ENPC ENPC Respiratory Emergencies 2 — Questions and Answers
Question 1: A 5-year-old presents with fever, severe sore throat, drooling, and tripod positioning. What is the PRIORITY nursing action?
- Obtain a throat culture immediately
- Prepare for airway management in a controlled setting with ENT and anesthesia present (Correct answer)
- Administer racemic epinephrine via nebulizer
- Obtain a lateral neck X-ray before any intervention
Correct answer: Prepare for airway management in a controlled setting with ENT and anesthesia present
Epiglottitis with tripod positioning is a life-threatening emergency requiring immediate controlled airway management to prevent complete obstruction.
Question 2: Which assessment finding is MOST indicative of tension pneumothorax in a pediatric trauma patient?
- Bilateral decreased breath sounds
- Tracheal deviation away from the affected side with hypotension and absent breath sounds (Correct answer)
- SpO2 of 92% with supplemental oxygen
- Dull percussion over the affected lung field
Correct answer: Tracheal deviation away from the affected side with hypotension and absent breath sounds
Tension pneumothorax classically presents with tracheal deviation away from the affected side combined with hemodynamic compromise.
Question 3: A 6-month-old presents with rapid breathing, nasal flaring, and wheezing during RSV season. What is the most likely diagnosis?
- Asthma
- Pneumonia
- Bronchiolitis (Correct answer)
- Croup
Correct answer: Bronchiolitis
RSV bronchiolitis is the most common lower respiratory infection in infants, presenting with wheezing and respiratory distress during winter.
Question 4: Evidence-based management of bronchiolitis in an infant with moderate respiratory distress primarily includes:
- Routine bronchodilators and systemic corticosteroids
- Supportive care with supplemental oxygen, nasal suctioning, and hydration (Correct answer)
- IV antibiotics and chest physiotherapy
- Immediate intubation and mechanical ventilation
Correct answer: Supportive care with supplemental oxygen, nasal suctioning, and hydration
Bronchiolitis management is primarily supportive, as bronchodilators and corticosteroids have not shown consistent clinical benefit.
Question 5: A child has SpO2 of 88% despite non-rebreather mask oxygen. Which intervention is MOST appropriate?
- Increase the oxygen flow rate on the NRB mask
- Apply a Venturi mask instead
- Initiate high-flow nasal cannula or prepare for non-invasive positive pressure ventilation (Correct answer)
- Switch to a simple face mask
Correct answer: Initiate high-flow nasal cannula or prepare for non-invasive positive pressure ventilation
Persistent hypoxemia despite a non-rebreather mask indicates the need for escalation to high-flow nasal cannula or non-invasive ventilation.
Question 6: After a near-drowning event, which finding MOST warrants hospital admission for monitoring?
- Heart rate of 100 bpm after rescue
- Normal lung exam immediately post-event
- Transient self-limited coughing during the submersion
- Any submersion with loss of consciousness or that required resuscitation (Correct answer)
Correct answer: Any submersion with loss of consciousness or that required resuscitation
Any child who required resuscitation or lost consciousness during submersion must be admitted to monitor for delayed pulmonary complications.
ENPC ENPC Respiratory Emergencies 2
A 5-year-old presents with fever, severe sore throat, drooling, and tripod positioning.
What is the PRIORITY nursing action?