CPEN BCEN Test Questions and Answers: Pediatric Emergency Nursing, Exams of Nursing

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A 6-year-old presents with a homemade splint on the left arm after falling off of a bicycle. Which of the following should be the nurse's PRIORITY? - ** VERIFIED ANSWERS ** ✔✔ Assess the neurovascular status A 12-year-old presents with low-grade fever and diffuse abdominal pain which increases with coughing. These symptoms suggest - ** VERIFIED ANSWERS ** ✔✔ appendicitis When assessing an infant with coarctation of the aorta, a nurse should expect to find - ** VERIFIED ANSWERS ** ✔✔ absent or diminished femoral pulses Continuous monitoring of a child's ETCO2 during cardiac arrest reveals 8 mmHg. This indicates that CPR is - ** VERIFIED ANSWERS ** ✔✔ ineffective and adjustments need to be made to compressions Abdominal pain can be a characteristic of which respiratory diagnosis? - ** VERIFIED ANSWERS ** ✔✔ pneumonia Which of the following is the NEXT step for a newborn with a heart rate of 80 beats/min after initial drying and suctioning? - ** VERIFIED ANSWERS ** ✔✔ Initiate ventilations Following a diagnosis of hyphema, discharge instructions to the care giver should include - ** VERIFIED ANSWERS ** ✔✔ re-bleeding may occur Which of the following is the treatment of choice for a lethargic neonate with narrow complex tachycardia and a heart rate of 230 beats/min? - ** VERIFIED ANSWERS ** ✔✔ cardioversion

A child presents with a fever, sore throat, and general malaise approximately 48 hours after a camping trip. It would be a PRIORITY for the nurse to - ** VERIFIED ANSWERS ** ✔✔ examine the child for open wounds. Which of the following is a common sign of meningococcal meningitis? - ** VERIFIED ANSWERS ** ✔✔ petechiae A patient is receiving intravenous potassium replacement. The nurse suspects hyperkalemia based on which the following: - ** VERIFIED ANSWERS ** ✔✔ peaked T waves The nurse should anticipate notifying the proper authorities for which of the following patients? - ** VERIFIED ANSWERS ** ✔✔ 6-year-old with positive gonorrhea Which of the following is MOST indicative of compartment syndrome? - ** VERIFIED ANSWERS ** ✔✔ pain out of proportion to the severity of the injury A 16-year-old is brought to the Emergency Department by friends following a seizure. They report it lasted about two minutes and broke up the party. The priority diagnostic test is: - ** VERIFIED ANSWERS ** ✔✔ a urine drug screen. 9-month-old presents to the Emergency Department with a mid-shaft tibia fracture. Which of the following statements from the parent might indicate history of non- accidental trauma (NAT). - ** VERIFIED ANSWERS ** ✔✔ Patient was riding a tricycle and fell off A 12-month-old presents with a 2-day history of nausea and vomiting. Vital signs include: BP 80/60 mm HgHR 56 beats/minRR 12 breaths/min The child is limp and ashen. Which of the following is the PRIORITY intervention? - ** VERIFIED ANSWERS ** ✔✔ manual ventilations A 6-year-old presents with a sudden onset of fever, chills, and macular rash of the palms, wrist, ankles, and soles of the feet. The child was recently on a camping

trip. The nurse suspects - ** VERIFIED ANSWERS ** ✔✔ Rocky Mountain Spotted Fever An 18-month-old patient presents to the Emergency Department with upper respiratory symptoms and wheezing. Chest x-ray reveals a radiopaque object in the left lower lobe. The nurse prepares the patient for a: - ** VERIFIED ANSWERS ** ✔✔ Rigid bronchoscopy A 2-year-old is crying and clinging to the mother in triage. Which of the following pain scales is MOST appropriate for the nurse to use when assessing the child? - ** VERIFIED ANSWERS ** ✔✔ FLACC A 2-month-old presents with irritability and is inconsolable. Which finding would lead the emergency nurse to suspect shaken baby syndrome? - ** VERIFIED ANSWERS ** ✔✔ Bilateral retinal hemorrhages A child arrives by ambulance following a witnessed seizure. As the nurse is preparing to start a peripheral IV, the child begins to have generalized seizure activity. Which medication can be given intranasally to control the seizure? - ** VERIFIED ANSWERS ** ✔✔ midazolam (Versed) An infant presents to the emergency department with feeding intolerance after 3 days of cold-like symptoms. Upon assessment, the patient is found to have an altered mental status, sunken fontanels, and decreased muscle tone. Vital signs are as follows: BP 66/30 mmHgHR 198 beats/minRR 50 breaths/minT (rectal) 97.3˚ F (36.3˚ C) The PRIORITY intervention is to - ** VERIFIED ANSWERS ** ✔✔ administer antibiotics. A nurse is caring for a 3-year-old that has a decrease in hearing and pain to right ear. Upon exam, the nurse notes impacted cerumen. The nurse should question an order for irrigation if the caregiver mentions a history of - ** VERIFIED ANSWERS ** ✔✔ tympanic membrane rupture.

A 16-year-old presents after running a cross country match. The patient is extremely fatigued with muscle pain and reports nausea and dark urine. The nurse should expect a diagnosis of - ** VERIFIED ANSWERS ** ✔✔ rhabdomyolysis What is the PRIORITY intervention for a 4-year-old child who has a fever, muffled voice and pallor? - ** VERIFIED ANSWERS ** ✔✔ Keep the patient calm A preschool child presents for possible sexual abuse. The MOST appropriate guideline when obtaining a history is to - ** VERIFIED ANSWERS ** ✔✔ determine what terms the child uses for the genital and anal areas A 9-year-old presents with a leg that is red and swollen around what appear to be two fang marks. Capillary refill in the toes is within normal limits and a pedal pulse can be palpated. The patient's vital signs include: BP 90/60 mmHgHR 100 beats/minRR 24 breaths/min Which of the following is the PRIORITY intervention? - ** VERIFIED ANSWERS ** ✔✔ Monitor for hypotension or shock A 5-week-old presenting with vomiting is noted to have a slightly bulging fontanel, hypothermia, and petechiae. The nurse should anticipate a workup for - ** VERIFIED ANSWERS ** ✔✔ meningitis An adolescent presents with a 3-day history of fever, sore throat, and muffled voice. The PRIORITY intervention should be - ** VERIFIED ANSWERS ** ✔✔ preparing emergency airway equipment In addition to airway, breathing, and circulation, which of the following assessments is MOST critical when assessing a 2-year-old with a temperature of 101.3° F (38.5° C)? - ** VERIFIED ANSWERS ** ✔✔ Glasgow Coma Scale score A nurse caring for a child with a traumatic brain injury observes drainage from the child's nose. The nurse should suspect the drainage is cerebral spinal fluid if - ** VERIFIED ANSWERS ** ✔✔ the drainage tests positive for glucose

A child presents with lethargy and bilateral ptosis after eating home canned vegetables. Which of the following additional findings would the nurse expect? - ** VERIFIED ANSWERS ** ✔✔ leg weakness A child presents after being bitten approximately 4 days ago while on a camping trip. The wound is purple, without drainage, and the physician suspects a brown recluse bite. What treatment does the nurse anticipate? - ** VERIFIED ANSWERS ** ✔✔ Prednisone, weight based Which of the following patients requires the MOST emergent intervention? - ** VERIFIED ANSWERS ** ✔✔ an obtunded child who is vomiting Which of the following injuries is MOST suggestive of child maltreatment? - ** VERIFIED ANSWERS ** ✔✔ circumferential burns to both feet Which of the following is the BEST method to assess adequacy of ventilation during procedural sedation? - ** VERIFIED ANSWERS ** ✔✔ capnography value A physician diagnoses a teenager with Wolff-Parkinson-White syndrome. When the caregiver asks how this condition is treated, the nurse should explain that: - ** VERIFIED ANSWERS ** ✔✔ Some patients may be candidates for a radiofrequency ablation A 3-year-old child presents following 36 hours of vomiting and diarrhea. Vital signs include: BP 78/45 mm HgHR 150 beats/minRR 38 breaths/minTemp 100.4° F (38° C)O2 sat 94% - ** VERIFIED ANSWERS ** ✔✔ intravenous volume replacement at 20 mL/kg When discharging a patient home with maxillomandibular fixation in place, the nurse recognizes the MOST important item for the caregivers to keep with them at all times is: - ** VERIFIED ANSWERS ** ✔✔ Wire cutters The Pediatric Assessment Triangle (PAT) reveals that a 6 month old has decreased muscle tone, head bobbing with respirations, and pale skin color. The PRIORITY

intervention is to - ** VERIFIED ANSWERS ** ✔✔ place on a stretcher and reposition the airway. A diagnosis of intussusception is made on a 2-year-old. The nurse should anticipate an initial treatment of - ** VERIFIED ANSWERS ** ✔✔ an air enema A child complains of headache, nausea, and dizziness shortly after moving to an older home. Which of the following interventions is MOST appropriate? - ** VERIFIED ANSWERS ** ✔✔ Obtain carboxyhemoglobin level A 6-year-old female presents for a possible urinary tract infection. During assessment, patchy areas of hair loss are noted. The nurse should also consider - ** VERIFIED ANSWERS ** ✔✔ physical abuse A 4-year child presents with abdominal pain and is crying. Which pain scale would be most appropriate for the nurse to use? - ** VERIFIED ANSWERS ** ✔✔ Faces scale A child presents with a right eye injury after being hit with a bat. Assessment findings include a misshapen pupil, sunken eye socket and loss of vision in the right eye. The injury the nurse should be expected is - ** VERIFIED ANSWERS ** ✔✔ globe rupture A 2-month-old presents with difficulty breathing associated with tachypnea, mild retractions, and copious amounts of nasal drainage. The MOST appropriate intervention is to - ** VERIFIED ANSWERS ** ✔✔ suction the nares A child with hemophilia presents with pain and swelling to the elbow. Factor replacement was administered by the caregivers prior to arrival. Pain is rated as 8 out of 10. The nurse's MOST appropriate intervention is to - ** VERIFIED ANSWERS ** ✔✔ obtain an order for a narcotic analgesic An afebrile 12-year-old male is complaining of abdominal pain, nausea and vomiting upon waking. What information is a PRIORITY for the nurse to obtain? - ** VERIFIED ANSWERS ** ✔✔ "Have you had any trauma to your abdomen?"

A child suspected of having mumps requires which type of isolation precautions? - ** VERIFIED ANSWERS ** ✔✔ droplet While caring for an intubated patient, the nurse notices a sudden drop in end tidal carbon dioxide from 38 mmHg to 22 mmHg. The nurse immediately suspects? - ** VERIFIED ANSWERS ** ✔✔ tube obstruction Which of the following pediatric patients should be referred to a burn center? - ** VERIFIED ANSWERS ** ✔✔ A patient with approximately 3% partial thickness burns to the wrist. A patient presents with a painful swollen pustule on the eyelid at the eyelash line without vision changes. The nurse should anticipate the use of - ** VERIFIED ANSWERS ** ✔✔ ophthalmic antibiotics. An infant presents with grunting respirations, faint heart sounds, and decreased peripheral perfusion. Which of the following is the PRIORITY action? - ** VERIFIED ANSWERS ** ✔✔ Reposition the airway. A toddler presents with 6 days of fever, irritability, and a rash. The nurse notes an enlarged reddened tongue and cracked lips. Which of the following orders should the nurse anticipate? - ** VERIFIED ANSWERS ** ✔✔ echocardiogram A child recently diagnosed with lymphoma presents with fatigue, abdominal fullness, and decreased urinary output. A diagnosis of tumor lysis syndrome has been made. Which of the following interventions should the nurse anticipate? - ** VERIFIED ANSWERS ** ✔✔ Administer allopurinol (Zyloprim). After receiving the medications for an allergic reaction to an unknown substance, what discharge instructions should the nurse reinforce prior to discharge? - ** VERIFIED ANSWERS ** ✔✔ "Keep a record of everything the child eats."

A 5-day-old neonate is diagnosed with hyperbilirubinemia. If left untreated, the infant may have long-term issues with - ** VERIFIED ANSWERS ** ✔✔ intellectual deficits. A 1-year-old presents unconscious and is being ventilated with a bag-mask device. Ventilation has become progressively more difficult. Which of the following is the PRIORITY intervention? - ** VERIFIED ANSWERS ** ✔✔ Place padding under the shoulders. A 6-year-old presents to triage. The caregiver reports the child is pulling at their ears and is restless. Vital signs are as follows: BP: 90/50 mmHgHR: 168 beats/minRR: 36 breaths/minTemperature: 99.5˚ F (37.5˚C), axillary A priority question during a review of the child's history is: - ** VERIFIED ANSWERS ** ✔✔ "When the last time they had pain medication?" Which of the following patients presenting with genitourinary complaints should be treated FIRST? - ** VERIFIED ANSWERS ** ✔✔ 8-year-old male with paraphimosis A 7-month-old child presents with vomiting and diarrhea. The child's weight is down approximately 2 kilograms from a previous visit one month ago. The parents relate they have been diluting the formula due to an inability to obtain formula. After stabilization of the child, what is the priority? - ** VERIFIED ANSWERS ** ✔✔ Obtain a social services consult. Which strategy is BEST for decreasing the incidence of drowning in children? - ** VERIFIED ANSWERS ** ✔✔ physical supervision during a bath An adolescent with cerebral palsy fell and broke off a permanent tooth. The priority treatment for this patient is to - ** VERIFIED ANSWERS ** ✔✔ rinse the tooth with saline A pediatric patient with a history of asthma presents with wheezing, shortness of breath and cough. Early administration of which medication may help prevent the patient from being admitted? - ** VERIFIED ANSWERS ** ✔✔ Steroids

What would be the most appropriate intervention for a child with suspected intussusception? - ** VERIFIED ANSWERS ** ✔✔ Air enema Which discharge instructions should be included for a teenage patient with a hematocrit of 30%? - ** VERIFIED ANSWERS ** ✔✔ "Taking iron with vitamin C will increase its efficiency." An adolescent presents with severe eye pain, stating "there is something stuck in my eye." The globe is intact. Which of the following is the PRIORITY intervention? - ** VERIFIED ANSWERS ** ✔✔ Administer topical analgesics. A 22-month-old presents after drinking windshield wiper fluid. Symptoms of this ingestion include - ** VERIFIED ANSWERS ** ✔✔ vomiting, diarrhea, ataxia, and visual impairment. A toddler presents with circumferential burns to their legs from a scald injury. Apart from wound care, which intervention would be most appropriate for the nurse to advocate for in this situation? - ** VERIFIED ANSWERS ** ✔✔ Complete skeletal x-rays A 5-day-old patient presents with feeding intolerance, lethargy, temperature instability, and apnea. The nurse has a high suspicion for - ** VERIFIED ANSWERS ** ✔✔ neonatal sepsis. A caregiver brings in a pale, ventilator-dependent 8-year-old. Which of the following questions has the HIGHEST priority? - ** VERIFIED ANSWERS ** ✔✔ "What is different today than usual with the child?" A pale 5-month-old presents with melena and fussiness. A priority assessment question to ask the caregivers is: - ** VERIFIED ANSWERS ** ✔✔ "Have you fed the baby whole milk?" A 12-year-old male presents after losing a tooth when he crashed his bike. Which of the following can be done to preserve the tooth until emergency dental care is

available? - ** VERIFIED ANSWERS ** ✔✔ Rinse the tooth and place it back in the socket. An infant presenting with tachypnea, intercostal retractions, and clear nasal drainage is diagnosed with bronchiolitis. The respiratory distress is probably caused by the infant's - ** VERIFIED ANSWERS ** ✔✔ smaller upper airways. A 3-year-old is being admitted following a submersion injury in a swimming pool. The patient is alert and responds appropriately. The following vital signs are noted: BP 80/40 mmHgHR 88 beats/minRR 24 breaths/min A student nurse questions the need for admission. An appropriate response is that the patient: - ** VERIFIED ANSWERS ** ✔✔ "needs to monitored for cerebral edema." An adolescent presents with superficial lacerations to both forearms. She is tearful and avoids eye contact with staff. Which of the following is the PRIORITY intervention for this patient? - ** VERIFIED ANSWERS ** ✔✔ Maintain a safe environment. Several healthcare providers are visibly upset after the death of an infant. The NEXT appropriate action is to - ** VERIFIED ANSWERS ** ✔✔ invite the nurses to a quiet area to express their feelings. An 8-year-old presents to the emergency department with a snake bite. The right arm is edematous. IV fluids are started in the left dorsal forearm. The physician reports the pressure in the extremity to be greater than 30mmHg. The nurse should anticipate - ** VERIFIED ANSWERS ** ✔✔ administration of antivenom. Which of the following are risk factors for necrotizing fasciitis? - ** VERIFIED ANSWERS ** ✔✔ varicella infection If administering epinephrine to a pediatric patient having a severe allergic reaction, the proper dose and concentration should be epinephrine - ** VERIFIED ANSWERS ** ✔✔ 0.01 mL/kg and 1 mg/mL

Which of the following is the PRIORITY intervention for a 2 day old with jaundice? - ** VERIFIED ANSWERS ** ✔✔ Prepare for phototherapy In order to assess a patient with suspected hyphema, the nurse knows the best position to assess the patient is: - ** VERIFIED ANSWERS ** ✔✔ high-fowlers A child with a ventriculoperitoneal shunt complains of headache and vomiting. The nurse should prepare to - ** VERIFIED ANSWERS ** ✔✔ send the child for imaging A patient arrives with painful, swollen glands in the throat, fever, and recent appetite loss. Until further evaluation and diagnostics can be performed, the nurse should initiate which type of isolation? - ** VERIFIED ANSWERS ** ✔✔ Droplet A previously healthy 7-year-old boy presents with nausea, vomiting, edema, and hematuria. The following vital signs are noted: BP 132/86 mm HgHR 110 beats/minRR 24 breaths/minT 98.4o F (36.8o C), oral Which of the following conditions is the MOST likely cause of this child's sudden illness? - ** VERIFIED ANSWERS ** ✔✔ acute renal failure Following a motor vehicle collision, a patient is diagnosed with a C7 fracture and anterior spinal cord syndrome. The nurse understands this patient will: - ** VERIFIED ANSWERS ** ✔✔ be wheelchair dependent A patient with a traumatic head injury presents with signs and symptoms of Cushing's triad. Which of the following would be an expected finding? - ** VERIFIED ANSWERS ** ✔✔ irregular, decreased respirations While caring for a stable 14-year-old trauma patient without a caregiver present, the trauma surgeon asks the nurse to witness a surgical consent over the phone. The MOST appropriate action is to - ** VERIFIED ANSWERS ** ✔✔ explain that two witnesses need to hear the parent consent. A 4-week-old infant is brought to the emergency department by her father who states the infant has been vomiting "forcefully" after each feeding but then wants

to feed again immediately after. The nurse suspects - ** VERIFIED ANSWERS ** ✔✔ pyloric stenosis. An 8 month old presents with swelling to the upper left extremity and decreased motion. The nurse suspects maltreatment with which of the following injuries: - ** VERIFIED ANSWERS ** ✔✔ an epiphyseal fracture Which of the following would be a contraindication to access a tunneled central venous access device? - ** VERIFIED ANSWERS ** ✔✔ redness and pain at the site A child presents with cyanosis and petechial hemorrhages to the upper chest, neck, and face after being pinned under a dresser. The nurse should suspect - ** VERIFIED ANSWERS ** ✔✔ traumatic asphyxia. A patient with a head injury is receiving mannitol at an appropriate dose. The nurse anticipates monitoring the: - ** VERIFIED ANSWERS ** ✔✔ potassium level Which of the following age groups are preoperational thinkers and concerned developmentally with initiative versus guilt? - ** VERIFIED ANSWERS ** ✔✔ preschool An unvaccinated child presents with difficulty breathing, temperature of 104° F (40°C), sore throat, and difficulty handling secretions. Which of the following is suspected? - ** VERIFIED ANSWERS ** ✔✔ epiglottitis An infant presents with grunting respirations, faint heart sounds, and decreased peripheral perfusion. Which of the following is the PRIORITY action? - ** VERIFIED ANSWERS ** ✔✔ Reposition the airway. A 16-year-old boy presents with gradual onset of left scrotal pain, fever, and abdominal pain. These symptoms are suggestive of - ** VERIFIED ANSWERS ** ✔✔ epididymitis

A child presents with fever, malaise, and generalized flat, red rash for 24 hours. The caregiver notes white spots inside the mouth. The nurse should suspect - ** VERIFIED ANSWERS ** ✔✔ measles. A 2-year-old with known cardiac history is brought in by ambulance for prolonged cyanosis following a temper tantrum. Treatment for this child would include - ** VERIFIED ANSWERS ** ✔✔ morphine A child with a large ventricular septal defect may display - ** VERIFIED ANSWERS ** ✔✔ congestive heart failure. Which of the following assessment findings should the nurse find worrisome? - ** VERIFIED ANSWERS ** ✔✔ an infant who does not respond to soothing Which developmental task is expected in a toddler? - ** VERIFIED ANSWERS ** ✔✔ autonomy A 5-year-old with a tracheostomy presents with a high fever, audible coarse breath sounds, and productive cough with copious amounts of thick, yellow sputum coming from the tracheostomy tube. The child appears in mild respiratory distress. Based on these symptoms, the nurse should suspect the MOST likely cause is - ** VERIFIED ANSWERS ** ✔✔ bacterial tracheitis. A 14-year-old male presents with the caregiver. He recently experienced the loss of a classmate. The caregiver reports recent poor attendance at school accompanied by weight loss, hypersomnia, limited interaction with the caregiver and a desire to be with the deceased classmate. Prior to discharge and away from the patient, what is the PRIORITY question to ask the caregiver? - ** VERIFIED ANSWERS ** ✔✔ "Are there any guns in the house?" A mother runs into the emergency department screaming that her child is choking on a piece of candy. The nurse observes a fearful 5-year-old with minimal air movement and dusky in color. The nurse's initial action should be to - ** VERIFIED ANSWERS ** ✔✔ perform abdominal thrusts.

A chest tube has been inserted for an adolescent presenting with a spontaneous pneumothorax. The nurse notes no fluctuation in the water seal chamber of the chest drainage system. Which of the following is the priority intervention? - ** VERIFIED ANSWERS ** ✔✔ checking for kinks in the tubing A child presents with fever, left eye pain, swelling, and impaired extraocular movement. The nurse anticipates a workup for - ** VERIFIED ANSWERS ** ✔✔ orbital cellulitis. A child with a history of sickle cell disease presents with altered level of consciousness, cool and clammy skin, and hypotension. Which of the following is the MOST likely cause of these symptoms? - ** VERIFIED ANSWERS ** ✔✔ splenic sequestration crisis A 5-week-old infant is brought in with a 2-day history of profuse vomiting after every feeding, constant hunger, and decreased wet diaper count. The infant has sunken eyes and dry mucus membranes. Vital signs include: BP 61/32 mm HgHR 184 beats/minRR 56 breaths/minCap refill 2 seconds Which of the following is the most appropriate INITIAL IV fluid? - ** VERIFIED ANSWERS ** ✔✔ 0.9 NS Which of the following congenital conditions might benefit from the use of High- frequency chest compression (HFCC) to assist with mucus breakdown? - ** VERIFIED ANSWERS ** ✔✔ Cystic Fibrosis A toddler presents with 6 days of fever, irritability, and a rash. The nurse notes an enlarged reddened tongue and cracked lips. Which of the following orders should the nurse anticipate? - ** VERIFIED ANSWERS ** ✔✔ echocardiogram A child with cellulitis of the lower leg is being discharged. Which of the following statements indicates the parents understand the discharge instructions? - ** VERIFIED ANSWERS ** ✔✔ "We will bring our child back to the emergency department if the leg continues to swell." A frantic parent reports that her 4-week-old had an episode of stiffening and lip smacking at home. The infant is now alert and pink, with flexed extremities. Which

of the following is the MOST likely cause of this episode? - ** VERIFIED ANSWERS ** ✔✔ seizure Le Forte fractures involve the - ** VERIFIED ANSWERS ** ✔✔ facial bones. A 10-year-old who was playing soccer arrives complaining of right shoulder pain. A diagnosis of a clavicle fracture is made. The nurse understands the discharge instructions are effective when the patient states - ** VERIFIED ANSWERS ** ✔✔ "I will wear my sling every day until the doctor says I don't have to." A child with 30% body surface area burns is awaiting transfer to the burn center. The nurse should - ** VERIFIED ANSWERS ** ✔✔ cover the burns with dry towel or sheet. Parents arrive with an unresponsive toddler and report finding her lying in the yard. Glascow Coma Scale (GCS) score is 5. Which of the following is the PRIORITY intervention for this patient? - ** VERIFIED ANSWERS ** ✔✔ Perform jaw thrust with cervical spine motion restriction. A 6-month-old presents to the Emergency Department displaying tachypnea with retractions, pharyngitis, rhinorrhea and copious secretions. The caregiver states that the patient just started daycare last week. The nurse suspects: - ** VERIFIED ANSWERS ** ✔✔ Respiratory Syncytial Virus (RSV) A 4-month-old presents with excessive crying. Assessment reveals a red swollen penis. The nurse should be concerned that the child may be suffering from - ** VERIFIED ANSWERS ** ✔✔ a hair tourniquet. A child with a head injury presents with altered mentation, nausea and vomiting. They are afebrile. The nurse places the head midline with the head of bed elevated 30 degrees. The nurse should prioritize administration of: - ** VERIFIED ANSWERS ** ✔✔ 3% sodium chloride. The typical presentation for pediatric scabies is a rash that is - ** VERIFIED ANSWERS ** ✔✔ small itchy vesicles, common in skin folds.

Which of the following assessment findings is an early indicator of shunt dysfunction? - ** VERIFIED ANSWERS ** ✔✔ personality changes A 2-year-old presents to the emergency department with tonic-clonic movements which the caregivers report occurring for one minute prior to arrival. The priority intervention is - ** VERIFIED ANSWERS ** ✔✔ turning patient to the side. Which of the following requires the MOST emergent evaluation? - ** VERIFIED ANSWERS ** ✔✔ 3-year-old whose head is on father's shoulder with vomiting, pale skin, and tachypnea A 7-year-old child with sickle cell disease arrives with his mother who states the child has chest pain. The child reports 0/10 pain on the FACES scale. The nurse should recognize that school-aged children - ** VERIFIED ANSWERS ** ✔✔ are likely to deny pain to avoid getting injections. EMS arrives with a 6-year-old who was an improperly restrained rear-seat passenger in a head-on collision. The patient complains of diffuse abdominal pain, nausea, and is tachycardic. Which injury should the nurse MOST suspect? - ** VERIFIED ANSWERS ** ✔✔ small bowel injury Which federal regulation ensures that a medical screening exam is performed to determine if an emergent condition exists? - ** VERIFIED ANSWERS ** ✔✔ Emergency Medical Treatment and Active Labor Act A child presents to emergency department with symptoms of anaphylaxis after eating cookies at a birthday party. The friend's parent is accompanying the child and is unable to reach the parents. The nurse recognizes this legal issue as - ** VERIFIED ANSWERS ** ✔✔ implied consent. In a 6-year-old child presenting with fever and a history of a known congenital heart defect, the most concerning contributing factor is - ** VERIFIED ANSWERS ** ✔✔ noncompliance with dental care.

An infant presents to the emergency department with feeding intolerance after 3 days of cold-like symptoms. Upon assessment, the infant is found to have an altered mental status, sunken fontanels and decreased muscle tone. Vital signs are as follows: BP 66/30 mmHgHR 198 beats/minRR 50 breaths/minT (rectal) 97.3˚ F (36.3˚ C) The nurse would suspect what type of shock? - ** VERIFIED ANSWERS ** ✔✔ distributive A toddler with a history of hypoplastic left heart syndrome presents with a fever and tachypnea. The child's oxygen saturation is 76% on room air. The nurse's FIRST priority is to - ** VERIFIED ANSWERS ** ✔✔ determine baseline oxygen saturation. A 2-year-old child has not used his left arm for the past hour. His mother reported grabbing his hand to prevent him from falling from a slide. The nurse should suspect - ** VERIFIED ANSWERS ** ✔✔ subluxation of the radial head An anxious adolescent presents with palpitations, a heart rate of 184 beats/min, and normal skin tone. Which of the following is the PRIORITY intervention? - ** VERIFIED ANSWERS ** ✔✔ Provide comfort and reassurance. Which of the following is a component of the Pediatric Assessment Triangle (PAT)?

• ** VERIFIED ANSWERS ** ✔✔ circulation A 3-year-old presents with nausea, vomiting, and diarrhea for 5 days. The vital signs are: BP 85/45 mm HgHR 136 beats/minRR 32 breaths/minT (rectal) 100.0o F (37.8o C)O2 sat 96% on room air The nurse should anticipate orders for: - ** VERIFIED ANSWERS ** ✔✔ oral rehydration A child is complaining of abdominal and shoulder pain after an all-terrain vehicle crash. He is pale and tachycardic. These symptoms are suggestive of - ** VERIFIED ANSWERS ** ✔✔ splenic injury.

A child arrives to emergency department making a high-pitched noise while breathing, appears pale, and has swelling to the face after eating lunch at school. Utilizing the Pediatric Assessment Triangle (PAT), the nurse would score the patient as - ** VERIFIED ANSWERS ** ✔✔ sickest. Post-tonsillectomy bleeding is - ** VERIFIED ANSWERS ** ✔✔ most common 5- days after surgery. An unresponsive 2-year-old presents with gurgling respirations with retractions. The patient's pulse is present at a rate of 80 beats/min. Which of the following is the PRIORITY intervention? - ** VERIFIED ANSWERS ** ✔✔ Suction the airway. A mother arrives with her three children. The children present with sudden onset of vomiting, diarrhea, abdominal pain, and rhinorrhea. The mother states that they were playing in the yard and shed earlier in the day. Which of the following is the BEST next intervention for the nurse? - ** VERIFIED ANSWERS ** ✔✔ Escort the family outside to the decontamination area. A 5-year-old presents to the emergency department with a fever for the past 2 days. The patient is dancing around singing songs. The skin is pink and there is no evidence of respiratory distress. Utilizing the Pediatric Assessment Triangle (PAT), the nurse would score the patient as - ** VERIFIED ANSWERS ** ✔✔ sick. An 8-month-old infant presents with irritability, and a swollen third digit of the foot. They are afebrile with normal vital signs. The infant should first be evaluated for - ** VERIFIED ANSWERS ** ✔✔ hair tourniquet. A 5-year-old who has recently been on antibiotics presents with tea-colored urine. Which of the following is the MOST likely cause of these symptoms? - ** VERIFIED ANSWERS ** ✔✔ glomerulonephritis A 10-year-old presents to the emergency department with abdominal pain, vomiting and a sudden onset of scrotal pain with swelling. The parent states that the symptoms started approximately one hour ago while the child was playing outside. The nurse should anticipate which diagnostic test will be ordered? - ** VERIFIED ANSWERS ** ✔✔ ultrasound

The discharge instructions that should be reinforced to the parents of a breast feeding infant diagnosed with otitis media are - ** VERIFIED ANSWERS ** ✔✔ "Continue to allow the child to nurse as before." A patient arrives to the emergency department intubated and ventilated via a bag- mask device. EMS reports that the patient fell from a climbing apparatus at school. Upon assessment, the patient is difficult to ventilate and has absent breath sounds on the left side. A needle decompression is performed. The nurse anticipates the PRIORITY will be to - ** VERIFIED ANSWERS ** ✔✔ insert a chest tube. An 8-year-old presents with mild dyspnea and drooling following an all-terrain vehicle crash. There is bruising around the neck at the laryngeal area. Upon palpation, the nurse should expect to feel - ** VERIFIED ANSWERS ** ✔✔ subcutaneous emphysema. Seizures resulting from diluting infant formula are MOST likely caused by - ** VERIFIED ANSWERS ** ✔✔ hyponatremia. What is a PRIORITY treatment for Ludwig's angina? - ** VERIFIED ANSWERS ** ✔✔ administrating antibiotics as ordered A 2-year-old presents with a left thigh deformity after tripping over a toy. Further assessment and diagnostic studies show a left femur fracture, multiple healed fractures to bilateral legs, and blue-tinted sclera. The nurse is suspicious for - ** VERIFIED ANSWERS ** ✔✔ osteogenesis imperfecta.