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10 free Paramedic practice questions: Pediatric and Special Population Emergencies

These are real questions from the same bank the app draws from. Each one is written to the NREMT Paramedic content specifications and kept inside the Paramedic scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 10

A paramedic is transporting a 5-day-old patient on a continuous prostaglandin E1 infusion for a heart defect that depends on the ductus arteriosus staying open. Fifteen minutes into transport the newborn becomes apneic. Which action should the paramedic take?

Show the answer and rationale

Correct answer · Support ventilation with a bag mask and continue the infusion

Apnea is a well recognized effect of a prostaglandin E1 infusion, reported in roughly 10 to 12 percent of infants on it and more likely at higher doses and in smaller infants. Knowing that is what keeps you from making the reflex mistake. The infusion is the only thing holding the ductus arteriosus open, and in a newborn whose circulation depends on that opening, a closing ductus is immediately life threatening. Stopping the drug to fix the breathing trades a problem you can manage with a bag mask for one you cannot manage at all. Treat the apnea as a ventilation problem: bag mask ventilation, or an advanced airway if the apnea persists, with the infusion running the whole time. Expect it, watch for it, and be set up to ventilate before it happens rather than after.

Why the others are wrong

Stop the infusion and give naloxone, then reassess the breathing: Reaching for a reversal agent when a newborn stops breathing shows the right pattern of thinking about a drug effect. Naloxone reverses opioids and has no effect on prostaglandin E1, and giving it here costs time while the infusion you stopped is the real threat.

Stop the infusion and support ventilation with a bag mask: Stopping a drug that just caused an adverse effect is sound reasoning almost everywhere else in medicine, and the ventilation half of this answer is correct. Interrupting this infusion lets the ductus start closing, and for a ductal dependent lesion that is worse than the apnea you were treating.

Cut the infusion rate in half and give warmed blow by oxygen: Cutting the dose feels like a middle path, since the apnea is more likely at higher doses. A partial rate leaves the ductus at risk without reliably fixing the apnea, and oxygen delivered near the face does nothing for a newborn who is not moving air at all.

Question 2 of 10

A paramedic is clearing secretions from the mouth of a 2-month-old patient before ventilating. What is the correct time limit for each suction pass and the correct vacuum setting?

Show the answer and rationale

Correct answer · 5 seconds per pass, with the vacuum at the same setting used for an adult

Two rules live in this answer and they pull in different directions, which is why it gets missed. The time limits are 15 seconds for an adult, 10 seconds for a child, and 5 seconds for an infant. Those are single limits and never ranges, so an answer written as a span is wrong on its face. The force is the other half. Suction force is not adjusted by age at all, and the vacuum setting for an infant is the same one you use on an adult. What changes with age is the clock and the device. For a newborn or young infant the device is a bulb syringe, squeezed before it goes in and released to draw secretions, mouth first and then each nostril. Around all of that, preoxygenate if the patient tolerates it, suction on the way out rather than on the way in, reoxygenate between passes, and stop to ventilate if the heart rate falls.

Why the others are wrong

10 seconds per pass, with the vacuum turned down below the adult setting: Ten seconds is a real limit that you will use often, and it is easy to carry to the youngest patients. Ten seconds belongs to a child, and an infant desaturates faster than that, which is why the infant limit is five.

5 to 10 seconds per pass, with the vacuum turned down below the adult setting: A range looks safer than a single number, since it sounds like it leaves room for judgment. These limits are taught as single numbers rather than ranges, and turning the vacuum down is the second error in the same option.

15 seconds per pass, with the vacuum at the same setting used for an adult: Fifteen seconds is a genuine limit and the vacuum half of this answer is correct. Fifteen seconds is the adult limit, and applying it to a 2-month-old patient triples the time the airway spends without oxygen.

Question 3 of 10

A 3-year-old patient is in cardiac arrest on a living room floor. One paramedic has been doing CPR alone at 30 compressions to 2 breaths. A second paramedic arrives and takes over the bag mask. No advanced airway has been placed. Which change should the crew make to the CPR?

Show the answer and rationale

Correct answer · Change to 15 compressions to 2 breaths, still pausing for the breaths

The ratio in a child is set by how many rescuers are working, not by how old the patient is. One rescuer runs 30 compressions to 2 breaths, and the moment a second set of hands takes the airway the ratio changes to 15 to 2. The second half of this is the part that gets missed. Continuous compressions with a breath every 2 to 3 seconds is the rule once an advanced airway is in place, and no advanced airway is in place here, so the crew still pauses for the two breaths. Keep the rest of the quality bundle running while you make the change: 100 to 120 compressions a minute, a depth of at least one third of the front to back chest diameter, full recoil, interruptions under 10 seconds, and a compressor swap about every 2 minutes.

Why the others are wrong

Keep 30 compressions to 2 breaths, since the ratio is set by the age: Plenty of pediatric numbers do change with age, which makes this a reasonable guess. The ratio is not one of them. It tracks the number of rescuers, so the same 3-year-old gets 30 to 2 from one provider and 15 to 2 the moment a second provider takes the airway.

Move to continuous compressions with one breath every 2 to 3 seconds: This is a real rule quoted accurately, which is what makes it the closest call on the board. It applies once an advanced airway is in place, and this crew has a bag mask, so the compressions still pause for the breaths.

Keep 30 compressions to 2 breaths and rotate compressors every minute: Rotating compressors is genuinely part of high quality CPR, so half of this answer is right. The swap comes about every 2 minutes rather than every minute, and the ratio still needed to change the moment the second provider arrived.

Question 4 of 10

A 2-year-old patient with two days of a cold now has a barking cough and stridor at rest with retractions. Nebulized epinephrine is given and the stridor resolves within minutes. A caregiver asks whether the child still needs to be seen at the hospital. What should the paramedic explain about this treatment?

Show the answer and rationale

Correct answer · Its effect fades in about two hours and the stridor can return

Nebulized epinephrine is a bridge rather than a fix. It constricts the vessels in the swollen tissue below the vocal cords and opens the airway within minutes, which is why the stridor vanishes and everyone in the room relaxes. The effect fades over roughly two hours and the stridor can come back as it wears off, so a child who receives it is transported and watched rather than considered treated. The drug that actually changes the course of the illness is a corticosteroid such as dexamethasone, which works on the inflammation over several hours and lasts well past the epinephrine. Two drugs, two jobs. Knowing which one you just gave is what keeps a dramatic improvement from turning into a child left at home who obstructs again after you clear.

Why the others are wrong

It confirms the diagnosis, so no further observation is needed: A treatment that works does support the diagnosis you made, and the response here was immediate. Improvement from a temporary drug is not a reason to stop watching a child, and this is exactly the child who needs observation as the effect wears off.

It works only when a corticosteroid is given at the same time: Pairing the two drugs is standard for moderate to severe croup, so the association is correct. Each works on its own and on its own schedule, and the epinephrine had already opened this airway before any corticosteroid could have taken effect.

It treats the inflammation itself, so the swelling will not come back: The airway did open, so it genuinely looks like the swelling was treated. Epinephrine squeezes the blood vessels in the swollen tissue rather than reducing the inflammation, and a corticosteroid is the agent that works on the swelling itself.

Question 5 of 10

A 5-year-old patient who has been ill for two days is lethargic with warm, flushed extremities and capillary refill of 3 seconds. The vital signs are BP 74/40, P 172, R 34, and SpO₂ 97% on room air. Which category of shock does the skin finding point to?

Show the answer and rationale

Correct answer · Distributive, since vasodilation makes the skin warm and flushed

Three of the four shock categories give you cool, pale, clammy skin, because the body clamps down the peripheral vessels to defend the pressure. Distributive shock is the one that does not, since the problem is vasodilation itself, so the skin runs warm and flushed instead. Warmth is the discriminator that actually sorts it, and distributive covers septic, anaphylactic, and neurogenic shock. One caution goes with that. Anaphylactic and neurogenic shock are reliably warm and dry, while a septic child is frequently sweaty, so never build a septic shock judgment on dry skin. Another is that septic shock in an infant can present with no fever at all and sometimes with a temperature below normal, so the absence of a fever does not move sepsis off your list.

Why the others are wrong

Cardiogenic, since a failing pump backs blood up into the skin: Cardiogenic shock does occur in children and a heart rate of 172 looks like it could be driving the problem. The tell for a rate that is the cause is a rate around 220 in an infant or 180 in a child with an abrupt onset and no variability, and cardiogenic shock still presents with cool, poorly perfused skin.

Hypovolemic, since two days of fluid loss leaves the skin warm: Hypovolemic shock is the most common category in children and two days of illness fits the history perfectly, which makes this the strongest rival. Fluid loss produces pale, cool, clammy skin from vasoconstriction, so the warmth here argues against it rather than for it.

Obstructive, since a blocked outflow tract flushes the skin: Obstructive shock belongs on the list and it is the category where fluid alone will not fix the problem. It comes from a tension pneumothorax, tamponade, or a pulmonary embolism, and the obstruction to outflow makes the skin cool rather than flushed.

Question 6 of 10

A 4-year-old patient with several days of vomiting and diarrhea has mottled, cool extremities, capillary refill of 4 seconds, and weak radial pulses. The vital signs are BP 62/38, P 176, R 36, and SpO₂ 95% on room air. How should this patient's shock be staged?

Show the answer and rationale

Correct answer · Decompensated, since hypotension means the compensating mechanisms failed

Shock is staged as compensated or decompensated, and both stages apply to all four categories. Compensated means perfusion is already inadequate while tachycardia and vasoconstriction still hold the pressure inside the normal range, so the child looks sick with abnormal skin signs and a pressure that reads normal. Decompensated means those mechanisms have failed and hypotension has appeared. That is the whole model. There is no third stage beyond decompensated, so any option offering a stage after decompensated, or a stage in between, is naming something that does not exist. The reason the two stage model matters is what it tells you to do: treating a compensated child aggressively is what prevents the transition, and a child who is already hypotensive has used up the margin you were supposed to spend earlier.

Why the others are wrong

Late compensated, the stage between compensated and decompensated: Adding a stage in the middle feels like it captures a child who is sliding between the two. There are two stages and nothing in between them, and inventing a middle label delays the aggressive treatment that a decompensated child needs now.

Compensated, since tachycardia is still holding the pressure up: Children do compensate impressively and hold a normal pressure far longer than adults, so this is the right instinct applied to the wrong numbers. A pressure of 62 systolic in a 4-year-old is hypotension, and once the pressure falls the compensating stage is over.

Irreversible, since the pressure has already fallen this far: A child this sick feels like the worst category available, and the word sounds like it belongs to the sickest patients. Shock has compensated and decompensated stages only, and there is no irreversible stage in this model to assign anyone to.

Question 7 of 10

A 2-year-old patient is removed from a car parked in direct sun on a hot afternoon. The skin is hot and dry with no sweating, and the patient responds only to painful stimulus. The vital signs are BP 78/44, P 168, R 34, and SpO₂ 96% on room air. Which action should the paramedic take?

Show the answer and rationale

Correct answer · Place cold packs at the groin, armpits, and neck and keep the skin wet

One hyperthermic presentation is not a fever, and this is it. A child found in a hot car or over bundled who is hot with skin that has stopped sweating and an altered mental status is in heat stroke. Sweating means exhaustion, and hot and dry means heat stroke. That distinction flips your treatment. Fever management is passive cooling only, because the body is defending a raised set point and chilling the skin just produces shivering, which makes more heat. Heat stroke is a thermoregulatory system that has failed outright, with no set point being defended and nothing gained by cooling slowly. Aggressive cooling means exactly what the fever rule forbids: get the child out of the environment, strip the clothing, put cold packs at the groin, the armpits, and the sides of the neck, and keep the skin wet with air moving over it.

Why the others are wrong

Remove the excess clothing only, since chilling the skin causes shivering: Removing clothing is correct as far as it goes, and the shivering concern is a real rule that you were taught for a reason. That rule belongs to fever alone, and reading it into a hot car presentation withholds the one treatment that changes the outcome here.

Wrap the patient to prevent a rapid drop in core temperature in transport: Avoiding a temperature overshoot is a real concern in other kinds of cooling, so caution is not unreasonable. A child in heat stroke is being harmed by the heat right now, and insulating that child keeps in the heat you are supposed to be removing.

Give an antipyretic and let the temperature come down on its own: An antipyretic is reasonable for a child whose temperature is driven by illness, and lowering the temperature is the right goal. An antipyretic works by lowering a set point, and in heat stroke there is no set point being defended for it to lower.

Question 8 of 10

A 6-year-old patient with a tracheostomy is found unresponsive with agonal respirations at school. The tracheostomy tube is in place and appears intact. The vital signs are BP 88/52, P 52, R 4, and SpO₂ 79% on room air. How should ventilation be delivered?

Show the answer and rationale

Correct answer · Through the stoma, with a bag mask connected to the tracheostomy tube

In a child with a tracheostomy, the stoma is the airway. When that child needs ventilation, ventilate through the stoma first, connecting the bag mask directly to the tracheostomy tube, or sealing an infant mask over the stoma itself if the tube has come out. Trying the mouth and nose on a child whose airway has been surgically diverted wastes the time that matters most, and this patient has a heart rate of 52 and a saturation of 79%, so the time is already short. The other thing to know about these calls is the most common emergency, which is the tube obstructing with dried or thick secretions. Suctioning it is in scope: pass a soft catheter no further than the length of the tube, suction only on withdrawal, stay inside 10 seconds in a child and 5 seconds in an infant, and reoxygenate between passes.

Why the others are wrong

Through the mouth with a bag mask after an oral airway is inserted: An oral airway is a sound way to open an obstructed upper airway in most unresponsive patients. This child's upper airway is not the route to the lungs at all, so opening it changes nothing about where the breath goes.

Through the mouth and nose with a bag mask while the stoma is covered: Ventilating through the face is the route you use on every other patient, and covering the stoma at least acknowledges it is there. Air pushed into the mouth and nose of a child whose airway is diverted does not reach the lungs, and the seconds spent finding that out are the ones this patient does not have.

Through the nose with a bag mask after the tracheostomy tube is removed: Removing a tube that might be obstructed is a real step on these calls when suctioning fails. Nothing here suggests the tube is blocked, it is described as in place and intact, and the nose is not the route to a surgically diverted airway either way.

Question 9 of 10

A paramedic is placing an intraosseous needle in the proximal tibia of a 3-year-old patient in decompensated shock. Where should the needle enter?

Show the answer and rationale

Correct answer · One to two centimeters below the tuberosity on the flat medial surface

The adult landmark is not the pediatric one, and carrying the adult habit onto a small leg is the error worth naming. Current instructions for the intraosseous driver put the adult site about one centimeter proximal to the tibial tuberosity. The pediatric site is deliberately distal to it: the flat medial surface one to two centimeters below and medial to the tuberosity in a small child, angled away from the growth plate. On a small leg the difference between those two is a centimeter or two, which is the entire margin you have. Confirm the placement by the needle standing unsupported, by aspirate, and by flushing without swelling in the tissue around it. Expect that the infusion hurts in a conscious patient and will not run by gravity, so push the fluid with a syringe or drive it with a pressure bag, and flush with 2 to 5 mL of saline in a child.

Why the others are wrong

About one centimeter above the tibial tuberosity on the flat surface: This is the correct adult landmark, which is exactly why it is the most common error on a pediatric call. Proximal to the tuberosity on a small child puts the needle at the growth plate, and the pediatric site is deliberately below it.

At the widest part of the proximal tibia, level with the growth plate: Going for the widest part of the bone sounds like it gives the most room for error. The widest part of the proximal tibia is where the growth plate sits, and damaging it is the specific injury the pediatric landmark exists to avoid.

Directly over the tibial tuberosity, where the landmark is easiest to feel: The tuberosity is the easiest landmark to find on a small leg, so aiming at it feels efficient. The tuberosity is the reference point rather than the target, and the bone there is thick cortical bone rather than the flat medial surface the needle is meant for.

Question 10 of 10

A toddler in respiratory distress shows nasal flaring, grunting, and retractions, then begins to appear less distressed with a slowing heart rate. How should the paramedic interpret this change?

Show the answer and rationale

Correct answer · The slowing heart rate is an ominous, late sign of hypoxia and impending arrest, not improvement

Bradycardia in a distressed child is an ominous, late sign, often reflecting significant hypoxia and impending arrest: a tiring, quieting child with a slowing heart rate is a serious warning sign, not reassurance.

Why the others are wrong

The child is improving and requires less aggressive intervention: Decreasing work of breathing that isn't from true improvement, combined with a slowing heart rate, signals decompensation, not improvement. This requires more aggressive intervention, not less.

The slowing heart rate is a reassuring sign that the child is calming down: Unlike some adult presentations, a slowing heart rate in a sick child is not reassuring.

Retractions and grunting are normal findings in children and do not indicate distress: Retractions, nasal flaring, and grunting are pediatric-specific warning signs of significant respiratory distress, not normal findings.

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