PEDS exam 4 emergency questions

A 5-year-old child is exhibiting manifestations of hypotension. Which of the following is the first-line treatment for poor perfusion and hypotension? - Atropine - Sodium bicarbonate - Volume replacement - Epinephrine

Volume replacement - volume replacement is the first-line treatment for poor perfusion and hypotension. Atropine is used for symptomatic bradycardia that is unresponsive to ventilation and oxygenation. Sodium bicarbonate is used for metabolic acidosis. Epinephrine is the drug of choice for children during and immediately after resuscitation.

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? - Apply a cervical collar and request a cervical exam - Assess the child's breathing by using a pulse oximeter - Ask the child to rate the pain from 0-10 or use a picture scale - Perform a jaw-thrust technique to assess the patency of the airway

Perform a jaw-thrust technique to assess the patency of the airway - the nurse would first evaluate the airway, assessing its patency. Position the airway in a manner that promotes good air flow. Since cervical spine injury is a possibility, do not use the head tilt-chin lift maneuver; use only the jaw-thrust technique for opening the airway. The description of the injury would be suspicious for cervical injury. The nurse would evaluate the child's airway before evaluating pain scale and managing cervical concerns, although the nurse is managing cervical concerns by not performing a head tilt-child lift maneuver. A pulse oximeter measurement would not be the priority.

A child who weighs 53 lbs (24 kg) is receiving fluid volume replacement as part of the treatment for shock. The nurse is evaluating the child's hourly urinary output to determine if the child's condition is improving. Which output would the nurse interpret as most indicative of improvement? - 12 mL - 15 mL - 22 mL - 30 mL

30 mL - improved urinary output of 1 to 2 mL/kg/hour is the goal. The child weighs 53 pounds, which is equivalent to 24 kg. Thus, improvement in this child would be noted by an hourly urinary output between 24 and 48 mL/hour.

When a poison has been ingested by a child, what should the parents do first? - Induce vomiting. - Get the child to an emergency facility. - Call the local poison control center. - Administer an emetic.

Call the local poison control center - 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 client.

The nurse plans to educate the parents of a child experiencing 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 contractibility - Dobutamine will work to eliminate the bacteria causing the infection - Dobutamine is used to provide vasodilation, thus increasing blood pressure - Dobutamine will work to dry secretions and inhibit serotonin and histamine

Dobutamine is used to improve cardiac contractibility - dobutamine improves the contractibility of the heart muscle during shock. The medication is not an antibiotic. Vasodilation would result in lower blood pressure. Atropine (anticholinergic) increases cardiac output, dries secretions, and inhibits serotonin and histamine.

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? - Septic - Cardiogenic - Hypovolemic - Distributive

Hypovolemic - although septic, cardiogenic, hypovolemic, and distributive shock can occur in children, hypovolemic shock is the most common type of shock that occurs in children.

A 3-year-old girl had a near-drowning incident when she fell into a wading pool. Which intervention is the highest priority? - Suctioning the upper airway to ensure airway patency - Inserting a nasogastric tube to decompress stomach - Covering the child with warming blankets - Assuring the child stays still during an X-ray

Suctioning the upper airway to ensure airway patency - 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.

While caring for a newborn client, the nurse notices that the client's respirations occasionally rise to 80 to 90 breaths per minute, especially during breastfeeding. What should the nurse anticipate first in the client's plan of care? - Cardiopulmonary assessment - Gastrointestinal assessment - Integumentary assessment - Neurological assessment

Cardiopulmonary assessment - the nurse should anticipate a cardiopulmonary assessment, because rapid respirations that increase while the client nurses may indicate that a cardiopulmonary condition is present. Although a variety of conditions may cause these findings, the nurse should not anticipate a gastrointestinal, integumentary, or neurological assessment first.

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? - Naloxone - Atropine - Lidocaine - Ketamine

Naloxone - 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