Deck 35: Caring for the Critically Ill Child

Question 1

A critically ill child on a ventilator is mildly anemic.Which action by the nurse is the most appropriate?

A)Decrease the administration rate of the IV fluids.
B)Draw minimal amounts of blood for laboratory tests.
C)Have parents sign consent for blood transfusions.
D)Monitor the child's hemoglobin levels daily.

Answer 1

Draw minimal amounts of blood for laboratory tests.

Question 2

Family members are visiting a child who is mechanically ventilated and heavily sedated.The parents are visibly distressed.Which statement from the nurse is most appropriate?

A)"Her latest arterial blood gases show compensated acidosis."
B)"I'm glad you are here;let me get you some chairs to sit in."
C)"She is so heavily sedated that she will not know if you are here or not."
D)"You can talk to and touch your child to let her know you are here."

Answer 2

"You can talk to and touch your child to let her know you are here."

Question 3

A child in the emergency department has just undergone emergent intubation.When listening to lungs,the nurse notes absent sounds on the left side.What action by the nurse is the most appropriate?

A)Ask a more experienced provider to assess the child.
B)Facilitate completion of a portable chest x-ray.
C)Hyperoxygenate the patient and suction the airway.
D)Reposition the endotracheal tube and reassess.

Answer 3

Reposition the endotracheal tube and reassess.

Question 4

A mechanically ventilated adolescent has a RASS score of -3.The child is receiving pain medication and sedation by intravenous infusion.Which action by the nurse is the most appropriate?

A)Assess the child for uncontrolled pain.
B)Document findings and continue to monitor.
C)Increase the fentanyl (Sublimaze)infusion.
D)Suction the patient in case of tube obstruction.

Question 5

A pediatric intensive care nurse wants to practice in a way that helps reduce parents' stress while their child is in the unit.Which action by the nurse would be most helpful?

A)Explain procedures to the parents first,then to the child.
B)Include the parents in all decisions and care activities.
C)Provide comprehensive discharge teaching in advance.
D)Round with physicians to ensure parents' understanding.

Question 6

A child is mechanically ventilated.Which assessment finding indicates that a priority goal is being met?

A)Enteral feeding tube present
B)PaCO2: 40 mm Hg
C)Intact skin integrity
D)Ventilator on control mode

Question 7

A nurse is assessing a critically ill child's respiratory status.The child is grunting and has nasal flaring,but the pulse oximeter reads the child's oxygen saturation at 96%.Which nursing action is the priority in this situation?

A)Conduct a thorough assessment and call the provider.
B)Document the findings in the child's medical chart.
C)Notify the rapid response team immediately.
D)Turn up the oxygen and reassess the child in 30 minutes.

Question 8

A mechanically ventilated 2-year-old child has copious oral secretions.What action by the nurse takes priority?

A)Assess placement of the endotracheal tube.
B)Clean and dry the skin around the mouth.
C)Raise the head of the child's bed to 60°.
D)Suction the oral cavity every 2 hours.

Question 9

A nurse is working with a student in the pediatric intensive care unit.The student reports that a 3-year-old patient looks very anxious,and the parents report that this behavior is not normal for her and she seems disoriented.Which action suggested by the registered nurse is the most appropriate?

A)Assess the child for sensory overload.
B)Encourage the child to take a short nap.
C)Have the parents leave for a short break.
D)Plan age-appropriate diversionary activities.

Question 10

A child on a ventilator suddenly desaturates.Which nursing action is the priority?

A)Assess for displacement of the tube.
B)Assess for obstruction of the tube.
C)Ensure the ventilator is functioning properly.
D)Listen to lung sounds for pneumothorax.

Question 11

A nursing student asks a pediatric intensive care nurse why being bed-bound for several weeks would affect a young child's growth and development.Which response by the nurse is the most appropriate?

A)"A child on bedrest has depression,slowing development."
B)"Bedrest causes muscle weakness that limits activity."
C)"Growth and development are highly connected to activity."
D)"Isolation from peers has a negative effect on growth."

Question 12

The nursing manager of the pediatric intensive care unit wants to provide patients with improved sleep and rest.Which intervention would have the greatest impact on promoting rest in this environment?

A)Clustering care so nursing interruptions are limited
B)Decreasing the noise in the unit,especially at night
C)Enforcing a 2-hour "quiet time" on each shift
D)Turning off equipment alarms when children are sleeping

Question 13

The staff in the pediatric intensive care unit is preparing to intubate a 3-year-old child.To facilitate intubation by providing skeletal muscle paralysis,which drug does the nurse anticipate administering?

A)Fentanyl citrate (Sublimaze)
B)Lorazepam (Ativan)
C)Pentobarbital sodium (Nembutol)
D)Vecuronium bromide (Norcuron)

Question 14

A child is hospitalized with anemia and critically low hemoglobin.The health-care provider orders a blood transfusion.The parents won't sign the consent form even though they have been told that without it,their child will die.What does the pediatric intensive care nurse understand about this situation?

A)Legally permissible to give the transfusion against the parents' objections
B)Legally permissible to give the transfusion after getting an emergency court order
C)Not legally permissible to give the transfusion if both parents are in agreement
D)Not legally permissible to give the transfusion if the parents won't sign the consent

Question 15

The nurse has just repositioned a child who is intubated and mechanically ventilated.Which action by the nurse takes priority?

A)Assess placement of the endotracheal tube.
B)Document the condition of the child's skin.
C)Ensure that the child cannot pull on tubing.
D)Turn the ventilator alarms back on.

Question 16

A nursing student asks how excessive noise and sensory overload could cause feelings of panic in hospitalized children.Which response by the registered nurse is the most appropriate?

A)"Children are frightened by all the activity in the intensive care unit."
B)"Excessive noise irritates the inner ear,which leads to behavior changes."
C)"It's just the body's natural way of dealing with unfamiliar stimuli."
D)"Stimulation of the adrenal glands leads to secretion of stress hormones."

Question 17

A child is being mechanically ventilated and is very agitated and fighting the ventilator despite receiving fentanyl citrate (Sublimaze)and midazolam (Versed).Which action by the nurse is the most appropriate?

A)Restrain the hands so child does not pull out the endotracheal tube.
B)Request an order for vecuronium bromide (Norcuron).
C)Slow the frequency and depth of mandatory ventilations.
D)Tell the family that someone must stay at the bedside.

Question 18

A nurse is supervising a student who is suctioning a 5-year-old patient in the pediatric intensive care unit.Which action by the student results in the nurse intervening?

A)Auscultates lung sounds beforehand
B)Cleanses catheter after suctioning
C)Hyperoxygenates prior to suctioning
D)Sets suction pressure to 150 mm Hg

Question 19

A child in the pediatric intensive care unit is alert and able to eat.The child's parent asks the nurse "Why do you keep feeding my child so much? I don't want her to become fat." Which response by the nurse is the most appropriate?

A)"I understand your concerns and would be worried too."
B)"She is undernourished and needs to gain some weight."
C)"Very sick children need more nutrition for healing."
D)"We are monitoring her intake and she won't get fat."

Question 20

A child in the pediatric intensive care unit has a pulse oximeter for continuous oxygen saturation readings.Which action by the nurse is important for this patient's safety?

A)Calibrate and "zero" the oximeter once per shift.
B)Ensure the machine stays plugged in at all times.
C)Have maintenance inspect the machine before use.
D)Move the oximeter probe to a new site each day.

Question 21

A 62-lb (28.1-kg)child has symptomatic bradycardia.Which medication does the nurse anticipate administering?

A)Atropine,0.28 mg IV push
B)Atropine,28 mg IV push
C)Norepinephrine,0.28 mg IV push
D)Norepinephrine,28 mg IV push

Question 22

A child is brought to the emergency department with moderate respiratory distress.She has an oxygen saturation of 89% but is awake,alert,and responsive,and is clinging to the mother.The nurse is consulting about appropriate oxygen delivery devices and expresses concern about the patient retaining CO?.Which oxygen delivery device is the most appropriate for this child?

A)Facial CPAP
B)Nasal cannula
C)Oxygen tent
D)Venturi mask

Question 23

A child in the pediatric intensive care unit is started on cortisone.When the nurse enters the room to check his blood glucose,the parents are concerned that he is now a diabetic.Which response by the nurse is the most appropriate?

A)"Being critically ill can raise a patient's blood glucose."
B)"I'm sorry;we should have been checking this all along."
C)"Increased blood glucose can be a side effect of steroids."
D)"The doctor is curious about how his glucose levels are."

Question 24

The nursing faculty informs a clinical group of nursing students about the detrimental effects of excessive noise exposure to patients in the pediatric intensive care unit.Which effects does the faculty member include in the discussion with the clinical group? (Select all that apply.)

A)Decreased immune function
B)Depressed pituitary function
C)Increased gastric secretions
D)Slower wound healing
E)Weight loss

Question 25

The pediatric intensive care nurse understands the effects of stress on the critically ill child.Which factors increase stress in this population? (Select all that apply.)

A)Communication barriers
B)Consistent sleep hours
C)Lighting
D)Noise
E)Pain

Question 26

The nursing manager is collaborating with health-care providers to determine appropriate candidates for ventilator weaning in the pediatric intensive care unit.Which child is the best candidate?

A)Oxygen requirement: 60%
B)Peak inspiratory pressure: 32 cm H2O
C)Spontaneous tidal volume: 2 mL/kg
D)Ventilator rate: 6 breaths/minute

Question 27

A patient in the pediatric intensive care unit has hemodynamic monitoring.Her cardiac output is 3 L/minute.Which assessment finding is consistent with this reading?

A)Capillary refill: 2 seconds
B)Temperature: 103°F (39.4°C)
C)Urine output: 3 mL/kg/hour
D)Weak,thready pulse

Question 28

The nurse has an order for isotonic crystalloid solution to treat a child with hypoperfusion.Which solution does the nurse choose?

A)Albumin
B)D5W (5% dextrose in water)
C)Normal saline
D)Whole blood

Question 29

A nurse is supervising a student working with hemodynamic monitors.Which action by the student requires the nurse to intervene?

A)Adjusts the transducer each time the patient is repositioned
B)Assesses all connections each time he or she is in the room
C)Positions the transducer at the fifth intercostal space
D)Positions the transducer in the mid-clavicular line

Question 30

A child has a radial arterial line in place.The nurse assesses the distal fingertips as cool and pale.Which action is most appropriate based on these assessment findings?

A)Apply warm,moist heat.
B)Disconnect the device.
C)Elevate the extremity.
D)Notify the provider.

Question 31

A patient in the intensive care unit has a pulmonary artery catheter for hemodynamic monitoring.On assessment,the nurse finds the patient clinically unchanged from the last assessment,but the hemodynamic data are significantly changed.Which action by the nurse is the most appropriate?

A)Document the findings and continue to monitor.
B)Level and recalibrate the hemodynamic line.
C)Notify the health-care provider of the findings.
D)Review the last set of laboratory data for any changes.

Question 32

A child in the intensive care unit had a pulmonary artery catheter inserted 2 hours ago.The child is increasingly restless.The child's vital sign trends show a slow increase in pulse rate.Which action by the nurse is the most appropriate based on the assessment findings?

A)Check to ensure the connections are secure.
B)Document the findings in the patient's chart.
C)Increase the frequency of hemodynamic readings.
D)Notify the health-care provider immediately.

Question 33

A nurse receives report on patients in the pediatric intensive care unit who are at risk for hypoperfusion.Which child should the nurse see first?

A)Hypotensive
B)Oliguric
C)Tachycardic
D)Weak pedal pulses

Question 34

A new nurse is caring for a child who has an arterial catheter in the radial artery.Which action by the new nurse causes the experienced nurse to intervene?

A)Checks to see if arterial line connections are secure frequently
B)Cleans the hub before giving medication through the site
C)Documents arterial blood pressures and mean arterial pressure
D)Monitors for blood loss at the site each time rounding is done

Question 35

A nurse receives report on a patient in the pediatric intensive care unit and is told the patient is on a ventilator in SIMV mode.Which information is inconsistent with the nurse's knowledge of this type of ventilation?

A)Breaths delivered with preset pressure
B)Can be used in cases of respiratory failure
C)Invasive form of ventilation that requires intubation
D)Will override any spontaneous breathing

Question 36

A mechanically ventilated child is being assessed for extubation.Which assessment finding would cause extubation to be delayed?

A)Alert and oriented with occasional confusion
B)Evidence that prior pulmonary infection has resolved
C)Peak inspiratory ventilator pressure of 14 cm H2O
D)3+ pitting pedal edema,1-lb weight gain overnight

Question 37

A 36-lb (16.4-kg)patient in the pediatric intensive care unit is started on a propofol (Diprovan)infusion.The health-care provider orders the infusion started at 410 µg/minute.Which action by the nurse is the most appropriate?

A)Administer the infusion using an infusion pump.
B)Consult the pharmacist about giving this drug as an infusion.
C)Ensure the appropriate antidote is available bedside.
D)Notify the provider that the dose is above the safe range.

Question 38

A child has just had an invasive hemodynamic monitor inserted.After connecting the monitoring device to the monitor,what action should the nurse take next?

A)Assess the child's postprocedural pain status.
B)Document hemodynamic assessments.
C)Have the parents return to the room to comfort the child.
D)Perform hand hygiene and dispose of equipment.

Question 39

A child is being weaned from the ventilator.He is awake and alert but getting increasingly tired.Which action by the nurse is the most appropriate?

A)Cluster nursing care so the child is able to get uninterrupted periods of rest.
B)Collaborate with other health team members to slow or stop the weaning process.
C)Draw a blood sample for blood gas analysis,and compare the results to the last blood gas values.
D)Have all of the child's visitors leave to allow the child to take a short nap.

Question 40

A toddler is critically injured and admitted to the pediatric intensive care unit.The child is on a ventilator and is sedated.The parents explain that the child is normally very active,wants to do everything himself,and is very chatty.Which aspects of this situation would cause the greatest psychosocial impact on this child? (Select all that apply.)

A)Activity restrictions
B)Body image disturbances
C)Communication barriers
D)Loss of control
E)Separation from peers

Question 41

A student nurse assesses a child for nonverbal signs of pain to report to the registered nurse.Which information should the student include? (Select all that apply.)

A)Complaints of nausea
B)Diaphoresis
C)Facial grimacing
D)Sleepiness
E)Tachypnea

Question 42

A child's blood pressure is 92/64 mm Hg.Therefore,the mean arterial pressure is ____________________.

Question 43

A child weighs 32 lb.The health-care provider orders a loading dose of midazolam (Versed)prior to intubation.The safe dose range for this drug is ____________________.

Question 44

A 7-year-old child is in the pediatric intensive care unit on a ventilator.Sedation is maintained with a midazolam (Versed)drip.Which items should the nurse ensure are readily available at the child's bedside? (Select all that apply.)

A)Back-up ventilator
B)Bag-valve mask device
C)Flumazinil (Romazicon)
D)Narcan (Naloxone)
E)Working suction setup

Question 45

A nurse is preparing to transfer a child from the intensive care unit to progressive care.The parents seem very anxious and do not want the child to transfer.Which responses by the nurse are most appropriate? (Select all that apply.)

A)"I am interested in what is most stressful about moving your child."
B)"Parents are always involved with their child's care in any unit."
C)"The nurses will monitor your child closely as often as needed."
D)"We can keep her here if you really insist on it."
E)"You should be happy because your child is getting better."

Question 46

A nurse is assessing patients in the pediatric intensive care unit for signs of hypoperfusion.Which assessment findings are indicative of this condition? (Select all that apply.)

A)Capillary refill: 2 seconds
B)Mean arterial pressure: 32 mm Hg
C)Mental status: lethargic
D)Pedal pulses: bounding
E)Urinary output: 2 mL/kg/hour

Question 47

A registered nurse working with a student nurse explains problems that can cause ventilator alarms.Which patient problems does the nurse include? (Select all that apply.)

A)Asynchronous breathing
B)Biting the endotracheal tube
C)Copious secretions obstructing the tube
D)Coughing and gagging
E)Kinking of the ventilator tubes

Question 48

A child who weighs 28 lb needs fluid resuscitation.The nurse plans to administer ____________________.

Question 49

A nurse is removing an arterial line from a patient's radial artery.What actions by the nurse are most appropriate after the line is removed? (Select all that apply.)

A)Apply pressure for at least 5 minutes.
B)Assess perfusion distal to the site.
C)Monitor the patient for bleeding.
D)Place a clean dressing over the site.
E)Secure the insertion site with Steri-Strips.

Question 50

A child is admitted to the pediatric intensive care unit with respiratory distress and respiratory acidosis.The child's pulse oximeter reads 98%.Which actions by the nurse are the most appropriate at this time? (Select all that apply.)

A)Assess the child's most recent hemoglobin and hematocrit levels.
B)Prepare for immediate intubation and mechanical ventilation.
C)Request an order to use a transcutaneous carbon dioxide monitor.
D)Titrate the oxygen flow rate down to prevent oxygen toxicity.
E)Wait 30 minutes,then draw another sample for arterial blood gasses.