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?
A. Hypoglycemia
B. Severe anemia
C. Low pH level
D. Elevated serum bicarbonate Correct Answer C. Low pH
level
Which of the following pathologic processes would most
likely be attributed to a primary diagnosis of cystic
fibrosis?
A. Hypernatremia
B. Constipation
C. Obesity
D. Epiglottitis Correct Answer B. Constipation
Which of the following is the highest priority intervention
for a well-appearing 2-month-old with a fever?
A. Lumbar puncture
B. Urine culture
,C. Intravenous fluid bolus
D. Chest radiograph Correct Answer B. Urine culture
The caregivers of a 6-year-old report the child developed a
cough with nasal congestion and "pink-eye" that started
two days ago. Today they noticed a raised, red rash on
the face, and grey papules in the mouth. Which of the
following is the priority intervention for this patient?
A. Obtain a nasopharyngeal swab
B. Place in airborne isolation
C. Place in contact isolation
D. Obtain a fingerstick glucose Correct Answer C. Place in
contact isolation
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?
A. Lumbar spine magnetic resonance imaging
B. Complete neurologic exam
C. Urinalysis by straight catheterization
D. Cervical spine radiographs Correct Answer D. Cervical
spine radiographs
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?
A. Presence of ataxia
B. Pulsating, unilateral pain
C. Occurrence of photophobia
,D. Nausea, vomiting Correct Answer A. Presence of ataxia
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?
A. Medicate with ondansetron for emesis
B. Identify the type of formula the caregiver uses
C. Obtain a stool specimen for culture
D. Initiate intravenous access with 0.9% sodium chloride
Correct Answer B. Identify the type of formula the
caregiver uses
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?
A. EMLA (lidocaine 2.5% and prilocaine 2.5%)
B. LET (lidocaine/epinephrine/tetracaine)
C. LMX (lidocaine 4%)
D. Tetracaine 4% Correct Answer B. LET
(lidocaine/epinephrine/tetracaine)
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?
A. Osteomyelitis
B. Physical maltreatment
, C. Ehlers-Danlos syndrome
D. Osteogenesis imperfecta Correct Answer D.
Osteogenesis imperfecta
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?
A. Increased diastolic blood pressure
B. Bounding peripheral pulses
C. Prolonged capillary refill
D. Increased urine output Correct Answer A. Increased
diastolic blood pressure
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?
A. Chest pain with deep inspiration
B. Thoracic spine pain with palpation
C. Intermittent shortness of breath
D. Constant left shoulder pain Correct Answer D. Constant
left shoulder pain
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?
A. Empowerment, voice, and choice
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