Scenario: Baby Emma, a 32-week preterm neonate with respiratory distress syndrome (RDS), requires emergency transport to a tertiary care center for advanced respiratory support. The transport team discusses the risks and benefits of high-frequency oscillatory ventilation (HFOV) with Emma’s parents. The parents, who are non-English speakers, appear overwhelmed but nod in agreement without asking any questions. Which action by the transport team best ensures valid informed consent?

A 4-week-old neonate in cardiopulmonary arrest during transport has pulseless electrical activity (PEA). Which of the following is the most critical initial intervention to address the likely underlying cause?

During neonatal transport, which of the following physiologic impacts is MOST critical to monitor due to the risk of rapid decompensation in preterm infants?

Scenario: During an emergency neonatal transport in extreme winter conditions, the transport team is preparing Baby Liam, a 32-week preterm infant with respiratory distress, for transfer. The team is concerned about maintaining thermoregulation while ensuring adequate oxygenation. Which of the following environmental interventions is the MOST critical to prioritize during transport?

Scenario: A 6-month-old infant, Emma, is being transported due to severe diarrhea and vomiting for the past 24 hours. On assessment, she has sunken fontanelles, dry mucous membranes, and delayed capillary refill (>3 sec). Her heart rate is 170 bpm, and blood pressure is 60/40 mmHg. The transport team suspects severe dehydration. Which of the following is the most appropriate initial fluid therapy for Emma during transport?

Scenario: Baby Liam, a 3-day-old neonate with congenital heart disease, requires urgent transport from a rural hospital to a tertiary care center via air ambulance. The transport team must ensure compliance with Federal Aviation Administration (FAA) regulations. Which of the following is a critical FAA requirement for neonatal/pediatric air transport?

A 32-week preterm neonate, Baby Liam, is being transported via air ambulance from a rural hospital to a tertiary care center at an altitude of 8,000 feet. The transport team notices an unexpected increase in the infant’s oxygen requirement during ascent. Which of the following is the MOST likely physiological explanation for this change?

Which law of science explains the physiologic impact of pressure changes on gas volume during neonatal and pediatric air transport?

Scenario: A 3-year-old patient, Liam, presents with severe diarrhea and vomiting for 48 hours. During transport, he appears lethargic, has sunken eyes, delayed capillary refill (>4 sec), and weak peripheral pulses. His heart rate is 160 bpm, blood pressure is 70/40 mmHg, and respiratory rate is 30/min. Which is the most immediate intervention to address his hypovolemic shock?

A 4-week-old preterm neonate (corrected gestational age 32 weeks) is being mechanically ventilated during transport. The current settings include PIP 18 cmH2O, PEEP 5 cmH2O, rate 40 bpm, and FiO2 0.30. The transport team notes worsening oxygenation (SpO2 dropping to 86%) and increased work of breathing. Which of the following is the most appropriate initial ventilator adjustment to improve oxygenation while minimizing the risk of volutrauma?

When communicating with a critically ill 6-year-old child during transport, which of the following is the most age-appropriate strategy to reduce anxiety and improve cooperation?

Scenario: Baby Liam, a 32-week preterm neonate with respiratory distress, is being evaluated at a rural hospital. The on-call pediatrician determines that Liam requires a higher level of care, including surfactant administration and mechanical ventilation, which the facility cannot provide. The nearest tertiary care center is 60 miles away. The transport team is en route, but the pediatrician is unsure about the legal obligations under EMTALA. What is the primary responsibility of the transferring hospital under EMTALA in this scenario?

Which of the following Federal Aviation Administration (FAA) regulations is specifically applicable to the medical equipment and crew requirements for neonatal and pediatric air transport?

Scenario: A 6-month-old infant, Noah, presents with irritability, bulging fontanelle, and episodes of bradycardia during transport. His mother reports a recent history of vomiting and lethargy. On assessment, his pupils are sluggish and unequal. Which intervention is the most critical to address suspected increased intracranial pressure (ICP) during transport?

Scenario: A 3-day-old preterm neonate, Baby Emma (gestational age 30 weeks, weight 1.2 kg), is being transported to a tertiary care center for worsening respiratory distress. She is currently on synchronized intermittent mandatory ventilation (SIMV) with the following settings: PIP 18 cmH₂O, PEEP 5 cmH₂O, rate 40/min, FiO₂ 0.4. During transport, her SpO₂ drops to 86%, and she develops increased work of breathing. Which of the following is the most appropriate initial ventilator adjustment to optimize oxygenation and ventilation?

A 3-week-old preterm neonate (32 weeks gestation) is being transported due to worsening respiratory distress. The transport team notes generalized edema, weight gain of 15% above birth weight, and decreased urine output over the past 24 hours. Which of the following is the most likely underlying cause of these findings?

Scenario: A 4-year-old patient, Liam, is being transported via air after sustaining severe burns covering 30% of his body. During flight, you notice increasing edema, hypotension, and decreased urine output. The transport team suspects third spacing is occurring. Which of the following is the most accurate explanation of the underlying pathophysiology in this scenario?

Which of the following is the most significant physiological risk associated with prolonged vibration exposure during neonatal and pediatric transport?

Scenario: During the transport of a critically ill 3-day-old neonate, Emma, the transport team encounters severe turbulence. The team notices that the infant’s oxygen saturation begins to drop, and her heart rate becomes unstable. The transport isolette is securely fastened, but the team is concerned about the infant’s worsening condition. Which of the following is the most appropriate immediate physical intervention to stabilize Emma during transport?

A 3-day-old preterm neonate, Baby Emma (gestational age 30 weeks, birth weight 1.2 kg), is being prepared for transport to a tertiary care center due to worsening respiratory distress and signs of dehydration. Her urine output has decreased to 0.8 mL/kg/hr over the past 6 hours, and her serum sodium is 152 mEq/L. Which of the following is the most appropriate initial fluid management strategy during transport?

A 2-week-old neonate with a peripherally inserted central catheter (PICC) is being transported for further management. During transport, the PICC line appears dislodged with no blood return. What is the most appropriate immediate action?

Which psychological stressor is most commonly reported by neonatal and pediatric transport teams during high-acuity transports?

A preterm neonate (32 weeks gestation) is being prepared for transport. Which of the following is the most effective strategy to prevent hypothermia during transport?

A 32-week preterm neonate with respiratory distress syndrome (RDS) is being prepared for transport. The transport team notes increasing oxygen requirements (FiO₂ 0.6) and worsening retractions. Which of the following is the most appropriate initial intervention to stabilize respiratory failure in this patient?

A 3-week-old neonate presents with poor feeding, tachypnea, and hepatomegaly during transport. Echocardiography reveals a large ventricular septal defect (VSD). Which of the following is the most likely underlying pathophysiology contributing to congestive heart failure (CHF) in this patient?

Scenario: During the transport of a 3-week-old preterm neonate (32 weeks GA, now 35 weeks corrected) named Liam, who is postoperative for necrotizing enterocolitis (NEC), you note increased heart rate, decreased oxygen saturation, and grimacing. The transport team suspects pain but is unsure of the safest and most effective pharmacological intervention. Which of the following is the most appropriate analgesic for Liam during transport?

Scenario: A 4-day-old neonate, Baby Liam, born at 32 weeks gestation, is being transported for worsening hypotension and poor perfusion. His heart rate is 160 bpm, blood pressure is 40/25 mmHg, and capillary refill is 4 seconds. The transport team initiates fluid resuscitation, but the hypotension persists. Which first-line vasoactive medication should be administered next?

A 3-day-old preterm neonate, Baby Emma (gestational age 32 weeks, birth weight 1.8 kg), is being transported to a tertiary care center for respiratory distress and poor feeding. Laboratory results reveal serum sodium of 125 mEq/L (normal: 135–145 mEq/L) and urine output of 1 mL/kg/hr. Which of the following is the most appropriate initial management step for her hyponatremia?

During neonatal transport, a preterm infant with hypotension requires fluid resuscitation. Which of the following statements is MOST accurate regarding fluid dynamics in this scenario?

In the context of peer-to-peer communication during neonatal and pediatric transport, which of the following is the most effective strategy to ensure accurate and timely information exchange between team members?

Scenario: Baby Emma, a 32-week preterm neonate with respiratory distress syndrome (RDS), requires emergency transport to a tertiary care center for advanced respiratory support. The transport team discusses the risks and benefits of high-frequency oscillatory ventilation (HFOV) with Emma’s parents. The parents, who are non-English speakers, appear overwhelmed but nod in agreement without asking any questions. Which action by the transport team best ensures valid informed consent?

A 4-week-old neonate in cardiopulmonary arrest during transport has pulseless electrical activity (PEA). Which of the following is the most critical initial intervention to address the likely underlying cause?

During neonatal transport, which of the following physiologic impacts is MOST critical to monitor due to the risk of rapid decompensation in preterm infants?

Scenario: During an emergency neonatal transport in extreme winter conditions, the transport team is preparing Baby Liam, a 32-week preterm infant with respiratory distress, for transfer. The team is concerned about maintaining thermoregulation while ensuring adequate oxygenation. Which of the following environmental interventions is the MOST critical to prioritize during transport?

Scenario: A 6-month-old infant, Emma, is being transported due to severe diarrhea and vomiting for the past 24 hours. On assessment, she has sunken fontanelles, dry mucous membranes, and delayed capillary refill (>3 sec). Her heart rate is 170 bpm, and blood pressure is 60/40 mmHg. The transport team suspects severe dehydration. Which of the following is the most appropriate initial fluid therapy for Emma during transport?

Scenario: Baby Liam, a 3-day-old neonate with congenital heart disease, requires urgent transport from a rural hospital to a tertiary care center via air ambulance. The transport team must ensure compliance with Federal Aviation Administration (FAA) regulations. Which of the following is a critical FAA requirement for neonatal/pediatric air transport?

A 32-week preterm neonate, Baby Liam, is being transported via air ambulance from a rural hospital to a tertiary care center at an altitude of 8,000 feet. The transport team notices an unexpected increase in the infant’s oxygen requirement during ascent. Which of the following is the MOST likely physiological explanation for this change?

Which law of science explains the physiologic impact of pressure changes on gas volume during neonatal and pediatric air transport?

Scenario: A 3-year-old patient, Liam, presents with severe diarrhea and vomiting for 48 hours. During transport, he appears lethargic, has sunken eyes, delayed capillary refill (>4 sec), and weak peripheral pulses. His heart rate is 160 bpm, blood pressure is 70/40 mmHg, and respiratory rate is 30/min. Which is the most immediate intervention to address his hypovolemic shock?

A 4-week-old preterm neonate (corrected gestational age 32 weeks) is being mechanically ventilated during transport. The current settings include PIP 18 cmH2O, PEEP 5 cmH2O, rate 40 bpm, and FiO2 0.30. The transport team notes worsening oxygenation (SpO2 dropping to 86%) and increased work of breathing. Which of the following is the most appropriate initial ventilator adjustment to improve oxygenation while minimizing the risk of volutrauma?

When communicating with a critically ill 6-year-old child during transport, which of the following is the most age-appropriate strategy to reduce anxiety and improve cooperation?

Scenario: Baby Liam, a 32-week preterm neonate with respiratory distress, is being evaluated at a rural hospital. The on-call pediatrician determines that Liam requires a higher level of care, including surfactant administration and mechanical ventilation, which the facility cannot provide. The nearest tertiary care center is 60 miles away. The transport team is en route, but the pediatrician is unsure about the legal obligations under EMTALA. What is the primary responsibility of the transferring hospital under EMTALA in this scenario?

Which of the following Federal Aviation Administration (FAA) regulations is specifically applicable to the medical equipment and crew requirements for neonatal and pediatric air transport?

Scenario: A 6-month-old infant, Noah, presents with irritability, bulging fontanelle, and episodes of bradycardia during transport. His mother reports a recent history of vomiting and lethargy. On assessment, his pupils are sluggish and unequal. Which intervention is the most critical to address suspected increased intracranial pressure (ICP) during transport?

Scenario: A 3-day-old preterm neonate, Baby Emma (gestational age 30 weeks, weight 1.2 kg), is being transported to a tertiary care center for worsening respiratory distress. She is currently on synchronized intermittent mandatory ventilation (SIMV) with the following settings: PIP 18 cmH₂O, PEEP 5 cmH₂O, rate 40/min, FiO₂ 0.4. During transport, her SpO₂ drops to 86%, and she develops increased work of breathing. Which of the following is the most appropriate initial ventilator adjustment to optimize oxygenation and ventilation?

A 3-week-old preterm neonate (32 weeks gestation) is being transported due to worsening respiratory distress. The transport team notes generalized edema, weight gain of 15% above birth weight, and decreased urine output over the past 24 hours. Which of the following is the most likely underlying cause of these findings?

Scenario: A 4-year-old patient, Liam, is being transported via air after sustaining severe burns covering 30% of his body. During flight, you notice increasing edema, hypotension, and decreased urine output. The transport team suspects third spacing is occurring. Which of the following is the most accurate explanation of the underlying pathophysiology in this scenario?

Which of the following is the most significant physiological risk associated with prolonged vibration exposure during neonatal and pediatric transport?

Scenario: During the transport of a critically ill 3-day-old neonate, Emma, the transport team encounters severe turbulence. The team notices that the infant’s oxygen saturation begins to drop, and her heart rate becomes unstable. The transport isolette is securely fastened, but the team is concerned about the infant’s worsening condition. Which of the following is the most appropriate immediate physical intervention to stabilize Emma during transport?

A 3-day-old preterm neonate, Baby Emma (gestational age 30 weeks, birth weight 1.2 kg), is being prepared for transport to a tertiary care center due to worsening respiratory distress and signs of dehydration. Her urine output has decreased to 0.8 mL/kg/hr over the past 6 hours, and her serum sodium is 152 mEq/L. Which of the following is the most appropriate initial fluid management strategy during transport?

A 2-week-old neonate with a peripherally inserted central catheter (PICC) is being transported for further management. During transport, the PICC line appears dislodged with no blood return. What is the most appropriate immediate action?

Which psychological stressor is most commonly reported by neonatal and pediatric transport teams during high-acuity transports?

A preterm neonate (32 weeks gestation) is being prepared for transport. Which of the following is the most effective strategy to prevent hypothermia during transport?

A 32-week preterm neonate with respiratory distress syndrome (RDS) is being prepared for transport. The transport team notes increasing oxygen requirements (FiO₂ 0.6) and worsening retractions. Which of the following is the most appropriate initial intervention to stabilize respiratory failure in this patient?

A 3-week-old neonate presents with poor feeding, tachypnea, and hepatomegaly during transport. Echocardiography reveals a large ventricular septal defect (VSD). Which of the following is the most likely underlying pathophysiology contributing to congestive heart failure (CHF) in this patient?

Scenario: During the transport of a 3-week-old preterm neonate (32 weeks GA, now 35 weeks corrected) named Liam, who is postoperative for necrotizing enterocolitis (NEC), you note increased heart rate, decreased oxygen saturation, and grimacing. The transport team suspects pain but is unsure of the safest and most effective pharmacological intervention. Which of the following is the most appropriate analgesic for Liam during transport?

Scenario: A 4-day-old neonate, Baby Liam, born at 32 weeks gestation, is being transported for worsening hypotension and poor perfusion. His heart rate is 160 bpm, blood pressure is 40/25 mmHg, and capillary refill is 4 seconds. The transport team initiates fluid resuscitation, but the hypotension persists. Which first-line vasoactive medication should be administered next?

A 3-day-old preterm neonate, Baby Emma (gestational age 32 weeks, birth weight 1.8 kg), is being transported to a tertiary care center for respiratory distress and poor feeding. Laboratory results reveal serum sodium of 125 mEq/L (normal: 135–145 mEq/L) and urine output of 1 mL/kg/hr. Which of the following is the most appropriate initial management step for her hyponatremia?

During neonatal transport, a preterm infant with hypotension requires fluid resuscitation. Which of the following statements is MOST accurate regarding fluid dynamics in this scenario?

In the context of peer-to-peer communication during neonatal and pediatric transport, which of the following is the most effective strategy to ensure accurate and timely information exchange between team members?