Chapter 51: Nursing Care During a Pediatric Emergency - ML6

The nurse is preparing to assess and intubate a school-aged child who presents via ambulance to the emergency department. The child has been manually ventilated prior to arrival. The nurse obtains a nasogastric tube in preparation to care for the child for what reason?

The nasogastric tube will alleviate any accumulation of air in the stomach

The nurse is providing staff education regarding the use of the BroselowTM tape for pediatric emergencies. What would the nurse include in the education plan?

The tape is useful to estimate the child's weight based on the length.

The nurse notes absent breath sounds in the right upper, middle, and lower lung fields of a 24-month-child. What question by the nurse to the parents of the child would be most appropriate?

"Was your child playing with a toy with small parts?"

The child's physician requests that the nurse should notify her if the child's urine output is less than 1 ml/kg of body weight each hour. The child weighs 56 lb (25.46 kg). Calculate the minimum amount of urine output the child should produce each hour. Record your answer using a whole number.

25

The nurse is caring for a 2-year-old toddler who swallowed an unknown number of acetaminophen tablets and was rushed to the clinic, arriving 45 minutes after the ingestion. Which is the priority intervention?

Perform a gastric lavage.

When the nurse is caring for a child presenting with a traumatic injury, which action is priority?

Perform a primary assessment

The nurse is examining a 10-month-old infant who has fallen from the back porch. Which nursing action has priority?

maintaining an adequate airway

A 2-year-old boy is in respiratory distress. Which nursing assessment finding would suggest the child aspirated a foreign body?

noting absent breath sounds in one lung

A nurse is conducting an in-service education program for a group of pediatric nurses working on the pediatric unit of a local facility. The nurse is comparing the adult chain of survival with the pediatric chain of survival. The nurse determines that the teaching was successful when the group identifies which activity as the first step in the pediatric chain?

prevention of cardiac arrest and injuries

The nurse is preparing an in-service program on pediatric cardiopulmonary resuscitation. The nurse would include a discussion that cardiopulmonary arrest in infants and children is most likely the result of:

respiratory failure.

The nurse receives shift report from the previous shift on several pediatric clients. For which child would the nurse further assess the electrolyte levels immediately following report?

the 15-year-old who had a resolved episode of ventricular tachycardia the previous shift

Which assessment finding would indicate to the health care team that a child would need to be reintubated due to improper placement of the endotracheal tube?

Breath sounds are heard over the abdominal area.

A 12-year-old boy has broken his arm and is showing signs and symptoms of shock. Which of the following would the nurse do first?

Establish a suitable IV site.

Which nursing diagnosis would be appropriate for teaching interventions for a single mother who leaves her toddler unattended in the bathtub?

Risk for suffocation

A nurse is preparing discharge instructions for a child treated for ingestion of an unknown amount of ibuprofen. The child was treated with an activated charcoal gastric lavage. Which piece of information should the nurse include to provide anticipatory guidance to the parent?

Stools will be black in color for the next few days.

The health care team is performing cardiopulmonary resuscitation on a child following a suspected poisoning. Which action by the nurse would indicate that CPR is warranted?

The nurse assesses the child's heart rate at 45 and begins chest compressions.

Administration of which medication reverses the histamine release and hypotension that are seen in anaphylaxis?

epinephrine

A child is in shock and requires IV fluids but establishing an IV site has been difficult. Peripheral sites have been unsuccessful to establish the IV. Which location would be the most appropriate site for the nurse to establish IV access?

intraosseous

The nurse is assessing an 8-year-old child in the emergency department. Which assessment finding would be a priority and alert the nurse to intervene immediately?

minimal air movement in the lung fields

The nursing instructor is speaking with a group of nursing students about medication used in rapid sequence intubation. Which statement by a student indicates a need for further education?

"Ketamine is the anesthetic typically used for children who have suffered head trauma and need to be intubated."

A 7-year-old girl is in the intensive care unit following a bicycle accident. Which would be most helpful in providing support to the girl's parents?

Providing honest answers in a reassuring manner

The nurse plans to educate the parents of a child experiencing septic shock about the purpose of administering dobutamine intravenously to their child. What would the nurse include in this educational plan?

Dobutamine is used to improve cardiac contractility.

The nurse has performed an across-the-room assessment of an 8-year-old child and has classified her as emergent. Which of the following signs and symptoms has the nurse seen?

The child's lips are blue.

The nurse is assessing a 6-week-old infant in the home setting. The nurse notes the infant has a regular breathing pattern with brief periods of apnea followed by a respiratory rate of 40. What would the nurse further assess in the infant?

skin color and heart rate

The nurse is attempting to establish peripheral vascular access in a child requiring pediatric advanced life support. The decision to use the intraosseous route would be made if the nurse were unsuccessful after how many attempts within 90 seconds?

three

The child presents to the emergency department via ambulance in uncompensated SVT at a rate of 262 beats per minute. The nurse receives an order to administer adenosine IV. In addition to adenosine, what would the nurse bring to the bedside in preparation to administer the adenosine?

a generous saline flush to follow the IV medication

The nurse is preparing to present an educational session on pediatric cardiopulmonary arrests. The nurse will include which statement in the teaching?

"Most pediatric arrests stem from airway and breathing issues."

The nursing instructor is speaking with a group of nursing students about defibrillation and cardioversion. Which statement by a student would indicate a need for further education?

"The initial energy amount for defibrillation is 4 joules/kg."

The nurse is assessing a child with a suspected head injury. The child opens the eyes only in response to the nurse placing pressure in the child's nail bed. What score on the Glasgow coma scale for eye opening should the nurse assign based on this assessment finding?

2

The child's ability to perfuse is poor due to inadequate circulation. The physician writes an order for the child to receive 20 ml of normal saline for each kilogram of body weight. The child will receive the normal saline as a bolus through a central intravenous line. The child weighs 78 lb (35.46 kg). Calculate the amount of normal saline the nurse should administer as a bolus. Record your answer using a whole number.

709

A child is brought to the emergency department in severe respiratory distress. As the nurse begins an assessment, the child becomes unresponsive and stops breathing. The nurse calls for help and the health care team begins resuscitative measures. The nurse attempts to escort the child's parent from the room but the parent refuses to leave. Which is the best action for the nurse to take?

Allow the parent to stay in the room but remain at the parent's side for support.

The nurse is caring for a child who has recently been intubated. The nurse notes that the tracheal tube has an end-tidal CO2 monitoring device that is purple in color. What is the first intervention by the nurse?

Auscultate the chest to determine breath sounds.

Assessment of a child reveals a tension pneumothorax. The nurse would prepare the child for:

needle thoracotomy.

A nurse is assessing a child brought to the emergency department. The child has a fever of 102.4°F. (39.1°C). The nurse continues the assessment, integrating knowledge that which of the following reflects the effect of fever on the basal metabolic rate?

tachypnea

The parents of a preschool child are distraught as they carry their limp child into the emergency room. The parents report the child fell approximately 10 feet from a large slide and hit his head "hard enough to knock him out." What is the nurse's next action?

Perform a jaw-thrust technique to assess the patency of the airway.

The nurse is conducting an educational class regarding the use of the intraosseous site for administration of fluid to the pediatric client experiencing an emergency, such as shock. What would the nurse include in this educational presentation?

The intraosseous site is preferred if peripheral access cannot be attained rapidly.

A nurse manager is debriefing a group of coworkers who had just finished caring for a child who suffered a cardiac arrest. One of the coworkers states, "Why did they let the family stay while we were working on the child?" What is the best response by the nurse?

"Allowing the family to stay during the resuscitation may assist the family in coping."

The nurse is providing support to the parents of a 10-year-old boy receiving emergency care. The boy is their foster child. Which comment will be most effective?

"Hold your child's hand while this is going on."

A 9-year-old has suffered a severe anaphylactic reaction and dies. The nurse is providing support for the grieving parents. Which comment would best help them cope?

"How can I help you get through this?"

A nurse is providing care to a child hospitalized after an accident that resulted in a substantial loss of blood. The nurse is preparing to administer IV fluids using a 60-milliliter syringe attached to the child's IV site. The child's parent asks the nurse why there is no IV bag hanging. What is the best response for the nurse to make?

"I need to administer small amounts of fluid as quickly as possible."

A 6-year-old girl who is being treated for shock is pulseless with an irregular heart rate of 32 bpm. Which intervention is priority?

Initiate cardiac compressions.

The nurse has completed teaching a CPR course for a local day care. Which statement by a participant indicates a need for further education?

"I will place the heel of my hand on the sternum of a 9-month-old when performing CPR."

The nurse is planning to provide education on injury prevention to caregivers of toddlers. Which information will the nurse include in the session? Select all that apply.

- car seat safety - burn prevention - water safety - poisoning prevention

A 5-year-old child fell on the playground and briefly lost consciousness. Magnetic resonance imaging (MRI) of the head was normal, and the child is now alert and awake with stable vital signs. The nurse provides discharge teaching for this family. Which statement by the caregiver indicates a need for additional teaching by the nurse?

"We will wake the child up every hour to assess overnight."

The nurse is providing education to a community group on child play safety. Which statement by a parent indicates teaching was effective?

"When my child rides a bicycle, a helmet will be worn at all times."

A child's parent calls the clinic nurse and states, "My child just drank an unknown amount of a cleaning solution. What should I do?" Which statement by the nurse is best?

"You need to hang up with me and call the poison control center now."

The nurse is collecting a brief health history from the parents of a 3-year-old child brought to the emergency department experiencing a cardiac emergency. What questions are appropriate for inclusion? Select all that apply.

- "Has your child had any recent illnesses?" - "What foods or drugs is your child allergic to?" - "Tell me about any coughing or wheezing you may have noticed when your child has been playing lately."

The nurse is caring for a child experiencing a cardiac arrest. The nurse has administered IV epinephrine at 1:15 p.m. At what time can the nurse administer another dose of epinephrine?

1:20 p.m.

The nurse is assessing the neurologic status of an infant. What would the nurse identify as an abnormal finding?

Lack of interest in surroundings

An emergency department nurse is caring for a 5-year-old child who was just brought in by ambulance with partial-thickness (second-degree) and full-thickness (third-degree) burns to their face, neck, and chest. The client is awake and alert. Vital signs: temperature, 97.2°F (36.2°C); heart rate, 148 beats/min; blood pressure, 68/39 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 90% on 2 liters by nasal cannula.

- Apply oxygen to maintain oxygen saturations 95% or greater. - Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. - Initiate fluid resuscitation per Lund and Browder chart using Parkland formula with 0.9% saline.

The nurse must calculate the adolescent's cardiac output. The child's heart rate is 76 beats per minute and the stroke volume is 75 ml. Calculate the child's cardiac output in ml/min. Record your answer using a whole number.

5700

The nurse is caring for a 7-year-old client who suffered extensive burns from a house fire. Which finding in the client's history most concerns the nurse?

The child was trapped in a burning bedroom.

The nurse is caring for a child who has had an endotracheal tube placed and is hooked to a ventilator. When assessing the child, the nurse notes that they child is exhibiting signs of poor oxygenation. What should the nurse do? Select all that apply.

- Assess tracheal tube placement. - Assess for the presence of decreased breath sounds on one side of the chest. - Assess for tracheal tube obstruction. - Assess the ventilator equipment, checking to see that all tubing is connected correctly.

A nurse is providing discharge teaching to the parent of a child hospitalized after experiencing respiratory arrest. The parent expresses concerns about the child's well-being. Which action(s) is appropriate for the nurse take? Select all that apply.

- Review signs and symptoms of respiratory distress with the parent. - Encourage the parent to discuss specific concerns about the child. - Reinforce when the health care provider should be called.

A child is hospitalized with suspected sepsis. The health care provider has prescribed an intravenous fluid bolus of lactated Ringer's solution 15 ml/kg to infuse over 20 minutes. The child weighs 52 lb (23.6 kg). How much fluid should the nurse administer? Record your answer using a whole number.

354

A nurse is providing care to a child diagnosed with septic shock. The nurse believes the child's condition is progressing to decompensated shock. What significance does the nurse's belief have on the child's condition?

Additional measures are necessary to meet the child's metabolic requirements.

A 13-year-old boy has had a near-drowning experience. The nurse notices he has labored breathing and a cough. Which of the following would be the priority?

Administer 100% oxygen by mask.

The nurse is called into a toddler's room. The toddler's parent says "My toddler is having trouble breathing." What should the nurse do first?

Assess patency of the airway.

A nurse witnesses a child get hit by a car while riding a bike. The child is lying motionless in the street. What action should the nurse take next?

Ensure a safe environment.

The nurse has been caring for a child who suffered a severe burn 2 days ago. The nurse notes that the child's hematocrit level is 32% (0.32). What is the best action by the nurse?

No action is needed at this time because this is a normal finding.

Which medication is used for symptomatic bradycardia unresponsive to ventilation and oxygenation?

atropine

The nurse is ventilating a 9-year-old girl with a bag valve mask. Which action would most likely reduce the effectiveness of ventilation?

setting the oxygen flow rate at 15 L/minute