TestPrep - Obstetrics and Pediatrics

Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50

beats/min. Treatment for this child should include:

A) high-flow oxygen via nonrebreathing mask and rapid transport.

B) oxygen via a nasal cannula at 6 L/min and rapid transport.

C) positive pressure ventilation, chest compressions, and rapid transport.

D) back slaps and chest thrusts while attempting artificial ventilations.

C) positive pressure ventilation, chest compressions, and rapid transport.

A heart rate less than 60 beats/min in an infant or child, especially when accompanied by signs of poor perfusion and inadequate breathing, should be

treated with positive pressure ventilation, chest compressions, and rapid transport. Respirations of 8 breaths/min and a heart rate of 50 beats/min will not

maintain adequate oxygenation and perfusion in a child. Passive oxygenation (ie, nasal cannula, nonrebreathing mask) is not appropriate for a child with

inadequate ventilation, especially when accompanied by bradycardia. Back slaps and chest thrusts are indicated for a responsive infant with a severe foreign

body upper airway obstruction.

A 3-year-old child presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal

retractions and an oxygen saturation of 91%. What should you do?

A) Gently restrain the child and assist her ventilations.

B) Ask the mother to hold an oxygen mask near the child's face.

C) Apply a nasal cannula with the flow rate set to 6 L/min.

D) Apply a nonrebreathing mask with the flow rate set to 12 L/min.

B) Ask the mother to hold an oxygen mask near the child's face.

Do not assume that a child will simply allow you to administer oxygen to him or her as you would to an adult. The child in this scenario, who is in respiratory

distress and is mildly hypoxemic (Sp02 of 91%), should receive supplemental oxygen; however, it should be given in a nonthreatening manner. Agitating a sick

or injured child causes an increase in oxygen consumption and demand, which may cause the child's condition to deteriorate. In this scenario, ask the child's

mother to hold an oxygen mask near the child's face (blow-by oxygen). Small children are not as likely to tolerate a nasal cannula or nonrebreathing mask as

an adult would. Closely monitor the child's condition and be prepared to assist her ventilations with a bag-mask device if she deteriorates. Allow the child to

assume a position of comfort and transport.

Which of the following statements regarding crowning is correct?

A) Crowning represents the end of the second stage of labor.

B) Gentle pressure should be applied to the baby's head during crowning.

C) It is safe to transport the patient during crowning if the hospital is close.

D) Crowning always occurs immediately after the amniotic sac has ruptured.

B) Gentle pressure should be applied to the baby's head during crowning.

Crowning occurs when the baby's head is visible at the vaginal opening; it is an obvious sign of delivery in progress. When crowning is observed, you should

apply gentle pressure to the infant's head to prevent an explosive delivery. Care must be taken to avoid putting pressure on the fontanelles (the soft spots on

the infant's head). Crowning represents the end of the first stage of labor and the beginning of the second stage; it does not always occur immediately after the

amniotic sac has ruptured. If the infant's head is born and the amniotic sac is still intact, you need to pinch the thin membrane with your fingers, which will

usually cause the sac to easily rupture, and then suction the infant's mouth and nose.

When is it appropriate to clamp and cut the umbilical cord?

A) As soon as the cord has stopped pulsating

B) After the placenta has completely delivered

C) Before the newborn has taken its first breath

D) Immediately following delivery of the newborn

A) As soon as the cord has stopped pulsating

Generally, it is safe to clamp and cut the umbilical cord once it has stopped pulsating and the baby is breathing adequately. There is evidence to suggest that

delayed clamping of the umbilical cord is beneficial. When blood flow through the umbilical cord ceases, it will stop pulsating. If the cord does not stop

pulsating and/or the baby is not breathing adequately, the cord should not be clamped and cut and the baby should be kept at the level of the mother's

perineum and managed appropriately while en route to the hospital.

A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have:

A) slow, shallow respirations.

B) a slow capillary refill time.

C) strong, bounding radial pulses.

D) a weakly palpable carotid pulse.

B) a slow capillary refill time.

Compensated shock in the infant or child is characterized by poor peripheral perfusion (eg, delayed[> 2 seconds] capillary refill time, weak peripheral pulses, pallor), tachycardia, and tachypnea. In compensated shock, the child's blood pressure is maintained and his or her mental status is adequate. In decompensated shock, the child's compensatory mechanisms have failed; blood pressure falls, central pulses become weak, and mental status begins to deteriorate. It is critical to recognize an infant or a child in compensated shock, begin immediate treatment, and transport without delay.

A 5-year-old child has burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned?

A) 45%

B) 54%

C) 63%

D) 72%

A) 45%

According to the pediatric Rule of Nines, the child's head represents 18% of his or her total body surface area (TBSA), the anterior chest represents 9% (the

entire anterior torso [chest and abdomen] represents 18%), and each entire upper extremity represents 9%. Therefore, burns to the head, anterior chest, and

both upper extremities cover 45% of the child's TBSA. The Rule of Nines is modified for infants and children. The head accounts for 18% of the child's TBSA

(9% in adults) because the head is proportionately larger than an adult's. The lower extremities account for 13.5% (some references cite 14%) of the child's

TBSA (18% in adults) because the child's lower extremities are proportionately smaller than an adult's.

You are performing CPR on a 3-year-old child while your partner prepares the AED. What compression to ventilation ratio should you be providing?

A) 3 to 1

B) 15 to 2

C) 30 to 1

D) 30 to 2

D) 30 to 2

A universal compression to ventilation ratio of 30:2 is used for all one-rescuer CPR (adult, child, and infant), with the exception of the newborn. A compression

to ventilation ratio of 3:1 is used for newborns (one- and two-rescuer). Two-rescuer infant and child CPR is performed at a compression to ventilation ratio of

15:2. In this scenario, you are performing one-rescuer CPR as your partner prepares the AED; therefore, you should give 30 compressions and 2 breaths.

However, when you and your partner resume CPR, give 15 compressions and 2 breaths.

Signs and symptoms of pelvic inflammatory disease include:

A) generalized lower abdominal pain, nausea, and fever.

B) pain around the umbilicus and heavy vaginal bleeding.

C) abdominal cramping and an odorless vaginal discharge.

D) upper abdominal pain, diarrhea, and an absence of fever.

A) generalized lower abdominal pain, nausea, and fever.

Pelvic inflammatory disease (PIO) is an infection of the upper female reproductive organs, specifically, the uterus, ovaries, and fallopian tubes. It occurs

almost exclusively in sexually active women. In PIO, disease-causing organisms enter the vagina during sexual activity and migrate through the cervical

opening and into the uterine cavity. The infection may then progress to the fallopian tubes, producing scarring that can increase the risk for ectopic

pregnancy. The most common presenting symptom of PIO is generalized lower abdominal pain. Other signs and symptoms include an abnormal and often

foul-smelling vaginal discharge, increased pain during sexual intercourse, fever, general malaise, and nausea and vomiting. Diarrhea and vaginal bleeding are

not common signs of PIO.

A 29-year-old woman, who is 38 weeks' pregnant, presents with heavy vaginal bleeding, a blood pressure of 70/50 mm Hg, and a heart rate

of 130 beats/min. She is pale and diaphoretic, and denies abdominal cramping or pain. What should you suspect?

A) Placenta previa

B) Abruptio placenta

C) Ruptured ovarian cyst

D) Ruptured ectopic pregnancy

A) Placenta previa

Of the conditions listed, placenta previa would be the least likely to present with abdominal pain, although some patients may have pain or cramping.

Placenta previa is a condition in which the placenta develops over and covers some or all of the cervix. As the cervix dilates, the vasculature that attaches the

placenta to the uterine wall tears, resulting in vaginal bleeding that is often severe enough to cause shock. By contrast, abruptio placenta is a condition in

which the placenta prematurely separates from the uterine wall; it is characterized by tearing abdominal pain, heavy vaginal bleeding, and shock. Placenta

previa and abruptio placenta occur during the later stages of pregnancy. A ruptured ovarian cyst typically causes lower abdominal pain, often unilateral.

Ectopic pregnancy, a condition in which the egg implants and grows outside the uterus (usually in a fallopian tube), is a first-trimester condition; it is

typically discovered between 8 and 10 weeks of pregnancy. If the ectopic pregnancy ruptures, the patient often presents with a sudden stabbing pain in the

lower abdomen and shock due to intra-abdominal hemorrhage.

You are assessing a 5-year-old boy with major trauma. His blood pressure is 70/40 mm Hg and his pulse rate is 140 beats/min. and weak.

The child's blood pressure:

A) indicates decompensated shock.

B) reflects adequate compensation.

C) is appropriate based on his age.

D) suggests increased intracranial pressure.

A) indicates decompensated shock.

The low normal systolic blood pressure (SBP) for a child between 1 and 10 years of age is calculated by multiplying his or her age (in years) by 2 and adding 70.

Using this formula, the low normal SBP for a 5-year-old child is 80 mm Hg; anything less indicates hypotension. Therefore, a SBP of 70 mm Hg in a 5-year-old

child, especially in the context of major trauma, indicates decompensated shock. Patients with increased intracranial pressure are typically hypertensive, not

hypotensive. High normal SBP in this same age group is calculated by multiplying his or her age (in years) by 2 and adding 90. Therefore, the high normal SBP

for a 5-year-old child is 100 mm Hg.

A 2-year-old boy experienced a seizure that lasted 3 minutes. His mother states that he began running a fever earlier in the day. He is alert,

crying, and is clinging to his mother. His skin is hot and flushed and his heart rate is 140 beats/min. What should you do?

A) Place him in a cold water bath to reduce his fever.

B) Remove any unnecessary clothing and transport.

C) Administer chewable aspirin if his mother has any.

D) Allow his mother to transport him to his pediatrician.

B) Remove any unnecessary clothing and transport.

The child's presentation is consistent with a febrile seizure. Most febrile seizures are short-lived, so in most cases, the seizure will have stopped prior to EMS

arrival. The primary focus of treatment is to make the child comfortable, remove any heat-retaining clothing, and transport to the hospital. Administer

oxygen if there is evidence of hypoxemia. Placing the child in cool (or cold) water should be avoided; this would induce shivering (which produces heat) and

could cause an acute temperature spike, which could cause another seizure. Aspirin should not be administered to children because it increases the risk of

Reye syndrome, a rare but serious condition that causes swelling in the liver and brain. The child should be transported via EMS in case he has another

seizure; it is not advisable to allow a parent to transport.

A 9-month-old infant presents with a cough, runny nose, and respiratory distress. A whoop sound is heard during inhalation. What should

you suspect?

A) Croup

B) Pertussis

C) Bronchiolitis

D) Pneumonia

B) Pertussis

Pertussis, also known as whooping cough, is a communicable disease caused by a bacterium that is spread via the droplet route. The typical signs and

symptoms are similar to a common cold, and include coughing, sneezing, and a runny nose. As the disease progresses, the coughing becomes more severe

and is characterized by a distinctive whoop sound heard during inhalation. Infants with pertussis may develop pneumonia or respiratory failure. Croup is

unlikely; it is caused by upper airway inflammation and is characterized by stridor and a seal-bark cough. Bronchiolitis is also unlikely; it is a viral infection

that causes lower airway constriction and inflammation. Wheezing is commonly observed in children with bronchiolitis. Although pneumonia cannot be

completely ruled out, the whoop sound heard during inhalation makes pertussis the most likely cause of this child's symptoms.

A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding

from her mouth and nose. You should:

A) open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her

ventilations.

B) open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via nonrebreathing

mask.

C) manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and suction her

oropharynx.

D) suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist her ventilations.

A) open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her

ventilations.

In any semiconscious or unconscious patient with a head injury, you should manually stabilize the head and open the airway with the jaw-thrust maneuver. If

there are any secretions in the mouth, suction the oropharynx. If possible, insert a simple airway adjunct. The patient in this scenario is semiconscious and

likely has an intact gag reflex; therefore, you should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal

airway in patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After ensuring a patent airway, you

should turn your attention to the patient's breathing. Slow, irregular breathing will not provide adequate minute volume and should be treated with

ventilatory assistance.

A 4-year-old boy with a tracheostomy tube has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%.

During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:

A) ventilate through the tracheostomy tube.

B) carefully suction the tracheostomy tube.

C) remove the tracheostomy tube and clean it.

D) place an oxygen mask over the tracheostomy tube.

B) carefully suction the tracheostomy tube.

Obstruction of a tracheostomy tube with thick secretions is a common, and potentially life -threatening, complication. You must first suction the tube to

ensure that it is clear of secretions; this will often improve the patient's condition. Do not vigorously suction the tube, however, as this may induce or worsen

bradycardia. Placing an oxygen mask over an obstructed tracheostomy tube will be of little to no benefit. If the child's condition does not improve following

suctioning (eg, he remains bradycardic, his oxygen saturation remains low), attach a bag-mask device to the tracheostomy tube and begin ventilating him. Do

not remove the tracheostomy tube; this is beyond the EMT's scope of practice, plus there is no guarantee that you will be able to replace it.

Which of the following is considered a severe burn in a pediatric patient?

A) Partial thickness burns to 15% of the body surface area

B) Any full-thickness burn, regardless of body surface coverage

C) Any partial-thickness burn that involves the lower extremities

D) Superficial burns that cover 5% to 10% of the body surface area

B) Any full-thickness burn, regardless of body surface coverage

Minor burns in pediatric patients include small coverage area superficial burns and partial-thickness burns that involve less than 10% of the body surface area.

Partial-thickness burns involving 10% to 20% of the body surface area are classified as moderate burns. Severe burns in pediatric patients include any fullthickness

burn, regardless of location or body surface area coverage; partial-thickness burns involving more than 20% of the body surface area; and any burn

involving the hands, feet, face, airway, or genitalia.

You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before, but had a

miscarriage at 19 weeks. You should document her obstetric history as:

A) gravida 2, para 0.

B) gravida 1, para 1.

C) gravida 0, para 2.

D) gravida 2, para 1.

A) gravida 2, para 0.

Gravida is the term used to describe the number of times a woman has been pregnant, regardless of whether she carried the infant to term. Para is the term

used to describe the number of times a woman has carried a fetus beyond 28 weeks, regardless of whether the infant was born dead or alive. Because your

patient is currently pregnant and was pregnant once before, she is gravida 2. However, because she had a miscarriage with her first pregnancy (she did not

carry beyond 28 weeks) and has not yet delivered the baby she is currently carrying, she is para 0. When she delivers, she will become gravida 2 and para 1.

You arrive at a residence shortly after a 4-year-old boy experienced an apparent febrile seizure. The child is alert and crying. His skin is

flushed, hot, and moist. His mother tells you that the seizure lasted about 2 minutes. You should:

A) begin rapid cooling measures at once.

B) give him acetaminophen or ibuprofen.

C) provide supportive care and transport.

D) allow the mother to take her child to the doctor.

C) provide supportive care and transport.

Febrile seizures are common in children between the ages of 6 months and 6 years; they occur when the child's body temperature suddenly rises or when an

already febrile child experiences an acute fever spike. Treatment for a child who has experienced a febrile seizure involves providing supportive care (eg,

monitoring ABCs, administering oxygen as tolerated) and transporting to the hospital. Any infant or child who experienced a seizure should be transported

by EMS. Although febrile seizures are typically self-limiting and are rarely life threatening, there are other causes of fever and seizures, such as meningitis.

The EMT is generally not authorized to administer medications unless directed by local protocol or direct medical control. Active cooling (eg, cool or cold

water baths) should be avoided; a sudden lowering of the child's temperature may cause him to shiver, which may cause a sudden fever spike and induce

another seizure.

The MAIN reason why small children should ride in the backseat of a vehicle is because:

A) they are much less likely to be ejected from the vehicle.

B) the back of the front seat will provide a cushion during a crash.

C) they can experience severe injury or death if the air bag deploys.

D) their legs are highly prone to injury from striking the dashboard.

C) they can experience severe injury or death if the air bag deploys.

Children younger than 12 years should ride in the backseat of a vehicle, preferably in the middle, and be restrained in a device that is appropriate for their size.

Merely placing the child in the backseat does not reduce the risk of ejection; the child must be properly restrained. Young children, especially those restrained

in a child safety seat, may be critically injured or killed by air bags if they are riding in the front passenger seat of a car. This occurs because the child safety seat

positions the child too close to the air bag; the force of the deploying air bag may cause severe head and spinal trauma.

A 4-year-old child has had several generalized seizures over the past 20 minutes, but never woke up in between the seizures. The child's

skin is hot and flushed. What should you suspect?

A) febrile seizure

B) A focal motor seizure

C) An absence seizure

D) Status epilepticus

D) Status epilepticus

Status epilepticus is defined as a prolonged (greater than 20 minutes) seizure or multiple seizures without a return of consciousness in between seizures. A

febrile seizure is caused by an abrupt rise in body temperature, usually due to a non-life-threatening infection (eg, middle ear infection). Most febrile seizures

last less than 5 minutes, have resolved by the time EMS arrives at the scene, and are not followed by a postictal period. The child in this scenario, although

febrile (hot, flushed skin), did not experience a seizure caused by fever alone; you should suspect other causes of fever and seizures, such as meningitis.

Absence seizures are characterized by a blank stare and an absence of tonic-clonic motor activity. Like febrile seizures, absence seizures are usually of short

duration and are not followed by a postictal period. A focal motor seizure is isolated to one part of the body, such as an extremity, but can progress to a

generalized tonic clonic seizure.

You and your partner are performing CPR on a 2-year-old woman in cardiac arrest. During your resuscitation attempt, you should:

A) hyperventilate her because she is severely hypoxic.

B) allow the chest to fully recoil in between compressions.

C) perform compressions and ventilations at a ratio of 30:2.

D) attach the AED pads after 5 minutes of high-quality CPR.

B) allow the chest to fully recoil in between compressions.

When performing two-rescuer CPR on an infant or a child, use a compression to ventilation ratio of 15:2 (30:2 for one-rescuer infant or child CPR), compress

the chest by one-third the depth of the chest (about 2 inches), and allow the chest to fully recoil between compressions. Full recoil of the chest is essential to

high-quality CPR; it maximizes the amount of blood that returns to the heart, which maximizes the amount of blood ejected from the left ventricle during

chest compressions. Do not hyperventilate any patient; deliver each breath over 1 second while observing the chest for visible rise. Hyperventilation causes

gastric distention and increases the risk of aspiration if regurgitation occurs. Furthermore, hyperventilation causes a reduction in blood return to the heart

because it hyperinflates the lungs and puts pressure on the heart. Attach pediatric AED pads as soon as possible, analyze the child's cardiac rhythm, and

deliver a single shock if indicated.

After attaching the AED to a 7-year-old child in cardiac arrest, you push the analyze button and receive a shock advised message. After

delivering the shock, you should:

A) assess for a carotid pulse.

B) immediately perform CPR.

C) reanalyze the cardiac rhythm.

D) open the airway and ventilate.

B) immediately perform CPR.

After the AED delivers a shock, you should immediately begin or resume CPR, starting with chest compressions. Perform CPR for 2 minutes and then

reanalyze the child's cardiac rhythm. If the AED states that a shock is advised, defibrillate without delay and then continue CPR. If the AED states no shock

advised, resume CPR and reassess in 2 minutes. Do not check for a pulse after defibrillation or if the AED gives a no shock message; this merely causes an

unnecessary delay in performing chest compressions. Continue CPR and cardiac rhythm analysis and defibrillation (if indicated) every 2 minutes until ALS

personnel arrive or the patient starts to move spontaneously.

A 5-year-old child is unresponsive and cyanotic. His pulses are weak and slow, and his breathing is slow. What should you do?

A) Begin chest compressions.

B) Ventilate with a bag-mask device.

C) Give oxygen by nonrebreathing mask.

D) Apply the automated external defibrillator.

B) Ventilate with a bag-mask device.

Most cardiac arrests in infants and children are caused by hypoxia secondary to respiratory failure. Unlike adults, they rarely develop dysrhythmias such as

ventricular fibrillation. When infants and children become hypoxic, they develop bradycardia. Any infant or child who has bradycardia and poor breathing

should be ventilated with a bag-mask device immediately. The presence of cyanosis indicates severe hypoxia and must be treated aggressively. If the child's

heart rate falls below 60 beats/min despite adequate bag-mask ventilation, begin chest compressions. The automated external defibrillator (AED) is only

indicated for patients in cardiac arrest; the child in this scenario is not in cardiac arrest.

Oxygen and other nutrients are transferred to the developing fetus via the:

A) umbilical vein.

B) amniotic fluid.

C) umbilical arteries.

D) mother's liver.

A) umbilical vein.

The organ of oxygen and carbon dioxide exchange between the mother and the developing fetus is the placenta. The fetus is attached to the placenta by the

umbilical cord, which contains two arteries and one vein. The fetus receives its supply of oxygen and other nutrients from the placenta via the umbilical vein.

Carbon dioxide and other waste products are returned from the fetus to the placenta via the umbilical arteries. The amniotic sac acts as a cushion for the

developing fetus and helps protect it from infection.

If a woman is having her first child, the first stage of labor:

A) generally does not allow time for you to transport.

B) is typically very short and lasts only about 2 hours.

C) is shorter than in women who have had other children.

D) is usually the longest and lasts an average of 16 hours.

D) is usually the longest and lasts an average of 16 hours.

There are three stages of labor: dilation of the cervix, delivery of the baby, and delivery of the placenta. The first stage begins with the onset of contractions

and ends when the cervix is fully dilated. Since assessing for cervical dilation is not performed in the prehospital setting, the first stage of labor is said to have

ended when crowning occurs. Because the cervix has to be stretched thin by uterine contractions until the opening is large enough for the fetus to pass

through into the vagina, the first stage is usually the longest, lasting an average of 16 hours for a first delivery. With subsequent pregnancies, the first stage of

labor typically progresses more quickly. You will usually have enough time to transport the mother during the first stage of labor, especially if this is her first

pregnancy. It should be noted, however, than some primigravida (pregnant for the first time) women progress through the first stage of labor very quickly.

A 3-year-old child experienced a seizure that lasted about 10 minutes. He has a fever of 103.5°F, his skin is hot to the touch, and he has a rash

on his trunk. What should you suspect?

A) Epilepsy

B) Meningitis

C) Intracranial hemorrhage

D) An allergic reaction

B) Meningitis

Febrile seizures and fever with seizures are not one in the same. Febrile seizures are caused by fever and fever alone. Conversely, fever with seizures could be

something else. The rash on the child's trunk indicates possible sepsis, and should make the EMT suspect meningitis; a rash is not a common finding with

simple febrile seizures. Rash and fever are not common findings with intracranial hemorrhage, and fever is not commonly associated with an allergic reaction.

You are dispatched to a residence for a 4-year-old girl who is sick. Your assessment reveals that she has increased work of breathing and is

making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your

MOST immediate concern should be:

A) preparing to treat her for a febrile seizure.

B) taking her temperature to see how high it is.

C) assessing the need for ventilation assistance.

D) determining if the child has a history of croup.

C) assessing the need for ventilation assistance.

The child is clearly experiencing respiratory distress and probably has croup (laryngotracheobronchitis), a viral upper airway infection. The presence of

stridor (high-pitched sound heard during inhalation) indicates swelling of the upper airway. Your most immediate concern should be assessing the adequacy

of her breathing and determining if ventilation assistance is necessary. If signs of respiratory failure are present (eg, signs of physical exhaustion, bradycardia,

bradypnea [slow respirations]), you must begin assisting her ventilations with a bag-mask device; otherwise, she will likely deteriorate and develop cardiac

arrest. She may experience a febrile seizure if her fever acutely spikes; although this is a concern, it is not the most immediate concern in a child with an

airway or breathing problem.

A child typically begins to develop stranger anxiety when he or she is a/an:

A) infant.

B) neonate.

C) toddler.

D) preschooler.

C) toddler.

A toddler is a child between 1 and 3 years of age. During this period, children begin to walk and explore their environment. They are able to open doors,

drawers, boxes, and bottles. Because they are explorers by nature and are not afraid, injuries in this age group increase. Stranger anxiety also develops early in

this period. Toddlers often resist separation from caregivers and are afraid to let others come near them.

Upon assessing a newborn, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What should you do?

A) Initiate positive pressure ventilations.

B) Provide blow-by oxygen with oxygen tubing.

C) Assess the newbom's skin condition and color.

D) Perform chest compressions at 120 per minute.

A) Initiate positive pressure ventilations.

Positive pressure ventilations are indicated in the newborn if he or she is apneic or has gasping respirations, if the heart rate is less than 100 beats/min, or if central cyanosis persists despite the delivery of blow-by oxygen. Chest compressions are indicated if the heart rate is less than 60 beats/min, despite adequate positive pressure ventilation. In many cases, the newborn's heart rate will increase to greater than 100 beats/min with adequately performed positive pressure ventilation. If the newborn is breathing adequately and has a heart rate greater than 100 beats/min, you should proceed to assess skin color.

A 3-year-old girl is unresponsive and has slow, shallow breathing. Her heart rate is 65 beats/min and her skin is cyanotic. Her caregiver

advises that the child ingested an unknown quantity of her narcotic painkillers. What should you do?

A) Administer naloxone via the intranasal route

B) Ventilate with a bag-mask device at 20 breaths/min

C) Begin chest compressions at a rate of100 to 120/min

D) Administer high-flow oxygen via nonrebreathing mask

B) Ventilate with a bag-mask device at 20 breaths/min

The child's breathing is clearly inadequate and she is significantly hypoxemic. Initial treatment for an opioid overdose, regardless of the patient's age, is to

optimize ventilation and oxygenation. Opioid-related deaths are the result of respiratory failure; the most immediate and effective way to prevent this is to

ventilate the patient. For the child, provide 20 to 30 breaths/min (one breath every 2 to 3 seconds). The child is also significantly bradycardic, which is likely

the result of a combination of the opioid and hypoxemia. After restoring ventilation and oxygenation, administer naloxone (Narcan) via the intranasal route, if

allowed by local protocol, in a dose that is appropriate for the pediatric patient. If her heart rate falls below 60 beats/min despite adequate ventilation and

oxygenation, begin chest compressions.

A prolapsed umbilical cord is dangerous because the:

A) cord might pull the placenta from the uterine wall during delivery.

B) mother may die of hypoxia due to compromised placental blood flow.

C) cord may be wrapped around the baby's neck, causing strangulation.

D) baby's head may compress the cord, cutting off its supply of oxygen.

D) baby's head may compress the cord, cutting off its supply of oxygen.

A prolapsed umbilical cord, a condition in which a portion of the umbilical cord delivers before the baby, is a dangerous condition; the baby's head may

compress the cord, cutting off its own supply of oxygen. Therefore, when a prolapsed umbilical cord is discovered, it is important to take immediate action.

Place the mother in a position in which her hips are elevated. It may be necessary to insert your gloved fingers into the vagina and lift the baby's head off of the

cord. A nuchal cord occurs when the umbilical cord is wrapped around the baby's neck; it is relatively common and is usually easily treated by simply sliding

the cord from around the baby's neck. A nuchal cord and a prolapsed umbilical cord usually do not occur at the same time.

A newborn is considered to be premature if it:

A) weighs less than 6.5 pounds.

B) is born before 37 weeks' gestation.

C) is born to a heroin-addicted mother.

D) has meconium in or around its mouth.

B) is born before 37 weeks' gestation.

A term gestation is between 37 and 42 weeks. A premature newborn is one that is born before 37 weeks' gestation or weighs less than 5.5 pounds (2.5 kg).

Compared to women who do not abuse drugs, smoke, or drink alcohol during pregnancy, women who do are more likely to deliver prematurely or to deliver a

low-birth-weight baby. The risk of the fetus voiding its first bowel movement (meconium) in utero increases any time the fetus is distressed, regardless of its

gestational age or weight; the presence of meconium does not define a premature newborn.

At what stage during pregnancy does the embryo become a fetus?

A) 2 weeks

B) 6 weeks

C) 8 weeks

D) 10 weeks

D) 10 weeks

The fertilized egg travels to the uterus where, if implantation occurs, the fertilized egg becomes an embryo (the stage from O to 10 weeks after fertilization) and then a fetus (the stage from 10 weeks until delivery) and grows until the time of delivery at approximately 9 months (40 weeks) of gestation.

After 30 seconds of positive pressure ventilation, a newborn's heart rate is 50 beats/min and its face and trunk are cyanotic. The EMT should:

A) give blow-by oxygen.

B) begin chest compressions.

C) increase the ventilation rate.

D) resuction the mouth and nose.

B) begin chest compressions.

Immediate treatment for newborn bradycardia (heart rate less than 100 beats/min) involves positive pressure ventilation. If the heart falls below 60 beats/min

despite positive pressure ventilation, you should begin chest compressions. Central cyanosis (cyanosis to the face and trunk) and severe bradycardia indicate

significant hypoxia; if immediate corrective action is not taken, cardiopulmonary arrest could follow. Blow-by oxygen is appropriate for newborns with central

cyanosis who are otherwise breathing adequately and have a heart rate that is greater than 100 beats/min. The mouth and nose should be suctioned if

secretions are present. Increasing the ventilation rate could cause more harm secondary to increased intrathoracic pressure.

Which of the fo llowing signs is the MOST ominous in a child with respiratory distress?

A) Bradypnea

B) Tachycardia

C) Nasal flaring

D) Retractions

A) Bradypnea

Retractions, nasal flaring, and tachycardia are all common findings in infants and children with respiratory distress. As the child begins to tire, however,

retractions often become weak and ineffective and the accessory muscles become less prominent during breathing. Bradypnea, a decrease in the respiratory

rate, is an ominous sign and indicates impending respiratory arrest. Do NOT mistake bradypnea for a sign of improvement; it usually indicates that the child's

condition has deteriorated. Therefore, you should be prepared to provide ventilatory assistance.

The function of the uterus is to:

A) dilate and expel the baby from the cervix.

B) house the fetus as it grows for 40 weeks.

C) provide oxygen and other nutrients to the fetus.

D) provide a cushion and protect the fetus from infection.

B) house the fetus as it grows for 40 weeks.

The uterus is a muscular organ where the fetus grows for 39 to 40 weeks. It is responsible for contracting during labor, which in conjunction with dilation of

the cervix (the opening of the uterus), expels the baby from the uterus into the birth canal. The placenta is the organ of exchange that delivers oxygen and

other nutrients from the mother to the fetus and returns metabolic waste products from the fetus to the mother. The amniotic sac, also called the bag of

waters, provides a cushion for the developing fetus and helps protect it from infection.

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. Treatment should include:

A) uterine massage for 5 minutes, and then transport.

B) placing her in a left-lateral recumbent position and transport.

C) treating for shock and performing uterine massage during transport.

D) placing sterile pads into her vagina and treating for shock during transport.

C) treating for shock and performing uterine massage during transport.

Blood loss of up to 500 mL within the first 24 hours after delivery is considered normal and usually is well tolerated by the mother. However, any bleeding,

regardless of the severity, with accompanying signs of shock, must be treated at once. In this case, you should apply high-flow oxygen, treat for shock (keep

her supine and cover her with warm blankets), and provide rapid transport to the hospital while massaging the uterine fundus en route. Placing the mother

on her left side is appropriate before she delivers (and if she is not in shock) and prevents supine hypotensive syndrome. Dressings should never be packed

into the vagina as this increases the risk for maternal infection.

While assessing a woman in labor, the EMT notices that a loop of the umbilical cord is protruding from her vagina. In which position should

the EMT place the patient?

A) Left side with her head elevated

B) Supine with her pelvis elevated

C) Left side with her legs elevated

D) Semi-sitting with her knees bent

B) Supine with her pelvis elevated

Treatment for a prolapsed umbilical cord focuses on maintaining a pulsatile cord. Elevate the mother's pelvis; this will allow the baby to slide slightly back into

the vagina, off of the cord. The knee-to -chest position may accomplish this same goal. Cover any exposed cord with a moist, sterile dressing, administer

oxygen to the mother, and transport without delay.

After drying, warming, and suctioning a newborn's mouth and nose, assessment reveals central cyanosis, a weak cry, and a heart rate of 60

beats/min. What should you do?

A) Clamp and cut the umbilical cord and transport at once.

B) Begin chest compressions and reassess after 30 seconds.

C) Resuction the mouth and nose and reassess the heart rate.

D) Ventilate with a bag-mask device at 40 to 60 breaths/min.

D) Ventilate with a bag-mask device at 40 to 60 breaths/min.

The initial treatment for a cyanotic and bradycardic newborn is positive pressure ventilation (PPV). Ventilate the newborn with a bag-mask device at a rate of

40 to 60 breaths/min and then reassess the heart rate after 30 seconds. If the heart rate is below 60 beats/min after 30 seconds of adequate PPV, you should

begin chest compressions. The umbilical cord should not be clamped and cut until it stops pulsating and the newborn is breathing adequately. Unnecessary

suctioning can worsen hypoxia and bradycardia and should be avoided.

During delivery of the head, it is noted that the umbilical cord is wrapped tightly around the baby's neck. An attempt to slide the cord over the

baby's head is unsuccessful. The EMT should:

A) clamp and cut the umbilical cord.

B) position the mother on her left side.

C) gently pull on the cord to loosen it.

D) place an oxygen mask on the baby.

A) clamp and cut the umbilical cord.

In most cases, a nuchal cord (cord wrapped around the baby's neck) can easily be slid over the baby. However, if this is not possible, you should clamp and cut

the cord and continue with the delivery. A tightly-wrapped cord around the neck can cause (or worsen) fetal hypoxia. Do NOT pull on the umbilical cord as

doing so could cause it to tear and bleed; this would be bad! Positioning the mother on her left side will do nothing if the cord is strangling the baby. Administer

supplemental oxygen to the mother as needed, and transport without delay.

Your assessment of a 2-year-old boy reveals that he has is not interacting normally and has poor muscle tone. His respirations are 30

breaths/min and unlabored and his skin is pink. These findings suggest a problem with which of the following body systems?

A) Cardiac

B) Neurologic

C) Respiratory

D) Circulatory

B) Neurologic

The Pediatric Assessment Triangle (PAT) is a structured assessment tool that allows you to rapidly form a general impression of the child's condition without

touching him or her. This first glance assessment, which can be performed in less than 30 seconds, will help you identify the general category (neurologic,

respiratory, or circulatory) of the patient's physical problem and establish urgency for treatment and/or transport. The PAT is comprised of three

components: appearance, work of breathing, and skin circulation. Abnormal mentation and poor muscle tone suggest abnormal neurologic function, such as

what caused by hypoglycemia, stroke, or other neurologic problems. A respiratory rate of 30 breaths/min is normal for a 2-year-old child, and considering that his breathing is not labored, a primary respiratory problem is unlikely. Pallor or mottled skin suggests a circulatory problem; however, the child's skin is pink.

You will know that the third stage of labor has begun when:

A) the placenta has delivered.

B) the entire baby has delivered.

C) the mother's contractions become regular.

D) the baby's head is visible at the vaginal opening.

B) the entire baby has delivered.

Labor is divided into three stages. The first stage begins with the onset of contractions and ends when the cervix is fully dilated. In the field, the EMT cannot

determine the degree of cervical dilation, so the appearance of the baby's head at the vaginal opening (crowning) is used to mark the end of the first stage of

labor. As the first stage of labor progresses, the mother's contractions become more frequent and regular. The second stage of labor begins with full cervical dilation (or in the field, crowning) and ends when the baby is completely delivered. The third stage of labor begins with the birth of the baby and ends when the placenta (afterbirth) has delivered.

Which of the following statements regarding two-rescuer child CPR is correct?

A) The chest should not be allowed to fully recoil in between compressions, as this may impair venous return.

B) Compress the chest with one or two hands to a depth that is equal 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.

B) Compress the chest with one or two hands to a depth that is equal to one-third the diameter of the chest.

When performing two-rescuer CPR on a child (1 year of age to the onset of puberty [12 to 14 years of age]), the chest should be compressed with one or two

hands (depending on the size of the child), and a compression to ventilation ratio of 15:2 should be used. It is important to compress the chest to an adequate

depth: one-third the anterior-posterior diameter of the chest (about 2 inches in the child). The chest should be allowed to fully recoil in between

compressions to maximize venous return to the heart. If an advanced airway device (ie, ET tube, supraglottic airway) is not in place, two rescuers should

deliver "cycles" of CPR; the compressor should pause briefly so the ventilator can deliver two breaths. A compression to ventilation ratio of 30:2 is used for

one-rescuer child CPR. After an advanced airway device has been inserted, "cycles" of CPR should not be performed; compressions should be continuous at a

rate oflOO to 120/min and ventilations should be delivered at a rate oflO breaths/min (one breath every 6 seconds).

A newborn has cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do?

A) Resuction the mouth

B) Briskly dry off the infant

C) Begin chest compressions

D) Begin artificial ventilations

D) Begin artificial ventilations

Central cyanosis (cyanosis to the head, face, and trunk) alone initially should be treated with blow-by oxygen; however, when it is accompanied by a heart rate

that is less than 100 beats/min, artificial ventilations should be initiated and continued until the heart rate exceeds 100 beats/min. Newborn bradycardia is

defined as a heart rate of less than 100 beats/min. Chest compressions are indicated if the newborn's heart rate falls below 60 beats/min, despite 30 seconds

of adequate positive pressure ventilation. A newborn should be dried off thoroughly, regardless of its appearance at birth.

A 5-year-old, 40-pound child was bitten by fire ants and is semiconscious. His breathing is labored and shallow, he has audible stridor, and his

blood pressure is low. Which of the fo llowing would be the MOST appropriate treatment for him?

A) Ventilation with a bag-mask device and 0.15 mg epinephrine via auto-injector

B) Oxygen via nonrebreathing mask and 0.3 mg epinephrine via auto-injector

C) Ventilation with a bag-mask device and 0.3 mg epinephrine via auto-injector

D) Oxygen via nonrebreathing mask and 0.15 mg epinephrine via auto-injector

A) Ventilation with a bag-mask device and 0.15 mg epinephrine via auto-injector

The child is clearly in anaphylactic shock with inadequate ventilation. Therefore, you should assist his ventilations with a bag-mask device and administer

epinephrine as soon as possible. The correct dose for a child who weighs between 15 and 30 kg (33 to 66 pounds) is 0.15 mg via EpiPen Jr. Patients who weigh

more than 30 kg (66 pounds) should receive 0.3 mg of epinephrine (adult EpiPen).

Which of the following is the definitive sign of imminent delivery of a baby?

A) Crowning

B) Urge to defecate

C) Lengthy contractions

D) Contractions less than 3 minutes apart

A) Crowning

The operative word in this question is definitive. While the urge to defecate, contractions that are less than 2 to 3 minutes apart, and contractions that are

lengthy, are all strong indicators that delivery is very close, nothing is more definitive than visualization of the presenting part of the baby at the vaginal

opening (crowning).

Which of the following would be the MOST significant finding in a 2-month-old infant who is dehydrated?

A) Dry mucous membranes

B) Absence of tear production

C) Delayed capillary refill time

D) Heart rate of 130 beats/min

C) Delayed capillary refill time

Infants and small children can become significantly dehydrated following even a few episodes of vomiting and/or diarrhea. All of the clinical findings listed are

consistent with dehydration. Delayed capillary refill time, however, indicates decreased perfusion; therefore, it is the most significant finding of the options

listed. Tachycardia is expected in any patient who is dehydrated; 130 beats/min is not excessively fast for a 2-month-old infant.

The correct method for inserting an oropharyngeal airway in a small child is to:

A) insert the airway with the curvature toward the roof of the mouth and then rotate it 180 degrees.

B) depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue.

C) open the airway with the tongue-jaw lift maneuver and insert the airway until you meet slight resistance.

D) insert the airway as you would in an adult, but use an airway that is one size smaller than you would normally use.

B) depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue.

Keeping in mind that a child's tongue is proportionately large, the correct method for inserting an oropharyngeal (oral) airway is to use a tongue blade to

depress the tongue and slide the airway straight in, with the downward curve of the airway facing the tongue, until it rests just beyond the curvature of the

tongue. If you use an oral airway that is too small, it will not reach the curvature of the tongue and propel it forward. If you use an oral airway that is too large,

it may obstruct the airway. If you meet resistance when inserting an oral airway, you are likely using an airway that is too large. Oral airways are rigid, and the

hard palate of a child is rather fragile. An improperly inserted oral airway could lacerate or fracture a child's hard palate.

When you begin to assess a woman in labor, she 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 next?

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?

C) At how many weeks' gestation are you?

When assessing a patient in labor, the first question you should ask is how far along in the pregnancy she is. If she is less than 39 weeks gestation (a

pregnancy is considered full term once it reaches 39 weeks, but has not gone beyond 40 weeks and 6 days), you should prepare for possible resuscitation of

the newborn if delivery occurs in the field. Other questions, such as asking if her amniotic sac (bag of waters) has ruptured and whether she has received

prenatal care, also can help you anticipate and prepare for potential complications. You should also inquire as to how many times the patient has been

pregnant, regardless of whether she carried the baby to term (gravida), and the number of times she has carried a baby beyond 28 weeks, regardless of

whether it was born dead or alive (para).

While performing a visual inspection of a 30-year-old woman in labor, you can see the umbilical cord at the vaginal opening. What should you

do?

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 rapid transport.

B) Relieve pressure from the cord with your gloved fingers.

The goal in treating a prolapsed umbilical cord is to maintain a pulsatile cord. Place your gloved fingers into the vagina and lift the presenting part of the baby

off of the umbilical cord. Positioning the mother with her hips elevated may allow the baby to slide off of the umbilical cord. Continued pressure on the

umbilical cord will cut off the baby's oxygen supply. In addition, you should keep the cord moist by covering it in saline-soaked dressings. Give the mother

high-flow oxygen and provide rapid transport to the hospital. Uterine massage is only indicated AITER delivery to control postpartum bleeding.

Which of the following is the MOST detrimental effect of gastric distention in infants and children?

A) Rupture of the trachea

B) Decreased ventilatory volume

C) Acute rupture of the diaphragm

D) Less effective chest compressions

B) Decreased ventilatory volume

Gastric distention can be lethal if not detected and managed appropriately in any patient, but especially infants and children. As air insufflates the stomach, the

diaphragm is pushed into the thoracic cavity, which decreases the amount of air that can fill the lungs. This results in decreased ventilatory volumes during

artificial ventilation. Gastric distention also increases the risks of regurgitation and aspiration. You must be able to deliver adequate ventilations to the patient.

Remember, respiratory failure is the most common cause of cardiopulmonary arrest in children.

Following delivery of the baby and placenta, the mother continues to experience moderate vaginal bleeding. The EMT should:

A) carefully insert several gauze pads into her vagina.

B) sit her up and apply direct pressure to her vaginal area.

C) keep her supine and massage the fund us of her uterus.

D) place her on her side and elevate her lower extremities.

C) keep her supine and massage the fund us of her uterus.

Postpartum hemorrhage should be treated by placing the mother supine and firmly massaging the fund us (top) of the uterus. Fundal massage causes

vasoconstriction of the uterine blood vessels, which is why it helps control bleeding. Another option is to allow the mother to nurse her baby; doing so

causes her pituitary gland to release oxytocin, which also causes vasoconstriction of the uterus. Inserting any type of dressing or gauze into the vagina is

clearly inappropriate and will not help control the bleeding. Direct pressure to the vaginal area will accomplish nothing in controlling postpartum

hemorrhage. If postpartum hemorrhage is severe enough to produce signs of shock, keep the mother supine, cover her with a warm blanket, administer

oxygen, and transport without delay.

A high normal respiratory rate for an infant between 1 month and 1 year of age is:

A) 30 breaths/min.

B) 40 breaths/min.

C) 60 breaths/min.

D) 70 breaths/min.

C) 60 breaths/min.

Normal respiratory rates for infants between 1 month and 1 year of age range between 30 to 60 breaths/min. Normal respiratory rates for a toddler between 1

and 3 years of age range between 24 to 40 breaths/min. Normal respiratory rates for preschool-age children between 4 and 5 years of age range between 22 and 34 breaths/min. Normal respiratory rates for school-age children between 6 and 12 years of age range between 18 and 30 breaths/min. These respiratory

rate ranges are cited in the 2015 Pediatric Advanced Life Support Guidelines from the American Heart Association.

Which of the following parameters is the LEAST reliable when assessing the perfusion status of a 2-year-old child?

A) Capillary refill time

B) Systolic blood pressure

C) Skin color and temperature

D) Presence of peripheral pulses

B) Systolic blood pressure

You should not rely on the systolic blood pressure (SBP) when concluding the perfusion status of anyone. More reliable parameters include peripheral pulses,

capillary refill time (most reliable in children younger than 6 years of age), and the condition and temperature of the skin. Remember that the body's

compensatory mechanisms work to maintain the SBP, so when it falls, this corresponds to decompensated shock. A maintained SBP does NOT rule out shock!

Following a motor vehicle crash, a 3-year-old girl has an obvious deformity to the mid-shaft humerus. What should you suspect?

A) This is not an uncommon injury in a small child

B) She was exposed to significant traumatic force

C) She has a greenstick fracture because her bones are soft

D) She has an underlying condition that causes brittle bones

B) She was exposed to significant traumatic force

The deformity to the child's humerus indicates a complete fracture. Fractures of the humerus or femur do not normally occur without major trauma, such as

falls from a high place or a motor vehicle crash. Your index of suspicion should be high if an infant or young child sustains a complete fracture of any bone.

Infants and small children are more likely to experience greenstick (incomplete) fractures , as opposed to complete fractures, due to their soft and pliable

bones. A complete fracture in a pediatric patient indicates that the child was exposed to significant traumatic force. In rare instances, children may have an

underlying medical condition that causes brittle bones; however, this would not be a safe assumption to make.

A 3-year-old girl presents with respiratory distress. She is crying and is clinging to her mother. Her heart rate is 150 beats/min and her

oxygen saturation is 89%. What should you do?

A) Administer blow-by oxygen via nonrebreathing mask.

B) Administer an inhaled bronchodilator via face mask.

C) Ventilate with a bag-mask device at 20 breaths/min.

D) Ventilate with a bag-mask device at 30 breaths/min.

A) Administer blow-by oxygen via nonrebreathing mask.

If a child presents with respiratory difficulty, the method of oxygen delivery depends on his or her mental status, respiratory effort, and heart rate. A child

with respiratory distress has an increased work of breathing, is agitated and tachycardic, and is clinging to his or her parent. Oxygen for a child with

respiratory distress should be given by the least threatening method. You should avoid further agitation of the child, which may cause deterioration of his or

her condition. Give the child oxygen via the blow-by technique; allow the parent to hold the oxygen mask near the child's face. In this particular child, you

have not assessed enough to determine if wheezing is present; therefore, an inhaled bronchodilator is not indicated at this time. If the child develops signs of

respiratory failure, such as a decreased level of consciousness, signs of physical exhaustion, reduced tidal volume (shallow breathing), cyanosis, and

bradycardia, you should ventilate with a bag-mask device attached to supplemental oxygen.

Which of the following clinical findings are consistent with epiglottitis?

A) High fever and drooling

B) Low-grade fever and stridor

C) Low-grade fever and wheezing

D) High fever and crackling breath sounds

A) High fever and drooling

Epiglottitis is a bacterial infection of the soft tissue in the area above the vocal cords. In preschool- and school-aged children especially, the epiglottis can swell

to two to three times its normal size, potentially causing an airway obstruction. Signs and symptoms include a high fever, sore throat, and respiratory distress.

Because it hurts to swallow, drooling is very common. In many cases, you will find the child in the tripod position. Wheezing indicates a lower airway

obstruction, such as asthma or bronchiolitis; it is not commonly seen in children with epiglottitis. Fever, crackles heard in the lungs, and respiratory distress

are common findings with pneumonia, not epigiottitis.

You are responding to a call for a 2-year-old child who fell from a second-story window. With the mechanism of injury and the age of the patient in mind, you should suspect that the primary injury occurred to the child's:

A) head.

B) chest.

C) abdomen.

D) lower extremities.

A) head.

Because a child's head is proportionately larger than the rest of the body when compared to an adult, the head commonly is the primary site of injury in

pediatric patients. This is especially true in fall - related injuries, in which gravity causes the head to precede the rest of the body. Head injury is a leading cause

of traumatic death in infants and small children.

You receive a call for a 3-month-old infant who was found unresponsive by his mother when she woke up. The infant is pulseless and apneic and his skin is cold and pale. You should:

A) carefully inspect the environment in which the infant was found.

B) attempt full resuscitative measures, and transport the infant to the hospital.

C) perform CPR for 10 minutes and then contact medical control for further direction.

D) withhold chest compressions but apply the AED to analyze the infant's cardiac rhythm.

A) carefully inspect the environment in which the infant was found.

When managing a case of sudden unexpected infant death (SUID), you will be faced with three tasks: assessment and management of the infant,

communicating with and providing emotional support to the family, and assessing the scene. It is clear that the infant in this scenario is deceased; therefore,

resuscitation (in any form) would be futile and therefore is not indicated. Be very clear (yet tactful and empathetic) when advising the parents or caregivers of

this. When assessing the scene, you should note the position in which the infant was found, any signs that suggest the infant was recently ill (eg, medications,

humidifiers), and the general condition of the house (ie, clean or dirty). Assessment of the scene is an important part of the overall investigation, along with a

post-mortem and review of the infant's medical history, in attempting to determine the cause of death.

In which of the following situations should the lone rescuer call 9-1-1 and retrieve an AED before initiating CPR on a pulseless and apneic

child?

A) The child is between 1 and 8 years of age.

B) The child's past medical history is unknown.

C) An opioid overdose is suspected or confirmed.

D) The child's collapse was witnessed and sudden.

D) The child's collapse was witnessed and sudden.

If you are off duty or otherwise alone and witness the sudden collapse of a child (1 year of age to the onset of puberty [12 to 14 years of age]) who is pulseless

and apneic, you should immediately call 9-1-1 and retrieve an AED,just as you would for an adult. The sudden collapse of a child is consistent with a primary

cardiac problem, not respiratory failure (the most common cause of cardiac arrest in infants and children). Therefore, early defibrillation is crucial in this

patient population. Children with respiratory failure typically get progressively sicker and then develop cardiac arrest; they usually do not collapse suddenly.

If the suspected cause of the cardiac arrest is respiratory failure, or if the child's collapse was not witnessed and sudden, you should perform CPR for 2

minutes before calling 9-1-1 and retrieving the AED. In these cases, it should be assumed that respiratory failure is the underlying cause. Cardiac arrest

secondary to an opioid overdose is the result of hypoxia; in these cases, CPR should be performed for 2 minutes before calling 9-1-1 and retrieving the AED.

The child's medical history is not a factor when determining whether or not to call 9-1-1 first or perform CPR first.

Which of the following is the MOST common cause of shock in infants and children?

A) Hypovolemia

B) Cardiac failure

C) Accidental poisoning

D) Severe allergic reaction

A) Hypovolemia

Of the causes of shock listed, hypovolemia is clearly the most common in children. Hypovolemia can occur as a result of dehydration (even from a few episodes

of vomiting and/or diarrhea), prolonged and excessive fever, and blood loss from trauma. Less common causes include severe allergic reactions (anaphylaxis)

cardiac failure, and poisonings.

Compared to nonpregnant women, otherwise healthy pregnant woman are at greater risk for:

A) joint dislocations.

B) type 1 diabetes.

C) pathologic fractures.

D) congestive heart failure.

A) joint dislocations.

There are a number of anatomic and physiologic changes that occur during pregnancy. Blood volume, cardiac output, and heart rate all increase. Blood

pressure, however, decreases slightly. The increased size of the uterus directly affects the respiratory system. As the uterus grows, it pushes up on the

diaphragm, displacing it from its normal position. As the pregnancy continues, respiratory capacity changes, with increased respiratory rates and decreased

minute volumes. You may observe that a pregnant patient breathes faster, but has a decreased ability to take a deep breath. These are all normal pregnancyrelated

changes. Increased hormones affect the musculoskeletal system by making the joints looser and less stable; this increases the risk of joint

dislocations. A pathologic fracture is caused by an underlying abnormal condition, such as osteoporosis or bone cancer; pregnant patients are not at risk for

pathologic fractures. Changes in the cardiovascular system and the increased demands of supporting the fetus significantly increase the workload of the

heart. A healthy woman's body can handle the increased cardiac workload and demand. Not all women are healthy when they begin their pregnancy,

however. Cardiac compromise, including heart failure can occur if the woman has preexisting heart disease. Some pregnant women develop gestational

diabetes, which is caused when the pregnancy hormones create insulin resistance. This is different from type 1 diabetes, where the body does not produce

any insulin.

A 5-year-old boy was struck by a car and is found lying 15 feet away. Based on the child's age and mechanism of injury, you should suspect

that the PRIMARY injury occurred to the:

A) head.

B) pelvis.

C) lower legs.

D) upper thorax.

B) pelvis.

Children are smaller than adults; therefore, when they are injured by the same mechanism as an adult, the location of their injuries may differ from those of

an adult. For example, when an adult is struck by a vehicle, the primary injury typically occurs at or below the knees, depending on the height of the bumper

at the time of impact. Because the child is shorter, initial impact typically occurs at or near the pelvis. Secondary injury occurs when child's chest collides

with the vehicle's grille. Tertiary injury occurs when the child strikes his or her head on the pavement after being propelled away from the vehicle. In some

cases, the child is pulled underneath the vehicle and is dragged.

You are transporting a woman who is 35 weeks' pregnant and reports a headache. She suddenly becomes pale, light-headed, and

tachycardic. What should you do?

A) Administer high-flow oxygen.

B) Position her on her left side.

C) Reassess her blood pressure.

D) Elevate her lower extremities.

B) Position her on her left side.

Supine hypotensive syndrome can occur beyond the second trimester. When the mother lies supine, the pregnant uterus can compress the inferior vena

cava (IVC), which reduces venous return to the right side of the heart. As a result, cardiac output decreases and the patient develops signs of shock (ie, pallor,

tachycardia, hypotension). You should immediately position the mother on her left side to relieve pressure off of the IVC. After this intervention, reassess her

to determine if there is any improvement. If she has respiratory distress and/or her oxygen saturation is less than 94% on room air, administer supplemental

oxygen. Elevating her lower extremities will not resolve the problem and may only make it more difficult for her to breathe.

While triaging patients at the scene of a mass-casualty incident, you encounter a 3-year-old boy who is unresponsive and apneic. After

opening his airway, you determine that he remains apneic. According to the JumpSTART triage system, what should you do next?

A) Assess for a palpable pulse

B) Deliver 5 rescue breaths

C) Assign him as immediate

D) Assign him as deceased

A) Assess for a palpable pulse

The JumpSTART triage system was developed for infants and children in order to accommodate the developmental and physiological differences in children.

The system is intended for children younger than 8 years of age or who appear to weigh less than 100 pounds (45 kg). If the child is unresponsive and apneic,

you should open the airway. If the child begins to breathe, assign an immediate category. If the child remains apneic, assess for the presence of a pulse. If

there is no palpable pulse, a deceased category is assigned. If a palpable pulse is present, deliver 5 rescue breaths. If breathing resumes after 5 rescue

breaths, assign an immediate category. If the child remains apneic, assign a deceased category.

After the baby's head delivers, it is usually tilted:

A) with the face up.

B) posteriorly, face down.

C) posteriorly, to one side.

D) anteriorly, with the chin up.

C) posteriorly, to one side.

As the baby's head begins to deliver, it is usually in a posterior, face -down position. After the head delivers completely, however, it usually tilts to the side in

preparation for delivery of the shoulders. Remember to check for the presence of a nuchal cord (umbilical cord wrapped around the neck), and to suction the

baby's mouth and nose as soon as its head delivers.

In which of the following situations would the EMT MOST likely deliver a baby at the scene?

A) Contractions are 8 to 10 minutes apart and irregular.

B) The hospital is 15 miles away and crowning is not present.

C) Contractions are 3 minutes apart and mother feels the urge to push.

D) The amniotic sac has ruptured and contractions occur regularly.

C) Contractions are 3 minutes apart and mother feels the urge to push.

The EMT should prepare for delivery at the scene when delivery is imminent or can be expected within a few minutes (eg, the mother feels the urge to push,

contractions are 2 to 3 minutes apart and regular, crowning is present); when a natural disaster (eg, flood, fire, tornado) has occurred and your route to the

hospital is blocked; and when transportation is not available (eg, mechanical malfunction of the ambulance). These are just some of the factors to consider when making that critical decision. Rupture of the amniotic sac and the onset of contractions signals the beginning of the first stage of labor; delivery is usually not imminent at this point and it is generally safe to transport.

A 30-year-old woman presents with vaginal bleeding and light-headedness. She states that she has soaked four sanitary pads. Her BP is 90/50

mm Hg, her pulse rate is 120 beats/min, and her respiratory rate is 24 breaths/min. What should you do?

A) Instruct her to insert a tampon to help control the bleeding.

B) Position her supine and prepare for immediate transport.

C) Position her on her side and reassess her blood pressure.

D) Place a trauma dressing over her vagina and apply pressure.

B) Position her supine and prepare for immediate transport.

The patient is in shock and requires immediate transport. Position her supine, keep her warm, and administer supplemental oxygen. Her bleeding is coming

from a source that you cannot control. Direct pressure to the vaginal area will not accomplish bleeding control, nor will a tampon

A woman who is 34 weeks' pregnant is in cardiac arrest. During the resuscitation attempt, you should:

A) defer defibrillation until arrival at the hospital.

B) perform chest compressions at a faster rate.

C) manually displace the uterus toward the left.

D) allow partial chest recoil in between compressions.

C) manually displace the uterus toward the left.

Treatment for a pregnant patient in cardiac arrest is no different than in nonpregnant patients, with a few exceptions. If the woman is in the last month or two

of pregnancy, compressions may need to be performed a little higher on the sternum than usual. This is because the pregnant uterus can push the heart higher

into the chest cavity. Otherwise, compressions should be at a rate of 100 to 120/min, at a depth of at least 2 inches. Full recoil of the chest is critical in allowing

more blood to return to the heart. A person should be assigned to manually displace the uterus to the left; this relieves pressure from the inferior vena cava and

facilitates blood return to the heart. If the AED advises a shock, deliver it! Do not defer defibrillation.

Following an injury, a 5-year-old child moans and makes incomprehensible sounds. According to the modified Glasgow Coma Scale for

children, what score should be assigned for verbal response?

A) 1

B) 2

C) 3

D) 4

A) 1

The Glasgow Coma Scale (GCS) is modified for children (older than 1 year of age) to accommodate their age- related behavior. Under the verbal component of

the GCS, a score of 5 is assigned if the child engages in oriented conversation; a score of 4 is assigned if the child is confused, but still converses; a score of 3 is

assigned if the child cries in response to pain; a score of 2 is assigned if the child uses inappropriate words; and a score of 1 is assigned if the child moans, is

using is incomprehensible words or making incomprehensible sounds, or if there is no response at all.

A 30-year-old woman is 22 weeks' pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. What should you suspect?

A) Preeclampsia

B) Gestational diabetes

C) A hypertensive emergency

D) A condition unrelated to pregnancy

A) Preeclampsia

Preeclampsia typically develops after the 20th week of gestation; it most commonly occurs in primigravida (first-time pregnancy) women. Preeclampsia is

characterized by a headache, visual disturbances, edema to the hands and feet, anxiety, and persistent hypertension. Left untreated, preeclampsia can lead to

seizures (eclampsia). Gestational diabetes, a condition in which the pregnancy hormones estrogen and progesterone impair the effects of insulin (insulin

resistance), is characterized by an increase in the patient's blood glucose level (BGL); there is no mention of the patient's BGL in this scenario. A hypertensive

emergency usually occurs when the systolic blood pressure acutely rises above 180 mm Hg.

You receive a call for a 4-month-old infant who suddenly became limp, cyanotic, and apneic. Upon EMS arrival, the mother tells you that she flicked his feet and he woke up. He is breathing adequately. He has good muscle tone and his skin is warm and pink. What should you do?

A) Administer oxygen via nonrebreathing mask.

B) Allow a parent to transport him to the hospital.

C) Contact the infant's pediatrician to seek advice.

D) Transport to the hospital and monitor him en route.

D) Transport to the hospital and monitor him en route.

Infants who have cyanosis and apnea and are unresponsive when found by a parent sometimes resume normal breathing and normal color with stimulation.

This is called an apparent life-threatening event (ALTE), also known as a brief resolved unexplained event (BRUE). In addition to cyanosis, the classic ALTE is

characterized by a distinct change in muscle tone (limpness) and choking or gasping. After the ALTE, you may find an infant who appears healthy and shows

no signs of illness or distress, such as the infant in this scenario. Even though the infant appears normal now, something happened acutely to cause the initial

problem. Infants with this type of event should be transported by EMS to the emergency department for evaluation. Oxygen is not indicated for this

particular child; he is breathing normally and has no signs of hypoxemia.

Which of the following would MOST likely occur in conjunction with a breech presentation?

A) Vertex presentation

B) Prolapsed umbilical cord

C) Maternal hypertension

D) Premature rupture of the amniotic sac

B) Prolapsed umbilical cord

In most deliveries, the baby's head is the presenting part (vertex presentation). In a breech presentation, the baby's head is not the presenting part; the

buttocks usually are. Breech presentations are associated with a higher incidence of prolapsed umbilical cord, a condition in which a part of the umbilical cord

precedes the presenting part of the baby. Furthermore, breech presentations increase the risk of delivery- related trauma to the baby. Maternal hypertension

and premature rupture of the amniotic sac (bag of waters) are not common concurrent findings in women with a breech presentation.

A 3-year-old child presents with respiratory distress. The child is being held by her mother and does not react to your presence. This finding

indicates that the child:

A) has severe hypoxia.

B) probably is sleeping.

C) is afraid of your presence.

D) is reacting normally for her age.

A) has severe hypoxia.

A 3-year-old child typically is very attentive to his or her surroundings, especially when a stranger enters the environment. The fact that the child does not

acknowledge your presence is an abnormal (and ominous) sign and indicates significant hypoxia. Therefore, you must treat aggressively (ie, ventilatory support)

to prevent respiratory arrest and subsequent cardiac arrest.

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.

A) examining the child in the parent's arms.

If the child's condition is stable, the parent should be allowed to hold the child during the examination. This will minimize anxiety in the child and will make the

assessment easier for you. In general, you should avoid separating the child and parents unless the child's condition warrants it. When assessing the abdomen

of any patient, you should palpate the most painful area last.

When caring for a woman who was sexually assaulted, the EMT should:

A) ask the patient if she wishes to change her clothes.

B) obtain a concise, detailed account of what happened.

C) place any articles of her clothing in a clean plastic bag.

D) focus any assessments on life-threatening conditions.

D) focus any assessments on life-threatening conditions.

As with any patient, your immediate assessment should focus on finding and treating immediately life-threatening injuries or conditions. Patients who were

sexually assaulted may have evidence on (or in) them that could be crucial to bringing the perpetrator to justice. Therefore, you should discourage the patient

from showering, urinating, or changing clothes. Again, your assessment should be focused on injuries that are life-threatening. Any articles of clothing that are

removed should be placed in a paper bag; condensation can form in plastic bags and potentially destroy evidence. Documentation of the call should include

information that is relevant to patient care; concise, detailed information regarding what happened will be gathered by law enforcement personnel.

A 6-month-old infant with a head injury moans in response to pain. According to the modified Glasgow Coma Scale for infants, what score

should be assigned for verbal response?

A) 1

B) 2

C) 3

D) 4

B) 2

The Glasgow Coma Scale (GCS) is modified for infants (younger than 1 year of age) to accommodate their age-related behavior. Under the verbal component of

the GCS, a score of 5 is assigned if the infant coos or babbles; a score of 4 is assigned if the infant has an irritable cry; a score of 3 is assigned if the infant cries

in response to pain; a score of 2 is assigned if the infant moans in response to pain; and a score of 1 is assigned if there is no response at all.

A 32-year-old woman who is 36 weeks' pregnant reports a sudden onset of severe abdominal pain, which she describes as a tearing

sensation, and vaginal bleeding. Her medical history includes hypertension and she admits to using cocaine. Which of the following should

you suspect?

A) The umbilical cord is wrapped around the baby's neck.

B) The placenta has implanted over the cervical opening.

C) Excessive fetal movement has torn the amniotic sac.

D) The placenta has detached from the wall of the uterus.

D) The placenta has detached from the wall of the uterus.

Given the patient's presentation and medical history, you should suspect that she is experiencing abruptio placenta. This condition occurs when the placenta

acutely detaches from the uterine wall. Signs and symptoms include acute, severe abdominal pain that is often described as a ripping or tearing sensation;

vaginal bleeding; and signs of shock. Risk factors include hypertension, abdominal trauma, and cocaine use, among others. Cocaine is a potent

vasoconstrictor, and frequent use can cause vascular injury. In pregnant patients, this vascular injury could cause premature placental separation. Placenta

previa occurs when part or all of the placenta implants over the cervical opening; vaginal bleeding is common, but abdominal pain is not. Nuchal cord (cord

wrapped around the baby's neck) is discovered during delivery; vaginal bleeding and abdominal pain do not occur with this condition. A ruptured or torn

amniotic sac would present with clear vaginal discharge; vaginal bleeding and abdominal pain do not occur with this condition.

Which of the following assessment findings would you expect to encounter in a newly born infant?

A) Cyanosis to the hands and feet

B) Shallow, irregular, gasping breaths

C) Delayed apnea for up to 2 minutes

D) Heart rate between 80 and 100 beats/min

A) Cyanosis to the hands and feet

Immediately following birth, and possibly for up to 12 to 24 hours, cyanosis to the hands and feet (acrocyanosis) is a common finding in newborns and usually

resolves on its own. Cyanosis to the face and trunk, however, is not normal. Irregular breathing is normal in the newborn; shallow or gasping breaths, however,

are not. A healthy newborn should have a heart rate greater than 100 beats/min. A heart rate less than 100 beats/min indicates hypoxia. Most newborns begin

to breathe immediately or within the first 30 seconds following birth; apnea beyond 30 seconds is not normal.

You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. What should you do?

A) Inform the parents of your suspicions.

B) Call the police and have the parents arrested.

C) Advise the parents that the child needs to be transported.

D) Transport the child to the hospital regardless of the parent's wishes.

C) Advise the parents that the child needs to be transported.

You must handle cases of suspected child abuse with great care. You must never accuse the parents or caregiver of abuse. If you are wrong, you could be held

liable for slander. Actions that would suggest such an accusation include summoning the police to have the parents arrested. Instead, you should advise the

parents or caregiver that the child needs to be transported by ambulance, even if the injury is not life-threatening. The goal is to get the child to safety;

however, this must be done legally (with parental consent). In most cases, you need the consent of only one parent to transport the child. Once at the hospital,

you must apprise the receiving physician of your suspicions.

The MOST important initial steps of assessing and managing a newborn include:

A) suctioning the airway and obtaining a heart rate.

B) clearing the airway and keeping the infant warm.

C) keeping the infant warm and counting respirations.

D) drying and warming the infant and obtaining an APGAR score.

B) clearing the airway and keeping the infant warm.

In the initial steps of assessing and managing the newborn, the most important aspects include clearing the airway of amniotic fluid and making sure that the

baby stays warm. The APGAR score should not be relied on as the initial indicator for resuscitation because it is not performed until the child is 1 minute old.

Clearly, this is too long to wait before assessment and intervention. After the airway has been cleared and the newborn has been warmed, the respirations,

heart rate, color, and oxygen saturation (Sp02) should be assessed and managed accordingly.

A woman is 30 weeks pregnant. During your assessment, she tells you that she delivered a stillborn baby at 38 weeks and currently has no

living children. How should you document her obstetric history?

A) Gravida 1; para 1

B) Gravida 2; para 1

C) Gravida 1; para 2

D) Gravida 2; para 2

D) Gravida 2; para 2

Gravida refers to the number of times a woman has been pregnant, regardless of the length of the pregnancy. Para refers to the number of babies carried

beyond 28 weeks, regardless of whether the baby was born dead or alive. The patient in this scenario has been pregnant twice (including her current

pregnancy); therefore, she is a gravida 2. Since she has surpassed week 28 of her current pregnancy, and delivered her last baby (albeit, stillborn) past 28 weeks,

she is a para 2.

You should assist with the delivery of the baby's head by:

A) carefully rotating its head to where it is facing up when it delivers.

B) placing the palm of your hand firmly against the back of the baby's skull.

C) grasping each side of the baby's head and gently pulling to facilitate delivery.

D) placing your fingers on the bony part of the skull and applying gentle pressure.

D) placing your fingers on the bony part of the skull and applying gentle pressure.

Assist with the delivery of the baby's head by placing the flat parts of your fingers on the bony part of the skull as it emerges from the vagina and then applying

gentle pressure to avoid an explosive delivery. Avoid pressing your fingers on the anterior and posterior fontanelles (soft spots). Do not attempt to rotate the

baby's head or pull on it to facilitate delivery; these actions clearly increase the risk of injury.

Which of the following assessment findings would indicate primary central nervous system dysfunction in an infant or small child?

A) Nasal flaring

B) Easily distracted

C) Pale extremities

D) Poor muscle tone

D) Poor muscle tone

Of the findings listed, poor muscle tone (as a primary finding) would indicate dysfunction of the central nervous system. Children should be easily distracted, so

an inability to distract the child would be abnormal. Nasal flaring indicates a primary respiratory problem and signals increased work of breathing. Pallor

indicates poor peripheral blood flow; therefore, it would indicate a perfusion problem. When assessing an infant or child, the pediatric assessment triangle

(PAT) will enable you to determine, by visual inspection, if the problem is neurologic, respiratory or circulatory in origin.

Which of the following signs or symptoms are more common in children than in adults following an isolated head injury?

A) Nausea and vomiting

B) Altered mental status

C) Tachycardia and diaphoresis

D) Changes in pupillary reaction

A) Nausea and vomiting

It is relatively common for children to vomit following a head injury such as a concussion. In adults, vomiting--though less common--is an ominous sign and

indicates increased intracranial pressure. You must always be prepared for vomiting and have suctioning equipment readily available when managing the

patient with a head injury. Altered mental status and pupillary changes following a head injury are equally as common in children and adults. Tachycardia and

diaphoresis are signs of shock and are not commonly observed in patients with an isolated head injury.

After an advanced airway device has been inserted in a 6-month-old infant in cardiopulmonary arrest, you should deliver ventilations at a

rate of:

A) 8 breaths/min.

B) 10 breaths/min.

C) 12 breaths/min.

D) 20 breaths/min.

B) 10 breaths/min.

After an advanced airway device (eg, ET tube, supraglottic airway) has been inserted during cardiac arrest, ventilate the patient at a rate of 10 breaths/min

(one breath every 6 seconds). This ventilation rate applies to all age groups, except the newborn. Health care providers often deliver excessive ventilation,

particularly when an advanced airway device is in place. Excessive ventilation (eg, hyperventilation) is detrimental because it causes an increase in

intrathoracic pressure, which impedes blood flow back to the heart and decreases coronary perfusion. Hyperventilation also increases the risks of

regurgitation and aspiration in the patient who does not have an advanced airway device in place. A ventilation rate of20 to 30 breaths/min (one breath

every 2 to 3 seconds) would be appropriate for an apneic infant or child who has a pulse.

A newborn has a heart rate of 130 beats/min, cyanosis of the hands and feet, and rapid respirations. The infant cries when you flick the soles

of its feet and resists attempts to straighten its legs. You should assign an APGAR score of:

A) 7

B) 8

C)9

D) 10

C) 9

The APGAR score, which is obtained at 1 and 5 minutes after birth (and every 5 minutes thereafter), assigns numbers (0, 1, or 2) to the following five areas:

appearance, pulse, grimace, activity, and respirations. A score of 1 is assigned for appearance if the newborn's body is pink, but its hands and feet remain blue.

If its heart rate is greater than 100 beats/min, it receives a score of 2 for the pulse. If it cries and tries to move its foot away when soles of its feet are flicked,

it is assigned a score of 2 for grimace/irritability. If it resists attempts to straighten its hips and knees, a score of 2 is assigned for activity/muscle tone. If its

respirations are rapid, a score of 2 is assigned. Based on these parameters, the newborn in this scenario would receive an APGAR score of 9.

Prevention of cardiac arrest in infants and small children should focus primarily on:

A) keeping the child warm.

B) avoiding upsetting the child.

C) providing immediate transport.

D) ensuring adequate ventilation.

D) ensuring adequate ventilation.

The most common cause of cardiac arrest in infants and children is failure of the respiratory system. Their hearts generally are healthy, and they rarely go into

ventricular fibrillation (V- Fib). The key to preventing cardiac arrest in the majority of infants and children is to ensure adequate ventilation and oxygenation.

Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her

face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet

delivered. You should:

A) massage the lower part of the mother's uterus until the placenta delivers.

B) give the newborn high-flow oxygen via a nonrebreathing mask and transport.

C) reassess the newborn every 5 minutes and transport after the placenta delivers.

D) keep the newborn warm, give oxygen to the mother if needed, and transport.

D) keep the newborn warm, give oxygen to the mother if needed, and transport.

The newborn is stable and does not require care beyond providing thermal management and monitoring. Oxygen is indicated for the newborn if it has

central cyanosis (cyanosis to the face and trunk), and should be delivered via the blow-by technique with the flowmeter set at 5 L/min. Cyanosis to the

periphery of the body (eg, hands and feet), which is called acrocyanosis, is a normal finding in the newborn. You should not wait at the scene for the placenta

to deliver; it can take up to 45 minutes for this to occur. Begin transport, keep the newborn warm, and give oxygen to the mother if indicated. Massaging the

uterine fundus (top part of the uterus) is indicated for women with postpartum vaginal bleeding (ie, BOTH the baby and placenta have delivered).

A 34-year-old woman, who is 36 weeks' pregnant, is having a seizure. You should transport her in which position?

A) Prone

B) Left side

C) Supine

D) Semi-Fowler

B) Left side

Initial care for any patient who is seizing--pregnant or otherwise--involves ensuring a patent airway, ensuring adequate ventilation, and administering highflow

oxygen. If the patient is breathing inadequately, ventilation assistance is indicated. Suction any secretions from the patient's mouth. The pregnant patient

should be placed on her left side (lateral recumbent position); this will prevent supine hypotensive syndrome, a condition in which the pregnant uterus

compresses the inferior vena cava and reduces cardiac output. A lateral recumbent position will also facilitate the draining of oral secretions, thus minimizing

the risk of aspiration.

During transport of a woman in labor, the patient 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. You should:

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) ask the mother to take short, quick breaths until you arrive at the hospital.

D) apply gentle pressure to the baby's head and notify the hospital immediately.

B) advise your partner to stop the ambulance and assist with the delivery.

If, during transport, the mother begins to deliver the infant, your first action should be to advise your partner to stop the ambulance and assist you with the

delivery. Delivery of a baby should NEVER be attempted in the back of a moving ambulance; it is not safe for you, the mother, or the baby. During delivery,

you should apply gentle pressure to the top of the baby's head (be careful of the fontanelles) to prevent an explosive delivery. After the head is delivered, you

should quickly run your fingers around its neck to determine if the cord is wrapped around its neck (nuchal cord). If a nuchal cord is not present, suction the

baby's mouth and nose and continue with the delivery.

Treatment for a responsive 4-year-old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin

color, includes:

A) oxygen, back slaps, and transport.

B) supplemental oxygen and transport.

C) assisted ventilations, back slaps, and transport.

D) subdiaphragmatic thrusts until the object is expelled.

B) supplemental oxygen and transport.

If a child (1 year of age to the onset of puberty [12 to 14 years of age]) with a mild airway obstruction is alert and has adequate air movement (ie, a strong

cough, normal skin color), you should offer oxygen, avoid agitating the child, and provide transport to the hospital. Attempts to relieve a mild airway

obstruction may result in a severe airway obstruction. If signs of a severe airway obstruction develop, you must take immediate action to remove the object

(eg, back slaps and chest thrusts in a responsive infant; subdiaphragmatic [abdominal] thrusts in a responsive adult or child). Finger sweeps are indicated

ONLY if the patient is unresponsive and you can see the object in his or her mouth.

A woman who is 39 weeks' pregnant is unresponsive, apneic, and pulseless. When treating her, the EMT should:

A) manually displace her uterus to the left.

B) ventilate her at a rate of 20 breaths/min.

C) ensure that she is positioned on her left side.

D) delay defibrillation until ALS is at the scene.

A) manually displace her uterus to the left.

During the later stages of pregnancy, a supine position should be avoided. The pregnant uterus can compress the aorta and inferior vena cava (lVC), thus

impairing blood flow (aortocaval compression). In this case, however, the patient is in cardiac arrest; she must remain supine in order to perform effective CPR.

Therefore, if the uterine fund us (top of the uterus) is above the level of the umbilicus (likely the case at 39 weeks), the EMT should manually displace her uterus

to the left to relieve pressure off the IVC. The chest compression and ventilation rates are no different for pregnant patients than they are for non-pregnant

patients. Do not delay defibrillation, if it is indicated.

A 29-year-old pregnant woman reports a severe headache, blurred vision, and swelling of her hands and feet. Which of the following

additional signs or symptoms would MOST likely be present?

A) Hypertension

B) Hyperglycemia

C) Abdominal pain

D) Vaginal bleeding

A) Hypertension

The patient's signs and symptoms are consistent with preeclampsia, a condition that could ultimately lead to seizures (eclampsia). Signs and symptoms of

preeclampsia include hypertension, headache, visual disturbances, and edema. Hyperglycemia during pregnancy is a possible sign of gestational diabetes, not

preeclampsia. Abdominal pain and vaginal bleeding should make you suspicious for another underlying problem (ie, abruptio placenta, spontaneous abortion)

as they are not commonly observed in patients with preeclampsia.

In contrast to the contractions associated with true labor, Braxton-Hicks contractions:

A) do not increase in intensity and are alleviated by a change in position.

B) may be intensified by activity and are accompanied by a pink discharge.

C) generally follow rupture of the amniotic sac and occur with regularity.

D) consistently become stronger and are not alleviated by changing position.

A) do not increase in intensity and are alleviated by a change in position.

During pregnancy, the mother may experience false labor, or Braxton-Hicks contractions, in which there are contractions but they do not represent true labor.

Unlike true labor contractions, Braxton-Hicks contractions do not increase in intensity, are not regular, and are typically alleviated by activity or a change in

position. The contractions associated with true labor, once they begin, consistently get stronger and closer together and are regular; a change in position does

not relieve the contractions. True labor is also commonly followed by, or in some cases preceded by, a rupture of the amniotic sac (bag of waters) and a pink or red vaginal discharge that is generally accompanied by mucus (bloody show).

Which of the following is a sign of inadequate breathing in an infant?

A) Sunken fontanelles

B) Abdominal breathing

C) Expiratory grunting

D) Heart rate of 130 beats/min

C) Expiratory grunting

Expiratory grunting in an infant or a child with a respiratory problem is an ominous sign; it indicates impending respiratory arrest. Grunting represents the

child's attempt to maintain oxygen reserve in the lungs. Sunken fontanelles, the soft spots on the infant's skull, indicate dehydration. Because infants have a

protuberant abdomen and rely heavily on their diaphragm to breathe, their abdomen appears to move more than their chest during breathing; this is a

normal finding and is why infants are often referred to as belly breathers. An infant or a child with inadequate breathing may be tachycardic at first; however,

as hypoxia becomes more severe, bradycardia often occurs. Bradycardia in an infant or a child with a respiratory problem indicates impending

cardiopulmonary arrest.

A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and administer

supplemental oxygen. En route to the hospital, you should be MOST alert for:

A) hypotension.

B) convulsions.

C) combativeness.

D) respiratory distress.

B) convulsions.

High fever and an altered mental status indicate sepsis (severe infection). A generalized rash should alert you to the possibility of meningitis, a condition

caused by infection and inflammation of the meninges that protect the brain and spinal cord. Children with meningitis are at risk for seizures (convulsions),

usually due to increased intracranial pressure (lCP) and/or high fever; therefore, you must continually monitor the child's condition en route to the hospital

and be prepared to treat seizures if they occur. Remember that seizure deaths are caused by cerebral hypoxia. You should also be alert for vomiting, which

can jeopardize the airway. Hypotension can occur in patients with sepsis and should also be of concern; however, seizures directly compromise ventilation

and oxygenation.

A 5-year-old child has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given,

and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. What should you do?

A) Lower the extremities and reassess the child.

B) Begin positive pressure ventilations and reassess the child.

C) Insert a nasopharyngeal airway and increase the oxygen flow.

D) Listen to the lungs with a stethoscope for abnormal breath sounds.

A) Lower the extremities and reassess the child.

Because infants and small children rely heavily on their diaphragm for breathing (as evidenced by belly breathing), elevating their lower extremities can cause

the diaphragm to shift into the thoracic cavity and decrease the effectiveness of breathing. Therefore, in the case of this child, you should lower the lower

extremities and reassess. A supine position is recommended for any patient in shock, regardless of age.

During respiratory distress, a child is trying to keep the alveoli open by increasing pressure in the chest cavity. What sound would you expect

to hear?

A) Stridor

B) Crackles

C) Wheezing

D) Grunting

D) Grunting

A grunting sound heard during exhalation reflects the pediatric patient's attempt to keep the alveoli open by increasing pressure in the chest cavity; it is a sign

of inadequate oxygenation. Stridor is a high- pitched sound heard during inhalation; it indicates inflammation or a partial obstruction of the upper airway. A

crackling or bubbling sound hear during inhalation indicates fluid in the lungs. Wheezing is a high- or low- pitched whistling sound that is usually heard during

exhalation; it indicates a partial lower airway obstruction caused by bronchospasm (ie, asthma, bronchiolitis).

The appropriate technique for performing two-rescuer CPR on a 4-year-old child includes:

A) 30 compressions to 2 ventilations, compressing the chest one-third the depth of the chest, and delivering each breath over 1 second.

B) 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise

occurs.

C) 30 compressions to 2 ventilations, compressing the sternum with the heel of both hands, and delivering each breath over 1 to 2

seconds.

D) 15 compressions to 2 ventilations, compressing the sternum with your thumbs, and delivering 100 to 120 compressions per minute.

B) 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs.

When performing two-rescuer CPR on an infant (less than 1 year of age) or a child (1 year of age to the onset of puberty [12 to 14 years of age]), use a

compression to ventilation ratio of 15:2. Compress the chest by one-third the depth of the chest (about 1.5 inches for infants; about 2 inches for children), at a

rate of 100 to 120/min, and allow the chest to fully recoil in between compressions. Deliver each breath over 1 second, just enough to produce visible chest

rise, and allow complete exhalation. For a child, use the heel of one or both hands to compress the chest, depending on the size of the child. For two-rescuer

infant CPR, use the tips of your thumbs to compress the chest (two-thumb, encircling-hands technique); the two-finger technique may be used for onerescuer

infant CPR. A 30:2 compression to ventilation ratio is used for all adult and one-rescuer CPR.

Which of the following is an abnormal finding?

A) Heart rate of 80 beats/min in a 3-month-old infant

B) Rapid, irregular breathing in a newly born infant

C) Systolic BP of 100 mm Hg in a 10-year-old child

D) Respiratory rate of 26 breaths/min in a 2-year-old child

A) Heart rate of 80 beats/min in a 3-month-old infant

The heart rate for an infant up to 3 months of age varies, depending on whether they are awake or asleep, but averages 140 beats/min. Therefore, a heart rate

of 80 beats/min is grossly abnormal in this same age group and indicates bradycardia. Newborn infants normally have irregular breathing that ranges between

40 and 60 breaths/min. The systolic BP for a child between 6 and 12 years of age typically ranges between 90 and 115 mm Hg. The respiratory rate in a child

between 1 and 3 years of age typically ranges between 24 and 40 breaths/min.