Pediatric Nurse Exam Pediatric Nurse Common Pediatric Emergencies 3 — Questions and Answers
Question 1: A 2-year-old presents with sudden onset of unilateral wheezing and decreased breath sounds on the right. The episode began while the child was eating peanuts. What is the priority action?
- Begin abdominal thrusts immediately
- Obtain a chest X-ray before any intervention
- Place the child in a position of comfort and prepare for bronchoscopy (Correct answer)
- Administer albuterol via nebulizer
Correct answer: Place the child in a position of comfort and prepare for bronchoscopy
A suspected bronchial foreign body requires urgent bronchoscopy for removal; keeping the child calm reduces the risk of complete airway obstruction.
Question 2: A 5-year-old seizing child has had continuous tonic-clonic activity for 8 minutes. IV access is unavailable. Which benzodiazepine route is most appropriate?
- Oral lorazepam
- Intramuscular haloperidol
- Intranasal midazolam (Correct answer)
- Sublingual diazepam
Correct answer: Intranasal midazolam
Intranasal midazolam is the preferred alternative route when IV access is unavailable because it achieves rapid drug delivery through nasal mucosa.
Question 3: An infant with bronchiolitis has an SpO2 of 91% on room air, mild retractions, and is feeding poorly. What is the most appropriate initial intervention?
- Administer nebulized albuterol
- Administer nebulized racemic epinephrine
- Provide supplemental oxygen and ensure adequate hydration (Correct answer)
- Start systemic corticosteroids
Correct answer: Provide supplemental oxygen and ensure adequate hydration
RSV bronchiolitis management is supportive — supplemental oxygen for hypoxia and hydration for poor feeding; bronchodilators and steroids are not recommended.
Question 4: A 9-year-old is brought in after a near-drowning in a backyard pool. The child is breathing spontaneously with an SpO2 of 94%. What is the nurse's primary concern over the next 24 hours?
- Hypothermia only
- Delayed pulmonary edema and hypoxia (Correct answer)
- Cervical spine injury
- Hypernatremia from saltwater aspiration
Correct answer: Delayed pulmonary edema and hypoxia
Secondary drowning or delayed pulmonary edema can develop 4–8 hours after a submersion event, so close monitoring for respiratory deterioration is essential.
Question 5: A 14-month-old is brought in with bruising in various stages of healing over the torso and buttocks. The caregiver's explanation is inconsistent with the pattern of injuries. What is the nurse's first responsibility?
- Confront the caregiver with findings
- Discharge the child with a follow-up appointment
- Document findings and report suspected child abuse to the appropriate authorities (Correct answer)
- Photograph the injuries and place them in the chart without reporting
Correct answer: Document findings and report suspected child abuse to the appropriate authorities
Nurses are mandated reporters and must report suspected child abuse immediately to child protective services or law enforcement regardless of certainty.
Question 6: A 6-year-old with known sickle cell disease presents with sudden, severe chest pain, fever, and a new pulmonary infiltrate on X-ray. What emergency complication does the nurse recognize?
- Pneumonia
- Acute chest syndrome (Correct answer)
- Pulmonary embolism
- Spontaneous pneumothorax
Correct answer: Acute chest syndrome
Acute chest syndrome in sickle cell disease presents with chest pain, fever, and a new infiltrate and is the leading cause of death in these patients.
Question 7: A 3-year-old ingested an unknown number of iron tablets from a grandmother's purse. Which early GI finding is characteristic of iron toxicity?
- Constipation and abdominal bloating
- Hematemesis and bloody diarrhea (Correct answer)
- Watery diarrhea without blood
- Absence of GI symptoms
Correct answer: Hematemesis and bloody diarrhea
Iron toxicity causes corrosive GI injury in the first phase, resulting in hematemesis and bloody diarrhea within hours of ingestion.
Pediatric Nurse Exam Pediatric Nurse Common Pediatric Emergencies 3
A 2-year-old presents with sudden onset of unilateral wheezing and decreased breath sounds on the right.
The episode began while the child was eating peanuts.
What is the priority action?