Answers for Emergency Nursing Pediatric Course

1. 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. (wrong answer)
A. The size of the medication bottle.
B. The expiration date of the medication. (wrong answer)
B. The expiration date of the medication.
C. The number of pills left in the bottle. (correct answer)
D. The person for whom the medication was prescribe.(wrong answer) D. The person for whom the medication was prescribe.

Reference: Chapter 18, Poisonings.

2. 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. (wrong answer)
A. Placing them in a secluded room.
B. Referring to their child as "the patient". (wrong answer)
B. Referring to their child as "the patient".
C. Telling the family how they should feel. (wrong answer)
C. Telling the family how they should feel.
D. Appointing one staff member to communicate with them. (correct answer)

Reference: Chapter 20, Crisis Intervention.

3. 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. (wrong answer)
A. Minor surface injury.
B. Significant underlying injury. (correct answer)
C. Significant surface injury. (wrong answer)
C. Significant surface injury.
D. Minor underlying injury. D. Minor underlying injury.

Reference: Chapter 11, Pediatric Trauma.

4. 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. (wrong answer)
A. Documentation of the family�s health insurance coverage.
B. Pertinent family health history. (wrong answer)
B. Pertinent family health history.
C. Confirmation of acceptance from the receiving hospital. (correct answer)
D. Confirmation of a medical diagnosis. (wrong answer) D. Confirmation of a medical diagnosis.

Reference: Chapter 21, Stabilization and Transport.

5. 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. (wrong answer)
A. Obstructive shock.
B. Distributive shock. (wrong answer)
B. Distributive shock.
C. Hypovolemic shock. (correct answer)
D. Cardiogenic shock. (wrong answer)
D. Cardiogenic shock.

Reference: Chapter 11, Pediatric Trauma.

6. 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?" (correct answer)
B. "Don�t cry while you are getting the stitches. Be brave like a man." (wrong answer)
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?" (wrong answer)
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?" (wrong answer) D. "Does your cut hurt? Would you like your mommy to hold you?"

Reference: Chapter 17, Procedural Preparation and Sedation.

7. What is the preferred sit for intraosseous access in the infant?
A. Lateral malleolus (wrong answer)
A. Lateral malleolus
B. Iliac crest (wrong answer)
B. Iliac crest
C. Proximal femur (wrong answer)
C. Proximal femur
D. Anteromedial tibia (correct answer)

Reference: Chapter 8, Vascular Access

8. 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. (correct answer)
B. Have difficulty localizing or describing the pain. (wrong answer)
B. Have difficulty localizing or describing the pain.
C. Are unable to use the 1 to 10 scale to report their pain. (wrong answer)
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. (wrong answer) D. Feel that the pain is a punishment for something they did wrong.

Reference: Chapter 12, Pain Assessment and Management

9. 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. (wrong answer)
A. Administration of epinephrine.
B. Supplemental warming measures. (wrong answer)
B. Supplemental warming measures.
C. Rapid sequence intubation. (correct answer)
D. Administration of albuterol. (wrong answer) D. Administration of albuterol.

Reference: Chapter 6, Respiratory Distress and Failure.

10. Which combination of medications is best to have prepared for a pediatric resuscitation?
A. Dopamine and sodium bicarbonate. (wrong answer)
A. Dopamine and sodium bicarbonate.
B. Epinephrine and glucose. (correct answer)
C. Naloxone and lidocaine. (wrong answer)
C. Naloxone and lidocaine.
D. Pentothal and vecuronium. (wrong answer) D. Pentothal and vecuronium.

Reference: Chapter 7, Shock.

11. 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. (wrong answer)
A. Arterial blood gas.
B. Finger-stick glucose. (correct answer)
C. Complete blood count with differential. (wrong answer)
C. Complete blood count with differential.
D. Toxicology screen. (wrong answer) D. Toxicology screen.

Reference: Chapter 14, The Neonate.

12. 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. (wrong answer)
A. Chest compressions.
B. Umbilical vein cannulation. (wrong answer)
B. Umbilical vein cannulation.
C. Endotracheal intubation. (wrong answer)
C. Endotracheal intubation.
D. Bag-mask ventilation. (correct answer)

Reference: Chapter 14, The Neonate.

13. 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. (wrong answer)
A. Heart rate of 160 beats/minute.
B. Respiratory rate of 34 breaths/minute. (wrong answer)
B. Respiratory rate of 34 breaths/minute.
C. Blood pressure of 80/60 mm Hg. (wrong answer)
C. Blood pressure of 80/60 mm Hg.
D. Urine output of 11 ml/hour. (correct answer)

Reference: Chapter 11, Pediatric Trauma.

14. 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. (wrong answer)
A. Review her medical record for pre-existing developmental problems.
B. Obtain a head computerized tomography scan. (wrong answer)
B. Obtain a head computerized tomography scan.
C. Conduct a developmental screening test. (wrong answer)
C. Conduct a developmental screening test.
D. Ask the parents if her behavior is unusual. (correct answer)

Reference: Chapter 11, Pediatric Trauma.

15. 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. (wrong answer)
A. Encouraging the caregiver to hold and comfort the child.
B. Monitoring for signs and symptoms of increased intracranial pressure (ICP). (correct answer)
C. Collecting urine for toxicology screen. (wrong answer)
C. Collecting urine for toxicology screen.
D. Encouraging oral fluids and food. (wrong answer) D. Encouraging oral fluids and food.

Reference: Chapter 15, Childhood Illnesses.

16. The Pediatric Assessment Triangle is used to:
A. Identify all life-threatening conditions that the child presents with. (wrong answer)
A. Identify all life-threatening conditions that the child presents with.
B. Perform a complete head-to-toe assessment on the child. (wrong answer)
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. (wrong answer)
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. (correct answer)

Reference: Chapter 5, Triage

17. 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?" (wrong answer)
A. "Are his immunizations current?"
B. "Has anything happened to him at school recently?" (wrong answer)
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?" (correct answer)
D. "Has he been complaining of a sore throat or earache?" (wrong answer) D. "Has he been complaining of a sore throat or earache?"

Reference: Triage

18. 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. (wrong answer)
A. Read a story to the infant.
B. Offer the infant a pacifier. (correct answer)
C. Return when the infant is consoled. (wrong answer)
C. Return when the infant is consoled.
D. Ignore the infant�s behavior. (wrong answer) D. Ignore the infant�s behavior.

Reference: Chapter 3, From the Beginning�Dealing with Children

19. 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. (correct answer)
B. Apply cricoid pressure and establish intravenous access. (wrong answer)
B. Apply cricoid pressure and establish intravenous access.
C. Inform the physician of the heart rate and ask the physician to intubate faster. (wrong answer)
C. Inform the physician of the heart rate and ask the physician to intubate faster.
D. Administer blow-by oxygen and begin chest compressions. (wrong answer) D. Administer blow-by oxygen and begin chest compressions.

Reference: Chapter 7, Shock

20. 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. (wrong answer)
A. Obtain intravenous access.
B. Apply a pulse oximeter. (wrong answer)
B. Apply a pulse oximeter.
C. Prepare a chest x-ray. (wrong answer)
C. Prepare a chest x-ray.
D. Administer 100% oxygen. (correct answer)

Reference: Chapter 6, Respiratory Distress and Failure.

21. The best method to open the airway in an injured child is:
A. Placing the head and neck in hyperextension. (wrong answer)
A. Placing the head and neck in hyperextension.
B. Using the jaw thrust maneuver. (correct answer)
C. Placing the head and neck in flexion. (wrong answer)
C. Placing the head and neck in flexion.
D. Using the head tilt maneuver. (wrong answer) D. Using the head tilt maneuver.

Reference: Chapter 4, Initial Assessment

22. 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. (correct answer)
B. Administer 100% oxygen, obtain venous access, administer 0.
1 mg/kg of epinephrine 1:10,000, and prepare for endotracheal intubation. (wrong answer)
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. (wrong answer)
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. (wrong answer) D. Administer 100% oxygen, prepare for a venous cutdown, administer 20 ml/kg of an isotonic solution, and obtain a chest x-ray.

Reference: Chapter 7, Shock.

23. 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. (wrong answer)
A. Hold the child to comfort him.
B. Wait for the parent�s arrival. (wrong answer)
B. Wait for the parent�s arrival.
C. Observe for behavioral pain cues. (correct answer)
D. Use a doll to demonstrate the examination. (wrong answer) D. Use a doll to demonstrate the examination.

Reference: Chapter 3, From the Beginning - Dealing with Children.

24. Which ocular finding is associated with child maltreatment?
A. Glaucoma. (wrong answer)
A. Glaucoma.
B. Conjunctivitis. (wrong answer)
B. Conjunctivitis.
C. Iritis. (wrong answer)
C. Iritis.
D. Retinal hemorrhage. (correct answer)

Reference: Chapter 13, Child Maltreatment.

25. 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. (wrong answer)
A. Dry and arm the infant as soon as is it delivered.
B. Stimulate and ventilate the infant immediately after delivery. (wrong answer)
B. Stimulate and ventilate the infant immediately after delivery.
C. Suction the mouth and nose of the infant while on the perineum. (correct answer)
D. Administer blow-by oxygen and rub the back immediately after delivery. (wrong answer) D. Administer blow-by oxygen and rub the back immediately after delivery.

Reference: Chapter 14, The Neonate