Ricci 51 (A) Flashcards
The nurse is caring for a 6-year-old girl who was injured in a bicycle accident. Which question would be most important for the nurse to ask during the health history?
A) “Has she been diagnosed with any chronic disorders?”
B) “Is your daughter currently taking any medications?”
C) “Is she allergic to any medications or drugs?”
D) “Tell me how the bicycle accident happened.”
D
The priority inquiry is to determine the nature of the emergency so that appropriate interventions may be initiated. This will also provide direction for obtaining more in depth information as time permits. Information about allergic reactions to drugs, medications being taken, and chronic disorders that may affect treatment will be gathered next.
The nurse is caring for a 7-year-old boy experiencing respiratory distress who is scheduled to have a chest radiograph. What would be most important for the nurse to include in the child’s plan of care?
A) Administering a sedative to help calm the child
B) Assisting the child to lie still during the chest radiograph
C) Accompanying the child to continue observation
D) Informing the child that he might hear a loud banging noise
B
Chest radiographs that disclose alterations in normal anatomy or lung expansion, or evidence of pneumonia, tumor, or foreign body, are commonly performed for respiratory emergencies. Therefore, the nurse would need to assist the child in remaining still during the procedure. A sedative may be ordered for magnetic resonance imaging (MRI). Accompanying the child to continue observation would be necessary if the child was to undergo a computed tomography scan. Telling the child about a loud banging noise would be appropriate if the child was having an MRI.
A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the emergency department. Which action would be most appropriate?
A) Ventilating the child with a bag-valve-mask
B) Estimating the child’s weight using a Broselow tape
C) Providing therapy using automated external defibrillation
D) Using rescue breathing and chest compressions
A
The child is exhibiting signs of ineffective oxygenation and ventilation. Therefore, ventilating the child with a bag-valve-mask and 100% oxygen would be effective and efficient. Estimating the child’s weight with a Broselow tape is typically done by ambulatory care providers. According to the American Heart Association, automated external defibrillators are recommended for use in children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse outside the hospital setting. Rescue breathing and chest compressions are implemented for children who are not breathing and do not have a pulse or when the pulse rate is less than 60 beats per minute.
When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action?
A) Assisting ventilation with a bag-valve-mask (BVM) device
B) Treating ventricular fibrillation using a defibrillator
C) Managing compensated shock to prevent decompensated shock
D) Treating supraventricular tachycardia using cardioversion
C
The principles of PALS stress evaluating and managing compensated shock with the goal of preventing decompensated shock and thereby preventing cardiopulmonary arrest. Assisting ventilation with a BVM device, treating ventricular fibrillation using a defibrillator, and treating supraventricular tachycardia using cardioversion are interventions that may be used to treat both children and adults
A 9-year-old girl who has fallen from a second-story window is brought to the emergency department. Which assessment would be the priority?
A) Evaluating pupils for equality and reactivity
B) Monitoring oxygen saturation levels
C) Asking the child if she knows where she is
D) Using the appropriate pain assessment scale
B
Airway is always the priority in any emergency situation. Therefore, monitoring oxygen saturation levels, part of the rapid cardiopulmonary assessment, would be performed before any of the other assessments. Evaluating pupils for equality and reactivity, asking the child if she knows where she is, and using an appropriate pain assessment scale are assessments that would follow the ABCs.
The parents bring their 3-year-old son to the emergency department after he ingested some of his mother’s medicine. Which assessment would be of critical importance for this child?
A) Assessing mental status and skin moisture and color
B) Evaluating the effectiveness of the child’s breathing
C) Noting the child’s pulse rate and quality
D) Auscultating all lung fields for signs of edema
A
In cases of poisoning, clinical manifestations vary widely depending on the medication or chemical ingested. Therefore, it is important to pay particular attention to the child’s mental status, skin moisture and color, and bowel sounds. Evaluating the effectiveness of the child’s breathing and noting the child’s pulse rate and quality are basic to any rapid cardiopulmonary assessment. Auscultating all lung fields for signs of pulmonary edema would be critically important for a child who is a near-drowning victim.
What would the nurse do first for a 5-year-old girl with profound bradycardia?
A) Provide oxygen at 100%
B) Administer epinephrine as ordered
C) Use warming blankets
D) Perform gastric lavage
A
The most common cause of profound bradycardia is respiratory compromise, hypoxia, and shock; thus, oxygenation and ventilation are the priorities. If the bradycardia persists, the next step would be to administer epinephrine or atropine as ordered. Hypothermia or toxic ingestion can cause bradycardia. Treating the underlying problem will relieve the bradycardia.
Which measure would be most appropriate for the nurse to do to ensure that a child’s endotracheal (ET) tube is correctly positioned?
A) Auscultate for abdominal breath sounds
B) Mark the tracheal tube at the child’s lip
C) Watch for a yellow display on a CO2 monitor
D) Inspect for water vapor in the tracheal tube
C
The best way to verify correct tracheal tube placement is to use a CO2 monitor. If the tube is properly placed, the monitor display will turn yellow with each exhalation. Auscultation for breath sounds and inspecting the tube for signs of water vapor are valid confirmations, but not as good as CO2 monitors. Marking the tube alerts the nurse if the tube becomes misplaced.
Which intervention would be most helpful in preventing barotrauma when ventilating a 3-year-old girl with a bag-valve-mask?
A) Choosing the correct size bag and face mask
B) Setting the flow rate at exactly 10 L/minute
C) Maintaining the airway in the open position
D) Delivering one breath every 3 to 5 seconds
D
Barotrauma is often the result of healthcare provider or nurse practitioners ventilating the child too rapidly using too much tidal volume. Therefore, delivering one breath every 3 to 5 seconds is the best way to prevent barotrauma. Choosing the correct size bag and face mask and setting the correct flow rate are important for effective ventilation, as is maintaining the airway in the open position. However, these actions would have little impact on preventing barotrauma.
The nurse is providing care to a 4-year-old boy with a broken arm and an infected laceration from a fall. The nurse notes a significant elevation in the child’s heart rate. Which intervention would be least appropriate?
A) Administering antipyretics as ordered for fever
B) Using a defibrillator to reduce the heart rate
C) Administering analgesics to reduce pain
D) Allowing the parents to comfort the child
B
Fever, fear, and pain are common explanations for significant increases in the heart rate of a child. This normal elevation in heart rate is known as sinus tachycardia and can be managed by treating the underlying causes. Antipyretics, analgesics, and comfort from the parents would be appropriate. However, defibrillation should be avoided.
A child weighing 51 lb (23.1 kg) requires defibrillation. How many joules would the nurse expect to give initially?
A) 46
B) 92
C) 102
D) 204
A
The initial amount of energy or joules for defibrillation is 2 joules/kg. The child weighs 51 lb, which is 23 kg, so 46 joules would be used.
A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. This type of breathing is:
A) hypoventilation.
B) hyperventilation.
C) periodic breathing
D) stridor.
C
Periodic breathing is regular breathing with occasional short pauses followed by rapid breathing for a short period, then eventually resumption of a normal respiratory rate. Hypoventilation refers to a decrease in the depth and rate of respirations. Hyperventilation refers to an increased depth and rate of respirations. Stridor refers to a high-pitched, easily audible inspiratory noise.
The nurse is gathering the necessary equipment for tracheal intubation for a child who is 2 years old. Which tracheal tube size would the nurse obtain?
A) 4.5
B) 5
C) 5.5
D) 6
A
To calculate tracheal tube size, divide the child’s age by 4 and add 4. For a 2-year-old child, 2 divided by 4 equals 0.5 plus 4 equals 4.5. The nurse also should have one size smaller ready.
What would lead the nurse to suspect that a 5-year-old child is experiencing supraventricular tachycardia?
A) Heart rate 160 beats per minute
B) Flattened P waves
C) Normal QRS complex
D) History of fever
B
Supraventricular tachycardia is manifested by flattened P waves, a heart rate greater than 180 beats per minute, a narrow QRS complex, and usually no significant history. A heart rate of 160 beats per minute, normal QRS complex, and history of fever, fluid loss, hypoxia, pain, or fear would suggest sinus tachycardia.
What would be most appropriate to use to help maintain a patent airway in an infant experiencing a respiratory emergency?
A) Neck hyperextension
B) Head tilt–chin lift technique
C) Jaw-thrust maneuver
D) Small towel under shoulders
The infant will benefit from a small sheet or towel folded under the shoulders. This facilitates keeping the infant’s airway in the sniff position as recommended by the American Heart Association’s Basic Cardiac Life Support guidelines. Neck hyperextension and flexion should be avoided because these may occlude the airway. The head tilt–chin lift technique is appropriate to open the airway of a child older than age 1 year if a cervical spine injury is not suspected. The jaw-thrust maneuver is used if there is concern about the cervical spine.
