Paramedic National Test Prep: Obstetrics & Pediatrics, Questions and answers, Graded A+

Paramedic National Test Prep: Obstetrics & Pediatrics, Questions and answers, Graded A+ Document Content and Description Below Paramedic National Test Prep: Obstetrics & Pediatrics, Questions and answers, Graded A+ A 6-year-old boy fell off his bike and injured himself. His mother tells you that he was wearing a helmet at the time of the incident. The boy is sitting next to his mother on the couch, holding his left arm against his chest. He is conscious and alert, but appears scared. You do not see any obvious bleeding or other injuries. You should: A: manually stabilize his left arm and tell him who you are. B: ask mom to leave the room to keep the child calm. C: kneel down beside him and ask him what his name is. D: palpate the radial pulse in his left arm as you talk to him. - *C: kneel down beside him and ask him what his name is* Reason: Your initial approach to a sick or injured child is dependent upon two factors: the age of the child and the severity of his or her condition. There is no indication that the child in this scenario is severely injured; therefore, there is no need to rush in and begin an immediate hands-on assessment. Separating an obviously scared sick or injured 6-year-old child from his or her parent will only cause him or her further distress; the parent will probably not be too happy either. Before you lay hands on the child, position yourself at—or better yet, below—his level, ask him what his name is, and then tell him your name. This non-threatening approach will facilitate cooperation, build a rapport with the child, and gain his trust. Towering over any patient typically instills fear and anxiety and should be avoided whenever possible. After you have established a rapport with the child—and hopefully gained his trust—you should then proceed by asking him if you can look at his injured arm. If he allows this, proceed with your assessment, which includes manually stabilizing the injured arm and assessing distal circulation, sensory, and motor functions. You are assessing a 7-year-old boy who has signs of shock. What is the low normal systolic blood pressure for a child of this age? A: 95 to 100 mm Hg B: 80 to 85 mm Hg C: 70 to 80 mm Hg D: 85 to 95 mm Hg - *B: 80 to 85 mm Hg* Reason: When estimating the low normal systolic blood pressure for a child between 1 and 10 years of age, use this formula: (age [in years] × 2) + 70. Therefore, the low normal systolic blood pressure for a 7-year-old child would be 80 to 85 mm Hg (7 [age in years] × 2 = 14 + 70 = 84). When estimating the high normal systolic blood pressure for a child between 1 and 10 years of age, use this formula: (age [in years] × 2) + 90. Emergency care for a child with suspected anemia should include: A: correction of the underlying cause. B: multiple normal saline boluses. C: immunosuppressant drug therapy. D: supplemental oxygen and transport. - *D: supplemental oxygen and transport* Reason: Anemia, a decreased red blood cell count, cannot be treated definitively in the prehospital setting. Therefore, your focus should be to provide supportive care (ie, maintaining the ABCs, administering oxygen) and transporting the patient to the hospital where identification and correction of the underlying cause can be provided. Treatment for an unresponsive 18-month-old child with a severe foreign body airway obstruction includes: A: continuous abdominal thrusts until the obstruction is relieved or the child becomes pulseless. B: back slaps and chest thrusts, followed by an open cricothyrotomy to bypass the obstruction. C: CPR, followed by attempts to visualize and remove the obstruction under direct laryngoscopy. D: high-quality CPR, followed by insertion of a pediatric supraglottic or perilaryngeal airway device. - *C: CPR, followed by attempts to visualize and remove the obstruction under direct laryngoscopy* Reason: In a severe (complete) foreign body airway obstruction, no air exchange is occurring. All unresponsive patients with a severe airway obstruction should receive CPR. In the infant or child, perform 30 chest compressions (15 compressions if two rescuers are present), open the airway and visualize the mouth (remove the obstruction with a finger sweep only if you can see it), and attempt to ventilate. Repeat this procedure several times. If this is unsuccessful, continue chest compressions, visualize the airway with a laryngoscope (direct laryngoscopy), and attempt to remove the obstruction with Magill forceps if you can see it. Back slaps and chest thrusts are appropriate for a responsive infant with a severe airway obstruction, and abdominal thrusts are appropriate for responsive children and adults with a severe airway obstruction. The narrowest portion of a child's airway is at the cricoid ring; therefore, many airway obstructions occur at this level. As a result, a cricothyrotomy may not be successful because the cricothyroid membrane is above the level of the cricoid ring. Direct laryngoscopy is less invasive and should be attempted first. Supraglottic and perilaryngeal airway devices are of no benefit to patients with a severe airway obstruction because their function relies upon an unobstructed trachea. Which of the following statements regarding isoimmunization (Rh disease) is correct? A: Rh disease typically occurs during first-time pregnancies when a woman with Rh-positive blood becomes pregnant by a man with Rh-negative blood. B: Rh disease is most prominent with subsequent pregnancies and occurs when an Rh-negative mother becomes pregnant by a man with Rh-positive blood. C: If the mother's blood is Rh positive and her baby's blood is Rh negative, fetal blood can pass into the maternal circulation and produce maternal antibodies to the Rh factor. D: An Rh-positive woman who becomes pregnant by an Rh-negative man should receive RhoGAM, which prevents her body from attacking subsequent Rh-negative pregnancies. - *B: Rh disease is most prominent with subsequent pregnancies and occurs when an Rh-negative mother becomes pregnant by a man with Rh-positive blood* Reason: Rh factor is a protein found on the red blood cells (RBCs) of most people. When this factor is absent, the person is said to be Rh negative. When a woman who is Rh negative becomes pregnant by a man who has the factor (Rh positive) and the fetus inherits this factor, the fetal blood can pass into the mother's circulation and produce maternal antibodies (isoimmunization) to the factor. Rh disease is normally not a problem in first pregnancies; however, in subsequent pregnancies, the antibody will aggressively cross the placental barrier to attack the fetal RBCs, which the mother's body identifies as foreign proteins. This attack can result in death of the fetus or cause hemolytic disease (erythroblastosis fetalis) in a newborn. Newborns with hemolytic disease may present with jaundice, anemia, and hepatomegaly (an enlarged liver). RhoGAM (Rho[D] immune globulin) contains IgG anti-D (anti-RhD) antibodies, which bind and destroy fetal Rh D-positive RBCs that have passed through the placenta from the fetus to the maternal circulation. RhoGAM, an intramuscular (IM) injection, is given to Rh-negative women who become pregnant by Rh-positive men; it prevents the woman's body from attacking subsequent Rh-positive pregnancies. You are assessing the cardiac rhythm of a 6-year-old child. The rhythm is regular, the rate is 170 beats/min, the QRS complexes measure 0.11 seconds, and P waves are not visible. You should suspect: A: atrial fibrillation. B: sinus tachycardia. C: supraventricular tachycardia. D: ventricular tachycardia. - * D: ventricular tachycardia* Reason: The cardiac rhythm described fits the definition of ventricular tachycardia (V-Tach). V-Tach in children is characterized by a regular rhythm, a rate greater than 150 beats/min (often much faster), QRS complexes that are greater than 0.09 seconds in duration, and absent P waves. Supraventricular tachycardia (SVT) in children is characterized by a regular rhythm, a rate greater than 180 beats/min ( 220 beats/min in infants), QRS complexes that are equal to or less than 0.09 seconds in duration, and absent P waves (P waves may be present, but the ventricular rate is often too fast for them to be visible). In SVT, there is no beat-to-beat variability during patient movement. Sinus tachycardia in children is characterized by a regular rhythm, a rate less than 180 beats/min ( 220 beats/min in infants), QRS complexes that are equal to or less than 0.09 seconds in duration, and visible P waves (the rate can often bury the P waves). In sinus tachycardia, beat-to-beat variability is noted during patient movement. Atrial fibrillation in children is characterized by an irregularly irregular rhythm, a variable rate, QRS complexes that are less than or equal to 0.09 seconds in duration, and absent P waves. An infant or child with cardiogenic shock: A: often presents with increased work of breathing and an enlarged liver. B: requires an epinephrine infusion to increase myocardial contractility. C: classically has a bradycardic rhythm on the cardiac monitor. D: often needs a significant volume of IV fluid to improve perfusion. - *A: often presents with increased work of breathing and an enlarged liver* Reason: Cardiogenic shock (pump failure) is uncommon in children, but may be the result of congenital heart disease, myocarditis, or a dysrhythmia. Children in cardiogenic shock are listless or lethargic; are pale or mottled; and have cool, clammy skin. In addition, they also show signs of increased work of breathing owing to congestive heart failure and pulmonary edema. Impaired ventricular function causes an increase in central venous pressure; this manifests as an enlarged liver (hepatomegaly) and jugular venous distention (JVD). However, JVD is difficult to assess in infants; it is more appreciable in older children. In children with certain congenital heart diseases, their Sp02 may remain low despite high-flow oxygen; parents will often alert you of this. Unless you are certain of the diagnosis of cardiogenic shock (the child has congenital heart disease, is afebrile, and has no history of volume loss), err on the side of fluid resuscitation. Administer a single fluid bolus slowly, and monitor carefully to assess its effect. Increased work of breathing, a drop in Sp02, or worsening perfusion after a fluid bolus confirms your suspicion of cardiogenic shock. If your transport time is long, medical control may order a dopamine infusion to increase cardiac contractility and improve perfusion. Epinephrine has more pronounced chronotropic effects than dopamine, which may significantly increase cardiac oxygen consumption and demand; thus, it is not the drug of choice for patients with cardiogenic shock. After delivering a baby, you clear the airway and take measures to prevent hypothermia. As you assess the newborn, you note the presence of central cyanosis and a pulse rate of 90 beats/min. Treatment should include: A: intubation and tracheal suctioning. B: chest compressions. C: positive pressure ventilations. D: tactile stimulation. - *C: positive pressure ventilations* Reason: Central cyanosis (cyanosis of the trunk, neck, and head) and a pulse rate of less than 100 beats/min are both indicators of hypoxia in the newborn and should be treated with immediate positive-pressure ventilation (PPV). If the heart rate falls below 60 beats/min despite adequate PPV for 30 seconds, chest compressions should be started. Tactile stimulation (ie, flicking the soles of the feet, briskly rubbing the lateral thorax) is indicated if the newborn's initial respiratory effort is poor. Tracheal suctioning is indicated if there is thick, particulate meconium in the amniotic fluid and the newborn is not vigorous (eg, central cyanosis, poor muscle tone, bradycardia). You are transporting an intubated 7-year-old child who experienced a traumatic brain injury. Full spinal precautions have been applied, you are ventilating the child at a rate of 20 breaths/min, and an intraosseous catheter has been placed in the child's proximal tibia. Reassessment of the child's blood pressure reveals a reading of 70/40 mm Hg. You should: A: give a 20 mL/kg crystalloid bolus and reassess blood pressure. B: increase the rate of ventilation to 35 breaths/min. C: raise the head of the backboard to lower intracranial pressure. D: ventilate as needed to maintain an ETCO2 of 35-45 mm Hg. - *A: give a 20 mL/kg crystalloid bolus and reassess blood pressure* Reason: According to the Brain Trauma Foundation (BTF), hypotension in a child between 6 and 12 years of age exists when the systolic BP falls below 80 mm Hg. In the brain-injured child—or any patient for that matter—a single episode of hypotension can be disastrous because it results in a decrease in cerebral perfusion pressure (CPP), which leads to cerebral ischemia and potential brain damage. If the systolic BP falls below 80 mm Hg in a brain-injured child between 6 and 12 years of age, you should administer a 20 mL/kg isotonic crystalloid bolus and then reassess the blood pressure; additional fluid boluses may be needed. Ventilations in the brain-injured child should be guided to an end-tidal CO2 (ETCO2) of between 32 and 35 mm Hg. Routine hyperventilation should be avoided in the brain-injured patient unless signs of brain herniation are present. Signs of brain herniation include unresponsiveness, asymmetric or bilaterally fixed and dilated pupils, and decerebrate (extensor) posturing or no motor response to painful stimuli. If these signs are observed in the brain-injured child, brief periods of mild hyperventilation (30 breaths/min) may be beneficial. You respond to a daycare center for a 2-year-old female who is having a seizure. Upon arrival, you find the child lying in a bed. She is no longer seizing, but her level of alertness is decreased. Her skin is hot to the touch and she is tachypneic and tachycardic. According to a daycare center employee, she picked up the child after the seizure stopped, but the child began crying uncontrollably. You should suspect that this child has: A: bacterial meningitis. B: a viral infection. C: ingested a toxin. D: had a febrile seizure. - *A: bacterial meningitis* Reason: Your initial impression of this child may be that she experienced a febrile seizure. However, there are some key clinical signs that point to bacterial meningitis. Following a febrile seizure, the postictal state—if there is one—is generally short-lived, and the child's mental status has often returned to baseline by the time you arrive at the scene. Furthermore, most children who are sick or injured are consoled after being picked up. However, a child who begins to cry—or cries worse—upon being picked up is likely in severe pain due to traction being pulled on the inflamed meninges of the spinal cord; this is called paradoxical irritability. The presence of "hot" skin indicates a high fever, which is more common with bacterial infections. There is no evidence that a toxic ingestion occurred, although you should inquire about the possibility. Febrile seizures occur when a child's body temperature acutely rises; they are typically benign and do not cause neurologic damage. Bacterial meningitis, however, is a life-threatening infection of the central nervous system that can result in severe sepsis, permanent neurologic damage, or death. Febrile seizures and seizures with a fever are NOT the same thing. You receive a call for an 18-month-old female who is not breathing. When you arrive at the scene, emergency medical responders are providing effective two-rescuer CPR. According to the child's father, she had a cough and runny nose for the past several days, but when he tried to wake her up from her nap, she was unresponsive. When you apply the cardiac monitor, you will MOST likely see: A: asystole. B: ventricular fibrillation. C: tachycardic PEA. D: ventricular tachycardia. - *A: asystole* Reason: Primary ventricular dysrhythmias (ie, V-Fib, pulseless V-Tach) are uncommon in infants and children, although research has indicated that at some point during cardiopulmonary arrest, some children are in a "shockable" rhythm. Since most cases of cardiopulmonary arrest in the pediatric population are the result of respiratory failure, you would most likely encounter asystole or bradycardic PEA—signs of prolonged hypoxia—during the initial cardiac rhythm analysis. The child's prearrest history (ie, cough, runny nose) suggests respiratory failure as the precursor to her cardiopulmonary arrest. You are assessing an injured 4-year-old child and suspect that his injury was intentionally inflicted. Which of the following findings should increase your suspicion of this? A: the chi