TCRN TCRN Special Patient Populations 2 — Questions and Answers
Question 1: A 4-year-old child is brought in after a motor vehicle crash. The child's weight is estimated at 16 kg. What is the appropriate initial IV fluid bolus for pediatric hemorrhagic shock?
- 10 mL/kg of normal saline
- 20 mL/kg of isotonic crystalloid (Correct answer)
- 40 mL/kg of lactated Ringer's
- 5 mL/kg of packed red blood cells
Correct answer: 20 mL/kg of isotonic crystalloid
The standard initial fluid bolus for pediatric hemorrhagic shock is 20 mL/kg of isotonic crystalloid.
Question 2: When assessing a 7-year-old trauma patient, the nurse notes that the child is able to follow commands but is crying and inconsolable. Using the Pediatric Glasgow Coma Scale, how should verbal response be scored?
- Score of 2 — incomprehensible sounds
- Score of 3 — inappropriate words
- Score of 4 — confused (Correct answer)
- Score of 5 — oriented
Correct answer: Score of 4 — confused
In the pediatric GCS, a child who is crying but not using appropriate conversational words scores a 3 for inappropriate words.
Question 3: A 3-year-old is found to have a femur fracture with no reported mechanism of injury. What is the nurse's priority action?
- Apply traction splint and prepare for surgery
- Administer opioid analgesia immediately
- Initiate non-accidental trauma (NAT) screening and notify social work (Correct answer)
- Obtain MRI to evaluate for pathological fracture
Correct answer: Initiate non-accidental trauma (NAT) screening and notify social work
Femur fractures in non-ambulatory toddlers without clear mechanism are a red flag for non-accidental trauma and require mandatory reporting and social work involvement.
Question 4: A child's endotracheal tube size is being estimated using the Broselow tape. The tape reads 'red zone.' What other information does the Broselow tape provide beyond ETT size?
- Only medication doses
- Only equipment sizes
- Weight-based medication doses and equipment sizes simultaneously (Correct answer)
- Heart rate and blood pressure norms only
Correct answer: Weight-based medication doses and equipment sizes simultaneously
The Broselow tape provides weight-based estimates for both medication doses and equipment sizes (ETT, BP cuff, laryngoscope blade) simultaneously.
Question 5: Which of the following findings is most consistent with spinal cord injury without radiographic abnormality (SCIWORA) in a pediatric patient?
- C-spine fracture visible on CT scan
- Normal CT and MRI with neurological deficits (Correct answer)
- Compression fracture at T12 on X-ray
- Odontoid fracture without neurological symptoms
Correct answer: Normal CT and MRI with neurological deficits
SCIWORA is defined by neurological deficits with normal CT and MRI, and occurs more commonly in children due to ligamentous laxity.
Question 6: A 5-year-old trauma patient has an estimated blood volume of 80 mL/kg. The child weighs 20 kg. What is the estimated total blood volume?
- 800 mL
- 1,200 mL
- 1,600 mL (Correct answer)
- 2,000 mL
Correct answer: 1,600 mL
Total blood volume = 80 mL/kg × 20 kg = 1,600 mL; a 10% loss (160 mL) can cause significant hemodynamic compromise.
Question 7: A 10-year-old is admitted after blunt abdominal trauma. The CT shows a grade III splenic laceration. The child is hemodynamically stable. What is the preferred management strategy?
- Immediate splenectomy to prevent delayed rupture
- Angioembolization only
- Non-operative management with close monitoring (Correct answer)
- Exploratory laparotomy to assess full extent
Correct answer: Non-operative management with close monitoring
Hemodynamically stable pediatric patients with splenic lacerations are managed non-operatively to preserve splenic immune function whenever possible.
TCRN TCRN Special Patient Populations 2
A 4-year-old child is brought in after a motor vehicle crash.
The child's weight is estimated at 16 kg.
What is the appropriate initial IV fluid bolus for pediatric hemorrhagic shock?