Pediatric Patient Assessment and Management, Exams of Medicine

Download Pediatric Patient Assessment and Management and more Exams Medicine in PDF only on Docsity! ENPC Test 128 Multiple Choice Questions with Answers and Rationales. A 4-day-old who is brought to the emergency department with the parental complaint of "not acting right" is found to be hypoglycemic. What is the appropriate glucose concentration to administer to this neonate? A.Dextrose 5% B.Dextrose 10% C.Dextrose 25% D.Dextrose 50% - Correct Answer B Dextrose 10% is the preferred concentration for neonates with hypoglycemia to protect their fragile vasculature while providing needed glucose. Dextrose 5% is not used to treat hypoglycemia in children. Dextrose 25% is used for children above the age of 5 years. Dextrose 50% is not recommended for use in pediatrics unless it is diluted. Assessment of the fontanelle provides the most useful information for which two components of the primary survey? A.Circulation and disability B.Breathing and circulation C.Disability and exposure D.Circulation and exposure - Correct Answer A A sunken fontanelle is a red flag for circulation assessment in pediatric triage and may indicate dehydration . A bulging fontanel is a red flag for disability assessment in pediatric triage and can indicate increased intracranial pressure. Which of the following indicates the need for additional caregiver education regarding a urinary tract infection? A.I should encourage my child to drink extra fluids. B.I need to make a follow-up appointment with child's physician. C.My child will grow out of their frequent urinary tract infections. D.My child should complete all of their antibiotic medication. - Correct Answer C A nurse providing trauma informed care to the family of a seriously ill child should be doing which of the following? A.Placing the family in a quiet, secluded room B.Referring to their child as "the patient" C.Making sure the family does not stay at the bedside. D.Appointing one staff member to stay with the family - Correct Answer D Caregivers experiencing the crisis of a critically ill child have low attentiveness and increased stress so would benefit from having a member of the healthcare team to stay with them as much as possible and communicate updates on the plan of care. Caregivers should be allowed to stay with their child as much as possible and not placed in a secluded room away for them. The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure history. 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 caregiver states the burns accidentally occurred three days ago, but was afraid to bring the patient in due to an ongoing child welfare investigation.Which of the following groups of interventions are the priority for this patient? A.Call police and child welfare authorities and have security detain the caregiver B.Administer intravenous analgesics and obtain a point of care glucose B.Insertion of orogastric to remove of water and debris from stomach C.Endotracheal intubation to provide positive pressure ventilation D.Removal of wet clothing to prevent hypothermia - Correct Answer C The primary survey assessment and treatment of deficits are the priority. Airway control and positive pressure ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8) should be performed while also maintaining cervical spine stabilization. The child is responsive only to painful stimuli, has shallow respirations, and diminished breath sounds. All of these are breathing problems and must be addressed immediately. Removing wet clothing is necessary, but is not the main priority initially. With intubation an orogastric tube will be placed and abdominal thrusts are not necessary to remove fluid from the abdomen. A 3-month-old is brought to the emergency department with new onset of fever. You note the child to be pale, tachypneic, and tachycardic, with weak distal pulses. Which intervention is the priority for this patient? A.Administer an appropriate dose of an antipyretic B.Infuse a rapid 10-20 mL/kg bolus of an isotonic crystalloid C.Prepare a broad spectrum antibiotic infusion D.Administer a vasoactive medication - Correct Answer B This patient most likely has septic shock. An immediate goal is to reverse shock and restore tissue perfusion with fluids. An antipyretic may be needed based on the temperature and patient symptoms. An antibiotic should be started within an hour, and vasoactive medications may not be needed if fluid resuscitation is successfu A 6-month-old is seen for a recurrent respiratory infection. During the assessment, the mother adds that the patient's stools seem to be fatty or "greasy". Which of the following disease processes would be a primary concern for this child? A.Cystic fibrosis B.Bronchopulmonary dysplasia C.Pneumonitis D.Down syndrome - Correct Answer A In patients with cystic fibrosis, thick mucus inhibits the release of pancreatic enzymes necessary for digestion. This results in impaired absorption and the inability to utilize ingested fats. These fats are excreted in the stools and can present as "fatty" or "greasy". Combined with the recurrent upper respiratory infections for an infant, cystic fibrosis should be ruled out. The other three disease processes frequently present with respiratory issues but fatty stools would not normally be seen. A 14-year-old patient sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain control interventions is most likely to result in improvement in symptoms related to pain? A.Applying a topical lidocaine-based cream B.Elevating the extremity to the level of the heart C.Placing warm compresses on the affected extremity D.Applying a splint to the affected extremity - Correct Answer D Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures. This will also help to minimize complications. Topical creams and elevation of the extremity will not help with pain control. The application of ice in an appropriate manner can help, but not warmth which would be contraindicated in the early stages of the injury. Which of the following is a known cause of pediatric seizures? A.Benzodiazepine overdose B.Supraventricular tachycardia C.Overdiluted formula D.Congenital heart disease - Correct Answer C Water overload is a well-documented etiology of hyponatremia in infants, which can be caused by excess dilution of formula. Hyponatremia is a known cause of seizures. Benzodiazepine overdose is more likely to result is respiratory depression and coma. CHD and SVT are not readily known to cause seizures. For the infant, what duration of time is consider apneic? A.10 seconds B.20 seconds C.5 seconds D.15 seconds - Correct Answer B The respiratory rate, depth, and regularity all continue to change the first year of life, making respiratory assessments different than those of older children. Infants breathe faster and less regularly, with apnea not considered as such until 20 seconds without a breath or associated with other physiologic effects such as bradycardia. 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? A.Assess the oropharynx B.Assess endotracheal tube placement C.Insert an orogastric tube D.Insert a second intravenous access - Correct Answer B If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place, assess its placement, patency, and the oral airway (in that order) before moving to the next step of the triangle (PAT) reveals an age-appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted in both nares. Which of the following is the best next step? A.Obtain a history including immunization status B.Suction nasal passages using a bulb syringe C.Administer oxygen by nasal cannula with patient in caregiver's arms D.Respiratory assessment is completed so move to circulatory - Correct Answer B 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. A good, thorough history should always include immunization status for pediatric patients. The nose needs to be clear before applying oxygen via nasal cannula. Respiratory assessment includes interventions to improve breathing so you would not move to move to circulation until that is accomplished. You need to draw blood from a 2-year-old. Which of the following is the best approach for this patient? A.Allow them to hold the blood tubes before drawing B.Have them watch a cartoon on an I-pad or cell phone C.Give them an explanation of what will happen D.Prepare the equipment in the room so they can see - Correct Answer B The best approach to a toddler who requires interventions is to provide distractions whenever possible. They are in the cognitive development phase of "sensorimotor/preoperational" so having the caregiver present is helpful. You should move from the least invasive to most invasive tasks, and don't let them watch you prepare since it will increase anxiety. Differences in infants airways - Correct Answer - nose breathers- suction if needed, prefer nose breathers til 6 mo - larger tongue than their oral cavity - easier obstruction - weak cartilage rings- collapse like a bendy straw compared to adults whose are mature and don't collapse with neck flexion/resp distress - large heads can cause slight flexion, have towels under head - monitor ET placement often VS for 3-5 years - Correct Answer RR 18-35 HR VS for 1-12 mo olds - Correct Answer RR 30-55 HR 90-180 VS for 12-18 yo - Correct Answer RR 12-20 HR 60-100 VS for 1-3 yo - Correct Answer RR 22-40 HR 85-104 VS for 5-12 yo - Correct Answer RR 16-30 HR 90-115 VS for less than 1 mo - Correct Answer RR 35-60 HR 90-180 Be aware infants can respond to infection with which VS change - Correct Answer hypothermia vs hyperthermia How to perform procedures on child - Correct Answer least invasive to most invasive Tachycardia is considered a sign of ___ in peds until proven otherwise - Correct Answer inadequate tissue perfusion CO in infants vs adults - Correct Answer twice that of adults- leaves less for reserves Abdominal trauma pediatric are at higher risk for injury due ot - Correct Answer -larger organs such as spleen/kidney -not fully attached sigmoid/colon -protruding belly, higher ribcage, small pelvis, immature abdominal muscles Birth to 12 mo nursing technique/stage of development - Correct Answer trust vs mistrust- take in quiet voice, separation anxiety 1-3 yrs nursing technique/stage of development - Correct Answer autonomy vs shame and doubt, let sit on caregivers lap 3-6 yrs nursing technique/stage of development - Correct Answer preschool, initiative vs guilt, give simple explanations 6-12 yrs nursing technique/stage of development - Correct Answer school age, industry vs inferiority, people pleasers 13-18 yrs nursing technique/stage of development - Correct Answer adolescence- identity vs role confusion, honest and straight forward communication 3 parameters of PAT - Correct Answer appearance, work of breathing, circulation to skin What to look at for PAT appearance - Correct Answer T-tone; muscle tone/flaccid I-Interactiveness C-Consolability L-Look/gaze-; eyes open, staring off, sleeping S-Speech/cry apply gentle pressure on symphyis pubis if crests are stable inspect perineium consider how to collect urinary output (foley, external, weigh diapers) inspect/palpate all 4 extrems for neurovascular status Inspect posterior surfaces Imaging if suspected spinal/pelvis injury log roll Signs of heart disease in neonates - Correct Answer respiratory or shock symptoms with no fever or sick contacts Fracture in infant may be sign of - Correct Answer abuse- due to cartilage it is hard to break Any signs of altered mental status check? - Correct Answer blood sugar! Sites for Io access - Correct Answer medial tibia below tuberosity, distal tibia, femur, humerus Red flag for triage in children - Correct Answer if caregiver says they are fussy Any alteration in mental status in pediatric pt should be considered a result of - Correct Answer Decreased cerebral perfusion or hypoglycemia until proven otherwise What can you use to measure ET tube for pediatric pts? - Correct Answer Their fifth (pinky) finger Best way to deliver fluid bolus for little children - Correct Answer 20 mL syringe and push/pull method Urine output of less than ___ can reflect poor end-organ failure - Correct Answer 1mg/kg/hour How long may it take for newborns oxygen sats to read over 90%? - Correct Answer 10 minutes What can be common in neonates that seems alarming? - Correct Answer Acrocyanosis (blueness of hands, feet, skin around mouth) due to cold Central cyanosis is BAD (paleness or blueness of head, lips, trunk) do resuscitation blue baby syndrome - Correct Answer The illness that occurs when we have too much nitrates in our water, especially in children. Bluish discoloration especially when crying Sign hemoglobin can't transport oxygen to tissue Mild no treatment, some may need methylene blue, ascot if acid, blood, hyperbaric oxygen Infant receiving prostaglandin is at increased risk for __ - Correct Answer Apnea so have airway and ET supplies ready What kind of shock is associated with trauma? - Correct Answer Hypovolemic (hemorrhage) or obstructive (pneumothorax) Indications for pediatric chest compressions - Correct Answer Pulselessness Heart rate less than 60 with signs of poor perfusion Give oxygen and ventilation if no improvement start CPR A silent chest may indicate - Correct Answer Air flow so bad can't make wheeze A silent chest may indicate - Correct Answer Air flow so bad can't make wheeze Whose at higher risk for dehydration? - Correct Answer Infants, toddlers, children with disabilities Red flag assessment signs for pt with history of vomiting - Correct Answer Bilious vomiting, hematemesis or bloody stools, projectile, evidence of shock or dehydration, neuro changes, distention or pain, no bowel sounds, weight loss What do you think this child has? Hypotension, vomiting, abdominal cramping, diarrhea - Correct Answer Anaphylaxis Unilateral lower abdominal pain is considered __ from time of menarche due to risk of - Correct Answer Emergency Risk of hemorrhage from ruptured fallopian tube til pregnant test confirmed What to do first when preparing to go into room of kid with infectious disease - Correct Answer Don PPE and consider safety threats/precautions Sign of non-blanching rash - Correct Answer Non blanching means doesn't fade or turn white when pressure applied Sign of it may indicate shock or meningitis Things to know if bicycle crash - Correct Answer helemt, excursion, involving handlebar thinsg to know if fall injury - Correct Answer how it happened, how their body looked, how far from ground, what they landed on Do concussions show up in CT? - Correct Answer No- determined by s/s Normal pediatric temps - Correct Answer 97.2-100.4 Typically fevers are okay and viral in pediatric pts, when should you be concerned about a fever?> - Correct Answer if they are immunocompromised ill-appearing the higher the fever, the higher chance ___ will occur - Correct Answer febrile seizures Meningitis diagnosis and tx - Correct Answer diagnosed with cultures, labs, CT to rule out inc ICP prior to LP tx ABX Kawasaki disease - Correct Answer (inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. s/s higher fever, rash tx IVIG, high dose aspirin scarlet fever s/s - Correct Answer fever, sore throat, strawberry tongue, rash on trunk that spreads to limbs tx ABX signs of bad dehydration (lost 5% of body weight) - Correct Answer prolonged cap refill, skin turgor abnormal, abnormal resp pattern, cool extrems, weak pulses, no tears How much to ORT to replace fluid loss - Correct Answer 50-100 ml/kg over 2-4 hours give 5-10 ml every 5 min monitor for signs fluid overload Examples of surgical abdomen and keep NPO - Correct Answer appendicitis, pyloric stenosis, intussception, malrotation and volvus, s/s appendicitis - Correct Answer Persistent RLQ Pain, pain in umbilical region, rupture of appendix: sudden severe pain pyloric stenosis - Correct Answer inadequate stomach emptying after feeding s/s infant whose persistently hungry after forceful nonbilious vomiting after feeding intussusception - Correct Answer Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools Malrotation and Volvulus - Correct Answer intestine twists on itself EMERGENCY s/s bilious vomiting, pain, shock, poor feeds tx NG/OG and surgery Kid comes in with abdominal pain, ask what else? - Correct Answer how long, anything makes better, throwing up-what's that look like, stools, ate anything new/swallowed toy Ingestion of what can be deadly to pediatrics? - Correct Answer button batteries and,magnets burns, bleeding, chemical leaks poisoning tx for battery/magnet consumption - Correct Answer if asymptomatic: 5-10 ml honey at home, repeat in ER q 10 min for up to 6 doses NPO besides honey symptomatic: NPO no honey, oral sucralfate ovarian torsion - Correct Answer Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary ectopic pregnancy s/s - Correct Answer pelvic pain, vaginal bleeding 6-8wks after last period, pain in abdomen, bloating, nausea, vomit, cramping testicular torsion - Correct Answer a sharp pain in the scrotum caused by twisting of the vas deferens and blood vessels leading into the testicle tx immediate urology and surgery priapism - Correct Answer a painful erection that lasts 4 hours or more but is not accompanied by sexual excitement find out if ischemic or not, needle aspiration, urology