Pediatric Nurse Management of Acute Illness 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?

Accepted Answer

Initiating intravenous fluids and supplemental oxygen.

Answer

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?

Accepted Answer

Initiate oral rehydration solution (ORS) in small, frequent amounts.

Answer

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?

Accepted Answer

Administering a prescribed dose of oral dexamethasone.

Answer

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?

Accepted Answer

"This is likely a simple febrile seizure. Focus on comfort measures and fever control with antipyretics."

Answer

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?

Accepted Answer

Periumbilical pain that migrates to the right lower quadrant.

Answer

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.

Pediatric Nurse Exam Practice Test

Pediatric Nurse Exam Practice Test

Pediatric Nurse Management of Acute Illness Questions and Answers