ULTIMATE ENPC
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an acetaminophen overdose?
A bolus infusion of 150 mg/kg NAC should be administered.
A 3-year-old has a two-day history of runny nose, low-grade fever, and a "barky" cough at night. The child is awake and alert with noted stridor. Pulse oximetry is 96% on room air. Which of the following interventions would be the most appropriated for this child?
Administration of nebulized epinephrine
An infant presents to the emergency department with difficulty breathing. The patient is pale and respirations appear rapid and shallow. Which location on the torso is the most effective site for assessing bilateral breath sounds?
Bilateral midaxillary
The nurse is triaging an infant brought to the emergency department by their caregiver. Which finding by the nurse leads the infant to be placed in isolation?
The presence of a purpuric rash necessitates the infant to be placed in isolation immediately as this is a symptom of possible meningitis.
Which of the following questions reflects the concept of the "teach-back" method?
"Would you repeat those instructions, so I can make sure I was clear?"
6P's Assessment for Musculoskeletal Trauma
(pg 283) Pallor : color different from uninjured Pain Pulselessness Parasthesia Paralysis Poikilothermia
PQRST for Pain
(pg86) Precipitating and palliating factors Quality Radiation Severity, symptoms, and site Time or triggering factors
A 6-year-old child weighing 20 kg (44.1 lb) arrives in full arrest following an electrocution event. CPR is in progress after defibrillation for ventricular fibrillation. What is the intravenous dose of epinephrine for this patient?
0.01 mg (wrong) Remediation feedback: The pediatric dose of intravenous epinephrine during a cardiac arrest is 0.01 mg/kg.
Normal Urine Output for child
1 to 2ml / Kg / Hr
Burn Transfer Criteria
1. Partial thickness >10% of BSA 2. Face, hands, feet, genetalia, perineum or major joints 3. Third degree burns in any age group. 4. Electrical burns, including lightning injury, and chemical burns. 5. Inhalation injury. 6. Burn injury in pt with preexisting medical disorders that could complicate tx. 7. Concomitant trauma (such as fx) in which the burn injury poses the greatest risk of morbidity or mortality. 8. Burned children in hospital wo qualified equipment or personnel to care for them 9. Pt who will require special social, emotional, or rehabilitative intervention.
Which of the following is considered a "red flag" when triaging a pediatric patient?
100.4°F
What age is the respiratory system considered fully developed?
8 years old
During a diaper change on a 4-month-old infant, the nurse measures the infant's urinary output. After subtracting the weight of a dry diaper, the wet diaper weighs 22 grams. What is the infant's estimated urinary output?
22 mL
A 12-year-old restrained, back -seat passenger involved in a motor vehicle crash is noted to have hypotension, tachycardia, and contusions and discoloration across the lap area. On exam a splenic rupture is suspected. Which of the following diagnoses should be suspected as a companion injury with these findings and associated mechanism of injury?
A chance fracture (fracture of the lumbar spine) is often associated with belted passengers. Injuries associated with the "seatbelt sign" are small bowel, abdominal vasculature, ureteral, and splenic and liver injuries.
The nurse is planning to begin oral rehydration therapy for a 9-month-old with mild dehydration. She provides the caregivers with a glucose and sodium solution and instructs them to administer small amounts: A. Every 2 to 5 minutes B. Every 10 to 12 minutes C. Every 15 minutes D. Every 30 minutes
A. 2-5
The triage nurse is assessing a 14 year old male who was brought in by ambulance. The patient reports he was playing his video games at home when he had a sudden onset of groin pain that was so severe he became nauseated and vomited. Further assessment reveals a swollen scrotum. What is the priority intervention for this patient?
Preparing the patient for ultrasound
A 15-year-old with a history of schizophrenia is taking risperidone (Risperdal) and lithium (Eskalith). She presents with dystonia, akinesia, a shuffling gait, muscle rigidity, and tremors. What does the nurse suspect is the cause of these signs and symptoms? A. Extrapyramidal symptoms B. Tardive dyskinesia C. Neuroleptic malignant syndrome D. Serotonin syndrome
A. Extrapyramidal symptoms
A preschooler has a small laceration that required 2 stitches. The nurse covers the wound with a bandage knowing that it will comfort the child to have it covered. What is the developmental reason for this intervention? A. Preschoolers are magical thinkers and imagine bandages keep their insides from coming out B. Preschoolers fear physical disability and believe a bandage will prevent disability C. Preschoolers explore orally and will likely chew or suck on the stitches if left uncovered D. Preschoolers are concerned with body image and don't want to appear different than peers
A. Magical thinkers
Testicular Torsion expected finding A. Normal Urinalysis B. Bilateral elevation of testicles C. Present Cremtaic reflex D.Something Stupide
A. Normal Urinalysis.
A 2-year-old has a suspected cervical spinal injury. In order to ensure neutral spinal alignment, padding should be placed under which area? A. Shoulders B. Head C. Neck D. Waist
A. Shoulders
A 5-year-old child presents with hives, swelling of the lips and face, and stridor that developed about an hour after eating lunch. The child has no known allergies. Which of the following is the priority intervention?
Administer intramuscular epinephrine
A 3-year-old is brought by caregivers with generalized tonic-clonic activity, unresponsiveness, and drooling that began 6 minutes prior to arrival. Which of the following interventions would be most appropriate for this event?
Administer intranasal midazolam
A term infant is delivered in the emergency department. Which assessment finding is most concerning?
Acrocyanosis (wrong) Remediation feedback: Normal findings for a newborn include a heart rate between 90-180 bpm, respiratory rate of 30-55 breaths/minute, and systolic blood pressure of 67-84 mm Hg. They may also exhibit acrocyanosis, particularly when in cool environments.
Which patient reflects an EMTALA compliant transfer?
An infant with respiratory difficulties being transferred to another hospital with the same level of pediatric care. Parents are not present, and records are copied. (wrong) Remediation feedback:
An anxious 12-year-old child presents to the emergency department with a sudden onset of nausea, diarrhea, abdominal cramping, flushing, and hypotension. Symptoms started about 60 minutes after lunch. Which of the following conditions is the most likely cause of these symptoms?
Anaphylaxis
Pediatric Assessment Triangle : (3) components
Appearance. Work of Breathing. Circulation to the skin. This forms the "general impression". If there is an acute disruption in 1 component, child is "sicker". If there is an acute disruption in 2+ components the child is "sickest"
A 10-year-old arrives at the ED post motor vehicle crash. The following assessment is noted: hypotension, tachycardia, absent breath sounds from the left chest with an increased respiratory rate, pain on palpation of the pelvis, tinge of blood noted at the urinary meatus, moderate active bleeding from a laceration to left thigh, pulse oximetry of 86% without supplemental oxygen, deformity to the left upper leg, and a Glasgow Coma Score of 7. Which of the following orders will prompt the nurse to have a discussion with the provider before initiating?
Assist with chest tube insertion (wrong) Remediation feedback: Urinary catheters are contraindicated for placement if pelvic injury is suspected or blood is noted at the urinary meatus. Scrotal or perineal discolorations with edema to the areas is also a contraindication for this adjunct.
Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? A. Peripheral pulses B. Blood pressure C. Capillary refill D. Level of consciousness
B. Blood Pressure
A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but all are incontinent and salivating, with excess tearing. Which of the following is the priority intervention?
Removal of clothing and decontamination
Which combination of medications is best to have prepared for a pediatric resuscitation? A. Dopamine and sodium bicarbonate. B. Epinephrine and glucose. C. Naloxone and lidocaine. D. Pentothal and vecuronium.
B. Epinephrine and glucose.
When taking vital signs on a stable infant, which of the following should be done first?
Respiratory rate
An 11-year-old presents to the emergency department with a complaint of hitting his head while playing soccer. The nurse enters the room and performs an across-the-room assessment. He is staring at the wall. He has no increased work of breathing, and his color is pink. Using the pediatric assessment triangle (PAT), what classification will the nurse assign? A. Well B. Sick C. Sicker D. Sickest
B. Sicker
An 8-month-old child presents with purpura, irritability, and a rectal temperature of 39.4�C (102.9�F). An intervention of high priority is: A. Encouraging the caregiver to hold and comfort the child. B. Monitoring for signs and symptoms of increased intracranial pressure (ICP). C. Collecting urine for toxicology screen. D. Encouraging oral fluids and food.
B. Monitoring for signs and symptoms of increased intracranial pressure (ICP).
A 16-month-old child was an unrestrained front seat passenger in a motor vehicle crash. The chest x-ray reveals multiple rib fractures. These findings suggest what type of injury? A. Minor surface injury. B. Significant underlying injury. C. Significant surface injury. D. Minor underlying injury.
B. Significant underlying injury.
The nurse is reevaluating the effectiveness of interventions for a 4-year-old child with a suspected tension pneumothorax. Which assessment finding indicates the interventions were effective?
Bilateral chest wall rise with assisted ventilations.
The best method to open the airway in an injured child is: A. Placing the head and neck in hyperextension. B. Using the jaw thrust maneuver. C. Placing the head and neck in flexion. D. Using the head tilt maneuver.
B. Using the jaw thrust maneuver.
Two ambulances collide in front of the hospital. The victims include three pediatric victims. Using the JumpSTART triage system, which category assignment will the nurse give to a 2-year-old who is lying on the ground, alert and crying with spontaneous respirations of 36 breaths/minute and present peripheral pulses? A. Green B. Yellow C. Red D. Black
B. Yellow
A 5-year-old arrives in the ED with a 4 day history of vomiting. Vital signs: HR 136 beats/minute, RR 36 breaths/minute, BP 92/56 mm Hg, T 38oC (100.4oF), and pulse oximetry 93% on room air. The child is pale with warm, dry skin and a capillary refill of 3 seconds. A fluid bolus is completed. Which of the following reassessment findings indicate that a second fluid bolus is necessary?
Blood pressure of 92/78 mm Hg
A 3-year-old is assessed for the presence of increasing amounts of serosanguineous drainage from his left nares over the past 6 hours. Which of the following foreign bodies is the most likely etiology?
Button battery
Which of the following screening statements/questions is most appropriate in assessing an adolescent for dating violence? A. "What triggers violence you've experienced from your partner?" B. "Does your partner feel entitled to sex even if you say 'no'?" C. "Tell me about a time when you've felt unsafe in your relationship." D. "Do you feel if you tried harder to please, your partner will not become violent?"
C. "Tell me about a time when you've felt unsafe in your relationship."
Which piece of information is most important to know prior to transferring a patient to another facility? A. Documentation of the family's health insurance coverage. B. Pertinent family health history. C. Confirmation of acceptance from the receiving hospital. D. Confirmation of a medical diagnosis.
C. Confirmation of acceptance from the receiving hospital.
A 10-year-old child who was struck by a car has a distended, tense abdomen. The child's heart rate is 144 beats/minute, respirations 24 breaths/minute, and blood pressure 120/80 mm Hg. Capillary refill is more than 3 seconds, and skin is pale and cool. The patient's signs and symptoms suggest: A. Obstructive shock. B. Distributive shock. C. Hypovolemic shock. D. Cardiogenic shock.
C. Hypovolemic shock.
A 3-year-old is transported by prehospital personnel after being struck by a car. The parents are en route. The child is screaming and uncooperative. Which is the best approach while conducting the secondary survey? A. Hold the child to comfort him. B. Wait for the parent's arrival. C. Observe for behavioral pain cues. D. Use a doll to demonstrate the examination.
C. Observe for behavioral pain cues.
A 2-year-old arrives with a 2-day history of vomiting and diarrhea. The patient has a fever of 38.4oC (101.2°F), resting HR of 152 beats/minute, RR of 34 breaths/minute, and blood pressure of 94/ 56 mm Hg. Assessment reveals a capillary refill time of > 5 seconds. Which of the following would be most indicative of the need for intravenous rehydration therapy for this patient?
Capillary refill
An 8-month-old infant with pneumonia has severe intercostal and substernal retractions, weak muscle tone, lethargy, and gray skin color. The infant's condition does not improve after bag-mask ventilation. The next step in treatment is most likely to be: A. Administration of epinephrine. B. Supplemental warming measures. C. Rapid sequence intubation. D. Administration of albuterol.
C. Rapid sequence intubation.
A 14-year-old patient with Down syndrome presents with an abnormal gait, head tilted to the left, decreased sensation to the extremities, and urinary incontinence. The patient has no history of trauma. Which of the following diagnostics is the priority for this patient?
Cervical spine radiographs
A 14-year-old patient had a reduction of a temporomandibular joint dislocation in the ED. Which of the following should be included in the discharge instructions?
Cold or warm, not hot, compresses are recommended along with nonsteroidal anti-inflammatory medications for pain control.
A 6-year-old involved in a boating crash is awaiting admission for surgical repair of a fractured ankle. Which of the following manifestations during reassessments would cause the greatest concern for possible intra-abdominal trauma?
Constant left shoulder pain
Which of the following pathologic processes would most likely be attributed to a primary diagnosis of cystic fibrosis?
Constipation
The Pediatric Assessment Triangle is used to: A. Identify all life-threatening conditions that the child presents with. B. Perform a complete head-to-toe assessment on the child. C. Assess the status of the child's airway only upon arrive in the ED. D. Determine the severity of the child's illness or injury using the "across-the-room" assessment.
D. Determine the severity of the child's illness or injury using the "across-the-room" assessment.
A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by: A. Placing them in a secluded room. B. Referring to their child as "the patient". C. Telling the family how they should feel. D. Appointing one staff member to communicate with them.
D. Appointing one staff member to communicate with them.
A 7-year-old female sustains a minor head injury and did not lose consciousness. She does not respond to commands and groans in response to questions. Which action will quickly determine if her behavior indicates a serious head injury? A. Review her medical record for pre-existing developmental problems. B. Obtain a head computerized tomography scan. C. Conduct a developmental screening test. D. Ask the parents if her behavior is unusual.
D. Ask the parents if her behavior is unusual.
Which intervention should be performed next if tactile stimulation, positioning, drying, and blow-by oxygen administration do not increase a newborn's heart rate? A. Chest compressions. B. Umbilical vein cannulation. C. Endotracheal intubation. D. Bag-mask ventilation.
D. Bag-mask ventilation.
Which of the following is a family-centered care concept ?
Cultural backgrounds are assessed and incorporated into the plan of care.
A 6- week-old infant is pale, has marked substernal retractions, expiratory grunting, and poor muscle tone. The emergency nurse should first: A. Obtain IV. B. Apply a pulse ox. C. Prepare a chest x-ray. D. Administer 100% oxygen.
D. Administer 100% oxygen.
What is the preferred sit for intraosseous access in the infant? A. Lateral malleolus B. Iliac crest C. Proximal femur D. Proximal tibia
D. Proximal tibia
Caregivers bring in their 3-week-old neonate and describe nonbilious vomiting after every feeding that is becoming more forceful over the past 24 hours. The last time he vomited the vomitus hit a chair 2 feet away. They say he cries, roots, and sucks vigorously on his pacifier right after vomiting as though still hungry. He is not experiencing any diarrhea. What condition is the most likely cause of these signs and symptoms? A. Intussusception B. Volvulus C. Gastroenteritis D. Pyloric stenosis
D. Pyloric Stenosis
A 10-kg child has deep partial-thickness burns over 35% of the total body surface area. Which evaluation parameter indicates that fluid resuscitation is adequate? A. Heart rate of 160 beats/minute. B. Respiratory rate of 34 breaths/minute. C. Blood pressure of 80/60 mm Hg. D. Urine output of 11 ml/hour.
D. Urine output of 11 ml/hour.
A 12-year-old female patient arrives awake and alert with an acute onset of abdominal pain on the right side, nausea, vomiting, and vaginal spotting. On palpation, the pain is localized to the right side and there is tenderness to the breasts. Which of the following laboratory tests is the priority for this patient?
Human chorionic gonadotropin
A child with an injury to the lower cervical spine with spinal cord involvment would most likely demonstrate which of the following findings during assessment?
Decreased respiratory effort
Neutropenic pt with a temperature
Don't take rectal temp. No invasive procedures if not necessary.
A 13-year -old male presents to the triage desk complaining of nausea and vomiting. The patient looks distressed and pale. He complains of spasming pain in his right scrotum which has now become constant and more severe. Which of the following assessment findings would the nurse expect with this patient?
Elevated right testicle
An 8-year-old pedestrian is thrown onto the hood of a moving vehicle striking the windshield. On arrival to the ED. the patient is minimally responsive with active bleeding from the nose and mouth. The patient is vomiting. Which of the following interventions would most likely be considered?
Endotracheal intubation
An 8-month-old arrives with a 12-hour history of intermittent abdominal pain, non-bilious vomiting, and a low grade fever. On assessment the child is intermittently inconsolable followed by periods of normal activity. A sausage-shaped mass is noted during palpation of the abdomen. The nurse should prepare for which of the following?
Enema with air
An 8-year-old male presents to the emergency department with incoherent speech, hallucinations, and violent behavior. What is the priority in caring for this patient?
Ensure safety of the patient and staff
You are discharging a patient home who has a history of depression. Discharge teaching should include which of the following?
Ensuring all firearms in the home are locked up with no access available by the patient.
Bradycardia pharm treatment
Epinephrine (1:10,000), 0.01mg/kg every 3-5min
A child in cardiopulmonary arrest is receiving chest compressions and manual ventilations with a bag-mask device. Once return of spontaneous circulation has been confirmed, which of the following would be the priority intervention?
Establishing a secure airway
A 6-week-old is brought to the emergency department by the caregivers for poor feeding, listlessness, and fever. Assessment reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal temperature of 96.0 F (35.5 C), and a bulging anterior fontanel. Capillary refill is 4 seconds. Based on these findings what is the most likely diagnostic test the nurse should anticipate?
Lumbar puncture
An adolescent is awaiting ICU admission for pneumonia. During reassessment, which of the following findings would be most indicative that respiratory failure is developing?
Extreme lethargy
Oral Rehydration for 9month old with mild dehydration.
Glucose and sodium solution, every 2 to 5min with 5 to 10ml
A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant and having vaginal bleeding. The patient is unsure of the gestational age and has not had any prenatal treatment. The patient is quiet and lets her boyfriend answer most of the questions. Which of the following is the most appropriate action for the nurse to take at this point?
Have the boyfriend leave the room during the pelvic exam.
A 5-year-old presents with decreased level of consciousness and a wide complex and rapid rate on the electrocardiogram. Which of the following characteristics would indicate ventricular tachycardia as opposed to other tachydysrhythmias?
Heart rate between 120 to 200 beats/minute
A 4-year-old presents with vomiting, lethargy, frequent urination, weight loss, and dry mucous membranes. Vital signs reveal deep respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR of 144 beats per minute. Which of the following laboratory values would be most expected in this child?
Hypoglycemia (wrong) Remediation feedback: Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting, abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss. Expected laboratory values would reveal an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an elevated blood glucose level > 200 mg.dL.
A six-week-old infant presents to the emergency department with seizures. The infant is afebrile with a normal glucose level ,and caregivers report no signs of illness other than formula intolerance, which they treated by adding extra water to the formula. The nurse would expect to find which of the following laboratory abnormalities?
Hyponatremia
Decompensated shock in children #1 sign
Hypotension
A 3-week old is brought to the emergency department with a history of fussiness, spitting up, crying, and watery stools. Assessment reveals an alert child with moist mucous membranes. Which of the following should be the priority?
Identify the type of formula the caregiver uses
A 5-year-old patient presents with severe dehydration and signs of shock due to viral gastroenteritis. Which of the following physiologic responses by this patient will have the greatest impact on improving their cardiac output?
Increased heart rate
A school-aged child arrives in the emergency department with a 2-day history of vomiting. The child is cool and pale, with weak pulses, elevated heart rate, and capillary refill of 4 to 5 seconds. Which of the following is the priority intervention for the child?
Initiate a fluid bolus
A child presents with a history of poor oral intake. The patient is pale, lethargic, and has shallow, rapid respirations. Central pulses are weak and capillary refill time is four seconds. Which of the following interventions has the highest priority?
Initiate an intravenous fluid bolus
Immediately following birth, a full-term neonate is not breathing and has a heart rate of 45 beats/minute. The neonate has been warmed, dried, stimulated, and suctioned without improvement. What the next step in resuscitation?
Initiate positive-pressure ventilation with 21% oxygen at 40-60 breaths per minute.
Which of the following is the recommended method of insulin administration for a pediatric patient with diabetic ketoacidosis?
Insulin infusion
A 5-year-old presents with sudden onset nausea, vomiting, abdominal cramping, hives, and hypotension after eating lunch. Which of the following is the priority intervention?
Intramuscular epinephrine
A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately. After several attempts, your team has been unsuccessful at establishing vascular access. Of the following, which is the next best option for establishing access quickly?
Intraosseous in the patient's medial tibia.
A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following intravenous medication orders should the nurse question?
Ketorolac Remediation feedback: Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-operatively due to its potential to increase the bleeding risk.
A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for topical anesthesia would be the best choice for this procedure?
LET (lidocaine/epinephrine/tetracaine)
TBI considerations
MD has to say when they can return, not the pt or caregiver. Should be a "gradual return to play"
A 12-year-old presents to the emergency department with a severe headache. The mother reports that the child has been experiencing headaches and has had multiple seizures for the past several months. The child was seen by their primary doctor and prescribed an anti-seizure medication, but the prescription was not filled because "the doctor just wants money." This is an example of what type of neglect?
Medical
Nonblanchable Rashes of concern
Meningocoxcemia Petiachia/Purpura
A child with an electrical injury is seen 1 hour post event. Which of the following types of specimen samples would provide visual information regarding a potential complication of this injury?
Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine.
A 4-week-old infant born prematurely is brought to the emergency department due to the rapid onset of abdominal distention, vomiting, bloody stools, and exhibiting signs of shock. Based on these findings, what condition should the nurse suspect?
Necrotizing enterocolitis
An 8-year-old trauma patient suddenly develops increased respiratory distress with a rise in heart rate from 112 beats/minute to 142 beats/minute associated with an abrupt hypotensive event. Distention of the jugular veins is noted. Which of the following emergent interventions should be anticipated first?
Needle decompression is emergently necessary to release the air and allow expansion of the lung again.
Minimal Acceptable BP's
Newborn = 60 Infant = 70 Child = 70 + (2 x age in yrs)
A parent presents to the emergency department carrying her 12-week-old infant. The PAT reveals an infant who is quiet and opens eyes with stimulation, whose breathing is regular and even, and whose skin is pale, with a scattered vesicular rash. What is the priority intervention for this infant?
Obtain a full set of vital signs (wrong) Place patient in isolation (correct) Remediation feedback: An abnormal PAT in the presence of a rash should be considered life-threatening until proven otherwise and the patient placed in isolation.
After an explosion at a school, you are helping triage patients. In your field triage room you find a 5-year-old patient who is not breathing. What is the appropriate initial intervention?
Open the airway and assess for breathing.
A 6-month-old arrives with swelling to the left thigh. Caregivers deny any traumatic event. Assessment findings include a patient who is active and alert, in the 10th percentile for length, and has blue-grey sclera. Radiographs reveal a midshaft fracture of the left femur. Which of the following is the most likely cause?
Osteogenesis imperfecta
Components in the prioritization of pediatric emergency care (4)
PAT, Focused Assessment (objective information), Focused pediatric Hx(subjective information), assignment of an acuity rating decision
A child with bipolar disorder is brought to the emergency department for increasing irritability, agitation, pressured speech, and a decreased need for sleep. What should be included in the plan of care for this child?
Performing a suicide risk assessment
EMS is transporting a 12-year-old restrained passenger involved in a high-speed motor vehicle collision. The patient complains of increasing dyspnea. Breath sounds are clear and equal, and heart sounds are difficult to auscultate. Vitals include HR 132 beats/minute, RR 36 breaths/minute, and BP 80/55 mm Hg. Which of the following is the priority intervention?
Pericardiocentesis
During the assessment of a 16-year-old patient, the ED nurse identifies them as a potential sex trafficking victim. Which of the following trauma-informed care principles has the highest priority for this patient?
Physical and psychological safety
Which of the following is the priority intervention for the nurse caring for an immunocompromised pediatric patient with a fever?
Placement in a negative pressure room
A 2-year-old arrives with parents stating the child may have ingested a button battery. The patient initially choked and coughed and is now drooling with bloody sputum. Which of the following is the priority intervention?
Prepare the patient for hospitalization
A child was found unresponsive under the monkey bars during recess and arrives with the following assessment: eyes open only with supraorbital pressure stimulus, no verbal response is elicited, and withdraws arms and legs when a swab is inserted in the nose. Which of the following is the priority intervention for this child?
Prepare for immediate intubation
During your primary assessment of a 3-year-old, the child is pale, with a respiratory rate of 70 breaths/minute, costal retractions, poor air movement, and a pulse oximetry reading of 89%. What is the priority intervention for this patient?
Prepare for intubation
A 3 year-old patient presents following frequent emesis and diarrhea over the past 12 hours. Which of the following assessment findings indicate that the patient' body is compensating for the fluid loss?
Prolonged capillary refill (wrong) Diastolic pressure will increase (correct) Remediation feedback: In the early compensated phase of shock attributed to fluid volume loss, the diastolic pressure will increase due to vasoconstriction (increasing systemic vascular resistance) as a compensatory mechanism causing a narrowed pulse pressure. A normal systolic pressure is maintained during this phase. Other manifestations of early shock states are tachycardia, normal capillary refill, decreased urine output, mild irritability, tachypnea, and weak peripheral pulses.
A pediatric resuscitation has ended with the death of the child. Coroner notification has not been made yet. In dealing with the family of this child, how can the nurse facilitate their grieving process until legally required notification has been made?
Provide simple, straightforward information
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive procedures appear to be distressed and withdrawn. Which of the following interventions would best ensure a sense of comfort and control for these parents?
Providing frequent updates and re-educating them on the care that is being provided
A 7-year-old is being seen for new onset of headaches. Which of the following manifestations would most likely rule out the potential of a primary etiology?
Pulsating, unilateral pain (wrong) Remediation feedback: Urinary catheters are contraindicated for placement if pelvic injury is suspected or blood is noted at the urinary meatus. Scrotal or perineal discolorations with edema to the areas is also a contraindication for this adjunct.
A neonate presents to the emergency department with irritability, weak cry, and hypotonia. Which of the following is a priority intervention?
Serum blood glucose
A caregiver presents to the emergency department with an 18-month-old and reports the child is not using their left arm after playing a game with an older sibling. The child is alert and curious, with regular, even respirations, and skin color is appropriate. Using the Pediatric Assessment Triangle (PAT), how would you categorize this patient?
Sick
A 12-year-old complains of a severe headache for the past 8 hours. Which of the following past history disease processes would be considered a "red flag" and warrant immediate evaluation for this patient?
Sickle cell disease
6week old infant, no medical hx. eating poorly, vomiting, "hard to wake up", responsive to pain. Anterior fontanel bulging, tachypnic. Diagnostic evaluation expected?
Skeletal survey Possible shaken baby syndrome
Which of the following is a first-line treatment for atopic dermatitis?
Skin hydration therapy
After a seizure at home, a 9-month-old infant is awake and interacting appropriately. Vital signs on arrival are HR 150 beats/minutes, RR 36 breaths/minute (unlabored), BP 80/52 mm Hg, SaO2 97% without supplemental oxygen, and T 102.7°F (39.3°C) rectally. During re-evaluation 2 hours after arrival, which of the following assessments would indicate appropriate measures were taken in treating this child?
Temperature 37.7°C (99.9°F)
An 18-month-old is seen for fever, slight circumoral cyanosis, and wheezing noted on auscultation in the right upper lobe of the lung field after a choking event 4 days ago. The white blood cell count is elevated and the patient noted to be tachypneic, tachycardic, agitated, and has an increased respiratory effort. At the time of the event, the patient was started on antibiotics with subsequent increasing manifestations instead of improvement. Which of the following would be considered to be definitive treatment for the suspected diagnosis?
The definitive treatment would be a bronchoscopy in order to retrieve the suspected foreign body instead of diagnostic tests to locate the foreign body itself.
A 2-year-old is seen with a 3-day history of irritability, vomiting, and the presence of foul-smelling urine. The child is hypotensive and tachycardic. Which of the following methods for obtaining a urine sample is most appropriate in this circumstance?
Urinary catherization
Which of the following is the highest priority intervention for a well-appearing 2-month-old with a fever?
Urine culture
A 10-year-old playing baseball is hit in the chest with a ball. He immediately demonstrates loss of consciousness with no pulses. Which of the following is the priority intervention?
Utilize AED/defibrillator
Which of the following physiological changes in an infant increase the chances of drowning?
Weak neck muscles
A caregiver states their 3-year-old child ate some marijuana gummies approximately 3 hours prior to arrival. The PAT reveals the child is pink, difficult to arouse, and work of breathing is normal. What is your initial intervention?
You should check blood sugar for any altered level of consciousness.
A parent brings in a 4-month-old infant reporting seizure-like activity at home. The parent denies a fever and reports that the infant is otherwise healthy. Which of the following is most important for the nurse to inquire about?
hyponatremia is the leading cause of new-onset non-febrile seizures. The most common contributing factor is over-dilution of infant formula.
Parents report their 3-year-old child has developed noisy breathing. On assessment, high-pitched wheezes are audible and auscultated on inspiration and expiration. What medication would be appropriate to administer first?
initial medication intervention includes an inhaled short-acting beta agonist.
Infants are obligate nose breathers. If nose is obstructed ___________
mouth then suction nose
