Med Emergencies
What is an early sign of neurological injury
decreased level of consciousness
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, anxious, 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
What is the formula for calculating hourly maintenance fluid for pediatric patients
4-2-1 rule: 4 ml/kg/hr for the first 10 kg 2 ml/kg/hr for the next 10kg 1 ml/kg/hr thereafter
The nurse is unable to palpate the anterior fontanelle of a 10 month old. What should she do?
1) notify the doctor
2) ask mom if child is experiencing any abnormal neurological symptoms
3) nothing, expected finding
4) place the patient's head of bed to 30 degrees
3) nothing, expected finding
What pharmacological drug is the first line of treatment for acute asthma exacerbation?
Ventolin
A mom brings her child in with complaints of 2 days history of fever, cough and occasional barky cough that gets better with cold air. What diagnosis does the child most likely have?
Croup
Which of the following patients would be triaged at an urgent acuity level? A. 3 week old with fever 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. 3 week old with fever
Which position should you place a head injury patient with a suspicion of high intracranial pressure?
elevating the patient's head to thirty degrees, keeping their neck in a neutral position
Which patient needs to be triaged as most acute 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 2 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
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
Bradycardia, irregular respirations, wide pulse pressure and decreased LOC are signs of what?
Cushings triad/signs of increased ICP
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, running around chatting, PRAM of 1 B). A child with sickle cell with fever and chest pain . 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
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
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
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?
Vagal maneuvers
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
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%
What method is recommended to administer fluid bolus to pediatric patients during fluid resuscitation?
3-way stopcock
Nurse Sunshine suspects that a child, age 4, is being neglected physically. To best assess the child’s nutritional status, the nurse should ask the parents which question?
A)“Is your child a picky eater?”
B)“What did your child eat for breakfast?”
C)“Do you think your child eats enough?”
D) “Has your child always been so small?”
“What did your child eat for breakfast?”
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?
Ingestion of a toxin/drug found in garage
Fever, tachycardia, narrow pulse pressure and tachypnea are common in which kind of shock?
septic shock
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
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 his dentist tomorrow 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
Which situation would the triage nurse suspect child abuse:
a) 2 year old with a pulled elbow that was sustained when mom was trying to pull him away from touching the stove
b) 3 year old with burns to feet sustained when child pulled pot of hot water from stove and it fell on him
c) 18 month old femur fracture sustained from tripping on toy
d) 12 year old with severe abdominal bruises sustained after falling over bike handle bars
b) 3 year old with burns to feet sustained when child pulled pot of hot water from stove and it fell on him
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%