Pediatric Nurse Exam Pediatric Nurse Management of Acute Illness 3 — Questions and Answers
Question 1: A 3-year-old is brought to the ED with ingestion of an unknown substance. The child is lethargic with pinpoint pupils and slow respirations. What antidote should the nurse prepare?
- Flumazenil
- Naloxone (Correct answer)
- N-acetylcysteine
- Activated charcoal only
Correct answer: Naloxone
Pinpoint pupils, CNS depression, and respiratory depression are classic signs of opioid toxicity, treated with naloxone.
Question 2: Which sign best indicates adequate rehydration in a child with moderate dehydration from acute gastroenteritis?
- Return of skin turgor and urine output >1 mL/kg/hr (Correct answer)
- Resolution of fever
- Normal bowel sounds
- Absence of vomiting for 30 minutes
Correct answer: Return of skin turgor and urine output >1 mL/kg/hr
Restored skin turgor and adequate urine output are the most reliable clinical indicators of successful rehydration.
Question 3: A 5-year-old with meningitis becomes increasingly agitated and shows signs of increased intracranial pressure. The nurse should place the child in which position?
- Trendelenburg position
- Head elevated 30 degrees with neck in neutral alignment (Correct answer)
- Flat supine with head turned to the side
- Prone position
Correct answer: Head elevated 30 degrees with neck in neutral alignment
Head elevation of 30 degrees with neutral neck alignment promotes venous drainage and helps reduce ICP.
Question 4: A nurse is assessing a 14-month-old with suspected intussusception. Which stool description is most characteristic?
- Watery green diarrhea
- Currant jelly stools (blood and mucus) (Correct answer)
- Clay-colored stools
- Fatty, foul-smelling stools
Correct answer: Currant jelly stools (blood and mucus)
Currant jelly stools containing blood and mucus are the classic late finding of intussusception due to intestinal ischemia.
Question 5: A 2-year-old with burns covering 18% TBSA is admitted. Using the Parkland formula, which fluid is most appropriate for the first 24 hours?
- 5% dextrose in water (D5W)
- Lactated Ringer's solution (Correct answer)
- Normal saline with 5% albumin
- 0.45% normal saline
Correct answer: Lactated Ringer's solution
Lactated Ringer's solution is the standard fluid for burn resuscitation per the Parkland formula in the first 24 hours.
Question 6: A 4-year-old presents with sudden high fever, toxic appearance, and a stiff neck. Blood cultures are drawn. While awaiting results, which intervention takes priority?
- Wait for culture sensitivity results before antibiotics
- Administer empiric IV antibiotics immediately (Correct answer)
- Perform lumbar puncture before any treatment
- Administer antipyretics only and observe for 2 hours
Correct answer: Administer empiric IV antibiotics immediately
Empiric antibiotics must be started immediately in suspected bacterial meningitis; treatment should not be delayed for culture results.
Question 7: A school-age child with sickle cell disease develops acute chest syndrome. Which intervention is MOST important?
- Restrict oral fluids to prevent pulmonary edema
- Administer supplemental oxygen and IV hydration (Correct answer)
- Apply cold compresses to the chest
- Hold all analgesics to avoid respiratory depression
Correct answer: Administer supplemental oxygen and IV hydration
Supplemental oxygen to maintain oxygenation and IV hydration to promote sickling reversal are cornerstones of acute chest syndrome management.
Pediatric Nurse Exam Pediatric Nurse Management of Acute Illness 3
A 3-year-old is brought to the ED with ingestion of an unknown substance.
The child is lethargic with pinpoint pupils and slow respirations.
What antidote should the nurse prepare?