Home › Guides › NREMT OB & peds
NREMT — EMT & Paramedic
NREMT Obstetrics & Pediatrics Practice Questions
OB and pediatrics earn their reputation as the questions candidates fear most — low real-world reps, high stakes, and the NREMT knows it. The good news: the exam draws from a small set of patterns. Deliveries: when to stay, what normal looks like, the two or three complications with specific maneuvers. Newborns: the first-minute algorithm. Children: the assessment triangle, the compensation cliff, and the age-adjusted red flags.
If you remember nothing else: most deliveries need a catcher, not a clinician; most sick newborns need warmth, drying and ventilation; and children compensate beautifully until they fall off a cliff — so treat the working-hard child before the numbers crash.
Field deliveries and the newborn minute
Transport vs deliver: crowning, the urge to push/bear down, or contractions roughly 2 minutes apart and lasting a minute in a multigravida mean delivery is imminent — prepare to deliver on scene rather than gambling on the ride. Normal delivery support: control the head's emergence, check for a nuchal cord (slip it over the head; if tight, per protocol clamp-and-cut), suction per current guidance only when needed, deliver the shoulders, dry/stimulate/warm. Cord care: clamp and cut after pulsation per protocol; placenta delivers on its own — never pull. Postpartum hemorrhage: fundal massage and breastfeeding stimulation, treat for shock, transport.
Complications with maneuvers: breech — support the body, never pull, form an airway 'V' with fingers if the head doesn't follow, rapid transport; prolapsed cord — the true field emergency: knees-to-chest or extreme Trendelenburg positioning, a gloved hand relieving presenting-part pressure off the cord (do not push the cord back), high-flow O2, lights-and-sirens transport; limb presentation — position and go. Newborn (the inverted pyramid): warm, dry, stimulate, position the airway; if breathing inadequate or heart rate under 100 → positive-pressure ventilation with room air to start (per NRP-aligned teaching); heart rate under 60 despite 30 seconds of effective ventilation → chest compressions at 3:1. APGAR at 1 and 5 minutes — but never delaying resuscitation to score it.
Pediatric assessment: the triangle and the cliff
The Pediatric Assessment Triangle — appearance (tone, interactiveness, consolability, look/gaze, speech/cry), work of breathing (retractions, nasal flaring, grunting, positioning), circulation to skin (pallor, mottling, cyanosis) — forms your from-the-doorway impression before touching the child. An abnormal arm of the triangle classifies the emergency: appearance alone → neuro/metabolic; breathing alone → respiratory distress; appearance + breathing → respiratory failure; appearance + circulation → shock.
The compensation cliff: children maintain blood pressure by heart rate and vasoconstriction far longer than adults — hypotension is a late, pre-arrest finding. Tachycardia, delayed cap refill, mottling, and declining interactiveness are the early alarms. Respiratory failure is the dominant pediatric arrest pathway, so aggressive airway/ventilation support is the highest-yield intervention in nearly every sick-kid stem. Other patterned answers: grunting = impending respiratory failure; drooling/tripoding with stridor = keep the child calm, position of comfort, no oral exam, rapid transport; bradycardia in a child = hypoxia until proven otherwise — ventilate.
Practice questions with answers & rationales
Q1. A multigravida at term has contractions 2 minutes apart and says 'the baby is coming.' Examination shows crowning. Transport or deliver?
Answer: Deliver on scene — crowning is the definitive sign of imminent birth, and a delivery in the truck on the highway is the worse alternative. Set up your OB kit, control the head, check for a nuchal cord, support the delivery, and prepare for two patients (warmth and newborn assessment). The credited logic: crowning, bearing-down urge, or contraction pattern in an experienced mother = stay.
Q2. After the head delivers, you find the cord wrapped tightly around the neck and cannot slip it over. Next action?
Answer: Per protocol: clamp the cord in two places and cut between the clamps, then proceed with the delivery promptly — a tight nuchal cord prevents delivery and strangulates as the body emerges. (If it's loose, simply slip it over the head — that's the first attempt.) This is one of the few 'cut first' moments in field OB and a heavily tested distinction.
Q3. You see a loop of umbilical cord at the vaginal opening with contractions ongoing. Walk through your actions.
Answer: Prolapsed cord — fetal circulation is being crushed between the presenting part and the pelvis. Position mother knees-to-chest or deep Trendelenburg; insert a gloved hand to lift the presenting part off the cord (and keep it there for the entire transport); do not push the cord back; keep the cord moist per protocol; high-flow oxygen; emergent transport with early notification — this baby needs a cesarean. Checking the cord for pulsation confirms the intervention is working.
Q4. A newborn is limp and not breathing after drying and stimulation; heart rate is about 80. What's the next step?
Answer: Positive-pressure ventilation — room air initially per NRP-aligned field teaching — at 40–60 breaths/min, reassessing heart rate after 30 seconds of effective ventilation. Ventilation is the entire heart of newborn resuscitation: most depressed newborns respond to it alone. Compressions enter only if the rate is below 60 despite 30 seconds of effective PPV (then 3:1, with ventilations continuing). Jumping to compressions at HR 80 is the planted error.
Q5. Using the Pediatric Assessment Triangle, classify: a toddler who is limp and poorly responsive, breathing fast with deep retractions and grunting.
Answer: Abnormal appearance + abnormal work of breathing = respiratory failure (not just distress) — the child is failing despite effort, and grunting is the classic impending-failure sound. Action: immediate airway positioning, high-concentration oxygen, assisted BVM ventilation if breathing remains inadequate, rapid transport. The PAT's value is exactly this: classifying severity before vitals are even measured.
Q6. An injured 4-year-old has HR 158, RR 32, cap refill 4 seconds, mottled legs — BP 96/60 ('normal for age'). Interpret.
Answer: Compensated shock, and significantly so: marked tachycardia, prolonged cap refill, and mottling are the early system. Children defend blood pressure until they've lost a large fraction of volume — hypotension in a child is a pre-arrest sign, not the threshold for concern. Care: hemorrhage control, oxygen, warmth, rapid transport, ALS for vascular access/fluids per protocol — initiated now, while the BP still looks reassuring.
Q7. A febrile 2-year-old sits tripoding, drooling, with stridor, looking toxic. What should you avoid, and why?
Answer: Avoid anything that upsets the child: no oral examination, no tongue depressor, no IV attempts, no forcing a mask — agitation can convert a narrowed airway (epiglottitis/severe croup picture) into a closed one. Keep the child calm on the caregiver's lap, position of comfort, blow-by oxygen if tolerated, and rapid, gentle transport with ALS ready for an airway emergency. 'Examine the throat' is the famous fatal distractor.
Common mistakes to avoid
- Transporting a crowning mother because the hospital is 'only ten minutes away.'
- Pulling — on the baby, the cord, or the placenta. Field OB is controlled support, never traction (breech especially).
- Pushing a prolapsed cord back in, or positioning the mother flat instead of relieving pressure off the cord.
- Starting newborn compressions before 30 seconds of effective ventilation, or skipping warmth/drying (hypothermia kills newborns).
- Reading a normal pediatric blood pressure as stability — kids compensate until just before arrest.
- Examining the airway of a drooling, stridorous, tripoding child. Calm, position of comfort, go.