BCEN Pediatric Emergencies 3 — Questions and Answers
Question 1: A 4-year-old presents with sudden onset high fever, drooling, tripod positioning, and refusal to swallow. Which action is contraindicated?
- Preparing for definitive airway in the OR
- Keeping the child calm and upright
- Performing a throat exam with a tongue depressor (Correct answer)
- Calling anesthesia immediately
Correct answer: Performing a throat exam with a tongue depressor
Attempting to visualize the throat with a tongue depressor in suspected epiglottitis can trigger complete airway obstruction.
Question 2: Which pediatric vital sign parameter is MOST reliable for detecting early shock?
- Blood pressure
- Heart rate (Correct answer)
- Respiratory rate
- Capillary refill time
Correct answer: Heart rate
Heart rate is the most sensitive early indicator of shock in children, as blood pressure is maintained until decompensation occurs.
Question 3: A 6-week-old presents with projectile vomiting after every feeding, weight loss, and a palpable 'olive' mass in the epigastrium. The nurse anticipates which diagnosis?
- Intussusception
- Malrotation with volvulus
- Pyloric stenosis (Correct answer)
- Hirschsprung disease
Correct answer: Pyloric stenosis
Pyloric stenosis classically presents at 2-8 weeks with projectile non-bilious vomiting and a palpable pyloric mass.
Question 4: A 9-year-old with asthma presents with an O2 sat of 88%, accessory muscle use, and no improvement after two albuterol nebulizations. What is the next priority intervention?
- Oral prednisone and discharge planning
- IV magnesium sulfate (Correct answer)
- Immediate intubation
- Heliox therapy alone
Correct answer: IV magnesium sulfate
IV magnesium sulfate is indicated in severe asthma exacerbations not responding to bronchodilators as a bronchodilating adjunct.
Question 5: A 3-year-old is found unresponsive in the bathtub. After 2 minutes of CPR, a rhythm is identified as ventricular fibrillation. What is the appropriate defibrillation dose?
- 1 J/kg
- 2 J/kg (Correct answer)
- 4 J/kg
- 360 J
Correct answer: 2 J/kg
The initial defibrillation dose for pediatric VF is 2 J/kg per PALS guidelines.
Question 6: Which electrolyte abnormality is most commonly associated with pyloric stenosis?
- Hyperkalemic metabolic acidosis
- Hypokalemic hypochloremic metabolic alkalosis (Correct answer)
- Hyponatremic metabolic acidosis
- Hyperchloremic metabolic alkalosis
Correct answer: Hypokalemic hypochloremic metabolic alkalosis
Persistent vomiting of gastric contents in pyloric stenosis causes loss of H⁺ and Cl⁻, resulting in hypokalemic hypochloremic metabolic alkalosis.
Question 7: A 15-month-old presents with colicky abdominal pain, 'currant jelly' stools, and a sausage-shaped abdominal mass. Which diagnostic/therapeutic procedure is most appropriate?
- Emergent laparotomy
- Air or contrast enema (Correct answer)
- Nasogastric decompression only
- CT scan before any intervention
Correct answer: Air or contrast enema
Air or contrast enema is both diagnostic and therapeutic for intussusception and is the preferred initial intervention in stable patients.
BCEN Pediatric Emergencies 3
A 4-year-old presents with sudden onset high fever, drooling, tripod positioning, and refusal to swallow.
Which action is contraindicated?