Chapter 38

) The mother of a 3-year-old boy has called 911 because her son has a low-grade fever and difficulty breathing. On scene, the mother tells you that she is a licensed practical nurse (LPN), and that she suspects her son is suffering from croup. Which statement made by the mother would reinforce this suspicion? A) "At night, he seems to get a barking-like cough." B) "When he is short of breath, his heart rate increases." C) "There are times when he continually drools." D) "When I turn the air conditioner on, he becomes more short of breath."

A) "At night, he seems to get a barking-like cough."

Which statement made by the EMT is most appropriate regarding dealing with caregivers and children during a medical emergency? A) "I try to include the caregiver in all that I do with his or her child so that the child and caregiver are more comfortable." B) "It is best to separate the caregiver from the child so that a proper assessment and care can be given." C) "I include the caregiver in the care until I get the information that I need, then I remove the child to continue the assessment in the ambulance." D) "I tell the caregiver that everything will be okay so the caregiver remains calm and is better able to help the child."

A) "I try to include the caregiver in all that I do with his or her child so that the child and caregiver are more comfortable."

After a 29-year-old male with chest pain is removed from the house by stretcher, the man's 7-year-old son throws a temper tantrum. His mother is embarrassed and states that he has not done this since he was 2 years old. Given the situation, your response would be: A) "I would not be concerned. This is a stressful event he doesn't understand, and he may just be having trouble coping with it." B) "You really need to correct this behavior now so it does not happen in the hospital. They will make you take him home." C) "It may be wise to contact your pediatrician and let him know about the temper tantrum. It may be controllable with medications." D) "A 7-year-old is too old for this type of behavior. You may want to talk to his pediatrician."

A) "I would not be concerned. This is a stressful event he doesn't understand, and he may just be having trouble coping with it."

Another EMT tells you that he had a call the previous shift in which he thought a 5-year-old boy might be the victim of abuse, since he had bruises on both upper legs and chest. However, the EMT did not communicate this suspicion to anyone or transport the patient. What would your best response be? A) "If you do not take steps to report this suspicion, you can be punished in a court of law." B) "Let's see if we can go back to the house to make a better assessment of the situation." C) "This sounds more like neglect, rather than physical abuse, so there is not much to do at this point." D) "Bruises in these areas are very typical for an active 5-year-old, making abuse unlikely."

A) "If you do not take steps to report this suspicion, you can be punished in a court of law."

A 5-year-old boy who is drooling has suspected epiglottitis. His pulse rate is 144 beats/min, respirations are 46 breaths/min, and blood pressure is 110/52 mmHg. The patient is noncompliant with the pulse oximeter, but his skin is normal colored. Which statement made by the EMT indicates proper care of this patient? A) "Let's give him some supplemental oxygen." B) "I need to depress his tongue with the tongue blade to see the swelling." C) "Let's suction his airway to remove the secretions." D) "We need to place him on his side to drain secretions and transport immediately!"

A) "Let's give him some supplemental oxygen."

A 14-year-old female with a history of congenital heart disease and evidence of reaching puberty is in cardiac arrest. Which instruction would you give other EMTs on scene? A) "Let's use the adult pads and adult settings for the AED." B) "Just do CPR until ALS arrives since we do not know the specific heart condition." C) "Remember that for pediatric patients, it is 2 shocks followed by 2 minutes of CPR." D) "We will need the special pediatric pads for this patient."

A) "Let's use the adult pads and adult settings for the AED."

When providing care to the pediatric patient who has been injured or ill, the most important aspect of care normally revolves around: A) Airway and respiratory support B) Assessment and support of circulation C) Ability to provide rapid transport D) Knowledge of illnesses that affect children

A) Airway and respiratory support

The mother of a 4-month-old boy awoke to find him in his crib and not breathing, so she summoned EMS. On scene, you are providing resuscitative care while the parents watch your actions in disbelief. Which decision made by the EMT would be most appropriate regarding their presence in the room? A) Allow them to observe the resuscitation if they wish B) Escort them to another part of the house despite them wanting to stay C) Move the patient to the ambulance for continued resuscitation en route without the parents' presence D) Ask the parents to wait in the ambulance for transport

A) Allow them to observe the resuscitation if they wish

You are transporting a very sick 3-year-old with suspected septic shock. His airway is patent, respirations tachypneic, and radial pulse weak, with skin that is hot to the touch. Vital signs are pulse, 152 beats/min; respirations, 32 breaths/min; blood pressure, 94/64 mmHg; and SpO2, 94% on a nonrebreather face mask. The patient has a rectal temperature of 103.9°F. Tylenol has been administered. During transport to the hospital, you should be most concerned with which clinical finding? A) Blood pressure of 84/32 mmHg B) SpO2 of 94% despite oxygen C) Heart rate of 156 beats/min D) Temperature of 104.1°F

A) Blood pressure of 84/32 mmHg

The increased pliability of the child's ribs makes him more prone to: A) Bruising or other injury to the lungs B) Rib fractures and flail segments C) Cardiac arrest from heart damage D) Overinflation of the lungs

A) Bruising or other injury to the lungs

Assessment of an alert and oriented 9-year-old child with a history of asthma reveals him to be breathing 20 times per minute with adequate chest rise and fall. You also note that he exhibits nasal flaring and has slight retractions of the intercostal muscles. His heart rate is 100 beats per minute and his blood pressure is 102/64 mmHg. On room air, he has a pulse oximeter reading of 98%. The EMT would recognize: A) Compensated respiratory distress B) Late respiratory failure C) Hypoxic respiratory failure D) Decompensated respiratory failure

A) Compensated respiratory distress

After you obtain a refusal at a residence in a neighborhood, a couple approaches the ambulance and inform you that they have concerns that a 6-year-old child who lives in a home two doors away may be physically abused. They state that they heard the child crying and what sounded like physical abuse occurring. In this situation, you would: A) Contact the police and wait in the ambulance until they arrive B) Attempt entry into the home to determine whether the child is injured C) Inform the couple that they must contact a child welfare agency D) Knock on the door and confront the parents about the complaint

A) Contact the police and wait in the ambulance until they arrive

On scene at a school cafeteria, you are presented with a 11-year-old boy who attempted to eat a small plum whole. He is conscious with stridorous respirations and unable to cough when instructed to do so. His skin color is gray and cyanotic. What would your immediate action be? A) Deliver five abdominal thrusts B) Provide positive pressure ventilation C) Place an oral pharyngeal airway D) Check for radial and carotid pulses

A) Deliver five abdominal thrusts

You have been called to a lower-income housing complex for a 11⁄2-year-old child who is short of breath and has a fever. When assessing this patient, which technique would be appropriate? A) Determining the respiratory rate before laying hands on the child B) Auscultating breath sounds over the anterior chest only C) Checking capillary refill by pressing on the skin of the fingers D) Performing the primary assessment after the secondary assessment

A) Determining the respiratory rate before laying hands on the child

You have been called for a 2-year-old girl who has been sick for two days. In preparing to assess the patient, it is important that you recognize that patients in this age group generally: A) Do not like having clothing removed B) Tolerate separation from their caregiver C) Have little fear of strangers D) Like to be touched

A) Do not like having clothing removed

Croup is recognized as an illness that involves: A) Edema beneath the glottis B) Bronchiolar constriction C) Swelling of the epiglottis D) Infection within the lungs

A) Edema beneath the glottis

When evaluating capillary refill time in a pediatric patient, the EMT must remember that: A) It is considered more reliable than in an adult B) It should be less than 5 seconds C) It is not a good test of perfusion D) It is not affected by environmental conditions

A) It is considered more reliable than in an adult

What is the best location for assessing breath sounds in the pediatric patient? A) Midaxillary region of the lungs B) Anteriorly at the apex of the lung C) Anteriorly at the base of the lung D) Posteriorly just below the scapula

A) Midaxillary region of the lungs

You have been called to a home by neighbors because they are concerned for the welfare of the children inside. On scene, you find two children left by themselves. They are playing in a filthy room with no light or heat. They are dirty and have insect bites all over their bodies. One is in a soiled diaper and has hard stool caked to the buttocks. The EMT would best recognize this situation as one of: A) Neglect B) Parental negligence C) Physical abuse D) Felonious care

A) Neglect

The mother of a 2-year-old has called EMS because her son has an axillary temperature of 103.2°F. On scene, your assessment reveals the boy to be confused and lethargic, with a rectal temperature of 104.1°F. When caring for this child, you would: A) Remove the child's clothes and sponge his body with tepid water B) Apply washcloths soaked in cold water until the child begins to shiver C) Administer oxygen and cool the child by sponging his body with alcohol D) Have the mother administer rectal Tylenol and cool the child by sponging his body with cold water

A) Remove the child's clothes and sponge his body with tepid water

) On the scene of a medical emergency, you are directed to a 5-month-old baby in his crib. He responds to painful stimuli by whimpering and is breathing at a rate of 50 breaths per minute. His airway is open, and his brachial pulse is fast, weak, and difficult to locate. Assessment of his skin reveals it to be cool and pale in color. According to the mother, her child has had vomiting and diarrhea for four days. She also reports that the father of the baby has diabetes. Based on this information, the EMT would recognize which condition? A) Shock B) Hypoglycemia C) Cardiac arrest D) Heart failure

A) Shock

The EMT is correctly assessing breath sounds on a 3-year-old male when he: A) Understands that sounds from the left lung can be heard on the right side of the chest B) Listens carefully for at least 1 minute to both sides of the anterior chest C) Listens to both the anterior and posterior aspects of the thorax for 1 minute D) Instructs the child to breathe through his nose as he listens to the posterior thorax

A) Understands that sounds from the left lung can be heard on the right side of the chest

On scene, a 6-year-old male who is short of breath will not allow EMRs to place a nonrebreather face mask on his face. Assessment indicates moderate respiratory distress with the following vital signs: pulse, 124 beats/min; respirations, 24 breaths/min; blood pressure, 98/56 mmHg; and SpO2, 92%. At this time, you try: A) Using a nasal cannula with 2 lpm oxygen B) Holding the nonrebreather mask firmly to the patient's face C) Start positive pressure ventilation D) Placing a nasal airway and nasal cannula with 6 lpm oxygen

A) Using a nasal cannula with 2 lpm oxygen

You are assessing the pupils of a 5-year-old who fell off a bed while playing. Which of the statement would be most appropriate prior to performing this assessment? A) "I am going to look at your pupils with my light." B) "I am going to use this light to look into your eyes." C) "I need to test your visual acuity by shining a light in your eyes." D) "Open your eyes so that I can look at them."

B) "I am going to use this light to look into your eyes."

A 5-year-old male is drooling with stridorous respirations and has a fever of 104°F. Which statement made by the patient would concern the EMT most? A) "I am not hungry at all." B) "It hurts to swallow." C) "I have a headache." D) "My nose will not stop running."

B) "It hurts to swallow."

ou have been asked to speak to a group of new mothers regarding the emergency treatment of a fever. During your presentation, one of the mothers asks you which temperature would cause a child to seize. Your response would be: A) "When a child's temperature rises above 105°F, seizure activity will occur." B) "It is not the specific temperature that is of concern, but the rate at which the body temperature rises." C) "If the temperature of a child's fever rises slowly over several hours, she is at greater risk for seizures." D) "For a child to seize when she has a fever, she must also have a history of seizures or a cardiac condition."

B) "It is not the specific temperature that is of concern, but the rate at which the body temperature rises."

You are assessing a 12-year-old female in respiratory distress and with a history of asthma. Which statement, made by her mother, would be most concerning? A) "The doctor stopped her prescription for steroids." B) "Two years ago she needed to have a breathing tube inserted into her throat." C) "Her asthma started bothering her last night." D) "There is a history of asthma on her father's side of the family."

B) "Two years ago she needed to have a breathing tube inserted into her throat."

While attempting resuscitation of a baby with possible SIDS, which question would be appropriate for the EMT to ask the mother? A) "Why did you have the baby in bed with you and not in a crib?" B) "Were there any problems with the pregnancy or his birth?" C) "Do you think that you may have rolled on him and smothered him?" D) "Why do you keep the temperature so cold in this bedroom?"

B) "Were there any problems with the pregnancy or his birth?"

When preparing to provide positive pressure ventilation to a child, what will be an acceptable tidal volume if the child weighs 22 kg? A) 200 mL B) 154 mL C) 246 mL D) 104 mL

B) 154 mL

A coworker is telling you about a recent EMS call in which he provided care to a preschooler. Based on this description, you know that age of the patient would have been: A) 1-2 years B) 3-5 years C) 6-8 years D) more than 9 years

B) 3-5 years

You have been summoned to a grocery store for a 6-year-old girl who has collapsed. On scene, you find the girl lying unresponsive on the floor. You quickly open the patient's airway and determine that she is not breathing. When you try to ventilate her with the bag-valve mask, you are unable to do so. Repositioning the head and reattempting ventilation is not successful in passing air into the lungs. What would your next action be? A) Perform a blind finger sweep B) Administer 30 chest compressions C) Ventilate the patient with greater force D) Place an oral airway

B) Administer 30 chest compressions

You are assessing a 6-year-old girl with possible pneumonia. She has labored breathing and a fever of 102°F. When you are assessing and classifying her respiratory status, which finding would provide the strongest evidence that she is in respiratory failure? A) Respiratory rate of 36 breaths/min B) Altered mental status C) Fever of 102°F D) Nasal flaring

B) Altered mental status

You are caring for an 8-month-old boy who is unresponsive after choking on a piece of hard candy. As you look into his mouth, you can see the candy in the back of his oropharynx. What would your next action be? A) Provide five abdominal thrusts B) Attempt to retrieve and remove the candy C) Check the brachial pulse D) Perform a blind finger sweep

B) Attempt to retrieve and remove the candy

You are transporting a child with a small laceration to his leg, sustained after cutting himself of a piece of broken glass. During transport, you observe a pulse oximeter reading of 87% on the frantic, crying, and actively moving child. The child is alert and oriented with a normal pulse and respiratory rate with pink skin that is warm to touch. You should consider: A) Starting positive pressure ventilation with supplemental oxygen B) Attempting to calm the child and obtain another SpO2 reading C) Applying high-concentration oxygen via a nonrebreather mask D) Checking the laceration for uncontrolled bleeding

B) Attempting to calm the child and obtain another SpO2 reading

A 7-year-old child was riding his bike downhill and struck a parked car. He was thrown from the bike, impacting his head and back on the roadway. Presently, the patient is alert, oriented, and complaining of a severe headache. His airway is open and his breathing is adequate. A radial pulse is rapid and easily palpated, and his skin is cool and moist. After taking manual spine motion restriction of the head and neck, the EMT should: A) Secure the patient to the long spine board B) Consider the need for supplemental oxygen C) Perform a rapid trauma exam and obtain vital signs D) Apply a cervical collar and place the patient on the cot

B) Consider the need for supplemental oxygen

The EMT is properly assessing the breathing of a 3-year-old when he: A) Counts the respiratory rate for 15 seconds and multiplies by 4 B) Counts the respiratory rate for 30 seconds and multiplies by 2 C) Counts the respiratory rate for 15 seconds and observes chest rise and fall D) Counts the respiratory rate for 10 seconds and multiplies by 6

B) Counts the respiratory rate for 30 seconds and multiplies by 2

You are suspicious that a child is being physically abused and neglected. What would be your best course of action in such a situation? A) Confront the alleged abuser B) Document the situation C) Notify other family members D) Place the child in a safe home

B) Document the situation

Which behavior would the EMT recognize as uncharacteristic of a conscious and stable 2- year-old boy who fell and hurt his hand? A) Cries any time you or your female partner touch him B) Does not cry or protest when taken from his mother C) Becomes upset when you lift his shirt to assess his abdomen D) Apologizes several times for falling and hurting his hand

B) Does not cry or protest when taken from his mother

As you assess a very sick 3-year-old patient with a fever, rash, and sore neck, you suddenly suspect he might have meningitis. Your immediate action would be to: A) Call for paramedic assistance B) Don additional BSI precautions of a mask and gown C) Administer aspirin for immediate fever reduction D) Place a cervical collar on the patient's neck and immediately transport him

B) Don additional BSI precautions of a mask and gown

Which disease or illness would you suspect when confronted with a pediatric patient exhibiting an acute onset of respiratory distress and an audible inspiratory stridor sound, but no cough? A) Croup B) Epiglottitis C) COPD D) Bronchiolitis

B) Epiglottitis

You have been called to a local daycare facility for a sick child. At the scene, panicked daycare workers inform you that the 4-year-old child was lethargic all morning and wanted to sleep. After resting for several minutes, she began to "shake all over." This lasted for approximately 30 seconds. Your assessment reveals the patient to be responsive to painful stimuli and breathing adequately. Her airway is open and her radial pulse is strong and bounding. Her skin is hot and moist to the touch, with no signs of cyanosis. You are told that the patient has no medical history. En route to the hospital, the patient's mental status improves. Based on this presentation and information, you assume that the seizure occurred secondary to: A) Hypoxia B) Fever C) Hypoglycemia D) Altered mental status

B) Fever

You are assessing a 21⁄2-year-old female who was involved in a minor car accident. She is currently alert and oriented. While you are assessing her for possible injuries, which assessment procedure would be considered appropriate? A) Assess the child starting at her head and moving to her feet B) If possible, allow the child to hold a favorite toy during the assessment C) Be firm with the child and provide concrete instructions on what you expect D) Touch and hold the child as much as possible

B) If possible, allow the child to hold a favorite toy during the assessment

A 15-year-old male with a history of seizures presents as oriented. He takes the anticonvulsant Keppra and has no other medical history according to his mother. The mother called EMS because the patient missed taking his medicine and she wants you to "check him out." Which action would be most appropriate for the EMT to take at this time? A) Check the patient's blood sugar B) Obtain a full set of vital signs C) Apply high-concentration oxygen through a nonrebreather mask D) Assist the mother in administering a dose of Keppra

B) Obtain a full set of vital signs

) You have arrived at a residence to find a 6-month-old girl in her crib in cardiac arrest. Quick assessment reveals no rigor mortis or lividity. The mother states that she put the baby to bed at 9 p.m. last night and awoke at 3 a.m. to find her in her present state. What would your first action be? A) Ask if the baby has any medical conditions B) Open the airway and provide 2 ventilations C) Inquire whether the mother wants resuscitation started D) Apply oxygen and move the baby to the ambulance

B) Open the airway and provide 2 ventilations

A 6-year-old male has a decreased level of consciousness. His mother states that the family does not have health insurance, so they did not take him to the hospital last week when he started vomiting and had copious amounts of diarrhea. She reports that he has not had anything to eat or drink since then. The patient has snoring respirations that are rapid and inadequate. His radial pulse cannot be located, and his carotid pulse is rapid and weak. His capillary refill is 5 seconds and his skin is cool to the touch. What would your first intervention in caring for this child be? A) Take manual spine motion restriction of the head and neck B) Open the airway using the head-tilt, chin-lift maneuver C) Provide positive pressure ventilation D) Attach the automated external defibrillator

B) Open the airway using the head-tilt, chin-lift maneuver

You are securing a 4-year-old-boy on a long spine board during a spine motion restriction process. Which action would be appropriate when performing this intervention? A) Do not apply the chest strap across the thorax B) Place padding between his shoulders/back and the spine board C) Secure the chest and legs to the board after the head D) Place a pillow or padding under the head to maintain normal spinal alignment

B) Place padding between his shoulders/back and the spine board

) A 7-year-old with a fever of 101.3°F and shortness of breath has a patent airway, but tachypneic respirations. His heart rate is 132 beats/min, respirations are 28 breaths/min, and blood pressure is 94/60 mmHg, with an SpO2 of 96% on room air. Crackles and wheezes are noted in the base of the right lung only. Given this presentation, you would suspect and treat the patient for: A) Bronchiolitis B) Pneumonia C) Asthma D) Upper respiratory infection

B) Pneumonia

You have been called to an apartment for a child who is sick. As you approach the 4-year-old boy, you note that he is sitting upright in his mother's arms with his chin thrust forward. He has a sickly appearance and is drooling. His airway appears open and his breathing is adequate. His radial pulse is strong and his skin is hot to the touch. Which intervention would be most appropriate in the care of this patient first? A) Suctioning secretions from the back of the airway B) Provision of supplemental oxygen via a nonrebreather mask C) Placement of an oropharyngeal airway D) Placing the boy supine for transport

B) Provision of supplemental oxygen via a nonrebreather mask

After the unsuccessful resuscitation of a 3-year-old boy who was shot by his mother's boyfriend during a domestic dispute, you find yourself extremely stressed and anxious over the call. You are having trouble sleeping and the resultant anxiety is affecting your home life. What should be your initial action, given this situation? A) Make a conscious effort to focus on anything positive about the event B) Talk to a close friend or fellow EMS provider about your feelings C) Use the tragedy as an incentive to learn more about pediatric trauma D) Consider finding a profession outside of medicine

B) Talk to a close friend or fellow EMS provider about your feelings

Which assessment findings related to the mental status of a 1-year-old would the EMT consider normal? A) The patient turns his head to sounds B) The patient is curious about your penlight C) The patient moans when pressure is applied to his finger D) The patient does not keep his eyes open

B) The patient is curious about your penlight

Which instructions would you provide to a new EMT who is preparing to assess a stable 9- month-old boy who has a rash? A) "To keep the baby calm, do not touch him during the assessment." B) "Start at the head and slowly work your way to the feet." C) "Allow the mother hold him as you do the assessment." D) "It is important not to undress a baby during assessment, as this will stress the baby."

C) "Allow the mother hold him as you do the assessment."

What would be the most appropriate instructions to give a new EMT with whom you are working regarding the ventilation of an unresponsive and apneic 3-year-old boy? A) "Let's ventilate him at a rate of 28 breaths per minute." B) "Make sure to give each ventilation over 3 seconds." C) "Deliver one breath every 3 seconds." D) "Do not administer cricoid pressure since it is contraindicated."

C) "Deliver one breath every 3 seconds."

) You suspect a very sick child to be in shock. His skin is dry, radial pulse weak, and blood pressure low. Which statement made by the parents would reinforce this suspicion? A) "He has had a headache since last night." B) "I gave him an aspirin this morning." C) "He has had diarrhea for three days." D) "His stepfather has really bad diabetes."

C) "He has had diarrhea for three days."

You are concerned that a sick 5-year-old patient with lower abdominal pain and a temperature of 100.3°F has appendicitis. He describes the pain as generalized and crampy. Although he complains of nausea, he is not vomiting. His pulse, respirations, blood pressure, and SpO2 are normal, and there are no immediate life-threatening conditions. Based on these assessment findings, his father informs you that he does not wish his son to be transported, and will call the pediatrician in the morning. How would you respond? A) "I'm okay with that; monitor his fever and make sure to call first thing in the morning." B) "I am concerned that your son has appendicitis and by law we must treat and transport him." C) "I have to tell you, if he has appendicitis, it will just get worse and can become a major medical emergency for him." D) "If you insist, there is nothing I can legally do; let me talk to the pediatrician to let him know what is going on."

C) "I have to tell you, if he has appendicitis, it will just get worse and can become a major medical emergency for him."

Which statement made by another EMT during a continuing education session, regarding treatment of the pediatric patient in the prehospital setting, is correct? A) "When treating a sick pediatric patient in the prehospital setting, the EMT must determine the exact illness so as to provide the most appropriate treatment." B) "If the primary assessment of a sick pediatric patient shows no acute life threats, the patient is stable and will not deteriorate." C) "It is critical that the EMT be able to determine the adequacy of the airway and respiratory status of the patient, as these are commonly the reason for acute deterioration." D) "Since pediatric patients can deteriorate very quickly, they should all be transported with lights and sirens during the ride to the hospital, with ALS intercept arranged for."

C) "It is critical that the EMT be able to determine the adequacy of the airway and respiratory status of the patient, as these are commonly the reason for acute deterioration."

While performing the reassessment of a 2-year-old male who is severely dyspneic, you note that he is now unresponsive and not breathing. He has a heart rate of 32 beats per minute and his skin is cool and diaphoretic. Which instruction would you provide to another EMT who is helping you transport the patient? A) "We need to get a blood pressure and then I will call medical direction." B) "Please increase the oxygen in the nonrebreather face mask to 15 liters per minute." C) "Let's start chest compressions and positive pressure ventilations." D) "We need to try humidified oxygen to see if he will improve with that."

C) "Let's start chest compressions and positive pressure ventilations."

An Emergency Medical Responder asks you why you should not overextend the airway on a pediatric patient when performing a head-tilt, chin-lift maneuver. Your reply would be: A) "The pediatric cervical spine is delicate and can be injured if the neck is hyperextended." B) "The trachea of the pediatric patient is very short and can be injured by extension." C) "The cartilage of the trachea is very soft and can 'kink' if the neck is extended too far." D) "The pediatric esophagus is very thick and will occlude the airway if the neck is hyperextended."

C) "The cartilage of the trachea is very soft and can 'kink' if the neck is extended too far."

You are treating a 6-month-old patient who was accidentally dropped down a flight of steps, when her mother stumbled at the top of the stairway. The infant will only open her eyes and moan to deep painful stimuli, and tries to withdraw from the pain. Given these findings, you calculate her Pediatric Glasgow Coma Scale score to be: A) 4 B) 6 C) 8 D) 10

C) 8

Your partner informs you that the 3-year-old boy you have been called to care for is breathing 26 times per minute. As a knowledgeable EMT, you would recognize this to be: A) A rapid rate B) Adequate breathing C) A normal rate D) Inadequate breathing

C) A normal rate

A 1-year-old male is in respiratory distress and wheezing. His pulse is 156 beats/min, respirations are 32 breaths/min, and SpO2 is 95% on 4 lpm of blow-by oxygen provided by on- scene EMRs. His mother denies a medical history for the patient, but states that she has asthma and uses an albuterol inhaler. Given this information, what would be appropriate in the care of this child? A) Transport the patient in low Fowler's position B) Contact medical direction for authorization to administer albuterol MDI C) Add humidification to the oxygen D) Increase the oxygen to a high concentration through a mask

C) Add humidification to the oxygen

An infant is short of breath and has rhonchi in both lungs. He is alert with adequate respirations at a rate of 38 breaths per minute. His skin color is pink but cool to the touch. Due to the patient's movement, it is difficult to get a reliable pulse oximeter reading. Additionally, when EMRs place a pediatric mask on his face, he becomes very upset and physically struggles to remove it. In this situation you would: A) Place a nasal airway and start positive pressure ventilation B) Secure the mask to the patient's face using tape C) Allow the mother to hold the infant and provide blow-by oxygen D) Transport the infant with no further attempt at oxygen therapy

C) Allow the mother to hold the infant and provide blow-by oxygen

You have been called for a 7-year-old girl who has vomited once and complains of abdominal pain. When you are performing the secondary assessment and obtaining a medical history, which action by you would be considered most appropriate? A) Asking mostly questions that can be answered with a "yes" or "no" B) Standing above the child and smiling while asking questions C) Allowing the child to play with the stethoscope before listening to her lungs D) Using "baby talk" when asking the child questions about her pain

C) Allowing the child to play with the stethoscope before listening to her lungs

A 2-year-old patient is awake and in respiratory distress with stridorous respirations. His airway is patent and pulses rapid. Vital signs are pulse, 144 beats/min; respirations, 28 breaths/min; SpO2, 93% on room air; and temperature, 101°F. The patient has no medical history, although diabetes runs in the family. Appropriate care for this patient would include: A) High-concentration oxygen by mask B) Checking blood sugar C) Blow-by oxygen that is humidified D) Providing aspirin for fever

C) Blow-by oxygen that is humidified

A 2-month-old presents with labored breathing, fever, and coughing. Auscultation of the lungs reveals significant wheezing bilaterally. Based on this presentation, an EMT would recognize that the patient most likely has: A) Asthma B) Epiglottitis C) Bronchiolitis D) Croup

C) Bronchiolitis

You have arrived at the emergency department with a young child whom you believe is the victim of child abuse. To which person would it be best to report your suspicion? A) Registered nurse B) Security guard C) Emergency physician D) Hospital administrator

C) Emergency physician

You are treating a 9-year-old male who is short of breath and has a history of asthma. At the scene, he presents in severe respiratory distress, with intercostal retractions, lethargy, and expiratory wheezing. His pulse is 136 beats/min, respirations are 32 breaths/min, and SpO2 is 95%. You have assisted the patient with his albuterol MDI and are transporting him emergently to the hospital. As you reassess the patient, which finding is most concerning? A) SpO2 of 94% B) Increased wheezing heard bilaterally C) Heart rate of 68 beats/min D) Blood pressure of 100/64 mmHg

C) Heart rate of 68 beats/min

A malnourished child would be an example of: A) Physical abuse B) Emotional abuse C) Neglect D) Nutritional abuse

C) Neglect

When assessing a 3-year-old who is in respiratory distress, which assessment finding would be most concerning? A) Retraction of the muscles between the ribs B) Abdominal rise and fall during breathing C) Retractions observed above the clavicles D) Respiratory rate of 28 breaths per minute

C) Retractions observed above the clavicles

You are transporting a critically ill 4-year-old patient. Regarding the panicked and upset mother, you would: A) Secure the mother to the stretcher and allow her to hold the patient B) Ask the mother to get to the hospital by way of private vehicle C) Secure the mother in the "captain's chair" of the ambulance, behind the patient, during transport to the hospital D) Allow the mother to kneel next to the stretcher so her son can see her

C) Secure the mother in the "captain's chair" of the ambulance, behind the patient, during transport to the hospital

An 8-year-old child was chasing his dog when the boy ran out into the street and was struck by a car. He is responsive to verbal stimuli and has an unstable pelvis and a bruise to the side of his face. His airway is open and his breathing is rapid and shallow. His radial pulse is rapid and weak and his skin is cool, moist, and diaphoretic. The patient also has abrasions to his back after being thrown by the car onto the pavement. Based on these assessment findings, the EMT would treat the patient for which life-threatening condition? A) Hypoxia B) Head injury C) Shock D) Back injury

C) Shock

) A 6-year-old male is in severe respiratory distress with inspiratory stridor. He has pale, moist skin, with cyanosis noted around his mouth. The patient is very lethargic and cannot hold his head up. His mother is panicked and reports that he has a history of asthma. Breath sounds are diminished and his vital signs are pulse, 162 beats/min; respirations, 40 breaths/min; blood pressure, 122/66 mmHg; and SpO2, 81%. What would your immediate action be? A) Apply a nonrebreather mask with 15 lpm oxygen B) Insert an oral airway and ventilate with a bag-valve mask C) Start positive pressure ventilation D) Administer the patient's albuterol MDI and provide immediate transport

C) Start positive pressure ventilation

) You have been called to a preschool for a seizing child. On arrival, staff directs you to a bed in which a 4-year-old boy is lying. Staff state that the child began making "funny" noises in his sleep, then began to seize for approximately 60 seconds. Your assessment indicates that the boy is responsive to painful stimuli and is breathing, but has gurgling sounds coming from the upper airway. His radial pulse is rapid and strong, and his skin is cool and diaphoretic. What is your immediate action in caring for this child? A) Apply oxygen B) Place a cervical collar C) Suction the airway D) Start positive pressure ventilation

C) Suction the airway

While in an apartment to provide care for a 52-year-old female with shortness of breath, you note a baby sleeping in a nearby crib. Which observation related to the baby would prompt you to intervene and speak to the family? A) The baby is sleeping on a hard mattress B) The crib is near a closed window C) The baby is sleeping on her abdomen D) The baby is sleeping in the afternoon

C) The baby is sleeping on her abdomen

A 6-month-old male was outside with his parents and was stung on the tongue after putting a bottle in his mouth that had a bee on the nipple. In comparison to the same injury in an adult, why would the EMT be more concerned with this child? A) A child's airway has more blood vessels than an adult's airway, making bleeding more of a concern B) Children tend to be highly allergic to bee stings while the same allergy in an adult is less common C) The child's tongue is proportionally larger, increasing the chance of airway occlusion from minor swelling D) When injured, a child's mouth produces more saliva, making airway occlusion a major concern

C) The child's tongue is proportionally larger, increasing the chance of airway occlusion from minor swelling

When involved with a pediatric patient, the EMT recognizes that patient assessment begins when: A) You are pulling up on scene outside the house B) You physically touch the patient C) You first lay eyes on the patient D) You arrive by the side of the patient.

C) You first lay eyes on the patient

Pediatric patients are patients who range in age from: A) 1 year to 8 years B) birth to 12 years C) birth to 18 years D) 1 year to 15 years

C) birth to 18 years

You are assessing a 5-year-old boy who complains of arm pain after falling down three steps. As you physically assess the patient, he tries to bite your hands. His mother is at his side. Which statement by you is appropriate to make regarding the behavior of biting? A) "If you bite me, I will not help you feel better." B) "Do you bite your mother? Why would you try to bite me?" C) "Mom, you need to stop him from biting me." D) "I know that you hurt, but biting is not okay."

D) "I know that you hurt, but biting is not okay."

At the scene of an MVC, you must remove an injured child from his car seat and provide full spine motion restriction precautions prior to transport to the hospital. Which statement made by the lead EMT indicates that this procedure is being performed correctly? A) "Let's carefully lift the baby from the car seat, while manually holding her neck, and place her on the long board." B) "As we place the patient on the long board, we will need to insert a towel under her neck to prevent flexion of the head." C) "Before we slide her feet-first from the car seat onto the long board, we will need to apply an infant cervical collar." D) "To get her on the long board, let's tilt the car seat backward, and carefully slide her out head- first."

D) "To get her on the long board, let's tilt the car seat backward, and carefully slide her out head- first."

) What would be the calculated minimally acceptable systolic blood pressure for a 9-year-old girl who has a significant bleed following an injury involving broken glass? A) 96 mmHg B) 79 mmHg C) 100 mmHg D) 88 mmHg

D) 88 mmHg

When assessing a 3-year-old child for possible injuries after the child fell down a flight of stairs, which finding would raise the EMT's suspicion that the child may be a victim of physical abuse? A) The child cries when you palpate his arm B) Several bruises are located on his knees and shins C) The child is fearful and appears thinner than other children this age D) Bruises are found on his chest and abdomen

D) Bruises are found on his chest and abdomen

You are by the side of a 2-year-old male whose mother states he has a cough that has slowly worsened over the past three days. The patient's airway is patent and respirations labored. Intercostal retractions are accompanied by stridorous respirations. His skin is very warm to the touch. Vital signs are as follows: pulse, 152 beats/min; respirations, 28 breaths/min; SpO2, 97%; and temperature, 100.3°F. Breath sounds are clear and equal. Based on this presentation, you would suspect and treat the patient for: A) Asthma B) Bronchiolitis C) Foreign body airway obstruction D) Croup

D) Croup

What would be a primary concern for an 11-year-old female with a prolonged asthmatic episode lasting several days and a low-grade temperature? A) Laryngeal edema B) Croup C) Febrile seizure D) Dehydration

D) Dehydration

) When assessing a central pulse of a young child, the EMT would palpate the: A) Radial pulse B) Brachial pulse C) Pedal pulse D) Femoral pulse

D) Femoral pulse

You have arrived on the scene to help a child who is short of breath. The mother is screaming hysterically that her 3-year-old boy cannot breathe, making assessment of the patient very difficult. Your initial action in the management of this situation would be to: A) Inform the mother that you will call the police if she does not calm down B) Quickly remove the child to the ambulance and assess while transporting C) Summon the police to the residence to subdue the mother D) Have your partner talk to the mother while you assess the child

D) Have your partner talk to the mother while you assess the child

A concerned parent asks you which vaccine will decrease the risk of her child getting epiglottitis. Which vaccine would you tell her? A) Hepatitis B) Influenza C) Haemophilus influenzae D) Hib vaccine

D) Hib vaccine

You have been called for a 4-year-old female who is short of breath. Her mother informs you that she has had a fever and runny nose for two days and today began to have difficulty breathing. Furthermore, the mother is having a difficult time waking her daughter up. You find the girl lying in bed with snoring respirations despite use of the head-tilt, chin-lift airway maneuver. Your assessment reveals her to be responsive to painful stimuli and breathing at 12 times per minute with minimal chest and abdominal rise and fall. Her skin is warm to the touch with cyanosis around the lips. Your partner informs you that her heart rate is 124 beats per minute. What is your immediate action in caring for this child? A) Positive pressure ventilation B) Suctioning the airway C) Application of a nonrebreather face mask and oxygen D) Insertion of a nasal airway

D) Insertion of a nasal airway

The EMT is correctly assessing a child's apical pulse when he: A) Carefully feels over both carotid arteries for at least 30 seconds B) Uses a stethoscope to listen to and count the femoral pulse rate C) Feels both carotid and brachial pulses for equality and rate D) Listens with a stethoscope to the child's left side of the chest

D) Listens with a stethoscope to the child's left side of the chest

An extremely high fever in a 2-month-old infant should be considered which medical emergency until otherwise proven? A) Bacterial pneumonia B) Cerebral abscess C) Viral bronchitis D) Meningitis

D) Meningitis

You have been called for a 2-week-old baby who is sick. Assessment reveals him to have a fever and rhonchi that is audible with a stethoscope over the lungs. Which of the additional assessment findings would be most concerning to you given the age of this patient? A) Respiratory rate of 30 breaths per minute B) Wet diaper in need of changing C) Continual moaning and crying D) Nasal passages occluded by mucus

D) Nasal passages occluded by mucus

A frantic mother has contacted EMS because she believes that her 4-year-old daughter got into her blood pressure medications and ate three or four pills. The patient presents as awake and oriented, with pale skin that is cool and diaphoretic. Her pulse is rapid and respirations adequate. Vital signs are pulse, 116 beats/min; respirations, 22 breaths/min; blood pressure, 82/44 mmHg; and SpO2, 99%. After completing the primary assessment, what would your immediate action be? A) Apply high-concentration oxygen B) Educate the mother on safe storage of medications C) Contact poison control and induce vomiting D) Obtain the name and dosage of the medication, and then call the poison control center

D) Obtain the name and dosage of the medication, and then call the poison control center

An 8-year-old boy is unresponsive following the accidental ingestion of his father's high blood pressure medications. His airway is open and his breathing is labored and inadequate. The pulse rate is 48 beats per minute and his skin is cool and diaphoretic. Your partner states that the patient's lungs have crackles in them and the blood pressure is 60/40 mmHg. Which intervention represents the most important care that you will provide to the patient next? A) Determination of the exact medication taken B) Oral airway and high-concentration oxygen C) Administration of activated charcoal D) Positive pressure ventilation

D) Positive pressure ventilation

A mother asks you what causes her son to get bronchiolitis. You would inform her that this infection is caused by: A) An unknown bacterium B) The same bacterium that causes strep throat C) A pneumonia-type virus D) Respiratory syncytial virus

D) Respiratory syncytial virus

After placing a small rock in her mouth, a 7-month-old girl begins to choke. You are on scene within minutes and find her unresponsive in her mother's arms. You attempt to provide ventilations with the bag-valve mask, but are unsuccessful after two attempts. What would your next action be? A) Attempt ventilation with a pocket mask B) Administer five chest thrusts C) Provide five abdominal thrusts D) Start cardiopulmonary resuscitation

D) Start cardiopulmonary resuscitation

Assessment of a 4-year-old reveals him to be unresponsive with no spontaneous respirations or pulse. Your immediate action would be to: A) Attach the automated external defibrillator B) Transfer to stretcher and immediately transport C) Begin rescue breathing at 20 breaths per minute D) Start chest compressions

D) Start chest compressions

You are on scene of an MVC in which a 3-year-old female was in a car seat in the backseat. The child appears not to be injured, but the mother would like her taken to the hospital for an evaluation. Since the patient will need a car seat for transport, which criteria would indicate that the car seat she is currently sitting in cannot be used to safely transport the patient? A) The mother sustained minor injuries B) The car was easily driven by the police department from the scene for safe storage C) The front air bags of the car deployed D) The car seat appears to have a crack in the side when impacted by the door handle

D) The car seat appears to have a crack in the side when impacted by the door handle

You are assessing a 9-month-old boy who has had a fever for the past two days. What would be a likely finding if the fever has caused dehydration? A) Palpation of the anterior fontanelle reveals it to be bulging B) The heart rate is at the high end of the "normal" range C) Respirations are labored and rapid D) The mother informs you that the baby is wetting very few diapers daily

D) The mother informs you that the baby is wetting very few diapers daily

You note a 5-year-old patient seizing as you approach him. Which observation or piece of information would be most alarming? A) The patient has no history of seizures B) The patient has a history of leukemia C) The patient is incontinent of urine and feces D) The patient has been seizing for 12 minutes

D) The patient has been seizing for 12 minutes

) You have been called to care for a 21-month-old female who has been bitten by a dog. Given the patient's age, you would appropriately classify the patient as a(n): A) Infant B) School-age child C) Preschooler D) Toddler

D) Toddler

A 3-year-old female has been accidentally struck in the chest with a baseball bat during a domestic altercation. Assessment indicates redness to the right lateral chest with no deformity, crepitus, or broken skin. Vital signs are pulse, 124 beats/min; respirations, 22 breaths/min; blood pressure, 108/62 mmHg; and SpO2, 99% on room air. Given these assessment findings, what would your best action be? A) Provide spine motion restriction precautions and treat the patient as if she is in shock B) Release the child into the custody of the police department for temporary foster home placement C) Treat injury as if it is a flail chest and provide immediate transport D) Treat the child for suspected internal chest injury

D) Treat the child for suspected internal chest injury

) You are called to a home for a 7-year-old female with a suspected upper respiratory infection. As you assess the patient, you note a bruise to her right upper arm. As you continue to assess and care for this child, you should: A) Apply an ice pack to the arm and transport the patient B) Note the bruise and continue to treat for the respiratory infection C) Ask the mother if the child hurt herself playing D) Treat the respiratory infection and perform a head-to-toe assessment

D) Treat the respiratory infection and perform a head-to-toe assessment