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JBL Test Prep: Questions 323-368

Terms in this set (46)

#323:
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#324: 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. What should you suspect?
A) Preeclampsia
B) Gestational diabetes
C) A hypertensive emergency
D) A condition unrelated to pregnancy
A) Preeclampsia

Preeclampsia typically develops after the 20th 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 180 mm Hg.
#325:
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#326: Which of the following statements regarding pediatric anatomy is correct?
A) The child's trachea is more rigid and less prone to collapse.
B) The occiput is proportionately larger when compared to an adult.
C) Relative to the overall size of the airway, a child's epiglottis is smaller.
D) Airway obstruction is common in children of their large uvula.
B) The occiput is proportionately larger when compared to an adult.

Compared to adults, infants and small children have a proportionately larger head, specifically the occiput (back of the head). Therefore, when positioning an infant's or child's airway, padding in between the shoulder blades is often needed to maintain neutral alignment of the head. Infants and children are at risk for an airway obstruction because their entire airway is smaller, not because their uvula is large. An infant's or child's trachea is less rigid than an adult's; therefore, it collapses more easily during respiratory distress. Relative to the overall size of an infant or a child's airway, the epiglottis is larger; it is also floppier.
#327: You should assist with the delivery of the baby's head by:
A) carefully rotating its head to where it is facing up when it delivers.
B) placing the palm of your hand firmly against the back of the baby's skull.
C) grasping each side of the baby's head and gently pulling to facilitate delivery.
D) placing your fingers on the bony part of the skull and applying gentle pressure.
D) placing your fingers on the bony part of the skull and applying gentle pressure.

Assist with the delivery of the baby's head by placing the flat parts of your fingers on the bony part of the skull as it emerges from the vagina and then applying gentle pressure to avoid an explosive delivery. Avoid pressing your fingers on the anterior and posterior fontanelles (soft spots). Do not attempt to rotate the baby's head or pull on it to facilitate delivery; these actions clearly increase the risk of injury.
#328:
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#329: A newborn is considered to be premature if it:
A) weighs less than 6.5 pounds.
B) is born before 37 weeks' gestation.
C) is born to a heroin-addicted mother.
D) has meconium in or around its mouth.
B)
#330:
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#331: You receive a call for a 3-month-old infant who was found unresponsive by his mother when she woke up. The infant is pulseless and apneic and his skin is cold and pale. You should:
A) carefully inspect the environment in which the infant was found.
B) attempt full resuscitative measures, and transport the infant to the hospital.
C) perform CPR for 10 minutes and then contact medical control for further direction.
D) withhold chest compressions but apply the AED to analyze the infant's cardiac rhythm.
A) carefully inspect the environment in which the infant was found.

When managing a case of sudden unexpected infant death (SUID), you will be faced with three tasks: assessment and management of the infant, communicating with and providing emotional support to the family, and assessing the scene. It is clear that the infant in this scenario is deceased; therefore, resuscitation (in any form) would be futile and therefore is not indicated. Be very clear (yet tactful and empathetic) when advising the parents or caregivers of this. When assessing the scene, you should note the position in which the infant was found, any signs that suggest the infant was recently ill (eg, medications, humidifiers), and the general condition of the house (ie, clean or dirty). Assessment of the scene is an important part of the overall investigation, along with a post-mortem and review of the infant's medical history, in attempting to determine the cause of death.
#332: To maintain neutral alignment of an 18-month-old child's airway, you should:
A) hyperextend the head.
B) slightly flex the head.
C) place a rolled towel under the back of the head.
D) place padding in between the shoulder blades.
D) place padding in between the shoulder blades.

Infants and small children have proportionately large heads, specifically the occiput (back of the head). Therefore, it is often necessary to place padding in between the scapulae (shoulder blades) to ensure neutral alignment of the head. Padding behind the head places the child's head in the sniffing position, which is used to facilitate intubation. If the infant's or child's head is hyperextended, the large occiput may push the head forward, resulting in hyperflexion. Flexing the child's head (even slightly) can collapse the trachea, resulting in obstruction of the airway.
#333:
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#334: You and your partner are performing CPR on a 2-year-old woman in cardiac arrest. During your resuscitation attempt, you should:
A) hyperventilate her because she is severely hypoxic.
B) allow the chest to fully recoil in between compressions.
C) perform compressions and ventilations at a ratio of 30:2.
D) attach the AED pads after 5 minutes of high-quality CPR.
B) allow the chest to fully recoil in between compressions.

When performing two-rescuer CPR on an infant or a child, use a compression to ventilation ratio of 15:2 (30:2 for one-rescuer infant or child CPR), compress the chest by one-third the depth of the chest (about 2 inches), and allow the chest to fully recoil between compressions. Full recoil of the chest is essential to high-quality CPR; it maximizes the amount of blood that returns to the heart, which maximizes the amount of blood ejected from the left ventricle during chest compressions. Do not hyperventilate any patient; deliver each breath over 1 second while observing the chest for visible rise. Hyperventilation causes gastric distention and increases the risk of aspiration if regurgitation occurs. Furthermore, hyperventilation causes a reduction in blood return to the heart because it hyperinflates the lungs and puts pressure on the heart. Attach pediatric AED pads as soon as possible, analyze the child's cardiac rhythm, and deliver a single shock if indicated.
#335:
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#336: You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before, but had a miscarriage at 19 weeks. You should document her obstetric history as:
A) gravida 2, para 0.
B) gravida 1, para 1.
C) gravida 0, para 2.
D) gravida 2, para 1.
A) gravida 2, para 0.

Gravida is the term used to describe the number of times a woman has been pregnant, regardless of whether she carried the infant to term. Para is the term used to describe the number of times a woman has carried a fetus beyond 28 weeks, regardless of whether the infant was born dead or alive. Because your patient is currently pregnant and was pregnant once before, she is gravida 2. However, because she had a miscarriage with her first pregnancy (she did not carry beyond 28 weeks) and has not yet delivered the baby she is currently carrying, she is para 0. When she delivers, she will become gravida 2 and para 1.
#337:
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#338:
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#339:
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#340:
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#341: Which of the following is an abnormal finding?
A) Heart rate of 80 beats/min in a 3-month-old infant
B) Rapid, irregular breathing in a newly born infant
C) Systolic BP of 100 mm Hg in a 10-year-old child
D) Respiratory rate of 26 breaths/min in a 2-year-old child
A) Heart rate of 80 beats/min in a 3-month-old infant

The heart rate for an infant up to 3 months of age varies, depending on whether they are awake or asleep, but averages 140 beats/min. Therefore, a heart rate of 80 beats/min is grossly abnormal in this same age group and indicates bradycardia. Newborn infants normally have irregular breathing that ranges between 40 and 60 breaths/min. The systolic BP for a child between 6 and 12 years of age typically ranges between 90 and 115 mm Hg. The respiratory rate in a child between 1 and 3 years of age typically ranges between 24 and 40 breaths/min.
#342: A 29-year-old woman, who is 38 weeks' pregnant, presents with heavy vaginal bleeding, a blood pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies abdominal cramping or pain. What should you suspect?
A) Placenta previa
B) Abruptio placenta
C) Ruptured ovarian cyst
D) Ruptured ectopic pregnancy
B)
#343: A 5-year-old, 40-pound child was bitten by fire ants and is semiconscious. His breathing is labored and shallow, he has audible stridor, and his blood pressure is low. Which of the following would be the MOST appropriate treatment for him?
A) Ventilation with a bag-mask device and 0.15 mg epinephrine via auto-injector
B) Oxygen via nonrebreathing mask and 0.3 mg epinephrine via auto-injector
C) Ventilation with a bag-mask device and 0.3 mg epinephrine via auto-injector
D) Oxygen via nonrebreathing mask and 0.15 mg epinephrine via auto-injector
A
#344:
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#345:
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#346: During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should:
A) gently push the protruding arm back into the vagina.
B) encourage the mother to push and give her high-flow oxygen.
C) cover the arm with a sterile towel and transport immediately.
D) insert your gloved fingers into the vagina and try to turn the baby.
C) cover the arm with a sterile towel and transport immediately.

On rare occasions, the presenting part of the fetus is neither the head nor the buttocks, but a single arm or leg. This is called a limb presentation. You cannot successfully deliver such a presentation in the field. These infants usually must be delivered at the hospital. If you encounter a limb presentation, instruct the mother to stop pushing if she is experiencing a contraction; instead, instruct her to pant. Pushing may place pressure on the fetus, potentially causing injury. Cover the protruding limb with a sterile dressing or towel and transport immediately. Never try to push the limb back in, and never pull on it. Place the mother on her back, with head down and pelvis elevated. Because both mother and fetus are likely to be physically stressed in this situation, give the mother high-flow oxygen.
#347: After the baby's head delivers, it is usually tilted:
A) with the face up.
B) posteriorly, face down.
C) posteriorly, to one side.
D) anteriorly, with the chin up.
C) posteriorly, to one side.

As the baby's head begins to deliver, it is usually in a posterior, face-down position. After the head delivers completely, however, it usually tilts to the side in preparation for delivery of the shoulders. Remember to check for the presence of a nuchal cord (umbilical cord wrapped around the neck), and to suction the baby's mouth and nose as soon as its head delivers.
#348: A 3-year-old girl presents with respiratory distress. She is crying and is clinging to her mother. Her heart rate is 150 beats/min and her oxygen saturation is 89%. What should you do?
A) Administer blow-by oxygen via nonrebreathing mask.
B) Administer an inhaled bronchodilator via face mask.
C) Ventilate with a bag-mask device at 20 breaths/min.
D) Ventilate with a bag-mask device at 30 breaths/min.
A) Administer blow-by oxygen via nonrebreathing mask.

If a child presents with respiratory difficulty, the method of oxygen delivery depends on his or her mental status, respiratory effort, and heart rate. A child with respiratory distress has an increased work of breathing, is agitated and tachycardic, and is clinging to his or her parent. Oxygen for a child with respiratory distress should be given by the least threatening method. You should avoid further agitation of the child, which may cause deterioration of his or her condition. Give the child oxygen via the blow-by technique; allow the parent to hold the oxygen mask near the child's face. In this particular child, you have not assessed enough to determine if wheezing is present; therefore, an inhaled bronchodilator is not indicated at this time. If the child develops signs of respiratory failure, such as a decreased level of consciousness, signs of physical exhaustion, reduced tidal volume (shallow breathing), cyanosis, and bradycardia, you should ventilate with a bag-mask device attached to supplemental oxygen.
#349: A 4-year-old child has had several generalized seizures over the past 20 minutes, but never woke up in between the seizures. The child's skin is hot and flushed. What should you suspect?
A) febrile seizure
B) A focal motor seizure
C) An absence seizure
D) Status epilepticus
D) Status epilepticus

Status epilepticus is defined as a prolonged (greater than 20 minutes) seizure or multiple seizures without a return of consciousness in between seizures. A febrile seizure is caused by an abrupt rise in body temperature, usually due to a non-life-threatening infection (eg, middle ear infection). Most febrile seizures last less than 5 minutes, have resolved by the time EMS arrives at the scene, and are not followed by a postictal period. The child in this scenario, although febrile (hot, flushed skin), did not experience a seizure caused by fever alone; you should suspect other causes of fever and seizures, such as meningitis. Absence seizures are characterized by a blank stare and an absence of tonic-clonic motor activity. Like febrile seizures, absence seizures are usually of short duration and are not followed by a postictal period. A focal motor seizure is isolated to one part of the body, such as an extremity, but can progress to a generalized tonic clonic seizure.
#350: A 3-year-old child experienced a seizure that lasted about 10 minutes. He has a fever of 103.5°F, his skin is hot to the touch, and he has a rash on his trunk. What should you suspect?
A) Epilepsy
B) Meningitis
C) Intracranial hemorrhage
D) An allergic reaction
B) Meningitis

Febrile seizures and fever with seizures are not one in the same. Febrile seizures are caused by fever and fever alone. Conversely, fever with seizures could be something else. The rash on the child's trunk indicates possible sepsis, and should make the EMT suspect meningitis; a rash is not a common finding with simple febrile seizures. Rash and fever are not common findings with intracranial hemorrhage, and fever is not commonly associated with an allergic reaction.
#351: When caring for a woman who was sexually assaulted, the EMT should:
A) ask the patient if she wishes to change her clothes.
B) obtain a concise, detailed account of what happened.
C) place any articles of her clothing in a clean plastic bag.
D) focus any assessments on life-threatening conditions.
D) focus any assessments on life-threatening conditions.

As with any patient, your immediate assessment should focus on finding and treating immediately life-threatening injuries or conditions. Patients who were sexually assaulted may have evidence on (or in) them that could be crucial to bringing the perpetrator to justice. Therefore, you should discourage the patient from showering, urinating, or changing clothes. Again, your assessment should be focused on injuries that are life-threatening. Any articles of clothing that are removed should be placed in a paper bag; condensation can form in plastic bags and potentially destroy evidence. Documentation of the call should include information that is relevant to patient care; concise, detailed information regarding what happened will be gathered by law enforcement personnel.
#352:
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#353: A 4-year-old boy with a tracheostomy tube has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:
A) ventilate through the tracheostomy tube.
B) carefully suction the tracheostomy tube.
C) remove the tracheostomy tube and clean it.
D) place an oxygen mask over the tracheostomy tube.
B) carefully suction the tracheostomy tube.

Obstruction of a tracheostomy tube with thick secretions is a common, and potentially life-threatening, complication. You must first suction the tube to ensure that it is clear of secretions; this will often improve the patient's condition. Do not vigorously suction the tube, however, as this may induce or worsen bradycardia. Placing an oxygen mask over an obstructed tracheostomy tube will be of little to no benefit. If the child's condition does not improve following suctioning (eg, he remains bradycardic, his oxygen saturation remains low), attach a bag-mask device to the tracheostomy tube and begin ventilating him. Do not remove the tracheostomy tube; this is beyond the EMT's scope of practice, plus there is no guarantee that you will be able to replace it.
#354: Oxygen and other nutrients are transferred to the developing fetus via the:
A) umbilical vein.
B) amniotic fluid.
C) umbilical arteries.
D) mother's liver.
C
#355: A newborn has a heart rate of 130 beats/min, cyanosis of 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. You should assign an APGAR score of:
A) 7
B) 8
C) 9
D) 10
C) 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 grimace/irritability. If it resists attempts to straighten its hips and knees, a score of 2 is assigned for activity/muscle tone. If its respirations are rapid, a score of 2 is assigned. Based on these parameters, the newborn in this scenario would receive an APGAR score of 9.
#356:
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#357: A prolapsed umbilical cord is dangerous because the:
A) cord might pull the placenta from the uterine wall during delivery.
B) mother may die of hypoxia due to compromised placental blood flow.
C) cord may be wrapped around the baby's neck, causing strangulation.
D) baby's head may compress the cord, cutting off its supply of oxygen.
D) baby's head may compress the cord, cutting off its supply of oxygen.

A prolapsed umbilical cord, a condition in which a portion of the umbilical cord delivers before the baby, is a dangerous condition; the baby's head may compress the cord, cutting off its own supply of oxygen. Therefore, when a prolapsed umbilical cord is discovered, it is important to take immediate action. Place the mother in a position in which her hips are elevated. It may be necessary to insert your gloved fingers into the vagina and lift the baby's head off of the cord. A nuchal cord occurs when the umbilical cord is wrapped around the baby's neck; it is relatively common and is usually easily treated by simply sliding the cord from around the baby's neck. A nuchal cord and a prolapsed umbilical cord usually do not occur at the same time.
#358:
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#359: 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 younger 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).
#360: Which of the following findings should make the EMT suspect an ectopic pregnancy in a woman who reports abdominal pain?
A) Menstrual period began 3 days ago
B) Spontaneous abortion 6 months ago
C) Recent pelvic inflammatory disease
D) Cesarean section scar on the abdomen
C) Recent pelvic inflammatory disease

Pelvic inflammatory disease and scarring of the fallopian tubes are risk factors for ectopic pregnancy. There is no correlation between past Cesarean deliveries or spontaneous abortions and an increased risk of ectopic pregnancy. It is important to remember that acute abdominal pain in any female of childbearing age, especially with a missed menstrual period, is an ectopic pregnancy until proven otherwise.
#361: A 5-year-old child has burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned?
A) 45%
B) 54%
C) 63%
D) 72%
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.
#362: The MAIN reason why small children should ride in the backseat of a vehicle is because:
A) they are much less likely to be ejected from the vehicle.
B) the back of the front seat will provide a cushion during a crash.
C) they can experience severe injury or death if the air bag deploys.
D) their legs are highly prone to injury from striking the dashboard.
C) they can experience severe injury or death if the air bag deploys.

Children younger than 12 years should ride in the backseat of a vehicle, preferably in the middle, and be restrained in a device that is appropriate for their size. Merely placing the child in the backseat does not reduce the risk of ejection; the child must be properly restrained. Young children, especially those restrained in a child safety seat, may be critically injured or killed by air bags if they are riding in the front passenger seat of a car. This occurs because the child safety seat positions the child too close to the air bag; the force of the deploying air bag may cause severe head and spinal trauma.
#363: After 30 seconds of positive pressure ventilation, a newborn's heart rate is 50 beats/min and its face and trunk are cyanotic. The EMT should:
A) give blow-by oxygen.
B) begin chest compressions.
C) increase the ventilation rate.
D) resuction the mouth and nose.
B) begin chest compressions.

Immediate treatment for newborn bradycardia (heart rate less than 100 beats/min) involves positive pressure ventilation. If the heart falls below 60 beats/min despite positive pressure ventilation, you should begin chest compressions. Central cyanosis (cyanosis to the face and trunk) and severe bradycardia indicate significant hypoxia; if immediate corrective action is not taken, cardiopulmonary arrest could follow. Blow-by oxygen is appropriate for newborns with central cyanosis who are otherwise breathing adequately and have a heart rate that is greater than 100 beats/min. The mouth and nose should be suctioned if secretions are present. Increasing the ventilation rate could cause more harm secondary to increased intrathoracic pressure.
#364: A 32-year-old woman who is 36 weeks' pregnant reports a sudden onset of severe abdominal pain, which she describes as a tearing sensation, and vaginal bleeding. Her medical history includes hypertension and she admits to using cocaine. Which of the following should you suspect?
A) The umbilical cord is wrapped around the baby's neck.
B) The placenta has implanted over the cervical opening.
C) Excessive fetal movement has torn the amniotic sac.
D) The placenta has detached from the wall of the uterus.
D) The placenta has detached from the wall of the uterus.

Given the patient's presentation and medical history, you should suspect that she is experiencing abruptio placenta. This condition occurs when the placenta acutely detaches from the uterine wall. Signs and symptoms include acute, severe abdominal pain that is often described as a ripping or tearing sensation; vaginal bleeding; and signs of shock. Risk factors include hypertension, abdominal trauma, and cocaine use, among others. Cocaine is a potent vasoconstrictor, and frequent use can cause vascular injury. In pregnant patients, this vascular injury could cause premature placental separation. Placenta previa occurs when part or all of the placenta implants over the cervical opening; vaginal bleeding is common, but abdominal pain is not. Nuchal cord (cord wrapped around the baby's neck) is discovered during delivery; vaginal bleeding and abdominal pain do not occur with this condition. A ruptured or torn amniotic sac would present with clear vaginal discharge; vaginal bleeding and abdominal pain do not occur with this condition.
#365:
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#366: Upon assessing a newborn, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What should you do?
A) Initiate positive pressure ventilations.
B) Provide blow-by oxygen with oxygen tubing.
C) Assess the newborn's skin condition and color.
D) Perform chest compressions at 120 per minute.
A) Initiate positive pressure ventilations.

Positive pressure ventilations are indicated in the newborn if he or she is apneic or has gasping respirations, if the heart rate is less than 100 beats/min, or if central cyanosis persists despite the delivery of blow-by oxygen. Chest compressions are indicated if the heart rate is less than 60 beats/min, despite adequate positive pressure ventilation. In many cases, the newborn's heart rate will increase to greater than 100 beats/min with adequately performed positive pressure ventilation. If the newborn is breathing adequately and has a heart rate greater than 100 beats/min, you should proceed to assess skin color.
#367:
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#368: After drying, warming, and suctioning a newborn's mouth and nose, assessment reveals central cyanosis, a weak cry, and a heart rate of 60 beats/min. What should you do?
A) Clamp and cut the umbilical cord and transport at once.
B) Begin chest compressions and reassess after 30 seconds.
C) Resuction the mouth and nose and reassess the heart rate.
D) Ventilate with a bag-mask device at 40 to 60 breaths/min.
D) Ventilate with a bag-mask device at 40 to 60 breaths/min.

The initial treatment for a cyanotic and bradycardic newborn is positive pressure ventilation (PPV). Ventilate the newborn with a bag-mask device at a rate of 40 to 60 breaths/min and then reassess the heart rate after 30 seconds. If the heart rate is below 60 beats/min after 30 seconds of adequate PPV, you should begin chest compressions. The umbilical cord should not be clamped and cut until it stops pulsating and the newborn is breathing adequately. Unnecessary suctioning can worsen hypoxia and bradycardia and should be avoided.
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