CH 44

Question 1

When attempting resuscitation of a child with pulseless electrical activity, you should:

give atropine if the heart rate is less than 60 beats/min.
attempt to identify an underlying cause of the arrest.
administer epinephrine via the endotracheal tube, if possible.
perform synchronized cardioversion if the rate is fast.

Answer 1

attempt to identify an underlying cause of the arrest.

Question 2

When inserting an oropharyngeal airway in a child, you should:

hyperextend the head to facilitate insertion.
use a tongue blade to depress the tongue.
open the mouth with the tongue-jaw lift.
suction the oropharynx for 15 seconds first.

Answer 2

use a tongue blade to depress the tongue.

Question 3

In young children, air bags pose a particular threat for injuries to the:

thoracic organs.
head and neck.
abdominal organs.
soft tissues of the face.

Answer 3

head and neck.

Question 4

A 12-year-old boy presents with marked respiratory distress; hot, moist skin; and anxiety. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child’s grandmother, his symptoms began suddenly about 30 minutes ago. You should be most suspicious for:

laryngotracheobronchitis.
acute viral croup.
subglottic narrowing.
bacterial epiglottitis.

Answer 4

bacterial epiglottitis.

Question 5

A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. You should:

transport immediately and establish vascular access en route to the hospital.
start an IV line and give adenosine while monitoring her cardiac rhythm.
establish vascular access and administer a 20-mL/kg normal saline bolus.
apply chemical ice packs to the child’s face to try to slow her heart rate.

Answer 5

establish vascular access and administer a 20-mL/kg normal saline bolus.

Question 6

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

Answer 6

it should be evaluated in the context of the Pediatric Assessment Triangle and remainder of the primary assessment.

Question 7

A 10-month-old infant presents with an acute onset of increased work of breathing. According to the infant’s mother, the child was crawling around in the living room prior to the event and was fine 10 minutes earlier. Your assessment reveals that the infant appears alert to his surroundings, has loud inspiratory stridor, and pink skin. You should:

apply a pediatric nonrebreathing mask and transport expeditiously.
avoid agitating the infant, offer supplemental oxygen, and transport.
look inside the infant’s mouth using a tongue blade and penlight.
deliver five sharp back slaps between the infant’s shoulder blades.

Answer 7

avoid agitating the infant, offer supplemental oxygen, and transport.

Question 8

A 10-year-old child fell approximately 15 feet from a balcony, landing on a sidewalk. He is conscious and alert, and complains of pain to the right side of his body. After completing your primary survey, you should:

correct immediate life threats, perform a detailed head-to-toe exam, apply spinal precautions, and transport.
apply spinal precautions, begin transport, and perform a rapid assessment while en route to the hospital.
perform a focused physical exam, obtain baseline vital signs, apply spinal precautions, and transport.
provide any immediately needed care, perform a rapid assessment, apply spinal precautions, and transport.

Answer 8

provide any immediately needed care, perform a rapid assessment, apply spinal precautions, and transport.

Question 9

Beta-blocker ingestion in small children would most likely cause:

acute hypoglycemia.
ventricular fibrillation.
agitation or irritability.
marked hypertension.

Answer 9

acute hypoglycemia.

Question 10

When a child experiences a low cardiac output state, they rely mostly on:

increased tidal volume.
increased stroke volume.
central vasoconstriction.
an increase in heart rate.

Answer 10

an increase in heart rate.

Question 11

In contrast to a complex febrile seizure, a simple febrile seizure:

is not associated with tonic-clonic body movement and occurs in children older than 6 years of age.
is of short duration and occurs when the child’s body temperature gradually rises above 102.5 degrees Fahrenheit.
lasts less than 15 minutes and occurs in children without underlying neurologic abnormalities.
is focal in nature and tends to occur in children with a baseline developmental abnormality.

Answer 11

lasts less than 15 minutes and occurs in children without underlying neurologic abnormalities.

Question 12

Medications used to prevent an asthma attack include:

beta-2 agonists.
inhaled steroids.
oral ibuprofen.
inhaled albuterol.

Answer 12

inhaled steroids.

Question 13

Any child with unexplained hyperpnea should be suspected of having which type of toxicity?

Beta blocker
Salicylate
Organophosphate
Opiate

Answer 13

Salicylate

Question 14

Upon arriving at the scene of a 4-year-old boy in respiratory distress, you enter the residence and see the child, who is conscious, sitting on his father’s lap. The father is aware of your presence, but the child is not. Your initial action should be to:
quickly build good rapport with the child by picking him up and asking him what his name is.
visually assess the child from across the room for any signs of increased work of breathing.
allow the father to carry his son to the ambulance, where you can perform an initial assessment.
make physical contact with the child as soon as possible in order to identify any life threats.

Answer 14

visually assess the child from across the room for any signs of increased work of breathing.

Question 15

Which of the following statements regarding nasogastric (NG) and orogastric (OG) insertion in children is correct?

Insertion of an orogastric tube is contraindicated in children with severe head trauma or injury to the midface.
Prior to inserting an NG or OG tube in an unresponsive child without a gag reflex, you should intubate their trachea.
Gastric decompression with an NG or OG tube is only appropriate for children older than 10 years of age.
The correct size NG or OG tube for a child should be half the ET tube size that they would need.

Answer 15

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

Question 16

Which of the following represents the correct drug, dose, and delivery route for an 18-kg child experiencing severe respiratory distress due to bronchospasm?

Ipratropium, 0.5 mg nebulized
Epinephrine, 0.1 mg/kg IM
Albuterol, 0.25 mg nebulized
Albuterol, 1 mg nebulized

Answer 16

Ipratropium, 0.5 mg nebulized

Question 17

Which of the following clinical findings is the most consistent with hypertrophic cardiomyopathy?

Chest pain with fever
Unexplained syncope
Unresolving bradycardia
Sustained hypertension

Answer 17

Unexplained syncope

Question 18

Children between 1 and 2 years of age:

may have negative associations with health care providers.
have a well-developed sense of cause and effect.
generally explore the world exclusively by crawling.
are capable of basic reasoning.

Answer 18

may have negative associations with health care providers.

Question 19

If a child who is wearing a helmet strikes a fixed object on their bicycle and flies over the handlebars, you would most likely encounter:

compression injuries to the intra-abdominal organs.
open or closed fractures of the lower extremities.
facial fractures with associated brain injury.
stretching or tearing injuries to the kidneys.

Answer 19

compression injuries to the intra-abdominal organs.

Question 20

If the parent or caregiver of a sick or injured child is emotionally distraught:
you should remove them from the scene immediately.
you should firmly tell them that the situation is under control.
you should advise them to follow the ambulance in their personal vehicle.
provide support, but remember that your first priority is the child.

Answer 20

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

Question 21

You and your partner arrive at the scene shortly after a 2-year-old child experienced an apparent seizure. The child’s father tells you that his son’s entire body began shaking and that the episode lasted less than 5 minutes. Your assessment of the child reveals that he is conscious, is crying, and has hot, moist skin. His heart rate is 160 beats/min, and his respirations are 40 breaths/min. You should:

cool the child with tepid water, administer high-flow oxygen, and transport.
establish vascular access, give a 20-mL/kg saline bolus, and transport.
advise the father to take his son to see a pediatrician the following day.
keep the child cool and transport him to the hospital for physician evaluation.

Answer 21

keep the child cool and transport him to the hospital for physician evaluation.

Question 22

Distributive shock in children is most often the result of:

spinal injury.
anaphylaxis.
heart failure.
sepsis.

Answer 22

Sepsis

Question 23

To maintain a neutral airway position in an unresponsive infant, you should:

insert an appropriate-sized oral airway.
pad underneath the infant’s occiput.
slightly extend the infant’s head.
place a towel roll under the shoulders.

Answer 23

place a towel roll under the shoulders.

Question 24

Vasopressor support to improve vascular tone in a child in septic shock should be considered:

if the child’s sustained heart rate is greater than 130 beats/min.
as soon as sepsis is suspected as the underlying problem.
if hypotension persists despite 60 mL/kg of isotonic fluid.
only if other causes of distributive shock are ruled out.

Answer 24

if hypotension persists despite 60 mL/kg of isotonic fluid.

Question 25

Which of the following presentations of bruises is rarely incurred accidentally? Bruises on the hands Bruises on both shins Bruises in a straight line Bruises on the forehead

Answer 25

Bruises in a straight line

Question 26

In contrast to adults, young children are more prone to liver and spleen injuries because these organs: are relatively smaller and less protected. are more mobile and less supported. extend well below the rib cage. are highly vascular.

Answer 26

extend well below the rib cage.

Question 27

Bradydysrhythmias in children most often occur secondary to: drug ingestion. severe hypoxia. cardiac irritability. AV heart block.

Answer 27

severe hypoxia.

Question 28

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

Answer 28

initiate CPR immediately.

Question 29

What is the approximate total blood volume of a 60-pound child? 3.8 L 1.9 L 2.4 L 3.1 L

Answer 29

1.9L

Question 30

A young child with marked respiratory distress who is agitated and thrashing about should receive oxygen via: a method that minimizes metabolic demand and oxygen consumption. the blow-by technique while they sit on the caregiver's lap. positive-pressure ventilation after they have been properly sedated. nonrebreathing mask, because agitation indicates cerebral ischemia.

Answer 30

a method that minimizes metabolic demand and oxygen consumption.

Question 31

Ventricular shunts are typically placed in children who: are born with an abnormally small brain, which results in a relative increase in the amount of circulating cerebrospinal fluid. have impaired circulation and absorption of cerebrospinal fluid, leading to increased size of the ventricles of the brain and increased intracranial pressure. have experienced a severe traumatic brain injury that results in chronic cerebral edema and increased intracranial pressure. are born with a congenital condition in which the ventricles of the brain produce excessive amounts of cerebrospinal fluid.

Answer 31

have impaired circulation and absorption of cerebrospinal fluid, leading to increased size of the ventricles of the brain and increased intracranial pressure.

Question 32

The most appropriate vagal maneuver for an infant involves: applying a heat stimulus to the body. firmly massaging the carotid artery. blowing into an occluded straw. holding ice packs firmly to the face.

Answer 32

holding ice packs firmly to the face.

Question 33

You are dispatched to a daycare center for a 5-year-old girl with trouble breathing. Upon arriving at the scene, you assess the child and note that she is responsive to pain only, has weak intercostal retractions, and is breathing at a slow rate with shallow depth. You should: begin assisting her ventilations with a bag-mask device and assess her pulse rate. apply oxygen via pediatric nonrebreathing mask and attach a pulse oximeter. administer high-flow oxygen, assess her cardiac rhythm, and establish IO access. deliver two effective rescue breaths and assess her pulse for at least 5 seconds.

Answer 33

begin assisting her ventilations with a bag-mask device and assess her pulse rate.

Question 34

When treating a child who is seizing with diazepam, the paramedic should remember that: the half-life is short and breakthrough seizures may occur during long transports. a single dose of diazepam usually terminates all seizures, without the need to redose. naloxone should be administered if signs of respiratory depression develop. it is a long-acting drug and has the greatest potential for respiratory compromise.

Answer 34

the half-life is short and breakthrough seizures may occur during long transports.

Question 35

You should be most suspicious for child abuse when caring for an injured 4-year-old child if: there was an unusual delay in calling 9-1-1. the caregiver demands that you treat the child. you can smell alcohol on the caregiver's breath. the child presents with bruises to both shins.

Answer 35

there was an unusual delay in calling 9-1-1.

Question 36

Which medication used to treat pediatric seizures has a short duration of action and therefore may need repeat dosing for recurrent seizures? Midazolam Dilantin Lorazepam Ativan

Answer 36

Midazolam

Question 37

Once you suspect that a child may have been abused, you should: question the child in front of the caregiver. transport the child to the hospital at once. carefully document what you see and hear. apprise the caregiver of your suspicions.

Answer 37

carefully document what you see and hear.

Question 38

Failure of a child's oxygen saturation to increase despite high-flow oxygen is most indicative of: congenital heart disease. right-sided heart failure. decreased vascular tone. relative hypovolemia.

Answer 38

congenital heart disease.

Question 39

Which orogastric or nasogastric tube would be the most appropriate size for a 4-year-old child? 8-F 4-F 10-F 6-F

Answer 39

10-F

Question 40

Sorbitol is not recommended for use in young children because it: induces vomiting, which increases the risk for pulmonary aspiration. has been linked to sudden cardiac death due to ventricular dysrhythmias. prolongs the QT interval and is associated with ventricular fibrillation. can cause severe diarrhea and life-threatening electrolyte abnormalities.

Answer 40

can cause severe diarrhea and life-threatening electrolyte abnormalities.

Question 41

In children, complex partial seizures would most likely manifest with: generalized tonic-clonic movement of all extremities. focal motor jerking with loss of consciousness. a brief loss of attention without abnormal body movement. focal motor jerking without loss of consciousness.

Answer 41

focal motor jerking with loss of consciousness.

Question 42

You should be most suspicious for cardiogenic shock in an infant or child if: their heart rate varies with activity. perfusion decreases following a fluid bolus. they appear listless or lethargic. their heart rate is greater than 150 beats/min.

Answer 42

perfusion decreases following a fluid bolus.

Question 43

The Pediatric Assessment Triangle will help answer which of the following questions? “Is the child's pulse elevated?” “What is the child's level of pain?” “Is the child sick or not sick?” “Will the child cooperate during my exam?”

Answer 43

“Is the child sick or not sick?”

Question 44

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

Answer 44

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

Question 45

Which of the following is the first-line treatment for a hemodynamically unstable child with bradycardia? Transcutaneous pacing Chest compressions Ventilatory support Epinephrine IV or IO

Answer 45

Ventilatory support

Question 46

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

Answer 46

your ability to assess accurately for physiologic abnormalities is impaired.

Question 47

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

Answer 47

wheezing during inspiration and expiration.

Question 48

The first-line treatment of pediatric patients in distributive shock is: drug-assisted intubation. volume resuscitation. continuous positive airway pressure. a vasopressor infusion.

Answer 48

volume resuscitation.

Question 49

The general area of a child's body that sustains initial trauma after being struck by an automobile depends mainly on: whether the vehicle ran over the child following impact. the travel speed of the vehicle and the weight of the child. whether the child turns away from or toward the vehicle. the child's height and the height of the bumper upon impact.

Answer 49

the child's height and the height of the bumper upon impact.

Question 50

When assessing an otherwise healthy child who is injured, you notice that his general appearance is abnormal. This should make you most suspicious for: a head injury. hypoglycemia. child abuse. internal bleeding.

Answer 50

a head injury.

Question 51

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

Answer 51

makes it easier to manipulate the epiglottis.

Question 52

A 4-year-old girl presents with a fever of 103.2 degrees Fahrenheit. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child should include: icepacks to the extremities. free-flow oxygen. 81 mg of aspirin. 750 mg of acetaminophen.

Answer 52

free-flow oxygen.

Question 53

You are called to a residence for a ventilator-dependent child with respiratory distress. Upon your arrival, the child's mother tells you that the child was doing fine, but then suddenly began experiencing labored breathing. She further tells you that the child's home ventilator was recently replaced with a newer one. Assessment of the child reveals that she is in marked respiratory distress and has intercostal retractions. Your first action should be to: disconnect the child from the ventilator and begin bag-mask ventilations. assess the patency of the tracheostomy tube to determine if it is dislodged. remove the tracheostomy tube and replace it with a similar-sized endotracheal tube. suction the child's tracheostomy tube to rule out secretions as the problem.

Answer 53

disconnect the child from the ventilator and begin bag-mask ventilations.

Question 54

Assessment of a child in a cold environment would most likely yield: delayed capillary refill. a rapid, weak pulse. a slow, irregular pulse. flushing of the skin.

Answer 54

delayed capillary refill.

Question 55

A child with early hypoxia would most likely present with: bradycardia. tachycardia. bradypnea. mottled skin.

Answer 55

tachycardia.

Question 56

If an infant or small child swallowed a rigid foreign body, they would most likely experience respiratory distress because: when an infant or child is stressed they tend to swallow a lot of air. the esophageal foreign body can compress the relatively pliable trachea. a foreign body in the esophagus would cause reflux and aspiration. the feeling of a foreign body in the throat would cause severe anxiety.

Answer 56

the esophageal foreign body can compress the relatively pliable trachea.

Question 57

Treatment for pediatric asystole includes: hyperventilation. cardiac pacing. epinephrine. atropine.

Answer 57

epinephrine.

Question 58

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

Answer 58

ventilatory assistance with a bag-mask device.

Question 59

A sick or injured child's general appearance is most reflective of: their central nervous system function. the etiology of the problem. their cardiovascular status. their ability to be consoled.

Answer 59

their central nervous system function.

Question 60

Which of the following are signs of pain in an infant? Labored tachypnea and pallor A heart rate that is not variable Tachycardia and inconsolability Diaphoresis and dilated pupils

Answer 60

Tachycardia and inconsolability

Question 61

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

Answer 61

weakened and enlarged, making it a less efficient pump.

Question 62

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

Answer 62

is anatomically and physiologically similar to an adult.

Question 63

Hemodynamically stable children with a wide QRS complex tachycardia that persists despite initial treatment: are likely experiencing supraventricular tachycardia. respond well to adenosine. should receive amiodarone. will usually respond favorably to vagal maneuvers.

Answer 63

should receive amiodarone.

Question 64

Following significant blunt trauma to the abdomen, a 9-year-old boy presents with diaphoresis and pallor. He is conscious and alert, with a blood pressure of 90/58 mm Hg, a heart rate of 130 beats/min, and a respiratory rate of 28 breaths/min with adequate depth. With an estimated ground transport time of 30 minutes, you should: apply supplemental oxygen, start two large-bore IV lines with normal saline, administer several crystalloid boluses of 20 mL/kg, apply spinal precautions if indicated, and transport to an appropriate medical facility. administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion. assist his ventilations to increase tidal volume, cover him with a blanket, establish at least one large-bore IV line, administer a 20-mL/kg normal saline bolus, and transport to a trauma center. apply warm blankets, elevate his lower extremities 12 inches, administer high-flow oxygen, insert an IO catheter, administer a 250-mL normal saline bolus, and transport expeditiously to an appropriate trauma center.

Answer 64

administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion.

Question 65

The most appropriate airway management for an actively seizing child whose airway is not maintainable with positioning involves: immediate endotracheal intubation. 100% oxygen and a left lateral recumbent position. insertion of an oropharyngeal airway adjunct. nasal airway insertion and suctioning as needed.

Answer 65

nasal airway insertion and suctioning as needed.

Question 66

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary survey reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid exam of her body does not reveal any gross injuries or bleeding. You should: suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask. insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea. open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device. manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min.

Answer 66

open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.

Question 67

You are assessing a 10-year-old child with a wide-complex tachycardia, but cannot decide whether electrical or pharmacologic therapy is the most appropriate initial treatment approach. Which of the following interventions would pose the greatest potential for harm? Establishing vascular access and rapidly administering 3 mg of adenosine Starting an IV line and administering amiodarone followed by procainamide Establishing IO access, administering a sedative, and cardioverting at 15 joules Administering high-flow oxygen and obtaining a 12-lead ECG tracing

Answer 67

Starting an IV line and administering amiodarone followed by procainamide

Question 68

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

Answer 68

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

Question 69

A 6-month-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned? 27% 21% 45% 36%

Answer 69

36

Question 70

Epiglottitis in children: is uncommon because children are vaccinated against Haemophilus influenza type b. should be suspected if the child presents with diffuse wheezing. should be confirmed by visualizing the larynx and epiglottis with a laryngoscope. presents with a sudden onset of low-grade fever and dyspnea.

Answer 70

is uncommon because children are vaccinated against Haemophilus influenza type b.

Question 71

If a child with a functioning central venous line requires emergency drug therapy, you should: carefully cleanse the injection port on the central line and administer the drug in the usual fashion. avoid using the central line if possible and attempt to establish peripheral IV access elsewhere. administer the drug through the central line, but only give half the usual dose of the drug. flush the central line with at least 30 mL of normal saline first and then administer the emergency drug.

Answer 71

avoid using the central line if possible and attempt to establish peripheral IV access elsewhere.

Question 72

Upon arriving at the scene of a 4-year-old girl who is ill, you note that she is tachypneic and tachycardic. Her skin is warm and moist, and there are no signs of increased work of breathing. The child's mother denies any vomiting or diarrhea. This child's tachycardia and tachypnea are most likely the result of: early hypoxemia. a cardiac problem. moderate dehydration. fever and anxiety.

Answer 72

fever and anxiety.

Question 73

In contrast to the SAMPLE history of a child with an illness, the SAMPLE history of an injured child should include a specific inquiry regarding: routine medication use. the date of their last tetanus shot. any prior hospitalizations. any known drug allergies.

Answer 73

the date of their last tetanus shot.

Question 74

You are dispatched to a residence for a 17-year-old woman with acute abdominal pain. When you arrive and begin your assessment, it is clear that the patient is uncomfortable with the presence of her parents because she is reluctant to answer your questions. You should: recognize that the parents are an invaluable resource for information. reassure the patient and tell her that her candor is vital to your treatment. tell the patient that her parents must legally be present during the exam. diplomatically ask the parents if their daughter can have some privacy.

Answer 74

diplomatically ask the parents if their daughter can have some privacy.

Question 75

You are dispatched to a residence at 6:15 AM for an unconscious 3-month-old infant who is not breathing. Upon arrival at the scene, you find the father performing CPR on the infant. The infant's mother is sitting on the couch, crying. Your assessment reveals that the child is apneic and pulseless. Her skin is pale and cold, and there is gross lividity to her chest. You should: continue CPR and assess the infant's cardiac rhythm to confirm asystole. pronounce the infant dead if she does not respond to 5 minutes of full ACLS. recognize that the infant has been deceased for an extended period of time. tell the parents that the child likely suffocated because she slept on her stomach.

Answer 75

recognize that the infant has been deceased for an extended period of time.

Question 76

Which of the following components is used to distinguish sinus tachycardia from supraventricular tachycardia? P wave presence Respiratory rate Oxygen saturation QRS complex width

Answer 76

P wave presence

Question 77

An oral or nasal airway in an unresponsive infant or child may: avert the need for intubation. cause gastric distention. stimulate the vagus nerve. replace manual head positioning.

Answer 77

avert the need for intubation.

Question 78

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

Answer 78

use the AVPU scale.

Question 79

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

Answer 79

blood pressure may remain adequate in compensated shock.

Question 80

A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child's mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child's ventilations with high-flow oxygen, your partner informs you that the child's heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should: establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate. initiate one-rescuer CPR while your partner attempts to establish vascular access. ask your partner to insert an IO catheter and administer epinephrine 1:10,000. attempt immediate transcutaneous pacing while continuing ventilation assistance.

Answer 80

initiate one-rescuer CPR while your partner attempts to establish vascular access.

Question 81

Which of the following is the most appropriate dose of activated charcoal for a 45-pound child? 5 g 20 g 15 g 10 g

Answer 81

20 g

Question 82

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

Answer 82

closely monitor the child's cardiac rhythm.

Question 83

If a 2-year-old child with a foreign body airway obstruction becomes unresponsive, you should place them in a supine position and then: assess for a carotid pulse. visualize the upper airway. perform abdominal thrusts. perform chest compressions.

Answer 83

perform chest compressions.

Question 84

When assessing a child's circulation by looking at their skin, pallor is most indicative of: poor oxygenation and a state of circulatory collapse. peripheral vasoconstriction and compensated shock. vasomotor instability and decompensated shock. systemic vasodilation with resulting low blood pressure.

Answer 84

peripheral vasoconstriction and compensated shock.

Question 85

When mechanically securing an injured child's head and neck to a backboard, you should: place tape or a strap or tape over the chin. use towel rolls instead of a cervical collar. manually stabilize the child's torso first. place padding underneath the occiput.

Answer 85

use towel rolls instead of a cervical collar.

Question 86

The decision to transport an acutely ill child immediately or to remain at the scene to perform additional interventions is dependent on the: child's previous illnesses. child's age and fear level. expected benefits of treatment. number of EMS staff present.

Answer 86

expected benefits of treatment.

Question 87

A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to three puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should: administer a dose of albuterol. give epinephrine 1:1,000 SQ. give nebulized ipratropium. ventilate her with a bag-mask device.

Answer 87

give nebulized ipratropium.

Question 88

While assessing the airway of a 3-year-old girl who is unresponsive, you hear a snoring sound during each of her slow, shallow breaths. You should: manually maneuver her head and reassess her breathing status. provide free-flow oxygen as you perform nasotracheal intubation. begin bag-mask ventilations to improve her low tidal volume. insert an oropharyngeal airway and apply high-flow oxygen.

Answer 88

manually maneuver her head and reassess her breathing status.

Question 89

Which of the following is a common sign or symptom of meningitis in young children? Poor feeding Abdominal pain Tachycardia Nuchal rigidity

Answer 89

Nuchal rigidity

Question 90

Early distributive shock in children is characterized by: warm, flushed skin. pallor and diaphoresis. gross neurologic deficits. weak peripheral pulses.

Answer 90

warm, flushed skin.

Question 91

To ensure that an infant's head is in a neutral position during spinal immobilization, you should: slightly extend the infant's head. place padding under the infant's shoulders. place a towel roll behind the infant's neck. use towel rolls for lateral head stabilization.

Answer 91

place padding under the infant's shoulders.

Question 92

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

Answer 92

small children have a relatively large occiput.

Question 93

You receive a call at 11:50 PM for a 3-year-old boy with respiratory distress. As soon as you enter the child's residence, you can hear a loud, barking cough. You find the child sitting on his mother's lap. He is conscious and appears alert to his surroundings. According to the child's mother, he has been sick for the past few days with a low-grade fever, but then began experiencing a high-pitched cough. His skin is warm and dry, his heart rate is 120 beats/min, and his oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should: establish vascular access, give an appropriate dose of methylprednisolone, and transport. allow the child to assume a position of comfort, avoid agitating him, and transport. administer high-flow oxygen via pediatric nonrebreathing mask, keep him calm, and transport. administer 0.5 mL of racemic epinephrine via nebulizer, apply the cardiac monitor, and transport.

Answer 93

allow the child to assume a position of comfort, avoid agitating him, and transport.

Question 94

If an initial cardioversion attempt is unsuccessful in a 33-pound child, you should repeat the procedure using: 10 joules. 30 joules. 50 joules. 15 joules.

Answer 94

30 joules.

Question 95

You are assessing a 7-month-old infant who presents with listlessness, pallor, and increased work of breathing. The infant's mother tells you that the child was born 2 months premature and was in the neonatal intensive care unit for 3 weeks. She denies any recent vomiting, diarrhea, or fever. The infant's oxygen saturation is 89% and does not improve with supplemental oxygen. Her heart rate is rapid and weak and does not vary with activity. When you apply the cardiac monitor, you will most likely encounter a: rhythm with QRS complexes less than 0.08 seconds in duration and a heart rate less than 220 beats/min. narrow QRS complex rhythm with absent P waves and a heart rate greater than 220 beats/min. rhythm with QRS complexes greater than 0.08 seconds in duration and a heart rate greater than 180 beats/min. wide QRS complex rhythm with occasional P waves and a rate greater than 150 beats/min.

Answer 95

narrow QRS complex rhythm with absent P waves and a heart rate greater than 220 beats/min.

Question 96

You receive a call for a “sick child.” When you arrive at the scene, the child's mother tells you that her 5-year-old son has had vomiting and diarrhea for the past day and will not eat or drink anything. On exam, the child's level of consciousness appears consistent with his age. His skin is cool and pale, he is tachypneic, his capillary refill time is 4 seconds, and his heart rate is 150 beats/min. The most appropriate treatment for this child involves: establishing IV access and administering a 20-mL/kg normal saline bolus, applying high-flow oxygen, administering 25% dextrose, and transporting. administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route. applying high-flow oxygen via pediatric nonrebreathing mask, assessing his blood glucose level, elevating his legs 12 inches, and transporting. administering supplemental oxygen, starting an IV line, assessing his blood glucose level, delivering at least two 20-mL/kg normal saline boluses, and transporting.

Answer 96

administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route.

Question 97

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

Answer 97

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

Question 98

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

Answer 98

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

Question 99

Adenosine may be considered for a hemodynamically stable child with a wide-complex tachycardia if: the heart rate is over 180 beats/min. the child has a history of congenital heart disease. the ventricular rhythm is regular and monomorphic. the QRS complex is less than 0.12 seconds.

Answer 99

the ventricular rhythm is regular and monomorphic.

Question 100

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

Answer 100

defibrillation.

Question 101

Immediate treatment for a conscious child with anaphylaxis includes: a dopamine infusion. diphenhydramine IV. epinephrine IM. normal saline boluses.

Answer 101

epinephrine IM.

Question 102

When assessing a 5-year-old child, you should: conduct a toe-to-head exam. conduct a head-to-toe exam. ask simple yes or no questions, if possible. first ask a parent where the child is experiencing pain.

Answer 102

conduct a head-to-toe exam.

Question 103

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

Answer 103

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

Question 104

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

Answer 104

may avert the need for endotracheal intubation.

Question 105

A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The most appropriate initial treatment for this child involves: conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls. administering oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations. recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation. assisting his ventilations with a bag-mask device and determining whether his tachycardia is ventricular or supraventricular in origin.

Answer 105

administering oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.

Question 106

The work-of-breathing component of the Pediatric Assessment Triangle includes which of the following? Checking the pulse oximetry reading Auscultating the lungs for adventitious sounds Noting the child's position during breathing Determining the child's respiratory rate

Answer 106

Noting the child's position during breathing

Question 107

In contrast to adults, cardiac arrest in children is usually caused by: respiratory failure. a toxic ingestion. congenital anomalies. a dysrhythmia.

Answer 107

respiratory failure.

Question 108

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

Answer 108

receive initial fluid resuscitation at the scene.

Question 109

Unlike sinus tachycardia, supraventricular tachycardia in infants is characterized by: an unvarying pulse rate. a pulse rate greater than 180 beats/min. a history of fever or dehydration. the presence of P waves.

Answer 109

an unvarying pulse rate.

Question 110

Which of the following statements regarding simple febrile seizures is correct? Any child who experiences a simple febrile seizure is at significant risk for developing epilepsy. More than one simple febrile seizure in a child is highly suggestive of an underlying neurologic problem. They are unique to children, are common, and typically do not cause any type of permanent deficit. The overall prognosis for a child with simple febrile seizures worsens with each seizure episode.

Answer 110

They are unique to children, are common, and typically do not cause any type of permanent deficit.

Question 111

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

Answer 111

is typically asymptomatic and does not require special treatment.

Question 112

When caring for a child with a ventricular shunt or gastrostomy tube, it is important to: obtain a complete medical history from the caregiver and then develop a treatment plan based on your knowledge of special health care devices. assure the caregiver that you can care for the child effectively and recommend that they follow the ambulance in their own vehicle. provide supportive care only and then rapidly transport the child to the most appropriate medical facility. recognize that the caregiver is a key resource and that their expertise should be utilized to assist in the care of the child.

Answer 112

recognize that the caregiver is a key resource and that their expertise should be utilized to assist in the care of the child.

Question 113

Adolescents tend to struggle with which of the following issues? Stranger anxiety Peer pressure Distraction Limited mobility

Answer 113

Peer pressure

Question 114

Which of the following is the most appropriate endotracheal tube for a 6-year-old child? 5.0 mm, uncuffed 4.5 mm, cuffed 5.5 mm, uncuffed 4.0 mm, cuffed

Answer 114

5.5 mm, uncuffed

Question 115

A 9-year-old, 55-pound girl presents with generalized hives, marked facial swelling, and loud inspiratory stridor. She is conscious but appears sleepy. You can most rapidly improve this child's condition by: administering epinephrine IM. administering diphenhydramine. administering a nebulized bronchodilator. starting an epinephrine infusion.

Answer 115

administering epinephrine IM.

Question 116

In the newborn, hypoglycemia is defined as a blood glucose level of less than: 40 mg/dL. 50 mg/dL. 60 mg/dL. 70 mg/dL.

Answer 116

40 mg/dL.

Question 117

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

Answer 117

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

Question 118

Ventilating a child too fast with a bag-mask device may cause: reflex hypertension. decreased preload. cerebral vasodilation. severe hypercarbia.

Answer 118

decreased preload.

Question 119

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

Answer 119

is used to estimate a child's weight based on their height.

Question 120

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

Answer 120

purpuric rash.

Question 121

A 9-year-old who fell off his bike has an isolated deformity to his forearm and is in significant pain. The child is conscious and alert, his vital signs are stable, and his mother is present. Your initial effort to relieve this child's pain should involve: not allowing the child to visualize his deformed arm. encouraging the child to breathe high-flow oxygen. administering morphine or fentanyl via slow IV push. providing calm reassurance to both mother and child.

Answer 121

providing calm reassurance to both mother and child.

Question 122

Treatment for a child with respiratory distress should include which of the following? Position of comfort and supplemental oxygen Semi-sitting position and bag-mask ventilation Sniffing position and bag-mask ventilation Supine position and drug-assisted intubation

Answer 122

Position of comfort and supplemental oxygen

Question 123

Your primary survey of an unresponsive 5-year-old, 40-pound child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should: charge the defibrillator to 80 joules while CPR is ongoing. continue high-quality CPR and reassess in 2 minutes. start an IV and administer 0.2 mg of epinephrine 1:10,000. defibrillate with 40 joules and immediately resume CPR.

Answer 123

defibrillate with 40 joules and immediately resume CPR.

Question 124

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

Answer 124

they can no longer compensate, which causes hypoxia and hypercarbia.

Question 125

You are providing high-flow oxygen to a 3-year-old boy with severe respiratory distress. When you reassess him, you note that he is pale and that his respiratory rate has decreased from 30 breaths/min to 12 breaths/min. You should: begin treatment with a beta-2 agonist medication. auscultate his lung sounds and reassess his oxygen saturation. secure his airway with an endotracheal tube. assist his ventilations with a bag-mask device.

Answer 125

assist his ventilations with a bag-mask device.

Question 126

The goal in treating a child with epiglottitis is to: intubate them before the epiglottis blocks the upper airway. administer corticosteroids to reduce edema in the upper airway. administer oxygen by nonrebreathing mask and transport at once. transport them to the hospital with a maintainable airway.

Answer 126

transport them to the hospital with a maintainable airway.

Question 127

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

Answer 127

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

Question 128

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

Answer 128

obstruction by the tongue.

Question 129

Which of the following is often not acquired during the SAMPLE history of an adult, but should be routinely acquired when obtaining the history of an infant or child? Prescribed medications Nature of symptoms Immunizations Preceding events

Answer 129

Immunizations

Question 130

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

Answer 130

involve restriction of airflow during exhalation.

Question 131

You and your partner are caring for a child with stable supraventricular tachycardia that was refractory to initial treatment. As your partner is preparing to establish vascular access, the child's level of consciousness decreases markedly. You reassess the child and note that her femoral pulse is rapid and weak. You should: preoxygenate the child and then perform endotracheal intubation. immediately perform synchronized cardioversion and reassess. begin chest compressions as your partner establishes the IV line. establish vascular access and administer 0.1 mg/kg of adenosine.

Answer 131

immediately perform synchronized cardioversion and reassess.

Question 132

Unlike other types of shock, a child in cardiogenic shock would most likely present with: unlabored tachypnea. a primary cardiac dysrhythmia. an enlarged spleen. increased work of breathing.

Answer 132

increased work of breathing.

Question 133

Rapid IV fluid administration in a child with diabetic ketoacidosis increases the risk of: hyperkalemia. cerebral edema. hypokalemia. hemodilution.

Answer 133

cerebral edema.

Question 134

Which of the following is a sign of decompensated shock in the infant or child? Increased peripheral perfusion Prolonged capillary refill Hypertension Abnormal mentation

Answer 134

Prolonged capillary refill

Question 135

Counting an infant's respiratory rate for 15 seconds and then quadrupling that number: 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. is recommended because it is the quickest way to determine if the infant's baseline respiratory rate is abnormally slow or abnormally fast. may yield a falsely low respiratory rate because infants may have periodic breathing or variable respiratory rates with short periods of apnea. is appropriate only if you are auscultating the child's respirations with a stethoscope while simultaneously listening to lung sounds.

Answer 135

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

Question 136

With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once: their body weight is 55 pounds. their resting vital signs are consistent with those of an adult. they reach 8 to 10 years of age. they have developed secondary sexual characteristics

Answer 136

they have developed secondary sexual characteristics.

Question 137

You are transporting an unresponsive intubated 4-year-old child. An IO catheter is in place, and you are ventilating the child at an age-appropriate rate. Suddenly, the child becomes cyanotic and experiences a significant drop in her heart rate and oxygen saturation, and there is loss of a capnographic waveform. You attempt to auscultate her lung sounds but are unable to hear over the drone of the engine. You should: increase your ventilation rate and reassess the child's condition. extubate immediately and ventilate with a bag-mask device. administer 0.02 mg/kg of atropine via rapid IO push and reassess. look for vapor mist in the endotracheal tube and attach a colorimetric device.

Answer 137

extubate immediately and ventilate with a bag-mask device.

Question 138

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

Answer 138

perform 30 chest compressions and then look in the mouth.

Question 139

Which of the following statements regarding chest trauma in children is correct? Most cases of fatal chest trauma occur in children who fall more than 10 feet. Signs of a pneumothorax are often more obvious in children than in adults. Children are more prone to intrathoracic trauma due to compression forces. The pliability of children's rib cages predisposes them to sternal fractures.

Answer 139

Children are more prone to intrathoracic trauma due to compression forces.

Question 140

You receive a call to a residence for a 6-year-old girl with a decreased level of consciousness. The child has hydrocephalus following surgery to remove a brain tumor and has a ventricular shunt in place. The child's level of consciousness is markedly decreased from its baseline, and the child's caregiver tells you that she thinks the shunt is obstructed. Which of the following sets of vital signs is most indicative of shunt obstruction and increased intracranial pressure? Blood pressure 90/50 mm Hg; pulse 110 beats/min; respirations 10 breaths/min Blood pressure 140/92 mm Hg; pulse 58 beats/min; respirations 8 breaths/min Blood pressure 130/68 mm Hg; pulse 70 beats/min; respirations 28 breaths/min Blood pressure 106/66 mm Hg; pulse 80 beats/min; respirations 14 breaths/min

Answer 140

Blood pressure 140/92 mm Hg; pulse 58 beats/min; respirations 8 breaths/min