Question 1

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?
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.

Accepted Answer

This child's oxygen saturation does not correlate with respiratory distress and acidosis.Appropriate actions include assessing the child's hemoglobin and hematocrit and requesting the use of a carbon dioxide monitor.If the child is anemic,even with a saturation of 98%,the child will not have enough oxygen for tissue needs.The child may also have high levels of carbon dioxide causing or caused by the respiratory distress and acidosis,so this value should be monitored.The oximeter may not be working properly or reading accurately.Without further information,it is unknown if the child needs immediate intubation and mechanical ventilation.Titrating oxygen down in the face of respiratory distress is not warranted.Waiting 30 minutes is also not warranted,as this child is quite ill.

Question 2

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?
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."

Accepted Answer

Parents are often anxious about moving their child out of the intensive care unit for many reasons.The caring nurse will ask what is most stressful so that this topic can be addressed.Assuring them that they will remain involved in their child's care is reassuring.Letting the parents know that the new staff will continue to monitor and care for the child based on his or her needs is also important.The nurse should not offer to keep a child in the intensive care unit to placate the parents,as this may not be possible in the facility.It is also not desirable to maintain a higher level of care than needed.Telling the parents how they should feel is dismissive of their concerns.

Question 3

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 ____________________.

Accepted Answer

The answer of A child weighs 32 lb.The health-care provider...

Question 4

A registered nurse working with a student nurse explains problems that can cause ventilator alarms.Which patient problems does the nurse include?
A) Asynchronous breathing
B) Biting the endotracheal tube
C) Copious secretions obstructing the tube
D) Coughing and gagging
E) Kinking of the ventilator tubes

Accepted Answer

Asynchronous breathing,biting the tube,secretions,and coughing and gagging are all patient-related problems that lead to ventilator alarms.Kinked tubing is a ventilator problem.

Question 5

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

Accepted Answer

The answer of A child who weighs 28 lb needs...

Question 6

A student nurse assesses a child for nonverbal signs of pain to report to the registered nurse.Which information should the student include?
A) Complaints of nausea
B) Diaphoresis
C) Facial grimacing
D) Sleepiness
E) Tachypnea

Accepted Answer

Objective manifestations of pain include tachycardia,tachypnea,diaphoresis,sleep disturbances,hypertension,and nausea.

Question 7

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

Accepted Answer

Signs of hypoperfusion include urinary output less than 1 mL/kg/hour,mean arterial pressure less than 45-50 mm Hg,decreased peripheral and pedal pulses,tachycardia,mental status changes,lethargy,delayed capillary refill,and pallor.A capillary refill of 2 seconds is normal.Mean arterial pressure of 32 mm Hg is too low and is indicative of hypoperfusion.Lethargy is a sign of hypoperfusion.Bounding pedal pulses may indicate fluid overload,and a urine output of 2 mL/kg/hour is normal.

Question 8

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

Accepted Answer

For the child on a ventilator,the nurse should have a bag-valve mask for manual ventilation and working suction.The antidote for Versed is Romazicon,which should also be available.A back-up ventilator for every ventilator in use is not only prohibitively expensive,but having the bag-valve mask allows for manual ventilation in case of ventilator failure.Narcan is not the antidote for Versed.

Question 9

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

Accepted Answer

The answer of A child's blood pressure is 92/64 mm...

Question 10

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?
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.

Accepted Answer

After removing the invasive device,pressure is held for at least 5 minutes,and up to 20 minutes,at the femoral site.Perfusion distal to the insertion site must be assessed,including for warmth,sensation,movement,color,pulse,and capillary refill time.The patient should be monitored for bleeding.The dressing should be sterile,and Steri-Strips are not routinely needed.

Quiz 35: Caring for the Critically Ill Child

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?

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?

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 ____________________.

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

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

A student nurse assesses a child for nonverbal signs of pain to report to the registered nurse.Which information should the student include?

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

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?

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

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?