Chapter 43 Pediatric Emergencies Flashcards
1
Q
- In contrast to adults, children:
A) land on their feet when they fall.
B) have proportionately larger heads.
C) experience head injury less frequently.
D) lose most body heat through the chest.
A
Ans: B
Page: 2007
Type: General Knowledge
2
Q
2. Compared to adults, the smaller diameter of a child's airway makes it more vulnerable to: A) laryngospasm. B) inhalation injury. C) oropharyngeal secretions. D) obstruction by the tongue.
A
Ans: D
Page: 2007
Type: General Knowledge
3
Q
- A child’s vocal cords can be difficult to visualize during intubation because:
A) the epiglottis is floppy and U-shaped.
B) the cords themselves are more posterior.
C) a sniffing position is difficult to achieve.
D) the area of the cricoid cartilage is narrow.
A
Ans: A
Page: 2007
Type: General Knowledge
4
Q
- Which of the following statements regarding a child’s chest wall is correct?
A) Lung sounds are difficult to hear because of the thick intercostal muscles.
B) Children are belly breathers because they rely heavily on their diaphragms.
C) A child’s chest wall has proportionately more subcutaneous fat on the chest.
D) Retractions are less obvious in children owing to their noncompliant rib cages.
A
Ans: B
Page: 2008
Type: General Knowledge
5
Q
5. When a child experiences a low cardiac output state, he or she relies MOST on: A) increased tidal volume. B) central vasoconstriction. C) an increase in heart rate. D) increased stroke volume.
A
Ans: C
Page: 2008
Type: General Knowledge
6
Q
6. Most children begin to develop stranger anxiety between \_\_\_ and \_\_\_ months of age. A) 3, 6 B) 6, 12 C) 12, 18 D) 18, 24
A
Ans: B
Page: 2005
Type: General Knowledge
7
Q
- Children between 1 and 3 years of age:
A) are capable of basic reasoning.
B) have a well-developed sense of cause and effect.
C) generally explore the world exclusively by crawling.
D) may have negative associations with health care providers
A
Ans: D
Page: 2005
Type: General Knowledge
8
Q
- The FIRST step in examining a toddler in stable condition is to:
A) let the child sit on a parent’s lap.
B) place yourself at the child’s level.
C) quickly examine any painful areas.
D) allow the child to hold a favorite toy.
A
Ans: A
Page: 2005
Type: General Knowledge
9
Q
- When assessing a 5-year-old child, you should:
A) be able to conduct a head-to-toe exam.
B) ask simple yes or no questions if possible.
C) generally use a toe-to-head exam approach.
D) first ask a parent where the child is hurting.
A
Ans: A
Page: 2006
Type: General Knowledge
10
Q
- An 8-year-old child:
A) is analytic but is not capable of abstract thought.
B) should not be the initial historian regarding an illness.
C) is anatomically and physiologically similar to an adult.
D) generally requires little reassurance and encouragement.
A
Ans: C
Page: 2006
Type: General Knowledge
11
Q
- With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once:
A) he or she reaches the age of 8 to 10 years.
B) resting vital signs are consistent with an adult.
C) his or her body weight is estimated at 55 pounds.
D) secondary sexual characteristics have developed.
A
Ans: D
Page: 2007
Type: General Knowledge
12
Q
12. A 15-year-old child can be difficult to treat for all of the following reasons, EXCEPT: A) peer pressure. B) stranger anxiety. C) independence issues. D) cognizance of body image.
A
Ans: B
Page: 2007
Type: General Knowledge
13
Q
- When assessing and caring for a 17-year-old gang member, it is MOST important to remember that he or she:
A) must be separated from other gang members.
B) generally desires the presence of a caregiver.
C) typically boasts about the use of illicit drugs.
D) may have a weapon and a reputation to earn.
A
Ans: D
Page: 2007
Type: General Knowledge
14
Q
- Establishing good rapport with the caregiver of a sick or injured child at the scene is vital because:
A) caregivers often take their anger out on prehospital professionals.
B) he or she will be a source of important information and assistance.
C) doing so will quickly deescalate any hostility that he or she may have.
D) the caregiver generally will not accompany the child in the ambulance.
A
Ans: B
Page: 2010
Type: General Knowledge
15
Q
- If the parent or caregiver of a sick or injured child is emotionally distraught:
A) provide support, but remember that your first priority is the child.
B) you should firmly tell him or her that the situation is under control.
C) he or she should follow the ambulance in his or her personal vehicle.
D) the parent or caregiver should be removed from the scene immediately.
A
Ans: A
Page: 2011
Type: General Knowledge
16
Q
- The pediatric assessment triangle was designed to:
A) formulate a working field diagnosis upon first sight of an ill child.
B) identify immediate life threats through a rapid hands-on assessment.
C) help EMS providers form a hands-off general impression of an ill child.
D) provide a means for performing a rapid head-to-toe physical assessment.
A
Ans: C
Page: 2011
Type: General Knowledge
17
Q
- The pediatric assessment triangle will help answer all of the following questions, EXCEPT:
A) “Is the child sick or not sick?”
B) “Will the child cooperate during my exam?”
C) “Does the child require emergency treatment?”
D) “What is the most likely physiologic abnormality?”
A
Ans: B
Page: 2011
Type: General Knowledge
18
Q
- A sick or injured child’s general appearance is MOST reflective of:
A) the etiology of the problem.
B) his or her cardiovascular status.
C) his or her central nervous system function.
D) his or her ability to be consoled.
A
Ans: C
Page: 2011
Type: General Knowledge
19
Q
- A child who is disinterested in your presence and has a blank stare and poor muscle tone:
A) is likely hypoglycemic or in septic shock.
B) should be ventilated with a bag-mask device.
C) will most likely require pharmacologic support.
D) requires immediate intervention and transport.
A
Ans: D
Page: 2012
Type: General Knowledge
20
Q
- The work-of-breathing component of the pediatric assessment triangle includes all of the following, EXCEPT:
A) listening for grunting or audible wheezing.
B) noting the child’s position during breathing.
C) auscultating the lungs for adventitious sounds.
D) looking for substernal or intercostal retractions.
A
Ans: C
Page: 2012-2013
Type: General Knowledge
21
Q
- A conscious child who is in the sniffing position:
A) is trying to align the axes of the airway to improve ventilation.
B) is clearly experiencing a lower airway obstruction.
C) will refuse to lie down and leans forward on outstretched arms.
D) assumes a physical position that optimizes accessory muscle use.
A
Ans: A
Page: 2013
Type: General Knowledge
22
Q
- In contrast to adults, retractions in children are:
A) more evident in the intercostal area.
B) less commonly seen below the sternum.
C) usually less prominent above the clavicles.
D) evident in the sternocleidomastoid muscles.
A
Ans: A
Page: 2013
Type: General Knowledge
23
Q
- When assessing a child’s circulation by looking at his or her skin, pallor is MOST indicative of:
A) vasomotor instability and decompensated shock.
B) peripheral vasoconstriction and compensated shock.
C) poor oxygenation and a state of circulatory collapse.
D) systemic vasodilation with resulting low blood pressure.
A
Ans: B
Page: 2014
Type: General Knowledge
24
Q
- Which of the following statements regarding acrocyanosis is correct?
A) Acrocyanosis is seen in the skin and mucous membranes and is a late finding if respiratory failure or shock is present.
B) Acrocyanosis is only considered to be a normal finding in newborns and usually resolves within 12 hours following birth.
C) Acrocyanosis is a bluish discoloration of the chest, abdomen, and face and is the most extreme visual indicator of poor perfusion.
D) Acrocyanosis is cyanosis of the hands and feet, and is a normal finding in infants younger than 2 months of age who are cold.
A
Ans: D
Page: 2014
Type: General Knowledge
25
25. The length-based resuscitation tape:
A) is only reliable in children who weigh less than 20 kg.
B) should not be relied upon for determining pediatric drug doses.
C) is used to estimate a child's weight based on his or her height.
D) is generally more accurate than the weight given by a caregiver.
Ans: C
Page: 2014
Type: General Knowledge
26
26. Counting an infant's respiratory rate for 15 seconds and then quadrupling that number:
A) is recommended because it is the quickest way to determine if the infant's baseline respiratory rate is abnormally slow or abnormally fast.
B) may yield a falsely low respiratory rate because infants may have periodic breathing or variable respiratory rates with short periods of apnea.
C) is impractical because the inherent respiratory rate of an infant is usually rapid and counting for such a short period of time leaves room for error.
D) is appropriate only if you are auscultating the child's respirations with a stethoscope while simultaneously listening to lung sounds.
Ans: B
Page: 2015
Type: General Knowledge
27
27. A normal respiratory rate in a child:
A) may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued.
B) generally ranges between 15 and 20 breaths per minute and is influenced easily by factors such as excitement, fear, or fever.
C) cannot be established accurately because a toddler's respirations generally are grossly irregular and extremely difficult to count.
D) is a sign of impending respiratory failure if it is observed in conjunction with a room air oxygen saturation reading of less than 96%.
Ans: A
Page: 2015
Type: General Knowledge
28
28. When evaluating a child's oxygen saturation level with a pulse oximeter:
A) you should recall that peripheral vasodilation from a warm environment will typically yield a false reading.
B) it should be evaluated in the context of the pediatric assessment triangle and remainder of the primary assessment.
C) you should provide ventilatory assistance with a bag-mask device if the reading is below 94% and not increasing rapidly.
D) a reading of less than 96% on room air indicates respiratory distress and necessitates the administration of supplemental oxygen.
Ans: B
Page: 2015
Type: General Knowledge
29
```
29. Early hypoxia in a child would MOST likely present with:
A) tachycardia.
B) bradypnea.
C) mottled skin.
D) bradycardia.
```
Ans: A
Page: 2015
Type: General Knowledge
30
```
30. If you cannot palpate the femoral pulse in an unresponsive infant, you should:
A) apply an AED at once.
B) palpate the brachial pulse.
C) initiate CPR immediately.
D) assess for adequate breathing.
```
Ans: C
Page: 2015
Type: General Knowledge
31
```
31. Assessment of a child in a cold environment would MOST likely yield:
A) a rapid, weak pulse.
B) flushing of the skin.
C) delayed capillary refill.
D) a slow, irregular pulse.
```
Ans: C
Page: 2015
Type: General Knowledge
32
32. It is important to remember that blood pressure is only one component in the overall assessment of a child because:
A) it is an unreliable measurement of perfusion in all children.
B) hypotension is seen much earlier in children than in adults.
C) blood pressure may remain adequate in compensated shock.
D) it generally yields a falsely low reading in agitated children.
Ans: C
Page: 2018
Type: General Knowledge
33
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33. To evaluate function of an infant's or child's cerebral cortex, you should:
A) assess pupil reaction.
B) use the AVPU scale.
C) assess for posturing.
D) evaluate motor activity.
```
Ans: B
Page: 2015-2016
Type: General Knowledge
34
34. When a child who is too young to verbalize is in significant pain:
A) your ability to assess accurately for physiologic abnormalities is impaired.
B) narcotic analgesic drugs should be avoided unless transport will be delayed.
C) benzodiazepine drugs are preferred over opiates to minimize central nervous system depression.
D) pain scales using facial expressions are a valuable tool to assess pain severity.
Ans: A
Page: 2016
Type: General Knowledge
35
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35. The decision to transport an acutely ill child immediately or remain at the scene to perform additional interventions is LEAST dependent on:
A) the child's age and fear level.
B) transport time to the hospital.
C) expected benefits of treatment.
D) your EMS system's regulations.
```
Ans: A
Page: 2017
Type: General Knowledge
36
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36. Which of the following is often not acquired during the SAMPLE history of an adult, but should be routinely acquired in an infant or child?
A) Prescribed medications
B) Nature of symptoms
C) Preceding events
D) Immunizations
```
Ans: D
Page: 2017
Type: General Knowledge
37
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37. In contrast to adults, cardiac arrest in children is usually caused by:
A) a dysrhythmia.
B) a toxic ingestion.
C) respiratory failure.
D) congenital anomalies.
```
Ans: C
Page: 2019
Type: General Knowledge
38
38. Respiratory distress in children:
A) represents the end result of prolonged hypoxia and indicates impending cardiopulmonary failure.
B) is a compensated state in which increased work of breathing results in adequate pulmonary gas exchange.
C) is associated with a decreased level of consciousness, abnormally slow respirations, and weak muscle retractions.
D) is characterized by prominent use of the sternocleidomastoid muscles in infants and children younger than 2 years of age.
Ans: B
Page: 2019
Type: General Knowledge
39
39. When an infant or child is in respiratory failure:
A) tachypnea is usually present despite a marked decrease in heart rate.
B) decreased cerebral perfusion leads to restlessness and a weak, rapid pulse.
C) he or she can no longer compensate, which causes hypoxia and hypercarbia.
D) oxygen via nonrebreathing mask should be given if tidal volume is reduced.
Ans: C
Page: 2019
Type: General Knowledge
40
40. Common signs of impending respiratory failure in infants and children include:
A) a falling oxygen saturation despite high-flow oxygen administration.
B) abdominal breathing and a pulse rate less than 120 beats per minute.
C) marked agitation and tachycardia with ectopic ventricular complexes.
D) tachypnea and hyperpnea with nasal flaring and prominent retractions.
Ans: A
Page: 2020
Type: General Knowledge
41
41. Diffuse rales, rhonchi, and wheezing in an infant:
A) can usually be heard without a stethoscope.
B) are typical signs of lower airway inflammation.
C) suggest swelling of the supraglottic structures.
D) are signs of acute asthma until proven otherwise.
Ans: B
Page: 2020
Type: General Knowledge
42
42. A young child with marked respiratory distress who is agitated and thrashing about should receive oxygen via:
A) nonrebreathing mask because agitation indicates cerebral ischemia.
B) the blow-by technique while he or she sits on the lap of a caregiver.
C) positive-pressure ventilation after he or she has been properly sedated.
D) a method that minimizes metabolic demand and oxygen consumption.
Ans: D
Page: 2020
Type: General Knowledge
43
43. If an infant or small child swallowed a rigid foreign body, he or she would MOST likely experience respiratory distress because:
A) a foreign body in the esophagus would cause reflux and aspiration.
B) when an infant or child is stressed, he or she tends to swallow a lot of air.
C) the feeling of a foreign body in the throat would cause severe anxiety.
D) the esophageal foreign body can compress the relatively pliable trachea.
Ans: D
Page: 2021
Type: General Knowledge
44
44. A typical finding for a foreign body aspiration is:
A) a child with recent flu-like symptoms who presents with acute stridor.
B) an otherwise healthy child with a progressive increase in work of breathing.
C) an afebrile child with a sudden onset of coughing or gagging while playing.
D) a temperature less than 102°F with sudden drooling, crowing, and dyspnea.
Ans: C
Page: 2021
Type: General Knowledge
45
45. If you have reason to believe that an unresponsive child has a foreign body airway obstruction, you should:
A) assess for a pulse and then begin chest compressions.
B) perform 30 chest compressions and then look in the mouth.
C) administer abdominal thrusts until the object is expelled.
D) try to remove it by performing a finger sweep of the mouth.
Ans: B
Page: 2022
Type: General Knowledge
46
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46. If a 2-year-old child with a foreign body airway obstruction becomes unresponsive, you should position him or her supine and then:
A) visualize the upper airway.
B) perform chest compressions.
C) assess for a carotid pulse.
D) perform abdominal thrusts.
```
Ans: B
Page: 2022
Type: General Knowledge
47
47. Appropriate treatment for a conscious child with anaphylaxis includes:
A) 0.5 mg/kg of diphenhydramine IV.
B) 0.01 mg/kg epinephrine 1:1,000 IM.
C) pharmacologically assisted intubation.
D) a dopamine infusion to increase the blood pressure.
Ans: B
Page: 2022
Type: General Knowledge
48
48. Which of the following statements regarding croup is correct?
A) Croup is also referred to as acute bacterial subglottic stenosis.
B) Hallmark signs of croup include high fever and a sore throat.
C) Most cases of croup result in severe hypoxia and hypercarbia.
D) Croup is a viral upper airway infection that may cause stridor.
Ans: D
Page: 2022-2023
Type: General Knowledge
49
49. The MOST important initial treatment for a child in respiratory failure due to suspected croup is:
A) prompt intubation before the airway closes.
B) a 2.25% concentration of racemic epinephrine.
C) ventilatory assistance with a bag-mask device.
D) continuous administration of a beta-2 agonist.
Ans: C
Page: 2023
Type: General Knowledge
50
50. Epiglottitis in children:
A) presents with a sudden onset of low-grade fever and dyspnea.
B) should be suspected if the child presents with diffuse wheezing.
C) is rare now that children are vaccinated against Haemophilus influenza type B.
D) should be confirmed by visualizing the larynx and epiglottis with a laryngoscope
Ans: C
Page: 2023
Type: General Knowledge
51
51. The goal in treating a child with epiglottitis is to:
A) transport him or her to the hospital with a maintainable airway.
B) administer corticosteroids to reduce edema in the upper airway.
C) intubate him or her before the epiglottis blocks the upper airway.
D) administer oxygen by nonrebreathing mask and transport at once.
Ans: A
Page: 2023
Type: General Knowledge
52
52. In contrast to upper airway emergencies, lower airway emergencies:
A) often present with more prominent retractions.
B) are generally associated with high-grade fever.
C) include laryngotracheobronchitis and diphtheria.
D) involve restriction of airflow during exhalation.
Ans: D
Page: 2024
Type: General Knowledge
53
53. A child who is experiencing a moderate asthma attack would MOST likely present with:
A) a markedly prolonged expiratory phase.
B) wheezing during inspiration and expiration.
C) an inability to speak in complete sentences.
D) an oxygen saturation between 80% and 90%.
Ans: B
Page: 2024
Type: General Knowledge
54
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54. Medications used to prevent an asthma attack include:
A) inhaled steroids.
B) beta-2 agonists.
C) inhaled albuterol.
D) oral ibuprofen.
```
Ans: A
Page: 2024
Type: General Knowledge
55
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55. Which of the following represents the correct drug, dose, and delivery route for an 18-kg child experiencing severe respiratory distress due to bronchospasm?
A) Albuterol, 1 mg nebulized
B) Ipratropium, 0.5 mg nebulized
C) Albuterol, 0.25 mg nebulized
D) Epinephrine, 0.1 mg/kg IM
```
Ans: B
Page: 2024
Type: General Knowledge
56
56. Which of the following statements regarding bronchiolitis is correct?
A) Infants who were born past 42 weeks are at highest risk for respiratory failure and arrest secondary to bronchiolitis.
B) The pathophysiology of bronchiolitis is acute bronchospasm secondary to a bacterium that enters the lower respiratory tract.
C) Bronchiolitis is usually caused by the metapneumovirus and occurs with greatest frequency during late spring and early summer.
D) Bronchiolitis is a viral infection of the lower airway that commonly affects infants and children younger than 2 years of age.
Ans: D
Page: 2025
Type: General Knowledge
57
57. To maintain a neutral airway position in an unresponsive infant, you should:
A) slightly extend the infant's head.
B) pad underneath the infant's occiput.
C) place a towel roll under the shoulders.
D) insert an appropriate-sized oral airway.
Ans: C
Page: 2026
Type: General Knowledge
58
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58. An oral or nasal airway in an unresponsive infant or child may serve all of the following purposes, EXCEPT:
A) facilitating oral suctioning.
B) averting the need for intubation.
C) replacing manual head positioning.
D) helping to maintain an open airway.
```
Ans: C
Page: 2026
Type: General Knowledge
59
59. When inserting an oropharyngeal airway in a child, you should:
A) use a tongue blade to depress the tongue.
B) open the mouth with the tongue-jaw lift.
C) hyperextend the head to facilitate insertion.
D) suction the oropharynx for 15 seconds first.
Ans: A
Page: 2027
Type: General Knowledge
60
60. Nasopharyngeal airways are rarely used in children younger than 1 year of age because:
A) the diameter of their nares is small and easily obstructed by secretions.
B) most nasopharyngeal airways are too large and result in an obstruction.
C) nasopharyngeal stimulation commonly results in a tachycardic response.
D) unlike older children, small children often have a more active gag reflex.
Ans: A
Page: 2027
Type: General Knowledge
61
61. Proficiency in ventilating apneic infants or children with a bag-mask device:
A) cannot be achieved by practicing on a manikin.
B) may avert the need for endotracheal intubation.
C) is more important for paramedics than EMTs.
D) is difficult because their faces are much smaller.
Ans: B
Page: 2029
Type: General Knowledge
62
62. Appropriate bag-mask ventilation for an apneic 3-year-old child involves:
A) ensuring a consistently delivered tidal volume of 400 mL.
B) providing hyperventilation to ensure carbon dioxide elimination.
C) hyperextending the head to ensure an adequate mask-to-face seal.
D) delivering each breath over 1 second until the chest rises visibly.
Ans: D
Page: 2029-2030
Type: General Knowledge
63
63. When ventilating an apneic child with a bag-mask device, it is important for the paramedic to remember that:
A) each ventilation should be delivered over a period of 2 to 3 seconds.
B) the presence of chest rise is an unreliable indicator of proper ventilation.
C) regurgitation and aspiration may occur, even with proper ventilation technique.
D) posterior cricoid pressure will virtually eliminate the risk of pulmonary aspiration.
Ans: C
Page: 2029-2030
Type: General Knowledge
64
64. When preparing to intubate a small child, it is important to remember that:
A) the small child's epiglottis is very rigid.
B) prolonged attempts often cause tachycardia.
C) you should hyperventilate before intubating.
D) small children have a relatively large occiput.
Ans: D
Page: 2031
Type: General Knowledge
65
65. The use of a straight blade during pediatric intubation:
A) is generally reserved for neonates only.
B) makes it easier to manipulate the epiglottis.
C) is associated with a higher risk of bradycardia.
D) facilitates laryngoscopy by lifting the vallecula.
Ans: B
Page: 2031
Type: General Knowledge
66
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66. The MOST appropriate ET tube for a 6-year-old child is:
A) 4.0 mm, cuffed.
B) 4.5 mm, cuffed.
C) 5.0 mm, uncuffed.
D) 5.5 mm, uncuffed.
```
Ans: D
Page: 2031
Type: General Knowledge
67
67. Because stimulation of the parasympathetic nervous system and bradycardia can occur during intubation of a child, you should:
A) closely monitor the child's cardiac rhythm.
B) premedicate with 0.04 mg/kg of atropine.
C) limit your intubation attempt to 10 seconds.
D) use a curved blade instead of a straight blade.
Ans: A
Page: 2032
Type: General Knowledge
68
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68. A(n) ___ orogastric or nasogastric tube would the MOST appropriate size for a 4-year-old child.
A) 4F
B) 6F
C) 8F
D) 10F
```
Ans: D
Page: 2031, 2034
Type: General Knowledge
69
69. Which of the following statements regarding nasogastric (NG) and orogastric (OG) insertion in children is correct?
A) Gastric decompression with an NG or OG tube is only appropriate for children older than 10 years of age.
B) The correct size NG or OG tube for a child should be half the ET tube size that he or she would need.
C) Prior to inserting an NG or OG tube in an unresponsive child without a gag reflex, you should intubate his or her trachea.
D) Insertion of an orogastric tube is contraindicated in children with severe head trauma or injury to the midface.
Ans: C
Page: 2034
Type: General Knowledge
70
70. In contrast to a child with pulmonary edema secondary to congestive heart failure, the respirations of a hypercarbic child without pulmonary edema would MOST likely be:
A) rapid with audible rhonchi.
B) tachypneic and without retractions.
C) slow with increased work of breathing.
D) bradypneic with periods of marked apnea.
Ans: B
Page: 2044
Type: General Knowledge
71
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71. Signs of compensated shock in the infant or child include all of the following, EXCEPT:
A) abnormal mentation.
B) tachycardia and pallor.
C) prolonged capillary refill.
D) decreased peripheral perfusion.
```
Ans: A
Page: 2035-2036
Type: General Knowledge
72
72. Infants and children in shock:
A) typically become hypotensive sooner than adults because of a relative decrease in total blood volume.
B) generally remain alert for longer periods than adults despite a significant decrease in cerebral perfusion.
C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.
D) maintain end-organ perfusion longer than adults, making capillary refill time a less reliable perfusion indicator.
Ans: C
Page: 2036
Type: General Knowledge
73
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73. The approximate total blood volume of a 60-pound child is:
A) 2.2 L.
B) 2.9 L.
C) 3.4 L.
D) 3.8 L.
```
Ans: A
Page: 2036
Type: General Knowledge
74
74. When caring for an infant or child who is in compensated shock, you should:
A) intubate at the earliest sign of altered mentation.
B) administer a 10-mL/kg normal saline fluid bolus.
C) assist ventilations to improve tissue oxygenation.
D) establish IV or IO access en route to the hospital.
Ans: D
Page: 2037
Type: General Knowledge
75
75. A child in decompensated shock with hypotension should:
A) be intubated to protect his or her airway.
B) receive initial fluid resuscitation at the scene.
C) be given 25% dextrose to prevent hypoglycemia.
D) receive volume expansion with 5% dextrose in water.
Ans: B
Page: 2038
Type: General Knowledge
76
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76. Distributive shock in children is MOST often the result of:
A) sepsis.
B) spinal injury.
C) heart failure.
D) anaphylaxis.
```
Ans: A
Page: 2040
Type: General Knowledge
77
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77. Early distributive shock in children is characterized by:
A) warm, flushed skin.
B) weak peripheral pulses.
C) pallor and diaphoresis.
D) gross neurologic deficits.
```
Ans: A
Page: 2040
Type: General Knowledge
78
78. A child in anaphylactic shock:
A) should receive 0.1 mg/kg of epinephrine IM.
B) is treated primarily with saline fluid boluses.
C) may require a low-dose epinephrine infusion.
D) should receive epinephrine 1:1,000 via the IV route.
Ans: C
Page: 2040
Type: General Knowledge
79
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79. Unlike other types of shock, a child in cardiogenic shock would MOST likely present with:
A) an enlarged spleen.
B) unlabored tachypnea.
C) increased work of breathing.
D) a primary cardiac dysrhythmia.
```
Ans: C
Page: 2040
Type: General Knowledge
80
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80. Failure of a child's SpO2 to increase despite high-flow oxygen is MOST indicative of:
A) relative hypovolemia.
B) congenital heart disease.
C) right-sided heart failure.
D) decreased vascular tone.
```
Ans: B
Page: 2040
Type: General Knowledge
81
81. You should be MOST suspicious for cardiogenic shock in an infant or child if:
A) he or she appears listless or lethargic.
B) his or her heart rate varies with activity.
C) his or her heart rate is greater than 150 beats/min.
D) perfusion decreases following a fluid bolus.
Ans: D
Page: 2040
Type: General Knowledge
82
```
82. Bradydysrhythmias in children MOST often occur secondary to:
A) severe hypoxia.
B) drug ingestion.
C) AV heart block.
D) cardiac irritability.
```
Ans: A
Page: 2041
Type: General Knowledge
83
```
83. The preferred initial pharmacologic agent for pediatric bradycardia is:
A) atropine.
B) epinephrine.
C) dobutamine.
D) amiodarone.
```
Ans: B
Page: 2041
Type: General Knowledge
84
84. First-degree heart block in children:
A) is typically asymptomatic and does not require special treatment.
B) should be suspected when a randomly dropped QRS is observed.
C) should be treated with cardiac pacing, even if the child is stable.
D) does not respond to atropine and should be treated with dopamine.
Ans: A
Page: 2041
Type: General Knowledge
85
```
85. Which of the following is the first-line treatment for a hemodynamically unstable child with bradycardia?
A) Epinephrine IV or IO
B) Chest compressions
C) Ventilatory support
D) Transcutaneous pacing
```
Ans: C
Page: 2041
Type: General Knowledge
86
86. The presence of tachycardia in children:
A) commonly reflects an underlying cardiac pathology that requires emergent intervention.
B) often causes hypotension and is usually associated with a QRS complex greater than 0.08 seconds.
C) should be interpreted in the context of the pediatric assessment triangle and the primary assessment.
D) necessitates a 20-mL/kg bolus of an isotonic crystalloid solution until the cardiac rhythm is assessed.
Ans: C
Page: 2041
Type: General Knowledge
87
```
87. Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia?
A) Pulse rate
B) P wave presence
C) Systolic blood pressure
D) QRS complex width
```
Ans: D
Page: 2041-2042
Type: General Knowledge
88
88. Unlike sinus tachycardia, reentry supraventricular tachycardia in infants is characterized by:
A) a presence of P waves.
B) an unvarying pulse rate.
C) a history of fever or dehydration.
D) a pulse rate greater than 180 beats/min.
Ans: B
Page: 2041-2042
Type: General Knowledge
89
89. The MOST appropriate vagal maneuver for an infant involves:
A) blowing into an occluded straw.
B) holding ice packs firmly to the face.
C) firmly massaging the carotid artery.
D) applying a heat stimulus to the body.
Ans: B
Page: 2041
Type: General Knowledge
90
```
90. If an initial cardioversion attempt is unsuccessful in a 33-pound child, you should repeat the procedure using ___ joules:
A) 10
B) 15
C) 30
D) 50
```
Ans: C
Page: 2042
Type: General Knowledge
91
91. Hemodynamically stable children with a wide QRS complex tachycardia:
A) should receive amiodarone.
B) respond well to adenosine.
C) are likely experiencing supraventricular tachycardia.
D) will respond to vagal maneuvers.
Ans: A
Page: 2042
Type: General Knowledge
92
92. Cardiopulmonary arrest in the pediatric patient:
A) usually presents with pulseless electrical activity.
B) requires high epinephrine doses.
C) typically requires defibrillation.
D) is most often a secondary event.
Ans: D
Page: 2043
Type: General Knowledge
93
```
93. Treatment for pediatric asystole includes:
A) atropine.
B) epinephrine.
C) cardiac pacing.
D) hyperventilation.
```
Ans: B
Page: 2043
Type: General Knowledge
94
94. When attempting resuscitation of a child with pulseless electrical activity, you should:
A) administer epinephrine via the ET tube if possible.
B) attempt to identify an underlying cause of the arrest.
C) perform synchronized cardioversion if the rate is fast.
D) give atropine if the heart rate is less than 60 beats/min.
Ans: B
Page: 2043
Type: General Knowledge
95
```
95. Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform:
A) intubation.
B) cardioversion.
C) defibrillation.
D) CPR for 5 minutes.
```
Ans: C
Page: 2043
Type: General Knowledge
96
```
96. Ductal-dependent congenital heart defects typically present with __________ in the neonatal period.
A) hypertension
B) low-grade fever
C) hyperirritability
D) respiratory distress
```
Ans: D
Page: 2043
Type: General Knowledge
97
97. Dilated cardiomyopathy is a condition in which the heart is:
A) deprived of oxygen due to sudden coronary vasospasm.
B) unusually thick and must pump harder to eject blood.
C) temporarily impaired by an isolated bacterial infection.
D) weakened and enlarged, making it a less efficient pump.
Ans: D
Page: 2044
Type: General Knowledge
98
```
98. Etomidate should be avoided as an induction agent in pediatric intubation in the presence of:
A) hypovolemia.
B) tachycardia.
C) hypotension.
D) septic shock.
```
Ans: D
Page: 2046
Type: General Knowledge
99
```
99. Common signs and symptoms of meningitis in young children include all of the following, EXCEPT:
A) poor feeding.
B) nuchal rigidity.
C) bulging fontanelle.
D) irritability and fever.
```
Ans: B
Page: 2048
Type: General Knowledge
100
```
100. Meningococcal meningitis with sepsis is typically characterized by a(n):
A) purpuric rash.
B) insidious onset.
C) low-grade fever.
D) persistent cough.
```
Ans: A
Page: 2048
Type: General Knowledge
101
101. Which of the following is the MOST easily correctable problem in a child with an altered mental status?
A) Ingestion of aspirin 2 hours ago
B) High fever with a widespread rash
C) Blood glucose reading of 40 mg/dL
D) Dehydration associated with hypokalemia
Ans: C
Page: 2045
Type: General Knowledge
102
102. Which of the following clinical presentations is MOST consistent with cocaine ingestion in a child?
A) Diaphoresis, miosis, tachycardia, and bronchospasm
B) Miosis, bradycardia, hypoventilation, and hypotension
C) Mydriasis, diarrhea, hypothermia, and hallucinations
D) Hypertension, tachycardia, diaphoresis, and mydriasis
Ans: D
Page: 2046
Type: General Knowledge
103
103. In children, complex partial seizures would MOST likely manifest with:
A) focal motor jerking with loss of consciousness.
B) generalized tonic-clonic movement of all extremities.
C) focal motor jerking without loss of consciousness.
D) a brief loss of attention without abnormal body movement.
Ans: A
Page: 2046-2047
Type: General Knowledge
104
104. In contrast to a complex febrile seizure, a simple febrile seizure:
A) lasts less than 15 minutes and occurs in children without underlying neurologic abnormalities.
B) is focal in nature and tends to occur in children with a baseline developmental abnormality.
C) is not associated with tonic-clonic body movement and occurs in children older than 6 years of age.
D) is of short duration and occurs when the child's body temperature gradually rises above 102.5°F.
Ans: A
Page: 2047
Type: General Knowledge
105
105. Which of the following statements regarding simple febrile seizures is correct?
A) The overall prognosis for a child with simple febrile seizures worsens with each seizure episode.
B) There is no relationship between simple febrile seizures and future developmental or learning disabilities.
C) More than one simple febrile seizure in a child is highly suggestive of an underlying neurologic problem.
D) Any child who experiences a simple febrile seizure is at significant risk for developing epilepsy.
Ans: B
Page: 2047
Type: General Knowledge
106
106. The MOST appropriate airway management for an actively seizing child whose airway is not maintainable with positioning involves:
A) immediate endotracheal intubation.
B) insertion of an oropharyngeal airway adjunct.
C) nasal airway insertion and suctioning as needed.
D) 100% oxygen and a left lateral recumbent position.
Ans: C
Page: 2047
Type: General Knowledge
107
```
107. Common medications used to treat pediatric seizures in the prehospital setting include all of the following, EXCEPT:
A) Ativan.
B) Dilantin.
C) Diazepam.
D) Midazolam.
```
Ans: B
Page: 2047
Type: General Knowledge
108
```
108. The use of lorazepam for seizures in the prehospital setting is limited by its:
A) short half-life.
B) slow onset of action.
C) long duration of action.
D) refrigeration requirement.
```
Ans: D
Page: 2047
Type: General Knowledge
109
109. In contrast to toxic ingestions in toddlers, toxic ingestions in adolescents:
A) are usually unintentional.
B) typically involve multiple agents.
C) are associated with lower mortality.
D) involve small quantities of a single agent.
Ans: B
Page: 2056
Type: General Knowledge
110
```
110. Beta blocker ingestion in small children would MOST likely cause:
A) acute hypoglycemia.
B) agitation or irritability.
C) marked hypertension.
D) ventricular fibrillation.
```
Ans: A
Page: 2057
Type: General Knowledge
111
```
111. The management for any potentially toxic exposure in children begins by:
A) identifying the toxin.
B) providing an antidote.
C) ensuring a patent airway.
D) assessing respiratory effort.
```
Ans: C
Page: 2057
Type: General Knowledge
112
```
112. Which of the following is the MOST appropriate dose of activated charcoal for a 45-pound child?
A) 5 g
B) 10 g
C) 15 g
D) 20 g
```
Ans: D
Page: 2058
Type: General Knowledge
113
113. Sorbitol is not recommended for use in young children because it:
A) induces vomiting, which increases the risk for pulmonary aspiration.
B) can cause severe diarrhea and life-threatening electrolyte abnormalities.
C) has been linked to sudden cardiac death due to ventricular dysrhythmias.
D) prolongs the QT interval and is associated with ventricular fibrillation.
Ans: B
Page: 2058
Type: General Knowledge
114
```
114. Any child with unexplained hyperpnea should be suspected of having _________ toxicity.
A) opiate
B) salicylate
C) beta blocker
D) organophosphate
```
Ans: B
Page: 2059
Type: General Knowledge
115
```
115. The incidence of sudden infant death syndrome peaks between the ages of:
A) 2 and 4 months.
B) 3 and 6 months.
C) 4 and 8 months.
D) 8 and 12 months.
```
Ans: A
Page: 2062
Type: General Knowledge
116
```
116. Identified risk factors associated with sudden infant death syndrome include all of the following, EXCEPT:
A) low birth weight.
B) young maternal age.
C) exposure to tobacco smoke.
D) sleeping in a supine position.
```
Ans: D
Page: 2062
Type: General Knowledge
117
```
117. Fever in infants younger than 2 months of age is defined as a body temperature that is ____°F or greater.
A) 99.2
B) 100.4
C) 101.2
D) 102.0
```
Ans: B
Page: 2059
Type: General Knowledge
118
```
118. Which of the following is LEAST characteristic of an apparent life-threatening event in an infant?
A) Pallor or cyanosis
B) A period of apnea
C) Brief loss of a pulse
D) Loss of muscle tone
```
Ans: C
Page: 2062-2063
Type: General Knowledge
119
```
119. What forms of child maltreatment are often difficult to identify and may go unreported?
A) Sexual and emotional abuse
B) Emotional abuse and neglect
C) Neglect and physical abuse
D) Physical and emotional abuse
```
Ans: B
Page: 2060
Type: General Knowledge
120
120. You should be MOST suspicious for child abuse when caring for an injured 4-year-old child if:
A) there was an unusual delay in calling 9-1-1.
B) the child presents with bruises to both shins.
C) the caregiver demands that you treat the child.
D) you can smell alcohol on the caregiver's breath.
Ans: A
Page: 2060-2061
Type: General Knowledge
121
121. Once you suspect that a child may have been abused, you should:
A) apprise the caregiver of your suspicions.
B) transport the child to the hospital at once.
C) question the child in front of the caregiver.
D) carefully document what you see and hear.
Ans: D
Page: 2061
Type: General Knowledge
122
```
122. Bruises that occur _________________ are rarely incurred accidentally.
A) in a toddler
B) to both shins
C) to the forehead
D) in a straight line
```
Ans: D
Page: 2061
Type: General Knowledge
123
```
123. An infant or small child who falls from a significant height would MOST likely experience:
A) lumbar spine fractures.
B) lateral thoracic trauma.
C) a traumatic brain injury.
D) bilateral femur fractures.
```
Ans: C
Page: 2063
Type: General Knowledge
124
```
124. When assessing an otherwise healthy child who is injured, you notice that his general appearance is abnormal. This should make you MOST suspicious for:
A) child abuse.
B) a head injury.
C) hypoglycemia.
D) internal bleeding.
```
Ans: B
Page: 2063-2064
Type: General Knowledge
125
125. Which of the following statements regarding chest trauma in children is correct?
A) The pliability of children's rib cages predisposes them to sternal fractures.
B) Signs of a pneumothorax are often more obvious in children than in adults.
C) Children are more prone to intrathoracic trauma due to compression forces.
D) Most cases of fatal chest trauma occur in children who fall more than 10 feet.
Ans: C
Page: 2010
Type: General Knowledge
126
126. In contrast to adults, young children are more prone to liver and spleen injuries because the organs:
A) extend well below the rib cage.
B) are both highly vascular.
C) are more mobile and less supported.
D) are relatively smaller and less protected.
Ans: A
Page: 2009
Type: General Knowledge
127
127. If a child who is wearing a helmet strikes a fixed object on his or her bicycle and flies over the handlebars, you would MOST likely encounter:
A) facial fractures with associated brain injury.
B) stretching or tearing injuries to the kidneys.
C) open or closed fractures of the lower extremities.
D) compression injuries to the intra-abdominal organs.
Ans: D
Page: 2063
Type: General Knowledge
128
128. The general area of a child's body that sustains initial trauma after being struck by an automobile depends MAINLY on:
A) the child's height and the height of the bumper upon impact.
B) the travel speed of the vehicle and the weight of the child.
C) whether the child turns away from or toward the vehicle.
D) whether the vehicle ran over the child following impact.
Ans: A
Page: 2063
Type: General Knowledge
129
```
129. In young children, air bags pose a particular threat for injuries to the:
A) thoracic organs.
B) abdominal organs.
C) head and neck.
D) soft tissues of the face.
```
Ans: C
Page: 2063
Type: General Knowledge
130
130. When mechanically securing an injured child's head and neck to a backboard, you should:
A) place padding underneath the occiput.
B) avoid placing a strap or tape over the chin.
C) use towel rolls instead of a cervical collar.
D) manually stabilize the child's torso first.
Ans: B
Page: 2065
Type: General Knowledge
131
131. To ensure that an infant's head is in a neutral position during spinal immobilization, you should:
A) provide slight extension of his or her head.
B) place padding under the infant's shoulders.
C) place a towel roll behind the infant's neck.
D) use towel rolls for lateral head stabilization.
Ans: B
Page: 2066-2067
Type: General Knowledge
132
```
132. In contrast to the SAMPLE history of a child with an illness, the SAMPLE history of an injured child should include a specific inquiry regarding:
A) routine medication use.
B) any known drug allergies.
C) any prior hospitalizations.
D) his or her last tetanus shot.
```
Ans: D
Page: 2067
Type: General Knowledge
133
```
133. Signs of pain in an infant would MOST likely include:
A) tachycardia and inconsolability.
B) a heart rate that is not variable.
C) diaphoresis and dilated pupils.
D) labored tachypnea and pallor.
```
Ans: A
Page: 2068
Type: General Knowledge
134
134. Which of the following statements regarding burns in the pediatric patient is correct?
A) A child's larger skin surface–to–body mass ratio increases his or her susceptibility to heat and fluid loss.
B) A burn that is characterized by clear demarcation lines is generally suggestive of an unintentional burn.
C) Unlike adults, the rule of palm is an inaccurate tool to determine the extent of burns in pediatric patients.
D) A child with burns to both lower extremities has burns to approximately 36% of his or her body surface area.
Ans: A
Page: 2068
Type: General Knowledge
135
135. You would MOST likely encounter a child with a tracheostomy tube breathing spontaneously on room air if:
A) he or she has a brainstem abnormality that affects the respiratory drive.
B) the tracheostomy tube was placed because of a congenital airway anomaly.
C) the purpose of the tube is to bypass a mechanical upper airway obstruction.
D) a self-limiting condition necessitated placement of the tracheostomy tube.
Ans: C
Page: 2069
Type: General Knowledge
136
136. If a child with a functioning central venous line requires emergency drug therapy, you should:
A) administer the drug through the central line, but only give half the usual dose of the drug.
B) avoid using the central line if possible and attempt to establish peripheral IV access elsewhere.
C) carefully cleanse the injection port on the central line and administer the drug in the usual fashion.
D) flush the central line with at least 30 mL of normal saline first and then administer the emergency drug.
Ans: B
Page: 2070
Type: General Knowledge
137
137. Ventricular shunts are typically placed in children who:
A) are born with a congenital condition in which the ventricles of the brain produce excessive amounts of cerebrospinal fluid.
B) have experienced a severe traumatic brain injury that results in chronic cerebral edema and increased intracranial pressure.
C) are born with an abnormally small brain, which results in a relative increase in the amount of circulating cerebrospinal fluid.
D) have impaired circulation and absorption of cerebrospinal fluid, leading to increased size of the ventricles of the brain and increased intracranial pressure.
Ans: D
Page: 2070
Type: General Knowledge
138
138. When caring for a child with a ventricular shunt or gastrostomy tube, it is important to:
A) provide supportive care only and then rapidly transport the child to the most appropriate medical facility.
B) recognize that the caregiver is a key resource and that his or her expertise should be utilized to assist in the care of the child.
C) assure the caregiver that you can care for the child effectively and recommend that he or she follow the ambulance in his or her own vehicle.
D) obtain a complete medical history from the caregiver and then develop a treatment plan based on your knowledge of special health care devices.
Ans: B
Page: 2070-2071
Type: General Knowledge
139
139. Most injuries in pediatric patients:
A) can be totally eliminated with training.
B) involve trauma to the chest and spine.
C) are predictable and preventable events.
D) occur due to gross caregiver negligence.
Ans: C
Page: 2071
Type: General Knowledge
140
140. You are dispatched to a residence for a 17-year-old woman with acute abdominal pain. When you arrive and begin your assessment, it is clear that the patient is uncomfortable with the presence of her parents because she is reluctant to answer your questions. You should:
A) recognize that the parents are an invaluable resource for information.
B) diplomatically ask the parents if their daughter can have some privacy.
C) tell the patient that her parents must legally be present during the exam.
D) reassure the patient and tell her that her candor is vital to your treatment.
Ans: B
Page: 2007
Type: Critical Thinking
141
141. Upon arriving at the scene of a 4-year-old boy with respiratory distress, you enter the residence and see the child, who is conscious, sitting on his father's lap. The father is aware of your presence, but the child is not. Your initial action should be to:
A) make physical contact with the child as soon as possible in order to identify any life threats.
B) allow the father to carry his son to the ambulance, where you can perform an initial assessment.
C) quickly build good rapport with the child by picking him up and asking him what his name is.
D) visually assess the child from across the room for any signs of increased work of breathing.
Ans: D
Page: 2011-2012
Type: Critical Thinking
142
142. While assessing the airway of a 3-year-old girl who is unresponsive, you hear a snoring sound during each of her slow, shallow breaths. You should:
A) insert an oropharyngeal airway and apply high-flow oxygen.
B) begin bag-mask ventilations to improve her low tidal volume.
C) provide free-flow oxygen as you nasotracheally intubate her.
D) manually maneuver her head and reassess her breathing status.
Ans: D
Page: 2015
Type: Critical Thinking
143
143. A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves:
A) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.
B) conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls.
C) recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation.
D) assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin.
Ans: A
Page: 2015
Type: Critical Thinking
144
```
144. Upon arriving at the scene of a 4-year-old girl who is ill, you assess her and note that she is tachypneic and tachycardic. Her skin is warm and moist, and there are no signs of increased work of breathing. The child's mother denies any vomiting or diarrhea. This child's tachycardia and tachypnea are MOST likely the result of:
A) fever and anxiety.
B) early hypoxemia.
C) a cardiac problem.
D) moderate dehydration.
```
Ans: A
Page: 2015
Type: Critical Thinking
145
145. A 9-year-old who fell off his bike has an isolated deformity to his forearm and is in significant pain. The child is conscious and alert, his vital signs are stable, and his mother is present. Your initial effort to relieve this child's pain should involve:
A) encouraging the child to breathe high-flow oxygen.
B) not allowing the child to visualize his deformed arm.
C) providing calm reassurance to both mother and child.
D) administering morphine or fentanyl via slow IV push.
Ans: C
Page: 2016-2017
Type: Critical Thinking
146
146. A 10-year-old child fell approximately 15 feet from a balcony, landing on a sidewalk. He is conscious and alert, and complains of pain to the right side of his body. After completing your primary assessment, you should:
A) apply spinal precautions, begin transport, and perform a rapid assessment while en route to the hospital.
B) provide any immediately needed care, perform a rapid assessment, apply spinal precautions, and transport.
C) perform a focused physical exam, obtain baseline vital signs, apply spinal precautions, and transport.
D) correct immediate life threats, perform a detailed head-to-toe exam, apply spinal precautions, and transport.
Ans: B
Page: 2017-2018
Type: Critical Thinking
147
147. You are dispatched to a daycare center for a 5-year-old girl with trouble breathing. Upon arriving at the scene, you assess the child and note that she is responsive to pain only, has weak intercostal retractions, and is breathing at a slow rate with shallow depth. You should:
A) apply oxygen via pediatric nonrebreathing mask and attach a pulse oximeter.
B) deliver two effective rescue breaths and assess her pulse for at least 5 seconds.
C) administer high-flow oxygen, assess her cardiac rhythm, and establish IO access.
D) begin assisting her ventilations with a bag-mask device and assess her pulse rate.
Ans: D
Page: 2015, 2019
Type: Critical Thinking
148
148. A 10-month-old infant presents with an acute onset of increased work of breathing. According to the infant's mother, the child was crawling around in the living room prior to the event and was fine 10 minutes earlier. Your assessment reveals that the infant appears alert to his surroundings, has loud inspiratory stridor, and pink skin. You should:
A) look inside the infant's mouth using a tongue blade and penlight.
B) avoid agitating the infant, offer supplemental oxygen, and transport.
C) deliver five sharp back slaps between the infant's shoulder blades.
D) apply a pediatric nonrebreathing mask and transport expeditiously.
Ans: B
Page: 2020
Type: Critical Thinking
149
149. You are providing high-flow oxygen to a 3-year-old boy with severe respiratory distress. When you reassess him, you note that he is pale and his respiratory rate has decreased from 30 breaths/min to 12 breaths/min. You should:
A) assist his ventilations with a bag-mask device.
B) secure his airway with an ET tube.
C) begin treatment with a beta-2 agonist medication.
D) auscultate his lung sounds and reassess his SpO2.
Ans: A
Page: 2019-2020
Type: Critical Thinking
150
150. Several cycles of chest compressions have failed to remove a foreign body airway obstruction in an unresponsive infant. Your next action should be to:
A) perform laryngoscopy and try to visualize the foreign body.
B) continue chest compressions and perform a cricothyrotomy.
C) open the infant's airway and sweep the infant's mouth with your finger.
D) perform back slaps and chest thrusts and then look in the mouth.
Ans: A
Page: 2022
Type: Critical Thinking
151
151. A 9-year-old, 55-pound girl presents with generalized hives, marked facial swelling, and loud inspiratory stridor. She is conscious but appears sleepy. You can MOST rapidly improve this child's condition by:
A) starting an infusion of epinephrine at 5 µg/min.
B) administering up to 50 mg of diphendydramine.
C) administering 0.25 mg of epinephrine IM.
D) intubating her and administering albuterol via the ET tube.
Ans: C
Page: 2022
Type: Critical Thinking
152
152. You receive a call at 11:50 PM for a 3-year-old boy with respiratory distress. As soon as you enter the child's residence, you can hear a loud, barking cough. You find the child sitting on his mother's lap. He is conscious and appears alert to his surroundings. According to the child's mother, he has been sick for the past few days with a low-grade fever, but then began experiencing a high-pitched cough. His skin is warm and dry, his heart rate is 120 beats/min, and his oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should:
A) administer high-flow oxygen via pediatric nonrebreathing mask, keep him calm, and transport.
B) establish vascular access, give an appropriate dose of methylprednisolone, and transport.
C) administer 0.5 mL of racemic epinephrine via nebulizer, apply the cardiac monitor, and transport.
D) allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital.
Ans: D
Page: 2022-2023
Type: Critical Thinking
153
```
153. A 12-year-old boy presents with marked respiratory distress; hot, moist skin; and anxiety. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child's grandmother, his symptoms began suddenly about 30 minutes ago. You should be MOST suspicious for:
A) acute viral croup.
B) bacterial epiglottitis.
C) subglottic narrowing.
D) laryngotracheobronchitis.
```
Ans: B
Page: 2023
Type: Critical Thinking
154
154. A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to 3 puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should:
A) give 0.35 mg of epinephrine 1:1,000 SQ.
B) give 0.5 mg of nebulized ipratropium.
C) administer another 2.5-mg dose of albuterol.
D) assist her ventilations with a bag-mask device
Ans: B
Page: 2024
Type: Critical Thinking
155
155. You are transporting an unresponsive intubated 4-year-old child. An IO catheter is in place, and you are ventilating the child at an age-appropriate rate. Suddenly, the child becomes cyanotic and experiences a significant drop in her heart rate and oxygen saturation, and loss of a capnographic waveform. You attempt to auscultate her lung sounds but are unable to hear over the drone of the engine. You should:
A) extubate immediately and ventilate with a bag-mask device.
B) increase your ventilation rate and reassess the child's condition.
C) administer 0.02 mg/kg of atropine via rapid IO push and reassess.
D) look for vapor mist in the ET tube and attach a colorimetric device.
Ans: A
Page: 2034
Type: Critical Thinking
156
156. You receive a call for a “sick child.” When you arrive at the scene, the child's mother tells you that her 5-year-old son has had vomiting and diarrhea for the past day and will not eat or drink anything. On exam, the child's level of consciousness appears consistent with his age. His skin is cool and pale, he is tachypneic, his capillary refill time is 4 seconds, and his heart rate is 150 beats/min. The MOST appropriate treatment for this child involves:
A) applying high-flow oxygen via pediatric nonrebreathing mask, assessing his blood glucose level, elevating his legs 12 inches, and transporting at once.
B) establishing IV access and administering a 20-mL/kg normal saline bolus, applying high-flow oxygen, administering 25% dextrose, and transporting.
C) administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route.
D) administering supplemental oxygen, starting an IV line, assessing his blood glucose level, delivering at least two 20-mL/kg normal saline boluses, and transporting.
Ans: C
Page: 2036-2037
Type: Critical Thinking
157
157. You are assessing a 7-month-old infant who presents with listlessness, pallor, and increased work of breathing. The infant's mother tells you that the child was born 2 months premature and was in the neonatal intensive care unit for 3 weeks. She denies any recent vomiting, diarrhea, or fever. The infant's oxygen saturation is 89% and does not improve with supplemental oxygen. Her heart rate is rapid and weak and does not vary with activity. When you apply the cardiac monitor, you will MOST likely encounter a:
A) wide QRS complex rhythm with occasional P waves and a rate greater than 150 beats/min.
B) rhythm with QRS complexes greater than 0.08 seconds in duration and a heart rate greater than 180 beats/min.
C) narrow QRS complex rhythm with absent P waves and a heart rate greater than 220 beats/min.
D) rhythm with QRS complexes less than 0.08 seconds in duration and a heart rate less than 220 beats/min.
Ans: C
Page: 2040-2042
Type: Critical Thinking
158
158. A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child's mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child's ventilations with high-flow oxygen, your partner informs you that the child's heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should:
A) ask your partner to insert an IO catheter and administer epinephrine 1:10,000.
B) attempt immediate transcutaneous pacing while continuing ventilation assistance.
C) establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate.
D) initiate one-rescuer CPR while your partner attempts to establish vascular access.
Ans: D
Page: 2041
Type: Critical Thinking
159
159. A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. After applying high-flow oxygen, you should:
A) apply chemical ice packs to the child's face to try to slow her heart rate.
B) establish vascular access and administer a 20-mL/kg normal saline bolus.
C) start an IV line and give adenosine while monitoring her cardiac rhythm.
D) transport immediately and establish vascular access en route to the hospital.
Ans: B
Page: 2036-2037, 2042
Type: Critical Thinking
160
160. You and your partner are caring for a child with stable supraventricular tachycardia that was refractory to initial treatment. As your partner is preparing to establish vascular access, the child's level of consciousness decreases markedly. You reassess the child and note that his femoral pulse is rapid and weak. You should:
A) perform immediate synchronized cardioversion and reassess.
B) begin chest compressions as your partner establishes the IV line.
C) preoxygenate the child and then perform endotracheal intubation.
D) establish vascular access and administer 0.1 mg/kg of adenosine.
Ans: A
Page: 2041-2042
Type: Critical Thinking
161
161. You are assessing a 10-year-old child with apparent ventricular tachycardia, but cannot decide whether electrical or pharmacologic therapy is the most appropriate initial treatment approach. Which of the following interventions would pose the GREATEST potential for harm?
A) Administering high-flow oxygen and obtaining a 12-lead ECG tracing
B) Establishing IO access, administering a sedative, and cardioverting at 15 joules
C) Starting an IV line and administering amiodarone followed by procainamide
D) Establishing vascular access and rapidly administering 3 mg of adenosine
Ans: C
Page: 2042
Type: Critical Thinking
162
162. Your primary assessment of an unresponsive 5-year-old, 40-pound child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should:
A) continue high-quality CPR and reassess in 2 minutes.
B) defibrillate with 40 joules and immediately resume CPR.
C) start an IV and administer 0.2 mg of epinephrine 1:10,000.
D) charge the defibrillator to 80 joules while CPR is ongoing.
Ans: B
Page: 2042-2043
Type: Critical Thinking
163
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163. A 4-year-old girl presents with a fever of 103.2°F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child includes all of the following, EXCEPT:
A) 81 mg of aspirin.
B) free-flow oxygen.
C) 250 mg of acetaminophen.
D) simple cooling measures.
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Ans: A
Page: 2059-2060
Type: Critical Thinking
164
164. You and your partner arrive at the scene shortly after a 2-year-old child experienced an apparent seizure. The child's father tells you that his son's entire body began shaking and that the episode lasted less than 5 minutes. Your assessment of the child reveals that he is conscious, is crying, and has hot, moist skin. His heart rate is 160 beats/min, and his respirations are 40 breaths/min. You should:
A) advise the father to take his son to see a pediatrician the following day.
B) cool the child with tepid water, administer high-flow oxygen, and transport.
C) establish vascular access, give a 20-mL/kg saline bolus, and transport him.
D) keep the child cool and transport him to the hospital for physician evaluation.
Ans: D
Page: 2047-2048
Type: Critical Thinking
165
165. You are dispatched to a residence at 6:15 AM for an unconscious 3-month-old infant who is not breathing. Upon arrival at the scene, you find the father performing CPR on the infant. The infant's mother is sitting on the couch, crying. Your assessment reveals that the child is apneic and pulseless. His skin is pale and cold, and there is gross lividity to his chest. You should:
A) continue CPR and assess the infant's cardiac rhythm to confirm asystole.
B) recognize that the infant has been deceased for an extended period of time.
C) pronounce the infant dead if he does not respond to 5 minutes of full ACLS.
D) tell the parents that the child likely suffocated because he slept on his stomach.
Ans: B
Page: 2062
Type: Critical Thinking
166
166. A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should:
A) manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min.
B) suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask.
C) open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.
D) insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea.
Ans: C
Page: 2063-2064
Type: Critical Thinking
167
167. Following significant blunt trauma to the abdomen, a 9-year-old boy presents with diaphoresis and pallor. He is conscious and alert, with a blood pressure of 90/58 mm Hg, a heart rate of 130 beats/min, and a respiratory rate of 28 breaths/min with adequate depth. With an estimated ground transport time of 30 minutes, you should:
A) assist his ventilations to increase tidal volume, cover him with a blanket, establish at least one large-bore IV line, administer a 20-mL/kg normal saline bolus, and transport to a trauma center.
B) administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion.
C) apply supplemental oxygen, start two large-bore IV lines with normal saline, administer several crystalloid boluses of 20 mL/kg, apply spinal precautions if indicated, and transport to an appropriate medical facility.
D) apply warm blankets, elevate his lower extremities 12 inches, administer high-flow oxygen, insert an IO catheter, administer a 250-mL normal saline bolus, and transport expeditiously to an appropriate trauma center.
Ans: B
Page: 2036-2038, 2063-2065
Type: Critical Thinking
168
168. You are called to a residence for a ventilator-dependent child with respiratory distress. Upon your arrival, the child's mother tells you that the child was doing fine, but then suddenly began experiencing labored breathing. She further tells you that the child's home ventilator was recently replaced with a newer one. Assessment of the child reveals that she is in marked respiratory distress and has intercostal retractions. Your FIRST action should be to:
A) suction the child's tracheostomy tube to rule out secretions as the problem.
B) assess the patency of the tracheostomy tube to determine if it is dislodged.
C) remove the tracheostomy tube and replace it with a similar-sized ET tube.
D) disconnect the child from the ventilator and begin bag-mask ventilations.
Ans: D
Page: 2069
Type: Critical Thinking
169
169. You receive a call to a residence for a 6-year-old girl with a decreased level of consciousness. The child has hydrocephalus following surgery to remove a brain tumor and has a ventricular shunt in place. The child's level of consciousness is markedly decreased from its baseline, and the child's caregiver tells you that she thinks the shunt is obstructed. Which of the following sets of vital signs is MOST indicative of shunt obstruction and increased intracranial pressure?
A) Blood pressure 140/92 mm Hg; pulse 58 beats/min; respirations 8 breaths/min
B) Blood pressure 106/66 mm Hg; pulse 80 beats/min; respirations 14 breaths/min
C) Blood pressure 90/50 mm Hg; pulse 110 beats/min; respirations 10 breaths/min
D) Blood pressure 130/68 mm Hg; pulse 70 beats/min; respirations 28 breaths/min
Ans: A
Page: 2070
Type: Critical Thinking
170
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170. A 6-year-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned?
A) 21%
B) 27%
C) 30%
D) 36%
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Ans: A
Page: 2068
Type: Critical Thinking
