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EMT TESTPREP OBSTETRICS AND PEDIATRICS EXAM|
100 QUESTIONS WITH CORRECT ANSWERS|A +
GRADED
A 5-year-old child experienced partial-thickness burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned? A: 45% B: 63% C: 72% D: 54% A: 45% According to the pediatric rule of nines, the child's head represents 18% of his or her total body surface area (TBSA), the anterior chest represents 9% (the entire anterior torso [chest and abdomen] represents 18%), and each entire upper extremity represents 9%. Therefore, burns to the head, anterior chest, and both upper extremities cover 45% of the child's TBSA. The rule of nines is modified for infants and children. The head accounts for 18% of the child's TBSA (9% in adults) because the head is proportionately larger than an adult's. The lower extremities
account for 13.5% (some references cite 14%) of the child's TBSA (18% in adults) because the child's lower extremities are proportionately smaller than an adult's. The 5-minute Apgar assessment of a newborn reveals a heart rate of 130 beats/min, cyanosis to the hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists attempts to straighten its legs. These findings equate to an Apgar score of: A: 9 B: 7 C: 10 D: 8 A: 9 The Apgar score, which is obtained at 1 and 5 minutes after birth (and every 5 minutes thereafter), assigns numbers (0, 1, or 2) to the following five areas: Appearance, Pulse, Grimace, Activity, and Respirations. A score of 1 is assigned for appearance if the newborn's body is pink, but its hands and feet remain blue. If its heart rate is greater than 100 beats/min, it receives a score of 2 for the pulse. If it cries and tries to move its foot away when soles of its feet are flicked, it is assigned a score of 2 for
Following delivery of a newborn and placenta, you note that the mother has moderate vaginal bleeding. The mother is conscious and alert and her vital signs are stable. Treatment for her should include: A: treating her for shock and providing rapid transport. B: massaging the uterus if signs of shock develop. C: carefully packing the vagina with sterile dressings. D: administering oxygen and massaging the uterus. D: administering oxygen and massaging the uterus. Postpartum bleeding is most effectively controlled by massaging the fundus (top) of the uterus. Uterine massage stimulates the pituitary gland to secrete a hormone called oxytocin, which constricts the blood vessels in the uterus and helps stops the bleeding. Do not wait for signs of shock to develop before performing uterine massage. The goal is to control the postpartum bleeding in order to prevent shock. Administer supplemental oxygen as needed, begin transport, and monitor her for signs of shock (ie, tachycardia, pallor, diaphoresis, tachypnea) en route. Vaginal bleeding is never treated by placing anything inside the vagina; this action increases the risk of maternal infection.
You will know that the third stage of labor has begun when: A: the baby's head is visible at the vaginal opening. B: the placenta has delivered. C: the entire baby has delivered. D: the mother's contractions become regular. C: the entire baby has delivered. Labor is divided into three stages. The first stage begins with the onset of contractions and ends when the cervix is fully dilated. In the field, the EMT cannot determine the degree of cervical dilation, so the appearance of the baby's head at the vaginal opening (crowning) is used to mark the end of the first stage of labor. As the first stage of labor progresses, the mother's contractions become more frequent and regular. The second stage of labor begins with full cervical dilation (or in the field, crowning) and ends when the baby is completely delivered. The third stage of labor begins with the birth of the baby and ends when the placenta (afterbirth) has delivered. Which of the following signs is MOST indicative of inadequate breathing in an infant?
A: have a female EMT perform the assessment. B: recognize that the patient is a walking crime scene. C: ensure that all life-threatening injuries are treated. D: discourage her from showering or changing clothes. C: ensure that all life-threatening injuries are treated. Victims of sexual assault can present a unique challenge for the EMT. The patient is a walking crime scene; potential evidence could be on or in him or her. Furthermore, many victims will not want to be assessed by a member of the opposite sex. Like any other patient, however, your first priority is to assess for and treat life-threatening injuries or conditions and begin immediate transport if indicated. If possible, an EMT of the opposite sex should assess the patient. To help preserve potential evidence, discourage the patient from showering, douching, going to the bathroom, or changing clothes. Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. You should: A: immediately resuction its mouth and nose. B: begin ventilations with a bag-mask device.
C: start CPR if the heart rate is less than 80 beats/min. D: gently flick the soles of its feet for up to 60 seconds. B: begin ventilations with a bag-mask device. The initial steps of newborn resuscitation, which are performed on all newborns following delivery, include drying, warming, positioning, suctioning, and tactile stimulation. If the newborn remains apneic after the initial steps of resuscitation, or has a heart rate less than 100 beats/min, you should begin positive-pressure ventilations (PPV) with a bag-mask device at a rate of 40 to 60 breaths/min. Continued tactile stimulation (eg, flicking the soles of the feet, rubbing the lateral thorax) of an apneic newborn wastes time; you must ventilate at once. If the newborn's heart rate is less than 60 beats/min despite effective PPV, you should begin chest compressions. A 3-year-old boy is found to be in cardiopulmonary arrest. As you begin one-rescuer CPR, your partner prepares the AED. The appropriate compression to ventilation ratio for this child is: A: 30: B: 3: C: 5: D: 15:
Do not assume that a child will simply allow you to administer oxygen to him or her as you would to an adult. The child in this scenario, who is in respiratory distress and is mildly hypoxemic (SpO2 of 93%), should receive supplemental oxygen; however, it should be given in a nonthreatening manner. Agitating a sick or injured child causes an increase in oxygen consumption and demand, which may cause the child's condition to deteriorate. In this scenario, ask the child's mother to hold an oxygen mask near the child's face (blow-by oxygen). Closely monitor her condition and be prepared to assist her ventilations with a bag-mask device if she deteriorates. An oxygen flow rate of 6 to 8 L/min is too low for a nonrebreathing mask; a flow-rate of 12 to 15 L/min should be used. Do NOT use a flow-restricted, oxygen-powered ventilation device (FROPVD) on any child; doing so may cause severe gastric distention and lung injury. Allow the child to assume a position of comfort and transport. Which of the following assessment parameters is a more reliable indicator of perfusion in infants than adults? A: Pulse quality B: Capillary refill C: Blood pressure D: Level of orientation B: Capillary refill
Capillary refill time (CRT) is a reliable indicator of perfusion in children less than 6 years of age. When the capillary bed (eg, fingernail, forehead) is blanched, blood should return to the area in less than 2 seconds. Because peripheral perfusion decreases with age, CRT is a less reliable indicator of perfusion in older children and adults. Note that cold temperatures can affect CRT. Pulse quality is reliable in patients of any age; weak or absent peripheral pulses indicate poor perfusion in anyone. Blood pressure is the least reliable indicator of perfusion in patients of any age; it usually does not fall until the body's compensatory mechanisms have failed. Assessing an infant's level of orientation is not possible; infants do not know who they are, where they are, what happened, and what day it is. When assessing an infant's mental status, note his or her level of alertness and interactivity (eg, tracking with his or her eyes, crying versus quiet). A child typically begins to develop stranger anxiety when he or she is a/an: A: infant. B: toddler. C: neonate. D: preschooler. B: toddler.
meningitis are at risk for seizures (convulsions), usually due to increased intracranial pressure (ICP) and/or high fever; therefore, you must continually monitor the child's condition en route to the hospital and be prepared to treat seizures if they occur. Remember that seizure deaths are caused by cerebral hypoxia. You should also be alert for vomiting, which can jeopardize the airway. Hypotension can occur in patients with sepsis and should also be of concern; however, seizures directly compromise adequate ventilation and oxygenation. The function of the uterus is to: A: provide oxygen and other nutrients to the fetus. B: provide a cushion and protect the fetus from infection. C: dilate and expel the baby from the cervix. D: house the fetus as it grows for 40 weeks. D: house the fetus as it grows for 40 weeks. The uterus is a muscular organ where the fetus grows for 37 to 42 weeks (average of 40 weeks). It is responsible for contracting during labor, which in conjunction with dilation of the cervix (the opening of the uterus), expels the baby from the uterus into the birth canal. The placenta is the organ of exchange that delivers oxygen and other nutrients from the mother to the fetus and returns metabolic waste products from the fetus to the mother. The amniotic sac, also called the
bag of waters, provides a cushion for the developing fetus and helps protect it from infection. The purpose of the pediatric assessment triangle is to: A: identify if the child has a medical condition or a traumatic injury. B: form a general impression of the child without touching him or her. C: detect immediate life threats through a quick hands-on assessment. D: determine if the child's problem is respiratory or circulatory in nature. B: form a general impression of the child without touching him or her. The pediatric assessment triangle (PAT) is a structured assessment tool that allows you to rapidly form a general impression of the infant's or child's condition without touching him or her. The intent is to provide a "first glance" assessment to identify the general category of the child's physiologic problem and to establish urgency for treatment and/or transport. The PAT is a visual assessment of the child before performing a hands-on assessment; it consists of three elements: appearance (muscle tone and mental status), work of breathing, and circulation to the skin. The only equipment required for the PAT are your own eyes and ears.
A: Pancreas B: Spleen C: Liver D: Kidney B: Spleen Abdominal trauma commonly occurs in children as the result of motor vehicle versus pedestrian accidents. The contusions over the left upper quadrant and the signs of shock suggest significant injury to the spleen. The liver lies in the right upper quadrant, and the pancreas and kidneys lie in the retroperitoneal space. Although the exact injury cannot be determined in the field, you must treat the patient for shock and provide rapid transport. A 30-year-old woman is 22 weeks pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. She is MOST likely experiencing: A: a condition unrelated to pregnancy. B: preeclampsia.
C: gestational diabetes. D: a hypertensive emergency. B: preeclampsia. Preeclampsia typically develops after the twentieth week of gestation; it most commonly occurs in primigravida (first-time pregnancy) women. Preeclampsia is characterized by a headache, visual disturbances, edema to the hands and feet, anxiety, and persistent hypertension. Left untreated, preeclampsia can lead to seizures (eclampsia). Gestational diabetes, a condition in which the pregnancy hormones estrogen and progesterone impair the effects of insulin (insulin resistance), is characterized by an increase in the patient's blood glucose level (BGL); there is no mention of the patient's BGL in this scenario. A hypertensive emergency usually occurs when the systolic blood pressure acutely rises above 160 mm Hg. After clearing the airway of a newborn who is not in distress, it is MOST important for you to: A: obtain an APGAR score. B: apply blow-by oxygen. C: keep the newborn warm. D: clamp and cut the cord.
D: positioning the mother with her hips elevated, administering high- flow oxygen, and providing transport. D: positioning the mother with her hips elevated, administering high- flow oxygen, and providing transport. Limb presentations represent a dire emergency for the newborn and do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the birth canal and remove pressure from the umbilical cord. Administer high-flow oxygen to the mother, cover the protruding limb with a sterile sheet (or any clean sheet, if a sterile sheet is not available), and transport immediately. Do NOT pull on the protruding limb as this may cause injury to the newborn. You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be: A: preparing to treat her for a febrile seizure. B: determining if the child has a history of croup. C: assessing the need for ventilation assistance. D: taking her temperature to see how high it is.
C: assessing the need for ventilation assistance. The child is clearly experiencing respiratory distress and probably has croup (laryngotracheobronchitis), a viral upper airway infection. The presence of stridor (high-pitched sound heard during inhalation) indicates swelling of the upper airway. Your most immediate concern should be assessing the adequacy of her breathing and determining if ventilation assistance is necessary. If signs of respiratory failure are present (eg, signs of physical exhaustion, bradycardia, bradypnea [slow respirations]), you must begin assisting her ventilations with a bag- mask device; otherwise, she will likely deteriorate and develop cardiac arrest. She may experience a febrile seizure if her fever acutely spikes; although this is a concern, it is not the most immediate concern in a child with an airway or breathing problem. Seizures in children MOST often are the result of: A: an abrupt rise in body temperature. B: a life-threatening infection. C: a temperature greater than 102°F. D: an inflammatory process in the brain. A: an abrupt rise in body temperature.
