Pediatric Emergency Care, Exams of Nursing

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Which of the following factors is associated with the HIGHEST risk of newborn hypoglycemia? - CORRECT ANSWER- - morbid obesity in the mother Which of the following statements regarding the brain stem is MOST correct? - CORRECT ANSWER- - The brain stem connects the spinal cord to the brain Which of the following scenarios MOST accurately depicts reflection in action? - CORRECT ANSWER- - Reflection gives you the chance to continuously improve thinking and decision making, and, in turn, your patient care as you modify your experience base. Which of the following statements regarding the hangman's fracture is MOST correct? - CORRECT ANSWER- - It is a fracture of C2 that is secondary to significant distraction of the neck You are assessing a 10-year-old child with apparent ventricular tachycardia, but cannot decide whether electrical or pharmacological therapy is the most appropriate inital treatment approach. Which of the following interventions would pose the GREATEST potential for harm? - CORRECT ANSWER- - starting an IV line and administering amiodarone followed by procainamide Chest compressions are indicated in the newborn if its heart rate remains less than ___ beats/min despite effective positive-pressure ventilations for ___ seconds. - CORRECT ANSWER- - 60, 30

The MOST effective way for the paramedic to avoid tunnel vision is to: - CORRECT ANSWER- - always keep your mind open to all the possible causes of your patient's current condition. When applying a vest-type extrication device to a seated patient, his or her head should be secured to the device: - CORRECT ANSWER- - only after the torso is fastened securely ___ occurs after a call is over and commonly is associated with the run review or critique. - CORRECT ANSWER- - The last stage in the critical thinking process Although extremely painful, injuries to the ___ spine are typically the LEAST significant: - CORRECT ANSWER- - coccygeal In contrast to toxic ingestions in toddlers, toxic ingestions in adolescents: - CORRECT ANSWER- - typically involve multiple agents Endotracheal intubation is clearly indicated in the newborn if: - CORRECT ANSWER- - meconium is present in the amniotic fluid and the newborn is limp and has a heart rate of 70 beats/min. Uncertainty regarding the specific cause of a patient's problem is called: - CORRECT ANSWER- - medical ambiguity. Vagal tone remains intact following a spine injury because: - CORRECT ANSWER- - the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries Displacement of bony fragments in the anterior portion of the spinal cord results in: - CORRECT ANSWER- - anterior cord syndrome

When suctioning the newborn's oropharynx to clear secretions prior to intubation, it is MOST important to: - CORRECT ANSWER- - monitor a newborn's heart rate Which of the following situations is MOST challenging with regard to your critical thinking and decision-making skills? - CORRECT ANSWER- - Patients whose conditions fall somewhere around the midpoint on the spectrum between "no big deal" minor and "oh my gosh" serious pose as the greatest challenge. The hormonal effects associated with the fight-or-flight response can affect your performance as a paramedic by: - CORRECT ANSWER- - (sensory overload) impaired critical thinking skills or diminished concentration and assessment abilities The upper thoracic spinal nerves: - CORRECT ANSWER- - innervate the muscles of the chest that help in breathing and coughing 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: - CORRECT ANSWER- - diplomatically ask the parents if their daughter can have some privacy A spinal cord contusion is: - CORRECT ANSWER- - caused by a short-duration shock or pressure wave within the cord Signs of hypovolemia in the newborn include all of the following, EXCEPT: - CORRECT ANSWER- - profound acrocyanosis Which of the following actions has the LEAST impact on the paramedic's ability to think under pressure? - CORRECT ANSWER- - POSITIVES: Take a moment to scan the situation. Take another moment to stop and think. Make decisions and act on behalf of the patient.

Stay calm, and maintain clear, concise mental control. Plan to regularly and continually re- evaluate the patient. The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is: - CORRECT ANSWER- - pressure lesion development When reading the scene, the paramedic must remember that: - CORRECT ANSWER- - is a relative goldmine of information and becomes unavailable once you initiate transport to the hospital. Primary elements include: evaluate the overall safety of the situation, the environmental conditions, the immediate surroundings, access and exit issues, and evaluating the mechanism of injury Which of the following statements regarding a child's chest wall is MOST correct? - CORRECT ANSWER- - children are belly breathers because they rely heavily on their diaphragms Any motor or sensory deficits noted during the neurologic examination of a patient with a possible spinal cord injury: - CORRECT ANSWER- - should be documented and monitored Cerebrospinal fluid (CSF) shunts are typically placed in children who: - CORRECT ANSWER- - have impaired circulation and absorption of CSF, leading to an increased size of the ventricles of the brain and increased intracranial pressure Which of the following is NOT a typical element to evaluate when reading the scene of a motor vehicle crash? - CORRECT ANSWER- - primary elements (evaluate the overall safety of the situation, the environmental conditions, the immediate surroundings, access and exit issues, and evaluating the MOI) During your assessment of a 30-year-old woman in active labor, she admits to being a chronic heroin abuser and states that she last "shot up" about 6 hours ago. After the baby

delivers, you will MOST likely need to: - CORRECT ANSWER- - give positive-pressure ventilations In which of the following situations would it be MOST appropriate to apply a vest-type extrication device to a patient who is seated in his or her crashed motor vehicle? - CORRECT ANSWER- - Conscious with neck pain and stable vital signs When you introduce yourself to your patient and ask why 9- 1 - 1 was called, the patient looks at you, shakes your hand, and answers your questions appropriately. From these findings, you can gather that the patient: - CORRECT ANSWER- - that the patient has a Glascow Coma Scale score of 15 (spontaneous eye opening, follows commands, appropriate verbal response) A typical finding for a foreign body aspiration is: - CORRECT ANSWER- - an afebrile child with a sudden onset of coughing or gagging while playing Following a spinal injury, a patient presents with abdominal breathing and use of the accessory muscles in the neck. This suggests injury at or above: - CORRECT ANSWER- - C3- C When a patient advises you of his or her chief complaint, you should: - CORRECT ANSWER-

• determine if this is a new problem or the worsening of a preexsisting condition A child in anaphylactic shock: - CORRECT ANSWER- - may require a low-dose epinephrine infusion The innermost meningeal layer that rests directly on the spinal cord is the: - CORRECT ANSWER- - pia mater

When caring for a critically ill patient, three or more sets of vital signs will allow you to: - CORRECT ANSWER- - assess trends and to reassess whether the patient's condition is stabilizing, getting better, or getting worse After addressing any life threats in the order in which you find them, you should next: - CORRECT ANSWER- - consider the worst case scenario that could be causing Pt's symptoms and rule it in or out If the mechanism of injury indicates that your patient may have sustained a spinal cord injury: - CORRECT ANSWER- - assume that a spine injury exists, regardless of neurologic findings When caring for a child with a CSF shunt or gastrostomy tube, it is MOST important to: - CORRECT ANSWER- - 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 A child who is experiencing a moderate asthma attack would MOST likely present with: - CORRECT ANSWER- - wheezing during inspiration and expiration Given the number of possible diagnoses in any situation and the limited physical and technical resources of the field. you will MOST likely: - CORRECT ANSWER- - Be treating Pt's that may not be able to be diagnosed until they reach the hospital The MOST effective method of decreasing morbidity and mortality associated with spinal cord injury (SCI) is: - CORRECT ANSWER- - public education and prevention strategies Signs of a diaphragmatic hernia include all of the following, EXCEPT: - CORRECT ANSWER-

• bilaterally absent breath sounds

When caring for a patient with multiple pathophysiologies, it is MOST important for the paramedic to: - CORRECT ANSWER- - add them up as you develop your care plan to make sure nothing is overlooked that can be addressed in the field setting. You are dispatched to a senor citizen's center where an elderly woman apparently fainted. When you arrive, you find the patient sitting in a chair. An employee of the center tells you that he caught the patient before she fell to the ground. Your initial assessment reveals that the patient is conscious and alert and is breathing adequately. You should: - CORRECT ANSWER- - obtain vital signs and assess her blood glucose level Common causes of respiratory distress in the newborn include: - CORRECT ANSWER- - mucous obstruction of the nose No matter how sure he or she is of the working diagnosis, the thinking paramedic must: - CORRECT ANSWER- - Always keep part of the thought process open to other possibilities. The ___ is the largest component of the central nervous system and contains billions of neurons that serve a variety of functions. - CORRECT ANSWER- - Brain Caput succedaneum is MOST accurately defined as: - CORRECT ANSWER- - temporary swelling of the soft tissue of the baby's scalp secondary to pressure from the dilating cervix Excellence in prehospital care is: - CORRECT ANSWER- - the gradual result of you as a provider constantly striving to improve your practice, which requires that you always have an attitude that is open to learning. You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/ mmHg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should: - CORRECT ANSWER- - give 0. mg of atropine and consider a dopamine infusion

The approximate total blood volume of a 60-pound child is: - CORRECT ANSWER- - 2.2 liters Which of the following is a subjective finding? - CORRECT ANSWER- - the symptoms a pt describes (degree of pain) All of the following are subjective findings: - CORRECT ANSWER- - again, anything you can't observe directly or measure The goal in treating a child with epiglottitis is to: - CORRECT ANSWER- - transport him or her to the hospital with a maintainable airway A term infant is born between ___ after conception. - CORRECT ANSWER- - 37 and 42 weeks When providing patient care, it is MOST important that you maintain effective communication with: - CORRECT ANSWER- - your partner During a mass-casualty incident (MCI), data collection is of importance for: - CORRECT ANSWER- - pt care totals, severity of injuries, mass care procedures Newborn hypoglycemia is defined as a blood glucose level lower than: - CORRECT ANSWER- - 40 mg/dL During your rapid assessment of a newborn's cardiopulmonary status, you not that its respirations are adequate, you feel 8 pulsations in a 6-second time frame, and the newborn is centrally pink but peripherally cyanotic. The MOST appropriate next action should be to: - CORRECT ANSWER- - administer positive-pressure ventilations

Notification of EMS usually occurs when: - CORRECT ANSWER- - Someone tells EMS that an emergency exists. Devices that allow your voice to be transmitted when a button is pushed and allow the listener to hear you when the button is released are called: - CORRECT ANSWER- - Push-to- talk The general area of a child's body that sustains inital trauma after being struck by an automobile depends MAINLY on: - CORRECT ANSWER- - the child's height and the height of the bumper upon impact A conscious child who is in the sniffing position: - CORRECT ANSWER- - is trying to align the axes of the airway to improve ventilation In contrast to analogue telecommunications equipment, digital telecommunications equipment: - CORRECT ANSWER- - Offer many advantages in terms of speed, privacy, programability and GPS. Under the instructions of a good emergency medical dispatcher (EMD), a layperson should be able to: - CORRECT ANSWER- - Clear an obstructed airway, perform chest compressions or reassuring the patient can be carried out. In recent years, the use of telemetry has returned because: - CORRECT ANSWER- - The AHA recommended that a 12 lead ECG be taken and transmitted to the receiving facility for all patients with potential acute coronary syndrome. The term "frequency," as it applies to radio communications, is MOST accurately defined as: - CORRECT ANSWER- - how frequently the wave recurs in a given time (usually 1 second)

Low-band frequencies: - CORRECT ANSWER- - may have ranges up to 2,000 miles but are unpredictable because changes in ionospheric conditions may cause "skip interference", with patchy losses in communication Biotelemetry is MOST accurately defined as: - CORRECT ANSWER- - is the capability of measuring vital life signs and transmitting them to a distant terminal All of the following factors may cause distortion of an ECG signal, EXCEPT: - CORRECT ANSWER- - FACTORS INCLUDE: muscle tremor, loose ECG electrodes, sources of 60-cycle alternating current (AC), attenuation (reduction) of transmitter power, caused by weak batteries or transmission beyond the range of the transmitter At minimum, sending the 12-lead ECG of a patient with chest pain to the emergency department physician via telemetry would: - CORRECT ANSWER- - Allow the receiving hospital to have the appropriate resources (equipment, medications, personnel, etc.) prepared and ready, pending the arrival of the patient. Specifically, the administration of fibrinolytic therapy. Cellular telephones are more advantageous than regular two-way radios in that cellular telephones: - CORRECT ANSWER- - For EMS: cell phones have a longer range than a two- way radio - For the Public: 911 service is free + cell phones have GPS capability In order for the paramedic to talk and transmit an ECG simultaneously on one frequency, a ___ system is required. - CORRECT ANSWER- - multiplex Radio transmission distances from a mobile transceiver are reduced: - CORRECT ANSWER- - in mountainous areas or where there are many tall buildings. A/an ___ receives a weak signal and retransmits it at a higher power on another frequency. - CORRECT ANSWER- - repeater

A base station decoder within the emergency department: - CORRECT ANSWER- - translates a telemetry signal into an oscilloscope tracing Which of the following statements regarding the use of cellular telephones and landline telephones is MOST correct? - CORRECT ANSWER- - Cellular and landline phones overcome problems caused by overcrowded ems radio frequencies. When communicating medical information via radio, you should be: - CORRECT ANSWER-

• Simple, brief, direct The FIRST principle of communicating by radio is: - CORRECT ANSWER- - Clarity! When transmitting information via radio, you should: - CORRECT ANSWER- - use a normal conversational tone of voice When transmitting data over the radio, you should NOT disclose the patient's: - CORRECT ANSWER- - Name Which of the following words would be the MOST difficult to hear over the radio? - CORRECT ANSWER- - Yes and no, use affirmative and negative When transmitting your radio report to the hospital, you should: - CORRECT ANSWER- - Use standard formats agreed on by your EMS service for transmission of information When relaying medical information to a physician in person, you should: - CORRECT ANSWER- - Be mindful of the of the information you are supplying Which of the following is NOT patient data that typically is communicated during your radio report to the hospital? - CORRECT ANSWER- - ALL IMPORTANT

• • CORRECT ANSWER- - Patients age/sex
• • CORRECT ANSWER- - Chief complaint
• • CORRECT ANSWER- - Brief pertinent history of illness or injury
• • CORRECT ANSWER- - Anything the physician needs to know about the patients other medical history relative to the current situation
• • CORRECT ANSWER- - Patients l.o.c and degree of distress
• • CORRECT ANSWER- - Vital signs
• • CORRECT ANSWER- - Pertinent physical findings in head to toe order
• • CORRECT ANSWER- - ECG findings
• • CORRECT ANSWER- - Treatment given and response When a panicked person calls 9- 1 - 1 for help: The EMD must: - CORRECT ANSWER- - • Answer the telephone promptly
• • CORRECT ANSWER- - Identify himself or herseld and the agency
• • CORRECT ANSWER- - Speak directly into the mouthpiece

• • CORRECT ANSWER- - Observe telephone courtesy
• • CORRECT ANSWER- - Take charge of the conversation Which of the following information is of LEAST importance for the emergency medical dispatcher (EMD) to obtain from the caller?(ALL IMPORTANT) - CORRECT ANSWER- - • The exact location of the patient
• • CORRECT ANSWER- - The telephone number of the caller
• • CORRECT ANSWER- - The callers perception of the nature of his or her or the patients problem
• • CORRECT ANSWER- - Specific info concerning the patients condition
• • CORRECT ANSWER- - If the emergency is a motor vehicle collision find out vehicle type, number of persons, and apparent hazards at the scenes. If the emergency medical dispatcher (EMD) suspects that your patient has a life- threatening emergency, the EMD should make you aware of the situation and then: - CORRECT ANSWER- - provide instructions to the caller in very simple terms about emergency care techniques (such as airway maintenance, Heimlick maneuver, CPR, hemorrhage control) In order to ensure that all recorded times associated with an incident are accurate, the paramedic should: - CORRECT ANSWER- - compare your times with those of the dispatcher to ensure accuracy an proper timekeeping. Several times are absolutely vital to be kept and documented for the accurate report writing.

The patient care report (PCR): - CORRECT ANSWER- - should be a detailed segment indication the elements of the call; a written record of the events that transpire during a call for service. It is a legal record for the call and is part of the patient's medical record and the hospital's ED chart. The MOST significant problem associated with making up your own medical abbreviations and documenting them on the patient care report is: - CORRECT ANSWER- - can cause confusion and, in the worst cases, could lead to medication and treatment errors Data collected from the state EMS office for the purpose of research would likely NOT include: - CORRECT ANSWER- - verify call volumes and skills used and include (# of calls an agency responds to, the types of calls, care provided, and patient outcomes. The National Emergency Medical Services Information System (NEMSIS): - CORRECT ANSWER- - store the EMS data for each the states. The MOST effective way to maintain your own knowledge of standard medical terminology is to: - CORRECT ANSWER- - learn the established and accepted medical terms and abbreviations for your EMS operation. Ongoing review of the A&P chapter. It is MOST important for the paramedic to exercise extreme care when using medical abbreviations because: - CORRECT ANSWER- - Incorrect or inappropriate medical abbreviations can cause confusion and, in the worst cases, could lead to medication and treatment errors. Which of the following incident times is NOT commonly documented on the patient care report? - CORRECT ANSWER- - Vital incident times include (time of call, dispatch, arrival at the scene, with patient, med administration, departure from scene, arrival at med facility, back in service)

Which of the following documentation styles would likely be MOST difficult and time- consuming to apply in EMS? - CORRECT ANSWER- - body systems approach Which of the following statements includes a pertinent negative? - CORRECT ANSWER- - pertinent negative is described as: a record of negative findings that warrant no care or intervention but thorough and complete examination and history were performed When documenting a statement made by the patient or others at the scene, you should: - CORRECT ANSWER- - indicate who made the statement and place the exact words in quotations The accuracy of your patient care report depends on all of the following factors, EXCEPT: - CORRECT ANSWER- - DOCUMENTATION ACCURACY INCLUDES: times, narrative information, checkboxes, and it must be comprehensive and precise If you receive another call before completing the patient care report accurately for the previous call: - CORRECT ANSWER- - details may be forgotten and important information left out, or worse, inaccurate information may be written Prior to submitting a patient care report to the receiving hospital, it is MOST important for: - CORRECT ANSWER- - should be reviewed, by the paramedic who authors them, for completeness, accuracy, grammar, spelling, and proper use of medical terminology and abbreviations, to help ensure a well-written and well-documented report When a competent adult patient refuses medical care, it is MOST important for the paramedic to: - CORRECT ANSWER- - ensure that your Pt is well informed of the situation at hand. explain in detail and make sure the Pt fully understands the potential consequences of refusing, including death and have a witness.

For purposes of refusing medical care, a patient's mental status may be considered impaired if he or she: - CORRECT ANSWER- - Is not orientated to person, place, time, and event. or makes non sensical statments. If your response to a call for a traumatic injury is canceled, you should document: - CORRECT ANSWER- - Be sure to document who you were cancelled by, such as law enforcement, on the PCR. A poorly written patient care report: - CORRECT ANSWER- - might lead a judge or jury to decide in favor of the plaintiff. In contrast to paper documentation, computer-based documentation: - CORRECT ANSWER- - may assist you in writing accurate, timely, and legible reports. An accurate and legible patient care report: - CORRECT ANSWER- - should be complete to the point that people reviving them, whether your medical director or the administrative office clerk billing for the service provided, can read them and understand exactly what transpired on the call. Respiratory Rate (RR) - CORRECT ANSWER- - The number of respiratory cycles per minute Adult- 12 to 20 Children- 18 to 24 Infant- 40 to 60 Factors that affect RR Increase: Fever, Emotions, Pain, Hypoxia, Acidosis, Stimulant drugs

Decrease: Depressant drugs, Sleep Total Lung Capacity )TLC) - CORRECT ANSWER- - The maximum lung capacity; The total amount of air contained in the lung at the end of maximal inspiration. Avg Adult(M)- 6 liters Tidal Volume (Vt) - CORRECT ANSWER- - The average volume of gas inhaled or exhaled in one respiratory cycle. Avg Adult(M)- 500mL Dead Space Volume (Vd) - CORRECT ANSWER- - The amount of gas in the Tidal Volume (Vt) that remains in air passageways unavailable for gas exchange. Avg Adult(M) - 150mL Alveolar Volume (Va) - CORRECT ANSWER- - The amount of gas in the Tidal Volume (Vt) that reaches the alveoli for gas exchange It is the difference between Tidal Volume (Vt) and Dead Space Volume (Vd) Va = Vt - Vd Minute Volume (Vmin) - CORRECT ANSWER- - The amount of gas moved in and out of the respiratory tract in one minute

Vmin = Vt X RR Alveolar Minute Volume (V a-min) - CORRECT ANSWER- - The amount of gas that reaches the alveoli for gas exchange in one minute V a-min = ( Vt - Vd ) X RR or V a-min = Va X RR Stridor - CORRECT ANSWER- - A high-pitched noise while inhaling Cyanosis - CORRECT ANSWER- - The bluish appearance of the skin Dysphonia - CORRECT ANSWER- - Difficulty speaking Aphonia - CORRECT ANSWER- - Pt cannot speak Asphyxia - CORRECT ANSWER- - The inability to move air into and out of the respiratory system Flail Chest - CORRECT ANSWER- - A defect in the chest wall that allows a segment to move freely which causes paradoxical chest wall motion Paradoxical Breathing - CORRECT ANSWER- - Asymmetrical chest wall movement that lessens respiratory efficiency Orthopnea - CORRECT ANSWER- - Increased difficulty breathing while lying down Pulsus Paradoxus - CORRECT ANSWER- -

Kussmaul's Respiration - CORRECT ANSWER- - Deep, slow, or rapid gasping, breathing, commonly found in diabetic ketoacidosis Cheyne-Stokes Respirations - CORRECT ANSWER- - Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brainstem injury Biot's Respirations - CORRECT ANSWER- - Irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure Central Neurogenic Hyperventilation - CORRECT ANSWER- - Deep, rapid respirations, indicating incranial pressure Agonal Respirations - CORRECT ANSWER- - Shallow, slow, or infrequent breathing, indication brain anoxia