ANCC Pediatric Nursing 2 — Questions and Answers
Question 1: A 6-year-old presents with barking cough, inspiratory stridor, and low-grade fever. The child is alert and not drooling. Which nursing intervention is the priority?
- Prepare for immediate intubation at bedside
- Place in cool mist environment and administer racemic epinephrine per order (Correct answer)
- Position the child supine for airway assessment
- Obtain throat swab culture before initiating any treatment
Correct answer: Place in cool mist environment and administer racemic epinephrine per order
The presentation describes croup. For mild-to-moderate croup with maintained airway, cool mist and racemic epinephrine for moderate cases are the priority interventions. Dexamethasone is also standard.
Croup (viral laryngotracheobronchitis) typically affects children 6 months to 3 years and is caused by parainfluenza virus. Alert status and absence of drooling distinguish it from epiglottitis. Management: dexamethasone 0.6 mg/kg PO or IM for mild croup; add racemic epinephrine via nebulizer for moderate croup; cool humidified air for comfort. Epiglottitis presents with high fever, drooling, tripod position, and toxic appearance — never examine the throat in that scenario.
Question 2: A child weighing 44 lbs requires amoxicillin 40 mg/kg/day divided every 8 hours. Available suspension is 250 mg/5 mL. How many mL per dose?
- 5.3 mL (Correct answer)
- 10.7 mL
- 3.0 mL
- 8.0 mL
Correct answer: 5.3 mL
44 lbs divided by 2.2 = 20 kg. Total daily dose = 40 mg/kg x 20 kg = 800 mg/day. Per dose (q8h) = 800/3 = 267 mg. Volume = (267/250) x 5 mL = 5.3 mL.
Step-by-step: (1) 44 lbs / 2.2 = 20 kg; (2) 40 mg/kg x 20 kg = 800 mg/day; (3) 800/3 = 266.7 mg per dose; (4) (266.7/250) x 5 = 5.33 mL. Always use independent double-check for pediatric calculations. Standard amoxicillin dosing is 40 mg/kg/day; high-dose for resistant organisms is 80-90 mg/kg/day.
Question 3: A 3-year-old presents with suspected epiglottitis. Which nursing action is the absolute priority?
- Obtain a throat culture to identify the causative organism
- Avoid any agitation; keep child calm with parent; do NOT examine the throat (Correct answer)
- Place child supine and prepare for bag-mask ventilation
- Administer ibuprofen to reduce fever immediately
Correct answer: Avoid any agitation; keep child calm with parent; do NOT examine the throat
Epiglottitis is a life-threatening emergency. Throat examination or any agitation can precipitate complete airway obstruction. The child must be kept calm with the parent while an emergent airway team is assembled.
Epiglottitis: high fever, drooling, dysphagia, hot potato voice, toxic appearance, tripod position. Critical rules: NEVER examine the throat; keep child calm with parent; allow position of comfort; do not start IV or draw blood while awake; assemble emergency airway team (anesthesia plus ENT) immediately; go to OR for controlled intubation under anesthesia. Supine positioning and agitation risk airway collapse.
Question 4: A 28-week gestation newborn in the NICU — which finding is most consistent with respiratory distress syndrome (RDS)?
- Expiratory grunting, nasal flaring, subcostal retractions, and cyanosis on room air (Correct answer)
- Unilateral absent breath sounds with mediastinal shift
- Coarse crackles with productive cough and purulent secretions
- Apnea episodes lasting 15 seconds with rapid spontaneous resolution
Correct answer: Expiratory grunting, nasal flaring, subcostal retractions, and cyanosis on room air
RDS in preterm neonates presents with expiratory grunting, nasal flaring, intercostal/subcostal retractions, and cyanosis — classic signs of surfactant deficiency.
Neonatal RDS occurs due to surfactant deficiency in infants under 32 weeks. Surfactant matures around 35 weeks. Signs: expiratory grunting generates intrinsic PEEP preventing alveolar collapse; nasal flaring reduces nasal resistance; retractions reflect accessory muscle use; cyanosis indicates hypoxemia. Treatment includes exogenous surfactant, CPAP or ventilation, and antenatal betamethasone. Unilateral absent breath sounds suggests pneumothorax.
Question 5: A 10-year-old with sickle cell disease has fever 38.9 C, SpO2 94%, chest pain, and bilateral pulmonary infiltrates. Which complication does this represent?
- Aplastic crisis due to parvovirus B19 infection
- Acute chest syndrome (ACS) (Correct answer)
- Vaso-occlusive pain crisis isolated to chest wall
- Pulmonary embolism from hypercoagulable state
Correct answer: Acute chest syndrome (ACS)
Acute chest syndrome is defined by new pulmonary infiltrate on CXR plus fever, chest pain, cough, hypoxia, or wheezing in a sickle cell patient. It is the leading cause of death in sickle cell disease.
ACS is the most common cause of mortality in sickle cell disease. Criteria: new pulmonary infiltrate plus fever, chest pain, cough, tachypnea, or hypoxia. Etiology: fat embolism from infarcted bone marrow, atypical infection (Mycoplasma, Chlamydia, viral), in-situ sickling. Treatment includes simple or exchange transfusion, incentive spirometry, supplemental O2 to maintain SpO2 at or above 95%, broad-spectrum antibiotics covering atypicals, bronchodilators, and adequate analgesia. Aplastic crisis presents with severe anemia but no pulmonary infiltrates.
Question 6: A 2-year-old weighing 13 kg needs acetaminophen 15 mg/kg every 4-6 hours. Available concentration is 160 mg/5 mL. How many mL per dose?
- 6.1 mL (Correct answer)
- 4.1 mL
- 3.0 mL
- 2.5 mL
Correct answer: 6.1 mL
Dose = 15 mg/kg x 13 kg = 195 mg. Volume = (195/160) x 5 mL = 6.09 mL, approximately 6.1 mL.
Calculation: 15 mg/kg x 13 kg = 195 mg. Available: 160 mg/5 mL. Volume = (195/160) x 5 = 6.09 mL approximately 6.1 mL. Maximum single dose is 1000 mg; maximum daily dose is 75 mg/kg/day or 5 doses. Counsel parents to use provided measuring device only and to check all combination products for acetaminophen content to prevent accidental overdose.
ANCC Pediatric Nursing 2
A 6-year-old presents with barking cough, inspiratory stridor, and low-grade fever.
The child is alert and not drooling.
Which nursing intervention is the priority?