Nokea
When ventilating an apneic 3-year-old child with a bag-valve mask device, what is the MOST important action to take?
- A. Avoid hyperventilation and ensure adequate chest rise.
- B. Squeeze the bag with both hands and use a pediatric mask.
- C. Immediately insert an oropharyngeal airway.
- D. Provide one breath every 3 to 5 seconds.
Correct Answer: A
Rationale: When ventilating an apneic child, the most important action is to avoid hyperventilation and ensure adequate chest rise. Hyperventilation can lead to decreased cardiac output and increased intracranial pressure. Adequate chest rise confirms effective ventilation and minimizes the risk of complications. Choice B is incorrect because using both hands to squeeze the bag may not ensure proper ventilation and can lead to complications. Choice C is incorrect as inserting an oropharyngeal airway is not the initial action in ventilating an apneic child with a bag-valve mask. Choice D is incorrect as providing ventilations every 3 to 5 seconds may not be appropriate for effective ventilation in a pediatric patient.
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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 ruptured ovarian cyst.
- C. an ectopic pregnancy.
- D. a spontaneous abortion.
Correct Answer: C
Rationale: Severe lower abdominal pain, light vaginal bleeding, and a history of missed periods are concerning for an ectopic pregnancy. The absence of a normal menstrual period along with these symptoms raises suspicion for an ectopic pregnancy, which requires immediate medical attention due to the risk of rupture and life-threatening complications. A normal pregnancy would typically present with different symptoms such as a positive pregnancy test and typical signs of early pregnancy. A ruptured ovarian cyst may present with similar symptoms but typically lacks the history of missed periods. A spontaneous abortion usually involves heavier bleeding and tissue passage, which is not described in this scenario.
Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include:
- A. high-flow oxygen via non-rebreathing mask and rapid transport.
- B. assisted ventilation with a bag-mask device and rapid transport.
- C. positive-pressure ventilation, chest compressions, and rapid transport.
- D. back slaps and chest thrusts while attempting artificial ventilations.
Correct Answer: C
Rationale: In a 5-year-old child who is unresponsive with severe bradycardia and bradypnea, the priority is to provide positive-pressure ventilation to support breathing and perform chest compressions to support circulation. This child is in cardiac arrest, and the recommended treatment according to pediatric basic life support guidelines involves a combination of positive-pressure ventilation and chest compressions to maintain oxygenation and circulation. Rapid transport to a medical facility for further advanced care is crucial in this critical situation. Choices A, B, and D are incorrect because high-flow oxygen via non-rebreathing mask, assisted ventilation with a bag-mask device, and back slaps with chest thrusts are not sufficient in a cardiac arrest situation where the child requires immediate positive-pressure ventilation and chest compressions to maintain oxygenation and circulation.
You are dispatched to a residence for a child with respiratory distress. The child is wheezing and has nasal flaring and retractions. His oxygen saturation is 92%. You should:
- A. place the child in a supine position.
- B. administer high-flow oxygen.
- C. begin chest compressions.
- D. administer low-flow oxygen.
Correct Answer: B
Rationale: In a scenario where a child presents with respiratory distress, wheezing, nasal flaring, retractions, and an oxygen saturation of 92%, the appropriate intervention is to administer high-flow oxygen. This helps to improve oxygenation and alleviate the respiratory distress the child is experiencing. Placing the child in a supine position can worsen their condition by affecting their ability to breathe effectively. Chest compressions are not indicated in this case as the child is not in cardiac arrest. Administering low-flow oxygen may not provide adequate oxygenation for a child in respiratory distress with a saturation of 92%. Therefore, the priority is to administer high-flow oxygen to improve oxygen levels and support the child's breathing.
What are the MOST important initial steps in assessing and managing a newborn?
- A. Drying and warming the infant, obtaining an APGAR score.
- B. Clearing the airway, keeping the infant warm.
- C. Suctioning the airway, obtaining a heart rate.
- D. Keeping the infant warm, counting respirations.
Correct Answer: B
Rationale: The most crucial initial steps in assessing and managing a newborn involve clearing the airway to ensure proper breathing and keeping the infant warm to maintain body temperature. Airway clearance helps prevent respiratory distress, while warmth is essential to prevent hypothermia, a common issue in newborns. These steps are vital in the immediate care of a newborn to support their transition to extrauterine life and ensure their well-being. Choice A is incorrect because obtaining an APGAR score is important but not as critical as clearing the airway. Choice C is incorrect as suctioning the airway is not always necessary and obtaining a heart rate is secondary to ensuring a clear airway and warmth. Choice D is incorrect because counting respirations is not as immediate and crucial as clearing the airway.
What is the leading cause of death in geriatric patients?
- A. Hypertension.
- B. Arthritis.
- C. Heart disease.
- D. Altered mental status.
Correct Answer: C
Rationale: Heart disease is the leading cause of death in geriatric patients. It encompasses a range of conditions affecting the heart and blood vessels, such as coronary artery disease and heart failure, which are more prevalent in older individuals. These conditions can lead to serious complications and ultimately result in higher mortality rates among the elderly population. Hypertension (choice A) is a risk factor for heart disease but not the leading cause of death in geriatric patients. Arthritis (choice B) is a chronic condition affecting the joints, not a primary cause of death in this population. Altered mental status (choice D) is a symptom rather than a leading cause of death in geriatric patients.