Pediatric Nurse Management of Acute Illness Questions and Answers — Questions and Answers
Question 1: A 9-month-old infant is brought to the emergency department with a 2-day history of rhinorrhea, cough, and wheezing. Assessment reveals a respiratory rate of 65 breaths/minute, prominent intercostal retractions, and an oxygen saturation of 91% on room air. The infant is having difficulty breastfeeding. Which of the following is the priority nursing intervention?
- Administering a prescribed bronchodilator via nebulizer.
- Obtaining a nasopharyngeal swab for RSV testing.
- Initiating intravenous fluids and supplemental oxygen. (Correct answer)
- Encouraging the mother to continue breastfeeding frequently.
Correct answer: Initiating intravenous fluids and supplemental oxygen.
The infant is showing clear signs of respiratory distress (tachypnea, retractions, hypoxia) and dehydration (difficulty feeding), which are common in severe bronchiolitis. The priority is to stabilize the infant by correcting hypoxemia with supplemental oxygen and addressing dehydration with IV fluids, as oral intake is compromised. While an RSV test may be done, it is not the immediate priority over stabilization. Bronchodilators are not routinely recommended as they have not shown consistent efficacy. Encouraging breastfeeding is important but not the priority when the infant is in significant respiratory distress and unable to feed effectively.
Question 2: A 4-year-old child presents with a 24-hour history of vomiting, watery diarrhea, and a low-grade fever. The nurse assesses the child and notes dry mucous membranes, decreased skin turgor, and a capillary refill time of 3 seconds. The child is awake and alert but irritable. Which of the following is the most appropriate initial management strategy?
- Administer an IV bolus of 0.9% normal saline.
- Provide clear liquids such as water and apple juice as tolerated.
- Administer an anti-diarrheal medication as prescribed.
- Initiate oral rehydration solution (ORS) in small, frequent amounts. (Correct answer)
Correct answer: Initiate oral rehydration solution (ORS) in small, frequent amounts.
The child is exhibiting signs of mild to moderate dehydration. For children who are awake and alert, oral rehydration therapy with an ORS is the first-line treatment. ORS contains the appropriate balance of electrolytes and glucose to promote absorption. Small, frequent amounts help prevent vomiting. An IV bolus is typically reserved for severe dehydration or when oral rehydration fails. Clear liquids like apple juice can worsen diarrhea due to high sugar content, and water alone does not replace electrolytes. Anti-diarrheal medications are generally not recommended in children.
Question 3: A 2-year-old is brought to the clinic with a 'barking' cough and inspiratory stridor that is worse at night. The parents report the child has had a runny nose and low-grade fever for two days. The child is alert, with no cyanosis, and mild subcostal retractions are noted. Which nursing action is the highest priority for managing this child's condition?
- Administering a prescribed dose of oral dexamethasone. (Correct answer)
- Preparing for immediate endotracheal intubation.
- Obtaining a chest X-ray to rule out pneumonia.
- Keeping the child NPO in anticipation of surgery.
Correct answer: Administering a prescribed dose of oral dexamethasone.
The child's symptoms of a barking cough and inspiratory stridor are classic for croup (laryngotracheobronchitis). For mild to moderate croup, corticosteroids like dexamethasone are the cornerstone of treatment to reduce airway inflammation and edema. Minimizing distress is also a key intervention. Intubation is only considered in cases of life-threatening croup with impending respiratory failure. A chest X-ray is not routinely required for diagnosis unless the presentation is atypical. Keeping the child calm and comfortable is a priority, and NPO status is not indicated for mild to moderate croup.
Question 4: Parents call the pediatric clinic after their 18-month-old child experienced a generalized seizure lasting 2 minutes during a febrile illness (temperature 103°F/39.4°C). The child is now postictal but easily arousable. Which of the following pieces of advice is most appropriate for the nurse to provide?
- "Bring the child to the emergency department immediately for a full neurologic workup."
- "This is likely a simple febrile seizure. Focus on comfort measures and fever control with antipyretics." (Correct answer)
- "Administer a dose of aspirin now and another in 4 hours to prevent another seizure."
- "Give the child a cool water bath immediately to lower the temperature quickly."
Correct answer: "This is likely a simple febrile seizure. Focus on comfort measures and fever control with antipyretics."
This scenario describes a simple febrile seizure, which is common and typically benign in children aged 6 months to 5 years. The primary management involves parental education, reassurance, and symptomatic treatment of the fever with antipyretics like acetaminophen or ibuprofen for comfort. Antipyretics do not prevent the recurrence of febrile seizures but can improve the child's comfort. An ED visit is not typically necessary for a simple febrile seizure if the child has returned to baseline. Aspirin is contraindicated in children due to the risk of Reye's syndrome. Cool water baths are not recommended as they can cause shivering, which may increase the core body temperature.
Question 5: A 7-year-old child is admitted with a suspected diagnosis of acute appendicitis. Which of the following clinical findings would most strongly support this diagnosis?
- High-grade fever and profuse, watery diarrhea.
- Diffuse abdominal pain with a history of chronic constipation.
- Periumbilical pain that migrates to the right lower quadrant. (Correct answer)
- Abdominal cramping that is relieved by having a bowel movement.
Correct answer: Periumbilical pain that migrates to the right lower quadrant.
The classic presentation of appendicitis involves vague, periumbilical pain that, over several hours, migrates and localizes to the right lower quadrant (McBurney's point). This pain pattern is a key diagnostic indicator. While fever and vomiting may be present, a high-grade fever is more indicative of perforation. Diarrhea can occur but is not the primary symptom and can lead to misdiagnosis. Diffuse pain and pain relieved by defecation are more characteristic of gastroenteritis or constipation.
Question 6: A 3-year-old female presents with fever, vomiting, and foul-smelling urine. A clean-catch urine sample is obtained. Which of the following urinalysis results would be most indicative of a urinary tract infection (UTI)?
- Positive for ketones and trace protein.
- Negative for nitrites and positive for 1-2 WBCs/hpf.
- Positive for leukocyte esterase and nitrites. (Correct answer)
- Specific gravity of 1.030 and amber color.
Correct answer: Positive for leukocyte esterase and nitrites.
The presence of both leukocyte esterase (an enzyme released by white blood cells) and nitrites (which are formed when bacteria convert nitrates to nitrites) in urine is highly suggestive of a UTI. While a high number of WBCs would also be indicative, the combination of positive leukocyte esterase and nitrites is a strong predictor. Ketones can be present with dehydration from vomiting. A high specific gravity indicates concentrated urine, which can also be a sign of dehydration.
