EPC 4E Test
Positive-pressure ventilations should be initiated on a newborn who is apnea, shows signs of inadequate respiratory effort, or has which of the following? - Pulse oximetry less than 95% - Heart rate less than 100 after stimulation and oxygen delivery - Respiratory rate greater than 20 breaths per minute - No available nasal cannula
Heart rate less than 100 after stimulation and oxygen delivery
When evaluating a child with multiple bruises on their body, which of the following is the best indicator that the injuries are not the result of child maltreatment? - Bruising found on infants who are not yet crawling - An 18 month old with bruising on his head - Bruising on the torso, ears, or neck in a child 4 years of age or younger - Bruises that are located away from bony prominences
An 18 year old with bruising on his head
You are caring for a newborn, and their heart rate remains less than 60 after positive-pressure ventilation. What should be your next action? - Increase oxygen percentage - Oral suctioning - Obtain IV access and administer epinephrine - Begin chest compressions
Begin chest compressions
When utilizing a tourniquet on a 7 year old, which of the following is correct? - Appropriate to switch to an elastic-style tourniquet when a windlass-style tourniquet is too large - Appropriate to use over joints or cloths with bulky material - Appropriate to occasionally release the tourniquet - Appropriate to utilize for minor bleeding
Appropriate to switch to an elastic-style tourniquet when a windlass-style tourniquet is too large
Which of the following behavioral health disorders is most likely to be a risk factor for suicidal ideation? - Anxiety - Depression - Autism spectrum disorder - Attention-deficit/hyperactivity disorder (ADHD)
Depression
A 10 year old male is complaining of thirst, hunger, and excessive urination. He also has vomiting and his breath smells like nail polish remover. His blood glucose level is 358 mg/dL. You suspect he is suffering from: - Inflammatory bowel disease - Meningitis - Diabetic ketoacidosis - Influenza
Diabetic ketoacidosis
Which of the following is the correct sequence of initial steps in caring for a newborn? - Dry, elevate the baby above the mother's heart until the cord is up -Dry, warm, position, stimulate gently, suction if needed - Cut the cord, suction, turn upside down to drain secretions - Warm, stimulate if needed, put drops in the eyes
Dry, warm, position, stimulate gently, suction if needed
You can build trust and cooperation with the caregivers by doing which of the following? - Only speaking directly to the child - Enlisting the caregivers as members of the patient care team - Ignoring the caregiver - Understanding how children think and communicate
Enlisting the caregivers as members of the patient care team
While assessing a 9 year old female, you note she has a fever, stiff neck, and petechia. You suspect meningitis. Which of the following steps is appropriate? - Avoid touching the child to limit the risk of infection - Ensure your entire crew is wearing masks, gloves, and eye protection - Immediately perform your assessment without considering body substance isolation because of the patient's acuity - Administer an IV fluid bolus and diazepam IM
Ensure your entire crew is wearing masks, gloves, and eye protection
While caring for an infant or toddler, the healthcare provider should do which of the following? - Examine the infant from toe to head unless they are critical - Remove all the patient's clothing immediately - Immediately load the child and transport to the closest facility as quickly as possible - Let the infant ride on mom's lap on the stretcher during transport
Examine the infant from toe to head unless they are critical
You are treating an 11 year old male patient who has a hearing impairment and is in a wheelchair. What is the best method to assess this patient? - Face the patient at eye level as you speak to them - Stand above eye level so you can assess them from above - Speak loudly into their ear - Walk up and grab the wheelchair to secure it
Face the patient at eye level as you speak to them
When obtaining your impression of pediatric patients, which of the following parameters are quickly assessed? - Revised trauma score, blood pressure, heart rate - Glasgow Coma Scale, airway, breathing - General appearance, work of breathing, circulation to the skin - Airway, respiratory rate, pulse, cardiac rhythm
General appearance, work of breathing, circulation to the skin
An 8 year old male has had vomiting and diarrhea for 4 days. His general appearance is poor and his interactions are obtunded. The family states this is not usual for him. You note that he has weak peripheral pulses, but his central pulses are strong. What does this tell you? - He requires immediate intubation - He is in compensated shock - Nothing; you need a blood pressure to determine if he is in shock - He is in decompensated shock
He is in compensated shock
You arrive on scene to find a 3 year old female patient who is unresponsive and has no palpable pulses. Initial treatment for this patient includes which of the following? - Opening the airway, positive-pressure ventilations, chest compressions, IV/IO access - 100% oxygen, chest compressions, IV/IO access - Opening the airway, oxygen, naloxone - Hands-only CPR
Opening the airway, positive-pressure ventilations, chest compressions, IV/IO access
When treating a preschool-aged child who is suffering from mild to moderate pain, treatment should include which of the following? - IN fentanyl - IM ketamine - IV opioids - PO acetaminophen
PO acetaminophen
Which of the following best describes respiratory failure? - Inadequate respiratory effort - Patient can no longer maintain oxygenation and ventilation - Patient has asthma - Patient has visible retractions
Patient can no longer maintain oxygenations and ventilation
Which of the following is one of the ways the pediatric airway differs from the adult airway? - The larynx is more posterior - The epiglottis is stiffer - Neutral airway positioning involves hyperextending the neck - The tongue is larger in relation to the size of the mouth
The tongue is larger in relation to the size of the mouth
You respond to a 6 month old male in respiratory distress. He presents with copious amounts of nasal drainage, expiratory wheezes, and nasal flaring. His skin is warm and clammy. Which of the following would be your initial treatment? - Insert an airway adjunct - Suction the nostrils - Provide oxygen using a blow-by method - Provide oxygen using a BVM at 15 L/min
Suction the nostrils
You and your partner respond to a 5 year old male with special healthcare needs who is on a ventilator at home. Upon arrival, you find him on the ventilator but in clear respiratory distress. What should you attempt first? - Immediately remove the trach tube and replace it with a new, smaller one - Suction the tube to clear any secretions or mucus plugs - Increase the rate, tibial volume, and the percentage of oxygen delivered by the ventilator - Nothing; leave him on the ventilator until you reach the hospital
Suction the tube to clear any secretions or mucus plugs
An 8 year old male was struck by a car while riding his bike. He presents with hypotension, respiratory distress, and decreased breath sounds on the right. Which of the following injuries would present the greatest immediate danger to the patient? - Closed head injury - Ruptured diaphragm - Lacerated liver - Tension pneumothorax
Tension pneumothorax
Which of the following should be considered when assessing the airway in the pediatric patient? - All pediatric airways require advanced maneuvers; utilizing basic life support is not enough - It is important to look, listen, feel, and watch for chest movement when assessing a pediatric airway - The anatomical differences between an adult and pediatric airway impact the care provided - Anatomical differences between an adult and a pediatric airway are inconsequential
The anatomical differences between an adult and pediatric airway impact the care provided
When caring for children with special healthcare needs, it is important to remember which of the following? - The caregivers and even children may be more knowledgeable about the underlying healthcare needs than you - You should use a completely different assessment approach than the one you use for other children - Their "normal" will always be the same as for any other children of the same age - You should always take them to the closest hospital, regardless of that hospital's pediatric capabilities
The caregivers and even the children may be more knowledgeable about the underlying healthcare needs than you
When initiating fluid replacement in a badly injured 5 year old, which of the following is correct? - 10 mL/kg is the amount for IV crystalloid boluses - Oral fluids are preferred over IV fluids - D5NS is the fluid of choice - 20 mL/kg boluses of NS are preferred
20 mL/kg boluses of NS are preferred
You respond to a 2 year old male for difficulty breathing. He presents with inspirations stridor, barking cough, and a temperature of 100.9 °F. Which of the following actions should be your initial treatment? - Administer nebulized epinephrine - Prepare to intubate - Administer nebulized albuterol - Administer IV fluids
Administer nebulized epinephrine
Accurate documentation of suspected child maltreatment is extremely important. Which of the following is correct when documenting child maltreatment? - Document the subjective information about the situation - All information should be documented verbatim - Document your conclusion about who abused the child - Document the weapon or mechanism you think was the cause of the injuries
All information should be documented verbatim
In which of the following situations is endotracheal intubation indicated in a pediatric patient? - A patient is postictal form a seizure with a normal respiratory effort - There is evidence of meconium spirit ion and good general appearance immediately after birth - There are signs of basilar skull fracture - All other airway management resources have been exhausted
All other airway management resources have been exhausted
Helpful practices in treating adolescent patients include which of the following? - Lying about painful procedures so they don't get upset - Asking the patient questions in front of their parents/caregivers - Allowing them to make simple choices about their care - Not questioning them directly about their history
Allowing them to make simple choices about their care
Which of the following is true about ventricular fibrillation in pediatrics? - Ventricular fibrillation is commonly seen in neonates - Children who respond to early defibrillation from witnessed sudden cardiac arrest have the best documented outcomes - Ventricular fibrillation is commonly seen in children - Children should be defibrillated at 360J
Children who respond to early defibrillation from witnessed sudden cardiac arrest have the best documented outcomes
You and your partner respond to an 8 year old female who has a central line for chemotherapy. She was playing with it and it now appears to be leaking. What should your initial actions be? - Remove the remaining portion of the line and apply a dressing - Have the parents take her to the hospital - Initiate an IV bolus using the central line - Clamp the line if possible and transport to her usual hospital
Clamp the line if possible and transport to her usual hospital
While caring for a 4 year old female, you note numerous unexplained bruises and injuries in various stages of healing. Her mother refuses to let you transport the child to the hospital. You are suspicious of child maltreatment. Which of the following actions should you take? - Attempt to talk the mother into allowing you to transport the patient to the hospital, then give up if she continues to refuse - Have mom sign a refusal form - Contact medical control and/or call the police for assistance, per your agency protocols - Directly share your concerns of abuse with the mother
Contact medical control and/or call the police for assistance, per your agency protocols
An 8 year old female is pulseless and apnea after being pulled from a lake on an early fall afternoon. Upon completing 5 minutes of cardiac arrest management, you and your partner achieve return of spontaneous circulation (ROSC). Continued treatment for this patient includes: - Maintaining an ETCO2 of less than 20 mmHg - Continuing positive-pressure ventilation - Discontinuing ventilatory support - Administering a fluid bolus of 10 mL/kg
Continuing positive-pressure ventilations
Which of the following is an appropriate technique when suctioning a child with a tracheostomy tube? - Suction the or pharynx with a Yankauer for 15 seconds - Force the suction catheter down the tracheostomy tube and suction while removing the catheter - Cover the suction port and suction for 15 seconds while removing the catheter - Cover the suction port and suction for 3-5 seconds while removing the catheter
Cover the suction port and suction for 3-5 seconds while removing the catheter
Which of the following is the most common cause of upper airway obstruction in pediatric patients younger than 6 years? - Foreign body obstruction - Anaphylaxis - Croup - Bronchiolitis
Croup
You and your partner respond to a motor vehicle collision with a 3 year old patient. During your initial assessment, you find her to be lethargic. She has a patent airway, normal work of breathing, a respiratory rate of 34, sinus tachycardia, and weak central pulse. These findings indicate: - Respiratory failure - Hypoperfusion - Traumatic brain injury - Central nervous system dysfunction
Hypoperfusion
Initial steps for cardiac arrest in a child include which of the following? - Hands-only CPR - Administration of medication prior to CPR - Immediate use of an AED or defibrillator - Immediate high-quality, choreographed CPR with ventilations
Immediate high-quality, choreographed CPR with ventilations
A 13 year old female was struck by a car while riding her bike. She presents with hypotension, respiratory distress, and decreased breath sounds on the right. Which of the following is the highest priority treatment for this patient? - NG tube placement - Immediate needle decompression of the right chest - Wide-open IV fluids - Elevation of the head of the stretcher
Immediate needle decompression of the right chest
A 2 year old male is found at the bottom of a swimming pool. He is unresponsive and apnea. After removing him the from water, which of the following would be the proper order of pediatric resuscitation for this patient? - Initiate PAT, abdominal thrusts to force any fluids form his lungs, assess pulses, begin CPR if indicated - Remove his wet clothing and cover him with dry blankets - Assess his cardiac rhythm, initiate PAT, initiate basic airway management, transport - Initiate PAT, primary survey, address clinical interventions that are needed, begin CPR if indicated
Initiate PAT, primary survey, address clinical interventions that are needed, begin CPR if indicated
A 7 year old male was involved in a bike versus vehicle collision while on a bike ride with his family. He was hit head-on by the vehicle and struck the handlebars. Based on the mechanism of injury, what is the most likely acute, life-threatening injury? - Sternum fracture - Fractured tibia and fibula - Intra-abdominal organ rupture - Orbital fracture
Intra-abdominal organ rupture
Which of the following descriptions is accurate for post-traumatic stress disorder (PTSD)? - It is severe sadness and hopelessness for a period of 2 weeks or greater - It develops in some pediatric patients who experience or witness a traumatic event - It is more common in boys than in girls - It is the most common reason for pediatric behavioral health EMS transports
It develops in some pediatric patients who experience or witness a traumatic event
The Pediatric Assessment Triangle (PAT) is an important aspect of the assessment of a pediatric patient. Which statement is true about the PAT? - It is a tool used to obtain your first impression of a pediatric patient - It follows the XABCDE approach - If three sides of the triangle are compromised, you do not have to consider moving quickly - The PAT does not focus on the ABCs of a pediatric patient
It is a tool used to obtain your first impression of a pediatric patient
You are dispatched to an 11 year old female patient complaining of abdominal pain. Upon your arrival, you find the patient lying on the couch in the fetal position. The PAT reveals the patient is alert and has a patent airway, increased work ob breathing, and pale skin. The patient is crying and says, "my belly hurts." Mom informs you that the patient has been vomiting all day. Your physical exam notes a distended abdomen, but no signs of physical trauma. Vital signs are BP 82/50, HR 138, RR 28, SpO2 94%, GCS 15 (E4, V5, M6), and a blood glucose 112 mg/dL. The patient has a history of asthma and sickle cell disease. In this scenario, which of the following findings is critical with this patient? - Patient age - Respiratory rate - Blood glucose level - Patient is crying in the fetal position
Patient is crying in the fetal position
When assessing a pediatric patient, which of these actions is completed first? - Primary survey - Focused history - Bleeding control - Pediatric Assessment Triangle (PAT)
Pediatric Assessment Triangle (PAT)
A 2 year old female who has had a cold now presents with 3 minutes of tonic-clinic movements of all extremities and does not respond to voice. Her skin feels hot. Immediate basic care for her should include which of the following? - Protect her form self-harm, maintain her airway, and give oxygen - Hold her down and force a bite block in her mouth - Place her in a tub of cold water or use ice packs on her neck - She does not require any interventions
Protect her from self-harm, maintain her airway, and give oxygen
A 12 year old male presents with respiratory distress. After assessing his airway, what initial parameters would you evaluate for breathing? - Skin color, respiratory rate, and arterial blood gas - Respiratory rate, depth, effort, and breath sounds - External bleeding and respiratory rate, depth, and effort - Respiratory rate is all that needs to be assessed
Respiratory rate, depth, effort, and breath sounds
Which of the following is correct about ingestion of marijuana in food (edibles)? - Naloxone administration is recommended - Airway compromise is a concern - Toxic ingestion is largely a diagnosis of exclusion in the field - Poison control should be immediately contacted
Toxic ingestion is largely a diagnosis of exclusion in the field
Intraosseous vascular access in children with a critical condition is: - Contraindicated in most cases - Usually achieved rapidly with a high success rate - Difficult to obtain and has a low success rate - Experimental
Usually achieved rapidly with a high success rate
A 7 year old male has been vomiting for 3 days. His HR is 200, with a capillary refill of 3 seconds; his mucous membranes are dry; and he's a little sleepy. Treatment for this patient includes: - Vascular access, 20 mL/kg bolus of NS or LR, treat hypoglycemia if present - Synchronized cardioversion - Oral glucose - Dopamine IV
Vascular access, 20 mL/kg bolus of NS or LR, treat hypoglycemia if present
Children respond to volume-related hypo perfusion by which of the following mechanisms? - Vigorous vasodilation - Increasing cerebral perfusion - Decreasing heart rate - Vigorous vasoconstriction
Vigorous vasoconstriction
Which of the following is important when preparing for an endotracheal intubation in a pediatric patient? - Younger pediatrics do not need a towel to elevate their shoulders to prevent potential obstructions - Right mainstream intubation is unlikely - Using an uncured tube is preferred in pediatric patients - Visualizing a pediatric airway may be difficult due to the larynx being more anterior and superior
Visualizing a pediatric airway may be difficult due to the larynx being more anterior and superior
Hypothermia increases oxygen demands, and newborns can easily become hypothermic. Which of the following is the recommended way to prevent heat loss in a newborn? - Placing the newborn on a bed alone - Avoiding skin-to-skin contact between the newborn and mother - Warming and drying the newborn and placing on mom for skin-to-skin contact - Placing the newborn directly under a warming lamp without drying
Warming and drying the newborn and placing on mom for skin-to-skin contact
