Pediatric Nurse Exam Pediatric Nurse Management of Acute Illness 5 — Questions and Answers
Question 1: A 5-year-old with suspected septic shock has a heart rate of 168, capillary refill of 4 seconds, and mottled skin. After two 20 mL/kg NS boluses, the child remains hypotensive. What is the next priority?
- Administer a third 20 mL/kg fluid bolus only
- Begin vasoactive medications (dopamine or epinephrine) (Correct answer)
- Perform immediate lumbar puncture
- Switch to oral rehydration therapy
Correct answer: Begin vasoactive medications (dopamine or epinephrine)
Fluid-refractory septic shock requires initiation of vasoactive agents to restore perfusion pressure after adequate fluid resuscitation.
Question 2: A nurse assesses a 2-year-old with suspected child abuse who has multiple bruises in different stages of healing. What is the nurse's legal and ethical obligation?
- Discuss concerns with the parents and give them a chance to explain
- Report suspected abuse to child protective services immediately (Correct answer)
- Document findings and wait for physician confirmation before reporting
- Consult social work and delay reporting until the team agrees
Correct answer: Report suspected abuse to child protective services immediately
Nurses are mandated reporters and must report suspected child abuse to CPS immediately upon reasonable suspicion, without waiting for physician confirmation.
Question 3: A 9-year-old with hemophilia A sustains a knee injury and reports pain and swelling. What is the first intervention?
- Apply heat and begin range-of-motion exercises
- Administer factor VIII concentrate promptly (Correct answer)
- Give aspirin for pain and anti-inflammatory effect
- Apply a tight circumferential bandage
Correct answer: Administer factor VIII concentrate promptly
Early administration of factor VIII is critical to stop bleeding in hemophilia A; delay worsens joint damage (hemarthrosis).
Question 4: A 16-year-old with a new diagnosis of Graves' disease presents with a heart rate of 138, tremors, and diaphoresis. Which medication does the nurse anticipate administering first?
- Radioactive iodine
- Propranolol for symptom control (Correct answer)
- Levothyroxine supplementation
- High-dose IV corticosteroids
Correct answer: Propranolol for symptom control
Beta-blockers such as propranolol are used immediately to control the sympathetic symptoms of hyperthyroidism while definitive therapy is planned.
Question 5: A nurse is preparing to discharge a 6-year-old after treatment for mild asthma exacerbation. Which teaching point is MOST important for the family?
- Discontinue all controller medications once symptoms resolve
- Use rescue inhaler (albuterol) BEFORE controller medication during attacks
- Identify and avoid asthma triggers and know when to return to ED (Correct answer)
- Avoid all exercise permanently to prevent future exacerbations
Correct answer: Identify and avoid asthma triggers and know when to return to ED
Teaching trigger avoidance and clear return-to-ED criteria (worsening dyspnea, no response to albuterol) is the most essential discharge education for asthma families.
Question 6: A 3-year-old ingested acetaminophen 3 hours ago. The dose is calculated at 200 mg/kg. Which intervention is most critical?
- Observe and monitor liver enzymes at 24 hours only
- Administer N-acetylcysteine (NAC) promptly (Correct answer)
- Give syrup of ipecac to induce vomiting
- Administer activated charcoal only and no antidote
Correct answer: Administer N-acetylcysteine (NAC) promptly
N-acetylcysteine is the specific antidote for acetaminophen overdose and is most effective when given within 8 hours of ingestion.
Question 7: A 4-year-old with suspected foreign body aspiration has unilateral decreased breath sounds on the right. What is the nurse's priority action?
- Perform abdominal thrusts immediately
- Maintain airway patency and prepare for bronchoscopy (Correct answer)
- Place the child in left lateral decubitus position
- Administer albuterol nebulization as first treatment
Correct answer: Maintain airway patency and prepare for bronchoscopy
A child with suspected bronchial foreign body who is not in complete obstruction should be kept calm and prepared for rigid bronchoscopy for safe removal.
Pediatric Nurse Exam Pediatric Nurse Management of Acute Illness 5
A 5-year-old with suspected septic shock has a heart rate of 168, capillary refill of 4 seconds, and mottled skin.
After two 20 mL/kg NS boluses, the child remains hypotensive.
What is the next priority?