Pediatric Nurse Exam Pediatric Nurse Common Pediatric Emergencies 5 — Questions and Answers
Question 1: A 12-year-old presents with altered mental status, diaphoresis, and a blood glucose of 38 mg/dL. The child is unconscious and cannot swallow. What is the appropriate glucose correction?
- Oral glucose gel administered buccally
- IV dextrose 10% (D10W) at 2 mL/kg (Correct answer)
- IV dextrose 50% (D50W) at 1 mL/kg
- Subcutaneous regular insulin to stabilize glucose
Correct answer: IV dextrose 10% (D10W) at 2 mL/kg
For severe hypoglycemia in children, IV dextrose 10% at 2 mL/kg (0.2 g/kg) is preferred over D50W because the hyperosmolar solution can cause vein damage and rebound hypoglycemia.
Question 2: A 3-year-old with a known peanut allergy develops urticaria, vomiting, and wheezing at a birthday party. Epinephrine is given. After 5 minutes, symptoms return with worsening hypotension. What phenomenon is occurring?
- Anaphylaxis refractory to epinephrine
- Biphasic anaphylactic reaction (Correct answer)
- Epinephrine overdose
- Secondary allergic cascade from a different allergen
Correct answer: Biphasic anaphylactic reaction
Biphasic anaphylaxis is a recurrence of symptoms 1–72 hours after initial resolution; all patients with anaphylaxis should be observed for at least 4–6 hours after treatment.
Question 3: A newborn at 36 hours of life develops jaundice, poor feeding, and high-pitched cry. Total serum bilirubin is at the exchange transfusion threshold. What is the immediate priority?
- Discharge with follow-up in 48 hours
- Start phototherapy and recheck bilirubin in 6 hours
- Prepare for emergency exchange transfusion (Correct answer)
- Begin IV immunoglobulin (IVIG) therapy and phototherapy
Correct answer: Prepare for emergency exchange transfusion
Bilirubin at the exchange transfusion threshold with neurological signs requires emergency exchange transfusion to prevent permanent kernicterus.
Question 4: A 6-year-old who was struck by a car presents with hypotension, tachycardia, and abdominal rigidity. Hematocrit is 22%. During massive blood transfusion, what ratio of products should the nurse anticipate?
- 10 units packed red blood cells: 1 unit FFP
- 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets (Correct answer)
- Packed red blood cells only until hemoglobin exceeds 10 g/dL
- Colloid solution before any blood products
Correct answer: 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets
Massive transfusion protocol in pediatric trauma uses a balanced 1:1:1 ratio of pRBC, FFP, and platelets to mimic whole blood and prevent coagulopathy.
Question 5: A 4-year-old presents with a temperature of 41.2°C, seizure activity, and altered mental status. The parents report the child has not had any vaccines. A lumbar puncture reveals cloudy CSF with neutrophils, low glucose, and high protein. Which organism is most likely responsible?
- Herpes simplex virus
- Streptococcus pneumoniae (Correct answer)
- Cryptococcus neoformans
- Enterovirus
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae is the most common cause of bacterial meningitis in unvaccinated children over 1 month of age, producing the classic CSF profile described.
Question 6: A 2-year-old is found with an empty acetaminophen bottle. The ingestion occurred approximately 3 hours ago. The child is currently asymptomatic. What is the most appropriate treatment?
- Observe at home and monitor for symptoms
- Administer syrup of ipecac to induce emesis
- Administer activated charcoal and N-acetylcysteine (NAC) (Correct answer)
- Administer NAC only after liver enzyme elevation is confirmed
Correct answer: Administer activated charcoal and N-acetylcysteine (NAC)
Acetaminophen toxicity causes delayed hepatotoxicity; activated charcoal within 4 hours plus NAC (the antidote) should be initiated based on ingestion amount, not symptoms.
Question 7: A 15-year-old presents with a first-time generalized tonic-clonic seizure that self-terminated in 90 seconds. The child is now post-ictal and afebrile. Which assessment finding would most immediately require further emergency workup?
- Mild headache after the seizure
- Tongue laceration sustained during seizure
- Focal neurological deficit persisting more than 30 minutes (Correct answer)
- Transient confusion lasting 10 minutes after the event
Correct answer: Focal neurological deficit persisting more than 30 minutes
A persistent focal neurological deficit (Todd's paralysis lasting >30 minutes) may indicate an underlying structural lesion such as a tumor or hemorrhage requiring urgent neuroimaging.
Pediatric Nurse Exam Pediatric Nurse Common Pediatric Emergencies 5
A 12-year-old presents with altered mental status, diaphoresis, and a blood glucose of 38 mg/dL.
The child is unconscious and cannot swallow.
What is the appropriate glucose correction?