SNLE Pediatric Nursing 2 — Questions and Answers
Question 1: What is the nursing priority for a child with croup (laryngotracheobronchitis)?
- Administer antibiotics
- Keep the child calm, provide cool mist humidity, administer nebulized epinephrine for severe cases, and monitor for airway obstruction (Correct answer)
- Restrict fluids
- Place the child in a supine position
Correct answer: Keep the child calm, provide cool mist humidity, administer nebulized epinephrine for severe cases, and monitor for airway obstruction
Croup management: keep the child calm (crying worsens obstruction), cool mist/humidified air, oral or nebulized corticosteroids (dexamethasone), nebulized racemic epinephrine for moderate-severe stridor, monitor respiratory status, and prepare for intubation if severe obstruction.
Question 2: What nursing assessments are important for a child with suspected meningitis?
- Only temperature check
- Assess for nuchal rigidity, Kernig's and Brudzinski's signs, photophobia, petechial rash, altered consciousness, and bulging fontanelle in infants (Correct answer)
- Only blood pressure
- Only appetite changes
Correct answer: Assess for nuchal rigidity, Kernig's and Brudzinski's signs, photophobia, petechial rash, altered consciousness, and bulging fontanelle in infants
Meningitis assessment: nuchal rigidity (stiff neck), positive Kernig's sign (resistance to knee extension with hip flexed), positive Brudzinski's sign (flexion of hips/knees with neck flexion), photophobia, petechial/purpuric rash (meningococcal), irritability, bulging fontanelle (infants), and altered consciousness.
Question 3: How should a nurse administer an intramuscular injection to an infant?
- In the deltoid muscle
- In the vastus lateralis (anterolateral thigh) using a 25-gauge, 5/8 to 1-inch needle (Correct answer)
- In the gluteal muscle
- In the dorsal gluteal site
Correct answer: In the vastus lateralis (anterolateral thigh) using a 25-gauge, 5/8 to 1-inch needle
For infants, the vastus lateralis (anterolateral thigh) is the preferred IM injection site due to its well-developed muscle mass. The deltoid is too small, and gluteal muscles are not fully developed (risk of sciatic nerve injury). Use a 25-gauge needle, 5/8 to 1 inch length.
Question 4: What is the nurse's role in managing a child with asthma exacerbation?
- Restrict fluid intake
- Administer bronchodilators (albuterol) via nebulizer, position upright, monitor SpO2, administer corticosteroids as ordered, and assess respiratory status frequently (Correct answer)
- Encourage vigorous physical activity
- Apply cold compresses to the chest
Correct answer: Administer bronchodilators (albuterol) via nebulizer, position upright, monitor SpO2, administer corticosteroids as ordered, and assess respiratory status frequently
Asthma exacerbation management: immediate bronchodilator (albuterol nebulizer), upright position (Fowler's/tripod), continuous SpO2 monitoring, supplemental oxygen if needed, systemic corticosteroids (oral prednisolone or IV methylprednisolone), frequent respiratory assessment, and keep the child calm.
Question 5: What anticipatory guidance should a nurse provide to parents of a 6-month-old regarding safety?
- Only car seat usage
- Choking prevention (small objects), fall prevention (never leave on elevated surfaces), water safety, proper car seat use, and safe sleep environment (Correct answer)
- Only sun protection
- Safety guidance isn't needed until the child walks
Correct answer: Choking prevention (small objects), fall prevention (never leave on elevated surfaces), water safety, proper car seat use, and safe sleep environment
At 6 months, safety guidance includes: choking hazards (no small objects, cut food appropriately), fall prevention (never leave unattended on beds/changing tables), water safety (never leave alone in bath), rear-facing car seat, safe sleep (alone, on back, in crib), and poison prevention.
Question 6: What is the nurse's priority when caring for a child with acute otitis media (ear infection)?
- Administer IV antibiotics immediately
- Manage pain (analgesics), assess tympanic membrane, administer oral antibiotics if prescribed, and educate parents on proper medication administration (Correct answer)
- Apply cold compresses to the ear
- Restrict all fluids
Correct answer: Manage pain (analgesics), assess tympanic membrane, administer oral antibiotics if prescribed, and educate parents on proper medication administration
Acute otitis media nursing care: pain management (acetaminophen/ibuprofen, warm compresses), administer prescribed antibiotics (amoxicillin is first-line), educate parents on completing the full antibiotic course, assess for complications (hearing loss, mastoiditis), and teach preventive measures.
SNLE Pediatric Nursing 2
What is the nursing priority for a child with croup (laryngotracheobronchitis)?