Quiz 20 - Pediatrics

Question 1

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:

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

B. recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation.

C. assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin.

D. conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls.

Answer 1

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

Question 2

Which of the following statements regarding burns in the pediatric patient is correct?

A. A burn that is characterized by clear demarcation lines is generally suggestive of an unintentional burn.

B. Unlike adults, the rule of palm is an inaccurate tool to determine the extent of burns in pediatric patients.

C. A child with burns to both lower extremities has burns to approximately 36% of his or her body surface area.

D. A child’s larger skin surface–to–body mass ratio increases his or her susceptibility to heat and fluid loss.

Answer 2

D. A child’s larger skin surface–to–body mass ratio increases his or her susceptibility to heat and fluid loss.

Question 3

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

A. 12, 18

B. 18, 24

C. 6, 12

D. 3, 6

Answer 3

C. 6, 12

Question 4

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 his femoral pulse is rapid and weak. You should:

A. begin chest compressions as your partner establishes the IV line.

B. establish vascular access and administer 0.1 mg/kg of adenosine.

C. preoxygenate the child and then perform endotracheal intubation.

D. perform immediate synchronized cardioversion and reassess.

Answer 4

D. perform immediate synchronized cardioversion and reassess.

Question 5

Ventricular shunts are typically placed in children who:

A. are born with a congenital condition in which the ventricles of the brain produce excessive amounts of cerebrospinal fluid.

B. are born with an abnormally small brain, which results in a relative increase in the amount of circulating cerebrospinal fluid.

C. have experienced a severe traumatic brain injury that results in chronic cerebral edema and increased intracranial pressure.

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

Answer 5

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

Question 6

The work-of-breathing component of the pediatric assessment triangle includes all of the following, EXCEPT:

A. auscultating the lungs for adventitious sounds.

B. noting the child’s position during breathing.

C. looking for substernal or intercostal retractions.

D. listening for grunting or audible wheezing.

Answer 6

A. auscultating the lungs for adventitious sounds.

Question 7

Etomidate should be avoided as an induction agent in pediatric intubation in the presence of:

A. hypovolemia.

B. septic shock.

C. hypotension.

D. tachycardia.

Answer 7

B. septic shock.

Question 8

Beta blocker ingestion in small children would MOST likely cause:

A. ventricular fibrillation.

B. marked hypertension.

C. agitation or irritability.

D. acute hypoglycemia.

Answer 8

D. acute hypoglycemia.

Question 9

Children between 1 and 3 years of age:

A. are capable of basic reasoning.

B. may have negative associations with health care providers.

C. generally explore the world exclusively by crawling.

D. have a well-developed sense of cause and effect.

Answer 9

B. may have negative associations with health care providers.

Question 10

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should:

A. 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.

B. 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.

C. 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.

D. 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 10

C. 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 11

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:

A. rhythm with QRS complexes less than 0.08 seconds in duration and a heart rate less than 220 beats/min.

B. wide QRS complex rhythm with occasional P waves and a rate greater than 150 beats/min.

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

D. rhythm with QRS complexes greater than 0.08 seconds in duration and a heart rate greater than 180 beats/min.

Answer 11

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

Question 12

Which of the following statements regarding bronchiolitis is correct?

A. The pathophysiology of bronchiolitis is acute bronchospasm secondary to a bacterium that enters the lower respiratory tract.

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

C. Infants who were born past 42 weeks are at highest risk for respiratory failure and arrest secondary to bronchiolitis.

D. Bronchiolitis is usually caused by the metapneumovirus and occurs with greatest frequency during late spring and early summer.

Answer 12

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

Question 13

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. tachypneic and without retractions.

B. bradypneic with periods of marked apnea.

C. rapid with audible rhonchi.

D. slow with increased work of breathing.

Answer 13

A. tachypneic and without retractions.

Question 14

Signs of compensated shock in the infant or child include all of the following, EXCEPT:

A. tachycardia and pallor.

B. abnormal mentation.

C. prolonged capillary refill.

D. decreased peripheral perfusion.

Answer 14

B. abnormal mentation.

Question 15

Meningococcal meningitis with sepsis is typically characterized by a(n):

A. insidious onset.

B. low-grade fever.

C. persistent cough.

D. purpuric rash.

Answer 15

D. purpuric rash.

Question 16

In contrast to adults, retractions in children are:

A. evident in the sternocleidomastoid muscles.

B. more evident in the intercostal area.

C. less commonly seen below the sternum.

D. usually less prominent above the clavicles.

Answer 16

B. more evident in the intercostal area.

Question 17

Common signs of impending respiratory failure in infants and children include:

A. tachypnea and hyperpnea with nasal flaring and prominent retractions.

B. marked agitation and tachycardia with ectopic ventricular complexes.

C. a falling oxygen saturation despite high-flow oxygen administration.

D. abdominal breathing and a pulse rate less than 120 beats per minute.

Answer 17

C. a falling oxygen saturation despite high-flow oxygen administration.

Question 18

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:

A. begin bag-mask ventilations to improve her low tidal volume.

B. insert an oropharyngeal airway and apply high-flow oxygen.

C. manually maneuver her head and reassess her breathing status.

D. provide free-flow oxygen as you nasotracheally intubate her.

Answer 18

C. manually maneuver her head and reassess her breathing status.

Question 19

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 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:

A. look for vapor mist in the ET tube and attach a colorimetric device.

B. extubate immediately and ventilate with a bag-mask device.

C. increase your ventilation rate and reassess the child’s condition.

D. administer 0.02 mg/kg of atropine via rapid IO push and reassess

Answer 19

B. extubate immediately and ventilate with a bag-mask device.

Question 20

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. After applying high-flow oxygen, you should:

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

B. start an IV line and give adenosine while monitoring her cardiac rhythm.

C. transport immediately and establish vascular access en route to the hospital.

D. apply chemical ice packs to the child’s face to try to slow her heart rate.

Answer 20

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

Question 21

Which of the following statements regarding chest trauma in children is correct?

A. The pliability of children’s rib cages predisposes them to sternal fractures.

B. Signs of a pneumothorax are often more obvious in children than in adults.

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

D. Most cases of fatal chest trauma occur in children who fall more than 10 feet.

Answer 21

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

Question 22

Hemodynamically stable children with a wide QRS complex tachycardia:

A. should receive amiodarone.

B. are likely experiencing supraventricular tachycardia.

C. will respond to vagal maneuvers.

D. respond well to adenosine.

Answer 22

A. should receive amiodarone.

Question 23

Which of the following statements regarding croup is correct?

A. Croup is also referred to as acute bacterial subglottic stenosis.

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

C. Most cases of croup result in severe hypoxia and hypercarbia.

D. Hallmark signs of croup include high fever and a sore throat.

Answer 23

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

Question 24

Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia?

A. Pulse rate

B. P wave presence

C. QRS complex width

D. Systolic blood pressure

Answer 24

C. QRS complex width

Question 25

What forms of child maltreatment are often difficult to identify and may go unreported?

A. Emotional abuse and neglect

B. Neglect and physical abuse

C. Sexual and emotional abuse

D. Physical and emotional abuse

Answer 25

A. Emotional abuse and neglect

Question 26

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?

A. Blood pressure 130/68 mm Hg; pulse 70 beats/min; respirations 28 breaths/min

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

C. Blood pressure 106/66 mm Hg; pulse 80 beats/min; respirations 14 breaths/min

D. Blood pressure 90/50 mm Hg; pulse 110 beats/min; respirations 10 breaths/min

Answer 26

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

Question 27

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

A. the cords themselves are more posterior.

B. the area of the cricoid cartilage is narrow.

C. the epiglottis is floppy and U-shaped.

D. a sniffing position is difficult to achieve

Answer 27

C. the epiglottis is floppy and U-shaped.

Question 28

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:

A. administer high-flow oxygen, assess her cardiac rhythm, and establish IO access.

B. deliver two effective rescue breaths and assess her pulse for at least 5 seconds.

C. apply oxygen via pediatric nonrebreathing mask and attach a pulse oximeter.

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

Answer 28

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

Question 29

When preparing to intubate a small child, it is important to remember that:

A. the small child’s epiglottis is very rigid.

B. you should hyperventilate before intubating.

C. small children have a relatively large occiput.

D. prolonged attempts often cause tachycardia.

Answer 29

C. small children have a relatively large occiput.

Question 30

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. “What is the most likely physiologic abnormality?”

D. “Does the child require emergency treatment?”

Answer 30

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

Question 31

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 assessment, you should:

A. correct immediate life threats, perform a detailed head-to-toe exam, apply spinal precautions, and transport.

B. perform a focused physical exam, obtain baseline vital signs, apply spinal precautions, and transport.

C. apply spinal precautions, begin transport, and perform a rapid assessment while en route to the hospital.

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

Answer 31

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

Question 32

Which of the following is LEAST characteristic of an apparent life-threatening event in an infant?

A. A period of apnea

B. Loss of muscle tone

C. Pallor or cyanosis

D. Brief loss of a pulse

Answer 32

D. Brief loss of a pulse

Question 33

In contrast to adults, children

A. lose most body heat through the chest.

B. experience head injury less frequently.

C. have proportionately larger heads.

D. land on their feet when they fall.

Answer 33

C. have proportionately larger heads.

Question 34

Epiglottitis in children:

A. presents with a sudden onset of low-grade fever and dyspnea.

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

C. should be suspected if the child presents with diffuse wheezing.

D. should be confirmed by visualizing the larynx and epiglottis with a laryngoscope.

Answer 34

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

Question 35

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.

Answer 35

C. respiratory failure.

Question 36

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.

Answer 36

C. his or her central nervous system function.

Question 37

Upon arriving at the scene of a 4-year-old boy with 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:

A. allow the father to carry his son to the ambulance, where you can perform an initial assessment.

B. quickly build good rapport with the child by picking him up and asking him what his name is.

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

D. make physical contact with the child as soon as possible in order to identify any life threats.

Answer 37

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

Question 38

Bradydysrhythmias in children MOST often occur secondary to:

A. AV heart block.

B. drug ingestion.

C. severe hypoxia.

D. cardiac irritability.

Answer 38

C. severe hypoxia.

Question 39

The length-based resuscitation tape:

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

B. is generally more accurate than the weight given by a caregiver.

C. should not be relied upon for determining pediatric drug doses.

D. is only reliable in children who weigh less than 20 kg.

Answer 39

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

Question 40

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:

A. suction the child’s tracheostomy tube to rule out secretions as the problem.

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

C. assess the patency of the tracheostomy tube to determine if it is dislodged.

D. remove the tracheostomy tube and replace it with a similar-sized ET tube.

Answer 40

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

Question 41

The decision to transport an acutely ill child immediately or remain at the scene to perform additional interventions is LEAST dependent on:

A. expected benefits of treatment.

B. the child’s age and fear level.

C. your EMS system’s regulations.

D. transport time to the hospital.

Answer 41

B. the child’s age and fear level.

Question 42

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

Answer 42

C. Ventilatory support

Question 43

In contrast to upper airway emergencies, lower airway emergencies:

A. are generally associated with high-grade fever.

B. include laryngotracheobronchitis and diphtheria.

C. often present with more prominent retractions.

D. involve restriction of airflow during exhalation.

Answer 43

D. involve restriction of airflow during exhalation.

Question 44

An 8-year-old child:

A. should not be the initial historian regarding an illness.

B. is anatomically and physiologically similar to an adult.

C. is analytic but is not capable of abstract thought.

D. generally requires little reassurance and encouragement.

Answer 44

B. is anatomically and physiologically similar to an adult.

Question 45

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:

A. look inside the infant’s mouth using a tongue blade and penlight.

B. apply a pediatric nonrebreathing mask and transport expeditiously.

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

D. deliver five sharp back slaps between the infant’s shoulder blades.

Answer 45

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

Question 46

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:

A. 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.

B. 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.

C. 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.

D. 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.

Answer 46

C. 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 47

A 6-year-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned?

A. 36%

B. 30%

C. 21%

D. 27%

Answer 47

C. 21%

Question 48

Once you suspect that a child may have been abused, you should:

A. question the child in front of the caregiver.

B. carefully document what you see and hear.

C. apprise the caregiver of your suspicions.

D. transport the child to the hospital at once.

Answer 48

B. carefully document what you see and hear.

Question 49

The MOST appropriate airway management for an actively seizing child whose airway is not maintainable with positioning involves:

A. nasal airway insertion and suctioning as needed.

B. insertion of an oropharyngeal airway adjunct.

C. immediate endotracheal intubation.

D. 100% oxygen and a left lateral recumbent position.

Answer 49

A. nasal airway insertion and suctioning as needed.

Question 50

Unlike other types of shock, a child in cardiogenic shock would MOST likely present with:

A. an enlarged spleen.

B. a primary cardiac dysrhythmia.

C. unlabored tachypnea.

D. increased work of breathing.

Answer 50

D. increased work of breathing.