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 - Answer
A 7-month-old presents to the emergency department with a complaint of
fever. Assessment reveals a patent airway and slight cyanosis around his
lips and nail beds. He is alert and interactive. His vital signs are 38.5 °C
(101.3 °F), HR 134, RR 32, BP 78/54 mm Hg, and SpO2 84%. The nurse
notes a healed surgical scar on his chest. Based on this assessment, what
is the nurse's priority?
A. Administer ibuprofen to treat the fever
B. Begin oxygen via a nonrebreather mask
C. Obtain a surgical history
D. Ask if the SpO2 is normal for him - Answer
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 - Answer
The pediatric prioritization process components include the focused
assessment, focused history, acuity rating decision and:
A. the pediatric assessment triangle (PAT).
B. developmental characteristics.
C. head-to-toe assessment.
D. life-saving interventions. - Answer
, A 2-year-old is brought to the emergency department by her father when
he found her face down in the pool. She remains unresponsive and is
breathing shallowly and slowly. Her color is pale. What is the priority?
A. Administer 100% oxygen
B. Immobilize the cervical spine
C. Begin bag-mask ventilation
D. Insert an oral airway - Answer
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 - Answer
The nurse is preparing to administer a feeding through a nasogastric
feeding tube. The tube position was verified by radiograph after insertion
2 hours ago. How will the nurse verify placement before feeding?
A. Instill air and listen over the epigastrium
B. Test the pH of the gastric contents
C. Observe color of a gastric aspirate sample.
D. Repeat the radiograph - Answer
What is the best method to rapidly administer a 20 mL/kg bolus of 0.9%
normal saline to a pediatric patient weighing 16 kg?
A. A 20-mL syringe with a stopcock
B. An infusion pump
C. A rapid infuser
D. A pressure bag - Answer
Immediately after intraosseous insertion the nurse assesses the infusion
and notes that the fluid is not dripping. How should the nurse respond?
A. Use an infusion pump to deliver the fluids
B. Remove the device and insert in another site
C. Advance the device and reassess the flow
D. Attempt to aspirate bone marrow - Answer
A 13-month-old presents to the emergency department with a 2-day
history of a low-grade fever, increased work of breathing, and tonight
developed a barking cough and inspiratory stridor. What condition does
the nurse suspect?
A. Epiglottitis
B. Foreign body aspiration
C. Tracheomalacia
D. Croup - Answer
In providing education to a family regarding obtaining baseline peak
airway flow for a child with asthma, the nurse will recommend what time
of day?
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