CFRN Pediatric and Neonatal Patients 5 — Questions and Answers
Question 1: A 6-year-old with known type 1 diabetes is unresponsive with a blood glucose of 28 mg/dL and no IV access. The most appropriate immediate treatment is:
- Oral glucose gel squeezed into the cheek
- Glucagon 1 mg IM (Correct answer)
- D50W 1 mL/kg via intraosseous route
- Normal saline 20 mL/kg IV bolus
Correct answer: Glucagon 1 mg IM
Glucagon 1 mg IM is the appropriate emergency treatment for severe hypoglycemia in a child without IV access.
Question 2: A neonate is born with gastroschisis. During transport, the exposed bowel should be managed by:
- Replacing the bowel into the abdomen manually and applying a pressure dressing
- Wrapping the bowel in dry sterile gauze only
- Covering the bowel with saline-moistened warm gauze and a plastic wrap or bowel bag (Correct answer)
- Applying petroleum gauze directly and securing with a tight abdominal binder
Correct answer: Covering the bowel with saline-moistened warm gauze and a plastic wrap or bowel bag
Exposed bowel in gastroschisis must be kept moist and warm with saline-moistened gauze and covered with plastic wrap or a bowel bag to prevent heat and fluid loss.
Question 3: A 16-month-old presents with multiple bruises in various stages of healing, a posterior rib fracture on X-ray, and a history inconsistent with the injury pattern. The flight nurse's priority is:
- Discharge after pain management and advise the family to follow up
- Document and notify receiving facility of suspected non-accidental trauma (Correct answer)
- Confront the caregivers directly before transport
- Defer reporting to the receiving physician only
Correct answer: Document and notify receiving facility of suspected non-accidental trauma
Posterior rib fractures and inconsistent history are hallmarks of non-accidental trauma; the flight nurse must document findings and notify the receiving team per mandatory reporting obligations.
Question 4: A 3-year-old weighing 15 kg requires intraosseous (IO) access. After confirming placement, the maximum single fluid bolus volume that should be delivered via IO in this patient is:
- 50 mL (normal saline)
- 150 mL (normal saline)
- 300 mL (normal saline) (Correct answer)
- 600 mL (normal saline)
Correct answer: 300 mL (normal saline)
IO bolus dose for pediatric resuscitation is 20 mL/kg; for a 15 kg child that equals 300 mL per bolus.
Question 5: A term neonate requires PPV during resuscitation. After 30 seconds of PPV with no improvement in heart rate, what is the NEXT step per NRP guidelines?
- Increase oxygen concentration to 100% and continue PPV
- Perform MR. SOPA corrective steps (mask adjustment, reposition, suction, open mouth, pressure increase, alternative airway) (Correct answer)
- Initiate chest compressions immediately
- Administer epinephrine 0.1 mg/kg IV
Correct answer: Perform MR. SOPA corrective steps (mask adjustment, reposition, suction, open mouth, pressure increase, alternative airway)
If PPV is not producing chest rise or improving heart rate, NRP directs the provider through corrective ventilation steps (MR. SOPA) before escalating to compressions.
Question 6: A 7-year-old with anaphylaxis from a bee sting has received epinephrine IM and diphenhydramine. During transport, the child becomes hypotensive again. The next intervention should be:
- Repeat epinephrine 0.01 mg/kg IM and start IV fluid bolus 20 mL/kg (Correct answer)
- Double the diphenhydramine dose IV
- Give methylprednisolone 2 mg/kg IV and observe
- Administer glucagon 1 mg IV for refractory anaphylaxis
Correct answer: Repeat epinephrine 0.01 mg/kg IM and start IV fluid bolus 20 mL/kg
Biphasic or refractory anaphylaxis with hypotension requires repeat epinephrine IM plus aggressive IV fluid resuscitation.
Question 7: When calculating medication doses for a pediatric patient using a length-based resuscitation tape (Broselow tape), which principle is MOST important?
- Always round up to the nearest adult dose if the child appears large
- Use the color zone corresponding to the child's measured length regardless of actual weight (Correct answer)
- Add 10% to all doses for obese-appearing children
- The tape is only validated for neonates under 5 kg
Correct answer: Use the color zone corresponding to the child's measured length regardless of actual weight
The Broselow tape is length-based and validated for use by color zone; the color zone corresponding to measured length provides weight estimates and pre-calculated doses even if the child appears over- or underweight.
CFRN Pediatric and Neonatal Patients 5
A 6-year-old with known type 1 diabetes is unresponsive with a blood glucose of 28 mg/dL and no IV access.
The most appropriate immediate treatment is: