Pediatric Nurse Common Pediatric Emergencies Questions and Answers — Questions and Answers
Question 1: A 5-year-old is brought to the emergency department after a bee sting. The child is anxious, with widespread urticaria, inspiratory stridor, and diffuse wheezing. Vital signs are: HR 140, RR 32, BP 70/40 mmHg, SpO2 92%. What is the priority medication to administer?
- Diphenhydramine IV
- Albuterol via nebulizer
- Epinephrine IM (Correct answer)
- Methylprednisolone IV
Correct answer: Epinephrine IM
The child is exhibiting signs of anaphylaxis, a life-threatening multi-system allergic reaction characterized by respiratory compromise (stridor, wheezing) and hypotension. Intramuscular (IM) epinephrine is the first-line, priority treatment for anaphylaxis. It rapidly reverses bronchoconstriction, vasoconstricts peripheral blood vessels to improve blood pressure, and reduces edema. While albuterol, diphenhydramine, and corticosteroids are often used as adjunctive therapies, they do not act as quickly or broadly as epinephrine and should never be used as a substitute for it in an acute life-threatening reaction.
Question 2: A nurse is assessing a 7-year-old child who sustained a head injury after falling from a bicycle. Which of the following is considered an early sign of increased intracranial pressure (ICP) in a conscious child?
- Bradycardia
- Headache and vomiting (Correct answer)
- Fixed and dilated pupils
- Decorticate posturing
Correct answer: Headache and vomiting
Headache and vomiting (often forceful and without nausea) are classic early signs of increased intracranial pressure in a verbal child. These symptoms result from pressure on the brainstem and stretching of the meninges. Bradycardia, along with hypertension and irregular respirations (Cushing's triad), is a late and ominous sign. Fixed and dilated pupils and abnormal posturing are also late findings indicating significant brainstem compression and herniation.
Question 3: An 8-month-old infant is brought to the ED with a history of sudden, intermittent episodes of inconsolable crying and drawing his knees to his chest. The parent reports one diaper with bloody, mucus-like stool. Between episodes, the infant is lethargic. Which condition should the nurse suspect?
- Gastroenteritis
- Pyloric Stenosis
- Appendicitis
- Intussusception (Correct answer)
Correct answer: Intussusception
This clinical presentation is classic for intussusception, where one segment of the intestine telescopes into another. The key features are intermittent, severe, colicky abdominal pain; lethargy between episodes; and the passage of 'currant jelly' stool (a mixture of blood and mucus). Gastroenteritis typically presents with watery diarrhea. Pyloric stenosis involves projectile, non-bilious vomiting and is more common in younger infants. Appendicitis is rare in infants and presents with more constant, localizing pain.
Question 4: A 10-year-old with a new diagnosis of Type 1 Diabetes is brought to the ED with lethargy, Kussmaul respirations, and a blood glucose of 520 mg/dL. The child is tachycardic and has dry mucous membranes. The nurse should anticipate which initial intravenous fluid bolus for resuscitation?
- Dextrose 5% in 0.45% Saline
- 0.9% Normal Saline (Correct answer)
- Lactated Ringer's with 40 mEq of potassium
- 3% Saline
Correct answer: 0.9% Normal Saline
The initial priority in managing pediatric Diabetic Ketoacidosis (DKA) is to restore intravascular volume and improve tissue perfusion. An isotonic crystalloid, such as 0.9% Normal Saline, is the standard initial fluid for resuscitation. Dextrose-containing fluids are not used initially as they would worsen hyperglycemia. Potassium should not be added to the initial bolus; it is added to subsequent maintenance fluids only after serum potassium levels are known and adequate urine output is confirmed. 3% Saline is a hypertonic solution used for treating cerebral edema, not for initial volume expansion in DKA.
Question 5: A 2-year-old is brought to the emergency department after ingesting a handful of their mother's prenatal vitamins. The nurse should be prepared for which priority intervention, as it is the specific chelating agent for severe iron toxicity?
- N-acetylcysteine
- Activated charcoal
- Deferoxamine (Correct answer)
- Naloxone
Correct answer: Deferoxamine
Deferoxamine is the specific iron-chelating agent used to treat moderate to severe iron poisoning. It binds with iron in the bloodstream to form a complex that is excreted by the kidneys. N-acetylcysteine is the antidote for acetaminophen overdose. Activated charcoal is not effective because it does not bind well to iron. Naloxone is an opioid antagonist.
Question 6: A 3-year-old is brought to the clinic following a witnessed choking episode while eating popcorn. The initial coughing has subsided, but the nurse auscultates wheezing and diminished breath sounds over the right lung fields. This presentation is most consistent with which of the following emergencies?
- Acute asthma exacerbation
- Laryngotracheobronchitis (Croup)
- Foreign body aspiration (Correct answer)
- Bacterial pneumonia
Correct answer: Foreign body aspiration
The history of a choking event followed by unilateral wheezing and diminished breath sounds is the classic presentation for a foreign body aspiration into a mainstem bronchus. The object is more likely to lodge in the right bronchus due to its wider angle and more direct path from the trachea. Asthma typically presents with bilateral wheezing. Croup is characterized by a barking cough and inspiratory stridor. Pneumonia would likely be accompanied by fever and other signs of infection.
