Peds PrepU for Exam _ - Ch 35: Pediatric Emergencies

Capillary glucose 62 mg/dl (reference range: 70 to 140 mg/dl) A 4-year-old child is brought to the emergency department with a suspected ingestion of the parent's glyburide medication. A capillary glucose is drawn (above). Which treatment will the nurse initiate for this child? epinephrine IV lactated Ringer's bolus IV dextrose 25% IV oxygen via facemask

dextrose 25% IV (Explanation: GLYBURIDE is a SULFONYLUREA ANTIDIABETIC medication that can cause hypoglycemia, which this child is exhibiting. Hypoglycemia can be treated with DEXTROSE 25% IV to raise the blood glucose level. Oxygen, lactated Ringer's, and epinephrine are not effective treatments for hypoglycemia. Chapter 35: Pediatric Emergencies - Page 778)

A 5-year-old client has bradycardia due to a toxic substance ingestion. The health care provider orders atropine sulfate 0.02 mg/kg IV. The child weighs 18 kg. The medication is available in a vial containing 0.1 mg/mL. How many milliliters (ml) of atropine would the nurse administer to the child?

3.6 (Explanation: 0.02 mg/kg x 18 kg = 0.36 mg desired dose (Desired dose x Quantity)/(Amount on Hand) = amount to give 0.36 mg x 1 ml/ 0.1 mg = 3.6 ml Chapter 35: Pediatric Emergencies - Page 766)

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? Check the vital signs. Assess the level of consciousness. Check for visible injuries. Ensure a safe environment.

Ensure a safe environment. (Explanation: The nurse should ensure that the area is safe before approaching the child. The nurse can then assess the child's CARDIAC status, BREATHING, other VITAL SIGNS, DISABILITY, and stabilize the cervical spine. Chapter 35: Pediatric Emergencies - Page 763)

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? administration of acetylcysteine performing hands-only CPR stimulation of vomiting assessing for consciousness

administration of acetylcysteine (Explanation: In the emergency department, ACTIVATED CHARCOAL or ACETYLCYSTEINE, a MUCOLYTIC agent (and 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. Chapter 35: Pediatric Emergencies - Page 778)

BP 88/44 HR 60 beats/min RR 10 breaths/min Temp 97.2 F Peripheral pulses: diminished Skin: pale, cool, diaphoretic Mental status: lethargic, difficult to arouse A nurse is providing care to a 16-year-old adolescent brought to the emergency department with suspected opioid toxicity. The nurse has completed an assessment with the above findings. Which finding best supports opioid toxicity? blood pressure mental status respirations skin

respirations (Explanation: The adolescent's respiratory rate of 10 breaths/min best supports opioid toxicity. While bradycardia and hypotension are signs of opioid toxicity, they also suggest toxicity from cardiac medications. Lethargy is also a sign of other medication toxicity, including cardiac, hypoglycemic, and antidepressant medications. Pallor and diaphoresis are associated with hypoglycemic medication and acetaminophen toxicities. Chapter 35: Pediatric Emergencies - Page 778)

A nurse is providing care to a child who experienced a life-threatening injury. Despite the efforts of the health care team, it is determined that the child will not survive. The health care team has met with the parents to explain the situation. How can the nurse provide the best support to the parents? Offer the parents the services of pastoral care. Provide continuous updates on the child's condition Provide reassurance that they will be alright. Be "present" with the family.

Be "present" with the family. (Explanation: The nurse should recognize the importance of being "present" with the family by giving them needed time and attention during this situation. Being present allows the nurse to RECOGNIZE the NEEDS that are most important to the family. Offering pastoral care services and providing continuous updates are important in supporting the family, but each one by itself may not be the best way to support that particular family. Providing reassurance that the family will be alright is inappropriate because the nurse has no way of knowing that, and it provides false reassurance. Chapter 35: Pediatric Emergencies - Page 765-766)

The nurse is teaching the parents of a 2-year-old child how to avoid accidental poisonings. What will the nurse include in the teaching? Select all that apply. Keep cleaning supplies in plain sight at all times. Store detergents in easy-to-use, personalized containers. Install carbon monoxide detectors. Cook meats to the recommended temperature. Follow directions for use for all dangerous substances.

Cook meats to the recommended temperature. Install carbon monoxide detectors. Follow directions for use for all dangerous substances. (Explanation: The nurse should teach the parents to the recommended temperature, install carbon monoxide detectors, and follow the directions for use for all dangerous substances. Detergents should be kept in their ORIGINAL containers, not personalized containers. Cleaning supplies should be stored out of the reach and OUT OF SIGHT of children. Chapter 35: Pediatric Emergencies - Page 781)

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. Dobutamine is used to provide vasodilation, thus increasing blood pressure. Dobutamine will work to dry secretions and inhibit serotonin and histamine. Dobutamine will work to eliminate the bacteria causing the infection.

Dobutamine is used to improve cardiac contractility. (Explanation: Dobutamine IMPROVES the CONTRACTILITY 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. Chapter 35: Pediatric Emergencies - Page 766)

A summer camp nurse is called to assist with a 9-year-old camper who has fallen from a tree and is unresponsive. The nurse suspects possible cervical spine injury and needs to provide artificial respiration. What is the appropriate approach to opening this child's airway? Use a tongue depressor to hold the tongue down. Tilt the forehead backward. Perform a chin lift maneuver. Perform a jaw thrust maneuver.

Perform a jaw thrust maneuver. (Explanation: In the case of a suspected cervical spine injury, it is essential to reduce movement of the head and neck to prevent possible damage to the spinal cord. The best approach to open the airway is to perform a jaw thrust maneuver, which lifts the jaw forward without moving the head or neck. The chin lift and tilting of the forehead will both risk moving the head and neck. A tongue depressor will not assist in opening the airway for artificial respiration. Chapter 35: Pediatric Emergencies - Page 764)

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 child is assessed for injury before applying the cardiac monitor. The nurse assesses the child's neurological status following chest compressions. The child is monitored for respiratory complications such as pneumonia. The nurse assesses the child's heart rate at 45 and begins chest compressions.

The nurse assesses the child's heart rate at 45 and begins chest compressions. (Explanation: The child with a pulse of LESS THAN 60 beats per minute should receive chest compressions to maintain adequate perfusion and circulation. The nurse would assess for injuries, the child's neurologic status, and respiratory complications AFTER CPR has stabilized the child. Chapter 35: Pediatric Emergencies - Page 779)

Which medication is used for symptomatic bradycardia unresponsive to ventilation and oxygenation? atropine sodium bicarbonate naloxone calcium carbonate

atropine (Explanation: Atropine is used for SYMPTOMATIC BRADYCARDIA UNRESPONSIVE TO VENTILATION AND OXYGENATION. Atropine INCREASES CARDIAC OUTPUT, DRIES SECRETIONS, and INHIBITS SEROTONIN and HISTAMINE release. SODIUM BICARBONATE is used to combat acidosis when there is low perfusion. NALOXONE reverses the effect of opioids. CALCIUM CARBONATE is used for documented or suspected hypocalcemia, hyperkalemia, hypermagnesemia, and calcium channel blocker overdose. Chapter 35: Pediatric Emergencies - Page 765)

A nurse is providing care to a 14-year-old child hospitalized after an overdose of fentanyl. Which aspect of the plan of care should the nurse prioritize? perfusion hydration oxygenation cognition

oxygenation (Explanation: The nurse prioritizes oxygenation. An overdose of the opioid fentanyl can cause respiratory depression; thus, oxygenation is a priority. An opioid overdose can also affect perfusion (circulation) and cognition (neurologic functioning); however, these are DIRECTLY affected by OXYGENATION (airway and breathing), which should be the priority. Hydration should be included in the plan of care, but oxygenation is the priority. Chapter 35: Pediatric Emergencies - Page 779-780)

The nurse is speaking to the mother of a dying child about the best ways to manage pain and discomfort. Which is the best response by the nurse? "We will keep the lights and a television on in the room at all times so your child doesn't become scared." "We will not be repositioning your child since it seems to hurt him." "We will provide pain medication around the clock to help prevent recurrence or escalation of pain." "We will provide pain medication to your child whenever she seems to be in pain."

"We will provide pain medication around the clock to help prevent recurrence or escalation of pain." (Explanation: Provide pain medication AROUND THE CLOCK rather than on an "AS NEEDED" basis to prevent recurrence or escalation of pain. MINIMIZING light and noise can help keep a calm environment. FREQUENT but GENTLE position changes can also help decrease pain and discomfort. Chapter 27: Oncologic Disorders - Page 565)

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 give your child ipecac syrup to induce vomiting." "You need to hang up with me and call the poison control center now." "Immediately take your child to your local emergency facility." "Monitor your child's breathing and heart rate closely for the next 24 hours."

"You need to hang up with me and call the poison control center now." (Explanation: The nurse would tell the parent to call a poison control center to receive information of how to best treat the child. A poison control center will provide the most accurate information on the next steps for the client. The nurse would not recommend ipecac syrup, which induces vomiting. Not all poisons should be vomited. Strong acids, for example, could cause as much destruction of tissue being vomited as being swallowed. The child can be brought to the local emergency facility; however, calling a poison control center is best. Health care professionals should be the ones to monitor the child, not the parents or caregivers in this situation. Chapter 35: Pediatric Emergencies - Page 779)

WBCs High RBCs Normal Platelets Normal Hgb Normal Hct Normal Glucose Normal BUN Normal Creatinine Normal Lactate High Blood cultures: Pending A 3-year-old child is brought to the emergency room with lethargy, irregular breathing, and mottled skin. The parents report a fever over the past 24 hours, with the child's breathing worsening in the past hour. Crystalloid IV therapy is started and bloodwork is drawn (above). Vital signs are pulse rate 148 beats/min, respiratory rate 32 breaths/min, blood pressure 74/48 mm Hg, temperature 101.7°F (38.7°C), oxygen saturation 93%. What treatment will the nurse prioritize to take next in the plan of care? Provide steroid therapy to reduce inflammation. Initiate broad-spectrum antibiotics to treat infection. Await results of blood culture tests. Administer acetaminophen to reduce fever.

Initiate broad-spectrum antibiotics to treat infection. (Explanation: This child is presenting with signs of SEPTIC SHOCK, including a history of FEVER, ELEVATED RESPIRATORY RATE and HEART RATE, and ELEVATED LEUKOCYTES, C-REACTIVE PROTEIN (CRP), and LACTATE. Crystalloid IV therapy has already been initiated and blood culture tests drawn. The NEXT priority is to initiate broad-spectrum ANTIBIOTIC treatment to address the INFECTIOUS CAUSE of the septic shock. This antibiotic treatment should NOT wait for the results of the blood culture tests, which may take 1 to 3 days for results. ANTIPYRETIC treatment to reduce fever and steroid therapy may also be indicated, but antibiotic treatment of the infection is the priority alongside fluid management, respiratory support and hemodynamic management of the sepsis. Chapter 35: Pediatric Emergencies - Page 774) (Notes: C-reactive protein (CRP) is a protein made by the liver. The level of CRP increases when there's inflammation in the body. Mottled skin is a net or web-like pattern on the skin. This pattern will usually appear red, bluish, purple, or brown. Researchers believe that mottled skin develops when there is a lack of blood flow to the skin.)

The nurse is caring for a 7-year-old child with shock. What is the priority treatment in the child's care? administering IV fluids intramuscular epinephrine inotropic support dopamine therapy

administering IV fluids (Explanation: The priority treatment in the care of a child with SHOCK is ADMINISTERING IV FLUIDS. INOTROPIC SUPPORT may also be given for those who have not responded to IV fluids. (An inotrope s a drug or any substance that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscular contractions. Positively inotropic agents increase the strength of muscular contraction) Intramuscular EPINEPHRINE is given in addition to IV fluids in the case of anaphylactic shock. Cardiogenic shock indicates the use of DOPAMINE THERAPY in addition to administering IV fluids. Chapter 35: Pediatric Emergencies - Page 776-777)

A nurse on a pediatric unit finds a 3-year-old child unconscious. The child does not respond to stimuli. The nurse calls a code and starts to perform cardiopulmonary resuscitation (CPR). Complete the following sentence(s) by choosing from the lists of options. The nurse should first address the child's level of consciousness / breathing / perfusion / airway followed by the child's airway / breathing / level of consciousness / perfusion, then airway / level of consciousness / perfusion / breathing

airway, breathing, perfusion (Explanation: The nurse should prioritize care based on the ABCs (airway, breathing, then circulation), especially with children because respiratory arrest is most often caused by choking. The nurse must ensure a patent airway first. Breathing is addressed after airway. Perfusion or circulation is addressed after airway and breathing. Level of consciousness is assessed AFTER the ABCs and PRIOR to initiating cardiopulmonary resuscitation (CPR). Chapter 35: Pediatric Emergencies - Page 763)

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: underlying heart disease. lethal arrhythmia. respiratory failure. neurologic trauma.

respiratory failure. (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. Chapter 35: Pediatric Emergencies - Page 768)

An 8-year-old child is brought to the emergency trauma room after a fall from a second-story window. The child's parents have arrived at the hospital and are distressed and concerned that the child is going to die. Which member of the interdisciplinary team may assist with the family at this time? Select all that apply. psychologist social worker psychiatrist chaplain resident physician

social worker chaplain (Explanation: A social worker and hospital chaplain are trained in communicating and supporting families in CRISIS in medical settings. The resident physician is more likely involved in the care of the child. A psychologist and psychiatrist may provide support and therapy if there is ongoing trauma from this situation, but are not likely to support the family in the emergency room and during the crisis and trauma. Chapter 35: Pediatric Emergencies - Page 766)

The nurse is preparing to present an educational session on pediatric cardiopulmonary arrests. The nurse will include which statement in the teaching? "Activate the emergency response system first in an unwitnessed event." "Start cardiopulmonary resuscitation (CPR) in an infant if the heart rate is below 75 beats per minute." "Most pediatric arrests stem from airway and breathing issues." "Obtaining an automated external defibrillator (AED) is vital to survival."

"Most pediatric arrests stem from airway and breathing issues." (Explanation: Most PEDIATRIC ARRESTS are related primarily to airway and breathing, and usually only secondarily to the heart issues. This information guides the nurse to ALWAYS assess the airway first in case of an emergency involving cardiopulmonary arrest. While obtaining an AED is important, pediatric arrests are MORE OFTEN RESPIRATORY related instead of CARDIAC. In an UNWITNESSED event, CPR should be started FIRST. The emergency response system is first activated when the event is WITNESSED. CPR should be started when an infant's heart rate is less than 60 BEATS per minute. Chapter 35: Pediatric Emergencies - Page 768)

A nurse is providing teaching to a group of parents on how to protect children from accidental poisonings. Which statement made by a parent requires intervention by the nurse? "Our adolescent always ask us before taking any over-the-counter medication." "We have found walking sticks useful whenever we go on hikes." "Hot, soapy water is best for cleaning surfaces used for meat preparation." "My toddler helps out by bringing the gummy vitamins to me every morning."

"My toddler helps out by bringing the gummy vitamins to me every morning." (Explanation: The nurse will intervene if a parent states that the toddler is able to get to the vitamins on one's own. Medications, personal care products, and cleaning supplies should be kept locked away and out of sight of small children. Walking sticks can be used to scare snakes and other poisonous creatures away when hiking. Hot, soapy water should always be used to clean surfaces and utensils used for meat prep to avoid cross contamination. Preadolescents and adolescents should be taught about medication safety and to ask parents before using them. Chapter 35: Pediatric Emergencies - Page 781)

A 13-year-old adolescent has had a near-drowning experience. The nurse notices the client has labored breathing and a cough. What is the priority intervention? Have the client sit up straight in a chair. Administer 100% oxygen by mask. Perform postural drainage every hour. Check the client's capillary refill time.

Administer 100% oxygen by mask. (Explanation: Management of the near-drowning victim focuses on ASSESSING the client's airway, breathing, and circulation (ABCs) and CORRECTING HYPOXEMIA. Administering oxygen is the primary intervention to assist breathing. It is best to let the adolescent assume the most COMFORTABLE POSITION for him or her. Checking capillary refill time helps determine ineffective tissue perfusion, but it does not provide an intervention for the labored breathing. Postural drainage techniques to remove water from the lungs are of NO proven value in a near-drowning experience. Chapter 35: Pediatric Emergencies - Page 771)

The health care provider orders IV lactated Ringer's bolus of 200 ml over 20 minutes for a 2-year-old child with sepsis and a temperature of 38.8°C (101.9°F). The child weighs 13.5 kg. Which approach will the nurse use to administer this fluid bolus? Ask the health care provider to change the bolus time to 60 minutes. Insert an indwelling catheter prior to bolus initiation. Ensure the IV fluids are warmed prior to administration. Administer using a stop-cock and push/pull technique.

Administer using a stop-cock and push/pull technique. (Explanation: The nurse would administer the bolus using a STOP-COCK and PUSH/PULL technique to RAPIDLY administer a fluid bolus over 20 minutes. IV fluid boluses may be warmed OR cooled depending on the clinical situation; in a febrile child, the fluids would NOT be warmed because the goal is to reduce body temperature. Because correcting hypovolemia in sepsis is essential to maintaining perfusion, the bolus time would NOT be EXTENDED to 60 minutes. While inserting an indwelling catheter may be appropriate to assess fluid output, the first priority is the administration of the fluid bolus. Chapter 35: Pediatric Emergencies - Page 765)

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? Ask someone from pastoral care to take the parent to the waiting room. Allow the parent to stay in the room but remain at the parent's side for support. Tell the parent that family members are not allowed in the room during resuscitation. Gently take the parent by the hand and lead him or her from the room.

Allow the parent to stay in the room but remain at the parent's side for support. (Explanation: The best action for the nurse to take would be to allow the parent to remain in the room but the nurse (or another designated team member such as pastoral care) should stay with the parent to be a resource for questions and provide support. Research has shown that parents who are present during resuscitation of their child were able to cope better with the situation than parents who were not present during resuscitation. If the parent is refusing to leave the room, taking the parent by the hand to lead him or her from the room, asking pastoral care to take the parent to the waiting room or telling the parent that family is not allowed during a resuscitation will not be very effective. These options could cause the parent to become more upset and agitated. Chapter 35: Pediatric Emergencies - Page 768)

The nurse is preparing to assess a 13-year-old child in the emergency department with opioid toxicity. What will the nurse include in the assessment? Select all that apply. Monitor for bleeding. Monitor for bradycardia. Evaluate mental status. Assess for hypoglycemia. Assess for slowed respiratory rate and apnea.

Assess for slowed respiratory rate and apnea. Evaluate mental status. Monitor for bradycardia. (Explanation: The nurse assesses for slowed respiratory rate and apnea, evaluates the child's mental status, and monitors for bradycardia in a 13-year-old child with opioid toxicity. Monitoring for bleeding should be performed for SALICYLATE toxicity. Assessing for hypoglycemia should be performed for a child with toxicity with hypoglycemic agents. Chapter 35: Pediatric Emergencies - Page 778)

A toddler is brought to the emergency department after sustaining a life-threatening injury. During an assessment, the nurse utilizes the Glasgow Coma Scale. The toddler's score is 7. Based on this score, what inference can the nurse make about the child? The child's neurologic system is intact. It will be necessary to intubate the child. Naloxone administration will be required. The cardiovascular system is functioning normally.

It will be necessary to intubate the child. (Explanation: A Glasgow Coma Scale score LESS THAN 8 is an INDICATION TO INTUBATE during an emergent situation. Naloxone would be administered for bradypnea or apnea due to opioid toxicity. A Glasgow Coma Scale score of 7 does not indicate that the child's neurologic system is intact. The Glasgow Coma Scale does not assess cardiovascular functioning. Chapter 35: Pediatric Emergencies - Page 765)

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

Perform a jaw-thrust technique to assess the patency of the airway. (Explanation: 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. Chapter 35: Pediatric Emergencies - Page 764)

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. Tell the parent that the child's provider will address any concerns during the follow-up visit. Reassure the parent that the child's infection has been cured. Encourage the parent to discuss specific concerns about the child. Reinforce when the health care provider should be called. Review signs and symptoms of respiratory distress with the parent.

Reinforce when the health care provider should be called. Encourage the parent to discuss specific concerns about the child. Review signs and symptoms of respiratory distress with the parent. (Explanation: The most appropriate actions would be for the nurse to reinforce signs and symptoms of respiratory distress, and when the health care provider or 911 should be called. The nurse should also encourage the parent to share specific concerns about the child and address them at that moment INSTEAD OF DELAYING until the follow-up visit. Providing reassurance that the respiratory infection has been cured does NOT address the parent's expressed concerns. Chapter 35: Pediatric Emergencies - Page 768)

Temp 95.9 F HR 122 beats/min RR 24 breaths/min BP 81/42 mm Hg O2 Sat 89% The nurse assesses a 2-year-old child who is brought to the hospital emergency department after being submerged in a swimming pool for less than 5 minutes (above). The parents report that the child was not breathing when initially pulled from the pool, but resumed spontaneous respirations after rescue breathing. Which is the priority action for the nurse? Begin rewarming protocol. Apply oxygen via face mask. Start IV fluid resuscitation. Initiate positive-pressure ventilation.

Apply oxygen via face mask. (Explanation: This child is showing signs of hypoxia related to submersion injury, including decreased oxygen saturation. Because HYPOXIA is the UNDERLYING CAUSE of most submersion symptoms, the initial priority is to improve oxygen level. In this case, with SPONTANEOUS RESPIRATIONS present, administering oxygen via FACE MASK is the priority intervention. POSITIVE PRESSURE VENTILATION would be used if there was SUBOPTIMAL breathing. Rewarming and IV fluids are secondary priorities, AFTER initiating oxygen therapy. Chapter 35: Pediatric Emergencies - Page 771)

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 (Explanation: Urine output should be calculated using weight in kilograms. 25.46 kg x 1 ml/kg = 25.46 ml/hour. The child must produce 25 ml/hour Chapter 35: Pediatric Emergencies - Page 776-777)

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? "Your child is too young to receive IV fluids by that method." "Hanging an IV bag would cause the infusion to flow too quickly." "I need to administer small amounts of fluid as quickly as possible." "Children need much less fluid than adults."

"I need to administer small amounts of fluid as quickly as possible." (Explanation: CHILDREN who require FLUID RESUSCITATION should receive SEVERAL SMALL BOLUSES over SHORT PERIODS of time (20 ml/kg over 5 to 10 minutes). Infusing the fluid via GRAVITY would be too SLOW for RESUSCITATION purposes. Children are NOT too young to receive IV infusions via a more TRADITIONAL method. Children may need less fluid overall than adults but that is NOT the rationale FOR USING A SYRINGE for fluid resuscitation. Chapter 35: Pediatric Emergencies - Page 776-777)

A school nurse is a first responder to an emergency collapse of bleachers in the gymnasium. Upon arrival, the nurse finds a student lying on the floor beneath some debris and another student calling for help. What would the nurse's first action be? Triage the student calling for help for injuries. Assess the environment for safety hazards before approaching. Assess the student on the floor for responsiveness and breathing. Begin performing CPR on the student on the floor.

Assess the environment for safety hazards before approaching. (Explanation: The nurse's first priority in an emergency situation is to assess the scene for safety and hazards, in order to ensure the nurse's own safety while providing emergency care. Only after surveying the scene, the nurse would next assess the student on the floor and begin CPR if indicated, as well as assess the student calling for help. Chapter 35: Pediatric Emergencies - Page 763)

When the nurse is caring for a child presenting with a traumatic injury, which action is priority? Ensure the code cart is available Apply an oxygen saturation monitor Perform a primary assessment Notify the primary health care provider

Perform a primary assessment (Explanation: The nurse would perform a primary assessment. When assessing a child with a traumatic injury, airway (A), breathing (B), and circulation (C) 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 would NOTIFY the health care provider and APPLY monitors as needed. The nurse should ensure a code cart is available before the START of the shift. Chapter 35: Pediatric Emergencies - Page 763)

A 5 y/o female child is hospital day 4 after experiencing respiratory arrest secondary to pneumonia. The child's vital signs are currently within normal parameters. Lungs are clear bilaterally although an occasional cough productive for small amounts of clear mucus is present. The child has received IV antibiotics for 3 days and is currently on PO antibiotics and will be discharged with same. Child is scheduled for discharge home in the A.M. Parents are at the bedside and are expressing concern about the client's continued well-being. Based on the nurse's note (above), which is the nurse's most appropriate next step r/t the parents' concern? Explain that the child should finish the antibiotics as prescribed. Contact the child's health care provider to come and speak to the parents. Ask the parents what worries them most about their child's condition. Provide reassurance that the child's pneumonia has reso

Ask the parents what worries them most about their child's condition. (Explanation: The nurse's most appropriate next step is to address the parents' concern by asking them what worries them most about their child's condition. While it is appropriate to provide reassurance that the child's pneumonia is resolving, the nurse should find out what SPECIFICALLY concerns the parents. The nurse should address the parents' concerns directly BEFORE contacting the health care provider to come and speak to the parents. The importance of completing the course of antibiotics should be included in the discharge instructions, but the nurse's next step should be to address the parents' concerns. Chapter 35: Pediatric Emergencies - Page 768)

A 12-year-old child is hospitalized after a submersion injury. After being rescued, the child received cardiopulmonary resuscitation (CPR) for approximately 7 minutes before regaining consciousness and spontaneously breathing. In providing care for the child, which intervention will the nurse prioritize? Monitor lung function. Monitor temperature. Administer antibiotics. Administer IV fluids.

Monitor lung function. (Explanation: The nurse's priority is to monitor the child's lung function. Seventy percent of near-drowning survivors develop ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS). The nurse will need to monitor the child's temperature and administer antibiotics and IV fluids, but the priority intervention is to monitor the child's lung function. Chapter 35: Pediatric Emergencies - Page 771-772)

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?" "Would you like to see the chaplain?" "Can I get you something to eat?" "You would be more comfortable here in the lounge."

"How can I help you get through this?" (Explanation: The experience of an emergency situation and an unexpected death is very frightening to parents. The nurse plays a key role in providing empathy and support. Using open-ended questions elicits the parents' thoughts and fears and helps the nurse assess the issues at hand. Questions that can be answered with "yes" or "no" are less effective. The nurse should provide honest answers in a reassuring manner and never give false reassurances such as "It's going to be all right." That is something that cannot be promised. Parents should be encouraged to stay with the child until they are ready to leave. Moving them to the lounge may cause more emotional distress. Calling the chaplain is a good support for the family but only if the family wishes chaplaincy services. Eating would be the least thought for parents shortly after their child has died. The nurse offering this to the parents may be very uncomfortable in the situation and can only offer a tangible solution for an emotional problem. Chapter 35: Pediatric Emergencies - Page 766)

A pediatric nurse is conducting an education session for caregivers on poisoning prevention in children. Which statement by a parent indicates the need for further education on this topic? "I have saved the phone number for the Poison Control Center in my phone in case of emergencies." "I keep syrup of ipecac on hand to induce vomiting if my child ingests something toxic." "I keep all cleaning products in their original containers and store them in a locked cabinet out of my child's reach." "I always store my child's vitamins and over-the-counter medications in a high cabinet."

"I keep syrup of ipecac on hand to induce vomiting if my child ingests something toxic." (Explanation: The statement about keeping syrup of ipecac on hand indicates the need for further teaching, because there is NO evidence that syrup of ipecac is clinically effective in poisoning, and inducing vomiting may cause additional harm depending on the poison ingested. (Ipecac, or syrup of ipecac (SOI), is a medication once used to induce vomiting. Its medical use has virtually vanished, and it is no longer recommended for routine use in toxic ingestion.) The remaining statements about cleaning products, medication storage, and keeping the Poison Control Center phone number are all effective strategies to reduce the risk for poisoning in children. Chapter 35: Pediatric Emergencies - Page 781)

A nurse is providing care to a 10-year-old child hospitalized after a near-drowning incident. The child is awake and alert, and vital signs are within normal parameters. The child has a mild, productive cough and has been placed on supplemental oxygen via nasal cannula. The child's parent asks the nurse "Why does my child need to be hospitalized? My child seems ok." Which is the nurse's best response? "We need to monitor your child overnight to make sure your child is alright." "Your child's heart and lungs should be monitored for changes for 6 to 8 hours." "Do not worry, your child can come home tomorrow morning." "Even though your child is fine now, the condition could change later."

"Your child's heart and lungs should be monitored for changes for 6 to 8 hours." (Explanation: The nurse's best response is that the child's heart and lungs should be monitored for changes for 6 TO 8 HOURS. This answer provides the parent with a clear rationale for the hospitalization. Telling the parent that the child needs to be monitored overnight to make sure the child is alright and that the child's condition could change later is appropriate, but giving the parents a SPECIFIC reason for the hospitalization is the best option. Telling the parent not to worry and that the child can come home tomorrow does not answer the parent's question and provide information that cannot be verified at this time. Chapter 35: Pediatric Emergencies - Page 771)

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. The nurse receives prescriptions for the client. Click to highlight the prescription(s) that requires immediate implementation. Prescriptions: 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. Administer acetaminophen by mouth (PO) 325 mg q6h prn for fever. Initiate a regular diet as tolerated.

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. (Explanation: The nurse applies oxygen to maintain an oxygen saturation of 95% or greater. The nurse will need to monitor the child's airway closely because the burns are on the chest and neck. Partial-thickness (second-degree) burns are very painful. The nurse administers 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hours. Fluid resuscitation is implemented promptly to PREVENT SHOCK. Fluid resuscitation for children is determined using the Lund and Browder chart and Parkland formula. Because the child sustained burns to the neck and chest, the nurse would NOT administer anything by mouth including medications such as acetaminophen PO 325 mg q6h prn for fever or a regular diet as tolerated. Chapter 35: Pediatric Emergencies - Page 767-770)

A 6-year-old child is successfully resuscitated after a cardiac arrest and is being monitored in the intensive care unit. Which assessment finding will the nurse identify as a potential sign of systemic/ischemic reperfusion injury? resumption of urine output edema and hypotension increased oxygen saturation nausea and vomiting

edema and hypotension (Explanation: AFTER a CARDIAC ARREST, clients would be observed for signs of systemic/ischemic REPERFUSION INJURY, where INFLAMMATORY RESPONSES arise WITH the RESUMPTION OF PERFUSION. VASOPLEGIA may arise, with profound VASODILATION and LOSS OF SYSTEMIC VASCULAR RESISTANCE. This may present as EDEMA and HYPOTENSION, as intravascular fluid shifts to extravascular spaces. Nausea and vomiting are not common symptoms of reperfusion injury. Increased oxygen saturation and resumption of urine output are both positive signs in post-resuscitation care and are not associated with reperfusion injury. Chapter 35: Pediatric Emergencies - Page 766-767)

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

epinephrine (Explanation: Epinephrine REVERSES HISTAMINE release and HYPOTENSION due to anaphylaxis. It INCREASES the HEART RATE and SYSTEMIC VASCULAR RESISTANCE. DIPHENHYDRAMINE and CIMETIDINE are HISTAMINE BLOCKERS. They are used for MILDER forms of allergic reactions. ATROPINE is an ANTICHOLINERGIC. It causes TACHYCARDIA, INHIBITS SECRETIONS, and RELAXES SMOOTH MUSCLE. Chapter 35: Pediatric Emergencies - Page 766)

A nurse is teaching a group of parents about strategies to prevent drowning accidents in children. Which statement by a parent requires intervention by the nurse? "All children riding in boats should wear life jackets." "A 4-foot (1.25-meter) fence with a locking gate surrounds our pool." "We have a small wading pool that our toddler loves to play in." "Children who know how to swim should be supervised by an adult."

"We have a small wading pool that our toddler loves to play in." (Explanation: The nurse will intervene if a parent mentions having a wading pool that the toddler loves to play in. The nurse should DETERMINE whether the toddler is SUPERVISED when playing in the pool. EVEN if a child knows how to swim, he or she should STILL be supervised. A FENCE AT LEAST 4 FEET (1.25 meters) HIGH with a SELF-CLOSING or LOCKING gate should surround a pool on ALL sides. When riding in boats, children should wear life jackets or other personal flotation devices. Chapter 35: Pediatric Emergencies - Page 772)

Which treatment is the antidote for acetaminophen toxicity? activated charcoal naloxone acetylcysteine sodium bicarbonate

acetylcysteine (Explanation: ACETYLCYSTEINE is utilized for acetaminophen toxicity. SODIUM BICARBONATE is used for metabolic toxicity. NALOXONE is used for opioid overdose. ACTIVATED CHARCOAL is used for salicylate toxicity such as aspirin. Chapter 35: Pediatric Emergencies - Page 778)

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 30 ml 22 ml

30 ml (Explanation: 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. Chapter 35: Pediatric Emergencies - Page 776-777)

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 (Explanation: The nurse will multiply the client's weight in kilograms by the prescribed amount of fluid. 23.6 kg × 15 ml/kg = 354 ml Chapter 35: Pediatric Emergencies - Page 765)

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? The child's condition has deteriorated to terminal status. Resuscitative efforts have been successful in improving the child's condition. Additional measures are necessary to meet the child's metabolic requirements. Homeostatic mechanisms are working to maintain systemic perfusion.

Additional measures are necessary to meet the child's metabolic requirements. (Explanation: Decompensated shock indicates that the child is NO LONGER ABLE TO COMPENSATE for the body's DECREASED PERFUSION. Without appropriate intervention, HYPOTENSION and CARDIOVASCULAR COLLAPSE will occur. It does not indicate that resuscitative efforts have improved the child's condition or that the child's homeostatic mechanisms are working to maintain perfusion (compensated shock). Deterioration to terminal status indicates IRREVERSIBLE or REFRACTORY SHOCK. Chapter 35: Pediatric Emergencies - Page 775)

A 2-year-old child is brought to the emergency department by a parent who reports that the child has ingested some cleaning fluid. The child appears asymptomatic upon initial assessment. What would the nurse's initial action be for this child? Prepare for gastric lavage. Administer activated charcoal. Contact the poison control center for guidance. Obtain a baseline ECG.

Contact the poison control center for guidance. (Explanation: In suspected poisoning in children, the priority is to contact the poison control center to provide EXPERT GUIDANCE on appropriate treatment based on the substance ingested and the child's condition. Further treatment and assessments are guided by the poison control center. Interventions such as administering activating charcoal, performing an ECG, or doing a gastric lavage may be indicated BASED on the specific GUIDANCE. Chapter 35: Pediatric Emergencies - Page 779)

A nurse is providing care to a child hospitalized with a severe asthma exacerbation. The child had been showing signs of improvement but now seems excessively sleepy, has paradoxical breathing, and a respiratory rate of 9 breaths/min. Which action will the nurse take next? Ensure an open airway. Administer oxygen. Determine the underlying cause. Assess the heart rate.

Ensure an open airway. (Explanation: The nurse's next step is to ensure the child has an open airway. Once the airway is OPEN, OXYGEN can be administered (via bag/mask), and the HEART RATE assessed. AFTER airway, breathing, and circulation are attained, the nurse can determine the UNDERLYING CAUSE of the symptoms. Chapter 35: Pediatric Emergencies - Page 768)

A 12-year-old boy has broken his arm and is showing signs and symptoms of shock. Which action should the nurse take first? Provide oral analgesics as ordered. Draw blood for type and cross-match. Establish a suitable IV site. Begin hyperventilation.

Establish a suitable IV site. (Explanation: The GOAL of TREATING SHOCK is to RESTORE CIRCULATING BLOOD VOLUME. This requires that VASCULAR ACCESS be obtained to administer FLUIDS and VASOACTIVE drugs. HYPERVENTILATION is reserved for temporary treatment of severe intracranial pressure. ANALGESICS should not be administered prior to neurologic and cardiovascular examination being performed. CHELATION THERAPY is a treatment for metallic poisoning. Chapter 35: Pediatric Emergencies - Page 776-777)

A nurse has provided teaching on water safety to the parents of a child hospitalized after a near drowning. What action will the nurse take to evaluate the parents' learning? Ask the parents if they understand the information provided. Ask the parents if they plan to teach their child to swim. Provide an opportunity for the parents to ask questions. Have the parents verbalize ways they can reduce the child's risk of drowning.

Have the parents verbalize ways they can reduce the child's risk of drowning. (Explanation: The best way for the nurse to evaluate the parents' learning is to ask them to verbalize ways they can reduce their child's risk for drowning. Asking the parents if they understand the information will result in a yes/no answer and does not provide the nurse assurance that the parents understood the information. The nurse should provide an opportunity for the parents to ask questions, but it does not tell the nurse that the parents understood the information. The nurse could ask if the parents plan to teach the child to swim, but their answer will not indicate an understanding of the teaching. Chapter 35: Pediatric Emergencies - Page 772)

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

Monitor for ventricular arrhythmias. (Explanation: Once dobutamine has been administered, the nurse should monitor for the development of ventricular arrhythmias. Monitoring for shortness of breath, dyspnea, or worsening of asthma would be appropriate when administering ADENOSINE. Administering LIDOCAINE requires monitoring for hypotension and seizures. Administering FLUIDS is the priority intervention for ANY child in shock. Reference: Chapter 35: Pediatric Emergencies - Page 766)

A 3-year-old child has sustained injuries from a fall. Once the airway is secured, which of the following interventions would be done next? Administering 100% oxygen. Checking mouth for debris. Establishing antecubital IV access. Stabilizing the cervical spine.

Stabilizing the cervical spine. (Explanation: If head or spine injuries are suspected, then AFTER the AIRWAY is opened, the CERVICAL SPINE must be STABILIZED to prevent damage. Checking the mouth for debris is part of securing an airway. Administering oxygen and establishing IV access would be done AFTER the C-spine is stabilized. Chapter 35: Pediatric Emergencies - Page 764)

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 (Explanation: Although septic, cardiogenic, hypovolemic, and distributive shock can occur in children, hypovolemic shock is the most common type of shock that occurs in children. Chapter 35: Pediatric Emergencies - Page 773)