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Free NREMT practice questionsFree Paramedic practice questions · Medical/Obstetrics/Gynecology

9 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 9

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

A 2-month-old is an infant, and the suction limit for an infant is 5 seconds per pass. The limit is 15 seconds for an adult and 10 seconds for a child. Each limit is a single number, never a range. Suction force does not change with age. You use the same vacuum setting on an infant that you use on an adult. What changes with age is the time limit and the device. A newborn or young infant gets a bulb syringe. Squeeze the bulb before it goes in, then let go to pull the secretions out. Suction the mouth first, then each nostril. Preoxygenate if the patient tolerates it. Suction on the way out, not on the way in. Give oxygen again between passes. If the heart rate falls, stop suctioning and ventilate.

Why the others are wrong

10 seconds per pass, with the vacuum turned down below the adult setting: Ten seconds is the suction limit for a child. An infant's oxygen level drops faster than a child's. That's why the infant limit is 5 seconds. Option A also turns the vacuum down, and the vacuum stays at the adult setting.

5 to 10 seconds per pass, with the vacuum turned down below the adult setting: A range of 5 to 10 seconds sounds like it leaves room for judgment. Suction limits are single numbers, not ranges. Turning the vacuum down below the adult setting is a second error in the same option.

15 seconds per pass, with the vacuum at the same setting used for an adult: The vacuum half of option D is right, since the setting is the same one you use on an adult. Fifteen seconds is the adult time limit. On a 2-month-old, 15 seconds triples the time the airway goes without oxygen.

Question 2 of 9

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

Change to 15 compressions to 2 breaths, and keep pausing for the breaths. In a child, the ratio is set by how many rescuers are working, not by the child's age. One rescuer does 30 compressions to 2 breaths. Once a second rescuer takes the airway, the ratio changes to 15 to 2. Continuous compressions with one breath every 2 to 3 seconds starts only after an advanced airway is placed. This crew is using a bag mask with no advanced airway, so the compressor still pauses for the 2 breaths. Keep the rest of good CPR going while you make the change. Push 100 to 120 times a minute. Push at least one third of the depth of the chest, front to back. Let the chest fully recoil, keep pauses under 10 seconds, and swap compressors 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. The compression ratio is not one of them. The ratio follows the number of rescuers, so the same 3-year-old gets 30 to 2 from one rescuer and 15 to 2 from two.

Move to continuous compressions with one breath every 2 to 3 seconds: Continuous compressions with one breath every 2 to 3 seconds is a real rule. That rule applies once an advanced airway is in place. This crew is ventilating with 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 part of good CPR. The swap comes about every 2 minutes, not every minute. The ratio also has to change to 15 to 2 now that a second paramedic has taken the bag mask.

Question 3 of 9

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 wears off in about two hours, and the stridor can come back. This child has croup, with a barking cough and stridor at rest after two days of a cold. Epinephrine squeezes the blood vessels in the swollen tissue below the vocal cords. The airway opens within minutes. That's why the stridor went away. As the epinephrine wears off, the stridor can return. Transport this child and keep watching for the stridor to come back. The drug that changes the course of croup is a corticosteroid such as dexamethasone. Dexamethasone works on the inflammation over several hours and lasts well past the epinephrine. Tell the caregiver the child still needs to be seen at the hospital.

Why the others are wrong

It confirms the diagnosis, so no further observation is needed: A treatment that works does support the croup diagnosis, and the response here was immediate. Improvement from a short acting drug is not a reason to stop watching a child. Watch this child as the epinephrine wears off.

It works only when a corticosteroid is given at the same time: Epinephrine and a corticosteroid are often given together for moderate to severe croup. Each drug works on its own and on its own schedule. The epinephrine opened this airway within minutes, before any corticosteroid could have worked.

It treats the inflammation itself, so the swelling will not come back: The airway did open, so it looks like the swelling was treated. Epinephrine squeezes the blood vessels in the swollen tissue and does not treat the inflammation. A corticosteroid is the drug that works on the swelling itself.

Question 4 of 9

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

This child is in distributive shock. The arms and legs are warm and flushed, with a blood pressure of 74/40 and a pulse of 172. Three of the four shock categories give you cool, pale, clammy skin. In those three, the body clamps down the blood vessels in the arms and legs to hold up the pressure. In distributive shock, the problem is the blood vessels dilating. With the vessels dilated, the skin stays warm and flushed. Warm skin is the finding that sorts distributive shock from the other three. Distributive shock includes septic, anaphylactic, and neurogenic shock. Anaphylactic and neurogenic shock are reliably warm and dry. A septic child is often sweaty. Sweaty skin does not rule out septic shock. An infant in septic shock can also have no fever at all, or even a temperature below normal. A missing fever does not take sepsis off your list.

Why the others are wrong

Cardiogenic, since a failing pump backs blood up into the skin: Cardiogenic shock does happen in children, and a pulse of 172 could look like the cause. A heart rate that causes shock is usually around 220 in an infant or 180 in a child. That rate starts suddenly and does not vary. Cardiogenic shock also gives you cool skin with poor perfusion, not warm, flushed skin.

Hypovolemic, since two days of fluid loss leaves the skin warm: Hypovolemic shock is the most common type of shock in children, and two days of illness fits the history. Fluid loss makes the blood vessels in the skin clamp down. That gives you pale, cool, clammy skin. The warm, flushed skin in this child points away from hypovolemic shock.

Obstructive, since a blocked outflow tract flushes the skin: Obstructive shock comes from a tension pneumothorax, a tamponade, or a pulmonary embolism. Fluid alone will not fix obstructive shock. The blockage to blood flow out of the heart makes the skin cool, not flushed.

Question 5 of 9

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

This child is in decompensated shock. The blood pressure is 62/38 and the pulse is 176. The extremities are mottled and cool, capillary refill is 4 seconds, and the radial pulses are weak. Shock has two stages, compensated and decompensated, and both stages apply to all four categories of shock. In compensated shock, perfusion is already poor while a fast heart rate and tight blood vessels hold the blood pressure in the normal range. In decompensated shock, those mechanisms have failed and the blood pressure has dropped. This child's systolic of 62 is low, so the compensation has failed. There is no stage after decompensated and no stage in between. Aggressive treatment in compensated shock is what prevents the drop. This child is already hypotensive and needs aggressive treatment now.

Why the others are wrong

Late compensated, the stage between compensated and decompensated: A middle stage sounds like it fits a child who is sliding from one stage to the next. Shock has two stages, and there is nothing between them. Calling this child late compensated delays the aggressive treatment a decompensated child needs now.

Compensated, since tachycardia is still holding the pressure up: Children do compensate well and hold a normal blood pressure much longer than adults. A pressure of 62 systolic in a 4-year-old is hypotension. Once the pressure falls, the child is no longer compensating.

Irreversible, since the pressure has already fallen this far: Irreversible sounds like the right word for a child this sick. Shock has only compensated and decompensated stages. There is no irreversible stage to assign this child to.

Question 6 of 9

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

This child is in heat stroke. The child was in a car parked in direct sun. The skin is hot and dry with no sweating, and the child responds only to pain. Hot, dry skin with an altered mental status is heat stroke. Sweating skin would point to heat exhaustion instead. The core temperature in heat stroke is 104°F or higher. Heat stroke is not a fever. In a fever, the body is holding a raised set point, and you only cool passively. In heat stroke, the body's temperature control has failed. There is no set point being defended, and cooling slowly gains you nothing. Cool this child aggressively. Get the child out of the heat and take off the clothing. Put cold packs at the groin, the armpits, and the sides of the neck. 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: Taking off the extra clothing is part of cooling this child. Clothing removal alone is how you cool a child with a fever. In a fever, chilling the skin causes shivering, and shivering makes more heat. The shivering rule belongs to fever, and this child is in heat stroke. Stopping at the clothing holds back aggressive cooling, the one treatment that changes the outcome.

Wrap the patient to prevent a rapid drop in core temperature in transport: A temperature that drops too fast is a real concern in some other kinds of cooling. This child is being hurt by the heat right now. Wrapping the child holds 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 with a fever from an illness. An antipyretic works by lowering the body's set point. In heat stroke, there is no set point being defended, so the antipyretic has nothing to lower.

Question 7 of 9

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

This child breathes through a tracheostomy, so the stoma is the airway. The child is unresponsive with agonal respirations at a rate of 4. The heart rate is 52 and the SpO₂ is 79%. The tracheostomy tube is in place and intact, so ventilate through the stoma first. Connect the bag mask directly to the tracheostomy tube. If the tube has come out, seal an infant mask over the stoma itself. The most common emergency with these tubes is a blockage from dried or thick secretions. Suctioning the tube is in your scope. Pass a soft catheter no farther than the length of the tube, and suction only as you pull out. Stay under 10 seconds in a child and 5 seconds in an infant, and give oxygen between passes.

Why the others are wrong

Through the mouth with a bag mask after an oral airway is inserted: An oral airway opens a blocked upper airway in most unresponsive patients. This child's stoma is open, and the tube in it is intact. A breath you give at the mouth escapes out the stoma instead of filling the lungs. The tube in the neck is the direct route.

Through the mouth and nose with a bag mask while the stoma is covered: Bagging the mouth and nose with the stoma covered is the backup route for a child with a tracheostomy. You use it when the stoma cannot be used, or when bagging through the stoma gives no chest rise. This child's tube is in place and intact, so the stoma route has not failed. Many children who have had a tracheostomy for a long time cannot be ventilated through the mouth and nose at all. A child breathing 4 times a minute with a heart rate of 52 needs the direct route first.

Through the nose with a bag mask after the tracheostomy tube is removed: Removing the tracheostomy tube is a step some protocols allow when suctioning and removing the inner cannula do not clear a blocked tube. Nothing in this question says the tube is blocked. The tube is in place and appears intact. With the tube out and the stoma uncovered, air you push in at the nose leaks out the neck.

Question 8 of 9

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

In a small child, the intraosseous site in the proximal tibia is on the flat medial surface. The site sits one to two centimeters below and medial to the tibial tuberosity. This patient is 3 years old, so you use the pediatric site. The pediatric site sits below the tuberosity on purpose. Staying below the tuberosity, with the needle angled away from the growth plate, keeps the needle clear of the growth plate. Current driver instructions put the adult site about one centimeter above the tuberosity. On a small leg, the adult and pediatric sites are only a centimeter or two apart. To confirm placement, the needle should stand up on its own and you should be able to aspirate. A flush should go in without swelling in the tissue around it. In a conscious patient, the infusion hurts. Fluid will not run in by gravity, so push it with a syringe or use a pressure bag. In a child, flush with 2 to 5 mL of saline.

Why the others are wrong

About one centimeter above the tibial tuberosity on the flat surface: About one centimeter above the tibial tuberosity is where current driver instructions put the adult site. On a 3-year-old, going above the tuberosity moves the needle toward the growth plate. The pediatric site is below the tuberosity to keep the needle away from the growth plate.

At the widest part of the proximal tibia, level with the growth plate: The widest part of the proximal tibia sounds like it gives you the most room. Option C puts the needle level with the growth plate. Keeping the needle off the growth plate is the reason the pediatric site sits below the tuberosity.

Directly over the tibial tuberosity, where the landmark is easiest to feel: The tibial tuberosity is the easiest landmark to feel on a small leg. The tuberosity is the landmark you measure from. Moving medial takes the needle off the tuberosity and onto flat bone with a wide marrow cavity under it.

Question 9 of 9

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

This toddler is close to respiratory arrest. The child was flaring, grunting, and retracting, and now looks less distressed while the heart rate slows. A child's heart responds to a long stretch of hypoxia by slowing down, once the body can no longer compensate. The heart muscle itself is not getting enough oxygen. The child looks calmer because the breathing muscles are wearing out, not because the lungs are clearing. Start aggressive airway management and support the ventilations right away.

Why the others are wrong

The child is improving and requires less aggressive intervention: Looking less distressed usually means a patient is getting better. In this toddler, the heart rate is slowing at the same time. A slowing heart rate after flaring, grunting, and retractions means the child is decompensating. This child needs more aggressive care, not less.

The slowing heart rate is a reassuring sign that the child is calming down: A slowing heart rate is reassuring in an adult coming down from a fast heart rate or recovering from a vagal episode. This child's heart rate is slowing after a stretch of hard work to breathe. In a toddler with respiratory distress, a slowing heart rate means arrest is close.

Retractions and grunting are normal findings in children and do not indicate distress: Grunting by itself can show up briefly in a normal newborn right after birth. This patient is a toddler who is also flaring and retracting. Grunting, flaring, and retractions together are classic signs of serious respiratory distress in a child.

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