Pediatric Nurse Exam Pediatric Nurse Common Pediatric Emergencies 4 — Questions and Answers
Question 1: A 4-month-old is brought in unresponsive with bulging fontanelle, high-pitched cry, and petechial rash. Temperature is 39.8°C. What condition is the nurse most concerned about?
- Viral meningitis
- Bacterial meningitis with possible sepsis (Correct answer)
- Roseola infantum
- Benign febrile seizure
Correct answer: Bacterial meningitis with possible sepsis
Bulging fontanelle, high-pitched cry, and petechiae in a febrile infant are classic signs of bacterial meningitis with meningococcal sepsis, requiring immediate IV antibiotics.
Question 2: A 16-year-old presents after a motor vehicle accident with absent breath sounds on the left, tracheal deviation to the right, and hypotension. What emergency condition does the nurse suspect?
- Hemothorax
- Tension pneumothorax (Correct answer)
- Cardiac tamponade
- Flail chest
Correct answer: Tension pneumothorax
Tension pneumothorax causes absent breath sounds, tracheal deviation away from the affected side, and obstructive shock requiring immediate needle decompression.
Question 3: An 8-year-old with asthma arrives in severe respiratory distress. A silent chest is auscultated. What does a silent chest indicate in this context?
- The child has improved and air is moving freely
- Complete airway obstruction with minimal to no air movement (Correct answer)
- The stethoscope is placed incorrectly
- Mild asthma with well-controlled bronchospasm
Correct answer: Complete airway obstruction with minimal to no air movement
A silent chest in a child with status asthmaticus indicates critical airflow obstruction, meaning very little air is moving — an ominous pre-arrest sign.
Question 4: A 2-year-old presents with sudden colicky abdominal pain, currant jelly stools, and a sausage-shaped abdominal mass. What is the priority intervention?
- Immediate surgical laparotomy
- Abdominal X-ray and discharge with follow-up
- Emergent air or contrast enema for reduction (Correct answer)
- NPO and IV fluids with watchful waiting
Correct answer: Emergent air or contrast enema for reduction
Intussusception is first treated with air or hydrostatic contrast enema under fluoroscopy, which successfully reduces the intussusception in 80–90% of cases without surgery.
Question 5: A 10-month-old is brought in with decreased level of consciousness, retinal hemorrhages, and a bulging fontanelle. Radiographs reveal multiple subdural hematomas in different stages. The history is inconsistent. What is the most likely diagnosis?
- Accidental head trauma
- Abusive head trauma (shaken baby syndrome) (Correct answer)
- Glutaric aciduria type I
- Normal variant in infants
Correct answer: Abusive head trauma (shaken baby syndrome)
The triad of subdural hematomas, retinal hemorrhages, and encephalopathy with an inconsistent history is the hallmark presentation of abusive head trauma.
Question 6: A 5-year-old is in respiratory arrest following a submersion injury. Rescuers have been performing CPR for 10 minutes. Water temperature was 4°C. What resuscitation principle is most applicable?
- Cease resuscitation because prognosis is uniformly poor after 10 minutes
- Continue aggressive resuscitation because hypothermic drowning can have favorable outcomes (Correct answer)
- Administer epinephrine only if the water was fresh, not salt
- Defibrillate immediately regardless of rhythm
Correct answer: Continue aggressive resuscitation because hypothermic drowning can have favorable outcomes
Cold-water submersion can provide cerebral protection through hypothermia; the principle 'not dead until warm and dead' guides prolonged resuscitation efforts.
Question 7: A 7-year-old presents with a bee sting allergy and begins using their epinephrine auto-injector. The nurse notes the device was accidentally injected into the thumb instead of the thigh. What complication is most concerning?
- Systemic epinephrine toxicity
- Finger ischemia from vasoconstriction (Correct answer)
- Infection at the injection site
- Subcutaneous fat necrosis
Correct answer: Finger ischemia from vasoconstriction
Accidental digital injection of epinephrine causes intense vasoconstriction that can lead to ischemia of the digit, requiring treatment with phentolamine.
Pediatric Nurse Exam Pediatric Nurse Common Pediatric Emergencies 4
A 4-month-old is brought in unresponsive with bulging fontanelle, high-pitched cry, and petechial rash.
Temperature is 39.8°C.
What condition is the nurse most concerned about?