Pediatric Emergency Questions
A 14-month-old trauma victim has arrived in the emergency department. Which of the following challenges will the nurse need to address first? a) Risks from reduced core temperature b) Inadequate systemic perfusion c) Increased metabolic demands d) Possible tissue damage from hypoxia
Possible tissue damage from hypoxia Explanation: Oxygen should be administered by a non-rebreather mask until oxygenation and perfusion status is completely assessed. This will stabilize the effects of hypoxia. Reduced core temperature and resultant metabolic demands, as well as the need for epinephrine, are secondary to the ABCs (airway, breathing, and circulation).
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) High-pitched breath sounds over the trachea b) Minimal air movement through the lungs c) Low-pitched bronchial sounds over the periphery d) Resonance over the lungs on percussion
Minimal air movement through the lungs Explanation: Minimal or no air movement requires immediate intervention because this child's status is severely compromised. Breath sounds over the trachea typically are high pitched. Breath sounds over the peripheral lung fields are lower pitched. Normally percussion over air-filled lungs reveals resonant sounds.
A 4-year-old girl has been admitted to the emergency department after accidently ingesting a cleaning product. Which of the following treatments is most likely appropriate in the immediate treatment of the girl's poisoning? a) Intravenous rehydration b) Administration of activated charcoal c) Gastric lavage d) Inducing vomiting
Administration of activated charcoal Correct Explanation: Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.
After assessing a child's airway, breathing, and circulation (ABCs), which of the following would the nurse do next? a) Remove the child's clothing. b) Obtain a full set of vital signs. c) Assess level of consciousness. d) Provide pain management.
Assess level of consciousness. Correct Explanation: Once the ABCs are completed, the nurse's next step is to assess the child's level of consciousness or disability. This would be followed by removing the child's clothing and diaper (exposure) to assess for underlying signs of illness or injury. Next, full vital signs are taken while facilitating the family presence, followed by giving comfort by managing pain and providing emotional support. The acronym ABCDEFG is a useful reminder of the order of assessment: airway, breathing, circulation, disability, exposure, full vital signs and facilitating family, and giving comfort.
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 is the priority intervention? a) Provide sedation as ordered. b) Check his capillary refill time. c) Administer 100% oxygen by mask. d) Have the child sit up straight in a chair.
Administer 100% oxygen by mask. Explanation: Management of the near-drowning victim focuses on assessing his airway, breathing, and circulation (ABCs) and correcting hypoxemia. Administering oxygen is the primary intervention to assist breathing. It is best to let the child assume the most comfortable position for him. Checking capillary refill time helps determine ineffective tissue perfusion. Providing sedation is an intervention for pain that will be assessed after effective breathing is established.
A home care nurse provides health education to parents regarding the care of their toddler. Which of the following precautions should the nurse suggest the parents take to protect the toddler from drowning? 1) Teach the toddler water is bad 2) Tell the toddler to stay away from the pool 3) Avoid unattended baths for the toddler.
Avoid unattended baths for the toddler. Correct Explanation: The parents should not leave the toddler for an unattended bath. Toddlers are naturally inquisitive, and instructing them to stay away from the pool or teaching them that water is dangerous is insufficient to ensure safety.
An unconscious client is brought to the emergency department after ingesting too much prescribed medication. Which of the following is the highest priority nursing intervention? a) Establish a patent airway. b) Establish IV access. c) Call family members. d) Administer antacids.
Establish a patent airway. Correct Explanation: Initial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function. This is a priority over communication with the family, establishing IV access or administering other medications.
A child is learning to ride a bicycle. He should be instructed to use a(an) a) Helmet b) Knee pads c) Light d) Wrist guard
Helmet Correct Explanation: Children should wear properly fitted helmets when cycling, riding, or playing contact sports
The nurse is caring for a 10-month-old infant with signs of respiratory distress. Which is the best way to maintain this child's airway? a) Inserting a small towel under shoulders b) Using the head tilt chin lift technique c) Employing the jaw-thrust maneuver d) Placing the hand under the neck
Inserting a small towel under shoulders Explanation: Inserting a small, folded towel under shoulders best positions the infant's airway in the "sniff" position as is recommended by the American Heart Association (AHA) Basic Cardiac Life Support (BCLS) guidelines. The hand should never be placed under the neck to open the airway. The head tilt chin lift technique and the jaw-thrust maneuver are used with children over the age of 1 year.
The nurse is assessing the neurologic status of an 11-month-old girl. Which finding would be cause for concern? a) Palpation of the head reveals a closed posterior fontanel. b) The child is crying and looking around fearfully. c) The child's eyes remain closed unless she is spoken to. d) Inspection shows a sluggish pupillary reaction.
Inspection shows a sluggish pupillary reaction. Correct Explanation: A sluggish pupillary reaction may occur with increased intracranial pressure, which would be cause for concern. A closed posterior fontanel in an 11-month-old would be a normal finding. Crying and looking around are encouraging signs indicating improved neurologic status. Opening the eyes when being spoken to is an encouraging sign.
The nurse is examining a 10-year-old boy with tachypnea and increased work of breathing. Which finding is a late sign that the child is in shock? a) Significantly decreased skin elasticity b) Delayed capillary refill with cool extremities c) Blood pressure slightly less than normal d) Equally strong central and distal pulses
Significantly decreased skin elasticity Explanation: Decrease skin turgor is a late sign of shock. Blood pressure is not a reliable method of evaluating for shock in children because they tend to maintain normal or slightly below normal blood pressure in compensated shock. Equal central and distal pulses are not a sign of shock. Delayed capillary refill with cool extremities are signs of shock that occur earlier than changes in skin turgor.
A 3-year-old girl had a near-drowning incident when she fell into a wading pool. Which intervention would be of the highest priority? a) Inserting a nasogastric tube to decompress stomach b) Assuring the child stays still during an X-ray c) Suctioning the upper airway to ensure airway patency d) Covering the child with warming blankets
Suctioning the upper airway to ensure airway patency Correct Explanation: Due to the potentially devastating effects of drowning-related hypoxia on a child's brain, airway interventions must be initiated immediately. The child's airway should be suctioned to ensure patency. Other interventions such as covering the child with blankets, inserting a nasogastric tube, and assuring that the child remains still during X-ray are interventions that are appropriate once airway patency is achieved and maintained.
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? a) The child is guarding one hand. b) The child is asleep on the mother's lap. c) The child is scratching a rash. d) There is a blue color to the lips.
There is a blue color to the lips. Correct Explanation: Blue lips is a sign of cyanosis. The child is in respiratory distress and should be cared for on an emergency basis. An injured hand and a rash are not emergencies. The sleeping child could have a fever that may be the result of an underlying pathology; however, this cannot be determined from across the room.
Which of the following nursing diagnoses would be appropriate for teaching interventions for a single mother who leaves her toddler unattended in the bathtub? a) Risk for Falls b) Risk for Imbalanced Body Temperature c) Noncompliance d) Risk for Suffocation
Risk for Suffocation Correct Explanation: Death from drowning occurs from suffocation. Nearly half of all drowning victims are children under the age of 5. Most drowning deaths in young children occur because of inadequate supervision of a bathtub or pool.
When a poison has been ingested by a child, the parents should be instructed to do which of the following first? a) Induce vomiting. b) Call the local poison control center. c) Administer an emetic. d) Get to an emergency facility.
Call the local poison control center. Correct Explanation: Not all poisons should be vomited. Strong acids, for example, could cause as much destruction of tissue being vomited as being swallowed. The poison control center will provide the most accurate information on the next steps for the patient.
A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in teaching parents about how to protect a toddler from accidental poisoning? a) Label poisonous solutions. b) Do not leave the toddler alone. c) Closely monitor the toddler's activity. d) Keep cleaning solutions locked up.
Keep cleaning solutions locked up. Correct Explanation: The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time.
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? 1) Atropine 2) Naloxone 3) Lidocaine 4) Ketamine
Naloxone Correct Explanation: Oxycodone is an opioid analgesic whose effects can be reversed by the administration of naloxone. Atropine decreases secretions and reduces the vagal effects of intubation. It also is used for sinus bradycardia, asystole, and pulseless electrical activity. Lidocaine is used to correct ventricular arrhythmias. Ketamine may be used for rapid-sequence intubation.
A 2-year-old boy is in respiratory distress. Which nursing assessment finding would suggest the child aspirated a foreign body? a) Noting absent breath sounds in one lung b) Hearing a hyperresonant sound on percussion c) Hearing dullness when percussing the lungs d) Auscultating a low-pitched, grating breath sound
Noting absent breath sounds in one lung Explanation: Unilateral absent breath sounds are associated with foreign body aspiration. Dullness on percussion over the lung is indicative of fluid consolidation in the lung as with pneumonia. Auscultating a low-pitched, grating breath sound suggests inflammation of the pleura. Hearing a hyperresonant sound on percussion may indicate pneumothorax or asthma.
The nurse is caring for a 2-year-old who has been rushed to the clinic immediately after swallowing an unknown number of acetaminophen tablets. Which of the following is the priority intervention? a) Perform a gastric lavage. b) Administer N-acetylcysteine. c) Initiate chelation therapy. d) Start IV fluid replacement.
Perform a gastric lavage. Explanation: If the child ingested the pills within the last 60 minutes, a gastric lavage and administration of activated charcoal would be the preferred treatment. If the acetaminophen is in the bloodstream, N-acetylcysteine may be administered. Chelation therapy is meant for metal poisoning. IV fluid replacement is used to treat hypovolemic shock.
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) Administering intravenous dopamine as ordered c) Giving blood if saline provides inadequate response d) Inserting a urinary catheter for monitoring urinary output
Administering intravenous dopamine as ordered Explanation: 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.
Which medication is used for symptomatic bradycardia unresponsive to ventilation and oxygenation? a) Atropine b) Naloxone c) Sodium bicarbonate d) Calcium carbonate
Atropine Correct Explanation: Atropine is used for symptomatic bradycardia unresponsive to ventilation and oxygenation. Sodium bicarbonate is used for metabolic acidosis. Naloxone reverses the effect of opioids. Calcium carbonate is used for documented or suspected hypocalcemia, hyperkalemia, hypermagnesemia, and calcium channel blocker overdose.
The parents of a 7-month-old boy with a broken arm agree on how the accident happened. Which account would lead the nurse to suspect child abuse? a) "He was climbing out of his crib and fell." b) "The gate was open and he fell down three steps." c) "Mom turned and he fell from changing table." d) "He fell out of a shopping cart in the store."
"He was climbing out of his crib and fell." Explanation: The nurse would be suspicious of a 7-month-old climbing out of his crib, since it is not consistent with his developmental stage. Other areas of concern are if the parents have different accounts of the accident and if the injury is not consistent with the type of accident.
A 4-year-old girl is brought to the emergency room following ingestion of large amounts of acetaminophen (Tylenol). Which of the following interventions does the nurse expect? a) Stimulation of vomiting b) Assessing for consciousness c) Performing hands-only CPR d) Administration of acetylcysteine
Administration of acetylcysteine Correct Explanation: In the emergency department, activated charcoal or acetylcysteine, a mucolytic agent and also the specific antidote for acetaminophen poisoning, will be administered. Acetylcysteine prevents hepatotoxicity by binding with the breakdown product of acetaminophen so that it will not bind to liver cells. Unfortunately, acetylcysteine has an offensive odor and taste. Administering it in a small amount of a carbonated beverage can help the child to swallow it.
When assessing a child with a traumatic injury, which of the following would be the priority assessment? a) Airway patency and airflow b) Breathing effectiveness and breath sounds c) Level of consciousness and papillary reaction d) Pulse rate and skin color
Airway patency and airflow Correct Explanation: 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.
Assessment of a child reveals a tension pneumothorax. The nurse would prepare the child for which of the following? a) Needle thoracotomy b) Suctioning c) Intubation d) Defibrillation
Needle thoracotomy Correct Explanation: A needle thoracotomy is indicated for tension pneumothorax to relieve the air collected in the space. Intubation is indicated for apnea and in situations in which the airway cannot be maintained. Suctioning would be indicated for excessive airway secretions that influence airway patency. Defibrillation is used to stimulate or alter the heart's electrical rhythm.
A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding which of the following? a) Putting child safety locks on kitchen cabinets b) Placing house plants out of reach of children c) Putting medicine away where children cannot reach it d) Removal or covering of flaking paint on the walls of the home
Removal or covering of flaking paint on the walls of the home Correct Explanation: The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries. A child with a blood lead level over 5 μg/dL needs to be rescreened to confirm the level and then active interventions begun to prevent further lead exposure such as removal of the child from the environment containing the lead source or removal of the source of lead from the child's environment. Removal of the lead source is not an easy task in homes because simple repainting or wallpapering does not necessarily remove the source of peeling paint adequately. After some months, the new paint will begin to peel because of the defective paint underneath. The walls must therefore be covered by paneling or dry wall or other solid protective material. The other answers refer to safety measures to prevent other types of poisoning, such as from household cleaners, medicine, and plants.
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 which of the following? a) Underlying heart disease b) Respiratory failure c) Neurologic trauma d) Lethal arrhythmia
Respiratory failure Correct Explanation: Cardiopulmonary arrest in infants and children typically results from disorders that lead to respiratory failure and shock. In adults, the most common causes of cardiopulmonary arrest are lethal arrhythmias secondary to heart disease. Although neurologic trauma can lead to respiratory failure, it alone is not the most likely factor.
