Pediatric Emergencies

Question 1

In contrast to adults, children:

Select one:

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.

Answer 1

b. have proportionately larger heads.

Question 2

Compared to adults, the smaller diameter of a child’s airway makes it more vulnerable to:

Select one:

a. laryngospasm.
b. inhalation injury.
c. oropharyngeal secretions.
d. obstruction by the tongue.

Answer 2

d. obstruction by the tongue.

Question 3

A child’s vocal cords can be difficult to visualize during intubation because:

Select one:

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.

Answer 3

a. the epiglottis is floppy and U-shaped.

Question 4

Which of the following statements regarding a child’s chest wall is correct?

Select one:

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 non-compliant rib cages.

Answer 4

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

Question 5

When a child experiences a low cardiac output state, he or she relies MOST on:

Select one:

a. increased tidal volume.
b. central vasoconstriction.
c. an increase in heart rate.
d. increased stroke volume.

Answer 5

c. an increase in heart rate.

Question 6

Most children begin to develop stranger anxiety between ___ and ___ months of age.

Select one:

a. 3, 6
b. 6, 12
c. 12, 18
d. 18, 24

Answer 6

b. 6, 12

Question 7

Children between 1 and 2 years of age:

Select one:

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.

Answer 7

d. may have negative associations with health care providers.

Question 8

The FIRST step in examining a toddler in stable condition is to:

Select one:

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.

Answer 8

a. let the child sit on a parent’s lap.

Question 9

When assessing a 5-year-old child, you should:

Select one:

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.

Answer 9

a. be able to conduct a head-to-toe exam.

Question 10

An 8-year-old child:

Select one:

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.

Answer 10

c. is anatomically and physiologically similar to an adult.

Question 11

With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once:

Select one:

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.

Answer 11

d. secondary sexual characteristics have developed.

Question 12

A 15-year-old child can be difficult to treat for all of the following reasons, EXCEPT:

Select one:

a. peer pressure.
b. stranger anxiety.
c. independence issues.
d. cognizance of body image.

Answer 12

b. stranger anxiety.

Question 13

Establishing good rapport with the caregiver of a sick or injured child at the scene is vital because:

Select one:

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.

Answer 13

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

Question 14

If the parent or caregiver of a sick or injured child is emotionally distraught:

Select one:

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.

Answer 14

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

Question 15

The Pediatric Assessment Triangle was designed to:

Select one:

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.

Answer 15

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

Question 16

The Pediatric Assessment Triangle will help answer all of the following questions, EXCEPT:

Select one:

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?”

Answer 16

b. “Will the child cooperate during my exam?”

Question 17

A sick or injured child’s general appearance is MOST reflective of:

Select one:

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.

Answer 17

c. his or her central nervous system function.

Question 18

A child who is disinterested in your presence and has a blank stare and poor muscle tone:

Select one:

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.

Answer 18

d. requires immediate intervention and transport.

Question 19

The work-of-breathing component of the Pediatric Assessment Triangle includes all of the following, EXCEPT:

Select one:

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.

Answer 19

c. auscultating the lungs for adventitious sounds.

Question 20

A conscious child who is in the sniffing position:

Select one:

a. is trying to align the axes of the airway to improve ventilation.
b. is clearly experiencing an obstruction of the lower airway.
c. will refuse to lie down and leans forward on outstretched arms.
d. assumes a physical position that optimizes accessory muscle use

Answer 20

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

Question 21

In contrast to adults, retractions in children are:

Select one:

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.

Answer 21

a. more evident in the intercostal area.

Question 22

When assessing a child’s circulation by looking at his or her skin, pallor is MOST indicative of:

Select one:

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.

Answer 22

b. peripheral vasoconstriction and compensated shock.

Question 23

Which of the following statements regarding acrocyanosis is correct?

Select one:

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.

Answer 23

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.

Question 24

The length-based resuscitation tape:

Select one:

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.

Answer 24

c. is used to estimate a child’s weight based on his or her height.

Question 25

Counting an infant’s respiratory rate for 15 seconds and then quadrupling that number:

Select one:

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.

Answer 25

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

Question 26

A normal respiratory rate in a child:

Select one:

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%.

Answer 26

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

Question 27

When evaluating a child’s oxygen saturation level with a pulse oximeter:

Select one:

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.

Answer 27

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

Question 28

Early hypoxia in a child would MOST likely present with:

Select one:

a. tachycardia.
b. bradypnea.
c. mottled skin
d. bradycardia.

Answer 28

a. tachycardia.

Question 29

If you cannot palpate the femoral pulse in an unresponsive infant, you should:

Select one:

a. apply an AED at once.
b. palpate the brachial pulse. Incorrect
c. initiate CPR immediately.
d. assess for adequate breathing

Answer 29

c. initiate CPR immediately.

Question 30

Assessment of a child in a cold environment would MOST likely yield:

Select one:

a. a rapid, weak pulse.
b. flushing of the skin.
c. delayed capillary refill.
d. a slow, irregular pulse.

Answer 30

c. delayed capillary refill.