P4- CH. 43 Pediatric Emergencies (knowt)

1. In contrast to adults, children:
A) land on their feet when they fall.
B) have proportionately larger heads.
C) experience head injury less frequently.
D) lose most body heat through the chest.

B) have proportionately larger heads

2. Compared to adults, the smaller diameter of a child's airway makes it more vulnerable to:
A) laryngospasm.
B) inhalation injury.
C) oropharyngeal secretions.
D) obstruction by the tongue.

D) obstruction by the tongue.

3. A child's vocal cords can be difficult to visualize during intubation because:
A) the epiglottis is floppy and U-shaped.
B) the cords themselves are more posterior.
C) a sniffing position is difficult to achieve.
D) the area of the cricoid cartilage is narrow

A) the epiglottis is floppy and U-shaped

4. Which of the following statements regarding a child's chest wall is correct?
A) Lung sounds are difficult to hear because of the thick intercostal muscles.
B) Children are belly breathers because they rely heavily on their diaphragms.
C) A child's chest wall has proportionately more subcutaneous fat on the chest.
D) Retractions are less obvious in children owing to their noncompliant rib cages.

B) Children are belly breathers because they rely heavily on their diaphragms.

5. When a child experiences a low cardiac output state, he or she relies MOST on:
A) increased tidal volume.
B) central vasoconstriction.
C) an increase in heart rate.
D) increased stroke volume.

C) an increase in heart rate

6. Most children begin to develop stranger anxiety between ___ and ___ months of age.
A) 3, 6
B) 6, 12
C) 12, 18
D) 18, 24

B) 6, 12

7. Children between 1 and 3 years of age:
A) are capable of basic reasoning.
B) have a well-developed sense of cause and effect.
C) generally explore the world exclusively by crawling.
D) may have negative associations with health care providers.

D) may have negative associations with health care providers

8. The FIRST step in examining a toddler in stable condition is to:
A) let the child sit on a parent's lap.
B) place yourself at the child's level.
C) quickly examine any painful areas.
D) allow the child to hold a favorite toy.

A) let the child sit on a parent's lap

9. When assessing a 5-year-old child, you should:
A) be able to conduct a head-to-toe exam.
B) ask simple yes or no questions if possible.
C) generally use a toe-to-head exam approach.
D) first ask a parent where the child is hurting.

A) be able to conduct a head-to-toe exam

10. An 8-year-old child:
A) is analytic but is not capable of abstract thought.
B) should not be the initial historian regarding an illness.
C) is anatomically and physiologically similar to an adult.
D) generally requires little reassurance and encouragement.

C) is anatomically and physiologically similar to an adult.

11. With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once:
A) he or she reaches the age of 8 to 10 years.
B) resting vital signs are consistent with an adult.
C) his or her body weight is estimated at 55 pounds.
D) secondary sexual characteristics have developed.

D) secondary sexual characteristics have developed

12. A 15-year-old child can be difficult to treat for all of the following reasons, EXCEPT:
A) peer pressure.
B) stranger anxiety.
C) independence issues.
D) cognizance of body image.

B) stranger anxiety

13. When assessing and caring for a 17-year-old gang member, it is MOST important to remember that he or she:
A) must be separated from other gang members.
B) generally desires the presence of a caregiver.
C) typically boasts about the use of illicit drugs.
D) may have a weapon and a reputation to earn.

D) may have a weapon and a reputation to earn.

14. Establishing good rapport with the caregiver of a sick or injured child at the scene is vital because:
A) caregivers often take their anger out on prehospital professionals.
B) he or she will be a source of important information and assistance.
C) doing so will quickly deescalate any hostility that he or she may have.
D) the caregiver generally will not accompany the child in the ambulance.

B) he or she will be a source of important information and assistance.

15. If the parent or caregiver of a sick or injured child is emotionally distraught:
A) provide support, but remember that your first priority is the child.
B) you should firmly tell him or her that the situation is under control.
C) he or she should follow the ambulance in his or her personal vehicle.
D) the parent or caregiver should be removed from the scene immediately.

A) provide support, but remember that your first priority is the child.

16. The pediatric assessment triangle was designed to:
A) formulate a working field diagnosis upon first sight of an ill child.
B) identify immediate life threats through a rapid hands-on assessment.
C) help EMS providers form a hands-off general impression of an ill child.
D) provide a means for performing a rapid head-to-toe physical assessment.

C) help EMS providers form a hands-off general impression of an ill child.

17. The pediatric assessment triangle will help answer all of the following questions, EXCEPT:
A) "Is the child sick or not sick?"
B) "Will the child cooperate during my exam?"
C) "Does the child require emergency treatment?"
D) "What is the most likely physiologic abnormality?"

B) "Will the child cooperate during my exam?"

18. A sick or injured child's general appearance is MOST reflective of:
A) the etiology of the problem.
B) his or her cardiovascular status.
C) his or her central nervous system function.
D) his or her ability to be consoled.

C) his or her central nervous system function.

19. A child who is disinterested in your presence and has a blank stare and poor muscle tone:
A) is likely hypoglycemic or in septic shock.
B) should be ventilated with a bag-mask device.
C) will most likely require pharmacologic support.
D) requires immediate intervention and transport.

D) requires immediate intervention and transport.

20. The work-of-breathing component of the pediatric assessment triangle includes all of the following, EXCEPT:
A) listening for grunting or audible wheezing.
B) noting the child's position during breathing.
C) auscultating the lungs for adventitious sounds.
D) looking for substernal or intercostal retractions.

C) auscultating the lungs for adventitious sounds.

21. A conscious child who is in the sniffing position:
A) is trying to align the axes of the airway to improve ventilation.
B) is clearly experiencing a lower airway obstruction.
C) will refuse to lie down and leans forward on outstretched arms.
D) assumes a physical position that optimizes accessory muscle use.

A) is trying to align the axes of the airway to improve ventilation.

22. In contrast to adults, retractions in children are:
A) more evident in the intercostal area.
B) less commonly seen below the sternum.
C) usually less prominent above the clavicles.
D) evident in the sternocleidomastoid muscles.

A) more evident in the intercostal area.

23. When assessing a child's circulation by looking at his or her skin, pallor is MOST indicative of:
A) vasomotor instability and decompensated shock.
B) peripheral vasoconstriction and compensated shock.
C) poor oxygenation and a state of circulatory collapse.
D) systemic vasodilation with resulting low blood pressure.

B) peripheral vasoconstriction and compensated shock.

24. Which of the following statements regarding acrocyanosis is correct?
A) Acrocyanosis is seen in the skin and mucous membranes and is a late finding if respiratory failure or shock is present.
B) Acrocyanosis is only considered to be a normal finding in newborns and usually resolves within 12 hours following birth.
C) Acrocyanosis is a bluish discoloration of the chest, abdomen, and face and is the most extreme visual indicator of poor perfusion.
D) Acrocyanosis is cyanosis of the hands and feet, and is a normal finding in infants younger than 2 months of age who are cold.

D) Acrocyanosis is cyanosis of the hands and feet, and is a normal finding in infants younger than 2 months of age who are cold.

25. The length-based resuscitation tape:
A) is only reliable in children who weigh less than 20 kg.
B) should not be relied upon for determining pediatric drug doses.
C) is used to estimate a child's weight based on his or her height.
D) is generally more accurate than the weight given by a caregiver.

C) is used to estimate a child's weight based on his or her height.

26. Counting an infant's respiratory rate for 15 seconds and then quadrupling that number:
A) is recommended because it is the quickest way to determine if the infant's baseline respiratory rate is abnormally slow or abnormally fast.
B) may yield a falsely low respiratory rate because infants may have periodic breathing or variable respiratory rates with short periods of apnea.
C) is impractical because the inherent respiratory rate of an infant is usually rapid and counting for such a short period of time leaves room for error.
D) is appropriate only if you are auscultating the child's respirations with a stethoscope while simultaneously listening to lung sounds.

B) may yield a falsely low respiratory rate because infants may have periodic breathing or variable respiratory rates with short periods of apnea.

27. A normal respiratory rate in a child:
A) may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued.
B) generally ranges between 15 and 20 breaths per minute and is influenced easily by factors such as excitement, fear, or fever.
C) cannot be established accurately because a toddler's respirations generally are grossly irregular and extremely difficult to count.
D) is a sign of impending respiratory failure if it is observed in conjunction with a room air oxygen saturation reading of less than 96%.

A) may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued.

28. When evaluating a child's oxygen saturation level with a pulse oximeter:
A) you should recall that peripheral vasodilation from a warm environment will typically yield a false reading.
B) it should be evaluated in the context of the pediatric assessment triangle and remainder of the primary assessment.
C) you should provide ventilatory assistance with a bag-mask device if the reading is below 94% and not increasing rapidly.
D) a reading of less than 96% on room air indicates respiratory distress and necessitates the administration of supplemental oxygen.

B) it should be evaluated in the context of the pediatric assessment triangle and remainder of the primary assessment.

29. Early hypoxia in a child would MOST likely present with:
A) tachycardia.
B) bradypnea.
C) mottled skin.
D) bradycardia.

A) tachycardia.

30. If you cannot palpate the femoral pulse in an unresponsive infant, you should:
A) apply an AED at once.
B) palpate the brachial pulse.
C) initiate CPR immediately.
D) assess for adequate breathing.

C) initiate CPR immediately.

31. Assessment of a child in a cold environment would MOST likely yield:
A) a rapid, weak pulse.
B) flushing of the skin.
C) delayed capillary refill.
D) a slow, irregular pulse.

C) delayed capillary refill.

32. It is important to remember that blood pressure is only one component in the overall assessment of a child because:
A) it is an unreliable measurement of perfusion in all children.
B) hypotension is seen much earlier in children than in adults.
C) blood pressure may remain adequate in compensated shock.
D) it generally yields a falsely low reading in agitated children

C) blood pressure may remain adequate in compensated shock.

33. To evaluate function of an infant's or child's cerebral cortex, you should:
A) assess pupil reaction.
B) use the AVPU scale.
C) assess for posturing.
D) evaluate motor activity.

B) use the AVPU scale.

34. When a child who is too young to verbalize is in significant pain:
A) your ability to assess accurately for physiologic abnormalities is impaired.
B) narcotic analgesic drugs should be avoided unless transport will be delayed.
C) benzodiazepine drugs are preferred over opiates to minimize central nervous system depression.
D) pain scales using facial expressions are a valuable tool to assess pain severity.

A) your ability to assess accurately for physiologic abnormalities is impaired.

35. The decision to transport an acutely ill child immediately or remain at the scene to perform additional interventions is LEAST dependent on:
A) the child's age and fear level.
B) transport time to the hospital.
C) expected benefits of treatment.
D) your EMS system's regulations.

A) the child's age and fear level.

36. Which of the following is often not acquired during the SAMPLE history of an adult, but should be routinely acquired in an infant or child?
A) Prescribed medications
B) Nature of symptoms
C) Preceding events
D) Immunizations

D) Immunizations

37. In contrast to adults, cardiac arrest in children is usually caused by:
A) a dysrhythmia.
B) a toxic ingestion.
C) respiratory failure.
D) congenital anomalies.

C) respiratory failure.

38. Respiratory distress in children:
A) represents the end result of prolonged hypoxia and indicates impending cardiopulmonary failure.
B) is a compensated state in which increased work of breathing results in adequate pulmonary gas exchange.
C) is associated with a decreased level of consciousness, abnormally slow respirations, and weak muscle retractions.
D) is characterized by prominent use of the sternocleidomastoid muscles in infants and children younger than 2 years of age.

B) is a compensated state in which increased work of breathing results in adequate pulmonary gas exchange.

39. When an infant or child is in respiratory failure:
A) tachypnea is usually present despite a marked decrease in heart rate.
B) decreased cerebral perfusion leads to restlessness and a weak, rapid pulse.
C) he or she can no longer compensate, which causes hypoxia and hypercarbia.
D) oxygen via nonrebreathing mask should be given if tidal volume is reduced.

C) he or she can no longer compensate, which causes hypoxia and hypercarbia.

40. Common signs of impending respiratory failure in infants and children include:
A) a falling oxygen saturation despite high-flow oxygen administration.
B) abdominal breathing and a pulse rate less than 120 beats per minute.
C) marked agitation and tachycardia with ectopic ventricular complexes.
D) tachypnea and hyperpnea with nasal flaring and prominent retractions.

A) a falling oxygen saturation despite high-flow oxygen administration.

41. Diffuse rales, rhonchi, and wheezing in an infant:
A) can usually be heard without a stethoscope.
B) are typical signs of lower airway inflammation.
C) suggest swelling of the supraglottic structures.
D) are signs of acute asthma until proven otherwise.

B) are typical signs of lower airway inflammation.

42. A young child with marked respiratory distress who is agitated and thrashing about should receive oxygen via:
A) nonrebreathing mask because agitation indicates cerebral ischemia.
B) the blow-by technique while he or she sits on the lap of a caregiver.
C) positive-pressure ventilation after he or she has been properly sedated.
D) a method that minimizes metabolic demand and oxygen consumption.

D) a method that minimizes metabolic demand and oxygen consumption.

43. If an infant or small child swallowed a rigid foreign body, he or she would MOST likely experience respiratory distress because:
A) a foreign body in the esophagus would cause reflux and aspiration.
B) when an infant or child is stressed, he or she tends to swallow a lot of air.
C) the feeling of a foreign body in the throat would cause severe anxiety.
D) the esophageal foreign body can compress the relatively pliable trachea.

D) the esophageal foreign body can compress the relatively pliable trachea.

44. A typical finding for a foreign body aspiration is:
A) a child with recent flu-like symptoms who presents with acute stridor.
B) an otherwise healthy child with a progressive increase in work of breathing.
C) an afebrile child with a sudden onset of coughing or gagging while playing.
D) a temperature less than 102°F with sudden drooling, crowing, and dyspnea.

C) an afebrile child with a sudden onset of coughing or gagging while playing.

45. If you have reason to believe that an unresponsive child has a foreign body airway obstruction, you should:
A) assess for a pulse and then begin chest compressions.
B) perform 30 chest compressions and then look in the mouth.
C) administer abdominal thrusts until the object is expelled.
D) try to remove it by performing a finger sweep of the mouth

B) perform 30 chest compressions and then look in the mouth.

46. If a 2-year-old child with a foreign body airway obstruction becomes unresponsive, you should position him or her supine and then:
A) visualize the upper airway.
B) perform chest compressions.
C) assess for a carotid pulse.
D) perform abdominal thrusts.

B) perform chest compressions.

47. Appropriate treatment for a conscious child with anaphylaxis includes:
A) 0.5 mg/kg of diphenhydramine IV.
B) 0.01 mg/kg epinephrine 1:1,000 IM.
C) pharmacologically assisted intubation.
D) a dopamine infusion to increase the blood pressure

B) 0.01 mg/kg epinephrine 1:1,000 IM.

48. Which of the following statements regarding croup is correct?
A) Croup is also referred to as acute bacterial subglottic stenosis.
B) Hallmark signs of croup include high fever and a sore throat.
C) Most cases of croup result in severe hypoxia and hypercarbia.
D) Croup is a viral upper airway infection that may cause stridor.

D) Croup is a viral upper airway infection that may cause stridor.

49. The MOST important initial treatment for a child in respiratory failure due to suspected croup is:
A) prompt intubation before the airway closes.
B) a 2.25% concentration of racemic epinephrine.
C) ventilatory assistance with a bag-mask device.
D) continuous administration of a beta-2 agonist.

C) ventilatory assistance with a bag-mask device.

50. Epiglottitis in children:
A) presents with a sudden onset of low-grade fever and dyspnea.
B) should be suspected if the child presents with diffuse wheezing.
C) is rare now that children are vaccinated against Haemophilus influenza type B.
D) should be confirmed by visualizing the larynx and epiglottis with a laryngoscope.

C) is rare now that children are vaccinated against Haemophilus influenza type B.

51. The goal in treating a child with epiglottitis is to:
A) transport him or her to the hospital with a maintainable airway.
B) administer corticosteroids to reduce edema in the upper airway.
C) intubate him or her before the epiglottis blocks the upper airway.
D) administer oxygen by nonrebreathing mask and transport at once.

A) transport him or her to the hospital with a maintainable airway.

52. In contrast to upper airway emergencies, lower airway emergencies:
A) often present with more prominent retractions.
B) are generally associated with high-grade fever.
C) include laryngotracheobronchitis and diphtheria.
D) involve restriction of airflow during exhalation.

D) involve restriction of airflow during exhalation.

53. A child who is experiencing a moderate asthma attack would MOST likely present with:
A) a markedly prolonged expiratory phase.
B) wheezing during inspiration and expiration.
C) an inability to speak in complete sentences.
D) an oxygen saturation between 80% and 90%

B) wheezing during inspiration and expiration.

54. Medications used to prevent an asthma attack include:
A) inhaled steroids.
B) beta-2 agonists.
C) inhaled albuterol.
D) oral ibuprofen.

A) inhaled steroids.

55. Which of the following represents the correct drug, dose, and delivery route for an 18-kg child experiencing severe respiratory distress due to bronchospasm?
A) Albuterol, 1 mg nebulized
B) Ipratropium, 0.5 mg nebulized
C) Albuterol, 0.25 mg nebulized
D) Epinephrine, 0.1 mg/kg IM

B) Ipratropium, 0.5 mg nebulized

56. Which of the following statements regarding bronchiolitis is correct?
A) Infants who were born past 42 weeks are at highest risk for respiratory failure and arrest secondary to bronchiolitis.
B) The pathophysiology of bronchiolitis is acute bronchospasm secondary to a bacterium that enters the lower respiratory tract.
C) Bronchiolitis is usually caused by the metapneumovirus and occurs with greatest frequency during late spring and early summer.
D) Bronchiolitis is a viral infection of the lower airway that commonly affects infants and children younger than 2 years of age.

D) Bronchiolitis is a viral infection of the lower airway that commonly affects infants and children younger than 2 years of age.

57. To maintain a neutral airway position in an unresponsive infant, you should:
A) slightly extend the infant's head.
B) pad underneath the infant's occiput.
C) place a towel roll under the shoulders.
D) insert an appropriate-sized oral airway.

C) place a towel roll under the shoulders.

58. An oral or nasal airway in an unresponsive infant or child may serve all of the following purposes, EXCEPT:
A) facilitating oral suctioning.
B) averting the need for intubation.
C) replacing manual head positioning.
D) helping to maintain an open airway.

C) replacing manual head positioning.

59. When inserting an oropharyngeal airway in a child, you should:
A) use a tongue blade to depress the tongue.
B) open the mouth with the tongue-jaw lift.
C) hyperextend the head to facilitate insertion.
D) suction the oropharynx for 15 seconds first.

A) use a tongue blade to depress the tongue.

60. Nasopharyngeal airways are rarely used in children younger than 1 year of age because:
A) the diameter of their nares is small and easily obstructed by secretions.
B) most nasopharyngeal airways are too large and result in an obstruction.
C) nasopharyngeal stimulation commonly results in a tachycardic response.
D) unlike older children, small children often have a more active gag reflex.

A) the diameter of their nares is small and easily obstructed by secretions.

61. Proficiency in ventilating apneic infants or children with a bag-mask device:
A) cannot be achieved by practicing on a manikin.
B) may avert the need for endotracheal intubation.
C) is more important for paramedics than EMTs.
D) is difficult because their faces are much smaller.

B) may avert the need for endotracheal intubation.

62. Appropriate bag-mask ventilation for an apneic 3-year-old child involves:
A) ensuring a consistently delivered tidal volume of 400 mL.
B) providing hyperventilation to ensure carbon dioxide elimination.
C) hyperextending the head to ensure an adequate mask-to-face seal.
D) delivering each breath over 1 second until the chest rises visibly.

D) delivering each breath over 1 second until the chest rises visibly.

63. When ventilating an apneic child with a bag-mask device, it is important for the paramedic to remember that:
A) each ventilation should be delivered over a period of 2 to 3 seconds.
B) the presence of chest rise is an unreliable indicator of proper ventilation.
C) regurgitation and aspiration may occur, even with proper ventilation technique.
D) posterior cricoid pressure will virtually eliminate the risk of pulmonary aspiration.

C) regurgitation and aspiration may occur, even with proper ventilation technique.

64. When preparing to intubate a small child, it is important to remember that:
A) the small child's epiglottis is very rigid.
B) prolonged attempts often cause tachycardia.
C) you should hyperventilate before intubating.
D) small children have a relatively large occiput.

D) small children have a relatively large occiput.

65. The use of a straight blade during pediatric intubation:
A) is generally reserved for neonates only.
B) makes it easier to manipulate the epiglottis.
C) is associated with a higher risk of bradycardia.
D) facilitates laryngoscopy by lifting the vallecula.

B) makes it easier to manipulate the epiglottis.

66. The MOST appropriate ET tube for a 6-year-old child is:
A) 4.0 mm, cuffed.
B) 4.5 mm, cuffed.
C) 5.0 mm, uncuffed.
D) 5.5 mm, uncuffed.

D) 5.5 mm, uncuffed.

67. Because stimulation of the parasympathetic nervous system and bradycardia can occur during intubation of a child, you should:
A) closely monitor the child's cardiac rhythm.
B) premedicate with 0.04 mg/kg of atropine.
C) limit your intubation attempt to 10 seconds.
D) use a curved blade instead of a straight blade.

A) closely monitor the child's cardiac rhythm.

68. A(n) ___ orogastric or nasogastric tube would the MOST appropriate size for a 4-year-old child.
A) 4F
B) 6F
C) 8F
D) 10F

D) 10F

69. Which of the following statements regarding nasogastric (NG) and orogastric (OG) insertion in children is correct?
A) Gastric decompression with an NG or OG tube is only appropriate for children older than 10 years of age.
B) The correct size NG or OG tube for a child should be half the ET tube size that he or she would need.
C) Prior to inserting an NG or OG tube in an unresponsive child without a gag reflex, you should intubate his or her trachea.
D) Insertion of an orogastric tube is contraindicated in children with severe head trauma or injury to the midface.

C) Prior to inserting an NG or OG tube in an unresponsive child without a gag reflex, you should intubate his or her trachea.

70. In contrast to a child with pulmonary edema secondary to congestive heart failure, the respirations of a hypercarbic child without pulmonary edema would MOST likely be:
A) rapid with audible rhonchi.
B) tachypneic and without retractions.
C) slow with increased work of breathing.
D) bradypneic with periods of marked apnea.

B) tachypneic and without retractions.

71. Signs of compensated shock in the infant or child include all of the following, EXCEPT:
A) abnormal mentation.
B) tachycardia and pallor.
C) prolonged capillary refill.
D) decreased peripheral perfusion.

A) abnormal mentation.

72. Infants and children in shock:
A) typically become hypotensive sooner than adults because of a relative decrease in total blood volume.
B) generally remain alert for longer periods than adults despite a significant decrease in cerebral perfusion.
C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.
D) maintain end-organ perfusion longer than adults, making capillary refill time a less reliable perfusion indicator.

C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.

73. The approximate total blood volume of a 60-pound child is:
A) 2.2 L.
B) 2.9 L.
C) 3.4 L.
D) 3.8 L.

A) 2.2 L.

74. When caring for an infant or child who is in compensated shock, you should:
A) intubate at the earliest sign of altered mentation.
B) administer a 10-mL/kg normal saline fluid bolus.
C) assist ventilations to improve tissue oxygenation.
D) establish IV or IO access en route to the hospital.

D) establish IV or IO access en route to the hospital.

75. A child in decompensated shock with hypotension should:
A) be intubated to protect his or her airway.
B) receive initial fluid resuscitation at the scene.
C) be given 25% dextrose to prevent hypoglycemia.
D) receive volume expansion with 5% dextrose in water.

B) receive initial fluid resuscitation at the scene.

76. Distributive shock in children is MOST often the result of:
A) sepsis.
B) spinal injury.
C) heart failure.
D) anaphylaxis.

A) sepsis.

77. Early distributive shock in children is characterized by:
A) warm, flushed skin.
B) weak peripheral pulses.
C) pallor and diaphoresis.
D) gross neurologic deficits.

A) warm, flushed skin.

78. A child in anaphylactic shock:
A) should receive 0.1 mg/kg of epinephrine IM.
B) is treated primarily with saline fluid boluses.
C) may require a low-dose epinephrine infusion.
D) should receive epinephrine 1:1,000 via the IV route.

C) may require a low-dose epinephrine infusion.

79. Unlike other types of shock, a child in cardiogenic shock would MOST likely present with:
A) an enlarged spleen.
B) unlabored tachypnea.
C) increased work of breathing.
D) a primary cardiac dysrhythmia.

C) increased work of breathing.

80. Failure of a child's SpO2 to increase despite high-flow oxygen is MOST indicative of:
A) relative hypovolemia.
B) congenital heart disease.
C) right-sided heart failure.
D) decreased vascular tone.

B) congenital heart disease.

81. You should be MOST suspicious for cardiogenic shock in an infant or child if:
A) he or she appears listless or lethargic.
B) his or her heart rate varies with activity.
C) his or her heart rate is greater than 150 beats/min.
D) perfusion decreases following a fluid bolus.

D) perfusion decreases following a fluid bolus.

82. Bradydysrhythmias in children MOST often occur secondary to:
A) severe hypoxia.
B) drug ingestion.
C) AV heart block.
D) cardiac irritability.

A) severe hypoxia.

83. The preferred initial pharmacologic agent for pediatric bradycardia is:
A) atropine.
B) epinephrine.
C) dobutamine.
D) amiodarone.

B) epinephrine.

84. First-degree heart block in children:
A) is typically asymptomatic and does not require special treatment.
B) should be suspected when a randomly dropped QRS is observed.
C) should be treated with cardiac pacing, even if the child is stable.
D) does not respond to atropine and should be treated with dopamine.

A) is typically asymptomatic and does not require special treatment.

85. Which of the following is the first-line treatment for a hemodynamically unstable child with bradycardia?
A) Epinephrine IV or IO
B) Chest compressions
C) Ventilatory support
D) Transcutaneous pacing

C) Ventilatory support

86. The presence of tachycardia in children:
A) commonly reflects an underlying cardiac pathology that requires emergent intervention.
B) often causes hypotension and is usually associated with a QRS complex greater than 0.08 seconds.
C) should be interpreted in the context of the pediatric assessment triangle and the primary assessment.
D) necessitates a 20-mL/kg bolus of an isotonic crystalloid solution until the cardiac rhythm is assessed.

C) should be interpreted in the context of the pediatric assessment triangle and the primary assessment.

87. Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia?
A) Pulse rate
B) P wave presence
C) Systolic blood pressure
D) QRS complex width

D) QRS complex width

88. Unlike sinus tachycardia, reentry supraventricular tachycardia in infants is characterized by:
A) a presence of P waves.
B) an unvarying pulse rate.
C) a history of fever or dehydration.
D) a pulse rate greater than 180 beats/min.

B) an unvarying pulse rate.

89. The MOST appropriate vagal maneuver for an infant involves:
A) blowing into an occluded straw.
B) holding ice packs firmly to the face.
C) firmly massaging the carotid artery.
D) applying a heat stimulus to the body.

B) holding ice packs firmly to the face.

90. If an initial cardioversion attempt is unsuccessful in a 33-pound child, you should repeat the procedure using ___ joules:
A) 10
B) 15
C) 30
D) 50

C) 30

91. Hemodynamically stable children with a wide QRS complex tachycardia:
A) should receive amiodarone.
B) respond well to adenosine.
C) are likely experiencing supraventricular tachycardia.
D) will respond to vagal maneuvers.

A) should receive amiodarone.

92. Cardiopulmonary arrest in the pediatric patient:
A) usually presents with pulseless electrical activity.
B) requires high epinephrine doses.
C) typically requires defibrillation.
D) is most often a secondary event.

D) is most often a secondary event.

93. Treatment for pediatric asystole includes:
A) atropine.
B) epinephrine.
C) cardiac pacing.
D) hyperventilation.

B) epinephrine.

94. When attempting resuscitation of a child with pulseless electrical activity, you should:
A) administer epinephrine via the ET tube if possible.
B) attempt to identify an underlying cause of the arrest.
C) perform synchronized cardioversion if the rate is fast.
D) give atropine if the heart rate is less than 60 beats/min.

B) attempt to identify an underlying cause of the arrest.

95. Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform:
A) intubation.
B) cardioversion.
C) defibrillation.
D) CPR for 5 minutes.

C) defibrillation.

96. Ductal-dependent congenital heart defects typically present with __________ in the neonatal period.
A) hypertension
B) low-grade fever
C) hyperirritability
D) respiratory distress

D) respiratory distress

97. Dilated cardiomyopathy is a condition in which the heart is:
A) deprived of oxygen due to sudden coronary vasospasm.
B) unusually thick and must pump harder to eject blood.
C) temporarily impaired by an isolated bacterial infection.
D) weakened and enlarged, making it a less efficient pump.

D) weakened and enlarged, making it a less efficient pump.

98. Etomidate should be avoided as an induction agent in pediatric intubation in the presence of:
A) hypovolemia.
B) tachycardia.
C) hypotension.
D) septic shock.

D) septic shock.

99. Common signs and symptoms of meningitis in young children include all of the following, EXCEPT:
A) poor feeding.
B) nuchal rigidity.
C) bulging fontanelle.
D) irritability and fever.

B) nuchal rigidity.

00. Meningococcal meningitis with sepsis is typically characterized by a(n):
A) purpuric rash.
B) insidious onset.
C) low-grade fever.
D) persistent cough.

A) purpuric rash.