Neuro & Sensory
This mandatory screening schedule recommended by the AAP checks all infants for Autism Spectrum Disorder (ASD).
What is 18 months and 24 months?
A toddler is admitted with severe dehydration secondary to acute gastroenteritis. Which clinical finding should the nurse expect during the physical assessment?
D. Sunken anterior fontanel and parched mucous membranes.
Severe dehydration in a toddler presents with pronounced signs of fluid volume deficit, including sunken fontanels, parched mucous membranes, tenting skin turgor and tachycardia.
The classic quadruplet of symptoms ("4 Ds") indicates acute epiglottitis.
What are Drooling, Dysphagia, Dysphonia, and Distressed breathing?
A 2-year-old child is prescribed ear drops for acute otitis media. When administering the medication, how should the nurse position the pinna of the ear?
Push the tragus forward without moving the pinna.
Pull the pinna down and back.
Pull the pinna straight outward horizontally.
B pull the pinna down and back.
for children under 3 years of age, now is shaped such that pulling the pin down and back straightened the canal for optimal drop installation
A school-age child is diagnosed with streptococcal pharyngitis (strep throat). The nurse provides discharge instructions to the parents. Which statement by a parent indicates a correct understanding of the management?
C. "If the sore throat returns next week, we can stop giving medication early to save pills.
a full 10 days
Completing a full 10-day course of antibiotics is essential to eradicate Group A beta-hemolytic streptococcus and prevent serious complications such as rheumatic fever and acute glomerulonephritis.
The immediate priority intervention for a chemical burn to the eye before gathering history or taking vital signs.
What is continuous irrigation with water or saline for 15–30 minutes?
A nurse is assessing a toddler in compensated shock. Which early clinical manifestation should the nurse expect to find?
C.Warm, flushed extremities with bounding pulses
A nurse is assessing a toddler in compensated shock. Which early clinical manifestation should the nurse expect to find?
Bradycardia and slow, shallow respirations
Profound hypotension
Hypotension is a late and ominous sign of shock in children; pediatric patients compensate effectively until sudden cardiovascular collapse occurs.
Warm, flushed extremities with bounding pulses
Unexplained mild tachycardia
Tachycardia is typically the earliest physiological sign of shock as the sympathetic nervous system attempts to maintain cardiac output when perfusion begins to fail.
A 3-year-old child presents to the emergency department with drooling, dysphagia, high fever, and a tripod seating posture. The child exhibits no spontaneous cough. What is the priority nursing action?
These findings are classic for acute epiglottitis. Crying or agitation can trigger complete, fatal airway obstruction; maintaining a position of comfort and preparing for emergency intubation are critical.
Over-the-counter medication strictly contraindicated in children due to the risk of Reye syndrome.
What is aspirin?
The required interval and maximum number of doses in 24 hours when administering acetaminophen to a pediatric patient
What is every 4 hours, up to a maximum of 5 doses in 24 hours?
An adolescent is brought to the emergency department after a pencil penetrated the right eye during a school altercation. Which initial action should the nurse take?
A. Irrigate the eye continuously with normal saline for 30 minutes
B. Gently pull the pencil straight out to relieve pressure on the optic nerve.
C. Cover only the affected eye with a sterile eye patch.
D. Stabilize the object in place and apply a protective shield over both eyes.
D. Stabilize the Object in place and apply protective shield over both eyes
Penetrating's objects must never be removed or manipulated outside of surgery. Bring the ice prevents consensual movements, which limits movement of the injured eye (since eyes move together)?
This is the minimum acceptable normal urine output for pediatric fluid balance monitoring.
What is 1 mL/kg/hour?
A nurse is monitoring an 8-year-old child who returned from a tonsillectomy 2 hours ago. Which assessment finding requires immediate nursing intervention?
B. A preference for cool, clear liquids instead of solid foods.
Frequent swallowing is a classic, early indicator of occult bleeding or hemorrhage from the surgical site, which is a major post-operative emergency.
The proper sequence when both eye drops and eye ointment are ordered for the same eye.
What is administering eye drops first, waiting 3 minutes, and then applying ointment?
The frequency with which a nurse must check a pediatric patient in physical restraints for circulation, skin integrity, positioning, and psychological distress.
What is every 30 minutes?
A nurse is caring for a 4-year-old child admitted with Autism Spectrum Disorder (ASD). Which nursing intervention is the highest priority when planning the daily care routine?
A. Provide complex, multi-step verbal directions to challenge cognitive processing.
B. Rotate nursing staff daily to promote socialization with different people.
C. Keep environmental stimuli low and maintain a consistent daily schedule.
D. encourage frequent participation in group play activities in the hospital playroom
answer is c. keep environmental stimuli low and maintain a consistent daily schedule. Children with ASD thrive on predictability and routine, and they are sensitive to environmental overstimulation; maintaining a quiet, structured environment, reduces anxiety, and behavioral outbursts.
The priority fluid bolus amount and type for a child in severe dehydration or hypovolemic shock.
What is an IV bolus of 20 mL/kg of isotonic fluid (0.9% Normal Saline or Lactated Ringer's)?
This upper airway sound is characterized by a harsh, high-pitched noise heard during inspiration in croup syndromes.
What is inspiratory stridor?
A pediatric patient in the post-anesthesia care unit displays a rapid rise in body temperature to 104.5∘F, severe muscle rigidity, and unexplained tachycardia following the administration of succinylcholine. Which medication should the nurse immediately prepare to administer?
Correct answer Dantrolene sodium
These manifestations indicate Malignant Hyperthermia, a life-threatening reaction to triggering anesthetics; Dantrolene sodium is the specific, life-saving antidote.
A 5-month-old infant is admitted with dehydration. The nurse needs to calculate urine output by weighing the infant's wet diapers. If a wet diaper weighs 85g and the dry diaper weighs 25, what is the recorded urine output in milliliters?
answer is 60 ml
Urine output is calculated by subtracting the dry diaper weight from the wet diaper weight (85 g−25 g=60 g). Using the standard conversion where 1 g equals 1 mL, the output is 60 mL
What is wet diaper weight (in grams) minus dry diaper weight (in grams), where 1 gram equals 1 mL of urine?
The speech pattern common in ASD where a child repeats words or phrases spoken by another person.
What is echolalia?
This dangerous late sign indicates that a child in shock is no longer able to compensate.
What is severe hypotension (or bradycardia)?
The sudden, ominous finding during a severe asthma attack or croup episode that indicates impending respiratory failure.
What is the sudden cessation of wheezing / silent chest (diminished/absent breath sounds)?
First-line emergency drug and administration site for a child experiencing anaphylaxis.
What is intramuscular (IM) Epinephrine in the vastus lateralis (thigh)?
The time frame after starting effective antibiotic therapy when a child with strep throat is no longer considered contagious and may return to school.
What is 24 hours?