisk capillary refill. b) weak distal pulses.

b) weak distal pulses.

Which of the following children would benefit the least from a nonrebreathing mask? a) A conscious 4-year-old male with adequate tidal volume b) A responsive 6-year-old male who responds appropriately c) An unresponsive 5-year-old male with shallow respirations d) A semiconscious 7-year-old female with normal ventilation

c) An unresponsive 5-year-old male with shallow respirations

A 5-year-old child has had severe vomiting and diarrhea for 4 days. Which of the following assessment findings would be the most indicative of decompensated shock? b) Respiratory rate of 30 breaths/min c) Blood pressure of 70/40 mm Hg d) Pulse rate greater than 120/min a) Capillary refill time of 4 seconds

c) Blood pressure of 70/40 mm Hg

Which of the following statements regarding pediatric trauma is correct? a) Children are less likely than adults to be struck by a car. c) Children are more likely to experience diving-related injuries. d) Inexperience and poor judgment are rare causes of pediatric trauma. b) A child's head is less frequently injured than an adult's head.

c) Children are more likely to experience diving-related injuries.

Which of the following statements regarding a pediatric patient's anatomy is correct? d) The child's epiglottis is less floppy and smaller than an adult's epiglottis. a) The tracheal rings of a child are more rigid than an adult's tracheal rings. b) A child's tongue is proportionately smaller than an adult's tongue. c) Children have a larger, rounder occiput compared to adults.

c) Children have a larger, rounder occiput compared to adults.

Which of the following findings is least suggestive of child abuse? a) Evidence of alcohol consumption or drug use at the scene c) Consistency in the method of injury reported by the caregiver d) An unexplained delay in seeking medical care after the injury b) Burns to the hands or feet that involve a glove distribution

c) Consistency in the method of injury reported by the caregiver

Which of the following statements regarding sudden infant death syndrome (SIDS) is correct? a) Certain cases of SIDS are predictable and therefore preventable. c) Death as a result of SIDS can occur at any time of the day or night. d) The cause of death following SIDS can be established by autopsy. b) SIDS is most commonly the result of an overwhelming infection.

c) Death as a result of SIDS can occur at any time of the day or night.

Which of the following assessment findings should concern the EMT the most when assessing a child who experienced a seizure? d) Short postictal phase c) Neck stiffness a) High fever b) Tachycardia

c) Neck stiffness

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The most appropriate treatment for this child includes: a) requesting a paramedic ambulance to insert an advanced airway device. c) administering blow-by oxygen and transporting the child with her mother. b) separating the child from her mother and providing ventilatory assistance. d) allowing the child to remain with her mother and applying a nasal cannula.

c) administering blow-by oxygen and transporting the child with her mother.

Signs of a severe airway obstruction in an infant or child include: d) mild respiratory distress. b) crying and anxiety. a) pink, dry skin. c) an ineffective cough.

c) an ineffective cough.

Pale skin in a child indicates that the: d) child's core body temperature is elevated. a) child is in severe decompensated shock. c) blood vessels near the skin are constricted. b) oxygen content in the blood is decreased.

c) blood vessels near the skin are constricted.

When assessing the heart rate of a 6-month-old infant, you should palpate the brachial pulse or ________ pulse. d) popliteal c) femoral b) carotid a) radial

c) femoral

In most children, febrile seizures are characterized by: d) isolated tonic-clonic activity, a duration of greater than 15 minutes, and a short postictal phase. a) a blank stare, a duration of between 15 and 30 minutes, and a prolonged postictal phase. b) unresponsiveness, complete body relaxation, a fever greater than 105°F, and a short postictal phase. c) generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase.

c) generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase.

A 2-month-old infant was found unresponsive in his crib by his mother. When you arrive, you determine that the infant is apneic and pulseless. His skin is pale and cold and his arms are stiff. You should: a) begin high-quality CPR and transport immediately. c) inform the child's mother that her son is deceased. d) begin high-quality CPR and request an ALS ambulance. b) request the medical examiner to perform an autopsy.

c) inform the child's mother that her son is deceased.

The secondary assessment of a sick or injured child: c) might not be possible if the child's condition is critical. d) is most appropriate when your transport time is short. b) should be performed, regardless of the circumstances. a) is a rapid head-to-toe exam to detect life threats.

c) might not be possible if the child's condition is critical.

When assessing an infant's ventilation status, you should: b) rule out hypoxia if cyanosis is absent. c) palpate the abdomen for rise and fall. a) observe the chest for rise and fall. d) give oxygen if the SpO2 is less than 90%.

c) palpate the abdomen for rise and fall.

After using the pediatric assessment triangle (PAT) to form your general impression of a sick or injured child, you should: c) perform a hands-on assessment of the ABCs. d) assess the child's heart rate and skin condition. b) obtain a SAMPLE history from the parents. a) evaluate the child's baseline vital signs.

c) perform a hands-on assessment of the ABCs.

Early signs of respiratory distress in the child include: a) cyanosis. c) restlessness. d) decreased LOC. b) bradycardia.

c) restlessness.

In contrast to adults, deterioration to cardiac arrest in infants and children is usually associated with: c) severe hypoxia and bradycardia. b) a sudden ventricular arrhythmia. a) irritability of the left ventricle. d) acute hypoxia and tachycardia.

c) severe hypoxia and bradycardia.

Greenstick fractures occur in infants and children because: d) twisting injuries are more common in children. b) their bones are more brittle than an adult's bones. a) the growth plate is commonly injured. c) their bones bend more easily than an adult's bones.

c) their bones bend more easily than an adult's bones.

Which of the following statements regarding preschool-age children is correct? c) The preschool age begins after the child turns 2 years old. b) Preschoolers are usually not fearful of pain or separation. a) They realize that injuries are not a form of punishment. d) They can usually identify painful areas when questioned.

d) They can usually identify painful areas when questioned.

An infant with severe dehydration would be expected to present with: d) absent urine output. b) moist oral mucosa. c) bulging fontanelles. a) excessive tearing.

d) absent urine output.

You respond to a skate park where a 10-year-old male fell from his skateboard and struck his head on the ground; he was not wearing a helmet. He is responsive to painful stimuli only and has a large hematoma on the back of his head. After your partner stabilizes his head and opens his airway, you assess his breathing and determine that it is slow and irregular. His pulse is slow and bounding. You should: c) apply high-flow oxygen via a nonrebreathing mask, obtain baseline vital signs, apply full spinal precautions, and perform a secondary assessment. b) insert an oral airway, hyperventilate him with a bag-valve mask, apply full spinal precautions, and transport to the closest trauma center. a) apply high-flow oxygen via a nonrebreathing mask, perform an in-depth secondary assessment, apply full spinal precautions, and transport. d) assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

d) assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

Hyperthermia differs from fever in that it is an increase in body temperature: a) of more than 2°F to 3°F per hour. d) caused by the inability of the body to cool itself. b) secondary to a severe bacterial infection. c) caused by inflammation of the spinal cord.

d) caused by the inability of the body to cool itself.

Burns in children are commonly caused by all of the following, except: b) scalding water in a bathtub. d) entrapment in a structural fire. c) exposure to caustic chemicals. a) hot items on a stovetop.

d) entrapment in a structural fire.

Immediate transport is indicated for a child when he or she: c) has a possible closed fracture of the radius. b) falls from a height greater than 4 to 5 feet. a) is experiencing mild to moderate pain. d) has a history compatible with a serious illness.

d) has a history compatible with a serious illness.

All of the following are normal findings in an infant or child, except: a) quiet breathing. c) belly breathing. b) fear or anxiety. d) head bobbing.

d) head bobbing.

The most accurate method for determining if you are delivering adequate tidal volume to a child during bag-valve mask ventilations is to: b) observe the child's skin color. d) observe the chest for adequate rise. a) monitor the child's heart rate. c) monitor the pulse oximeter reading.

d) observe the chest for adequate rise.

Before positioning an infant or child's airway, you should: b) thoroughly suction his or her airway. a) put padding behind his or her head. d) place him or her on a firm surface. c) rule out an injury to the spinal cord.

d) place him or her on a firm surface.

When immobilizing an injured child in a pediatric immobilization device, you should: a) secure the head before the torso. c) pad underneath the child's head. b) slide the device under the child. d) secure the torso before the head.

d) secure the torso before the head.