Pediatrics: Shock and Trauma Questions
A mother calls the nurse and reports that her child has ingested a toxin. Which statement by the nurse explains why inducing vomiting is contraindicated? "Vomiting can increase the toxicity of the agent." "Vomiting may cause additional damage to the esophagus." "Vomiting can increase the absorption in the oral mucosa." "Vomiting may cause bowel rupture due to the increase in pressure."
"Vomiting may cause additional damage to the esophagus." As the ingested agents makes a second trip through the esophagus, it may cause additional damage or burning of the tissue.
The nurse is caring for a child with a rapid breathing, headache, and the smell of wintergreen on the skin and clothes. Which additional signs and symptoms would the nurse assess for? Select all that apply. Bleeding Vomiting Confusion Diaphoresis Hyperglycemia Peripheral edema
Bleeding Wintergreen is a salicylate and is often used as a safe alternative to aspirin. The nurse would assess for bleeding and bruising related to the inhibition of prothrombin, decreased platelets levels, and capillary fragility. Correct Vomiting Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Oral poisoning typically manifests nausea and vomiting related to GI irritation. Correct Confusion Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Confusion, seizures, and coma are all related to the CNS effects of salicylate poisoning. Correct Diaphoresis Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Dehydration, sweating, and decreased urine production are typical in salicylate poisoning.
The nurse is triaging patients after a mass casualty. Place the patients in the order in which they should be seen. Select all that apply. 9 year old with 74 mm Hg systolic BP 5 year old with 76 mm Hg systolic BP 8 year old with 84 mm Hg systolic BP 10 year old with 90 mm Hg systolic BP
9 year old with 74 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (9-year-old child: 70 + 18 = 88 mm Hg) Correct 5 year old with 76 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (5-year-old child: 70 + 10 = 80 mm Hg) Correct 8 year old with 84 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (8-year-old child: 70 + 16 = 86 mm Hg)
The nurse is caring for a 12-year-old patient after a bicycle accident in which the child fell over the handlebars trying to jump a curb. Which type of injury does the child likely have? Blunt Progressive Penetrating Multisystem
Blunt A child who falls over the handlebars of a bicycle will likely sustain blunt force trauma.
The nurse is caring for a pediatric patient admitted with severe nausea and vomiting for several days. Which finding will help the nurse quickly evaluate peripheral tissue perfusion? Oral temp 102.3 F Flat anterior fontanel Bowel sounds hyperactive Capillary refill greater than 5 seconds
Capillary refill greater than 5 seconds Capillary refill is the best assessment method to quickly assess tissue perfusion.
Which type of poisoning might the nurse expect for a 6-year-old who has presented with a cherry-red mucosa and a history of altered mental status after playing in the garage with the car running? Lead Corrosives Hydrocarbons Carbon monoxide
Carbon monoxide Carbon monoxide (CO) binds tightly to hemoglobin, preventing the binding of oxygen. The CO makes the hemoglobin appear bright red, causing the patient to look rosy-cheeked and to have cherry-red lips.
The nurse is caring for a patient hospitalized after a crushing chest injury, leading to development of blood surrounding the pericardium. The nurse notes tachycardia, tachypnea, muffled heart sounds, weakened peripheral pulses, and delayed capillary refill. Which form of shock is the patient likely experiencing? Septic shock Cardiogenic shock Distributive shock Hypovolemic shock
Cardiogenic shock Cardiogenic shock results when the patient's heart cannot pump effectively to meet the patient's metabolic needs. In the early stages of cardiogenic shock, the child is able to compensate with tachycardia, tachypnea, and vasoconstriction to maintain cardiac output.
The nurse is caring for a 7-year-old patient who reports sustaining a leg injury while falling down the stairs three days ago. The nurse notes abrasions to the left elbow and a right tibia fracture. Which indicator may raise the suspicion of child maltreatment? Patient has abrasion on his elbow Delay in seeking treatment for the trauma Patient has never broken his tibia previously The patient was alone when the injury occurred
Delay in seeking treatment for the trauma Delay in seeking treatment for the trauma is an important indicator that might raise the suspicion of child maltreatment in the emergency setting.
Which clinical manifestations are likely to develop in a 3-year-old child after initial stabilization for bleach ingestion? Select all that apply. Development of metabolic acidosis Development of esophageal strictures Development of liver necrosis and jaundice Development of hypokalemia and dehydration Development of organ perforation and vascular complications
Development of esophageal strictures As the damaged esophagus begins to heal, the child may have continued difficulty swallowing due to the development of strictures. Development of organ perforation and vascular complications When a child has a severe burn, the damage can lead to eventual perforation of an organ. This can lead to vascular collapse and shock.
A nurse is teaching a group of parents about assessing the ABCDE's in children with toxic exposure. Which two assessment components should the nurse discuss in addition to the traditional ABC's of CPR? Select all that apply. Diuresis Disability Exposure Exudates Diaphoresis
Disability Seizure precautions should be implemented in poison exposures with neurological or metabolic side effects. The child's mental status should be assessed frequently. Exposure Treating toxic exposures and ingestions may include removal of dermal and ocular toxins, dilution of the toxin, administration of activated charcoal, and administration of an antidote. Gastric lavages are no longer recommended.
The nurse is caring for a child who is obtunded after being struck in the head by a baseball during a game. Which artificial airway should be used to maintain airway patency? Bag, valve, mask Oropharyngeal airway Endotracheal intubation Nasopharyngeal airway
Endotracheal intubation Endotracheal intubation is a single type of artificial airway that would suffice for an unconscious child or a child who has altered mental status.
After the patient's respiratory status is stable, which action is appropriate for the nurse to perform on an unresponsive, nonverbal trauma patient? Ensure Foley catheter is patent Ensure chest tube placement secure Maintain IV fluids at maintenance therapy Ensure cervical spine protection until definitive diagnosis is made
Ensure cervical spine protection until definitive diagnosis is made All unresponsive and nonverbal trauma patients should have cervical spine protection until definitive diagnosis can be made.
A 6-year-old child comes to the emergency department and presents with respiratory distress from gasoline skin exposure. Which action should the nurse take if the child becomes unconscious? Administer naloxone Administer activated charcoal Assess and support CNS function Assess and support cardiorespiratory function
Assess and support cardiorespiratory function If the child loses consciousness, assessment of the cardiorespiratory functions is necessary. If deficits are noted, provide proper support.
The nurse is caring for a child who was propelled to the ground when struck by a car. The child struck the occipital region of the skull on the ground. Which other area of the head should the nurse assess for injury? Frontal Parietal Temporal Basilar
Frontal Waddell's triad says that patients sustain injuries to the contralateral side of the head. The frontal region is contralateral to the occipital region.
The nurse is caring for a 10-year-old child in hypovolemic shock after a liver laceration from a bicycle injury. The nurse notes delayed capillary refill, lethargy, BP 74/48, and SpO2 88%. Which orders are most important for the nurse to complete first? Select all that apply. Administer IV antibiotics Give IV normal saline bolus Provide oxygen via nasal cannula Refer parents to hospital chaplain Perform range-of-motion exercises
Give IV normal saline bolus The nurse should administer IV fluid to replace fluid volume loss. Provide oxygen via nasal cannula The nurse should provide supplemental oxygen to help maintain the patient's tissue perfusion. Refer parents to hospital chaplain Referring patients to the hospital chaplain can help provide the emotional support necessary to cope with the child's condition. Perform range-of-motion exercises Range-of-motion exercises can help maintain muscle function in patients who are hospitalized, but it is not a priority action.
The nurse is caring for an infant with vomiting and diarrhea for the past week. The nurse notes a depressed anterior fontanel, decreased urine output, and lack of tears. Which prescription should the nurse complete first? Initiate oxygen Give an IV fluid bolus Administer oral antiemetic Apply barrier cream to the buttocks
Give an IV fluid bolus The patient's symptoms are indicative of hypovolemic shock. IV fluid resuscitation is the most important action.
A nurse has 25 years of experience working in the emergency department (ED) treating and managing pediatric patients. Treating which area of the pediatric patient should she have most experience? Arm Leg Head Wrist
Head The head makes up a large proportion of the child's body relative to the rest of the body. An experienced ED nurse should be used to treating head injuries because this area of the body is injured more than other areas.
The nurse is receiving a pediatric patient in shock who was just involved in an accident and has lost a large amount of blood. The patient should be assessed for which type of shock first? Septic shock Distributive shock Cardiogenic shock Hypovolemic shock
Hypovolemic shock This patient should be first assessed for hypovolemic shock because this is characterized by an overall decrease in circulating blood or fluid volume.
A patient comes to the emergency department and is being treated for distributive shock. Which patient presentation corresponds to this diagnosis? Select all that apply. A patient suffering from profuse diarrhea Inability of a patient to maintain vascular tone A patient with septic shock who has a bacterial infection A patient with an overall decrease in circulating blood volume A patient with myocardial fluid accumulation causing insufficiency in meeting the body's demands
Inability of a patient to maintain vascular tone This patient scenario corresponds to a patient diagnosed with distributive shock, and therefore the nurse should recognize septic shock as a form for distributive shock. A patient with septic shock who has a bacterial infection This patient scenario corresponds to a patient diagnosed with distributive shock, and therefore the nurse should recognize septic shock as a form of distributive shock.
The nurse is assessing a patient who fell two stories from a window. An artificial airway is in place, and the cervical spine has been stabilized. Which action is the most appropriate for the nurse to take next? Assess capillary refill Listen to lung sounds Obtain a blood pressure Evaluate the patient's Glasgow Coma Scale score
Listen to lung sounds To properly complete the primary survey, after establishing an airway and stabilizing the cervical spine, the nurse should assess the patient's breathing effort.
The nurse is caring for a patient who has sustained a gunshot shot wound to the leg. The wound is actively bleeding and the patient reports 10/10 pain. Which factor should the nurse consider a priority when assessing the severity of the patient's injury? The age of the patient The size of the patient Location of the penetration Time that the injury occurred
Location of the penetration The severity of an injury depends on the location of impact and the type of object. The nurse should consider the location of the injury and its impact on the primary survey.
Which finding will the nurse expect to see in a 5-year-old child whom the mother suspects to have ingested the acetaminophen 3 hours ago? Jaundice Malaise, pallor, weakness Right upper quadrant (RUQ) pain Recovery from physical symptoms
Malaise, pallor, weakness During the first 24 hours, the nurse would expect to see malaise, nausea, vomiting, sweating, pallor, and weakness.
The nurse is caring for a patient who has a penetrating chest wound. The patient is unresponsive, with labored breathing and delayed capillary refill. Which factor would the nurse consider during the initial assessment in addition to the patient's signs and symptoms? Name of the patient Mechanism of injury Time of day when injury occurred Geographic location when injury occurred
Mechanism of injury Nursing intervention depends on knowing the mechanism of injury, as well as the manifesting signs and symptoms.
A 2-year-old child comes to the emergency department with a substantial acetaminophen overdose. Which drug-specific medication should the nurse anticipate administering to this patient? Naloxone N-acetylcysteine Activated charcoal Diluted oil of wintergreen
N-acetylcysteine N-acetylcysteine is an antidote used for significant acetaminophen ingestion.
The nurse is caring for a child who has been struck by a car. The nurse notes a patent airway, labored breathing, and active bleeding from an open leg fracture. Which assessment should the nurse perform next? Neurologic assessment Auscultate bowel sounds Assess the cervical spine Head to toe skin assessment
Neurologic assessment After completing the primary survey, including the airway, breathing, and circulation, the nurse should assess the patient's neurologic status.
The nurse is caring for a patient in hypovolemic shock. The patient has a patent airway, unlabored breathing, and capillary refill less than 4 seconds. Which prescription should the nurse anticipate receiving first from the health care practitioner? Obtain vascular access Administer oral antibiotics Prepare patient for surgery Begin hemodynamic monitoring
Obtain vascular access Once the airway, breathing, and circulation are established, the next priority for the nurse is adequate vascular access.
A 5-year-old child presents to the emergency department and begins to exhibit neurological side effects after ingesting an unknown poison at home. Which action should the nurse take after assessing that the airway is stable? Gastric lavage Administer naloxone Initiate IV fluid resuscitation Prepare for seizure precautions
Prepare for seizure precautions Patients with neurological or metabolic side effects are prone to seizures and precautions are necessary.
The nurse is caring for an infant brought in with a high fever, cough, labored breathing, and tachypnea. Which general appearance finding would be most concerning for the nurse? Diarrhea Poor feeding Weak, continuous cry Skin is cool and mottled
Skin is cool and mottled Cool, mottled skin is a sign of poor tissue perfusion and can indicate shock in an infant with labored breathing and tachypnea.
The nurse is caring for a 3 year old diagnosed with pneumonia one week previously. The parents report the child has become lethargic and appears to have more difficulty breathing. The nurse notes delayed capillary refill, tachycardia, and tachypnea. Which prescription should the nurse implement first? Supplemental oxygen Hemodynamic monitoring IV fluid bolus of normal saline Parenteral antibiotic therapy
Supplemental oxygen Supplemental oxygen should be initiated first for a patient with signs of shock, hypoxia, and poor tissue perfusion.
The nurse is caring for a child who presents with blunt force trauma to the head and face, which the parents say was sustained during a fall. The nurse also notes the child is lethargic and confused and has bruises on the legs, arms, and abdomen in multiple stages of healing. Which area of body will be of most concern to the nurse? Kidneys and renal system Lungs and respiratory system The cervical spine and neurologic system Heart and cardiovascular system
The cervical spine and neurologic system The nurse should verify the stability of the cervical spine for a patient with blunt force trauma to the head and face.
The nurse is caring for a child who is unresponsive after being struck by a vehicle. The child sustained multiple injuries and was diagnosed with cardiogenic shock. The child's parents are tearful and refuse to speak with the provider about the child's prognosis. Which action would the nurse take to enhance family coping? Select all that apply. Ask the parents to refrain from staying at the child's bedside Provide concise, accurate information to the parents at frequent intervals Give information in a calm, relaxed, and empathetic manner Encourage parents to participate in the child's care as appropriate Provide simple explanations to the child and parents of procedures before initiating them Provide detailed information, using correct medical terminology so parents will understand
Provide concise, accurate information to the parents at frequent intervals The nurse's action of providing concise, accurate information to parents at frequent intervals enhances family coping. Correct Give information in a calm, relaxed, and empathetic manner The nurse's action of giving information in a calm, relaxed, and empathetic manner enhances family coping. Correct Encourage parents to participate in the child's care as appropriate The nurse's action of encouraging parents to participate in the child's care as appropriate provides them with some degree of control. Correct Provide simple explanations to the child and parents of procedures before initiating them The nurse's action of providing simple explanations to the child and parents before initiating them enhances family coping.
A positive outcome for a child with multiple traumas depends mainly on which two factors? Rescue breathing and cardiopulmonary resuscitation (CPR) Family support and age of child Rapid assessment and intervention Administering antibiotics and hemodynamic monitoring
Rapid assessment and intervention A positive outcome for a child who has sustained multiple trauma depends on rapid assessment and intervention, which begin at the scene of the accident and continue through the trauma center emergency department, the critical care and acute care units, and the rehabilitation phase.
In order to terminate ocular exposure, which interventions should the nurse provide to a patient who has experienced exposure to a powdered poison? Select all that apply. Administer a chelating agent Remove contaminated clothing Irrigate the eyes with warm water or saline Induce vomiting to reduce absorbed poison levels Eliminate powder from skin and clothing; wash skin
Remove contaminated clothing Remove any contaminated clothes; residual powder could endanger the child and health care workers. Irrigate the eyes with warm water or saline Irrigation of the eyes with water or normal saline is crucial for terminating ocular exposure of any poison. Eliminate powder from skin and clothing; wash skin Brush off chemical powders from the skin, and wash the skin. Residual powdered poison is dangerous for both the child and health care workers.
A mother brings in her 4-year-old child to the health care provider, stating that the child has marked constipation and describing the child as "sluggish." Which patient's social history is most significant? The family has recently moved into a historic house. The child has recently attended an outdoor day camp. The family has just returned from a vacation to the ocean. The child has recently started attending preschool at a newly built facility.
The family has recently moved into a historic house. A historic home may have lead paint and leaded glass which can lead to toxicity causing constipation. Exposure to lead can cause the symptoms described in this scenario.
A child accidentally aspirated lighter fluid after playing with a lighter. Which roles does the nurse have in managing this patient? Select all that apply. The nurse will administer IV fluids. The nurse will utilize measures to prevent emesis. The nurse will administer oxygen and support ventilation. The nurse will administer chelators and anti-coagulant medications. The nurse will monitor vital signs and observe for signs of CNS depression.
The nurse will administer IV fluids. Administration of IV fluids supports circulatory function and prevents dehydration. Correct The nurse will utilize measures to prevent emesis. Prevention of emesis will decrease the likelihood of additional aspiration of the low-density hydrocarbons. Correct The nurse will administer oxygen and support ventilation. Administration of oxygen and support of ventilation are essential due to potential damage to the lungs. The nurse will monitor vital signs and observe for signs of CNS depression. Vital signs and changes in CNS function are critical. This should be assessed regularly.
