Peds: Shock & trauma, SIDS, Emergencies

The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate? a. Imminent respiratory failure b. Hypoxia c. Normal respiration d. Airway obstruction

ANS: C Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. A very slow respiration rate is an indicator of respiratory failure. Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. The child with an airway obstruction will use accessory muscles to breathe.

Sudden infant death syndrome is diagnosed A) when an autopsy reveals a brainstem defect. B) when an infant dies after being shaken violently. C) when an autopsy fails to find a cause of death. D) when an infant is found dead in their crib.

C

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

a) 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.

What is the goal of the initial intervention for a child in cardiopulmonary arrest? a. Establishing a patent airway b. Determining a pulse rate c. Removing clothing d. Reassuring the parents

ANS: A The first intervention for a child in cardiopulmonary arrest, as for an adult, is to establish a patent airway. Assessment of pulse follows establishment of a patent airway. Clothing may be removed from the upper body for chest compressions after a patent airway is established. Reassuring the parents is important, but the primary survey and associated interventions come first.

A nurse is working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What assessment takes priority? a. Assess airway patency. b. Obtain a health history. c. Obtain a full set of vital signs. d. Evaluate for pain.

ANS: A The primary assessment consists of assessing the child's airway, breathing, circulation, level of consciousness, and exposure (ABCDEs). Airway always comes first. History, vital signs, and pain assessment are all part of the secondary survey

A 5-year-old child is in cardiopulmonary arrest, and the nursing staff is performing CPR. One of the nurses is doing compressions at the rate of 90 per minute. What action by the charge nurse is best? a. Take over compressions. b. Tell the nurse to speed up. c. Tell the nurse to slow down. d. Have the nurse compress more deeply.

ANS: B The rate of compressions for a child is at least 100/minute. The charge nurse tells the compressing nurse to speed up. If the compressor is fatigued, someone should take over, but that is not indicated in the question. The depth of compressions is not the issue.

A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding? a. The child is relaxed. b. Respiratory failure is likely. c. This child is in respiratory distress. d. The child's condition is improving.

ANS: B Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern. A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring. A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child nor does it demonstrate improvement.

A child is brought to the emergency department after ingesting an acidic substance. What action by the nurse is best? a. Induce vomiting in the child. b. Give syrup of ipecac. c. Ensure a patent airway. d. Attach the child to a cardiac monitor.

ANS: C Ensuring a patent airway is always the priority. Since the child ingested an acid that causes corrosive damage, inducing vomiting (which is what syrup of ipecac does) is not advised. The child may need a cardiac monitor, but airway is the priority

A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first? a. Temperature b. Heart rate c. Respiratory rate d. Blood pressure

ANS: C When taking children's vital signs, the nurse observes the respiratory rate first. Temperature and blood pressure should be measured after respiratory and heart rate because it can be upsetting for children. Heart rate is measured after respiratory rate.

A mother calls the nurse and reports that her child has ingested a toxin. Which statement by the nurse explains why inducing vomiting is contraindicated? "Vomiting can increase the toxicity of the agent." "Vomiting may cause additional damage to the esophagus." "Vomiting can increase the absorption in the oral mucosa." "Vomiting may cause bowel rupture due to the increase in pressure."

"Vomiting may cause additional damage to the esophagus." As the ingested agents makes a second trip through the esophagus, it may cause additional damage or burning of the tissue.

The nurse is triaging patients after a mass casualty. Place the patients in the order in which they should be seen. Select all that apply. 9 year old with 74 mm Hg systolic BP 5 year old with 76 mm Hg systolic BP 8 year old with 84 mm Hg systolic BP 10 year old with 90 mm Hg systolic BP

9 year old with 74 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (9-year-old child: 70 + 18 = 88 mm Hg) Correct 5 year old with 76 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (5-year-old child: 70 + 10 = 80 mm Hg) Correct 8 year old with 84 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (8-year-old child: 70 + 16 = 86 mm Hg)

A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the emergency department. Which of the following would be most appropriate? A) Ventilating the child with a bag-valve-mask B) Estimating the child's weight using a Broselow tape C) Providing therapy using automated external defibrillation D) Using rescue breathing and chest compressions

A

Which of the following would the nurse do first for a 5-year-old girl with profound bradycardia? A) Provide oxygen at 100% B) Administer epinephrine as ordered C) Use warming blankets D) Perform gastric lavage

A

The parents bring their 3-year-old son to the emergency department after having found that he has ingested some of his mother's medicine. Which assessment would be of critical importance for this child? A) Assessing mental status and skin moisture and color B) Evaluating the effectiveness of the child's breathing C) Noting the child's pulse rate and quality D) Auscultating all lung fields for signs of edema

A (check this though) assess the mental status bc of LOC and loopy and sometimes they start turning pale bc of it. Some kids come in breathing perfectly fine

When assessing the risk of a newborn for sudden infant death syndrome (SIDS), which are risk factors that the nurse should consider? Select all that apply. A) Race B) Gender C) Father's age D) Age E) Eye color

A, B, D

A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify which of the following as a common cause involving the upper airway? Select all answers that apply. A) Croup B) Asthma C) Pertussis D) Epiglottitis E) Pneumothorax

A,D

A 9-year-old girl who has fallen from a second-story window is brought to the emergency department. Which assessment would be a priority? A) Evaluating pupils for equality and reactivity B) Monitoring oxygen saturation levels C) Asking the child if she knows where she is D) Using the appropriate pain assessment scale

B

A child is brought to the emergency department with a suspected poisoning. Which of the following would the nurse least likely expect to be used? A) Gastric lavage B) Syrup of ipecac C) Activated charcoal D) Whole bowel irrigation

B

The nurse is caring for a 7-year-old boy experiencing respiratory distress who is scheduled to have a chest radiograph. Which of the following would be most important for the nurse to include in the child's plan of care? A) Administering a sedative to help calm the child B) Assisting the child to lie still during the chest radiograph C) Accompanying the child to continue observation D) Informing the child that he might hear a loud banging noise

B

The nurse is evaluating care provided to a new mother whose infant is at risk for sudden infant death syndrome (SIDS). Which statement by the mother indicates teaching has been effective? A) "I need to purchase loose-fitting sheets and blankets for the bed." B) "I plan to quit smoking." C) "I will place my baby in a side-lying position for sleep." D) "I will bottle-feed my baby since breastfeeding is a risk factor for SIDS."

B

The nurse is caring for a child with a rapid breathing, headache, and the smell of wintergreen on the skin and clothes. Which additional signs and symptoms would the nurse assess for? Select all that apply. Bleeding Vomiting Confusion Diaphoresis Hyperglycemia Peripheral edema

Bleeding Wintergreen is a salicylate and is often used as a safe alternative to aspirin. The nurse would assess for bleeding and bruising related to the inhibition of prothrombin, decreased platelets levels, and capillary fragility. Correct Vomiting Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Oral poisoning typically manifests nausea and vomiting related to GI irritation. Correct Confusion Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Confusion, seizures, and coma are all related to the CNS effects of salicylate poisoning. Correct Diaphoresis Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Dehydration, sweating, and decreased urine production are typical in salicylate poisoning.

A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. The nurse documents this finding as which of the following? A) Hypoventilation B) Hyperventilation C) Periodic breathing D) Stridor

C

A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address which of the following as the most common cause of pediatric injury? A) Sports B) Firearm use C) Falls D) Automobile accidents

C

The nurse is instructing new parents on ways to decrease the risk of sudden infant death syndrome (SIDS) with their newborn son. What should be included in these instructions? Select all that apply. A) There is nothing that can be done, so requirements for toys and bedding are of no consequence. B) Instruct that it is more common in babies from ages 6 months to 18 months. C) Avoid placing the baby in the prone or side-lying position for sleep. D) Remind the parents that the syndrome is more comm

C, E

The nurse is caring for a pediatric patient admitted with severe nausea and vomiting for several days. Which finding will help the nurse quickly evaluate peripheral tissue perfusion? Oral temp 102.3 F Flat anterior fontanel Bowel sounds hyperactive Capillary refill greater than 5 seconds

Capillary refill greater than 5 seconds Capillary refill is the best assessment method to quickly assess tissue perfusion.

Which type of poisoning might the nurse expect for a 6-year-old who has presented with a cherry-red mucosa and a history of altered mental status after playing in the garage with the car running? Lead Corrosives Hydrocarbons Carbon monoxide

Carbon monoxide Carbon monoxide (CO) binds tightly to hemoglobin, preventing the binding of oxygen. The CO makes the hemoglobin appear bright red, causing the patient to look rosy-cheeked and to have cherry-red lips.

The nurse is caring for a patient hospitalized after a crushing chest injury, leading to development of blood surrounding the pericardium. The nurse notes tachycardia, tachypnea, muffled heart sounds, weakened peripheral pulses, and delayed capillary refill. Which form of shock is the patient likely experiencing? Septic shock Cardiogenic shock Distributive shock Hypovolemic shock

Cardiogenic shock Cardiogenic shock results when the patient's heart cannot pump effectively to meet the patient's metabolic needs. In the early stages of cardiogenic shock, the child is able to compensate with tachycardia, tachypnea, and vasoconstriction to maintain cardiac output.

The nurse is planning care for a new mother who smoked during the pregnancy and whose sister lost a child to sudden infant death syndrome (SIDS). Which interventions are appropriate for the nurse to include in the plan of care for the new mother and baby? Select all that apply. A) Information on bottle-feeding the infant B) Reasons why the child should sleep with others C) Ages at which the child should receive immunizations D) Using bedding that is firm E) Smoking cessation information

D, E

The nurse is caring for a 10-year-old child in hypovolemic shock after a liver laceration from a bicycle injury. The nurse notes delayed capillary refill, lethargy, BP 74/48, and SpO2 88%. Which orders are most important for the nurse to complete first? Select all that apply. Administer IV antibiotics Give IV normal saline bolus Provide oxygen via nasal cannula Refer parents to hospital chaplain Perform range-of-motion exercises

Give IV normal saline bolus The nurse should administer IV fluid to replace fluid volume loss. Provide oxygen via nasal cannula The nurse should provide supplemental oxygen to help maintain the patient's tissue perfusion. Refer parents to hospital chaplain Referring patients to the hospital chaplain can help provide the emotional support necessary to cope with the child's condition. Perform range-of-motion exercises Range-of-motion exercises can help maintain muscle function in patients who are hospitalized, but it is not a priority action.

A nurse has 25 years of experience working in the emergency department (ED) treating and managing pediatric patients. Treating which area of the pediatric patient should she have most experience? Arm Leg Head Wrist

Head The head makes up a large proportion of the child's body relative to the rest of the body. An experienced ED nurse should be used to treating head injuries because this area of the body is injured more than other areas.

A 2-year-old child comes to the emergency department with a substantial acetaminophen overdose. Which drug-specific medication should the nurse anticipate administering to this patient? Naloxone N-acetylcysteine Activated charcoal Diluted oil of wintergreen

N-acetylcysteine N-acetylcysteine is an antidote used for significant acetaminophen ingestion.

The nurse is caring for a child who has been struck by a car. The nurse notes a patent airway, labored breathing, and active bleeding from an open leg fracture. Which assessment should the nurse perform next? Neurologic assessment Auscultate bowel sounds Assess the cervical spine Head to toe skin assessment

Neurologic assessment After completing the primary survey, including the airway, breathing, and circulation, the nurse should assess the patient's neurologic status.

The nurse is caring for a patient in hypovolemic shock. The patient has a patent airway, unlabored breathing, and capillary refill less than 4 seconds. Which prescription should the nurse anticipate receiving first from the health care practitioner? Obtain vascular access Administer oral antibiotics Prepare patient for surgery Begin hemodynamic monitoring

Obtain vascular access Once the airway, breathing, and circulation are established, the next priority for the nurse is adequate vascular access.

the emergency department calls to discuss admission of a 4-month-old, former premature 37 week infant, who presents with an unprovoked episode of apnea, hypotonia, and decreased responsiveness. The episode is estimated to have lasted 35 seconds and resolved when the mother blew in the infant's face. The infant has a normal physical exam with a reassuring mental status, respiratory status, and hemodynamic status. Which of the following is recommended for this infant?

Offer resources about cardiopulmonary resuscitation training

A 5-year-old child presents to the emergency department and begins to exhibit neurological side effects after ingesting an unknown poison at home. Which action should the nurse take after assessing that the airway is stable? Gastric lavage Administer naloxone Initiate IV fluid resuscitation Prepare for seizure precautions

Prepare for seizure precautions Patients with neurological or metabolic side effects are prone to seizures and precautions are necessary.

A positive outcome for a child with multiple traumas depends mainly on which two factors? Rescue breathing and cardiopulmonary resuscitation (CPR) Family support and age of child Rapid assessment and intervention Administering antibiotics and hemodynamic monitoring

Rapid assessment and intervention A positive outcome for a child who has sustained multiple trauma depends on rapid assessment and intervention, which begin at the scene of the accident and continue through the trauma center emergency department, the critical care and acute care units, and the rehabilitation phase.

The nurse is caring for a 3 year old diagnosed with pneumonia one week previously. The parents report the child has become lethargic and appears to have more difficulty breathing. The nurse notes delayed capillary refill, tachycardia, and tachypnea. Which prescription should the nurse implement first? Supplemental oxygen Hemodynamic monitoring IV fluid bolus of normal saline Parenteral antibiotic therapy

Supplemental oxygen Supplemental oxygen should be initiated first for a patient with signs of shock, hypoxia, and poor tissue perfusion.

A mother brings in her 4-year-old child to the health care provider, stating that the child has marked constipation and describing the child as "sluggish." Which patient's social history is most significant? The family has recently moved into a historic house. The child has recently attended an outdoor day camp. The family has just returned from a vacation to the ocean. The child has recently started attending preschool at a newly built facility.

The family has recently moved into a historic house. A historic home may have lead paint and leaded glass which can lead to toxicity causing constipation. Exposure to lead can cause the symptoms described in this scenario.

A child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a small toy. You should: A. perform abdominal thrusts. B. visualize the child's airway. C. perform a blind finger sweep. D. give oxygen and transport at once.

a

Most pediatric arrests are related to what?

airway and breathing

A 4-year-old girl has been admitted to the emergency department after accidently ingesting a cleaning product. Which treatment is most likely appropriate in the immediate treatment of the girl's poisoning? a) Gastric lavage b) Administration of activated charcoal c) Inducing vomiting d) Intravenous rehydration

b) Administration of activated charcoal Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

Infants leading cause of death

suffocation

An emergency department nurse is making a general appearance assessment on a preschool child just admitted to the emergency department. Which general assessment findings indicate the child "looks bad"? (Select all that apply.) a. Color pale b. Capillary refill less than 2 seconds c. Unwilling to separate from parents d. Cold extremities e. Lethargic

ANS: A, D, E Signs of a child "looking bad" on a general appearance assessment include pale skin, cold extremities, and lethargy. A capillary refill of less than 2 seconds is a "good sign" as well as a child who is unwilling to separate from parents (separation anxiety, expected).

Which initial assessment made by the triage nurse suggests that a child requires immediate intervention? a. The child has thick yellow rhinorrhea. b. The child has a frequent nonproductive cough. c. The child's oxygen saturation is 95% by pulse oximeter. d. The child is grunting.

ANS: D One of the initial observations for triage is respiratory rate and effort. Grunting is a sign of hypoxemia and represents the body's attempt to improve oxygenation by generating positive end-expiratory pressure. Rhinorrhea, coughing, and a normal SaO2do not need immediate intervention.

The nurse is caring for a patient who has a penetrating chest wound. The patient is unresponsive, with labored breathing and delayed capillary refill. Which factor would the nurse consider during the initial assessment in addition to the patient's signs and symptoms? Name of the patient Mechanism of injury Time of day when injury occurred Geographic location when injury occurred

Mechanism of injury Nursing intervention depends on knowing the mechanism of injury, as well as the manifesting signs and symptoms.

A child is brought to the emergency department with a suspected poisoning. What treatment would the nurse least likely expect to be used? a) Activated charcoal b) Gastric lavage c) Syrup of ipecac d) Whole bowel irrigation

c) Syrup of ipecac Ipecac is rarely used in the health care setting to induce vomiting and is no longer recommended for use in the home setting. Gastric lavage, administration of activated charcoal (binds with the chemical substance in the bowel), or whole bowel irrigation with polyethylene glycol electrolyte solutions may be used.

A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in teaching parents about how to protect a toddler from accidental poisoning? a) Closely monitor the toddler's activity. b) Label poisonous solutions. c) Do not leave the toddler alone. d) Keep cleaning solutions locked up.

d) Keep cleaning solutions locked up. The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time.

A child has been brought to the emergency department with carbon monoxide poisoning. After the child is stabilized, what action by the nurse is best? a. Have all family members tested for carbon monoxide poisoning. b. Help family determine source of the carbon monoxide. c. Prepare to administer syrup of ipecac. d. Notify social services about the child's condition.

ANS: B After the child has been stabilized, the nurse should help the family brainstorm about the source of the carbon monoxide poisoning, which must be eliminated before the child goes home. The nurse may need to offer assistance to find companies that can help in this search or notify the local fire department for assistance. There is no indication that other family members need to be tested, but those who show signs of carbon monoxide poisoning should be. Syrup of ipecac is no longer used after an oral ingestion. Social services may or may not need to be notified.

What condition does the nurse recognize as an early sign of distributive shock? a. Hypotension b. Skin warm and flushed c. Oliguria d. Cold, clammy skin (septic shock)

ANS: B An early sign of distributive shock is extremities that are warm to the touch. The child with distributive shock may have hypothermia or hyperthermia. Hypotension is a late sign of all types of shock. Oliguria is a manifestation of hypovolemic shock. Cold, clammy skin is a late sign of septic shock, which is a type of distributive shock.

Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated? a. The parents are extremely calm in the emergency department. b. The injury is unusual for a child of that age. c. The child does not remember how he got hurt. d. The child was doing something unsafe when the injury occurred.

ANS: B An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment. The nurse should observe the parents' reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup. The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian. The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

A nurse is caring for a child diagnosed with septic shock. He develops a dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order? a. Atropine sulfate b. Epinephrine c. Sodium bicarbonate d. Inotropic agentsA nurse is caring for a child diagnosed with septic shock. He develops a dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The phys

ANS: B Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability. Atropine sulfate is used to treat symptomatic bradycardia. Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest. Inotropic agents are indicated for hypotension or poor peripheral circulation in a child.

Which nursing action facilitates care being provided to a child in an emergency situation? a. Encourage the family to remain in the waiting room. b. Include parents as partners in providing care for the child. c. Always reassure the child and family. d. Give explanations using professional terminology.

ANS: B Include parents as partners in the child's treatments. Parents may need direct guidance in concrete terms to help distract the child. Allowing the parents to remain with the child may help calm the child. Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. Professional terminology may not be understood. Speak to the child and family in language that they will understand.

What is the leading cause of unintentional death in children younger than 19 years of age in the United States? a. Drowning b. Airway obstruction c. Pedestrian injury d. Motor vehicle injuries

ANS: D The Centers for Disease Control and Prevention (CDC) has consistently found that motor vehicle injuries are the leading cause of unintentional death in children younger than 19 years of age in the United States. Drowning, airway obstruction, and pedestrian injury do cause death but not at the rate of motor vehicle crashes.

The nurse is providing parenting teaching regarding reducing the risk of sudden infant death syndrome (SIDS). Which teaching point is a priority for the nurse to include? A) Instruct on side-lying and face-down positions when in the crib. B) Instruct on face-up position when in the crib. C) Ensure adequate nutritional intake for the mother and newborn. D) Encourage good hand washing.

B

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? A) Septic B) Cardiogenic C) Hypovolemic D) Distributive

C

As part of their orientation to their pediatric clinical rotation, an instructor is teaching a group of students how to perform cardiopulmonary resuscitation (CPR) on a child. Two students return demonstrate the skill using an infant manikin. Which of the following indicates the proper technique? A) Compressing 30 times for every 2 breaths B) Placing the heel of the hand on the midsternum C) Giving 2 breaths followed by 15 compressions D) Using two hands to perform chest compressions

C

The pediatric nurse is providing education to a new mother regarding ways to decrease the risk of sudden infant death syndrome (SIDS). Which statement by the nurse is appropriate? A) "You should keep the baby with you at all times to assess for apnea." B) "Make sure the baby has a soft blanket and pillow when sleeping." C) "It is recommended that you place your baby on his back for sleep." D) "SIDS has been linked to immunizations. I recommend that you avoid immunizing your baby."

C

When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action? A) Assisting ventilation with a bag-valve-mask (BVM) device B) Treating ventricular fibrillation using a defibrillator C) Managing compensated shock to prevent decompensated shock D) Treating supraventricular tachycardia using cardioversion

C

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. What should the caregivers be instructed to do? Select all that apply. a) Check the pupil reaction to light every 15 minutes for two hours. b) Observe and report any vomiting that occurs within six hours. c) Administer acetaminophen for headache. d) Observe for and report to provider any double or blurred vision

b) Observe and report any vomiting that occurs within six hours. d) Observe for and report to provider any double or blurred vision. e) Wake the child every one to two hours to check level of consciousness. The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The child's pupils are checked for reaction to light every four hours for 48 hours.

The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? a) Diseases b) Unintentional injuries, MVA, blunt trauma c) Drowning d) Poisoning

b) Unintentional injuries Unintentional injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2008). Injuries kill more adolescents than all diseases combined, with 46% of injury-related deaths due to motor vehicle accidents (U.S. Department of Health and Human Services, 2007). Unintentional injury accounts for about 48% of adolescent injury deaths, violence and homicide for 15.2%, and suicide for 11.8% of adolescent injury deaths (U.S. Department of Health and Human Services, 2007). Males are more likely than females to die of any type of injury.

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. What should the caregivers be instructed to do? Select all that apply. a) Check the pupil reaction to light every 15 minutes for two hours. b) Observe and report any vomiting that occurs within six hours. c) Administer acetaminophen for headache. d) Observe for and report to provider any double or blurred vision.

bde

A child accidentally aspirated lighter fluid after playing with a lighter. Which roles does the nurse have in managing this patient? Select all that apply. The nurse will administer IV fluids. The nurse will utilize measures to prevent emesis. The nurse will administer oxygen and support ventilation. The nurse will administer chelators and anti-coagulant medications. The nurse will monitor vital signs and observe for signs of CNS depression.

The nurse will administer IV fluids. Administration of IV fluids supports circulatory function and prevents dehydration. Correct The nurse will utilize measures to prevent emesis. Prevention of emesis will decrease the likelihood of additional aspiration of the low-density hydrocarbons. Correct The nurse will administer oxygen and support ventilation. Administration of oxygen and support of ventilation are essential due to potential damage to the lungs. The nurse will monitor vital signs and observe for signs of CNS depression. Vital signs and changes in CNS function are critical. This should be assessed regularly.

A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. The nurse documents this finding as which of the following? A) Hypoventilation B) Hyperventilation C) Periodic breathing D) Stridor

c

The nurse is teaching a first-time mother with a 14-month-old boy about child safety. Which is the most effective overall safety information to provide guidance for the mother? a) "Never let him out of your sight when outdoors." b) "Don't smoke in the house or car." c) "Put chemicals in a locked cabinet." d) "Place a gate at the top of each stairway."

a) "Never let him out of your sight when outdoors." Because they are curious and mobile, toddlers require direct observation and cannot be trusted to be left alone, especially when outdoors. The priority guidance is to never let the child be out of sight. Gating stairways, locking up chemicals, and not smoking around the child are excellent, but specific, safety interventions.

A 14-year-old girl arrives at the hospital in a comatose state. Her father, who found her comatose in her room, tells you that she has an opiate addiction. Which of the following would confirm that the coma was caused by opiate intoxication? a) One pupil dilated and the other normal b) Both pupils are dilated c) Both pupils are pinpoints d) One pupil dilated and the other deviated downward

c) Both pupils are pinpoints Observe the child's eyes for signs of dilated pupils from increased ICP. If both pupils are dilated, irreversible brainstem damage is suggested, although such a finding may also be present with poisoning with an atropine-like drug. Pinpoint pupils suggest barbiturate or opiate intoxication. One pupil dilated or the eye deviated downward or laterally more than the other suggests third cranial nerve compression or a tentorial tear (laceration of the membrane between the cerebellum and cerebrum) with herniation of the temporal lobe into the torn membrane.

The nurse is caring for a 2-year-old who has been rushed to the clinic immediately after swallowing an unknown number of acetaminophen tablets. Which of the following is the priority intervention? a) Administer N-acetylcysteine. b) Start IV fluid replacement. c) Perform a gastric lavage. d) Initiate chelation therapy.

c) Perform a gastric lavage. If the child ingested the pills within the last 60 minutes, a gastric lavage and administration of activated charcoal would be the preferred treatment. If the acetaminophen is in the bloodstream, N-acetylcysteine may be administered. Chelation therapy is meant for metal poisoning. IV fluid replacement is used to treat hypovolemic shock.

The parents bring their 3-year-old son to the emergency department after he ingested some of his mother's medicine. Which assessment would be of critical importance for this child? a) Evaluating the effectiveness of the child's breathing b) Noting the child's pulse rate and quality c) Auscultating all lung fields for signs of edema d) Assessing mental status and skin moisture and color

d) Assessing mental status and skin moisture and color In cases of poisoning, clinical manifestations vary widely depending on the medication or chemical ingested. Therefore, it is important to pay particular attention to the child's mental status, skin moisture and color, and bowel sounds. Evaluating the effectiveness of the child's breathing and noting the child's pulse rate and quality are basic to any rapid cardiopulmonary assessment. Auscultating all lung fields for signs of pulmonary edema would be critically important for a child who is a near-drowning victim.

The nurse is caring for an infant brought in with a high fever, cough, labored breathing, and tachypnea. Which general appearance finding would be most concerning for the nurse? Diarrhea Poor feeding Weak, continuous cry Skin is cool and mottled

Skin is cool and mottled Cool, mottled skin is a sign of poor tissue perfusion and can indicate shock in an infant with labored breathing and tachypnea.

A 6-year-old child comes to the emergency department and presents with respiratory distress from gasoline skin exposure. Which action should the nurse take if the child becomes unconscious? Administer naloxone Administer activated charcoal Assess and support CNS function Assess and support cardiorespiratory function

Assess and support cardiorespiratory function If the child loses consciousness, assessment of the cardiorespiratory functions is necessary. If deficits are noted, provide proper support.

The nurse is caring for a 7-year-old patient who reports sustaining a leg injury while falling down the stairs three days ago. The nurse notes abrasions to the left elbow and a right tibia fracture. Which indicator may raise the suspicion of child maltreatment? Patient has abrasion on his elbow Delay in seeking treatment for the trauma Patient has never broken his tibia previously The patient was alone when the injury occurred

Delay in seeking treatment for the trauma Delay in seeking treatment for the trauma is an important indicator that might raise the suspicion of child maltreatment in the emergency setting.

Which clinical manifestations are likely to develop in a 3-year-old child after initial stabilization for bleach ingestion? Select all that apply. Development of metabolic acidosis Development of esophageal strictures Development of liver necrosis and jaundice Development of hypokalemia and dehydration Development of organ perforation and vascular complications

Development of esophageal strictures As the damaged esophagus begins to heal, the child may have continued difficulty swallowing due to the development of strictures. Development of organ perforation and vascular complications When a child has a severe burn, the damage can lead to eventual perforation of an organ. This can lead to vascular collapse and shock.

A nurse is teaching a group of parents about assessing the ABCDE's in children with toxic exposure. Which two assessment components should the nurse discuss in addition to the traditional ABC's of CPR? Select all that apply. Diuresis Disability Exposure Exudates Diaphoresis

Disability Seizure precautions should be implemented in poison exposures with neurological or metabolic side effects. The child's mental status should be assessed frequently. Exposure Treating toxic exposures and ingestions may include removal of dermal and ocular toxins, dilution of the toxin, administration of activated charcoal, and administration of an antidote. Gastric lavages are no longer recommended.

The nurse is caring for a child who is obtunded after being struck in the head by a baseball during a game. Which artificial airway should be used to maintain airway patency? Bag, valve, mask Oropharyngeal airway Endotracheal intubation Nasopharyngeal airway

Endotracheal intubation Endotracheal intubation is a single type of artificial airway that would suffice for an unconscious child or a child who has altered mental status.

Which finding will the nurse expect to see in a 5-year-old child whom the mother suspects to have ingested the acetaminophen 3 hours ago? Jaundice Malaise, pallor, weakness Right upper quadrant (RUQ) pain Recovery from physical symptoms

Malaise, pallor, weakness During the first 24 hours, the nurse would expect to see malaise, nausea, vomiting, sweating, pallor, and weakness.

In order to terminate ocular exposure, which interventions should the nurse provide to a patient who has experienced exposure to a powdered poison? Select all that apply. Administer a chelating agent Remove contaminated clothing Irrigate the eyes with warm water or saline Induce vomiting to reduce absorbed poison levels Eliminate powder from skin and clothing; wash skin

Remove contaminated clothing Remove any contaminated clothes; residual powder could endanger the child and health care workers. Irrigate the eyes with warm water or saline Irrigation of the eyes with water or normal saline is crucial for terminating ocular exposure of any poison. Eliminate powder from skin and clothing; wash skin Brush off chemical powders from the skin, and wash the skin. Residual powdered poison is dangerous for both the child and health care workers.

The nurse is examining a 10-month-old girl who has fallen from the back porch. Which assessment will directly follow evaluation of the "ABCs?" a) Palpating the abdomen for soreness b) Palpating the anterior fontanel c) Auscultating for bowel sounds d) Observing skin color and perfusion

b) Palpating the anterior fontanel Once the ABCs have been evaluated, the nurse will move on to "D" and assess for disability by palpating the anterior fontanel for signs of increased intracranial pressure. Observing skin color and perfusion is part of evaluating circulation. Palpating the abdomen for soreness and auscultating for bowel sounds would be part of the full-body examination that follows assessing for disability.

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mcg/dL. Which action would the nurse expect to happen next? a) Repeat testing within 1 week with education to decrease lead exposure. b) Prepare to admit child to begin chelation therapy. c) Confirm with repeat testing in 1 month and referral to local health department. d) Repeat testing within 2 days and prepare to begin chelation therapy as ordered.

d) Repeat testing within 2 days and prepare to begin chelation therapy as ordered. The recommendation for blood lead levels of 45 to 69 mcg/dL is to confirm the level with a repeat laboratory test within 2 days and educate the parents to decreased lead exposure. She should also expect to begin chelation therapy as ordered and refer the case to the local health department for investigation of home lead reduction with referrals for support services. Repeat testing in 1 week with parent education is appropriate for lead levels between 20 and 44 mcg/dL. Repeat testing in 1 month and education would be appropriate for levels between 15 and 19 mcg/dL. Preparing to admit the child to begin chelation therapy immediately would be appropriate for lead levels greater than 70 mcg/dL

Young children leading cause of death

drowning, MVA, Blunt trauma

After the patient's respiratory status is stable, which action is appropriate for the nurse to perform on an unresponsive, nonverbal trauma patient? Ensure Foley catheter is patent Ensure chest tube placement secure Maintain IV fluids at maintenance therapy Ensure cervical spine protection until definitive diagnosis is made

Ensure cervical spine protection until definitive diagnosis is made All unresponsive and nonverbal trauma patients should have cervical spine protection until definitive diagnosis can be made.

The nurse is caring for an infant with vomiting and diarrhea for the past week. The nurse notes a depressed anterior fontanel, decreased urine output, and lack of tears. Which prescription should the nurse complete first? Initiate oxygen Give an IV fluid bolus Administer oral antiemetic Apply barrier cream to the buttocks

Give an IV fluid bolus The patient's symptoms are indicative of hypovolemic shock. IV fluid resuscitation is the most important action.

The nurse is receiving a pediatric patient in shock who was just involved in an accident and has lost a large amount of blood. The patient should be assessed for which type of shock first? Septic shock Distributive shock Cardiogenic shock Hypovolemic shock

Hypovolemic shock This patient should be first assessed for hypovolemic shock because this is characterized by an overall decrease in circulating blood or fluid volume.

The nurse is caring for a child who is unresponsive after being struck by a vehicle. The child sustained multiple injuries and was diagnosed with cardiogenic shock. The child's parents are tearful and refuse to speak with the provider about the child's prognosis. Which action would the nurse take to enhance family coping? Select all that apply. Ask the parents to refrain from staying at the child's bedside Provide concise, accurate information to the parents at frequent intervals Give infor

Provide concise, accurate information to the parents at frequent intervals The nurse's action of providing concise, accurate information to parents at frequent intervals enhances family coping. Correct Give information in a calm, relaxed, and empathetic manner The nurse's action of giving information in a calm, relaxed, and empathetic manner enhances family coping. Correct Encourage parents to participate in the child's care as appropriate The nurse's action of encouraging parents to participate in the child's care as appropriate provides them with some degree of control. Correct Provide simple explanations to the child and parents of procedures before initiating them The nurse's action of providing simple explanations to the child and parents before initiating them enhances family coping.

The nurse is caring for a child who presents with blunt force trauma to the head and face, which the parents say was sustained during a fall. The nurse also notes the child is lethargic and confused and has bruises on the legs, arms, and abdomen in multiple stages of healing. Which area of body will be of most concern to the nurse? Kidneys and renal system Lungs and respiratory system The cervical spine and neurologic system Heart and cardiovascular system

The cervical spine and neurologic system The nurse should verify the stability of the cervical spine for a patient with blunt force trauma to the head and face.

what is the most common neurological injury and caused of death resulting from child abuse

shaken baby syndrome

A nurse is preparing to educate a group of parents on sudden infant death syndrome (SIDS). Which intervention is appropriate to decrease an infant's risk for SIDS? A) Using firm bedding B) Ensuring the room temperature is at least 80°F at all times C) Recommending bed sharing D) Placing the infant in a prone position for sleeping

A

The nurse is placing a newborn baby in the nursery crib with the baby's back down. The mother tells the nurse that she doubts the baby will be able to sleep that way, as all the family members sleep on their stomachs. Which action by the nurse is appropriate? A) Instruct the mother that placing the baby on the back will reduce the risk of sudden infant death syndrome (SIDS) and it will not interfere with sleep. B) Place the baby on the stomach. C) Suggest the mother place the baby on the stomach

A

The nurse is planning care for a baby born to a mother who smoked during the pregnancy. The mother states that she believes in bed sharing. Which nursing diagnosis would be appropriate for this baby? A) Risk for Sudden Infant Death Syndrome (SIDS) B) Readiness for Enhanced Parenting C) Anxiety D) Deficient Knowledge

A

The nurse is providing care to a child experiencing shock. Which of the following intravenous solutions would the nurse expect to administer? A) Ringer lactate B) Dextrose 5% and water C) Dextrose 5% and normal saline D) Dextrose 10% and water

A

The student nurse attends a workshop on culture and diversity with regard to sudden infant death syndrome (SIDS) and is now aware that the rate of occurrence is highest among which group of infants? A) American Indians B) Caucasians C) Asians D) Hispanics

A

A nurse is preparing to educate a group of parents on sudden infant death syndrome (SIDS). Which variables should the nurse highlight as contributing to increased risk of SIDS? Select all that apply. A) Prone sleeping B) Side sleeping C) Loose bedding D) Bed sharing E) Supine sleeping

A, B, C, D

The nurse is planning care for the parents of an infant who died as the result of sudden infant death syndrome. Which collaborative interventions does the nurse plan for when providing care to these parents? Select all that apply. A) A psychosocial assessment B) A grief counselor referral C) A psychotherapist referral D) A visit from the chaplain E) A respiratory therapist referral

A, B, C, D

A child has a tracheal tube in place and will be receiving medications via this tube. Which of the following medications would the nurse expect to be administered in this manner? Select all answers that apply. A) Lidocaine B) Adenosine C) Atropine D) Dopamine E) Epinephrine F) Naloxone

A,C,E,F

A 2-year-old child is in the playroom. The nurse observes him picking up a small toy and putting it in his mouth. The child begins to choke. He is unable to speak. Which intervention is appropriate? a. Heimlich maneuver b. Abdominal thrusts c. Five back blows d. Five chest thrusts

ANS: A To clear a foreign body from the airway, the American Heart Association recommends the Heimlich maneuver for a conscious child older than 1 year of age. Abdominal thrusts are indicated when the child is unconscious. Back blows are indicated for an infant with an obstructed airway. Chest thrusts follow back blows for the infant with an obstructed airway.

Which is the most critical element of pediatric emergency care? a. Airway management b. Prevention of neurologic impairment c. Maintaining adequate circulation d. Supporting the child's family

ANS: A Airway management is the most critical element in pediatric emergency care. The other elements are important, but airway is always the priority.

What should be the emergency department nurse's next action when a 6-year-old child has a systolic blood pressure of 58 mm Hg? a. Alert the physician about the systolic blood pressure. b. Comfort the child and assess respiratory rate. c. Assess the child's responsiveness to the environment. d. Alert the physician that the child may need intravenous fluids.

ANS: A Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the child's age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the child's condition to the physician. Comforting the child and assessing respiratory rate are not priorities. Assessing the child's responsiveness is included in a neurologic assessment. It does not address the systolic blood pressure of 58 mm Hg. Although this child most likely requires intravenous fluids, the physician must be apprised of the systolic blood pressure so that appropriate intervention can be initiated.

What may cause hypovolemic shock in children? (Select all that apply.) a. Hyperthermia b. Burns c. Vomiting or diarrhea d. Hemorrhage e. Skin abscesses

ANS: A, B, C, D Hypovolemic shock is due to decreased circulating volume and can be caused by fluid loss due to hyperthermia, burns, vomiting or diarrhea, and hemorrhage. An abscess will not cause hypovolemia.

The nurse is preparing the plan of care for a child experiencing respiratory distress. Which of the following would be the priority? A) Providing supplemental oxygen B) Monitoring for changes in status C) Assisting ventilation D) Maintaining a patent airway

D

The nurse is providing supportive care for the parents of an infant who died from sudden infant death syndrome (SIDS). Which action by the nurse is appropriate? A) Advising the parents that an autopsy is not necessary B) Refraining from recommending support groups until after the investigation C) Interviewing the parents to determine the cause of the SIDS incident D) Contacting the family's spiritual leader for support

D

A patient comes to the emergency department and is being treated for distributive shock. Which patient presentation corresponds to this diagnosis? Select all that apply. A patient suffering from profuse diarrhea Inability of a patient to maintain vascular tone A patient with septic shock who has a bacterial infection A patient with an overall decrease in circulating blood volume A patient with myocardial fluid accumulation causing insufficiency in meeting the body's demands

Inability of a patient to maintain vascular tone This patient scenario corresponds to a patient diagnosed with distributive shock, and therefore the nurse should recognize septic shock as a form for distributive shock. A patient with septic shock who has a bacterial infection This patient scenario corresponds to a patient diagnosed with distributive shock, and therefore the nurse should recognize septic shock as a form of distributive shock.

Which of these age groups has the highest actual rate of death from drowning? a) Infants b) Toddlers c) School-age children d) Preschool children

b) Toddlers Toddlers and older adolescents have the highest actual rate of death from drowning.