22 Obstetrics, Neonatal & Pediatric Practice Questions & Answers

1. 1. A 26-year-old woman at 30 weeks' gestation was a restrained driver in a moderate-speed crash. She has diffuse abdominal tenderness. Her blood pressure is 118/74, her pulse is 104, and her skin is warm and dry. Why do these vital signs fail to rule out serious internal bleeding?

   • A.Circulating blood volume rises sharply in pregnancy, so maternal signs appear only after a large loss.✓ Answer
   • B.The fetal circulation transfuses the mother during bleeding, holding her measured pressure normal.
   • C.Uterine blood flow is autoregulated, so the mother's pressure drops before any fetal flow falls.
   • D.Progesterone tightens the vessels late in pregnancy, so blood loss shows up as high blood pressure.

   Maternal blood volume expands roughly 45-50 percent and the resting heart rate rises, so a pregnant patient can lose a large fraction of her circulating volume before her blood pressure falls. The uterine bed is the first circulation sacrificed, which is why fetal distress appears before any maternal vital-sign change. She must be treated as a shock patient: oxygen, vascular access, positioning off the vena cava, and rapid transport.

   Source: National EMS Education Standards (2021), AEMT column — Obstetrics: anatomy and physiology of normal pregnancy; trauma in pregnancyReport a problem with this question

2. 2. A woman at 34 weeks is laid supine on the stretcher. Within two minutes she becomes pale, lightheaded and nauseated, and her blood pressure falls from 122/78 to 88/52. What should the AEMT do first?

   • A.Turn her onto her left side, or displace the uterus left if supine.✓ Answer
   • B.Roll her onto her right side and slide a blanket under her shoulders.
   • C.Keep her flat on her back and raise both legs well above heart level.
   • D.Sit her fully upright on the stretcher and coach slow, deep breathing.

   After about 20 weeks the gravid uterus compresses the inferior vena cava when the patient lies flat, cutting venous return and cardiac output — supine hypotensive syndrome. Relief comes from moving the uterus off the vessel, either by turning the patient to her left side or by manually displacing the uterus leftward when she must remain supine. Right lateral positioning and leg elevation do not take the weight off the cava.

   Source: National EMS Education Standards (2021), AEMT — Obstetrics: assessment of the pregnant patient (supine hypotensive syndrome)Report a problem with this question

3. 3. A woman at 33 weeks' gestation has painless, bright red vaginal bleeding that began while she was resting. Her uterus is soft and non-tender and she reports normal fetal movement. Which action fits this presentation?

   • A.Pack the vaginal vault with sterile dressings to slow the rate of bleeding.
   • B.Place absorbent pads externally, count them for blood loss, and transport her.✓ Answer
   • C.Perform a gentle digital exam to see whether the cervix has begun to dilate.
   • D.Hold her at the scene until the bleeding stops, then recheck pulse and pressure.

   Painless bright red bleeding with a soft, non-tender uterus in the third trimester suggests placenta previa, in which the placenta lies over the cervical opening. Any digital or instrumented vaginal examination can tear the placenta and cause catastrophic hemorrhage, and the vagina is never packed. Blood loss is quantified by counting saturated pads while the patient is transported with oxygen and vascular access.

   Source: National EMS Education Standards (2021), AEMT — Obstetrics: third-trimester bleeding (placenta previa)Report a problem with this question

4. 4. A woman at 36 weeks was the restrained driver in a collision. She has constant severe abdominal pain, a firm board-like tender uterus, and only a small amount of dark vaginal blood. Her pulse is 122 and her blood pressure is 104/68. What does this picture most strongly suggest?

   • A.Placental abruption, with much of the blood hidden behind the placenta.✓ Answer
   • B.Ruptured membranes with the early onset of uncomplicated term labor.
   • C.Placenta previa, with the placenta covering the cervical opening.
   • D.Bladder injury from the lap belt producing referred pain in the uterus.

   Separation of the placenta from the uterine wall after blunt trauma produces continuous pain and a rigid, tender uterus, and the bleeding is frequently concealed behind the placenta, so the visible loss badly understates the true loss. Abruption is the leading cause of fetal death when the mother survives blunt trauma, so she is treated for hemorrhagic shock and transported rapidly even while her pressure looks acceptable.

   Source: National EMS Education Standards (2021), AEMT — Obstetrics: third-trimester bleeding (abruptio placentae) and trauma in pregnancyReport a problem with this question

5. 5. A 24-year-old woman whose period is two weeks late has sudden, severe left lower abdominal pain and light vaginal spotting. She is pale and diaphoretic with a pulse of 128 and also complains of pain in her left shoulder. What is the working impression and priority?

   • A.Pelvic inflammatory disease — control her pain and then transport routinely.
   • B.Unruptured ovarian cyst — position of comfort and non-emergency transport.
   • C.Threatened miscarriage — collect any tissue passed and transport her in.
   • D.Ruptured ectopic pregnancy — treat for hemorrhagic shock and transport now.✓ Answer

   An ectopic pregnancy implants outside the uterus, usually in a fallopian tube, and bleeds into the peritoneum when it ruptures. A missed period with unilateral lower abdominal pain, spotting and signs of poor perfusion is the classic pattern, and referred shoulder pain comes from blood irritating the diaphragm. It is the leading cause of first-trimester maternal death, so the patient is managed as internal hemorrhage with oxygen, vascular access and rapid transport.

   Source: National EMS Education Standards (2021), AEMT — Obstetrics: complications of pregnancy (ectopic pregnancy)Report a problem with this question

6. 6. A woman at 32 weeks reports a pounding headache, spots in her vision, and new swelling of her face and hands. Her blood pressure is 168/112. Which action best reflects the risk these findings carry?

   • A.Offer water and a snack, since dehydration explains headache and swelling.
   • B.Dim the lights, keep the compartment quiet, and move her gently.✓ Answer
   • C.Keep her sitting upright under bright light so her vision can be retested.
   • D.Have her walk to the ambulance to judge her exercise tolerance first.

   Headache, visual disturbance, facial and hand edema and new hypertension after 20 weeks describe preeclampsia, and the feared progression is an eclamptic seizure. Bright light, noise and jarring movement are recognized precipitants, so a dark, quiet, gentle environment with left lateral positioning is genuinely therapeutic while the AEMT obtains access, gives oxygen and arranges an ALS response.

   Source: National EMS Education Standards (2021), AEMT — Obstetrics: complications of pregnancy (preeclampsia and eclampsia)Report a problem with this question

7. 7. A woman at 36 weeks has a generalized seizure at home. It stops after about 90 seconds, and she remains unresponsive with snoring respirations. Her blood pressure is 172/108. What should the AEMT do?

   • A.Push an intravenous benzodiazepine and then reassess her airway.
   • B.Give an intravenous dextrose bolus, treating the seizure as low glucose.
   • C.Prepare magnesium sulfate for intravenous use to prevent another seizure.
   • D.Suction, position her left lateral, give oxygen, and request ALS.✓ Answer

   A seizure in the third trimester or in the weeks after delivery is eclampsia until proven otherwise. The AEMT's contribution is entirely supportive — clearing the airway, oxygen, left lateral positioning to relieve caval compression, protection from injury, vascular access and gentle transport in a quiet compartment. The definitive anticonvulsant for eclampsia sits outside the AEMT formulary in the national scope model, so the correct escalation is an ALS intercept or contact with medical direction rather than giving it.

   Source: 2019 National EMS Scope of Practice Model, AEMT medication table; National EMS Education Standards (2021), AEMT — eclampsiaReport a problem with this question

8. 8. A woman at 34 weeks collapses; she is pulseless and apneic, and chest compressions are begun on a firm surface. Which additional step best improves survival for both mother and fetus?

   • A.Withhold the defibrillator until arrival because of the risk to the fetus.
   • B.Lighten each compression to protect the uterus from injury during CPR.
   • C.Tilt the whole backboard toward her right and keep compressing on it.
   • D.Have a crew member hold the uterus displaced to the patient's left.✓ Answer

   Past about 20 weeks the gravid uterus compresses the vena cava and aorta, so venous return during compressions is poor no matter how good the technique. Continuous manual displacement of the uterus to the patient's left relieves that obstruction while keeping her flat, which is what high-quality compressions require. The best treatment for the fetus is effective resuscitation of the mother, and defibrillation is not modified by pregnancy.

   Source: AHA guidance on cardiac arrest in pregnancy (continuous manual left uterine displacement); National EMS Education Standards (2021), AEMTReport a problem with this question

9. 9. A woman who has delivered three times before is at term with contractions two minutes apart lasting about 50 seconds. She feels a strong urge to move her bowels, and the top of the infant's head is visible at the vaginal opening. What is the correct decision?

   • A.Have her sit on the toilet and wait until the urge to push has passed.
   • B.Load and transport at once, coaching the mother to keep her legs together.
   • C.Transport left lateral and recheck for crowning every five minutes en route.
   • D.Prepare to deliver on scene and set out the obstetric and warming supplies.✓ Answer

   Crowning, contractions roughly two minutes apart lasting nearly a minute, and an urge to bear down in a woman who has delivered before all say that birth is imminent, and labor in a multipara progresses fastest. Moving the patient risks an uncontrolled delivery in a moving vehicle, so the field is prepared instead. Holding the legs together or telling her to suppress the urge does not stop labor and can injure both patients.

   Source: National EMS Education Standards (2021), AEMT — Obstetrics: normal labor and assisted delivery (signs of imminent delivery)Report a problem with this question

10. 10. The infant's head delivers and the AEMT finds the umbilical cord wound tightly around the neck; it will not slip over the head. What should be done next?

    • A.Pull steadily on the head to free the shoulders and ease the tension.
    • B.Have the mother push hard so the body clears before it tightens.
    • C.Clamp the cord in two places, cut between the clamps, and slip it off.✓ Answer
    • D.Wait for the next contraction and deliver the body with it in place.

    A loose nuchal cord is simply slipped over the head, but a cord that will not slide tightens as the body descends and both strangles the infant and can tear the placenta from the uterine wall. Placing two clamps and cutting between them relieves the loop immediately so delivery can continue. Traction on the head does not free the cord and risks brachial plexus injury.

    Source: National EMS Education Standards (2021), AEMT — assisted delivery (nuchal cord)Report a problem with this question

11. 11. Ten minutes after an uncomplicated field delivery the placenta has not delivered and the mother has soaked two pads with blood. She is pale, her pulse is 118 and her blood pressure is 96/60. What should the AEMT do first?

    • A.Pack the vagina with sterile gauze and hold firm pressure on it.
    • B.Delay the transport until the placenta has delivered completely.
    • C.Pull gently and steadily on the cord to deliver the placenta now.
    • D.Massage the uterine fundus firmly and put the newborn to the breast.✓ Answer

    Bleeding after delivery is most often uterine atony: the uterus fails to contract, so the vessels at the placental site stay open. Firm fundal massage and nipple stimulation from nursing both trigger uterine contraction, which is the mechanism that actually closes those vessels. Traction on the cord can invert the uterus, the vagina is never packed, and transport with fluid support is not delayed waiting for the placenta.

    Source: National EMS Education Standards (2021), AEMT — postpartum complications (postpartum hemorrhage)Report a problem with this question

12. 12. The membranes rupture and a loop of pulsating umbilical cord is visible at the vaginal opening. The mother feels the urge to push. What must the AEMT do?

    • A.Have the mother push hard with each contraction to speed the delivery.
    • B.Hold the presenting part off the cord with two gloved fingers during transport.✓ Answer
    • C.Push the cord gently back into the vagina and cover it with moist gauze.
    • D.Lay the mother flat with her legs extended and transport without touching.

    In a prolapsed cord the presenting part compresses the cord against the pelvis and shuts off fetal circulation. The only field measure that restores flow is inserting two gloved fingers to lift the presenting part off the cord and keeping them there through transport, combined with hips elevated or a knee-chest position, oxygen, moist dressings over the exposed cord, and coaching the mother to pant rather than push. The cord is never pushed back inside.

    Source: National EMS Education Standards (2021), AEMT — abnormal delivery (prolapsed umbilical cord)Report a problem with this question

13. 13. The infant's head delivers and then pulls back tightly against the perineum, and the shoulders do not follow with the next contraction. What should the AEMT do?

    • A.Hyperflex the mother's hips toward her chest with suprapubic pressure.✓ Answer
    • B.Have a partner press on the top of the uterus to push the infant down.
    • C.Lay the mother flat with legs extended and transport without attempts.
    • D.Apply firm downward traction on the head until the shoulder passes.

    Shoulder dystocia is the anterior shoulder caught behind the pubic symphysis, and the retracting head is the classic turtle sign. Hyperflexing the mother's hips back toward her chest rotates the symphysis upward and flattens the sacrum, and suprapubic pressure pushes the shoulder into the wider oblique diameter. Traction on the head injures the brachial plexus, and fundal pressure drives the shoulder harder against the bone.

    Source: National EMS Education Standards (2021), AEMT — abnormal delivery (shoulder dystocia); McRoberts maneuver with suprapubic pressureReport a problem with this question

14. 14. A newborn delivers through thick green-stained amniotic fluid. He is limp and apneic, and his heart rate is 80. What is the correct immediate management?

    • A.Suction the trachea before ventilating, to remove the meconium first.
    • B.Begin chest compressions at once because that heart rate is this low.
    • C.Warm, dry and stimulate him, then begin positive-pressure breaths.✓ Answer
    • D.Suction the mouth and the nose at the perineum before the shoulders come.

    Routine suctioning on the perineum and routine tracheal suctioning of the non-vigorous meconium-stained newborn were removed from the resuscitation algorithm; both delay the one thing this infant needs, which is air moving into the lungs. Warming, drying and stimulation come first, and an apneic newborn whose heart rate is depressed then receives positive-pressure ventilation, with suction reserved for an airway that is actually obstructed. Compressions are added only when ventilation that visibly moves the chest fails to raise the heart rate.

    Source: AHA/AAP Neonatal Resuscitation algorithm, meconium-stained non-vigorous newborn; National EMS Education Standards (2021), AEMT — neonatal resuscitationReport a problem with this question

15. 15. A term newborn has been dried, warmed and stimulated but stays apneic. Positive-pressure ventilation is started and the chest visibly rises. After 30 seconds of effective ventilation his heart rate is 48 and falling. What should be done next?

    • A.Stop ventilating and switch to blow-by oxygen while rechecking the pulse.
    • B.Begin chest compressions coordinated with the ongoing ventilations.✓ Answer
    • C.Establish vascular access and give a fluid bolus to raise the rate.
    • D.Assign an Apgar score before changing anything in the resuscitation.

    Heart rate is the newborn's primary indicator of how the resuscitation is going. When the rate remains profoundly low despite ventilation that visibly moves the chest, oxygen is reaching the lungs but the myocardium is no longer perfusing, so compressions must be added and coordinated with the breaths while the oxygen concentration is increased. Apgar scoring is documentation and never delays treatment, and stopping ventilation removes the single most important intervention.

    Source: AHA/AAP Neonatal Resuscitation algorithm (heart rate as primary indicator); National EMS Education Standards (2021), AEMT — newborn stabilizationReport a problem with this question

16. 16. A newborn is delivered in a cool apartment and is vigorous and crying. Which action best protects him during the first minutes of life?

    • A.Wrap him in the damp delivery towels against his mother's skin.
    • B.Leave him uncovered so his color and breathing stay easy to see.
    • C.Bathe him in warm water to rinse off the fluid, then wrap him.
    • D.Remove the wet linen, dry him, cover his head, and warm the compartment.✓ Answer

    A newborn has a very large surface area relative to body mass, a thin layer of insulating fat, and skin wet with amniotic fluid, so evaporative heat loss is rapid. Hypothermia in turn drives hypoglycemia, acidosis and apnea, which is why drying, discarding the wet linen, covering the head and warming the compartment are done immediately. A damp blanket keeps the newborn cooling, and bathing simply prolongs the wet phase.

    Source: National EMS Education Standards (2021), AEMT — newborn stabilization (thermoregulation)Report a problem with this question

17. 17. A 32-year-old woman has had heavy vaginal bleeding for six hours, changing a pad about every twenty minutes. Her skin is cool, her pulse is 116 and her blood pressure is 100/62. She states she cannot be pregnant. How should the AEMT proceed?

    • A.Perform an internal exam to find the source before deciding on transport.
    • B.Pack the vagina with gauze and hold pressure until the bleeding slows.
    • C.Count the saturated pads, obtain vascular access, and transport her.✓ Answer
    • D.Treat it as a routine complaint, since she has ruled out any pregnancy.

    Heavy vaginal bleeding with cool skin and tachycardia is hemorrhagic shock regardless of its gynecologic cause, and the source cannot be controlled in the field. Counting saturated pads is the practical way to quantify loss and hand a useful number to the receiving team; the vagina is never packed and no internal examination is performed. Pregnancy is still considered possible in any patient of childbearing age, because an unrecognized ectopic presents exactly this way.

    Source: National EMS Education Standards (2021), AEMT — Gynecology: vaginal bleedingReport a problem with this question

18. 18. A 19-year-old reports that she was sexually assaulted an hour ago. She has no life-threatening injuries and asks to shower and change clothes before going to the hospital. What is the best response?

    • A.Let her shower and change quickly, then bag her clothing in plastic.
    • B.Examine the genital area to document the injuries for the report.
    • C.Wait for law enforcement before giving care or moving her from there.
    • D.Explain why waiting helps and put removed clothing in a paper bag.✓ Answer

    Washing, changing clothes, douching or urinating destroys physical evidence, so the patient is told plainly why waiting matters while her right to refuse is respected. Clothing that has to be removed goes into paper rather than plastic, because plastic traps moisture and degrades biological evidence. The field examination is limited to life threats, the scene is disturbed as little as possible, and care and transport are never delayed waiting for police.

    Source: National EMS Education Standards (2021), AEMT — Gynecology: sexual assault, patient consent and evidence preservationReport a problem with this question

19. 19. Standing in the doorway, and before touching a 2-year-old, the AEMT forms a structured first impression. Which three elements make up that impression?

    • A.Airway, breathing, and circulation with a carotid pulse check.
    • B.Level of consciousness, pupil reaction, and capillary refill.
    • C.Appearance, work of breathing, and circulation to the skin.✓ Answer
    • D.Pulse rate, respiratory rate, and blood pressure taken by cuff.

    The pediatric assessment triangle is a hands-off, equipment-free impression formed from across the room: appearance (tone, interactivity, consolability, gaze and cry), work of breathing, and circulation to the skin. It answers how sick the child is and how quickly to act before a single vital sign is measured, and it is deliberately made before touching the child because handling a frightened toddler changes everything that is then observed.

    Source: National EMS Education Standards (2021), AEMT — Pediatrics: assessment (Pediatric Assessment Triangle)Report a problem with this question

20. 20. A 3-year-old with two days of cough has been breathing hard. His retractions are now less pronounced, his respiratory rate has fallen from 48 to 16, he is limp and barely responsive, and his pulse has dropped from 160 to 62. What does this change indicate?

    • A.Improvement, since both the effort and the rate have come down.
    • B.A primary cardiac rhythm disturbance the AEMT should analyze first.
    • C.Impending respiratory arrest from hypoxia — start ventilating him.✓ Answer
    • D.A vagal response to coughing that will pass with rest and oxygen.

    Children compensate for respiratory illness by breathing fast and hard until the muscles exhaust, then decompensate abruptly. A falling respiratory rate, fading retractions, limp tone and a dropping heart rate are the picture of exhaustion and hypoxia, not recovery: bradycardia in a child is hypoxia until proven otherwise. The treatment is immediate oxygenation and assisted ventilation, because pediatric arrest is nearly always the end point of a respiratory problem rather than a primary rhythm problem.

    Source: National EMS Education Standards (2021), AEMT — Pediatrics: respiratory distress, respiratory failure and arrestReport a problem with this question

21. 21. An 18-month-old has vomited and had diarrhea for three days. He is listless, his mucous membranes are dry, capillary refill is four seconds, his pulse is 178, and his blood pressure is normal for his age. How should this be interpreted and managed?

    • A.Adequate perfusion, because the normal blood pressure rules out shock.
    • B.Stranger anxiety — calm him and recheck the capillary refill shortly.
    • C.Compensated shock — give a weight-based fluid bolus and reassess him.✓ Answer
    • D.Simple viral fever — encourage oral fluids and transport non-urgently.

    Children defend blood pressure by raising heart rate and clamping down peripheral vessels, so tachycardia, delayed capillary refill, dry membranes and altered behavior with a normal pressure define compensated shock. Hypotension in a child is a late, near-arrest finding, so a normal pressure never reassures. Volume is replaced according to the child's weight, using a length-based tape when the weight is unknown, and the child is reassessed after each bolus for improvement in mentation, refill and heart rate.

    Source: National EMS Education Standards (2021), AEMT — Pediatrics: shock, dehydration and fluid resuscitationReport a problem with this question

22. 22. A 9-month-old has a spiral fracture of the forearm; the father says the infant rolled off a couch. There are also bruises of several different colors across the infant's back. What should the AEMT do?

    • A.Chart only the injury treated, since reporting is the hospital's job.
    • B.Record the findings and statements objectively and report as required.✓ Answer
    • C.Photograph the bruises on a personal phone and give them to police.
    • D.Ask the father outright whether he hurt the child and note his reaction.

    A spiral fracture requires a twisting force a nine-month-old cannot generate, and bruises in several stages of healing on a non-ambulatory infant are inconsistent with the reported mechanism — both are recognized red flags for maltreatment. EMS clinicians are mandatory reporters in every state: the finding is documented objectively with the caregiver's words quoted rather than interpreted, the child is transported, and the report goes through the required channel. Confronting the caregiver on scene endangers the child and the crew and can destroy the investigation.

    Source: National EMS Education Standards (2021), AEMT — Pediatrics: child maltreatment, neglect and mandatory reportingReport a problem with this question

Practice questions based on the National Registry Advanced EMT Examination Specifications and the National EMS Education Standards. This site is not affiliated with or endorsed by the National Registry of Emergency Medical Technicians, and nothing here is medical advice. AEMT scope of practice is set by your state and by your medical director, and drug doses, concentrations, infusion rates and clinical thresholds come from your protocols — never from a practice test. Resuscitation guidance is revised on a cycle; always follow the guidelines and protocols currently in effect where you practice. Confirm eligibility and current exam requirements with the National Registry before you test. About AEMT certification →