SOLVED

41) Your patient is a seven-month-old child whose mother called because he suddenly became lethargic and pale. Your assessment reveals that he is in a supraventricular tachycardia at a rate of 244 per minute. The patient’s extremities are mottled and his capillary refill time is 4 seconds. Which of the following is the best treatment plan for this patient? A) Adenosine, 0.1 mg/kg rapid IV push, repeated at 0.2 mg/kg if unsuccessful B) Verapamil, 0.3 mg/kg over 3 to 5 minutes C) Diltiazem, 0.25 mg/kg over 2 minutes D) Synchronized cardioversion beginning at 0.5–1.0 joules/kg 42) Which of the following is TRUE of cervical spine injuries in children? A) They are more often due to penetrating trauma than in adults. B) The heavier head of the child increases the incidence of cervical distraction injuries. C) Pediatric patients do not require cervical spine immobilization unless neurologic deficit is present on assessment. D) The pediatric cervical spine should be immobilized in a position of moderate hyperextension. 43) Your patient is a three-year-old female who has had vomiting and diarrhea for 24 hours. Which of the following is the best way to gain her cooperation when assessing her vital signs? A) Avoid explanations, and finish the assessment quickly. B) Ask if you can check her doll to “see how the doll is feeling” before repeating the same procedures on the child. C) Say, “I’m going to take your blood pressure.” D) Explain that you want to give her arm a hug. 44) Your patient is a five-year-old female who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of the following is the best course of action? A) Start an IV for administration of succinylcholine and midazolam for RSI, intubate the trachea, and ventilate at a rate of 24 to 28 per minute. B) Provide high-concentration oxygen by nonrebreather mask, start an IV and repeat a full set of vital signs every 5 minutes en route to the emergency department. C) Inspect the hypopharynx for edema and be prepared for immediate surgical cricothyrotomy if airway obstruction is imminent. D) Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her. 45) Your patient is a nine-year-old female who was injured when her hand slipped into a hole in the ground while she was turning a cartwheel. She is upset and has an obvious deformity of her left humerus. She asks you if her arm is broken. Which of the following is the best response? A) “I’m sure you’ll be fine.” B) “I think it may be badly bruised.” C) “It looks that way, but an X-ray at the hospital will let us know for sure.” D) “I can’t tell you what I think. I’m not a doctor.” 46) As the pediatric patient progresses from respiratory distress to respiratory failure, which of the following occurs? A) Hyperactivity B) Increased arterial carbon dioxide tension C) Peripheral cyanosis D) Muscular rigidity 47) Which of the following organizations was formed to improve outcomes for pediatric patients who suffer potentially life-threatening injuries and illnesses? A) Pediatric Prehospital Emergency Providers (PPEP) B) Center for Pediatric Emergency Medicine (CPEM) C) Advanced Pediatric Emergency Services (APES) D) Emergency Medical Services for Children (EMSC) 48) You are caring for a seven-year-old female who was run over by the neighborhood ice cream truck. Other than some abrasions, the patient appears to have an isolated right femur fracture. The child is sobbing and uncooperative, and her mother is nearly hysterical, pleading with you not to let her daughter die. Your partner and the first responding engine crew are caring for the patient. Which of the following is the best way to gain control of this situation? A) Let the mother know that you and your partner are paramedics with special training in caring for injured children. Tell her you will be stabilizing her daughter’s leg to reduce her pain and that it would be very helpful if she could get a favorite toy for her daughter to take to the hospital with her. B) Let the mother know it is natural to feel guilty when her lack of supervision led to her daughter’s injury. Tell her that her daughter is probably not going to die but that it’s hard to say right now if her leg is permanently damaged. C) Tell the mother it is obvious from her daughter’s screaming that she isn’t in any immediate danger of dying. Tell her to calm down or you may have to have the police remove her from the scene. D) Tell the mother you can see how upset she is and that it would be better if she went inside the house because watching her daughter’s treatment is so upsetting to her. 49) Your patient is a 24-month-old female whom you have determined to be hypoglycemic. Which of the following will cause the LEAST amount of discomfort to the patient when given IV? A) 10 mL of 25 percent dextrose B) 25 mL of 50 percent dextrose C) 10 mL of 50 percent dextrose D) 25 mL of 10 percent dextrose 50) Your patient is a three-year-old male who has had a mild cold for 24 hours. This evening, the parents have called EMS because the child awoke with a hoarse, “barking” cough and seems to be having some difficulty breathing. You note that the child is afebrile and his breath sounds are clear but that he has significant inspiratory stridor. His respiratory rate is 30, his pulse is 124, and he is anxious but lacks peripheral cyanosis. Which of the following responses indicates the most likely cause and the appropriate treatment of the child’s problem? A) Epiglottitis, breathing cool night air B) Laryngotracheobronchitis, humidified oxygen C) Bronchiolitis, racemic epinephrine D) Asthma, albuterol