Pediatric Emergency Nursing

Med Emergencies

100

This color-coded tool is used to help prepare for a pediatric arrest coming to the ED.

Broselow tape

200

A six year old girl with a history of epilepsy presents limp in her father's arms with complaints of seizures. Her eyes are open with no response to verbal stimuli. What is the nurse's first action?

Determine the father's perception of her current state related to her baseline status.

300

A 4 year old trauma patient is brought in by ambulance being ventilated with a bag valve mask device. The physician intubates the patient. Postintubation, it is difficult to ventilate the patient yet breath sounds are auscultated throughout the lung fields. What is the priority nursing intervention that will improve ventilation?

Insert an orogastric tube

400

A 9 year old male presents to the ED with a chief complaint of fever that started this morning, severe sore throat, and difficulty swallowing. The nurse notes that the patient is leaning forward while sitting and drooling. What is the suspected diagnosis of this patient?

Epiglottitis

500

An 8 year old patient has been diagnosed with DKA. The patient has been evaluated and treated in the emergency department for the past 8 hours. During the last nursing assessment, the n use notes that the patient's heart rate has decreased from 100 beats per minute to 70 beats per minute. The patient now arouses only to pain and has a blood pressure of 128/86mmHg, which is an increase from 100/60 might 1 hour ago. The patient is demonstrating cut signs of what?

Cerebral edema

TRIAGE

100

Based on the following pediatric assessment triangle findings, which patient will the triage nurse choose to triage first? A). 2 year old lying quietly in her mother's arms. She is pale and there is little movement noted to extremities. Respirations are rapid and shallow. B). 3 year old female, screaming loading with a blood soaked paper towel dressing on her left middle finger. Skin color appears normal, and there is no obvious sign respiratory distress noted. C). 14 year old with dry heaves. Color is pale and there is no increased work of breathing. D). 1 year old wearing a blanket sleeper clinging to his mother's arm as she holds him on her hip. His face is flushed and breathing rapid with no other signs of increased work of breathing.

A. 2 year old lying quietly in her mother's arms

200

Which of the following patients would be triaged at an urgent acuity level? A. 2 year old complaining of joint pain with a temperature of 101 F B. 3 year old with a temp of 102.4 and right ear pain; the child grabs on to his mother when examined C. A 2 year old with a closed finger injury that is swollen and bruised D. A 4 year old with a 1.2 inch lac to the lower leg; bleeding is controlled

A. 2 year old complaining of joint pain with a temp of 101 F

300

The triage nurse has several patients present at the same time. Which patient is of the highest acuity and should be triaged first? A). 2 year old with audible wheezing and mild retractions B). 5 day old whose parents report a temperature of 36.0 (96.8 F) C). 6 year old who swallowed a coin yesterday and has a history of sickle cell disease D). 5 year old patient with a ventriculoperitoneal (VP) shunt who has a forearm laceration

B). 5 day old with reported temperature of 36.0

400

Which one of the following patients should be triaged and assessed first? A). 10 year old with audible wheezing, moderate retractions, and initial oxygen saturation of 89% B). 8 year old with a deformity to the forearm who is crying inconsolably and gripping the mother's hand C). 12 year old with a penetrating abdominal injury who is crying and staring at her hands while holding her oxygen D). 5 year old with a large hematoma on forehead, history of brief loss of consciousness, and who is talking to his father

A). 10 year old with audible wheezing, moderate retractions and initial oxygen saturation of 89%

500

Which of the following patients should be triaged next? A). 3 year old boy who is holding his head in his hands; has dry, cracked lips; and is slightly pale B). 3 year old girl who is crying intermittently but is otherwise content in her mother's arms, throwing her blanket on the floor C). 4 year old boy talking to his parents with an occasional nonproductive cough and red cheeks D). 2 year old girl asleep in her parent's arms with flushed cheeks and a sweaty forehead

A). 3 year old boy holding his head in his hands; has dry, cracked lips; and is slightly pale

Technical Skills

100

Use this formula for calculating maintenance fluid replacement for pediatric patients

4-2-1 4 ml/kg/hr for the first 10 kg 2 ml/kg/hr for the next 10kg 1 ml/kg/hr thereafter

200

An adolescent male wrestler presents to the ED with redness, tenderness, and induration to the buttock's crease. The emergency nurse should have what at the bedside?

gauze packing 0.25 to 0.5 in wide

300

A six month old requires a transfusion with PRBCs. The order is for 10ml/kg over 2 hours. The infant has 2 peripheral IV catheters, one 24 gauge in each hand. The nurse knows that: A). another larger size IV catheter will need to be inserted for the blood to infuse at the order rate B). the transfusion will need to be split between the 2 existing IV catheters to infuse at the ordered rate C). either existing IV catheter can be used for the transfusion at the ordered rate D). either existing IV catheter can be used, but the transfusion rate will need to be slowed.

C). either existing IV catheter can be used for the transfusion at the ordered rate

400

A 6 month old, 7 kg infant is intubated in the ED with a 4.0 uncured ETT. He is placed on a ventilator and is being volume ventilated with a set rate of 22, tidal volume 45 ml, FiO2 40% and PEEP 8. The patients SaO2 is 98%. The ventilator's high peak pressure alarm is sounding and after auscultation of the infant's lungs, the nurse notices diminished breath sounds in the left lung. What is the most likely cause of the ventilator's high pressure alarm?

Right main stem intubation

500

A 6 year old at a Little League game is struck in the mouth with a baseball bat. His two permanent upper central incisors are lying on the ground intact. An emergency nurse at the scene should prepare for which intervention: A). place the teeth in milk and advise the family to seek assistance from a dentist B). Rinse the teeth, place them back in the sockets, and allow the child to finish the game C). Call emergency services to pick up the child and transport him to the closest emergency department D). Place the teeth in a cup of water and have the child sit out the rest of the game

Call emergency services to pick up the child and transport to the ED

Assessment

100

This quick tool is used to assess small children for end-organ perfusion.

Pediatric Assessment Triangle

200

Using the pediatric assessment triangle (PAT), which finding would the triage nurse use to determine the triage category? A). 10 day old infant who is pale with mottled extremities B). 2 year old with poor skin turgor C). 3 month old with capillary refill of 4 seconds D). 6 month old sitting calmly with a heart rate of 188 beats/minute

A). 10 day old infant who is pale with mottled extremities

300

The following patients are assessed when walking into the ED, based on your assessment which patient is the highest priority: A). 2 year old who is drooling and has positioned herself with her neck extended B). 8 year old who is holding an obviously deformed arm close to his abdomen; he is sobbing and sniffling C). 14 year old with red, flat, pinpoint lesions on her face; she is texting with her cell phone D). 6 month old who is crying loudly and inconsolably and has a purple, blotchy face

A). 2 year old who is drooling and has positioned herself with her neck extended

400

Which breathing assessment would be noted using the pediatric assessment triangle (PAT)? A. Patient's mother states patient has had a nonproductive cough for the past 2 weeks B. Patient is sitting upright, leaning forward, using both arms to support herself C. Wheezing auscultated in both lower lung fields D. Pulse oximetry reading is 88% on room air

B. Patient sitting upright, leaning forward, using both arms to support herself

500

Early signs and symptoms of increased intracranial pressure in a neonate with a fever being evaluated for suspected meningitis.

What is restlessness and inconsolability?

Management

100

A 2 year old require cerebrospinal fluid specimen collection. What is the safest position for this procedure?

Side lying with the head flexed forward and the knees drawn up to the abdomen

200

A 5 year old male presents complaining of chest pain, rated 8 on the FACES pain rating scale. The vital signs are 97.8 F, HR 218 bp, RR 24 breaths per minutes, BP 105/64mmHg, and SpO2 100%. What interventions should be performed first?

What is Vagal maneuvers

300

A 5 year old with a history of anaphylaxis presents with acute onset of generalized hives, dyspnea, and bronchospasm. What is the first pharmacological intervention for this patient?

IM epinephrine

400

A 4 year old boy presents to the ED with new onset diarrhea, vomiting and lethargy that developed after playing in the garage. Exam reveals T 98.6 F, HR 100 bp, RR 30 breaths per minute and BP 100/60. He arouses to questions, has constricted pupils and is tearing and drooling profusely. What is the most likely cause of his symptoms?

What is insecticide

500

The nurse is assessing a 2 year old child who presents with a 1 week history of cold symptoms. During the assessment the nurse finds the patient is experiencing bradycardia episodes. Her current vital signs are 99 F, HR 63 BPM, RR 44 breaths per minute, SpO2 90%, and BP 92/63. What intervention will most likely correct the bradycardia?

Oxygen via non rebreather mask at 100%