Question 1

What is the initial treatment for hypoxia,acidosis,or hypothermia?

Accepted Answer

Bradycardia can result from hypoxia,acidosis,or hypothermia.Bradycardia is defined as a cardiac rate less than 100 beats/min for an infant and less than 60 beats/min for a child.Treatment initially includes adequate oxygenation and ventilation for the pediatric patient.

Question 2

What is the initial setting on a manual defibrillator for a patient older than 1 year?

Accepted Answer

On a manual defibrillator,the initial dose of electricity is 2 joules/kg.If using an automated external defibrillator,this should only be used for children older than 1 year.Immediately after the shock,cardiopulmonary resuscitation should be resumed for 2 minutes (five cycles).The compressions support the heart while it is in a recovery state even if a perfusion rhythm has returned.

Question 3

What is the key to effective pain management in children?

Accepted Answer

Pain assessment is the key to effective pain management.Many of the factors that influence an adult's pain also influence a child's pain.One difference is the influence of parental anxiety and behavior regarding their child's overall experience of pain.

Question 4

Which method can be used to establish an endotracheal tube size for a child younger than 2 years of age?

Accepted Answer

For a child younger than 2 years of age,endotracheal tube size is matched to the child's age.To ensure that the correct intubation equipment is selected for the different sizes and ages of pediatric patients,many hospitals use length-based,color-coded resuscitation tapes,such as the Broselow system.

Question 5

Which medication is used for weaning a child with an opioid dependency?

Accepted Answer

The most commonly used narcotics for children are morphine (0.02 to 0.1 mg/kg given intravenously),fentanyl (0.5 to 1.5 mcg/kg given intravenously),and hydromorphone (0.005 to 0.2 mg/kg given intravenously).Methadone (0.1 mg/kg)is an extremely long-acting narcotic,but it is not used as commonly for acute pain control.This drug is used for weaning from iatrogenic narcotic dependency or for chronic pain control.Meperidine (0.75 mg/kg)is not a drug of choice because it decreases cardiac output and causes tachycardia.

Question 6

A 3-month-old infant presents with vomiting and diarrhea.The infant appears to be drowsy; his pulse rate is 180 beats/min; and he has had a dry diaper for the past 3 hours.The nurse suspects the patient has developed which condition?

Accepted Answer

Severe dehydration: The child is drowsy,limp,cold,and sweaty,and the extremities may be cyanotic.The patient has a rapid or feeble pulse that is sometimes difficult to palpate and has respirations that are deep and a rate that is rapid; these are signs of hypotensive shock.The fontanel is very sunken; urine is not excreted for several hours,and no tears are evident; and the eyes are very sunken.Moderate dehydration: The child is thirsty,restless,lethargic,and irritable; has a rapid or weak pulse; has respirations that may be deep,and the rate may be rapid; has a sunken fontanel; and has normal or low blood pressure.The skin retracts slowly when pinched,mucous membranes are dry,and urine is dark and the amount reduced.Mild dehydration: The child is restless,thirsty,and alert; has a normal pulse rate and strength; and has normal blood pressure,respiratory rate,and fontanels.The skin readily retracts when pinched,mucous membranes are moist,and urine output is normal.

Question 7

What are the normal cerebral perfusion pressure values for a child?

Accepted Answer

The normal cerebral perfusion pressure (CPP)values in children are unknown.It is thought that CPP should be in the range of 40 to 60 mm Hg,but this figure may vary because perfusion is determined by blood flow and not blood pressure.

Question 8

To establish a patent airway in an infant or child younger than 2 years of age,the nurse would perform which action?

Accepted Answer

Knowledge of childhood anatomy is necessary to establish a patent airway.Infants and toddlers younger than 2 years of age,because of their large occiputs,need to have a small roll or towel placed under the upper shoulders,with the jaw slightly extended into a "sniffing" position.

Question 9

A 4-year-old child is admitted with fever,chills,headache,vomiting,lethargy,photophobia,and nuchal rigidity.Based on these clinical manifestations,what diagnosis would the nurse anticipate?

Accepted Answer

The clinical manifestations of bacterial meningitis include fever,chills,headache,vomiting,irritability or lethargy,photophobia,nuchal rigidity,and positive Kernig or Brudzinski sign.In meningococcemia,petechiae and purpura may be observed on the child.The late stages of this disease may produce an increased intracranial pressure and cardiovascular collapse.

Question 10

The patient is a 1-month-old infant with stable supraventricular tachycardia (SVT)at a rate of 250 beats/min.She weighs 6 kg.How much adenosine should be given?

Accepted Answer

If the child in supraventricular tachycardia (SVT)is unstable and shows signs of decreased cardiac output and poor perfusion,immediate treatment is indicated.If the child has IV access readily available,then adenosine 0.1 mg/kg should be administered up to a maximum of 6 mg rapid bolus.This dose can be doubled up to maximum of 12 mg for a second dose.

Question 11

Central cyanosis is associated with which phenomena?

Accepted Answer

Cyanosis is visible when hemoglobin is reduced by 5 g per 100 mL of blood.Cyanosis associated with desaturation of arterial blood is called central cyanosis.Peripheral cyanosis is a condition in which cyanosis exists but the child has normal arterial oxygen saturation.

Question 12

A 5-year-old boy has been admitted with severe asthma.His initial PaCO₂ was 30 mm Hg.One hour later his PaCO₂ is 45 mm Hg,and 1 hour after that,his PaCO₂ is 56 mm Hg.Which intervention would the nurse anticipate being ordered by the practitioner?

Accepted Answer

Criteria for mechanical ventilation include a PaCO₂ more than 55 mm Hg or increasing greater than 5 to 10 mm Hg per hour.

Question 13

What is the circulating blood volume of a neonate?

Accepted Answer

The circulating blood volume of a neonate is 80 to 85 mL/kg.

Question 14

The nurse is caring for a 6-month-old infant who is having frequent episodes of apparent life-threatening events (ALTEs).The practitioner has ordered a number of treatments for the patient.Which treatment would the nurse question as being inappropriate in this situation?

Accepted Answer

For frequent episodes of infant apnea,treatments include prone positioning,use of rocker beds,recurrent cutaneous stimulation,nasal continuous positive airway pressure,or a switch to continuous gavage feedings to help control symptoms of gastroesophageal reflux disease.Treatment also includes the use of respiratory stimulant drugs,such as theophylline or caffeine.The administration of sedatives would be contraindicated in this situation as they can depress respirations.

Question 15

What is the daily fluid requirement for a 60-kg child?

Accepted Answer

Fluids at 1500 mL/m² per day can be used for children who weigh more than 10 kg.

Question 16

What is the difference between the upper airway of an infant and that of an adult?

Accepted Answer

An infant's epiglottis is large and floppy,and because of its high placement,it can press against the pharyngeal soft palate on inspiration.An infant's tongue is also large relative to head size and fills the oral cavity.

Question 17

What is the pathophysiologic characteristic of a left-to-right shunt resulting from a congenital heart defect?

Accepted Answer

Cardiac defects that allow the blood to flow from a high pressure left side of the child's heart to the lower pressure right side,left-to-right shunt,cause an increase in pulmonary blood flow and congestive heart failure.Obstructive defects impede blood flow out of the ventricles.Whereas obstructions on the left side of the heart result in congestive heart failure (CHF),obstructions on the right side cause cyanosis.A pediatric patient with mixed lesions presents with variable clinical symptoms that depend on the degree of mixing of the pulmonary blood,hypoxemia,and CHF.

Question 18

A 4-year-old child is admitted with fever,chills,headache,vomiting,lethargy,photophobia,and nuchal rigidity.Nursing management for this patient would include which intervention?

Accepted Answer

Initial management includes use of isolation precautions,initiation of antibiotic therapy,maintenance of ventilation and hydration,reduction of increased intracranial pressure,management of systemic shock,control of seizures and temperature,and provision of family education and support.

Question 19

A 4-year-old child is admitted to the critical care unit with fever,chills,headache,vomiting,lethargy,photophobia,and nuchal rigidity.The patient has been unable to eat,and tube feedings are to be initiated.What is the preferred method for determining the insertion length of the nasogastric tube?

Accepted Answer

Determining the insertion length of a nasogastric tube in the child is from naris to ear to xiphoid process and then measuring to a point between the xiphoid and the umbilicus.

Question 20

Which process is a pathophysiologic consequence of respiratory syncytial virus (RSV)?

Accepted Answer

Respiratory syncytial virus involves inflammation of respiratory epithelium,leading to necrosis.The epithelium is replaced with nonciliated tissue.Submucosal edema forms with lymphocytic infiltrates and other alveolar debris.Obstruction occurs from mucus secretions and debris not being cleared because of the lack of ciliated epithelium.

Quiz 39: The Pediatric Patient