When you begin to assess a woman in labor, she states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be MOST appropriate to ask next?
A: How many other children do you have?
B: Has your bag of waters broken yet?
C: Have you had regular prenatal care?
D: At how many weeks gestation are you?
The correct answer is D;
Reason:
When assessing a patient in labor, the first question you should ask is how far along in the pregnancy she is. If she is at less than 37 weeks gestation (37 to 42 weeks is term), you should prepare for possible resuscitation of the newborn if delivery occurs in the field. Other questions, such as asking if her amniotic sac (bag of waters) has ruptured and whether or not she has received prenatal care, also can help you anticipate and prepare for potential complications. You should also inquire as to how many times the patient has been pregnant, regardless of whether she carried the baby to term (gravida), and the number of times she has carried a baby beyond 28 weeks, regardless of whether it was born dead or alive (para).
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A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, has a patent airway, and has adequate breathing. You should:
A: administer 1 g/kg of activated charcoal.
B: give oxygen and perform a head-to-toe exam.
C: contact poison control and give him oxygen.
D: give 15 mL of ipecac and contact medical control.
The correct answer is C;
Reason:
Once you determine that a poisoning has occurred, and have identified the poison, you should contact the poison control center at once: (800) 222-1222. Give the patient high-flow oxygen or assist his or her ventilations if necessary. Induction of vomiting with syrup of ipecac is no longer recommended because of the risk of aspiration. Activated charcoal is contraindicated in patients who have ingested a corrosive substance (eg, drain cleaner) or a petroleum product (eg, gasoline, motor oil). A head-to-toe exam is not practical in this situation, at least initially. Follow the directions given to you by the poison control center, transport the child without delay, and monitor his condition en route.
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Which of the following techniques represents the MOST appropriate method of opening the airway of an infant with no suspected neck injury?
A: Lift up the chin and hyperextend the neck.
B: Perform the technique as you would for an older child or adult.
C: Gently lift the chin while maintaining slight flexion of the neck.
D: Tilt the head back without hyperextending the neck.
The correct answer is D;
Reason:
Opening the airway in infants and small children involves keeping the head in a neutral or slightly extended position. Because the occipital region (back of the head) of the skull is proportionately larger in infants and small children when compared to an adult, hyperextension of the neck can result in a reverse flexion of the neck and subsequent airway blockage.
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Your assessmment of a newborn reveals cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do first?
A: Briskly dry off the infant.
B: Begin chest compressions.
C: Resuction the mouth.
D: Begin artificial ventilations.
The correct answer is D;
Reason:
Central cyanosis (cyanosis to the head, face, and trunk) alone initially should be treated with blow-by oxygen; however, when it is accompanied by a heart rate that is less than 100 beats/min, artificial ventilations should be initiated and continued until the heart rate exceeds 100 beats/min. Newborn bradycardia is defined as a heart rate of less than 100 beats/min. Chest compressions are indicated if the newborn's heart rate falls below 60 beats/min, despite 30 seconds of adequate positive-pressure ventilation. A newborn should be dried off thoroughly, regardless of its appearance at birth.
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You are responding to a call for a 2-year-old child who fell from a second-story window. With the mechanism of injury and the age of the patient in mind, you should suspect that the primary injury occurred to the child’s:
A: chest.
B: lower extremities.
C: abdomen.
D: head.
The correct answer is D;
Reason:
Because a child’s head is proportionately larger than the rest of the body when compared to an adult, the head commonly is the primary site of injury. This is especially true in fall-related injuries, in which gravity causes the head to precede the rest of the body. Head injury is a leading cause of traumatic death in infants and small children.
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A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding from her mouth and nose. You should:
A: open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via nonrebreathing mask.
B: open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations.
C: suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist her ventilations.
D: manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and suction her oropharynx.
The correct answer is B;
Reason:
In any semi- or unconscious patient with a head injury, you should manually stabilize the head and open the airway with the jaw-thrust maneuver. If there are any secretions in the mouth, suction the oropharynx. If possible, insert a simple airway adjunct. The patient in this scenario is semiconscious and likely has an intact gag reflex; therefore, you should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal airway in patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After ensuring a patent airway, you should turn your attention to the patient's breathing. Slow, irregular breathing will not provide adequate minute volume and should be treated with ventilatory assistance.
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Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. In addition to administering high-flow oxygen, treatment should include:
A: internal vaginal pads and treating for shock during transport.
B: uterine massage and transport.
C: placing her on her left side and transport.
D: treating for shock and uterine massage during transport.
The correct answer is D;
Reason:
Blood loss of up to 500 mL within the first 24 hours after delivery is considered normal and usually is well tolerated by the mother. However, any bleeding, regardless of the severity, with accompanying signs of shock, must be treated accordingly. In this case, you should apply high-flow oxygen, treat the patient for shock by elevating her legs (if allowed by local protocol) and providing warmth, and provide rapid transport to the hospital while massaging the uterine fundus en route. Placing the mother on her left side is appropriate before she delivers and prevents supine hypotensive syndrome. Dressings should never be packed into the vagina; placing pads into the vagina increases the risk for maternal infection.
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Seizures in children MOST often are the result of:
A: an inflammatory process in the brain.
B: a temperature greater than 102°F.
C: a life-threatening infection.
D: an abrupt rise in body temperature.
The correct answer is D;
Reason:
Seizures in children most often are the result of fever (febrile seizures). The occurrence of febrile seizures is not necessarily affected by how high the child’s fever gets, but how quickly it rises. The hypothalamus in the brain may not be able to accommodate such abrupt increases in body temperature. High fevers in children can be the result of massive infections, such as meningitis or encephalitis.
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When is it MOST appropriate to clamp and cut the umbilical cord?
A: Immediately following delivery of the newborn
B: As soon as the cord has stopped pulsating
C: Before the newborn has taken its first breath
D: After the placenta has completely delivered
The correct answer is B;
Reason:
Generally, it is safe to clamp and cut the umbilical cord once it has stopped pulsating and the baby is breathing adequately. When blood flow through the umbilical cord ceases, it will stop pulsating; this indicates that the baby is oxygenating its own blood. If the cord does not stop pulsating and/or the baby is not breathing adequately, the cord should not be clamped and cut and the baby should be kept at the level of the mother’s perineum and managed appropriately while en route to the hospital.
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A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect:
A: a normal pregnancy.
B: a spontaneous abortion.
C: an ectopic pregnancy.
D: a ruptured ovarian cyst.
The correct answer is C;
Reason:
An ectopic pregnancy should be assumed, until proven otherwise, in any woman of childbearing age who presents with abdominal pain, with or without vaginal bleeding. The fact that the patient's last menstrual period was 2 months ago should make you that much more suspicious. The majority of women with an ectopic pregnancy were not aware they were pregnant, whereas women with a spontaneous abortion (miscarriage) typically were. Furthermore, a spontaneous abortion typically presents with abdominal pain and moderate to heavy vaginal bleeding; the passage of clots of blood are not uncommon.
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A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and approach the child, you see him lying supine approximately 15 feet from the car. Based on the child’s age and mechanism of injury, which of the following should you suspect to be his PRIMARY injury?
A: Head injury
B: Lower leg injury
C: Upper thorax injury
D: Pelvic injury
The correct answer is D;
Reason:
Children are smaller than adults; therefore, when they are injured by the same mechanism of injury as an adult, the location of their injuries may differ from those of an adult. For example, when an adult is struck by a vehicle, the primary injury typically occurs at or below the knees, depending on the height of the bumper at the time of impact. Because the child is shorter, initial impact typically occurs at or near the pelvis. Secondary injury occurs when child’s chest collides with the vehicle’s grille. Tertiary injury occurs when the child strikes the side of his or her head on the pavement after being propelled away from the vehicle. In some cases, the child is pulled underneath the vehicle and is dragged.
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Which of the following is a more reliable indicator of perfusion in children than it is in adults?
A: Blood pressure
B: Heart rate
C: Capillary refill
D: Respiratory rate
The correct answer is C;
Reason:
In children younger than 6 years of age, capillary refill time (CRT) serves as an excellent indicator of perfusion; it assesses oxygen delivery to the capillaries. As a person gets older, however, CRT becomes less reliable. It is important to remember that factors such as cold temperature can affect CRT. Early in shock, the heart and respiratory rates increase in an attempt to compensate for decreases in oxygen; this occurs in both children and adults. When these compensatory mechanisms fail, the blood pressure falls, and the patient enters a state of decompensated shock. For this reason, you should not rely upon a patient's blood pressure to determine overall perfusion; the blood pressure may be maintained, despite inadequate perfusion.
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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: massaging the uterus if signs of shock develop.
B: carefully packing the vagina with sterile dressings.
C: administering oxygen and massaging the uterus.
D: treating her for shock and providing rapid transport.
The correct answer is C;
Reason:
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.
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If a woman is having her first child, the first stage of labor:
A: is usually the longest and lasts an average of 16 hours.
B: generally does not allow time for you to transport.
C: is typically very short and only lasts about 2 hours.
D: is shorter than in women who have had other children.
The correct answer is A;
Reason:
There are three stages of labor: dilation of the cervix, delivery of the baby, and delivery of the placenta. The first stage begins with the onset of contractions and ends when the cervix is fully dilated. Since assessing for cervical dilation is not performed in the prehospital setting, the first stage of labor is said to have ended when crowning occurs. Because the cervix has to be stretched thin by uterine contractions until the opening is large enough for the fetus to pass through into the vagina, the first stage is usually the longest, lasting an average of 16 hours for a first delivery. With subsequent pregnancies, the first stage of labor typically progresses more quickly. You will usually have enough time to transport the mother during the first stage of labor, especially if this is her first pregnancy. It should be noted, however, than some primigravida (pregnant for the first time) women progress through the first stage of labor very quickly.