Chapter 32

The first month of life after birth is referred to as the:

neonatal period

Which of the following statements regarding a 3-month-old infant is correct?

A 3-month-old infant can distinguish a parent from a stranger.

A child may begin to show signs of separation anxiety as early as:

6 months

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler:

at the feet

Which of the following statements regarding preschool-age children is correct?

They can usually identify painful areas when questioned

When assessing an 8-year-old child, you should:

talk to the child, not just the caregiver

When assessing or treating an adolescent patient, it is important to remember that:

they usually do not wish to be observed during a procedure

Which of the following statements regarding a pediatric patient’s anatomy is correct?

Children have a larger, rounder occiput compared to adults

The normal respiratory rate for a newborn should not exceed ______ breaths/min.

60

Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the:

intercostal muscles are not well developed

Pale skin in a child indicates that the:

blood vessels near the skin are constricted

Signs of vasoconstriction in the infant or child include:

weak distal pulses

Which of the following statements regarding spinal injuries in pediatric patients is correct?

If the cervical spine is injured, it is most likely to be an injury to the ligaments because of rapid movement of the head

Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because they are:

proportionately larger and situated more anteriorly

The suture of the anterior fontanelle is typically closed by _____ months of age, and the suture of the posterior fontanelle is typically closed by _____ months of age.

18, 6

The purpose of the pediatric assessment triangle (PAT) is to:

allow you to rapidly and visually form a general impression of the child

The components of the PAT are:

appearance, work of breathing, and skin circulation

After using the PAT to form your general impression of a sick or injured child, you should:

perform a hands-on assessment of the ABCs

A normal level of consciousness in an infant or child is characterized by:

age-appropriate behavior, good muscle tone, and good eye contact

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes:

administering blow-by oxygen and transporting the child with her mother.

Early signs of respiratory distress in the pediatric patient include all of the following, EXCEPT:

cyanosis

Before assessing the respiratory adequacy of an semiconscious infant or child, you must:

ensure that the airway is patent and clear of obstructions

You are dispatched to a local elementary school for an injured child. As you approach the child, you note that he is lying at the base of the monkey bars. He is unresponsive and there are no signs of breathing. You should:

stabilize his head and check for a pulse

Before positioning an infant or child’s airway, you should:

place him or her on a firm surface

To ensure that the airway of an infant or small child is correctly positioned, you may have to:

place a towel or folded sheet behind the shoulders

When assessing an infant’s ventilation status, you should:

palpate the abdomen for rise and fall

All of the following are normal findings in an infant or child, EXCEPT:

head bobbing

Drawing in of the muscles between the ribs or of the sternum during inspiration is called:

retracting

A high-pitched inspiratory sound that indicates a partial upper airway obstruction is called:

stridor

When assessing the heart rate of a 6-month-old infant, you should palpate the brachial pulse or
________ pulse.

femoral

After determining that an infant or child has strong central pulses, you should:

not rule out compensated shock

After squeezing the end of a child’s finger or toe for a few seconds, blood should return to the area within:

2 seconds

Capillary refill time is MOST reliable as an indicator of end-organ perfusion in children younger than:

6 years

immediate transport is indicated for a child when he or she:

has a history suggestive of a serious illness

You respond to a skate park where a 10year-old male fell from his skateboard and struck his head on the ground; he was not wearing a helmet. He is responsive to painful stimuli only and has a large hematoma to the back of his head. After your partner stabilizes his head and opens his airway, you assess his breathing and determine that it is slow and irregular. His pulse is slow and bounding. You should:

assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center

If the situation allows, a child should be transported in a car seat if he or she weighs less than _____ lb.

40

Which of the following inquiries should you make in private when obtaining a SAMPLE
history from an adolescent patient?

sexual activity

The secondary assessment of a sick or injured child:

may not be possible if the child’s condition is critical

Blood pressure is usually not assessed in children younger than _____ years.

3

Which of the following represents a low normal systolic blood pressure for a 6-year-old child?

82 mm Hg

Early signs of respiratory distress in the child include:

restlessness

An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of inhalation by:

grunting

The MOST ominous sign of impending cardiopulmonary arrest in infants and children is:

bradycardia

A viral infection that may cause obstruction of the upper airway in a child is called:

croup

45. Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if he or she presents with:

drooling or congestion

Signs of an upper airway obstruction in an infant or child include all of the following, EXCEPT:

wheezing

A 6-year-old male presents with acute respiratory distress. His mother states that she saw him put a small toy into his mouth shortly before the episode began. The child is conscious,
obviously frightened, and is coughing forcefully. You should:

encourage him to cough, give oxygen as tolerated, and transport

Signs of a severe airway obstruction in an infant or child include:

an ineffective cough

A child who has no recent history of illness suddenly appears cyanotic and cannot speak after
playing with a small toy. You should:

perform abdominal thrusts

An 8-year-old female with a history of asthma continues to experience severe respiratory distress despite being given multiple doses of her prescribed albuterol by her mother. She is
conscious, but clearly restless. Her heart rate is 130 beats/min and her respiratory rate is 30 breaths/min. She is receiving high-flow oxygen via a non-rebreathing mask. You should:

be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital.

The MOST efficient way to identify the appropriately sized equipment for a pediatric patient is to:

use a length-based resuscitation tape measure

An oropharyngeal airway should not be used in children who have ingested a caustic or petroleum-based product because it may:

cause the child to vomit

When inserting an oropharyngeal airway in an infant or child, you should:

depress the tongue with a tongue depressor

Which of the following statements regarding the use of nasopharyngeal airways in children is
correct?

They are rarely used in infants younger than 1 year

If a nasopharyngeal airway is too long, it may:

stimulate the vagus nerve

Use of a nonrebreathing mask or nasal cannula in a child is appropriate ONLY if:

his or her tidal volume is adequate

Which of the following children would benefit the LEAST from a nonrebreathing mask?

an unresponsive 5yearold male with shallow respirations

When administering oxygen to a frightened child, it would be MOST appropriate to:

place oxygen tubing through a hole in a paper cup

When ventilating a pediatric patient with a bag-mask device, the EMT should:

block the pop-off valve if needed to achieve adequate chest rise

The MOST accurate method for determining if you are delivering adequate tidal volume to a
child during bag-mask ventilations is to:

observe the chest for adequate rise

Cardiac arrest in the pediatric population is MOST commonly the result of:

respiratory or circulatory failure

In contrast to adults, deterioration to cardiac arrest in infants and children is usually associated with:

severe hypoxia and bradycardia

A common cause of shock in an infant is:

dehydration from vomiting and diarrhea

Blood loss in a child exceeding _____ of his or her total blood volume significantly increases the risk of shock.

25%

Which of the following is the LEAST reliable assessment parameter to evaluate when
determining the presence of shock in infants and children?

blood pressure

Common causes of seizures in children include all of the following, EXCEPT:

hyperglycemia

Febrile seizures are MOST common in children between:

6 months and 6 years

In most children, febrile seizures are characterized by:

generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase.

Febrile seizures in a child:

may indicate a serious underlying illness

A 2-year-old female has experienced a seizure. When you arrive at the scene, the child is
conscious, crying, and clinging to her mother. Her skin is hot and moist. The mother tells you that the seizure lasted approximately 5 minutes. She further tells you that her daughter has no history of seizures, but has had a recent ear infection. You should:

attempt cooling measures, offer oxygen, and transport

Which of the following groups of people is associated with the lowest risk of meningitis?

females

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT:

sunken fontanelles

Children with N meningitides would MOST likely present with:

cherry-red spots or a purplish rash

The signs and symptoms of poisoning in children:

vary widely, depending on the child’s age and weight

When questioning the parent of a child who ingested a poisonous substance, which of the
following questions would be of LEAST pertinence?

Why did your child ingest the poison?

A 4-year-old female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she is conscious and alert, is breathing adequately, and has skin burns around her
mouth. You should:

monitor her airway and give oxygen

Which of the following is the MOST appropriate dose of activated charcoal for a 20kg child?

20 g

The MOST common cause of dehydration in pediatric patients is:

vomiting and diarrhea

An infant with severe dehydration would be expected to present with:

absent urine output

Signs of severe dehydration in an infant include all of the following, EXCEPT:

slowed level of activity

A 6-month-old male presents with 2 days of vomiting and diarrhea. He is conscious, but his
level of activity is decreased. The infant’s mother tells you that he has not had a soiled diaper in over 12 hours. The infant’s heart rate is 140 beats/min and his anterior fontanelle appears to be slightly sunken. You should suspect:

moderate dehydration

The EMT should be MOST concerned when a child presents with fever and:

a rash

Hyperthermia differs from fever in that it is an increase in body temperature:

caused by the inability of the body to cool itself

Submersion injuries in the adolescent age group are MOST commonly associated with:

alcohol

Which of the following statements regarding pediatric trauma is correct?

Children are more likely to experience diving-related injuries

When a child is struck by a car, the area of greatest injury depends MOSTLY on the:

size of the child and the height of the bumper upon impact

Which of the following is MORE common in children than in adults following a head injury?

nausea and vomiting

When immobilizing an injured child in a pediatric immobilization device, you should:

secure the torso before the head

Padding underneath the torso when immobilizing an injured child is generally not necessary if he or she is:

older than 8 to 10 years

The pediatric patient should be removed from his or her car seat and secured to an appropriate spinal immobilization device if:

the car seat is visibly damaged

When a child experiences a blunt chest injury:

the flexible ribs can be compressed without breaking

When a child experiences a blunt injury to the abdomen:

he or she can compensate for blood loss better than adults

Burns in children are commonly caused by all of the following, EXCEPT:

entrapment in a structural fire

Critical burns in children include:

partialt-hickness burns covering more than 20% of the body surface

Greenstick fractures occur in infants and children because:

their bones bend more easily than an adult’s

Effective methods for providing pain relief to a child with an extremity injury include:

positioning, ice packs, and emotional support

Which of the following findings is LEAST suggestive of child abuse?

consistency in the method of injury reported by the caregiver

Bruising to the _________ is LEAST suggestive of child abuse.

shins

Death caused by shaken baby syndrome is usually the result of:

bleeding in the brain

With regard to the legal implications of child abuse:

EMTs must report all suspected cases of child abuse

When caring for a female child who has possibly been sexually abused, you should:

have a female EMT remain with her if possible

Which of the following statements regarding sudden infant death syndrome (SIDS) is correct?

Most cases of SIDS occur in infants younger than 6 months

Which of the following is NOT a known risk factor of SIDS?

putting a baby to sleep on his or her back

Causes of infant death that may be mistaken for SIDS include all of the following, EXCEPT:

hyperglycemia

During the attempted resuscitation of an infant with suspected SIDS:

allow the family to observe if they wish