a 3 year old girl had a near drowning incident whe
when a poison has been ingested by a child the pa
assessment of a child reveals a tension pneumothor
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Pediatric Emergency Questions
When a poison has been ingested by a child, the parents should be instructed to do which of the following
first?
a) Induce vomiting.
b) Call the local poison control center.
c) Administer an emetic.
d) Get to an emergency facility. - ANS Call the local poison control center.
Correct
Explanation:
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 patient.
Assessment of a child reveals a tension pneumothorax. The nurse would prepare the child for which of the
following?
a) Needle thoracostomy
b) Suctioning
c) Intubation
d) Defibrillation - ANS Needle thoracostomy
Correct
Explanation:
A needle thoracostomy is indicated for tension pneumothorax to relieve the air collected in space. Intubation
is indicated for apnea and in situations in which the airway cannot be maintained. Suctioning would be
indicated for excessive airway secretions that influence airway patency. Defibrillation is used to stimulate or
alter the heart's electrical rhythm.
A 6-year-old girl who is being treated for shock is pulseless with an irregular heart rate of 32 BPM. Choose
the priority intervention:
a) Administer doses defibrillator shocks in a row
b) Initiate cardiac compressions
c) Give three doses of epinephrine
d) Defibrillate once followed by three cycles of cardiopulmonary resuscitation (CPR) - ANS Initiate cardiac
compressions
Correct
Explanation:
The American Heart Association (AHA) emphasizes the importance of cardiac compressions in pulseless
clients with arrhythmias, making this the priority intervention in this situation. Current AHA
recommendations are for defibrillation to be administered once followed by five cycles of CPR. The AHA now
recommends against using multiple doses of epinephrine because they have not been shown to be helpful
and may actually cause harm to the child.
A 3-year-old girl had a near-drowning incident when she fell into a wading pool. Which intervention would be
of the highest priority?
,a) Inserting a nasogastric tube to decompress stomach
b) Assuring the child stays still during an X-ray
c) Suctioning the upper airway to ensure airway patency
d) Covering the child with warming blankets - ANS Suctioning the upper airway to ensure airway patency
Correct
Explanation:
Due to the potentially devastating effects of drowning-related hypoxia on a child's brain, airway interventions
must be initiated immediately. The child's airway should be suctioned to ensure patency. Other interventions
such as covering the child with blankets, inserting a nasogastric tube, and assuring that the child remains
still during X-ray are interventions that are appropriate once airway patency is achieved and maintained.
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 which of
the following?
a) Underlying heart disease
b) Respiratory failure
c) Neurologic trauma
d) Lethal arrhythmia - ANS Respiratory failure
Correct
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.
A 13-year-old girl suffered a serious fall while hiking with friends and injured her head. She is now being
evaluated by a nurse in the emergency room. The nurse notices clear fluid flowing from the girl's nose. The
girl's friend said that she had been suffering from pollen allergy recently. Which of the following
interventions should the nurse implement to determine whether the fluid is cerebrospinal fluid (CSF) or
rhinitis from an allergy?
a) Evaluate the client's level of consciousness
b) Assess the client's blood pressure
c) Perform a skull x-ray
d) Test the fluid with a glucose reagent strip - ANS Test the fluid with a glucose reagent strip
Correct
Explanation:
Rhinorrhea or otorrhea (clear fluid draining from the nose or ear, respectively) may be noticeable. The fluid is
cerebrospinal fluid (CSF) and is a serious finding because it means that the child's central nervous system is
open to infection. If it's not clear if the fluid is CSF or rhinitis from an allergy, test the fluid with a glucose
reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory
tract infection or allergy will not. The other interventions would not help determine whether the fluid was CSF
or rhinitis.
Which medication is used for symptomatic bradycardia unresponsive to ventilation and oxygenation?
a) Atropine
b) Naloxone
c) Sodium bicarbonate
d) Calcium carbonate - ANS Atropine
Correct
, Explanation:
Atropine is used for symptomatic bradycardia unresponsive to ventilation and oxygenation. Sodium
bicarbonate is used for metabolic acidosis. Naloxone reverses the effect of opioids. Calcium carbonate is
used for documented or suspected hypocalcemia, hyperkalemia, hypermagnesemia, and calcium channel
blocker overdose.
The nurse must calculate the adolescent's cardiac output. The child's heart rate is 76 beats per minute and
the stroke volume is 75 mL. Calculate the child's cardiac output. - ANS 5700
Explanation:
Cardiac output (CO) is equal to heart rate (HR) times ventricular stroke volume (SV). That is, CO = HR x SV 76
beats per minute x 75 mL = 5,700
A 4-year-old girl has been admitted to the emergency department after accidentally ingesting a cleaning
product. Which of the following treatments is most likely appropriate in the immediate treatment of the girl's
poisoning?
a) Intravenous rehydration
b) Administration of activated charcoal
c) Gastric lavage
d) Inducing vomiting - ANS Administration of activated charcoal
Correct
Explanation:
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.
The child's ability to perfuse well is poor due to inadequate circulation. The physician writes an order for the
child to receive 20 mL of normal saline for each kilogram of body weight. The child will receive the normal
saline as a bolus through a central intravenous line. The child weighs 78 pounds. Calculate
the amount of normal saline the nurse should administer as a bolus. Round to the nearest whole number.
_____ mL - ANS 709
Explanation:
78 pounds x 1 kg/2.2 pounds = 35.455 kg x 20 mL/kg = 709.1 mL. When rounded to the nearest whole number
= 709 mL
A 16-year-old boy is brought to the emergency department with a head injury. The nurse knows that
adolescents are vulnerable to injuries related to which of the following?
a) Play-related injuries
b) Falls from beds
c) Automobile accidents
d) Falls from staircases - ANS Automobile accidents
Correct
Explanation:
Adolescents are prone to injuries related to activities that involve high risk, such as driving. Adolescents
tend to be impulsive and take unnecessary risks as a result of peer pressure. Falling from the bed is
common in infants. Play-related injuries are commonly seen in school-aged children, and falling from
staircases is a common injury among toddlers.
Administration of which medication reverses histamine release and hypotension that are seen in
anaphylaxis?
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