Pediatric Emergency Care: Airway Management and Shock Assessment, Exams of Advanced Education

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Seizures in children most often are the result of A. a life-threatening infection B. a temperature greater than 102 degree F C. an abrupt rise in body temperature D. an inflammatory process in the brain. - Correct Answer-an abrupt rise in body temperature After clearing the airway of a newborn who is not in distress, it is most important for you to A. apply free-flow oxygen B. clamp and cut the chord C. keep the newborn warm. D. obtain an APGAR score. - Correct Answer-keep the newborn warm You are caring for a 6-year-old child with a possible fractured left arm and have reason to believe that the child was abused. How should you manage this situation? A. inform the parents of your suspicions B. Call the police so the parents can be arrested. C. Advise the parents that the child needs to be transported D. Transport the child to the hospital regardless of the parents wishes - Correct Answer- Advise the parents that the child needs to be transported At 0345, you receive a call for a woman in labor. upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby "now". This man escorts you into the living room where a 25-year old woman is lying on the couch in obvious pain. The woman states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be most appropriate to ask at this point? A. has your bag of waters broken yet? B. have you had regular prenatal care? C. At how many weeks gestation are you? D. how many other children do you have? - Correct Answer-At how many weeks gestation are you?

At 0345, you receive a call for a woman in labor. upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby "now". This man escorts you into the living room where a 25-year old woman is trying on the couch in obvious pain. Which of the following statements regarding crowning is true? A. Crowning represents the end of the second stage of labor. B. Crowning always occurs immediately after the amniotic sac has ruptured. C. It is safe to transport the patient during crowning if the hospital is close. D. Gentle pressure should be applied to the baby's head during crowning. - Correct Answer-Gentle pressure should be applied to the baby's head during crowning At 0345, you receive a call for a woman in labor. upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby "now". This man escorts you into the living room where a 25-year old woman is trying on the couch in obvious pain. After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action? A. Allow the head to deliver and check for the location of the cord. B. Advise your partner to stop the ambulance and assist with the delivery. C. Tell the mother to take short, quick breaths until you arrive at the hospital. D. Prepare the mother for an emergency delivery and open the obstetrics kit. - Correct Answer-Advise your partner to stop the ambulance and assist with the delivery. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn? A. Begin positive pressure ventilations. B. provide blow-by oxygen with oxygen tubing C. assess the newborn's skin condition and color. D. start chest compressions and contact medical control - Correct Answer-Begin positive pressure ventilations. Your assessment of a mother in active labor reveals that a limb is protruding from the vagina. Management of this condition should include A. positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport B. positioning the mother in a head-down position with her hips elevated, administering oxygen, and providing transport.

C. applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord. D. giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur. - Correct Answer-positioning the mother in a head-down position with her hips elevated, administering oxygen, and providing transport. When you attempt to assess a 22-year-old woman who has been sexually assaulted, she orders you not to touch her. Your most appropriate initial action should be to A. ask the patient to sign a release form. B. ask a female EMT-B to attempt to assess the patient. C. explain to the patient that she must be examined. D. transport the patient without performing an assessment. - Correct Answer-ask a female EMT-B to attempt to assess the patient. Which of the following techniques represents the most appropriate method of opening the airway of an infant with no suspected neck injury? A. Lift up the chin and hyperextend the neck. B. Tilt the head back without hyperextending the neck C. Gently lift the chin while maintaining slight flexion of the neck. D. Perform the technique as you would for an older child or adult. - Correct Answer-Tilt the head back without hyperextending the neck A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect A. croup B. epiglottitis C. lower respiratory infection D. foreign body airway obstruction - Correct Answer-foreign body airway obstruction Which of the following findings would indicate an altered mental status in a small child? A. Recognition of the parents B. Fright at the EMT-B's presence C. Lack of attention to the EMT-B's presence D. Consistent eye contact with the EMT-B - Correct Answer-Lack of attention to the EMT-B's presence Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year old child with possible shock? A. Distal capillary refill B. Systolic blood pressure C. Skin color and temperature

D. Presence of peripheral pulses - Correct Answer-Systolic blood pressure Care for an alert 4-year old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color includes A. back blows, abdominal thrusts, transport B. oxygen, avoiding agitation, transport C. assisting ventilations, back blows, transport D. chest thrusts, finger sweeps, transport - Correct Answer-oxygen, avoiding agitation, transport You are called to a residence for a "sick" 5-year-old child. When you arrive and begin your assessment, you note that the child is unconscious with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Management of this child should consist of A. 100% oxygen via a nonrebreathing mask and rapid transport. B. positive pressure ventilations with a BVM device and rapid transport. C. chest compressions, artificial ventilations, and rapid transport D. back blows and chest thrusts while attempting artificial ventilations - Correct Answer- chest compressions, artificial ventilations, and rapid transport Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. Management should include a. oxygen, uterine massage, and transport. B. oxygen, placement on the left side, and transport C. oxygen, treatment for shock, and uterus massage during transport D. oxygen, internal vaginal pads, and treatment of shock during transport. - Correct Answer-oxygen, treatment for shock, and uterus massage during transport While performing a visual inspection of a 30-year-old woman in active labor, you can see the umbilical cord at the vaginal opening. After providing high concentration oxygen, you should next A. massage the uterus to facilitate delivery of the fetus. B. relieve pressure from the cord with your gloved fingers. C. place the mother on her left side and provide rapid transport D. elevate the mother's lower extremities and provide immediate transport. - Correct Answer-relieve pressure from the cord with your gloved fingers A 34-year old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her A. on her left side. B. in the prone position

C. in the supine position D. in a semi-sitting position - Correct Answer-on her left side. A 7-year old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and initiate oxygen therapy. En route to the hospital, you should be most alert for A. vomiting B. seizures C. combativeness D. respiratory distress - Correct Answer-seizures Which of the following is the most common cause of shock (hypoperfusion) in infants and children? A. infection B. Cardiac failure C. Accidental poisoning D. sever allergic reaction - Correct Answer-infection Which of the following signs or symptoms is more common in Children than adults following head trauma? A. Nausea and vomiting B. Altered mental status C. Tachycardia and diaphoresis D. Changes in pupillary reaction - Correct Answer-Nausea and vomiting A 4-year old fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and bleeding from her mouth. After performing a jaw-thrust maneuver with simultaneous stabilization of her head, you should A. suction the oropharynx B. insert a nasopharyngeal airway C. initiate positive pressure ventilations D. CANT READ it - Correct Answer-suction the oropharynx Which of the following statements regarding 2-rescuer child CPR is correct? A. The chest should not be allowed to fully recoil in between compressions as this may impede venous return. B. Compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest. C. The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered.

D. A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations - Correct Answer-Compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest. General guidelines when assessing a 2-year old child with abdominal pain and adequate perfusion include A. examining the child in the parent's arms. B. palpating the painful area of the abdomen first. C. placing the child supine and palpating the abdomen D. separating the child from the parent to ensure a reliable examination - Correct Answer-examining the child in the parent's arms. You are managing a 10-month old infant who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. You have initiated supplemental oxygen therapy and elevated the lower extremities. En route to the hospital, you note that the child's work of breathing has increased. What must you do first? A. lower the extremities and reassess the child B. Begin positive pressure ventilations and reassess the child C. Place a nasopharyngeal airway and increase the oxygen flow. D. Listen to the lungs with a stethoscope for abnormal breath sounds. - Correct Answer- lower the extremities and reassess the child You are responding to a 23 y/o pedestrian who is 7 months pregnant and was struck by a motor vehicle. She is complaining of abdominal pain, skin is pale and cool, heart rate is 110, respirations 20 you should A. Position the pt on left side, administer O2 and transport emergently B. Place the pt on her back administer O2 and transport routine C. Position the pt in Trendelenburg, administer O2 and transport routine D. Place the pt on her right side, elevate the bottom of the cot, apply O2 and transport emergently - Correct Answer-Position the pt on left side, administer O2 and transport emergently How should you open the airway of an infant? A. Place head in the sniffing position B. Pad underneath the head C. Place the head in a neutral position D. Lift the neck and elevate the head - Correct Answer-Lift the neck and elevate the head a 2 y/o pt who has been sick all day, now has a barking cough. You should suspect A. Epiglottitis B. Asthma C. Croup D. Chronic laryngospasm - Correct Answer-Croup

During a birth the baby's head has delivered. You should A. Suction the nose and mouth with a bulb syringe B. Suction the mouth only with bulb syringe C. Suction for 15 seconds with pediatric suction device D. Insert a delee suction catheter in the mouth - Correct Answer-Suction the nose and mouth with a bulb syringe 27 yr old patient was sexually assaulted and has moderate vaginal bleeding. You should: a. pack the vagina with gauze b. avoid treatment to leave the criminal evidence intact c. apply direct pressure to the vaginal opening using trauma dressing d. place the patient in trendelenberg position - Correct Answer-apply direct pressure to the vaginal opening using trauma dressing 20 yr old patient is having lower abdominal pain and vaginal bleeding with large clots and tissue. Her last menstrual period was 8 weeks ago. What is likely her problem? a. gonorrhea b. placenta abruption c. spontaneous abortion d. ruptured ectopic pregnancy - Correct Answer-spontaneous abortion What are signs/symptoms of a ruptured ectopic pregnancy? a. heavy vaginal bleeding with clots and bleeding b. irregular contractions with lower back pain c. meconium staining d. signs of shock and unilateral lower abdominal pain - Correct Answer-signs of shock and unilateral lower abdominal pain Pregnant patient has three children, and had two abortions and one miscarriage. She is: a. G-6, P-3, Ab- b. G-7, P-3, Ab- c. G-6, P-3, Ab- d. G-7, P-4, Ab-3 - Correct Answer-G-7, P-3, Ab- What is the first thing you should do after the infant's head delivers? a. suction the mouth and nose b. tell mom to push one more time c. check for nuchal cord d. perform an APGAR score - Correct Answer-check for nuchal cord Patient is 36 weeks pregnant and is complaining of a headache, seeing spots before her eyes, and nausea. She has swollen feet and hands and her BP is 156/92. Your main concern is that: a. blood supply to the fetus may be decreased

b. the baby may be too big to deliver c. she may deliver prematurely d. she may have a seizure - Correct Answer-she may have a seizure Supine hypotensive syndrome occurs when: a. a supine position kinks the ascending aorta b. the pregnant uterus compresses the inferior vena cava c. the superior vena cava is compressed by the uterus d. blood pressure decreases as a result of hypovolemia - Correct Answer-the pregnant uterus compresses the inferior vena cava The ONLY indications for placing your gloved fingers in the vagina during delivery are: a. breech presentation and prolapsed umbilical cord b. limb presentation and severe vaginal hemorrhage c. vertex presentation and delivery of the placenta d. nuchal cord and presentation of an arm or leg - Correct Answer-breech presentation and prolapsed umbilical cord Your G-7; P-6 patient with a previous C-section is progressing well in her delivery with crowning of the baby's head. On her last push, the head disappears and the mom starts complaining of severe abdominal pain. What do you suspect? a. placenta abruptio b. placenta previa c. ruptured uterus d. cephalopelvic disproportion - Correct Answer-ruptured uterus Your patient is 37 weeks pregnant and was assaulted by her BF, who punched her in the abdomen. She is complaining of severe pain in her abdomen and her skin is pale and diaphoretic. BP 98/56, P 127, R 28. Her abdomen is rigid to palpation. Which of the following conditions do you suspect? a. spontaneous abortion b. placenta previa c. placenta abruptio d. ruptured ectopic pregnancy - Correct Answer-placenta abruptio You respond to a pregnant 28 yr old female at a shelter who states that her water "broke" and that she is now experiencing labor pains. She is complaining of bright red vaginal bleeding, but denies any pain. BP 110/70, P 112, R 20. a. placenta abruptio b. uterine rupture c. spontaneous abortion d. placenta previa - Correct Answer-placenta previa To maintain an open airway on a 4 yr old who is lying supine, you should: a. hyperextend the neck b. place a towel roll behind the head

c. place a towel roll behind the neck d. place padding behind the torso - Correct Answer-place padding behind the torso When inserting an oropharyngeal airway in an infant or child, you should: a. place padding under the child's head b. ensure that their neck is hyperextended c. an OPA cannot be used on pediatric patients d. depress the tongue with a tongue depressor - Correct Answer-depress the tongue with a tongue depressor A 2 yr old was playing on the floor with their mom's purse. Baby is blue, limp, and unresponsive. He was fine when she last saw him. What is likely his problem? a. croup b. seizure c. electrocution d. foreign body airway obstruction - Correct Answer-foreign body airway obstruction An 8 yr old at school began having difficulty breathing during lunch. He is wheezing with swollen lips and itching. He is in the nurse's office. What should you consider his problem? a. asthma attack b. allergic reaction c. croup d. epiglottitis - Correct Answer-allergic reaction In the middle of the night, you respond to a 3 yr old with a continuous high-pitched barky cough. The baby appears ill and mom states she has had a runny nose for a couple days. What should be one of your first considerations? a. asthma attack b. croup c. foreign body airway obstruction d. epiglottitis - Correct Answer-croup You are evaluating a disoriented 27 y/o female who is 32 weeks pregnant. Her husband states "her arms and legs just got stiff and she had a blank stare" she has no prior medical history you should suspect A. Eclampsia B. Ectopic pregnancy C. Epilepsy D. Placental abruption - Correct Answer-Eclampsia You respond to a girl's boarding school dormitory where you encounter a 15 yr old who appears very ill with pale skin, sunken eyes, and who is in a tripod position. Her roommate states that she complained of a sore throat for two days. Her fever is 102. What should be your main concern? a. croup

b. meningitis c. influenza d. epiglottitis - Correct Answer-epiglottitis

• caused by the flu; tripod position indicates they can't breathe; sore throat and fever are typical What are the signs of meningitis? a. fever, painful neck movement b. extremity rigidity, coughing c. altered LOC, wheezing d. paralysis of extremities, tremors - Correct Answer-fever, painful neck movement Your pt is nine months pregnant with her first child. Her contractions are 10 minutes apart, lasting for 20 seconds. She tells you that she is "having this baby now". You should A. Coach her to calm down and have her husband transport B. Prepare for an imminent on scene delivery C. Transport the patient on her left side and monitor D. Transport pt in supine position and monitor - Correct Answer-Transport the patient on her left side and monitor which of the following is an anatomical difference between an adult and an infant airway? A. The infants trachea is more rigid B. The infants trachea is softer C. The adults tongue is proportionally larger D. The adults mouth is proportionally smaller - Correct Answer-The infants trachea is softer A 2-year-old boy has a circumferential burn to his hand up to the wrist. The mother tells you a pot of boiling water spilled onto the boy. You should A. Reassure the mother and treat the burn with moist dressing B. Transport and inform the ER that you suspect abuse C. Talk to the boy separately and ask if he is being abused D. Confront the boy's mother about possible abuse - Correct Answer-Transport and inform the ER that you suspect abuse a father has dialed 911 because his 5-year-old daughter is choking. She is coughing vigorously. You should A. Perform abdominal thrusts until the object clears B. Suction with a bulb syringe C. Encourage the pt to keep coughing D. Sweep the mouth with gloved fingers - Correct Answer-Encourage the pt to keep coughing Bystanders are doing CPR on a 3-month-old infant. You should

A. Evaluate effectiveness of CPR while gathering info B. Stop CPR and call medical control for instructions C. Attach an AED and prepare to defibrillate D. Put the infant on a backboard and transport emergently - Correct Answer-Evaluate effectiveness of CPR while gathering info a 7 y/o female fell out of a tree and was unconscious for 2 minutes the pt is very scared and combative. You should A. Apply four point restraints and transport rapidly B. Obtain parental consent prior to transport C. Apply a c-collar and backboard D. Place pt on stretcher - Correct Answer-Apply a c-collar and backboard First responder has delivered a baby. The infant is blue and lethargic; the pulse is 90 you should A. Transport after placenta is delivered B. Dry, stimulate and apply oxygen C. Transport and administer CPR enroute D. Transport to closest hospital - Correct Answer-Dry, stimulate and apply oxygen you are called to the scene of a motor vehicle crash, where you find a three-year-old female sitting in an unsecured car seat. She has abrasions to her forehead and right arm. She is alert to voice, her skin is pink and dry, and she appears to breathing normally. You should A. Rapidly extricate the child and place her in a supine positon B. Place a short back board behind the child and gently extricate her from the car seat. C. Remove the child from the car seat and place her on a long spine D. Secure the child in the car seat using towels and tape to immobilize her head and chest - Correct Answer-Secure the child in the car seat using towels and tape to immobilize her head and chest Your 18-mo. old pt has pale cool skin, decreased mental status, and delayed cap refill. The mother tells you that the child's diaper has been dry for most of the day. First responders have applied oxygen. You should A. position the child on his side and transport B. rapidly transport and monitor vital signs C. ventilate with BVM and transport rapidly D. transport rapidly and apply wet towels enroute - Correct Answer-rapidly transport and monitor vital signs A 30-year-old female is experiencing vaginal bleeding and abdominal pain. She is drowsy. Her skin is pale, cool, clammy. Vitals are BP 90/60 P 120 R 20. You estimate that she may have lost 500cc of blood. Which of the following should concern you MOST? A. Hypovolemic shock due to blood loss B. Cardiogenic shock due to lack of perfusion

C. Septic shock due to a serious infection D. Neurogenic shock due to blood vessel dilation - Correct Answer-Hypovolemic shock due to blood loss Your pregnant patient has a history of asthma. She started having difficulty breathing 15 minutes prior to calling 911. She has used her inhaler three times with no relief. You should A. Encourage her to use her inhaler until she feels relief B. Start O2 therapy at high flow, transport and contact medical control for orders to administer a nebulizer C. Start O2 therapy at high flow and transport D. Start O2 therapy at high flow, administer a nebulizer, reassess to determine if transport is required - Correct Answer-Start O2 therapy at high flow, transport and contact medical control for orders to administer a nebulizer Your 26-year-old female pt was involved in 30 MPH head-on collision. She complains of slight stiffness in her neck. She is 36 weeks pregnant. What action should you take? A. Perform a complete physical exam, obtain hx to ensure lack of other injuries and advise pt to consult with primary doctor. B. Provide c-spine stabilization, O2 c-collar, long spine board and transport with pt in right lateral recumbent position. C. Provide c-spine stabilization, O2 c-collar, long spine board and transport with pt in left lateral recumbent position. D. Evaluate the patient, c-collar assist onto stretcher and transport in left lateral recumbent position - Correct Answer-Provide c-spine stabilization, O2 c-collar, long spine board and transport with pt in left lateral recumbent position You are called to an elementary school for a 10 y/o who fell at the playground. When you arrive, you find the school nurse and a teacher's aide performing CPR. What is the most appropriate action for you to take A. Obtain a history from the school nurse B. Ask the nurse to stop CPR while you check for breathing and a pulse C. Place the pt on a long spine board with a c-collar D. Perform a rapid head-to-toe trauma survey - Correct Answer-Ask the nurse to stop CPR while you check for breathing and a pulse immediately upon returning to the station form a scene where a child died, the crewmembers discuss the call. This is an example of A. support meeting B. defusing C. critical incident stress debriefing D. an informal debriefing - Correct Answer-an informal debriefing You should ventilate a newborn once every A. Three seconds B. Five seconds

C. Four seconds D. Two seconds - Correct Answer-Two seconds five minutes after delivery of a newborn, your patient is moving all extremities, has pink skin, a weak cry, is grimacing and has a pulse of 96. The APGAR score is A. 6 B. 8 C. 10 D. 4 - Correct Answer- A four-year-old pt has hot dry skin after being inside a car with the windows rolled up on a hot day. You should A. Cover with wet blankets to prevent rapid cooling B. Rapidly cool pt with ice packs everywhere C. Pour water on pt and fan vigorously D. Call the PD to report suspected child abuse - Correct Answer-Rapidly cool pt with ice packs everywhere A four-year-old pt is experiencing breathing difficulty and is not tolerating an O2 mask. You should A. Have the mother hold the mask over the pt's face B. Place the pt on the stretcher and hold the mask on the face C. Ventilate using a BVM with supplemental O D. Have the mother hold the mask near the pt's face - Correct Answer-Have the mother hold the mask near the pt's face When infants or children experience breathing difficulties, their pulse may A. Increase early, then decrease significantly B. Increase significantly, then return to normal C. Decrease significantly, then return to normal D. Decrease early, then increase significantly - Correct Answer-Increase early, then decrease significantly Your patient is in labor. As the baby's head delivers, you notice the amniotic sac hasn't broken. You should A. Place the mother on oxygen to prevent fetal distress B. Use your gloved finger to puncture the membrane C. Place mother on her knees to take pressure off the sac D. Have the mother pant to delay delivery - Correct Answer-Use your gloved finger to puncture the membrane You are ventilating an apneic infant. His pulse is 54. You are currently ventilating with a BVM with supplemental O2 You should. A. Obtain a complete set of vital signs B. Begin chest compressions C. Continue ventilations and transport

D. Insert a pediatric combitube - Correct Answer-Begin chest compressions A five-year-old female with asthma is having intercostal retractions. She cannot hold her head up to talk. You should A. Administer oxygen via NRB @ 15 LPM B. Administer O2 via blowby @ 6 LPM C. Contact medical control before assisting pt with prescribe inhaler D. Ventilate via BVM at 15 LPM - Correct Answer-Ventilate via BVM at 15 LPM You are conducting a physical exam on a responsive female toddler. You should A. Place the girl on her back as her parents help hold her B. Use a toes to head approach for the exam C. Use head to toe approach for the exam D. Examine the girl upright as her parents hold her - Correct Answer-Use a toes to head approach for the exam A 28 y/o female who is 12 weeks pregnant has twisted her left knee while walking. She states the pain is 10/10 in severity. You should A. Apply a traction splint and immobilize with a long spine board B. Transport on her left side and hold manual stabilization until she gets the hospital C. Splint with the stretcher and straps and transport her on her left side D. Splint using board splints and cravats and transport sitting - Correct Answer-Splint using board splints and cravats and transport sitting an infant is choking on a piece of candy. You are unable to see chest rise after numerous attempts to ventilate. You should A. Apply an AED B. Insert an OPA and reattempt C. Administer chest compressions D. Perform abdominal thrust - Correct Answer-Administer chest compressions What should you initially do to open the airway of an 8-month-old? A. Pad under head of child B. Turn pt onto their left side C. Place the head in an extended position D. Place the head in a neutral position - Correct Answer-Pad under head of child