Pediatric CCRN Critical Care Flashcards

A 2-year-old was brought in for a routine checkup at the pediatric clinic. The nurse would anticipate watching to evaluate the child's interactions with other kids.

Answer: Parallel play

At 2 years old, children are typically in the stage of parallel play. This means they play alongside other children, often with similar toys, but do not directly interact, share, or engage in cooperative activities. They are observing and learning from each other's presence without direct engagement, which is a normal developmental milestone for this age.

A young child may have pinworms because of how he described his initial sensations:

Answer: Anal itching

Pinworm infections (enterobiasis) are classically characterized by intense anal itching, especially at night. This occurs because the female pinworms migrate from the rectum to the perianal region to lay their eggs, causing significant irritation and pruritus. The itching can be severe enough to disrupt sleep and is the most common symptom described by affected children.

A school-aged youngster receives complete parental nutrition (TPN) from nurse Tammy through a peripheral I.V. line. What is the least quantity of glucose deemed safe, won't burn tiny veins, and yet delivers enough TPN?

Answer: 10%

For peripheral intravenous (IV) administration of total parenteral nutrition (TPN) in children, the glucose concentration is typically limited to 10%. Higher concentrations are hyperosmolar and can cause phlebitis, irritation, and sclerosis of the small, fragile peripheral veins. If higher glucose concentrations are required to meet nutritional needs, central venous access is necessary to prevent vascular damage.

The parents of a 3-year-old hospitalized with hemophilia receive advice from the nurse on caring for their kid at home. Which of the following parent-made statements suggests the need for more instructions?

Answer: “We will avoid having the child receive immunizations and cancel the scheduled dental appointments.”

Avoiding immunizations and canceling dental appointments for a child with hemophilia is incorrect and indicates a need for further instruction. Children with hemophilia still require immunizations, which should be administered subcutaneously with a small-gauge needle and pressure applied to minimize bleeding risk. Regular dental care is crucial to prevent gum disease and tooth decay, which could lead to more invasive procedures and potential bleeding complications.

The nurse intends to administer oral antibiotics to a 3-year-old child. Which of the following is the nurse's best course of action?

Answer: "Would you like to take your medicine from a spoon or a cup?"

For a 3-year-old, who is in Erikson's stage of initiative vs. guilt, offering limited choices provides a sense of control and autonomy. Asking 'Would you like to take your medicine from a spoon or a cup?' empowers the child, making them more cooperative and less resistant to taking medication. This approach respects their developing independence without giving them the option to refuse the medication entirely.

Metronidazole suspension, 200 mg per dosage, is being used to treat a 3-year-old child. The daily dosing range for the 30-pound youngster is 20–40 mg/kg of body weight given in three divided doses every eight hours. What should the nurse do knowing the safe drug administration principles?

Answer: Administer the medicine as ordered

The nurse first calculates the child's weight in kilograms (30 lbs / 2.2 = 13.6 kg). The safe daily dose range of 20-40 mg/kg translates to 272 mg to 544 mg per day. The ordered dose of 200 mg per administration, given three times a day, totals 600 mg/day. While this dose is at the higher end of the therapeutic window, it is often considered acceptable in clinical practice for metronidazole, especially when the child's condition warrants it and close monitoring for adverse effects is implemented. Therefore, the nurse would administer the medication as ordered.

Which of the following findings should a nurse disclose right away when examining a 3-week-old baby:

Answer: Inspiratory grunting

Inspiratory grunting in a 3-week-old baby is a significant sign of respiratory distress and should be reported immediately. Grunting is the sound of air being exhaled against a partially closed glottis, which helps to increase end-expiratory pressure and prevent alveolar collapse. This compensatory mechanism indicates increased work of breathing and potential underlying respiratory pathology requiring urgent assessment.

Which age group of pediatric kids in hospitals is most prone to see illness as a consequence of misbehavior?

Answer: Preschoolers

Preschoolers, typically aged 3-5 years, are in a stage of cognitive development characterized by magical thinking and egocentrism. They often perceive illness as a punishment for misbehavior or 'being bad,' as they struggle to understand abstract concepts like germs or disease processes. This can lead to feelings of guilt, fear, and confusion about their condition.

What is the most typical localized infection in a newborn that occurs preceding or as a result of sepsis?

Answer: Meningitis

Meningitis is the most typical localized infection in a newborn that can precede or result in sepsis. Newborns are particularly vulnerable to central nervous system infections due to their immature immune systems and the potential for pathogens to cross the blood-brain barrier. Untreated or rapidly progressing meningitis can quickly lead to systemic infection and life-threatening sepsis in this vulnerable population.

Which of the following variables will cause the oxyhemoglobin dissociation curve to shift to the right and have a negative effect?

Answer: Hyperthermia

The oxyhemoglobin dissociation curve shifts to the right when there is a decrease in hemoglobin's affinity for oxygen, meaning oxygen is more readily released to the tissues. Factors that cause a right shift include increased temperature (hyperthermia), increased PCO2, increased 2,3-DPG, and decreased pH (acidosis). Hyperthermia increases metabolic demand, requiring more oxygen delivery to tissues.

Which of the following typical pacemaker modes should be used as an emergency treatment to establish ventricular activity when there is AV dissociation and maintain cardiac output (CO) without an atrial kick?

Answer: VVI (ventricular demand pacing)

VVI (Ventricular Demand Pacing) is a common emergency pacemaker mode used to establish ventricular activity when there is AV dissociation. In this mode, the pacemaker senses intrinsic ventricular activity and paces the ventricle only if no intrinsic beat is detected within a set interval. This ensures a minimum heart rate and maintains cardiac output, even without the atrial kick, which is often lost with AV dissociation.

Which daily routine should be included in the bundle to lower the frequency of central line-associated bloodstream infections?

Answer: Review of catheter necessity

A crucial component of central line-associated bloodstream infection (CLABSI) prevention bundles is the daily review of catheter necessity. By regularly assessing if the central line is still essential for patient care, unnecessary catheters can be removed promptly. Removing catheters as soon as they are no longer needed significantly reduces the duration of exposure and the overall risk of infection.

Which of the following conditions are more likely in patients with cardiac abnormalities linked to increased pulmonary blood flow?

Answer: Heart Failure

Cardiac abnormalities linked to increased pulmonary blood flow, such as large ventricular septal defects (VSDs) or patent ductus arteriosus (PDA), cause a left-to-right shunt. This leads to an excessive volume of blood flowing into the pulmonary circulation, increasing the workload on the heart and lungs. Over time, this sustained overload can lead to pulmonary hypertension and ultimately result in congestive heart failure.

In a patient with bronchopulmonary dysplasia (BPD), which ventilatory parameters should be tapered down first?

Answer: Oxygen (FiO2) and peak inspiratory pressure (PIP)

In patients with bronchopulmonary dysplasia (BPD), the primary goal of ventilatory weaning is to reduce lung injury caused by high oxygen concentrations and barotrauma. Therefore, the fraction of inspired oxygen (FiO2) and peak inspiratory pressure (PIP) are typically tapered down first. Reducing FiO2 minimizes oxygen toxicity, while lowering PIP decreases mechanical stress on the fragile developing lungs.

A patient with heart failure who has bronchopulmonary dysplasia (BPD) is admitted. The nurse should prepare to administer interventions to ______.

Answer: Decrease Preload

In a patient with heart failure and bronchopulmonary dysplasia (BPD), interventions are aimed at improving cardiac function and reducing pulmonary congestion. Decreasing preload helps to reduce the volume of blood returning to the heart, thereby lessening the workload on the failing heart and alleviating symptoms of pulmonary edema, which is particularly critical in patients with compromised lung function like BPD.

A newborn with transposed great arteries is hospitalized. 46% is the SpO2 value. Which of the following medications should the nurse anticipate being given as a temporary solution until a balloon septostomy can be performed?

Answer: Alprostadil (PGE1)

In a newborn with transposed great arteries and low SpO2 (46%), Alprostadil (PGE1) is administered as a temporary measure. PGE1 maintains the patency of the ductus arteriosus, which is crucial for mixing oxygenated and deoxygenated blood in this condition. This allows for improved systemic oxygenation until a definitive surgical intervention like a balloon septostomy or arterial switch can be performed.