LPN LPN
LPN Pediatrics
1. Which position is MOST appropriate for a mother in labor with a prolapsed umbilical cord?
- A. Supine with legs elevated
- B. Supine with hips elevated
- C. Left lateral recumbent
- D. Left side with legs elevated
Correct answer: B
Rationale: The most appropriate position for a mother in labor with a prolapsed umbilical cord is supine with hips elevated. This position helps reduce pressure on the cord, preventing further complications and ensuring optimal blood flow to the fetus.
2. During the 5-minute Apgar assessment of a newborn, you note a heart rate of 130 beats/min, cyanosis in the hands and feet, and rapid respirations. The baby cries when you flick the soles of its feet and resists leg straightening. These findings correspond to an Apgar score of:
- A. 9
- B. 7
- C. 8
- D. 10
Correct answer: A
Rationale: The Apgar score is a rapid assessment tool to evaluate the newborn's transition to life outside the womb. The Apgar score is based on five components: heart rate (>100 bpm), respiratory effort (rapid breathing), muscle tone (resisting leg straightening), reflex irritability (crying when feet are flicked), and color (cyanosis to extremities). The described findings match a score of 9, indicating good overall condition and adaptation to extrauterine life.
3. You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should:
- A. reassess the newborn every 5 minutes and transport after the placenta delivers.
- B. keep the newborn warm, give oxygen to the mother if needed, and transport.
- C. massage the lower part of the mother's uterus until the placenta delivers.
- D. give the newborn high-flow oxygen via a non-rebreathing mask and transport.
Correct answer: B
Rationale: In this scenario, the appropriate action is to keep the newborn warm, ensure the mother receives oxygen if needed, and prepare for transport. The newborn is showing signs of central cyanosis (hands and feet being cyanotic), which can be due to various reasons, including inadequate oxygenation. Therefore, ensuring warmth and possible oxygen to the mother are important. Additionally, monitoring both the mother and baby during transport is crucial for their well-being.
4. A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:
- A. Ventilate through the tracheostomy tube.
- B. Place an oxygen mask over the tracheostomy tube.
- C. Remove the tracheostomy tube and clean it.
- D. Carefully suction the tracheostomy tube.
Correct answer: D
Rationale: In this scenario, the 4-year-old boy with a tracheostomy tube is showing signs of respiratory distress, including intercostal retractions, a low heart rate, and decreased oxygen saturation. The gurgling sound indicates a possible airway obstruction. Correctly, the immediate action should be to carefully suction the tracheostomy tube. Suctioning can help clear any secretions or obstructions, thus improving the child's ability to breathe effectively. Ventilating through the tube, placing an oxygen mask over it, or removing and cleaning the tube would not address the potential obstruction and could worsen the respiratory distress.
5. When you attempt to assess a 22-year-old woman who has been sexually assaulted, she orders you not to touch her. Your MOST appropriate initial action should be to:
- A. obtain a signed refusal and return to service.
- B. transport the patient without performing an assessment.
- C. explain to the patient that she must be examined.
- D. ask a female EMT to attempt to assess the patient.
Correct answer: D
Rationale: In cases of sexual assault, it's important to respect the patient's wishes and provide a female EMT to attempt the assessment if the patient prefers.
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