Ch. 31: Pediatric Emergencies (Orange book & online)

A 7-year-old girl is in the intensive care unit following a bicycle accident. Which of the following would be most helpful in providing support to the girl's parents? A. Providing honest answers in a reassuring manner B. Giving them brief explanations of procedures C. Describing the treatment plan for their daughter D. Encouraging them to read to their daughter

A. Providing honest answers to the parents' questions and concerns in a reassuring manner will provide the most support. Procedures and treatment plans should be explained in terms they can understand and repeated patiently, if need be. Encouraging the parents to read to their daughter will involve them in their child's care and help normalize the situation for the child.

A child, who is bleeding heavily, is in hypovolemic shock. e nurse determines that the child is currently compensating for the loss of blood when the nurse notes which of the following? 1. Tachycardia 2. Hypotension 3. Bradypnea 4. Cyanosis

ANSWER: 1 Rationale: 1. Tachycardia is a compensatory response. 2. Hypotension is a late sign of shock. 3. Bradypnea is a late sign of shock. 4. Cyanosis is a late sign of shock. TEST-TAKING TIP: Initially, when a child is losing blood, his or her body will compensate for the blood loss by increasing the heart rate, the respiratory rate, and by constricting the blood vessels. After the child has lost a significant quantity of blood and is in shock, the body no longer is able to compensate. Shock is a life-threatening event.

A child is receiving oral Chemet (succimer) for a BLL of 48 micrograms/dL. For which of the following side e ects should the child be monitored? 1. White blood cell count below 5,000 cells/mm3 2. Platelet count below 400,000 cells/mm3 3. Serum potassium above 3.5 mEq/L 4. Serum sodium above 135 mEq/L

ANSWER: 1 Rationale: 1. The child should be monitored for neutropenia, a serious side e ect of Chemet (succimer). 2. The normal platelet count is 150,000 to 400,000 cells/mm3. 3. The normal serum potassium level is 3.5 to 5 mEq/L. 4. The normal serum sodium level is 135 to 145 mEq/L. TEST-TAKING TIP: Chemet (succimer) usually is taken on an outpatient basis. The child should be monitored carefully, returning to the health-care provider's office for frequent BLL and CBC assessments.

A nurse observes a 6-year-old child fall from a 3rd-story window. e area is safe for the nurse to intervene. ere is no one else in the area. Which of the following actions should the nurse perform first? 1. Assess for breathing. 2. Assess carotid pulse. 3. Access emergency assistance. 4. Administer rescue breaths.

ANSWER: 1 Rationale: 1. The nurse should assess for breathing. 2. The nurse should assess the carotid pulse a er it is determined whether or not the child is breathing. 3. The nurse should access emergency assistance either once it is determined that the child is breathing and that the child's heart is contracting or a er the nurse has performed CPR for 2 full minutes. 4. Rescue breaths should be administered only a er it is determined that the child is not breathing but that the child's heart is contracting. TEST-TAKING TIP: The American Heart Association (2010) has developed a protocol for emergency care. Nurses should follow the set protocol. See Figure 10.1.

A nurse has determined that a 10-month-old child has an obstructed airway. e child is making no vocalizations and is not breathing. Which of the following actions by the nurse is appropriate at this time? 1. While tipping the child's head down, slap the child ve times between the shoulder blades. 2. Peer inside the child's mouth and look for the obstruction. 3. Insert the pinky nger into the child's mouth and sweep the mouth. 4. While standing behind the child, perform upward thrusts with sts placed under the rib cage.

ANSWER: 1 Rationale: 1. This action is appropriate. The rescuer should then follow the back blows with ve chest compressions. 2. The rescuer should look for the obstruction a er delivering a series of back blows and chest compressions. 3. A rescuer should insert only the pinky nger into the child's mouth and sweep the mouth if the object is visible in the mouth. 4. The Heimlich maneuver should be performed only on children over 1 year of age. TEST-TAKING TIP: Because infants are relatively small, it is safer and more effective to deliver back blows and chest compressions to dislodge an airway obstruction than to perform the Heimlich maneuver.

A nurse has completed an emergency assessment on a 3-year-old child who has just started to cry. While conducting the secondary assessment, the nurse should ask the parent which of the following questions? Select all that apply. 1. "Where is the child's injury?" 2. "Does your child have allergies?" 3. "When is your child due to eat next?" 4. "Does your child know how to swim?" 5. "What was the child doing before he was injured?

ANSWER: 1, 2, and 5 Rationale: 1. The nurse should ask, "Where is the child's injury?" 2. The nurse should ask, "Does your child have allergies?" 3. The nurse should ask, "When and what did your child last eat?" rather than "When is your child due to eat next?" 4. This question is not appropriate. A er the emergency is over and if the child's injury occurred near water, then it might be appropriate to ask whether the child is able to swim. 5. The nurse should ask, "What was the child doing before he was injured?" TEST-TAKING TIP: To determine whether an injured child needs immediate medical attention, it is important for a nurse to ask a number of important questions. The acronym SAMPLE will help the

A child is receiving IV calcium disodium versenate (CaNa2EDTA). For which of the following serious side e ects should the child be monitored? Select all that apply. 1. Seizures 2. Hypertension 3. Hyperglycemia 4. Hypercalcemia 5. Elevated serum creatinine

ANSWER: 1, 4, and 5 Rationale: 1. The child should be monitored for seizures. 2. Hypertension is not a common side e ect of CaNa2EDTA. 3. Hyperglycemia is not a common side effect of CaNa2EDTA. 4. Hypercalcemia is a common side e ect of CaNa2EDTA. 5. The child should be monitored for an elevated serum creatinine. TEST-TAKING TIP: Calcium disodium versenate (CaNa2EDTA) is administered to children with very high BLL (usually over 70 mcg/dL) or for children with lower BLL who are exhibiting signs of encephalopathy. When lead is chelated in these children, the BLL may rise prior to being excreted, placing the children at high risk for renal and central nervous system damage.

A 10-year-old child requires fluid resuscitation with isotonic intravenous fluids. The child weighs 77 lbs. The nurse would prepare a bolus of _______________ mL of fluid.

700 When administering a bolus dose of fluid for resuscitation, 20 mL/kg is given. The child weighs 77 lbs, or 35 kg, so the nurse would prepare a bolus dose of 700 mL of fluid.

The nurse is determining the systolic blood pressure of a 5-year-old girl. The nurse calculates the minimum acceptable systolic blood pressure as ________________.

80 Using the formula 70 + (2 times the age in years), the nurse would calculate this child's minimum systolic blood pressure as 70 + (2 x 5) = 80.

A 5-year-old girl is breathing spontaneously but is unable to maintain an airway. Which of the following would be the priority? A. Inserting an oropharyngeal airway B. Placing a towel under her shoulders C. Assisting with tracheal tube insertion D. Positioning her using head tilt/chin lift

A Inserting an oropharyngeal airway will help ensure that the child maintains a patent airway.

A 4-year-old girl, injured in an automobile accident, is suspected of having a head injury. Which of the following would be the priority? A. Opening the airway using the jaw thrust maneuver B. Hyperventilating the child with a bag-valve-mask C. Providing manual stabilization of the head and neck D. Stabilizing the head and neck with a pediatric backboard

A Opening the airway using the jaw thrust maneuver is the priority. If it cannot be opened successfully using the jaw thrust maneuver, it may be opened using the head tilt/chin lift maneuver

An 8-year-old girl with tachycardia is alert, breathing comfortably, and exhibiting signs of adequate tissue perfusion. Which nursing intervention would be most appropriate for this child? A. Applying ice to the child's face B. Oxygenating and ventilating the child C. Initiating cardiac compressions D. Administering epinephrine as ordered

A The child is exhibiting compensated supraventricular tachycardia (SVT). Vagal maneuvers such as ice to the face or blowing through a straw that is obstructed are priority interventions for compensated SVT

A group of nursing students are reviewing information about tachyarrhythmias in children. The students demonstrate a need for additional review when they identify which of the following as a characteristic of sinus tachycardia in children? A. Narrow QRS complex B. Heart rate below 180 beats per minute C. Beat-to-beat variability in rhythm D. Presence of P waves

A With sinus tachycardia, the QRS complex is normal.

A nurse discovers an 8-month-old child face down in a puddle of water. e child is not breathing and has no pulse. Which of the following actions should the nurse perform at this time? 1. 5 back slaps followed by 5 cardiac compressions 2. 30 cardiac compressions followed by 2 rescue breaths 3. A series of rescue breaths every 3 to 5 seconds 4. Call 911 to activate the emergency response team.

ANSWER: 2 Rationale: 1. The nurse should begin CPR in a 30 compressions to 2 rescue breaths ratio. 2. The nurse should begin CPR in a 30 compressions to 2 rescue breaths ratio. 3. The acronym for emergency care is CAB—cardiac compressions, airway, breathing. e nurse, therefore, should begin CPR in a 30 compression to 2 rescue breath ratio. 4. The nurse should wait to call 911 to activate the emergency response team until he or she has performed CPR for approximately 2 min. TEST-TAKING TIP: Even though liquid is the most common cause of airway obstruction in infants, it is recommended that CPR be instituted when a drowning victim is discovered rather than performing actions to dislodge an obstruction.

Two nurses are providing cardiopulmonary resuscitation on a 6-year-old child who collapsed on the school playground. Which of the following actions should the nurses perform? 1. Perform resuscitation in a 30 compressions to 2 breaths ratio. 2. Compress the child's chest to a depth of 2 inches. 3. Obtain the automated external defibrillator after 2 minutes. 4. Continue cardiopulmonary resuscitation for at least 2 hours.

ANSWER: 2 Rationale: 1. Child CPR by two rescuers should be performed in a 15 compressions to 2 breaths ratio. 2. The child's chest should be compressed to a depth of 2 in. 3. One of the rescuers should obtain the AED as soon as it is determined that the child needs resuscitation. 4. CPR should be continued until emergency personnel are on the scene or until the child is revived.

A nurse is caring for a 31⁄2-year-old child who consumed a bottle of aspirin 10 minutes earlier. Which of the following ndings would the nurse expect to see? 1. Hyperglycemia 2. Hyperpnea 3. Hyperthermia 4. Hypernatremia

ANSWER: 2 Rationale: 1. The nurse would not expect the child to be hyperglycemic. 2. The nurse would expect the child to be hyperpneic. 3. The nurse would not expect the child to be hyperthermic. 4. The nurse would not expect the child to be hypernatremic. TEST-TAKING TIP: The chemical term for aspirin is acetylsalicylic acid. In the period immediately after the ingestion, in an attempt to compensate for the acidosis, the child will instinctively increase his or her respiratory rate to exhale large quantities of carbon dioxide, which often results in respiratory alkalosis. When a large quantity of the drug is ingested, however, the child ultimately develops metabolic acidosis.

While supervising lunchtime in an elementary school, a school nurse observes a child abruptly stand up and appear to be gagging. Which of the following actions should the nurse perform at this time? 1. Inform the child that she should remain seated while eating. 2. Assess whether the child is able to cough e ectively. 3. Slap the child ve times between the shoulder blades. 4. Stand behind the child and place both sts under the rib cage.

ANSWER: 2 Rationale: 1. This child is in distress. It would be inappropriate to inform the child that she should remain seated while eating. 2. This action is appropriate. e nurse should rst assess whether the child is able to cough e ectively. 3. Back blows and cardiac compressions are performed when an infant has an airway obstruction. 4. It would be appropriate to stand behind the child and place both sts under the rib cage only if the child is unable to cough e ectively. TEST-TAKING TIP: When a child over 1 year of age is experiencing an airway obstruction and is able to cough effectively, a rescuer should not intervene physically, but rather should stand by the child and give the child encouragement. Only if the child is unable to cough effectively should the rescuer perform the Heimlich maneuver.

A 3-year-old child's blood lead level measures 12 micrograms/dL. The nurse would expect the child to exhibit which of the following signs/symptoms? 1. Hyponatremia 2. Polycythemia 3. Aggression 4. Polyphagia

ANSWER: 3 Rationale: 1. The nurse would not expect the child to be hyponatremic. 2. The nurse would expect the child to be anemic, not polycythemic. 3. The nurse would expect that child to exhibit aggression. 4. The nurse would not expect that child to exhibit polyphagia. TEST-TAKING TIP: Lead toxicity, even at low levels, can adversely affect the central nervous system and is exhibited as aggression, hyperactivity, and learning difficulties.

A 2-year-old child's blood lead level is 4 micrograms per dL. Based on the data, which of the following actions should the nurse take? 1. Notify the department of health regarding the value. 2. Recommend to the primary health-care provider that the child receive chelation therapy. 3. Educate the child's teacher regarding ways to prevent another incident. 4. Remind the parents of the importance of frequently washing their child's hands, especially prior to eating.

ANSWER: 4 Rationale: 1. It is not necessary to notify the department of health regarding the value. 2. Chelation therapy is not needed. 3. It is not necessary to question the parents regarding possible sources of the child's lead ingestion. 4. It would be important to remind the parents regarding the need for frequent handwashing. TEST-TAKING TIP: Frequent handwashing often is thought to be exclusively an infection control action. However, it also is important as a means of preventing lead ingestion. The soil of much of the United States has been contaminated with lead. Because young children often place their hands in their mouths, especially when eating, it is important for them to wash their hands frequently.

A preschool child was administered activated charcoal in the emergency department a er a poisoning event. e child is being discharged home. Which of the following adverse reactions to the medication should the parent be advised to report to the child's primary health-care provider? 1. Rash 2. Conjunctivitis 3. Lethargy 4. Constipation

ANSWER: 4 Rationale: 1. Rash is not a side e ect of activated charcoal ingestion. 2. Conjunctivitis is not a side e ect of activated charcoal ingestion. 3. Lethargy is not a side e ect of activated charcoal ingestion. 4. Constipation is a common side e ect of activated charcoal ingestion. TEST-TAKING TIP: Activated charcoal is administered to absorb an ingested poison from the gastrointestinal tract. The charcoal also, however, absorbs large quantities of fluid from the tract. As a result, constipation is a common side effect of the therapy.

A nurse is administering cardiopulmonary resuscitation as a 1-person rescuer to an infant who was found not breathing and with no pulse. Which of the following actions should the nurse perform? 1. Compress the child's chest with the palm of 1 hand. 2. Obtain an automated external defibrillator (AED) as soon as possible. 3. Access emergency assistance (call 911) as soon as possible. 4. Perform resuscitation in a 30 compressions to 2 breaths ratio.

ANSWER: 4 Rationale: 1. The nurse should compress the child's chest with two ngers. 2. An automated external de brillator (AED) should be obtained a er performing CPR for 2 min. 3. The nurse should call for emergency assistance (call 911) a er performing CPR for 2 min. 4. As a single rescuer, CPR should be performed in a 30 compressions to 2 breaths ratio. TEST-TAKING TIP: The American Heart Association (2010) has developed a protocol for emergency care. Nurses should follow the set protocol. See Figure 10.1.

A nurse working in a preschool discovers that a 21⁄2-year-old child has drunk a bottle of red paint. Place the following nursing actions in the correct order of priority. 1. Notify the child's parents. 2. Question the child's teacher regarding the incident. 3. Call the poison control center. 4. Assess the child for adverse effects from the ingestion.

ANSWER: The correct order of nursing actions is 4, 3, 1, 2 Rationale: 4. Assess the child for adverse e ects from the ingestion. 3. Call the poison control center. 1. Notify the child's parents. 2. Discuss with the teacher ways to prevent another child from ingesting paint. TEST-TAKING TIP: 4. The nurse must first determine whether the child is in immediate need of resuscitation. The teacher should resuscitate, if needed. 3. Once the child is determined to be breathing and in no immediate distress, the nurse must call the poison control center to determine if an antidote or other intervention should be administered or if the child should be transported to the emergency department. (PCC may also advise the nurse that the substance is not poisonous and, therefore, will not injure the child.) 1. The child's parents should then be notified that their child has ingested a nonfood substance and of the actions that are being taken to care for the child. 2. Finally, in order to prevent the situation from happening again in the future, the nurse should discuss poison prevention strategies with the child's teacher.

Assessment of a child reveals a tension pneumothorax. The nurse would prepare the child for which of the following? A. Defibrillation B. Needle thoracotomy C. Suctioning D. Intubation

B A needle thoracotomy is indicated for tension pneumothorax to relieve the air collected in the space.

The nurse is assessing the neurologic status of an 11-month-old girl. Which finding would be cause for concern? A. The child's eyes remain closed unless she is spoken to. B. Inspection shows a sluggish pupillary reaction. C. Palpation of the head reveals a closed posterior fontanel. D. The child is crying and looking around fearfully.

B A sluggish pupillary reaction may occur with increased intracranial pressure, which would be cause for concern

The nurse has administered IV adenosine as ordered to a child with supraventricular tachycardia. Which action would the nurse do next? A. Administer a rapid generous saline flush. B. Administer a rapid generous saline flush. C. Monitor for ventricular arrhythmias. D. Set up a continuous infusion for administration of adenosine.

B Administration of IV adenosine should be followed immediately by a rapid generous saline flush.

A 9-year-old boy nearly drowned when he fell through the ice while skating on a pond. The child is exhibiting bradycardia. Which of the following would the nurse expect to implement to resolve the child's bradycardia? A. Administering epinephrine as ordered B. Using a convective air warming blanket C. Giving intravenous isotonic fluids D. Providing 100% oxygen via face mask

B Bradycardia may be resolved by addressing the underlying condition-in this case by relieving hypothermia with a convective air warming blanket. Providing 100% oxygen and then administering epinephrine are primary and secondary treatments for arrhythmias. Giving fluids is an intervention for collapsed rhythms and hypovolemic shock.

The nurse is assessing the respiratory status and lungs of a 6-year-old child. Which of the following would the nurse report immediately? A. Low-pitched bronchial sounds over the periphery B. Minimal air movement through the lungs C. High-pitched breath sounds over the trachea D. Resonance over the lungs on percussion

B Minimal or no air movement requires immediate intervention because this child's status is severely compromised

A 14-year-old child is brought to the emergency department. His parents state that they think he took "too many of his pain pills." The child had been prescribed oxycodone every 4 hours for pain secondary to a bone infection. Which agent would the nurse expect to be administered to counteract the analgesics? A. Ketamine B. Naloxone C. Atropine D. Lidocaine

B Oxycodone is an opioid analgesic whose effects can be reversed by the administration of naloxone.

When assessing a child with a traumatic injury, which of the following would be the priority assessment? A. Breathing effectiveness and breath sounds B. Airway patency and airflow C. Pulse rate and skin color D. Level of consciousness and papillary reaction

B When assessing the child with a traumatic injury, the ABCs are assessed first: assess the patency of the airway and establish the effectiveness of breathing, examining the child's respiratory effort, breath sounds, and color; evaluate the circulation, noting pulse rate and quality and observing the color, skin temperature, and perfusion. Once this is accomplished, the nurse assesses for disability (D), rapidly assessing critical neurologic function including level of consciousness, pupillary reaction, and verbal and motor responses to auditory and painful stimuli.

When developing the plan of care for a 10-month-old infant in septic shock, which of the following would the nurse most likely include? A. Administering intravenous saline as ordered B. Giving blood if saline provides inadequate response C. Administering intravenous dopamine as ordered D. Inserting a urinary catheter for monitoring urinary output

C Although isotonic intravenous solutions such as saline, blood transfusion, and urinary catheter insertion are important for any child with shock, children experiencing septic shock often require larger volumes of fluid as a result of the increased capillary permeability. Thus, fluid alone may not improve the status of a child with septic shock, necessitating the use of vasoactive medications such as dopamine. Saline is the first choice for restoring fluid volume, but this child will most likely need vasoactive medications. Children in shock from trauma may require blood transfusions to restore volume. Once fluids are given, a urinary catheter will be placed to monitor urine output.

The nurse is preparing to insert an oropharyngeal airway. Which action would be most appropriate to determine the proper size? A. Measuring from the tip of the nose to earlobe to middle of xiphoid process B. Inspecting the child's fifth digit to estimate the diameter C. Placing the airway next to the cheek with tip pointing down D. Measuring distance from end of nose to tragus of ear

C The nurse determines the correct size by placing it next to the child's cheek with the tip pointing down. An airway that is too large will extend past the angle of the child's mandible and can obstruct the glottic opening when inserted.

The condition of an 11-year-old boy who is on mechanical ventilation begins to deteriorate. Which of the following would the nurse do next? A. Examine the child for signs of pneumothorax. B. Confirm that the ventilator is working properly. C. Check to see if the tracheal tube is displaced. D. Suction the tube to remove a mucus plug.

C Use the mnemonic DOPE for troubleshooting when the status of a child who is intubated deteriorates. This means checking for displacement and disconnections first. Checking the ventilator, suctioning for obstruction, and examining for signs of pneumothorax would come later.

The nurse is assessing the neurologic status of an infant. Which of the following would the nurse identify as a nonreassuring finding? A. Vigorous crying B. Making eye contact with the nurse C. Soft flat anterior fontanel D. Lack of interest in surroundings

D An infant who is not interested in the environment is a cause for concern

A 10-year-old boy with congenital heart disease is in shock. Which nursing intervention would be most appropriate for this child? A. Assessing for changes in mental status and alertness B. Monitoring urine output with a goal of 1 to 2 mL/kg/hour C. Palpating for pulses and capillary refill D. Assessing for pulmonary edema from fluid overload

D Assessing for pulmonary edema from fluid overload is the most appropriate intervention. Pulmonary edema is rare but may occur in children with preexisting cardiac conditions or severe chronic pulmonary disease. Assessing for changes in mental status and alertness, monitoring urine output, and palpating for improved pulses and capillary refill are valid interventions for managing shock of any kind.

A child is to undergo synchronized cardioversion. The child weighs 44 lbs. The nurse would expect how many joules to be delivered? A. 30 to 40 joules B. 5 to 10 joules C. 2 to 4 joules D. 10 to 20 joules

D Energy for cardioversion is delivered at 0.5 to 1 joule/kg. The child weighs 44 lbs or 20 kg. Therefore, the child would receive 10 to 20 joules.

A 6-year-old girl in shock is receiving dobutamine. Which of the following would the nurse most likely do? A. Give adequate fluids prior to administration B. Assess for shortness of breath and dyspnea. C. Monitor for hypotension or seizures. D. Monitor for ventricular arrhythmias.

D Once dobutamine has been administered, the nurse should monitor for the development of ventricular arrhythmias

The nurse is assisting with the intubation of a 6-year-old child and is gathering the necessary equipment. The nurse determines that the child needs which size tracheal tube? A. 4.5 B. 5.0 C. 4.0 D. 5.5

D To determine tracheal tube size, divide the child's age by 4 and add 4. The resulting number will indicate the size of the tracheal tube in millimeters. For this child, 6/4 + 4 = 5.5.