51) Your patient is in a state of hypoperfusion secondary to cardiomyopathy. In addition to oxygenation, which of the following interventions is indicated? A) An epinephrine drip at 0.1 to 1.0 mcg/kg/minute B) Atropine, 0.02 mg/kg of atropine sulfate C) A 20 mL/kg bolus of normal saline, repeated to a total of 80 mL/kg D) A dobutamine drip starting at 2.0 mcg/kg/minute 52) Which of the following would be acceptable choices for pediatric analgesia? 1. Fentanyl 2. Morphine 3. Nalbuphine 4. Meperidine 5. Butorphanol A) 1 and 2 only B) 2, 4, and 5 C) 1, 2, 3, and 4 D) 2, 3, and 4 53) The most common cardiac dysrhythmias in pediatric patients are: A) ventricular tachycardias. B) bradyarrhythmias. C) supraventricular tachycardias. D) intermittent atrioventricular blocks. 54) Your patient is a 14 month-old child who has been taking an antibiotic for three days for an ear infection. Her parents have called EMS because the child has not been eating or drinking, is irritable, has a fever, and generally appears very sick. Which of the following should you most highly suspect? A) Herpes zoster B) Bacterial meningitis C) Fifth disease D) An allergic reaction to the antibiotic 55) Which of the following is the leading cause of poisoning in toddlers and preschoolers? A) Medications taken for ADD/ADHD B) Iron-containing vitamins C) Hydrocarbons D) Alcohol 56) Your patient is a nine-year-old female who was struck by a vehicle as she ran across the street. She is unresponsive and has a hematoma over the left parietal area and an open, depressed skull fracture on the right parietal area. She has bruising on the left flank and hip. She is breathing irregularly at 8 times per minute and has a heart rate of 56. She has a faint carotid pulse but no radial pulse. Which of the following is/are most likely to account for your patient’s heart rate? 1. Normal range for a healthy, fit, nine-year-old child 2. Hypoxia due to impaired respiratory status secondary to traumatic brain injury 3. Increasing intracranial pressure due to traumatic brain injury exacerbated by hypoxia 4. Myocardial contusion A) 3 B) 4 C) 1 D) 2 and 3 57) You are in the home of a 17-year-old female complaining of abdominal pain. Her mother and father are hovering near her and answering most of the questions you ask her. You sense that the patient is uncomfortable answering questions in front of her parents. Which of the following is the best way to handle this situation? A) Tell the patient you know she might be embarrassed but that it is imperative that she give you the whole story so you know what to do for her. B) Defer the history to the triage nurse at the emergency department so as not to cause undue discomfort to the patient. C) Ask the parents to go to the kitchen with your partner so he can get some information for your paperwork. D) Tell the parents that their daughter is a big girl and probably doesn’t want to talk about her problems in front of them. 58) You have just arrived on the scene where an infant stopped breathing. You find a three-month-old child being held tightly by his mother, who is sobbing uncontrollably. On examination, you find that the child is apneic and pulseless and has dependent lividity and early rigor mortis. There are no obvious signs of injury. Which of the following is the best course of action? A) Begin full resuscitative measures, then contact medical control for orders to terminate resuscitation in the field. B) Gently tell the mother that the baby is dead and that there is nothing that can be done for him; allow her to hold him. C) Tell the mother that the baby is dead but that you cannot allow her to hold him until the police verify that no crime has been committed. D) Begin CPR and continue BLS measures until you are inside the ambulance; notify the hospital that you are transporting a deceased SIDS infant. 59) Which of the following provide(s) an acceptable estimate of the correct size of endotracheal tube for a pediatric patient? 1. The patient’s age in years plus 16, divided by 4 2. The diameter of the little finger 3. A length-based resuscitation tape 4. The child’s age in years plus 1 A) 1 and 2 B) 1, 2, and 3 C) 3 and 4 D) 1, 2, 3, and 4 60) Your patient is a seven-year-old female with a history of bee-sting anaphylaxis. She was stung by a bee and nearly immediately began having difficulty swallowing and breathing. Her father administered her prescribed 0.15 mg epinephrine auto-injector without result. On your arrival, the patient responds to painful stimuli; has labored, rapid, wheezing respirations; a heart rate of 60; and a blood pressure of 92/60. Her father tells you that she weighs 48 pounds. Which of the following is the best sequence of treatment for this patient? A) Hyperventilate for 1 to 2 minutes, intubate the trachea, administer 1:10,000 epinephrine endotracheally, start an IV of normal saline, and administer diphenhydramine, IV B) Assist ventilations with a bag-valve-mask device and supplemental oxygen, administer diphenhydramine subcutaneously, start an IV of normal saline, and administer 1:1,000 epinephrine intravenously. C) Begin a nebulized albuterol treatment with supplemental oxygen, administer 1:1,000 epinephrine subcutaneously, start an IV of normal saline and infuse a 400-mL bolus, and administer diphenhydramine, IM D) Assist ventilations with a bag-valve-mask device and supplemental oxygen, initiate a large-bore IV of normal saline, and administer 1:10,000 epinephrine intravenously, followed by diphenhydramine, IV