FISDAP EMT Practice Exam: OBSTETRICS &
PEDIATRICS - National EMS/NREMT Mastery
Test with Rationales
PART 1: OBSTETRIC EMERGENCIES (25 Questions)
NORMAL DELIVERY & IMMEDIATE NEWBORN CARE (Questions 1-5)
Scenario 1:
You are assisting with a full-term delivery in the ambulance. The infant's head delivers
and naturally rotates to the left. The mother reports a sudden gush of fluid with dark
green particulate matter. Your immediate priority is to:
A) Immediately suction the infant's mouth and nose before the body delivers
B) Clamp and cut the umbilical cord to prevent meconium aspiration
C) Check for a nuchal cord, then suction the mouth and nose
D) Tell the mother to stop pushing and transport immediately without completing
delivery
Correct Answer: C
All Correct Rationale:
Scene Size-Up & Impression: Normal delivery progression with meconium-stained fluid
(dark green = particulate meconium). Head has delivered and rotated normally.
,Protocol Citation: NREMT Obstetrics Skill Sheet, Step 4: "After delivery of the head,
check for nuchal cord. If present, attempt to reduce. Suction the mouth, then the nose
with a bulb syringe." AHA Neonatal Resuscitation Guidelines: Routine intrapartum
suctioning for meconium is no longer recommended; instead, clear airway if obvious
obstruction.
Action Analysis: The standard delivery sequence must continue regardless of
meconium presence. Checking for nuchal cord is the immediate priority after head
delivery to prevent compression. Suctioning follows to clear the airway before the first
breath. The meconium staining alerts you to prepare for possible resuscitation but does
not change the immediate delivery sequence.
Distractor Autopsy:
● A: Sequence Error. You must check for nuchal cord before suctioning; a tight cord
would prevent proper airway clearance.
● B: Protocol Violation. Cutting the cord before full delivery interrupts transition
circulation and is only indicated for a tight, non-reducible nuchal cord preventing
delivery.
● D: Dangerous Delay. Attempting to transport with a partially delivered infant risks
cord compression, head entrapment, and fetal hypoxia. Delivery must be
completed on scene.
Field Tip: "Head out, check cord, suction, then shoulders. Meconium means prepare for
resuscitation, don't panic."
Scenario 2:
You have just delivered a newborn who cried immediately and has good muscle tone.
The mother asks to hold the baby. The cord is still intact and pulsing. The appropriate
action is to:
A) Clamp and cut the cord immediately so the mother can hold the infant safely
,B) Keep the infant at the level of the vagina, dry and stimulate, then place skin-to-skin on
mother's chest
C) Hand the infant to the mother immediately to promote bonding
D) Suction the infant again before allowing any contact
Correct Answer: B
All Correct Rationale:
Scene Size-Up & Impression: Vigorous newborn (crying, good tone) with intact, pulsing
cord indicating ongoing placental transfusion.
Protocol Citation: NREMT Obstetrics Skill Sheet: "Dry, warm, and position the infant. If
vigorous, place skin-to-skin on mother's chest." WHO/Neonatal Resuscitation Program:
Delayed cord clamping (30-60 seconds) for vigorous infants improves iron stores and
circulation.
Action Analysis: The infant is vigorous and does not require immediate cord clamping.
Keeping the infant at vaginal level maintains placental blood flow while drying prevents
heat loss. Skin-to-skin contact promotes thermoregulation, bonding, and breastfeeding
initiation—all within EMT scope for a stable newborn.
Distractor Autopsy:
● A: Unnecessary Intervention. Immediate cord clamping in a vigorous infant
denies the benefit of delayed clamping and is not required for safety.
● C: Safety Risk. Handing the infant without drying risks hypothermia; without
ensuring cord slack, traction could occur.
● D: Unnecessary Procedure. Routine suctioning of vigorous infants is no longer
recommended and may cause bradycardia or delay bonding.
Field Tip: "Vigorous baby? Dry, warm, skin-to-skin. Let the cord pulse."
, Scenario 3:
During delivery, you note the anterior shoulder is delivered but the posterior shoulder is
stuck behind the pubic symphysis. The mother has been pushing for 60 seconds
without progress. This is:
A) A normal variation requiring continued maternal pushing
B) Shoulder dystocia requiring immediate McRoberts maneuver
C) Breech presentation requiring immediate transport
D) Umbilical cord prolapse requiring immediate cord clamping
Correct Answer: B
All Correct Rationale:
Scene Size-Up & Impression: Shoulder dystocia—diagnosed when shoulders fail to
deliver after the head, with anterior shoulder stuck behind pubic symphysis ("turtle sign"
may be present).
Protocol Citation: NREMT Obstetrics Skill Sheet, Complications Section: "For shoulder
dystocia: perform McRoberts maneuver (flex mother's thighs sharply against abdomen),
apply suprapubic pressure, and consider episiotomy if trained." ACOG Guidelines:
McRoberts is first-line intervention.
Action Analysis: Shoulder dystocia is an obstetric emergency with 5-7 minutes to
resolve before fetal hypoxia occurs. McRoberts maneuver (hyperflexing maternal
thighs) straightens the sacrum and rotates the symphysis pubis anteriorly, freeing the
impacted shoulder. This is the immediate, first-line intervention an EMT can perform.
Distractor Autopsy:
PEDIATRICS - National EMS/NREMT Mastery
Test with Rationales
PART 1: OBSTETRIC EMERGENCIES (25 Questions)
NORMAL DELIVERY & IMMEDIATE NEWBORN CARE (Questions 1-5)
Scenario 1:
You are assisting with a full-term delivery in the ambulance. The infant's head delivers
and naturally rotates to the left. The mother reports a sudden gush of fluid with dark
green particulate matter. Your immediate priority is to:
A) Immediately suction the infant's mouth and nose before the body delivers
B) Clamp and cut the umbilical cord to prevent meconium aspiration
C) Check for a nuchal cord, then suction the mouth and nose
D) Tell the mother to stop pushing and transport immediately without completing
delivery
Correct Answer: C
All Correct Rationale:
Scene Size-Up & Impression: Normal delivery progression with meconium-stained fluid
(dark green = particulate meconium). Head has delivered and rotated normally.
,Protocol Citation: NREMT Obstetrics Skill Sheet, Step 4: "After delivery of the head,
check for nuchal cord. If present, attempt to reduce. Suction the mouth, then the nose
with a bulb syringe." AHA Neonatal Resuscitation Guidelines: Routine intrapartum
suctioning for meconium is no longer recommended; instead, clear airway if obvious
obstruction.
Action Analysis: The standard delivery sequence must continue regardless of
meconium presence. Checking for nuchal cord is the immediate priority after head
delivery to prevent compression. Suctioning follows to clear the airway before the first
breath. The meconium staining alerts you to prepare for possible resuscitation but does
not change the immediate delivery sequence.
Distractor Autopsy:
● A: Sequence Error. You must check for nuchal cord before suctioning; a tight cord
would prevent proper airway clearance.
● B: Protocol Violation. Cutting the cord before full delivery interrupts transition
circulation and is only indicated for a tight, non-reducible nuchal cord preventing
delivery.
● D: Dangerous Delay. Attempting to transport with a partially delivered infant risks
cord compression, head entrapment, and fetal hypoxia. Delivery must be
completed on scene.
Field Tip: "Head out, check cord, suction, then shoulders. Meconium means prepare for
resuscitation, don't panic."
Scenario 2:
You have just delivered a newborn who cried immediately and has good muscle tone.
The mother asks to hold the baby. The cord is still intact and pulsing. The appropriate
action is to:
A) Clamp and cut the cord immediately so the mother can hold the infant safely
,B) Keep the infant at the level of the vagina, dry and stimulate, then place skin-to-skin on
mother's chest
C) Hand the infant to the mother immediately to promote bonding
D) Suction the infant again before allowing any contact
Correct Answer: B
All Correct Rationale:
Scene Size-Up & Impression: Vigorous newborn (crying, good tone) with intact, pulsing
cord indicating ongoing placental transfusion.
Protocol Citation: NREMT Obstetrics Skill Sheet: "Dry, warm, and position the infant. If
vigorous, place skin-to-skin on mother's chest." WHO/Neonatal Resuscitation Program:
Delayed cord clamping (30-60 seconds) for vigorous infants improves iron stores and
circulation.
Action Analysis: The infant is vigorous and does not require immediate cord clamping.
Keeping the infant at vaginal level maintains placental blood flow while drying prevents
heat loss. Skin-to-skin contact promotes thermoregulation, bonding, and breastfeeding
initiation—all within EMT scope for a stable newborn.
Distractor Autopsy:
● A: Unnecessary Intervention. Immediate cord clamping in a vigorous infant
denies the benefit of delayed clamping and is not required for safety.
● C: Safety Risk. Handing the infant without drying risks hypothermia; without
ensuring cord slack, traction could occur.
● D: Unnecessary Procedure. Routine suctioning of vigorous infants is no longer
recommended and may cause bradycardia or delay bonding.
Field Tip: "Vigorous baby? Dry, warm, skin-to-skin. Let the cord pulse."
, Scenario 3:
During delivery, you note the anterior shoulder is delivered but the posterior shoulder is
stuck behind the pubic symphysis. The mother has been pushing for 60 seconds
without progress. This is:
A) A normal variation requiring continued maternal pushing
B) Shoulder dystocia requiring immediate McRoberts maneuver
C) Breech presentation requiring immediate transport
D) Umbilical cord prolapse requiring immediate cord clamping
Correct Answer: B
All Correct Rationale:
Scene Size-Up & Impression: Shoulder dystocia—diagnosed when shoulders fail to
deliver after the head, with anterior shoulder stuck behind pubic symphysis ("turtle sign"
may be present).
Protocol Citation: NREMT Obstetrics Skill Sheet, Complications Section: "For shoulder
dystocia: perform McRoberts maneuver (flex mother's thighs sharply against abdomen),
apply suprapubic pressure, and consider episiotomy if trained." ACOG Guidelines:
McRoberts is first-line intervention.
Action Analysis: Shoulder dystocia is an obstetric emergency with 5-7 minutes to
resolve before fetal hypoxia occurs. McRoberts maneuver (hyperflexing maternal
thighs) straightens the sacrum and rotates the symphysis pubis anteriorly, freeing the
impacted shoulder. This is the immediate, first-line intervention an EMT can perform.
Distractor Autopsy:
