SOLVED

31) Your patient is a four-year-old male with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparent’s farm. On your arrival, you learn that the patient has been having increasing respiratory distress for 20 minutes. The patient has pale, cool, moist skin with cyanosis of his nail beds. He is sitting on the edge of a kitchen chair, leaning forward to breathe. He has a respiratory rate of 50 with the use of accessory muscles and a heart rate of 130. He is anxious and unable to speak more than one or two words at a time. Auscultation of the chest reveals scattered wheezing. As you prepare to treat the patient, he becomes drowsy and his respiratory rate decreases to 12. You can no longer auscultate his wheezes. Which of the following best explains the significance of the change in your patient’s status? A) Because of decreased respiratory, cardiovascular, and stored energy reserves, the child’s muscles have fatigued and he is now in respiratory failure. B) The child has realized that you are going to treat him, and he is more relaxed than he was initially and has stopped hyperventilating. C) This makes no sense in an asthma patient, and it is likely that the child ingested or was exposed to a toxic substance, which explains the decreased level of consciousness. D) The absence of wheezing indicates that bronchospasm has resolved spontaneously and the child now only needs supplemental oxygen. 32) All of the following are associated with an increased incidence of SIDS, EXCEPT: A) female infant. B) age between two and four months. C) low birth weight. D) fall and winter months. 33) Your patient is a 13 year-old male drowning victim. He was initially in cardiac arrest with a pulseless, wide-complex bradycardia. He is intubated and being ventilated with supplemental oxygen. After CPR and intubation, the patient is now in ventricular tachycardia with a weak radial pulse. Which of the following would be an appropriate treatment for this patient? A) Amiodarone, 5 mg/kg IV push B) Lidocaine, 3 mg/kg IV bolus, followed by a 3 mg/minute drip C) Procainamide, 20 mg per minute, up to 800 mg D) Synchronized cardioversion starting at 0.5–1.0 joules/kg 34) Which of the following is the most common result of blunt chest trauma in children? A) Anterior flail segment B) Intrathoracic injury without external bruising of the thorax C) Associated spinal cord injury D) Fractured ribs with a high incidence of hemothorax 35) Which of the following best explains the cause of Sudden Infant Death Syndrome (SIDS)? A) Congenital absence of the Hering-Breuer reflex B) Considered when other causes of death have been ruled out C) Diffuse axonal injury occurring due to “shaken baby syndrome” D) Aspiration of vomited formula or breast milk 36) Your patient is a 12-year-old male who was accidentally shot with a handgun by a playmate. You note one gunshot wound to the right upper quadrant of the abdomen but no exit wound. The patient is pale, with cool, mottled extremities. He is lethargic, has a heart rate of 140, a respiratory rate of 30, and a blood pressure of 92/60. Which of the following can be said for certain about this patient? A) He is in compensated shock. B) He is in irreversible shock. C) He is in decompensated shock. D) It is not possible to say anything for certain about this patient. 37) If unable to establish an airway by any other means, in which of the following patients would needle cricothyrotomy be contraindicated? A) Three-month-old infant B) Six-month-old infant C) Both of the above D) Neither of the above 38) Your patient is a five-year-old male with an allergic reaction to peanuts. He has hives, complains of nausea, and is wheezing. You have already placed the patient on an albuterol treatment with supplemental oxygen. Due to the speed with which the patient’s signs and symptoms developed after exposure to the antigen, you will be starting an intravenous line for medication administration and possible fluid infusion. Which of the following is the best way to communicate with the patient regarding the IV? A) Just before placing the IV, tell him you must put a needle in his arm but that it is for giving him medicine that will make him feel better. Tell him it will hurt, but only for a second. B) Tell him you are going to “start an IV in his arm” but that it won’t hurt a big boy like him. C) Be honest. Tell him it will hurt but that it’s okay if he wants to cry. Let him know as far in advance as possible so he has a chance to accept the idea. D) Tell him nothing. Have a parent distract him while you quickly place the IV 39) You are in the home of a 28-month-old male whose mother called EMS because he fell while running and struck his forehead on the corner of a table. The patient has a hematoma on his forehead but seems to have forgotten about the injury and is entertaining himself with some building blocks. Which of the following is the best way to begin assessing the child? A) To avoid upsetting him, observe him from a distance and make no physical contact with him. B) Pick him up from the floor with a cheerful, “Hey partner!” C) Sit next to him and ask if you can play with some of his toys. D) Ask his mother to pick him up and hold him on her lap. 40) Which of the following may compromise prehospital ventilation in the pediatric patient? A) Cricoid pressure B) Hyperextending the neck C) Using 100 percent oxygen for more than 30 minutes D) Placing a folded towel under the shoulders