Pediatric Emergency Care: Recognizing and Managing Critical Conditions, Exams of Nursing

Download Pediatric Emergency Care: Recognizing and Managing Critical Conditions and more Exams Nursing in PDF only on Docsity! PALS Final Exam 2023 Review Questions & Answers Already Graded A+ Mikey, a 2-year-old boy, is sitting upright on a hospital bed in room 3 of your emergency department. Your initial impression from the door does not raise immediate concern. On your entry to the room, you are able to look at Mikey more closely and notice on inhalation his nostrils are flaring. This is a sign of: - ANSWER Respiratory distress The proper site for a peripheral pulse assessment in the infant patient is: - ANSWER brachial You are called to the scene of a 3-year-old patient who was found anxious, *cyanotic* and lethargic after a fall down a flight of stairs. On assessing the patient, you find vital signs with a respiratory rate of 30, regular pulse rate of 130, regular capillary refill time of 4 seconds, and a blood pressure of 102/61. What kind of shock is the patient experiencing? - ANSWER compensate shock? A mnemonic that aids in performing a primary assessment is: - ANSWER ABCDE A consideration of treatment for a pediatric patient with acute fulminant myocarditis who is in cardiac arrest or at a high risk of cardiac arrest is: - ANSWER Extracorporeal membrane oxygenation (ECMO) Which of the following is the correct meaning for one of the individual letters in the AVPU scale? - ANSWER Alert - The child is alert and awake and responds to normal stimuli based upon age and environment The recommended route of vascular access on a hypotensive pediatric patient is: - ANSWER central IV You are called to the bedside of a 12-year-old male patient who was admitted after a week of persistent vomiting, diarrhea and limiting oral intake of both solids and liquids. The patient's airway is patent, ventilatory rate is within normal limits and the patient's circulatory status presents with tachycardia, a blood pressure of 70/40 and a capillary refill time of 5 seconds. The patient is speaking incoherently. The patient has no history of cardiac problems or congenital defects. The appropriate fluid administration dose for this patient is: - ANSWER 20 ml/kg 0.9% NaCl over 10 minutes You suspect your 8-year-old female patient of being hypovolemic. Her parents brought her to the emergency department with persistent vomiting and diarrhea for 5 days. The patient presents with *mottled skin* and reports of periods where "she just stopped breathing!" according to her parents. The patient is being managed with a BVM and supplemental oxygen. What is the best route of establishing vascular access for the purpose of fluid resuscitation? - ANSWER IV Which of the following cannot be administered through an ETT? - ANSWER Sodium bicarbonate You are examining the rhythm strip of a patient who presents with bradycardia. Which of the following characteristics may you notice in the rhythm? - ANSWER The most obvious sign of bradycardia on an ECG is slow heart rate. The characteristics of P- waves and the QRS complex may vary. When looking at an EKG, the following characteristics are seen with bradycardia patients: Slow heart rate, P-waves may not be noticeable, QRS complex may be wide or narrow, and P-waves and QRS complex may not be related to bradycardia. How do children's metabolic rates compare to adults'? - ANSWER higher Children's demand for oxygen is ___________ adults. - ANSWER greater Which of the following must you monitor while fluid resuscitating a patient? - ANSWER Urine output What type of pressure is monitored to obtain right ventricular cardiac preload? - ANSWER Central venous pressure (CVP) Define shock: - ANSWER When oxygen and nutrient supply to body tissue is insufficient compared to metabolic tissue needs Your 5-year-old patient is admitted to the PICU and is being treated by your team for hypovolemic shock. The team has administered one bolus of 20ml/kg of 0.9% NaCl . On re-evaluation the patient is alert and anxious with a heart rate of 145 beats per minute, a blood pressure of 76/48mmHg and a capillary refill time of 4 seconds. Which of the following is the patient's clinical condition? - ANSWER hypotensive shock To treat wheezing in a child, which medication is the most appropriate to administer? - ANSWER Albuterol You arrive on scene to assess a 9-year-old boy who was stung by a bee. The patient is found to be suffering from urticaria and is displaying respiratory distress with a presentation of nasal flaring, tachypnea and accessory muscle use. The patient's mother relates he has never had an allergic reaction to a bee sting, but his father is gravely allergic to bee stings. The patient relates it is hard to breathe. While gathering your initial set of vital signs you note the patient has a room air SpO2 is 90%. This finding classifies the patient as: - ANSWER When the blood is insufficiently oxygenated, hypoxemia can occur. Hypoxemia is a decreased saturation of oxyhemoglobin Which of the statements about supraventricular tachycardia (SVT) is correct? - ANSWER The clinical presentations demonstrate that children and infants lack the ability to tolerate this rhythm well. The mother of a 9-year-old patient reports that her son was playing with a friend when he collapsed while running. At the patients side, you apply an AED and deliver one shock. The patient regains a pulse but remains unresponsive. you successfully place an ETT. There is no evidence of shock or trauma. Your target range for SpO2 is: - ANSWER 94% - 99% Which of the following rhythms is non-shockable? - ANSWER asystole You and your team are treating a 9-year-old patient who is tachycardic. She has a heart rate of 184 and is short of breath but still able to speak in full sentences and is able to follow commands. Emergency intervention for this patient intially is __________. - ANSWER The patient is conscious, able to speak in full sentences and is able to follow commands, attempting vagal maneuvers first is appropriate for this patient. If bradycardia is the result of a complete heart block or an abnormal sinus node function, what therapy is recommended? - ANSWER cardiac pacing The correct IV epinephrine dose for the symptomatic bradycardia patient is: - ANSWER Administration of epinephrine for continuing symptomatic bradycardia via IV/IO is 0.01 mg/kg (1:10,000: 0.1 ml/kg). You arrive on scene to a 4-year-old child who presents *pulseless* and apneic with high-quality CPR being performed and vascular access established. Which is your next intervention? - ANSWER epinephrine Define tachypnea: - ANSWER Tachypnea is defined as an elevated breathing rate for age What is the most common pre-arrest rhythm in children? - ANSWER Bradyarrhythmia Which of the following is a lower airway obstruction? - ANSWER bronchiolitis You are called to the bedside of a patient admitted to the pediatric intensive care unit (PICU) for a 22-month-old patient in severe respiratory distress. The patient has a patent airway, is tachypneic with an increased work of breathing, has as a pulse rate of 150 beats per minute, with no neurologic deficits, and is normothermic. What mnemonic should be used to aid the performance of a secondary assessment? - ANSWER SAMPLE The chief purpose of the respiratory system is to: - ANSWER exchange gases Treatment of obstructive shock includes which of the following? - ANSWER Look for and treat causes of obstructive shock You are administering a bolus of normal saline to a 16 kg child. The appropriate volume is: - ANSWER 320 (20 x 16) What can cause head-bobbing in the infant patient? - ANSWER Increased respiratory effort Hypoxemic ischemia results from: - ANSWER caused by arterial or arteriolar obstruction or vasoconstriction Your patient is a 4-year-old boy who pulled the handle of a pot of hot oil from the top of the stove causing the contents to cover him. You note that the patient is being given iv fluids. The patient is most likely in what kind of shock due to the *burns*? - ANSWER Hypovolemic shock You are evaluating a 3-year-old female patient in the emergency department. Her parents brought her in for an evaluation of increasing cough, difficulty breathing, sputum and now increased irritability. On assessing your patient, you note a temperature of 100.4 F, respiratory rate of 38, and a room air SpO2 of 93%. With this information you can infer that the patient's airway resistance is: - ANSWER increase? A diagnostic test that shows acidosis, tissue hypoxia, anaerobic respiration, and/or high glucose is: - ANSWER Arterial lactate Septic shock is common in children because: - ANSWER They have an underdeveloped immune system and have difficulty fighting infections Which of the following are muscles involved in inspiration? - ANSWER diaphragm intercostals accessory muscles The parents of your patient indicate their child suffered a grand mal seizure for 3 minutes. On examination of the patient you note he is comatose and his breathing pattern is slow and irregular. This is referred to as _______________ and may cause respiratory failure. - ANSWER Disordered regulation of breathing Your patient is tachycardic with a blood pressure just above normal accepted values. The patient is alert to voice. In regards to oxygen therapy, which of the following is true? - ANSWER high flow oxygen Which of the following chest retractions represent moderate breathing difficulty? - ANSWER intercoastal Which of the following is a goal of shock management? - ANSWER The goal of shock management are to correct perfusion problems, improve perfusion/metabolic demand balance, restore organ function and prevent cardiac arrest. Which of the roles listed does data show have no impact on patient survival in an in- hospital cardiac arrest? - ANSWER medical response team? The most common cause of cardiac arrest in infants and children is: - ANSWER Respiratory inadequacy causing hypoxia You are assessing a 5-year-old patient with acute respiratory distress. You note a change in the patient's mental status as well as a decrease in the patients heart rate from 150 beats per minute to 66 beats per minute. You also note that the patients respiratory rate is currently 6 breaths per minute. Your immediate intervention is: - ANSWER When an adult, child or infant has a pulse but is not breathing effectively, rescuers should give breaths without chest compressions. For infant and children, give 1 breath every 3 to 5 seconds, about 12 to 20 breaths per minute. Which of the following statements is correct concerning respiratory management during post-resuscitation? - ANSWER Appropriate PaCO2 level is relative to clinical circumstances. For example, children with asthma and respiratory failure may respond poorly (increased morbidity) to rapid correction of PaCO2 with mechanical ventilation. A normal PaCO2 is preferred for patients with neurologic conditions. Which of the following is suggested treatments for septic shock? - ANSWER Aggressive fluid therapy Which of the following statements concerning cardiac arrest is correct? - ANSWER Uninterrupted CPR is critical when managing cardiac arrest Cardiogenic shock results from: - ANSWER Poor heart contractions Sinus tachycardia occurs in response to an increased need for oxygen and cardiac output. A common cause of sinus tachycardia include: - ANSWER Tissue hypoxia Which of the following statements about tachycardia is relative to the pediatric patient? - ANSWER Sinus tachycardia (ST) is a tachycardic rhythm produced by an increased rate of sinus node discharge. Sinus tachycardia occurs in response to an increased need for oxygen and cardiac output. Sinus tachycardia is not a constant rate, but instead varies as the need for oxygen varies. Sinus tachycardia occurs in response to an increased energy level, but is also a response to many common conditions. There is no indication that this rhythm may lead to cardiac arrest. Emergently using a paralytic agent such as succinylcholine for securing the airway in a pediatric patient may cause bradycardia. What medication and dose would you provide