Paramedics Exam Special Patient Populations 5 — Questions and Answers
Question 1: A neonate's heart rate remains below 60 bpm despite 30 seconds of adequate positive-pressure ventilation. What is the next step?
- Administer IV epinephrine 0.01 mg/kg
- Begin chest compressions at a 3:1 compression-to-ventilation ratio (Correct answer)
- Increase ventilation rate to 60 breaths per minute
- Administer naloxone if maternal opioid use is suspected
Correct answer: Begin chest compressions at a 3:1 compression-to-ventilation ratio
Per NRP guidelines, if the heart rate remains below 60 bpm after 30 seconds of effective PPV, chest compressions at a 3:1 ratio are initiated.
Question 2: A patient with a tracheostomy tube has increasing respiratory distress. After suctioning fails to relieve obstruction, your next action is to:
- Perform needle decompression of the chest
- Remove the tracheostomy tube and attempt ventilation via the stoma (Correct answer)
- Administer racemic epinephrine by aerosol mask
- Increase supplemental oxygen flow via the trach collar
Correct answer: Remove the tracheostomy tube and attempt ventilation via the stoma
If suctioning fails to clear a tracheostomy obstruction, remove the tube and attempt to ventilate through the stoma with a pediatric BVM.
Question 3: Which of the following statements about pain assessment in non-verbal geriatric patients is MOST accurate?
- Geriatric patients consistently underreport pain due to stoicism
- Behavioral cues such as grimacing, guarding, and restlessness should be used to assess pain (Correct answer)
- Cognitive impairment eliminates the patient's ability to experience pain
- A numeric pain scale is the most reliable tool for demented patients
Correct answer: Behavioral cues such as grimacing, guarding, and restlessness should be used to assess pain
Behavioral indicators—facial grimacing, guarding, restlessness, and moaning—are validated pain assessment tools in non-verbal or cognitively impaired patients.
Question 4: A 16-year-old athlete collapses suddenly on the field. Bystanders state he 'just dropped.' ECG shows coarse ventricular fibrillation. This scenario is MOST consistent with:
- Hypertrophic cardiomyopathy as the underlying cause of sudden cardiac arrest (Correct answer)
- Exercise-induced asthma causing hypoxic arrest
- Rhabdomyolysis-induced cardiac arrest
- Heat stroke progressing to cardiac arrest
Correct answer: Hypertrophic cardiomyopathy as the underlying cause of sudden cardiac arrest
Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young athletes and classically presents as a sudden collapse during exertion.
Question 5: When positioning a pregnant patient in her third trimester for transport, why should you tilt her to the left?
- To reduce diaphragm compression and improve ventilation
- To shift the uterus off the inferior vena cava and improve venous return (Correct answer)
- To reduce risk of aspiration by elevating the right hemidiaphragm
- To improve placental blood flow by increasing aortic perfusion pressure
Correct answer: To shift the uterus off the inferior vena cava and improve venous return
Left lateral tilt displaces the gravid uterus off the inferior vena cava, preventing supine hypotensive syndrome and improving cardiac output.
Question 6: A 9-month-old presents with a bulging fontanelle, high-pitched cry, fever, and a purpuric rash. What condition requires immediate aggressive management?
- Viral meningitis with benign course
- Bacterial meningitis with possible meningococcemia (Correct answer)
- Roseola infantum with febrile seizure
- Intracranial hemorrhage from non-accidental trauma
Correct answer: Bacterial meningitis with possible meningococcemia
Bulging fontanelle, high-pitched cry, fever, and a non-blanching purpuric rash indicate bacterial meningitis with possible meningococcal sepsis, a life-threatening emergency.
Question 7: An elderly patient with end-stage COPD has a valid DNR/POLST order but her family is demanding full resuscitation. The paramedic should:
- Follow the family's wishes because they are the legal decision-makers
- Disregard the DNR and provide full resuscitation to avoid conflict
- Honor the valid DNR order, which reflects the patient's documented wishes (Correct answer)
- Contact medical control and await orders before taking any action
Correct answer: Honor the valid DNR order, which reflects the patient's documented wishes
A valid DNR/POLST order reflects the patient's own autonomous decision and must be honored by paramedics even when family members disagree.
Paramedics Exam Special Patient Populations 5
A neonate's heart rate remains below 60 bpm despite 30 seconds of adequate positive-pressure ventilation.
What is the next step?