An unresponsive 2-year-old child was found by his mother with a bottle labeled “Elavil 50 mg” by his side. Which piece of information is important to obtain from his mother?
A. The size of the medication bottle.
B. The expiration date of the medication.
C. The number of pills left in the bottle.
D. The person for whom the medication was prescribe.
C. The number of pills left in the bottle.
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 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.
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 school-aged child is about to receive stitches. To evaluate his understanding of the procedure, you tell him:
A. “Young people your age have questions about getting stitches. What are your questions?”
B. “Don’t cry while you are getting the stitches. Be brave like a man.”
C. “You will probably receive 10 stitches. Do you have any questions before we restrain you?”
D. “Does your cut hurt? Would you like your mommy to hold you?”
A. “Young people your age have questions about getting stitches. What are your questions?”
What is the preferred sit for intraosseous access in the infant?
A. Lateral malleolus
B. Iliac crest
C. Proximal femur
D. Anteromedial tibia
D. Anteromedial tibia
An important consideration in the assessment of pain for an adolescent patient is that they:
A. May deny or minimize their pain when friends visit for fear of losing control.
B. Have difficulty localizing or describing the pain.
C. Are unable to use the 1 to 10 scale to report their pain.
D. Feel that the pain is a punishment for something they did wrong.
A. May deny or minimize their pain when friends visit for fear of losing control.
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.
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.
A 20-day-old infant has a 1-week history of not eating well. The infant has a weak cry and is jittery. Which laboratory test is indicated?
A. Arterial blood gas.
B. Finger-stick glucose.
C. Complete blood count with differential.
D. Toxicology screen.
B. Finger-stick glucose.
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.
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 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.
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).
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.
The caregivers of a 6-year-old boy who is brought to the emergency department for abdominal pain should first be asked:
A. “Are his immunizations current?”
B. “Has anything happened to him at school recently?”
C. “What is the reason for the child’s visit and how long has he been ill?”
D. “Has he been complaining of a sore throat or earache?”
C. “What is the reason for the child’s visit and how long has he been ill?”
A 9-month-old infant is crying loudly through the nursing assessment, and the caregiver is becoming distraught. The nurse should ask the caregiver to:
A. Read a story to the infant.
B. Offer the infant a pacifier.
C. Return when the infant is consoled.
D. Ignore the infant’s behavior.
B. Offer the infant a pacifier.
During an intubation attempt, the child�s heart rate drops to 40 beats/minute. Which intervention is indicated?
A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation.
B. Apply cricoid pressure and establish intravenous access.
C. Inform the physician of the heart rate and ask the physician to intubate faster.
D. Administer blow-by oxygen and begin chest compressions.
A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation.
A 6- week-old infant is pale, has marked substernal retractions, expiratory grunting, and poor muscle tone. The emergency nurse should first:
A. Obtain intravenous access.
B. Apply a pulse oximeter.
C. Prepare a chest x-ray.
D. Administer 100% oxygen.
D. Administer 100% oxygen.
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.
A 4-year-old child with a history of the flu has a heart rate of 80 beats/minute, respirations of 16 breaths/minute, and capillary refill of more than 3 seconds. The proper sequence for nursing interventions would be:
A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution.
B. Administer 100% oxygen, obtain venous access, administer 0.
1 mg/kg of epinephrine 1:10,000, and prepare for endotracheal intubation.
C. Position the airway, provide bag-mask ventilation, provide synchronized cardioversion, and provide supplemental warmth.
D. Administer 100% oxygen, prepare for a venous cutdown, administer 20 ml/kg of an isotonic solution, and obtain a chest x-ray.
A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution.
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.
Which ocular finding is associated with child maltreatment?
A. Glaucoma.
B. Conjunctivitis.
C. Iritis.
D. Retinal hemorrhage.
D. Retinal hemorrhage.
A pregnant 18-year-old woman arrives at the emergency department about ready to deliver a full-term infant. She states that she noticed a large amount of dark green fluid the last time she went to the bathroom. During the delivery, the nurse should prepare to:
A. Dry and arm the infant as soon as is it delivered.
B. Stimulate and ventilate the infant immediately after delivery.
C. Suction the mouth and nose of the infant while on the perineum.
D. Administer blow-by oxygen and rub the back immediately after delivery.
C. Suction the mouth and nose of the infant while on the perineum.
Which of the following would be an abnormal finding in a patient with glomerulonephritis?
Clear urine There is a decrease in urine output for patient’s with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored.
Clear urine There is a decrease in urine output for patient’s with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored.
Administration of nebulized epinephrine Moderate to severe croup is treated with dexamethasone and nebulized epinephrine.
The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak English and has identified their religion as Muslim. Which of the following interventions is most supportive of the family?
Allow the extended to family members to serve as interpreters during the procedure.
Which of the following patient presentations should increase suspicion of potential child maltreatment?
Bruising to the left ear of a newborn from sleeping on his side Any bruise in a non-exploratory location in children younger than 4 years and any bruising in a child younger than 4 months (TEN-4) are cause for suspicion of abuse
Bruising to the left ear of a newborn from sleeping on his side Any bruise in a non-exploratory location in children younger than 4 years and any bruising in a child younger than 4 months (TEN-4) are cause for suspicion of abuse
Commotio cordis Commotio cordis occurs when the chest is struck during the refractory period of the cardiac conduction cycle, resulting in a ventricular dysrhythmia or asystole. This type of injury usually occurs in recreational sports such as baseball or ice hockey
A 12-year-old who was recently started on anti-psychotic medication for schizophrenia is brought to the emergency department with severe muscle rigidity and hyperthermia. These symptoms are most likely caused by which of the following?
Neuroleptic malignant syndrome These are classic symptoms of neuroleptic malignant syndrome, which is a rare reaction to antipsychotic medications.
Which of the following patients should be evaluated first
An 18-month-old with bilious emesis Bilious emesis in an 18-month-old is always considered an emergent symptom indicative of a life-threatening bowel obstruction.
- Which of the following tasks can the nurse do to decrease adverse medication events?
Obtain the patient’s weight in kilograms This is the preferred measurement for medication calculations for pediatric and adult patients
Acute chest syndrome, stroke, and splenic sequestration are complications of which of the following diseases?
Sickle cell anemia These are all complications of sickle cell anemia.
During the assessment of a 16-year-old male patient, the ED nurse identifies him as a potential sex trafficking victim. The trauma informed approach to care emphasizes certain principles in caring for these types of patients. Which of the following care principles has the highest priority?
Physical and psychological safety Create an environment where patients feel safe, both physically and psychologically. Increase awareness of the patient’s interpersonal interactions with others to screen for risk of harm. Prioritize the patient being in a safe location
A 6-month-old is brought to the emergency department for a recurrent respiratory infection. When gathering a history from the caregiver, the emergency nurse learns that, in addition to the respiratory symptoms, the infant has had fatty stools. The emergency nurse should be concerned about which of the following disease processes?
Cystic Fibrosis Pancreatic insufficiency leads to fat malabsorption, which results in the fatty stools seen with cystic fibrosis.
The emergency nurse is caring for a patient with significant facial trauma and a suspected globe rupture. Which of the following medication orders would the nurse question?
Succinylcholine Succinylcholine may increase intraocular pressure and should be avoided.
A 7-year-old arrives via ambulance. The patient’s mother reports witnessing a seizure at home. The patient has no seizure history. Upon examination, the patient is post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and blood pressure of 86/72 mm Hg. Significant burns are noted to the patient’s back and lower extremities. The mother states the burns accidentally occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child welfare investigation. Which of the following are the MOST appropriate immediate interventions?
Draw and send a metabolic panel, administer a fluid bolus, and obtain a point of care glucose Significant burns can cause electrolyte imbalances. Electrolyte imbalances may be the cause of the patient’s seizure. Electrolyte imbalances need to be identified and treated.
In which of the following primary survey components can assessment of the fontanel provide the most useful information?
Circulation and disability A sunken fontanel may indicate dehydration; a bulging fontanel can indicate increased intracranial pressure.
A 5-year-old patient presents to the emergency department with severe dehydration due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of the following physiologic responses to shock has the greatest impact on improving cardiac output in the pediatric patient?
Increasing heart rate In pediatric patients, tachycardia is the primary compensatory mechanism to increase cardiac output.
A toddler has a chemical eye injury. Which of the following is the priority intervention?
Increasing heart rate In pediatric patients, tachycardia is the primary compensatory mechanism to increase cardiac output.
A 5 year-old with no health problems presents to the Emergency Department with a sudden onset of chest pain and shortness of breath. Parents state that the family was involved in a bad car crash one week ago. A thorough assessment and workup has not revealed any abnormalities. Which of the following steps is the best next step to take?
Ask about any new bed-wetting or sleep disturbances Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other behavioral symptoms to facilitate appropriate care and follow-up.
Which of the following is the most appropriate intervention for a child experiencing a seizure?
Prepare to administer intranasal midazolam Midazolam has gained favor because of its ease of use and quick onset of action.
An ambulance arrives with a 16-year-old male involved in a dirt bike crash who was intubated prior to arrival. Which of the following is the priority assessment or intervention?
Assess the endotracheal tube placement and patency If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place, assess its placement, tube patency, and the oral airway (in that order) before moving to the next step of the primary survey.
A three-year-old is rescued after being submerged in a residential pool for several minutes. On arrival at the Emergency Department he is responsive to painful stimuli, has shallow respirations with diminished breath sounds throughout, and has an occasional cough. What is the initial management priority?
Endotracheal intubation with positive pressure ventilation Airway control and positive pressure ventilation are the priority interventions for this patient.
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 doing which of the following?
Appointing one staff member to communicate with them. This will help create a solid patient-staff bond and facilitate communication.
You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following?
Ensuring all firearms in the home are locked in a safe place with no access by the patient. Promote injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and medications are under lock to prevent overdoses or suicide attempt.
A 3-year-old is injured in a motor vehicle collision. Upon arrival at the emergency department, the child has a diminished level of consciousness, equal bilateral breath sounds, and cool, pale skin. Vital signs are HR 140 beats/minute, RR 36 breaths/minute, and BP 70/40 mm Hg. The child is most likely in which of the following shock states?
Hypovolemic shock The mechanism and presentation lead to a suspicion of blood loss.
Which of the following is the priority intervention for a pediatric patient with diabetic ketoacidosis?
Insulin infusion A continuous infusion of insulin at 0.05-0.1 unit/kg/hr should be used to decrease blood glucose.
Which of the following describes a neonate’s normal position?
Flexion with extremities close to the body A neonate’s normal position is flexion with extremities close to the body.
The emergency nurse is caring for a 14-year-old patient who sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain interventions is most likely to result in improvement in symptoms?
Application of a splint to the affected extremity Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures.
The type of vascular access is appropriate in all of the patient situations given EXCEPT for which of the following?
Peripherally inserted central catheter line for one time fluid bolus This vascular access is most appropriate for long term medication administration and multiple blood draws.
A 5-year-old child presents to the emergency department after being hit by a car. She complains of left upper quadrant pain and the focused assessment with sonography for trauma (FAST) exam shows fluid around her spleen. Which of the following findings would be an early indication of ongoing blood loss?
Widening pulse pressure Narrowing pulse pressure and increasing heart rate are early indications of ongoing blood loss.
A 15-year-old patient has attempted suicide by overdosing on amitriptyline. The emergency nurse should expect which of the following symptoms?
Dysrhythmias QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose.
The parents of a 5-year-old child arrive at the emergency department. The child’s lips and face are swollen with hives on the face. The parents report the child ate peanut butter crackers in the last hour. The child has no known allergies. The nurse recognizes the findings are associated with:
Food allergy This a clinical manifestation seen in food allergies.
Which of the following statements demonstrates a nurse’s understanding of pediatric submersion injuries?
The best indicator of survival after submersion is the duration of time of submersion The duration of submersion is the best predictor of survival after drowning. In general, shorter times correlate to better outcomes.
A 2-month-old infant is brought to the emergency department. The mother states he has had trouble breathing for the past two days. The PAT reveals an age-appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted to both nares. Which of the following is the best next step?
Suction the nares with a bulb syringe Infants are preferential nose breathers and can have respiratory distress when the nares are occluded. Suctioning the nares is the priority intervention to open the airway.
During the tertiary survey, the emergency nurse should continue to conduct reevaluations of the Pediatric Assessment Triangle (PAT), abnormal findings, and which of the following other assessment components?
Primary survey, vital signs, pain management, and effectiveness of therapeutic interventions The additional components of the reevaluation in the tertiary survey include the primary survey, vital signs, pain management, and effectiveness of therapeutic interventions.
Which of the following interventions would the nurse anticipate for a pediatric patient with a fever and a history of a hematologic or oncologic condition?
Intravenous antibiotics This patient population is at risk for life-threatening sepsis, and treatment with intravenous antibiotics is indicated.
Prioritizing pediatric patients presenting with fever is often difficult. Which of the following patients is at greatest risk of serious illness?
A 7-year old boy with a history of sickle cell anemia and an oral temperature of 38.3°C (101°F) Children with chronic illnesses such as sickle cell disease are at greatest risk for life-threatening fever-related illnesses.
Which of the following indicates the need for additional parent/guardian education regarding a UTI?
My child will grow out of their frequent urinary tract infections UTIs are not a normal occurrence in children and may require additional investigation and follow up.
A 4-day-old who is brought to the emergency department with the parental complaint of “not acting right” is found to be hypoglycemic. The appropriate glucose concentration to administer to this neonate is which of the following?
D10 D10 is the preferred concentration for neonates to protect their fragile vasculature.
Which of the following actions by the nurse promotes pediatric patient safety?
Preparing medications in a distraction-free area To decrease errors, the nurse should be focused and systematic in verifying patient identification, medication order, route, time, and dose.
A 16-year-old trauma patient is noted to have external rotation and shortening of the left lower extremity and pain with palpation of the pelvis after being ejected from a motorcycle. Which of the following assessment findings is most concerning for a potentially life-threatening condition?
Bony crepitus and instability with gentle anteroposterior compression of the iliac crests Bony crepitus and instability to palpation of the pelvis are common findings in patients with unstable pelvic fractures. Unstable pelvic fractures may be associated with injury to major blood vessels and contribute to hypovolemic shock.
A 10-year-old patient was recently diagnosed with Marfan syndrome. The emergency nurse understands that this patient may be at risk for developing which of the following conditions?
Aortic Aneurism Cardiovascular defects associated with Marfan syndrome are mitral valve prolapse, heart failure, and aortic dissection/aneurysm.
A 2-month-old child with intermittent irritability, poor feeding and apneic episodes has a heart rate of 188 and an irregular respiratory rate. After three 0.9% sodium chloride fluid boluses at 20 ml/kg each with only minimal clinical improvement, what treatment should the emergency nurse anticipate next?
Start a vasopressor infusion A child in septic shock who is not responding to fluid resuscitation likely needs vasopressors to compensate for the vasodilation caused by the septic shock state.
Spinal shock results in which of the following transient conditions?
Pain at the site of injury and hyperesthesia above the level of the injury Spinal cord shock results in pain at the site of injury and hyperesthesia above the level of the injury.
A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following?
Sex Trafficking Red flags for sex trafficking include multiple bruises, unwanted or unintended pregnancy and being withdrawn or anxious in the presence of the caregiver.
All of the vaccine administrations listed are appropriate EXCEPT for which of the following?
Fifth Disease at 6 months There is an animal vaccine but not a human vaccine for fifth disease.
Which of the following statements indicates the caregiver understands your discharge teaching on influenza?
My child can go to daycare since they have been off of Tylenol and fever free for 24 hours. Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to go back to daycare or school.
A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but are all incontinent and salivating with excess tearing. Which of the followiing is the priority intervention?
Removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water.
A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% of the child’s total body surface area. The father states he briefly left the room while the child was in the bath and the child apparently played with the faucet. Which of the following interventions has the highest priority?
Obtain vascular access for analgesic and fluid administration Rapid vascular access and fluid administration are the priority interventions.
Which of the following findings would be most concerning for a secondary headache?
Pain with flexion of the neck Nuchal rigidity is associated with meningeal irritation and meningitis, which would be considered a more serious secondary headache condition.
A 6 year-old child presents to the emergency department with caregivers who report a cough with nasal congestion and “pink-eye” that started 2 days ago. They have been treating with an over-the-counter medicine without relief. Today they noticed a raised red rash on the face and papules in the mouth. You suspect which of the following?
Rubeola Rubeola presents with a cough, nasal inflammation (coryza), and non-purulent conjunctivitis. A rash begins as erythematous macules and papules on the hairline and face that spreads downward.
According to the American Academy of Pedatrics guidelines, which of the following describes how a neonate riding in a car should be positioned?
Rear facing in a convertible car seat until at least the age of 2
A 5 year-old with no health problems presents to the Emergency Department with a sudden onset of chest pain and shortness of breath. Parents state that the family was involved in a bad car crash one week ago. A thorough assessment and workup has not revealed any abnormalities. Which of the following steps is the best next step to take?
Ask about any new bed-wetting or sleep disturbances
Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other behavioral symptoms to facilitate appropriate care and follow-up.
You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following?
Ensuring all firearms in the home are locked in a safe place with no access by the patient.
Promoting injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and medications are under lock to prevent overdoses or suicide attempt.
A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% of the childs total body surface area. The father states he briefly left the room while the child was in the bath and the child apparently played with the faucet. Which of the following interventions has the highest priority?
Obtain vascular access for rapid fluid administration
Rapid vascular access and fluid administration are the priority interventions.
A 7-year-old arrives via ambulance. The patient’s mother reports witnessing a seizure at home. The patient has no seizure history. Upon examination, the patient is post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and blood pressure of 86/72 mm Hg. Significant burns are noted to the patient’s back and lower extremities. The mother states the burns accidentally occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child welfare investigation. Which of the following are the MOST appropriate immediate interventions?
Draw and send a metabolic panel and venous blood gas, administer a fluid bolus, and obtain a point of care glucose
Electrolyte imbalances need to be identified and treated to prevent another seizure.
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
ventilation to address hypoxia is the priority intervention.
A 14-year-old high school student who was pitching for his baseball team was hit in the chest by the ball and had a sudden cardiac arrest. Of the following, which is the most likely cause of the cardiac arrest?
Commotio cordis
Comotio Cordis “occurs when chest is struck during the refractory period of the cardiac conduction cycle. This type of injury usually occurs in recreational sports such as baseball or ice hockey.”
A 5-year-old child presents to the emergency department after being hit by a car. She complains of left upper quadrant pain and the focused assessment with sonography for trauma (FAST) exam shows fluid around her spleen. Which of the following findings would be an early indication of ongoing blood loss?
Focused Assessment: Vital Signs: “As the patient compensates for altered tissue perfusion, the pulse pressure narrows and the heart rate increases” – (need to rewrite either the question or the answers)
Widening Pulse pressure – not correct (suppose to be narrow pulse pressure)
Bradycardia – not correct
Decreasing diastolic blood pressure – late sign
Weak peripheral pulses – late sign
A 5-year-old patient presents to the emergency department with severe dehydration due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of the following physiologic responses to shock has the greatest impact on improving cardiac output in the pediatric patient?
Increasing heart rate
Pathophysiology: Cardiac Output. In pediatric patients, cardiac out is primarily regulate by increasing heart rate
Which of the following patient presentations should increase suspicion of potential child maltreatment?
Bruising to the left ear of a newborn from sleeping on his side
Pg 10- Any bruises in a non exploratory location (especially torso ears, neck) in children younger than 4
Pg 11Any bruising in a child younger than 4 months.
All of the vaccine administrations listed are appropriate EXCEPT for which of the following?
Fifth Disease at 6 months
There is an animal vaccine, but not a human vaccine for Fifth Disease.
Which of the following statements indicates the caregiver understands your discharge teaching on influenza?
My child can go to daycare since they have been off of Tylenol and fever free for 24 hours.
Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to go back to daycare or school.
The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak English and has identified their religion as Muslim. Which of the following interventions is most supportive of the family?
Dedicate a healthcare team member with a qualified interpreter to be with the family during the procedure.
Providing the option for family presence with an assigned team member to facilitate communication is most supportive of the family in this situation.
A 6 year-old child presents to the emergency department with caregivers who report a cough with nasal congestion and pink-eye that started 2 days ago. They have been treating with an over-the-counter medicine without relief. Today they noticed a raised red rash on the face and papules in the mouth. You suspect which of the following?
Rubeola On presentation the child starts with cough, nasal inflammation (coryza) and a non-purulent conjunctivitis.
After 2-4 days a rash begins as erythematous macules and papules on the face that spreads to the torso and extremities.
A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but are all incontinent and salivating with excess tearing. Which of the following is the priority intervention?
removal of clothing and decontamination
Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water
The emergency nurse is caring for a patient with significant facial trauma and a suspected globe rupture. Which of the following medication orders would the nurse question?
Succinylcholine
Succinylcholine may increase intraocular pressure and should be avoided.
A toddler has a chemical eye injury. Which of the following is the priority intervention?
Copious eye irrigation with an isotonic solution
Normal saline or Ringer’s lactate solution are both acceptable for irrigation. Irrigate until the pH of the eye returns to normal. The pH of Ringer’s lactate is closer to that of human tears and may be more comfortable than normal saline.
Which of the following medications is appropriate for treating the fever of a four-year-old with scleral jaundice and elevated aspartate transaminase (AST)?
(Do not pick acetaminophen)
The parents of a 5-year-old child arrive at the emergency department. The child’s lips and face are swollen with hives on the face. The parents report the child ate peanut butter crackers in the last hour. The child has no known allergies. The nurse recognizes the findings are associated with:
Food allergy These findings are typical of a food allergy. Because allergic reactions are so variable and do not always include classic manifestations, anticipate that any food-induced allergic reaction may unexpectedly progress to life-threatening anaphylaxis.
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 doing which of the following?
Appointing one staff member to communicate with them.
This will help create a solid patient-staff bond and facilitate communication
Which of the following patients should be evaluated first?
An 18-month-old with bilious emesis
Bilious emesis in an 18-month-old is always considered an emergent symptom indicative of a life-threatening bowel obstruction.
Which of the following would be an abnormal finding in a patient with glomerulonephritis?
Clear urine
Normal finding: There is a decrease in urine output for patient’s with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored
Which of the following indicates the need for additional parent/guardian education regarding a UTI?
My child will grow out of their frequent urinary tract infections
UTIs are not a normal occurrence in children and may require additional investigation and follow up
Which of the following interventions would the nurse anticipate for a pediatric patient with a fever and a history of a hematologic or oncologic condition?
Intravenous antibiotics
This patient population is at risk for life-threatening sepsis, and treatment with intravenous antibiotics is indicated.
Acute chest syndrome, stroke, and splenic sequestration are complications of which of the following diseases?
Sickle cell anemia
These are all typical complications of sickle cell anemia
A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following?
Sex Trafficking
Red Flags for sex trafficking may include multiple bruises, unwanted or unintended pregnancy, being withdrawn and guarded.
During the assessment of a 16-year-old male patient, the ED nurse identifies him as a potential sex trafficking victim. The trauma informed approach to care emphasizes certain principles in caring for these types of patients. Which of the following care principles has the highest priority?
Physical and psychological safety
Create an environment where patients feel safe, both physically and psychologically. Increase awareness of the patients interpersonal interactions with others to screen for risk of harm. Prioritize the patient being in a safe location.
During the tertiary survey, the emergency nurse should continue to conduct reevaluations of the Pediatric Assessment Triangle (PAT), abnormal findings, and which of the following other assessment components?
Primary survey, vital signs, pain management, and effectiveness of therapeutic interventions
The additional three components of the reevaluation in the Tertiary Survey includes primary survey, vital signs and pain management, effectiveness of therapeutic interventions. (p 38)
An ambulance arrives with a 16-year-old male involved in a dirt bike crash who was intubated prior to arrival. Which of the following is the priority assessment or intervention?
Assess the endotracheal tube placement and patency
If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place, assess its placement, tube patency and then the oral airway (in that order) before moving to the next step of the primary survey. (p 4)
In which of the following primary survey components can assessment of the fontanel provide the most useful information?
Circulation and disability
A sunken fontanel may indicate dehydration; a bulging fontanel can indicate increased intracranial pressure.
Which of the following actions by the nurse promotes pediatric patient safety?
Preparing medications in a distraction-free area
To decrease errors, the nurse should be focused and systematic in verifying patient identification, medication order, route, time, and dose.
Which of the following tasks can the nurse do to decrease adverse medication events?
Obtain the patient’s weight in kilograms
This is the preferred measurement for medication calculations for pediatric and adult patients.
Which of the following is the priority intervention for a pediatric patient with diabetic ketoacidosis?
Insulin infusion
A continuous infusion of insulin at 0.050.1 unit/kg/hr should be used to decrease blood glucose.
A 4-day-old who is brought to the emergency department with the parental complaint of “not acting right” is found to be hypoglycemic. The appropriate glucose concentration to administer to this neonate is which of the following?
D10
D10 is the preferred concentration for neonates to protect their fragile vasculature.
A 16-year-old is noted to have external rotation and shortening of the left lower extremity and pain with palpation of the pelvis after being ejected from a motorcycle. Which of the following assessment findings is most concerning for a potentially life-threatening condition?
Bony crepitus and instability with gentle anteroposterior compression
Bony crepitus and instability to palpation of the pelvis are common findings in patients with unstable pelvic fractures. Unstable pelvic fractures may be associated with injury to major blood vessels and contribute to hypovolemic shock.
Which of the following is a known cause of pediatric seizures?
Which of the following is the most appropriate intervention for a child experiencing a seizure?
Prepare to administer intranasal midazolam
Midazolam has gained favor because of its ease of use and quick onset of action
The emergency nurse is caring for a 14-year-old patient who sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain interventions is most likely to result in improvement in symptoms?
Application of a splint to the affected extremity
Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures.
According to the American Academy of Pediatrics guidelines, which of the follwing describes how a neonate riding in a car should be positioned?
Rear facing in a convertible carseat until at least the age of 2
The safest mode of transport for the neonate is rear facing until the age of 2 when the neck ligaments are stronger to support the head.
Which of the following describes a neonates normal position?
Flexion with extremities close to the body
A neonates normal position is flexion with extremities close to the body
A 6-month-old is brought to the emergency department for a recurrent respiratory infection. When gathering a history from the caregiver, the emergency nurse learns that, in addition to the respiratory symptoms, the infant has had fatty stools. The emergency nurse should be concerned about which of the following disease processes?
Cystic Fibrosis
In CF, the mucus can block pancreatic ducts, which does not allow full absorption of fats/proteins, leading to greasy/fatty stools.
A 3-year-old is brought to the emergency department with a 2-day history of a runny nose, low-grade fever, and a “barky” cough at night. The caregiver tells the emergency department nurse the coughing is getting worse. The child is awake and alert, with stridor. The nurse should anticipate which of the following?
Administration of nebulized epinephrine
Moderate to severe croup is treated with dexamethasone and nebulized epinephrine
Which of the following statements about the assessment and management of pediatric hypovolemia is accurate?
Delayed capillary refill is one indication to administer a fluid bolus
Other indications include tachycardia, dry mucous membranes, altered mental status, and cool skin.
Which of the following vital signs is most consistent with an adolescent in neurogenic shock after a spinal cord injury?
Pulse 50 beats/ minute, BP 80/30 mm Hg Neurogenic shock patients have bradycardia and hypotension with a widened pulse pressure due to vasodilation.
Spinal shock results in which of the following transient conditions?
pain at the site of injury and hyperesthesia above the level of injury
(Symptoms of spinal cord shock)
A three-year-old is rescued after being submerged in a residential pool for several minutes. On arrival at the Emergency Department he is responsive to painful stimuli, has shallow respiration’s with diminished breath sounds throughout, and has an occasional cough. What is the initial management priority?
Endotracheal intubation with positive pressure ventilation
Airway control and positive pressure ventilation are the appropriate interventions for this patient.
Which of the following statements demonstrates a nurse’s understanding of pediatric submersion injuries?
The best indicator of survival after submersion is the duration (Length) of time of submersion.
The duration of submersion is the best predictor of survival after drowning. In general, shorter times correlate to better outcomes.
A 15-year-old patient has attempted suicide by overdosing on amitriptyline. The emergency nurse should expect which of the following symptoms?
Dysrhythmias
QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose.
A 12-year-old who was recently started on anti-psychotic medication for schizophrenia is brought to the emergency department with severe muscle rigidity and hyperthermia. These symptoms are most likely caused by which of the following?
Neuroleptic malignant syndrome These are classic symptoms of neuroleptic malignant syndrome, which is a rare reaction to antipsychotic medications.
A 2-month-old infant is brought to the emergency department. The mother states he has had trouble breathing for the past two days. The PAT reveals an age-appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted to both nares. Which of the following is the best next step?
Using a bulb syringe suction nasal passages
Infants up to four months old are obligate nose breathers and can have respiratory distress when nares are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. (p6)
The type of vascular access is appropriate in all of the patient situations given EXCEPT for which of the following?
Peripherally inserted central catheter line for one time fluid bolus
This is most appropriate for long term medication administration and multiple blood draws